The effect of low-dose heparin therapy on serum platelet and transaminase levels

Review of recent literature permits characterization of a thrombocytopenic syndrome associated with full- or low-dose heparin therapy, the incidence, severity, and etiology of which remain controversial. This study was undertaken to determine the occurrence of thrombocytopenia accompanying subcutaneous heparin administration to healthy volunteers. Thirty-nine subjects received a regimen of 5000 USP units of heparin injected every 12 hr for 10 days. Serum liver enzymes were also monitored in a subgroup of the population. Two available heparin preparations, hog mucosa and beef lung extracts, were compared for the occurrence of these associated abnormalities. There was no thrombocytopenia observed in any person. However, as a group there was a significant (P = 0.01) downward linear trend in the mean platelet count during heparin administration, with a marked increase after cessation of the drug. Significant elevations of transaminase (SGOT and SGPT) levels occurred in 62% of the subjects, also returning to normal after heparin was discontinued. The enzyme pattern was characteristic of hepatocellular damage. The incidence of this finding was higher in subjects receiving hog mucosal heparin (93%) than in those receiving bovine heparin (37%, P < 0.05). Though not exhibiting thrombocytopenia, the subjects did have a decrease in mean platelet count. The etiology of the hypertransaminasemia is unknown, though the temporal correlation with the decrease in platelets suggests that the two are related, possibly through an immunologic mechanism. The enzyme elevations could result in inaccurate diagnosis based on these enzymes or pose potential danger to patients with marginal liver function. Patients receiving heparin should have liver enzymes as well as platelet counts followed regularly.     

Effects of parenteral alimentation on postoperative gastric function

The effects of parenteral hyperalimentation on postoperative gastric function were studied in eleven patients undergoing abdominal aortic surgery. Positive nitrogen balance was achieved in hyperalimented patients. Hyperalimentation was found to augment gastric mucosal regeneration, allowing for more physiologic secretory patterns and the maintenance of the protective gastric mucosal mechanism.     

Biliary stricture: A continuing study

Fortunately, benign stricture is becoming a much less frequently encountered problem in biliary surgery. This must be largely explained by repetitious warnings in the literature and by teachers during the past thirty years. Our efforts now perhaps should be directed toward early recognition and treatment of ductal injuries before irreversible liver injury has occurred. Use of solutions to flush ducts and stents warrants further study, and the use of percutaneous replaceable stents along with biliary solvents in the hope that better prognosis of such fibrosed ducts is justified. The true morbidity and mortality of biliary stricture cannot be accurately known unless a group of patients can be accurately followed throughout their entire lifetime when a final appraisal can be made.     

Calcium and 1-hydroxyethylidene-1,1-bisphosphonic acid: polynuclear complex formation in the physiological range of pH

1-Hydroxyethylidene-1,1-bisphosphonic acid (HEDP) is used in a variety of diagnostic, research and therapeutic applications at in vivo concentrations of from < 1 μ M to > 1 mM. Previous studies have shown that calcium and HEDP form polynuclear aggregate complexes at high pH. Calcium ion titrations at constant pH 8.0, and pH titrations at 1:1 and 2:1 ratios of total calcium to total diphosphonate, provide evidence for the occurrence of aggregation of calcium and HEDP under physiological conditions. A robust feature of several polynuclear models examined is a dramatic pH dependence of polynuclear species concentrations between pH 5.5 and 7.0.     

Percutaneous placement of Hickman catheters for prolonged venous access

The Hickman catheter is well established as a safe, reliable means of venous access in a variety of clinical situations. Although the technique for placement by surgical cutdown in the cephalic or external jugular vein is standardized, our experience placing 102 catheters in the last 40 months has led us to evolve and adopt a percutaneous method that we have now applied to almost all catheter placements. Operative time has been dramatially reduced, patient discomfort minimized, and no change in short- or long-term morbidity has been noted. The procedure has been described in detail, and our overall experience with placement of the Hickman catheter in a variety of clinical situations has been reviewed. We now consider this percutaneous technique to be the primary method of Hickman catheter placement unless specifically contraindicated.     

Surgical therapy for chronic pancreatitis: Selecting the appropriate approach

Surgical therapy of 37 patients with chronic pancreatitis is reviewed. Procedures included longitudinal pancreaticojejunostomy (10), DuVal (5), distal resection (4), pancreaticoduodenectomy (2), sphincteroplasty (7), pseudocyst drainage (6) and other miscellaneous procedures. Complication rates were 30 percent for lateral pancreaticojejunostomy, 28.5 percent for sphincteroplasty and 72.7 percent for resection procedures. The overall complication rate was 54.5 percent, and there were two deaths (5.4 percent). Follow-up is presented on 20 patients, of whom 16 are improved, 2 are unchanged and 2 are worse. Eight patients are dead and nine are lost to follow-up. Ductal anatomy is the most important consideration in the selection of a procedure. Lateral pancraticojejunostomy, when applicable, is the procedure of choice. Resection should be considered when pancreaticojejunostomy has failed or is not indicated with pancreaticoduodenectomy, the procedure of choice in the diffusely diseased gland. Sphincteroplasty should be reserved for use in stenosing papillitis or as an ancillary procedure. Splanchnicectomy can be used for temporary palliation.