Mustafa Al-Mousawi

A 46-year-old woman presented with a mass in the left breast and left axillary lymphadenopathy. Five years earlier she had received a renal transplant from an unrelated donor because of end-stage renal failure secondary to adult polycystic kidney disease. She was on immunosuppression therapy in the form of cyclosporine, azathioprine and prednisolone. Fine needle aspiration cytology of the breast mass showed a metaplastic (sarcomatoid) carcinoma, whereas the axillary lymph node aspirate suggested carcinosarcoma. Immunocytochemical studies revealed dense positivity for vimentin in the sarcomatous component and positivity for epithelial membrane antigen in the epithelial component. Rare cells were positive for cytokeratin. The cytodiagnosis was confirmed by excision biopsy of axillary lymph nodes. The patient died on the fourth postoperative day following left mastectomy and axillary clearance. The histopathology report of the breast tumor showed sarcomatoid carcinoma.

A previously healthy 30-year-old man underwent vagotomy and pyloroplasty for a chronic duodenal ulcer that had not responded to H2 blockers. On the third day his abdomen was slightly distended; this gradually increased and on the eighth day ascites was confirmed by ultrasonography. Paracentesis yielded 4 litres of milky, odorless fluid. He was treated by fat free diet as he refused parenteral nutrition and on day 15 a further two litres of fluid were withdrawn, this time straw coloured. By day 31 his abdomen had returned to normal and his serum albumin concentration (which had dropped to 26 g/l) had risen to 43 g/l. He has now remained well for two years. Chylous ascites is a rare complication of truncal vagotomy, but should be suspected if postoperative ascites develops. Early recognition and treatment are important.

The effects of the beta-2 receptor agonist, terbutaline, on hemodynamics and gas-exchange were evaluated in sheep exposed to endotoxin shock. Terbutaline was not given until signs of shock and lung injury had developed. Twenty sheep were anesthetized and ventilated without PEEP. After 90 min of stabilization (t = 0) all animals received E. coli endotoxin 10 micrograms/kg by i.v. infusion during 15 min. Thirty minutes later (t = 30) 10 animals (group TER) received i.v. infusion of terbutaline, 20 micrograms/kg/h, during 4 hours, while the other 10 served as controls (group S). The endotoxin infusion resulted in marked increase in pulmonary artery pressure (PAP) and a significant decrease in mean arterial pressure (MAP), respiratory compliance, arterial oxygen tension (PaO2) and oxygen delivery index (DO2) in both groups (t = 15 and t = 30). After 4 hours the PAP had decreased significantly in the terbutaline treated animals, but remained high in the controls (p less than 0.01). Also,...

The dynamic behavior of indium-111 oxine-labeled leukocytes was simultaneously recorded in multiple organs during endotoxin shock in sheep. Also, the effects of the beta-2 receptor agonist terbutaline were studied. An experimental protocol was designed to mimic a clinical condition in an intensive care setting as far as possible. The animals were ventilated with 50% oxygen to avoid hypoxemia and were given large amounts of intravenous fluids to reduce adverse effects of hypovolemia. A moderate dose of E. coli endotoxin (10 micrograms/kg bwt) was given by intravenous infusion to 14 adult sheep, seven of them receiving continuous intravenous infusion of terbutaline (20 micrograms/kg/hr) during 4 hr, starting 30 min after endotoxin, when signs of lung injury had developed. The other seven acted as controls. A marked pulmonary and hepatic leukocyte sequestration together with a sharp drop in leukocyte counts in peripheral blood occurred within minutes after start of the endotoxin infusi...

Although trials to exchange failing human organs with new ones started in the beginning of the past century, the first breakthrough came in December 1954, when the first successful kidney transplant between identical twins was performed in Boston, USA, by Dr Joseph Murray. Since then transplantation has come a long way to be recognised as the treatment of choice for thousands of new patients afflicted yearly with organ failure around the world.

Objectives: Studies that have evaluated the effect of obesity on kidney transplantation (KTx) outcome have yielded varying results. This study explores the effect of body mass index (BMI) on the outcome of kidney transplantation. Patients and methods: The medical records of 417 consecutive adult kidney recipients, who were transplanted between January 2004 and December 2010, were reviewed for the effect of BMI on the prevalence pre-KTx risk factors, mean duration of KTx surgery, mean hospital stay, the prevalence of post-KTx acute rejection, surgical complications, systemic infection, and recipient and graft survival. Results: in the study group, 44 recipients were under weight (BMI<20), 125 recipients were of normal weight (BMI 20-25), 123 recipients were pre-obese (BMI 25-30), and 125 recipients were obese (BMI>30). Recipient mean age and donor source were comparable in all groups. Increasing BMI was associated with higher prevalence of pre-KTx risk factors, surgical complic...

