Successful management of concommitant blunt injury to the trachea, esophagus, and cervical spine in a 6-year-old girl

A 6-year-old girl sustained an unusual constellation of injuries after blunt trauma sustained in a motor vehicle accident. Transection of the trachea and esophagus were managed successfully by repair through a median sternotomy while the patient was on cardiopulmonary bypass. A cervical spinal injury was fixated with halo traction and a femur fracture with internal fixation.     

Tracheal mucormycosis presented as an intraluminal soft tissue mass

BACKGROUND: Mucormycosis is a potentially lethal disease caused by an opportunistic fungal infection. It occurs mostly in diabetic or immunosuppressed patients and usually involves the lungs or paranasal sinuses. METHODS: We report a rare case of a patient with diabetic ketoacidosis who presented with progressive cough and dyspnea. CT of the neck and chest showed an intraluminal soft-tissue mass extending from the first tracheal ring to the thoracic inlet, causing severe destruction of the trachea. Direct laryngoscopy and biopsy demonstrated hyphal invasion with architecture typical of invasive mucormycosis. RESULTS: The patient underwent resection of the upper trachea and prolonged amphotericin B therapy and is disease free at 24 months after surgery. CONCLUSIONS: In patients with diabetes presenting with progressive hoarseness, dyspnea, and endobronchial mass, a fungal infection should be considered. In case of invasive tracheal mucormycosis, prompt diagnosis and early surgical resection may help improve survival.     

Is the Trachea a Marker of the Type of Environmental Pollution?

OBJECTIVES/HYPOTHESIS: The differentiated character of changes in the mucous relief of the trachea as induced by air containing pollutants from the wastes of nickel-, mercury-, and cement-producing plants and by Candida albicans occurring in the waste disposal site of a large town are identified. The trachea was chosen because it is the entrance gate for the penetration of polluted air into the lungs. Changes on the trachea influence the character and extent of changes in lungs. STUDY DESIGN: Histological study with Viennese grey strain laboratory rabbits and rats caught directly on an investigated site. METHODS: We present new results of the functional morphology of the respiratory system as the results of scanning and transmission electron microscopy studies that can reveal character and range of damage of mucosal relief of trachea relevant to the functional dynamics of mucociliary clearance. Under physiological conditions this mechanism allows that only respirable dust particles enter the deep respiratory tract. RESULTS: In case of a damaged tracheal relief because of exposure to various aerosols, the functional morphology is changed, which aids in understanding the mechanisms damaging to mucociliary clearance induced by living in heavily polluted areas. CONCLUSION: Understanding of these morphological changes on base of detailed electron microscopic findings sheds new light on elaborating novel diagnostic methods for clinical practice.     

气管切开后呼吸道管理的护理进展

介绍了气管切开后呼吸道管理的护理进展.重点阐述了气管切开的适应证,气道湿化的护理管理,吸氧、排痰的护理管理,气囊的护理管理,呼吸道感染的护理.     

小儿气管异物取出术的手术配合

目的总结小儿气管异物取出术的手术室护理配合。方法对127例小儿气管异物取出术的手术配合进行分析和总结。结果127例小儿气管异物取出均获成功。结论术前的充分准备,术中的密切配合是手术成功的可靠保障。     

"肺肾相关"的物质基础

目的 :通过观察雄激素受体 (AR)在健康雄性大鼠气管和肺中的表达 ,探讨中医学“肺肾相关”的物质基础。方法 :选用成年健康雄性大鼠 ,气管和肺冰冻切片 ,采用免疫组织化学LAB SA法染色 ,光镜下观察AR的表达。结果 :在雄性健康大鼠的气管、支气管的假复层柱状纤毛上皮、软骨细胞均有AR的阳性表达 ,AR特异性免疫组化染色多见于胞浆 ,也见于胞核。结论 :肾可通过雄性激素及其受体对肺进行调节 ,雄激素及其受体可能是“肺肾相关”的物质基础。     

