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Postoperative deep vein thrombosis
262
Iniurv. 12.262-263
PrintedinGreatBritain
Abstracts Thromboembolism Dextran 70 v. heparin prophylaxis
This is an international study based on a number of centres. Over 4000 patients undergoing operations in four branches of surgery were subjected to a prospective and randomized trial. Bleeding sufftcient to require withdrawal from the trial occurred more often with heparin than with Dextran 70, but Dextran 70 was the more often responsible for allergic reactions. Thirty-eight patients who died within 30 days of their operations had received Dextran 70 and 37 heparin. Respectively, 33 and 32 of them were subjected to necropsy and each group included 6 deaths from pulmonary embolism. Gruber U. F. et al. (1980) Incidences of fatal pulmonary embolism after prophylaxis with Dextran 70 and low-dose heparin. Br. Med. J. 1,69. Postoperative
deep vein thrombosis
Heparin, given intravenously in a dose of 1 unit per kilogram body weight per hour during and for 3-5 days after operation, reduced the occurrence of thromboembolism from 22 per cent to 4 per cent of patients and caused no extra bleeding. Negus D., Friedgood A., Cox S. J. et al. (1980) Ultra-low dose intravenous heparin in the prevention of postoperative deep-vein thrombosis. Lancet 1,89 1. Amputations Liver rupture after arm amputation
A 6-year-old boy had a subtotal amputation through the mid-part of his left upper arm> with the median and radial nerves and a small strip of skin being in continuity. Not many surgeons would argue against an attempt at revascularization of the limb, with the proviso that the patient’s condition should otherwise be satisfactory. The authors have demonstrated that despite other serious injuries, in this case liver rupture, the patient could be resuscitated and both the lifethreatening injury and the reconstruction of the arm could be attempted simultaneously. Two surgical teams were used, resulting two years later in satisfactory return of function of the arm. Xia-Pengchun, Li-Yunlian and Chen-Yuming (1979) Successful treatment of arm amputation complicated by liver rupture. Chin. Med. J. (Engl.) 92, 431. Finger replantation
in children
This is the first of two articles on replantation in the upper limb. Although these procedures are more diffrcult in children than in adults (because of the small
size of the vessels), the results in successful cases may be more rewarding. Good sensation and movement return, and growth is minimally retarded. Of 35 such procedures (carried out in children between the ages of I3 months and 14 years) 64.5 per cent were successful. The success rate was least in the younger children, when the little finger was re-implanted, and when the amputation was distally placed. Single, avulsed digits were not regarded as suitable for replantation. Technical details and the management of complications are discussed. O’Brien B. McC., Franklin J. D., Morrison W. A. et al. (1980) Replantation and revascularisation surgery in children. Hand 12, 12. Complications
in digital replantation
The second article in this journal on replantation describes the complications encountered following replantation of 20 amputated fingers. Sixteen of the 20 digits survived, in patients whose ages ranged from 17 to 57 years. Early and late complications are discussed. In contrast to the previous article, this author recommends suture of the arterial supply before the veins (usually two or three). It is also recommended that heparinization should be commenced immediately after operation, whereas the previous authors use aspirin, Persantine and Macrodex for 24 h, before starting heparin. Both articles confirm the value of re-implanting digits in which sensation and movement will be restored. Leung P. C. (1980) An analysis of complications in digital replantation. Hand 12,25. Organization topics Fluidized beds
Blowing air through fine glass beads makes them behave like a fluid, which can support the weight of a patient who lies on an easily washable sheet that is permeable to air but not the beads. It much facilitates the nursing of patients with or liable to bedsores. Thomson 6. W., Ryan D. W., Dunkin L. J. et al. (1980) Fluidized bed in the intensive therapy unit. Lancet 1.568. Immersion
problems
Immersion in water can kill by reflex actions and hypothermia as well as by the inhalation of water. Persons falling into water may be drunk or sustain injury, which may cause complication if unrecognized. Death from inhaling water may be early or delayed, which means that an apparently lucky escape requires
