Tracheal ulcer due to Epstein-Barr virus-positive diffuse large B-cell lymphoma of the elderly

A 74-year-old man was referred to our hospital because of a tracheal stenosis circumscribed with soft tissue density and a left pulmonary nodule. Open biopsy of a right submandibular lymph node revealed diffuse large B-cell lymphoma, and the malignant cells were positive for Epstein-Barr virus gene products. Bronchofiberscopy revealed a tracheal necrotizing ulcer. After chemotherapy, the tracheal ulcer resolved. To our knowledge, this is the first report of a case of Epstein-Barr virus-positive diffuse large B-cell lymphoma of the elderly with a tracheal ulcer.     

Ⅰ期端端吻合术治疗重度颈段气管狭窄临床分析

目的 探讨Ⅰ期气管、环气管部分切除端端吻合术在治疗重度颈段气管狭窄中的有效性、适应证和风险因素。 方法 回顾性分析2015年3月至2019年11月采用Ⅰ期部分气管、环气管切除端端吻合术治疗的重度颈段气管狭窄患者29例。其中男19例,女10例,17~51岁,平均31岁。手术方法包括气管-气管端端吻合(18例)、环气管吻合(9例)和甲状软骨气管吻合(2例)。狭窄程度按照Myer-Cotton法分为Ⅲ度18例,Ⅳ度11例。 结果 狭窄长度1~4 cm,平均2.5 cm。一次性手术成功拔管25例(86%)。术后并发症:皮下气肿1例,再次狭窄4例,吻合口裂1例,暂时性声带麻痹1例。 结论 Ⅰ期端端吻合术是一种有效治疗重度颈段气管狭窄的手术方法,手术成功率高。严格的术前适应证选择和术者经验是手术成功的关键。     

NIPPV和NCPAP作为早产儿拔管后无创呼吸支持模式的临床应用疗效对比

目的 探讨经鼻间歇正压通气(NIPPV)和经鼻持续气道正压通气(NCPAP)作为早产儿气管插管拔管后无创呼吸支持模式的临床应用疗效对比。方法 选取2016年1月～2017年6月在我院治疗的新生儿呼吸窘迫综合征65例,采用随机数字表法将患儿随机分为NIPPV组(n=32)和NCPAP组(n=33),观察两组撤机失败率、无创呼吸支持时间、无创后吸氧时间及总用氧时间,同时检测治疗前后二氧化碳分压(PaCO_2)、氧分压(PaO_2)和氧合指数(OI),两组并发症的发生情况。结果 NIPPV组和NCPAP组撤机失败率、无创后吸氧时间和总用氧时间比较,差异无统计学意义(P0.05);NIPPV组无创呼吸支持时间为2(1,3)d,明显短于NCPAP组(P0.05);NIPPV组和NCPAP组治疗前后PaO_2、PaCO_2比较,差异无统计学意义(P0.05);NIPPV组治疗后12 h、24 h OI分别为(240.100±31.140)%和(260.040±38.890)%,明显高于NCPAP组(P0.05);NIPPV组和NCPAP组支气管肺发育不良、早产儿视网膜病、新生儿坏死性小肠结肠炎和总发生率的比较,差异无统计学意义(P0.05)。结论 相比较NCPAP,早产儿气管插管拔管后应用NIPPV可缩短无创呼吸支持时间,值得临床使用。     

LMAsupreme^TM喉罩与气管插管静脉全麻在腹腔镜直肠癌切除手术中的应用

目的：探讨LMAsupreme ^TM喉罩和气管插管静脉全麻两种方法用于腹腔镜直肠癌切除手术时对患者血流动力学、呼吸参数变化及术中术后不良反应发生率的影响,评估LMAsupreme^TM喉罩在腹腔镜直肠癌切除术中应用的安全性及优越性。方法：选择腹腔镜直肠癌切除手术患者40例,ASAⅠ～Ⅱ级,随机分成2组,即LMAsupreme^TM喉罩组（s组）和气管插管组（T组）,每组20例。麻醉诱导后分别插入LMAsupreme^TM喉罩和气管插管,记录并比较两组在麻醉诱导前、喉罩和气管导管插入前即刻及插入后即刻、1min和5min时收缩压（SBP）、舒张压（DBP）、心率（HR）。记录建立二氧化碳（CO2）气腹前、后和体位改变后气道平台压（Pplat）、气道峰压（Ppeak）;观察手术过程中返流误吸、术后声嘶、咽痛、呛咳不良反应。结果：与T组比较,S组血流动力学平稳（P〈0．05）,呼吸参数稳定变化小（P〈0．05）,术中发生返流误吸无统计学差异,术后声嘶、咽痛、呛咳显著减少（P〈0．05）。结论：LMAsupremeTM喉罩在腹腔镜直肠癌切除术中应用能达到与气管导管同样的通气效果,对麻醉过程中血流动力学、呼吸参数影响更小,术中术后不良反应显著减少,且操作简单、易学,与气管插管方法相比在临床应用有更好的安全性及优越性。     

