Airway obstruction due to spontaneous retropharyngeal hemorrhage.

A patient is described with polycythemia vera who was taking anticoagulants and developed a spontaneous retropharyngeal hemorrhage after a violent sneezing episode. This progressed to tracheal compression with stridor after he had taken some aspirin for relief of the neck pain. An emergency tracheostomy was life saving.

Respiratory status of Los Angeles firemen. One-month follow-up after inhalation of dense smoke.

A standardized respiratory questionnaire and detailed pulmonary function tests were administered to 21 Los Angeles firemen one month following exposure to the combustion products of polyvinylchloride, which had produced transient hypoxemia in 19 of the firemen. The results of these studies were compared with those obtained in a sample of nonfiremen residing in the Los Angeles area who were matched by computer with the firemen for anthropomorphic characteristics and smoking status. The frequency of respiratory symptoms, the results of spirometric and plethysmographic studies, and the single-breath nitrogen washout were similar in the firemen, compared with the matched sample, whereas closing volume was higher in the matched controls. These findings suggest that although fighting fires may result in acute pulmonary injury secondary to discrete episodes of inhalation of smoke, it does not appear to predispose to the development of chronic respiratory symptoms or chronic functional respiratory impairment.

Transient hypoxemia in firemen following inhalation of smoke.

Mild to moderately severe hypoxemia was documented in 19 of 21 mostly asymptomatic firemen who were exposed to dense smoke containing polyvinylchloride and other pulmonary irritants. The hypoxemia was transient, with nearly complete reversibility within 24 hours. Subsequent tests for pulmonary function one month later demonstrated that this transient hypoxemia was not related to previous underlying pulmonary disease. The potential for serious complications of inhalation of smoke, particularly smoke from burning plastics, is heightened by the frequent lack of symptoms associated with the type of exposure, despite the development of hemoglobinemia. Precautionary measures should include uninterrupted use of an effective breathing apparatus by firemen exposed to smoke and to noxious fumes and temporary oxygen supplementation, even in asymptomatic firemen, following exposure to dense smoke.

Fiberoptic bronchoscopy in the diagnosis of lung cancer comparison of pre-and post-bronchoscopy sputa, washings, bruchings and biopsies.

Fiberoptic bronchoscopy (brushings, washings and biopsies) was performed and pre- and post-bronchoscopy sputum cytologies obtained on 70 patients with histopathologically proven lung cancer. Bronchoscopy, with its associated procedures performed in 52 patients with primary bronchogenic carcinoma, was diagnostic in 41 (79%). Of all the various methods of obtaining specimens, bronchial brushing and bronchial biopsy gave the highest percentage yield (67%). However, since brush specimens could be obtained from peripheral lesions under fluoroscopic guidance, a greater number of positive specimens were obtained by this procedure (34) than by forceps biopsy (25), making brushing more useful. Pre- and post-bronchoscopy sputa were positive and thus of value in two cases when brushing and biopsy were both negative. Bronchial washing did not add significantly to the yield of positives and could therefore be eliminated as an unnecessary cost-and time-consuming procedure. Fiberoptic bronchoscopy was not helpful in diagnosing mediastinal tumors (5), lung metastases (7) and bronchial adenomas (6).

Esophageal obturator airway: use and complications.

The esophageal obturator airway, in lieu of placement of an endotracheal tube, has been found to be an effective and reliably safe means of providing an artificial airway. By occluding the esophagus, it prevents gastric dilatation and aspiration. However, it is not totally without hazard. Two cases of pharyngoesophageal trauma are reported: a high esophageal tear found at post mortem examination and a pyriform sinus laceration noted on admission to the hospital. The authors recommend conservative treatment for cervical esophageal perforations and surgery for thoracic esophageal perforations. Despite these complications, the authors feel the esophageal obturator airway is safe and effective for use by those unskilled in direct endotracheal intubation when participating in cardiopulmonary resuscitation.

An intravenous radionuclide method to evaluate hypoxemia caused by abnormal alveolar vessels. Limitation of conventional techniques.

Using conventional concepts, it is possible that a single pathologic entity, pulmonary telangiectases, can produce hypoxia by 3 physiologic mechanisms; shunt, diffusion defect, and ventilation-perfusion abnormalities. The estimation of shunt or shunt-like effect is traditionally calculated by measuring the Po2 of arterial blood during the breathing of 100 per cent 02. This method, however, did not determine blood flow through large alveolar vessels in a patient with familial hemorrhagic telangiectasis who was severely hypoxemic while breathing air. This case served to test the concept that blood flowing through large vessels in the airspaces may be hypoxemic when the patient breathes air, but not 02. Blood flow through these vessles can be estimated by use of radionuclide lung perfusion techniques and estimation of the quantity of radioactive particles that pass through an abnormal pulmonary vascular bed and lodge in kidney and brain. Conventional approaches to estimating blood flow through these fistulas underestimated their effect.