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Purpose: To clarify the clinical significance of sivelestat sodium (SIV) administration, we surveyed the status of 40 patients treated with SIV for respiratory dysfunction following surgery. Methods: The subjects were patients who received SIV administration due to systemic inflammatory response syndrome (SIRS) and respiratory dysfunction (PaO/FO ratio ≤300 mmHg) after surgery at the Department of Surgery and Science, Kyushu University, and related facilities between April and December 2008. Results: The most frequent underlying condition was perforation of the digestive tract, followed by cancer of the upper digestive organs. The main causes of SIRS were surgical stress and infection. The mean P/F ratio at the initiation of SIV administration was 185.5 ± 72.0 mmHg. The ratio increased, and the number of SIRS-related factors decreased with time after SIV administration. Sivelestat sodium was administered within 24 h after the onset of respiratory dysfunction in 87.5% of the patients, and the survival rate at 28 days after the initiation of SIV administration was 90.0%. Conclusion: Our findings suggest that multidisciplinary postoperative management, including the administration of SIV, during the early phase after the onset of respiratory dysfunction leads to improvements in respiratory function and survival. [ABSTRACT FROM AUTHOR]

Objectives: This study analyzed the incidence and characteristics of bilateral peritonsillar abscesses (PTAs) that were treated with immediate tonsillectomy. Methods: The study analyzed 409 patients with PTAs treated between 1984 and 2008. The patients included 304 male and 105 female patients between 2 and 85 years of age (median age. 30 years). Immediate tonsillectomy was performed in 371 of the PTA patients (90.7%). The incidence of bilateral PTAs and candidate predictive factors for bilateral PTAs were reviewed, including age, duration of PTA symptoms, history of recurrent tonsillitis, history of PTAs, deviation of the uvula, body temperature on admission, white blood cell count on admission, and C-reactive protein level on admission. Results: Bilateral PTAs were found in 24 of 371 patients (6.5%). Younger age, absence of a deviated uvula, and a higher C-reactive protein value were the clinical features associated with bilateral PTAs in multivariate analysis. Conclusions: The occurrence of bilateral PTAs was not rare; this fact has to be taken into consideration in discussing therapeutic concepts. The clinical features of bilateral PTAs suggested that bilateral PTAs might be a part of (he natural history of PTAs, and that they occur in cases in which there is a delay in diagnosis and treatment. Further study is necessary to confirm the causation of bilateral PTAs. [ABSTRACT FROM AUTHOR]

Objectives: This study was designed to evaluate the efficacy and morbidity of immediate tonsillectomy used to treat peritonsillar abscess (quinsy) and parapharyngeal abscess. Subjects and method: This four-year, retrospective study was based on 31 patients hospitalised in a university hospital ENT and head and neck surgery department for peritonsillar and/or parapharyngeal abscess. All patients underwent immediate, bilateral tonsillectomy. The length of hospital stay, duration of antibiotic therapy, microbiological findings, complications, and the time to complete recovery and oropharyngeal healing were recorded. Results: The patients' mean post-tonsillectomy hospital stay was 2.84 days (median: 3 days). No post- operative haemorrhage was observed. All patients were considered to be cured at the day 10 follow-up visit, and complete oropharyngeal healing was observed at the day 21 visit. The duration of antibiotic therapy ranged from 10 to 15 days (mean: 11.5 days; median: 10 days). Discussion and conclusion: Immediate tonsillectomy appears to be a safe and effective surgical technique for the management of peritonsillar and parapharyngeal abscess; in particular, it markedly reduces patients' hospital stay (when performed early in the course of the disease) and duration of antibiotic therapy. Immediate tonsillectomy has become the first-line treatment for parapharyngeal abscess and several types of peritonsillar abscess in our department. [ABSTRACT FROM AUTHOR]

Abstract: Vagus nerve stimulation (VNS) for medically refractory seizures has been an approved therapy by the Food and Drug Administration since 1997, with additional approval as an adjunct therapy for major depression granted in 2005. Potential applications for VNS therapy in obesity, neuropsychiatric disorders, and chronic pain syndromes are under investigation. Bradyarrhythmias, including asystole, may occur during VNS device placement or as a delayed complication. A peritracheal hematoma may develop following VNS device placement, necessitating emergent management. Other respiratory complications may include vocal cord movement abnormalities with potential for aspiration. Vagus nerve stimulation results in sleep-related breathing pattern changes, with an associated increase in the number of obstructive apneas and hypopneas in both children and adults, which may impact perioperative care. [Copyright &y& Elsevier]

