Heparin-induced thrombocytopenia and thromboembolism in the postoperative period.

The heparin-induced thrombocytopenia and thrombosis (HITT) syndrome is associated with hemorrhage as well as development of systemic thrombosis. A case is presented in which a posthepatectomy patient had probable heparin-induced thrombocytopenia complicated by venous thrombosis and pulmonary emboli after receiving low doses of heparin as line flushes. HITT is reviewed and factors related to its successful management in this postoperative patient are analyzed in detail.

Resection of recurrent pulmonary metastases in patients with soft-tissue sarcomas.

Survival benefit and prognostic factors useful for patient selection have not been previously analyzed for patients with recurrent pulmonary metastases from soft-tissue sarcomas. Twenty-nine patients in our study had two or more resections of pulmonary metastases from 1976 to 1983. There were no operative deaths and three complications for 40 operations (7.5%). Factors predictive of increased survival following the second resection of pulmonary metastases were resectability and a disease-free interval of greater than six months from the first thoracotomy to the second recurrence in the lung. The tumor doubling time of the first recurrence and the presence of three or fewer nodules on full-lung tomography before the first thoracotomy, which were predictors of survival following initial resection, also predicted survival following subsequent resections. Overall median survival following the second resection was 14.5 months (22% overall three-year survival). The postresection actuarial survival curves for patients undergoing 1, 2, or 3 or more resections were not significantly different. Our findings demonstrate that patients undergoing repeated resections of pulmonary metastases from soft-tissue sarcomas can achieve prolonged survival.

Effect of K3T3 sarcomas on tissue concentrations of vitamin E.

In this study, the effect of tumor presence on the concentration of vitamin E in the liver, spleen, and kidney of BALB/c mice was measured, and the influence of the degree of fat saturation was assessed. In mice fed diets deficient in vitamin E, the presence of a transplanted sarcoma in the thigh significantly increased the concentration of the vitamin in all 3 organs. This was true whether the fat was saturated or unsaturated (hydrogenated coconut oil [HCO] or corn oil [CO], respectively). The tumor itself was generally lower in tocopherol than were other tissues of the tumor-bearing host. In mice fed diets containing vitamin E, the tumor increased the vitamin content in some organs but not others. Only in the kidney of tumor-bearing mice fed the HCO +/- E diet was there a significantly decreased content of the vitamin. A comparison of the spleen tocopherol content with mitogenesis by concanavalin A revealed a positive correlation, which explains why the spleens of tumor-bearing mice fed a diet deficient in vitamin E exhibited higher mitogenic activity than the spleens of normal mice fed the same diet (namely, the spleens from tumor-bearing mice had a higher content of tocopherol).