Gastrointestinal stromal tumor in ileal neobladder

Abstract  Gastrointestinal stromal tumor (GIST) is a recently described mesenchymal tumor that can develop in any portion of the gastrointestinal tract. The occurrence of a GIST in the urinary tract is rare, but GIST can present as tumor of the urinary tract or invade the urinary tract. This is the first reported case of GIST in the ileal neobladder, which presented as a submucosal tumor. The patient underwent an open exploration and partial resection of the neobladder pouch.     

COMPARISON OF THORACIC ELECTRICAL BIOIMPEDANCE AND THERMODILUTION FOR THE MEASUREMENT OF CARDIAC INDEX IN PATIENTS WITH SEVERE SEPSIS

Cardiac index was measured using thoracic bioimpedance (Clbi)and thermodilution (Cltd) in 19 patients with proven sepsis,undergoing artificial ventilation of the lungs. There was apoor correlation between the techniques (r = 0.36, 242 datasets, regression line Clbi = 0.16 Cltd + 2.56 litre min^–1m^–2). The overall bias (Cltd-Clbi) was 1.69 litre min^–1m^–2 with limits of agreement (precision) of +4.17 to –0.79litremin^–1 m^–2. In individual patients the bias was from0.46 to 4.56 litre min¹ m^–2 with the limits of agreementfrom ±0.29 to ±2.55 litre min^–1 m^–2around the bias values. The two techniques cannot be used interchangeablyin this group of patients. (Br. J. Anaesth. 1993; 70: 58–62) ^*Present address, for correspondence: Nuffield Department ofAnaesthetics, Radcliffe Infirmary, Woodstock Road, Oxford OX26HE     

Imaging of thoracic aortic dissection

Acute thoracic aortic dissection has a high mortality if untreated, so the diagnosis must be rapidly made if mortality is to be lowered significantly. Multiple imaging techniques are often used. This retrospective study from 1988 to 1993 assesses the usefulness in diagnosis of chest X-rays, computed tomography (CT) scanning, aortography, magnetic resonance imaging (MRI), trans-thoracic (TTE) and trans-oesophageal (TOE) echocardiography. Forty-two patients with a final clinical diagnosis of dissection were studied. The diagnosis was confirmed in 16 (13 at surgery and three at autopsy). Three died with dissection given as the only cause for death. Chest X-ray abnormalities were seen in all 19 patients with surgery or death from dissection, with a widened mediastinum and/or dilated aorta being present in 17. In the group of 16 patients with surgery or autopsy proof, CT scans found dissections in 9 of 12 patients studied and correctly classified the type in only five. Aortography was performed in five, with accurate depiction of dissection and type in all. TTE found dissections in three of eight patients imaged by this method. MRI and TOE were performed each on two patients, with accurate depiction of dissection and type in each. Because of the relatively low sensitivity of CT scanning in defining aortic dissections Westmead Hospital is currently assessing the use of TOE as the prime imaging modality prior to surgical intervention.     

Inhaled nitric oxide in acute respiratory failure in adults

We have assessed the acute effects of inhaled nitric oxide 8,32 and 128 volumes per million (vpm) on pulmonary haemodynamicsand arterial oxygenation in patients with severe acute respiratoryfailure. Fourteen patients requiring artificial ventilationwith mean pulmonary artery pressures greater than 30 mm Hg weregiven inhaled nitric oxide; haemodynamic values and blood-gastensions were measured before and after 10 min of inhalationof nitric oxide. Nitric oxide inhaled at 8, 32 and 128 vpm decreasedmean pulmonary artery pressure by 1.7 (SD 2.2), 3.2 (2.6) and3.3 (3.3) mm Hg, pulmonary vascular resistance by 20 (64), 53(57) and 66 (54) dyn s cm^–5 and increased arterial oxygentension by 2.5 (3.6), 3.0 (5.1) and 2.9 (3.9) kPa, respectively.All changes were significant (P < 0.05 or less) except forchanges in pulmonary vascular resistance at 8 vpm. The improvementin arterial oxygenation with 128 vpm was related to pulmonaryvascular resistance before commencing nitric oxide. The majorbeneficial effect of nitric oxide in acute respiratory failurewould appear to be improvement in oxygenation rather than reductionin pulmonary artery pressure. The degree of improvement in arterialoxygenation with nitric oxide was related directly to pulmonaryvascular resistance before treatment. Present address: Nuffield Department of Anaesthetics, RadcliffeInfirmary, Woodstock Road, Oxford 0X2 6HE Present address: Cheltenham General Hospital, Sandlord Road,Cheltenham GL53 7AN Present address: Department of Anaesthetics, Southampton GeneralHospital, Tremona Road, Southampton SO9 4XY Present address: Intensive Therapy Unit, Royal North Shore Hospital,St Leonards, NSW 2065, Australia