The incidence of mycobacterial infection (TB) is significantly higher in patients with end-stage renal disease and renal transplant recipients than in normal individuals. Tracheoesophageal fistulas (TEF) resulting from Mycobacterium tuberculosis infection are uncommon. We describe a 44-year old renal transplant recipient with such a lesion that had typical clinical presentation and radiological appearance of TEF and was successfully treated conservatively.

We attempt in this retrospective study to evaluate the incidence, clinical presentations, and outcome of lymphocele in renal transplant recipients. 528 patients (313 males and 215 females) have received renal allografts from 384 living and 144 cadaveric donors. Diagnosis of lymphocele was made basically by ultrasound examination, and symptomatic collections were drained either percutaneously or into the peritoneal cavity. There were 50 (9.5%) instances of lymphocele encountered between 2 weeks and 6 months after transplantation. The lymphocele presented clinically predominantly as a single pelvi-abdominal swelling in 28 (56%) cases or as a swelling associated with manifestations of utereric and/or venous compression in 18 (36%) cases, and it was more common after cadaveric transplantation. All the cases of lymphocele were successfully treated with no graft loss. Lymphocele is an uncommon complication after renal transplantation, and is formed during the early post transplantation pe...

The critical pathway of deceased donation provides a systematic approach to the organ donation process, considering both donation after cardiac death than donation after brain death. The pathway provides a tool for assessing the potential of deceased donation and for the prospective identification and referral of possible deceased donors.

The Declaration of Istanbul on Organ Trafficking and Transplant Tourism was adopted at an international meeting held in 2008. The Declaration has been published globally and consists of a preamble, a set of principles and a series of proposals to improve the ethics and expand the benefits of the international organ transplantation endeavor. To promote and monitor the implementation of the Declaration, a Declaration of Istanbul Custodian Group (DICG) has been created. The DICG has provided support for official efforts to ban the sale of organs, restrict transplant tourism and prosecute those who persist in violating the law. Substantial progress has been made thus far in countries that have been the source of transplant tourists and in countries that have been the source of donor organs for trafficking. In China, however, the use of organs from executed prisoners for transplantation purposes continues despite widespread condemnation of this practice.

Severe resistant hypertension in end-stage renal disease patients has traditionally been an indication for bilateral nephrectomy (BN) before kidney transplantation. Nevertheless the influence of BN on successful control of hypertension has not been well documented. We sought to clarify the effect of BN on blood pressure patterns and control in renal transplant patients. We retrospectively reviewed 28 patients who underwent BN between November 2003 and May 2009 before or after kidney transplantation. Nineteen of them were under treatment with 4 or 5 antihypertensives according to the international guide lines; they had BN for resistant hypertension. They were considered as group 1 (G1). Nine patients operated for indications other than resistant hypertension; they constitute group 2 (G2) and considered as a control group. All patients received triple immunosuppression according to our local protocol. BN was done either before, simultaneously or after transplantation. Antihypertensives were recorded before and after BN. We evaluated our patients at 3 months, 1 year, and 3 years. Acute rejection episodes and calcinurein nephrotoxicity were reported. In G1, the mean age was 30.2 years (range, 10-62). In G2, the mean age was 33.6 years (range, 11-61). Before BN, G1 patients used antihypertensive drugs (3.6 +/- 1.05 drugs per day; mean +/- SD), which was significantly higher than in G2 patients (2.0 +/- 1.65 drugs per day; P = .02). Three months after BN, G1 patients used 2.6 + 0.9 drugs per day, with gradual reduction in number of antihypertensives to 1.4 +/- 1.3 drugs per day at 3 years (P = .008). In G2, there was reduction in antihypertensive drug number per day, which was insignificant during the follow-up period. No difference was noted between G1 and G2 drug administered after BN. We conclude that BN is effective to help blood pressure control, in resistant hypertension in renal transplant patients, but it starts to show up 3 months after surgery, and continues to work for a year and more.

