Evaluation of accuracy of pharyngeal pulse oximetry in critically ill patients with low perfusion state

The reliability of pulse oximeter, when applied to fingers or toes, may be compromised in critically ill patients with low perfusion state. So modification of oximeter probes to be applied to an area more central and highly perfused is required for more accurate monitoring. This prospective controlled study was designed to compare pharyngeal pulse oximetry to the finger pulse oximetry in critically ill patients with low perfusion state. Sixty patients were divided into two equal groups according to their perfusion status [30 patients for each] into, a normal perfusion group [control group] and a low perfusion group. The low perfusion group was specified by a mean arterial blood pressure less than 60 mmHg and cardiac output less than 4 l/min. All the selected patients were intubated with a cuffed endotracheal tube and a cuffed oropharyngeal airway [COPA] device was used for application of the pharyngeal pulse oximeter For each patient, the hemodynamic monitoring data including, mean arterial pressure, heart rate, cardiac output stroke volume and systemic vascular resistance, and reading of the pharyngeal pulse oximetry, the finger pulse oximetry and arterial saturation obtained from blood gas analysis [which was taken as an indicator of accuracy] were recorded every 30 min for 3 hours. Compared to the control group, the mean arterial pressure [MAP], cardiac output [CO] and stroke volume [SV] were significantly lower while systemic vascular resistance [SVR] was significantly higher in low perfusion group at all time intervals [P<0.05] Results showed a statistical significant difference with under reading of finger oximetry in low perfusion group [P<0.05]. Also there was statistical significant difference in relative accuracy between the pharyngeal and finger oximetry in the low perfusion group [P<0.05]. The pharyngeal pulse oximetry [using COPA device as a method of application] provides a simple, non-invasive and feasible method for tracing oxygen saturation and is more accurate than finger pulse oximetry in critically ill patients with low perfusion state

Transforming growth factor beta 1 in essential hypertension and glomerulonephritis: the effects of inhibition of the renin angiotensin system on its serum level in glomerulonephritis

This study was carried out on 12 patients with essential hypertension without micro or macroalbuminuria [group I] and 15 patients with chronic glomerulonephritis with mean 24-hour urinary protein = 4.3 + 3.l g/24 hours, [group II], 7 patients had hypertension [group IIa] and 8 patients had normal blood pressure [group IIb]. Ten healthy subjects were taken as controls. Blood urea, serum creatinine, fasting and 2-hour postprandial plasma glucose, urine analysis, 24-hour urinary protein and serum TGF-beta 1 were measured in diseased groups and controls. TGF-beta 1 was significantly higher in group I with essential hypertension [mean +/- SD 80.4 +/- 18.2 ng/dl] and group II with glomerulonephritis. [387.2 +/- 89.0 ng/dl], compared to control group [36.3 +/- 12.9 ng/dl]. In group II, patients with glomerulonephritis mean serum TGF-beta 1 was significantly higher than group I patients with essential hypertension [p <0.001]. In group II, TGF-beta 1 was not significantly different in hypertensive [group IIa] or normotensive patients [group IIb] [mean serum TGF-beta l = 393.3 +/- 92.0 and 379.0 +/- 84.l ng/dl, respectively]. Patients with glomerulonephritis received the angiotensin converting enzyme inhibitor ACE-I [captopril 25-75 mg/day] for four weeks then blood urea, serum creatinine, 24-hour urinary protein and serum TGF-beta 1 were re-estimated. There was significant reduction in both 24-hour urinary protein and TGF-beta 1 after captopril with no significant changes in urea and creatinine. It might be concluded that serum TGF-beta 1is elevated in patients with essential hypertension and glomerulonephritis. In patients with glomerulonephritis the use of ACE-I may reduce proteinuria and serum TGF-beta 1. Reduction of TGF-beta 1 might be a possible mechanism in the reduction of proteinuria in patients with glomerulonephritis, however, other mechanisms cannot be ruled out

Preparation and physicochemical characterization of solid dispertions of indomethacin with different carriers

The purpose of this study was to improve the dissolution properties of poorly water soluble and bioavailable drug Indomethacin [IND], by incorporating the drug in three different types of solid dispersion systems .Solid dispersions of IND were prepared using 1/1, 1/3 and 1/5 [w/w] ratios of sodium deoxycholate [bile salt] DCNa, albumin and skimmed milk using kneading method for preparation of albumin and skimmed milk solid dispersions and the solvent evaporation method for DCNa solid dispersion. Characterization of solid dispersion[s] was performed by differential scanning calorimetry [DSC] and Fourier transform IR spectra. Dissolution studies conducted in distilled water [37degreeC] using the USP type II [paddle] dissolution apparatus showed significant increase in the dissolution profile of IND with all solid dispersions in this study. Specially, within the first 5 min, solid dispersion containing IND / DCNa [1:5] and IND / albumin [1:3] showed 6.75, 6.6 and 5.75 fold increases in IND dissolution respectively. DSC and FTIR elucidated the formation of complex between IND and the three carriers

Comparison between percutaenous ethanol injection and radiofrequency ablation in treatment of hepatocellular carcinoma

Hepatocellular carcinoma [HCC] is a common type of cancer with approximately 260000 new cases each year and liver cirrhosis could be a predisposing factor [Isselbacher and Dienstag 1998]. Management of HCC depend on the early detection of the tumor, the size and its site. Surgical management versus medical approaches were studied and gave different results in different situations. Radiofrequency ablation is a new minimally invasive technique, which must be evaluated properly. In the study comparison between results of percutaneous ethanol injection [PEI] and percutaneous rediofrequency ablation [PRFA] as a method of treatment of HCC of a diameter less than 3cm. 30 patients with HCC less than 3 cm in diameter either single or multiple lesion with a total number of 50 lesions were divided into 2 groups, group I: 15 patients having 22 lesions treated with PEI and group II 15 patients having 28 lesions treated with PRFA. Both groups were age, sex, histopathological type of tumor matched groups. The rate of complete success was detected as follows: in group I [PEI] 10 lesions [45.5%] of lesions showed complete success. In group II [PRFA] 21 lesions [75%] of lesions showed complete success, complications appeared more prominent in group I more than group II. We concluded that PRFA gave better results of treatment than PEI, less invasive less complications and less number of sessions

Treatment of hepato cellular carcinoma by percutaneous radio frequency ablation [P.R.F.A.]

Recent progress in diagnostic imaging modalities and clinical screening for high risk patients with hepatocellular carcinoma [HCC] have made it possible to detect small HCCs [< 3 cm]. However, the majority of patients with small HCCs cannot undergo surgical hepatic resection because of underlying advanced cirrhosis. The aim of this work is to determine the efficacy safety, and complications related to P.R.F.A. The study was carried on 16 patients with HCC. diagnosed by histological exlamination of their liver biopsies from the hepatic lesions. Patients were classified into patients with single lcsion [central or peripheral], and patients with multiple focal lesions whether peripheral or central or mixed lesions. Patients were followed up for at least 3 months after P.R.F.A. which was performed on a total 21 discrete ultrasono-raphically detectable HCC tumor nodules. The median diameter of tumors treated was [3 cm.]. Local tumor recurrence occurred in one patient [6.25%], and another patient had suffered from subcutaneous haematoma and pain for one week [6.25%]. We concluded that in patients with HCC, R.F.A. produces effective local control of the tumor in a significant proportion of patients and can be performed safely with minimal complications especially when the tumor is a small and single