Perioperative transorbital Doppler flow imaging offers an alternative to transcranial Doppler monitoring in those patients without a temporal bone acoustic window.

Transcranial Doppler has been used to identify microembolic signals before, during and after carotid endarterectomy, but 10% to 15% of patients are reported not to have suitable temporal bone window. The aim of this study was to assess the feasibility of transorbital Doppler monitoring of patients with absent temporal bone acoustic window. Between 2005 and 2008, those patients with absent temporal bone acoustic window were assessed for a transorbital acoustic window. During the study period, 318 carotid endarterectomy were performed. In the 29 (9.1%) with absent temporal bone acoustic window, 25 (86%) had satisfactory transorbital acoustic windows, consequently only four (1.2%) of patients could not be monitored postoperatively. One patient required postoperative transorbital acoustic windows directed glycoprotein IIb/IIIa receptor antagonist infusion due to excessive carotid microembolisation to prevent stroke. This is the first description of the use of transorbital flow imaging to determine postoperative cerebral blood flow, microembolic load and to direct the use of intravenous antiplatelet agents.

Evaluation of the role of laparoscopic ultrasonography in the staging of oesophagogastric cancers.

INTRODUCTION: The role of laparoscopic ultrasound (LUS) during staging laparoscopy for pancreatic cancers is established but remains debatable in evaluating oesophagogastric cancers. METHODS: A retrospective consecutive case series consisting of patients undergoing staging laparoscopy in two centres (centre A and B) was carried out over a 5-year period (2000-2005). Patients in centre B underwent LUS following laparoscopic assessment using a 7.5-MHz probe. Staging laparoscopy in both centres was performed using a standardised three-port protocol using a 30 degrees laparoscope. All suspicious lesions were sent for histological assessment for confirmation of malignancy. RESULTS: There were 201 patients in centre A (83 gastric, 138 lower oesophageal/junctional cancers) and 119 patients in centre B (51 and 68, respectively). There were no differences between the two centres for patient demographics and tumour site. There was no difference between the two centres for the detection of metastatic disease using laparoscopic assessment alone (A 13% versus B 20%, p = 0.12). However, there was a significant difference (13% versus 28%, p = 0.001) with the additional use of LUS in centre B. The findings in the additional 8% (n = 9) were para-aortic lymphadenopathy (n = 5), liver metastasis (n = 3) and local extension (n = 1). Five had gastric and four lower oesophageal/junctional cancers. The negative predictive value was 6.4% for centre A and 4.5% for centre B. CONCLUSION: The addition of LUS increased the detection rate of metastasis by 8% but there was little impact on the false-negative rate. LUS is useful in detecting metastatic lymphadenopathy beyond the limits of curative resection and liver metastasis.