Anesthetic management for a patient with bronchobiliary fistula after pancreaticoduodenectomy: A case report.

RATIONALE: Perioperative management of patients with bronchobiliary fistula (BBF) is an anesthetic challenge because they typically exhibit poor lung function preoperatively, require meticulous lung isolation intraoperatively and need postoperative respiratory support. PATIENT CONCERNS: A 44-year-old man with a past surgical history of pancreaticoduodenectomy presented fluctuating fever, jaundice, dyspnea and yellowish sputum. Despite intravenous antibiotic treatment and repeated percutaneous drainage, patient showed gradual deterioration with hypoxemia, and uncontrolled pneumonia. DIAGNOSES: The patient was diagnosed with BBF based on the clinical manifestation such as biloptysis with pneumonia, and imaging studies. INTERVENTIONS: Resection of the fistula and bilobectomy was performed under general anesthesia. Avoidance of positive pressure ventilation before lung isolation and precise lung isolation are essential for patients with BBF to protect the unaffected lung. Therefore, rapid sequence induction was performed. Left-sided double-lumen tube was inserted for lung isolation and position of the tube was confirmed by visualization with fiberoptic bronchoscopy. Bile-stained secretion was repeatedly suctioned in trachea and both bronchi during surgery. OUTCOMES: In spite of decrease in SpO2 with institution of one-lung ventilation, the patient's oxygenation was gradually improved as surgery progressed without hemodynamic instability. At the end of surgery, the double-lumen tube was replaced with a single-lumen endotracheal tube for postoperative mechanical ventilation. LESSONS: Absolute lung isolation using double-lumen tube for one-lung ventilation and bronchial toilet during surgery and replacement of single-lumen tube for postoperative respiratory support at the end of surgery are effective to improve oxygenation in patients with BBF.

A System-on-Chip Solution for Point-of-Care Ultrasound Imaging Systems: Architecture and ASIC Implementation.

In this paper, we present a novel system-on-chip (SOC) solution for a portable ultrasound imaging system (PUS) for point-of-care applications. The PUS-SOC includes all of the signal processing modules (i.e., the transmit and dynamic receive beamformer modules, mid- and back-end processors, and color Doppler processors) as well as an efficient architecture for hardware-based imaging methods (e.g., dynamic delay calculation, multi-beamforming, and coded excitation and compression). The PUS-SOC was fabricated using a UMC 130-nm NAND process and has 16.8 GFLOPS of computing power with a total equivalent gate count of 12.1 million, which is comparable to a Pentium-4 CPU. The size and power consumption of the PUS-SOC are 27×27 mm(2) and 1.2 W, respectively. Based on the PUS-SOC, a prototype hand-held US imaging system was implemented. Phantom experiments demonstrated that the PUS-SOC can provide appropriate image quality for point-of-care applications with a compact PDA size ( 200×120×45 mm(3)) and 3 hours of battery life.