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Biomedical subjects

B Krähenbühl

Publications and source records attributed to B Krähenbühl.

At least 19 recordsLinked to original sources
PubMed1989

Prevention of postoperative deep vein thrombosis by one daily injection of low molecular weight heparin and dihydroergotamine.

201 patients aged over 40 years undergoing abdominal surgery were divided randomly into two groups. Each patient received two subcutaneous injections daily: the first group received a morning injection of 1500 aPTT U of low molecular weight heparin combined with 0.5 mg dihydroergotamine (LMH/DHE) and an evening injection of placebo; the second group received morning and evening injections of 2500 IU standard heparin combined with 0.5 mg dihydroergotamine(H/DHE). 25 patients were withdrawn during the course of the trial, 13 in the LMH/DHE group and 12 in the H/DHE group. There was no significant difference between the two groups with regard to age, sex, body weight or history of thromboembolism. 125I-labelled fibrinogen test was routinely used to detect deep vein thrombosis (DVT), which was confirmed by phlebography. Ventilation-perfusion scanning was performed in patients in whom pulmonary embolism was suspected on clinical grounds. DVT occurred in 6 patients in the LMH/DHE group (6.9%) and in 7 patients in the H/DHE group (7.9%). Pulmonary embolism occurred in one patient in each group. The only noteworthy haemorrhagic incident was a haematoma of the abdominal wall in one patient (LMH/DHE). It was concluded that a single daily injection of 1500 aPTT U low molecular weight heparin combined with DHE is as effective and as well tolerated as two injections daily of 2500 IU standard heparin combined with DHE.

Abdomen↗
PubMed1988

Predicting amputation in severe ischaemia. The value of transcutaneous PO2 measurement.

The predictive value of the pedal transcutaneous oxygen tension (tcPO2) and of the distal systolic blood pressure (SBP) in forecasting the necessity for later amputation has been studied in 26 patients suffering from severe chronic ischaemia of the lower limbs. In all these patients vascular surgery had failed or not been possible, and they were threatened by amputation; they suffered from trophic lesions, or pain at rest, or both. The great toe SBP averaged 10 mmHg (range 0 to 60 mmHg) and the pedal tcPO2 10 mmHg (range 2 to 45 mmHg). After six minutes of oxygen inhalation there was an increase in pedal tcPO2 of 9 mmHg (0 to 50 mmHg). After a follow-up period averaging 7 months (range 10 days to 13 months), 13 patients underwent an amputation and nine (five of whom had been amputated) died. The great toe SBP in the patients who required amputation was initially lower than in those who did not. The pedal tcPO2 also was lower in amputated than in non-amputated patients. There was no amputation in the group showing an increase of at least 10 mmHg after six minutes of oxygen inhalation; and conversely, all patients in whom the pedal tcPO2 increased less than 10 mmHg were amputated. Thus increase in the pedal tcPO2 after oxygen inhalation appears the best criterion for estimating the prognosis of severely ischaemic limbs.

Adult↗
PubMed1986

[Femoral artery thrombosis associated with heparin-induced thrombopenia].

We report a case of acute thrombosis of the common femoral artery which occurred on the tenth day of postoperative prophylactic heparin therapy. Platelet count was 14,000/mm3 at the time of the acute event. Cessation of heparin administration resulted in progressive normalization of the platelet count. Iliofemoral thrombectomy, followed by popliteal thromboembolectomy, allowed successful recanalization of the occluded arteries, after failure of local thrombolysis with low-dose streptokinase. The pathogenesis, diagnosis and treatment of heparin-induced thrombocytopenia associated with thromboembolic complications are discussed.

Femoral Artery↗
PubMed1982

Diagnosis of deep vein thrombosis by combination of Doppler ultrasound flow examination and strain gauge plethysmography. An alternative to venography only in particular conditions despite improved accuracy of the Doppler method.

Doppler ultrasound flow examination, strain gauge plethysmography and contrast venography were performed in 160 lower limbs of 80 in-patients. Deep vein thrombosis (DVT) was suspected in 87 limbs. Using measurement of venous stop-flow pressure, the Doppler method hae an overall sensitivity of 83%. By combined use of Doppler and Plethysmography, sensitivity was increased to 96%. Specificity was 62% and 51%, respectively. With a positive and a negative predictive value of 80% and 73%, respectively, the combination of both non-invasive method cannot reliably replace venography in the diagnosis of DTV, although all (40/40) thromboses proximal to or involving the popliteal segment were detected by either Doppler and Plethysmography or both. After exclusion of 14 patients (18%) suffering from conditions known to alter the results of these non-invasive methods, the positive predictive value of abnormal findings in both Doppler and Plethysmography was increased to 94% for suspected limbs, whilst negative predictive value of both negative Doppler and Plethysmography was 90%, allowing the avoidance of venography in these patients.

Adolescent↗
PubMed1981

Mechanical versus pharmacologic prevention of deep venous thrombosis.

