Influence of coumarin treatment on patency and limb salvage after peripheral arterial reconstructive surgery

Article Abstract:

When reconstructive procedures are performed to repair blood vessels in the leg, subsequent blockage of the surgery site by clots is a pervasive complication. This may be prevented by the administration of coumarin, an anticoagulant, but the effectiveness of this drug needs to be evaluated in controlled trials. To this end, 116 patients (average age, 72) who underwent vascular reconstructive surgery received either dicumarol postoperatively (a coumarin derivative, 61 patients) or no additional anticoagulant (55 patients) besides heparin, another anticoagulant, which all patients received both before and after surgery. Ninety-two patients were operated on because of severe arterial insufficiency or borderline ischemia (inadequate blood supply), and the remaining 24 because of severe intermittent claudication (leg pain resulting from insufficient blood supply). Grafts of synthetic material or saphenous vein, or thromboendarterectomy (removal of a clot and the affected vessel lining from an artery), were performed on 29 percent, 42 percent, and 29 percent of the patients, respectively. Patients were examined by a vascular surgeon monthly for the first six months after surgery, and regularly thereafter. Results regarding patency (openness, lack of blockage) of the vessels did not differ between the coumarin and control groups after one year, nor were differences found on later examinations. Serious bleeding complications occurred in 4 to 5 percent of the coumarin group. Overall, approximately 73 percent of operated limbs were salvaged, with patients who had borderline ischemia having higher rates of amputation and death than those with intermittent claudication. The results do not support routine use of coumarin in patients undergoing peripheral vascular surgery. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Drug therapy, Peripheral vascular diseases, Blood vessels, Coumarins, Vascular surgery, Graft occlusion, Vascular, Vascular graft occlusion

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Results of surgical treatment for hyperparathyroidism associated with renal disease

Article Abstract:

Chronic renal (kidney) failure can cause hyperparathyroidism, an abnormal endocrine condition characterized by excessive activity of any one of the four parathyroid glands. This hyperactivity causes increased resorption (loss) of calcium from the bones and increased absorption of calcium by the kidneys and gastrointestinal system. Usually these cases of secondary hyperparathyroidism (SHPT) can be successfully treated medically. Tertiary hyperparathyroidism (THPT) occurs when the kidney failure results in development of hypercellular parathyroid glands; these glands function autonomously after kidney transplant when kidney function is restored. In an effort to delineate the indications for surgery in these patients, a retrospective review was undertaken of 53 consecutive patients with either SHPT or THPT who underwent parathyroid exploration. Thirty-seven patients underwent subtotal thyroid excision, an additional eight patients had previously undergone surgery that had not been successful. Thirty patients complained of joint pain, of whom 87 percent improved; 81 percent of the 27 patients with pruritus (itching) improved; 73 percent of 31 patients with preoperative malaise improved. Symptoms of abdominal pain and irritated eyes were not likely to improve. Significant elevation of parathyroid hormone levels in the blood or an increased serum alkaline phosphatase level before surgery were the best predictors of success. It is concluded that both clinical and laboratory data can be used to predict the success of surgery in patients with SHPT and THPT. (Consumer Summary produced by Reliance Medical Information, Inc.)

Chronic kidney failure, Hyperparathyroidism, Thyroid gland

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Comparison of portal vein chemotherapy with hepatic artery chemotherapy in the treatment of liver micrometastases

Article Abstract:

At the time of their initial surgery, 70 percent of patients with colorectal cancer appear to have cancer limited to the bowel. However, most will develop metastasis, or spread of the cancer; bowel cancer most frequently metastasizes to the liver. It has been suggested that this liver metastasis is due to seeding of cancer cells into the portal vein of the liver during bowel surgery. It has also been suggested that many patients who appear to be free of cancer outside of their bowel may, in fact, have very small (micro) metastatic liver tumors. The use of local chemotherapy postoperatively in two clinical trials has improved survival. A study was conducted on rats to determine the relationship between the size of liver metastases at the time of treatment and the effectiveness of regional chemotherapy on altering tumor growth. The animals received 5-fluorouracil (5-FU) into either the portal vein or the hepatic artery for seven days; these infusions were begun at 0, 2, 4, and 6 days following tumor inoculation. When 5-FU was given via the portal vein on the day of tumor inoculation, liver metastasis was reduced by 91 percent; there was no tumor response when 5-FU was given on day 6. When compared to a control group, all 5-FU hepatic artery infusions were successful in reducing metastasis by approximately two-thirds regardless of the time that chemotherapy was administered. It appears that hepatic artery chemotherapy may play an important role in the treatment of colorectal cancer. (Consumer Summary produced by Reliance Medical Information, Inc.)

Colorectal cancer, Cancer, Metastasis, Cancer metastasis, Chemotherapy

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