Risk and preventative measures for postoperative acute renal failure [ARF]: a prospective controlled study

The extracorporeal circulation used during open heart surgery is associated with a significant decline in renal blood flow that can result in tubular injury. Although this complication is uncommon, it carries a poor prognosis. Although many experimental trials have highlighted the significant value of some pharmaceuticals in prevention of post ischaemic renal tubular injuries, few clinical trials are found. We aimed in this study to evaluate the efficacy of 4 drugs in the prevention of acute tubular necrosis [ATN] following open heart surgery. Patients received either diltiazem, captopreil, allopurinol or the antioxidant formula antox [n = 20 per agent], 20 control cases received placebo. Groups were matched in age, gender, type of cardiac disease, preoperative cardiac and kidney function and type of surgery. AII patients received the appointed agent for 1- week pre- and post- operative. Each group included 6 cases that underwent coronary bypass, 8 value replacements or repair and 6 total correction of congenital defects. In order to ascertain risk factors each case underwent a comprehensive history taking, clinical examination, 12 lead ECG, chest X-ray, echocardiography, arterial blood gas analysis, complete blood count, fasting and 2 hours post prandial [PP] blood sugar, coagulation profile, liver function tests, blood urea nitrogen [BUN], serum creatinine [Sc], creatinine clearance [CC], urine analysis and urine albumin/creatinine ratio [Alb/cr]. The total operation, total pump and ischaemic times were recorded for each case intra-operative as well as the use of any inotropes, vasopressors or diuretics and the occurrence of haematuria or haemoglobinuria. AII kidney function tests were repeated on the 1st, 4th and 7th post operative days. AII groups showed a postoperative significant increase in BUN, Sc, and Alb/cr and a significant decrease in CC; these changes were least with diltiazem. A highly significant correlation between preoperative Alb/cr and postoperative Sc was found for the population as whole [p<0.001]. ATN occurred only in coronary artery bypass graft, aortic valve, multiple valve and total correction of Fallot's IV patients. The incidence of ATN, duration of oliguria and need for dialysis were least with diltiazem, [P=0.05]. No single mortality was reported in either the diltiazem or allopurinol groups. In conclusion, prophylactic administration of diltiazem, to high risk patients help reduce mortality, incidence and duration of ATN, the need for dialysis and costs of hospital stay, Allopurinol is a good alternative in patients with poor left ventricular function

Study of serum level for some parameters in normal and pre eclamptic pregnancy

Fifty pregnant females were the subjects of the study: 30 women with normal pregnancy 10 in each trimester, 20 women with pre-eclampsia: 10 mild and 10 severe cases. Beside routine investigation and clinical examination all subjects were subjected for assessment of increased serum AAT, ATIII, GGT and uric acid levels as well as urinary protein per 24 hours. The highest level of AA T, A TIII, GGT and uric acid as well as urinary albumin was found in sever pre-eclamptic patients. A significant difference was found in ATIII level between the 1[st] and 2[nd] trimester, 2[nd] and 3[rd] trimesters, there was an increase in the level of ATIII by increase of gestation. ATIII, GGT and AAT was increased significantly in severe pre-eclampsia in comparison with 3[rd] trimester in normal pregnancy. The level of uric acid and urinary protein were proportional with the severity of pre-eclampsia

Pseudocholinesterase with pregnancy

The study comprised 120 pregnant female subjects, they were classified into five groups according to duration of pregnancy and a control group. Serum albumin and serum cholinesterase [CHE] were determined. Subjects of groups I, II, III and IV were sub-divided according to age, below 20 years, from 20 - 30 years, and over 30 years. Students t test was done to compare CHE levels among these age groups. Serum albumin levels were found to decrease during the course of pregnancy regularly and in pre-eclampsia there were more decrease with significant difference. Serum cholinesterase levels were found to decrease from the first trimester regularly till the third trimester. Pre-eclamptic levels were more decreased than all other groups. Also, cholinesterase over 30 years of age was higher than that of group from 20 - 30 years and that of group below 20 years, and that of group from 20 to 30 years was higher than that of group below 20 years

value of determination of paraproteins in malignant lymphoma

Forty three patients in stage III and IV malignant lymphoma [17 H.D. and 26 N.H.L] were investigated in this study for presence of paraproteins in their sera and subsequently of clinical manifestations of paraproteinaemia. Twenty nine of them were males and 14 were females. Their ages ranged between 15 and 65 years. Twenty one [48.8%] presented with one or more of the clinical manifestations related to paraproteins in their sera: cold urticaria was detected in 12 occasions, purpura in 8, chilblains in 6. tingling and numbness in 4, Chronic leg ulcers in 4, acrocyanosis in 2, vasculitis and Raynaud's phenomenon each in one occasion. Qualitative and quantitative determination of the different types of paraproteins was performed. Cryoglobulin was found in the sera of 30 patients [69.7%]. paraglobulin was detected in 14 patients [32.5%]. Simple type of cryoglobulin [mostly of IgG] was present in 19 patients and mixed type [IgG and IgM] in 11 patients and both types were more frequent in females. Cold urticaria, purpura, chilbains and chronic leg ulcers were associated with simple cryoglobulins in most occasions, while patients complaining of tingling sensation and numbness, acrocyanosis and vasculitis had mostly mixed cryoglobulins. Pyroglobulin have no clinical significance, yet it was associated with high level of cryoglobulin. Hypoalbuminaemia was detected in 56% of cases. The main disturbance in globulin was elevation in total globulin, alpha-1 and gamma fractions. Hypergammaglobulinaemia was marked in H.D. [88.1%] than N.H.L. patients [34.6%]. Chemotherapy treatment showed decrease in cryoglobulin level in some cases, while there was an obvious increase in the albumin, normalisation of globulin and improvement in the general condition of patients

Effect of combination chemotherapy on the clinical response of malignant lymphoma

This study included 56 patients with advanced stages of malignant lymphoma: 36 NHL, and 20 HD. The most common pathological subtypes were diffuse poorly differentiated lymphocytic in NHL and mixed cellularity in HD, both of which are known to be of unfavorable prognosis. Conventional combination chemotherapy produced nearly the same CR rate in both HD [57%] and NHL [50%], whereas the <> chemotherapy was more effective in HD [CR rate with MOPP-6 = 71.4%] and less effective in NHL [CR rate with CHOP= 40%, and CHOP-L 33.3%]. Although <> combinations were known to be better for clearing the disease, additional toxicities of these combinations apparently resulted in disturbing the patient-tumor relationship. This might explain the poorer response of NHL patients who received the aggressive combinations