[Distal trachea and bronchial large lesions and suture reinforcement with Polyglicol Acid (PGA) patch. First clinical experience]. / Lesioni estese della trachea e dei bronchi principali. Prime esperienze con l'impiego di Polyglycol Acid (PGA) patch riassorbibile.

BACKGROUND: Iatrogenic lacerations of the trachea and the bronchies are mostly complications of emergent intubations or percutaneous tracheotomies. The outcome is mainly influenced by thorough diagnostics, severity of the lesions, and urgent treatment. New materials are used to reduce the tension at the sutured points during ventilation. PATIENTS AND METHODS: Four patients were operatively treated with primary suturing of trachea and bronchies with Polydioxanon. The large wounds were then covered using resorbable Soft PGA Mesh (resorbable Polyglykol Acid patch). The first two patients were found hypoxic and was orotracheally intubated in an emergency. An air leckage was detected in the hospital due to a large lesion of the pars membranacea. The third patient was operated in an emergency due to ileus caused by progressive colonic carcinoma. The weaning period on Intensive Care Unite (ICU) was unsuccessful. In a difficult procedure she underwent a percutaneous tracheotomy (dystopia of the trachea due to an arteria lusoria) mainly resulting in esophagotracheal fistulae. The fourth patient was treated by esophagectomy due to a local progressive carcinoma. A long lesion between the carina and left main bronchus resulted. All lacerations were treated by single knot suture technique with Polydioxanone and finally covered (patched) with PGA Mesh. The outcome of the surgical treatment was analyzed. RESULTS: In bronchoscopies and CT-scans no air leackages during respiratory ventilation periods were observed. The first patient could be transferred into a normal ward from ICU at day 38. The second patient was found to be tetraplegic and was discharged into another hospital at day 48. One patient died at the 15th postoperative day due to urosepsis. The fourth patient left the ICU on day 10 and was discharged home at day 23. CONCLUSIONS: Large iatrogenic airway lacerations of the distal trachea should be managed by early surgical repair due to their life-threatening outcome. Although only a small number of patients were analyzed so far, a PGA Mesh might be useful to increase the suture safety reducing the tension at the suture points due to the cuff pressure during long ventilation periods.

Search for extraterrestrial point sources of neutrinos with AMANDA-II.

We present the results of a search for point sources of high-energy neutrinos in the northern hemisphere using AMANDA-II data collected in the year 2000. Included are flux limits on several active-galactic-nuclei blazars, microquasars, magnetars, and other candidate neutrino sources. A search for excesses above a random background of cosmic-ray-induced atmospheric neutrinos and misreconstructed downgoing cosmic-ray muons reveals no statistically significant neutrino point sources. We show that AMANDA-II has achieved the sensitivity required to probe known TeV gamma-ray sources such as the blazar Markarian 501 in its 1997 flaring state at a level where neutrino and gamma-ray fluxes are equal.