Paraplegia after thoracotomy--not caused by the epidural catheter

BACKGROUND: Paraplegia and peripheral nerve injuries may arise after general anaesthesia from many causes but are easily ascribed to central block if the latter has been used. CASE REPORT: A 56-yr-old woman, with Bechterev disease but otherwise healthy, was operated with left-sided thoracotomy to remove a tumour in the left lower lobe. She had an epidural catheter inserted in the mid-thoracic area before general anaesthesia was started. Bupivacaine 0.5% 5 ml was injected once and the infusion of bupivacaine 0.1% with 2 micrograms/ml fentanyl and 2 micrograms/ml adrenaline (5 ml/h) started at the end of surgery. The patient woke up with total paralysis in the lower limb and sensory analgesia at the level of T8, which remained unchanged at several observations. Laminectomy, performed 17 h after the primary operation, showed a large piece of a haemostatic sponge (Surgicel) compressing the spinal cord, which was then decompressed but the motor and sensory deficit remained virtually unchanged both then and a year later. CONCLUSIONS: This case shows--once again--that although central blocks may cause serious neurological complications and paraplegia, other causes are possible and have to be considered. However, all patients with an epidural catheter must be monitored for early signs and symptoms of an intraspinal process and the appropriate treatment has to be instituted instantly.     

Radiofrequency ablation in children

Radiofrequency (RF) catheter ablation has ushered in a new era in the management of patients with symptomatic tachyarrhythmias. By providing the ability to cure the underlying arrhythmic substrate, RF catheter ablation obviates the need for life-long antiarrhythmic drugs. In the reported series, the success has been high and the complications have been infrequent and relatively minor. Not unexpectedly, RF catheter ablation has become the treatment of choice for patients with symptomatic paroxysmal tachyarrhythmias. The role of radiofrequency catheter ablation in infants and small children remains controversial, and awaits a larger experience and longer follow-up data.     

Embolization with “Ethibloc” of vascular tumors and arteriovenous malformations in the head and neck

Summary Ethibloc has been used almost exclusively until now for embolization of tumors and bleeding vessels in the liver and kidney. Unlike with Gelfoam-particles, there is no recanalization. The resorption occurs so slowly that there is no interference with the necrosis of the embolized tumor. Due to its low viscosity, it passes catheters with thin lumina and fills the capillary bed of the tumor without danger of reaching the venous vessels. In this paper we describe a new technic of percutaneous catheter-embolization with Ethibloc using a coaxial catheter which we believe enhances safety and effectiveness. It has been successfully used in five patients. In the meantime two more patients have been treated successfully.Presented in part at the 17th Annual Meeting of the German Society of Neuroradiology, 9–10 October 1981 in Tübingen, FRG.     

Balloon Dilatation of the Pulmonary Valve in a Patient with Pulmonary Atresia and Intact Ventricular Septum Using a Commercially Available Radiofrequency Catheter

Using a commercially available 5F deflectable radiofrequency catheter, we have succeeded in percutaneous valvotomy of an imperforate pulmonary valve and consecutive balloon dilatation in a baby with pulmonary atresia and intact ventricular septum. After the procedure, right ventricular systolic pressure fell from 125 mmHg to 65 mmHg, and right ventriculography demonstrated anterograde blood flow into the pulmonary arteries. There were no major complications. Doppler echocardiography at 1 year after the procedure demonstrated a pressure gradient across the pulmonary valve of 20 mmHg with mild pulmonary and tricuspid regurgitations.     

中心静脉置管在肿瘤内科的用途及价值探讨

目的探讨中心静脉置管在肿瘤内科的用途及其价值,以满足肿瘤内科给药的多种特殊需求.方法以一次性中心静脉导管经锁骨下穿刺置管于上腔静脉末端.结果中心静脉置管用于治疗20种中晚期癌症患者482例,13种特殊用药所需399例(82.8%);肺癌和肺部转移癌为增加肺部药物持续浓度130例(27.0%);外周静脉条件差难以顺利给药127例(26.3%);需长期输液24例(5.0%);为避免外周静脉化疗的痛苦、不便和静脉炎或曾发生静脉炎,患者要求13例(2.7%);外周静脉留置针失败后1例(0.2%).结论经锁骨下中心静脉置管在肿瘤内科用途甚广,可满足多种病种给药的多种特殊需求,既有助于提高疗效减轻副作用,又可避免外周静脉给药的痛苦和不便及其局部并发症,有助于改善患者生活质量,值得推广.     

