Management of difficult airways in surgical patients at the Port Moresby General Hospital operating theatre and intensive care unit.

We report on the results of a retrospective audit of airway management in patients presenting to the Port Moresby General Hospital from 1998 to 2009. Safe and secure airway management can be challenging in the operating room during head and neck surgery. These challenges continue into the postoperative period and can present significant issues to intensive care staff. This series includes many patients with upper airway and upper gastrointestinal malignancy, head and neck trauma, head and neck infections, thyroid pathology and cleft palate. This series highlights the importance of anticipating the possibility of difficult airway preoperatively and modifying the airway management appropriately. We consider that all members of the operating team including surgeons, anaesthetists, intensive care physicians and nursing staff should cooperate and communicate effectively to optimize outcomes for these potentially difficult cases. A proposed airway management algorithm is presented to guide surgical teams performing head and neck surgery in Papua New Guinea and similar regions.

[The value and association of CCR7 expression in NSCLC with lymph node metastasis.].

BACKGROUND: It has became a hotspot research about the target metastasis of malignant tumor in recent years. It has been proven that metastasis of malignant tumor is a nonrandom but highlyorganized and selective process. The aim of this study is by analysing the expression of CC Chemokine Receptor 7 (CCR7) in pulmonary tumor tissue and metastasized lymph nodes in NSCLC, to explore the relationship between the expression of CCR7 in pulmonary tumor tissue and metastasized lymph nodes, and explore the significance. METHODS: SABC immunohitochemcal staining was used to investigate the expression of CCR7 by rabbit anti-human CCR7 monoclonal antibody, and the specimens were 17 cases of adenocarcinoma, 17 cases of Squamous cell Carcinoma, 12 cases of Adenosquamous Carcinoma, 4 cases of large cell carcinoma and 28 cases of metastasized lymph nodes of lung cancer. Negative control sections use 5 cases of inflammatory pseudotumor and 20 cases of normal lung tissue. Two independent pathologists observed all the specimens in the high power field (*400) of microscope by double blind method. RESULTS: 1.The expression of CCR7 in pulmonary tumor tissue was remarkably higher than normal lung tissue (P <0.005); 2. The expression of CCR7 between pulmonary tumor tissue and metastasized lymph nodes had no significant differences (P =0.177); 3. The expression of CCR7 had correlation with lymph nodes metastasis, The expression level in lymph nodes metastasis group was significantly higher than that in no lymph nodes metastasis group (P =0.016); 4. Along with the increment that clinical stage, the CCR7 expression had increases the high trend (P =0.003). CONCLUSIONS: CCR7 is over-expression in carcinoma cell nests and lymph node metastasis . It demonstrates that CCR7 may be related to the development of lymph node metastasis in NSCLC.