the bispectral index a sensitive monitor for survival after living donor liver transplantation?

Bispectral index [BIS] monitoring has been established as a standard monitoring method for the assessment of the depth of anesthesia during living donor liver transplantation [LDLT]. We tested the sensitivity and specificity of BIS readings during LDLT in predicting the postoperative 3-month survival. After receiving ethical approval, 42 patients who had undergone LDLT under sevoflurane-fentanyl-rocuronium anesthesia were studied. Correlations between BIS readings and extubation time, postoperative liver function tests, intensive care unit stay, and 3-month mortality were tested. Receiver operating characteristic curves were generated to determine the sensitivity and specificity of the BIS readings during different phases of surgery in predicting the survival outcome. The extubation time, liver function tests, coagulation factors V and VII, and intensive care unit stay were not statistically correlated with the BIS values. Receiver operating characteristic curve analyses showed reasonable sensitivity and specificity of mean BIS values during hepatic resection and neohepatic periods for predicting the 3-month mortality, with an unweighted accuracy of 76 and 73%, respectively. The nonsurvivors had significantly higher mean BIS values during the neohepatic phase [P<0.05]. The researchers concluded that the BIS monitoring during hepatic resection and neohepatic phases seems to be a suitable noninvasive monitoring tool with reasonable sensitivity and specificity for predicting the 3-month mortality after LDLT under sevoflurane-fentanyl anesthesia

Acupressure as a safe and easy method in post Management chemotherapy of nausea and Vomiting among leukemic children

One of the major problems facing the clinician dealing with cancer patient is the post chemotherapy nausea and vomiting. This study aimed to assess the effect of acupressure as a method to manage nausea and vomiting post chemotherapy in leukemic children. The study was conducted in pediatric hematology oncology unit at Tanta university hospital from May to August 2010. A convenient sample of 60 children with acute lymphoblast leukemia [ALL] was included in the study .Their ages ranged between 6-18 years. All of them were under chemotherapy. They were divided into two equal groups, group 1 [received acupressure at p 6 acupoint plus routine hospital care, group 11 as a control group [received routine hospital care only]. Visual analog scale [VAS] and Rhodes index scale [INVR] were used to assess intensity, duration and frequency of nausea and vomiting post chemotherapy. Results revealed significant reduction in the amount of vomiting and the intensity of nausea over time among acupressure group, compared to the usual-care group. Concerning child distress from nausea and vomiting, significant improvement was detected regarding the duration, seventy and distress from nausea and vomiting after one hour as well as after 2-3 hours in comparison with immediately after one hour .But no significant between after one hour and 2-3 hours . In conclusion, Acupressure at the P6 point is a value-added technique in addition to pharmaceutical management for children undergoing chemotherapy to reduce the amount and intensity of nausea and vomiting. Thus should be applied to children undergoing chemotherapy

Endosonography as a predictive tool for first oesophagogastric variceal bleeding

Endosonography [EUS] is a useful tool for evaluating the fine details of the vascular structures at the gastroesophageal junction. The aim of this study is to evaluate the value of extraluminal gastroesophageal vascular collaterals as predictors for first variceal bleeding. Fifty cirrhotic patients with no history of previous upper gastrointestinal [GI] bleeding were recruited into this prospective cohort study. All patients were subjected to upper endoscopy and EUS for assessing the number and size of extramural vascular collaterals and perforating vessels. All patients were followed up for 24 +/- 7.5 months for upper gastrointestinal bleeding. Eighteen out of 50 patients [36%] had at least one attack of upper GI bleeding during the follow up period. All patients had one or more types of extraluminal venous collaterals. The presence of gastric varices [p = 0.02], perigastric collaterals [p = 0.03] and perforators [p = 0.02] were independent risk factors for first variceal bleeding. The presence of 3 or more paraoesophageal collaterals and the presence of perforators were significantly higher in bleeders when compared to non-bleeders [p = 0.034]. Perigastric and paragastric collateral sizes were significantly larger in bleeders than in non-bleeders [p = 0.019 and 0.038, respectively]. Perigastric and paragastric collaterals of size more than or equal to 2 mm and 6.20 mm, respectively were associated with significantly increased risk of first variceal bleeding. EUS may be a promising tool for predicting first variceal bleeding in cirrhotic patients

