Establishment of the Kuwait medical school [1965 - 1976]

This is a study on the establishment of the Kuwait Medical School. It examines the planning needed to establish a medical school, focusing mostly on the work done by the 1973 planning committee of the Kuwait Medical Faculty. It also gives an insight on the process of medical education, since the establishment of the Kuwait Medical School was during a period when the process of medical education was revised. The study concludes that the establishment of the Kuwait Medical School was a great achievement and a fine example of early global collaboration in medical education

Repair of complex left main bronchial rupture

Complex left main bronchial rupture at or near the carina is extremely rare. This injury is frequently missed. The treatment requires surgical and anesthetic teams highly experienced with such complex injuries. We report the case of a 49-year-old man involved in a motor vehicle accident with a complex left main bronchus injury. He was successfully managed with primary repair

Blunt and penetrating thoracic trauma: management strategy and short-term outcome

To review our experience with blunt and penetrating chest injuries that required surgical interventions. Retrospective case series. Six general hospitals in Kuwait. One hundred fifty nine patients who underwent emergency surgery for thoracic trauma. Urgent thoracic surgical procedures [thoracotomy or sternotomy]. Pattern of injuries, indications for surgery, surgical approaches, short-term morbidity and mortality. One hundred fifty-nine patients [68 with blunt and 91 with penetrating injuries] underwent thoracotomy or sternotomy between January 1995 and December 2006. The mean age was 27 years [range: 2-70 years]. The causes of penetrating injuries were stab wounds [n = 65], gunshot wounds [n = 19] and iatrogenic [n = 7]. The causes of blunt thoracic injuries were motor vehicle accidents [n = 63] and fall from height [n = 5]. The indications for thoracotomy were hemorrhage [n = 115], airway disruption [n = 14], pericardial tamponade [n = 5], clotted hemothorax [n = 8] and diaphragmatic rupture [n = 17]. Major lung resections were performed in four patients [2.5%]. The morbidity was 10 / 159 [6%] and the mortality was 7 / 159 [4.4%]. The majority of deaths were due to adult respiratory distress syndrome [ARDS]. Prompt thoracotomy can be performed with minimal morbidity and mortality in cases of blunt and penetrating thoracic injuries. The complex pattern of such injuries requires a detailed assessment and management by a thoracic surgeon

results of thoracoscopic surgery for secondary spontaneous pneumothorax

To review our experience of video-assisted thoracoscopic surgery for the treatment of secondary spontaneous pneumothorax caused by bullous emphysema. Prospective study. Chest Diseases Hospital, Kuwait. Forty-six consecutive patients who under went thoracoscopy for secondary spontaneous pneumothorax by a single surgeon during a fiveyearperiod. Video-assisted thoracoscopic bullectomy and pleural symphysis procedure. Resolution of pneumothorax. Mean age of patients was 49.3 years [range: 38 - 70 years], and 44 were men [96%]. All patients had bullous emphysema; their mean preoperative forced expiratory volume in one second [FEV1] was 54.4% of predicted and mean forced vital capacity [FVC], 66.9% of predicted. Persistent pneumothorax was the most frequent indication for surgery, occurring in 35 patients [76%]. The most common method of management was stapling of an identifiedbulla, which was done in all patients. Pleurodesis was achieved by gauze abrasion [n = 23] and apical pleurectomy [n = 23]. Postoperative prolonged air leak occurred in seven patients [15%], six in the pleural abrasion group and one in the apical pleurectomy group [p = 0.04]. The mean [ +/- SD] postoperative hospital stay was 5.7 +/- 4.5 days. Mean follow-up is 42 months [range = 36 - 54 months] for all patients. Pneumothorax recurred in three patients [6.5%] in whom pleural abrasion was done. The recurrences occurred in the first six months of follow-up. Video-assisted thoracoscopic surgery is a safe procedure in the treatment of select secondary spontaneous pneumothorax caused by bullous emphysema. Apical pleurectomy is a more effective way of producing pleural symphysis

Symptomatic pleural effusion after coronary artery bypass grafting requiring intervention

