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Biomedical subjects

U F Gruber

Publications and source records attributed to U F Gruber.

At least 55 records · Page 3Linked to original sources
PubMed1978

[How effective is the interruption of the inferior vena cava for the prevention of recurrent pulmonary emboli?].

Analysis of results which have been obtained by interruption of the inferior vena cava for prevention of recurrent pulmonary emboli. The incidence of recurren emboli by means of the 3 possible methods ligature, plication and intraluminal filter is 6%, 5% or 2%. The incidence of fatal pulmonary emboli is 2%, 1% or 0,5%. There are no studies which do compare the effectiveness of operative procedures with the drug prevention. Both the operative and the drug prevention are not without mortality. Interruption of the inferior vena cava for the prevention of recurrent pulmonary emboli should be carried out in exceptional situations only as possibility of failure of anticoagulation.

Filtration↗
PubMed1977

[The value of acetylsalicylic acid for the prevention of postoperative thromboembolic complications].

All studies on the value of acetylsalicylic acid for the prevention of postoperative thromboembolic complications have been evaluated. Controlled, prospective and randomized studies have been analyzed only where the incidence of postoperative deep vein thrombosis or pulmonary emboli was proven by objective diagnostic methods such as the fibrinogen test, phlebography or autopsy. In 6 studies there is no significant reduction in the incidence of deep vein thrombosis in general surgical and orthopedic patients after acetylsalicylic acid prevention. One study, though it has definite methodological defects, does suggest a significant reduction in the number of postoperative fatal pulmonary emboli in 120 patients with fractures of the upper end of the femur. On the basis of all these data, the prevention of postoperative thromboembolic complications by means of acetylsalicylic acid cannot be recommended.

Aspirin↗
PubMed1977

[Prevention of postoperative thromboembolic complications with subcutaneously administered small doses of heparin].

In a prospective study 3 x 5000 IU sodium heparin s.c. have been used for the prevention of postoperative deep vein thrombosis. Prevention started preoperatively in general surgical and urological patients. The diagnosis was made in all cases by means of the iodine 125fibrinogen test. In 2 out of 22 patients with a correct protocol deep vein thrombosis was diagnosed. 4 patients showed bleeding complications, in 2 of them heparin had to be stopped. A review of the world literature reveals that heparin prevention has been tested in general surgery in 2253 patients. The incidence of deep vein thrombosis was 8.6% compared to 28% in the controls. In orthopedic surgery only 279 patients are documented, the deep vein thrombosis frequency dropped from 46% to 22.2%. The results are contradictory. Both in urology and gynecology only few patients have been studied, definite conclusions are therefore not possible. The number of fatal pulmonary emboli in about 4000 patients under heparin prevention was 0.2%, in a control group of similar size 0.8%. This difference is statistically significant.

Heparin↗
PubMed1977

Prevention of postoperative thromboembolism by dextran 40, low doses of heparin, or xantinol nicotinate.

The efficacy of dextran-40 infusions or low-dose heparin or xantinol-nicotinate administration in preventing postoperative thromboembolic complications has been investigated in a prospective, controlled, randomised trial as part of an international multicentre trial. 382 patients over the age of forty years undergoing elective major general surgery were investigated; 100 had a complete protocol in the control, 94 in the heparin, 92 in the dextran, and 32 in the xantinol-nicotinate group. 31 patients died: 13 in the control group, 10 in the heparin group, 6 in the dextran group, and 2 in the xantinol-nicotinate group. In 4 controls, 6 in the heparin group, and 1 in the dextran group the cause of death was acute pulmonary embolism. 4 further controls, 1 in the heparin group, and 2 in the dextran group had emboli found at necropsy, which either contributed to the deaths or were incidental findings. The distribution of pulmonary emboli in this study did not show the difference between the control and the heparin group reported in the multicentre trial. The 125I-fibrinogen test was done in all patients. The frequency of isotopic deep-vein thrombosis was 36-0% in the controls, 12-8% in the heparin group, 21-7% in the dextran group, and 40-6% in the xantinol-nicotinate group. The difference between the controls and the heparin groups was highly significant and between the control and the dextran group, probably significant. There were significantly more side-effects in the heparin group than in the dextran group.

