==================================CMR45================================== 45. Total parenteral nutrition in pregnant patients - indications for and complications of. Cholecystitis in pregnant women. Gallbladder pancreatitis in pregnant women. Subclavian vein thrombosis secondary to total parenteral nutrition. 1 UI - 87123124 AU - Curelaru ID ; Linder LE ; Gustavsson BG ; Hultman EE TI - Exchange of occluded, tunnelled, subclavian central venous catheters. A technique reusing the existing tunnel. AB - A technique for the exchange of occluded, tunnelled, subclavian venous catheters reusing the existing tunnel is described. It was successfully used 14 times in 5 patients needing permanent parenteral nutrition at home, in whom insertion of a new catheter by another route would have been cumbersome and hazardous. The tunnel was opened below the clavicle, and the catheter clamped. The catheter was then cut close to the tunnel exist, and its distal part removed centrally through the opening at the clavicle. A guide wire was simultaneously pulled through. An introducer cannula was placed over the central part of the catheter into the subclavian vein, and the occluded catheter was withdrawn and a new one inserted. The latter was then guided through the tunnel by the guide wire. The catheter was then fixed, and the wound was closed and dressed. Prophylactic cloxacillin was given i.v. for 3 days. No bleeding, pulmonary embolism, local infection or sepsis were observed. MH - Adult ; *Catheters, Indwelling/ADVERSE EFFECTS ; Female ; Human ; Male ; Middle Age ; Parenteral Hyperalimentation ; *Subclavian Vein SO - Acta Chir Scand 1986 Oct;152:583-6 2 UI - 87096443 AU - Fabrin B ; Eldon K TI - Pregnancy complicated by concurrent hyperparathyroidism and pancreatitis. AB - A case is presented of pregnancy complicated by hyperparathyroidism and acute pancreatitis in a 32-year-old gravida II, primipara. The diagnosis of pancreatitis was made during surgery; postoperatively the patient was diagnosed as suffering from hyperparathyroidism, and an adenomatous parathyroid gland was removed. The four previously reported cases of this trilogy are mentioned, and the methods of diagnosis discussed. MH - Acute Disease ; Adenoma/COMPLICATIONS/SURGERY ; Adult ; Case Report ; Female ; Human ; Hyperparathyroidism/*COMPLICATIONS/ DIAGNOSIS ; Pancreatitis/*COMPLICATIONS/DIAGNOSIS ; Parathyroid Neoplasms/COMPLICATIONS/SURGERY ; Pregnancy Complications/ *DIAGNOSIS ; Pregnancy SO - Acta Obstet Gynecol Scand 1986;65(6):651-2 3 UI - 87087083 AU - Lipkin EW ; Benedetti TJ ; Chait A TI - Successful pregnancy outcome using total parenteral nutrition from the first trimester of pregnancy. AB - A 27-yr-old gravida 3, para 2 was supported from the 8th week of pregnancy by intermittent daily total parenteral nutrition (TPN) following the loss of her small bowel. Nutrient intake was adjusted by monitoring nitrogen balance and the rate of increase in fetal cranial enlargement. Maternal calcium balance proved difficult to maintain, since massive urinary Ca+2 losses occurred during infusion of nutrients (576 +/- 2 mg/12 hr on TPN compared to 47 +/- 12 mg/12 hr off). This increase in urine Ca+2 was due to depressed Ca+2 reabsorption by the kidney (87.1 +/- .7 vs 98.1 +/- .3%) and increased filtered load (4623 +/- 241 mg/12 hr vs 2591 +/- 329). Initially calcium balance was -180 mg/day. Nitrogen balance assessed by total stool and urine nitrogen was 1.1 g/24 hr, which was judged to be suboptimal. Deficits were corrected by increasing nitrogen intake, lengthening the duration of infusion and the oral administration of elemental calcium during periods off infusion. A normal fetus was delivered vaginally without complications at 351/2 weeks. This patient demonstrates that normal fetal growth and development as well as appropriate maternal weight gain and nitrogen balance can be maintained throughout pregnancy, including the first trimester, by intermittent daily TPN. MH - Adult ; Calcium/METABOLISM/THERAPEUTIC USE ; Case Report ; Feces/ ANALYSIS ; Female ; Human ; Infant, Newborn ; Infarction/*THERAPY ; Intestine, Small/*BLOOD SUPPLY ; Mesenteric Vascular Occlusion/ *THERAPY ; Nitrogen/METABOLISM ; *Parenteral Hyperalimentation ; Pregnancy Complications, Hematologic/*THERAPY ; Pregnancy Trimester, First ; Pregnancy Trimester, Second ; Pregnancy ; Support, Non-U.S. Gov't ; Support, U.S. Gov't, P.H.S. SO - JPEN J Parenter Enteral Nutr 1986 Nov-Dec;10(6):665-9 4 UI - 86312164 AU - Lee RV ; Rodgers BD ; Young C ; Eddy E ; Cardinal J TI - Total parenteral nutrition during pregnancy. AB - Parenteral hyperalimentation or total parenteral nutrition has become an established therapy for patients with a wide variety of conditions that preclude oral feeding. Because pregnancy is an infrequent event in poorly nourished women with acute or chronic illness, total parenteral nutrition has not been widely used for pregnant patients. Some obstetricians believe that total parenteral nutrition entails risks in excess of its potential benefit to pregnancy and demands skills and knowledge that are either not available or are in limited supply. Sufficient favorable clinical experience has accumulated over the past 15 years so that total parenteral nutrition can be recommended in the management of malnutrition during pregnancy. The purpose of this report is to review the authors' experience and the literature about total parenteral nutrition during pregnancy. MH - Adult ; Birth Weight ; Caloric Intake ; Case Report ; Fat Emulsions, Intravenous/ADMINISTRATION & DOSAGE ; Female ; Gastrointestinal Diseases/*THERAPY ; Human ; Nutrition Disorders/ COMPLICATIONS/*THERAPY ; *Parenteral Hyperalimentation/ADVERSE EFFECTS ; Pregnancy ; Pregnancy in Diabetes/*THERAPY ; Pregnancy Complications/*THERAPY ; Prognosis ; Review ; Time Factors SO - Obstet Gynecol 1986 Oct;68(4):563-71 5 UI - 86299427 AU - Mifflin TE ; Hortin G ; Bruns DE TI - Electrophoretic assays of amylase isoenzymes and isoforms. AB - Electrophoretic methods provide an effective means for analysis of amylase isoenzymes and isoforms. A wide variety of such techniques have been developed and reflect different applications and analytic objectives of different investigators. Virtually all of the available clinical data on amylase isoenzymes and isoforms has resulted from application of these methods. Recent identification of selective amylase inhibitors and of monoclonal antibodies to amylase isoenzymes holds promise of development of rapid routine clinical assays for amylase isoenzymes. Electrophoretic methods will have an important role in validating these new assays. Furthermore, at the present time, electrophoretic methods provide the best approach for analyzing isoforms of the pancreatic and salivary isoenzymes. This may be clinically important in patients with tumors, pancreatic pseudocysts, or macroamylasemia. Further clinical experience is needed to define the roles of the various assays that are now available for the estimation of amylase isoenzymes and isoforms in human samples. MH - Alpha-Amylase/ANTAGONISTS & INHIBITORS/*ANALYSIS ; Blood Protein Electrophoresis/METHODS ; Chromatography/METHODS ; Cysts/ ENZYMOLOGY ; Female ; Human ; Immunologic Technics ; Isoelectric Focusing ; Neoplasms/ENZYMOLOGY ; Pancreas/ENZYMOLOGY ; Pancreatic Insufficiency/ENZYMOLOGY ; Pancreatitis/ENZYMOLOGY ; Pregnancy ; Review ; Saliva/ENZYMOLOGY ; Tissue Distribution SO - Clin Lab Med 1986 Sep;6(3):583-99 6 UI - 86264128 AU - Giordano M ; Gallo M ; Chianese U ; Maniera A ; Tirri G TI - Acute pancreatitis as the initial manifestation of systemic lupus erythematosus. AB - A 20-year-old female with three laboratory ARA criteria pro SLE (LE cells, FANA, and positive Coombs test with hemolytic anemia), not under steroid therapy, developed polyarthritis, erythematous rash and acute pancreatitis simultaneously. The latter regressed with high doses of 6-methylprednisolone. Twenty-five months after remission of pancreatitis, no new clinical manifestations (of SLE) have appeared. In another 74 cases of SLE with an average follow-up of 3 years and 8 months there were no other cases of pancreatitis. MH - Acute Disease ; Adult ; Amylases/METABOLISM ; Case Report ; Diagnosis, Differential ; Female ; Follow-Up Studies ; Human ; Lupus Erythematosus, Systemic/*DIAGNOSIS/DRUG THERAPY ; Methylprednisolone/THERAPEUTIC USE ; Pancreatitis/*DIAGNOSIS/DRUG