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[Suture fixation of a Swan Ganz catheter to the left brachiocephalic vein during re-thoracotomy].
This case report describes the intraoperative fixation of a Swan-Ganz catheter at the left brachiocephalic vein by a suture during rethoracotomy in a cardiac surgical patient. In case of a rethoracotomy by median sternotomy the right-sided veins should be preferred for the insertion of a Swan-Ganz-catheter. Furthermore the free mobility of the catheter should be controlled before closure of the thorax.
The queering of Swan Lake: a new male gaze for the performance of sexual desire.
This essay argues that, by re-gendering the ballet classic Swan Lake, choreographer Matthew Bourne has also queered it. He thrusts center stage an unstable relationship between two male characters, and in so doing, de-centers the conventionally fixed categories of sex, gender and sexual desire. He also forces a long-simmering relationship between homosexuality and dance out of the closet and into mainstream popular culture. Applying Mulvey's theory of spectatorship and Butler's theory of gendered performance, the essay describes how viewers may be intrigued, rather than repulsed, by the ambiguities surrounding Bourne's portrayal of sexual identity.
Re: "Erroneous cardiac output measurement due to loop formation of a swan-ganz catheter in the pulmonary artery".
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Swan-Ganz catheter induced pulmonary hemorrhage.
In over 3500 consecutive open heart procedures using Swan-Ganz catheterization at our institution, we have experienced three major pulmonary artery injuries secondary to this procedure. Pulmonary artery hemorrhage is a rare but frequently fatal complication and a mortality rate as high as fifty percent has been reported. In two of these cases, major retraction of the heart was needed for adequate exposure of the cardiac pathology. The Swan-Ganz catheter inadvertently was advanced into the wedge position for prolonged intervals of time, and periodic overdistention of the balloon occurred. The third case occurred in the cardiac catheterization laboratory. The need for aggressive surgical approach has been demonstrated. The authors have recommended steps to be taken when massive hemoptysis occurs and Swan-Ganz catheter perforation of the pulmonary artery is suspected. Re-evaluation of the "routine" use of the Swan-Ganz catheter may be necessary and overutilization may be a distinct possibility. When the use of this catheter is deemed appropriate, a more exact positioning of the distal portion of the catheter is mandatory if pulmonary artery perforation is to be avoided.
A method for the treatment of lead poisoning in the mute swan (Cygnus olor) and its long-term success.
A method for the treatment of lead poisoning in mute swans (Cygnus olor) is described. Chelation therapy, using sodium calcium edetate, was successful in resolving the clinical signs of lead poisoning in 49% of cases. Individually ringed swans were monitored after their release to the wild, in order to assess the long-term benefits of treatment. Re-sighting and recovery data suggested that at least 22% of swans treated for lead poisoning survived the first 2 years. The results indicate that despite treatment, once a swan becomes lead poisoned its chances of survival are reduced by 59% compared with untreated swans living in flocks.
The pathogenesis of the rheumatoid swan neck deformity.
Disappointment with the late results of intrinsic release for the rheumatoid "intrinsic-plus" hand has led to a re-appraisal of the role of intrinsic muscle contracture in the pathogenesis of the rheumatoid swan neck deformity. In cadaveric fingers, a properly placed suture typing the lateral band to the middle slip insertion causes a swan neck deformity. It is suggested that the usual "intrinsic-plus" hand and the fixed swan neck deformity of rheumatoid arthritis is caused by adhesions between the extensor tendons on the dorsum of the proximal interphalangeal joint, rather than by intrinsic muscle contracture and/or metacarpo-phalangeal dislocation.
Management of catheter-induced pulmonary artery perforation during weaning from cardiopulmonary bypass--a case report.
We report a case of pulmonary artery perforation induced by Swan-Ganz catheter. Brisk massive airway hemorrhage occurred after withdrawl of the Swan-Ganz catheter post cardiopulmonary bypass. Early recognition, immediate re-establishment of cardiopulmonary bypass, lobectomy of the sanguineous lobe subsequent to rupture of the involved pulmonary artery, and thorough bronchial toilet were the major determinants contributing to successfully rescuing the patient's life. She was discharged uneventfully in spite of high mortality rate of the catheter-induced pulmonary artery perforation.
Vertebral arteriovenous fistula as a result of Swan-Ganz catheter insertion: surgical correction in a symptomatic patient.
A case of a vertebral arteriovenous fistula is reported after being caused by insertion of a Swan-Ganz catheter into the vertebral artery prior to cardiac surgery. The patient's clinical symptoms which precipitated re-admission consisted of multiple episodes of diaphoresis and dizziness. A right carotid bruit was detected in the neck. Four vessel cerebral arteriograms could not accurately identify the origin of the fistula. The proximal carotid artery was considered by several radiologists to be the arterial source of the fistula. During the surgical procedure, a tortuous right vertebral artery was found to be the source of the fistula. Surgical correction of the fistula was successful with preservation of the vertebral artery. Recommendations from a review of the literature are made for the current treatment of this rare complication from an insertion of a Swan-Ganz catheter.
