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The effects of dextran on the antithrombin (AT) III activity and blood coagulation, evaluated with thromboelastography, were investigated in 26 patients (anaesthesia risk class I or II) scheduled for minor surgery under general anaesthesia. In the Dextran group the patients were infused first with dextran 7 ml/kg, then with Ringer's acetate. In the Ringer group, the patients received only Ringer's acetate. In the recovery room fluid therapy was continued with 5% dextrose in water until the first postoperative day. Blood loss and fluid replacement were comparable in the groups. Haematocrit (Hcr) decreased significantly in the Dextran group, and the platelet count decreased in both groups during surgery. The median baseline AT III values were similar in the study groups. In the recovery room, the median AT III value was lower in the Dextran than in the Ringer group, 78% and 92%, respectively (P < 0.05). By the following day, the AT III values had returned near the initial level. After surgery, the maximal amplitude of thromboelastogram was 48 mm in the Dextran group, and 58 mm in the Ringer group (P < 0.05). In conclusion, fluid replacement with dextran resulted in modest and short-lived alterations in blood coagulation.

Nineteen diabetic (DM) and twenty-two non-diabetic (NDM) uraemic patients undergoing renal transplantation were studied to evaluate coagulation abnormalities. Thirty-three healthy patients admitted for minor surgery served as controls. Antithrombin III (AT III), thromboelastogram (TEG), other haemostatic parameters and the influence of dialysis treatment were assessed in DM and NDM uraemic patients. All uraemic patients were anaemic and bleeding time was slightly prolonged (NS). The level of AT III was raised in the DM group when compared in the healthy controls (P < 0.001). Prothrombin time (PT) percentage was increased in both uraemic groups (P < 0.001) in comparison with the controls. Thrombocytosis was marked in DM patients (P < 0.001) when compared with controls and NDM patients. TEG parameters were similar in all groups. Continuous peritoneal dialysis treatment (CAPD) was associated with elevated total platelet count in NDM (P < 0.05) and DM group (P < 0.05) when compared with haemodialysis (HD) patients. Also, the PT was shortened in DM patients on CAPD vs HD (P < 0.05). AT III level was elevated in NDM patients on CAPD compared with those on HD (P < 0.05). There was no difference in clinical bleeding tendency during renal transplantation. Postoperatively, one patient in NDM group suffered from thrombosis of the graft artery and transplantectomy had to be performed. Our study showed a prethrombotic state in diabetic uraemic patients admitted for renal transplantation. The increased AT III activity may protect these patients against thrombotic complications. The role of CAPD treatment requires further studies.

Between February 1972 and December 1976 100 proximal gastric vagotomies (PGV) were performed on duodenal ulcer patients after failure of conservative treatment. The diagnosis was verified by preoperative barium meal and endoscopy and by peroperative examination. There was no operative mortality. Mean duration of postoperative hospital stay was 9.6 days. The percentual distribution in Visick-grading at the 1-year follow-up was 90% in class I + II, and 10% in class III + IV. The corresponding figures at the 5-year follow-up were 82% and 18%. The mean postoperative basal acid output did not change from one to five years. The reduction in pentagastrin stimulated acid output was unchanged at the 1- and 5-year follow-up. Neither did the mean acid output after insulin stimulation change between one and five years postoperatively. The mean concentration of serum gastrin was raised at one year but decreased to normal at the 5-year follow-up. Ten patients (10%) had ulcer recurrence during follow-up. Seven of these were successfully treated by gastric resection and three by antacids and cimetidine.