THERAPY ; Pregnancy ; Pregnancy Complications/DIAGNOSIS SO - Z Rheumatol 1986 Mar-Apr;45(2):60-3 7 UI - 86227349 AU - Herbert WN ; Seeds JW ; Bowes WA ; Sweeney CA TI - Fetal growth response to total parenteral nutrition in pregnancy. A case report. AB - Although clinical experience with total parenteral nutrition (TPN) in pregnancy is accumulating, assessment of the fetal growth response to this therapy has been limited primarily to birth weight. We performed serial ultrasonographic measurements of the fetal biparietal diameter (BPD), femur length (FL) and abdominal circumference (AC) in a patient who received TPN because of chronic malnutrition. BPD and FL were within normal limits before and after TPN. Consistent with asymmetric growth retardation, the AC was low prior to TPN and increased significantly after TPN was administered. Estimated fetal weight increased accordingly. These data suggest that TPN can reverse subnormal fetal growth secondary to maternal nutritional deprivation. MH - Adult ; Birth Weight ; Case Report ; Esophageal Stenosis/*THERAPY ; Female ; Fetal Development ; Fetal Growth Retardation/ *PREVENTION & CONTROL ; Human ; Infant, Newborn ; *Parenteral Hyperalimentation ; Pregnancy ; Pregnancy Complications/*THERAPY ; Protein-Calorie Malnutrition/*THERAPY ; Ultrasonic Diagnosis SO - J Reprod Med 1986 Apr;31(4):263-6 8 UI - 86192088 AU - Garrison R TI - Amylase. AB - The laboratory determination of serum and urine amylase activity is commonly requested by the Emergency physician. While depressed levels are occasionally seen, they are almost always secondary to chronic pancreatitis and pancreatic destruction. The typical abnormality is an elevation that may represent a normal physiologic process, a benign inflammation, the concomitance of ongoing disease, or an emergent problem. The differential diagnosis of hyperamylasemia is difficult, but most high levels are caused by pancreatitis and biliary tract disease. Serial determinations of amylase levels, as well as simultaneous assessments of urine and serum amylase, may be useful in determining the source of the problem. The laboratory methods for measurement are many and varied, reflecting the lack of a perfect test. Because of the different procedures, confusion has ensued over the units of description and the normal or reference ranges. Any standard equipped medical laboratory should be able to determine amylase activity in both serum and urine in a timely fashion. The average cost per amylase determination is $17.75. The actual time to perform the test in the laboratory is approximately 7.5 minutes, though turnaround times usually exceed 1 hour. The fractionation of amylase into isoenzymes is a sophisticated procedure requiring equipment not routinely found in a typical hospital laboratory. MH - Amylases/BLOOD/DIAGNOSTIC USE/*METABOLISM/URINE ; Biliary Tract Diseases/BLOOD ; Diagnosis, Differential ; Diagnostic Tests, Routine/ECONOMICS/*METHODS ; Female ; Gastrointestinal Diseases/ BLOOD ; Human ; Isoenzymes ; Molecular Weight ; Pancreas/INJURIES ; Pancreatic Diseases/*BLOOD/METABOLISM/URINE ; Pancreatic Neoplasms/BLOOD ; Pancreatic Pseudocyst/BLOOD ; Pancreatitis/ BLOOD/COMPLICATIONS/URINE ; Parotid Diseases/BLOOD ; Postoperative Period ; Pregnancy ; Pregnancy, Ectopic/BLOOD ; Review SO - Emerg Med Clin North Am 1986 May;4(2):315-27 9 UI - 86180691 AU - Yamauchi H ; Sunamura M ; Takeda K ; Suzuki T ; Itoh K ; Miyagawa K TI - Hyperlipidemia and pregnancy associated pancreatitis with reference to plasma exchange as a therapeutic intervention. AB - A 23 year old pregnant woman presented in her third trimester with severe pancreatitis and hyperlipidemia. Initial investigations suggested that her pancreatitis was induced by profound hypertriglyceridemia, which was the result of an underlying Fredrickson's V type hyperlipoproteinemia exacerbated by pregnancy. Concern for the life of the fetus prompted a caesarean operation and then drainage procedure for pancreatitis. Plasma exchange, carried out to lower the levels of lipids and the pancreatic enzymes, improved the signs and symptoms of the patient. Plasma exchange may be of great use in the management of hyperlipidemic