A comparative analysis of radiological and surgical placement of central venous catheters

Purpose To compare the differences in practice and outcome of all radiologically and surgically placed central venous catheters retrospectively over a 2-year period simultaneously, at a single institution. Methods A total of 253 Hickman catheters were inserted in 209 patients; 120 were placed radiologically in 102 patients and 133 were placed surgically in 107 patients. The indication was chemotherapy in 76% of radiological and in 47% of surgical cases; the remainder were for total parenteral nutrition and venous access. Results There were 6 (4.5%) primary surgical failures and a further 17 (13%) surgical cases requiring multiple placement attempts. Pneumothorax occurred once (0.8%) surgically and four times (3.3%) radiologically. There were no radiological primary misplacements but there were five (3.7%) surgical ones. Catheter or central vein thrombosis occurred in four (3.3%) radiological and five (3.7%) surgical cases. The rate of infection per 1000 catheter-days was 1.9 in radiologically placed catheters and 4.0 in surgically placed ones (p<0.001). Average catheter life-span was similar for the two placement methods (100±23 days). Conclusion Radiological placement is consistently more reliable than surgical placement. There are fewer placement complications and fewer catheter infections overall.     

Further investigation of the sites of vascular alpha 1 and alpha 2 adrenoceptors in the anaesthetised spontaneously hypertensive rat

We have looked at the role played by alpha 1 and alpha 2 adrenoceptors in the control of blood pressure in the anaesthetised spontaneously hypertensive rat (SHR) by examining the blood-pressure-lowering effects of the alpha 1-adrenoceptor antagonist prazosin and the alpha 2-adrenoceptor antagonist rauwolscine in 5 groups of animals: unoperated, adrenal demedullated, shamoperated, sympathectomised with 6-hydroxydopamine, and vehicle treated. Prazosin (1 mg/kg) produced significant falls in diastolic blood pressure (DBP) in all groups of rat but the fall was significantly less in sympathectomised animals. In the presence of prazosin (1 mg/kg), rauwolscine (0.1-1 mg/kg) lowered DBP in all groups of rat except the adrenal demedullated animals. In the absence of prazosin, rauwolscine (0.1 mg/kg) produced a significant fall in DBP only in sympathectomised animals. These results demonstrate that alpha 2 adrenoceptors are involved in blood pressure control in the intact or sympathectomised SHR but not following adrenal demedullation, suggesting that circulating catecholamines rather than neurally released noradrenaline (NA) are responsible for these alpha 2-adrenoceptor-mediated pressor effects. In contrast, only alpha 1-adrenoceptor-mediated pressor responses are reduced by sympathectomy, suggesting that neurally released NA acts mainly on alpha 1-adrenoceptors.     

The evolution of morphologic and biomechanical changes in reversed and in-situ vein grafts.

A comparative study of experimental reversed (RV) and in-situ (INS) vein grafts with respect to the evolution of morphologic and compliance characteristics was done in a canine model. In addition, the compliance characteristics in a series of human INS vein grafts were recorded as a function of time after operation. At 6 months after implantation, all experimental grafts displayed well-developed intimal hyperplasia. There was no significant difference in either absolute intimal thickness (INS 0.133 +/- 0.09 mm vs. RV 0.085 +/- 0.06 mm; NS) nor in the percentage of the total wall thickness occupied by the intima when experimental INS grafts were compared with RV grafts after 6 months. Similarly, compliance values of INS and RV vein grafts were similar at all time intervals examined up to 6 months after operation. Thirty-three human INS vein grafts had a mean compliance value of 1.74 +/- 0.72 (percent radial changes per mmHg X 10(-2) at a median postoperative interval of 14 weeks. This value did not differ significantly from those measured in the INS vein grafts. Although all vein grafts examined retained their native viscoelastic properties, this study suggests that functioning human INS vein grafts are less compliant than previously suspected on the basis of prior ex-vivo and clinical studies of RV saphenous vein grafts. The purported clinical superiority of the INS vein graft cannot be explained on the basis of superior biomechanical performance or failure to develop intimal hyperplasia.     

Common bile duct calculi: updated experience with dissolution with methyl tertiary butyl ether

The authors describe their experience with methyl tertiary butyl ether (MTBE) in a larger series of patients than previously reported in order to acquaint physicians with both its effectiveness for dissolution of common bile duct calculi and the limitations of its use. Ten patients with 13 biliary calculi underwent percutaneous stone dissolution treatment with the experimental cholesterol solvent, MTBE. Three stones completely dissolved within 30 minutes, seven were reduced in size, and three were visibly unaffected. All stones not completely dissolved were easily extracted by means of a stone basket except for one in a patient taken to surgery. Although MTBE perfusion is an effective technique for management of biliary calculi, practitioners should be aware that its use is quite time consuming and its odor difficult to control.