Long-Term Complications of Tracheal Intubation

Endotracheal intubation is an intervention frequently performed in the hospital setting in order to protect the central airway and provide mechanical support of ventilation. Many health care providers are expected to be able to intubate the patients for different indications. As the case in any medical intervention, endotracheal intubation can cause complications. These complications are categorized as early or late according to the time of onset of the presenting symptoms. This chapter will discuss the long term complications of endotracheal intubation that might be encountered by the treating physicians. The chapter will stress on the predisposing factors for these complications and the available methods to avoid and treat them

Survival and quality of life benefit after endoscopic management of malignant central airway obstruction

Although interventional management of malignant central airway obstruction (mCAO) is well established, its impact on survival and quality of life (QoL) has not been extensively studied.We prospectively assessed survival, QoL and dyspnea (using validated EORTC questionnaire) in patients with mCAO 1 day before interventional bronchoscopy, 1 week after and every following month, in comparison to patients who declined this approach. Material/Patients/Methods: 36 patients underwent extensive interventional bronchoscopic management as indicated, whereas 12 declined. All patients received full chemotherapy and radiotherapy as indicated. Patients of the 2 groups were matched for age, comorbidities, type of malignancy and level of obstruction. Follow up time was 8.0±8.7 (range 1-38) months.Mean survival for intervention and control group was 10±9 and 4±3 months respectively (p=0.04). QoL improved significantly in intervention group patients up to the 6(th) month (p<0.05) not deteriorating for those surviving up to 12 months. Dyspnea decreased in patients of the intervention group 1 month post procedure remaining reduced for survivors over the 12th month. Patients of the control group had worse QoL and dyspnea in all time points.Interventional management of patients with mCAO, may achieve prolonged survival with sustained significant improvement of QoL and dyspnea

Tracheoesophageal fistula managed with tracheal stent through flexible bronchoscopy without fluoroscopy

Inoperable malignant tracheoesophageal fistula (TEF) is characterised by an extremely poor prognosis. Tracheal or double (tracheal-esophageal) stenting through rigid bronchoscopy has been suggested as a valuable therapeutic option. We report on a patient with a large TEF successfully sealed by deployment of a self-expandable stent through flexible bronchoscopy (FB) without fluoroscopy. Dramatically improved health status permitted him to undergo radiation, attaining further clinical improvement. Four months after stent placement no sequelae were observed. During the fifth month a new fistula developed distally to the stent finally leading to death from septic complication. Palliative management of inoperable malignant TEF by tracheal stent placement through FB without fluoroscopy, is feasible, safe and rewarding leading to important clinical improvement

The effect of organic and conventional production methods on sea bream growth, health and body composition: A field experiment

This study aimed to develop a better understanding of organic sea bream aquaculture production in Greece, in particular its consequences for fish growth, health and body composition, and to propose and update standards for sustainable organic sea bream farming. Gilthead sea bream were kept in sea cages at densities of 4 kg m–3 (organic) and 15 kg m–3(conventional), and were fed organically produced feed (45% crude protein, 14% fat) or conventional feed (46% crude protein, 17% fat). The amino acid profile of the conventional diet, particularly the lysine content, which is one of most important dietary amino acids for sea bream, appeared to be unsatisfactory. “Organic” sea bream stored less fat content in their white muscle than the conventional sea bream. The liver lipid content was lower and the hepatosomatic index was higher for the organic sea bream. The microbiological analysis showed that both Enterobacteriaceae and Escherichia coli on the skin were below the enumeration detection limit in both the organic and conventional sea bream. Total viable counts on the skin and muscle of both the organically and conventionally cultured sea bream were approximately 3 log cfu g–1, which is well below the acceptable limit (7 log cfu g–1) for marine species. The results showed that the combination of a low stocking density and feed with a different ingredient composition but similar nutritional value resulted in similar growth rates and nutrient profiles of the final product. Further research on nutrition is required to provide information on setting the appropriate standards for organic sea bream aquaculture to ensure that the final product is in line with the consumers’ preferences

Validity and reliability of transbronchial needle aspiration for diagnosing mediastinal adenopathies

