Use of transesophageal doppler as a sole cardiac output monitor for reperfusion hemodynamic changes during living donor liver transplantation: an observational study

To report the use of transesophageal Doppler [TED], a minimally invasive cardiac output [COP] monitor, before, during and after reperfusion and study its effect on anesthetic management during living donor liver transplantation [LDLT]. A prospective observational study. A total of 25 consecutive recipients with a MELD score between 15 and 20 were enrolled. Data were recorded at baseline [TB]; anhepatic phase [TA]; and post-reperfusion-1, 5, 10 and 30 minutes. Fluid therapy was guided by corrected flow time [FTc] of the TED. Packed red blood cells [RBCs] were only given when hematocrit was less than 25%. Rotational thromboelastometry [ROTEM] and standard laboratory tests were used to guide component blood products requirements. Post-reperfusion, the COP, Cardiac Index [CI] and stroke volume [SV] increased significantly at all points of measurements; this was associated with a significant decrease in systemic vascular resistance [SVR] [P?<.05]. Immediately post-reperfusion, for 5 minutes, mean arterial blood pressure [ABP] dropped significantly [P<.05], and 14 out of the 25 patients required boluses of epinephrine [10 micro g] to restore the mean ABP; 3 of the 14 patients required norepinephrine infusion till the end of surgery. Central venous pressure [CVP] and urine output [UOP] at all measures were maintained adequately with FTc-guided fluid replacement. Eight out of the 25 patients required no blood transfusion, and 4 of the 8 patients required no catecholamine support. TED as a sole monitor for COP was able to present significant and reliable changes in the cardiovascular status of the recipients during reperfusion, which could help to guide fluid-and drug-supportive therapy in this population of patients. This preliminary study needs to be applied on a larger scale

Role and impact of changes of seminal plasma cytokines in male infertility

The present study was aimed to measure the levels of seminal plasma cytokines including tumor necrosis factor - alpha [TNF-alpha], interferon- gamma [INF- gamma], interleukin 8 [IL-8] and interleukin 6 [IL-6] in infertile and fertile males. It is aimed also to determine the relationship of seminal cytokines with semen quality. The study was performed upon 10 normal healthy and 30 adult men complaining of primary infertility in spite of regular vaginal coitus with intra-vaginal ejaculation and the duration of marriage was more than one year ago. Cases were classified equally into 4 groups according to history taking, clinical findings and semen examination. Group 1 [control] comprised of fertile adult men with sperm count >20 x 10 6 sperm/cc. Group II was infertile adult men with varicocele and oligospermia. Group III included infertile adult men with genitourinary tract infection with oligospermia. Group IV was infertile adult men with azospermia. TNF-alpha, INF-gamma, IL-8 and IL-6 concentrations in seminal plasma were determined using high sensitivity ELISA kits specific for each cytokine separately. Seminal levels of TNF-alpha, INF-gamma, IL-8 and IL-6 were significantly higher in oligospermia with genitourinary infection than the other groups while the azospermic group showed the lowest seminal levels of cytokines. There are a significant and positive correlation between both TNF-alpha, IFN-gamma, IL-8 and some abnormal parameters in semen analysis which actually leads to infertility. These parameters are percentage of immotile sperms, sluggish sperms and abnormal forms of sperms. IL-6 was significantly correlated with leukocytic count/HPF. Seminal plasma cytokines were significantly increased in oligospermic patients with genitourinary infection. They play an important role in male infertility as there are positive correlation between their levels in seminal plasma and different abnormalities in semen analysis. Their measurement in seminal plasma seems to be a sensitive and useful marker for infection/inflammation of the genital tract