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 28,634 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We experienced perioperative management for excision of a huge sternal chondrosarcoma squeezing the heart. A 46-year-old woman could not sleep due to dyspnea for 6 months. Dyspnea increased in the right decubitus and disappeared in the left decubitus. This suggested that the heart was squeezing the tumor. MRI and echocardiography revealed no invasion to the heart. Surgical removal was proposed. Anesthesia was induced with propofol and fentanyl. As this tumor composed of bone-like tissue and was tightly connected with thoracic cage, we thought that the use of muscle relaxant at the induction of anesthesia would not cause cardiovascular collapse and ventilation insufficiency even if the tumor was huge. Vecuronium was administered to facilitate endotracheal intubation. Hemodynamic variables were stable and mask ventilation was uneventful. Anesthesia was maintained with propofol, sevoflurane, supplemental dose of fentanyl and epidural anesthesia. The tumor had invaded the myocardium and was successfully flaked off from the myocardium without using any assisted devices. The tumor was excised including thoracic wall (sternum and parts of 3rd to 12th ribs, 20 cm in diameter). Thoracoplasty was performed using Marlex Mesh. Muscle relaxant was reversed after the end of the operation. Respiration was stable without flail chest. Endotracheal tube was successfully removed in the operation room. The postoperative course was uneventful.
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PMID:[Anesthetic management of a patient with squeezed heart by huge sternal tumor]. 1291 Sep 79

We followed, prospectively, 77 patients (90 hips) with early-stage, non-traumatic osteonecrosis of the femoral head for a mean period of nine years. At the time of final review, 56 (62%) were symptomatic. Using the Cox model, the initial radiological stage, the progression of staging, the reduction in size of the lesions and the percentage of necrotic volume on MRI were identified as risk factors. Using the Harris score of < 70 or surgery as the endpoint, the cumulative rates of survival were 60.0% at one year, 43.3% at two years, 38.9% at five years and 37.2% at ten years. Survival curves demonstrated that clinical deterioration could occur 90 months after the initial diagnosis, suggesting that asymptomatic patients should be followed carefully for several years. Radiological time-dependent reduction in size without progressive collapse may represent repair even when the collapse is minimal.
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PMID:Mid-term prognosis of non-traumatic osteonecrosis of the femoral head. 1293 94

The authors measured the average diameter of bilateral superior ophthalmic veins (SOV) in 13 patients with spontaneous intracranial hypotension (SIH) on contrast-enhanced, coronal, T1-weighted MRI. Compared with sex- and age-matched neurology inpatients with normal CSF pressure, the SIH group had a smaller SOV diameter (0.90 vs 1.85 mm, p < 0.001), which partly reversed after treatment (1.09 vs 0.90 mm, p = 0.045, n = 7). Collapsed SOV might provide an additional MRI finding for SIH.
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PMID:Collapsed superior ophthalmic veins in patients with spontaneous intracranial hypotension. 1461 Jan 34

There are few articles in the literature concerning anterior instrumentation in the surgical management of spinal tuberculosis in the exudative stage. So we report here 23 cases of active thoracolumbar spinal tuberculosis treated by one-stage anterior interbody autografting and instrumentation to verify the importance of early reconstruction of spinal stability and to evaluate the results of one-stage interbody autografting and anterior instrumentation in the surgical management of the exudative stage of throracolumbar spinal tuberculosis. Twenty-three patients, including two children (9 and 15 years old, respectively) and 21 adults with thoracolumbar spinal tuberculosis were treated surgically. T9 to L4 spinal segments were affected, and MRI/CT showed evident collapse of the vertebrae because of tuberculous destruction and paravertebral abscess. Neurological deficits were found in 15 patients. Before surgery, patients received standard anti-tuberculosis chemotherapy for 2 to 3 weeks. Under general endotracheal anaesthesia, the patients were placed in right recumbent positions, and a transthoracic, lateral extracavitary or extrapleural approach was chosen according to the tuberculosis lesion segment. After exposure, the tuberculous lesion region, including the collapsed vertebrae and in-between intervertebral disc, was almost completely resected in order to release the segmental spinal cord. Then, autologous iliac, rib or fibular graft was harvested to complete interbody fusion, and an anterior titanium-alloy plate-screw system was used to reconstruct the stability of the affected segments. Anti-tuberculosis chemotherapy was continued for at least 9 months, and the patients were supported with thoracolumbosacral orthosis for 6 months after surgery. All patients were followed up for an average of 2 years. All 23 cases were healed without chronic sinus formation or any recurrence of tuberculosis during the follow-up period. Spinal fusion occurred at a mean of 3.8 months after surgery. Of all patients with neurological deficits, 14 patients showed obvious improvement; only one patient with Frankel C lesion remained unchanged, but none of the patients got worse. During the follow-up period, a mean of 18 degrees of kyphosis correction was achieved after surgery in the adult group. Moderate progressive kyphosis because of this procedure fusion occurred postoperatively in a 9-year-old child after 2 1/2 years; another 15-year-old child did not demonstrate this phenomenon. Except for the early loosening of one screw in two cases (which did not affect the reconstruction of spinal stability), no other complications associated with this procedure were found during follow-up. Early reconstruction of spinal stability plays an important role in the surgical management of spinal tuberculosis. One-stage anterior interbody autografting and instrumentation in the surgical management of the exudative stage of spinal tuberculosis show more advantages in selected patients, but supplementary posterior fusion should be considered to prevent postoperative kyphosis when this procedure is performed in children.
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PMID:One-stage anterior interbody autografting and instrumentation in primary surgical management of thoracolumbar spinal tuberculosis. 1468 31

