1/4. Giant cervico-mediastinal lipoma. A clinical case.The lipoma is a circumscribed mesenchymal tumour originating from adipose tissue. The lesion is usually small and asymptomatic, and is most frequently located in the neck region. The case of a 77-year-old woman with chronic extrasystolic arrhythmia caused by a non-specified ischemic cardiopathy is reported. The woman presented a swelling at the front of her neck, observed for the first time about 6 months previously. This swelling progressively increased in size, provoking dysphagia, dysphonia, persistent cough, dyspnea, light jugular turgor and palpitations. Chest x-rays showed and opaque area at the front of the neck, which extended beyond the jugular incisure by about 2 cm. NMR of the neck showed a gross lipomatous formation at the front, mainly of the left, continuing in the front mediastinal region; the trachea was dislocated to the right and compressed at the back; the vasculo-nervous fasciculus, especially on the left, was compressed and enveloped by the adipose formation. The Holter test confirmed the presence of ventricular and supra-ventricular extrasystoles. Surgery was carried out under local anaesthesia because the displacement of the laryngo-tracheal axes precluded intubation. Histological analysis of the 9 x 4 x 2.2 cm mass confirmed the diagnosis of lipoma. After removal of the mass all the symptoms, which had been provoked by compression, as well as the cardiac arrhythmias disappeared. The prompt disappearance of the latter was particularly surprising. The possibility of the external compression of the nervous structures of the neck should be taken into consideration in cases of ventricular arrhythmia of unknown origin, and systematic study of the region carried out.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/4. The use of the high power lasers in oral surgery.The treatment of 2989 patients with different type of lasers was described. The argon laser beam was used in 57 cases (portwine stains, telangiectasias, angiofibromas and other vascular lesions) and 84 operations were performed by Nd YAG laser (leukoplakia, hemangioma etc.) furthermore 53 operations by combined laser beams. 2795 operation by carbon dioxide laser were performed in precancerous states and other white lesions, benign tumors and tumor-like states, malignant tumors and other lesions. The laser procedures were performed under local anaesthesia. Operations were rapid and bloodless and excellent cosmetic and functional results were obtained. The experience gained with this group of patients suggests that the ideal case for laser treatment are leukoplakia, hemangiomas and other vascular tumors and lesions of the face and the oral cavity and clotting disturbance.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
3/4. Difficulties in diagnosing lesions in the floor of the mouth--report of two rare cases.This article highlights 2 contrasting lesions of the floor of the mouth, the first being a benign lipoma growth and the latter, an adenoid cystic carcinoma. Both of these lesions appear clinically similar, presenting as a swelling with normal overlying mucosa and otherwise asymptomatic at the time of clinical examination. As the swelling for Case 1 is small and fluctuant, no special investigation was ordered, whereas a computed tomographic scan was ordered for the larger expansile lesion in Case 2. The lesions were excised under local and general anaesthesia respectively and a histology henceforth. Recovery for both cases were uneventful and no recurrence or complication was noted to date when this article was written. The two extreme natures of the lesions manifested in the region serve as a cautionary note to clinicians.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
4/4. Asymptomatic oropharyngeal lipoma complicating intubation.Oropharyngeal lipomas are rare tumours. We present the case of a young man with an asymptomatic lipoma almost completely occluding his supraglottic airway, found on magnetic resonance imaging (MRI) for a separate oral cavity lesion. Pre-operative anaesthetic assessment was undertaken because of the risk of airway obstruction at induction of general anaesthesia. We discuss the awake fibre-optic technique used for induction, as well as the treatment and follow-up of these tumours. This case highlights the need for formal anaesthetic assessment, in such cases, to avoid total airway obstruction at induction of general anaesthesia. It also emphasizes the extent of supraglottic obstruction that can be present without giving rise to any symptoms.- - - - - - - - - - ranking = 2keywords = anaesthesia (Clic here for more details about this article) |