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.

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.

[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.

[Urinary enzyme levels in healthy human subjects and in rats (author's transl)]. / Untersuchungen über die normale Enzymausscheidung im Harn des Menschen und der Rattle

Urinary MDH, LDH, gamma-GT, LAP and muramidase levels were studied in 11 healthy persons with a wide age range and in 51 male Winstar rats weighing 300 to 400 g. Normal ranges of these urinary enzymes were determined and compared with the results of other authors.

[Prophylactic effect of isosorbide dinitrate on postoperative cardiac complications (author's transl)]. / Prophylaktische Wirkung von Isosorbiddinitrat auf postoperative kardiale Komplikationen

Isosorbide dinitrate (ISD) was administered before, during and after 178 operations performed on 127 patients with arterial occlusive disease. Its influence on postoperative myocardial infarction, heart failure and mortality was tested by comparison with 188 operations performed on 140 patients with hypertension and/or old myocardial infarction receiving no ISD prophylaxis. Risk of cardiac complications was similar in both groups. Mortality in the ISD-treated group was significantly lowered as compared with the control group and was about half of the overall mortality in patients with arterial occlusive disease operated on at our hospital over the past 10 years. This difference depended partly on the influence of ISD on cardiac complications. Post-operative myocardial infarction during ISD prophylaxis occurred in 0.6% of cases as compared with 3.7% in the control group (p less than 0.05), whilst the respective values for postoperative heart failure were 5.7% and 18.2% (p less than 0.001). Both complications are related to absolute or relative hypoxia during the post-operative stress period. ISD is effective by lowering cardiac preload and afterload and thereby diminishing myocardial oxygen demand. ISD is the drug of choice for surgical patients since it provides a steady and long-lasting effect after sublingual absorption. ISD prophylaxis during the perioperative period is indicated in cases with coronary artery disease and with increased cardiac preload or afterload.

[The influence of vitamin a, gentamicin and anoxaemia on urinary enzyme excretion (author's transl)]. / Verhalten von Harnenzymen nach Vitamin A, Gentamycin und Klemmung der Nierenarterien

The excretion patterns of several urinary enzymes were investigated in the following four experimental groups of Wistar rats and compared with the normal range of each urinary enzyme studied. One group received vitamin A in high dosage; a second group was given vitamin A before and after bilateral clamping of the renal artery for 30 minutes; in the third group the renal arteries were clamped for 30 or 60 minutes; the last group of experimental animals received first low (2mg/kg, 4mg/kg) and subsequently high doses (100 mg/kg) of gentamicin. Vitamin A administration produced no increase in urinary enzyme activity, even in the group of rats with ischaemically-damaged kidneys, where ischaemia (clampin of the arteries) was responsible per se for an increase in enzyme excretion. With low doses of gentamicin the urinary enzymes remained within normal limits, but increased immediately to significantly pathological values after the first dose 100 mg/kg gentamicin.

[Urinary enzymes in the early detection of rejection reactions after renal transplantation (author's transl)]. / Harnenzyme zur Frühdiagnose von Abstossungsreaktionen nach Nierentransplantation

Urinary enzymes were studied in 15 patients subjected to kidney transplantation. The investigation was initiated immediately after operation and was continued for a period of between 2 and 8 weeks. There was a significant increase in urinary MDH activity in 94.2% of cases, of LDH activity in 95,65% and of gamma-GT activity in 95,17% of the cases. This detected increase in urinary enzyme activities preceded the clinical diagnosis of rejection by activities preceded the clinical diagnosis of rejection by at least 24 hours. Determination of these enzymes provides a reliable tool for the early detection of rejection crises.

[Thrombosis, embolism and aggregation inhibitors in surgery]. / Thrombosen, Embolien und Aggregationshemmer in der Chirurgie

The frequency in letal pulmonary embolism at the I. Chirurgische Univ.-Klinik and the Unfallchirurgie I, Vienna, and experimental and clinical studies of the protective effect of aggregation inhibitors are reported. Significant difference of extent in experimentally induced venous thrombosis was found in animal groups with and without preventive treatment. Two double-blind trials with acetylsalicylic acid and placebo brought significant differences in the frequency of letal pulmonary embolism in patients with hip fracture and a lower rate of immediate post-operative vascular reobstruction due to high peripher vascular resistance in patients undergoing vascular surgery.