Sterility and efficiency of two methods of cardiac output determination: closed loop and capped syringe methods

A prospective randomized study was done to compare the fluid contamination rates of two methods used to determine cardiac output by thermodilution under in-use conditions. Fifty patients were randomly assigned to have cardiac output measured by the capped syringe or closed loop method, and were followed with quantitative cultures of fluid and catheter. The two treatment groups (n = 25 each) were comparable in terms of age, sex, intensive care unit location, underlying diagnosis, and mean number of cardiac output determinations performed in the first 24 hours after placement of the catheter line. No differences in the rates of fluid contamination were seen at any time between the two groups. The overall fluid contamination rate was 2/124 cultures (1.8% with 95% confidence interval +/- 4.1%) with one colony of Staphylococcus epidermidis from a closed loop sample and one colony of Pseudomonas maltophilia in a capped syringe sample. Although no difference in contamination rates was documented, the closed loop system required less nursing time and effort.     

Electrolyte imbalances in cardiovascular disease: the forgotten factor

Hypomagnesemia is not an infrequent finding in diuretic-induced hypokalemia. Potassium replacement therapy in these cases may be ineffective in raising serum potassium levels unless normal magnesium concentrations are restored.     

Localization of arboviral antigen in brain tissues from patients with encephalitis

Brain tissues from 38 patients with a clinical suspicion of encephalitis or encephalopathy were examined by two immunoenzymatic techniques for the detection of arboviral antigen. Group B arboviral antigen was identified in 23 of these tissues. This simple method could be used for the diagnosis of the causal agent of encephalitis.     

APACHE II score and abdominal sepsis. A prospective study

Therapeutic trials for intra-abdominal sepsis require pretreatment stratification; physiologic scoring has been recently proposed for this purpose. We have prospectively tested the validity of one such scoring system, namely, the Acute Physiology and Chronic Health Evaluation (APACHE II). As part of a larger database, we correlated APACHE II scores with mortality in 100 patients hospitalized for generalized peritonitis or abdominal abscess. Use of steroids was recorded because of our suspicion that steroids increase mortality but blunt the physiologic response to sepsis. Thirty-one patients died, including 12 of 19 patients receiving steroids. Stepwise discriminant analysis revealed that the APACHE II score and steroid use were each independently associated with the rate of mortality. We report a prospective validation of pretreatment APACHE II scoring in abdominal sepsis. Steroid use is an independent risk factor.     

Corrosive oesophagitis: an analysis of 50 cases

A total of 50 consecutive patients who were treated in JIPMER Hospital between 1970 and 1981 for corrosive injuries of the oesophagus and stomach were analysed. There were 23 males and 27 females. All but seven presented with dysphagia due to an established stricture. In addition seven of them had associated stricture of the stomach. They were treated with either repeated dilatations or, in selected cases, oesophageal replacement. Perforation of the oesophagus is an important complication associated with oesophageal dilatation indicating the need for oesophageal replacement in multiple or long dense strictures. Results are quite satisfactory with both modalities of treatment. However, oesophageal replacement surgery, performed properly in selected cases, offers a permanent solution to these unfortunate victims.     

The value of sonography in the diagnosis and follow-up of patients with blunt renal trauma

Eighty-eight patients with blunt renal trauma were examined sonographically. Rupture of the kidney was diagnosed in 41 patients and contusion of the kidney in 45. The correlation between operative findings, sonography and urography showed positive sonographic findings to be correct in all patients with rupture of the kidney. In 4 patients with normal sonograms, the diagnosis of a contusion was based on the urographic results. Three patients underwent angiography. An intimal lesion was seen in 2 and a tear of the renal artery in 1. The results of our investigation suggest that sonography should be applied in the first place in the evaluation of blunt renal trauma. It is the investigation of choice during follow-up after surgical as well as conservative therapy.