Clinical and economic effects of central venous catheters on oncology patient care.

Central Venous Catheters (CVC) and ports are essential devices to the medical care of cancer patients. Every year about one million CVCs are inserted in cancer patients. The field of oncohematology is making a great contribution to the development of new models of catheters and to the use of innovative materials. New therapeutic protocols, based on continuous administration and higher doses of anticancer drugs with relative phlebitis problems, have raised the issue of long CVC in situ permanence. Different complications are related to the intravascular catheters such as those associated with insertion (pneumothorax, damages to arteries and nerves), or with the duration of catheterization (thrombosis and infections). Furthermore, Catheter-Related Bloodstream Infections (CRBSI), in particular, cause significant mortality and excessive hospital costs. The aim of this prospective study was to analyze the costs related to the use of polyurethane (PU) CVC. 44 patients with a non tunneled double lumen PU CVC in place were followed for 6 months, and for each patient, time of permanence, possible antibiotic prophylaxis, blood parameters, adverse events and medical treatments were monitored. Our results suggest that physicians should pay greater attention to the correlation between new medical devices and the real benefit for the patient, and economic consequences.

[Endoluminal pressure: risk factor for anastomotic dehiscence in rectal carcinoma. Preliminary results]. / Le pressioni endoluminali: un fattore di rischio delle deiscenze anastomotiche nel carcinoma rettale. Risultati preliminari.

The aim of this work was to evaluate the risk factors for anastomotic leakage with particular reference to endoluminal pressures in patients undergoing surgery for colorectal cancer between february 1998 and september 2000. In this preliminary report a total of 120 patients were identified; 96 patients were treated with a total mesorectal excision (with anastomosis less than 10 cm from the anal margin) for rectal cancer and 33 with a partial mesorectal excision (with anastomosis of the superior rectum) for rectosigmoid carcinoma. The leakages were observed in 10.4% of patients and the incidence of this complication was 15.6% in patients with rectal cancer. Using a transanal tube (7 x 2 cm) which reduces endoluminal pressure close to the anastomosis, a significant reduction in the number of leakages was observed. The authors suggest that the transanal tube represents a useful aid in resolving the problem of anastomotic leakage in rectal cancer and stress the importance of this simple, cheap surgical technique.

Inferior mesocaval shunt for bleeding anorectal varices and portal vein thrombosis.

Intractable bleeding from anorectal varices is a serious and often misdiagnosed complication of portal hypertension and no agreement has been reached on which could be the optimal diagnostic and therapeutic strategy. Indeed, fatal outcome has been often reported resulting from delayed diagnosis and improper treatment. The case of a 67-year-old gentleman with life-threatening bleeding from anorectal varices who successfully underwent inferior mesocaval shunt is reported, and surgical technique for establishing a shunt between the inferior mesenteric vein and inferior vena cava is described. A review of other therapeutic options is presented and results are discussed and compared to those obtained with this novel form of treatment. In our experience, immediate control of recurrent bleeding from anorectal varices was obtained with inferior mesocaval shunt. Technical ease, promptness of action and effectiveness, low procedure-related morbidity are the main features of the shunt. With the introduction of new promising second-line treatment modalities to primary and metastatic liver tumors, like percutaneous radiofrequency thermal ablation, and improvement in outcome of portal vein thrombosis, the inferior mesocaval shunt may represent a sound alternative for patients who are ineligible for transjugular intrahepatic portosystemic shunt or presenting with clotted shunt.

[J-pouch after total gastrectomy]. / J-pouch dopo gastrectomia totale.

The Authors report their initial experience with the construction of a J-pouch as restorative surgery following total gastrectomy (TG) for malignant neoplasms. In the last 10 months of the 1990 upon 52 interventions for gastric cancer 31 TG were performed, and in 13 cases a J-pouch on the proximal end of the jejunal segment was constructed. No mortality or specific morbidity was registered using the totally stapled technique. Within one month 3/4 of the patients had normal meals as far as quantity and quality; also the foamy regurgitation seemed to be minimal. The ease of the reconstructive technique and the short term results obtained encourage the use of such approach.