Swan-Ganz catheter-induced massive hemoptysis and pulmonary artery false aneurysm.
Swan-Ganz catheter-induced massive hemoptysis and later pulmonary artery false aneurysm occurred in a patient with prosthetic mitral regurgitation. This patient was successfully managed by double-lumen endotracheal intubation, control of pulmonary hypertension, reversal of anticoagulation, mitral valve re-replacement, and transcatheter embolization. The pertinent literature is reviewed.
[Practical nursing guide in the critical patient].
UNLABELLED: Nursing staff that have recently arrived to the ICU, nurses and students, may feel anxiety and fear due to lack of skill and/or knowledge of the techniques, the service's organization and the diseases treated. OBJECTIVES: 1. To know the intensive care aspects that pose greater difficulties to the professionals newly incorporated into the ICU of the Hospital General Universitario of Alicante 2. To provide these professionals with a written guide that responds to the needs and situations that they face day to day. 3. Inform the nursing students, prior to the onset of their practice activities in the ICU, on a combination of basic procedures that make it possible to take better advantage of them. 4. Communicate and facilitate access to the information contained in the guide to the maximum. MATERIAL AND METHODS: The professional workers who had recently received their degress and who worked in the ICU during the summery were surveyed to determine the techniques or procedures that posed the greatest difficulties. A < > was designed in paper and electronic form. RESULTS: The respiratory, Swan-Ganz catheter, defibrillation, cardiac arrhythmias and insertion of temporal pacemakers were the subjects posing the greatest difficulty. A total of 92% of the colleagues would re-chose their practices in the ICU; 33% liked working as a team most. CONCLUSIONS: 1. The technology used in the ICU poses problems for the recently arrived colleagues. 2. The guide may be used by the new professionals and students as work tool and contribute to communication between the university and the hospital. 3. The use of Internet to communicate the work done by the Nursing professionals offers great advantages and should be used as one more tool.
RE: Spontaneous abortion in the British semiconductor industry.
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Re: "Should we consider a subject's knowledge of the etiologic hypothesis in the analysis of case-control studies?".
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The migration of amphibian primordial germ cells in the chick embryo.
A fibrous band of extracellular materials on the chick embryo area pellucida/area opaca border is a preferential migratory pathway for chick embryo primordial germ cells (PGC). This band contains fibronectin, collagen Type I and sulphated glycosaminoglycans. It is known that PGCs from Xenopus laevis interact with fibronectin as they undergo migration in the embryo from their site of origin to the gonads. To establish whether this pathway is species specific in chick embryos it was decided to transplant PGC from Xenopus laevis embryos stage 48 on to chick embryos stage 4 fibrous band. Their rapid migration on this extracellular matrix and their subsequent re-orientation of the basement membrane has been studied by scanning electron microscopy.
[Ischemic retraction of the intrinsic muscles of the hand in leprosy (a trial of physiopathologic and therapeutic re-evaluation)].
An attempt of reevaluation of the ischemic contracture of intrinsic muscles is presented, study of a mechanism identical to the Volkman Syndrome (forearm muscles), etiopathogenic treatment (excision of infarcts) in the first stage and efficient palliative methods for the Swan neck fingers and deformity of the thumb.
Re: Routine perioperative pulmonary artery catheterization has no effect on rate of complications in vascular surgery: a meta-analysis.
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Drug treatment of patients with decompensated heart failure.
Decompensated heart failure (HF) may be defined as sustained deterioration of at least one New York Heart Association functional class, usually with evidence of sodium retention. Episodes of decompensation are most commonly precipitated by sodium retention, often associated with medication noncompliance. Our therapeutic approach to hospitalized patients is based on the documented hemodynamic responses to vasodilator therapy, with redistribution of mitral regurgitant flow to forward cardiac output and decompression of the left atrium. Invasive hemodynamic monitoring is seldom required for the effective management of patients with HF and there are risks associated with pulmonary artery catheterization. The currently available parenteral vasoactive drugs for decompensated heart failure include: (i) vasodilators such as nesiritide, nitroprusside and nitroglycerin (glyceryl trinitrate); (ii) catecholamine inotropes, primarily dobutamine; and (iii) inodilators such as milrinone, a phosphodiesterase inhibitor. Vasodilators are most appropriate for those patients who are primarily volume-overloaded, but with adequate peripheral perfusion. In this class of agents, nesiritide (recombinant human B-type natriuretic peptide) offers advantages over currently available drugs. Nesiritide produces rapid and sustained decreases in right atrial and pulmonary capillary wedge pressures, with reduction in pulmonary and systemic vascular resistance and increases in cardiac index. The hemodynamic effects of nesiritide infusion were sustained over a duration of 1 week and the drug may be used without intensive monitoring in patients with decompensated HF. Treatment with dobutamine is indicated in patients in whom low cardiac output rather than elevated pulmonary pressure is the primary hemodynamic aberration. However, milrinone reduces left atrial congestion more effectively than dobutamine, and is well tolerated and effective when used in patients receiving beta-blockers. In-patient therapy for decompensated HF is a short term exercise for symptom relief and provides an opportunity to re-assess management in the continuum of care.