pancreatitis. MH - Adult ; Biopsy ; Case Report ; Electrophoresis, Agar Gel ; Female ; Human ; Hyperlipidemia/*COMPLICATIONS/THERAPY ; Pancreas/ PATHOLOGY ; Pancreatitis/*COMPLICATIONS/THERAPY ; *Plasma Exchange ; Pregnancy ; Pregnancy Complications/*THERAPY ; Ultrasonic Diagnosis SO - Tohoku J Exp Med 1986 Feb;148(2):197-205 10 UI - 86175884 AU - Rayburn W ; Wolk R ; Mercer N ; Roberts J TI - Parenteral nutrition in obstetrics and gynecology. AB - Parenteral nutrition is required to maintain and restore an anabolic state when oral or enteral routes are not feasible. Despite 16 years of parenteral nutrition availability, reports about parenteral therapy in gynecologic patients or during pregnancy have not been published until relatively recently. Most information is anecdotal but suggests that this mode of therapy is safe, effective, and occasionally life-saving. Parenteral nutrition is used most commonly in women with gynecologic malignancies who are unable to obtain adequate nourishment either during or after surgery, radiation, or chemotherapy. Parenteral alimentation during pregnancy has been used mostly to provide adequate nutrition for those who suffer from prolonged hyperemesis or when there is difficulty in absorption of adequate nutrients. The proper selection and administration of dextrose, fat, protein, vitamins, trace elements, and electrolytes for pregnant women has been associated with apparent favorable perinatal outcomes. Preterm deliveries and intrauterine fetal growth retardation are relatively common and relate to the preexisting or a coexisting medical or obstetric complication. Nutritional assessment before therapy should include a detailed diet history and establishment of baseline clinical and laboratory parameters. Oral or enteral feedings should be attempted beforehand if possible to conserve high costs and potential complications. Parenteral requirements are extrapolated from recommended daily allowances for oral intake, allowing for adjustments in variable absorption. Standardized formulations and fat emulsions are available at pharmacies in many hospitals, making ordering of complex solutions easier, more efficient, and cost effective. Metabolic and septic complications occur infrequently with close monitoring. Few women require intravenous therapy for very long, and home parenteral nutrition is rarely necessary. MH - Adolescence ; Adult ; Birth Weight ; Caloric Intake ; Child ; Costs and Cost Analysis ; Dietary Proteins/ADMINISTRATION & DOSAGE ; Drugs/ADMINISTRATION & DOSAGE ; Electrolytes/ ADMINISTRATION & DOSAGE ; Fat Emulsions, Intravenous ; Female ; Food, Formulated ; Genital Neoplasms, Female/*THERAPY ; Gestational Age ; Home Care Services ; Human ; Hyperemesis Gravidarum/*THERAPY ; Infant, Newborn ; Lactation ; Metabolic Diseases/ETIOLOGY ; Middle Age ; Nutritional Requirements ; *Parenteral Feeding/ECONOMICS ; *Parenteral Hyperalimentation/ ADVERSE EFFECTS ; Pregnancy ; Respiration Disorders/ETIOLOGY ; Review ; Septicemia/ETIOLOGY ; Trace Elements/ADMINISTRATION & DOSAGE ; Vitamins/ADMINISTRATION & DOSAGE SO - Obstet Gynecol Surv 1986 Apr;41(4):200-14 11 UI - 86170357 AU - Ellsbury KE TI - Abdominal pain in pregnancy. AB - In many respects abdominal pain in pregnancy is managed just as in a nonpregnant patient, but the diagnostic criteria, methods of diagnosis, therapy, and consequences of mismanagement differ. This article discusses appendicitis, cholecystitis, urolithiasis, pancreatitis, and intestinal obstruction--conditions that often manifest a similar clinical picture. The article presents epidemiologic data, distinguishing characteristics, modifications of the workup, and treatment appropriate to pregnancy and perinatal complications of each condition. MH - *Abdomen ; Appendicitis/COMPLICATIONS/DIAGNOSIS/PHYSIOPATHOLOGY ; Cholecystitis/COMPLICATIONS/DIAGNOSIS/PHYSIOPATHOLOGY ; Female ; Fetal Death/ETIOLOGY ; Human ; Intestinal Obstruction/ COMPLICATIONS/DIAGNOSIS/PHYSIOPATHOLOGY ; Pain/COMPLICATIONS/ *DIAGNOSIS ; Pancreatitis/COMPLICATIONS/DIAGNOSIS/PHYSIOPATHOLOGY ; Pregnancy ; Pregnancy Complications/*DIAGNOSIS ; Urinary Calculi/COMPLICATIONS/DIAGNOSIS/PHYSIOPATHOLOGY SO - J Fam Pract 1986 Apr;22(4):365-71 