To identify risk factors for pleural effusion after coronary artery bypass grafting [CABG] and to describe the pleural fluid findings Case-control study Chest Diseases Hospital, Ministry of Health, Kuwait Four-hundred and twelve patients who underwent CABG at our institution from June 2006 to June 2007. Thoracocentesis or tube thoracostomy Age, sex, type of surgery, perioperative data, time of occurrence of the effusion after CABG, characteristics of fluid, and left ventricular ejection fraction Fifty-one patients [12.4%] suffered significant pleural effusion. Univariate analysis showed a higher risk profile in the pleural effusion group who had longer cardiopulmonary bypass time, longer aortic cross clamp time, diabetes mellitus, female gender and higher 24-hour blood loss [p < 0.005]. Furthermore, the pleural effusion group had longer intubation time [33.8 +/- 6.08 hours versus control 8.4 +/- 1.7 hours, p = 0.003]. Out of these 51 effusions, 34 were early and 17 late. Early effusions were bloody, contained higher lactate dehydrogenase and Creactive protein. Late effusions tended to be more difficult to manage. Large pleural effusion may develop in a proportion of patients after CABG. The occurrence seems mainly related to perioperative surgical variables. Most early effusions can be managed with therapeutic thoracocentesis. Resolution of late effusions may require pleurodesis

Pulmonary complications following major lung resection for benign and malignant lung diseases

To assess the incidence and to identify the possible associated risk factors for postoperative pulmonary complications after major lung resection. One hundred and sixty-eight consecutive patients undergoing major lung resection for benign and malignant lung disease over a 3-year period were included in the study. Preoperative assessment clinical parameters, intraoperative and postoperative events were recorded. Pulmonary complications were noted according to a precise definition. The risk of complications associated with age, comorbidity, forced vital capacity [FVC], blood transfusion and extended operation was evaluated using logistic regression analysis. The mean age of the patients was 47.1 years [range 16-80 years], 137 [77%] patients underwent lobectomy, 23 [14%] pneumonectomy, and 15 [9%] bilobectomy. Forty-six [27%] patients developed postoperative pulmonary complications and 2 [1.1%] died within 30 days following the operation. Age =/>65 years [OR 3.7, 95% CI: 1.5-8.6, p = 0.002], the presence of comorbid cardiopulmonary disease [OR 0.2, 95% CI: 0.1-0.5, p = 0.001], FVC <50% [OR 0.2, 95% CI: 0.1-0.8, p = 0.02], blood transfusion [OR 0.2, 95% CI: 0.1-0.4, p = 0.0001], and extended operation [OR 0.2, 95% CI: 0.07-0.6, p = 0.005] were the identified factors associated with the development of postoperative pulmonary complications, which necessitated an increased length of hospital stay. Postoperative pulmonary complications are more likely to develop in patients with age =/>65 years with comorbid cardiopulmonary disease, FVC <50%, blood transfusion, and extended operation

Risk factors of spontaneous pneumothorax in Kuwait

To determine the risk factors of spontaneous pneumothorax [SP] in Kuwait. From January 2002 through December 2003, 254 consecutive cases with a diagnosis of SP were reviewed. Analyses of pneumothorax rates by age, sex, smoking, body mass index [BMI] and climatic conditions were evaluated. Of the 254 patients, 242 [95%] were male and 12 [5%] were female; a larger proportion of 180 [88%] were Kuwaitis and 74 [12%] were expatriates. Two hundred and eight [82%] episodes were regarded as primary SP and 46 [18%] as secondary SP. The mean age was 24.5 +/- 5.8 years for primary SP and 45.7 +/- 14.5 years for secondary SP. One hundred and ninety-six [77%] individuals were current smokers. BMI in primary and secondary SP was 19.3 and 22.4, respectively [p < 0.001]. There was no relationship between SP and climatic conditions [a rise or fall in temperature, humidity or atmospheric pressure]. However, a slight increase in SP occurred in July, probably the hottest month in Kuwait. The data indicate that the most important risk factors of SP in Kuwait are smoking, low BMI and the male gender

