Use of the liver tissue oxygenation index as a noninvasive parameter of intestinal ischemia in rabbits.

OBJECTIVE: The tissue oxygenation index (TOI), measured by spatially resolved spectroscopy (SRS), reflects the ratio between oxygenated and deoxygenated tissue hemoglobin. We investigated whether liver TOI is a noninvasive parameter for early detection of intestinal ischemia. METHODS: In seven adult New Zealand rabbits the superior mesenteric artery (SMA) and vein were exposed by laparotomy. The SRS probe was attached at the skin above the liver to calculate the TOI. The bowel (SbO(2)) and peripheral (SpO(2)) oxygen saturation were continuously measured. The SMA was occluded, creating small bowel ischemia for 90 minutes. Then reperfusion was started for 1 hour. The median TOI and interquartile range (IQR) of the TOI were calculated. A paired Wilcoxon test was used to evaluate changes in the liver TOI and SpO(2) during ischemia and reperfusion. RESULTS: The median TOI was 54.3% (IQR 8) at the start of ischemia, 54.9% (IQR 9) after 30 minutes, 51% (IQR 11) after 60 minutes, and 50.3% (IQR 10) after 90 minutes. The median TOI values were 46.3% (IQR 5) after 30 minutes of reperfusion and 41.2% (IQR 5) after 60 minutes. The decrease in TOI became significant (p < 0.05) after 90 minutes of ischemia. The SpO(2) was stable during the experiment. DISCUSSION: A significant decrease in liver TOI was seen after 90 minutes of occlusion of the SMA and is likely to be the consequence of bowel ischemia. The further decrease after reperfusion might reflect reperfusion injury. Liver TOI may be a new tool for noninvasive early detection of intestinal ischemia and reperfusion. Further study is needed to confirm these findings.

Hydatid disease of the liver in children.

Between 1986 and 1997, 21 children (ten boys and 11 girls) had surgery for hydatid disease of the liver. Their mean age was 6.5 years (range 3-12). Abdominal distention with a mass was the commonest presenting symptom (71.4%), followed by abdominal pain (38%). Hepatomegaly with a palpable mass was present in 12 (57%). Three children had concomitant pulmonary and brain hydatid disease. The diagnosis was established clinically and by skin testing, serology and imaging techniques. All patients received a pre-operative course of mebendazole (50 mg/kg/day) for between 1 and 8 weeks. At surgery, 11 children had a single cyst, eight of which were in the right lobe of the liver. Ten children had multiple cysts occupying both liver lobes. Three forms of surgical treatment were used: capitonnage + partial excision of fibrous capsule; total excision of the cyst; and external drainage of the cyst cavity. Three children required re-operation. Mean follow-up time was 24 months. There were no deaths, but five children developed post-operative complications. Surgical treatment in the form of primary closure of the cyst cavity without drainage seems to offer the best therapeutic option for patients with large hydatid cysts.

Ten years' experience in the management of cervical teratomas.

Five patients with cervical teratoma were seen between 1982 and 1992 in the Maternity and Children's Hospital, Riyadh, Saudi Arabia. All presented with a cervical mass at birth. Their weights ranged between 2.6 and 3.5 kg (average 3.1 kg); all were full-term babies, three girls and two boys. Three cases were diagnosed antenatally; three had a history of maternal hydramnios; three presented with severe respiratory distress at birth and needed endotracheal intubation. All patients underwent surgical treatment except one who died before surgical intervention because of severe respiratory distress. Surgery included complete resection of the tumor. The postoperative courses were uneventful. The histopathology of the tumor showed tissue from all three germ layers. Over 3-11 years of follow-up, none of the patients showed signs of recurrence. Postoperative thyroid function tests and serum alpha-fetoprotein showed no abnormalities. We conclude that antenatal diagnosis help to reduce the morbidity and mortality due to upper airway obstruction. Surgery is safe and represents the only way of treating this tumor.