Search

Sinus-piriformis-Fisteln sind seltene kongenitale Fehlbildungen, die durch Grosenzunahme und Entzundung symptomatisch werden konnen. Zumeist manifestiert sich die Fistel als Thyreoiditis, wohingegen sie als Ursache einer akuten Dyspnoe im Neugeborenenalter untypisch ist. Wir berichten uber den Fall einer grosen Sinus-piriformis-Fistel, die bei einem mannlichen Neugeborenen fur eine akute Atmungsproblematik sorgte. Nur die – ggf. zweizeitig vorzunehmende – vollstandige Entfernung der Zyste schutzt vor moglichen Infektionen.

The hepatic metabolism of lidocaine (1 mg/kg intravenously) to its metabolite monoethylglycinexylidide (MEG-X) is the basis of the standard MEG-X test. To reduce the lidocaine-induced side effects, we evaluated the MEG-X formation after 0.5 and 1 mg/kg lidocaine intravenously in subjects with normal (n = 5) and severely impaired liver function (n = 7) (study I). From this study, a low-dose test (MEG-X concentration 30 minutes after 50 mg lidocaine intravenously [MEG-X30min] normalized to standard MEG-X test results) was developed. Sensory side effects from this low dose and from the standard MEG-X test were compared in a double-blind, randomized, cross-over study (study II) comprising 15 individuals with normal liver function and 45 patients with cirrhosis (15 Child A, 15 Child B, and 15 Child C). In study I, MEG-X formation rate was dose-independent in patients with severely impaired liver function. In study II, normalized MEG-X test results (ranging fromor = 4 to 120 microg/L) were virtually identical to the standard test results (mean difference: -1.9 microg/L; 95% confidence interval [CI]: -5.3; 1.5 microg/L). Fewer individuals experienced side effects (30% vs. 53%) with the low-dose test (P = .0013). In a multivariate analysis, the Child-Pugh score was inversely related to the occurrence of side effects. The low-dose MEG-X test gives almost identical results to the standard MEG-X test and is associated with fewer side effects, which occur less often in individuals with more severely compromised liver function.