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 23,843 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We report 4 cases of inadvertent subdural injection of local anesthetics among 640 patients receiving epidural anesthesia. In contrast to subarachnoid injection a typical sign was the development of patchy anesthesia in cervical segments and with late onset of symptoms. The case of a 63 year old woman scheduled for aortofemoral bypass surgery in epidural anesthesia is reported. She developed paresthesia, paresis and signs of sympatholysis in both arms 30 min after the injection of 10 ml bupivacaine 0.5% at T10-11. These symptoms lasted for 7 h. Subdural injection was documented using radiopaque dye. Two other cases of probable subdural injection leading to paresthesia and paresis in cervical segments after lumbar injection of 50 or 75 mg bupivacaine are reported. The symptoms began 15-30 min after injection and lasted for 60 min. The fourth case was that of a 26-year-old woman scheduled for cesarean section under epidural anesthesia. Following the injection of 75 mg bupivacaine 0.5% patchy anesthesia extending to T10 developed. By 10 min after an additional injection of 25 mg bupivacaine 0.5% she had paresis and paresthesia in both arms and was unable to cough. Her trachea was therefore intubated; 30 min later the level of anesthesia was below T5 and she could be extubated. Uneventful cesarean section was then performed. These cases demonstrate that as well as subarachnoid injection, inadvertent subdural injection of local anesthetic agents is a potential hazard of epidural anesthesia, not only in patients in an advanced state of pregnancy but also in nonpregnant patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Subdural spread of a local anesthetic following installation of a peridural catheter]. 235 46

The patient was a 29-year-old woman. She was well until autumn 1983, when she presented with polyarthralgia, fever above 39 degrees C, hepatosplenomegaly, swelling of lymphnode and salmon pink rash. Laboratory tests revealed marked leucocytosis with shift to the left, elevated ESR, strong positivity of CRP and abnormal liver function tests. However, anti-nuclear antibody and RA factor were negative. She was diagnosed as adult onset Still's disease (AOSD) by characteristic clinical course and laboratory data. During her disease course these abnormal findings could be well controlled neither by nonsteroidal anti-inflammatory drugs, immunosuppressive agents nor corticosteroids. Two and half years after the first admission, she began to complain of dry cough, dyspnea on efforts. Auscultation revealed an increased pulmonic sound and systolic murmur of cardiac apex. Chest X-Rays showed enlarged main pulmonary arteries. The lung fields were normal. Pulmonary function tests gave no evidence of a significant obstructive or restrictive defect but showed the low DLco and hypoxemia. Ventilation-perfusion lung scanning failed to reveal pulmonary embolism. Finally, right heart catheterization confirmed the pulmonary precapillary hypertension. Her pulmonary hypertension has progressed rapidly, strongly suggesting poor prognosis. Her pulmonary hypertension associated with no apparent parenchymal involvement was thought to be caused by a pulmonary vascular change probably related to AOSD. This case is a first case of AOSD with pulmonary hypertension.
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PMID:[A case of adult Still's disease with pulmonary hypertension]. 237 40

A 64-year-old woman complained of chest pain, back pain and dry cough. Chest X-ray film showed marked left hilar enlargement and left pleural effusion. Biopsy of the bronchial mucosa and demonstrated small cell carcinoma of the lung. Treatment with cisplatin, adriamycin and etoposide led to regression of symptoms and chest X-ray findings within 3 months. She received maintenance chemotherapies at the outpatient clinic for 2 years after the first therapy. Thirty-months after the first admission, chest X-ray film showed multiple small nodules in the left upper lobe. Chest tomography and high-resolution computed tomography showed acinar or lobular nodules disseminated in the left upper lobe. Mycobacterium tuberculosis was obtained from bronchoalveolar lavage fluid of the left upper lobe. Pulmonary tuberculosis in a long-term survivor of small cell carcinoma of the lung is very rare.
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PMID:[A case of pulmonary tuberculosis in a long-term survivor with small cell carcinoma of the lung]. 255 15

A clinico-radiologic analysis of 15 cases with exogenous allergic alveolitis in pigeon breeders was reported. There were 4 male and 11 female. The age ranged from 15-68 years, averaging 33.5 years. All cases had history of intimate contact with pigeons. The clinical manifestations were dry cough, dyspnea and Velcro's rales at the base of the lung. The X-ray appearances included increased, coarsened, tortuous and hazy lung markings, reticular shadows, ground glass appearance due to decreased lung lucency, patchy shadows and honeycombed areas of lucency etc. These findings however were nonspecific, and must be differentiated from other diseases. Therefore X-ray signs must be closely correlated with clinical picture before making the diagnosis.
Zhonghua Fang She Xue Za Zhi 1989 Jun
PMID:[Exogenous allergic alveolitis--a clinico-radiologic analysis of 15 cases of pigeon breeder's lung]. 258 4

A 28-year-old Chinese woman having sarcoidosis with ocular involvement was reported. She demonstrated bilateral hilar lymphadenopathy in a chest X-ray which was taken for a cough. Transbronchial lung biopsy revealed noncaseating epithelioid granulomas. Blurred vision occurred 8 months later when conjunctival follicle-like masses, granulomatous keratic precipitates, iridocyclitis, "snow-ball" vitreous opacity, and retinal periphlebitis developed in both eyes. Biopsy of the conjunctival follicle-like masses revealed noncaseating granulomas composed of epithelioid cells and multinuclear giant cells, typical of sarcoidosis. The ocular lesions waned under topical steroid treatment and vision improved. This is the only case with an ocular involvement among the 10 cases of sarcoidosis seen during the past 20 years at the Taipei Veterans General Hospital.
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PMID:[Sarcoidosis with ocular involvement]. 259 50

