Chest
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The advisability of prolonged oral or nasotracheal intubation is of continuing concern to physicians caring for patients requiring prolonged mechanical ventilatory assistance. Currently, in many health care centers, prolonged intubation is defined as being in excess of seven days. We treated a patient who required mechanical ventilatory assistance and in whom oral endotracheal intubation was maintained for two months without significant pathologic sequelae.
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A new method for nasotracheal intubation of infants and young children is described. This method offers a smooth, reliable, and rapid means of entry into these children's airways in a safe and efficient manner in a wide variety of cardiorespiratory illnesses. This technique should be reserved for well-trained physicians with adequate equipment and experience. It is an optional technique for intubation that should be available in all modern general and children's hospitals throughout the country.
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A young man with a typical clinical presentation of acute pericarditis, on M-mode echocardiography, was repeatedly found to have a relatively echo-free area posterosuperior to the left ventricle, disappearing as the left ventricular apex was scanned. A radioisotopic "pericardial scan" revealed pericardial fluid lateral and inferior to the heart but not at the apex. This represents an additional type of M-mode echocardiographic presentation of loculated pericardial effusion.