Summary: Spontaneous pneumothorax is an extremely frequent pathology. Despite this, there is still no clear consensus on managing these patients. Therefore, we perform a systematic review and meta-analysis of the effectiveness of percutaneous aspiration compared with tube drainage for treating idiopathic spontaneous pneumothorax. Controlled, randomised clinical trials were selected, in which the effectiveness of percutaneous aspiration is compared with that of chest tube drainage, in terms of resolution of the pneumothorax and rates of relapse and hospital admission. Relevant articles were identified by searching electronic databases (e.g., Medline, EMBASE, CENTRAL, mRCT and Pascal), as well as the references of the papers found in this manner, with a cut-off date of April 2009. Quality was assessed by two independent evaluators, using the CASPe appraisal tool. Effectiveness of percutaneous aspiration is compared with that of chest tube drainage, in terms of resolution of the pneumothorax and rates of relapse and hospital admission. [Copyright &y& Elsevier]

Abstract: Objective: Creation of a patent subglottic airway after partial cricotracheal resection (PCTR) may not always result in successful decannulation due to associated parameters such as co-morbidity and/or glottic involvement. We classified patients after incorporating these additional parameters into the original Myer–Cotton classification to assess whether this could better predict the outcome measures after PCTR. Methods: One hundred children with Myer–Cotton grade III or IV subglottic stenosis who underwent PCTR between 1978 and 2008 were identified from a prospectively collected database. The patients were classified into four groups based on the association of co-morbidity and/or glottic involvement. Delay in decannulation, revision open surgery and rates of decannulation were the outcome measures compared between the groups. Results: There were 68 children with Myer–Cotton grade III and 32 children with grade IV stenosis. Based on the new classification, there were 36 children with isolated SGS, 31 with associated co-morbidity, 19 with associated glottic involvement and 14 children with both co-morbidity and glottic involvement. A trend towards less optimal results was noticed with the association of co-morbidity and/or glottic involvement. Statistical significance was reached for maximum decannulation failure in the group with both co-morbidity and glottic involvement. Delayed decannulation significantly correlated in the group with associated glottic involvement. Conclusion: This new classification is relatively simple and aimed at providing more accurate and uniform prognostic information to both patients and surgeons when dealing with the whole spectrum of severe SGS. [Copyright &y& Elsevier]

Abstract: The cone-beam CT (CBCT), which is acquired using an on-board imager (OBI) attached to a linear accelerator, is used effectively in the verification of setup accuracy for lung radiation surgery. In this study, the respiratory organ motional effect on the CBCT was evaluated with a properly devised phantom system, and the level of possible error in conditions of a real clinical process was assessed. In a comparison study between the CBCT in static status and CBCT images acquired in 20 different motional cases, we confirmed that the image quality and information of CBCT were degraded, with an increase of motional ranges in the region of inhomogeneous structures. The 4D-CT MIP (50∼55%) for the planning of lung radiation surgery and the 4D-CT MIP (full phase) were compared with CBCT in the various motional cases for the evaluation of the influence of the motional effect on CBCT in the process of the setup error correction. The average ratio of relative difference between plan CT: 4D-CT MIP (50%∼55%) and CBCT was 5.79% and between plan CT: 4D-CT MIP (50%∼55%) and 4D-CT MIP (full phase) was 42.95% in the phantom study. In the analysis of clinical cases of lung radiation surgery, the gross tumor volumes were compared in each CT image. The average ratio of relative difference between plan CT: 4D-CT MIP (50∼55%) and CBCT was 10.72% and between plan CT: 4D-CT MIP (50∼55%) and 4D-CT MIP (full phase) was 28.19%. These results showed that, although a respiratory organ motional effect on CBCT introduced variation in image quality, the error as a result of this variation could be estimated relatively low in the setup error correction for a gated-lung radiation surgery when the planning was performed in 4D-CT MIP (50∼55%), which already included a related signal of motional effect. [Copyright &y& Elsevier]

The benefit of bullae ablation for the management of primary spontaneous pneumothorax (PSP) has been established. However, various modalities for bullae ablation have been reported from different centers. The present study aimed to assess whether endoloop ligation of bullae was as effective as staple bullectomy for preventing the recurrence of pneumothorax. Between January 1993 and December 2003, 226 patients (203 men and 23 women) with PSP were recorded and retrospectively reviewed. One hundred thirty (57.5%) patients were treated with endoloop ligation of bullae and the other 96 (42.5%) were treated with staple bullectomy. Mechanical abrasion was performed in all patients after bullae ablation. The recurrence rate of pneumothorax was 6.2% (8 patients) in the endoloop ligation group and 17.7% (17 patients) in the staple bullectomy group ( p = 0.006). The postoperative complication rate was 14.6 and 20.8% in the endoloop ligation and staple bullectomy groups, respectively ( p = 0.221). The long-term chest discomfort rate after endoloop ligation and staple bullectomy was 14.6 and 13.5%, respectively ( p = 0.819) Endoloop ligation of bullae is as effective as mechanical staple bullectomy for the management of bullae in primary spontaneous pneumothorax. [ABSTRACT FROM AUTHOR]

