Reciprocal changes in airflow resistance between nasal cavities are induced by lateral recumbency, and also by unilateral pressures to body surfaces in postures which avoid hydrostatic differences between sides. The reciprocating spontaneous nasal cycle in erect subjects and these nasal responses to lateral posture and pressure maintain total nasal resistance in the range of 2-3 cmH2O (0.2-0.3 KPa)/l/sec. In the resting subject, erect or recumbent, the centrally mediated autonomic tone of capacitance vessels of nasal erectile mucosa maintains an adequately patent nasal airway despite marked differences in airflow resistance between the nasal cavities which accompany lateral recumbency, asymmetrical body surface pressures or the spontaneous nasal cycle. In addition to passive hydrostatic influences on nasal mucosal blood content, activity of the vasomotor centre modified by impulses from pressure sensors of the body surfaces reciprocally alters the tone of the nasal capacitance vessels. Nasal disorders hamper these stabilizing reciprocal adjustments in airflow resistance and adversely affect breathing mechanics in recumbent subjects.
Verrucous carcinoma is a rare variant of well-differentiated squamous cell carcinoma. It usually occurs in the oral cavity, genital area, and sole. Verrucous carcinoma of the sole, also called epithelioma cuniculatum, often presents a diagnostic challenge both clinically and histopathologically. The authors report such a case that mimics infected epidermal cyst and gout clinically.
Many patients hospitalized with coronavirus disease 2019 are treated with venovenous extracorporeal membrane oxygenation and prone positioning to optimize oxygenation. However, this combination can result in lower extremity tissue necrosis, especially without adequate offloading. We report the case of a 31-year-old man who required mechanical ventilation and venovenous extracorporeal membrane oxygenation secondary to complications from coronavirus disease 2019, and subsequently developed pedal dry gangrene. The patient was discharged and healed without requiring an amputation. Our institution has since revised the prone positioning protocol to address offloading the lower extremities and feet.
Necrotizing fasciitis is a rare and potentially fatal infection, with mortality of up to 30%. This case report describes a patient recovering from a laryngectomy for laryngeal squamous cell cancer who developed nosocomial necrotizing fasciitis of the lower extremity due to Serratia marcescens . Only eight cases of necrotizing fasciitis exclusive to the lower extremity due to S marcescens have been previously reported. Patients with S marcescens necrotizing fasciitis of the lower extremity often have multiple comorbidities, are frequently immunosuppressed, and have a strikingly high mortality rate.
Objective: The purpose of this study is to determine the utility of using indocyanine green fluorescence angiography (IGFA) in assessing perfusion of chronic wounds after hyperbaric oxygen (HBO2) therapy. Method: From May 2016 to January 2018, 26 patients underwent both HBO2 and IGFA. A near-infrared charge- coupled camera measured the flow of intravenous indo- cyanine green into the wound. IGFA was done pre-HBO2, after approximately 10 HBO2 sessions, and upon completion of HBO2. The ingress rate at baseline, mid-therapy and post-HBO2 values were compared using descriptive statistics. Results: A total of 26 chronic wounds were identified. Baseline median ingress rate was 0.90 units/second (IQR: 0.28 to 6.10). Median ingress rate after approximately of 10 HBO2 sessions was 2.45 units/sec (IQR: 0.48 to 6.35). Six of 11 patients, however, exhibited a decrease in ingress rate from baseline to mid-therapy. Finally, median ingress rate post-HBO2 was 3.70 units/second (IQR: 0.30 to 9.90). Median increase in ingress and rate from baseline to mid-HBO2 treatment 0.30 units/second (IQR: -0.25 to 3.10) and from mid- to post-HBO2 was -0.40 units/second (IQR: -1.50 to 2.60). Conclusion: This preliminary study shows capability of IGFA to detect changes in blood flow to wounds following HBO2 therapy. Results support the use of IGFA to evaluate the changes in perfusion of patients undergoing HBO2 for chronic wounds. A larger sample size may help clarify the benefit of IGFA to predict potential for wound healing.
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