Transoesophageal doppler compared to central venous pressure for perioperative hemodynamic monitoring and fluid guidance in liver resection

Major hepatic resections may result in hemodynamic changes. Aim is to study transesophageal Doppler [TED] monitoring and fluid management in comparison to central venous pressure [CVP] monitoring. A follow-up comparative hospital based study. 59 consecutive cirrhotic patients [CHILD A] undergoing major hepatotomy. CVP monitoring only [CVP group], [n=30] and TED [Doppler group], [n=29] with CVP transduced but not available on the monitor. Exclusion criteria include contra-indication for Doppler probe insertion or bleeding tendency. An attempt to reduce CVP during the resection in both groups with colloid restriction, but crystalloids infusion of 6 ml/kg/h was allowed to replace insensible loss. Post-resection colloids infusion were CVP guided in CVP group [5-10 mmHg] and corrected flow time [FTc] aortic guided in Doppler group [>0.4 s] blood products given according to the laboratory data. Using the FTc to guide Hydroxyethyl starch 130/0.4 significantly decreased intake in TED versus CVP [1.03 [0.49] versus 1.74 [0.41] Liter; P<0.05]. Nausea, vomiting, and chest infection were less in TED with a shorter hospital stay [P<0.05]. No correlation between FTc and CVP [r=0.24, P > 0.05]. Cardiac index and stroke volume of TED increased post-resection compared to baseline, 3.0 [0.9] versus 3.6 [0.9] L/min/m [2], P<0.05; 67.1 [14.5] versus 76 [13.2] ml, P<0.05, respectively, associated with a decrease in systemic vascular resistance [SVR] 1142.7 [511] versus 835.4 [190.9] dynes.s/cm[5], P<0.05. No significant difference in arterial pressure and CVP between groups at any stage. CVP during resection in TED 6.4 [3.06] mmHg versus 6.1 [1.4] in CVP group, P=0.6. TED placement consumed less time than CVP [7.3 [1.5] min versus 13.2 [2.9], P<0.05]. TED in comparison to the CVP monitoring was able to reduced colloids administration post-resection, lower morbidity and shorten hospital stay. TED consumed less time to insert and was also able to present significant hemodynamic changes. Advanced surgical techniques of resection play a key role in reducing blood loss despite CVP more than 5 cm H[2]O. TED fluid management protocols during resection need to be developed

National survey of Prevalence of Mental Disorders in Egypt: preliminary survey

This study is an initial step for the National Survey of Prevalence of Mental Disorders in Egypt. We conducted a door-to-door household survey of 14 640 adults aged 18-64 years in 5 regions in Egypt. Mental disorders were diagnosed using the MINI-Plus diagnostic interview. Overall prevalence was estimated at 16.93% of the studied adult population. The main problems were mood disorders, 6.43%, anxiety disorders, 4.75%, and multiple disorders, 4.72%. Mental disorders were associated with sociodemographic factors [e.g. being female, being unemployed, being divorced] and physical illness [e.g. heart disease, kidney disease, hypertension]

Long-term efficacy of macroplastique injection for the treatment of urinary incontinence in males and females

Objective: To evaluate the long-term efficacy of endoscopic injection of Macroplastique [Polydimethylsiloxane, PDMS]in male and female urinary incontinence [UI]

Patients and Methods: A total of 87 patients with different causes of urinary incontinence have been treated by endoscopic injection of PDMS at our department between 1997 and 2001. The group consisted of 39 male and 48 female patients with a mean age of 58 and 44 years, respectively. All patients underwent a sophisticated history taking including urodynamics and were instructed to complete a pre- and postoperative voiding diary. The results were evaluated by questionnaire at 1, 6, 12 and 24 months after injection. The outcome was classified as dry in all circumstances, improved or failed

Results: At one month, 5 male [13%] and 10 female [21%] patients were dry, while 27 males and 29 females had improved and treatment had failed in 7 males [18%] and 9 females [19%]. At the last follow-up [mean injections = 2.5], 12 males patients [31%] and 27 female patients [56%] were classified as dry, 18 males [46%] and 14 females [29%] were improved, while in 9 males [23%] and 7 females [15%] the procedure had failed. The overall success rate [dry and improved] was 77% for the males and 85% for the females

Conclusion: The use of PDMS [Macroplastique] is a good and effective alternative for the treatment of intrinsic sphincter deficiency in male and female patients. The implants do not lose volume over time and have a good long-term effect

Evaluation of a single tube medium, Y-nitrophenyl-phi-D galactopyranoside phenylalanine motility sulphate for screening pathogenic members of the family enterobacteraceae

