1/7. Intraoperative respiratory failure in a patient after treatment with bleomycin: previous and current intraoperative exposure to 50% oxygen.patients treated with bleomycin (BLM) are at risk of developing acute respiratory distress syndrome (ARDS) post-operatively, and this has been associated with high intraoperative concentrations of oxygen. We report progressive arterial desaturation noticeable 2 h after the start of a 4-h radical neck dissection for which the anaesthesia included 50% O2 in N2O. The patient had received two courses of bleomycin within the previous 2 months and had undergone an uneventful right hemiglossectomy under shorter but otherwise similar anaesthesia 4 weeks previously. His pulmonary function tests before the second procedure showed a slight depression of diffusing capacity (DLco) to 80% of predicted and minimal airway obstruction consistent with his history of smoking. The pulse oximetric reading during his second procedure reached 75%, but rose to 95% after treatment with methylprednisolone salbutamol and inspired O2 concentrations between 80% and 100%. By the end of the procedure, he satisfied the criteria for ARDS and was transferred to the ICU, where he developed bilateral pneumonia, deteriorated and died of multiple organ failure. This case suggests that the risk of hyperoxic pulmonary damage in patients exposed to bleomycin may increase not only with the degree and duration of hyperoxia in a given exposure, but also with the latent effects of recent previous exposure. Near normality of pulmonary function tests cannot be taken as reassurance, and small changes may have more adverse prognostic significance than in patients who have not been exposed to bleomycin.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/7. 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 = 0.5keywords = anaesthesia (Clic here for more details about this article) |
3/7. Uncommon metastatic site of renal adenocarcinoma: the oral tongue.Primary tumours metastasizing to the tongue are very unusual and only anecdotal cases have been reported. An exhaustive literature review covering the period from 1970 onwards disclosed only 22 cases of renal adenocarcinoma metastasizing to the tongue. We report the case of an 87-year-old female patient with oral tongue, lung, liver, thyroid gland, pancreas and renal adenocarcinoma metastases. She had undergone contralateral nephrectomy for clear cell carcinoma 10 years before diagnosis of the metastases. The tongue lesion was surgically removed under local anaesthesia. tongue metastasis of renal adenocarcinoma is usually a manifestation of widespread disease. The prognosis for patients with lingual metastasis of renal adenocarcinoma is poor, the mean interval from diagnosis of tongue metastasis to death being 5.8 months. In our patient, metastatic involvement of the tongue was detected approximately 5 months before death. Treatment of renal adenocarcinoma metastasis to the tongue is usually palliative and aims to provide patient comfort by means of pain relief and prevention of bleeding and infection. Surgical excision is recommended as the primary treatment, with emphasis on preservation of tongue structure and function. Recent data regarding immunotherapy or immunochemotherapy for metastatic renal adenocarcinoma are encouraging.- - - - - - - - - - ranking = 0.5keywords = anaesthesia (Clic here for more details about this article) |
4/7. head and neck cancer after foreign body ingestion.INTRODUCTION: Ingestion of a foreign body is a common occurrence in our population. We present 2 cases that illustrate an unusual outcome of an otherwise usual occurrence. CLINICAL PICTURE: Two patients who presented with a history of ingestion of fish bones were worked up. The radiological findings were suspicious of a foreign body and both underwent examination under general anaesthesia. The endoscopic findings were normal. After further evaluation for persistent calcifications with computed tomography, a thyroid malignancy was found in the first patient and tongue cancer in the second patient. TREATMENT: The first patient underwent elective hemithyroidectomy and the second underwent wide excision of the tumour with neck dissection. OUTCOME: Both recovered uneventfully with regular follow-up in the outpatient clinic. CONCLUSION: There should be a high index of suspicion in patients with persistent calcifications.- - - - - - - - - - ranking = 0.5keywords = anaesthesia (Clic here for more details about this article) |
5/7. dermoid cyst of the tongue: an association of dermoid cyst with bronchogenic epithelium.A congenital dermoid together with a bronchogenic cyst of the tongue is extremely rare. The diagnosis made in this case of a 1-year-old boy was "teratoid cyst of the tongue". A surgical exploration was performed under general anaesthesia via a midline sagittal glossotomy. The tumour was completely dissected and excised, the microscopical examination of the surgical specimen revealed multiple cystic cavities lined by a keratinized squamous epithelium with skin appendages and fatty tissue. Others were composed of cylindrical, ciliated epithelial cells of respiratory type. This is the third reported case in the world literature. All cases were reviewed and compared with this case.- - - - - - - - - - ranking = 0.5keywords = anaesthesia (Clic here for more details about this article) |
6/7. Benign mesenchymoma of the tongue. Report of a case, with review of the literature.A benign mesenchymoma of the dorsal midtongue in an 88-year-old woman is presented. The tumour was excised under local anaesthesia, and microscopic examination revealed cartilage, bone, striated muscle, peripheral nerve, adipose and myxoid tissue, and blood vessels in addition to fibrous tissue. Eight cases including ours were found in the literature.- - - - - - - - - - ranking = 0.5keywords = anaesthesia (Clic here for more details about this article) |
7/7. Upper airway obstruction in neurofibromatosis.A patient with von Recklinghausen's neurofibromatosis developed severe upper airway obstruction at the induction of anaesthesia and required emergency cricothyroidotomy. The cause was a neurofibroma at the base of the tongue. Features of von Recklinghausen's neurofibromatosis which may be of importance to the anaesthetist are reviewed.- - - - - - - - - - ranking = 0.5keywords = anaesthesia (Clic here for more details about this article) |