A decade of oral anticoagulant treatment to maintain autologous vein grafts for femoropopliteal atherosclerosis.

To determine whether long-term oral anticoagulant treatment was effective in improving graft performance and preventing major amputation following vein bypass surgery for femoropopliteal atherosclerosis, a clinical trial was conducted in one single center and continued during 10 years. After 130 patients had electively received a femoropopliteal vein graft, they were randomly assigned to a therapy group (treatment with phenprocoumon [n = 66]) or to a control group (n = 64) that remained without any anticoagulant treatment. Primary end points of the study were graft reocclusion and limb loss. The median durations of primary patency and limb salvage were significantly longer for treated patients than that for controls. In addition, survival in the therapy group was longer. Following autologous vein bypass surgery in the treated group, the results were superior in terms of graft patency, limb salvage, and survival.

[Acetylsalicylic acid after iliac-femoro-popliteal interventions?]. / Acetyl-Salicyl-Säure (ASA) nach iliako-femoro-poplitealen Eingriffen?

To determine whether acetyl salicylic acid (ASA) in a daily dose of 1500 mg versus untreated controls is effective in patients with peripheral arterial disease a prospective randomized but not placebo-controlled one single centre trial was undertaken. Patients were assigned to one of two groups by means of multi-dimensional contingency tables whereas the risk factors age, sex, height, body weight, diabetic metabolic state, hypertension, history of myocardial infarction, smoking habits and preoperative clinical status according to the Fontaine classification where found in the state of balance. 298 patients with arterial occlusions in the iliaco-femoro-popliteal level were recruited during 1971-1974, the primary end points were probability of patency and probability of survival. In regard as well as to the probability of patency (p less than 0.56 Breslow, p less than 0.66 Mantel) as to the probability of survival (p less than 0.10 Breslow, p less than 0.70 Mantel) no statistical significant difference was detected. In conclusion ASA, in the doses administered here, was unable to improve patency or prolong patient survival, an outcome, which is at variance with results obtained by others.

[Prevention of thromboembolism in para-articular femoral fractures of the hip--results of a prospective randomized study of heparin-DHE and ASS-DHE]. / Thromboembolieprophylaxe bei hüftgelenknahen Oberschenkelfrakturen--Ergebnisse einer prospektiven randomisierten Studie zwischen Heparin-DHE und ASS-DHE.

The effectiveness of prophylaxis of thromboembolism either by acetyl-salicylic-acid (ASA) 0.5 g + dihydroergotamin (DHE) 2.5 mg three times a day or by Heparin 5000 IU + 0.5 mg DHE (HDHE) three times a day was compared in 404 patients, elder than 55 years, with fractures close by the hip joint. Effectiveness was proved daily clinical controls, perfusion scintigraphy on the day after admission, the fourth postoperative day and the day before discharge and by autopsy of the died patients. Clinical manifest thrombosis were seen on the operated legs in the HDHE-group in 7.6% of the patients, in ASA-DHE-group in 15.6%, on the not operated leg under prophylaxis by HDHE in 3.8%, by ASA-DHE in 4.1% of the patients. Increased postoperative bleeding could be found under HDHE in 16.1% of the patients, under ASA-DHE in 9.3% of the patients, wound haematoma in 9.5% under HDHE and in 5.7% of the patients of the ASA-DHE-group. Superficial wound infections occurred under HDHE in 8.1%, under ASA-DHE in 5.7% of the patients, deep infections under HDHE in 0.5% and under ASA-DHE in 1.6% of the patients. Gastrointestinal bleeding under HDHE in 0.5% of the cases and under ASA-DHE in 3.1% of the cases. Prophylaxis had to be discharged in 7.6% of the patients of the HDHE-group and of 19.7% of the ASA-DHE-group. Pathologic perfusion scars should be found in 54.0% of the patients of the HDHE-group and in 54.9% of the ASA-DHE-group. Pulmonal perfusion became worse despite of prophylaxis by HDHE in 15.6% of the cases and despite prophylaxis with ASA-DHE in 17.6%. Pulmonal perfusion became better under HDHE in 11.9% and under ASA-DHE in 12.4% of the cases. The mortality was 9.7%. Fatal thromboembolism occurred under HDHE in three patients (1.4%) and under ASA-DHE in three patients too (1.6%), after subcapital fractures in 0.5%, after pertrochanteric fractures in 2.1% and after subtrochanteric fractures in 6.25% of the patients without any significant difference between the two groups of prophylaxis. Fatal gastrointestinal bleeding had to be remarked in 1.0% of the patients of the HDHE-group and in 2.1% of the ASA-DHE-group, fatal infections in 0.5% of the patients of the HDHE-group and in 1.6% of the ASA-DHE-group. Fatal cardinal infarction could be seen under HDHE in 1.9% of the patients, under ASA-DHE no fatal cardial infarction occurred.(ABSTRACT TRUNCATED AT 400 WORDS)