Administration, Oral↗
PubMed1977

[Clinical diagnosis of thromboembolic complications. 125I fibrinogen test, thermography, ultrasound (author's transl)].

Early diagnosis of deep vein thrombosis (DVT) in all patients operated upon does not make sense. Prevention is better. Should dvt occur, phlebography is mandatory. The only other reliable objective method is the fibrinogen test, which is ideal for clinical research. Peripheral pulmonary emboli (pe) are more common than most people assume. Many are asymptomatic and lyse spontaneously, but often they are precursors of dangerous pe. Combined perfusion-ventilation scintigrams are often diagnostic. The combination of dyspnea, tachypnea, low pO2, and low pCO2 in the presence of a nearly normal chest X-ray makes a diagnosis of massive pe most likely. In all unclear situations pulmonary angiography is important.

Fibrinogen↗
PubMed1977

Sulfinpyrazone and postoperative deep vein thrombosis.

Small doses of subcutaneous heparin and infusions of dextran both reduce the incidence of fatal pulmonary embolism after elective general surgery. But both methods have disadvantages. Therefore, the protection against deep vein thrombosis afforded by sulfinpyrazone, a drug which can be taken by mouth as well as by injection, was assessed in a prospective study of 119 patients undergoing elective general or urological surgery. The prophylactic administration of sulfinpyrazone was compared with the effects of small doses of sodium heparin and infusions of dextran-70. The 125I-fibrinogen test was carried out in all patients during their hospitalization. Deep vein thrombosis was diagnosed in 13 of 30 patients (43%) who received sulfinpyrazone, in 9 of 29 (31%) receiving dextran-70 and in 2 of 22 (9%) having subcutaneous heparin. The difference between the sulfinpyrazone and heparin groups was statistically significant (p less than 0.01). Sulfinpyrazone in the dose used in this trial was not effective in reducing the incidence of deep vein thrombosis during elective general surgery.

Administration, Oral↗
PubMed1977

[The effectiveness of various micropore blood filters (author's transl)].

Recently so-called micropore blood transfusion filters have been introduced. They should decrease the number of microemboli produced by blood transfusion and thus decrease the incidence of postoperative and posttraumatic pulmonary insufficiency. Since these filters are rather expensive and several types and models are offered, it seemed to us important to review their properties and the results obtained with the most commonly used models (Pall, fenwal, Swank and Bentley). The efficacy of the various filters is apparently quite different. Depending on the indication, the use of different filters is possible. There is no filter which fulfils all prerequisites which must be made for an ideal micropore filter. On the basis of our literature review we conclude that filters made of Dacron wool are best suited for all purposes. There are no good reasons to use these micropore filters routinely for all blood transfusions. However, when large amounts of blood must be given rapidly and pulmonary function is already reduced, the use of micropore filters routinely for all blood transfusions. However, when large amounts of blood must be given rapidly and pulmonary function is already reduced, the use of micropore filters seems reasonable.

Blood↗
PubMed1977

[Is there an indication for the use of "micropore-blood filters"? (AUTHOR'S TRANSL)].

Recently "micropore" blood transfusion sets have been advocated to replace the traditional transfusion sets. Because of the higher cost it is important to review critically the data which would justify their clinical use. The filters eliminate microaggregates as they occur during blood storage. The question is wether micropore filters are able to reduce the incidence of posttraumatic or postoperative respiratory insufficiency. We have analysed all controlled in vivo studies. We found only one clinical study where in massively transfused polytrauma patients a decrease in the number of cases of respiratory insufficiency was documented. However, due to the small number of patients investigated, a significant difference in favour of the micropore filters could not be demonstrated. Animal experiments reveal more: Exchange transfusions carried out in dogs through micropore filters do not lead to functional or morphological pulmonary changes. Using traditional transfusion sets, a significant increase in pulmonary artery pressure and resistance was found together with a decrease in arterial pO2, pH and oxygen consumption. All these results correlate well with morphological changes in the lung. On the basis of our literature review, we conclude that there are no clear data which would make it mandatory to use micropore filters in clinical practice. On the other hand, there are several indirect hints than large amounts of microaggregates are not ideal for pulmonary function. The expensive micropore filters could therefore perhaps be used with advantage in massive tranfusions.

Animals↗