Prediction of postoperative venous thrombosis.
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Biomedical subjects
Publications and source records attributed to G Mellbring.
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A method for the specific determination of tissue plasminogen activator in plasma samples has been developed. The method is based on a recently described parabolic rate assay for tissue plasminogen activator (Rånby and Wallén, 1980) measuring plasmin activity by a chromogenic tripeptide-paranitroanilide substrate. The potential interference by plasmin inhibitors in plasma is overcome by acidification of the plasma samples to pH 4 for 15 min prior to the analysis. The baseline activity (after 10 min of rest) in 22 healthy individuals was determined to be 0.05 +/- 0.03 (SD) IU/ml (0.2 +/- 0.1 ng/ml). After venous occlusion for 10 min at 100 mm Hg the activator concentrations had increased to 1.2 +/- 1.2 (SD) IU/ml (5.2 +/- 5.2 ng/ml). Furthermore, prior to venous occlusion almost no plasmin-alpha 2-antiplasmin complex was found in the samples, whereas a pronounced increase in this complex was noted in 90% of the subjects after venous occlusion. During exercise, a gradual work-load dependent increase of tissue plasminogen activator concentration was observed. At maximal work-load the concentration was 2.3 +/- 1.9 (SD) IU/ml (9.9 +/- 8.1 ng/ml active enzyme), which after 10 min rest decreased to 26 +/- 12 (SD) % of the values at maximal work-load. In these samples only small amounts of plasmin-alpha 2-antiplasmin complex were detected, although the activator content was of the same order of magnitude as after venous occlusion.
Immunization of a goat with partially reduced and S-carboxymethylated plasmin B-chain-alpha 2-antiplasmin complex resulted in a large population of antibodies with rather high specificity towards the complex. These antibodies do not react with plasminogen or plasmin in complex with other inhibitors than alpha 2-antiplasmin. However, they react fully with native alpha 2-antiplasmin, but a 200-fold higher concentration, as compared to plasmin-alpha 2-antiplasmin complex, is needed to obtain a similar displacement curve in a double-antibody radioimmunoassay. The results indicate a conformational change in the vicinity of the reactive site in alpha 2-antiplasmin, as a result of complex formation with plasmin. A method for determination of plasmin-alpha 2-antiplasmin complex in plasma has been elaborated using the described radioimmunoassay. About 1.5 mg plasmin-alpha 2-antiplasmin complex/l can be detected, which equals the condition when about 1% of the alpha 2-antiplasmin in plasma is in complex with plasmin. In normal individuals plasmin-alpha 2-antiplasmin complex could be detected only rarely. However, patient with acute processes, as evidenced by high fibrinogen levels, surgical patients postoperatively or patients with malignancy have often detectable levels.
In a prospective study of 50 patients subjected to major abdominal surgery, the frequencies of postoperative deep vein thrombosis and pulmonary embolism were analysed. The patients were randomized to one of two groups receiving either neurolept anaesthesia or neurolept anaesthesia combined with thoracic epidural analgesia. Five patients were excluded. No special anti-thrombotic prophylaxis was administered. Deep vein thrombosis was diagnosed with the 125I-fibrinogen test and pulmonary embolism with pre- and postoperative lung perfusion scintigraphy combined with lung X-ray. Patients with positive scintigraphy were subjected to pulmonary angiography for verification of the diagnosis. Deep vein thrombosis was treated when diagnosed. The frequency of deep vein thrombosis was equal in both groups (38%). No patient with pulmonary embolism was recorded during the first seven days after operation. It is concluded that the addition of thoracic epidural analgesia to neurolept anaesthesia does not alter the postoperative frequency of deep vein thrombosis in patients subjected to major abdominal surgery. Early diagnosis and treatment of postoperative deep vein thrombosis might prevent pulmonary embolism. Problems encountered in the diagnosis of postoperative pulmonary embolism are discussed.
The effect of legislation for the compulsory wearing of seat belts by car drivers and front seat passengers was prospectively analysed in the county of Skaraborg, Sweden. After legislation fewer vehicle occupants were admitted to the hospitals, depsite a 40 per cent increase in crashes reported to insurance companies in the country. The frequency of seat belt wearing among injured victims was considerably lower than that recorded in regular traffic surveys. Significantly fewer head and neck injuries were suffered by restrained drivers than by unrestrained. Restrained front seat passengers had more thoracic injuries than unrestrained, but the degree of severity was less. The frequency of seat belt wearing by rear seat passengers was low, but they were injured as severely as front seat occupants. It seems important to insist on an increase in seat belt wearing for this category.
Iatrogenous oesophageal lesions are rare complications since the introduction of fiber instruments. A recent case is presented of an intramural lesion of the oesophagus in a 33-year-old woman subjected to fiberendoscopy. Etiology, diagnostic and therapeutic measures are discussed. When oesophageal disease is suspected and instruments with side optic are to be used it is advisable to check the oesophagus with a forward viewing fiberscope or contrast X-ray first. Even when a slight resistance is noticed on insertion of the instrument, a perforation must be suspected and the patient subjected to diagnostic and therapeutic measures without delay.
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Explore the source record for details and available documents.