A 16-year-old, 28-week pregnant woman was admitted to our hospital with multiple bone fractures caused by a traffic accident. She had massive blood transfusion because of anemia in her laboratory findings and ritodrine hydrochloride was administered because of the fear of threatened abortion. She developed a cough with bloody sputum on the 4th day after admission, and developed pulmonary insufficiency with PaO2 41.0 torr and presented bilateral diffuse infiltrates on chest roentgenograms on the next day. Swan-Ganz catheterization revealed normal pulmonary capillary wedge pressure and analysis of the lavage fluid from the patient showed an increase in the percentage of neutrophils (40.0%) and the existence of leukotriene B4 which is known to be the most potent chemokinetic and chemotactic agent for neutrophils. Her condition was considered to be permeability edema developing adult respiratory distress syndrome (ARDS) and 1 g/day of methylprednisolone was administered intravenously for 3 days, which brought about remarkable improvement of her respiratory failure. This report suggests that analysis of the lavage fluid may provide useful information for the early diagnosis of ARDS and the indications of corticosteroid treatment.
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PMID:[Increased neutrophils in bronchoalveolar lavage fluid from a patient with developing adult respiratory distress syndrome]. 261 14

A 60-year-old woman was admitted to our hospital in June 1985, complaining of fever, cough and right lower chest pain, with a five-year history of asymptomatic primary biliary cirrhosis. Chest X-ray on admission showed an infiltrative shadow in the right lower lung field. She was first treated with various antibiotics unsuccessfully. Hemoptysis continued. Dyspnea and anemia appeared. Chest X-ray 17 days after admission showed multiple infiltrative shadows in the both lung fields. She was treated with steroid pulse therapy successfully. During prednisolone treatment decreasing nodular shadows with cavities appeared on chest X-ray. An open lung biopsy was performed in March 1986. The histologic findings showed a necrotizing vasculitis with granuloma and perivascular fibrosis. She was treated with prednisolone and prednisolone-azathioprine therapy unsuccessfully, but successfully with prednisolone-cyclophosphamide therapy. This case was a rare case of Wegener's granulomatosis with transition from fulminant type to granulomatous type. No similar case of Wegener's granulomatosis with asymptomatic primary biliary cirrhosis has been reported in the literature.
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PMID:[Wegener's granulomatosis in a woman with asymptomatic primary biliary cirrhosis]. 263 Jul 76

We reported a case of pneumonitis due to Sho-saiko-to. A 71-year-old woman was admitted to our hospital because of pneumonia. She complained of dry cough, pyrexia and severe dyspnea. Fine crepitation was heard on physical examination of the chest and a chest X-ray film revealed diffuse reticulo-nodular shadow in both lung fields. We suspected summer-type hypersensitivity pneumonitis and followed her up, however her condition deteriorated. Under a suspicion of drug-induced pneumonitis, all drugs were stopped and she was given prednisolone. Consequently her complaints, laboratory data and chest X-ray findings markedly improved. Microscopic examination of a transbronchial lung biopsy specimens showed interstitial pneumonitis. The results of a lymphocyte stimulation test were positive for sho-saiko-to. She gave informed consent after receiving an explanation of the challenge test. She was tested with 2.5 g sho-saiko-to twice and developed high fever and dyspnea with hypoxia, while the chest X-ray film also revealed diffuse infiltrative shadows similar that on admission. Based on these findings, we diagnosed this case as pneumonitis due to sho-saiko-to. To our knowledge, there has been no previous case of pulmonary hypersensitivity due to sho-saiko-to reported in the world.
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PMID:[A case of pneumonitis due to sho-saiko-to]. 263 Jul 77

A 35-year-old obese black American woman presented with nausea, vomiting, diarrhea, fever, cough, and chest pain of 2 weeks duration. She was pancytopenic and acidotic, with respiratory failure and hypotension. A diagnosis of septic shock was made, and the patient died 48 hours after admission. Blood cultures were positive for organisms that were reported to be Klebsiella rhinoscleromatis. At autopsy she had massive hepatic necrosis with numerous Mikulicz's cells. The lungs, spleen, and bone marrow were also involved. To our knowledge, this is the first report of a case of systemic infection with K rhinoscleromatis.
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PMID:Disseminated Klebsiella rhinoscleromatis infection. 268 80

A 57-year-old woman who suffered from acute myeloblastic leukemia during the course of chronic thyroiditis, is described. The patient was diagnosed as having chronic thyroiditis in 1984 when she was 53 year-old, and was treated with L-T4.Na. She admitted in July 1988 because of general fatigue, fever, cough and sore throat. On admission, hematological examination in the peripheral blood showed marked anemia and increased leukocytes with 20.5% leukemic cells positive for peroxidase staining. Bone marrow aspiration showed 38.8% leukemic cells. She was diagnosed acute myeloblastic leukemia. She reached complete remission after combination chemotherapy. The case of acute myeloblastic leukemia associated with chronic thyroiditis is rarely reported. We reviewed the literature and discussed acute myeloblastic leukemia associated with chronic thyroiditis including this case.
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PMID:[Acute myeloblastic leukemia associated with chronic thyroiditis]. 269 19


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