Comparison of fiberoptic bronchoscopic intubation using silicone and polyvinyl chloride double-lumen tubes / 대한마취과학회지

Background@#Direct insertion of a double-lumen tube (DLT) using a flexible fiberoptic bronchoscope (FOB) is an option for DLT intubation. The difficult process of fiberoptic intubation is that the different properties of polyvinyl chloride and silicone DLTs may affect railroading differently. Therefore, we aimed to compare intubation using polyvinyl chloride and silicone DLTs over an FOB. @*Methods@#Patients aged 19–75 years who required one-lung ventilation under general anesthesia were enrolled in this study. After induction of anesthesia, the anesthesiologist intubated the DLT using FOB. The primary outcome was the difficulty of railroading over the flexible FOB scaled into five grades (I, II-1, II-2, III, and IV). Additionally, the intubation time and mucosal damage were recorded. @*Results@#A total of 46 patients participated in this study, 23 each in the silicone and polyvinyl groups. The difficulty of railroading over the FOB was significantly different between the two groups (P < 0.001). In the silicone group, the grades of difficulty in railroading were limited to I and II-1; 20 patients (87%) presented no difficulty in advancing the tube. In contrast, in the polyvinyl group, 13 patients (57%) had scores of II-2 and III. Both the intubation time and mucosal damage were significantly better in the silicone group than in the polyvinyl group. @*Conclusions@#Intubation using a silicone DLT over an FOB was easier and faster than that with a polyvinyl chloride DLT with lesser trauma around the glottis.

Radiologic Findings of Emphysematous Pyelonephritis

PURPOSE: Emphysematous pyelonephritis is a rare, life threatening infection of kidney and the pennephric space, characterized by the production of gas within the renal parenchyma. The aim of this study is to analyze the clinical and radiologic characteristics of emphysematous pyelonephritis. MATERIALS AND METHODS: We reviewed 7 cases of the emphysematous pyelonephritis. Six patients had plain abdominal radiographs, ultrasonograms and abdominal CT scans. Only one patient had plain radiograph and ultrasonogram. In 5 operated cases, CT findings were compared with surgical records. RESULTS: Plain radiographs showed characteristic diffuse mottling of gas in renal fossa. On sonogram, intrarenal gas was identified as echogenic loci with dirty shadows. CT scan showed inflammatory mass with gas and fluid levels in adjacent to the kidney. CT findings corresponded relatively wall with the surgical findings in regard to disease extent. CONCLUSION: lntrarenal gas in appropriate clinical setting is highly specific for emphysematous pyelonephritis. CT is the most sensitive method for demonstrating the disease extent as well as specific diagnosis.

Radiologic Findings of Emphysematous Pyelonephritis

PURPOSE: Emphysematous pyelonephritis is a rare, life threatening infection of kidney and the pennephric space, characterized by the production of gas within the renal parenchyma. The aim of this study is to analyze the clinical and radiologic characteristics of emphysematous pyelonephritis. MATERIALS AND METHODS: We reviewed 7 cases of the emphysematous pyelonephritis. Six patients had plain abdominal radiographs, ultrasonograms and abdominal CT scans. Only one patient had plain radiograph and ultrasonogram. In 5 operated cases, CT findings were compared with surgical records. RESULTS: Plain radiographs showed characteristic diffuse mottling of gas in renal fossa. On sonogram, intrarenal gas was identified as echogenic loci with dirty shadows. CT scan showed inflammatory mass with gas and fluid levels in adjacent to the kidney. CT findings corresponded relatively wall with the surgical findings in regard to disease extent. CONCLUSION: lntrarenal gas in appropriate clinical setting is highly specific for emphysematous pyelonephritis. CT is the most sensitive method for demonstrating the disease extent as well as specific diagnosis.

