[Cystic and cavitary lesions of the lung: imaging characteristics and differential diagnosis]. / Kystes et cavités du poumon: description sémiologique et approche étiologique.

Gas containing lesions of the lung can be differentiated into cystic and cavitary lesions based on their imaging characteristics, which is helpful for differential diagnosis. The imaging features include number, size, thickness and smoothness of the walls, content, lesion distribution and occasional associated lesions. Some imaging features have characteristic diagnostic implications: mural nodule and meniscus sign. Cysts are characterized by thin and regular walls, less than 2 mm in thickness. The differential diagnosis includes: histiocytosis X, lymphangioleiomyomatosis, cystic metastases, septic emboli, pulmonary sequestration. Emphysema, honeycombing and cystic bronchiectases should also be considered. Cavitary lesion have thicker walls. The most frequent etiologies include abscess, cavitary tumors, mycobacterial infections and fungal infections.

Combined regional-general anesthesia: evaluation of remifentanil based general anesthesia and postoperative epidural analgesia.

OBJECTIVES: To evaluate whether remifentanil based general anesthesia combined with epidural analgesia for postoperative pain, has any advantages with respect to consumption of drugs, blood loss, quality of pain control, hemodynamic profile, in major abdominal surgery, as compared to other combined techniques. METHODS: A retrospective study based on chart reviews of patients who have undergone colectomy, radical cystectomy and radical prostatectomy over one year period in our Institution, operated under combined regional-general anesthesia. Twenty-six patients were analyzed and were divided into three groups according to the type of anesthesia received. Group A: combined general-epidural for per-operative and postoperative pain (10 patients). Group B: combined spinal-general anesthesia (8 patients) post-operative analgesia consisted of parenteral mepiridine and paracetamol. Group C: remifentanil based general anesthesia followed by epidural for postoperative analgesia (8 patients). RESULTS: The demographic data, age and M/F distribution were comparable in the three groups. The remifentanil group showed less utilization of muscle relaxant (Cisatracurium) with respect to other groups (p < 0.001). The amount of intraoperative blood loss was not significantly different among the three groups. The efficacy of the postoperative epidural analgesia was demonstrated by the minimal utilization of analgesics (p < 0.05 and 0.01) in group A and C as compared to group B. In the group of remifentanil, the blood pressure was more stable and maintained at a systolic of 80-100 mmHg as compared to initial hypotension mainly in group C. CONCLUSION: The use of remifentanil based general anesthesia offers the advantage of non-accumulation of drugs and hemodynamic stability. Post-operative analgesia can be provided by epidural route which proved to be satisfactory in the remifentanil group. The effect on blood loss was not conclusive in this study.

Evaluation of remifentanil in endoscopic retrograde cholangio-pancreatography.

BACKGROUND AND OBJECTIVE: Endoscopic retrogade cholangio-pancreatography (ERCP) is a painful procedure that requires transient analgesia and conscious sedation. Remifentanil an ultrashort, very potent narcotic, is eliminated by plasma esterases, and does not interfere with liver function. It does not accumulate and is free of residual depression. Our aim is to find out if remifentanil can provide safe and effective sedation in ERCP, without undue technical difficulty secondary to sphincter spasm. PATIENTS AND METHODS: Thirty five patients, ASA I-II and III, scheduled to undergo elective ERCP were divided randomly in two groups: Midazolam-remifentanil group (group I), received remifentanil a loading dose of 0.2 microg/Kg/min over 5 minutes and a maintenance dose of 0.1-0.15 microg/Kg/min to achieve an adequate level of sedation and analgesia. Midazolam-fentanyl group (group II), received intermittent doses of midazolam and fentanyl guided by level of sedation. All patients were premedicated with midazolam 0.05 mg/kg IV, in divided doses as per patient tolerance, before starting the procedure. Sedation was assessed depending on Ramsey scale of sedation. SpO2, blood pressure, heart rate, respiratory rate, dosages of the medications, peroperative amnesia and operative time were recorded. Operator and patient satisfaction were rated on a scale of 1 to 4. RESULTS: There were statistically significant differences in the level of sedation (p = 0.003), patient satisfaction (p = 0.01) and the amount of midazolam used (p < 0.01) in favor of group I. Operator satisfaction was the same in the two groups. There was no statistically significant difference between the two groups regarding the peri-operative amnesia. The technical difficulty (catheterization of ampulla, duration of procedure, need of parasympatholytics...) was comparable in the two groups, as judged by the operator. There was one case of mild desaturation in group I that responded to stimulation. No other respiratory or cardiovascular events were noted. CONCLUSION: We recommend remifentanil in ERCP. Vigilance, however, must be exercised in titration and supervision of patients.

