Management of a patient with an unexpected obstructing carinal mass.

Surgical procedures involving the airway or for mediastinal masses present considerable challenges for the anesthesiologist. Aside from the obvious technical challenges of providing ventilation, the anesthesiologist must share the airway with the surgeon. Careful and meticulous preoperative evaluation and preparation and intraoperative interaction with the surgical team is critical to assure control of the airway.

Fluoro-deoxy-glucose positron emission tomography for evaluation of indeterminate lung nodules: assigning a probability of malignancy may be preferable to binary readings.

Objective: To assess the diagnostic value of fluorine-18 fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) using standard uptake values (SUV) in the differential diagnoses of indeterminate pulmonary nodules. Specifically, we assessed the probability of malignancy for various SUV ranges, and compared the diagnostic efficacy of SUV with and without correction for partial volume effects on the basis of lesion size.

Methods: The FDG-PET scans performed on 158 patients with biopsy-proven pulmonary lesions seen on computed tomography (CT) scan were retrospectively reviewed.

Preemptive epidural analgesia for thoracic surgery.

The purpose of this study was to determine if preemptive epidural analgesia performed before thoracotomy incision and during the operation reduces postoperative pain. Patients in the treatment group received 8 mL of 0.25% bupivacaine and 2 mL of fentanyl (50 microg/mL) via the epidural route prior to skin incision, followed by an infusion of bupivacaine 0.

Metachronous cancers or late recurrences after resection of stage I lung cancer.

In 2 patients with stage I lung cancer, tumors recurred at their resection lines 10 years after the original surgical resections. These cases suggest that the prognosis of late cancer occurrences after resected primary lung malignancies might be related to the interval of time between primary and subsequent cancers rather than to their categorization as recurrent or metachronous cancers.

Incidence of arrhythmias after thoracic surgery: thoracotomy versus video-assisted thoracoscopy.

Purpose: Atrial arrhythmias, especially supraventricular tachycardia (SVT) and atrial fibrillation, are common after thoracotomy and lung surgery. There are few existing data on the incidence of postoperative arrhythmias after video-assisted thoracoscopy (VAT). The purpose of the present investigation was to retrospectively determine the incidence of postoperative arrhythmias in patients who underwent VAT compared with those who underwent thoracotomy, and which factors are associated with an increased risk for arrhythmias in both groups.

Adoptive transfer of ex vivo activated memory T-cells with or without cyclophosphamide for advanced metastatic melanoma: results in 36 patients.

Autolymphocyte therapy (ALT) is the infusion of autologous peripheral blood mononuclear cells (PBMC) activated ex vivo by a cytokine-rich supernatant (T3CS) generated from a previous autologous lymphocyte culture using low doses of the anti-CD3 mitogenic monoclonal antibody. The mechanism of action is enhancement of a recall response by CD45RO+ (memory) T-cells (ALT cells) to host tumour without dependence on exogenous interleukin (IL)-2. The existence of anti-tumour-specific T-cells in melanoma patients has been well described, and efforts to utilise them therapeutically have achieved modest tumour response rates.

Early aggressive surgical management of parapneumonic empyemas.

We have analyzed our experience with 90 consecutive patients who were operated on for parapneumonic empyema between 1981 and 1992. Patients whose empyema did not resolve with chest tube drainage were taken to the operating room. Nineteen patients had limited thoracotomy and drainage.

Pleural effusion in non-Hodgkin's lymphoma.

Intrathoracic non-Hodgkin's lymphoma (NHL) usually presents with roentgenographic evidence of mediastinal lymph node enlargement, pulmonary masses, pleural effusion, and a clinical picture of a systemic disease with lymphadenopathy. The presentation of NHL with pleural effusion as the major roentgenographic abnormality and no clinical peripheral lymphadenopathy or organomegaly is unusual. During a seven-year period, we encountered 19 patients with NHL in whom pleural effusion was the major roentgenographic and clinical finding.

Primary endobronchial actinomycosis in association with foreign body aspiration.

A 66-year-old diabetic man presented with a bilobar pneumonia two months after aspiration of a chicken bone. Flexible fiberoptic bronchoscopy demonstrated a mass in the bronchus intermedius. Histologic examination of endobronchial biopsy specimens revealed bone fragments, vegetable matter, and sulfur granules containing Actinomyces organisms.

Giant emphysematous bullae: surgical treatment using the median sternotomy approach.