Objectives: After a first clinical study showing a high prevalence of gastrointestinal tract diseases in brachycephalic dogs presented for upper respiratory syndrome, a prospective study was performed to determine the influence of medical treatment for gastrointestinal tract disorders associated with upper respiratory syndrome surgery. Methods: The gastrointestinal tract and respiratory disorders of 61 brachycephalic dogs presented for upper respiratory syndrome were evaluated. Together with surgery of the upper respiratory tract, a specific gastrointestinal medical treatment was administered. A minimal follow-up of six months was required for inclusion. Results: Palatoplasty with rhinoplasty was the most common surgical correction (88·5 per cent). The mortality rate in the perioperative period was 3·3 per cent. Minor complications accounted for 26·2 per cent of cases. No aspiration pneumonia was encountered. A sufficient follow-up was obtained in 51 dogs. The improvement was judged by the owners as excellent or good in 88·3 per cent of the respiratory disorders and in 91·4 per cent of the gastrointestinal disorders. Clinically, a statistically significant improvement was obtained for both respiratory and gastrointestinal disorders. Clinical Significance: In comparison with other studies, digestive tract medical treatment combined with upper respiratory surgery seems to decrease the complication rate and improve the prognosis of dogs presented for upper respiratory syndrome. [ABSTRACT FROM AUTHOR]

Objective: To develop and evaluate a postprocessing tool to quantify ventilated split-lung volumes on the basis of ³He-MRI and to apply it in patients after single-lung transplantation (SLTX). High-resolution CT (HRCT) was employed as a reference modality providing split air-filled lung volumes. Lung volumes derived from pulmonary function test results served as clinical parameters and were used as the "gold standard." Material and methods: Eight patients (mean age, 54 years) with emphysema and six patients (mean age, 58 years) with idiopathic pulmonary fibrosis. All patients were evaluated following SLTX. HRCT was performed during inspiration (slice thickness, 1 mm; increment, 10 mm). For correlation with ³He-MRI, HRCT images were reconstructed in coronal orientation to match the same anatomic levels. Aerated lung was determined by threshold-based segmentation of CT. ³He-MRI was performed on a 1.5-T scanner using a two-dimensional, fast low-angle shot sequence in coronal orientation covering the whole lung after inhalation of a 300-mL bolus of hyperpolarized are gas followed by normal room air for the rest of the tidal volume. Lung segmentation on ³He-MRI was done using different thresholds. Results: In emphysematous patients, ³He-MRI showed excellent correlation (r = 0.9) with vital capacity, while CT correlated (r = 0.8) with total lung capacity, ³He-MRI correlated well with CT (r > 0.8) for grafts and native fibrotic lungs. In emphysematous lungs, MRI showed a good correlation (r = 0.7) with the nonemphysematous lung volume from CT. Increasing thresholds in ³He-MRI reveal differences between aerated and ventilated lung areas with a different distribution in emphysema and fibrosis. Conclusions: ³He-MRI is superior to CT in emphysema to demonstrate ventilated lung areas that participate in gas exchange. In fibrosis, ³He-MRI and CT have a similar impact. The decrease pattern and the intraindividual ratio between ventilation of native and transplanted lungs will have to be investigated as a new surrogate for the ventilatory follow-up in patients undergoing SLTX. Key words: CT; hyperpolarized ³He; MRI; single-lung transplantation; split-lung function. [ABSTRACT FROM AUTHOR]

Study objectives: To review our experience with specific characteristics, indications, and results of pulmonary resection in children with middle lobe/lingula syndrome. Design: Retrospective cohort study. Setting: Thoracic Surgery Department, Chest Diseases Hospital, Kuwait. Patients and intervention: Thirteen children with middle lobe, lingula, or both syndromes were treated with pulmonary resection from January 1995 to December 1999. Results: The mean age was 7.5 years (range, 5 to 10 years). Eight patients were girls, and five were boys. All patients underwent high-resolution CT and bronchoscopy. Bronchiectasis and atelectasis of right middle lobe, lingula, or both was noted in nine patients. Bronchial stenosis and inflammation of the bronchus was found endoscopically in four patients. The indications for surgery were recurrent respiratory tract infection with persistent atelectasis and bronchiectasis in nine patients, and recurrent respiratory tract infection with bronchiectasis in four patients. A right middle lobectomy was done on seven patients and a lingulectomy on four patients. Two patients underwent staged thoracotomies (right middle lobectomy and lingulectomy). There were no operative deaths. Only two patients had postoperative complications: atelectasis (n = 1), and pneumothorax (n = 1). Mean follow-up was 3.5 years (range, 3 to 5 years) for all patients. Nine patients were asymptomatic, and four patients had improved. Conclusion: Right middle lobe or lingula syndrome with the presence of bronchiectasis, bronchial stenosis, or failure of lung to re-expand are indications for early pulmonary resection. Key words: atelectasis; bronchiectasis; pulmonary resection; right middle lobe. [ABSTRACT FROM AUTHOR]

The author reflects on the disease management of patients with central airway obstruction. He states that the risk of fatal airway obstruction or cardio-vascular collapse during application of anesthesia in patients with central airway obstruction has been identified since 1970. He mentions that the anesthetic considerations for patients with central airway obstruction varies on individual pathology, anatomy, and proposed surgical procedure.

