Subcutaneous ancrod in prevention of deep vein thrombosis after hip replacement surgery.

In a randomised double-blind controlled trial we have assessed the use of ancrod ('Arvin') in the prophylaxis of deep vein thrombosis (DVT) in patients undergoing hip replacement surgery. Thirty-five patients received daily subcutaneous injections of ancrod and 38 patients received saline injections. DVT was detected by bilateral ascending venography (67 patients) 7-19 days after surgery. The frequency of major femoral DVT (greater than or equal to 5 cm long) was significantly reduced from 18 thrombi in the limbs of the placebo group to 5 in the ancrod group (p less than 0.01). The overall frequency of thrombi including calf DVT was not significantly different between the two groups. Four patients within the ancrod group had evidence of wound bleeding, compared with 2 placebo patients. One patient had a bleeding event which was considered severe enough to require cessation of ancrod injections.

Computed tomography in the localization of aldosterone-secreting adrenal adenomas.

Computed tomography (CT) has been shown to detect both adrenal glands in 88.5% of upper abdominal examinations and can visualize at least one gland in 96.5% of patients. However, in examinations carried out specifically to visualize the adrenals, the glands were located in 98% of cases. This technique was used in 18 patients with primary aldosteronism to localize aldosterone-secreting adrenal tumours and to distinguish these from non-adenomas (bilateral adrenal hyperplasia). The results were compared with quadric analysis, a statistical technique used to predict the likely surgical outcome. In seven patients the CT results were verified by operation (six adenomas, one adrenal hypertrophy). However, in one further patient a large adenoma (20 mm in diameter) which had not been predicted by CT scanning was found at operation. In the remaining ten patients who have been medically treated, results concordant with quadric analysis were obtained in eight cases. We would suggest that CT scanning should be the initial investigation for the pre-operative localization of adenomas but further comparative studies are required.

A comparison of computed tomography, ultrasound and scintigraphy in the diagnosis of alcoholic liver disease.

In 35 alcoholics with histologically proven liver disease, computed tomography (CT), grey scale ultrasonography and liver scintigraphy were evaluated for their abilities to detect an abnormal liver and to identify the patients with cirrhosis. Abnormal studies were present on CT in 83% of patients, in 64% on ultrasound and in 94% on scintigraphy. In 10 control patients specificity was 90% by CT, 100% by ultrasound and 70% by scintigraphy. CT and ultrasound were poor in identifying the alcoholics with cirrhosis. Scintigraphy suggested cirrhosis in all but one of the patients with this diagnosis. Similar images were obtained in half of the patients with fatty change without cirrhosis but, with the exception of one patient, this appeared to be due to co-existent hepatitis. The results suggest that scintigraphy is the best of the imaging tests for screening alcoholics for cirrhosis.

Low voltage electrocardiogram after acute myocardial infarction.

In a retrospective study of patients with acute myocardial infarction admitted to a coronary monitoring unit in 1971 12 per cent (39 patients) had low voltage electrocardiograms within 72 hours of admission. Of these, 7 patients (18%) died while in hospital and a further 9 (23%) died within one year of their infarction. Of the 23 patients who survived, 16 were severely incapacitated by their symptoms at the one-year follow-up. A low voltage electrocardiogram in association with acute myocardial infarction appears to imply a poor prognosis in terms of both mortality and morbidity, independently of other prognostic indices.

Subcutaneous ancrod in prevention of deep-vein thrombosis after operation for fractured neck of femur.

In a randomised double-blind controlled trial 53 patients received 5 daily subcutaneous injections of ancrod ('Arvin') after operation for fractured neck of femur, and 52 patients received saline fractured neck of femur, and 52 patients received saline injections. Deep-vein thrombosis (D.V.T.) was detected by bilateral ascending venography or necropsy 6--16 days after surgery. The frequency of D.V.T. and bilateral D.V.T. was significantly lower in the ancrod group (P less than 0.01). The frequency of major D.V.T. (thrombi in veins proximal to the calf, or calf-vein thrombi more than 3 cm long) was also significantly lower in the ancrod group (P less than 0.001). No complications of ancrod prophylaxis occurred. Ancrod reduced plasma-fibrinogen, and hence plasma and blood viscosity, during the first week after surgery; preoperative levels of fibrinogen and viscosity were not associated with post-operative D.V.T. Subcutaneous ancrod is a simple and effective alternative to oral anticoagulants for the reduction of the frequency of D.V.T. after operation for hip fracture, and merits assessment in other high-risk groups of patients.

Incidence and detection of occult hepatic metastases in colorectal carcinoma.

Isotope liver scan, ultrasonography, and computed tomography of the liver were performed during the postoperative period in 43 consecutive patients undergoing laparotomy for colorectal carcinoma. Obvious hepatic metastases were detected in six patients at the time of surgery. Eleven patients considered to have a disease-free liver at laparotomy developed hepatic metastases during the two-year follow-up period. These patients were considered to have had occult hepatic metastases at the time of surgery. Postoperative isotope liver scan, ultrasonography, and computed tomography detected the presence of overt metastases in four, five, and six patients respectively. Of the 11 patients with occult metastases, isotope liver scan, ultrasonography, and computed tomography detected one, three, and nine respectively. These observations suggest that 29% of patients undergoing apparently curative resection for colorectal carcinoma possess occult hepatic metastases and that computed tomography is superior to ultrasonography and isotope liver scan in detecting them.