Surgery
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Peripheral postcapillary venous pressure (PCVP) appears to be an indicator of peripheral perfusion (cutaneous blood flow) in the experimental animal. Eighteen male mongrel dogs under balanced anesthesia were subjected to either slow, continuous hemorrhage 0.65 ml/kg/min) or plasma expansion with dextran 40 (0.80 ml/kg/min) over a period of 1 hour. ⋯ The only parameter that consistently gave a predictable measure of the degree of induced volume change without requiring pulmonary arterial catheterization was PCVP. PCVP showed a close correlation with CO (r = 0.96).
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Catheter-related sepsis is one of the major complications of total parenteral nutrition (TPN) therapy. The relationship between microbial colonization of the skin at the site of catheter insertion and colonization of the central venous catheter was investigated in 74 catheters used to administer TPN therapy in 53 patients. Semiquantitative culture specimens were obtained from the insertion site and intravascular and subcutaneous catheter segments at the time of catheter removal. ⋯ The association between colonization of catheters and the presence of more than 10(3) bacterial or fungal colony-forming units at the insertion site was significant (P less than 0.005). These results demonstrated that colonization of catheters by organisms present on the skin at the site of catheter insertion occurred twice as frequently as colonization by the hematogenous route. The results also suggested that colonization of catheters by organisms present at the insertion site occurred only after a threshold number of organisms was reached.
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Forty-nine patients with acute mesenteric ischemia have been treated during the past 15 years. The overall mortality rate was 65%; the prognosis varied with the cause of disease. None of the 12 patients with primary thrombosis of the mesenteric arteries, 5 of 14 with spontaneous embolization, and 2 of 4 with arterial occlusion subsequent to diagnostic angiography survived. ⋯ There were 17 reexplorations, with only three contributing to survival (17.7%). Two patients with mesenteric venous thrombosis and one patient with arterial embolization benefited from resectional therapy during reexploration. The study emphasizes that diagnostic criteria, therapy, and prognosis can be correlated with the etiologic factor.