[Analysis of general and hemorrhagic complications after treatment of acute proximal deep venous thrombosis of the legs treated with anticoagulants, streptokinase and thrombectomy]. / Analiza powiklan ogólnych i krwotocznych po leczeniu ostrej, proksymalnej zakrzepicy zyl glebokich konczyn dolnych antykoagulantami, streptokinaza lub trombektomia.

The aim of the study was to present general and haemorrhagic complications in 164 patients with acute DVT in ilio-femoral segment treated with different methods of pharmacological (heparins, streptokinase) and surgical (venous thrombectomy with temporary arterio-venous fistulae) therapy. There were no fatal complications in 48 UH or LMWH treated patients. One patient bled from stress stomach, one developed intramuscular haematoma, one mild pulmonary embolism and one rise of body. Among 84 patients treated with SK five fatal bleeding complications were recorded. From other non fatal complications we recorded one GI bleeding, one splenic rupture and three massive intramuscular haematoma. Three patients died in the early post thrombectomy period. Non fatal complications included one wound haematoma, two wound infection and one with marginal necrosis. The use of LMWH or UH treatment in acute ilio-femoral venous thrombosis is save as the frequency of massive bleeding and serious general complications is rather low. Fatal haemorrhagic episodes are the major hazards of thrombolytic therapy. Venous thrombectomy with temporary arterio-venous fistula may provide a good chance for treatment of acute proximal DVT associated with complete occlusion of the lumen of affected veins in patients with severe ischemic venous thrombosis or with contraindications to heparin treatment.

[Disturbances of pulmonary gas exchange after sclerotherapy for esophageal varices]. / Zaburzenia wentylacji plucnej po skleroterapii zylaków przelyku.

Sclerotherapy of esophageal varices is a procedure which caries high risk of DIC and ARDS syndrome induced by intravenous administration of obliterative agent. The aim of the study was to investigate hematological and arterial and venous gasometric parameters before and after injection of 5% ethanolamine oleate (EO) to the esophageal varices. These investigations were carried out in 9 patients with liver cirrhosis (Child B and C) and in 7 dogs witch were infused with EO to the inferior vena cava. Both patients and animals had the values of pAO2, pVO2, satAO2, satVO2 and platelets count decreased but pACO2 and pVCO2 increased after injection of EO. PhA and phV values increased only in investigated patients but not in dogs in which decreased values of Hb, HT and RBC after EO injection were found. This observation was not confirmed in the treated patients. Conducted investigations show that EO injections to the venous system causes significant changes in the pulmonary function in humans as well as in the dogs.

[The value of phlebography, USG-doppler and intraoperative tests in diagnosis of perforating venous insufficiency in the calf]. / Skutecznosc badan flebograficznych, USG-doppler i sródoperacyjnych w wykrywaniu niewydolnych zyl przeszywajacych goleni.

Accuracy of phlebography, color duplex sonography and intraoperative findings have been compared in a group of 29 patients operated for postphlebitic syndrome. The highest number of perforating veins was identified during the operation, fewer on phlebography and the fewest on color duplex sonography. However in the upper part of the calf both the latter were found to be inaccurate.

Surgical strategy for management of deep venous thrombosis of the lower extremities.

Clinical experience proves that there is a considerable group of patients with acute proximal deep vein thrombosis (DVT) of the legs who have absolute or relative contraindications to anticoagulants or thrombolytic agents but require immediate medical treatment. The aim here is to present our strategy for qualifying patients for venous thrombectomy and the technique of the operation in patients with acute iliofemoral DVT. A total of 268 patients with DVT were evaluated. A proximal thrombosis was diagnosed in 225 cases (84%), and acute thrombosis was found in 126 (56%) of these 225 patients. Venous thrombectomy with temporary arteriovenous fistula was performed in 30 patients. In the remaining patients initial treatment included heparin, acenocumarol, or both in 61, thrombolytic agents in 26, and other therapy in 9 cases. Three patients died during the early postoperative period. Minor nonhemorrhagic complications were observed in four operated patients. One patient developed wound hematoma. In all but three operated cases the patency of the iliac and femoral veins with leg swelling in 16 patients was observed 1 year after fistula closure. There were no episodes of rethrombosis during this period. None of the thrombectomized patient had leg ulcers. Eight patients were free of clinical symptoms related to DVT. We believe that venous thrombectomy provides a good chance for satisfactory restoration of venous outflow in patients with acute proximal DVT. Venous thrombectomy with temporary arteriovenous fistula represents the treatment of choice in patients with acute, proximal DVT and with contraindications to heparin treatment.

[Hemangioma of bone and soft tissue in the midfoot--case report]. / Naczyniak kosci miekkich sródstopia--opis przypadku.

A case of in isolated arterovenous developmental disorder in 23 years old female is described. Bony changes were at the beginning obscured by skin and soft tissue changes. The diagnosis has been established on the basis of histopathological evaluation of the II metatarsal bone and soft tissue vascular changes removed at the operation.

Subcutaneous low molecular weight heparin versus subcutaneous unfractionated heparin in the treatment of deep vein thrombosis: a Polish multicenter trial.

