We have observed stimulated emission at room temperature from a photopumped homoepitaxial GaN for the first time. A homoepitaxial layer was grown by atmospheric metalorganic chemical vapor deposition (MOCVD) on small hexagonal bulk GaN prepared by the sublimation method. The lasing threshold of the pumping power density is 0.86 MW/cm2 and the stimulated emission is polarized with its electric vector perpendicular to the c-axis.
he intubating laryngeal mask airway (ILMA; LMA-Fastrach TM , Laryngeal Mask Company, Ltd., Henley on Thames, UK) has been recently introduced as a prototype of the laryngeal mask airway for blind endotracheal intubation (1-3). It allows for an endotracheal tube (ETT) of up to 8.0-mm inside diameter and does not require head and neck manipulations on insertion. The success rate of blind intubation using the ILMA was up to 99.3% in patients with or without airway problems (3). Therefore, the ILMA might be helpful for endotracheal intubation in patients with cervical spine disease. The purpose of this study was to investigate the utility of the ILMA for blind endotracheal intubation in patients undergoing cervical spine surgery.
A 75-year-old previously healthy man presented for elective resection of rectal cancer under general anesthesia. Six days before the operation, he had a high-grade fever, and elevated leukocyte count and C-reactive protein concentration, but this was resolved by an intravenous antibiotic. His condition was well controlled before the operation. Soon after the operation started, severe hypoxemia emerged, with low arterial pressure. Fiberoptic bronchoscopy demonstrated a massive amount of plasma-like edema fluid; the total amount of suctioned fluid was approximately 800 ml at the end of the surgery. This acute pulmonary edema appeared to be due to increased permeability rather than pulmonary congestion as indicated by chest radiography, pulmonary artery occlusion pressure, echocardiogram, and the protein-rich edema fluid. Elevated concentrations of the proinflammatory cytokines, interleukin (IL)-6 and IL-8, in both plasma and the pulmonary edema fluid, suggested a possible role of systemic and pulmonary inflammation in the development of this acute pulmonary capillary leak. According to the "two-hit" hypothesis, the bacterial infection preceding the operation may have primed the immune cells, and the following surgical stress may have then triggered rapid progression of acute respiratory distress syndrome. We should keep in mind that, especially following sepsis, sudden massive pulmonary capillary leak can occur during elective surgery, even though the patient's condition is well controlled.
The agreement between CIABG and ABG measurements was better for PCO(2) and pH than for PO(2). The PO(2) value displayed on the CIABG monitor may not always be reliable during thoracic surgical procedures.
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