Postoperative deep vein thrombosis in Sudanese patients

Hemostatic changes following surgery

Measurements of hemostatic variables were performed prior to and up to the fifth day following general surgery in patients of Arab origin (N = 53). There was a significant postoperative elevation in the levels of plasma fibrinogen, clotting factors VIII and reduction of factor VII, ATIII, plasminogen, packed cell volume and platelet count. No significant changes were noted in PT, PTT, TT, RT, alpha-2-antiplasmin and factor X. Platelet aggregation responses to ADP, adrenaline, collagen, arachidonic acid and ristocetin was likewise unaffected by surgery. It was concluded that although the changes in plasmatic coagulation parameters are similar to that reported in Caucasians, lack of evidence of enhanced aggregation following surgery may explain the presumed low incidence of deep vein thrombosis in Arabs.

Incidence of deep vein thrombosis after major abdominal surgery in Brisbane

There is some evidence that postoperative deep vein thrombosis (DVT) may be commoner in cool than in warm climates. To determine whether this complication is less common in the subtropical climate of Brisbane than in more temperate locations, the incidence of DVT after major abdominal surgery was assessed by 125I fibrinogen scanning. In order to avoid overestimating the incidence of DVT, abnormal scans were accepted as diagnostic only if the DVT was confirmed by venography or if the abnormality on the scan fulfilled more stringent criteria than have previously been applied. Thirty-six of 152 patients (24 per cent) developed a DVT; this incidence was significantly lower than in one previous study from Melbourne and higher than that found in South-East Asia and East Africa, but was not significantly different from that reported from Sydney, Japan and several centres in North America and Britain. There was no apparent seasonal variation in the incidence of the complication. The geographical variation in incidence of postoperative DVT may have been overestimated in previous reports and may be at least partly due to variations in screening technique.

Postoperative deep vein thrombosis in the Taiwanese Chinese population

Reports of the incidence of postoperative deep vein thrombosis in the Chinese population of Taiwan are few in the literature. Over a 3 year period, the fibrinogen degradation products test, the pulse volume recorder, and venography were used to study 220 patients undergoing major operations at the Veterans General Hospital in Taipei, Taiwan. Deep vein thrombosis was found in 17 patients (7.7 percent). A comparison of the three diagnostic methods showed that the sensitivities of the fibrinogen degradation products test and the pulse volume recorder were 56.3 percent and 93.7 percent, respectively; the specificities, 97.4 percent and 95.7 percent, respectively; and the accuracies, 85.5 percent and 95.5 percent, respectively. These results support the combined use of the fibrinogen degradation products test and the pulse volume recorder for screening and diagnosing deep vein thrombosis.

A comparative study of two estrogen dosages in combined oral contraceptives among Sudanese women

A prospective study of two combined oral contraceptives was conducted in the Sudan. No pregnancies occurred. Overall incidence of side effects was low. Headache was most frequently reported. Elevations were observed for weight, systolic and diastolic blood pressures, and SGOT and SGPT values while a decrease was seen for hemoglobin levels. Menstrual irregularities were not a problem for the users. Total 6-month use discontinuation rates were low for both pill groups.

Splenectomy and vasoligation for patients with haematemesis secondary to bilharzial hepatic fibrosis

One hundred and thirteen patients with haematemesis secondary to bilharzial hepatic fibrosis had splenectomy and vasoligation. There were 6 deaths in the immediate and 28 in the late postoperative period. The commonest cause of death was recurrent haematemesis followed by hepatic failure. Transient jaundice, ascites and infection were common in the postoperative period. The operation improved the cellular elements of the blood but the 20 per cent incidence of recurrent bleeding is unacceptable.

