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Use of the inferior vena cava clip in patients at high risk for pulmonary embolism
84
Citations from
the Literature
patients each), intubation (21). artificial ventilation and computed tomography of the brain (three patients each), blood culture and lumbar puncture (one patient each). and electroencephalography (two). In the placebo group the indications for these procedures did not change in any patient after injection. The 95% confidence interval for the difference in reduction of the frequency of indications for gastric lavage afIer injection between the two groups was 21% to 51%. that for intubation 25% to 55%. and that for urinary catheterisation 21% to 51%. In the flumazenil group 21 patients gave valuable information on their drug ingestion within IO minutes after injection compared with only one in the placebo group (p < 0.001). Nine adverse reactions were recorded in the flumazenil group, eight of which were graded as mild and one severe. The safety of the antagonist was acceptable, even though 60% of the patients in the flumazenil group had multiple drug poisoning including benzodiazepine. No epileptic seizures or arrhythmias were recorded. Conclusion: Flumazenil is a valuable and safe differential diagnostic tool in unclear cases of multiple drug poisoning. Use
of the inferior
ve3m cava clip in patients at high risk for
pulmonary embolii
Heaps JM; Lagasse LD UCLA Schoolof Medicine, CA 90024-1740.
10833 Lu Come Avenue, Los Angeles.
USA
GYNECOL ONCOL 1990 3913 (277-283) Sixteen gynecologic oncology patients at high risk of developing a postoperative pulmonary embolism underwent prophylactic clipping of the inferior vena cava during laparotomy for tumor resection. All patients had a prior history of deep venous thrombosis or pulmonary embolism or had an active deep venous thrombosis at the time of their surgery. Additionally. this group of I6 patients was characterized as being at high risk for recurrent thrombosis in the postoperative period based on traditional risk factors that are representative of most gynecologic oncology patients. The Adams-DeWeese or Moretz clip was used in this series. There were no pulmonary emboli in our I6 patients in the postoperative period or during follow-up. There were no signs of venous stasis attributable to clip placement. The procedure was quick, simple, and complication free and the external clip has the advantage of maintaining effectiveness throughout the patient’s lifetime. Prophylactic clipping of the inferior vena cava at the time of laparotomy in patients at an increased risk of thrombosis deserves further study.
GYNECOLOGICAL ENDOCRINOLOGY Prevalence and determinants of estrogen replacement therapy in elderly women Cauley JA; Department
estrogen replacement therapy in 9704 nonblack women. age 265 years, who participated in the multicenter prospective Study of Osteoporotic Fractures. Overall. 13.7% of women reported current use of oral estrogen; 10.9% took estrogen alone and 2.8% took estrogen opposed by progestin. Four percent currently used parenteral estrogen compounds. Current use declined sharply with age from 17% at age 65 to 4% at age z 85. The primary determinant of estrogen replacement therapy was the type of menopause; the odds of using estrogen replacement therapy in current users compared with never users were approximately five times higher in women with a surgical menopause. Estrogen use was more common among women who had higher levels of education and were less obese. Furthermore, estrogen replacement therapy users were more likely to drink alcohol and to participate in sports and recreation. A diagnosis of osteoporosis was the major determinant of continued estrogen use, but only 24% of women with a diagnosis of osteoporosis used estrogen replacement therapy. We conclude that only a small proportion of elderly women in the United States use estrogen replacement therapy. Selection factors for use of estrogen are evident and may introduce bias in studies of estrogen and disease. In consideration of the distribution of these selection factors. estrogen users will tend to be at lower risk of coronary disease and possibly breast cancer but at greater risk for hip fractures.
Cummings
SR;
of Epidemiology,
School of Public Health.
Black DM; Mascioli SR; Seeley DG University of Pittsburgh. Graduate
Pittsburgh,
PA 15261.
USA
AM J OBSTET GYNECOL 1990 l63/5 I (1438-1444) To better understand which women use estrogen replacement therapy, we examined the prevalence and determinants of
Int J Gynecol Obstet 36
The relationship between plasma estradiol and the increase in bone
. hormone implants
Studd J; Sawas M; Waston N: Gamett T: Fogelman I: Cooper D Dulwich Hospital Menopause Clinic, Fertility and Endocrine Centre. Lister Hospital,
London SE22 8PT.
GBR
AM J OBSTET GYNECOL 1990 163/5 I (1474-1479) Twenty-three postmenopausal women with a median of 2 years past menopause (range, I to I2 years) and a median age of 52 years (range, 39 to 62 years) were recruited to participate in a longitudinal study designed to investigate the factors that influence the increase in bone density with subcutaneous estradiol and testosterone implants. All women received 75 mg of estradiol with I00 mg testosterone subcutaneously. Bone density was measured at the spine and hip by dual-photon absorptiometry before therapy and after I year of subcutaneous hormonal therapy. The mean pretreatment bone density at the lumber vertebrae and neck of the femur was 0.84 grams of hydroxyapatite per square centimer (SD, 0.1 I) and 0.73 grams of hydroxyapatite per square centimeter (SD, 0. IO), respectively. The bone density at both sites increased with values of 0.91 grams of hydroxyapatite per square centimeter (SD. 0. I I) and 0.75 grams of hydroxyapatite per square centimeter (SD. 0. I I). respectively. These values represent an increase of 8.3% (p c 0.0001 ) at the spine and 2.8% (p < 0.01) at the neck of the femur. The plasma estradiol level increased from a median of 80.5 pmol/L to 453 pmol/L (p < 0.001) The percentage increase of vertebral bone density was not related to age, number of years past the menopause, pretreatment bone density. or serum testosterone levels. but a significant correlation was found between the percentage increase in bone density at the spine and the serum estradiol level (p < 0.02, r = 0.45).
