We prospectively studied 40 patients (ASA grades I-III) undergoing surgery of the forearm and hand, to investigate the use of ultrasonic cannula guidance for supraclavicular brachial plexus block and its effect on success rate and frequency of complications. Patients were randomized into Group S (supraclavicular paravascular approach; n = 20) and Group A (axillary approach; n = 20). Ultrasonographic study of the plexus sheath was done. After visualization of the anatomy, the plexus sheath was penetrated using a 24-gauge cannula. Plexus block was performed using 30 mL bupivacaine 0.5%. Onset of sensory and motor block of the radial, ulnar, and median nerves was recorded in 10-min intervals for 1 h. Satisfactory surgical anesthesia was attained in 95% of both groups. In Group A, 25% showed an incomplete sensory block of the musculocutaneous nerve, whereas all patients in Group S had a block of this nerve. Complete sensory block of the radial, median, and ulnar nerves was attained after an average of 40 min without a significant difference between the two groups. Because of the direct ultrasonic view of the cervical pleura, we had no cases of pneumothorax. An accidental puncture of subclavian or axillary vessels, as well as neurologic damage, was avoided in all cases. An ultrasonography-guided approach for supraclavicular block combines the safety of axillary block with the larger extent of block of the supraclavicular approach.

In quantification of pleural effusions, the sonographic measurement method presented is preferable to radiographic measurement.

The aim of this study was to evaluate the appearance, extent, and distribution of parenchymal changes in the lung after acute respiratory distress syndrome (ARDS) as a function of disease severity and therapeutic procedures. High-resolution computed tomography (HRCT), clinical examination, and lung function tests were performed in 15 patients, 6-10 months after ARDS. The appearance and extent of parenchymal changes were compared with the severity of ARDS, as well as with clinical and therapeutic data. Lung parenchymal changes resembling those found in the presence of pulmonary fibrosis were observed in 13 of 15 patients (87%). The changes were significantly more frequent and more pronounced in the ventral than in the dorsal portions of the lung ( p<0.01). A significant correlation was observed between the extent of lung alterations and the severity of ARDS ( p<0.01), and the duration in which patients had received mechanical ventilation either with a peak inspiratory pressure greater than 30 mmHg ( p<0.05), or with more than 70% oxygen ( p<0.01). Acute respiratory distress syndrome frequently is followed by fibrotic changes in lung parenchyma. The predominantly ventral distribution of these changes indicates that they may be caused by the ventilation regimen and the oxygen therapy rather than by the ARDS.

In this prospective study, the authors examined 123 patients with benign or malignant neoplasms (breast cancer, n = 44; liver neoplasms, n = 43; and tumors affecting other organs, n = 36) to establish general criteria for evaluation of neoplastic lesions by means of duplex sonography. The frequency shifts determined by means of different Doppler frequencies (2.31 or 3.75 MHz) were converted into flow velocities. Only the highest systolic peak flow velocity obtained from a lesion was used for statistical evaluation. Receiver operating characteristic curves showed that a flow velocity of 0.4 m/sec is the optimal threshold value with which to differentiate benign from malignant tumors. The data obtained in all lesions indicated that only positive findings are potentially reliable. It is concluded that negative results of sonography should not be used to diagnose the presence of a benign lesion. The resistive index of the tumors was of negligible importance.

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