Public knowledge of oral cancer and modelling of demographic background factors affecting this knowledge in Khartoum State, Sudan

Objectives: knowledge of oral cancer affects early detection and diagnosis of this disease. This study aimed to assess the current level of public knowledge of oral cancer in Khartoum State, Sudan, and examine how demographic background factors affect this knowledge

Methods: this cross-sectional study involved 501 participants recruited by systematic random sampling from the outpatient records of three major hospitals in Khartoum State between November 2012 and February 2013. A pretested structured questionnaire was designed to measure knowledge levels. A logistic regression model was utilised with demographic background variables as independent variables and knowledge of oral cancer as the dependent variable. A path analysis was conducted to build a structural model

Results: of the 501 participants, 42.5% had no knowledge of oral cancer, while 5.4%, 39.9% and 12.2% had low, moderate and high knowledge levels, respectively. Logistic regression modelling showed that age, place of residence and education levels were significantly associated with knowledge levels [P = 0.009, 0.017 and <0.001, respectively]. According to the structural model, age and place of residence had a prominent direct effect on knowledge, while age and residence also had a prominent indirect effect mediated through education levels

Conclusion: education levels had the most prominent positive effect on knowledge of oral cancer among outpatients at major hospitals in Khartoum State. Moreover, education levels were found to mediate the effect of other background variables

Immunopathological Changes in the Brain of Immunosuppressed Mice Experimentally Infected with Toxocara canis

Toxocariasis is a soil-transmitted helminthozoonosis due to infection of humans by larvae of Toxocara canis. The disease could produce cognitive and behavioral disturbances especially in children. Meanwhile, in our modern era, the incidence of immunosuppression has been progressively increasing due to increased incidence of malignancy as well as increased use of immunosuppressive agents. The present study aimed at comparing some of the pathological and immunological alterations in the brain of normal and immunosuppressed mice experimentally infected with T. canis. Therefore, 180 Swiss albino mice were divided into 4 groups including normal (control) group, immunocompetent T. canis-infected group, immunosuppressed group (control), and immunosuppressed infected group. Infected mice were subjected to larval counts in the brain, and the brains from all mice were assessed for histopathological changes, astrogliosis, and IL-5 mRNA expression levels in brain tissues. The results showed that under immunosuppression, there were significant increase in brain larval counts, significant enhancement of reactive gliosis, and significant reduction in IL-5 mRNA expression. All these changes were maximal in the chronic stage of infection. In conclusion, the immunopathological alterations in the brains of infected animals were progressive over time, and were exaggerated under the effect of immunosuppression as did the intensity of cerebral infection.

Immunopathological Changes in the Brain of Immunosuppressed Mice Experimentally Infected with Toxocara canis

Toxocariasis is a soil-transmitted helminthozoonosis due to infection of humans by larvae of Toxocara canis. The disease could produce cognitive and behavioral disturbances especially in children. Meanwhile, in our modern era, the incidence of immunosuppression has been progressively increasing due to increased incidence of malignancy as well as increased use of immunosuppressive agents. The present study aimed at comparing some of the pathological and immunological alterations in the brain of normal and immunosuppressed mice experimentally infected with T. canis. Therefore, 180 Swiss albino mice were divided into 4 groups including normal (control) group, immunocompetent T. canis-infected group, immunosuppressed group (control), and immunosuppressed infected group. Infected mice were subjected to larval counts in the brain, and the brains from all mice were assessed for histopathological changes, astrogliosis, and IL-5 mRNA expression levels in brain tissues. The results showed that under immunosuppression, there were significant increase in brain larval counts, significant enhancement of reactive gliosis, and significant reduction in IL-5 mRNA expression. All these changes were maximal in the chronic stage of infection. In conclusion, the immunopathological alterations in the brains of infected animals were progressive over time, and were exaggerated under the effect of immunosuppression as did the intensity of cerebral infection.