Prevention and treatment of early postoperative deep vein thrombosis in africans: a Nigerian experience with dihydroergotamine mesylate

Post-operative deep vein thrombosis is regarded as rare among Africans, even though there are no known specific factors existing in the African population which either increase or decrease the incidence of deep vein thrombosis in the surgical patient. But by using human fibrinogen labeled with radioactive iodine (125I), despite its limitations in detecting thrombi proximal to the femoral veins, we were able to demonstrate those which were still at the subclinical stage of the disease process apart from overt cases of deep vein thrombosis (DVT). Whereas, miniheparinization and treatment with Dextran 70 may be better, accepted methods of prophylaxis in the immediate post-operative days, in 38 consecutive post-operative cases studied, we were able to show the benefits of dihydroergotamine mesylate in the prevention of deep vein thrombosis among Nigerians. It was also shown that since DVT may occur in the femoral segments without a concomitant involvement of the calf veins, assertions based only on data obtained from clinical examinations of the calf for evidence of DVT are bound to be understatements of the true incidence.

Incidence of postoperative deep vein thrombosis in Hong Kong Chinese

Postoperative deep vein thrombosis is considered to be rare in Chinese. The 125I-labelled fibrinogen test was used to determine the true incidence of postoperative deep vein thrombosis in Chinese. Deep vein thrombosis was found in 2.6 per cent, a very low incidence compared with Caucasian series.

Seasonal variation in the incidence of deep vein thrombosis

Two double-blind controlled clinical trials of the effectiveness of prophylactic low dose subcutaneous calcium heparin (dose based on body weight) in the prevention of deep vein thrombosis (DVT) have been completed. The first was concerned with upper abdominal operations in 242 patients over 21 years of age, and the second with 50 patients presenting with a fracture of the neck of the femur. There was no increase in the incidence of bleeding or wound complications in the patients given heparin. In each trial, the incidence of DVT as diagnosed by 125I-labelled fibrinogen was significantly reduced in the treated group. The incidence of DVT in the control groups varied significantly during the period of the trials. The incidence was much higher in the cold half of the year than in the hot months. In the first trial, this variation in incidence was directly correlated with the average temperature and the diurnal variation in temperature in the perioperative period. These results may help to explain the considerable variation in the incidence of postoperative DVT reported from various parts of the world, and also from within Australia.

Outpatient surgery in a developing country

233 outpatient operations were performed under general anaesthesia on Nigerian patients whose selection was not influenced by adverse social circumstances. The complication-rate was similar to that found in comparable series from the United Kingdom. The incidence of wound infection was related to the age and social circumstances of the patient and was not affected by the type of hospital in which the operation was performed.

The incidence of venous thrombosis in the lower limbs following elective gallbladder surgery

The frequency of postoperative venous thrombosis and the prophylactic effect of dextran 40 and 70 were studied in 90 otherwise healthy patients undergoing cholecystectomy. The 125-I-fibrinogen test was employed as the diagnostic method. The frequency of thrombosis was very low (1.1%) compared with other investigations on patients undergoing elective general surgery. Thus nothing can be concluded about the prophylactic effect of dextran from this series, but it can be presumed that this type of patient does not need routine prophylaxis against deep venous thrombosis.

Adrenergic, coagulation, and fibrinolytic responses to heat

Two groups of volunteers were exposed to heat in a sauna bath-one group for 10 minutes and the other for 15. There was no change in plasma adrenaline concentration until the subjects emerged from the sauna bath, when there was a slight increase in concentration. Factor VIII and thrombo-elastograph patterns did not change but marked activation of fibrinolysis was stimulated by exposure to heat. These findings support the concept that fibrinolysis is not mediated by direct adrenergic activity.

Prostatectomy and deep vein thrombosis in Sudanese patients

One hundred and four Sudanese patients who had undergone the operation of prostatectomy (transvesical or retropubic but not transurethral) in Khartoum Civil Hospital were investigated for evidence of postoperative deep vein thrombosis (D VT) by the use of the 125 1-fibrinogen test. Of these 104 patients, 10 had evidence of DVT, i.e. an incidence of 9.6 per cent. This differs sharply from the incidence (21-47 per cent) reported from Swedish and British hospitals, and further confirms our previous findings that the incidence of postoperative D VT in Sudanese patients is significantly lower than in European patients.