Canadian journal of surgery. Journal canadien de chirurgie
-
Case Reports
Air embolism with neurologic complications: a potential hazard of central venous catheters.
In two patients air embolism caused by disconnection of subclavian venous catheters resulted in cerebral damage. Both patients were receiving long-term parenteral nutrition; both were in an upright position and were slightly dehydrated at the time the embolism occurred. ⋯ It is important to recognize and treat the condition promptly. Also important in the prevention of this condition is catheterization in patients who are properly hydrated and who are in the Trendelenburg position, and care of the catheter thereafter.
-
Case Reports
Perforated peptic ulcer in pregnancy with survival of mother and child: case report and review of the literature.
Peptic ulcer in pregnancy and its complications, though rare, can be life-threatening to mother and fetus. Perforated peptic ulcer in pregnancy is extremely rare; when this occurs survival of both mother and child is unusual. ⋯ The authors report an additional case of perforated ulcer in pregnancy with survival of mother and infant, and review the relevant literature. Early surgical diagnosis and treatment followed by vaginal delivery of the fetus offers the best hope for survival of mother and child.
-
Thirty bypass grafts to coronary arteries were made possible by manual core endarterectomy. The overall patency rate of the grafts was 57%, which is less than the patency rate of bypass grafts to nonendarterectomized vessels (75 to 80%). ⋯ Routine anticoagulant therapy in the postoperative period, to prevent early occlusion, was not used. The results of this and other studies suggest that coronary endarterectomy with bypass grafting is a useful procedure in situations where the coronary artery is so severely obstructed that standard saphenous vein bypass grafting cannot be performed; the procedure is superior to coronary endarterectomy alone.
-
The goat is an ideal animal for intracardiac surgical investigation. The animal is docile and easy to care for; it has an ideal heart size, a high cardiac output and a long life expectancy. ⋯ Anoxic cardiac arrest is tolerated for up to 35 minutes. Initial experience in 36 animals with operations on the right side of the heart resulted in a 72% long-term survival.
-
Bacterial and fungal growth in 10% soybean oil emulsion (Intralipid) and 5% fibrin hydrolysate in 5% dextrose was studied at 4, 25 and 37 degrees C. Staphylococcus aureus, Streptococcus pyogenes, Str. fecalis, Pseudomonas aeruginosa, Klebsiella pneumoniae, Escherichia coli and Candida albicans were grown in broth at 37 degrees C, diluted in saline and inoculated into each of the two preparations as well as a mixture of the two. Growth was measured at 24, 48 and 72 hours. ⋯ The fibrin hydrolysate-dextrose solutions given by infusion into a central vein for hyperalimentation have been shown to support predominantly fungal growth, and contamination of the solution and ultimately of the indwelling catheter is a constant hazard. Because both bacteria and C. albicans grew equally well in 10% soybean oil emulsion, its use as a caloric source when infused into a central vein may increase the occurrence of sepsis. When this emulsion is used to provide essential fatty acids or calories, it should be given via a peripheral vein, so that a central catheter will not be contaminated.