Immunohistochemical expression of nuclear factor kappa-B/p65 and cyclooxygenase-2 in non-small cell lung cancer patients: Prognostic value and impact on survival

Nuclear factor kappa B/p65 [NF-KB/p65] regulates the expression of various molecules important in tumorigenesis as cyclooxygenase-2 [COX-2]. To study the immunohistochemical expression of NF-KB/p65 and COX-2 in NSCLC, investigate the relationship between their expression and the clinicopathological parameters, evaluate their prognostic value and clarify their impact on survival. Fifty NSCLC patients were enrolled in this study and subjected to: full medical history and physical examination, routinelaboratory tests and CT chest. Fiberoptic bronchos-copy was done and biopsies were taken from visible masses and 20 mucosal biopsies of the same patients [as control]; sent for histopathological and immunohistochemical examination using anti-COX2 and anti-NF-KB/p65 antibodies. The median follow up of patients was 13 [range 4-22 months]. Results: Thirty six [72%] showed positive NF-icB/p65 expression, it was higher in squamous cell carcinoma and adenocarcinoma than in normal biopsies. Adenocarcinoma showed higher NF-KB/ p65 positivity compared to squamous and large cell carcinomas. A significant relationship was found between NF-KB/p65 expression and overall survival. Forty five [90%] showed positive COX-2 expression, no expression was detected in normal biopsies. COX-2 expression was significantly higher in adenocarcinoma compared to squamous and large cell carcinomas. NF-KB/p65 and COX-2 expression was significantly correlated with advanced tumor stage, lymph node metastasis and grade. A significant positive relationship was found between NF-KB/p65 and COX-2 expression. NF-KB/P65 and COX-2 expression has a prognostic value in NSCLC, they are suitable targets for development of new lung cancer therapies; inhibition of NF-KB and COX-2 will augment the efficacy of anticancer therapy

Role of multidetector CT [MDCT] in preoperative resectability assessment of central cholangiocarcinoma

CT is an excellent imaging technique for evaluating the soft-tissue extent of hilar cholangiocarcinoma and the relation between the tumor and the hepatic vasculature. To assess the role of multidetector CT [MDCT] in preoperative resectability assessment of hilar cholangiocarcinoma. The study included 20 patients presenting with hilar cholangiocarcinoma. Informed consent signed by the patients. All patients subjected to proper history taking, clinical examination as well as routine laboratory investigations. Triphasic abdominal MDCT. Post-processing techniques including multi-planner reformation [MPR], maximum intensity projection [MIP] and minimum intensity projection [MinIP]. 11 patients with portal vein invasion, 10 patients with hepatic artery invasion. Four patients had type I obstruction; four patients, type II obstruction; two patients, type IIIa obstruction; four patients, type IIIb obstruction; and six patients, type IV obstruction. The tumors were considered resectable in 12 patients in the preoperative assessment. Multidetector CT provides important information on the preoperative assessment of central cholangiocarcinoma resectability and the extent of surgery

Urine carcinoembryonic antigen determination in urinary bladder bilharziasis predicts carcinoma in patients with premalignant lesions. observations of 43 Egyptian cases

Both urinary bilharziasis and urothelial neoplasia are associated with increased production of tissue carcinoembryonic antigen [CEA]. Urine and serum CEA were determined in 43 patients with urinary bladder carcinoma including 22 post bilharzial and 21 nonbliharzial cases, in addition to 10 normal control cases. A significant increase was detected in both urine and serum CEA levels with bladder carcinoma compared to control cases. Urinary CEA was significantly elevated in 86% of bilharzial, versus 62% in nonbilharzial bladder carcinoma cases. Only 10.5% of control cases had urinary CEA elevation. The mean urinary CEA in bilharzial patients were higher than that of nonbilharzial carcinoma, but the difference was not statistically significant. There was a definite relationship between urine CEA and the stage of malignancy; the higher the stage, the higher the level of urine CEA. No relationship could be detected between the stage of malignancy and serum CEA, or between the grades of malignancy and urine or serum CEA levels. In conclusion, urinary CEA is more useful than serum CEA in the early detection of urothelial carcinoma particularly if provoked by bilharziasis. Its level is also correlated with the tumor stage

outcome of surgical decompression for carpal tunnel syndrome yields better functional results than conservative management and steroid injection

