Shiraz Emedical Journal
Volume:3 Issue: 4, Oct 2002

Alveolar absorptive surface measures about 100 m2. The Inhaled Therapeutic System uses a fine powdered formulation or liquid insulin (Pulmosol powder technology or AERX device respectively). Minimum dose of insulin that can be delivered by inhalation is 3 units (1mg), but efforts are under way to further reduce the minimum possible dose. A newer technology, called AIR uses dry particle aerosol to prolong pulmonary insulin action. Aerosol insulin is absorbed and cleared faster than cutanous forms; also time to maximum glucose concentration and maximum glucose infusion is shorter. Newer devices guarantee the stability of inhaled insulin dose even better than cutanous forms. In fact, the most important advantage of this new mode of therapy is the enhanced therapeutic comfort and flexibility of mealtime, because it should be taken just before meal. The most important disadvantages include mild to moderate cough (without impairing pulmonary function tests), lower bioefficacy (about 10%) that results in more doses needed and higher cost (because of devices and higher insulin needed).

Lungs and liver may be involved simultaneously in several disease processes such as α1- antitrypsin deficiency and cystic fibrosis. Autoimmune liver disease can be associated with lymphocytic interstitial pneumonitis, fibrosing alveolitis, intrapulmonary granulomatosis and bronchiolitis obliterans with organizing pneumonia. Sarcoidosis also involves liver and lungs in 70% of patients. Some drugs such as amiodarone gives simultaneous lung and liver disease(5). Liver disease can also induce changes in respiratory system especially lungs, most commonly hepatopulmonary syndrome(HPS), portopulmonary hypertension (PPH) and hepatic hydrothorax (pleural effusion). Why lungs respond to liver disease in these two different ways is not clear and relates to balance of vasodilator and vasoconstrictor agents that are released by injured liver or not removed by it. HPS is a triad of liver disease, intrapulmonary vasodilatation and hypoxemia, due to hyperdynamic systemic and pulmonary circulation that leads to abnormal gas exchange and hypoxemia. PPH results from widespread intrapulmonary vasoconstriction and vascular remodeling and leads to increase pulmonary vascular resistance and pressure and finally to right sided heart failure. Nitric oxide is suggested to have primary role in vasodilatation. The diagnostic method of choice for diagnosing intrapulmoanry vasodilatation is contrast enhanced echocardiography. It is a progressive disease with poor outcome if left untreated. No effective medical therapy exists and orthotopic liver transplantation is the therapy of choice. In instances when discrete A-V communications is seen during pulmonary angiography, embolotherapy is recommended for treatment of HPS.

The second Iranian congress of gastroenterology and hepatology was held in Tehran, in October 2001. More than 100 abstracts were presented in this congress, reflecting the current research interests in this field in Iran. Here we summarize some of research works presented in this congress. All abstracts are published in journal of Govaresh, official journal of Iranian society of gastroenterology and hepatology, Volume 6, Number 31, 2001.

The patient is an 18 years old boy, who presented with chief complaints of fever & cough for 10 days. He comes from an endemic area with family history of Kala Azar. Diagnosis of Kala Azar was made based on history, physical examination and paraclinical investigations but he was resistant to glucantime, and so received amphotericin B, which was effective. In addition to full description of the case, this article reviews the Kala Azar.