Comparative study between I-gel, a new supraglottic airway device, and classical laryngeal mask airway in anesthetized spontaneously ventilated patients

To compare two different supraglottic airway devices, the laryngeal mask airway [LMA] and the I-gel, regarding easiness of insertion of the device, leak pressure, gastric insufflation, end tidal CO[2], oxygen saturation, hemodynamic and postoperative complications in anesthetized, spontaneously ventilated adult patients performing different non-emergency surgical procedures. The study was carried out as a prospective, randomized, clinical trial among 80 patients who underwent different surgical procedures under general anesthesia with spontaneous ventilation in supine position. They were equally randomized into two groups: I-gel and LMA groups. Both the devices were compared with regard to heart rate, arterial BP, SPO[2], end-tidal CO[2], number and duration of insertion attempts, incidence of gastric insufflation, leak pressure and airway assessment after removal of the device. No statistically significant difference was reported between both the groups, regarding heart rate, arterial BP, SPO[2] and end-tidal CO[2]. The mean duration of insertion attempts was 15.6 +/- 4.9 seconds in the I-gel group, while it was 26.2 +/- 17.7 seconds in the LMA group. The difference between both the groups regarding duration of insertion attempts was statistically significant [P=0.0023*], while the number of insertion attempts was statistically insignificant between both the study groups [P>0.05]. Leak pressure was [25.6 +/- 4.9 vs. 21.2 +/- 7.7 cm H 2 O] significantly higher among studied patients of the I-gel group [P=0.016*] and the incidence of gastric insufflation was significantly more with LMA group 9 [22.5%] vs. I-gel group [5%] [P=0.016]. Both LMA and I-gel do not cause any significant alteration in the hemodynamic status of the patients, end tidal CO[2], and SPO[2]. The postoperative complications were not significantly different except nusea and vomiting was statistically significant higher in LMA group [P=0.032]. among both LMA and I-gel patients. Insertion of I-gel was significantly easier and more rapid than insertion of LMA. Leak pressure was significantly higher with I-gel than LMA and thus incidence of gastric insufflation was significantly lower with I-gel

Phenotyping and genotyping of pseudomonas aeruginosa urine isolates in Zagazig University Hospitals

Pseudomonas aeruginosa [P. aeruginosa] is an important nosocomial pathogen. therefore sensitive typing techniques are required for its control. Seventy six isolates of P.aeruginosa were recovered from midstream urine specimens obtained from the different Departments in the Zagazig University Hospitals [ZUHs]. Five isolates were polymorphic while the remaining 71 isolates were unimorphic. Different morphotypes of the same isolates were studied separately. In addition, 10 environmental isolates were obtained from the wards of the Urology Department. All isolates and their morphological variants were characterized by morphotyping on primary isolation, biochemical reactions using API 20 NE system, serotyping, antimicrobial susceptibility typing and genotyping using enterobacterial repetitive intergenic consensuspolymerase chain ration [ERIC-PCR] and random amplification of polymorphic DNA [ RAPD] using API2H primer. The unimorphic clinical and environmental isolates belonged to morphotype 1 [56.3% and 60%, respectively], morphotype 2 [22.5 % and 30%, respectively] and morphotype 4 [19.7% and 10%. respectively]. For the clinical and environmental isolates, including morphological variants, 14.1% and 30%, respectively showed atypical biochemical reactions. All were esculin positive. Forty seven percent of the clinical isolates and variants were serologically typable and none of the environmental isolates was typable. Among the typable clinical isolates and variants, serotypes 4 [17.1%] and 6 [7.9%] were the commonest. All isolates could be grouped under 14 antimicrobial susceptibility types. ERIC-PCR yielded 31 typing patterns. Twenty one patterns comprised the clinical isolates and their morphological variants, and 10 patterns comprised the environmental isolates. RAPD by API2H primer yielded 13 types for both clinical and environmental isolates. We concluded that ERIC-PCR was the most discriminatory of all the phenotypic and molecular methods used in this study for typing P.aeruginosa. On the other hand, RAPD using API2H primer seems to be useful for further subtype isolates of the same ERIC pattern. Furthermore. P.aeruginosa isolates of the same genotype can be discriminated by using phenotypic methods like serotyping and antimicrobial susceptibility typing. Interestingly, the majority of morphological variants obtained on primary culture from the same midstream urine samples may represent different strains rather than phenotypic plasticity of the same strain. Therefore, antibiograms should be performed separately for such colonial variants. Moreover, in our study, the environmental isolates of P. aeruginosa played a little role, if any, in the spread of P. aeruginosa nosocomial urinary tract infection

Immunohistochemical study of cellular fibronectin in mammary cystic hyperplasia and various breast neoplasms

The immunoperoxidase technique was utilized on formalin fixed, paraffin-embedded sections using specific monoclonal antibody to detect fibronectin. Cytoplasmic fibronectin [FN] was detected in 80% of cases of fibrocystic disease, in 70% of benign mammary neoplasm and in 73% of mammary carcinomas. The cytoplasmic fibronectin tends to concentrate at the cell membranes. While normal breast tissue, 50% of the cases of fibrocystic disease, 60% of benign neoplasm and a solitary case of adenoid cystic carcinoma expressed luminal FN, none of malignant mammary lesions manifested it. The prevalence of cellular FN was higher in medullary carcinomas in comparison to infiltrating duct and lobular carcinomas. The data obtained enhance the role of cellular FN in explaining the different biological behavior of malignant breast neoplasms

Urinary tract infection in percutaneous nephrolithotripsy

Sixty cases of renal calculi, underwent percutaneous extraction or distruction by ultrasound. Pre operative bacteriological study revealed that 36 cases had sterile urine and 24 had significant bacteriuria. Post operatively urine culture revealed that 14 out of the 36 cases with pre operative sterile urine and 22 out of the 24 cases with already infected urine gave positive culture [60%] and the remaining 24 cases [40%] gave no growth. In these 36 post operatively infected cases, the organisms were isolated from the bladder urine only in 12 cases; from the nephrostomy urine only in 2 cases and from both in 22 cases. So the organisms were isolated in bladder urine in 34 cases [34 out of 36] and in nephrostomy urine in 24 cases. It is found that infection was high in cases with history of stone passing spontaneously, previous urinary tract infection and previous open stone removal procedures, at the same time high infection rate was observed in cases with big stones which need ultrasonic destruction, in cases with prolonged ureteric catheter stay, in cases with multiple parenchymal puncture and in cases with complex intra-operative complications