Surgery for carpal tunnel syndrome is reserved for severe cases or for those having intractable and longstanding symptoms. Non-surgical treatment modalities include hand splinting, ultrasound, oral non-steroidal anti-inflammatory drugs, local steroid injection, and some physiotherapeutic measures. The objective of this study is to evaluate the effectiveness of non-surgical treatment versus standard surgery in improving clinical outcome. Twenty seven patients with carpal tunnel syndrome were categorized into three groups [12, 9 and 6 patients respectively]. Group I received conservative management, and intra-canal injection of Triamicinolone Acetonide was added to group II. Open release of the carpal ligament was kept for patients of Group III. Treatment was given for the recommended period for each modality, and the follow up was for 6 months. Assessment was for the degree of pain relief and improvement in hand grip strength using the ppi scale and a dynamometer. Except three, all patients were females and the disease affected the right hand more than the left. After 6 months, results were: In group 1I 36% improvement of pain, but with no affect on hand grip strength. In group II, relief of pain reached up to 75% of patients with 12.76% average increase in hand grip strength. In group III surgery gave 82% improvement of pain with 20.5% average increase in hand grip strength. Open surgical release of the transverse carpal ligament should not be confined to patients with severe symptoms only. Conservative treatment is reserved for patients that either refuse surgery, or are unfit for surgery. Endoscopic release is not recommended for the time being

Evaluation of some liver fibrosis markers in chronic liver diseases

Liver fibrosis is a dynamic bi-directional process involving phases of progression and regression. Its diagnosis is dependent on histopathological examination of biopsy specimens. The aim of this study was to evaluate some non invasive serum markers of liver fibrosis and to correlate them with liver biopsy. Fifty patients with chronic liver diseases matched with 10 age and sex healthy blood donors were included in the study. For both groups; estimation of serum matrix metalloproteinase 9[MMP-9], tissue inhibitor of metalloproteinase 1[TIMP-1] by ELISA technique and haptoglobin by RID, scoring of the age-platelet index [API], AST to platelet ratio index[APRI],and prothrombin time [PT] were done. For the patients, histopathological examination of liver biopsy specimens for assessment of necroinflammatory grade [A] and fibrosis stage [F] applying the METAVIR scoring system. API showed a significant positive correlation with both fibrosis and necroinflammatory activity, by using ROC curve for discrimination of significant fibrosis [F>/= 2] and moderate to severe necroinflammatory activity [A>/= 2], the AUROCs were 0.88 +/- 0.09 and 0.69 +/- 0.16 respectively. In case of Platelet count the AUROC was 0.80 +/- 0.12 for the diagnosis of established cirrhosis [F4]. PT showed a significant positive correlation with fibrosis progression, and it was a sensitive predictor of significant fibrosis and the AUROCs, for [F >/= 2] and [F4] were 0.67 +/- 0.15 and 0.76 +/- 0.15 respectively. While APRI showed a significant positive correlation with both fibrosis stage and necroinflammatory grade and the AUROCs were 0.68 +/- 0.15 and 0.69 +/- 0.15, for [F >/= 2] and [F4] respectively .The mean serum level of MMP-9 was significantly higher in patients than controls [P < 0.05] and showed a significant negative correlation with fibrosis stage [P < 0.05]. By using ROC curve to assess MMP-9 for discrimination of significant fibrosis [F>/= 2] and cirrhosis [F4], the AUROCs were 0.67 +/- 0.17 and 0.69 +/- 0.18 respectively, while for [A>/= 2], it was0.75 +/- 0.16. The mean value of serum TIMP-1 was significantly higher in patients than controls [P < 0.05], with significant positive correlation with necroinflammatory grade[P < 0.05]. The AUROCs for [F>/= 2] and [F4] were 0.58 +/- 0.2 and 0.53 +/- 0.19 respectively, while for [A>/= 2], it was 0.67 +/- 0.17. Haptoglobin showed a significant negative correlation with fibrosis progression[r=-0.4, P < 0.05] and AUROC for [F>/= 2] and [F4] were 0.75 +/- 0.17 and 0.78 +/- 0.15 respectively. MMP-9 was a fair marker of fibrosis as well as inflammatory activity, and TIMP-1 was a sensitive and to a lesser extent specific marker of advanced liver disease, discriminating inflammatory activity rather than fibrosis stage. On the other hand API was the best marker that can discriminate significant fibrosis, while platelet count for diagnosis of cirrhosis. Among the assessed serum markers, haptoglobin, API and PT were the most sensitive predictors of significant fibrosis, while haptoglobin and API were the most sensitive predictors of cirrhosis. Finally, these serum assays, although promising, are still in need of being refined with further prospective studies

