Laryngeal damage due to an unexpectedly large and inappropriately designed cuffed pediatric tracheal tube in a 13-month-old child

PURPOSE: To present a case of laryngeal damage in an infant caused by a too large and inappropriately designed cuffed tracheal tube. CLINICAL FEATURES: A 13-month-old child undergoing cardiac surgery was intubated with an uncuffed endotracheal tube with an internal diameter (ID) of 4.0 mm. Because of an important air leak around the tracheal tube during mechanical ventilation, a cuffed endotracheal tube ID 4.0 mm was inserted. The air leak with the tube cuff not inflated was acceptable at 25 cm H2O airway pressure. After extubation on the third postoperative day, the patient showed increasing stridor and respiratory deterioration. Fibreoptic laryngoscopy of the spontaneously breathing patient showed a large intra-laryngeal web. After surgical removal of the web, the child rapidly recovered and was discharged from the hospital on the 12th postoperative day. Inspection of the 4.0 mm (ID) cuffed tracheal tube revealed a cuff positioned inappropriately high and an increase of 0.7 mm in outer tube diameter compared to the 4.0 mm (ID) uncuffed tracheal tube from the same manufacturer. The tube cuff is likely to be situated within the larynx when placed in accordance to insertion depth formulas or radiological criteria, as used for uncuffed tracheal tubes in children. CONCLUSION: The larger than expected tracheal tube with its intra-laryngeal cuff position in a 13-month-old child likely caused mucosal damage and an inflammatory reaction within the larynx resulting in granulation tissue formation and fibrous healing around the tracheal tube.     

Treatment of a recurrent inguinal lymphocele in a penis cancer patient by lymphography and selective ligation of lymphatic vessels

We report a case of recurrent inguinal lymphocele formation after inguinal lymphadenectomy treated by lymphographic mapping and selective ligation of the lymphatic vessels. Lymphographic mapping was performed by puncturing a lymphatic vessel at the dorsum of the foot. After isolating the vessels that drained into the lymphocele, they were clipped and divided through a small skin incision. The described technique showed an instant and complete suspension of the lymph secretion with subsequent complete healing. Lymphatic mapping and selective ligation of afferent lymphatic vessels proved to be an effective treatment of a recurrent inguinal lymphocele.     

Study of return rate and return time of undeliverable postal letters

Postal questionnaires are widely used to collect data in health research and epidemiologic studies. One problem related to mail surveys is the availability of an up-to-date and accurate list of people in the population from which to draw the sample for the survey. For the identification of incorrect postal addresses it is important that all incorrectly addressed mails are returned as undeliverable. This study examines the proportion of unreturned postal letters that were sent to incorrect addresses. We sent 339 letters to existing addresses throughout Germany, but used fictional names name of persons. Three hundred and three letters (98.2%) were returned as undeliverable. The return rates only slightly differed by layout of the envelopes, region and deliverer.     

Die Aufklärungspflicht bei endoskopischen Operationen

Ohne Zusammenfassung     

Rheo-optical fourier transform infrared spectroscopy of polyurethanes and their blends with polyolefins

Rheo-optical Fourier transform infrared spectroscopy was used to analyze the orientational behavior of hard and soft segments of thermoplastic poly(ether urethane)s (TPU-Et) and poly(ester urethane)s (TPU-Es) and their blends with a 20 mass-% contribution of either polyethylene (PE) or polypropylene with an amorphous rubber phase (PP). The blends show a reduced stress level, lower elongation-to-break and a lower degree of orientation of the segments — especially for the TPU-Es blends — compared to those of pure TPU's when uniaxially elongated. Blends of TPU-Et with PP show reduced stress but increased strain compared to pure films of TPU-Et. This is caused by an improved adhesion of the rubber phase in the polypropylene and the polyether phase of TPU-Et. Optical micrographs visualize deformed polyolefin particles in elongated films of TPU-Et/PP blends. In the TPU-Et/PP blend we could achieve equivalent orientation for the polyolefin phase and the segments of TPU-Et caused by this higher phase adhesion compared to the other blends. Orientation functions (OF's) of absorption bands which specifically represent hard or soft polyurethane segments or which are characteristic of the polyolefin phase have been calculated to monitor the molecular alignment due to the mechanical treatment.     

Block copolymers with bipyridine containing segments: Synthesis and self-organization by Cu(I) complexation

The synthesis and properties of segmented ABA triblock and (AB)_n multiblock copolymer systems with 6,6′-disubstituted 2,2′-bipyridine (bpy) building blocks B and poly(oxytetramethylene) soft segments A are described. The access to the disubstituted bipyridines in large scale quantities was achieved by modification of conventional synthetic routes. In the presence of copper(I) ions these polymers formed mononuclear [Cu(I)(bpy)₂] complexes in solution through self-assembly. The complexed copolymers were microphase separated systems in bulk with nano to mesoscopic superstructures consisting of copper-bpy complex aggregates in a polyether matrix. The thermal, mechanical and elastomer properties of the block copolymers varied with composition.