RESUMEN
In a randomized, double-blind trial, 5,000 USP units of sodium heparin or saline were give subcutaneously at least two hours before surgery and at 12 hour intervals thereafter to patients requiring total hip replacement, surgical correction of hip fracture, or major lower extremity amputation for vascular insufficiency. Lung perfusion scans were performed before surgery and at weekly intervals during the postoperative period. Pulmonary arteriograms were requested in patients developing new perfusion defects on serial scans. Two hundred twelve patient hospitalizations were analyzed. We diagnosed acute pulmonary embolism by serial lung perfusion scans or at autopsy in 37 patients. The incidence of pulmonary embolism in 40 patients with below the knee amputation was too low to warrant conclusions. The incidence of acute pulmonary embolism in 94 patients undergoing above the knee amputation was 25% in patients receiving heparin and 27% in patients receiving saline. The incidence of acute pulmonary embolism in 78 patients undergoing hip surgery was 13% in patients receiving heparin and 12% in patients receiving saline. We conclude that the regimen used had no significant effect on the incidence of acute pulmonary embolism in patients undergoing hip surgery or above the knee amputation.
Asunto(s)
Amputación Quirúrgica , Fijación Interna de Fracturas , Heparina/administración & dosificación , Fracturas de Cadera/cirugía , Pierna/cirugía , Complicaciones Posoperatorias/prevención & control , Embolia Pulmonar/prevención & control , Enfermedad Aguda , Adulto , Anciano , Método Doble Ciego , Evaluación de Medicamentos , Femenino , Heparina/uso terapéutico , Humanos , Inyecciones Subcutáneas , Masculino , Persona de Mediana Edad , Embolia Pulmonar/diagnóstico por imagen , Radiografía , CintigrafíaRESUMEN
100 kidney transplants have been carried out on 91 patients (7 had 2 transplants and 2 had 3 transplants). 4 transplants were from living related donors and 96 from cadavers. 76 patients survive, all but one with functioning kidneys. The cumulative survival of patients was 82% at 2 years and 80-7% at 5 years. 8 patients died with functioning grafts, and 2 of the other deaths took place more than 3 months after removal of a rejected kidney and resumption of haemodialysis. There were no deaths from sepsis in the first 60 days after transplantation. The cumulative survival of all grafts was 82-1% at 2 and 5 years. The cumulative survival of first grafts was 82-5% at 2 and 5 years.