Evaluation of the impact of educational program on elderly knowledge about osteoporosis

Osteoporosis is a major public health affects or threatens an estimated 150 million women and men worldwide. Approximately 7% of all women aged 35-40 years and 33% of women older than 65 years have involutional osteoporosis. The World Health Organization define osteoporosis as a skeletal disorder characterized by compromised bone strength predisposing to an increased risk of fracture The aim of this study was to assess the elderly knowledge about osteoporosis and to evaluate the impact of educational program on elderly knowledge about osteoporosis. The study was carried out in El-Saada elderly club at Talkha, Mansura district. The study subject comprised 31 elderly visiting El-Saada elderly club regularly. A quasi experimental study was used in the study through evaluating the elderly knowledge about osteoporosis prior to the development of the educational program by using structured interview questionnaire sheet, after implementation of the program the same questionnaire was used to reassess the elderly knowledge immediately after program implementation and after one month of implementation. The results revealed a lack of knowledge which improved in the immediate post test but the knowledge declined after one month in some items. The study recommended that regular educational program should be held to increase their awareness, which helps them to catch the sign of the disease and prevent it. Key words: osteoporosis, elderly knowledge and educational program

Transferrinuria in type 2 diabetes mellitus: An early marker of diabetic nephropathy

Diabetic nephropathy is the commonest cause of end-stage renal failure in the Western world. The incidence of DN rises rapidly over the first 15 to 20 years of diabetes to decline sharply afterwards. The stages of DN progress from normoalbuminuria to microalbuminuria to clinical proteinuria and finally to end-stage renal failure. Several studies proved the applicability of urinary albumin quantification in the early diagnosis of diabetic nephropathy. Several studies of different urinary proteins demonstrated the increased excretion of other high and low molecular mass proteins in different stages of diabetic nephropathy: macromolecular, e.g. transferrin and micromolecular proteins like alpha 1-microalbumin. Elevated urinary transferrin excretion rates have been reported in patients with type 2 diabetes and its complications. Therefore, the aim of the present study was to evaluate the role of transferrin as an early marker for the detection of nephropathy in Egyptian type 2 diabetic patients. Sixty Egyptian type 2 diabetic patients grouped according to the presence or absence of albumin in urine into three groups: group I consisted of 20 normoalbuminuric Egyptian type 2 diabetic patients, group II included 20 microalbuminuric Egyptian type 2 diabetic patients, and group Ill comprised 20 macroalbuminuric Egyptian type 2 diabetic patients. Twenty healthy subjects of matched age and sex were included as a control group. Laboratory investigations included FBG and 2 hours PPBG, HbA[1C] serum albumin, ALT, AST, prothrombin activity, blood urea, serum creatinine and creatinine clearance, and complete urine analysis. Determination of microalbuminuria in fresh urine samples was done using immunoturbidimetry. Estimation of urinary transferrin was done by immuno-nephelometry. Results: Type 2 diabetic patients who had frank proteinuria had a significantly longer duration of diabetes mellitus as compared to micro and norrnoalbuminuric patients. Type 2 diabetic patients with frank proteinuria had significantly higher FBG, PPBG and HbA[1C] levels as compared to normoalbuminuric type 2 diabetic patients and controls. Type 2 diabetic patients with frank proteinuria had significantly higher blood urea and serum creatinine and a significantly lower creatinine clearance as compared to norrnoalbuminuric type 2 diabetic patients and controls. Type 2 diabetic patients with frank proteinuria showed significantly higher urinary albumin and transferrin excretion as compared to normo-and microalbuminuric type 2 diabetic patients and controls. Also, microalbuminuric type 2 diabetic patients had significantly higher urinary albumin and transferrin excretion as compared to normoalbuminuric type 2 diabetic patients and controls. In normoalbuminuric type 2 diabetic patients, a negative correlation was observed between creatinine clearance and transferrinuria. In microalbuminuric type 2 diabetic patients, a strong positive correlation was found between albuminuria and transferrinuria. In type 2 diabetic patients with frank proteinuria, strong positive correlations were obtained between blood urea and serum creatinine and transferrinuria, while a strong negative correlation was observed between creatinine clearance and transferrinuria. However, no significant correlations were found in any of the type 2 diabetic groups between duration of the disease, blood pressure, FBG, PPBG, or HbA[1C] and transferrinuria. Urinary transferrin is a convenient diagnostic parameter of renal impairment in Egyptian type 2 diabetic patients. Transferrinuria could be considered as an early marker of diabetic nephropathy as compared to microalbuminuria