12 UI - 86162900 AU - Robin AP ; Greig PD TI - Basic principles of intravenous nutritional support. AB - Parenteral nutrition has been one of the major advances in clinical medicine in the 20th century. By maintaining or re-establishing optimal nutritional status, one can help to ensure an optimal response to appropriate medical or surgical management of the primary disease process. In order to plan an appropriate nutritional regimen, the health-care provider must be equipped to pursue the following thought processes: Understand the consequences of malnutrition. Identify the patient who may benefit from nutritional support. Assess the underlying clinical and metabolic setting. Assess the current nutritional status. Formulate a goal of nutritional intervention--a therapeutic plan. Determine the route and method of administration; the quantity and source of energy and nitrogen; and requirements for fluid, electrolytes, minerals, vitamins, and trace elements. Monitor the patient. Evaluate the efficacy and determine the duration of therapy. MH - Catheterization/ADVERSE EFFECTS ; Dietary Carbohydrates/ METABOLISM ; Dietary Proteins/METABOLISM ; Energy Metabolism ; Female ; Glycogen/METABOLISM ; Heart Failure, Congestive/THERAPY ; Hepatic Encephalopathy/THERAPY ; Human ; Intraoperative Period ; Kidney Diseases/THERAPY ; Male ; Metabolic Diseases/THERAPY ; *Parenteral Hyperalimentation/ADVERSE EFFECTS ; Pregnancy ; Review ; Starvation/METABOLISM ; Stress/METABOLISM ; Triglycerides/METABOLISM SO - Clin Chest Med 1986 Mar;7(1):29-39 13 UI - 86162658 AU - Landon MB ; Gabbe SG ; Mullen JL TI - Total parenteral nutrition during pregnancy. AB - Several years ago, most obstetricians would have thought that any disease severe enough to require parenteral nutrition would also lead to infertility or early pregnancy loss. Women with many complex disease states have now been successfully treated by TPN during pregnancy, resulting in favorable outcomes for both mother and fetus. Theoretically, these patients, if not supplied with an adequate amount of essential nutrients by TPN, might have experienced excessive perinatal morbidity and mortality. The difficulties involved with studying maternal-fetal exchange processes in humans leave considerable gaps in our current knowledge about nutritional requirements during normal pregnancy. Some have suggested that subtle degrees of malnutrition may jeopardize normal growth and development. In states of severe protein calorie malnutrition, there remains little doubt that intrauterine growth is diminished. In such cases in which there is poor maternal weight gain, it may be critical to initiate some method of nutritional support. Whereas TPN during pregnancy has been sporadically employed in the treatment of cases of suspected fetal growth retardation, limited experience with this therapy suggests that at present we primarily direct treatment toward patients with specific disease states that are accompanied by overt malnutrition. Parenteral nutrition support should begin only after a period of adequate nutritional assessment and monitoring. If such support is necessary, TPN should be administered by a team of qualified knowledgeable individuals who are very familiar with the techniques. The relatively high rate of premature delivery associated with patients requiring TPN during pregnancy requires the presence of an intensive care nursery in the institution. MH - Female ; Human ; Maternal-Fetal Exchange ; Nutrition ; Nutrition Disorders/*COMPLICATIONS/PHYSIOPATHOLOGY/THERAPY ; *Parenteral Hyperalimentation/ADVERSE EFFECTS/METHODS ; Placenta/PHYSIOLOGY ; Pregnancy ; Pregnancy Complications/PHYSIOPATHOLOGY/*THERAPY ; Review ; Support, Non-U.S. Gov't SO - Clin Perinatol 1986 Mar;13(1):57-72 14 UI - 86141026 AU - Gallant C ; Kenny P TI - Oral glucocorticoids and their complications. A review. AB - Glucocorticoid preparations form one of the cornerstones of the modern medical pharmacopeia. This class of medications has been especially useful to dermatologists, who are purported to be among its most prolific users. Oral glucocorticoids, available now for over 30 years, are prescribed to over 7% of hospitalized patients. Of this