Mitsuo Hirose

Postoperative deep venous thrombosis in Japan: Incidence and prophylaxis

The incidence of postoperative deep venous thrombosis was investigated using the iodine-125-fibrinogen method in 256 patients undergoing major surgery. Deep venous thrombosis was found in 49 patients (15.3 percent), and nonfatal pulmonary embolism developed in one of seven patients in whom the thrombus extended to the popliteal vein. The same investigation was performed in 110 patients who wore a graduated compression stocking on one leg, with the other leg serving as a control. Deep venous thrombosis was found in 4 of 110 stockinged legs (3.6 percent) and in 16 of 110 control legs (14.5 percent). The incidence of deep venous thrombosis decreased significantly in patients who wore the stocking. An increase in femoral venous flow velocity was found in the stockinged legs by the Doppler method. The mean velocity of venous return by xenon-133 clearance was significantly greater in the stockinged legs than in the control legs. These findings were considered to support the efficacy of graduated compression stockings for the prevention of deep venous thrombosis.

Effects of intermittent pneumatic leg compression for prevention of postoperative deep venous thrombosis with special reference to fibrinolytic activity

The mechanism of intermittent pneumatic leg compression for prevention of postoperative deep venous thrombosis was investigated. The incidence of postoperative deep venous thrombosis was studied using iodine-125 fibrinogen in 64 patients with malignant disease who had intermittent pneumatic leg compression for 48 hours postoperatively. Changes in euglobulin lysis time and B beta 15-42 peptide were investigated before and after operation in 16 patients with benign disease, in 27 patients with malignant disease who did not have postoperative intermittent pneumatic leg compression, and in another 29 patients with malignant disease who had postoperative intermittent pneumatic leg compression. The overall incidence of deep venous thrombosis was 6.25 percent. A prolongation of euglobulin lysis time was found postoperatively in all three groups, which was significant in malignant disease groups, although less significant in the group with intermittent pneumatic leg compression when compared with the benign disease group. Preoperatively, a significant increase in B beta 15-42 peptide was found in patients with malignant disease when compared with patients with benign disease. Postoperatively, the B beta 15-42 level increased in the same pattern in all groups and no significant differences in the levels were found among them. A significant shortening of euglobulin lysis time by intermittent pneumatic leg compression, in addition to its hemodynamic effects, is considered an important factor in the prevention of postoperative deep venous thrombosis.

Clinical evaluation of branched chain aminoacid infusion in patients with liver cirrhosis following direct operation for esophageal varices with special reference to changes in serum neutral aminoacid concentration.

食道静脈瘤を有する肝硬変症の血漿遊離アミノ酸を測定した結果, 芳香族アミノ酸 (AAA) の上昇と, 分枝鎖アミノ酸 (BCAA) の低下を認めた. これらの症例に食道静脈瘤直達手術を施行し術後の血漿遊離アミノ酸の変動を検討したところ, 術前値よりさらにBCAA/AAA (モル比) は低下し, 手術後2例に羽ばたき振顫が認められた. 20例において術後に特殊組成アミノ酸製剤を輸液したところ, 血漿遊離アミノ酸のインバランスは改善された. その際短時間に点滴輸液するよりはIVHにて24時間かけて輸液する方が効果的であった. また20例中術後肝性脳症を来した症例は1例も認められなかった.

Surgical treatment of thoracic aneurysm in a hemodialysis-dependent patient: a case report.

A 53-year-old woman who was on hemodialysis underwent the resection of an aneurysm of the descending thoracic aorta as well as graft replacement. The operation was performed with the aid of femoro-femoral bypass perfusion and an artificial kidney inserted on the venous side of bypass line. Although the perfusion time was short, the uremic metabolic substance was efficiently removed, resulting in easy management after surgery.