The purpose of this study was to describe the CT findings of focal organizing pneumonia and to compare the findings with pathology. CT findings of histologically proven focal organizing pneumonias in 26 consecutive patients were analyzed. In 17 patients who had undergone surgical resections, the findings were correlated with pathology. Focal organizing pneumonias appeared as a nodule (n= 13) or a mass (n=13), ranging from 9 mm to 66 mm in diameter. Ground-glass opacity was seen in 6/13 (46%) nodules and 6.5/13 (50%) masses (k=.48) with an extent ranging from 5% to 75% (mean, 16%). In 4/26 (15%) patients, the extent was more than 50% of the lesion. They showed smooth (n=4), lobulated (n=8), spiculated (n=1), or lobulated and spiculated margin (n=13). On correlative analysis, nodule or mass on CT consisted histologically of intraalveolar exudate or microabscess, chronic inflammatory cell infiltration, fibrotic nodules, and polypoid granulation tissue in the alveolar or bronchiolar spaces. Ground-glass opacity consisted of interstitial fibrosis and chronic inflammatory cell infiltration and intraalveolar polypoid granulation tissue. Focal organizing pneumonia may simulate a lung cancer with variable appearances on CT and the findings reflect underlying histopathology of the disease.
Adult ; Aged ; Aged, 80 and over ; Female ; Human ; Male ; Middle Age ; Pneumonia/pathology/*radiography ; *Tomography, X-Ray Computed

Pulmonary hypertension is characterized by elevated pulmonary arterial pressure and secondary right ventricular failure. A thromboembolic occlusion of the proximal or distal pulmonary vasculature results in chronic thromboembolic pulmonary hypertension. We report an uncommon case that presented to our hospital with symptoms of dyspnea on exertion over 2 years. The patient had been treated for profound pulmonary thrombosis and right ventricular failure with adequate anticoagulation and sildenafil. Our echocardiography disclosed a large atrial septal defect with severe pulmonary hypertension and right ventricular failure. A diagnosis of Eisenmenger syndrome with pulmonary artery thrombosis was made. Although Eisenmenger syndrome with pulmonary thrombosis is well described in western societies, a huge pulmonary thrombosis is seldom reported in eastern countries. Profound pulmonary thrombosis may obfuscate the actual diagnosis of pulmonary artery hypertension with underlying congenital heart disease. A physical examination and echocardiography are essential in patients with pulmonary hypertension.
Arterial Pressure ; Dyspnea ; Echocardiography ; Eisenmenger Complex ; Heart Diseases ; Heart Septal Defects, Atrial ; Humans ; Hypertension ; Hypertension, Pulmonary ; Physical Examination ; Piperazines ; Pulmonary Artery ; Pulmonary Embolism ; Purines ; Sulfones ; Thrombosis ; Sildenafil Citrate

BACKGROUND: Ropivacaine and levobupivacaine, both single S-enantiomers, show less toxicity on the central nervous and cardiovascular system than racemic bupivacaine. Earlier studies have shown that levobupivacaine and bupivacaine are almost equipotent while ropivaciane was 60% less potent than bupivacaine. The aim of this prospective, double blinded study was to compare the clinical efficacy and safety of epidural anesthesia produced by 0.5% levobupivacaine and 0.5% ropivacaine for a cesarean section. METHODS: Sixty-two parturients undergoing an elective cesarean section were randomized to receive either epidural levobupivacaine 0.5% 20 ml (n = 31) or epidural ropivacaine 0.5% 20 ml (n = 31). Surgery was commenced when the sensory block had reached the dermatome level, T6. The onset, duration, quality of the sensory and motor block and abdominal muscle relaxation were evaluated. The blood pressure and heart rate of the mother and neonatal outcome, as assessed by the Apgar score and umbilical pH, were also recorded. RESULTS: There was no difference in the onset time, the segmental spread of sensory block and analgesic supplement between the two groups. However, levobupivacaine produced a longer duration of sensory block than ropivacaine (levobupivacaine 224.1 +/- 66.6 min, ropivacaine 176.5 +/- 32.8 min, P < 0.05). The onset time (except Bromage scale 2), intensity and duration of the motor block and muscle relaxation were similar in both groups. There was no difference in the maternal and neonatal outcomes between the two groups. CONCLUSIONS: 0.5% levobupivacaine and 0.5% ropivacaine produced equivalent efficacy and safety in epidural anesthesia for a cesarean section, but levobupivacaine resulted in a longer duration of sensory block.
Abdominal Muscles ; Anesthesia, Epidural* ; Apgar Score ; Blood Pressure ; Bupivacaine ; Cardiovascular System ; Cesarean Section* ; Female ; Heart Rate ; Humans ; Hydrogen-Ion Concentration ; Mothers ; Muscle Relaxation ; Pregnancy ; Prospective Studies ; Relaxation

