Factors affecting difference between EGW and AGW in liver transplantation

Background: An accurate preoperative estimate of the graft weight and remnant liver volume is vital to avoid small-for-size syndrome[SFSS] in the recipient and ensure donor safety after Living donor liver transplantation [LDLT]. CT has been widely used as a method for the preoperative volumetric assessment of the liver transplantation. The graft size as measured from preoperative imaging which is often different from the actual weight of the liver graft as obtained by the donor hepatectomy. The difference between preoperative volumetry and Actual graft weight [AGW] was graded into minimal difference [15%]

Aim of the Work: This study was conducted to assess different preoperative factors that might affect the difference between estimated graft weight and actual graft weight in liver transplantation

Patients and Methods: This single center retrospective study was conducted on 86 cases who have been subjected to donation for liver transplantation in Ain Shams Center of organ transplantation. Donors were divided into two groups: Group [A]: formed of 33 donors who showed minimal difference [15%] between EGV and AGW. Each donor data was examined for: Age, Sex: male or female, Body mass index [BMI], Lipid profile [positive / negative] Type of hepatectomy [Rt lobe / Lt lobe], AGW.Estimated graft weight [EGW], Total liver volume, Liver biopsy: Fibrosis [positive/ negative], Steatosis: Negative: [0%] and Positive: [5% or 10%]

Results: EGW of 903 gm was identified as cutoff point of the best specificity with the best sensitivity showing 60.4% and 60.6% for sensitivity and specificity, respectively. At this cutoff point, 47.7% of cases [n=41] showed EGW < 903 gm, while 52.3% of cases [n=45] showed EGW >/= 903 gm. Thus, it can be said that cases showed EGW >/= 903 gm have a probability of 71.1% to have big difference between EGW and AGW [>/=15%]. EGW of 1069 gm was identified as another cutoff point of a better specificity on ROC curve showing 32.1% and 93.9% for sensitivity and specificity, respectively, on ROC curve. At this cutoff point, 77.9% of cases [n=67] showed EGW < 1069 gm, while 22.1% of cases [n=19] showed EGW >/= 1069 gm. Thus, it can be said that cases showed EGW >/=1069 gm have a probability of 89.5% to have big difference between EGW and AGW [>/=15%]. TLW of 1587 gm was identified as cutoff point of the best specificity with the best sensitivity and specificity on ROC curve showing 56.6% and 60.6% for sensitivity and specificity, respectively, on ROC curve. At this cutoff point, 50% of cases [n=43] showed TLW < 1587 gm, while 50% of cases [n=43] showed TLW >/= 1587 gm. Thus, it can be said that cases showed TLW >/=1587 gm have a probability of 69.8% to have big difference between EGW and AGW [>/=15%]. TLW of 1807 gm was identified as another cutoff point of better specificity on ROC curve showing 18.9% and 93.9% for sensitivity and specificity, respectively, on ROC curve. At this cutoff point, 86% of cases [n=74] showed TLW < 1807 gm, while 14% of cases [n=12] showed TLW >/= 1807 gm. Thus, it can be said that cases showed TLW >/=1807 gm have a probability of 83.3% to have big difference between EGW and AGW [>/=15%]

Conclusion: TLV and EGV in CT volumetry are most reliable preoperative factors that can predict big difference between EGW and AGW. Re-evaluation of CT volumetry protocol is recommended for better prediction

Role of peritoneal ports for treatment of intractable ascites

Ascites is a common complication of advanced malignancies and cirrhosis. Symptoms of marked abdominal distention, shortness of breath, diminished appetite, fatigue, and lower-extremity edema can significantly compromise a patient's everyday life. Treatment options for intractable ascites include serial paracentesis, peritoneovenous shunting, transjugular intrahepatic portosystemic shunt [TIPS] creation, and tunneled peritoneal catheters that may be external or, more recently, attached to subcutaneous ports. It is therefore appropriate to evaluate a port specifically designed for peritoneal access as a mean of controlling intractable ascites. We present a minimally invasive treatment for palliative drainage of symptomatic ascites in patients with advanced malignancy. The aim of this work is to evaluate the percutaneous implantable access system specifically designed for peritoneal access as a method to control intractable ascites as regards complications and patency. This is a prospective intervention study will be conducted on 40 patients with intractable ascites referred from the oncology clinic to the diagnostic imaging department for percutaneous placement of peritoneal portcath as a palliative treatment for the patient. Good technical success rate [100%] in insertion was found with removal of ascites gradually. Immediate relief of symptoms [100%]. There were no major complications. There was one minor complication [2.5%], a leakage at the port placement site in a patient with pancreatic carcinoma. The leakage stopped spontaneous with removal of ascites and the patient underwent conservative management. peritoneal port systems for treatment intractable ascites is efficient way to avoid ascites related morbidity with increases patient compliance, satisfaction by decreased hospital visits as the drainage and patients monitor can be done in their homes. Port aspiration can be performed in some cases by patients or family members without nursing assistance. In comparison with tunneled peritoneal catheters with external components, the complication rate appears to be minimal

Effect of age on the vestibular evoked myogenic response potentials [VEMP]

To evaluate the effect of aging on the vestibular evoked potentials. Fifty males free from auditory and vestibular symptoms participated in this study. They were divided into 5 groups according to age; 15-25, 26-40, 41-55, 56-65 and 66 years and above. One channel recordings were obtained using three electrodes; active electrode placed on the upper half of sternocleidomastoid muscle ipsilateral to the stimulated ear, reference electrode placed on the lateral end of the upper sternum and a ground electrode placed on the fore head. Rarefaction clicks of 0.1 milliseconds duration were generated by D.C. pulse and delivered via a TDH-49 P. Telephonics ear phone. Monaural stimulation was employed with a stimulus presentation level of 95 dB nHL and stimulus repetition rate of 5 Hz. EMG signals were amplified and band pass filtered between 10 and 500 Hz. Each averaged response was based upon 100 stimulus sweeps and was replicated once. The results of this study showed that VEMP is a reproducible response the distinct morphology of which decreases by age. VEMP is a reproducible response that can be incorporated intoclinical use but results should be cautiously interpreted when dealing with older age groups as distinct morphology decreases with age

Venographic pattern of the foot: in post-phlebitic syndrome

Thirty-two patients with post-phlebitic syndrome were evaluated clinically and by venography for the foot. The results showed a correlation between the degree of oedema, foot symptoms and the venographic findings. The venograms of the foot in severe cases showed dilatation and tortuosity of the superficial dorsal and communicating veins with loss of their valvular pattern. Thrombosis of the deep plantar veins were detected in 60% of these severe cases

Evaluation of cervical lymphography as a diagnostic tool

Forty-Six patients with lesions in the head or neck were studied by different methods of cervical lymphography [perlingual, per thyroid or direct lymphadenography]. The lymphographic results of each case were interpreted with the clinical, operative and histological findings. The results showed that cervical lymphography can be a valuable diagnostic tool. The choice of the route of injection was clarified