[Sciatic, femoral and cutaneous nerve block for arthroscopic meniscectomy in a patient with Eisenmerger's syndrome. Case report]. / Blocco dei nervi sciatico, femorale e cutaneo laterale della coscia per meniscectomia in artroscopia in un paziente affetto da sindrome di Eisenmerger. Caso clinico.

The principal complication to prevent in Eisenmerger disease with left-right shunt during surgery decreasing of systemic pressure with reduction of pulmonary perfusion and break-down of central oxigenation. A 32 ys old male patient (ASA risk 3) to undergo an extirpation of meniscus by arthroscopic surgery, suffering from Eisenmerger's syndrome with left-type only ventricle, diagnosed when he was 3 ys old and but no repaired by any operation. We performed a sciatic, femoral and lateral cutaneous of thigh nerves block with ropivacaine, that consents a prolonged antalgic effect in postoperative period with minimizing of systemic and pulmonary hypotension risk compared to general, epidural or spinal anaesthesia. Basing on our experience and literature references we think that the anaesthesiological technique with the lowest risk for lower limb surgery in Eisenmerger's syndrome is truncular block.

[Bone metastasis of leiomyosarcoma. Apropos of a case]. / Métastase osseuse d'un leiomyosarcome. A propos d'un cas.

INTRODUCTION: Bone leiomyosarcoma is a rare tumor, whether it may be primary or secondary. The authors report on the case of a woman, aged 67, admitted in January 1992 complaining of pain in the left hip and the upper end of the femur. CASE REPORT: In 1985 the patient underwent surgical excision of a soft tissue tumor in the right thigh, histologically diagnosed as a benign fibrous tumor. This lesion recurred locally four times and repeated excisions were performed throughout the years, always with a histological diagnosis of a benign lesion. On admission to hospital, the physical examination as well as laboratory data and plain roentgenograms were unremarkable. Both tomography and MRI showed a lesion in the upper end of the left femur. An isotopic bone scan showed marked increased uptake in the left hip extending to the femoral diaphysis. An open biopsy was performed for histology, immunohistochemistry and electron microscopy. A diagnosis of metastatic leiomyosarcoma was made. The retrospective histological examination of specimens of the soft tissue tumor excised in 1985 showed the same immunohistochemical features of the contralateral leiomyosarcoma. On this basis, one stage resection of the left hip and the upper end of the femur was performed and a Kotz modular prosthesis was inserted. Postoperative healing was achieved without any complications and the function of the operated limb was satisfactory. Three months after the operation pulmonary lesions were noted on chest radiographs and CT scan. The patient died two years after the first admission for widespread metastasis. DISCUSSION: In the reported case, the bony metastasis appeared to be the presenting finding of the soft tissue tumor of the contralateral thigh. This presentation is rare in previously published series. The misdiagnosis of the primary tumor had caused local recurrences, and an increased malignity occurred. According to the literature, a soft tissue leiomyosarcoma can be easily confused with other spindle cell lesions. Therefore an accurate histological and ultrastructural diagnosis is necessary for adequate surgical treatment.