Plasma cross-linked fibrin degradation products fraction D in patients undergoing elective abdominal surgery.

In 18 patients undergoing major abdominal surgery we measured the plasma D-dimer concentration (EIA d-dimer kit) preoperatively, postoperatively, and on postoperative day 1, 3, 4, 5, and 6. The patients received thromboembolic prophylaxis with low-molecular weight heparin. All patients were screened with the 125I-fibrinogen uptake test. Preoperatively, the median plasma D-dimer concentration was 500 ng/ml (200-3200 ng/ml) rising to 1800 ng/ml (500-4600 ng/ml) (p less than 0.05) immediately postoperatively. The plasma D-dimer level increased further during the following days to a maximum of 4800 ng/ml (1600-8600 ng/ml) on the 6th postoperative day (p less than 0.01). One patient developed deep-venous thrombosis. The plasma D-dimer concentration of this patients was within the range of the other patients. In conclusion, the EIA D-dimer test does not seem to be a potential screening procedure for postoperative thrombosis.

[Electron microscopy of needle biopsies from cancer patients with unknown primary tumors]. / Elektronmikroskopi af nålebiopsier fra cancerpatienter med ukendt primaer tumor.

The aim of the present study was to evaluate the diagnostic value of electron microscopy (EM) performed on Surecut biopsies from patients without known primary tumour. The material consisted of 108 consecutive biopsies, obtained over a period of two years, from patients with tumour(s) in the liver or lymph nodes (on the neck, in the axilla or retroperitoneum). From each patient fine needle aspirations and Surecut biopsies for light microscopy and electron microscopy were taken. Only biopsies in which material for both electron microscopy and light microscopy was sufficient were included (60%). Immunohistochemical reactions were performed on paraffin sections when indicated. Final diagnoses were confirmed on surgically removed specimens and/or autopsies. Electron microscopy was necessary for obtaining the final histological diagnosis in 15% of the cases. It is therefore recommended to obtain additional ultrasound guided biopsies for EM from cancer patients with tumours in the liver or lymph nodes in cases where the primary origin of the tumour is unknown.

3-dimensional ultrasound based demonstration of the posterior urethra during voiding combined with urodynamics.

A new method for continuous 3-dimensional demonstration of the posterior urethra during micturition is described. The method is based on a series of transverse ultrasonic scans through the urethra. It seems to provide on optimal model of the urethra and used in combination with urodynamics this technique also has a potential in diagnostics and urodynamic research.

Ultrasonically guided interstitial Nd-YAG laser diffuser tip hyperthermia: an in vitro study.

Ultrasonically guided interstitial Nd-YAG laser diffuser tip hyperthermia is a new technique that involves placement of a laser fiber in solid tissue under ultrasound guidance followed by irradiation from within the area to be treated. We have previously described a diffuser tip modification of the bare laser fiber, that proved to produce spherical coagulations of predictable size. In the present paper we describe the development of an ultrasonically guided technique which permits simultaneous laser irradiation and interstitial temperature measurements under real time ultrasound monitoring. The laser lesion appeared on the ultrasound image as a hyperechoic area growing in size with time as energy was applied. Macroscopically the laser lesion emerged as a sphere with a central cavity delineated by a rim of charred tissue and beyond this a larger zone of whitish coagulation. The correlation coefficient (Pearson's r) between ultrasonically and macroscopically measured diameter of the laser lesion was calculated to r = 0.89. It is concluded that ultrasonically guided interstitial Nd-YAG laser diffuser tip hyperthermia may have a potential as a tool in the future treatment of ultrasonically visible neoplasias like liver metastases and prostate cancer.

Upper urinary tract deterioration after implantation of artificial urinary sphincter.

The preoperative urodynamic evaluations of twenty patients with myelomeningocele who had had artificial sphincter implantation because of urinary incontinence were reviewed. Four patients developed hydronephrosis and severe impairment of renal function between two and six years after implantation of the artificial sphincter. The condition was partly reversible after removal of the artificial sphincter. The urodynamic evaluation prior to implantation revealed in the four mentioned patients compared to the 16 patients with normal upper urinary tract, a tendency to lower bladder compliance, lower bladder capacity and more severe detrusor hyperreflexia, but it was not possible to make a clear discrimination between the two groups. Attention is drawn to this unfortunate combination of effects after artificial sphincter implantation. Periodic control of the upper urinary tract by urography is recommended.

Local staging of prostate cancer with transrectal ultrasound: a literature review.

A literature review was undertaken to investigate whether transrectal ultrasound can predict the local stage of prostate cancer. Twelve papers were found which correlated ultrasound findings with surgical findings and another paper reported on strategic staging biopsies guided by transrectal ultrasound. Eleven of these papers reported on ultrasound findings in patients in whom digital rectal examination had defined localized disease. One paper compared ultrasound findings and digital rectal findings. One paper indicated that transrectal ultrasound, though not suited to patients with clinically localized disease defined by digital rectal examination, may be superior as the initial staging tool. We conclude that transrectal ultrasound has too low a specificity to upgrade the diagnostic results of digital rectal examination, but that it may be more useful as the primary staging tool and for guidance in strategic staging biopsies.

Low molecular weight heparin (Logiparin) as thromboprophylaxis in elective abdominal surgery. A dose finding study.

The efficacy and safety of a new not yet registered low molecular weight heparin (LMWH) (Logiparin) as thromboprophylactic agent was assessed in 51 patients undergoing major elective surgery. The patients were divided into three groups receiving either 2,500 anti-Xa international units (IU) (group 1), 50 IU per kg body weight (group 2) or 3,500 IU (group 3) subcutaneously once daily. All patients were screened with the 125I-fibrinogen uptake test, and whenever a FUT was abnormal or when clinical signs were present ascending phlebography was performed. Thrombosis occurred in 12.5% of the patients in group 1 and 0% of the patients in groups 2 and 3 (p greater than 0.05). In groups 1 and 2 only minor bleeding complications were recorded. In group 3 there was one haemorrhagic episode requiring interruption of the LMWH treatment. The optimal doses of this new LMWH seems to be in the range 2,500 IU-3,500 IU once daily. The final dose recommendation has to be established in large scale clinical trials.