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Biomedical subjects

U F Gruber

Publications and source records attributed to U F Gruber.

At least 73 records · Page 4Linked to original sources
PubMed1977

[Prevention of thromboembolic complications in transurethral resection of the prostate (author's transl)].

1. The effect of 2 X 500 ml Dextran 70 i.v. for prevention of postoperative deep vein thrombosis in patients with transurethral resection of the prostate was investigated in a controlled, prospective and randomized study. The diagnosis of deep vein thrombosis was made by means of the 125I-fibrinogen test. 2. A total of 86 patients were studied. Two out of 47 in the control group developed deep vein thrombosis and 3 out of 39 in the dextran group. The total number of all thromboembolic complications in the control group is 19.2% as compared to 7.7% in the dextran group. This difference is statistically seen not significant. 3. Dextran prophylaxis showed no side effects. 4. A search of the literature on thromboembolic complications in urology shows the following. The incidence of deep vein thrombosis is general urology is about the same as in general surgery, i.e. every third patient develops deep vein thrombosis. There are no studies which would show that the number of fatal pulmonary emboli can be significantly reduced by any sort of preventive method in urologic patients. 5. The incidence of deep vein thrombosis in open prostatectomies is around 50%. In transurethral resection, however, this figure is between 5 and 10%. But nevertheless there are fatal pulmonary emboli. There exist no studies showing a significant reduction in the incidence of deep vein thrombosis after prostatectomy by any form of prevention. In order to avoid the postthrombotic syndrom and fatal complications, a prevention of thromboembolism seems reasonable, if this form of prevention has minimal side effects.

Adult↗
PubMed1977

[Prophylaxis of thromboembolic complications in gynecological surgery (author's transl)].

Eight prospective, controlled, randomised studies on the incidence of postoperative thrombosis in gynaecological patients receiving various drugs for prevention of thromboembolism are analysed. In all patients diagnosis had been established by objective means. The rate of thrombosis in patients without drug prophylaxis has been found to vary between 14 and 29%. Infusions of dextran as well as administration of low-dose subcutaneous heparin significantly reduce the incidence of deep vein thrombosis, even as compared to postoperative oral anticoagulation with cumarins. No difference has been found between dextran and oral anticoagulants, when cumarin adminstration was started before operation, nor between dextran and heparin. Aescin did not show any prophylactic effect. High age, severe leg-vein varicosis as well as surgery for malignant disease increase the risk of thrombosis. No significant influence of overweight, previous deep venous thrombosis, epidural anaesthesia or vaginal operation as compared to abdominal approach could be demonstrated. There are no properly controlled, prospective, randomised studies on the incidence of postoperative fatal pulmonary embolism as influenced by drugs in gynaecological surgery.

Age Factors↗
PubMed1976

[Dextran 40 in the prophylaxis of deep vein thrombosis in surgery (author's transl)].

The effectiveness of 4 X 500 ml dextran-40 infusions (Rheomacrodex) for the prevention of postoperative deep vein thrombosis was evaluated in a prospective, controlled, randomized study in urological and general surgical patients. The 125I-fibrinogen test was performed daily in all patients. 36 of 100 control patients developed deep vein thrombosis, but only 20 out of 92 (21.7%) did so in the dextran group (P less than 0.05). The number of patients showing bilateral deep vein thrombosis was significantly reduced under dextran prophylaxis (P less than 0.01). No side effects of dextran prophylaxis were seen.

Adult↗
PubMed1976

[Value of intermittent pneumatic compression of the calves for the prevention of postoperative thrombosis of the deep veins].

Six prospective, randomized studies using intermittent pneumatic compression of the calf for prevention of postoperative deep vein thrombosis are available and have been analyzed. In 4 studies a significant reduction in the incidence of deep vein thrombosis could be demonstrated. Compared to controls, the reduction in the deep vein thrombosis rate by intermittent compression is about 60%. The frequency of deep vein thrombosis is lower if the patients are treated not only intraoperatively but also for 24-28 h postoperatively. The difference in deep vein thrombosis rate between these two schedules is statistically probable significant. No definite statement can be made regarding the efficacy of deep vein thrombosis prevention in patients with malignant disease, since here the results are controversial. No studies are available on the effect of intermittent pneumatic compression of the leg on the incidence of fatal postoperative pulmonary emboli. This method must therefore be regarded as an interesting alternative in clinical investigation.

Humans↗
PubMed1976

[The course of postoperative deep vein thrombi as judged by repeated phlebographies].

Phlebography was carried out in a prospective randomised, controlled study during which dextran and small doses of s.c. heparin have been compared in general surgical and urological patients, in 31 persons with proven deep vein thrombois diagnosed with the 125I-fibrinogen test. In 16 out of the 31 patients a second phlebogram coule be performed two weeks later. In this study all thrombi occurred intraoperatively. In 24 of the 31 patients, the appearance of thrombi was multilocular. Independent of the prevention instituted and irrespective of the therapy, the following phenomena could be seen 14 days after the first phlebogram: 9 thrombi retracted, 6 disappeared completely and 1 occluded the vein completely. 2 thrombi disappeared without any therapy whatsoever, the 4 others disappeared in patients receiving heparin and/or coumarin for treatment.