<0.05). 4. Histologic examination revealed that AM protected leukocyte infiltration and epithelial migration was nearly completed at 4 weeks. Terudermis(R) group showed mild neutrophil infiltration until 2 weeks and completion of epithelization at 4 weeks. Control group showed massive leukocyte infiltration until 4 weeks. 5. Microvessels were increased sharply at 1 week and control group at 1 and 4 week showed significant differences with Terudermis(R) group of same interval(p<0.05) but no differences were found with AM group(p<0.05). CONCLUSION: EGF and EGF-R were well preserved in freeze-dried AM. AM attached to collagen acted as excellent biologic dressing which had similar effect with Terudermis(R). AM showed anti-inflammatory action and healing was completed at 4 weeks after full-thickness skin defect.
Amnion* ; Animals ; Bandages* ; Biological Dressings ; Collagen* ; Epidermal Growth Factor ; Leukocytes ; Microvessels ; Neutrophil Infiltration ; Rats* ; Skin ; Wound Healing* ; Wounds and Injuries*

BACKGROUND: We performed a prospective, double blind study to compare the clinical effect of vertical infraclavicular brachial plexus block produced by 0.5% levobupivacaine and 0.5% ropivacaine for upper limb surgery. METHODS: We included 60 patients receiving upper limb surgery under infraclavicular brachial plexus block. The infraclavicular brachial plexus block was performed via the vertical technique with 30 ml of 0.5% levobupivacaine or 0.5% ropivacaine. We observed which nerve type was stimulated and scored the sensory and motor block. The quality of block was assessed intraoperatively. The duration of sensory and motor block and complications were assessed. RESULTS: There were no significant differences in frequencies of stimulated nerve type, evolution of sensory and motor block quality, or success of block. There were no significant difference in duration of sensory block, but duration of motor block was prolonged after 0.5% levobupivacaine. There were no complications. CONCLUSIONS: Both 0.5% levobupivacaine and 0.5% ropivacaine had similar effects in the vertical infraclavicular brachial plexus block.
Amides ; Brachial Plexus ; Bupivacaine ; Double-Blind Method ; Humans ; Prospective Studies ; Upper Extremity

BACKGROUND: Continuous epidural analgesia with an opioid-local anesthetic combination is an effective strategy for postoperative pain relief after abdominal surgery. Levobupivacaine, the pure S (-) enantiomer of racemic bupivacaine, is similar to its native agent for anesthetic efficacy but has less cardiotoxic and neurotoxic potential than the bupivacaine. We compared the efficacy and safety of 0.1% levobupivacaine with sufentanil or 0.2% levobupivacaine with the same dose of suentanil for patient-controlled epidural analgesia after major abdominal surgery. METHODS: Forty patients scheduled for major abdominal surgery under general anesthesia were randomized to receive either 0.1% levobupivacaine with sufentanil 0.75microgram/ml (n = 20) or 0.2% levobupivacaine with sufentanil 0.75microgram/ml (n = 20) for postoperative epidural analgesia using a patient-controlled analgesia pump at a rate of 3 ml/h and bolus dose of 2 ml on demand. Visual analogue scale (VAS) pain scores at rest, on coughing, during mobilization from the supine to the sitting position and on ambulation were assessed during 48 hours following the surgery. In addition, degree of motor block and mobilization, additional analgesic requirements and adverse effects were assessed. RESULTS: There were no significant differences in VAS pain scores at rest, on coughing, during mobilization from the supine to the sitting position and on ambulation. There were no significant differences in mean volume of local anesthetic consumption, additional analgesic requirements, degree of motor block and mobilization and the incidence of adverse effects. CONCLUSIONS: 0.1% levobupivacaine with sufentanil provided comparable postoperative epidural analgesia and incidences of adverse effects to 0.2% levobupivacaine with the same dose of suentanil in patients undergoing major abdominal surgery.
Analgesia, Epidural ; Analgesia, Patient-Controlled ; Anesthesia, General ; Bupivacaine ; Cough ; Humans ; Incidence ; Pain, Postoperative ; Sufentanil ; Walking

