[The esophageal tracheal combitube].
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Biomedical subjects
Publications and source records attributed to R Georgi.
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Massive nasal haemorrhage occurred during an attempted nasal endotracheal intubation in a 52-year old patient, scheduled for bone grafting to the mandibula. Ventilation of the patient by face mask and conventional endotracheal intubation by laryngoscopy were not possible due to massive bleeding. This situation was successfully managed by the use of a Combitube. The role of the Combitube in difficult airway management as well as its extensive contraindications are discussed. Rare complications when using the Combitube, their diagnosis and treatment are mentioned.
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Acute angioneurotic edema due to angiotensin converting enzyme (ACE) inhibitors usually develops shortly after therapy has been started. In this case, hypopharyngeal edema occurred with a delay of nine days. It required endotracheal intubation and could only be differentiated from an inflammatory process by examination under general anesthesia. The mechanism of action of ACE inhibitors, the pathogenesis of angioneurotic edema, its therapy outside as well as in the hospital, and the case described are being discussed. It is concluded that severe reactions induced by ACE inhibitors must be expected even after considerable time of therapy.
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Many pathological changes in pharynx and larynx can cause problems in endotracheal intubation. Their preliminary signs and symptoms are often uncharacteristic. Thus prophylaxis is not always possible. Some representative diseases of larynx and pharynx are demonstrated by means of endoscopic photographs and by case reports. The photos were taken during endoscopic examinations in an ENT-clinic. The method of anaesthesia used in these cases is described, as well as prophylactic measures to be taken, if a difficult intubation may be expected. Finally, the procedure in case of an unexpected critical intubation is discussed.
Twenty-two children with idiopathic hypercalciuria (IH) as well as their parents and siblings were compared to 29 control children and their parents and siblings. Urinary calcium excretion following calcium deprivation or calcium loading was significantly higher in parents and siblings of the IH children than in the corresponding controls. Significantly higher rates of glomerular filtration and increased urinary excretion of sodium potassium and phosphate were found in all family members in the IH group as compared to controls. Significant positive correlations of the five variables studied (glomerular filtration and urinary excretion of calcium, phosphate, sodium, and potassium) were noted within individuals and also within families, both in the IH and the control groups, notwithstanding the lower mean levels in the latter. Serum concentrations of calcium, phosphate, potassium, and sodium were similar in the IH and controls. The distributions of all urinary variables in both the IH and control groups were unimodal with considerable overlap of the two groups, suggesting that IH may be a single entity, possibly representing the upper end of normality. Our data seem to indicate that IH is more likely to be due to nutritional than to genetic factors, since maintenance of sodium potassium homeostatis in the face of increased excretion necessitates increased ingestion of these electrolytes, while increased sodium ingestion is known to be associated with increased urinary excretion of calcium, potassium, and phosphate.
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