Comparative histological and clinical study of two inhalar anaesthetics

Sevoflurane [Fluromethyl 1,1,1,3,3,3, Hexafluoro isopropyl ether] is one of the newly introduced inhalational Anaesthesia. It is considered as a rapid acting and potent inhalation anaesthetic agent. It is metabolized in the body into non-toxic substances. It also has a rapid uptake and elimination rate due to its low blood gas partition coefficient, which approaches that of nitrous oxide. Interest in sevoflurane has increased with the recent emphasis for out patient surgery because it has a mild ethereal odor and low solubility in blood; lipid; and tissues. So, it is suggested as being anaesthetic of the future. This study is designed to illustrate the histological and the clinical effects of sevoflurane in comparison with isoflurane as a common inhalational anaesthetic agent, regarding the haemodynamic, hepatic and renal effects. The clinical study included 80 adult persons of both sexes, during surgical operations. The patients were divided into 2 groups, 40 persons each. Group I: received sevoflurane and group II: received isoflurane. Routine examinations; investigations; Liver and renal function tests were done just before induction and after 2 hours; 4 hours; 24 hours and 7 days of recovery. The experimental study was done on 90 rats of both sexes. They were divided into 3 groups: 30 rats each. Group [A]: control group, group [B]: Anaesthetized with sevoflurane and group [C]: Anaesthetized with isoflurane. Each group was subdivided into 2 subgroups, 15 rats. The 1st subgroup was sacrificed after 24 hours of exposure. The 2nd subgroup was sacrificed after 7 days from the start of exposure. The rats were sacrificed and their blood was investigated. Liver and kidney structure were evaluated histologically and histochemically. Our results revealed that, sevoflurane and isoflurane had non-significant post-operative clinical manifestations and non-significant changes on the liver or kidney function tests. Histological examination of liver revealed normal hepatocytes and mild congestion in blood sinusoids and central veins in sevoflurane group. While, liver sections in isoflurane group showed more congestion, dilatation and cellular infiltration. . Histological examination of the kidney revealed no changes in the sevoflurane group. In contrast, isoflurane group had congestion and cellular infiltration of renal parenchyma. All changes almost completely disappeared after seven days of recovery. Histochemical results revealed significant decrease in PAS positive material and succinic dehydrogenase enzyme activity in hepatocytes and renal tubules, mainly in isoflurane than sevoflurane groups. While, acid and alkaline phosphatase enzymes activity showed non-significant decrease in both drugs. All changes were non-significant after seven days of recovery. This study proved that the sevoflurane had no harmful effect and can be considered as a safe inhalational drug

role of colour doppler sonography in the differential diagnosis of breast lesions [in correlation with Mammography, conventional ultrasonography and histopathology]

To evalute the role of colour doppler sonography [CDS] in the differential diagnosis of breast lesions prospective study of 104 patients who underwent breast imaging diagnostic techniques from January 1995 to December 1997 was done. A good history and clinical examination were conducted to all patients. Mammography and conventional ultrasonography were done firstly as a preliminary test, then colour doppler sonography was done to all patients for examination of all lesions detected by mammography and/or ultrasonography and completed by examination of the whole diseased breast and the contralateral breast especially the corrosponding area to the lesion as a control. All the detected breast lesions were excised surgically and their pathological results were obtained and proved that 38 lesions were benign while 66 ones were malignant. Mammography showed an accuracy of 84.2% for benign and 83.4 for malignant lesions with a 6% false positive and 3% false negative. Ultrasonography showed an accuracy of 78.9% for benign and 74.2% for malignant lesions with a 7.6% false positive and 10.5% false negative. Colour doppler sonography showed an accuracy of 76.3 for benign and 77.3% for malignant lesions with a 3% false positive and 5.3% fasle negative. Malignant lesions were characteristically more vascular than the benign ones because they stimulate the growth of new blood vessels by secreting angiogenesis factors. Most malignant lesions had more than 3 blood vessels either within the lesion or at its periphery while the benign ones even the largest had no more than 3 vessels. Malignant vessels are usually tortuous, larger, and occur away from the site of normal vessels. The maximum velocity of blood flow was much higher in malignant lesions [mean 31.2 cm/sec] than benign ones [mean 18.9 cm/sec]. Systolic/diastolic [S/D] ratio and resistance index [RI] of the flowing blood were estimated for all lesions and were non specific in all values. We concluded that colour doppler sonography is a new promising technique, non invasive, fast, easy and safe. Its of great value in differential diagnosis of breast lesions and helps in diagnosis of their local and distant extention to lymph nodes. A triple imaging technique [combined use of mammography, conventional ultrasonography and colour doppler sonography is considered an ideal pathway in differential diagnosis of breast lesions, with an accuracy nearly to 100%, helps to avoid the false positive and negative results and reduces the number of unnecessary biopsies. It can be used as a routin procedure in the programs of screening, early detection and diagnosis of breast lesions

Significance of amniotic fluid index assessment in pregnancy induced hypertension

The significance of determination of amniotic fluid index [AFI] has been evaluated for antepartum fetal surveillance in 100 cases of pregnancy induced hypertension [PIH]. All the women were subjected to history taking, clinical examination, ultrasound assessment of AFI and fetal biometry. The frequency of oligohydramnios [AFI <5cm] in cases of PIH range from 8-10%, while the frequency of borderline oligohydramnios was 20%. Oligohydramnios was associated with abnormal FHR 70%, meconium stained AF grade II or III 70%, cesarean section CS for fetal distress 70%, 1-min. Apgar score <7 60%, and 5-min. Apgar score <7 20%. Also, AFI [<5 cm] was important in the prediction of fetal growth retardation in 60% of cases, while its negative predictive value was 83%. On the other hand, PIH with normal AFI had favorable findings regarding fetal outcome

Comparison of gentamicin, piperacillin, and ciprofloxacin in pseudomonas aeruginosa-induced experimental pneumonia in guinea pigs

The therapeutic efficacy of gentamicin, piperacillin and ciprofloxacin in the treatment of experimental acute pneumonia induced by pseudomonas aeruginosa in guinea pigs were compared. Gentamicin [10 mg/kg], piperacillin [200 mg/kg] and ciprofloxacin [5 mg/kg] were administered subcutaneously in guinea pigs infected with pseudomonas aeruginosa. Experimental acute pneumonia was induced by challenging the guinea pigs with intratracheal injection of 10[7] CFU of pseudomonas aeruginosa. A fourth group of guinea pigs were administered saline as control. Mortality rates were as follows 100% control animals, 50% piperacillin and 25% for both gentamicin, piperacillin and ciprofloxacin. The peak serum level of gentamicin, piperacillin and ciprofloxacin was 2 h, 2h and 1 h, respectively. Our results suggest that ciprofloxacin was the most potent against pseudomonas aeruginosa induced pneumonia in guinea pigs as compared to gentamicin and piperacillin with peak serum level at 1h and with the lowest mortality rate [25%]