Diaphragmatic excursion assessment by ultrasound versus volume associated weaning parameters as a prediction in extubation in critically Ill patients

Background: Liberating a patient from ventilator is a continuous process as with any disease condition which starts with recognition of patient being ready to be weaned from ventilator by letting the patient breathe on T-piece and, if successful proceeding to SBT followed by extubation, if it is tolerated well [simple weaning]. Otherwise letting patient on ventilator till next such trial being successful. Difficulty in weaning from mechanical ventilation is one of the most frequently encountered problems in MICU. An estimated 20% of mechanically ventilated patients face failed extuabtion [requiring reintubation within 48 h of extuabtion]

Aim of the study: This study was designed to assess the value of the excursion of diaphragm tested by ultrasonography to predict weaning from mechanical ventilation versus volume associated weaning parameters in medical intensive unit's patients

Patients and Methods: A prospective study was carried out on 30 patients ready for weaning. All patients were divided into two equal groups.Group A [successful weaning group] and Group B [failed weaning group]

Results: Of the entire group of 30 patients, 21 patients [70%] had succeeded extubation and 9 patients [30%] failed. By applying cut-off level 1cm determined in our study the sensitivity and specificity of mean liver and spleen displacement were 95.2% and 88.9% respectively, which is higher than Pi max [85.7% and 77.8%] by cut-off level

Conclusions: The present study concluded that ultrasonographic measurement of liver and spleen displacement during SBT before extubation is a good method for predicting extubation outcome

Outcome of surgical management of adenocarcinoma of esophagogastric junction

Adenocarcinoma of the esophagogastric junction [AEG] is a challenging disease for the surgeon. Because of its borderline location, the choice of surgical strategy is controversial. Efforts are currently directed to select patients who may benefit from extensive resection. Therefore, we carried out this prospective study to evaluate the outcome of surgical treatment based on Siewert's classification. From January 2004 to December 2006, 36 patients with AEG underwent resection. The choice of surgical approach was based on the location of the tumor center. The treatment of choice was esophagectomy and proximal gastrectomy for type I tumors and extended gastrectomy and distal esophagectomy for type II and III tumors. The outcome of surgery and prognostic factors were analyzed. Fourteen out of the 36 AEG cases [39%] were diagnosed as having type I tumors, twelve [33%] had type II and 10 [28%] had type Ill AEG tumors. Esophagectomy with proximal gastreetomy was carried out in all patients with type I tumors. Eleven patients with type I tumors underwent transhiatal resection while 3 patients underwent transthoracic resection. All type III tumor patients underwent transabdominal resection by total gastrectomy with transhiatal resection of the distal esophagus. The extent of surgery for type II tumors was the same as type III however, ten patients had a transabdominal resection, while one patient had a thoracotomy and another patient underwent transhiatal esophagectomy. The overall 2-year survival rate was 33.3%. Survival rate was significantly associated with pT stage, pathological node-positive category and tumor stage. Postoperative 30-day mortality and morbidity rates were 30.5%, 36.1%; respectively. Siewert's classification provides a useful tool for selecting the surgical approach but should be tailored to individual patients to achieve R0 resection. Survival is still largely stage dependent and earlier diagnosis holds the key to improve prognosis

Laparoscopic adrenalectomy for adrnal tumors

Laparoscopic adrenalectomy is rapidly becoming the surgical technique of choice for removal of diseased adrenal glands. Laparoscopy offers a shorter length of hospital stay, a decrease in postoperative pain, a shorter time to return to preoperative activity level, improved cosmesis and reduces morbidity in the patient. To evaluate the technique of laparoscopic adrenalectomy and to analyze its benefits and complications. A study done on 29 cases chosen non randomized from those suffering of adrenal masses and treated at NCI with laparoscopic adrenalectomy, with male to female ratio 3:2, age of the patient varied between 2-56 years. The highest incidence of resected adrenal tumors is the non functioning adenoma in 31% of cases. The operative time varied between 90-190 minutes will, mean 130 minutes, blood loss ranged from 180-600 cc with mean 250cc. As regards operative complications; Conversion to open in 6.9% and significant bleeding in one case which was controlled laparoscopicaly in 3.4%. There was no mortality in the study. The laparoscopic approach has essentially become the gold standard for nearly all benign and some malignant tumors

Psychotherapy vs medical treatment in anovulatory infertility

Fifty anovular infertile patients, diagnosed as anovular patients on the base of proliferative endometrial biopsy. Hormonal assessments of ovulation were done before and after the study, for assessment and follow-up. The patients were subjected to two types of treatment. Thirty patients received clomid, Parlodel and H.C.G., the other 20 patients were subjected to psychotherapy as follow; 10 formulating a group were subjected to group psychotherapy and 10 patients to marital therapy with their husbands. Medical treatment has much better effect on the conception ratio, but it did not correct the psychic condition of the patient. Patients who conceived with psychotherapy achieved the best psychic condition of all the groups. The bad psychic condition had been found to be the cause of hypoprogesteronemia. F.S.H. and L.H. proved to be a relation to the psychic condition of the patients. Couple therapy proved to have much better effect on patients subjected to psychotherapy than group therapy