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Venous thrombosis: Early diagnosis with the aid of phlebography and abortive treatment with heparin
SELECTED
Bauer, ct.: Venous Thrombosis: md Abortive Treatment With
Early Heparin.
869
ABSTRACTS Diagnosis Arch.
With the Aid of Phlebography Surg.
43: 462, 1941.
For successfully combating thromboembolic disease two measures are necessaryearly diagnosis and immediate energetic treatment with heparin. Phlebography permits of an earlier diagnosis than any other known method. With its aid the first manifestations of the disease in the lower part of the leg can be revealed. If in this stage regular treatment with heparin is started, almost ideal results can be expected, for the whole disease often takes an abortite course. In twenty-one cases in which the diagnosis of an early stage of thrombosis in the lower part of the leg was confirmed by phlebographic examination, the patients were treated with heparin, 100 mg. three times daily for three to five days. All of the patients recovered and were ambulatory within a few days. In thirty-two similar cases in which treatment with heparin was not used, two patients died, three had pulmonary embolism, eight had pulmonary infarct, and in twenty-four the thrombosis spread to the femoral veins. The average length of confinement to bed was forty-three days. AUTHOR. Marvin, Bull.
H. M.: Newer New York Acad.
Surgery of the Heart and Large Vessels: Med.
17:
Medical
Aspects.
737, 1941.
The author believes that, of the operations mentioned, those designed to provide the heart with a new source of blood are probably valueless. Surgical ligation of the patent ductus arteriosus seems destined to be of great importance in a group of patients that will probably always be numerically small. Total thyroidectomy may have a limited place, but in the absenee of an elevated basal metabolic rate the indications for it are not very clear and the results are apt to be unsatisfactory. Alcohol injection,5 into the thoracic sympathetic ganglia have been proved to be highly satisfactory by years of experience. The Brauer operation for adhesive mediastinopericarditis seems to me to be of demonstrated value in a few cases, and I believe the time has not come to discard it. Pericardiectomy for constrictive pericarditis may be confidently regarded as a major therapeutic procedure and a brilliant surgical contribution. AUTHOR.
Fine, J., and Sears, J. B.: The Prophylaxis of Pulmonary of the Femoral Vein. Ann. Surg. 114:.801, 1941.
Embolism
by Division
Thrombosis of the deep veins of the lower leg is the focus of the origin of the great majority of pulmonary cmboli. Pulmonary embolism until recently has been regarded as a dramatic postoperative catastrophe for which adequate prophylactic or therapeutic measures are not availThis is no longer tenable except in the case of massive embolus which has able. occurred in the absence of detectable signs of venous thrombosis of the lower leg and in the absence of a previous episode of embolism. If the surgeon will conscientiously observe the patient from the very beginning and throughout the postoperative period for the signs and symptoms of phlebitis in the deep veins of the lower leg, he is likely to discover the existence of at least suspicious evidence of phlebitis in a much larger number of instances than heretofore in advance of the discharge of an cmbolus. If the evidence of phlebitis in the lower leg is clear-cut, immediate division of the femoral vein below or above the profunda should be done (bilaterally if both legs are
Bauer, ct.: Venous Thrombosis: md Abortive Treatment With
Early Heparin.
869
ABSTRACTS Diagnosis Arch.
With the Aid of Phlebography Surg.
43: 462, 1941.
For successfully combating thromboembolic disease two measures are necessaryearly diagnosis and immediate energetic treatment with heparin. Phlebography permits of an earlier diagnosis than any other known method. With its aid the first manifestations of the disease in the lower part of the leg can be revealed. If in this stage regular treatment with heparin is started, almost ideal results can be expected, for the whole disease often takes an abortite course. In twenty-one cases in which the diagnosis of an early stage of thrombosis in the lower part of the leg was confirmed by phlebographic examination, the patients were treated with heparin, 100 mg. three times daily for three to five days. All of the patients recovered and were ambulatory within a few days. In thirty-two similar cases in which treatment with heparin was not used, two patients died, three had pulmonary embolism, eight had pulmonary infarct, and in twenty-four the thrombosis spread to the femoral veins. The average length of confinement to bed was forty-three days. AUTHOR. Marvin, Bull.
H. M.: Newer New York Acad.
Surgery of the Heart and Large Vessels: Med.
17:
Medical
Aspects.
737, 1941.
The author believes that, of the operations mentioned, those designed to provide the heart with a new source of blood are probably valueless. Surgical ligation of the patent ductus arteriosus seems destined to be of great importance in a group of patients that will probably always be numerically small. Total thyroidectomy may have a limited place, but in the absenee of an elevated basal metabolic rate the indications for it are not very clear and the results are apt to be unsatisfactory. Alcohol injection,5 into the thoracic sympathetic ganglia have been proved to be highly satisfactory by years of experience. The Brauer operation for adhesive mediastinopericarditis seems to me to be of demonstrated value in a few cases, and I believe the time has not come to discard it. Pericardiectomy for constrictive pericarditis may be confidently regarded as a major therapeutic procedure and a brilliant surgical contribution. AUTHOR.
Fine, J., and Sears, J. B.: The Prophylaxis of Pulmonary of the Femoral Vein. Ann. Surg. 114:.801, 1941.
Embolism
by Division
Thrombosis of the deep veins of the lower leg is the focus of the origin of the great majority of pulmonary cmboli. Pulmonary embolism until recently has been regarded as a dramatic postoperative catastrophe for which adequate prophylactic or therapeutic measures are not availThis is no longer tenable except in the case of massive embolus which has able. occurred in the absence of detectable signs of venous thrombosis of the lower leg and in the absence of a previous episode of embolism. If the surgeon will conscientiously observe the patient from the very beginning and throughout the postoperative period for the signs and symptoms of phlebitis in the deep veins of the lower leg, he is likely to discover the existence of at least suspicious evidence of phlebitis in a much larger number of instances than heretofore in advance of the discharge of an cmbolus. If the evidence of phlebitis in the lower leg is clear-cut, immediate division of the femoral vein below or above the profunda should be done (bilaterally if both legs are