Identification of members of the Enterobacteriaceae requires the application of biochemical tests before serological confirmation. Of the important tests in such a setting are ONPG, phenylalanine deaminase, motility, H2S and indole production. ONPG-PA-M sulfate medium is a semisolid medium in which all these reactions can be detected. The present study evaluated this medium for detecting such reactions in comparison to the diagnostic set in the microbiology lab [TSI, MIO and urease] and the standard API 20-E system for enterobacteria were evaluated. The reactions of 192 gram negative isolates from stool and other clinical specimens [urine, pus and sputum] as well as 63 control strains were compared. All tested strain showed identical reactions in the three sets, except for a missed positive ONPG reaction in the ONPGPA-M sulfate medium [by an atypical E. coli] and two missed H2S production in the TSI that were detected by the single tube medium [one E. coli and one Cit. freundii]. The ONPGPA-M sulfate medium appeared to be a reliable in assessing these reactions and even superior to TSI in detecting H2S, in addition to the cost reduction achieved by performing all these tests in a single tube. Thus, its use in routine microbiology laboratories was recommended

Cystoid macular edema in aphakic diabetics

One hundred and ten patients who underwent cataract extraction were divided into three groups. The first group consisted of 50 patients, 25 were diabetics, 25 non diabetics. All the 50 pts have undergone ECCE. The second group consisted of 40 patients, 20 diabetics, 20 non diabetics, where they have undergone ICCE. The third group were 20 cases who were complicated by vitreous loss during either ECCE or ICCE, 10 of them were diabetic, 10 were non diabetic. All cases were followed up for 12 weeks for evidence of clinical cystoid macular oedema [CMO] where fluorescine angiography was done in all suspected cases. In the groups of ECCE non diabetics, no cases of CMO were found while only one case was found in diabetic patients. In the group of ICCE one case was found among the non diabetic patients, 2 cases were found in the diabetic patients. In the group of vitreous loss 4 cases were found, 1 in the non diabetics 3 in the diabetics. CMO proved to be of higher incidence in diabetic patients and this incidence increased in ICCE than in ECCE and much increased with vitreous loss. It is better to shift to ECCE in diabetic patients and utmost care should be taken to avoid vitreous loss in these patients

Aerobic gram-negative bacilli in Zawia Central Hospital, Libya

Gram-negative bacilli from the hospital environment colonize the patient's pharyngeal, intestinal and other body sites within the first few hours to days of hospitalization. 26.7% of positive cultures from vascular catheters [used commonly in modern medical practice and especially in intensive care units] were Gram-negative bacilli including Pseudomonas aeruginosa, Enterobacter species, Escherichia coli, Serratia species, Klebsiella species and Proteus species. Settlement plates set in the hospital yielded 84 Gram- negative strains [constituting 21.9% of all aerobic airborne bacteria] divided into 14 species exhibiting variabilities in their resistance patterns to 17 antibiotics. Proteus mirabilis was the most frequently isolated species of the Gram-negative bacilli

Virological evaluation of the multiple use system and water renovation at Alexandria poultry processing plant [APPP]

The Egyptian poultry industry has experienced substantial growth during the past five years. The expansion has led to a considerable increase in water consumption and the need for multiple recycling and reuse of processing waters in Egypt. The present study was designed to valuate the multiple use system and water renovation at Alexandria Poultry Processing Plant [APPP] through isolation and identification of viruses. 576 water samples tap water and reused chlorinated APPP water were inoculated on Vero cells, chick fibroblast cells and on the chorioallantoic membrane of 11 days old fertile hens eggs. Water samples were inoculated directly and after Talc-celite concentration. From reused water 8 specimens should cytopathic changes on vero cells, of which 2 were neutralized by polioviruses antisera and one with adenoviruses. Meanwhile 2 specimens gave cytopathic changes on chick fibroblasts and 4 specimens gave pocks on the chorioallantoic membranes. All suspected cytopathic changes and pocks tested by neutralization test for polio, Coksackie, ECHO, Herpes 1 and 2 and NDV and all proved negative. Except the 2 strains of polic from washer and scalder tanks after 6 hours use of 3 and 4 times previously used water. The adenovirus strain was isolated from the chiller tank after 6 hours use of once previously used water. No isolates could be obtained from renovated water. This study stresses the possibility of enteroviruses contamination in the recycling water process, which is a potential hazard to human health. The Talc-celito filter may partially remove viruses from water but not completely. To avoid viruses accumulation in the reuse of recycle process water, the free residual chlorine concentration entering the multiple-use system, must be adjusted to constant level during the whole operational period

role of newly recognized bacterial pathogens in acute diarrheal disorders of children living in Alexandria

