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Query: UMLS:C0020505 (hyperphagia)
 6,116 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Indwelling venous catheters are invaluable for long-term chemotherapy, antibiotics, and hyperalimentation. However, their placement and chronic use can cause serious complications. This study was done to develop guidelines for minimizing complications of long-term vascular access. Complications associated with 355 lines placed in 297 patients were recorded prospectively at the George Washington University Hospital. Single or double lumen catheters were placed via the infraclavicular subclavian approach (126), external jugular cutdown (133), internal jugular cutdown (22), and cephalic vein cutdown (42). While catheters were malpositioned in 15 cases (5.2%), route of placement did not influence this adverse outcome. Pneumothorax occurred only in the subclavian approach (5.6%). Axillary vein thrombosis was significantly more prevalent in catheters placed via the subclavian vein (10.3%) compared with the external jugular (2.3%) P < 0.05 or cephalic (2.3%) vein. Line sepsis occurred in 28 instances; this was statistically associated with an abnormal white blood count and with the use of double-lumen catheters (double-lumen catheter sepsis = 18.4%, single lumen = 4.4%, P < 0.01). The morbidity of long-term venous catheters is affected significantly by the route of placement, the number of catheter lumens, and the pre-placement white blood count. As a result of our analysis, we recommend single-lumen catheter placement using the external jugular cutdown route whenever possible.
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PMID:Avoiding complications of long-term venous access. 836 59

Indications of rethoracotomy after esophagectomy for esophageal cancer are reviewed in this paper. Hemothorax, pneumothorax, pyothorax and chylothorax are the main causes of rethoracotomy. Complications indicating rethoracotomy are summarized as follows: 1) Hemothorax; emergency rethoracotomy is indicated in cases of bleeding through the chest drain over 100ml/hr, which is continuing over 5 hours or in cases when normal blood pressure cannot be maintained without blood transfusion. In many cases the bleeding point is the chest wall, from the branches of the intercostal artery. 2) Pneumothorax; reoperation for pneumothorax is rare. But rethoracotomy and bullectomy or closure of fustula is indicated when a large volume of air leakage and lung collapse continues over a week. 3) Pyothorax; old pyothorax with bronchial fistula is treated by closure of fistula and plombage with omentum or muscle flap. 4) Chylothorax; chylothorax is not a frequent complication of esophageal surgery but when it occurs reoperation is not rare. In cases with 1,500ml/day or more of chyle drainage for over 5 days under fasting with intravenous hyperalimentation, rethoracotomy and ligation of thoracic duct is indicated.
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PMID:[Indications of rethoracotomy after esophagectomy for esophageal cancer]. 877 13

Spontaneous esophageal rupture is a life-threatening condition for which surgical intervention within 24h after the onset is usually recommended. This report describes two cases of spontaneous esophageal rupture successfully treated by conservative therapy. In the first case, a 68-year-old man was hospitalized for severe upper abdominal pain following hematemesis. A large left pleural effusion occurred the next day and spontaneous esophageal rupture was diagnosed 1 week later, following placement of an intrathoracic drain. In the second case, a 38-year-old man was admitted for severe back pain following vomiting and esophageal rupture diagnosed within 3 h after onset by computed tomography (CT), which showed left pleural effusion, pneumothorax, and pneumomediastinum. Both patients were successfully treated conservatively with continuous intrathoracic drainage, intravenous antibiotics, and hyperalimentation. We conclude that spontaneous esophageal rupture can be treated conservatively under intensive observation.
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PMID:Spontaneous esophageal rupture successfully treated by conservative therapy: report of two cases. 1206 93


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