Pulmonary alveolar hemorrhage from a pulmonary artery false aneurysm after Swan-Ganz catheterization in a thoracic aortic aneurysm patient: a case report.

Pulmonary artery (PA) rupture caused by a PA Swan-Ganz catheter is a rare complication but remains fatal in almost 50% of cases. False aneurysm of the PA is a rare presentation of PA rupture and should be considered as a possible diagnosis in a patient with a new lung mass after PA catheterization. We present a case of sudden-onset pulmonary alveolar hemorrhage during cardiovascular surgery due to a traumatic PA false aneurysm. The Swan-Ganz catheter might have been displaced by the thoracic aortic aneurysm with displacement of the catheter causing the false aneurysm and bleeding.

[Usefulness of Epidrum for teaching identification of the epidural space].

BACKGROUND: Epidrum (ED) is a device to facilitate the epidural anesthesia procedure. Using ED, we can visually confirm the needle's penetration into the epidural space by collapse of the diaphragm. We investigated the usefulness of ED for teaching identification of the epidural space. METHODS: Forty parturients scheduled for cesarean section were randomly allocated to an ED group or loss of resistance (LOR) group. Epidural anesthesia was performed by residents (operators) under the instruction of advising doctors (observers). In the LOR group, the epidural space was identified by the conventional LOR technique using a glass syringe filled with normal saline. In the ED group, ED was attached to a Tuohy needle and was charged with 1.5 ml of air to expand its diaphragm. Ease of identification of the epidural space was scored by the operator and the observer. The time to identify the epidural space (TI) was recorded. RESULTS: TI in the ED group was significantly shorter than that in the LOR group. ED was superior to LOR for identification of the epidural space not only by operators but also by observers. CONCLUSIONS: The results suggest that ED is a useful device for teaching identification of the epidural space.

[PainVision].

It is very difficult to assess pain intensity. A method for quantitative measurement of pain intensity using a painless electrical stimulation (PainVision PS-2100; Nipro Co, Osaka, Japan) has recently been developed in Japan. Pain degree is calculated from two parameters, current perception threshold and pain compatible electrical current by using PainVision. The former parameter is defined by the lowest electrical current detected; the latter parameter defined by the electrical current judged as being compatible with the intensity of ongoing pain. The pain degree calculated by PainVision showed a significant positive correlation with the pain intensity assessed by visual analogue scale, though there were inter-individual differences in the measured values. It is likely that PainVision is an appropriate device to quantify pain intensity for intra-individual comparison between before and after management of pain.

[Effects of percutaneous lidocaine administration and xenon-ray irradiation on post-herpetic neuralgia in liver transplant recipients: a report of three cases].

We report three cases of liver transplant recipients (LTRs) with postherpetic neuralgia (PHN). They were referred to our department because of poor pain control. Repeated percutaneous lidocaine (2%, 15 ml) administration to the site of the pain via an iontophoresis system and xenon-ray irradiation were effective for the three patients. Visual analogue scale for pain decreased significantly and requirements of analgesics diminished considerably during the therapy without serious side effects. PHN is relatively common in LTRs, but treatment options are restricted because of immunosuppressive therapy and hepatic and/or renal dysfunction. However noninvasive frequent iontophoretic administration of lidocaine and xenon-ray irradiation produced satisfactory pain relief for PHN in LTRs.