There are some names that are well known in pediatric anesthesia but who were these people? For 60 years before work stations appeared, the Ayre’s T Piece was widely used. Appropriately initialed, T.P. Ayre (Philip) ( Figure 1 ) was a Newcastle anesthetist who gave several hundred anesthetics as a student, so it was natural that he should become an anesthetist. Ayre’s T Piece was developed about 1937. It allowed fresh gas to be delivered to an endotracheal tube, allowing the anesthetist to be distanced from the operative field. The original T Piece was derived from part of a Phillips airway, which Ayre had been using. It had a bend in the side arm within the lumen of the connecting tube so that the gas could be delivered flowing toward or away from the patient. Ayre soon realized that patients did better when the flow was directed toward the patient. He thought that this aided inspiration. More importantly, although he may not have understood the reason, it kept the airways open preventing alveolar collapse and a reduction in functional residual capacity (FRC). This was unwittingly the first step in the development of the use of positive end expiratory pressure (PEEP). However, when it came to manufacturing the T piece, the makers preferred the simplicity of a tube attached at right angles to the airway ( Figure 2 ), and hence, the advantage was lost until an angled side arm was developed. Figure 1 Open in figure viewer PowerPoint T. Philip Ayre. 相似文献
The immediate radical re-resection (IRR) after simple cholecystectomy in incidental gallbladder carcinoma (IGBC) is debated in the literature. The German S3 guidelines recommend IRR in T2 and more advanced stages. Current literature recommends more extensive surgery even in T1b tumors.
Methods
The German registry database was used for this study.
Results
To date 883 cases of IGBC have been analyzed. In 8 out of 39 patients with a T1a tumor IRR was carried out as well as in 43 out of 109 patients with a T1b tumor. There was a significant survival benefit for re-resected T1b patients. There was also a significant survival benefit for the 215 T2 tumors and the 75 T3 patients with IRR compared to the 441 T2 tumors and 207 T3 tumors without IRR. Comparison of liver resection techniques showed good results for the wedge resection technique in T1b and T2 carcinomas. For T3 carcinomas more radical techniques showed better results. Less than 50?% of T2–3 tumors in the registry have been re-resection.
Conclusions
The IRR should be highly recommended in patients with T1b and more advanced IGBC. The wedge resection technique is an attractive procedure for T1b and T2 IGBC due to the lower invasiveness in spite of oncological adequacy. 相似文献
Between 1959 and 1979, 242 patients with T3 and T4 lesions of the vocal cords were treated at our institution. Treatment consisted of total laryngectomy in all patients. Different modalities of regional node dissections were performed on 187 patients. In addition, 50 patients received irradiation with cobalt-60 postoperatively for specific features of the disease. In the group of 192 patients whose treatment consisted of surgery alone, 28 (14 percent) had recurrence in the neck and 10 (5 percent) had stomal recurrence. Of the patients treated with combined therapy, three (6 percent) had ipsilateral neck recurrences and one (2 percent) had stomal recurrence. For lesions staged N0, failure rates above the clavicles were 16 percent and 31 percent for patients with T3 and T4 lesions, respectively, in the group treated by surgery alone, 9 percent and 6 percent for patients with T3 and T4 lesions, respectively, in the combined therapy group. The rate of failure above the clavicles for lesions staged N+ was 32 percent in the group treated with surgery alone and 8 percent in the combined therapy group. In this study, a correlation was made between the failure rates above the clavicles and different clinical and histologic characteristics of the tumor, surgical findings, and the different modalities of cervical node dissection used. From analysis of the data, recommendations have been made for the selective treatment of patients with advanced glottic carcinomas. 相似文献
Although radical resection is the best treatment for local aggressive benign tumors or malignant tumors of the spine, total spondylectomy for lower thoracic vertebrae may cause anterior spinal artery syndrome. There are few reports in the literature in which this syndrome has been documented in association with thoracic spondylectomy, although this syndrome is the most common neurologic complication after abdominal aortic surgery. A 50-year-old woman with a giant cell tumor of the thoracic vertebrae was treated by posterior and anterior surgery. Thoracic segmental arteries from T10 to T12 had to be resected bilaterally to dissect the aorta free from the tumor. After resection of all feeding arteries to the tumor, the tumor and entire parts of T10, T11, and T12 were removed. Postoperative neurologic examination disclosed flaccid paralysis of the lower extremities and sphincter incontinence. Although pain and temperature sensation were absent, vibration and position sense were intact, showing anterior spinal artery syndrome. Intraoperative somatosensory-evoked potential monitoring only showed that transient deterioration failed to adequately reflect this neurologic injury. Major reconstructive surgery involving lower thoracic regions may cause anterior spinal artery syndrome. Somatosensory-evoked potential monitoring might not reliably predict overall neurologic outcome involving the blood supply of the lower thoracic regions. 相似文献
Lung cancer invading neighboring anatomical structures such as the chest wall, pericardium, diaphragm, and left atrium are categorized as T3 or T4, which is regarded as locally advanced lung cancer. The purpose of this study was to evaluate results of surgical treatment of T3-4N0-2M0 non-small cell lung cancer according to involved organs. From 1981 to April 2005, 148 patients with lung cancer invading neighboring organs were surgically treated in our hospital. The 5-year survival was 41.4% in all cases. According to 5-year survival of clinical characteristics, the chest wall (parietal pleura) group (45.5%) had a significantly better prognosis compared with the left atrium (0%, p = 0.03) and diaphragm (0%, p = 0.04) groups. T3N0 (50.3%), IIB (55.4%), IIIA (44.6%), and complete resection groups (49.0%) showed a significantly better prognosis compared with T3N2 (27.9%, p = 0.01), III B (0%, p < 0.0001), and incomplete resection groups (13.9%, p < 0.0001), respectively. These results indicate that the prognosis of patients with N2 disease or incomplete resection remains poor in regardless with the type of involved organs. 相似文献