Clinical Trials as Topic↗
PubMed1976

[Trends in the nuclear-medical diagnosis of thrombosis].

Use of the 125I-fibrinogen-uptake test for detection of freshly developing thrombi is well known. The administration of radiofibrinogen to detect preformed thrombus - the retrospective variant of the 125I-fibrinogen-uptake test - allows the diagnosis of established thrombosis. The correlation with ascending phlebography is 90%. 125I-Fibrinogen cannot be used for scanning, due to its low energy, while 131I-fibrinogen if used involves a high radiation dose to the patient. First experiments with new radiopharmaceuticals for detection of deep vein thrombosis are proposed. Indication lists for the retrospective variant of the 125I-fibrinogen-uptake test are given.

Fibrinogen↗
PubMed1976

Bilateral fractures of the lower leg due to skiing accidents.

The results of treatment in 13 bilateral lower leg fractures due to skiing accidents are presented. All patients were treated by internal fixation according to the principles of the Swiss Association for the Study of Internal Fixation. The patients on the average were mobilized after nine days, discharged after 24 days, started to use walking braces after 17 days, and undertook partial weight bearing 10 weeks and full weight bearing 14 weeks after the accident.

Adolescent↗
PubMed1975

[The value of dextran 70 in the prevention of thromboembolism in general surgery, orthopedics, urology and gynecology. A review of the literature].

28 prospective, controlled, randomised studies on the incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE) in surgical patients on dextran 70 prophylaxis are analysed. In all patients the diagnosis had been established by objective methods (fibrinogen test, phlebography, autopsy). In patients undergoing hip surgery (11 studies, mainly fractures of the upper end of the femur) the reduction in the number of DVT under dextran prophylaxis is the more evident the longer after operation phlebography is carried out. Coumarin and dextran prevention are equally effective. In 3 studies where diagnosis by the fibrinogen test was established during the first postoperative week only, no significant effect of dextran can be shown; there is no difference between the effect of dextran, coumarin or small doses of subcutaneous heparin. The effectiveness of dextran prophylaxis in reducing the DVT rate in general surgery (4 papers) is not clear, though 7 studies show that the number of fatal PE is reduced more than fivefold (p less than 0.0005). In patients on dextran prophylaxis, the incidence of DVT is equal to that in patients on coumarin prophylaxis before major gynecological surgery (4 papers). On postoperative initiation coumarin is significantly less effective than dextran. 2 further studies show that dextran is significantly effective as compared to controls and that there is no difference between dextran and heparin prophylaxis. Out of 1932 control patients 36 died of fatal PE verified at autopsy. Only 8 PE were seen in the group of 2011 patients receiving dextran prophylaxis (p less than 0.005). The effectiveness of dextran 70 corresponds to that of small doses of subcutaneous heparin. Dextran prevention is more effective in women than in men. Dextran prophylaxis is simple to carry out, has few contraindications, only rarely causes complications and is already effective during operation.

Amputation, Surgical↗
PubMed1975

[Incidence of postoperative deep vein thrombosis in general surgical and urological patients an investigation by means of the 125I-Fibrinogen test in 95 patients withoug prophylaxis (author's transl)].

We present the results of a control group of 95 patients who were thoroughly investigated in a prospective, randomized study, where the efficacy of small doses of s.c. heparin and dextran 40 is checked. The 125I-fibrogen test was used in all patients. 1. 35.8% of the patients develop deep vein thrombosis (DVT) during the first post-operative week. More than half of them show bilateral thrombosis. 2. There is no statistically significant difference in the thrombosis incidence between males and females. 3. 47% of the patients over 60 years develop postoperative DVT. Among those younger than 60 years, only 23% have DVT (P less than 0.025). 4. The DVT incidence in surgery of the colon is 58.3%. 5. Surgery for a malignant disease means probably increased risk for DVT (P less than 0.025). 6. More than half of the patients having a previous history of varicose veins develop postoperative DVT (P less than 0.025). 7. Obese patients are statistically seen not more prone to develop DVT than those of normal body build. 8. Immediately after operation 32.4% of DVT are diagnosed, 24 hrs. later 61.8%. 94% of all DVT are diagnosed up to the third postoperative day. 9. With the exeption of one patient, all DVT develop in the calf veins, 3/4 of all abnormal values were measured in the midcalf region.

Adult↗
PubMed1975

[Subcutaneous small heparin doses for the prevention of thrombosis in general surgery and urology].

