Marion S. DeWeese

Morbid and mortal complications associated with prolonged central venous cannulation: Awareness, recognition, and prevention

Abstract During the past few years clinical use of central venous cannulation has increased, principally because of the recognized benefits derived from monitoring central venous pressure and providing hyperosmolar parenteral alimentation. As experience has accumulated with placement and maintenance of vena caval catheters, various associated complications have become apparent. During recent months it seemed that complications were occurring at a rate out of proportion to the increased frequency with which we were employing this modality. Subsequent review of our experience with more than 350 central venous cannulations disclosed that preventable complications can be attributed to two primary factors; a more relaxed attitude toward critical points of catheter placement as an individual or group attains experience with this modality, and delegation of catheter care to nonsurgical personnel after a polyethylene cannula has been inserted. Prolonged central venous cannulation can be accomplished with minimal sequelae, if careful and persistent attention is directed toward certain details of catheter placement and maintenance. Herein we have outlined and emphasized precautions which will preclude occurrence of the most dangerous complications, and minimize the frequency with which the others occur. When employed with proper care, few untoward sequelae will detract from the over-all value of central venous cannulation, a proven clinical adjunct in the management of critically ill patients.

Primary carcinoma of the gallbladder

Abstract The clinical records of thirty-three patients treated at the University of Missouri Medical Center for carcinoma of the gallbladder have been studied retrospectively. Eighty-five per cent of these patients were over sixty years of age and all but three were female. The most common symptom was abdominal pain. Gallstones were present in 75.8 per cent. The most common histologic type of tumor encountered was adenocarcinoma, but 12.1 per cent of the tumors were adenoacanthoma. The mean survival time after operation was 2.95 months. On the basis of current information and knowledge, early cholecystectomy in all patients with calculous disease appears to offer the best hope for decreasing the distressingly high mortality associated with carcinoma of the gallbladder.

Wound fluid zinc levels during tissue repair. Sequential determination by means of surgically implanted teflon cylinders.

Abstract We have implanted cylinders (wound) of Edwards Teflon arterial graft in the panniculus of adult mongrel dogs of both sexes. We have noted the wound fluid and plasma zinc concentrations at varying intervals after cylinder implantation and recorded a rise in plasma and wound fluid zinc concentration post implant. There appears to be an inverse relationship of wound fluid pH and zinc concentration which is indicative of a metabolic mechanism for the concentration of zinc at, and the transport of zinc to a surgically inflicted wound site. We have not discounted the possibility of an electrochemical mechanism for zinc concentration and transport. We rather consider the metabolic/electrochemical activity at the wound site as being a prime factor in zinc transport. At present we are studying zinc concentrations in wounds with aerobic and anerobic metabolism.