Faysal Najjar

Familial jejunal atresia:Three cases in one family

10 Atrophy of the right pectoral muscle; absence of the ulna and ulnar side of the hand Absence of finger on the right hand; deformity of the right foot Bilateral lobster claw deformity of the hands and feet; cleft palate Sparse axillary and pubic hair; saddle nose; hypertelorlsm; high-arched palate Short status; short small nose; a broad nasal root; protrusion of the external ear; high-arched palate No anomalies

End-tidal carbon dioxide tension during laparoscopic cholecystectomy.: Correlation with the baseline value prior to carbon dioxide insufflation

An investigation of end‐tidal carbon dioxide tension changes was carried out in 19 healthy adult patients undergoing laparoscopic cholecystectomy. Following induction of anaesthesia, and throughout surgery, the end‐tidal carbon dioxide tension was continuously monitored by capnography. The value following carbon dioxide insufflation increased with time to reach a maximum value after 40 min. Correlation of the individual maximum end‐tidal carbon dioxide tension during laparoscopy with the corresponding baseline value prior to carbon dioxide insufflation showed a positive linear relationship (correlation coefficient 0.86). The correlation showed that an end‐tidal carbon dioxide tension of 5.32 kPa (40 mmHg) can be achieved during laparoscopy when the baseline value is adjusted to around 4.0 kPa (30 mmHg).

Trauma management in a war zone: the Lebanese war experience.

Lessons learned from the Vietnam and Korean conflicts have emphasized the necessity of an organized preparedness for optimal management of casualties. The present report summarizes the experience of a tertiary care center in the present Lebanese war. Between 1975 and 1986, approximately 30,000 war casualties were treated at the American University of Beirut Medical Center (AUBMC). A disaster plan was implemented whenever more than 25 major trauma victims were received within 1 hour. In-field stabilization and emergency room (ER) thoracotomy were not employed. The results are illustrated by an analysis of 1,500 cases of abdominal trauma, (1,314 high-velocity gunshot wounds, 29 stab wounds, 157 blunt injuries). A total of 1,420 patients were operated on within 6 hours of admission and 711 within the first hour. Overall mortality was 130, 8.7%; 9.5% for gunshot wounds, 3.4% for stab wounds, and 2.5% for blunt trauma. One hundred forty-five patients or 9.7% had negative findings at laparotomy. The factors affecting mortality were hypotension on admission (26.5% for a BP less than 90 mm Hg and 2.8% for a BP higher than 90 mm Hg) and the presence of extra-abdominal injuries (14.4% with and 4.4% without). The chief causes of death were hemorrhage (3.7%), sepsis (2.1%), and ARDS (1.2%).

Can Pulse Oximetry and End-Tidal Capnography Reflect Arterial Oxygenation and Carbon Dioxide Elimination During Laparoscopic Cholecystectomy?

An investigation was carried out on 13 ASA class 1 or 2 adult patients undergoing laparoscopic cholecystectomy. Throughout laparoscopy, the end-tidal PCO2 was continuously monitored by capnography and the arterial hemoglobin oxygen saturation by pulse oximetry. Also, repeated measurements of arterial blood gases were done. Ventilation was controlled using an inspired oxygen concentration of 33% and tidal volume of 10 to 15 ml/kg at a rate of 10-14/min. The report showed that both the mean end-tidal PCO2 and arterial PCO2 progressively increased following carbon dioxide insufflation, to reach a maximal value after 30 min, with no significant change in the arterial-alveolar PCO2 gradient. Also, the arterial PO2 significantly decreased, and the hemoglobin oxygen saturation was always above 98% whether monitored by arterial blood gas analysis or by pulse oximetry. The results suggest that end-tidal capnography and pulse oximetry can be used as noninvasive techniques for monitoring arterial oxygenation and carbon dioxide elimination during laparoscopic cholecystectomy.