Histological and immunohistochemical studies of the rabbit ovary at different physiological conditions

This study was conducted on twenty healthy female balady rabbits to investigate the histological structure of the rabbit ovary at different physiological conditions, in addition to evaluate cytokeratin 7 localization in this organ. The animals were classified into four groups each comprised five animals: neonates, adult non-pregnant non-lactating, adult pregnant and adult lactating rabbits. Upon sacrifaction, ovaries samples were prepared for general histological structure and with improved Biotin-Streptavidin amplified detecting staining methods to localize the sites of intermediate filaments cytokeratin 7. Moreover, minute parts were prepared for transmission electron microscope examination.Light microscopic examination of the ovarian sections showed an outer broad cortex and an inner narrow medulla with no line of demarcation in between. Also, a dense tunica albuginea was organized under the covering epithelium and appeared well developed in adult pregnant rabbit ovary. The cortex, in neonates contained only primordial follicles which differentiated to various ovarian follicles at adult ages. But, it was noticed that atretic follicles were found more abundant in the ovarian cortex during pregnancy. The medulla was formed of fibrovascular connective tissue stroma which became more vascular with pregnancy. The corpus luteum of pregnancy was large in size and accounted for more than one half the volume of the ovary and characterized by the presence of numerous lipid droplets in the small luteal cells cytoplasm. The ovarian interstitial tissue was ill developed at neonate stage. While, in adult age it appeared formed of polygonal cells with pale cytoplasm and rounded nuclei. With pregnancy they became hypertrophied with vacuolated cytoplasm and vesicular nuclei. The ovary of lactating female was similar in its histological structure to that of the cyclic one. In conclusion, the present study showed that rabbit ovaries at different physiological conditions had its own characteristic histological features which suit its functional demands. Cytokeratin 7 was found to be represented in the ovarian surface epithelium, all stages of follicular development, oocyte, luteal cells and in the medullary stroma mainly around the blood vessels. So, from this study, it could be recommended that cytokeratin 7 could be used as a tumour marker to distinguish different types of ovarian tumours

