Teruo Matsumoto

Major long-term complications in 1,422 permanent venous access devices

A retrospective review was undertaken of 1,422 permanent venous access devices (PVADs) implanted from 1989 to 1991 at Hahnemann University Hospital. This included 730 single-lumen Hickman catheters, 368 double-lumen Hickman catheters, 307 single-lumen Portacath infusion ports, and 17 double-lumen Portacath infusion ports. Indications for placement were as follows: antibiotics in 28%; chemotherapy in 51%; hyperalimentation in 4%; intravenous fluids in 4%; hemodialysis in 3%; and undocumented indications in 10%. There were 60 PVADs removed and/or replaced prior to the completion of intended therapy (4% overall). Indications for removal were catheter infection in 1% of cases and catheter malfunction in 3% of cases. The percentage of Portacath infusion ports removed was significantly greater than the percentage of Hickman catheters that were removed (p < 0.001). However, there was no significant relationship between catheter infection or the malfunction rate, and the number of lumens, initial indication for placement, or number of catheters placed. Life-threatening complications associated with PVAD insertion occurred in fewer than 1% of cases. The insertion of PVADs is a safe and efficient mode of long-term venous access.

Adult respiratory distress syndrome in association with acute pancreatitis: Evaluation of positive end expiratory pressure ventilation and pharmacologic doses of steroids

Abstract Patients with adult respiratory distress syndrome in association with acute pancreatitis were studied intensively. A rise in pulmonary wedge pressure was seen after elevation of the serum amylase level with concomitant depression of the serum calcium level. Pharmacologic doses of steroids did not seem to be efficacious in reducing QsQt changes. However, inception of positive end expiratory pressure ventilation caused diminution in QsQt ratios.

Pathophysiology of stress ulcer and its prevention: II. Prostaglandin E1 and microcirculatory responses in stress ulcer☆

PGE1 completely prevented the formation of stress ulcers when administered in doses of 4 to 5 mg/kg or more. However, at this dose, complications and mortality were significant.

Acupuncture, electric phenomenon of the skin, and postvagotomy gastrointestinal atony

Abstract Skin resistance changed significantly at the meridian point after vagotomy in rabbits. Application of an acupuncture needle with electric stimulation on the meridian point minimizes the change of skin resistance. Reduction of gastrointestinal motility after vagotomy is also minimized by this application.

Frey's syndrome.

Freys syndrome occurs after parotid gland surgery or injury to the parotid gland and is characterized by gustatory sweating and erythema of the face upon mastication. The syndrome occurs in 50 to 60 per cent of all patients undergoing parotid surgery but the symptoms are only distressing to about 10 per cent of patients undergoing parotidectomy. A case of Freys syndrome is reported The patient obtained good relief of symptoms with scopolamine cream and atropine cream. Other methods of therapy are discussed along with their limitations. Noninvasive therapy with topical anticholinergic creams is effective and seems appropriate in the control of gustatory sweating.

Incidence of stress ulcer formation associated with steroid therapy in various shock states

The use of pharmacologic doses of steroids early in the shock state, within the first hour when possible, for periods of less than forty-eight hours seems to reduce the incidence of gastric ulceration and hemorrhage in low flow states associated with septic, cardiogenic, and hemorrhagic shock.

Thrombolytic therapy of synthetic graftocclusions before vascular reconstructive procedures

The objective of this study was to evaluate the impact of thrombolysis of synthetic grafts before urgent vascular reconstruction. In 29 patients, 41 thrombosed synthetic grafts that underwent intraarterial thrombolysis were studied. The cases were divided into three groups: group I--complete thrombolysis followed by reconstruction; group II--complete thrombolysis alone; and group III--incomplete lysis requiring reconstruction or sympathectomy. Follow-up ranged from 1 to 556 days (mean: 149 days). Kaplan-Meier analysis was used to determine patency and limb salvage rates. One-year patency and limb salvage rates were 53% and 95%, 34% and 67%, and 38% and 48%, respectively, for groups I, II, and III. Eighteen complications occurred in 16 of the 41 (39%) episodes. One patient died of intracranial hemorrhage. The best results were achieved when complete lysis was followed by appropriate reconstruction. Patency was equally poor in complete thrombolysis alone and reconstructions required by incomplete thrombolysis. Limb salvage was better after complete thrombolysis, regardless of the appropriate reconstruction.

Use of intragastric balloons for weight reduction: An experimental study

The effect of intragastric balloons as a noninvasive method for weight reduction was observed in nine castrated Yorkshire pigs. None of the animals lost weight. The appetites of the experimental animals were inhibited for only a short period of time. A significant dilatation of the stomach after balloon insertion was noted which resulted from increased food intake and obliterated the effect of the intragastric balloons. A long-standing lower blood glucose level played an important role in the increments in food intake and dilatation of the stomach. At the same time, ulceration was seen in 83.3 percent of the animals that received balloons. We conclude that intragastric balloon therapy may not be an effective approach for managing morbid obesity in human subjects.

Central peripheral temperature gradient: Its value and limitations in the management of critically III surgical patients

Monitoring the central peripheral temperature gradient in critically ill surgical patients is a simple, sensitive, noninvasive and inexpensive method that can accurately reflect the state of peripheral circulation. It serves as an early warning sign, and its return to normal is a good measure of the efficacy o f therapy. Recognition of the cause of an abnormal gradient is essential to successful management since it can result from pain as well as hypovolemia. Warm-up patterns vary, and every patient should be treated individually. Forcing vasodilatation is usually unnecessary and amy be dangerous in hypothermic patients and in patients with hypovolemia if blood volume is not corrected simultaneously. Peripheral vascular disease, central hypothermia and the use of vasoactive drugs limit the usefulness of this method.

Pathophysiology of stress ulcer and its prevention. I. Pharmacologic doses of steroid.

The efficacy of a large dose of Decadron on stress ulcer formation in restrained rats has been studied using microangiohistologic technics. When a pharmacologic dose of Decadron was administered twenty-four hours prior to the procedure, Dacadron prevented ulcer formation.