CT and MRI Findings of 4th Ventricular Tumors

PURPOSE: The purpose of our study is to evaluate characteristic features of 4th ventricular tumors in CT and MRI. MATERIALS AND METHODS: Pathologically proved 9 patients with 4th ventricular tumor were examined by CT and/or MRI. 4th ventricular tumors were epedymoma(4 cases), medulloblastoma(2 cases), choroid plexus papilIoma(2 cases), and oligodendroglioma(1 case). Included in our study were only those mass lesions that were located at surgery predominently within 4th ventricle with or without ventricular expansion. RESULTS: The origin of 4th ventricular tumor was the roof (epedymoma 3 cases, medulloblastoma 2 cases), the floor (epedymoma 1 case), and the undetermined(remaining 3 cases). On MRI, all tumors were hypointense exept ependymoma(3 cases) showing isointensity on T1WI. All tumors were hyperintense on PDWI and T2WI. On Gd-DTPA enhanced T1WI, strong enhancement was seen in all but epedymoma(1 case) which showed mild enhancement. On CT, as compared with MR images, various density on precontrast and postcontrast images were seen. Calcification was seen in choroid plexus papilloma(1 case) and oligodendroglioma(1 case). Hydrocephalus is seen in all cases exept ependymoma(2 cases) and oligodendroglioma(1 case). Hemorrhage within tumor was present only in epedymoma(2 cases). Cystic change or necrosis of tumor was seen in ependymomma(3 cases), choroid plexus papilloma(1 case), and oligodendroglioma(1 case). Peritumoral edema was seen in medulloblastoma(1 case). Extension through the foramen Luschka and the Magendie was seen in ependymoma(2 cases), choroid plexus papilloma(2 cases), and medulloblastoma(1 case). Seeding along the CSF pathway was seen only in ependymoma(2 cases). CONCLUSION: The results of our study may suggest that specific diagnosis of 4th ventricular tumor can be suggested preoperatively by analysing the origin in 4th ventricle, difference of CT density or MRI signal inten. sity, presence of extension or seeding through cerebrospinal fluid of the lesion.

MR Imaging of Gestational Trophoblastic Tumors

PURPOSE: To evaluate the MR findings of gestational trophoblastic tumor(GTT) in correlation with pathological results. MATERIALS AND METHODS: Nine patients who confirmed the diagnosis (four choriocarcinomas and five invasive moles) constituted the basis of our study. Pathologic specimens were taken from the tumors corresponding to the regions of interest on MR images. The MR images were analyzed in respect of the morphology and signal intensity of the tumors, uterine and adnexal vascularity, and the adnexal lesion. RESULTS: The MR findings of four choriocarcinomas were well-defined, hemorrhagic masses with central necrosis;the masses were hyperintense on Tl-weighted images. In contrast, the five invasive moles showed irregular and permeative masses with densely enhanced solid components and tiny cystic lesions. The trophoblastic proliferation, coagulation necrosis, and molar villi had variable signal intensities on Tl-and T2-weighted images. CONCLUSION: Our results suggest that MR imaging is a promising tool for noninvasive morphologic analysis of GTTS.

CT Findings of Spontaneous Subarachnoid Hemorrhage of Unknown Cause

PURPOSE: Spontaneous subarachnoid hemorrhage(S-SAH) is a relatively rare disease with good clinical course and prognosis. The purpose of this study is to evaluate the cisternal blood distribution on CT in patient with S-SAH. MATERIALS AND METHODS: Out of 406 patients with subarachnoid hemorrhage on brain CT scan, 11 patients confirmed to be S-SAH by angiography and clinical follow-up were examined. We analysed the CT findings of these 11 cases retrospectively. RESULTS: Five patients had only perimesencephalic distribution of hemorrhage:the prepontine, the interped- uncular, and the suprasellar cisterns were involved in 4 cases each, the basal sylvian cistern in 3 cases, and the ambient cistern in 2 cases. The quadrigeminal and a portion of the lateral sylvians were also involved in 1 case each. Six patients revealed cisternal hemorrhage extending beyond the perimesencephalic cistern into the ventricles, cortical sulci, and lateral sylvian fissure. Intraventricular hemorrhage was noted in 3 cases of these 6 patients. CONCLUSION: Our study suggests that uncomplicated clinical course and normal anglographic finding are more important than CT distribution of cisternal hemorrhage in diagnosing S-SAH.