We report a case of nocardiosis in an immunocompetent patient who presented with pain and multiple swellings in the face. Nocardia asteroides was isolated from the parotid and submandibular salivary glands. The patient was successfully treated by surgical drainage and oral administration of trimethoprim and sulfamethoxazole. To the best of our knowledge, this is the first reported case from India on N. asteroides affecting the salivary gland. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Laryngotracheal separation (LTS) is an effective and reliable definitive treatment for intractable aspiration. A major advantage of this treatment for intractable aspiration is its’ potential reversibility. Should the underlying disorder improve, a reversal of the procedure may be attempted. This has been successfully achieved in the adult population. To our knowledge, no previous cases have been reported of successful reversal of LTS in children. Methods: A retrospective review from 2003 to 2010 identified four cases of intractable aspiration treated with LTS in our department. Two of these patients displayed objective evidence of sufficient recovery of their underlying aspiration to consider reversal. Patient selection for reversal was dependent upon successful oral intake for 9 months along with videofluoroscopic evidence of normal or minimally impaired swallow. Results: Two children who were successfully treated for intractable aspiration with LTS demonstrated objective evidence of recovery sufficient to attempt reversal. Both children underwent successful surgical reversal of LTS using a cricotracheal resection with end-to-end anastamosis, similar to that used in treatment of subglottic stenosis. Both children can now tolerate oral diet and their speech and language development is in line with their overall developmental level. Conclusions: Laryngotracheal separation is an effective and reliable definitive treatment for intractable aspiration facilitating protection of the airway and allowing safe swallowing with unimpeded respiration, but with the major drawback of loss of phonation. To our knowledge, we document the first two cases of successful LTS reversal in children. [ABSTRACT FROM AUTHOR]

The article examines whether minimal access video-assisted thoracic surgery is as effective as open surgery (thoracotomy) in preventing recurrence of spontaneous pneumothorax. The article presents the findings of Allanah Barker and her colleagues who researched the issue. It is suggested in the article that the video-assisted thoracic surgery is preferable to a policy of thoracotomy. The article reports that early and late pain is less common for those patients who participate in video-assisted thoracic surgery, and they return to full health and mobility faster than with open surgery.

Comments on an article which examined the effectiveness of laser-assited uvulopalatoplasty (LAUP) in patients with sleep-related breathing disorders, published in the June 1998 issue of the 'Archives of Otolaryngology Head and Neck Surgery.' Indications for LAUP; Benefits of LAUP.

Nouveau-né aux échographies ante natales déclarées normales. Dès H 24 de vie, détresse respiratoire progressivement croissante ; avis chirurgical demandé à J 5. Important emphysème global du poumon droit faisant évoquer un obstacle de la bronche souche. Fibroscopie : lésion kystique endo-luminale de la carène obstruant l’ostium de la bronche droite. Une lésion kystique identique existe au niveau de la carène, exo-luminale «en miroir» de la précédente sur le scanner. Aggravation rapide de la détresse respiratoire et intervention en urgence à J 5 par thoracotomie droite : exérèse de la lésion externe avec affaissement de la lésion endo luminale en contrôle endoscopique per opératoire et bon «air-way» du poumon droit. Cependant résultat temporaire car lésion endo-luminale retrouvée égale à elle-même à l’endoscopie à J+5. Intervention per endoscopique à J+6 : réalisation après ponction, d’une «électrofenestration». Suites simples. Anatomopathologie confirmant le kyste bronchogénique. Contrôle endoscopique satisfaisant à + 2 ans chez un enfant asymptomatique. À ce jour, une seule observation identique de kyste bronchogénique trans mural de la carène a été retrouvée dans la littérature avec un traitement uniquement endoscopique. [ABSTRACT FROM AUTHOR]

The article announces the 4th National Audit Project (NAP4) in Great Britain which encourages patients that suffered harm from airway management during anaesthesia to report their cases. It collects data on major complications of airway management resulting in death or brain damage, needle cricothyroidotomy, and Intensive Care Unit admission. NAP4 would focus on cases with poor outcome caused by difficult airway management and will run from September 1, 2008 to August 31, 2009.