I got a good response to a missive sent out via email, so we are trying this again. This is what I sent previously:
Numerous people responded correctly. It is indeed a papilloma, which was causing variable obstruction as it swung back and forth through the vocal cords on it’s pedicle. It was managed by videolaryngoscopic intubation with a microlaryngoscopy tube (MLT) followed by surgical debulking by the ENT. Here is a nice simple summary of MLTs and other special ETTs used in ENT surgery, although they erroneously attribute the acronym RAE. Click here for more about ETTS and to see the correct source.
Pic for this week:
This is a bronchoscopic view from the mid-tracheal level in an infant. Can you tell:
A) What is going on here?
B) Is there a classification system for this pathology, and can you fit this case into it?
C) What is the main challenge and advised technique for dealing with this airway?
Despite working most of the Easter weekend, I was able to gab a few hours and head down to Wolfgat Nature Reserve, on the shore of False Bay near Cape Town. Here, when the southerly winds blow against the dunes and low sea cliffs, one can enjoy hours of simple, smooth soaring. Equipped with my beloved Gradient XC3 glider, a lightweight Sup’Air harness and my GoPro, I took my turn cavorting over the cliffs and doing wingovers above the waves with the playful gulls. Magic. Watch in HD if you can.
The video was shot on GoPro and then, as an experiment, I downloaded the footage wirelessly and edited the entire thing on my iPad. It’s a bit of a rough cut but amazes me that the technology has advanced to the stage where this is possible. It also makes converting your fun footage into something shareable while traveling a serious option. Impressive.
The music is by an artist specializing in ‘Chillstep’ (relaxed melodic dubstep) that I am really enjoying at the moment, called Blackmill. Check out his stuff on iTunes and elsewhere online. Kudos.
A quiet moment on call has me trying to make inroads into the photographs from our Patagonian explorations last October. Here’s an image that was immediately emotive: A group of hikers on a guided exploration of a small part of the Perito Moreno Glacier as dwarfed by the immense magnitude of the ice. I love the mystery and majesty of glaciers; the idea of such harsh hardness being in constant flux, constantly flowing between accumulation and ablation while appearing immobile. You can explore a glacier for an entire day, convinced of its permanence, and then return the next to find the landscape changed, fresh and beaconing with new discoveries. The mute whiteness from afar disguises endless shades of blue, and the stark purity of the ice unfolds to reveal the pebbles and dirt it has collected along it’s course, like a child of the wilderness who can’t return from an adventure unsoiled.
Great flight for two hours on a beautiful morning today. Took off over mist-shrouded fields and landed 82km and two hours later back at the Altona airstrip to find a large group of PPG and microlight pilots chatting in the sunshine… and offering me a fresh up of coffee. Can it get better?
…at Red Cross Children’s this beautiful evening. Forgive me these gratuitous shots, but Cape Town truly delivered the most beautiful autumn evenings. Having floor-to-ceiling windows in the theatre certainly helps. Now, back to work…
What a whirlwind! The 2014 South African Society of Anaesthesiologist’s national congress has come and gone, and the full 6 days are a barely distinguishable blur in my mind. After presenting 5 talks and workshops, sitting in every lecture I could attend and the nearly daily evening functions I am completely exhausted but still exhilarated. Kudos to the organisers and staff.
As usual, I have made a set of rough notes, which you may download here. Please feel free to share the link if they are useful. Beware that there may be errors or misunderstandings, as I take these down in real time during the talks and often only write what I consider to the be core messages. There are some links in the notes to other web resources and presentations. My presentations are accessible here. Click the link below to open and/or download the full set of my rough notes:
If you are a speaker or have resources you’d like hosted online for open access, I am very happy to facilitate this free of charge (I maintain this site at my own expense, and am dedicated to open science and education). You comments are welcomed – post below or drop me a mail.
Here is a gratuitous photo from Sun City and my rough notes from the 2014 SASA Congress Refresher Course. Please accept with the usual caveats regarding possible errors and being an incomplete impression. Some fascinating talks. Also, I have below a link to Dr Eric Hodgson’s slides on from his talk on Cardiac Failure. Enjoy!