To retrospectively review the long-term outcome of renal transplant in diabetics at Mubarak Al-Kabeer Hospital and Hamad Al-Essa Organ Transplant Center, Kuwait from 1983 to 1998. There were 631 renal transplant patients, comprising 79 (12.5%) patients with pretransplant diabetes mellitus (pre-TDM), 117 (18.5%) patients with post-transplant diabetes mellitus and 435 (69%) nondiabetics (ND). Subjects with post-transplant diabetes mellitus were excluded from the comparative analysis. Distribution of sex, source of donors and mode of immunosuppression were similar in pre-TDM and ND groups. Fifty-three (67%) recipients in pre-TDM and 90 (20.5%) in the ND group (p < 0.01) were above 45 years of age. However, 26 (33.3%) pre-TDM and 345 (79.5%) ND were below age 45. Among those who died, coronary artery disease led to death in 36% of pre-TDM and 27% in ND. Hyperlipidemia requiring drug therapy was observed in 37% pre-TDM and 6% ND. The incidence of severe infections was nearly twice in pre-TDM over ND recipients (1.9 vs. 1.0 per patient, p < 0.001). Acute rejection episodes were more frequently seen in pre-TDM (43%) than ND (33%), however the difference was not statistically significant. The patient survivals at 1, 5, 10, 14 years were significantly lower in pre-TDM (84, 65, 58 and 58%, respectively) than in ND (97, 93, 86 and 82%, respectively). The major contributory factors were severe infections and coronary artery disease. The cumulative graft survival showed a similar pattern (52% in pre-TDM, 73% in ND at 10 years). However, when death is excluded, the 10-year pure graft survival probability was similar for the pre-TDM and ND groups (76% vs. 80%). Our study indicates poor patient survival in pre-TDM due to coronary artery disease and infections, whereas the pure long-term graft survival was equally good in pre-TDM and ND transplant recipients.

Allergic rhinitis (AR) is the most common allergic problem in Kuwait. Most of the patients who have either AR or asthma are referred to the Al-Rashed Allergy Center. To determine if there is a seasonal variation in AR in Kuwait and to correlate it with the daily pollen count. Information about the new patients referred to the center over a 5-year study period (1996-2000) was extracted from the center's records. The daily pollen count in Kuwait city was obtained from the Air Biology Laboratory. There was a significant seasonal variation with a bimodal increase in the number of patients with AR referred to the center. The main peak in the number of patients occurred in September-October, and there was a smaller peak in April-May. The mean number +/- SD of new patients per month over the 5-year period varied from 87 +/- 32 for December to 367 +/- 104 for September. Similarly, the average daily pollen count varied from 3.7 +/- 1.0 pollens per mm3 in January to 124 +/- 92 in October. There was high correlation between the number of new AR patients and the average total pollen count (Pearson correlation, r=0.77, p<0.001), as well as with Chenopodiaceae and Amaranthaceae (weed) pollens (r=0.75, p<0.001), while there was no correlation between the number of new patients and either tree or grass pollens. Seasonal AR occurs during two periods in Kuwait, i.e. September-October and April-May, with September-October being the main season. The rise in AR during late summer in Kuwait is mainly associated with the pollination of Chenopodiaceae species.

Kuwait is a desert country where the prevailing high temperatures, low humidity, and scant vegetation suggest a low prevalence of allergy. We evaluated the prevalence of atopic sensitization (presence of allergen-specific IgE) among young adult blood donors by screening a total of 505 subjects (male: female ratio 1.6) with mean age of 28.4 years (range 18-50 years). The Pharmacia CAP-Phadiatop test, which detects serum IgE specific to most common airborne allergens, was used. Some of the specific sensitizing allergens were also identified by the related CAP-RAST method. Sensitization was detected in 223 of the 505 subjects (44.2%) screened. Kuwaiti nationals had a significantly higher prevalence rate (50.2%) than non-Kuwaitis (34.2%) (chi 2 = 8.6, P < 0.003). The highest prevalence rate was found among male Kuwaitis (53.8%). The prevalence of current or previous allergic disease (subject-reported) was 20.6%. Bermuda grass, house-dust mite (Dermatophagoides pteronyssinus), and Chenopodium album were the most prevalent sensitizing allergens, with frequencies of 53.6%, 52.7%, and 50.9%, respectively, among the sensitized subjects (corresponding to 23.7%, 23.3%, and 22.5%, respectively) for the entire population. Sensitization increased with age, but only among the expatriates, younger Kuwaitis being as frequently sensitized as the older ones. Polysensitization was found to be common. Of the 109 CAP-RAST-positive subjects, 71 (65.1%) were sensitized to more than one allergen, and 30 of these (42.3%) were sensitized to four or more allergens. These results show that atopy is highly prevalent among young adults in Kuwait, and the higher prevalence rate among nationals than expatriates suggests the involvement of genetic or local environmental factors. The results also confirm that mite and plant pollens may be major sensitizing allergens even in a desert environment.