The impact of saline flush of the epidural catheter on resolution of epidural anesthesia in volunteers: a dose-response study.

UNLABELLED: We evaluated the effect of 1, 20, and 40 mL of epidural saline flush on recovery from lidocaine epidural anesthesia. Eight volunteers were studied for three study periods, each separated by 72 h. The volume of saline was randomized, and a new catheter was inserted for each study period. A standardized dose of 20 mL of 2% plain lidocaine was injected for 10 min, followed by an epidural saline flush 30 min later. Sensory block was assessed by pinprick and transcutaneous electrical stimulation and motor block by a modified Bromage scale and isometric maximal force contraction. Times to void and ambulate independently before discharge were recorded. Peak plasma lidocaine concentrations and time to peak concentration were determined. Results from six volunteers showed that epidural saline, 40 mL, significantly altered anesthetic resolution, accelerating the time of complete sensory and motor block regression (P < 0.05). Median peak levels of sensory and motor block and times to void and ambulate were similar among treatment groups. Peak plasma lidocaine concentrations were similar in all treatment groups. Our data suggest that a 40-mL epidural saline injection 30 min after the induction facilitates regression of epidural lidocaine anesthesia, but a 20-mL bolus does not. Epidural saline injection does not affect vascular absorption of epidural lidocaine. IMPLICATIONS: Epidural catheter flushing with 40 mL of saline, after establishment of epidural lidocaine anesthesia, can facilitate sensory and motor block recovery. However, this does not affect vascular absorption of epidural lidocaine.

Endovaginal sonographic appearance of benign ovarian masses.

This article illustrates the different appearances of benign ovarian and paraovarian masses at endovaginal sonography. A retrospective study was performed of the records for 118 patients with 140 surgically proved benign adnexal masses, including dermoid cysts (n = 27), endometriomas (n = 40), epithelial inclusion cysts (n = 14), serous cystadenomas (n = 11), mucinous cystadenomas (n = 14), fibromas (n = 11), cystadenofibromas (n = 12), paratubal cysts (n = 5), hydrosalpinges (n = 3), and tubo-ovarian abscesses (n = 3). Preoperative diagnosis was made in 96% of the dermoid cysts on the basis of a hyperechoic attenuating component or multiple small horizontal interfaces and in 100% of uncomplicated fibromas on the basis of a hypoechoic attenuating mass. There was an overlap among the endovaginal sonographic appearances of the other condition.

Transvaginal US appearance of endometrial abnormalities.

A retrospective study was performed on a series of 44 patients who had undergone transvaginal ultrasound (US) before hysterectomy. The surgically proved endometrial abnormalities included cystic atrophy, cystic and adenomatous hyperplasia, polyps, and malignancy. The following endometrial findings were evaluated: endometrial thickness, echogenicity, smoothness or irregularity of the contour, definition of the contour, and the presence of cystic areas. Some overlapping features were present between the benign and malignant conditions. Although cystic changes were seen in 76% of benign conditions manifesting with endometrial thickening, cystic changes were also present in 24% of endometrial malignancies. In the majority of endometrial malignancies, the endometrial contour was poorly defined, but 40% of the cases manifested as well-defined endometrial thickening. Most endometrial carcinomas (88%) were either diffusely or partially echogenic, 12% were isoechoic, and there was no endometrial carcinoma that was purely hypoechoic. Although the presence of cystic changes favors a benign condition, malignancy cannot be reliably excluded. Malignancy should be considered in the presence of a poorly defined, irregular endometrium. Transvaginal US has a significant role in the assessment of the endometrium, and although it can help in the differentiation between some benign and malignant conditions, there remain some overlapping features.

Hypoechogenic embryologic ventral aspect of the head and uncinate process of the pancreas: in vitro correlation of US with histopathologic findings.

PURPOSE: To evaluate the hypothesis that hypoechogenicity of the embryologic ventral aspect of the head of the pancreas is due to diminished fat content. MATERIALS AND METHODS: Ultrasound and histopathologic findings in 13 pancreatic autopsy specimens were compared, and the prevalence of areas of hyperattenuation of the embryologic ventral aspect of the head of the pancreas at computed tomography (CT) was studied. RESULTS: In vitro examination of pancreatic autopsy specimens showed this variant in seven (54%) of the 13 specimens, and histopathologic correlation confirmed that there is diminished fat content corresponding to the hypoechoic portion of the head of the pancreas. This difference in attenuation was visible on 21 (22%) of 96 CT scans. There was a statistically significant (P < .05, r = .212) increase in the prevalence of this finding with increasing age. CONCLUSION: Hypoechogenicity of the embryologic ventral aspect of the head of the pancreas is due to diminished fat content. This difference in attenuation is also commonly seen on CT scans.