ABSTRACT
Background: Nitric oxide improves gas exchange following primary lung allograft dysfunction. Nitroprusside, a potent nitric oxide donor, has reduced reperfusion injury and improved oxygenation in experimental lung transplantation. Methods: We sought to study the effect on lung allograft outcomes of fortifying the preservation solution with nitroprusside. We conducted a single-center clinical study of 46 consecutive lung recipients between 1998 and 2000: 24 patients received donor organs preserved in modified Euro-Collins solution with prostaglandin E1 (PGE1) (control group), and 22 patients received organs preserved in modified Euro-Collins with PGE1 and nitroprusside (NP group). The primary endpoint was overall survival. Results: Baseline characteristics were similar between the groups except for a significantly longer graft ischemic time in the NP group vs the control group (253.3 ± 52 vs 225.3 ± 41 minutes, respectively, P=0.04). No significant differences were found in partial pressure arterial oxygen to fraction inspired oxygen ratio at ≤48 hours, primary graft dysfunction, or bronchiolitis obliterans-free days. Overall survival at 1, 3, and 5 years was 89%, 73%, and 63% in the control group and 76%, 38%, and 23% in the NP group. Log-rank survival analysis showed that the NP group had a significantly increased risk of mortality (P=0.034) compared to the control group. Conclusion: The addition of nitroprusside to the lung transplant perfusate in this clinical trial did not improve survival; however, a large randomized trial would likely reduce confounding ischemia times and increase the power of the study.
ABSTRACT
BACKGROUND: Bilateral acute uveitis can cause significant morbidity, and a complete workup is often warranted. This report illustrates a case of sarcoid uveitis definitively diagnosed by skin biopsy in a patient with red tattoo ink. CASE REPORT: A 40-year-old African American male presented with bilateral photophobia and intraocular pressures of 26 mmHg in both eyes, 1+ grade cell and flare in both eyes, and granulomatous (mutton fat) keratic precipitates in both eyes. Serum angiotensin-converting enzyme level was elevated at 146 U/mL (normal value <40 U/mL), and computed tomography imaging revealed mediastinal and hilar lymphadenopathy. Multifocal induration and elevation in the areas of red pigment of a tattoo were also present and on punch biopsy revealed noncaseating granulomas, confirming the diagnosis of sarcoid uveitis. CONCLUSION: Our case suggests that a complete physical examination and inquiry about the presence of any tattoos should be conducted as part of the workup of uveitis.