Diagnosis of head and neck carcinomas by means of immunological tumour markers (Beta-2-microglobulin, immunoglobulin E, ferritin, N-acetyl-neuraminic acid, phosphohexose-isomerase).

In a great number of patients with squamous cell cancer of the head and neck, tumour markers in the serum were determined before any therapy, in order to evaluate their possible usefulness as parameters for monitoring therapy as well as for early detection of cancer. Patients with primary tumours (n = 101) were distributed to groups TI-II and TIII-IV according to the UICC classification 1978, and investigated together with a group of recurrences (n = 105). 50 age-matched healthy individuals served as controls. Substances investigated were beta 2-Microglobulin (beta 2-M), Immunoglobulin E (IgE), Ferritin, N-Acetyl-Neuraminic Acid (sialic acid; NANA), Phosphohexose-Isomerase (PHI). Not only were the mean values of the groups compared with each other, but also the percentages of the respective groups displaying increases above the upper norm limit (95. percentile) were calculated. Critical evaluation of the results led to the conclusion that in particular IgE, NANA and--with some reservations--ferritin should be further investigated as biological serum markers in serial determination with special regard to their possible relevance for cancer treatment.

Serum immunoglobulin levels in patients with head and neck cancer (IgE, IgA, IgM, IgG).

In the present study, 226 patients with squamous cell cancer of the head and neck, who had had undergone no antitumor therapy, were examined pretherapeutically for serum immunoglobulin levels (IgG, IgM, IgA, IgE). In cancer patients, significant elevations of mean levels of IgA and IgE were found in comparison to healthy controls (n = 100) and patients with chronic laryngitis (n = 63). IgG and IgM were in the range of the control groups. Levels above the upper limit were detected in 40.9% for IgE and 43.9% for IgA in the groups of cancer patients and in about 6% for both immunoglobulins in the control group. The group of patients with relapses in the follow-up were found to have pretherapeutically significantly higher levels of both IgE and IgA in comparison to those without evidence of disease for more than 6 months. These results point to the fact that determination of serum IgA and IgE levels in patients with head and neck cancer might be applicable as parameters for monitoring malignant disease, being additionally of some prognostic significance.

[Nifedipine and vecuronium bromide. How does a patient treated with calcium antagonists react to nondepolarizing muscle relaxants? Brief scientific communication]. / Nifedipin und Vecuroniumbromid. Wie reagiert der mit Ca-Antagonisten behandelte Patient auf nichtdepolarisierende Muskelrelaxantien? Kurze wissenschaftliche Mitteilung.

