Introduction: Propofol use during endoscopic procedures has become increasingly popular and assessing and maintaining airway patency is a significant challenge. Anesthesiologists often use airway maneuvers to maintain...Introduction: Propofol use during endoscopic procedures has become increasingly popular and assessing and maintaining airway patency is a significant challenge. Anesthesiologists often use airway maneuvers to maintain airway patency and ventilation during procedural sedation. A novel, non-invasive, Respiratory Volume Monitor (RVM) that provided continuous, real-time measurements of minute ventilation (MV), tidal volume (TV) and respiratory rate (RR) was used to monitor respiratory performance before, during, and after endoscopic procedures, quantify MV changes before and after airway maneuvers, and to quantify propofol-induced respiratory depression. Methods: RVM traces were obtained from 25 patients undergoing sedation for endoscopic procedures. Airway maneuvers were performed in 19/25 patients. All 25 patients received propofol as the primary sedative. Results: Forty-five airway maneuvers were performed. During these maneuvers, all respiratory parameters increased relative to pre-maneuver levels. On average, MV increased by 24% ± 5% (mean ± SEM), TV 14% ± 5% and RR: 17% ± 6%. The cohort average MVBASELINE was 9.5 ± 0.7 L/min (TV = 670 ± 60 ml, RR = 15 ± 0.7). Following propofol MV decreased transiently, reaching nadir five minutes after the last dose of propofol at 82% ± 10% of baseline (MV = 7.5 ± 1.0 L/min). The reduction in MV was driven by reduction in TV, not RR. Conclusions: Data demonstrated that RVM was able to track changes in ventilation and was able to quantify respiratory changes following airway maneuvers. All patients had a significant reduction in ventilatory volumes after propofol. Five minutes after the last dose of propofol, MV and TV were significantly reduced while RR was not, suggesting that monitoring respiratory rate alone was not a sufficient indicator of respiratory status.展开更多
Due to the anatomical peculiarity of the appendix,diagnosis of tumors arising from this area can be challenging by clinicoradiologic means.We report a case of a rare primary appendiceal signet ring carcinoma with an u...Due to the anatomical peculiarity of the appendix,diagnosis of tumors arising from this area can be challenging by clinicoradiologic means.We report a case of a rare primary appendiceal signet ring carcinoma with an uncommon presentation.An 86-year-old woman was admitted toour hospital with subacute epigastric pain.Computed tomography demonstrated bowel wall thickening with fat stranding in the ileocecal region.The leading diagnostic consideration was inflammatory bowel disease.Upon colonoscopy,a swollen,distorted ileocecal valve was identified.The remaining colon was otherwise unremarkable.Extensive biopsy sampling of the ileocecal region and colon was performed.A lymphangitic signet ring carcinoma within the ileocecal region was diagnosed on biopsy;there was no dysplasia or carcinoma of the remaining biopsies.By cytomorphology and immunoprofile,a lymphangitic signet ring carcinoma of appendiceal origin was the primary consideration,further confirmed upon subsequent laparotomy.This case represents an unusual pattern of appendiceal tumor spread with localized,lymphangitic involvement,creating a milieu which closely simulates Crohn’s disease on imaging modalities.展开更多
Background/aim: A lack of data exists concerning the development of late posto perative, non-proliferative vitreoretinopathy (PVR), rhegmatogenous retinal det achments (RRDs) after successful posterior segment intraoc...Background/aim: A lack of data exists concerning the development of late posto perative, non-proliferative vitreoretinopathy (PVR), rhegmatogenous retinal det achments (RRDs) after successful posterior segment intraocular foreign body (PSI OFB) removal. The authors present a series of PSIOFB cases over several years wi th posterior hyaloid separation resulting in RRD in two patients, 4 and 8 months after initial injury and vitrectomy. This report aims to increase aware ness concerning the possibility of late RRDs complicating PSIOFB injuries and to emphasise careful long term observation. Methods: Medical records of consecutiv e cases referred for presumed PSIOFB injury during a 4 year period were retrospe ctively reviewed. All eyes referred for presumed PSIOFB injuries were included. Results: 11 patients were included in the series. Two patients had eyes so badly injured by large PSIOFBs that primary globe closure was followed within days by enucleation. Nine patients underwent pars plana vitrectomy for PSIOFB removal. Two patients experienced late RRDs that were managed with excellent long term vi sual outcomes. Conclusions: Late RRD may occur following successful removal of P SIOFBs, even several months after initial management. These RRDs may be successf ully managed with a variety of methods, depending upon the extent and location o f the detachment and causative break as well as surgeon comfort and preference.展开更多