Effects of L-carritine on grawth of Egypt children with sickle cell anaaenia

Growth improvement on L-Garnitine therapy has been observed in transfusion dependent sickle cell anaemia patients. We plan to study 27 Egyptian sickle Jell patients on low transfusion regimen for 6 months follow-up study period. The study included .13 males and 14 females aged [546 years]. Anthropometric measurements were done before starting L-Carnitine and six months after L-Carnitine [50 mg/kg orally]. Measurements included weighs, height, body mass index, skeletal muscle development and measurements of body fat. Twenty patients [10 males and 10 females.] of the same age and social classes were followed in the study as a control. Patients were divided according to their ages into 2 groups [5-10 years] and [11-26 years,]. The study showed increase in the standard deviation score [SDS] of weight and height per age of the supplemented children compared to control groups. There were increase in the chest/head ratio [C/H R], deltoid circumference, mid arm muscle circumference, mid arm fat circumference and subscapaular and supra iliac skin fold thicknesses compared to controls. These results were more apparent in the young age groups. We concluded the beneficial effect of L-Carnitine on the physical growth of patients with sickle cell anaemia especially the young, a longer period of supplementation is recommended

Ulnar lengthening for kienbock disease using ring external fixator [Ilizarov]

An ulnar lengthening, using ring external fixator [Ilizarov], was performed in nine pateints who had Kienbock disease. Stages I and IV were excluded from this study. Four pateints [44%] had a history of trauma and all nine wrists had a negative ulnar varience [average 3 mm.] on radiographs. All Wrists were re-examined after an average follow up of 18 months. At that time, the pain had decreased in 89% of the wrists. Extension of the wrists had improved on average of 32%; flexion, 27%; radial deviation, 30%; and ulnar deviation, 40%. The grip strength had improved about 50%. Radiographic evaluation showed improvement in shape of lunate in 44%, and stabilization in 56%. The results were excellent and good in 89% of pateints. Ulnar lengthening is an effective treatment for kienbok disease in wrists that do not have degenerative changes in adjacent carpal joints. Pain, range of motion, and grip strength can be expected to improve

Moderate hydration and dopamine infusion during anaesthesia for renal transplantation: does it matter with the incidence of postoperative ANT

This study was conducted on 20 kidney recipient randomly classified into 2 groups, dopamine infusion was given to the second group [n = 10] to evaluate the effect of moderate hydration with or without dopamine on the incidence of ATN. Heart rate, mean blood pressure, central venous pressure, urine output and creatinine were recorded perioperatively. The results of this study showed that there is no significant difference between the 2 groups on the incidence of ATN. It was concluded that moderate hydration without dopamine decrease the incidence of ATN after renal transplantation

Hemodynamic and oxygenation variables during radical cystectomy

The effect of anesthetics on hemodynamic variables [HV] has been clarified, but ambiguity existed concerning their effect on oxygenation variables [OV]. Radical cystectomy provided a clinical setting for studying the effect of anesthetics on perioperative HV and OV. Patients subjectd to radical cystectomy [n = 33] were assigned through balanced randomization to receive one of four anesthetic modalities, namely, group I: inhalation anesthesia using N[2] O:O[2],halothane, d-tubocurarine [n 11]; group II: inhalation anesthesia sing N[2] O:O[2], halothane, d-tubocurarine, and supplemented with epidural analgesia [EA] [n = 11]; group III: total intravenous anesthesia [TIVA] using ketamine 10-30 micro g. kg[-1]. min [-1], propofol 2 mg. kg[-1]. h [-1], d-tubocurarine, and supplemented with continuous EA [n = 6]: and group IV:TIVA using ketamine 20-50 micro g. kg[-1]. min [-1], midazolam in increments of 1.5 to 5 mg, and supplemented with intermittent EA [n = 5]. Monitoring entailed continuous ECG, pulse oximetry, invasive arterial pressure, and pulmonary artery catheter for HV [HR, MAP, PAP, PAOP, CO, SVR, and PVR] and OV [PaO[2], SaO[2], PvO[2], SvO[2], a-vDO[2], O[2]ext, Q[s]/Q[t], DO[2], and VO[2]]. The heart rate was lower in TIVA while other HV did not show striking differences. Group I showed higher arterial oxygen tension than group II and IV. Mixed venous oxygen tension and saturation were higher in group I over group IV. Other OV did not show remarkable differences. In conclusion, HV and OV in 4 anesthetic modalities did not elicit striking differences

