Central venous catheter design and maintenance complications.
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Biomedical subjects
Publications and source records attributed to J L Peters.
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Recurrence of adrenal cortical carcinoma 22 years after first presentation is reported in a 54-year-old woman with Cushing's syndrome. This tumour is normally associated with poor prognosis and prolonged survival is rare. Although the patient had remained well with apparent 'cure' in the intervening years, it is suggested that hormonal changes related to the menopause and the development of primary hypoadrenalism stimulated recurrence of malignant activity and return of Cushingoid features.
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Two patients with air embolism (one fatal) which occurred during intravenous feeding with a central venous catheter are reported. The connection between intravenous administration sets and such catheters is shown to be a danger area which requires further technological improvement. The world literature concerning this hazard is reviewed.
The clinical presentations of 3 patients found to have an abdominal aortic aneurysm with ureteric involvement have been described. The world literature concerning this problem and methods of surgical treatment have been reviewed. The importance of medial displacement of the ureters as an early diagnostic sign indicating the presence of an abdominal aortic aneurysm is again emphasised. The possibility of a relatively benign course for the aneurysm should be considered in patients with renal or cardiorespiratory complications. In such cases, treatment of the ureteric involvement alone is justified.
A simple cannula method of partial or total left ventricular bypass, utilizing a roller pump and outflow filter, has been developed and applied clinically. One of three patients with severe cardiac and multisystem failure was pumped with total left ventricular bypass for six days and decannulated with recovery of myocardial function after nine days. These results are encouraging and suggest that a number of patients could be salvaged from temporary cardiac failure with a simple cannula-roller-pump bypass system.
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Transapical left ventricular bypass has been demonstrated in normal sheep and one lamb. Recently, TALVB was applied in 3 clinical cases of cardiac failure, with recovery of myocardial function in one patient after 9 days of bypass (6 days total TALVB). These studies suggest that LV apical cannula-roller pump bypass with low dose heparin anticoagulation and secondary surgery to remove the cannula may salvage some patients now dying of temporary cardiac failure.
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A patient is described who developed a benign oesophageal stricture following cardiac surgery. A brief review of the literature is given and the possible dangers of oral potassium cholride therapy in patients with dysphagia are highlighted.