Search

The relationship between gallstones and gallbladder cancer was investigated in a case-control study in 131 subjects with gallbladder cancer and 2,399 subjects without gallbladder cancer. Included in the study were male and female subjects from 3 racial groups: white, black, and Southwestern American Indian. For the non-Indian group there was a significant relationship between gallstones and gallbladder cancer, with an overall estimated relative risk (RR) of 4.4 (95% confidence interval, 2.6-7.3). For the Indian population the overall estimated RR was much higher: RR = 20.9; 95% confidence interval = 8.1-54. By the combination of the RR, the prevalence of gallstones, and the overall incidence of gallbladder cancer, the risk of gallbladder cancer was calculated in each population for subjects with untreated gallstones. In older subjects with gallstones the estimated 20-year cumulative risk for gallbladder cancer ranged from 0.13% in black males to 1.5% in Indian females. It was concluded that the risk of gallbladder cancer in untreated subjects with gallstones is heterogeneous, depending on race and sex as well as the period of exposure to gallstones.

Over a 12-month period, this survey was conducted prospectively to examine the complication rate associated with the insertion and use of central venous catheters on the Louisiana State University Service at Charity Hospital, New Orleans. No attempt was made to alter or influence the current techniques and methods for catheter insertion. Three-hundred and ninety-seven patients received 554 catheters. The overall complication rate was 13.7%. Major mechanical complications occurred with 4.0% of catheters, and infectious complications occurred with 5.2%. Of the 22 major mechanical complications, 13 were associated with morbidity. Twelve of the 13 complications with morbidity occurred with 286 subclavian catheterizations (4.2%), while only 1 of the 13 complications with morbidity occurred with 248 internal jugular catheterizations (0.4%). Based on these data, it is recommended that the internal jugular approach be used in the majority of patients, reserving the subclavian approach for patients on long-term parenteral nutrition or when the internal jugular approach is not feasible technically.