Vertebral Body Avascular Osteonecrosis: An Unusual Late Complication of Tracheostomy.

Vertebral body erosion is a rare late complication of tracheostomy. Here we present the case of a 30-year-old female patient, in a vegetative state after severe brain injury, with a permanent tracheostomy and prolonged mechanical ventilation, who suffered from recurrent episodes of severe air leakage with oxygenation drop due to a puncture in the tracheostomy tube cuff. A neck computed tomography (CT) detected destruction of two vertebral bodies, C7 and Th1, and a bony fragment - a remnant of C7 penetrated the trachea and probably repetitively punctured the inflated cuff. A biopsy of the C7 vertebral body was performed under CT guidance to rule out osteomyelitis. The biopsy revealed necrotic bone spicules surrounded by vascular-rich fibrous tissue, without evidence of inflammation. C7 vertebral body avascular osteonecrosis was diagnosed. The case highlights the importance of monitoring cuff pressure during long-term use of cuffed endotracheal tubes to avoid hyperinflation and subsequent ischemic complications.

Prolificacy and lamb survival at birth in Awassi and Assaf sheep carrying the FecB (Booroola) mutation.

Prolificacy up to the fifth parity and lamb survival at birth were investigated in >or=31/32 Awassi and >or=31/32 Assaf sheep belonging to the ++, B+ and BB genotypes at the FecB locus. In the Awassi, prolificacy of ++, B+ and BB ewes was 1.28, 1.90 and 1.92 lambs born/lambing (LB/L), respectively. In the Assaf, prolificacy of ++, B+ and BB ewes was 1.68, 2.40 and 2.55LB/L, respectively. Lamb survival at birth in the ++ Awassi and the ++ Assaf averaged 0.98 and 0.94, respectively. It declined to 0.93 and 0.86, and 0.85 and 0.78 in the B+ and BB Awassi and B+ and BB Assaf, respectively. For singles, twins, triplets, quadruplets and quintuplets, lamb survival rate at birth was 0.98, 0.92, 0.86, 0.78 and 0.65, respectively. FecB genotype-litter size interactions were not significant (P<0.05). A compilation of study results in which prolificacy of the ++ and B+ genotypes at the FecB locus were investigated in a range of breed-environment combinations revealed that the B allele has a multiplicative effect on prolificacy as B+ prolificacy was significantly (P<0.05) linearly associated with ++ prolificacy.