Clinical efficacy of low molecular weight heparin in postoperative thrombosis prophylaxis.

In a randomized controlled clinical trial, the efficacy and safety of two low molecular weight heparin ( LMWH ) fractions in the prophylaxis of deep vein thrombosis (DVT) were assessed. One hundred twenty-six patients undergoing major abdominal surgery received alternatively 2,500 APTT units b.i.d. of two LMWH fractions or 5,000 APTT units b.i.d. of an unfractionated sodium mucosal heparin ( UFH ). LMWH 2 differed from LMWH 1 by presenting a lower mean molecular weight and a higher anti-Xa/APTT ratio in vitro. Patients were randomly allocated to the three groups, and the development of DVT was studied with the 125I-fibrinogen uptake test ( RFUT ). The study was interrupted and the code broken prematurely because of otherwise unexplainable bleeding events. While no thrombosis and no severe bleeding were detected in the UFH group, three (7%) RFUT -positive DVT and two (5%) hemorrhagic complications occurred in the LMWH 1 group. No thrombosis and nine (22%) cases of severe bleeding were observed in the LMWH 2 group. Thus, the latter group differed significantly from the control group with regard to subjective and objective criteria for postoperative bleeding. Although these results do not allow general conclusions as to the value of LMWH fractions in the prevention of DVT, they indicate that these preparations just as ordinary heparin have a limited therapeutic range.

Bronchial carcinoma and long-term survival. Retrospective study of 433 patients who underwent resection.

The long-term follow-up of patients with bronchial carcinoma treated by surgery is presented. Of 471 patients who underwent thoracotomy, the tumour could not be resected in 38 (8%). Sixty-three (13.4%) died within the first four weeks; 125 (28.9%) survived more than five years. A high percentage developed either late metastases, late recurrences, or a second primary lung carcinoma. The results of surgical resection for bronchial carcinoma cannot be considered satisfactory, although resection remains the best treatment even in those patients with an apparently unfavourable prognosis. In spite of reservations regarding retrospective studies, conclusions can be drawn regarding diagnosis, therapy, and prognosis. Questions concerning histological type, size, and site of tumour, and tumour stage can be answered only after an adequate postoperative interval. Five years after operation the patient who has apparently been successfully treated may die from a second primary carcinoma.

[Special diagnostic and therapeutic aspects of pulmonary histiocytosis X in twelve cases from 1969 to 1975 (author's transl)]. / Diagnostische und therapeutische Besonderheiten bei zwölf Fällen von pulmonaler Histiocytosis X 1969--1975

15 cases of histiocytosis X and 274 cases of histologically confirmed sarcoidosis were diagnosed during the investigation period from 1969 to 1975. Data of 12 adults with primary pulmonary histiocytosis X were evaluated in extenso. The necessary histological verification of diagnosis was only possible by open lung biopsy. Already in early stage small excavations were found by tomography in half of the cases. Eelvation of serum copper and of the index of leukocyte alkaline phosphatase was striking. In a single case antinuclear antibodies were proven. An intra patient comparison verifies corticosteroids suppressing the disease. On the occasion of a second lung biopsy in one case could be seen that after treatment no more histiocytosis-specific substrate was existing. Exacerbation and relapse during and after continuous long-term therapy were not observed. The features of histiocytosis X and sarcoidosis are set side by side in order to show differences and relations.

[Pulmonary varices (author's transl)]. / Intrapulmonale Varizen

In world literature up to now 41 cases of pulmonary varices have been described. Two own cases showed particulars in so far as one patient had an internal fistula between a varix in the base of the upper lobe of the lung and another varix in the apex of the lower lobe. Besides a varix the second patient had an AV-fistula in the right middle lobe. Already pre-operatively either case was diagnosed as vascular anomaly by angiography. By injecting the contrast medium into the vessels of the resection specimen a clear representation of the varices could be obtained.