Diarrheal diseases in infants and young children are still among the most important public health problems in developing countries. This study was designed to determine the role of different enteropathogens of infantile diarrhea. Five hundred diarrheal cases were randomly selected from El-Shatby and El-Anfoushi pediatric hospitals together with two hundred control subjects. Campylobacter jejuni was taking the upper hand among enteropathogens detected in our study being detected in 20%, ETEC/St and LT in 11.1%, Salmonella species in 2.6%, and Shigella species in 1.8%. On the other hand Yersinia enterocolitica and Vibrio parahaemolyticus were not detected in our study. Campylobacter was found all the year round. ETEC, Salmonella and Shigella were summer pathogens. It was evident that lack of adequate breast feeding played an important role in the high isolation ratio of enteropathogens

Antibodies titre of herpes simplex virus and herpes zoster virus in sera of patients with facial palsy

This work aimed to study the causative relationship between acute non traumatic facial palsy [Bell's palsy] and HSV or HZV. This was demonstrated by serological test using ELISA technique. Fifty patients and 50 normal controls were studied. Out of the 50 normal controls, 10% had specific IgG antibodies for HSV-1, 20% of whom were found to have specific IgG antibodies for HSV-2. No control had specific IgG antibodies for HZV. 62% had signs of activity of HSV-1, 36% of HSV-2, 24% of both strains of HSV, 6% of HZV and 2 patients had signs of activity of both HSV-1 and HZV. In a whole, 94% of patients had signs of activity of one or both of the 2 strains of HSV. 96% had signs of viral activity compared to 30% of normal controls. 30% of patients reported immediate viral prodrome just before the onset of Bell's palsy

prevalence of cytomegalovirus [CMV] infection in multi transfused children

This study was earned out on 25 patients with chronic blood diseases necessitating repeated blood transfusions, together with 25 normal controls. The ages of cases and controls ranged from 2 to 13 years. Cases reveived blood transfusions repeatedly from 50 to 300 times. From all cases and controls urine and sera were collected and tested by the ELISA technique for both cytomegalovirus [CMV] antigen and antibody 56% of the cases had CMV antigen in their urine and 44% In their sera they had CMV antibody. Meanwhile in the control group 16% and 8% had the antigen and antisera respectively. The difference for both the antigen and antisera was statistically significant between the cases and controls. There was no statistical difference concerning the age, sex, blood grouping clinical variety of the blood disease, or according to the number of blood transfusions given. The risk of CMV Infection after blood transfusions is not a remote possibility. Screening f or CMV of blood donors is strongly recommended, specially if the donated blood is intended to be used In. vulnerable cases as pregnant ladies and newborn infants

effect of idoxuridine treatment on the antibody level in herpetic stomatitis cases, using the enzyme linked immunosorbent assay [ELISA]

Sixty four children clinically diagnosed as having herpetic gingivo stomatitis were included in the study. Scrapings from the lesions were inoculated on vero cell tissue culture cells for HSV isolation. Acute and convalescent sera were collected from all patients as well as from 50 control children. 45 HSV isolates were obtained. Half of these cases received idoxyuridine local ointment and the other half had 1% gentian violet paint. Antibodies were tested by the enzyme linked immunosorbent among [ELISA] using goat horse radish peroxidase cenjugate antihuman IgG as a substrate optical density was measured by Dynatech microplate ELISA reader at 410 nm filter. Significant difference was detected between the acute convalescent HSV antibody titer. The difference between HSV antibody titers in those received IDU and gentian violet was found to be statistically non significant. It was concluded that IDU acts only locally and has no remote or systemic effect on the virus or the antibody production capacity

role of cytomegalovirus [CMV] in hepatitis of children, using the enzyme linked immunosorbent assay [elisa]

Hepatitis is a common concomitant of cytomegalo virus [CMV] infection in infancy. Using ELISA technique, 25 children with hepatitis were studied for CMV infection. Together with 25 children as control.Sera were tested for liver function tests, and for CMV antibody. Urine was tested for CMV antigen for both cases and controls. Liver function tests showed that all cases had liver impairment. CMV antisera were detected in 16% of the cases in 8% of the controls. CMV antigen was detected in 32% of the cases and in 20% of the control. The role of CMV in the causation of hepatitis has been discussed

In vitro biological behaviour of meningioma cells

Fourteen pathologically verified specimens of meningiomas obtained from patients with 2 spinal and 12 intracranial tumors of different histopathological subtypes has been carried out. Using the technique of monolayer tissue culture, the morphologic characters of the cultivated cells were compared with those of the original tumor. The rate of growth of the cells was measured [and a correlation was made between the in vitro cell kinetics and the clinical course of the tumor under study]