A 21-year-old woman was referred to our hospital for sudden onset of right flank distension. Ultrasonography, abdominal CT scan and MRI revealed a giant cyst 20 x 11 x 10 cm on the right kidney. Percutaneous puncture of the lesion was performed and fluid was drained. The fluid was yellowish and puriform. Gradually, the drainage fluid creatinine concentration increased. Cystography revealed communication between the lesion and the pyelocalyceal system. The patient underwent drainage for 25 days, causing the cyst to almost fully collapse. No recurrence has been detected in the follow-up for about 1 year. This case is the 38th case of the rupture of a renal cyst reported in the Japanese literature. We reviewed 37 cases of rupture of renal cysts previously reported in Japan.
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PMID:[Spontaneous rupture of infected renal cyst presenting sudden onset of right flank distension: a case report]. 1523 85

Spontaneous osteonecrosis of the medial tibial plateau is less recognized than osteonecrosis of the medial femoral condyle, but it presents in a similar manner. These patients have a sudden onset of pain on the medial side of the knee associated with a spectrum of MRI changes in the tibial subchondral bone. The small lesions can resolve with only minimal residual scar remaining in the subchondral zone. If the lesion is large, it can collapse or show MRI changes of osteonecrosis. Recognition of this problem may help avoid unnecessary intra-articular surgical intervention.
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PMID:Spontaneous osteonecrosis of the knee: tibial plateaus. 1527 45

A 68-year-old woman had felt a chest and back pain for 3 months. Gradually her symptom became aggravated, and she felt severe dyspnea in supine position and dysphagia combined with superior vena cava syndrome. A huge posterior mediastinal tumor was revealed and her esophagus was severely narrowed on the chest MRI. Therefore, emergency tumor resection was scheduled under general anesthesia. Anesthesia was induced by midazolam (2 mg) with the patient in the right lateral position. After gas exchange and oxygenation were comfirmed by pulse oximetry reading and clinical signs, she was slowly turned to supine position. But, suddenly, ST-segment depression and low amplitude developed in electrocardiogram and systolic blood pressure was depressed to below 60 mmHg. Therefore, she was rapidly retuned to right lateral position, and ST-segment and systolic blood pressure recoverd. On the next time, although she was slowly turned to the right semi-lateral position, there was almost no circulatory failure. A bronchial tube was intubated in her left bronchia under bronchoscope. We should remember that the preparation of percutaneous cardiopulmonary support (PCPS) should be considered as a means of protection against cardiovascular collapse or airway obstruction perioperatively.
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PMID:[A patient with a huge posterior mediastinal tumor and ST-segment depression in electrocardiogram]. 1544 83

The purpose of this study was to use cine-MRI during continuous respiration to measure the respiratory lumenal diameter change in the pharynx and at an upper tracheal level. Fifteen non-smokers and 23 chronic obstructive pulmonary disease (COPD) patients with smoking history (median 50 pack-years) were included. Cine-MRI with seven frames/s was performed during continuous respiration. Minimal and maximal cross-sectional lumenal diameters within the pharynx and the upper tracheal lumen area were measured. The median diameter change in the pharynx (tracheal area) was 70% (1.4 cm(2)) in volunteers and 76% (1.7 cm(2)) in smokers (P=0.98, P=0.04). Tracheal lumenal collapse was a median of 43% in volunteers and 64% in smokers (P=0.011). No clear disease-related difference of the pharynx-lumen was found. The maximal cross-sectional area of the upper trachea lumen as well as the respiratory collapse was larger in COPD patients than in normal subjects. This information is important for the modelling of ventilation and prediction of drug deposition, which are influenced by the airway diameter.
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PMID:Respiratory lumenal change of the pharynx and trachea in normal subjects and COPD patients: assessment by cine-MRI. 1551 80

The cardinal and classic features of postural headache and low cerebrospinal fluid (CSF) pressure in intracranial hypotension may not dominate the clinical picture of the syndrome and may be associated with additional various neurological symptoms and signs. Reports of unusual clinical presentations continue to appear in the literature. Despite the considerable variability of the clinical spectrum, neuroradiological studies reveal more constant and characteristic features. Brain MRI findings include intracranial pachymeningeal thickening and post-contrast enhancement, subdural fluid collections and downward displacement or "sagging" of the brain. Spinal MRI findings include collapse of the dural sac with a festooned appearance, intense epidural enhancement owing to dilatation of the epidural venous plexus, and possible epidural fluid collections. In fact, spinal studies may demonstrate CSF leakage from spinal dural defects, which are considered the most common cause of the syndrome. Myelo-MR may suggest the possible point of CSF leakage, by demonstrating an irregular root sleeve; myelo-CT and radioisotope myelocisternography (RMC) are often needed to confirm the point of CSF leakage. Neuroimaging studies are, therefore, essential for suggesting and confirming the diagnosis.
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PMID:Headache and intracranial hypotension: neuroradiological findings. 1554 24

The prenatal diagnosis, natural history and management of mainstem bronchial atresia have not been described previously. We report two cases of prenatally diagnosed proximal bronchial atresia. The first patient presented at 18 weeks with sonographic and MRI findings consistent with bronchial atresia with fetal hydrops. The mother developed the mirror syndrome and labor was induced. A non-viable fetus was delivered at 25 weeks. The second patient presented at 16 weeks gestation with evidence of an intrathoracic mass that was subsequently prenatally diagnosed as a right mainstem bronchial atresia. The right lung increased rapidly in size and was associated with the onset of fetal hydrops. At 24 weeks, fetal pneumonectomy was performed but the fetus expired intraoperatively due to cardiovascular collapse. Post-mortem findings in both cases confirmed the presence of an atretic mainstem bronchus with massive enlargement of the lung. Bronchial atresia involving the mainstem bronchus is associated with a poor prognosis.
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PMID:Prenatal diagnosis and management of mainstem bronchial atresia. 1560 65


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