[Nephrologic findings before and after gynecologic surgery].
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Biomedical subjects
Publications and source records attributed to R Fridrich.
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We present the results of a control group of 95 patients who were thoroughly investigated in a prospective, randomized study, where the efficacy of small doses of s.c. heparin and dextran 40 is checked. The 125I-fibrogen test was used in all patients. 1. 35.8% of the patients develop deep vein thrombosis (DVT) during the first post-operative week. More than half of them show bilateral thrombosis. 2. There is no statistically significant difference in the thrombosis incidence between males and females. 3. 47% of the patients over 60 years develop postoperative DVT. Among those younger than 60 years, only 23% have DVT (P less than 0.025). 4. The DVT incidence in surgery of the colon is 58.3%. 5. Surgery for a malignant disease means probably increased risk for DVT (P less than 0.025). 6. More than half of the patients having a previous history of varicose veins develop postoperative DVT (P less than 0.025). 7. Obese patients are statistically seen not more prone to develop DVT than those of normal body build. 8. Immediately after operation 32.4% of DVT are diagnosed, 24 hrs. later 61.8%. 94% of all DVT are diagnosed up to the third postoperative day. 9. With the exeption of one patient, all DVT develop in the calf veins, 3/4 of all abnormal values were measured in the midcalf region.
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1. The effectiveness of 3 X 5000 IU s. c. heparin daily (starting preoperatively) for the prevention of postoperative deep vein thrombosis was evaluated in a prospective, controlled, randomized study including general surgical and urological patients. 125I-fibrinogen test was performed daily in all patients. 2. 178 patients fulfilled the conditions of the protocol. 35.8% of the 95 patients in the control group developed deep vein thrombosis, but only 13.3% of 83 subjects in the heparin group did so. The difference is statistically highly significant (p less than 0.001). 3. The vast majority of all thrombi in both groups appeared before the 3rd postoperative day. 4. With 1 exception, all deep vein thrombi in the heparin group started in the mid-calf region. In the control group 5 deep thrombi originated in the popliteal vein. 5. Heparin displays a better effect in males (n = 34; p less than 0.01) than in females (n = 49; p less than 0.025). 6. In patients undergoing surgery for malignant disease heparin does not reduce the incidence of deep vein thrombosis. 7. Heparin is far more effective in patients under 60 years of age than in those over 60 (p less than 0.005). 8. Heparin is more effective in obese patients than in those of normal body build. 9. Heparin prophylaxis also reduces the incidence of deep vein thrombosis in patients who exhibit predisposing factors. In patients of the control group with preexisting disease of the venous system, there were significantly more deep vein thrombi (p less than 0.01) than in those without predisposing factors. 10. In the heparin group 29% of all thrombin time determinations show a definite prolongation of more than 26 sec (normal value 15 sec). 11. In 14 patients (=16.9%) of the heparin group, 21 side effects or complications were seen. Bleeding complications were the main problem, comprising 5 wound hematomas and hematomas at the injection site, 4 postoperative bleeding episodes and 2 reoperations. There were no complications in the control group. 12. According to the results of 10 well controlled studies, there is no doubt that in general surgery small doses of subcutaneous heparin, commencing preoperatively, do reduce the incidence of postoperative deep vein thrombosis to a significant degree. However, whether this form of prophylaxis is also effective in patients with fractures of the hip and in elective hip surgery cannot, on the evidence available, be decided. In the fields of gynecological surgery and urology as well, more data are needed before this form of heparin prophylaxis can be recommended.
The radio-fibrinogen test is a simple and sensitive method for diagnosing deep vein thrombosis. Intravenously administered radioactive labelled fibrinogen is incorporated as radioactive fibrin in freshly developing thrombi, and such labelled thrombi may be detected on the body surface with nuclear medical equipment. Homologous iodine 125 labelled fibrinogen is chiefly used since it is known not to transmit viral hepatitis. The weak gamma emittor 125-I allows the use of a portable scintillation detector rate meter with an easily moved measuring device. This bedside method does not involve discomfort for the patient. The correlation between ascending phlebography and the radioactive fibrinogen test is more than 90 percent. The radiofibrinogen test may be used to study thromboembolic diseases, to evaluate drugs for prevention of thromboembolic complications and to confirm clinically suspected fresh deep vein thrombi. Details of the method as used in several thousand measurements are given.
The administration of 0-2-0-4 mCi 90 yttrium (90Y) into a normal rabbit knee joint fails to induce medical synovectomy and results in the proliferation of the synovialis. The synovial mesothelium shows early radiation damage but subsequently follows a restitution of the whole. Later (within 4 to 16 weeks) an extensive fibrosis of the stratum synovialis develops, as well as an occlusion and sclerosis of smaller synovial vessels and capillaries. These changes explain the beneficial therapeutic effect of 90Y in a chronic inflammatory joint effusion. After irradiation that joint cartilage shows an increased cellular proliferation of the superficial tangential cells and in the vicinity of the cruciate ligaments small foci of degenerated cartilage are present. The overall pattern of a joint treated with intra-articular 90Y corresponds to the histological pattern encountered regularly in joints of older people. Changes of the cartilage after the 90Y radiation could represent a factor predisposing the treated joint to a subsequent development of osteoarthrosis.
In an open, controlled trial, radioactive 90Yttrium was injected in doses of 3-6 mCi into 40 joints with chronic effusions in patients suffering from rheumatoid arthritis and other rheumatoid diseases. The processing in a computer was carried out by the punch card method. Intra-articular administration of 90Y resulted in a significant improvement of five objective criteria. In our study we have paid particular attention to the clinical and statistical differentiation of the effects of systemic, and especially of basic therapy, from the effects of topical intra-articular therapy. At the time of the last check-up examination, 43% of the patients were free of any effusion. The treatment was well tolerated. Skin necrosis occurred in only one single case. Intra-articular treatment with radioactive 90Yttrium represents a valuable contribution to the therapeutic arsenal for the treatment of the chronic articular effusions when all other methods of treatment failed.
A pretherapeutic evaluation of skeletal metastases should be carried out in all patients with proven mammary cancer including early stages. The scintigraphy is more reliable for detecting bone metastases than the conventional roentgenological survey. We recommend to employ complementally skeletall scintigraphy and conventional X-ray survey in the search for bone tumors. Negative scintigraphical results do not require any supplementary research. In case of a pathological scan or skeletal pain, a target roentgneological examination should be carried out to differentiate between benign diseases and neoplatic lesions.
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