The Use of a Fabricated Endotracheal Tube During an Acute Massive Pulmonary Hemorrhage: A Case Report.

A massive pulmonary hemorrhage is an emergency that can lead to airway compromise and cardiovascular collapse. The goals of airway management are to isolate and protect the nonbleeding lung while providing a route for interventions to diagnose and control the bleeding site. We present a case of an adult male with a lung mass who underwent a bronchoscopy and cryobiopsy that was complicated by a massive pulmonary hemorrhage. We report the successful use of an elongated fabricated end-to-end endotracheal tube to manage his airway during this time-critical situation.

Peripheral neuromodulation for the treatment of refractory trigeminal neuralgia.

Trigeminal neuralgia is a type of orofacial pain that is diagnosed in 150,000 individuals each year, with an incidence of 12.6 per 100,000 person-years and a prevalence of 155 cases per 1,000,000 in the United States. Trigeminal neuralgia pain is characterized by sudden, severe, brief, stabbing or lancinating, recurrent episodes of pain in the distribution of one or more branches of the trigeminal nerve, which can cause significant suffering for the affected patient population. In many patients, a combination of medication and interventional treatments can be therapeutic, but is not always successful. Peripheral nerve stimulation has gained popularity as a simple and effective neuromodulation technique for the treatment of many pain conditions, including chronic headache disorders. Specifically in trigeminal neuralgia, neurostimulation of the supraorbital and infraorbital nerves may serve to provide relief of neuropathic pain by targeting the distal nerves that supply sensation to the areas of the face where the pain attacks occur, producing a field of paresthesia within the peripheral distribution of pain through the creation of an electric field in the vicinity of the leads. The purpose of the present case report is to introduce a new, less-invasive interventional technique, and to describe the authors' first experience with supraorbital and infraorbital neurostimulation therapy for the treatment of trigeminal neuralgia in a patient who had failed previous conservative management.

Basic flap design.

Basic flap design utilization for reconstruction of head and neck defects requires creativity from the surgeon. Ultimately, the surgeon must closely restore the basic functions and properties of the surgical flap and adjacent tissue. All options within the reconstructive ladder should be considered. When possible, like should be replaced with like (similar tissue) within an esthetic zone. When considering a flap design, the surgeon must remember that the donor site must be closed in an esthetic and functional manner. Finally, knowledge of normal anatomy, the extent of the defect, and the patient is vital for successful outcomes.

Modal decomposition method for acoustic impedance testing in square ducts.

Accurate duct acoustic propagation models are required to predict and reduce aircraft engine noise. These models ultimately rely on measurements of the acoustic impedance to characterize candidate engine nacelle liners. This research effort increases the frequency range of normal-incidence acoustic impedance testing in square ducts by extending the standard two-microphone method (TMM), which is limited to plane wave propagation, to include higher-order modes. The modal decomposition method (MDM) presented includes four normal modes in the model of the sound field, thus increasing the bandwidth from 6.7 to 13.5 kHz for a 25.4 mm square waveguide. The MDM characterizes the test specimen for normal- and oblique-incident acoustic impedance and mode scattering coefficients. The MDM is first formulated and then applied to the measurement of the reflection coefficient matrix for a ceramic tubular specimen. The experimental results are consistent with results from the TMM for the same specimen to within the 95% confidence intervals for the TMM. The MDM results show a series of resonances for the ceramic tubular material exhibiting a monotonic decrease in the resonant peaks of the acoustic resistance with increasing frequency, resembling a rigidly-terminated viscous tube, and also evidence of mode scattering is visible at the higher frequencies.