Efficacy and safety of prolonged thromboprophylaxis with a low molecular weight heparin (dalteparin) after total hip arthroplasty--the Danish Prolonged Prophylaxis (DaPP) Study.

The aim of this study was to compare the efficacy and safety of prolonged (35 days) thromboprophylaxis with a standard length (7 days) regimen of a low molecular weight heparin in patients undergoing total hip arthroplasty. The study was multicentre, randomised, double-blind, and prospective with two groups. Following seven days on a standard length regimen of dalteparin (5000 antifactor Xa units subcutaneously once daily starting 12 h before surgery), patients were randomized to continue the prophylaxis with either subcutaneous injections of dalteparin or placebo injections for a further 28 days. Efficacy was evaluated at the end of the study (day 35) in all patients with bilateral ascending phlebography to detect deep vein thrombosis. Bleeding complications and other adverse events were registered throughout the study period. Three hundred consecutive patients agreed to participate before the operation: 281 were finally randomised and 215 completed the study; two patients died before randomisation; 17 developed deep vein thrombosis; none developed pulmonary embolism; and five of 113 patients (4.4%, 95% CI 1-10%) developed deep vein thrombosis in the dalteparin group, compared with 12 of 102 (11.8%; 95% CI 6-20%) in the placebo group (p=0.039). Deep vein thrombosis in the proximal veins was diagnosed in one patient (0.9%; 95% CI 0-5%) in the dalteparin group, and in five (5.0%; 95% CI 2-11%) in the placebo group (p=0.076). Major bleeding was observed in one patient in the placebo group; minor bleeding complications and adverse events were equally distributed between the groups. We concluded that prolonged (35 days) thrombo prophylaxis with dalteparin is more effective than a standard length (7 days) regimen without increased risk of bleeding complications or other adverse events.

[CT diagnosis of pancreatic or periampullary cancer]. / CT-diagnostik ved cancer i pancreas eller periampullaert.

Seventy-seven patients had abdominal computed tomography (CT) performed as part of the diagnostic work-up for suspicion of pancreatic cancer. The CT-images were reviewed by two radiologists who did not know the clinical course, the surgical procedure, or the final diagnosis. The positive predictive value of CT for the diagnosis of pancreatic or periampullary cancer was 92% (82-97%) and the negative predictive value 69% (41-89%). The 95% confidence limits of the positive predictive value of CT in staging the extent of periampullary cancer in 52 patients varied between 21-79% and 59-100%, with the lowest values in diagnosis of liver metastases. The confidence limits for the negative predictive values in staging varied between 17-56% and 67-94%, with the highest values concerning liver metastases. We conclude that CT cannot be used as the only diagnostic procedure for confirming or excluding the diagnosis of pancreatic or periampullary cancer, and that the staging of periampullary cancer by CT alone is too inaccurate for the evaluation of resectability.

CT for assessment of pancreatic and periampullary cancer.

Over a period of 2 years, 77 patients, strongly suspected of having pancreatic cancer, had abdominal CT as part of the diagnostic work-up. The CT images were reviewed by 2 radiologists who did not know the clinical course, the surgical procedure, or the final diagnosis. The positive predictive value of CT for the diagnosis of pancreatic cancer was 92% (82-97%) and the negative predictive value 69% (41-89%). The 95% confidence limits of the positive predictive value of CT in staging the extent of periampullary cancer in 52 patients varied between 21 to 79% and 59 to 100%, with the lowest values in diagnosis of liver metastases. The confidence limits for the negative predictive values in staging varied between 17 to 56% and 67 to 94%, with the highest values concerning liver metastases. We conclude that CT cannot be used as the only diagnostic procedure for confirming or excluding the diagnosis of pancreatic or periampullary cancer, and that the staging of periampullary cancer by CT alone is too inaccurate for the evaluation of resectability.

Peliosis of the spleen associated with a paraganglioma. Case report.

We report a case of splenic peliosis imitating metastases on CT. The patient was a 44-year-old man who previously had a retroperitoneal paraganglioma surgically removed. Peliosis must be considered a potential differential diagnosis of hypodense foci of the spleen seen on CT.

Skeletal scintigraphy and radiography at onset of acute lymphocytic leukemia in children.

99mTechnetium skeletal scintigraphy performed at the time of diagnosis was compared with pain and radiographs in 24 children with acute lymphocytic leukemia. Localized intense uptake of the labeled compound in one or several metaphyses and increased uptake in diaphyses were typical findings by scintigraphy. The skeleton of each child was subdivided into 18 regions, and investigated for the presence of pain and for possible radiographic and scintigraphic abnormalities. In a total of 432 regions (18 regions in each of 24 children), pain was present in 23 regions, radiographic anomalies in 54 regions, and abnormal technetium uptake in 98 regions. Signs and symptoms were most often found in the lower extremities. Pain and radiographic or scintigraphic abnormalities were not regularly found in the same skeletal regions. The individual number of radiographic abnormalities was negatively correlated with age, whereas the number of regions with abnormal technetium uptake was positively correlated with age. No significant correlation was found between the number of abnormal scintigraphic or radiographic regions and the clinical outcome of the disease.