A 39-yr-old woman presented with dyspnea and cough. She had undergone total thyroidectomy for multinodular goiter 15 yr earlier, with subsequent T4 replacement therapy. Inspiratory stridor was noted. Serum TSH was 2.95 mIU/ml (normal, 0.3–4.0 mIU/ml). A magnetic resonance image (MRI) of the neck showed a subglottic tumor with severe occlusion of the trachea (Figs. 1 and 2). Direct laryngoscopy ...

Secretion management in the mechanically ventilated patient includes routine methods for maintaining mucociliary function, as well as techniques for secretion removal. Humidification, mobilization of the patient, and airway suctioning are all routine procedures for managing secretions in the ventilated patient. Early ambulation of the post-surgical patient and routine turning of the ventilated ...

PURPOSE Wegener's granulomatosis (WG) is a rare multisystem inflammatory disease, which infrequently involves the subglottic area and trachea. Treatment usually involves the use of immunosuppressive agents with corticosteroids. Some patients, however, continue to have symptoms of airway obstruction after clinical remission following the standard therapeutic regimen. OBJECTIVE To investigate l...

Congenital tracheobiliary or bronchobiliary fistula is a rare developmental anomaly with a persistent communication between the biliary system and the trachea or bronchus. We report a case of a congenital tracheobiliary fistula and hypoplastic common hepatic duct associated with hypoplastic left heart syndrome in a 5-day old boy presenting with bilious endotracheal-tube secretions. The tracheob...

The sheath of omentum that forms about a long rubber tube left within the peritoneal cavity provides so efficient a barrier to ascending infection that such a tube can be employed for the permanent drainage of the common duct, whereas a short tube will regularly come away after a few days. A method is described whereby the total bile of a considerable number of dogs has been obtained in a steri...

CASE HISTORY An 83-yr-old female presented with a history of worsening dyspnoea. In 1952, the patient had undergone surgical treatment for progressive pulmonary tuberculosis (TB) of the left-upper lobe. Treatment had consisted of an artificial pneumothorax and a cavernostomy via incision and drainage of a tuberculous cavity. Since surgery, the patient had cared for the cavernostomy herself by o...

Feeding-related adverse events after percutaneous endoscopic gastrostomy (PEG) such as aspiration pneumonia can impede the use of PEG. Percutaneous endoscopic transgastric jejunostomy (PEG-J) using large-bore jejunal tubes with gastric decompression function may improve outcomes by circumventing gastric passage during enteral nutrition and improving drainage of excessive gastric secretions. Thi...

An 18-yr-old man with insulin-dependent diabetes developed severe subglottic stenosis after a very brief period of intubation. Emergency tracheostomy was complicated by the development of bilateral pneumothoraces. This case highlights the importance of making an early diagnosis to minimize the risk of complications and examines postintubation subglottic stenosis in the context of poorly control...