<p>Abstract</p> <p>Background</p> <p>The aim is to assess the validity and reliability of transbronchial needle aspiration (TBNA) of mediastinal and hilar adenopathies and to evaluate factors predictive of TBNA outcome.</p> <p>Methods</p> <p>We performed an analysis of prospectively collected data of patients (n = 580) who underwent TBNA (n = 685) from January 1998 to December 2007 in our center. Validity and reliability were evaluated for the overall sample and according to specific pathology. Factors predicting the successful acquisition of diagnostic samples were analyzed by multivariate analysis.</p> <p>Results</p> <p>Overall sensitivity, specificity, accuracy, and positive and negative predictive (NPV) values for TBNA were 68%, 100%, 68.8%, 100%, and 10%, respectively. The most sensitive and accurate TBNAs were obtained for patients with small cell lung carcinoma and the worst results were for patients with lymphomas. NPV were similar for all pathologies. The most predictive factors of outcome were adenopathy size and the presence of indirect signs at the puncture site.</p> <p>Conclusion</p> <p>The sensitivity and accuracy of TBNA are high in small cell lung cancer, followed by other types of carcinoma, sarcoidosis, and tuberculosis, and low for lymphoproliferative diseases. The NPV of TBNA for all individual pathologies is low. The size of the adenopathy and the presence of indirect signs at the puncture site predict the achievement of diagnostic samples.</p

Virulence of a T6SS Campylobacter jejuni chicken isolate from North Romania

Objectives: In this study we have investigated the in vitro and in vivo virulence characteristics of a new T6SS positive Campylobacter jejuni chicken isolate (SV12) originating from a poultry population in North Romania. A detailed phenotypic characterization was performed and compared to the T6SS negative C. jejuni 81-176 wild strain. Results: Our results indicate that the significantly higher capacity to attach and invade HCT-8 cells of C. jejuni SV12 isolate is associated with increased motility, increased resistance to bile salts and serum resistance, when compared to C. jejuni strain 81-76. Mice infected with the SV12 isolate showed statistically higher levels of colonization at both 7- and 14-days post-inoculation and in the stomach, caecum, duodenum and large intestine. Infection with the SV12 strain induced a stronger immune response as the gene transcript levels of IL-17, TNFα and IFNγ were more pronouncedly up-regulated compared to the C. jejuni strain 81-176. The present study showed that the new isolate SV12 had an enhanced virulence capacity compared to the wild strain which was evident in vivo as well. This work also provides an insight on the colonization pattern and host immune response differences between T6SS positive and T6SS negative C. jejuni

Therapeutic bronchoscopy for central airway diseases

Over the past century rigid bronchoscopy has been established as the main therapeutic means for central airway diseases of both benign and malignant aetiology. Its use requires general anaesthesia and mechanical ventilation usually in the form of manual or high-frequency jet ventilation. Techniques applied to regain patency of the central airways include mechanical debulking, thermal ablation (laser, electrocautery and argon plasma coagulation) and cryo-surgery. Each of these techniques have their advantages and limitations and best results can be attained by combining different modalities according to the type, location and extent of the airway blockage. If needed, deployment of airway endoprostheses (stents), as either fixed-diameter silicone or self-expandable metal stents, may preserve the airways patency often at the cost of several complications. Newer generation of customised stents either three-dimensional printed or drug-eluting stents constitute a promise for improved safety and efficacy results in the near future. Treating central disease of benign or malignant aetiology, foreign body aspiration or massive bleeding in the airways requires a structured approach with combined techniques, a dedicated team of professionals and experience to treat eventual complications. Specific training and fellowships in interventional pulmonology should therefore be offered to those who wish to specialise in this field. ©ERS 2020

Effect of irradiation on foods of animal origin

The very nature of the technology of irradiating food to reduce microbiological bio-burden and increase shelf-life has given rise to concerns about the effects of the process on the food itself. This article reviews the considerable body of experimental data that have been generated on the subject and shows that, at least at low doses, irradiation of food does not have a significant effect on the food and is harmless to the end-consumer

Irradiation of Insects: Disinfestation

The purpose of a quarantine disinfestation treatment is to prevent the establishment of a pest associated with a commodity to be imported into a country or region where it does not already occur, or where its presence is restricted. Traditional treatments, which most commonly involved chemical fumigants, such as ethylene dibromide and methyl bromide, and both hot (43-48°C) and cold (0-3°C) temperatures, work by killing essentially 100% of all stages of quarantined pests that might be present in the commodity. Alternative quarantine treatments for fresh commodities are needed because fumigants are being lost due to health and environmental problems; heat damages many commodities, such as stone and pome fruits and avocados; and cold treatment requires 12 or more days. Ionizing irradiation was suggested as a possible quarantine treatment 70 years ago, and considerable research to that effect has been done during the past approximately 45 years. Furthermore, residue-free advantages of irradiation disinfestation over chemical fumigation have been demonstrated repeatedly. Unlike other disinfestation techniques, irradiation does not need to kill the pests to provide quarantine security; therefore, live, but sterile, insects may occur with the exported commodity, making inspection for the target pests redundant as a confirmation of treatment application and efficacy. Moreover, irradiation treatment can be applied to the commodity after packaging. © 2010 Elsevier Inc. All rights reserved