PURPOSE Underdeveloped nations carry the burden of most cervical cancer, yet access to adequate treatment can be challenging. This report assesses the current management of cervical cancer in sub-Saharan Africa to better understand the needs of underdeveloped nations in managing cervical cancer. METHODS A pre- and postsurvey was sent to all centers participating in the Cervical Cancer Research Network's 4th annual symposium. The pre- and postsurvey evaluated human papillomavirus and HIV screening, resources available for workup and/or treatment, treatment logistics, outcomes, and enrollment on clinical trials. Descriptive analyses were performed on survey responses. RESULTS Twenty-nine centers from 12 sub-Saharan countries saw approximately 300 new cases of cervical cancer yearly. Of the countries surveyed, 55% of countries had a human papillomavirus vaccination program and 30% (range, 0%-65%) of women in each region were estimated to have participated in a cervical cancer screening program. In the workup of patients, 43% of centers had the ability to obtain a positron emission tomography and computed tomography scan and 79% had magnetic resonance imaging capabilities. When performing surgery, 88% of those centers had a surgeon with an expertise in performing oncological surgeries. Radiation therapy was available at 96% of the centers surveyed, and chemotherapy was available in 86% of centers. Clinical trials were open at 4% of centers. CONCLUSION There have been significant advancements being made in screening, workup, and management of patients with cervical cancer in sub-Saharan Africa; yet, improvement is still needed. Enrollment in clinical trials remains a struggle. Participants would like to enroll patients on clinical trials with Cervical Cancer Research Network's continuous support.

The authors have clinically examined the larynges of 117 patients who were successfully extubated in a Respiratory Care Unit, and have examined the larynges at autopsy from an additional 68 patients who failed to survive in the same Respiratory Care Unit. Based on these observations, our understanding of the pathogenesis of laryngotracheal trauma has allowed us to modify our clinical management in order to minimize such damage. Influence of this study on the management of patients is described.

Direct measurement of the inspired tracheal oxygen concentration was made in patients breathing through standard aerosol face masks. Factors affecting the tracheal FIO2 were analyzed using both mechanical and mathematical models. When oxygen is delivered to the face mask at low flow rates, there is considerable patient variation in the measured tracheal FIO2. Delivery of oxygen at higher flow rates (15 litres per minute or greater), reduces such variation. Furthermore, turbulent air currents within and around the face mask reduce the measured FIO2 and contribute to fluctuations in the FIO2. This effect may be virtually eliminated by placing shields around the mask orifices as described. Using the shielded mask, it is possible to deliver the desired oxygen concentration to the patient more accurately and to maintain humidification of the delivered gases. Changes desired in inspired oxygen concentration are accomplished by changing the concentration of the incoming gas mixture, and not by merely changing the flow rate of oxygen delivered to the system. Using the shielded mask, it is possible to deliver an inspired oxygen concentration of 100 per cent. This is not true with most other commonly used face masks, and, therefore, caution should be used to avoid administration of unnecessary high inspired oxygen concentrations with this type of mask.