Fulminant pulmonary edema after near-drowning: remarkably high colloid osmotic pressure in tracheal fluid

A 44-year-old man developed severe permeability pulmonary edema associated with septic shock after near-drowning. Colloid osmotic pressure (COP) of deep tracheal fluid was persistently higher than plasma COP. Tracheal/plasma COP ratio reached a peak value of 1.75. A massive colloid infusion of 5% protein solution was incriminated in the development of this markedly elevated COP in the tracheal fluid.     

The experience with definitive irradiation of clinically limited squamous cell cancer of the trachea

Squamous cell cancer of the trachea is an uncommon malignancy infrequently cured by either surgery or irradiation. Failure to control the primary tumor has been the most common cause for death. Our experience in three patients with small squamous cell cancer of the trachea treated by definitive irradiation is encouraging. The primary tumor was controlled in each patient. Histologic confirmation of tumor sterilization was observed in two. One patient remains alive and well at 54 months; one patient developed an epidural metastases at 16 months and subsequently died; and the third patient developed a separate primary lung cancer at 48 months. Two patients developed significant radiation complications.     

A new method for evaluating antitussives in cats using an electrode-cannula.

An emplaced laryngo-tracheal electrode-cannula was employed to induce and to measure cough in cats anesthetized with either sodium pentobarbital or Dial--urethane. Carbetapentane citrate, codeine sulfate and dextromethorphan hydrobromide were tested for antitussive action by this method. Relative antitussive potency obtained in order of decreasing effectiveness was dextromethorphan hydrobromide, codeine sulfate and carbetapentane citrate.     

Survival of severe congenital diaphragmatic hernia has morbid consequences

Background/Purpose

Fetal tracheal occlusion (TO) was developed in an attempt to enhance prenatal lung growth and improve survival in fetuses with severe congenital diaphragmatic hernia (CDH). We conducted a randomized, controlled clinical trial in 24 fetuses with severe left CDH (liver herniated into the thorax and low lung-to-head ratio) to compare survival after endoscopic fetal TO vs standard perinatal care (control) and prospectively followed up the 16 survivors (9 control, 7 TO) to compare neurodevelopmental, respiratory, surgical, growth, and nutritional outcomes.

Methods

At 1 and 2 years old, subjects underwent evaluation consisting of medical and neurological history and physical, developmental testing, nutritional assessment, oxygen saturation and pulmonary function testing, chest radiograph, and echocardiogram. Growth and developmental measures were corrected for prematurity. Data were analyzed by Mann-Whitney rank sum test, Fisher's Exact test, and logistic and linear regression.

Results

Infants with TO were significantly more premature at birth (control vs TO, 37.4 ± 1.0 vs 31.1 ± 1.7 weeks; P < .01). Growth failure (z score for weight <2 SDs below mean) was severe in both groups at 1 year of age (control vs TO, 56% vs 86%; P = .31). There was considerable catch-up growth by age 2 years (growth failure: control vs TO, 22% vs 33%; P = .19). There were no differences in other growth parameters. There were also no differences in neurodevelopmental outcome at 1 and 2 years. Supplemental oxygen at hospital discharge was a significant predictor of worse neurodevelopmental outcome at 1 and 2 years old (P = .05 and P = .02, respectively). Hearing loss requiring amplification has been diagnosed in 44% of the group (control vs TO, 44% vs 43%; P = 1.0).

Conclusions

In this group of infants with severe CDH, there were no differences in outcome at 2 years old despite significant prematurity in the TO group. Oxygen supplementation at hospital discharge identified the most vulnerable group with respect to neurodevelopmental outcome, but all infants had significant growth failure, and hearing impairment is a substantial problem in this population. Severe CDH carries significant risk of chronic morbidity.     

Laryngotracheal application of lidocaine spray increases the incidence of postoperative sore throat after total intravenous anesthesia

Purpose To determine the effect of laryngotracheal application of different doses of lidocaine spray on postoperative sore throat and hoarseness, we evaluated the incidence and severity of these complications in 168 ASA I–III patients aged 15–92 years in a placebo-controlled study.Methods After induction of anesthesia with propofol, ketamine, fentanyl, and vecuronium, the laryngotracheal area was sprayed immediately before intubation with lidocaine spray either 5 times (L5 group, n = 47) or 10 times (L10 group, n = 48) or with normal saline 1ml (placebo group, n = 51). Postoperative sore throat and hoarseness were evaluated immediately after surgery and on the day after surgery.Results The incidence of sore throat was significantly higher in the L10 group than in the placebo group on both the day of and the day after surgery. The severity of sore throat was significantly higher in the L5 and L10 groups than in the placebo group on the day of surgery. On the day after surgery, the severity of sore throat remained significantly higher in the L10 group than in the placebo group. Although the incidence and severity of sore throat increased in a dose-dependent manner, these were not significantly different between the L5 and L10 groups. In addition, the incidence and severity of hoarseness did not differ at all among the three groups.Conclusion We recommend that applications of lidocaine spray to the laryngotracheal area should be avoided to help eliminate unnecessary postoperative sore throat, thereby leading to improvement in patient satisfaction.     

