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PREVENTION OF DEEP-VEIN THROMBOSIS WITH SUBCUTANEOUS HEPARIN
1380
chromosome, such that its fluorescence is in more
compact
a
comparably
area.
Division of Medical Genetics, Departments of Pædiatrics and Medicine, Child Development and Rehabilitation Center,
University of Oregon Medical School, Portland, Oregon 97201, U.S.A.
HERMAN E. WYANDT FREDERICK HECHT.
PREVENTION OF DEEP-VEIN THROMBOSIS WITH SUBCUTANEOUS HEPARIN
SIR,-I was extremely pleased to read the report of Mr. Williams (Oct. 30, p. 950), which further confirms our successful results.1 Mr. Williams’ results are somewhat improved over those reported by Kakkar et al., possibly because of his following our programme more exactly and controlling heparin prophylaxis with the modified Dale and Laidlaw coagulometer rather than with the thrombin clotting-time as done by Kakkar et al. I was, however, somewhat surprised by Mr. Williams’ observation of 4 instances of deep-vein thrombosis in one leg in patients who had had heparinised retropubic prostatectomies. We have used the prophylactic heparin regimen now in 14 suprapubic prostatectomies and 50 transurethral prostatectomies without incident, except for slight increased postoperative bleeding. It is true, however, that we have not evaluated our material with the 125I-fibrinogen test, only checking for evidence of pulmonary thromboembolism. Perhaps Dr. Pai and Mr. Negus (Nov. 13, p. 1099) are justified in advising caution in interpreting the 15% to 30% arbitrary figures for the 125I-fibrinogen test as indicating leg-vein thrombosis. Department of Pathology, The Mount Vernon Hospital, Mount Vernon, New York 10550, U.S.A.
J. G. SHARNOFF.
Leg with collection cuff and strain
gauges.
is reduced to zero. Venous volume is expressed in ml. per 100 ml. tissue and venous emptying in ml. per min. x 100 ml. tissue. The plethysmographic method does not hurt or inconvenience the patient and has not entailed any risk so far as our present experience goes (250 patients). It is a suitable method for screening venous function in patients with a suspected acute thrombosis, for detecting the development of thrombosis, and for following the course during and after treatment. Department of Surgery, TORGIL HALLBÖÖK University of Lund, LENNART LING. Sweden.
rapidly
XO/XX MOSAICISM IN THE ROKITANSKY-KUSTER-HAUSER SYNDROME SIR,-Dr. Van Campenhout and Dr. Leduc (Oct. 23, p. 928) describe two atypical cases of Rokitansky-KusterHauser syndrome. The published evidence suggests that
DEEP VENOUS THROMBOSIS: DIAGNOSTIC TECHNIQUES
SIR,-In the discussion of diagnosing deep-vein thrombosis (Aug. 28, p. 445; Oct. 2, p. 763), no-one has mentioned the plethysmographic method. The capacity of the veins (venous volume) and the emptying of the veins after venous stasis (venous emptying) are reduced in venous occlusive diseases 3-b and acute deep-vein thrombosis can be diagnosed by determining the venous volume and venous emptying 6,7 by means of venous occlusion plethysmography. Plethysmography-with strain gauge —means that latex gauges filled with mercury are placed round the largest girth of the calf and smallest girth of the ankle. An occlusive cuff (12 cm. broad and 58 cm. long) is placed above the knee joint (see accompanying figure). The examination is carried out with the patient supine, in bed or on wheeled stretcher. Both legs are examined simultaneously, with the most dependent part of the calf at least 20 cm. above heart level. Venous volume is determined as the increase in volume of the part of the limb surrounded by the strain gauge with an occlusive pressure of 50 mm. Hg in the cuff. Venous emptying is defined as the fastest decrease of the volume in calves and ankles when the occlusive pressure 1. 2. 3. 4. 5. 6. 7. 8. 9.
