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Biomedical subjects

U F Gruber

Publications and source records attributed to U F Gruber.

At least 37 records · Page 2Linked to original sources
PubMed1983

[Perispinal anesthesia and subcutaneous administration of low-dose heparin-dihydergot for prevention of thromboembolism].

The risk of haematoma formation in the spinal canal following spinal or epidural anaesthesia given in the presence of s.c. heparin-dihydroergotamine (DHE) for prevention of postoperative thromboembolic complications was examined. The data were obtained from a study that compared the effectiveness of s.c. heparin-DHE and i.v. Dextran 70. Heparin-DHE was administered two hours before anaesthesia and surgery and during the postoperative course. All patients underwent elective or emergency operations of the musculo-skeletal system. The s.c. heparin-DHE group consisted of 187 patients operated under spinal (82 patients) or epidural (105 patients, 66 of whom received an epidural catheter) anaesthesia. There were no clinical signs to suggest the presence of an epidural haematoma nor were there any neurological symptoms. The same was true in the dextran group. Specific neurological examinations were not carried out, but the clinical results were controlled by means of a questionnaire filled out by the patients 6 weeks postoperatively. We conclude that s.c. heparin-DHE or i.v. dextran 70 has been used safely in the presence of spinal or epidural anaesthesia in these patients.

Adolescent↗
PubMed1982

[1st direct comparison of allergic side effects of dextran with and without hapten].

In a Swiss multicentre study for evaluation of heparindihydroergotamine in the prevention of postoperative thromboembolic complications, 3887 patients received dextran 70 for comparison. During this trial monovalent hapten-dextran was introduced in two of the participating centres for clinical evaluation. 701 patients in the trial therefore received either 10 or 20 ml hapten before the first dextran infusion was started. Thus, direct evaluation of the incidence of dextran-induced anaphylactoid reactions in two groups of patients, on receiving hapten prevention and the other not, was possible for the first time. 32 dextran-induced anaphylactoid reactions occurred in the 3186 patients not receiving hapten. The incidence of these reactions is therefore 1%. Four of the reactions were severe and 1 was fatal. In the group of patients receiving hapten there was no reaction either to the dextran infusion or to the hapten injection. According to the zero hypothesis, 7 dextran-induced anaphylactoid reactions were expected.

Adult↗
PubMed1982

Prevention of fatal postoperative pulmonary embolism by heparin dihydroergotamine or Dextran 70.

Eight thousand and one patients were admitted to a prospective, randomized multicentre trial comparing the prophylactic efficacy of heparin-dihydroergotamine (DHE) and Dextran 70 against fatal pulmonary embolism after emergency or elective orthopaedic surgery. Of the 7413 patients correctly admitted to the trial, 3698 were allocated to receive heparin-DHE and 3715 to receive Dextran 70. Twenty-eight patients in the heparin-DHE and 27 in the dextran group died within 40 days of operation. Necropsy was performed in 19 cases in each group. In 6 patients in the heparin-DHE and in 9 in the dextran group pulmonary embolism was the sole or a contributory cause of death (n.s.). In the dextran group there were more diffuse intraoperative bleeding complications (P less than 0.01), more massive postoperative haemorrhages (P less than 0.01), more small wound haematomas (P less than 0.05) and more allergic reactions (P less than 0.05). This is the first large multicentre trial dealing with elective and emergency procedures in orthopaedic patients.

Adolescent↗
PubMed1982

Mezlocillin prophylaxis in biliary tract surgery. Results of a retrospective and a prospective trial.

We have evaluated the case histories of all patients who underwent surgery of the biliary tract in 1979. In that year every surgeon was able to administer antibiotics postoperatively whenever he considered it necessary. Of the 71 patients, 39% received postoperative antibiotic treatment. In 1980, 50 patients over the age of 50 received a 36-hour course of mezlocillin prophylaxis when they underwent surgery of the biliary tract, either as an elective or emergency operation. Only 8% of these patients required antibiotics postoperatively. In comparison to the 39% from 1979, this difference is highly significant statistically. This pilot study justifies further investigations to determine whether single-dose mezlocillin prophylaxis is able to reduce the incidence of infectious complications, the duration of the hospital stay and the total amount of antibiotics administered.

Aged↗
PubMed1982

[Is there a seasonal fluctuation in the appearance of deep venous thrombosis?].

We have evaluated data from 481 patients. In all of them the incidence of postoperative dvt was registered by the 125I-labelled fibrinogen test. We have analysed our data in order to compare them with the results of Lawrence from Sydney. This author found a much higher incidence in dvt in the cold half of the year than in the hot months. However, in Basel there is no statistically significant difference in the incidence of dvt from month to month nor between the 4 seasons, and all this is independent from the type of drug prevention used. The conclusion we draw is that it is reasonable to use prevention of thromboembolic complications all the year round when living in Central Europe.

Anticoagulants↗
PubMed1981

[Prevention of deep vein thrombosis in internal medicine].