Citations from
the Literature
patients each), intubation (21). artificial ventilation and computed tomography of the brain (three patients each), blood culture and lumbar puncture (one patient each). and electroencephalography (two). In the placebo group the indications for these procedures did not change in any patient after injection. The 95% confidence interval for the difference in reduction of the frequency of indications for gastric lavage afIer injection between the two groups was 21% to 51%. that for intubation 25% to 55%. and that for urinary catheterisation 21% to 51%. In the flumazenil group 21 patients gave valuable information on their drug ingestion within IO minutes after injection compared with only one in the placebo group (p < 0.001). Nine adverse reactions were recorded in the flumazenil group, eight of which were graded as mild and one severe. The safety of the antagonist was acceptable, even though 60% of the patients in the flumazenil group had multiple drug poisoning including benzodiazepine. No epileptic seizures or arrhythmias were recorded. Conclusion: Flumazenil is a valuable and safe differential diagnostic tool in unclear cases of multiple drug poisoning. Use
of the inferior
ve3m cava clip in patients at high risk for
pulmonary embolii
Heaps JM; Lagasse LD UCLA Schoolof Medicine, CA 90024-1740.
10833 Lu Come Avenue, Los Angeles.
USA
GYNECOL ONCOL 1990 3913 (277-283) Sixteen gynecologic oncology patients at high risk of developing a postoperative pulmonary embolism underwent prophylactic clipping of the inferior vena cava during laparotomy for tumor resection. All patients had a prior history of deep venous thrombosis or pulmonary embolism or had an active deep venous thrombosis at the time of their surgery. Additionally. this group of I6 patients was characterized as being at high risk for recurrent thrombosis in the postoperative period based on traditional risk factors that are representative of most gynecologic oncology patients. The Adams-DeWeese or Moretz clip was used in this series. There were no pulmonary emboli in our I6 patients in the postoperative period or during follow-up. There were no signs of venous stasis attributable to clip placement. The procedure was quick, simple, and complication free and the external clip has the advantage of maintaining effectiveness throughout the patient’s lifetime. Prophylactic clipping of the inferior vena cava at the time of laparotomy in patients at an increased risk of thrombosis deserves further study.
GYNECOLOGICAL ENDOCRINOLOGY Prevalence and determinants of estrogen replacement therapy in elderly women Cauley JA; Department
estrogen replacement therapy in 9704 nonblack women. age 265 years, who participated in the multicenter prospective Study of Osteoporotic Fractures. Overall. 13.7% of women reported current use of oral estrogen; 10.9% took estrogen alone and 2.8% took estrogen opposed by progestin. Four percent currently used parenteral estrogen compounds. Current use declined sharply with age from 17% at age 65 to 4% at age z 85. The primary determinant of estrogen replacement therapy was the type of menopause; the odds of using estrogen replacement therapy in current users compared with never users were approximately five times higher in women with a surgical menopause. Estrogen use was more common among women who had higher levels of education and were less obese. Furthermore, estrogen replacement therapy users were more likely to drink alcohol and to participate in sports and recreation. A diagnosis of osteoporosis was the major determinant of continued estrogen use, but only 24% of women with a diagnosis of osteoporosis used estrogen replacement therapy. We conclude that only a small proportion of elderly women in the United States use estrogen replacement therapy. Selection factors for use of estrogen are evident and may introduce bias in studies of estrogen and disease. In consideration of the distribution of these selection factors. estrogen users will tend to be at lower risk of coronary disease and possibly breast cancer but at greater risk for hip fractures.
Cummings
SR;
of Epidemiology,
School of Public Health.
Black DM; Mascioli SR; Seeley DG University of Pittsburgh. Graduate
Pittsburgh,
PA 15261.
USA
AM J OBSTET GYNECOL 1990 l63/5 I (1438-1444) To better understand which women use estrogen replacement therapy, we examined the prevalence and determinants of
Int J Gynecol Obstet 36
The relationship between plasma estradiol and the increase in bone
. hormone implants
Studd J; Sawas M; Waston N: Gamett T: Fogelman I: Cooper D Dulwich Hospital Menopause Clinic, Fertility and Endocrine Centre. Lister Hospital,
London SE22 8PT.
GBR
AM J OBSTET GYNECOL 1990 163/5 I (1474-1479) Twenty-three postmenopausal women with a median of 2 years past menopause (range, I to I2 years) and a median age of 52 years (range, 39 to 62 years) were recruited to participate in a longitudinal study designed to investigate the factors that influence the increase in bone density with subcutaneous estradiol and testosterone implants. All women received 75 mg of estradiol with I00 mg testosterone subcutaneously. Bone density was measured at the spine and hip by dual-photon absorptiometry before therapy and after I year of subcutaneous hormonal therapy. The mean pretreatment bone density at the lumber vertebrae and neck of the femur was 0.84 grams of hydroxyapatite per square centimer (SD, 0.1 I) and 0.73 grams of hydroxyapatite per square centimeter (SD, 0. IO), respectively. The bone density at both sites increased with values of 0.91 grams of hydroxyapatite per square centimeter (SD. 0. I I) and 0.75 grams of hydroxyapatite per square centimeter (SD. 0. I I). respectively. These values represent an increase of 8.3% (p c 0.0001 ) at the spine and 2.8% (p < 0.01) at the neck of the femur. The plasma estradiol level increased from a median of 80.5 pmol/L to 453 pmol/L (p < 0.001) The percentage increase of vertebral bone density was not related to age, number of years past the menopause, pretreatment bone density. or serum testosterone levels. but a significant correlation was found between the percentage increase in bone density at the spine and the serum estradiol level (p < 0.02, r = 0.45).