The prevention postoperatively of deep venous thrombosis was studied using three different regimens in 227 patients undergoing surgical procedures. Seventy-six patients received 5,000 units of heparin subcutaneously and 0.5 milligrams of dihydroergotamine twice a day. In 76 patients, intermittent pneumatic compression of the legs was applied preoperatively and postoperatively with active physiotherapy. The last 75 patients received subcutaneously 5,000 units of heparin each eight hours. Systematic deep venous thrombosis detection was carried out using both the 125I fibrinogen test and the Doppler method, being confirmed by phlebography if positive. The 125I fibrinogen test proved to be more sensitive and more specific. The incidence of deep venous thrombosis and pulmonary embolism were comparable in the groups, mechanical prophylaxis being as effective as the two other regimens. No side-effects were noted with the use of intermittent compression boots. A venoconstricting agent associated with heparin may permit smaller doses with the same prophylactic effect.

Adult↗
PubMed1980

[Prevention of deep venous thrombosis (TVP) and pulmonary embolism. Comparison of heparin (3 x 5000 IU/day), heparin (2 x 5000 IU/day) + 0.5 mg dihydroergot, and physiotherapy (intermittent compression stockings + physical exercise). Value of Doppler diagnosis in systematic detection of TVP compared with phlebography and scanning of the legs using labelled fibrinogen].

We compared the protective value of the above treatments in 227 randomised patients. Investigations in each patient included pulmonary scanning before and after operation, repeated postoperative Doppler and radioactive limb scanning completed by phlebography to confirm positive results. The heparin DHE group and the "physiotherapic" group each totalized 76 patients and the heparin group 75. These comparable groups show that HDHE and heparin prophylaxis are identical; but physiotherapy is perhaps better. Compared with phlebography leg scanning sensitivity is 95%, whilst it's specificity is 99%. Doppler sensitivity is only of 21%, whilst it's specificity is 95%. In conclusion, "physiotherapic" prophylaxis, including Flowtron, is as effective as heparin alone. Doses of heparin may be reduced, without loss of effect, if supplemented by a veinoconstrictive agent as DHE. The low Doppler sensitivity contraindicates its use in asymptomatic DVT detection.

Adult↗
PubMed1979

[Edema, heavy legs and popliteal compression].

Fifty patients with edema and heaviness of the lower limbs lacking any general or local explanation were investigated by a plethysmographic method to detect venous stasis of the calf. In 27 of them, hyperextension of the knee produced venous stasis, which was only elicited in one of 39 normal subjects. In 9 patients with edema of systemic origin there was no stasis when the knee was extended. Intermittent venous stasis due to hyperextension of the knee therefore appears to be a causal phenomenon in many cases of edema of unknown origin. A popliteal cyst was found in 9 of 16 patients who underwent knee arthropathy. Further studies are necessary to determine what mechanisms may produce venous stasis when the knee is placed in hyperextension.

Adult↗
PubMed1979

[Heparin treatment. Comparison between intravenous and subcutaneous administration].

48 patients with acute deep venous thrombosis of the lower limbs were treated with sodium heparin. In 23 patients heparin was injected subcutaneously (s.c.) twice a day and in 25 patients heparin was given by continuous intravenous perfusion (i.v.). Pain and edema disappeared after 8.7 days (s.c.) and 11.7 days (i.v.) respectively. One non fatal pulmonary embolism occurred in each group. A second venography was performed in 24 patients after 7 days of treatment and revealed no difference between the two groups. As judged by repeated thrombin time determination, anticoagulation was ineffective on at least one day in 39% of patients treated subcutaneously and in 60% of patients treated intravenously. The two pulmonary embolisms occurred in patients with ineffective anticoagulation. It is concluded that heparin may be used either intravenously or subcutaneously in the treatment of acute deep venous thrombosis. Thromboembolic complications occurred with both methods of treatment when anticoagulation was ineffective.

Heparin↗
PubMed1979

[The hand in diabetes. Study of 97 diabetics compared to a control group].

To determine whether there is hand involvement specific to diabetes, 97 diabetics were compared with the same number of matched controls. Hands were examined with particular emphasis on skin, intrinsic muscles, articular mobility, sense of touch and vibration, digital systolic pressure, and radiological analysis of bones and joints. The most significant involvement, clearly present in 7 cases and less specifically in 12 other diabetics, included all of the following: atrophy and weakness of intrinsic muscles, painful interphalangeal rigidity limiting extension or flexion of the fingers, periarticular swelling of the phalanges, and trophic changes of the skin. Separately, these changes are not specific to diabetes: in the control group, although less frequent, they were found in patients aged 60 and over and are considered to be signs of senescence. Diabetes apparently accelerates the process of aging. Diabetic changes in the hand appear to be facilitated by neuropathy but not by arterial involvement. X-ray revealed a higher incidence of osteopenia and above all of vascular calcifications in the diabetic.

Adult↗