Safety and experience with awake video-assisted thoracoscopic surgery [VATS] in compromized patients

Background: Video-assisted thoracoscopic surgery [VATS] was implemented as a minimally-invasive technique to reduce tissue trauma. Thoracic epidural anesthesia furtherly-reduces intra-operative metabolic stress, postoperative pain, in addition to supporting awake VATS, by which then completely avoiding the drawbacks of mechanical ventilation and general anesthesia in high-risk patients. In this study we report the safety and experience with using VATS in patients where general anesthesia was deemed unsafe or not suitable. The VATS procedure was done in awake patients utilizing thoracic epidural analgesia and I.V sedation

Methods: In this prospective study twenty five patients underwent VAT surgery for different thoracic pathologies at New Kasr El Aini Teaching Hospital, Cairo University between February 2005 and December 2006. There were 19 male and 6 females ranging in age from 55 to 79 years and their body mass index ranging from 25 to 31. All patients had various co-morbid conditions [hepatic, cardiac, renal and/or respiratory compromise] hence general anesthesia was deemed a hazardous option

Results: Twenty five patients underwent 28 VAT procedures which included pleural biopsy and talc poudrage in 7 patients; bullectomy in 7 patients; pleuropericardial window in 4 patients; lung biopsy in 4 patients; evacuation of clotted hemothorax in 2 patients; and wedge resection of pulmonary nodule in 1 patient. There were no morbidity or mortality related to the procedure. However there were 2 late mortalities which were attributed to the primary disease

Conclusion: Awake video-assisted thoracoscopic procedure was carried out in various thoracic pathologies with technical ease and minimal morbidity and mortality complications. In our experience this procedure is considered soundly-safe particularly in patients athigh risk for general anesthesia

DNA polymorphism of the lipoprotein lipase gene and of the apolipoproteins AI, CIII, AIV genes cluster in Egyptian cad patients and in healthy control subjects

Coronary artery disease [CAD] is a major cause of mortality in Egypt. CAD is a multifactorial disorder with both environmental and genetic factors involved in its aetiology and pathogenesis. Dyslipidaemias are among the major risk factors for CAD. Lipoprotein lipase [LPL] gene an apolipoprotein AI-CIII-AIV genes cluster are among the main candidate genes involved in lipid metabolism. The aim of the present study is to determine and detect the frequencies of common DNA polymorphisms of LPL gene and apo AI-CIII-AIV gene cluster in Egyptian CAD patients and healthy control subjects. The study sample included 121 Egyptian male CAD patients and 101 male controls. Mutations and polymorphisms that were previously found to be common in European or Asian populations were chosen to be examined in the current study. These included D9N, N291S, S447X, and Hindlll restriction fragment length polymorphism [RFLP] for LPL gene. Those for the apolipoprotein AI-CIII-AIV genes cluster were: Xmnl RFLP, Al promoter 75G>A, Mspl RFLP, and Pstl RFLP for apo al, Sstl RFLP for apo CIII, and T347S For apo AVI. The N291S and the homozygous pattern of the rare allele of S447X reported in other ethnic groups were not detected in the studied groups. The frequencies of other mutations and polymorphism were reported. Some of these frequencies are comparable with other reported frequencies in the literatures of other ethnic groups. However, there were no statistical significant difference between the CAD patients and the normal males. Failure of the present study to detect significant association between the different polymorphic sites and CAD reflects the complexity of the disease where other environmental and genetic factors may be involved

Activities of phenylalanine and tyrosine aminotransferases in amycolatopsis methanolica mutants

Amycolatopsis methanolica mutant GH 141-19 is an auxotrophic strain able to grow on glucose mineral media supplemented with L- phenylalanine plus L-tyrosine mixtures at a doubling time of 2.5 hours, while mutant GH 71 can grow in media supplemented with only L- phenylalanine at doubling time of 3 hours. Mono Q FPLC anion exchange chromatography of strain GH 71 revealed the presence of 2-phenylalanine aminotransferase activity peaks, these overlapped with the 2-tyrosine aminotransferase peaks present. In mutant GH 141-19 only single phenylalanine and overlapping tyrosine aminotransferase peaks were observed indicating that mutant GH 141-19 is deficient in the second aromatic amino acid aminotransferase peak