The effect of volume loading in 20 patients with clinical and bacteriological evidence of generalized sepsis was studied. The patients were divided into two groups according to their response to volume loading. Group A included 9 patients in whom the initial pulmonary capillary wedge pressure (PWP) was lower than the central venous pressure (CVP). In this group the intravenous administration of 5089 + 409 ml/24 hr fluids was accompanied by a significant rise in blood pressure from 94.4 ± 9.3 mm Hg to 118.9 ± 6.3 mm Hg with no significant change in pulse rate or CVP. PWP rose from 5.7 ± 1.8 to 10.0 ± 1.4. The rise in cardiac output from 8.0 ± 1.3 liter/ min to 9.7 ± 1.1 liter/min was not statistically significant.Group B included 11 patients in whom the initial PWP was higher than the CVP. In this group, signs of fluid overloading appeared after administration of 3151 ± 540 ml/24 hr. There was no significant change in blood pressure, pulse rate, CVP, PWP or cardiac output. Urine output was adequate in both groups. This volume load did not affect pulmonary oxygenating capacity (PaO2/F102) and effective lung compliance in both groups, but the maintenance of an unchanged oxygenating capacity necessitated an increase in PEEP in some patients.
A patient with sigmoidocystic fistula d u e t o "collision" between mucoid adenocarcinoma of the colon a n d transitional cell carcinoma of the urinary bladder is presented. A wide resection of the colonic tumor, along with the involved bladder segment, a n d a decompressive colostomy with bladder drainage by catheter, were performed. The clinical symptoms, diagnostic procedures, operative treatment, and prognosis are discussed. Although fistular formation is a n indication of advanced carcinoma, wide resection of the tumor and the associated fistular along with the node-bearing area will result in a reasonable percentage of 5-year survivals.Cancer 38:335-340, 1976.
ESICOCOLIC FISTULA SECONDARY TO COLONICV cancer is a relatively rare complication.Aldrete et a1.l reported 42 fistulas in approximately 13,000 operations for cancer of the colon (0.32%). Lockhart-Mummery2 reported the finding of cancer of the colon adherent to the urinary bladder i n 157 out of 3780 cases (4%) of carcinomas of the left colon, excluding the rectum. In 23 of these, a fistula had developed into the lumen of the bladder, an incidence of 0.6%. Most authors agree that the occurrence of vesicocolic fistulas of neoplastic origin is second only to that of fistulas caused by an inflammatory process, mainly diverticulitis of the c0lon.~-4 In spite oE its general acceptance as an uncommon complication, Couris et al,3 reviewing the literature, found that 55% of the intestinovesical fistulae were of neoplastic origin, 52% were on the basis of an inflammatory lesion, and 13% were traumatic. Of the 133 intestinovesical fistulae due to neoplasms, 72 were secondary to carcinoma of the sigmoid colon (54%), 29 followed car-
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.