Prophylactic tracheostomy in aged and poor risk general surgical patients

The most common postoperative complications are those involving respiration, and they are especially dangerous to patients classified as poor risks because of age or other handicaps. Among the 11 patients whose histories are given, some who were nearly moribund from respiratory difficulties were saved by tracheostomy; others made good recoveries from major surgery under conditions that would have been hopeless without the help afforded by prophylactic tracheostomy. If this possibility is foreseen, an orderly procedure can be carried out in the operating room instead of desperate measures on the ward. Scrupulous care of the tracheostomy is essential; this includes aseptic precautions, humidification of the inhaled air or oxygen, and the systematic but gentle use of suction to aspirate accumulating mucus. © 1959, American Medical Association. All rights reserved

Tuberculous bronchial "emboli"

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Complications of chronic necrotizing pulmonary aspergillosis: review of published case reports

Chronic necrotizing pulmonary aspergillosis (CNPA), a form of chronic pulmonary aspergillosis (CPA), affects immunocompetent or mildly immunocompromised persons with underlying pulmonary disease. These conditions are associated with high morbidity and mortality and often require long-term antifungal treatment. The long-term prognosis for patients with CNPA and the potential complications of CNPA have not been well documented. The aim of this study was to review published papers that report cases of CNPA complications and to highlight risk factors for development of CNPA. The complications in conjunction associated with CNPA are as follows: pseudomembranous necrotizing tracheobronchial aspergillosis, ankylosing spondylarthritis, pulmonary silicosis, acute respiratory distress syndrome, pulmonary Mycobacterium avium complex (MAC) disease, superinfection with Mycobacterium tuberculosis, and and pneumothorax. The diagnosis of CNPA is still a challenge. Culture and histologic examinations of bronchoscopically identified tracheobronchial mucus plugs and necrotic material should be performed in all immunocompromised individuals, even when the radiographic findings are unchanged. Early detection of intraluminal growth of Aspergillus and prompt antifungal therapy may facilitate the management of these patients and prevent development of complications