Communicating by electrolarynx with a blind tetraplegic spinal cord injury patient on mechanical ventilation in the ICU.

STUDY DESIGN: Single-subject case. OBJECTIVES: To describe the atypical presentation of communication with a blind tetraplegic spinal cord injury patient on a respirator using an electrolarynx. SETTING: Critical care center in Osaka, Japan. METHODS: A 53-year-old blind man with tetraplegic spinal cord injury was admitted to our center. It was difficult for him to express his desires and to communicate with others about his severe condition and other details of his care. We began to use an electrolarynx to communicate with this patient because he could move his mouth. RESULTS: With use of the electrolarynx, the patient gradually became better able to speak fluently by electrolarynx on the first day of use. The electrolarynx allowed us and his family to communicate with him. He was pleased with the improvement in communication. CONCLUSION: An electrolarynx is a useful method for communicating with blind tetraplegic spinal cord injury patients on mechanical ventilation.

Electron-bombarded ⟨110⟩-oriented tungsten tips for stable tunneling electron emission.

A clean tungsten (W) tip apex with a robust atomic plane is required for producing a stable tunneling electron emission under strong electric fields. Because a tip apex fabricated from a wire by aqueous chemical etching is covered by impurity layers, heating treatment in ultra-high vacuum is experimentally known to be necessary. However, strong heating frequently melts the tip apex and causes unstable electron emissions. We investigated quantitatively the tip apex and found a useful method to prepare a tip with stable tunneling electron emissions by controlling electron-bombardment heating power. Careful characterizations of the tip structures were performed with combinations of using field emission I-V curves, scanning electron microscopy, X-ray diffraction (transmitted Debye-Scherrer and Laue) with micro-parabola capillary, field ion microscopy, and field emission microscopy. Tips were chemically etched from (1) polycrystalline W wires (grain size ∼1000 nm) and (2) long-time heated W wires (grain size larger than 1 mm). Heating by 10-40 W (10 s) was found to be good enough to remove oxide layers and produced stable electron emission; however, around 60 W (10 s) heating was threshold power to increase the tip radius, typically +10 ± 5 nm (onset of melting). Further, the grain size of ∼1000 nm was necessary to obtain a conical shape tip apex.

Increased levels of tumor necrosis factor and interleukin 1 in bronchoalveolar lavage fluids from pigs infected with Mycoplasma hyopneumoniae.

We examined the levels of tumor necrosis factor (TNF)-alpha and interleukin-1 (IL-1) in bronchoalveolar lavage fluids (BALF) from pigs experimentally infected with Mycoplasma hyopneumoniae using biological assays with WEHI-164 cells and D10.G4.1 cells, respectively. Increased TNF-alpha and IL-1 in BALF were found in infected pigs with gross and/or microscopic lesions. A time-course study suggested TNF-alpha and IL-1 to be persistently elevated in infected pigs. Their presence in BALF would thus appear to be associated with the development of pneumonic lesions in M. hyopneumoniae infected pigs.

Experimental pneumonia of pigs infected with Aujeszky's disease virus and Actinobacillus pleuropneumoniae.

Experimental infections were induced out to examine whether Aujeszky's disease virus (ADV) infection in pigs results in a severe pneumonia by Actinobacillus pleuropneumoniae. Intranasal inoculation of ADV (10(6.9) median tissue culture infective dose/head) in 4-month-old primary specific-pathogen-free pigs was followed by the inoculation of A. pleuropneumoniae type 1 (10(3.1) or 10(5.1) colony-forming-units/head). The pigs inoculated with ADV alone developed clinical signs of Aujeszky's disease but not pneumonia, and those inoculated with A. pleuropneumoniae (10(3.1) CFU/head) alone did not develop clinical symptoms and lung lesions. Whereas all the pigs inoculated dually with ADV and A. pleuropneumoniae (10(3.1) CFU/head) showed severe or very severe clinical symptoms and moderate or severe pneumonia and one of them died. The pigs inoculated with A. pleuropneumoniae (10(5.1) CFU/head) alone had severe clinical symptoms and one of the 2 pigs died acutely. Furthermore, all of the 3 pigs inoculated with ADV and A. pleuropneumoniae (10(5.1) CFU/head) showed clinical symptoms and moderate or severe pneumonic lesions and one pig died of disease. It was concluded that the clinical symptoms of A. pleuropneumoniae became severer by concomitant infection with ADV.