Pulmonary arteriovenous malformation presenting with severe hypoxemia

To report a case of right pulmonary arteriovenous malformation [PAVM] affecting the right upper lobe, following the incidence of empyema thoracis in the contralateral lung. A 19-year-old, previously healthy male presented with acute respiratory distress, left pleuritic chest pain, fever and hypoxemia. Clinical findings, laboratory and radiological examinations including pulmonary angiogram were consistent with the diagnosis of left pneumonia complicated with parapneumonic pleura! effusion and right upper lobe PAVM. The patient was intubated and ventilated because of persistent hypoxemia. He was successfully treated by percutaneous transcatheter embolization. This case shows that percutaneous transcatheter embolization is a safe and effective first option for the treatment of PAVM

Surgical treatment and follow-up of pulmonary hydatid cyst

To report our experience of surgical procedures in the management of hydatid cysts of the lung and to assess the effect of postoperative chemotherapy. Subjects and In a longitudinal cohort study, 64 consecutive patients who presented with hydatid cysts of the lung from 1994 to 1998 were included. The main measures were: characteristics on presentation, operative techniques, postoperative morbidity, and the outcome of treatment. The mean age was 28 years [range 4-65 years]. The most common symptoms were cough, chest pain, fever, and hemoptysis. Chest radiographs and computed tomograms were the main method of diagnosis. Pulmonary cystotomy and capitonnage were performed in 46 patients. Pulmonary resection was needed in 8 of 64 patients. Simultaneous combined resection of hydatid cysts through thoracotomy with transdiaphragmatic removal of liver cysts was performed in one stage in 13 patients. Chest radiographs and CT scans showed a smoothly outlined spherical opacity in 45 patients. Other radiographic findings included ill-defined shadow [in 8 patients], pleural effusion [7 patients], air fluid level [3 patients], and hydropneumothorax in a single patient. There were 8 [12.5%] cases of immediate postoperative complications. These occurred mostly in patients who had cysts larger than 10 cm [p = 0.003]. Thirty-four patients were treated by a 3-month course of albendazole chemotherapy. Four patients [6%] had recurrences of the disease during the follow-up period. These recurrences occurred in patients with large cysts >10 cm [p = 0.001]. Conservative surgical methods are the preferred surgical techniques. Postoperative chemotherapy with albendazole for 3 months is recommended

Video-assisted thoracoscopy versus thoracotomy for primary spontaneous pneumothorax: a Randomized controlled trial

Video-assisted thoracic surgery has been evaluated to replace thoracotomy for recurrent or persistent spontaneous pneumothorax. This study aimed to compare the clinical results and long-term follow-up of both procedures in treating primary spontaneous pneumothorax. In a prospective comparison, all 60 patients aged 14-57 years with recurrent or persistent primary spontaneous pneumothorax seen at the Chest Diseases Hospital in Kuwait were randomly allocated to treatment by video-assisted surgery or thoracotomy. Subsequently various factors were analysed and compared in both groups, and the follow-up of both procedures was 3 years. The mean and standard deviation [SD] operating time was longer in the thoracotomy group [95.3 +/- 16.4 min] than in those undergoing video-assisted thoracoscopy [77.5 +/- 13.7 min; p < 0.0001]. The mean +/- SD amount of analgesics [Demerol] used in the first 12 h postoperatively was 67.16 +/- 27.1 mg in the video-assisted thoracoscopy group and 148.3 +/- 24.5 mg in the thoracotomy group [p < 0.0001]. The mean 24-hour chest tube drainage was less in the video-assisted thoracoscopy group than in the thoracotomy group [82 vs. 347.1 ml; p < 0.0001]. The mean duration of intercostal chest tube was 4.1 days in the thoracoscopy group and 5 days in the thoracotomy group [p = 0.18]. The length of hospital stay was shorter in the thoracoscopy group than in the thoracotomy group [6.5 vs. 10.7 days; p < 0.0001]. After a follow-up of 3 years, the number of recurrences was 3 in the thoracoscopy group and none in the thoracotomy group. Video-assisted thoracoscopy has many clinical advantages over thoracotomy for recurrent or persistent primary spontaneous pneumothorax; but it results in a higher recurrence rate. The future role of video-assisted thoracoscopic surgery in this disease remains to be determined by a larger study