Extracorporeal membrane oxygenation for the anesthetic management of a patient with a massive intrathoracic goiter causing severe tracheal obstruction with positional symptoms: A case report.

INTRODUCTION: Perioperative anesthetic management in cases of severe airway obstruction with positional symptoms can be associated with difficulties in ventilation or intubation, with a risk of acute respiratory decompensation at every stage of anesthesia. PATIENT CONCERNS: Here we describe the anesthetic management of a 67-year-old man with a massive intrathoracic goiter causing severe tracheal obstruction with positional symptoms. The patient presented with progressive dyspnea that was aggravated in the supine position and was scheduled for total thyroidectomy. DIAGNOSIS: Preoperative computed tomography showed a large goiter extending into the thoracic cavity, with diffuse segmental tracheal narrowing for 6 cm. The diameter at the narrowest portion of the trachea was 4.29 mm. INTERVENTIONS: Before the induction of general anesthesia, we applied extracorporeal membrane oxygenation (ECMO) in preparation for potential difficulties in securing the airway during general anesthesia. Subsequently, anesthesia was successfully induced and maintained. OUTCOMES: After the surgical procedure, fiberoptic bronchoscopy and chest radiography showed resolution of the tracheal narrowing. ECMO was weaned 2 hours after the surgery, and the patient was extubated on the first postoperative day. He was discharged without any complication. CONCLUSION: The findings from this case suggest that the use of ECMO before the induction of general anesthesia is a safe method for maintaining oxygenation in patients with severe tracheal obstruction.

Improvement in the Electrical Performance of Ge-Doped InZnO Thin-Film Transistor.

We fabricated amorphous oxide semiconductor thin-film transistors (TFTs) using Ge-doped InZnO (Ge-IZO) thin films as active-channel layers. The Ge-IZO thin films were deposited at room temperature by radio-frequency (RF) magnetron co-sputtering system, and then annealed in air for 1 h at 300 °C. Some processing parameters such as sputtering oxygen partial pressure [O2/(Ar + O2)] and sputtering power for GeO2 target were changed to investigate what was the optimal amount of Ge in the Ge-IZO active layer. A small concentration of Ge added to IZO by co-sputtering enhanced the carrier concentration, mobility, and conductivity; but further increase in Ge concentration degraded the device performance. In order to optimize the electrical properties of Ge-IZO TFTs, we tried to adjust the processing parameters and the best Ge-IZO TFT was obtained at a co-sputtering oxygen partial pressure of 2% and GeO2 target power of 10 W. The fabricated Ge-IZO TFT exhibited an on/off ratio of 3.0 x 10(7), a saturation mobility of 13.05 cm2/V·s, a subthreshold swing of 0.95 V/dec, and a threshold voltage of 0 V. XPS and XRD analyses of Ge-IZO films were performed to investigate the binding energies of atoms in Ge-IZO films and the crystallinity of the films. 90% transmittance of visible light was achieved, which makes the technology useful for transparent devices.

Effects of Double Active Layer and Acetic Acid Stabilizer on the Electrical Properties of a Solution-Processed Zinc Tin Oxide Thin-Film Transistor.

We investigated the effects of a double active layer (DAL) and acetic acid stabilizer on zinc tin oxide (ZTO) thin-film transistors (TFTs) fabricated using a solution process. The DAL was composed of two layers created by a ZTO solution doped with the same or different percentiles of an atomic Sn concentration (30 at.%, 60 at.%). The electrical performance of the ZTO TFTs significantly was improved after we added acetic acid (AA) instead of monoethanolamine (MEA). This was accomplished by applying a type 2 DAL (bottom layer: Sn 60 at.%, top layer: Sn 30 at.%, 60/30) instead of other types (30/30 or 60/60). It was demonstrated that AA plays a role in lowering the decomposition temperature, enhancing the metal-oxygen bridge, and decreasing hydroxyl groups in the film. In addition, the type 2 DAL structure (60/30) lowered the Ioff of the ZTO TFT and controlled the carrier concentration in the channel. The best performances were obtained at a Sn concentration of 60 at.% in the bottom ZTO layer and 30 at.% in the top ZTO layer, with AA added as a stabilizer. The ZTO TFT exhibited an on/off ratio of 1.1 x 10(9), a saturation mobility of 5.04 cm2/V·s, a subthreshold slope of 0.11 V/decade, and a threshold voltage of 1.6 V.

Acute intestinal obstruction caused by a persimmon phytobezoar after dissolution therapy with Coca-Cola.

Bezoars are concretions or hard masses of foreign matter that are found in the gastrointestinal tract. Recent reports have demonstrated the efficacy of Coca-Cola administration for the dissolution of phytobezors. Here we report on a 73-year-old man with a very large gastric persimmon diospyrobezoar, and this caused small intestinal obstruction after partial dissolution with oral and injected Coca-Cola.

Clinical aspects of rifampicin-associated pseudomembranous colitis.

Pseudomembranous colitis (PMC) is known to develop after antibiotic administration, but antituberculosis agents are rarely associated with this disorder. We report 6 cases of PMC after rifampicin administration; the clinical manifestations, laboratory findings, imaging findings, and clinical course are described. The median age of patients was 68 years (range, 54 to 82 y). All patients were diagnosed with active pulmonary tuberculosis by sputum smear and culture, and 2 suffered from type 2 diabetes mellitus. The average interval between initiation of antituberculosis therapy and the onset of diarrhea was 19.8 days. The anatomic distribution of PMC included the rectum and sigmoid colon in 5 cases and up to the hepatic flexure in 1 case. All patients were cured with medical treatment, which include discontinuation of rifampicin and oral metronidazole and vancomycin. PMC recurred in 1 patient after retreatment with rifampicin. Our findings suggest that patients who are treated with antituberculosis agents, who develop acute diarrhea during or after therapy, should be evaluated for PMC.

Endoscopic incision of a septum in a case of spontaneous intramural dissection of the esophagus.

Intramural dissection of the esophagus is a rare esophageal disorder that is characterized by a long laceration between the esophageal mucosa and submucosa but without perforation. It reveals characteristic radiologic and endoscopic features. The etiology of intramural dissection of the esophagus remains uncertain. The most common presenting symptoms are sudden retrosternal pain, hematemesis, odynophagia, dysphagia, and back pain. Conservative management is usually thought to be adequate. We report a case of spontaneous intramural esophageal dissection, in which the symptom of dysphagia did not improve with the conservative management, and an endoscopic incision of the septum between true and false lumens using a needle-type diathermy knife was done safely and effectively.