Bronchoscope-assisted Tritube® placement for resection of sequential tracheal stenosis

Symptomatic tracheal stenosis is a rare but significant complication of long-term tracheal intubation and mechanical ventilation. Airway management for tracheal resection in severe tracheal stenosis, especially sequential stenoses, requires multidisciplinary planning. A valuable method of airway management is the insertion of a small-bore, cuffed tracheal tube (Tritube®, Ventinova Medical B.V., Eindhoven, The Netherlands) in combination with flow-controlled ventilation. In this case, a patient with tracheal stenosis following prolonged ventilation required resection of the stenosed tissue. A Tritube was placed via a J-tipped guidewire inserted through the working channel of a bronchoscope. Bronchoscopic cuff visualisation along the tube in severe stenosis is impossible because of the outer diameter of the tracheal tube. In this case, we therefore estimated the position of the tube tip based on the distance from the vocal cords to the carina measured on pre-operative computed tomography imaging. During completion of the dorsal tracheal anastomosis, cross field ventilation using a conventional tracheal tube had to be started due to impeded ventilation caused by the Tritube protruding distal to the carina. In severe sequential tracheal stenosis, a small-bore tracheal tube can safely be placed by guidance with a J-tipped guidewire. However, it is important to plan a backup method of ventilation, such as cross field ventilation, prior to commencing a critical procedure.

[Acute colonic pseudo-obstruction (Ogilvie's syndrome) - a rare complication after ablation mammae and direct reconstruction with a free TRAM flap]

We report a case of a 62 year old woman who presented with Ogilvie's syndrome as a complication of mastectomy with free TRAM flap reconstruction due to angiosarcoma of the right breast. In the acute postoperative period, the patient expired as a result of Ogilvie's syndrome related complications. Several assumptions regarding the causes of Ogilvie's Syndrome as well as current theories about aetiology, diagnosis and therapy are discussed in this case presentation.

[Distal biceps tendon ruptures--experiences with soft tissue preserving reinsertion by bone anchors]

The repair of the distal biceps tendon rupture with bone anchors achieves excellent results. The important function of the M. biceps brachii as a powerful supinator and flexor can be reestablished and the soft tissue can be protected. We describe the repair of the rupture of distal biceps tendon by an anatomic refixation of the tendon to the tuberositas radii with bone anchors through a single anterior incision. In a four year period we treated eight patients with this technique. All patients were men with a mean age of 50 years. In each case the mechanism of injury was a single traumatic event with a large load on the flexed elbow. In average surgery was performed within five days and the patients stayed in the hospital for two days. Clinical follow up after almost two years showed no nerve damage or heterotopic bone formation. The range of motion and isometric muscle testing were almost symmetrical. All patients were able to return to preinjury activity level without any limitations.