The CVP catheter: an invasive therapeutic adjunct.

Invasive techniques continue to be used in monitoring and treating the critically ill patient in spite of preference for, and increasing use of, non-invasive or minimally invasive techniques. With or without simultaneous determination of left ventricular filling pressure, the central venous pressure (CVP) catheter is widely used for gaining access to the right heart, determining right ventricular filling pressure, and for rapid infusion of fluids or medications. Even in expert hands the insertion of the CVP line is occasionally followed by complications that may require therapeutic interventions of varying degrees of severity. The possible hazards from this simple and often necessary therapeutic adjunct call for a systematic informed-consent approach which is often neglected despite its relevance in today's clinical practice. The data presented are typical of a standard teaching hospital experience. Securing informed consent for CVP catheter insertion is encouraged.

Intraluminal radiation for esophageal cancer: a Howard University technique.

The objective of radiotherapeutic management in esophageal cancer is to accomplish maximum tumor sterilization with minimal normal tissue damage. This sincere effort is most often countered by the differential in tumor dose response vs normal tissue tolerance. Intraluminal isotope radiation, with its inherent advantage of rapid dose falloff, spares the lungs, the spinal cord, and other vital structures, yet yields adequately high doses to esophageal tumor. Though in existence since the turn of the century, the method of intracavitary radium bougie application dropped out of favor due to technical difficulties imposed by the size of the radium source and radiation exposure to the personnel involved. The authors describe a simple "iridium 192 afterloading intraluminal technique" that eliminates technical problems and reduces radiation exposure considerably.

Computed tomography of adult colonic intussusception: clinical and experimental studies.

The CT features of a case of adult ileocolic intussusception and of experimentally induced ileocolic, cecocolic, and colocolic intussusceptions are presented. Both the clinical and experimental cases demonstrated (1) "target" masses with enveloped, eccentrically located areas of low density and (2) interspersed low- and high-density stripes within the intussusception producing a "layered" or "stratified" pattern. This layered pattern of abdominal masses may be characteristic of intussusceptions regardless of location.