[Clinical backgrounds of six cases of childhood tuberculosis].

Clinical backgrounds of six children who entered Matsue National chest Hospital due to pulmonary tuberculosis and tuberculous pleuritis were investigated and the following results were obtained. 1) Of six children five had not received BCG vaccination. 2) There were two children who developed tuberculosis after the completion of chemoprophylaxis. 3) None was detected by the examination of the household of the source cases. 4) Both patients and doctors were responsible for the delay in detecting the source, which ranged between five and seventeen months in total. 5) Among the source cases there were two patients who were smear-negative but culture-positive. In view of the above observations it is suggested that BCG vaccination is important for the prevention of tuberculosis in children and that follow-up examinations should be continued after the completion of chemoprophylaxis. It should also be emphasized that early detection of the source case is imperative for the prevention of tuberculosis.

[A case who developed mechanical pulsus alternans after Bentall's operation for annuloaortic ectasia].

Left ventricular pulsus alternans developed immediately after Bentall's operation in a 37-year-old patient with Marfan's syndrome accompanied by severe left heart failure due to annuloaortic ectasia. Echocardiographic examination suggested that this symptom was caused by alternating contractility based on left ventricular myocardial failure. Left heart failure disappeared early after operation, but pulsus alternans persisted until 7 months after operation, when EDVI decreased from 225 ml/m2 to 113 ml/m2.

[A case of Marfan's syndrome that required emergency Bentall's operation due to acute dissecting aortic aneurysm (DeBakey type II) following surgery of abdominal aortic aneurysm].

Graft replacement was performed in a 29-year-old man for an abdominal aortic aneurysm associated with Marfan's syndrome. Since the dissecting aortic aneurysm (DeBakey type II) accompanied by disruption of the right coronary artery developed 74 days after operation, the emergency Bentall's operation was successfully carried out with bypassing of the right coronary artery using a saphenous vein graft. Fifteen Japanese cases operated on for abdominal aortic aneurysm associated with Marfan's syndrome are reviewed, and the problems concerning surgery of abdominal aortic aneurysm and Bentall's operation are discussed.

[A case of quadricuspid aortic valve associated with mitral regurgitation].

A case of a 60-year-old man associated with quadricuspid aortic valve and mitral regurgitation is reported. The aortic valve consisted of three larger cusps and a small accessory cusp situated between the right and the non-coronary cusps. The aortic regurgitation resulted from malcoaptation of the four cusps and the mitral regurgitation resulted from annulus dilatation and thickening of the anterior leaflet. The surgical treatment was performed successfully by the aortic and mitral valve replacements with St. Jude Medical valves. The patient is doing well fifteen months postoperatively. Sixteen Japanese cases of quadricuspid aortic valve which were corrected surgically are reviewed.

[A left subclavian arterial aneurysm caused by fibromuscular dysplasia: a case report].

A 70-year-old man complained left supraclavicular pulsatile tumor. Angiography and CT revealed the left subclavian arterial aneurysm that was just behind the clavicle. The aneurysm was resected through a cross-clavicle incision and an 8 mm Hemashield graft was implanted. The pathological study showed change of fibromuscular dysplasia. The post-operative course was uneventful.

[Oozing type left ventricular rupture: report of three cases].

Two cases of postinfarction oozing type left ventricular rupture and a case of oozing type left ventricular rupture due to catheter perforation for left ventriculography are reported. The technique used to repair the rupture is fibrin glue-oxycellulose fixation method. The post operative course of three cases were uneventful. But left ventricular aneurysm remained in two cases.

[A case of surgical repair for combined septal perforation and cardiac rupture after myocardial infarction].

The successful surgical repair of the combination of septal perforation and cardiac rupture after myocardial infarction was underwent on a 73-year-old man. Complete correction could be performed under the fibrillated heart state employing cardiopulmonary bypass, resulted in the early postsurgical cardiac performance.

[Two case reports of recurrent mediastinitis with chronic mediastinal fistula successfully treated with muscle flap re-transposition].

We experienced two cases of recurrent poststernotomy mediastinitis with chronic mediastinal fistula. Both cases had already received muscle flaps for post operative mediastinitis. However, chronic mediastinal fistula appeared after nine months in the first case, and eleven months in the second case. We removed the infected tissue and the predgets, which were used on the ascending aorta. Then closed the wound by the muscle flap closure. The chronic fistula were closed, and the functional and cosmetic results were excellent.