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Dextran useless in preventing pulmonary embolism
92
Injury: the British Journal of Accident Surgery Vol. 4/No. 1
or symptoms in the legs were given macro-aggregated human serum albumin tagged with laxI and had their lungs scanned. Those that had a positive result were subjected to phlebography and were given 125I fibrinogen. A second group, of 50 persons, had clinical evidence of iliofemoral thrombosis, which was confirmed by phlebography, after which they, too, were given XZSl fibrinogen. Eight-seven per cent of the patients presenting with pulmonary embolism gave a negative result when subjected to peripheral scanning Forty showed thrombi that did not occlude the vessels but only 2 of these gave a positive result on scanning. Twenty-six of the 72 patients showed no evidence of thrombosis with either test. Thirty-four of the 50 persons with swollen legs had negative results on scanning. Thus of 90 persons with proven thrombi 72 gave negative results on scanning; 13 of the 18 that gave positive results did so only after a long interval. The authors conclude that although scanning is of value in the study of the natural history of thromboembolism it is a poor guide to the need for prophylaxis, and they express the opinion that phlebography remains the most important investigative procedure in venous thrombo-embolism MAVOR,G. E., MAHAFFY,R. G., WALKER,M. G., DtrrmE, J. S., DHALL,n. P., GADDIE,J., and REID, G. F. (1972), ' Peripheral venous scanning with lzq. tagged fibrinogen ', Lancet, 1,661.
Dextran useless in preventing pulmonary embolism Results of a prospective, double-blind clinical trial of de×tran 75 in high-risk surgical patients showed some reduction in thrombophlebitis but no reduction in the incidence of pulmonary embolism or in mortality. A few anaphylactoid reactions occurred. BRISMAN, R., PARKS, L. C., and HALLER, J. A., jun. (1971), ' Dextran prophylaxis in surgery ', Ann. Surg., 174, 137.
Compression of the calf for deep vein thrombosis In a random, controlled clinical trial of compression of the calves, both legs, ankles, and feet were encased in one-piece leggings of polyvinyl chloride that were inflated to a pressure of 40--45 mm. Hg for alternate minutes. Placing three layers of tube gauze under the leggings made them comfortable for periods of 24-28 hours. Inflation was started wherl premedication was carried out. Tests were carried out on persons undergoing general surgical operations, mostly on herniae or the gastro-intestinal tract. The presence or absence of thrombosis was demonstrated by using radioactive iodinated fibrinogen. In patients with malignant disease there was no benefit from intermittent compression but in the others, in one series, 21 per cent of the control patients developed thrombosis in contrast to 2"4 per cent of the test patients, and in another series the figures were, respectively, 50 per cent and 5 per cent. Obesity,
length of time in hospital before operation, and duration of anaesthesia did not affect the incidence of deep venous thrombosis, whereas the age of the patient and the severity of operation did. HILLS, N. H., PFLUG, J. J., JEYASINGH, K., BOARDMAN, L., and CALNAN, J. S. (1972), 'Prevention of deep vein thrombosis by intermittent pneumatic compression of the calf ', Br. reed. J., 1, 131.
Detection of proximal vein thrombosis Thrombosis of the lilac and femoral veins was readily detected by using ultrasound. Among other things, it was found that when there was complete occlusion of the lilac vein the Valsalva action had no effect on flow in the femoral vein. Of 50 persons studied because they had chronic swollen legs, 15 had normal findings when tested with ultrasound and 13 of these were shown by phlebography to have no obstruction; 2 appeared to have the left common lilac vein compressed by the right common lilac artery. Thirty-three patients with abnormal findings with ultrasound were shown to have more or less venous obstruction by thrombus. Five patients with normal findings with both ultrasound and phlebography were shown to have lymphatic obstruction. The authors conclude that ultrasound is a simple and useful way of selecting from persons with swollen lox~er limbs those for whom phlebography is required. YAP, S. T., GOURMO$, S., and HOBBS, J. T. (1972), ' Detection of proximal vein thrombosis by D6ppler ultrasound flow-detection method ', Lancet, 1, 1. THORACIC INJURIES
AND
ABDOMINAL
Avoiding hypoxia during traeheo-bronchial toilet In this paper it is shown that the most effective way to prevent hypoxia during endotracheal suction is to hyperinflate the lungs for 1 minute with 100 per cent oxygen prior to suction and to limit suction to 15 seconds. FELL, T., and CHENEY,F. W. (1971), 'Prevention of hypoxia during endotracheal suction ', Ann. Surg., 174, 24.
Delayed rupture of spleen Since 14 per cent of splenic ruptures occur days or weeks after injury, detection methods to help in diagnosis should be of considerable interest. Prager, Morel, and Dex, from the Pennsylvania State University, describe sophisticated methods of demonstrating the lesion, including haematocrit reading, red blood-cell morphology, bone-marrow studies, haptoglobin level, and radio-isotope spleen scan. In splenic scanning using technetium sulphide Tc 99m colloid, they point out that the camera is more useful than the scanner. PRAGER,D., MOREL,D., and DEX, W. (1971), ' The syndrome of chronic occult rupture of the spleen ', J. Am. reed. Ass., 218, 1824.
