Surgical thrombectomy versus conservative treatment for deep venous thrombosis; functional comparison of long-term results.

It is known that deep venous thrombosis (DVT) of the ilio-femoro-popliteal axis is frequently associated with irreversible damage to valvular competence of the veins and consequently with varying degrees of chronic venous insufficiency. Because preservation of the valvular function of deep veins can play an important role in preventing the postphlebitic syndrome we analysed and compared the long-term functional outcome of two equally large cohorts of patients treated either surgically for restoration of venous patency and valvular function (24 patients) or medically with heparin, oral anticoagulants and compression stockings (25 patients). The study was also intended to examine the impact of duration and extent of DVT as predictive factors of late outcome. Follow-up time was 7.6 and 7.9 years respectively, operative mortality nil. Assessment of venous function was based on clinical observations as well as on measurement of haemodynamic parameters. Non-fatal pulmonary embolism after onset of treatment occurred in both cohorts with an equal frequency of 13%. Patients operated on for ilio-femoral DVT were with few exceptions totally independent of any form of adjunctive hosiery which was in sharp contrast to the conservatively managed group. If onset of DVT had occurred more than 3 days earlier and extended from the ilio-femoral axis to the popliteo-crural level, surgery usually failed and patients were no better off than in the comparable medical group. The same pattern of late outcome was found for all other clinical and haemodynamic parameters; i.e. clinical signs of venous hypertension, valvular competence as judged by sonography, patient's self-assessment and the expelled volume and refilling time measured by dynamic plethysmography after standardised leg work. The mean expelled volume was 1.1 +/- 0.5 ml/100 g/min. for the surgical group treated early for ilio-femoral DVT and 0.7 +/- 0.5 ml/100 g/min for the corresponding medical group (P = 0.05). Recovery or refilling time was 50 +/- 21 s for the surgical group and 28 +/- 26 s for the medical group (P = 0.03). Thus, the clinical and haemodynamic effect of surgical thrombectomy was significantly superior to conservative management in ilio-femoral thrombosis treated within 3 days. For extensive thrombosis treated early the advantage of surgical thrombectomy was also evident, but the difference between the two treatment groups was not significant. The advantage of surgery was however totally lost in patients operated on for extensive DVT of long duration (i.e. greater than 3 days).(ABSTRACT TRUNCATED AT 400 WORDS)

Gore-tex versus Oreopoulos peritoneal catheters: clinical evaluation and comparison.

Ten Gore-tex and ten Oreopoulos peritoneal catheters were evaluated in a comparative clinical trial with an average follow-up of 13 1/2 months per catheter. Catheter survival was significantly poorer in the Gore-tex group (p = 0.0016) because of catheter-related complications like tunnel infections, fissure, migration and painful catheter which made it necessary to remove seven Gore-tex catheters. Substantial corrections of the Gore-tex catheter design are proposed.

Experimental pancreaticosplenic composite transplantation in the pig. Operative technique and assessment of graft function.

A large animal model for substitutive pancreaticosplenic composite transplantation with urinary drainage to the bladder has been developed in the pig. Transplantations were performed in 7 nontissue-typed donor-recipient combinations without immunosuppressive medication. Six recipients showed perfect graft function at least until the 5th postoperative day. Blood glucose, intravenous glucose tolerance tests and urine amylase concentrations proved to be sensitive markers of graft function. Scintigraphic follow-up examination with 99mTc tin colloid could only record perfusion of the splenic transplantation. With this model the role of the spleen in pancreaticosplenic composite transplantations can be studied in forthcoming experiments.

[Kidney transplantation in childhood: 10 years' experience]. / Nierentransplantation im Kindesalter: Bilanz nach 10 Jahren.

We report our experiences with 35 renal transplantations in 31 patients in childhood and adolescence. Kidneys were obtained exclusively from deceased donors. At the present time 23 patients are still alive, 19 with a functioning graft whereas 4 are again on haemodialysis. Three-year patient survival rates are 80% and three-year graft survival 62%. Chronic rejection was the main reason for loss of graft or graft function in 14 of 19 patients. Our experiences confirm that renal transplantation is the optimal available therapy for terminal renal insufficiency in childhood.

[Indications and results of surgical treatment of spontaneous pneumothorax]. / Zu Indikation und Ergebnissen der operativen Behandlung des Spontanpneumothorax.

Our own collective of patients parietal pleurectomy in complicated spontaneous pneumothorax during the last 15 years (between 1963-1978) is investigated. There were 253 cases of spontaneous pneumothorax 48 of which (19%) have been operated. Indication for operation followed individual aspects, primarily recurrence, persistent pneumothorax, hematopneumothorax and simultaneous bilateral pneumothorax gave reason for operation. The morbidity (17%) is analysed, long-term results and reasons of recurrence regarding cases of diffuse bullous lung disease are illustrated in two patients. Simple dry sponge abrasio is discussed as an alternative to parietal pleurectomy.