Seven patients were operated for simultaneous excision of giant emphysematous bullae through a median sternotomy. They were all symptomatic and with a history of alcohol and/or drug abuse. Preoperative evaluation included bilateral chest tomograms and complete pulmonary function test.

Pulmonary infection with Mycobacterium avium-intracellulare: diagnosis, clinical patterns, treatment.

Most physicians fail to recognize Mycobacterium avium-intracellulare (MAI) as a major pathogen for pulmonary disease among patients admitted to hospitals throughout the United States. In a review of all records of positive MAI cultures during the 10 years beginning July 1, 1979, at The Mount Sinai Hospital, New York City, we have identified 244 patients who had pulmonary disease primarily or secondarily complicated by MAI. We also identified another 243 patients as false positive for MAI infection.

Granulomatous Pneumocystis carinii pneumonia in three patients with the acquired immune deficiency syndrome.

Pneumocystis carinii pneumonia is a frequent manifestation of the acquired immune deficiency syndrome (AIDS). It usually presents radiologically as diffuse bilateral infiltrates and histologically as a foamy, eosinophilic intra-alveolar exudate containing the organisms' cysts. We recently studied two rare cases of P carinii pneumonia presenting as pulmonary nodules on chest x-ray films in two patients with AIDS.

Computed tomography of mediastinal collaterals in SVC syndrome.

A patient undergoing treatment for abdominal lymphoma presented with a superior vena cava (SVC) syndrome. The presence of a wide mediastinum and "nodular" mediastinal densities on CT presented a diagnostic problem, necessitating thoracotomy. The thoracotomy was negative for tumor or infection.

Bronchoscopy in diffuse lung disease: evaluation by open lung biopsy in nondiagnostic transbronchial lung biopsy.

Transbronchial lung biopsy through the flexible bronchoscope is used widely for the diagnosis of diffuse lung disease; however, a significant number of specimens obtained by the bronchoscopic 2-mm biopsy forceps will reveal nonspecific findings, eg, interstitial fibrosis or nonspecific pneumonitis. Such a report may be an accurate reflection of the presence of idiopathic pulmonary fibrosis or nonspecific pneumonitis, but may merely indicate that the true diagnosis has been missed. We retrospectively studied 38 patients with diffuse lung disease whose transbronchial lung biopsies yielded nonspecific abnormalities.

Computed tomography findings in tuberculous mediastinitis.

Tuberculous mediastinitis can be an elusive diagnosis. Computed tomography may be performed in patients before establishing this diagnosis, and one should consider this disease when mediastinal mass with infiltration of adjacent fat planes is noted. Five such cases are described.

Inflammatory pseudotumor of the thymus.

A 44-year-old man with inflammatory pseudotumor of the thymus is reported. The patient was seen with fever, myalgia, and dyspnea and was found to have an anterior mediastinal mass and bilateral pleural effusions. The resected lesion consisted of a well-circumscribed mass of chronic inflammatory and fibrous tissue that virtually replaced the thymus.

Factors affecting overdrive suppression of idioventricular pacemakers and associated potassium shifts.

A characterization of the factors controlling overdrive suppression of idioventricular pacemakers was investigated in canine hearts with complete atrioventricular block perfused in vitro. The following results were obtained: 1) overdrive suppression increases as a function of driving rate in a sigmoidal fashion; 2) overdrive suppression is maximal after 3 min; 3) the pause is a function of spontaneous rate prior to overdrive; 4) overdrive causes an initial net K loss; 5) overdrive is followed by a transient net K grain; 6) increasing [K]o does not affect K loss; 7) net K loss with drive is less in pre-driven hearts; 8) net K uptake after overdrive is little affected by ventricular activity; 9) acetylcholine does not alter ventricular K balance; and 10) paired stimulation increases overdrive suppression and K loss whether or not each stimulus is followed by a contraction. The following conclusions are drawn.

Extracorporeal membrane oxygenation for massive pulmonary thromboembolism.

This study was undertaken to determine whether extracorporeal membrane oxygenation (ECMO) could modify the effects of massive lethal thromboembolism and prevent death. Twenty anesthetized dogs were prepared for venoarterial perfusion with a demand pump and membrane lung and were perfused slowly for 1 1/2 hours to lessen homologous blood shock; 1 ml per kilogram of 24-hour-old tantalum-impregnated thrombus was injected intravenously. The dogs had profound systemic hypotension with an elevated mean pulmonary artery pressure (62.