RESUMO
The removal of a central venous catheter (CVC) can be complicated by rare but potentially life-threatening neurocardiopulmonary distress. The clinical courses of eight patients who had CVC removal complications are reviewed. Seven patients had catheter removal from the right internal jugular vein, and one from the right subclavian vein. The complications occurred after complete removal of the catheter (four patients), after guidewire replacement for catheter change (three patients), and after detachment of the hemostasis side port of the Swan introducer during sheath removal (one patient). Each of them had more than one complication. The major complications were: neurologic paresis or coma (four patients), respiratory failure (four patients), and shock (two patients). One patient died of pulmonary sepsis. The overall mortality rate was 12.5 per cent. Guidelines for safe removal of central venous catheters are proposed. Possible mechanisms of the complications are discussed. We refer to the observed complications as the CVC removal distress syndrome.
Assuntos
Cateterismo Venoso Central/efeitos adversos , Coma/etiologia , Hemiplegia/etiologia , Veias Jugulares , Insuficiência Respiratória/etiologia , Choque/etiologia , Veia Subclávia , Adulto , Idoso , Idoso de 80 Anos ou mais , Cateterismo Venoso Central/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Estudos Retrospectivos , SíndromeAssuntos
Simulação por Computador , Hemoglobinas/metabolismo , Modelos Químicos , Método de Monte Carlo , Dinâmica não Linear , Oxigênio/metabolismo , Oxiemoglobinas/metabolismo , Análise de Regressão , Algoritmos , Humanos , Cinética , Análise dos Mínimos Quadrados , Polarografia , Ligação Proteica , Conformação ProteicaRESUMO
In patients with lung cancer, the goals of limited resection procedures of the lung and major airways are to provide an adequate cancer operation while preserving functioning lung tissue. Discussed in this article are sleeve lobectomy, an alternative to pneumonectomy in patients with cancer in a lobar orifice; segmentectomy or wedge resection, an alternative to lobectomy in those with a peripheral lung cancer; and thoracoscopy, an alternative to open thoracotomy for various chest malignancies.
Assuntos
Neoplasias Pulmonares/cirurgia , Pneumonectomia , Brônquios/cirurgia , Humanos , Neoplasias Pulmonares/mortalidade , Pneumonectomia/métodos , Taxa de Sobrevida , ToracoscopiaRESUMO
Make a guess: Would a company that needs the work-improvement ideas of employees, but whose experience with the use of a suggestion box has been less than successful, obtain more and better quality ideas by enlisting the participation of its employees or by assigning them an idea quota? Donald W. Myers and Earnest R. Archer report the experience of a company that tried both approaches--participative and authoritative--and, surprisingly, in a world where participation is the magic formula, the group assigned a quota produced more and better ideas than did the participatory group.