chiniofon and Postoperative-Complications

The relationship between the rate of 111In-platelet deposition on vascular grafts and subsequent thrombosis has been examined in patients undergoing femoropopliteal by-pass. Sixty-seven patients undergoing femoropopliteal by-pass using vein, Dacron or PTFE were randomized to aspirin plus dipyridamole (ASA/DPM) or placebo. Autologous 111In-platelets were injected in the second postoperative week and Thrombogenicity Index (TI) calculated as the mean daily rise in the ratio of radioactivity graft/contralateral thigh. Graft patency was assessed to 1 year. Mean (+s.e.m.) TI at 1 week in 21 grafts that occluded within 12 months was 0.19 +/- 0.018 compared with 0.07 +/- 0.009 in the 38 that remained patient (P less than 0.001). Grafts with a TI less or greater than the median had a 90 per cent or 39 per cent cumulative 1-year patency, respectively (P less than 0.001). In the prosthetic grafts ASA/DPM reduced mean TI from 0.17 +/- 0.02 to 0.11 +/- 0.01 (P less than 0.02) and enhanced 1-year patency from 36 to 67 per cent (P less than 0.05). Following femoropopliteal by-pass TI related to subsequent graft patency. Radiolabelled platelet deposition therefore provides a guide as to how new materials or antithrombotic drugs may influence clinical graft thrombosis. Platelet inhibition reduced both graft thrombogenicity and subsequent occlusion.

Topics: Aspirin; Blood Platelets; Blood Vessel Prosthesis; Dipyridamole; Double-Blind Method; Drug Combinations; Female; Femoral Artery; Humans; Hydroxyquinolines; Indium; Male; Middle Aged; Organometallic Compounds; Oxyquinoline; Popliteal Artery; Postoperative Complications; Radioisotopes; Risk; Thrombosis

Topics: Abdomen; Abscess; Female; Humans; Hydroxyquinolines; Indium; Leukocytes; Male; Organometallic Compounds; Oxyquinoline; Postoperative Complications; Radionuclide Imaging

A technique for monitoring pancreatic allografts in man is presented. The method utilizes 111-indium labelled autologous platelets and provides quantitative and qualitative analysis of uptake of the tracer by the graft. Five patients without any significant accumulation of radiolabelled platelets in their transplants had an uneventful recovery and left hospital with satisfactory graft function. The three patients who suffered graft failure showed abnormal uptake of the tracer. This presented as a diffuse platelet accumulation within the transplanted pancreas in the case of acute rejection, or as a focal accumulation in two cases of venous thrombosis. Minor complications such as perigraft haematoma can also be diagnosed using this technique. We suggest that 111-indium labelled platelets provide a valuable diagnostic aid in the management of pancreatic transplant recipients.

Topics: Adolescent; Adult; Blood Platelets; Female; Graft Rejection; Humans; Hydroxyquinolines; Indium; Male; Middle Aged; Organometallic Compounds; Oxyquinoline; Pancreas; Pancreas Transplantation; Postoperative Complications; Radioisotopes; Radionuclide Imaging; Thrombophlebitis

Indium 111 platelet imaging for the detection of deep vein thrombosis and pulmonary emboli was performed in 171 patients after abdominal and pelvic surgery. Fifteen patients were found to have inadequate circulating blood pools of indium 111 platelets, making the study nondiagnostic. Of 156 patients with technically satisfactory images, 46 (29.5%) had images consistent with deep venous thrombosis and/or pulmonary emboli. The incidence, time of occurrence, and location of thromboemboli was similar to those of other reports of postoperative patients groups studied by iodine 125 fibrinogen uptake testing. Eighty patients had normal indium 111 platelets and 30 patients had diffusely distributed indium 111 platelets found in the operative field, suggesting accumulation in a postoperative hematoma. None of these results was confused with a diagnosis of deep venous thrombosis. When compared with another accurate diagnostic test in 23 patients, indium 111 platelet imaging was found to have a sensitivity of 100% and specificity of 90%. The technique of indium 111 platelet imaging is performed easily in patients after surgery with some limitations as to the use of donor platelets and the occasionally altered imaging of the operative site. This diagnostic technique enjoys the distinct advantage in that it allows surveillance of the legs, pelvis, abdomen, and chest by a single method, making it a near-ideal method of postoperative thromboembolism surveillance.

Topics: Blood Platelets; Female; Humans; Hydroxyquinolines; Indium; Methods; Organometallic Compounds; Oxyquinoline; Postoperative Complications; Pulmonary Embolism; Radioisotopes; Radionuclide Imaging; Thrombophlebitis

The radiopharmaceuticals gallium-67 and indium-111 labelled leucocytes have been compared in 15 patients with a painful joint prosthesis in an attempt to identify those patients with periprosthetic infection. Gallium-67 images were abnormal in five out of six patients with periprosthetic infection and normal in seven out of nine without evidence of infection. Indium-111 leucocyte images were abnormal in three out of six patients with infection and normal in all nine patients without infection. Indium-111 labelled leucocyte imaging is technically more difficult to perform than gallium-67 imaging. This, combined with the higher sensitivity of gallium-67 imaging for infection around a prosthetic joint, leads us to conclude that gallium-67 imaging is superior to indium-111 leucocyte imaging in identifying infection as a cause of a painful prosthetic joint.

Topics: Adult; Aged; Bacterial Infections; Female; Gallium Radioisotopes; Hip Prosthesis; Humans; Hydroxyquinolines; Indium; Joint Prosthesis; Knee Prosthesis; Leukocytes; Male; Middle Aged; Organometallic Compounds; Oxyquinoline; Pain, Postoperative; Pelvis; Postoperative Complications; Radioisotopes; Radionuclide Imaging