[Stiffened triple axial catheterization of tortuous cervivoencephalic vessels]. / Cathétérisme triple axial renforcé des tortuosités cervico-encéphaliques.

Tortuous anatomy of the cervicoencephalic vessels can cause failure in 4 to 6% of interventional procedures by slippage of the material back in the aorta, kinking or difficulty to move forward a balloon. stent or microcatheter. We report on an old patient with high vascular tortuosity, referred for embolization of a ruptured aneurysm of the left inferior cerebellar artery. Access wasn't possible until we used a "triple axial system" with a long 7F sheath, positioned in the left subclavian artery and strongly supported by a super stiff guidewire with its distal end floating freely in the vascular lumen. Inside the sheath and parallel to the guidewire, we pushed a 4F catheter till the mid-vertebral artery. The microcatheter-microguide system tracked through it, towards the aneurysm, with the backward tendency being neutralized by the increased stiffness. Our technique presents the advantage of a strong back-up support, without increased risks such as vasospasm, clotting or dissection, since the guidewire serving as a stiff rail, lies exteriorly to the navigated vessel. Efficiency of this elegant and relatively low risk solution has yet to be proved in larger series.

[Unusual variation of the splenic artery]. / Variante originale de l'artère splénique.

The authors describe an exceptional variation of the splenic artery found on a preoperative angiogram and confirmed after surgery on splenopancreatectomy specimens. Total duplication of the splenic artery is herein reported for the first time and suggest the need for a new classification of digestive arteries anomalies.

Oxigenoterapia domiciliaria en niños con displasia broncopulmonar / Home oxygen therapy in children with bronchopulmonary dysplasia

Con el objeto de evaluar la factibilidad, ventajas y complicaciones de la oxigenoterapia ambulatoria en el tratamiento de la displasia broncopulmonar (DBP) se estudiaron 8 casos de DBP grave dados de alta del servicio de neonatología de una clínica privada de Santiago. La edad gestacional era 27 ñ 2 semanas, el peso al nacer 1.181 ñ 353 g, el alta se dio con oxemia estable con oxígeno en naricera y flujo inferior a 1,5 1 min, PCO2 menor de 50 mmHg y peso ascendente. Antes del alta se adiestró a los padres en la administración del oxígeno y en técnicas básicas de reanimación. Se administró oxígeno en domicilio por 71 días en promedio (rango 7 a 339), con buena aceptación familiar, sin dificultades ni complicaciones y sólo dos rehospitalizaciones, ambas por bronconeumonía. El incremento ponderal se mantuvo entre los percentiles 3 y 50. La oxigenoterapia en domicilio es una alternativa ventajosa en el tratamiento de la DBP

Septicemia neonatal de comienzo precoz por Listeria monocytogenes / Listeria monocytogenes early onset neonatal sepsis

Se presentan seis casos de septicemia neonatal de comienzo precoz por Listeria monocytogenes diagnosticados entre diciembre de 1984 y noviembre de 1986. Se destacan algunos signos clínicos peculiares como la presencia de meconio en el líquido amniótico, asociado a prematurez, hepatomegalia, esplenomegalia, exantema maculopapular y el hallazgo de proctitis con prolapso anal. Cuatro de los seis pacientes evolucionaron muy grave con compromiso pulmonar extenso y requirieron de ventilación mecánica, tres de ellos fallecieron en los primeros cinco días a pesar del diagnóstico y tratamiento oportunos. La gravedad y alta letalidad de esta enfermedad hace necesario intentar reconocer la infección materna cuyo tratamiento podría prevenir la sepsis neonatal