A case of bronchopericardial fistula with tension pneumopericardium closed successfully by transpericardial intervention: A novel procedure

A pneumopericardium is a collection of air or gas in the pericardial sac which may cause cardiac tamponade, known as tension pneumopericardium. Tension pneumopericardium is a rare and lethal presentation of bronchopericardial fistula. There are very few reports in the literature of patients surviving with this condition, although prompt diagnosis and early intervention are important. Treatment options are limited. We present a rare case of tension pneumopericardium with cardiogenic shock due to bronchopericardial fistula in a patient with bronchogenic carcinoma who was successfully treated with transpericardial intervention.     

Orbital schwannoma with cystic degeneration

Background:  Schwannoma is a benign, slowly growing, painless, peripheral nerve sheath tumour that is uncommon in orbit. Longstanding tumours may develop degenerative changes. Extensive cystic change in orbital schwannoma is quite rare. We conducted this study to analyse the cases of orbital schwannoma, which were predominantly cystic and describe their clinical, imaging and histopathological features.
Method:  A retrospective analysis of histopathology records of all the orbital tumours operated between 1993 and 2008 was undertaken at a tertiary care referral centre in northern India. The clinical, imaging and histopathological features of patients with cystic schwannoma were studied.
Results:  A total of 600 specimens of orbital tumours were received during the study period. We found 39 cases of orbital schwannoma. Out of these, 16 (41%) had extensive cystic degeneration. The age of these patients ranged from 20 to 65 years. Eleven of the patients were female. Duration of symptoms varied from 3 months to 15 years. The most common clinical symptom was painless progressive proptosis with diminution of vision. The radiological picture was quite variable resulting in a primary diagnosis of combined venous-lymphatic vascular malformation in 2, lacrimal gland tumour in 2, dermoid cyst in 1, hydatid cyst in 2 and schwannoma in 5 cases.
Conclusion:  Orbital schwannoma is a great masquerader in the orbit. Extensive cystic changes in schwannoma are uncommonly reported. Cystic schwannoma constituted 41% of all orbital schwannomas in our series. To the best of our knowledge, this is the largest case series of orbital cystic schwannomas.     

In Vivo Effects of Dexmedetomidine on Laser-Doppler Flow and Pial Arteriolar Diameter

Background: The alpha2 -adrenergic agonist dexmedetomidine alters global cerebral blood flow (CBF). However, few studies have investigated the action of dexmedetomidine on the cerebral microcirculation. This investigation examined the effects of dexmedetomidine on (1) regional CBF in the rat cerebral cortex using laser-Doppler flowmetry and (2) on pial arteriolar diameter.

Methods: Halothane-anesthetized rats were fitted with instruments to measure CBF as determined by laser-Doppler flow (CBFldf) or to measure pial arteriolar diameter by preparing a cranial hollow deepened until a translucent plate of skull remained, thereby maintaining the integrity of the cranial vault. In both groups, 20 micro gram/kg dexmedetomidine was infused intravenously. Thirty minutes later, the mean arterial pressure was restored to control values with an infusion of phenylephrine (0.5 to 5 micro gram/kg/min).

Results: Administration of dexmedetomidine was associated with decreases in end-tidal and arterial carbon dioxide. The CBFldf and pial arteriolar diameter were measured during normocapnia (controlled carbon dioxide) and during dexmedetomidine-induced hypocapnia. Intravenous administration of dexmedetomidine significantly decreased systemic arterial pressure concurrent with a decrease in CBFldf (22% in normocapnic animals, 36% in hypocapnic animals). Restoration of mean arterial pressure increased CBFldf in normocapnic but not in hypocapnic animals. Similarly, dexmedetomidine significantly reduced pial vessel diameter in both normocapnic (9%) and hypocapnic animals (17%). However, vessel diameters remained decreased in the normocapnic and hypocapnic animals after the mean arterial pressure was restored.     

Perineural cysts resembling complex cystic adnexal masses on transvaginal sonography

Perineural cysts may be discovered incidentally on pelvic sonography and can easily mimic more common gynecologic masses. We report the complex cystic adnexal mass like appearance of these incidentally noted cysts which mimicked malignancy on sonography in a postmenopausal female, with stage I breast cancer and vaginal spotting. © 2011 Wiley Periodicals, Inc. J Clin Ultrasound 2013