细管胸腔闭式引流与常规胸腔穿刺控制恶性胸腔积液随机对照研究

背景与目的恶性胸腔积液是晚期恶性肿瘤常见的一个问题。治疗多为姑息性，常采用胸腔穿刺或粗管闭式引流。粗管闭式引流损伤大，易感染，患者活动受限。本研究的目的是观察细孔径导管胸腔闭式引流后注药治疗恶性胸腔积液的临床疗效。方法将恶性胸腔积液患者随机分成两组，分别进行中心静脉导管闭式引流和常规胸腔穿刺，并均于胸腔内注入顺铂（cisplatin，DDP）和白介素-2（interleukin-2，IL-2）。结果细孔径导管闭式引流组胸腔积液的控制率为80．00％，明显优于常规穿刺组的36．67％（P〈0．01）。细孔径导管闭式引流组的不良反应少于常规穿刺组。结论应用细孔径导管装置引流恶性胸腔积液操作安全、简便，能最大限度地排净胸腔积液，对控制癌性胸腔积液有较好的疗效，能显著改善患者生活质量。     

Glue embolization of a ruptured celiac trunk pseudoaneurysm via the gastroduodenal artery

Percutaneous transcatheter embolization of splanchnic artery aneurysms is a minimally invasive and alternative therapy to conventional surgical intervention. Due to a high-grade stenosis at the origin of the celiac trunk, a retrograde approach to the celiac trunk pseudoaneurysm via the gastroduodenal artery was necessary. To prevent undesirable embolization into the peripheral left gastric artery initial occlusion of the central portion of the left gastric artery was performed with microcoils using a Tracker catheter. Complete occlusion of the celiac trunk itself and the short adjacent segments of the celiac artery was achieved by using a mixture of N-butyl-2-cyanoacrylate and ethiodized oil as the embolizing agent. Received: 22 June 1999; Revised: 7 September 1999; Accepted: 1 October 1999     

A catheter technique in ophthalmic regional anaesthesia. Clinical investigations

BACKGROUND: Usually general anaesthesia is chosen if ophthalmic surgery of longer duration is expected. Our goal was to introduce a flexible catheter preoperatively into the extra- or intraconal space and to provide sufficient anaesthesia by continuous administration of a local anaesthetic via the catheter. METHODS: The continuous anaesthetic technique was applied in 28 patients undergoing vitreoretinal surgery. An indwelling catheter was introduced in 20 patients into the intraconal and in 8 patients into the extraconal space. In 6 patients, the position of the catheter was controlled by ultrasound examination prior to the injection of the local anaesthetic agent. RESULTS: For all patients adequate anaesthesia could be achieved and maintained with continuous retrobulbar administration (CRA) of a local anaesthetic by catheter. There were two patients who experienced moderate pain intraoperatively during continuous peribulbar administration (CPA). No complications occurred with the placement of the catheters. The catheter did not disturb the surgeon or the process of the ophthalmic surgery. CONCLUSIONS: Continuous administration of a local anaesthetic agent via an indwelling catheter into the intraconal space allowed ophthalmic anaesthesia without time restriction. Thus, CRA is a good alternative to general anaesthesia for patients undergoing long-lasting ophthalmic surgery.     

经皮心包穿刺置管引流大量心包积液21例

目的:探讨经皮心包穿刺置管引流大量心包积液的可行性、安全性.方法:分析1999年3月～2004年3月收治的21例大量心包积液临床资料.结果:21例患者均一次引流成功,病因分析;心包转移瘤(8例)、结核性心包炎(5例)、甲状腺功能减退症(2例)、系统性红斑狼疮(1例)、尿毒症(2例)、不明原因(3例).结论:经皮心包穿刺置管引流大量心包积液的可行、安全.     

输卵管阻塞介入治疗51例临床分析

目的：探索输卵管阻塞性不孕的诊断与非血管介入治疗方法。方法：对51例输卵管阻塞患者，采用9F、5．5F、3F用轴导管导向法，在X线监视下经阴道放入，分别置于宫颈部、子宫角部及左右输卵管，造影证实后，行再通术。结果：技术操作成功率100％，无严重并发症，随访3～18个月，51例双侧输卵管通畅，有效率达96％。结论：输卵管阻塞同轴导管导丝导向法介入治疗是一种简便、实用、效果较好的一种治疗方法。