In a prospective multicenter trial, 149 consecutive patients with phlebographically proven proximal and/or distal deep vein thrombosis of the leg were randomly allocated to receive subcutaneously for 10 days either low molecular weight heparin CY 216 (Fraxiparine) in a fixed dose or unfractionated heparin (UFH) in doses adjusted according to the activated partial thromboplastin time. Pre- and post-treatment phlebograms were assessed blindly using the Arnesen's score system in 134 patients available for analysis of the treatment efficacy. The mean phlebographic score after 10 days of treatment was significantly decreased in both groups (p less than 0.001) in comparison with the baseline score but the difference in score changes between the two groups was not statistically significant. There was an improvement in 45/68 patients (66%) in the Fraxiparine group and in 32/66 patients (48%) in the UFH group, and an increase in the thrombus size in 10/68 (15%) and 12/66 (18%), respectively. One symptomatic non-fatal pulmonary embolism and one major bleeding episode were observed in the UFH group. During a follow-up period of 3 months, two rethromboses had occurred in the UFH group and none in the Fraxiparine group. It is concluded that subcutaneous fixed dose Fraxiparine is safe and at least as effective as subcutaneous adjusted UFH in the treatment of deep vein thrombosis.

[Continuous intravenous infusion versus intermittent administration of streptokinase in patients with deep venous thrombosis of the lower extremity]. / Ciagly wlew dozylny i przerywane stosowanie streptokinazy u chorych na zakrzepice zyl glebokich konczyn dolnych.

In a multicenter randomized trial, the efficacy and safety of two streptokinase (SK) dosage regimens have been evaluated in patients with proximal deep vein thrombosis of inferior limbs. Twenty-nine patients received SK by a continuous intravenous infusion (250,000 IU as initial dose, 100,000 IU/h as maintenance dose), and 26 patients were treated with intermittent SK administration (500,000 IU as initial dose, followed by 250,000 IU every 12 h). Thrombolytic therapy was continued for 4 days, then the patients received heparin for 5 days and oral anticoagulant for 3 months. The results of treatment as judged by phlebographic examinations were similar in the two groups. Complete, substantial or partial thrombolysis was achieved in 52% of patients in the continuous infusion group and in 58% of patients in the intermittent treatment group. During SK administration, major bleeding complications occurred in 6 patients treated by continuous infusion and in 2 of the second group. The results showed that the intermittent SK administration is as effective and safe as the method of continuous SK infusion in the treatment of deep vein thrombosis.

Hazards of thrombolytic therapy in deep vein thrombosis.

From 1965 to 1985, 64 deep vein thrombosis (DVT) patients were treated with streptokinase (SK). In 26 cases 'high-dose SK' (IV 100,000 units/h for 4 days) was used and in 38 patients a 'low-dose SK' regime (IV 250,000 units every 12 h for 4 days) was employed. The clinical signs of DVT subsided in 78 per cent of treated patients within 30 days of completing SK treatment. A repeat phlebography was performed immediately after SK therapy in 29 patients (45 per cent) and a total recanalization or partial thrombolysis was achieved in 80 per cent of the studied cases. In 15 patients minor and major haemorrhagic complications occurred. There were five fatalities, all in the high-dose SK group (three intracranial haemorrhages and two major bleeds). Three patients developed pulmonary embolism and none of them died. The post-treatment clinical and phlebographic evaluation did not reveal any significant difference between the two methods of SK administration, but more haemorrhagic complications (P less than 0.02, chi=5.50825) occurred in the high-dose SK patients. This report emphasizes the risk of bleeding complications during thrombolytic therapy. If SK is to be used, therefore, careful selection of patients and meticulous monitoring are mandatory.

Effect of motilin on the lower oesophageal sphincter.

The effect of motilin on lower oesophageal sphincter (LES) pressure has been studied in unanesthetised specially trained dogs using an infusion manometric technique. Motilin produced significant rises in resting pressure and contractions of the LES after doses ranging from 0-009 mug/kg to 0-05 mug/kg. Doses greater than 0-05 mug/kg resulted in repetitive high amplitude contractions. Atropine 30 mug/kg completely abolished the effect of the lower doses of motilin. Higher doses of motilin in atropinised dogs still caused a small rise in baseline pressure and contractile activity still appeared. Hexamethonium 2 mg/kg resulted in both a diminished rise in LES pressure and the disappearance of contractions after motilin. Hexamethonium and atropine together completely abolished the LES response to motilin. We conclude that motilin increases LES pressure by acting on preganglionic cholinergic neurones to release acetylcholine which excites other cholinergic neurones supplying the circular muscle of the LES.

Respiratory disorders in severely burned patients.

The authors reported their own experiences with prevention and treatment of pulmonary complications developing in burn disease. In burn shock the most important problem is maintenance of a sufficient volume of circulating blood and cardiac output, and effective control of pain resulting from thermal injury. Later, the most important becomes prevention of infections and early mobilization of patients. It was demonstrated that physiotherapy, air humidification, lung expansion and inhalations of broncholytic and mucolytic drugs prevented effectively pulmonary complications. When severe respiratory disturbances developed, controlled respiration was successfully applied in 9 cases.