ABSTRACT
BACKGROUND: Laparoscopic and endoscopic ultrasound is used to assess resectability of gastrointestinal malignancies. Lymph node size greater than 1 cm is a criterion used to identify suspicious nodes. We define size and echo characteristics of suprapancreatic and periportal nodes to determine if this criterion is reliable for suprapancreatic and periportal lymph nodes. METHODS: A prospective study of 21 patients with nonacute gallbladder disease was performed. Each underwent laparoscopic cholecystectomy with intraoperative ultrasound. The suprapancreatic and periportal nodes were evaluated in a transverse and longitudinal axis. Length and width measurements were taken in both orientations. Length-to-width ratios were calculated. Shape and echo textures were characterized. RESULTS: The mean size of both nodes was greater than 1 cm in the transverse and longitudinal orientation. Two nodes were "round." Remaining nodes were "oblong." All nodes had a hyperechoic center with a hypoechoic rim. CONCLUSION: In suprapancreatic and periportal lymph nodes, size greater than 1 cm should not be used as criterion for malignancy.
Subject(s)
Cholecystectomy, Laparoscopic , Endosonography , Lymph Nodes/diagnostic imaging , Adult , Aged , Aged, 80 and over , Anthropometry , Female , Humans , Lymph Nodes/anatomy & histology , Lymphatic Metastasis/diagnosis , Lymphatic Metastasis/diagnostic imaging , Middle Aged , Prospective Studies , Reference Values , Ultrasonography, InterventionalABSTRACT
BACKGROUND: We report the use of retroperitoneal aortic aneurysm repair utilizing exclusive regional anesthesia (no intubation or inhalation anesthetic) in high pulmonary risk patients. METHODS: Six patients were retrospectively reviewed. Pulmonary disease was diagnosed by clinical history and pulmonary function tests. Patients received intravenous sedation and regional anesthesia. Retroperitoneal aortoiliac aneurysm repair was performed. RESULTS: All patients used inhaled steroids and albuterol. Three required theophylline and home oxygen. FEV1 = 23% +/- 5% predicted, FVC = 34% +/- 5% predicted, and PO2 = 62 +/- 2 mm Hg. Operative time was 247 +/- 25 minutes. Blood loss was 840 +/- 479 mL. Five of six patients (83%) tolerated awake aneurysm repair and had intensive care unit stays of 2.4 +/- 0.6 days, and postoperative hospital stays of 8.2 +/- 1.8 days. One patient was converted to general anesthesia and had a prolonged hospital stay. CONCLUSIONS: With thorough patient communication, awake retroperitoneal aortic aneurysm repair can be safely performed in select patients with severe pulmonary disease.
