Assessment of endothelial dysfunction in idiopathic pulmonary fibrosis

Background: Idiopathic pulmonary fibrosis [IPF] is defined as a specific form of chronic fibrosing interstitial pneumonia limited to the lung, with the histopathology of UIP on surgical lung biopsy. Recent epidemiological evidence indicates that patients with IPF have an increased risk of cardiovascular disease. The vascular endothelium acts to maintain vascular homeostasis through multiple mechanisms, and alteration in its function precedes the development, progression and clinical expression of atherosclerosis

Aim of the work: To assess the prevalence of endothelial dysfunction in patients with idiopathic pulmonary fibrosis and its correlation with pulmonary hypertension

Subjects and methods: The study included two groups. The patient group included 30 IPF patients subdivided into 2 subgroups: Subgroup I [15 IPF cases] with pulmonary hypertension; Subgroup II [15 IPF cases] without pulmonary hypertension. The control group included 10 normal healthy individuals. Patients were subjected to written informed consent, detailed history taking, thorough clinical examination, collagen profile, arterial blood gases [PaO[2], SaO[2]], Pulmonary function tests [spirometry], 6 min walk test, HRCT chest scan, echocardiography, and brachial artery duplex to assess endothelial dysfunction

Results: Subgroup [I] and Subgroup [II] showed a statistically highly significant difference in brachial artery flow mediated dilatation [BADFMD] and endothelium - reactive dilatation [ERD] which indicate endothelial dysfunction compared to the control group

Conclusion: This work concluded that BADFMD and ERD more affected in IPF patients regardless of presence or absence of PH than normal population. So, endothelial dysfunction is a possible link between IPF and cardiovascular disease

Relaesable scleral flap suture in trabeculectomy: preliminary results of a new technique

To demonstrate a technique for a releasable scleral flap suture placed to reduce post-trabeculectomy complications. Under a fornix based conjunctival flap, a rectangular partial thickness scieral flap is fashioned. A scierostomy is made followed by a peripheral iridectomy and the scieral flap is secured. A trapezoid suture is then placed from the sciera across the scleral flap to exit on the corneal surface and then tightend under the conjunctival flap which is then secured. During the follow-up, this suture can be safely removed on the slit lamp if the lOP is high. If the lOP is ideal, the suture can be left in place. Immediate postoperative complications as flat anterior chamber and choroidal detachment didn't occur. The suture was removed only if the filtration was not sufficient and the lOP was high. The releasable scieral flap suture was effective in preventing post trabeculectomy complications. In addition, it can be easily removed on the slit lamp without the need to fish under the conjunctiva, or to search for equipments as lasers

Clinical prognostic factors in patients with advanced stage of prostate cancer

Objectives: To determine the prognostic factors that could predict patient outcome in patients with advanced stage prostate cancer

Patients and Methods: In this study we retrospectively evaluated the medical record data of 222 patients with advanced stage prostate cancer treated by hormonal therapy [either castration or total androgen blockade [TAB]]. All pre- and post- treatment data records were evaluated with respect to patient age, prostate and tumor size, tumor grade, stage, PSA, alkaline and acid phosphatase and the number of bone lesions. The response to the hormonal treatment was evaluated either early [12 months after treatment] or late [over all follow-up visits until the last visit or death]. Descriptive statistics, student T test, multivariate and Kaplan Meier's curve were used for data analysis

Results: Within 12 months of treatment 70% of the cases showed an improvement with a significant decrease of their pre-treatment values after hormonal therapy. Patient age, tumor stage, the number of bone lesions, serum alkaline and acid phosphatase levels in the pre-treatment data were significantly independent predictors of the overall survival outcome [p= 0.0015, 0.002, 0.001, 0.0002 and 0.028, respectively], while the pre-treatment PSA serum level, tumor grade and the type of hormonal treatment used [either castration or TAB] were no predictors of patient outcome [p= 0.18, 0.82 and 0.47, respectively]. Importantly, the PSA serum level and the number of bone lesions in the first 12 months of patient follow-up were significant predictors of the overall disease survival status [p=0.001 and 0.028, respectively]. The mean follow-up period of alive cases was 39.42 months ranging from 6 - 171 months. Of the 222 cases 110 [51.6%] had overall disease progression during a mean of 59.4 months, while mortality was reported in 118 cases [53.2%] in the course of a mean of 59.9 months

Conclusion: The pre-treatment patient age, tumor stage, serum alkaline and acid phosphatase, as well as the post-treatment PSA level and the number of bone lesions were significant independent predictors of the overall patient outcome in patients with advanced stage prostate cancer. However, a survival analysis in relation to the treatment type did not reveal a statistically significant difference between the outcomes of castration and TAB