group, some 17% may experience adverse effects. It behooves any physician who uses these powerful agents to be aware of the potential complications and side effects. In this article we have undertaken to summarize and discuss selective examples of this rapidly growing segment of the literature. MH - Administration, Oral ; Animal ; Cardiovascular Diseases/ CHEMICALLY INDUCED ; Connective Tissue/DRUG EFFECTS ; Eye Diseases/CHEMICALLY INDUCED ; Female ; Gastrointestinal Diseases/ CHEMICALLY INDUCED ; *Glucocorticoids/ADMINISTRATION & DOSAGE/ ADVERSE EFFECTS/PHARMACODYNAMICS ; Half-Life ; Human ; Hypothalamo-Hypophyseal System/DRUG EFFECTS/METABOLISM ; Immunity/ DRUG EFFECTS ; Infection/IMMUNOLOGY ; Mineralocorticoids/ADVERSE EFFECTS/METABOLISM/PHARMACODYNAMICS ; Neoplasms/CHEMICALLY INDUCED ; Organic Mental Disorders, Substance-Induced/ETIOLOGY ; Osteoporosis/CHEMICALLY INDUCED ; Pancreatitis/CHEMICALLY INDUCED ; Pituitary-Adrenal System/DRUG EFFECTS ; Pregnancy ; Pregnancy Complications/CHEMICALLY INDUCED/DRUG THERAPY ; Review ; Stomach Diseases/CHEMICALLY INDUCED ; Tuberculosis/DRUG THERAPY/ IMMUNOLOGY SO - J Am Acad Dermatol 1986 Feb;14(2 Pt 1):161-77 15 UI - 86127985 AU - Hiatt JR ; Hiatt JC ; Williams RA ; Klein SR TI - Biliary disease in pregnancy: strategy for surgical management. AB - Acute biliary tract disease complicated intrauterine pregnancy in 26 patients seen during a 5 year period. Biliary symptoms were distinct and occurred during the first trimester in 7 patients, the second trimester in 5 patients, the third trimester in 12 patients, and in two early postpartum patients. Nine patients had marked hyperamylasemia which resolved with medical management, and no severe cases of pancreatitis occurred. Ultrasonography was used to confirm the presence of gallstones in 18 patients and demonstrated dilated intrahepatic ducts in one of two patients with surgically proved choledocholithiasis. Nineteen patients had cholecystectomy and cholangiography, and 4 had common bile duct explorations. Only two of seven patients who presented in the first trimester had term pregnancy. Diagnosis of cholelithiasis in pregnancy by ultrasonography is accurate and reliable. The risk to the fetus of radionuclide scanning and conventional radiography is not justified. Secondary hyperamylasemia is common but responds to conservative therapy. Operation may be delayed until delivery in most patients, with urgent exploration reserved for uncertainty in diagnosis, choledocholithiasis, or acute cholecystitis that does not resolve with medical measures. MH - Acute Disease ; Adult ; Biliary Tract Diseases/DIAGNOSIS/*SURGERY/ THERAPY ; Cholecystitis/SURGERY ; Cholelithiasis/DIAGNOSIS/ SURGERY/THERAPY ; Common Bile Duct Calculi/DIAGNOSIS/SURGERY/ THERAPY ; Delivery ; Female ; Fetal Death ; Human ; Pregnancy ; Pregnancy Complications/*SURGERY/THERAPY ; Ultrasonic Diagnosis SO - Am J Surg 1986 Feb;151(2):263-5 16 UI - 86123471 AU - Bern MM ; Bothe A Jr ; Bistrian B ; Champagne CD ; Keane MS ; Blackburn GL TI - Prophylaxis against central vein thrombosis with low-dose warfarin. AB - Low-dose warfarin was given to patients to prevent venous thrombosis. Patients at greatest risk for having thrombi adjacent to central venous catheters were detected by the von Kaulla assay. Patients with normal von Kaulla assays had one thrombus per 1844 days at risk while those with accelerated von Kaulla assays had one thrombus per 500 days at risk. Low-dose warfarin therapy given to patients at high risk reduced the incidence of venous thrombosis from one thrombus per 251 days to one thrombus per 1617 days. Thus low doses of warfarin that do not prolong the prothrombin time appear to offer prophylaxis against venous thrombosis in patients at high risk for developing venous thrombosis adjacent to the central venous catheters. MH - Adolescence ; Adult ; Aged ; Blood Coagulation Tests/METHODS ; Catheters, Indwelling/ADVERSE EFFECTS ; Female ; Human ; Male ; Middle Age ; Parenteral Hyperalimentation ; Partial Thromboplastin Time ; Prothrombin Time ; Subclavian Vein ; Thrombophlebitis/ETIOLOGY/*PREVENTION & CONTROL ; Warfarin/ ADMINISTRATION & DOSAGE/*THERAPEUTIC USE SO - Surgery 1986 Feb;99(2):216-21