Clinicopathological and therapeutic patterns of idiopathic pulmonary fibrosis in Kuwait: a prospective study

Though common, the exact incidence and clinical pattern of idiopathic pulmonary fibrosis (IPF) in Gulf countries are not known. The results of a four-year prospective study undertaken in two tertiary hospitals in Kuwait are presented. The mean age at diagnosis of the 52 patients studied was 55.40 +/- 11.87 years. Thirty-two (61.5%) patients were male and 22 (42.3%) were smokers. The mean duration of symptoms at diagnosis was 2.1 +/- 0.92 years. Digital clubbing was found in 34 (65%) patients. The mean FVC, TLC and TLCO were 57%, 64.4% and 55% of predicted normal, respectively. The FVC value showed a significant difference between smokers and non-smokers (p < 0.05). HRCT findings were abnormal in all patients. Typical histological and high-resolution computed tomography findings of usual interstitial pneumonia, desquamative interstitial pneumonia and non-specific interstitial pneumonia were observed. This study revealed that IPF is prevalent in Kuwait, with patterns showing some similarities to those established elsewhere. The response to treatment was not encouraging, especially in the usual interstitial pneumonia subtype.     

Cerebral hemodynamic effects of phenylephrine and L-arginine after cortical impact injury

OBJECTIVE: To determine the effects of a pressor agent (phenylephrine and L-arginine) on the abnormal cerebral hemodynamics and on neurologic outcome after a severe cortical impact injury in rats. DESIGN: Prospective, randomized study. SETTING: University laboratory. SUBJECTS: Male Long-Evans rats, weighing 300 to 400 g, fasted overnight. INTERVENTIONS: The animals were anesthetized with isoflurane, and a severe cortical impact injury (velocity, 5 m/sec; deformation, 3 mm) was produced in the right parietal cortex. Five minutes after impact injury, one of the following three treatments were infused: 1 mL saline intravenously for 10 mins, 300 mg/kg L-arginine in 1 mL saline intravenously for 10 mins, or 0.3 microg/kg/min phenylephrine intravenously for 3 hrs. Mean arterial pressure, intracranial pressure (ICP), cerebral perfusion pressure (CPP), and laser Doppler flow (LDF) at the impact site and in the contralateral parietal cortex were monitored for 3 hrs after the impact injury. Histologic examination of the brain was performed at 2 wks after injury in a separate group of L-arginine- and saline-treated animals. MEASUREMENTS AND MAIN RESULTS: The immediate response to the impact injury was an increase in ICP, and a decrease in mean arterial pressure, CPP, and LDF. In the saline-treated animals, LDF decreased to <25% of the baseline values at the impact site and stayed at that level for the entire 3-hr monitoring period. On the contralateral side, LDF decreased initially and recovered gradually to approximately 50% of the preimpact baseline value. Infusion of both phenylephrine and L-arginine increased LDF back to near-baseline levels. However, phenylephrine increased ICP significantly, whereas ICP with L-arginine did not change. L-arginine treatment reduced the contusion volume from a median value of 5.28 mm3 to 0.63 mm3. CONCLUSIONS: Phenylephrine increased cerebral blood flow (CBF) by increasing CPP. L-arginine, however, increased CBF without changing CPP. The improvement in CBF was accompanied by a decrease in neurologic injury. Although the pressor agents are used currently to increase CBF after traumatic brain injury, other strategies may also increase CBF without the potential adverse effects of induced hypertension.     

Cryopreservation of cardiac homografts

A homograft valve bank for cryopreservation of cardiac homografts was established at the Institute of Cardiovascular Diseases in July 1995. From July 1995 to February 1999, 169 donor hearts were processed. All except four hearts were procured post mortem. Aortic valves (149) and pulmonary valves (139) were the common homografts dissected out for use. The valves were immersed in a cocktail of five broad spectrum antibiotics and antifungals for an average of 48 to 72 hours before cryopreservation. Fifty-three (35.57%) aortic and 42 (30.21%) pulmonary valves had to be discarded for various reasons like fungal contamination, failure to sterilise, HBsAg positivity etc.; 153 homografts have been released for use so far. Analysing the usual methods of procurement, sterilisation protocol, culture and cryopreservation used for cardiac homografts at this centre, this paper recommends observance of timeliness, use of appropriate media for preservation of heart parts, administration of specific drugs and safeguards necessary for cryopreservation procedure.     

Antithrombin, prekallikrein, and fibronectin levels in surgical patients

Antithrombin (AT), prekallikrein (PK), and fibronectin (FN) levels were measured in the plasma of 290 patients. The mean (+/- SD) lowest AT level measured in 287 patients was 70% +/- 18% (normal, 75% to 120% of control). The mean lowest AT level in 81 septic patients (49% +/- 17%) was significantly lower than in the 206 patients without sepsis (78% +/- 22%). The mean AT level in 60 patients who died (42% +/- 22%) was significantly lower than in 227 patients who lived (78% +/- 19%). The mean lowest PK level measured in 71 patients was 42% +/- 17% (normal, 80% to 120%). The mean PK level in 32 septic patients (26% +/- 12%) was significantly lower than in 39 patients who were not septic (54% +/- 19%). The mean lowest FN level measured in 45 patients was 193 +/- 86 micrograms/mL (normal, 160 to 240 micrograms/mL). The mean FN level in 15 septic patients (128 +/- 72 micrograms/mL) was significantly lower than in the 30 nonseptic patients (266 +/- 84 micrograms/mL). Following AT, PK, and FN levels in critically ill surgical patients may allow earlier diagnosis and more effective treatment of sepsis.