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Accurate knowledge of the hemodynamics of the common femoral artery is a critical part of both the preoperative evaluation of patients with peripheral vascular disease and the postoperative follow-up examination. Interrogation of the iliofemoral system with determinations of palpable pulse status, Doppler analog waveforms, and upper thigh pressure ratios has yielded an overall sensitivity of 91 percent and a specificity of 85 percent in the detection of inflow stenosis. This degree of accuracy (89 percent) allows practical surgical decisions to be based on the results of these noninvasive studies.

T HERE can be no doubt that the deveIopment of the diagnosis and treatment of anorecta1 diseases have Iagged considerabIy behind that of other branches of surgery. FaIse modesty on the part of both patient and physician with respect to confidences concerning, and manipuIations about, the Iower intestina1 tract has been one factor tending to retard the natura1 growth of the science of proctoIogy; but perhaps a mdre important factor has been the reIative diffIcuIty of making adequate examinations of the anus and rectum on account of the natura1 inaccessibility of the area invoIved. constructed examining table. In the inverted position the patient’s Iegs and thighs are horizonta1 and on a IeveI with the examiner’s waist; the trunk, neck and head are dependent and make with the thighs an angIe onIy sIightIy greater than go”. The knee-chest position is more easiIy assume< by the patient than the inverted position, and is onIy sIightIy Iess satisfactory for the examiner. The Iateral position, best modified to the typica Sims’ position, is somewhat more comfortabIe from the point of view of the patient, but very much Iess satisfactory than the other positions for the purposes of the examiner. If that branch of surgery under discussion is to deveIop satisfactoriIy in the future, it wiI1 do so onIy as a resuIt of the concerted effort of a11 surgeons to be as thorough in their proctoIogica1 examinations as they are in their other physica examinations. Inspection and paIpation are the onIy two methods of physica examination which are of vaIue in the diagnosis of proctoIogica1 diseases, and it therefore becomes incumbent upon the examiner to pIace the patient in as favorable a physica position as possibIe for examination, in order that the most may be made of the two senses upon which he must depend for a diagnosis. The Sims’ position is achieved as foIIows : the patient is made to Iie on the Ieft side with the Iegs flexed upon the thighs and the thighs upon the abdomen; the dependent shouIder and arm are puIIed backward so that the patient Iies on the side of the face and partIy on the anterior as we11 as the IateraI waI1 of the chest; the upper thigh is flexed to a somewhat greater extent than the Iower so as to aIIow the knee of the former to touch the bed or tabIe upon which the patient is being examined.