Respiratory mechanics during laparoscopic nephrectomy

37 adult ASA I or II patients divided into 3 groups and subjected to laparoscopic nephrectomy were assigned for this study. Oral diazepam was used for premedication. Induction with thiopentone sodium, suxamethonium sequence and maintenance of anesthesia were achieved differently in each group. In group 1, it was N2O: O2 halothane 0.5- 1%, while in group 2 N2O: O2 morphine were used. In group 3, lumber epidural analgesia [using bupivacain 0.8 mg/kg + 2 mg morphine] preceded general anesthesia, N2O: O2 was used for maintenance. Pancuronium was the non-depolarizing muscle relaxant used. Intraperitoneal CO2 insufflation was performed in lateral decubitus position. Respiratory mechanics including total chest compliance, peak inspiratory pressure, respiratory and expiratory resistance were recorded for every patient, before and after maximal CO2 insufflation and after deflation of CO2. Significant decrease in total chest compliance and significant increase in both peak inspiratory pressure and expiratory resistance were recorded with maximal CO2 insufflation. This was recorded in all groups studied irrespective to the mode of balanced anesthesia used. CO2 pneumoperitoneum during laparoscopic nephrectomy adds to the ventilatory impairment induced by anesthesia and lateral decubitus position which mandate careful adjustment of patient ventilation during the procedure

Noninvasive monitoring during laparoscopic nephrectomy

Thirty seven adult patients divided into 3 groups undergoing laparoscopic nephrectomy were used for this study. They were premedicated with oral diazepam. Thiopentone sodium, suxamethonium were used for induction of anesthesia and endotracheal intubation. Maintenance of anesthesia was with N2O: O2 halothane in group 1 and N2O: O2 morphine in group 2. In group 3, epidural analgesia using bupivacaine [0.8 mg/kg] and morphine [2 mg] preceded general anesthesia that was maintained with N2O: 02. Pancuronium was the muscle relaxant used to control ventilation. Intraperitoneal CO2 insufflation was performed in lateral decubitus position. Monitoring of pulse, systolic and diastolic blood pressure,% oxygen saturation either arterial or by pulse oxymetry and CO2 in arterial blood [PaCO2] and expired air [PETCO2], was done during the whole procedure. No sharp swings were recorded by monitoring pulse and blood pressure. Satisfactory% O2 saturation was maintained as detected by both methods of monitoring during the operation. Significant increase in both PaCO2 and PETCO2 was seen after CO2 insufflation. Both methods of monitoring CO2 run together with no significant difference between them in all groups studied. Noninvasive monitoring may be satisfactory for the majority of patients, while invasive cardiovascular and blood gas monitoring may be necessary for compromised patients

Arterial gasometry during laparoscopic nephrectomy

Thirty seven adult patients undergoing laparoscopic nephrectomy were chosen for this study. They were divided into three groups. Premedication was with oral diazepam. Thiopentone-suxamethonium were used for induction of anesthesia and endotracheal intubation. Maintenance of anesthesia was by N2O: O2 halothan 0.5-1% in group 1 and N2O: O2 morphine in group 2. In group 3 epidural analgesia using bupivacaine and morphine preceded general anesthesia which was maintained by N2O: O2. Muscle relaxation was achieved by pancuronium. Intraperitoneal insufflation of CO2 was performed in lateral decubitus position. Arterial blood samples were collected during the operation for determination of PaO2, PaCO2, SO2, pH and PAO2. Maintenance of significantly high PaO2, SO2, PAO2 and P[A-a]O2 over the basal level was achieved after increasing inspired O2 concentration from 21% to 35%. Significant increase in PaCO2 and P50 and significant decrease in pH extending to the postoperative period, were observed due to storage of excess CO2 in body tissue during the prolonged procedure. Arterial blood gas monitoring may be required to detect developing hypercarbia and acidosis during laparoscopic nephrectomy