The Effect of Hydroethanol Extract of Achillea Millefolium on β-adrenoceptors of Guinea Pig Tracheal Smooth Muscle

Different pharmacological effects of Achillea millefolium including its relaxant effect on smooth muscle have been shown previously. In the present study the stimulatory effect of the plant extract on β-adrenoceptor of tracheal muscle was examined in order to investigate one possible mechanism for its observed relaxant effect. Effect of three concentrations of hydroethanol extract, 10 nM propranolol, and saline on β-adrenoceptor was tested in two experimental groups including; nonincubated tracheal smooth muscles (group 1) and incubated tracheal smooth muscle with chlorpheniramine (group 2). Concentration response curves to isoprenaline were performed in precontracted tracheal smooth muscle in the presence of the extract, propranolol and saline. Values of EC₅₀ and CR-1 were measured. Leftward shifts in isoprenaline curves were observed in the presence of medium and high concentrations of the extract compared with saline in both groups. The values of EC₅₀ obtained in the presence of medium and high concentrations of the extract only in group 1 were nonsignificantly lower than that of saline. The values of CR-1 obtained in the presence of all concentrations of the extract in both groups were negative and significantly different with that of propranolol. The results indicated a small stimulatory effect of the extract on ß₂-adrenoceptors.     

The M2 selective antagonist AF-DX 116 shows high affinity for mnscarine receptors in bovine tracheal membranes

Summary We have characterized the muscarine receptors in bovine tracheal and left ventricular membranes using ³H-dexetimide/pirenzepine and ³H-dexetimide/AF-DX 116 competition studies. Pirenzepinc exhibited low (M₂) affinity binding to both preparations; K _d was 590 nM in left ventricle and 463 nM in trachea. AF-DX 116 exhibited high (M₂) affinity binding to left ventricle (K _d = 95.6 nM); in tracheal membranes it bound with high (M₂) affinity (K _d = 40.7 nM) to 74% of the receptors and with low (M₃) affinity (K _d = 2.26 M) to 26% of the receptors. It is concluded that bovine tracheal muscle membranes contain a heterogeneous population of muscarine binding sites, the majority having M₂ (heart) subtype characteristics and being located on the smooth muscle membranes; a minority having M₃ (exocrine gland) subtype characteristics and presumed to be located in submucosal glands. This is the first report of high affinity binding of AF-DX 116 to non-cardiac peripheral muscarine receptors. Send offprint requests to A. F. Roffel at the above address     

烧伤科成人院内获得性肺炎危险因素的研究

目的了解烧伤科成人院内获得性肺炎的危险因素,为临床治疗提供参考资料。方法对2001年1月～2010年12月于本院烧伤科患者中诊断为院内获得性肺炎者运用统计学方法进行回顾性分析。结果老年患者比年轻患者院内获得性肺炎感染率高,差异有统计学意义(χ2=28.3,P<0.05);重度及特重烧伤患者较轻中度烧伤患者院内获得性肺炎感染率高,差异有统计学意义(χ2=123.1,P<0.05);有吸入性损伤者较无吸入性损伤者院内获得性肺炎感染率高,差异有统计学意义(χ2=116.6,P<0.05);气管切开及机械通气者较未行气管切开者院内获得性肺炎感染率高,差异有统计学意义(χ2=51.2,P<0.05);女性较男性院内获得性肺炎感染率低,但差异无统计学意义(χ2=0.43,P>0.05)。痰培养显示,院内获得性肺炎主要有2种或2种以上细菌混合感染引起,革兰阴性杆菌是主要的致病菌。创面细菌迁移和胃肠-肺感染途径是院内获得性肺炎的重要感染途径。结论烧伤科感染院内获得性肺炎危险因素有年龄、烧伤程度、吸入性损伤、气管切开,与性别无关。对胃肠道反流和创面处理上需要引起足够的重视,并尽量避免交叉感染。