Subject(s)
Cysts/diagnosis , Spinal Cord Diseases/diagnosis , Adult , Humans , Male , Thoracic VertebraeABSTRACT
The rhabdomyosarcomas are rare tumors of mesenchymal tIssue. Whose most frequent localisations are génito-urinary, and occur in the child and young adult. It's an intrascrotal tumour, localised in the tunica vaginalis, epididymis or spermatic cord. The Authors report a case of paratesticular rhabdomyosarcoma in a 15 Year old child, who presented a right painless scrotal mass since two Months. The research of the tumoral markers is negative. Scrotal ultrasound shows a tissular mass in spermatic cord. Abdominal ultrasound and CT show retroperitoneal lymph node mass. Chest X-ray is normal. The intervention consists of a right castration. The histological examination of the spiceman confirms the diagnosis of the paratesticular rhabdomyosarcoma of the spermatic cord. The patient is treated by chemotherapy without improvement. Through this observation, the Authors underline the interest of the imagery and the aspects of the paratesticular tumours in ultrasound and CT.
Subject(s)
Genital Neoplasms, Male/diagnosis , Rhabdomyosarcoma, Embryonal/diagnosis , Spermatic Cord , Adolescent , Antineoplastic Agents/therapeutic use , Biopsy , Chemotherapy, Adjuvant , Diagnosis, Differential , Fatal Outcome , Genital Neoplasms, Male/surgery , Humans , Lymphatic Metastasis/diagnosis , Male , Orchiectomy , Prognosis , Rhabdomyosarcoma, Embryonal/surgery , Scrotum , Tomography, X-Ray Computed , UltrasonographyABSTRACT
One case of inflammatory pseudo-tumor revealed by mictional disorders is reported. Ultrasonography and computed tomography visualised a non specific formation of bladder dome witch extend to the Retzius space and umbilicus. The diagnosis of urachal tumor had been suspected. Anatomopathologic analysis of the operative piece disclose a diagnosis of the urachal remnants with foreign body type of inflammation. Since malignant transformation of urachal remnants is possible, surgical resection is advised.
Subject(s)
Granuloma, Plasma Cell/pathology , Urachus/pathology , Urinary Bladder Neoplasms/pathology , Adult , Diagnosis, Differential , Foreign-Body Reaction , Granuloma, Plasma Cell/diagnosis , Granuloma, Plasma Cell/surgery , Humans , Male , Urinary Bladder Neoplasms/diagnosis , Urinary Bladder Neoplasms/surgeryABSTRACT
BACKGROUND: It has been reported that, in children breathing spontaneously via an endotracheal tube, halothane depresses ventilation with paradoxic inspiratory movement. Endotracheal tubes have a higher airflow resistance than do laryngeal mask airways (LMAs). Therefore, the aim of this study was to compare spontaneous ventilation via the LMA with that via the endotracheal tube in children anesthetized with halothane. METHODS: The authors studied two groups of 6-24-month-old children with no cardiorespiratory and neurologic disorders, undergoing elective minor surgery with halothane anesthesia: one group breathing via LMA (n = 10) and one group breathing via endotracheal tube (n = 10). They measured tidal volume, respiratory rate, minute ventilation, and end-tidal CO2. They assessed paradoxic inspiratory movement using amplitude index and phase delay index. RESULTS: Age and weight were similar in both groups. Mean +/- SD tidal volume (7.5 +/- 1.9 ml/kg in the LMA group vs. 5.3 +/- 1.1 ml/kg in the endotracheal tube group; P < 0.05) and minute ventilation (325 +/- 105 ml.min-1.kg-1 in the LMA group vs. 246 +/- 38 ml.min-1.kg-1 in the endotracheal tube group; P < 0.05) were lower in the endotracheal tube group. The phase delay index (18 +/- 11% in the LMA group vs. 41 +/- 19% in the endotracheal tube group; P < 0.05) and the amplitude index (25 +/- 43% in the LMA group vs. 74 +/- 72% in the endotracheal tube group; P < 0.05) were significantly smaller with the LMA than with the endotracheal tube. CONCLUSIONS: In 6-24-month-old children anesthetized with halothane, paradoxic inspiratory movement is less when breathing through an LMA than through an endotracheal tube.
Subject(s)
Anesthetics, Inhalation/pharmacology , Halothane/pharmacology , Intubation, Intratracheal , Laryngeal Masks , Respiration/drug effects , Child, Preschool , Humans , InfantABSTRACT
Respiratory parameters, ventilatory response to carbon dioxide and quality of anaesthesia were studied in patients undergoing upper limb surgery under axillary blockade. Thirteen patients were randomly assigned to two groups, group A (n = 6), who were given 35 ml of 1.5% lidocaine with 1 in 200,000 of adrenaline, and group B (n = 7), who received 1 microgram.kg-1 of fentanyl with the same dose of lidocaine. Quality of the sympathetic, sensory and motor blocks were tested at 15 min (T1) and 45 min (T2) after the injection (T0). The other parameters measured at these three times, both with the patient in a half-sitting position breathing room air, and after a rebreathing test with CO2 through Read's circuit, were respiratory rate (FR), tidal volume (VT), minute ventilation (VE), and PetCO2. Fentanyl provided a better sensory and motor blockade at T1, without any difference in sympathetic blockade. The quality of the blocks was similar in both groups at T2. There were no significant differences in the respiratory parameters between the two groups. Moreover, there was no untoward effect due to fentanyl (nausea, pruritus). It is concluded that 1 microgram.kg-1 fentanyl added to a local anaesthetic solution may be useful, at least during the first hour of an axillary block, without any respiratory side-effects.
Subject(s)
Brachial Plexus , Carbon Dioxide/analysis , Fentanyl , Lidocaine , Nerve Block/methods , Adult , Aged , Drug Combinations , Female , Humans , Male , Middle Aged , Respiration/drug effectsABSTRACT
Intermittent Mandatory Pressure Release Ventilation (IMPRV) is a positive pressure spontaneous breathing ventilatory mode in which airway pressure is released intermittently and synchronously with patient's spontaneous expiration in order to provide ventilatory assistance. Eight critically ill patients free of any factor known to alter chest wall mechanics (group 1) and 8 critically ill patients whose spontaneous respiratory activity was markedly altered by a flail chest, or by a C5 quadraplegia and/or by the administration of opioids (group 2) were studied prospectively. CPAP and IMPRV were administered to each patient in a random order during a 1 h period using a CESAR ventilator. Gas flow, tidal volume, tracheal pressure, esophageal pressure, end-expiratory lung volume and hemodynamic parameters were measured. In group 1 patients, the ventilatory assistance provided by IMPRV was associated with a significant decrease in spontaneous tidal volume whereas all other respiratory parameters remained unchanged. In group 2 patients, IMPRV increased minute ventilation from 8.0 +/- 2.61/min to 12.2 +/- 1.81/min (p less than 0.05), decreased PaCO2 from 46 +/- 7.3 mmHg to 38 +/- 6.8 mmHg (p less than 0.05) and reduced respiratory frequency from 21 +/- 10 bpm to 14 +/- 5.7 bpm (p less than 0.07). These results show that IMPRV provides significant ventilatory assistance to patients with mild acute respiratory failure either by decreasing patient's contribution to minute ventilation or by increasing alveolar ventilation in presence of respiratory depression of central or peripheral origin.
