Postoperative thromboembolism is a well known problem after total hip replacement. Besides the intravasation of bone marrow and thromboplastic material it is discussed that it is caused by activated platelets. Therefore, we focussed our interest on platelet function during total hip replacement.In 12 male and female patients (age:52-84 years) with total hip replacement blood samples were taken at the following time intervals: 1.induction of anesthesia, 2.arthrotomy, 3.preparation of the acetabulum, 4. polymerization of the bone cement in the acetabulum, 5. preparation of the bone marrow in the femur shaft, 6. implantation of the prosthesis shaft, 7.2 hours postoperatively. A second group of 14 patients (age:55-81 years) was treated with 20 000 KIU/ kg BW aprotinin (TrasylolR) immediately after induction of anesthesia. Following tests were carried out: 1. platelet morphology according to KRZYWANEK, 2. platelet adhesiveness according to MORRIS, 3. collagen-induced platelet aggregation according to BORN, 4. spontaneous platelet aggregation according to BREDDIN.The number of shape-changed platelets is increasing with the duration of the operation and the maximum is to be seen when the femur shaft is prepared for the prosthesis. In contrast to these findings only a slight increase of shape- changed platelets occurs after application of aprotinin. Concerning the adhesiveness of platelets corresponding results were found. Platelet aggregation induced by collagen was also increased during the operation time. The increase of the aggregability characterized by the maximal amplitude was not seen in the aprotinin-group. The spontaneous platelet aggregation was enhanced in the non-treated group (angle α 2↑ maximal amplitude↑) whereas this phenomenon was not observed after application of aprotinin. The total hip replacement is closely related with a stimulation of platelet function. This could be the origin of postoperative thromboembolism.

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Liver metastases were demonstrated in a 48-year-old man 12 years after resection of a carcinoma of the sigmoid colon (pT2, G2, N0, Mx). A computer-driven external infusion pump was implanted and regional liver perfusion instituted with 5-fluoro-uracil. After seven chemotherapy cycles, 4-7 weeks apart, the liver metastases were no longer demonstrable by ultrasound and computed tomography. During the entire course of chemotherapy the patient was able to continue his profession as a teacher without any restriction.