[The laryngeal mask versus intubation in difficult intubation conditions in the Franceschetti-Zwahlen-Klein syndrome (Treacher-Collins syndrome)]. / Larynxmaske versus Intubation bei erschwerten Intubations-bedingungen beim Franceschetti-Zwahlen-Klein-Syndrom (Treacher-Collins-Syndrom).

A twenty-nine-year-old man suffering from Franceschetti syndrome requiring a retinal detachment operation was successfully anaesthetised using the laryngeal mask airway. The laryngeal mask has many advantages compared to endotracheal intubation in patients suffering from craniofacial abnormalities i.e. hypoplasia of the mandibular bone and ventral position of the larynx. In these cases the laryngeal mask is easily placed. However, the facilities of fibreoptic bronchoscopy should be readily available. The physician should have gained confidence in using a laryngeal mask before employing this device in cases of difficult intubation.

[Pulmonary function one year after extracorporeal lung assist. A long-term follow-up of patients with acute adult respiratory distress syndrome]. / Lungenfunktion ein Jahr nach extrakorporalem Lungenersatz (ELA). Langzeitverlauf von Patienten mit schwerstem ARDS.

This retrospective follow-up studied lung function and reconvalescence in 38 young patients without primary lung disease, who suffered from severe ARDS and survived by means of extracorporeal lung assist (ELA) treatment. Over a period of 3, 6, 9 and 12-20 months dynamic and static lung volumes and the results of X-ray and CT scan of the thorax were studied. Within the third and sixth month the forced vital capacity, FEV1, and arterial blood gases reached the lower range of normal values. Obvious relative emphysema RV/TLC was observed at the time of discharge from hospital and during the first four months. This was found to reverse during the following months. After a period of 12-20 months all patients had an abnormal diffusion capacity (TLCO) but with normal transfer coefficients (TLCO/VA). Even though ARDS did not induce obstructive changes, the diminished diffusion capacity and the slightly reduced expiratory peak flow in 25-75% of FVC (FEF 25-75) indicates slight changes in the small airways. Following up the X-ray and CT results we found extraordinary morphological restitution. Spiroergometry results showed a normal cardiopulmonary pattern for untrained individuals. 36 of the 38 patients were integrated in normal working and social life within 12-20 months.