Richard M. Stillman

Edema Following Femoropopliteal Bypass: Etiology and Prevention

Despite several studies attempting to determine its etiology, lymphedema remains the most common unwanted result of femoropopliteal bypass, occurring in 50 to 100 percent of patients. While not a life or limb threatening problem, it is nevertheless disturbing because it impedes function of the newly vascularized limb limiting ambulation, obscures evaluation of pedal pulses, and may compromise healing of skin ulcers or forefoot amputations. The purpose of this study was to evaluate a relatively atraumatic technique for isolating the popliteal artery. This method is designed to avoid damaging either the lymphatics or potential lymphovenous communications which have been demonstrated to occur in pathological states when there is proximal lymphatic obstruction.

The computer as an unbiased medical investigator: Experience on an active surgical service

An adaptable on-line computer system for entry, retrieval, and analysis of medical discharge summaries has been developed and applied in the Trauma Service of a busy city hospital. Each summary occupied 5 to 10 minutes of the physicians time and compared favorably in cost to the standard dictated summary. While the average dictated summary contained 15 +/- 7 relevant facts, the machine-generated summaries were found to have 53 +/- 20 relevant facts. The summaries are well organized, easily comprehensible, and a duplicate copy can be obtained at any time by using the patients name or number for identification. To date, 495 discharge summaries have been entered and reside in the memory of the computer. Statistical analysis from the data base is done by the computer, thus eliminating human prejudice. It provides facility for rapid and accurate retrospective studies as well as pattern-of-care and individual case review.

Potential Complications of Right Atrial Catheterization

Often credited with the introduction of the use of central venous catheters in humans, 1956 Nobel laureate Werner Forssman stressed acquiring a functional knowledge of anatomy, application of gentle technique, and selection of the proper catheter in order to avoid numerous obvious and potential complications. But even today, almost 30 years later, human error remains the single most frequent cause of complication in the widespread use of central venous catheters.