Analgesic levels and technical method in stereotactic pontine spinothalamic tractotomy

Stereotactic pontine spinothalamic tractotomy was performed on eight patients with severe pain due to malignancy. The procedure enables high levels of analgesia to be obtained with less risk of respiratory and micturition disorders than percutaneous or open cordotomy.

Extraction of large tracheal foreign bodies through a tracheostoma under bronchoscopic control

Despite various technical manipulations through contemporary endoscopic equipment, large tracheal foreign bodies may be lost during bronchoscopic extraction, with a 1 to 2% in-hospital mortality. Recently, emergency tracheostomy was performed during bronchoscopy after a tracheal foreign body had become dislodged in the subglottic region causing blockage of the airway, and the results of this procedure provoked its deliberate application in a second patient. In 3 additional infants, aspirated tracheal T tubes (Montgomery tubes), which were producing acute respiratory distress, were brought from the carina to the performed tracheostoma under bronchoscopic manipulation and were withdrawn. Elective application of this simultaneous approach--tracheostomy with bronchoscopy--may decrease morbidity and mortality from large tracheal foreign bodies.

Further experience in stereotactic pontine tractotomy

The problem with percutaneous and even stereotactic cordotomy is the difficulty in obtaining sufficiently high analgesic levels without autonomic complications, although the problem seemed to apply to relatively few patients since percutaneous and stereotactic spinal procedures achieved sufficiently high analgesic levels to encompass most patients' pain. There is a group of patients, however, with high pain in the shoulder and neck where conventional percutaneous and stereotactic spinal procedure are dangerous. From the standpoint of achieving high levels of analgesia with a low incidence of dysaesthesia, pontomedullary lesions appear to have advantages.