1/4. Percutaneous dilatational tracheostomy in a patient with thyroid cancer and severe airway obstruction.A patient with extensive metastatic thyroid cancer scheduled for palliative tracheostomy is presented. He had laryngeal dislocation with severe airway obstruction and few anatomical landmarks due to tumour infiltration and radiation. Successful percutaneous dilatational tracheostomy was performed under local anaesthesia.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/4. An unusual complication of minitracheostomy.A 72-year-old woman had a minitracheostomy inserted for sputum retention. This was undertaken by a relatively junior resident who opted to use an early model minitracheostomy kit Minitrach II. The following day the patients condition deteriorated and intubation was warranted, at which time it was apparent to senior staff that the minitracheostomy had been malpositioned. Ten days later, formal tracheostomy was performed under general anaesthesia. After incision, an abscess in the thyroid gland was found. histology subsequently revealed a Hurthle cell tumour of the thyroid. Thyroid abscess is exceedingly rare. It typically occurs in abnormal thyroid tissue and with a focus on infection. The combination of Hurthle cell adenoma and a foreign body (the minitracheostomy) was evidently causative in this instance. This complication of minitracheostomy insertion has not to our knowledge, previously been reported.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
3/4. head and neck cancer after foreign body ingestion.INTRODUCTION: Ingestion of a foreign body is a common occurrence in our population. We present 2 cases that illustrate an unusual outcome of an otherwise usual occurrence. CLINICAL PICTURE: Two patients who presented with a history of ingestion of fish bones were worked up. The radiological findings were suspicious of a foreign body and both underwent examination under general anaesthesia. The endoscopic findings were normal. After further evaluation for persistent calcifications with computed tomography, a thyroid malignancy was found in the first patient and tongue cancer in the second patient. TREATMENT: The first patient underwent elective hemithyroidectomy and the second underwent wide excision of the tumour with neck dissection. OUTCOME: Both recovered uneventfully with regular follow-up in the outpatient clinic. CONCLUSION: There should be a high index of suspicion in patients with persistent calcifications.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
4/4. Preoperative airway evaluation using multi-slice three-dimensional computed tomography for a patient with severe tracheal stenosis.A 71-yr-old female with a malignant thyroid tumour was to undergo thyroidectomy under general anaesthesia. Preoperative chest x-ray and plain computed tomography (CT) showed severe tracheal stenosis. Three-dimensional figures of the trachea and a virtual bronchoscopic movie were obtained from multi-slice CT to evaluate the stenotic region and to simulate fibroscopic tracheal intubation, respectively. After induction of general anaesthesia with propofol, a tracheal tube was successfully passed through the stenotic region under the guide of a fibroscope as simulated in the virtual movie. We conclude that multi-slice CT is useful for preoperative airway evaluation for patients with stenosis and distortion of the trachea.- - - - - - - - - - ranking = 2keywords = anaesthesia (Clic here for more details about this article) |