1. The effectiveness of 3 X 5000 IU s. c. heparin daily (starting preoperatively) for the prevention of postoperative deep vein thrombosis was evaluated in a prospective, controlled, randomized study including general surgical and urological patients. 125I-fibrinogen test was performed daily in all patients. 2. 178 patients fulfilled the conditions of the protocol. 35.8% of the 95 patients in the control group developed deep vein thrombosis, but only 13.3% of 83 subjects in the heparin group did so. The difference is statistically highly significant (p less than 0.001). 3. The vast majority of all thrombi in both groups appeared before the 3rd postoperative day. 4. With 1 exception, all deep vein thrombi in the heparin group started in the mid-calf region. In the control group 5 deep thrombi originated in the popliteal vein. 5. Heparin displays a better effect in males (n = 34; p less than 0.01) than in females (n = 49; p less than 0.025). 6. In patients undergoing surgery for malignant disease heparin does not reduce the incidence of deep vein thrombosis. 7. Heparin is far more effective in patients under 60 years of age than in those over 60 (p less than 0.005). 8. Heparin is more effective in obese patients than in those of normal body build. 9. Heparin prophylaxis also reduces the incidence of deep vein thrombosis in patients who exhibit predisposing factors. In patients of the control group with preexisting disease of the venous system, there were significantly more deep vein thrombi (p less than 0.01) than in those without predisposing factors. 10. In the heparin group 29% of all thrombin time determinations show a definite prolongation of more than 26 sec (normal value 15 sec). 11. In 14 patients (=16.9%) of the heparin group, 21 side effects or complications were seen. Bleeding complications were the main problem, comprising 5 wound hematomas and hematomas at the injection site, 4 postoperative bleeding episodes and 2 reoperations. There were no complications in the control group. 12. According to the results of 10 well controlled studies, there is no doubt that in general surgery small doses of subcutaneous heparin, commencing preoperatively, do reduce the incidence of postoperative deep vein thrombosis to a significant degree. However, whether this form of prophylaxis is also effective in patients with fractures of the hip and in elective hip surgery cannot, on the evidence available, be decided. In the fields of gynecological surgery and urology as well, more data are needed before this form of heparin prophylaxis can be recommended.

Adult↗
PubMed1975

[The radiofibrinogen test in differential diagnosis of fresh deep venous thrombosis].

The radio-fibrinogen test is a simple and sensitive method for diagnosing deep vein thrombosis. Intravenously administered radioactive labelled fibrinogen is incorporated as radioactive fibrin in freshly developing thrombi, and such labelled thrombi may be detected on the body surface with nuclear medical equipment. Homologous iodine 125 labelled fibrinogen is chiefly used since it is known not to transmit viral hepatitis. The weak gamma emittor 125-I allows the use of a portable scintillation detector rate meter with an easily moved measuring device. This bedside method does not involve discomfort for the patient. The correlation between ascending phlebography and the radioactive fibrinogen test is more than 90 percent. The radiofibrinogen test may be used to study thromboembolic diseases, to evaluate drugs for prevention of thromboembolic complications and to confirm clinically suspected fresh deep vein thrombi. Details of the method as used in several thousand measurements are given.

Diagnosis, Differential↗
PubMed1975

Dextran and the prevention of postoperative thromboembolic complications.

1. The purpose of fluid administration is not only the restoration of blood volume but also the normalization of impaired nutritive flow. 2. Plasma oncotic (colloid osmotic) pressure is the only force which can draw water into the circulation. In shock the infusion of colloid solutions is able to normalize nutritive flow and peripheral resistance almost at once. 3. Five per cent solutions of pasteurized plasma protein or albumin and 6 per cent dextran 70 yield a volume expansion corresponding to the amount infused. 4. The decrease in hematocrit produced by the infusion of these three colloidal solutions is accompanied by a decrease in whole blood viscosity resulting in a rise in cardiac output as well as in nutritional tissue flow. 5. Hemodilution improves oxygen supply as long as the hematocrit does not fall below 30 per cent, although normovolemia is the critical requirement. 6. Transmission of viral hepatitis is still the greatest danger of blood transfusion. 7. The use of large amounts of Ringer's lactate is not advised, as this solution does not reduce the total number of units of blood which need to be given. Pulmonary edema may become a problem. 8. Dextrans are best suited to initial volume replacement in shock. They increase plasma volume, improve blood flow, have antithrombotic properties, and are easily available and relatively cheap. Anaphylactoid reactions are rare. 9. Every third patient undergoing general surgery and every other patient having hip surgery develops a deep venous thrombosis. Widespread prophylaxis to prevent thromboembolic complications is mandatory. 10. The antithrombotic properties of dextran are due to a reduction in platelet adhesiveness, a change in fibrin clot structure, and the increased lysability of thrombi and the improvement of blood flow. 11. In a personal controlled, prospective, randomezed trial comparing subcutaneous heparin and intravenous dextran 40, 35.8 per cent of the controls (n=95), 13.2 per cent of the 83 patients in the heparin group, and 20.5 per cent in the dextran group (n=83) developed deep venous thrombosis. The difference between dextran and heparin is not significant; however, both treatment groups show a statistically significant effect compared to the controls.

Blood Coagulation Tests↗