Giant solitary fibrous tumor of the pleura causing respiratory insufficiency: report of 3 cases.

We present 3 cases of solitary fibrous tumors (SFTs) occupying entire hemithorax and resulting in respiratory insufficiency. All patients were treated by complete resection, resulting in immediate re-expansion of the lungs and recovery from respiratory insufficiency. Although, two patients remain alive without recurrence, one patient had pleural recurrences three times over a 20-year period, all of which were treated by surgical resection. All of the primary tumors exhibited areas of hypercellularity, hemorrhage, or necrosis. All of the recurrent tumors in the recurrent case displayed large areas of hypercellularity, similar to the part of primary tumor. Although, the MIB-1 index in primary tumors was less than 5%, the index of the recurrent tumors increased up to 11% with repeated recurrence. Giant SFTs usually display hypercellularity, hemorrhage, or necrosis. Tumors with hypercellularity could recur. MIB-1 index could display malignant characteristics of recurrent tumors. Long-term follow-up for more than 10 years after surgery is necessary, particularly for tumors with areas of hypercellularity.

Sedation With Meperidine for Endobronchial Ultrasound-guided Transbronchial Needle Aspiration.

BACKGROUND: Although endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has become increasingly available and more widely used for the diagnosis of mediastinal lymph node lesions, there are few reports regarding methods of anesthesia. We conducted a retrospective study assessing the efficacy of meperidine (MP) for EBUS-TBNA. METHODS: Sixty cases that underwent EBUS-TBNA between January 2006 and December 2009 at the Kameda Medical Center were retrospectively analyzed. We classified them into 2 groups: cases that were performed under sedation with intravenous MP cases (n=31) and cases with general anesthesia (GA cases: n=29). Furthermore, we also classified the MP cases into 2 groups: patients above 65 years of age (elderly patients) and the others (young patients) to assess the safety of MP for the elderly. RESULTS: MP of 35 mg was administered just before EBUS-TBNA. Mean age, weight, physical status (American Society of Anesthesiologists grade), the size of the lesions, and examination time were not different between the MP and GA cases. Although the mean number of centesis for the MP cases was less than that of the GA cases (2.7 vs. 3.2 times; P<0.05), accurate diagnostic rates and sensitivity and specificity of each disorder were not different. Although the lowest saturation of peripheral oxygen during examination of the MP cases was lower than that of the GA cases (93.6% vs. 97.6%; P<0.05), GA cases required more vasopressor for a decline in the blood pressure than MP cases. Finally, none of the cases had any complications during or after the examination. In comparison between the elderly and young patients, the physical status, examination time, and the frequency or degree of complications were not different either. CONCLUSIONS: EBUS-TBNA under the intravenous sedation by MP was as feasible and safe as that under GA. It has a possibility to be one of the effective drugs for sedation during EBUS-TBNA regardless of age, and we should analyze its safety and efficacy in prospective studies henceforth.