Sharnoff, J. G., DeBlasio, G. Lancet, 1970, ii, 1006. Kakkar, V. V., Field, E. S., Nicolaides, A. N., Flute, P. T. Wessler, S., Yen, E. T. Lancet, Sept. 25, 1971, p. 669. Winsor, T., Hyman, C. J. cardiovasc. Surg. 1961, 2, 146. Sakaguchi, S., et al. ibid. 1968, 9, 87. Ludbrook, J., Westcott, E. Surg. Gynec. Obstet. 1968, 127, 1017. Dahn, I., Eirikson, E. Acta chir. scand. 1968, suppl. 398, p. 33. Hallböök, T., Göthlin, J. ibid. 1971, 137, 37. Whitney, R. J. J. Physiol. 1953, 121, 1. Dahn, I., Hallböök, T. Scand. J. clin. Lab. Invest. 1970, 25, 419.
this well-defined developmental disorder of the mullerian ducts is not associated with anomaly of the sex chromosomes. We also have investigated the Rokitansky-KusterHauser syndrome clinically and cytogenetically and, of 14 cases, each had 46,XX karyotypes. In one of our later patients the " uterus bipartitus rudimentarius solidus cum vagina solida " was associated with gonadal dysgenesis XX type.1,2We know of only two reports in which this clinical picture is associated with gonosomal mosaicism. Serment et al.3 found XO/XX (on the basis of four cells of the aponeurosis culture); and Linquette et awl. demonstrated XX/XXX mosaicism. This 28-year-old woman was admitted because of priFemale secondary sexual features mary amenorrhoea. were normal; well-developed breasts, feminine hair, and external genitalia. The vagina was short, rudimentary, and blind-ended. Chromosome analysis by lymphocyte culture of peripheral blood verified a XO/XX mosaicism. The XO cell-line was found in 30% of the 50 cells examined. Laparotomy revealed two compact muscular buds 2-3 cm. in length, extending from the centre laterally and continuing in regular fallopian tubes of almost normal length. The ovaries were in their usual position and were macroscopically normal. Histological examination of the ovary revealed few primordial follicles, many follicular cysts, cystic corpora lutea, and cortical fibrosis. The interest in this case is that the Rokitansky-KusterHauser syndrome is associated with XO/XX mosaicism. 1. 2. 3. 4.
Papp, Z., Gardó, S., Herpay, G., Árvay, A. Schweiz. Z. Gynäk. Geburtsh. 1970, 1, 115. Gardó, S., Papp, Z., Árvay, A. ibid. 1971, 2, 73. Serment, H., Felce, A., Hartung, N., Tanguy, Y. Bull. Féd. Soc. Gynéc. Obstét. franç. 1966, 18, 284. Linquette, M., Gasnault, J. P., Dupont-Lecompte, J., Hubschman, B., André, A. Rev. franç. Endocr. clin. 1968, 9, 41.
chromosome, such that its fluorescence is in more
compact
a
comparably
area.
Division of Medical Genetics, Departments of Pædiatrics and Medicine, Child Development and Rehabilitation Center,
University of Oregon Medical School, Portland, Oregon 97201, U.S.A.
HERMAN E. WYANDT FREDERICK HECHT.
PREVENTION OF DEEP-VEIN THROMBOSIS WITH SUBCUTANEOUS HEPARIN
SIR,-I was extremely pleased to read the report of Mr. Williams (Oct. 30, p. 950), which further confirms our successful results.1 Mr. Williams’ results are somewhat improved over those reported by Kakkar et al., possibly because of his following our programme more exactly and controlling heparin prophylaxis with the modified Dale and Laidlaw coagulometer rather than with the thrombin clotting-time as done by Kakkar et al. I was, however, somewhat surprised by Mr. Williams’ observation of 4 instances of deep-vein thrombosis in one leg in patients who had had heparinised retropubic prostatectomies. We have used the prophylactic heparin regimen now in 14 suprapubic prostatectomies and 50 transurethral prostatectomies without incident, except for slight increased postoperative bleeding. It is true, however, that we have not evaluated our material with the 125I-fibrinogen test, only checking for evidence of pulmonary thromboembolism. Perhaps Dr. Pai and Mr. Negus (Nov. 13, p. 1099) are justified in advising caution in interpreting the 15% to 30% arbitrary figures for the 125I-fibrinogen test as indicating leg-vein thrombosis. Department of Pathology, The Mount Vernon Hospital, Mount Vernon, New York 10550, U.S.A.