Injury: the British Journal of Accident Surgery Vol. 4/No. 1
or symptoms in the legs were given macro-aggregated human serum albumin tagged with laxI and had their lungs scanned. Those that had a positive result were subjected to phlebography and were given 125I fibrinogen. A second group, of 50 persons, had clinical evidence of iliofemoral thrombosis, which was confirmed by phlebography, after which they, too, were given XZSl fibrinogen. Eight-seven per cent of the patients presenting with pulmonary embolism gave a negative result when subjected to peripheral scanning Forty showed thrombi that did not occlude the vessels but only 2 of these gave a positive result on scanning. Twenty-six of the 72 patients showed no evidence of thrombosis with either test. Thirty-four of the 50 persons with swollen legs had negative results on scanning. Thus of 90 persons with proven thrombi 72 gave negative results on scanning; 13 of the 18 that gave positive results did so only after a long interval. The authors conclude that although scanning is of value in the study of the natural history of thromboembolism it is a poor guide to the need for prophylaxis, and they express the opinion that phlebography remains the most important investigative procedure in venous thrombo-embolism MAVOR,G. E., MAHAFFY,R. G., WALKER,M. G., DtrrmE, J. S., DHALL,n. P., GADDIE,J., and REID, G. F. (1972), ' Peripheral venous scanning with lzq. tagged fibrinogen ', Lancet, 1,661.
Dextran useless in preventing pulmonary embolism Results of a prospective, double-blind clinical trial of de×tran 75 in high-risk surgical patients showed some reduction in thrombophlebitis but no reduction in the incidence of pulmonary embolism or in mortality. A few anaphylactoid reactions occurred. BRISMAN, R., PARKS, L. C., and HALLER, J. A., jun. (1971), ' Dextran prophylaxis in surgery ', Ann. Surg., 174, 137.
Compression of the calf for deep vein thrombosis In a random, controlled clinical trial of compression of the calves, both legs, ankles, and feet were encased in one-piece leggings of polyvinyl chloride that were inflated to a pressure of 40--45 mm. Hg for alternate minutes. Placing three layers of tube gauze under the leggings made them comfortable for periods of 24-28 hours. Inflation was started wherl premedication was carried out. Tests were carried out on persons undergoing general surgical operations, mostly on herniae or the gastro-intestinal tract. The presence or absence of thrombosis was demonstrated by using radioactive iodinated fibrinogen. In patients with malignant disease there was no benefit from intermittent compression but in the others, in one series, 21 per cent of the control patients developed thrombosis in contrast to 2"4 per cent of the test patients, and in another series the figures were, respectively, 50 per cent and 5 per cent. Obesity,
length of time in hospital before operation, and duration of anaesthesia did not affect the incidence of deep venous thrombosis, whereas the age of the patient and the severity of operation did. HILLS, N. H., PFLUG, J. J., JEYASINGH, K., BOARDMAN, L., and CALNAN, J. S. (1972), 'Prevention of deep vein thrombosis by intermittent pneumatic compression of the calf ', Br. reed. J., 1, 131.
Detection of proximal vein thrombosis Thrombosis of the lilac and femoral veins was readily detected by using ultrasound. Among other things, it was found that when there was complete occlusion of the lilac vein the Valsalva action had no effect on flow in the femoral vein. Of 50 persons studied because they had chronic swollen legs, 15 had normal findings when tested with ultrasound and 13 of these were shown by phlebography to have no obstruction; 2 appeared to have the left common lilac vein compressed by the right common lilac artery. Thirty-three patients with abnormal findings with ultrasound were shown to have more or less venous obstruction by thrombus. Five patients with normal findings with both ultrasound and phlebography were shown to have lymphatic obstruction. The authors conclude that ultrasound is a simple and useful way of selecting from persons with swollen lox~er limbs those for whom phlebography is required. YAP, S. T., GOURMO$, S., and HOBBS, J. T. (1972), ' Detection of proximal vein thrombosis by D6ppler ultrasound flow-detection method ', Lancet, 1, 1. THORACIC INJURIES
AND
ABDOMINAL
Avoiding hypoxia during traeheo-bronchial toilet In this paper it is shown that the most effective way to prevent hypoxia during endotracheal suction is to hyperinflate the lungs for 1 minute with 100 per cent oxygen prior to suction and to limit suction to 15 seconds. FELL, T., and CHENEY,F. W. (1971), 'Prevention of hypoxia during endotracheal suction ', Ann. Surg., 174, 24.
Delayed rupture of spleen Since 14 per cent of splenic ruptures occur days or weeks after injury, detection methods to help in diagnosis should be of considerable interest. Prager, Morel, and Dex, from the Pennsylvania State University, describe sophisticated methods of demonstrating the lesion, including haematocrit reading, red blood-cell morphology, bone-marrow studies, haptoglobin level, and radio-isotope spleen scan. In splenic scanning using technetium sulphide Tc 99m colloid, they point out that the camera is more useful than the scanner. PRAGER,D., MOREL,D., and DEX, W. (1971), ' The syndrome of chronic occult rupture of the spleen ', J. Am. reed. Ass., 218, 1824.