Iniurv. 12.262-263
PrintedinGreatBritain
Abstracts Thromboembolism Dextran 70 v. heparin prophylaxis
This is an international study based on a number of centres. Over 4000 patients undergoing operations in four branches of surgery were subjected to a prospective and randomized trial. Bleeding sufftcient to require withdrawal from the trial occurred more often with heparin than with Dextran 70, but Dextran 70 was the more often responsible for allergic reactions. Thirty-eight patients who died within 30 days of their operations had received Dextran 70 and 37 heparin. Respectively, 33 and 32 of them were subjected to necropsy and each group included 6 deaths from pulmonary embolism. Gruber U. F. et al. (1980) Incidences of fatal pulmonary embolism after prophylaxis with Dextran 70 and low-dose heparin. Br. Med. J. 1,69. Postoperative
deep vein thrombosis
Heparin, given intravenously in a dose of 1 unit per kilogram body weight per hour during and for 3-5 days after operation, reduced the occurrence of thromboembolism from 22 per cent to 4 per cent of patients and caused no extra bleeding. Negus D., Friedgood A., Cox S. J. et al. (1980) Ultra-low dose intravenous heparin in the prevention of postoperative deep-vein thrombosis. Lancet 1,89 1. Amputations Liver rupture after arm amputation
A 6-year-old boy had a subtotal amputation through the mid-part of his left upper arm> with the median and radial nerves and a small strip of skin being in continuity. Not many surgeons would argue against an attempt at revascularization of the limb, with the proviso that the patient’s condition should otherwise be satisfactory. The authors have demonstrated that despite other serious injuries, in this case liver rupture, the patient could be resuscitated and both the lifethreatening injury and the reconstruction of the arm could be attempted simultaneously. Two surgical teams were used, resulting two years later in satisfactory return of function of the arm. Xia-Pengchun, Li-Yunlian and Chen-Yuming (1979) Successful treatment of arm amputation complicated by liver rupture. Chin. Med. J. (Engl.) 92, 431. Finger replantation
in children
This is the first of two articles on replantation in the upper limb. Although these procedures are more diffrcult in children than in adults (because of the small
size of the vessels), the results in successful cases may be more rewarding. Good sensation and movement return, and growth is minimally retarded. Of 35 such procedures (carried out in children between the ages of I3 months and 14 years) 64.5 per cent were successful. The success rate was least in the younger children, when the little finger was re-implanted, and when the amputation was distally placed. Single, avulsed digits were not regarded as suitable for replantation. Technical details and the management of complications are discussed. O’Brien B. McC., Franklin J. D., Morrison W. A. et al. (1980) Replantation and revascularisation surgery in children. Hand 12, 12. Complications
in digital replantation
The second article in this journal on replantation describes the complications encountered following replantation of 20 amputated fingers. Sixteen of the 20 digits survived, in patients whose ages ranged from 17 to 57 years. Early and late complications are discussed. In contrast to the previous article, this author recommends suture of the arterial supply before the veins (usually two or three). It is also recommended that heparinization should be commenced immediately after operation, whereas the previous authors use aspirin, Persantine and Macrodex for 24 h, before starting heparin. Both articles confirm the value of re-implanting digits in which sensation and movement will be restored. Leung P. C. (1980) An analysis of complications in digital replantation. Hand 12,25. Organization topics Fluidized beds
Blowing air through fine glass beads makes them behave like a fluid, which can support the weight of a patient who lies on an easily washable sheet that is permeable to air but not the beads. It much facilitates the nursing of patients with or liable to bedsores. Thomson 6. W., Ryan D. W., Dunkin L. J. et al. (1980) Fluidized bed in the intensive therapy unit. Lancet 1.568. Immersion
problems
Immersion in water can kill by reflex actions and hypothermia as well as by the inhalation of water. Persons falling into water may be drunk or sustain injury, which may cause complication if unrecognized. Death from inhaling water may be early or delayed, which means that an apparently lucky escape requires