气管软骨蠕变实验的研究

以蠕变的方法研究气管软骨的蠕变特性,为研究新型人工气管材料和临床气管损伤移植提供气管软骨的蠕变特性参数。以电子万能试验机对10个人尸体气管软骨试样进行蠕变实验,蠕变实验应力增加速度为0.05 GPa/min,实验温度为36.5±1℃,设定实验时间7 200 s,采集100个实验数据,以归一化分析的方法处理实验数据。结果表明,气管软骨7 200 s应变上升了9.6%,气管软骨蠕变曲线是以指数关系变化的。本实验人气管软骨和以往报道的犬气管软骨具有不同的的蠕变特性。     

先天性心脏病合并气管狭窄的保守治疗策略

目的探讨先天性心脏病合并气管狭窄的保守治疗策略及可行性。方法回顾性分析阜外医院2009年1月至2011年12月间收治21例先心病合并气管狭窄的临床资料,对先心病并发上气道狭窄患儿术后采用早拔管策略;中下气道狭窄治疗上兼顾心肺功能调整及气道的管理。结果患儿年龄1～53月;体重4～14kg。术中插管困难发现18例,术后反复脱机困难发现3例。3例术后行纤维支气管镜及CT检查明确狭窄部位。除4例放弃心脏手术治疗外,合并上气道狭窄14例均治愈出院;中、下段狭窄3例中2例治愈出院,1例转外院置气管内支架。结论绝大多数先心病合并的节段性气道狭窄,实施早拔管的保守治疗策略是安全有效的;对合并长段狭窄的患儿在心、肺调整稳定后,仍反复脱机困难者应尽早考虑支架或外科治疗。     

小儿外伤性泪小管断裂T型硅胶支撑管置管术的疗效观察

目的观察T型硅胶支撑管置管术治疗小儿外伤性泪小管断裂的效果。方法回顾性病例研究。选取南京市第三医院2016年8月至2020年1月住院的小儿外伤性泪小管断裂者25例(25眼),采用"双套环"技术顺行置入T型支撑管。术后3~6个月拔管,拔管后随访1~3个月,观察疗效。结果25例中,治愈21例(84.00%,21/25),好转4例(16.00%,4/25)。结论T型支撑管置管术治疗小儿外伤性泪小管断裂,效果确切,安全方便。     

Intubation au vidéolaryngoscope sous-sédation

We report a video laryngoscopic tracheal intubation under sedation in a patient with a hip fracture. Preoperative assessment revealed signs of difficult airway management linked to a cervical spine immobilization. Here we describe an alternative method to awake fiber optic flexible intubation.     

Comparaison de l’Airtraq™ et du laryngoscope Macintosh pour l’intubation trachéale chez l’adulte avec stabilisation manuelle en ligne du rachis cervical

Introduction

Airtraq laryngoscope is a new and single use device for endotracheal intubation. Few studies showed the superiority of the Airtraq comparing to Macintosh laryngoscope in the setting of difficult intubation.

Study design

To compare the performance of these two laryngoscopes by simulating a situation of reduced mobility of the cervical spine by applying the Manual in-line stablization (MILS) maneuver.

Patients and methods

After obtaining the approval of the ethic committee, we realized a prospective single blind randomized study. During a 6-month period, 120 consenting patients scheduled for ORL or ophthalmologic surgery were included. They all had general anesthesia and orotracheal intubation. These patients were randomly and equally divided in two groups (n = 60), depending on the type of the laryngoscope used (Airtraq or Macintosh). Were excluded from the study the patients with history or criteria predicting difficult intubation. Each patient was intubated by one of the five experimented anesthetists selected for this work. The principle judgment criteria were: i) the time taken for the orotracheal intubation and ii) the intubation difficulty score (IDS). The secondary judgment criterion was the hemodynamic modifications after the endotracheal intubation.

Results

Demographic and upper airway track variables were comparable between the two groups. There was no case of failure of intubation in this serie. Nonetheless, all the patients of the Airtaq group were intubated from the first attempt, whereas half of the patients of the Macintosh group were intubated after the third attempt. Comparing to the Macintosh, the Airtraq reduces the time taken for the orotracheal intubation (14 ± 1 s vs 19 ± 3 s, P = 0.01), the necessity of additional maneuver to facilitate the intubation, and the intubation difficulty score (0.7 ± 0.3 vs 3.8 ± 1, P < 0.001). Orotracheal intubation using the Airtraq laryngoscope caused less hemodynamic stimulation than using the Macintosh.

Conclusion

Our study showed the usefulness of the Airtraq laryngoscope for endotracheal intubation for patients presenting conditions of difficult intubation such as reduced mobility of the cervical spine.     

Accident hypoxique en anesthésie pédiatrique dû à un réglage inadapté du respirateur

A 3-year-old child was anesthetized for ENT examination and surgery. After induction and tracheal intubation, the patient was ventilated (controlled mode). The respirator screen showed information compatible with a failure of intubation: no expired CO₂, no expired flow, no alarm of high pressure limit, and no respiratory chest movement. A fall of SpO₂ appeared rapidly which recovered after extubation and manual ventilation through a face mask and reintubation. The expiratory CO₂ was present when the patient was ventilated manually and disappeared under controlled ventilation. The increase in the value of the maximal insufflation pressure allowed efficient ventilation with an expiratory CO₂ curve and showed high ventilation pressure compatible with a bronchospasme. This case report shows that in case of bronchospasme, if the value of the maximal insufflation pressure is low, this may lead to an erroneous diagnosis of failure of intubation.