Inadvertant atrial fixation of a Swan-Ganz catheter by suture and a method for its percutaneous removal

A patient with type I dissection of the thoracic aorta inadvertently had a Swan-Ganz catheter sutured to the right atrium during surgical repair of the dissection. A method for its removal using percutaneous passage of a No. 15 scalpel blade is described. The hazards of Swan-Ganz catheters are explored, and the changing roles of nonsurgical interventional procedures are discussed.     

The surface tension of upper airway secretions in patients with and without respiratory disease.

The alveolar-arterial oxygen partial pressure (PAaO2) difference and surface tension of upper airway secretions (UASST) were simultaneously measured in 33 intubated patients. Patients without respiratory disease had UASST and PAaO2 gradients significantly lower than those with chronic obstructive lung disease. Patients in respiratory failure had UASST and PAaO2 gradients significantly higher than when they were out of failure. Correlation of UASST with PAaO2 was good (r = 0.81). These findings demonstrate that UASST closely correlate with the severity of pulmonary disease and suggest that their measurement may be a simple, clinically applicable method of assessing alveolar surfactant function.     

Cranberry Juice and Warfarin: When Bad Publicity Trumps Science

Based on anecdotal reports, the question of whether cranberry juice interacts with warfarin has been raised. This article discusses the potential mechanism, and systematically reviews case reports as well as clinical trials examining the possible interaction. We systematically searched MEDLINE via PubMed, and the Cochrane Library database. Fifteen case reports were summarized, including the initial unpublished brief reports to the Committee on Safety of Medicines and the subsequent 6 published case reports. Seven clinical trials were analyzed, including 3 studies using warfarin and 4 surrogate drugs. Only 2 cases had a validation scale suggesting a “probable” interaction, but even in these patients there were many reasons to question the validity of a relevant drug interaction. Randomized clinical trials and surrogate markers found no evidence to support the interaction between cranberry juice and warfarin. Because the moderate consumption of cranberry juice does not affect anticoagulation, we encourage the reexamination of initial warnings based on scientific evidence. We conclude that the initial precautionary warnings by administrating bodies are limited to anecdotal case reports and represent misleading conclusions.     

Oxygen uptake in exercising subjects with minimal renal disease

Patients with varying degrees of renal failure were studied for their blood lactate response to exercise on either a treadmill or a bicycle ergometer. In the group exercised on a treadmill, blood lactate and alanine levels were measured, and in the group exercised on the bicycle ergometer blood lactate levels and oxygen uptake were measured. In both groups regardless of the method of exercise or the degree of azotemia, a rapid rise in blood lactate similar to that previously reported with exercise was observed. Blood alanine levels, which were low in subjects with renal disease, did not change with exercise even with a rise in blood lactate levels. There was no difference in the oxygen uptake between normal controls and subjects with renal disease. We conclude that blood alanine levels are low in renal disease, and that with the degree of exercise studied the rise in blood lactate in patients with renal disease is not accompanied by a change in oxygen uptake and does not evoke a rise in blood alanine levels. The mechanisms for the abnormal rise in blood lactate in these patients does not appear to be due to anoxia.