文摘Introduction: Propofol use during endoscopic procedures has become increasingly popular and assessing and maintaining airway patency is a significant challenge. Anesthesiologists often use airway maneuvers to maintain airway patency and ventilation during procedural sedation. A novel, non-invasive, Respiratory Volume Monitor (RVM) that provided continuous, real-time measurements of minute ventilation (MV), tidal volume (TV) and respiratory rate (RR) was used to monitor respiratory performance before, during, and after endoscopic procedures, quantify MV changes before and after airway maneuvers, and to quantify propofol-induced respiratory depression. Methods: RVM traces were obtained from 25 patients undergoing sedation for endoscopic procedures. Airway maneuvers were performed in 19/25 patients. All 25 patients received propofol as the primary sedative. Results: Forty-five airway maneuvers were performed. During these maneuvers, all respiratory parameters increased relative to pre-maneuver levels. On average, MV increased by 24% ± 5% (mean ± SEM), TV 14% ± 5% and RR: 17% ± 6%. The cohort average MVBASELINE was 9.5 ± 0.7 L/min (TV = 670 ± 60 ml, RR = 15 ± 0.7). Following propofol MV decreased transiently, reaching nadir five minutes after the last dose of propofol at 82% ± 10% of baseline (MV = 7.5 ± 1.0 L/min). The reduction in MV was driven by reduction in TV, not RR. Conclusions: Data demonstrated that RVM was able to track changes in ventilation and was able to quantify respiratory changes following airway maneuvers. All patients had a significant reduction in ventilatory volumes after propofol. Five minutes after the last dose of propofol, MV and TV were significantly reduced while RR was not, suggesting that monitoring respiratory rate alone was not a sufficient indicator of respiratory status.
文摘Due to the anatomical peculiarity of the appendix,diagnosis of tumors arising from this area can be challenging by clinicoradiologic means.We report a case of a rare primary appendiceal signet ring carcinoma with an uncommon presentation.An 86-year-old woman was admitted toour hospital with subacute epigastric pain.Computed tomography demonstrated bowel wall thickening with fat stranding in the ileocecal region.The leading diagnostic consideration was inflammatory bowel disease.Upon colonoscopy,a swollen,distorted ileocecal valve was identified.The remaining colon was otherwise unremarkable.Extensive biopsy sampling of the ileocecal region and colon was performed.A lymphangitic signet ring carcinoma within the ileocecal region was diagnosed on biopsy;there was no dysplasia or carcinoma of the remaining biopsies.By cytomorphology and immunoprofile,a lymphangitic signet ring carcinoma of appendiceal origin was the primary consideration,further confirmed upon subsequent laparotomy.This case represents an unusual pattern of appendiceal tumor spread with localized,lymphangitic involvement,creating a milieu which closely simulates Crohn’s disease on imaging modalities.
文摘Background/aim: A lack of data exists concerning the development of late posto perative, non-proliferative vitreoretinopathy (PVR), rhegmatogenous retinal det achments (RRDs) after successful posterior segment intraocular foreign body (PSI OFB) removal. The authors present a series of PSIOFB cases over several years wi th posterior hyaloid separation resulting in RRD in two patients, 4 and 8 months after initial injury and vitrectomy. This report aims to increase aware ness concerning the possibility of late RRDs complicating PSIOFB injuries and to emphasise careful long term observation. Methods: Medical records of consecutiv e cases referred for presumed PSIOFB injury during a 4 year period were retrospe ctively reviewed. All eyes referred for presumed PSIOFB injuries were included. Results: 11 patients were included in the series. Two patients had eyes so badly injured by large PSIOFBs that primary globe closure was followed within days by enucleation. Nine patients underwent pars plana vitrectomy for PSIOFB removal. Two patients experienced late RRDs that were managed with excellent long term vi sual outcomes. Conclusions: Late RRD may occur following successful removal of P SIOFBs, even several months after initial management. These RRDs may be successf ully managed with a variety of methods, depending upon the extent and location o f the detachment and causative break as well as surgeon comfort and preference.
