Tracheal Ultrasound for the Accurate Confirmation of the Endotracheal Tube Position in Obese Patients.

OBJECTIVES: Obesity is a serious disorder that may lead to numerous difficulties in endotracheal tube (ETT) management. This study investigated the potential of tracheal ultrasound (TUS) for the accurate confirmation of the ETT position in obese patients. METHODS: A total of 68 obese patients undergoing tracheal intubation were enrolled in this study from January 2017 to June 2018. All patients received auscultation and TUS to evaluate the ETT position, which was ultimately verified by bronchoscopy. A correct position of the ETT was defined as placement at the trachea, whereas placement at the right/left main bronchus was classified as an incorrect position. RESULTS: We found 58 correct placements of the ETT at the trachea, 8 incorrect placements at the right main bronchus, and 2 incorrect placements at the left main bronchus. Compared with auscultation, TUS showed higher accuracy (85.29% versus 67.65%; P = .005), sensitivity (84.48% versus 67.24%; P = .005), and specificity (90.00% versus 70.00%; P < .001), as well as lower rates of false-positive (10.00% versus 30.00%; P < .001) and false-negative (15.52% versus 32.76%; P = .005) results for detecting the correct placement of the ETT, defined as placement at the trachea. CONCLUSIONS: Tracheal ultrasound is highly sensitive and specific in confirming the ETT position in obese patients.

Incidence of deep venous thrombosis in Chinese patients undergoing arthroscopic knee surgery for cruciate ligament reconstruction.

PURPOSE: This study investigated the incidence of deep venous thrombosis (DVT) in patients undergoing arthroscopic cruciate ligament surgery. METHODS: A total of 282 patients were examined by color Doppler ultrasound preoperatively and 3 and 7 days postoperatively. RESULTS: DVT was present in 34 of 282 patients (12.1 %); of these, 11 (32.6 %) underwent reconstruction of the anterior cruciate ligament (ACL), alone or in conjunction with the medial or lateral collateral ligament (MCL or LCL, respectively; 17.6 %); eight (23.5 %) of the posterior cruciate ligament (PCL); four (11.8 %) of the PCL-MCL/LCL; and five (14.7 %) of the ACL-MCL. In patients with tourniquets applied for <90, 90-120, and >120 min, the incidence of DVT was 5.6, 12.8, and 17.4 %, respectively. CONCLUSION: The incidence of DVT in normal patients undergoing ACL surgery was 12.1 %. A higher incidence was observed among cases of multiligament reconstruction, especially those involving the PCL, as well as in patients with tourniquets applied for more than 2 h. Based on these findings, prophylactic measures for DVT may be considered after arthroscopic knee surgery in order to decrease the incidence of DVT if specific risk factors are present. LEVELS OF EVIDENCE: IV.

[Nocturnal heart rhythm disorder in patients with obstructive sleep apnea syndrome].

OBJECTIVE: To explore the clinical characteristics of patients with obstructive sleep apnea syndrome (OSAS) and nocturnal arrhythmia. METHODS: During September 2010 to August 2011, a total of 446 subjects were recruited from Department of Sleep Breathing Disorder, Third Hospital, Hebei Medical University to receive polysomnography examination and electrocardiogram monitoring. According to the results, they were classified as mild (5 ≤ AHI < 15/h) or moderate (15 ≤ AHI < 40/h) or severe (AHI ≥ 40/h) OSAS. Then the incidence of different types of arrhythmias, risk factors and the relationship with OSAS severity were examined. RESULTS: Among 446 patients, the incidence of arrhythmia was 24.4% (109/446). The severity of OSAS (r = 1.857, P = 0.043) and age (r = 1.030, P = 0.003) had a positive relationship with the incidence of arrhythmias.Sinus bradycardia (79.8%, 87/109) and accidental ventricular premature beat (54.1%, 59/109) were most likely to occur than other types of arrhythmias (P < 0.01).In moderate and severity OSAS patients, the incidence of sinus bradycardia, frequent atrial premature beat, combined over two kinds of arrhythmias, atrial fibrillation and atrioventricular block were 50.0%, 0, 42.9%, 7.1%,0 and 90.9%, 14.8%, 57.9%, 4.5%, 5.7% respectively. And they were significantly higher than those of mild patients (all = 0) (all P < 0.05). CONCLUSIONS: Age and severity of OSAS have a positive relationship with the incidence of nocturnal arrhythmias.Sinus bradycardia and ventricular premature beat are the most likely to occur in OSAS patients.In moderate and severe group, sinus bradycardia, frequent atrial premature beat, combined over two kinds of arrhythmias, atrial fibrillation and atrioventricular block are more commonly encountered.

Application of triangular vector to functionally reconstruct the medial collateral ligament with double-bundle allograft technique.

PURPOSE: The purpose of this study was to present a novel medial collateral ligament (MCL) reconstruction technique and investigate the clinical outcomes of this surgical procedure. METHODS: From July 2006 to June 2009, 56 patients with medial instability of the knee were treated with MCL reconstruction and followed up for 33 months on average. These patients were divided into 2 groups based on whether anterior cruciate ligament (ACL) injury was present: 27 patients had isolated MCL injury, whereas 29 patients had combined MCL-ACL injury. All patients underwent reconstruction of the MCL with triangular double-bundle allograft, and we evaluated International Knee Documentation Committee (IKDC) scores, anteromedial rotatory instability (AMRI), and excessive knee medial opening (EKMO) both preoperatively and at follow-up. RESULTS: EKMO was significantly reduced to 2.9 mm at follow-up compared with 10.1 mm preoperatively. The incidence of AMRI was reduced to 9.4% (5 patients) compared with 67.9% (36 patients) preoperatively. Of the patients, 58.9% (33 patients) had a grade A IKDC subjective score and 35.7% (20 patients) had a grade B IKDC subjective score. Most patients had normal or nearly normal range of motion of the knee joint, whereas 4 patients (7.1%) lost more than 6° of range of motion in extension and 2 (3.6%) lost more than 25° in flexion. In 47 patients (83.9%) the symptoms were graded as normal or nearly normal according to IKDC symptom scores. No significant differences in IKDC subjective score, IKDC symptom score, flexion deficit score, AMRI, and EKMO were found between the isolated MCL injury group and the MCL-ACL injury group; however, a significant difference was found in knee extension deficit between groups. CONCLUSIONS: We have presented a new technique for reconstruction of the MCL with a triangular shape. This technique improved both valgus and rotational stability at short-term outcome. The clinical outcomes using IKDC evaluation indicate that no major difference exists in isolated MCL injury and combined MCL-ACL injury treated with this new technique. LEVEL OF EVIDENCE: Level IV, therapeutic case series.