Comparative estimation of anterior chamber depth and axial length by ultrasonography and orbscan II

To assess and compare the degree of agreement of anterior chamber depth [ACD] and axial length [AL] measurements by optical devices [Orbscan II] and contact ultrasound A-scan. In this prospective study of 30 eyes of 25 consecutive patients, ACD and AL estimation were done by 2 methods-scanning slit topography [Orbscan II] and contact ultrasound A-scan. One observer performed all Orbscan measurements and another performed all the ultrasonic measurements. Repeated measures Analysis of Variance [ANOVA] was used to analyze difference between ACD and AL measurements by the 2 methods. Difference in measurements between methods was assessed using the paired t test. The mean ACD [SD] by the 2 methods was 3.658 mm [0.254], and 3.406 mm [0.348], respectively. There was a statistically significant difference between measurements recorded by the 2 methods [P>.01]. Mean contact A-scan measurements were 0.252 mm lower than by Orbscan II. The mean AL were 24.220 mm [0.851] and 23.897 [0.857] mm respectively. There was none statistically significant difference between measurements recorded by the 2 methods [P>.01]. Mean contact A-scan measurements were 0.323 mm lower than by Orbscan II. Applanation ultrasound gives consistently lower measurements for ACD as well as the AL compared to Orbscan II

Evaluation of photorefractive keratectomy [PRK] re-treatment of under correction of laser in situ keratomileusis [LASIK] for myopia

To evaluate the results of photorefractive keratectomy [PRK] enhancements in eyes previously treated by laser in situ keratomileusis [LASIK] for myopia showing an under correction due to refractive regression or a primary under correction, when the residual stromal thickness is not in safe limits for in the bed correction. Fourteen [14] eyes of 8 patients previously treated by LASIK for myopia ranging between -11.25 to -3.25 that after a follow-up of 12 months or more ended up with a refraction of -3.0 to -1.25. The flap thickness was 160 mm for all eyes. In all cases, the residual stromal bed under the flap was considered too thin [255-285 um] to allow an in the-bed enhancement without exceeding an assumed safety thickness limit [250 win]. Those eyes were treated by PRK at least 12 months after LASIK. The PRK ablation parameters [diameter, attempted correction] were selected to avoid theoretical flap perforation. The deepest ablation was 75 um. We used a Bausch and Lomb 217 C excimer laser [Bausch and Lomb, Rochester, New York]. Objectively, refraction, uncorrected and best-corrected visual acuity [BCVA], slit-lamp evidence of cornea 1 opacity or other visible complications, and corneal topography. Subjectively, patient satisfaction and convenience with postoperative visual acuity. The initial postoperative period was characterized by very satisfactory refractive results. Objectively, BCVA increase [3 to 5 lines] and subjectively as regard visual acuity, all the patients were very happy with improved vision, during follow-up, myopic regression yet again occurred as well as a moderate haze [grade 1 and 2] developed in 5 eyes that induced a further myopic regression and BCVA loss 1 to 2 lines. No further surgical treatment was needed as the final results were improvement of 2-3 lines. We considered PRK -within limits- as a possible option in hand, to correct eyes previously treated by myopic LASIK that resulted in an under-correction much better when the under correction is low

Role of ultrasonography in ocular blunt trauma

To evaluate the reliability of ultrasonography in detecting lesions following non-perforating blunt trauma of the eye. 70 patients presented to Tanta University Eye Hospital with ocular blunt trauma were included in this study. Detailed history taking of the trauma, complete ophthalmological examination, and ultrasound examination were done in all cases. Evaluation of both the anterior and the posterior segments of the eye was performed using Mentor-B scan [10 M.Hz]. Different lesions of both anterior and posterior segments of the eye were demonstrated by ultrasonography. Traumatic hyphema [46.6%], cataract [26.6%], and vitreous hemorrhage [23.3%] were the most common causes of opaque media that interfered with visualization of the posterior segment. Ultrasound played an important role in revealing lesions that could not be seen clinically, as posterior capsular tears, retinal tears and detachment, cilio-choroidal detachment, posterior vitreous detachment, and macular lesions. B-scan ultrasound is a simple, helpful and reliable diagnostic tool in ocular trauma. It allows early and correct management of lesions obscured by opaque media