BACKGROUND: Despite the established efficacy of dexamethasone and lidocaine for preventing postoperative airway symptoms, no study has investigated the effects of dexamethasone plus lidocaine for attenuating postoperative airway symptoms. The purpose of this study was to explore whether combined dexamethasone and lidocaine are superior to dexamethasone alone in reducing postoperative sore throat, cough, and hoarseness for 24 h after tracheal extubation. METHODS: In total, 70 female patients undergoing breast mass excision were randomized in a prospective, double-blinded manner into two groups: Group DL received intravenous dexamethasone (8 mg) plus lidocaine (1.5 mg/kg) 5 min before induction of anesthesia, and lidocaine was injected once more at the end of surgery. Group D received dexamethasone (8 mg) plus normal saline instead of lidocaine in the same manner as Group DL. We assessed the incidence and severity of postoperative sore throat, cough, and hoarseness 1 and 24 h after extubation. RESULTS: The incidence of sore throat for 24 h after tracheal extubation was significantly lower in Group DL than in Group D (62.9% vs. 85.7%, respectively; P = 0.029). The severity of sore throat and hoarseness for 24 h after extubation was lower in Group DL than in Group D (P < 0.05). The incidence and severity of cough did not differ between the two groups for 24 h after extubation. CONCLUSIONS: Lidocaine combined with dexamethasone is more effectively reduces the incidence and severity of sore throat and severity of hoarseness for 24 h after extubation in patients who have undergone breast mass excision surgery.
Airway Extubation ; Anesthesia ; Breast ; Cough* ; Dexamethasone* ; Female ; Hoarseness* ; Humans ; Incidence ; Lidocaine* ; Pharyngitis* ; Prospective Studies

OBJECTIVE: The aim of our study was to describe and compare the radiologic findings of esophageal leiomyomas. MATERIALS AND METHODS: The chest radiographic (n = 12), esophagographic (n = 12), CT (n = 12), and MR (n = 1) findings of surgically proven esophageal leiomyomas in 12 consecutive patients [ten men and two women aged 34 - 47 (mean, 39) years] were retrospectively reviewed. RESULTS: The tumors, surgical specimens of which ranged from 9 to 90 mm in diameter, were located in the upper (n = 1), middle (n = 5), or lower esophagus (n = 6). In ten of the 12 patients, chest radiography revealed the tumors as mediastinal masses. Esophagography showed them as eccentric, smoothly elevated filling defects in 11 patients and a multilobulated encircling filling defect in one. In 11 of the 12 patients, enhanced CT scans revealed a smooth (n = 9) or lobulated (n = 2) tumor margin, and attenuation was homogeneously low (n = 7) or iso (n = 4). In one patient, the tumor signal seen on T2-weighted MR images was slightly high. CONCLUSION: Esophageal leiomyomas, located mainly in the middle or distal esophagus, are consistently shown by esophagography to be mainly eccentrically elevated filling defects and at CT, lesions showing homogeneous low or isoattenuation are demonstrated.
Adult ; Comparative Study ; Esophageal Neoplasms/*diagnosis/radiography ; Esophagus/pathology ; Female ; Human ; Leiomyoma/*diagnosis/radiography ; Magnetic Resonance Imaging ; Male ; Middle Age ; Tomography, X-Ray Computed

We report a case of 29-year-old, morbidly obese, diabetic primigravida who had undergone previously primary percutaneous coronary intervention with stent placement for an inferior wall myocardial infarction at 10 weeks of gestation. She remained asymptomatic with medication during the remainder of her pregnancy, but preoperative echocardiography revealed left ventricular dilation and a restrictive diastolic dysfunction with a preserved ejection fraction (46%). She developed acute pulmonary edema associated with hypertension after an elective Cesarean delivery under continuous epidural anesthesia despite the meticulous restriction of fluid.
Adult ; Anesthesia, Epidural ; Cesarean Section ; Echocardiography ; Female ; Humans ; Hypertension ; Inferior Wall Myocardial Infarction ; Myocardial Infarction ; Percutaneous Coronary Intervention ; Pregnancy ; Pulmonary Edema ; Stents

No abstract available.
Adrenoleukodystrophy* ; Anesthesia* ; Child* ; Humans