Airway colonisation in long-term mechanically ventilated patients

Objective To evaluate the impact of continuous subglottic suctioning and semi-recumbent body position on bacterial colonisation of the lower respiratory tract.Design A randomised controlled trial.Setting The ten-bed medical ICU of a French university hospital.Patients Critically ill patients expected to require mechanical ventilation for more than 5 days.Interventions Patients were randomly assigned to receive either continuous suctioning of subglottic secretions and semi-recumbent body position or to receive standard care and supine position.Measurements and results Oropharyngeal and tracheal secretions were sampled daily and quantitatively cultured. All included patients were followed up from day 1 (intubation) to day 10, extubation or death. Ninety-seven samples of oropharynx and trachea were analysed (40 for the suctioning group and 57 for the control group). The median bacterial counts in trachea were 6.6 Log₁₀ CFU/ml (interquartile range, IQR, 4.4–8.3) in patients who received continuous suctioning and 5.1 Log₁₀ CFU/ml (IQR 3.6–5.5) in control patients. Most of the patients were colonised in the trachea after 1 day of mechanical ventilation (75% in the suctioning group, 80% in the control group). No significant difference was found in the daily bacterial counts in the oropharynx and in the trachea between the two groups of patients.Conclusion Tracheal colonisation in long-term mechanically ventilated ICU patients was not modified by the use of continuous subglottic suctioning and semi-recumbent body position.     

40例原发性气管癌治疗结果

目的 回顾性分析原发性气管癌的临床资料和治疗结果。方法 40例原发性气管癌中,男性28例,女性12例,中位年龄47岁。从出现症状到确诊的中位时间为10个月(1～60个月)。其中腺样囊性癌15例,鳞癌14例,腺癌8例,小细胞癌2例,黏液表皮样癌1例。采用手术加放射治疗32例,单纯放射治疗6例,单纯手术治疗2例。结果 全组患者中位生存时间40个月,1,5,10年生存率分别为86％、59％和29％,局部控制率分别为84％、60％和50％,远处转移率分别为17％、51％和84％。结论 手术加术后放射治疗是原发性气管癌较合理的治疗模式。虽然本病治疗后容易出现复发,但积极的再治疗能够延长患者的生存期。     

Congenital airway abnormalities in neonates

Airway malformations such as laryngeal atresia, tracheal agenesis and subglottic stenosis are rare and present at birth with significant respiratory distress with or without stridor. There may be an initial improvement on bag and mask ventilation. Repeated attempts at intubation are met with failure. The related embryology and clinical aspect of airway malformations have been discussed. The prognosis in tracheal agenesis is universally fatal but cases with laryngeal atresia and subglottic stenosis may be saved with prompt tracheostomy and later surgical reconstruction.     

Patterns of cartilage structural protein loss in human tracheal stenosis

OBJECTIVES: The study sought to identify which of the major structural proteins in tracheal cartilage are lost in the inflammatory process, and to determine whether damaged cartilage shows signs of regeneration and whether this is an age-dependent phenomenon. STUDY DESIGN: Immunohistochemical analysis. METHODS: Archival human tracheal and subglottic stenosis segments removed for the treatment of airway compromise were investigated by means of immunohistochemical analysis for differential loss of collagen type I or type II or aggrecan. RESULTS: Specimens were found to have preferentially lost collagen I and aggrecan in areas of severe disruption of the cartilage ring. Collagen II was preserved. In addition, areas of apparent cartilage regeneration were identified based on increased collagen II and aggrecan relative to baseline levels in uninjured sections of the rings. Regenerative capacity was present in most of the specimens investigated and was not age specific. CONCLUSIONS: Collagen I and aggrecan are lost in areas of severe ring compromise, indicating that at least one of these two molecules is responsible for structural integrity. The remaining cartilage has some regenerative capacity, but it is small relative to the degree of cartilage damage. No new collagen I was identified in the cartilage ring, indicating that, although an intense inflammatory reaction occurred, fibroblasts did not deposit new collagen I as seen in other scar tissues.     

Effects of normal saline on endotracheal suctioning

This study was designed to determine the effects of saline solution administered prior to endotracheal suctioning by nurses working in intensive care on oxygenation, heart rate and long-term pulmonary hygiene. The study was carried out on an experimental basis in the Intensive Care Unit of a university hospital in Turkey. A total of 20 patients were included, who were mechanically ventilated because of pulmonary or cardiovascular problems or trauma. Data were collected using a data form. Each patient was monitored for 5 minutes following suctioning with or without saline solution and findings of heart rate, SpO2, and blood gas measurements were recorded. Data were analysed using percentage calculations, the student's t-test and the Friedman test. The study showed that most of the patients were between 60 and 69 years and were intubated because of respiratory insufficiency. Evaluation of blood gases following suctioning with or without saline solution showed partial decreases in pO2, pCO2, HCO3, and oxygen saturation (SaO2), which did not reach a significant level. No significant difference was found between pH levels recorded prior to and 5 minutes after suctioning without saline solution; however, the increase in pH following suctioning with saline solution was significant. Patients undergoing suctioning with saline solution exhibited significantly increased heart rates in the fourth and fifth minutes, whereas no increases were detected in these undergoing suctioning without saline solution. SpO2 values obtained by pulse oxymeter did not show significant differences. Saline solution administered with suctioning resulted in undesirable, although not significant, alterations in oxygen saturation and arterial blood gas levels.