Inadvertent catheterization of the internal thoracic vein mimicking pulmonary embolism: a case report.

Although aberrant locations are typical complications of central venous catheterization, the right internal thoracic vein (mammary vein) is an exceptional one. A case of this unusual aberrant location occurring after right internal jugular venous cannulation for total parenteral nutrition, is described. This aberrant position caused signs and symptoms resembling pulmonary embolism. This is the first known description of the symptoms induced by the infusion of parenteral solution into the right internal thoracic vein.

Energy metabolism of surgical patients in the early postoperative period: a reappraisal.

Energy metabolism was measured at the bedside in 22 uncomplicated surgical patients in the early (24 to 48 h) postoperative period with the use of continuous computerized indirect calorimetry with a canopy system. Energy production rates were higher than those predicted by the Harris-Benedict formula both in absolute value (1516 +/- 61 vs. 1387 +/- 49 kcal/day, p less than .05) and when normalized by body weight (BW; 23.5 +/- 0.5 vs. 21.7 +/- 0.5 kcal/day.kg BW, p less than .01) or by lean body mass (LBM; 32.8 +/- 0.8 vs. 30.2 +/- 0.9 kcal/day.kg LBM, p less than .01). Furthermore, surgical patients had higher energy production rates than those measured in 22 overnight fasted, resting healthy subjects matched for age, sex, and body size (23.5 +/- 0.5 vs. 21.8 +/- 0.6 kcal/day.kg BW, p less than .05). In both the patients and the control group, measured energy production bore a direct relation to LBM. We conclude that the early postoperative period of uncomplicated surgery is associated with a small (about 7%) but consistent increase in energy metabolism above the level observed in the overnight fasted, resting healthy individual. This increase appears to be an effect of surgery itself, and is not predicted by Harris-Benedict equations.