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To compare the analgesic efficacy of ultrasound-guided single-shot and continuous transversus abdominis plane (TAP) block to that of IV-PCA in patients undergoing laparoscopic cholecystectomy.Prospective randomized controlled trial.Post-anesthesia care unit and General ward.108 American Society of Anesthesiologist (ASA) physical status I-II patients undergoing laparoscopic cholecystectomy.Group A received IV-PCA; group B received both ultrasound-guided single-shot TAP block with 0.2% ropivacaine (20mL) and IV-PCA; and group C received continuous TAP block using an ultrasound-guidance-inserted indwelling catheter. In group C, infusion of 0.2% ropivacaine at a basal rate of 3mL/h, bolus dose of 4mL, and a lockout interval of 30min was maintained for 48h postoperatively. The primary outcome was evaluated analgesic efficacy using the numeric rating scale (NRS) for 48h postoperatively. Other outcomes included the number of patients requiring additional analgesics, patient satisfaction with postoperative pain control, and incidence of postoperative adverse events.Compared to other groups, group C had higher deep abdominal NRS at 1h postoperatively (P0.05), and lower incidence of postoperative urinary retention (P0.05). There were no significant intergroup differences in the number of patients requiring additional analgesics, and patient satisfaction with postoperative pain control.Compared to IV-PCA with or without single-shot TAP block, ultrasound-guided continuous TAP block provided similar analgesia in somatic pain and less analgesia in visceral pain. Moreover, the latter resulted in a lower incidence of postoperative urinary retention.

SummaryThe overall incidence of cardiac tumor is very low, and malignant cardiac tumors account for only 25% of all cardiac tumors. Angiosarcomas are the most common type of malignant cardiac tumors, characterized by rapidly proliferating, extensively infiltrating anaplastic cells derived from blood vessels and lining irregular blood-filled spaces. We present a 26-year-old man with angiosarcoma involving the right atrium, which was misdiagnosed as aortic intramural hematoma by computed tomography, finally confirmed by transesophageal echocardiography during the operation.

Purpose The possibility that the increased pulmonary artery systolic storage (PASS) correlates with an improved distribution of ventilation/perfusion (V A /Q) and hence benefits gas exchange in acute respiratory distress syndrome (ARDS) was examined. Pulmonary artery systolic storage is the fraction of stroke volume stored in PA during systole and then discharged to the capillaries. The increased PASS can augment the diastolic pulmonary capillary blood flow (PCBF), which can then increase capillary blood volume participating in gas diffusion. We examined this by assessing the correlation between PASS and physiologic dead space to tidal volume (VD/VT) ratio. Materials and Methods Included were 17 patients with ARDS. By using nitrous oxide-airway-pneumotachographic method, we measured the instantaneous PCBF, from which PASS was determined. Because PASS is the same as the flow volume of PCBF during diastole, PASS was determined from the flow volume of PCBF during diastole divided by the flow volume of PCBF during a whole cardiac cycle. The VD/VT ratio, used as an index of V A /Q, was measured by using the Bohr equation. Results There was a good inverse correlation between PASS and VD/VT ( r 2 = 0.785, P Conclusions Our data indicate that the increased PASS correlates with an improved distribution of V A /Q and hence benefits gas exchange in ARDS.

A 58-year-old man with right upper quadrant pain was referred to the radiology department. The patient underwent computed tomography and magnetic resonance imaging, which suggested the diagnosis of gallbladder cancer invading the liver. After surgical removal of the gallbladder, and the adjacent liver parenchyma was performed, the histologic diagnosis of IgG4-related cholecystitis was made.