Charles C. Wolferth

Does central venous pressure accurately reflect hemodynamic and fluid volume patterns in the critical surgical patient

Summary Pulmonary artery pressures and pulmonary capillary wedge pressures more accurately reflect left ventricular function than do central venous pressures. In more than 200 patients, we found that monitoring of hemodynamics via right heart catheterization with the Swan-Ganz catheter is superior to central venous pressure monitoring. All critical surgical patients admitted to our Shock/Trauma Unit are routinely monitored by means of this catheter.

Balloon dilatation of benign postsurgical biliary-enteric anastomotic strictures

Five benign postsurgical strictures in 3 patients were successfully dilated using the Grüntzig balloon catheter. Various aspects of the procedure as well as potential problems are discussed.We concluded that, although considerably more experience is needed, balloon dilatation potentially can reduce the need for surgical repair and provide a means to remove indwelling biliary drainage catheters.

Percutaneous Cholecystostomy in Obstructive Jaundice

Percutaneous insertion of a cholecystostomy tube is a potential alternative to percutaneous transhepatic biliary drainage. A case is presented in which percutaneous cholecystostomy was successfully performed without complications. The procedure and its possible usefulness are discussed.

Surgical management of diffuse hemorrhage from gastric mucosa

Abstract The role of the vagus nerves in gastric microcirculation and the efficacy of vagotomy with direct spray of a polymerizing agent on bleeding gastric mucosa were studied. To assess the efficacy of vagotomy in diffuse hemorrhage from the gastric mucosa, microcirculatory responses of the stomach prior and after vagotomy were studied using an ultropak intravital microscope and microangiohistologic technics with silicon rubber injection compound in dogs. Vagotomy opened arteriovenous shunts and reduced the hemorrhage from the mucosa. Vagotomy followed by the application of cyanoacrylate tissue adhesive spray which polymerized at the bleeding mucosal surface provided complete hemostasis without ill effects.

Thoracic Outlet Syndrome

* From: Department of Surgery, Hahnemann Medical College and Hospital, 230 North Broad Street, Philadelphia, Pennsylvania. † Present address: Department of Surgery, Springfield Hospital Medical Center, Springfield, Massachusetts. Until recently, the thoracic outlet syndrome was very poorly understood by the great majority of physicians. An example of this confusion is apparent by the many