A risk-to-benefit analysis for central venous catheters.

Reliable venous access is an important consideration in the management of the cancer patient, where long-term intravenous therapy is needed. A single institution retrospective analysis of 205 catheter placements allowed comparison of different lines and techniques. This experience shows that surgical introduction under general anaesthetic of a double-lumen, 12 gauge, silastic catheter in the superior vena cava, via the internal jugular vein and using a 15 cm anterior chest wall tunnel, resulted in longest survival, fewest infections, and enjoyed a high patient acceptability. A substantial cost-saving, particularly in antibiotic usage, was observed as a result of the improved technique.

Hepatitis C virus antibodies in patients with liver disease. The western Cape experience.

Hepatitis C virus (HCV) is a recently characterised non-A, non-B hepatitis (NANBH) agent, which appears to be important in both parenteral and sporadic NANBH. HCV infection has been associated with the development of chronic liver disease, cirrhosis and hepatoma. Groups of patients in the western Cape with chronic liver disease and hepatoma were screened for antibodies to HCV and the results were confirmed by standard neutralisation tests. Three of 19 patients with cirrhosis secondary to alcohol abuse or classic auto-immune chronic active hepatitis were considered to have antibodies to HCV at initial screening. All of these were false-positive results. Five of 20 patients with presumptive chronic NANBH were considered possibly to have antibodies to HCV. Only 1 patient with post-transfusional NANBH was confirmed to have specific HCV antibodies. Two of 30 patients with hepatoma had specific anti-HCV antibodies in contrast to 11 others with serum HBsAg positivity. One hundred blood transfusion donors and 25 antenatal patients were tested concurrently and shown to be negative for anti-HCV. Specific antibodies to HCV were present in very few patients with cirrhosis, presumptive NANBH and hepatoma tested in this local survey. False-positive reactions appeared to occur at a higher rate than true-positive results.

High prevalence of hepatitis C virus antibodies in a local haemophiliac population.

Non-A, non-B hepatitis is common among individuals with clotting factor deficiencies who have had multiple exposures to replacement concentrate. Newly introduced screening tests for hepatitis C virus antibody make it possible to determine the prevalence of this entity in defined populations. In 68 haemophiliac patients attending the Groote Schuur Hospital clinic, 44 were shown to be positive (65%). There was no significant correlation between seropositivity for this agent and severity of the bleeding disorder, age or elevation of the liver enzyme values.

Auto-erythrocyte sensitisation--the Gardner-Diamond syndrome. A case report.

A 34-year-old woman with a 3-year history of easy bruising of unexplained aetiology in anatomical sites consistent with self-infliction is described. Despite major surgery, the patient had never experienced inappropriate bleeding. Owing to psychological instability, the possibility of auto-erythrocyte sensitisation was considered; this was confirmed by subcutaneous injection of autologous red cells and haemolysate, which caused local tenderness and induration. This manifestation of Gardner-Diamond syndrome is unusual and is reported to draw attention to its existence and perhaps thereby avoid unnecessary and costly investigations.