14 prospective, randomized trials dealing with non-operated patients were analyzed. In all of them the presence of deep vein thrombosis was measured by the radioactive iodine fibrinogen uptake test. Various prophylactic regimens were tested. 13 studies concern patients after myocardial infarction and one a cerebral hemorrhage patient. Only 2 trials confirm the value of oral couramin administration for the reduction of deep vein thrombosis after myocardial infarction. Two studies show that prophylactic anticoagulation with a full dose of heparin reduces the incidence of deep vein thrombosis after myocardial infarction. In 3 studies, again after myocardial infarction, a statistically significant reduction in the incidence of deep vein thrombosis is found when small doses of heparin are given. In 1 study investigating a few patients no effect could be shown. Low doses of heparin reduce the incidence of deep vein thrombosis after acute cerebral hemorrhage. Early mobilization has reduced the incidence of deep vein thrombosis in 21 patients after myocardial infarction, as compared to 8 patients treated with bed rest. Heavy smokers suffering myocardial infarction show a statistically significant lower incidence of deep vein thrombosis than non-smokers, as 3 papers confirm.

Cerebrovascular Disorders↗
PubMed1980

Incidences of fatal postoperative pulmonary embolism after prophylaxis with dextran 70 and low-dose heparin: an international multicentre study.

A total of 4352 patients were admitted to a prospective' randomised multicentre trial comparing the prophylactic efficacy of dextran 70 and low-dose heparin against fatal pulmonary embolism after elective operations for general, orthopaedic, urological, and gynaecological conditions. Out of 3984 patients correctly admitted, 1993 were allocated to receive dextran 70 and 1991 to receive low-dose heparin. Withdrawal of prophylaxis because of bleeding or technical difficulties occurred more often in the heparin group, but allergic reactions were more common in the dextran group. Of the 75 patients who died within 30 days after operation, 38 had been given dextran and 37 low-dose heparin. Necropsy was performed in 33 and 32 of these cases respectively. In six patients in each group pulmonary embolism was the sole or a contributory cause of death. Of these, five patients in the dextran group and two in the heparin group had received a full course of prophylaxis. There was no statistically significant difference between the two treatment groups in the incidence of fatal pulmonary embolism after a full course of prophylaxis.

Aged↗
PubMed1980

Dihydroergotamine and heparin or heparin alone for the prevention of postoperative thromboembolism in gynecology.

The efficacy of combined dihydroergotamine and heparin (DHE-heparin) medication (2500 IU sodium heparin and 0.5 mg DHE, both given subcutaneously twice daily) or low doses of heparin (5,000 IU of sodium heparin given subcutaneously thrice daily) in preventing postoperative thromboembolic complications was investigated in a prospective, randomized trial in 125 patients over the age of 40 years undergoing elective major gynecological surgery. The I125-fibrinogen uptake test was used for the diagnosis of deep vein thrombosis. There was no statistically significant difference in the incidence of thromboembolism between the groups. Major bleeding occurred less often (p < 0.05) in the DHE-heparin group.

Adult↗
PubMed1980

Prevention of postoperative thromboembolism by dextran 70 or low-dose heparin.

The efficacy of intravenous infusion of dextran 70 or subcutaneous administration of low-dose heparin in preventing postoperative thromboembolic complications has been investigated in a prospective randomized trial. During part 1 of the study, 232 patients over the age of 40 years who were undergoing major gynecologic surgery underwent a complete test protocol. The 125I fibrinogen uptake test (FUT) was used for the diagnosis of deep vein thrombosis (DVT) in 117 patients in the dextran and 115 patients in the heparin group. Heparin was significantly more effective than dextran for reducing DVT (P less than .001). During part 2 of the study no FUT was done but the incidence of clinical and fatal pulmonary embolism (PE) and the number of complications were studied. Of 444 patients (parts 1 and 2) 1 fatal and 2 nonfatal pulmonary emboli were diagnosed. All the emboli occurred in the dextran group. The benefit: hazard ratio appeared to favor heparin for the prophylaxis of DVT.

Adult↗
PubMed1979

Dosage in low-dose heparin prophylaxis.

We investigated whether the dosage of heparin injected subcutaneously for the postoperative prophylaxis of thromboembolism influences efficacy. We considered prospective, controlled or comparative, randomized studies in which heparin was administered in a dosage of 5,000 U b.i.d. or t.i.d. subcutaneously. In major surgical procedures in general surgery, gynecology, urology and chest surgery, 2 x 5,000 and 3 x 5,000 U of heparin/day lower the frequency of postoperative deep venous thrombosis from about 30% to about one-fourth and one-third that amount, respectively. With regard to orthopedic/traumatic surgery, in a study of only 40 patients, 2 x 5,000 U/day reduced the incidence of thrombosis by one-half. The use of the higher dosage resulted in a decrease in DVT in 5 of 7 reports, but the other two authors measured no prophylactic effect at all. Proof that subcutaneous heparin prophylaxis is also able to reduce the number of fatal postoperative pulmonary emboli has been produced only in the case of the higher dosage. In our own group of patients there is no correlation between body weight and frequency of hemorrhagic complications. In our patients there is no relation between malignant tumor as the primary disease and the occurrence of hemorrhagic complications. There is no evidence that the lower dosage causes fewer hemorrhagic complications than the higher dosage.

Body Weight↗