The muscle-relaxation reactions of Ca-antagonist (nifedipine) pretreated patients and a control group (5 in each group) were observed after administration of vecuronium bromide using the "priming principle." Twitch depression induced by the "priming dose" of vecuronium bromide (20 micrograms/kg body weight and T4/T1 ratio in the Ca-antagonist-treated patients (35 +/- 13% and 0.42 +/- 0.14%, respectively), was significantly different (P less than 0.01) when compared with the control group (1.2 +/- 2.7% and 0.75 +/- 0.15%). Similarly, the onset time to maximum blockade after the intubating dose of vecuronium bromide (60 micrograms/kg body wt.) was significantly shorter in the nifedipine group (40 +/- 21 s) when compared with the controls (100 +/- 17 s). The duration of the effect observed clinically (until 25% recovery) in the nifedipine group 32.9 +/- 7.3 min versus 25 +/- 8.15 min was enhanced; however, the difference between the treated group and the control group was not significant.

Acetylsalicylic acid in combination with dihydroergotamine for preventing thromboembolism.

In a prospective randomized clinical trial involving 150 patients who underwent major abdominal surgery, acetylsalicylic acid (ASA) and dihydroergotamine (DHE) were examined either alone or in combination for their potential to prevent thromboembolism. Combined treatment with ASA and DHE was found to be more effective in preventing the spread of thrombi and their propagation to the femoral veins.

[Prophylaxis of thromboembolism in abdominal surgery. Comparison of low dose heparin, acetylsalicylic acid and their combination (author's transl)]. / Thromboembolie-Prophylaxe in der Abdominalchirurgie. Vergleich von niedrig dosiertem Heparin, Azetylsalizylsäure und deren Kombination.

The aim of the study was to compare the effect of three possibilities of prophylaxis of thromboembolism: low dose heparin, acetylsalicylic acid (ASA) and a combination of the two. The evaluation of the clinical observations showed no significant differences between the three prophylaxis groups. The iodine fibrinogen test showed no different reaction with regard to the leg, a superiority of ASA in the thigh was suggested, at least in our random samples. Whether this observation is the reason why the frequency of fatal pulmonary emboli can be reduced by ASA is discussed. The complete calculation points to a superiority for ASA here. The size of the selected samples is, however, too small for more definite statements.

[Differences in the evaluation of the iodine fibrinogen test (author's transl)]. / Unterschiede in der Beurteilung des Jod-Fibrinogen-Tests.

The iodine fibrinogen test was evaluated using 13 different methods in 5 patients. The great variation in obtained results to assess the data makes standardization of evaluation methods imperative.

[Factor XIII and the risk of postoperative impaired wound healing and bleeding (author's transl)]. / Faktor XIII und das Risiko postoperativer Wundheilungsstörungen und Blutungen.

Factor XIII concentration was investigated pre- and postoperatively in the plasma of 139 patients undergoing major abdominal surgery. Postoperative complications (impairment of wound healing and haemorrhage) were significantly more frequently seen in patients with a low concentration of factor XIII. A low preoperative concentration of factor XIII can be interpreted as a high risk factor.

[Is surgery for infections of the maxilla and face still justified? (author's transl)]. / Ist die chirurgische Therapie von Entzündungen im Kiefer- und Gesichtsbereich noch aktuell?

Based on the authors' studies and on publications by others from the Vienna Department of Maxillo-facial surgery over the past 60 years common infections of the maxilla and face and the incidences and prognosis of their life-threatening complications and reviewed. Fatalities as expected became substantially less frequent after the introduction of antibiotics, but the number of deaths due to septicaemic abscesses in contrast to those due to local complications has fallen only slightly since penicillin usage. The danger of overrating the therapeutic potential of antibiotics is emphasized, and despite major advances in chemotherapy the discrimination between pathologies preferably treated surgically or conservatively has by no means changes.

[Prevention of thromboembolism with antiaggregants (author's transl)]. / Medikamentöse Thromboembolie-Prophylaxe mit Aggregationshemmern.

Experimental investigations have shown that antiaggregants affect the size rather than the rate of venous thrombosis, while clinical trials with prophylactic acetylsalicylic acid have indicated primarily a reduced incidence of pulmonary embolism. Current experiences with acetylsalicylic acid in combination with dipyridamole or low-dose heparin suggest that the incidence of pathology diagnosed by 125I-fibrinogen and of deep vein thrombosis is equally reduced.