J. G. SHARNOFF.
Leg with collection cuff and strain
gauges.
is reduced to zero. Venous volume is expressed in ml. per 100 ml. tissue and venous emptying in ml. per min. x 100 ml. tissue. The plethysmographic method does not hurt or inconvenience the patient and has not entailed any risk so far as our present experience goes (250 patients). It is a suitable method for screening venous function in patients with a suspected acute thrombosis, for detecting the development of thrombosis, and for following the course during and after treatment. Department of Surgery, TORGIL HALLBÖÖK University of Lund, LENNART LING. Sweden.
rapidly
XO/XX MOSAICISM IN THE ROKITANSKY-KUSTER-HAUSER SYNDROME SIR,-Dr. Van Campenhout and Dr. Leduc (Oct. 23, p. 928) describe two atypical cases of Rokitansky-KusterHauser syndrome. The published evidence suggests that
DEEP VENOUS THROMBOSIS: DIAGNOSTIC TECHNIQUES
SIR,-In the discussion of diagnosing deep-vein thrombosis (Aug. 28, p. 445; Oct. 2, p. 763), no-one has mentioned the plethysmographic method. The capacity of the veins (venous volume) and the emptying of the veins after venous stasis (venous emptying) are reduced in venous occlusive diseases 3-b and acute deep-vein thrombosis can be diagnosed by determining the venous volume and venous emptying 6,7 by means of venous occlusion plethysmography. Plethysmography-with strain gauge —means that latex gauges filled with mercury are placed round the largest girth of the calf and smallest girth of the ankle. An occlusive cuff (12 cm. broad and 58 cm. long) is placed above the knee joint (see accompanying figure). The examination is carried out with the patient supine, in bed or on wheeled stretcher. Both legs are examined simultaneously, with the most dependent part of the calf at least 20 cm. above heart level. Venous volume is determined as the increase in volume of the part of the limb surrounded by the strain gauge with an occlusive pressure of 50 mm. Hg in the cuff. Venous emptying is defined as the fastest decrease of the volume in calves and ankles when the occlusive pressure 1. 2. 3. 4. 5. 6. 7. 8. 9.
Sharnoff, J. G., DeBlasio, G. Lancet, 1970, ii, 1006. Kakkar, V. V., Field, E. S., Nicolaides, A. N., Flute, P. T. Wessler, S., Yen, E. T. Lancet, Sept. 25, 1971, p. 669. Winsor, T., Hyman, C. J. cardiovasc. Surg. 1961, 2, 146. Sakaguchi, S., et al. ibid. 1968, 9, 87. Ludbrook, J., Westcott, E. Surg. Gynec. Obstet. 1968, 127, 1017. Dahn, I., Eirikson, E. Acta chir. scand. 1968, suppl. 398, p. 33. Hallböök, T., Göthlin, J. ibid. 1971, 137, 37. Whitney, R. J. J. Physiol. 1953, 121, 1. Dahn, I., Hallböök, T. Scand. J. clin. Lab. Invest. 1970, 25, 419.
this well-defined developmental disorder of the mullerian ducts is not associated with anomaly of the sex chromosomes. We also have investigated the Rokitansky-KusterHauser syndrome clinically and cytogenetically and, of 14 cases, each had 46,XX karyotypes. In one of our later patients the " uterus bipartitus rudimentarius solidus cum vagina solida " was associated with gonadal dysgenesis XX type.1,2We know of only two reports in which this clinical picture is associated with gonosomal mosaicism. Serment et al.3 found XO/XX (on the basis of four cells of the aponeurosis culture); and Linquette et awl. demonstrated XX/XXX mosaicism. This 28-year-old woman was admitted because of priFemale secondary sexual features mary amenorrhoea. were normal; well-developed breasts, feminine hair, and external genitalia. The vagina was short, rudimentary, and blind-ended. Chromosome analysis by lymphocyte culture of peripheral blood verified a XO/XX mosaicism. The XO cell-line was found in 30% of the 50 cells examined. Laparotomy revealed two compact muscular buds 2-3 cm. in length, extending from the centre laterally and continuing in regular fallopian tubes of almost normal length. The ovaries were in their usual position and were macroscopically normal. Histological examination of the ovary revealed few primordial follicles, many follicular cysts, cystic corpora lutea, and cortical fibrosis. The interest in this case is that the Rokitansky-KusterHauser syndrome is associated with XO/XX mosaicism. 1. 2. 3. 4.
Papp, Z., Gardó, S., Herpay, G., Árvay, A. Schweiz. Z. Gynäk. Geburtsh. 1970, 1, 115. Gardó, S., Papp, Z., Árvay, A. ibid. 1971, 2, 73. Serment, H., Felce, A., Hartung, N., Tanguy, Y. Bull. Féd. Soc. Gynéc. Obstét. franç. 1966, 18, 284. Linquette, M., Gasnault, J. P., Dupont-Lecompte, J., Hubschman, B., André, A. Rev. franç. Endocr. clin. 1968, 9, 41.