Tanaffos Respiration Journal
Volume:3 Issue: 1, Winter 2004

Tissue diagnosis of anterior mediastinal tumors is very important for making correct therapeutic decision. To evaluate the value of performing percutaneous core needle biopsy in these tumors, we decided to perform this study. CT guided core needle biopsy was performed in 17 patients with anterior mediastinal tumor during an18-month period. The biopsy specimens were sent for histopathological study, and if the result was not definite, immunohistochemical studies were performed. Percutaneous core needle biopsy provided adequate material in 15 from 17 cases. Of these 17 patients, 15 were diagnosed correctly by percutaneous core needle biopsy whereas 2 were not diagnosed definitely (one was “spindle cell tumor” and another one was “suggestive for lymphoma”). The procedure was technically successful in 15 cases, and no complications occurred. CT-guided core needle biopsy of the anterior mediastinal tumors may be a safe, cost-effective and reliable method which can provide a precise diagnosis in the majority of mediastinal tumors and may obviate the need for anterior mediastinotomy or exploratory thoracotomy in cases which are medically treatable or non-resectable. (Tanaffos

Osteoporosis is the most common metabolic bone disease that represents an increasingly serious problem, particularly as the population ages. It occurs because loss of bone mineral content. Osteoporosis, thus, causes significant morbidity, especially in elderly, due to recurrent pathologic fractures. It has been suggested that Chronic Obstructive Pulmonary Disease (COPD) is a risk factor for osteoporosis. We intended to investigate the relationship between COPD and osteoporosis in our patient population. Setting: Pulmonary diseases division of Hazrate Rasool-e-Akram hospital. Design: It is a case- control study. Target: One hundred volunteer men with history of at least 20 pack year cigarette smoking were sequentially assigned into two groups: 50 patients with COPD (according to the result of spirometry) and a control group of 50 individuals of matching age. Interventions: All individuals were underwent Bone Mass Densitometry (BMD) by Dual-Energy X-Ray Absorptiometry (DEXA), and Pulmonary Function Testing (PFT). Statistical Analysis: The data was processed using descriptive statistical analysis and t-test and c2 test. The frequency of osteoporosis in our patient and control groups were 52% (26 patients) and 8% (4 persons), respectively. The mean T-score value of spinal bone density in patient and control groups were -1.15 and +0.62 respectively (p<0.0001). The mean T-score value of femoral bone density was -2.58 in patient group and -0.49 in controls (p<0.0001). There was a statistically significant correlation between the presence of osteoporosis with both the severity and duration of COPD (p <0.0001). However, BMD was not correlated with the body mass index (BMI), age or the amount of cigarette smoking. Patients with COPD are 12.5 times more likely than their controls to develop osteoporosis (OR: 12.46, CI 95% = 3.9 – 39.85). Our study confirms that COPD is a risk factor for osteoporosis. There may be many contributing factors such as immobility, chronic respiratory acidosis and the use of gluccocorticoids. Therefore, prevention of osteoporosis should be a part of medical care for COPD patients)

Nd-YAG laser is a relatively safe and effective procedure in the management of various types of endobronchial lesions including tracheobronchial tumors. It has been used in treatment of benign tumors and as a palliative therapy in obstructive airway lesions due to non-operable lung cancers. In this study, patients who underwent laser therapy because of their endobronchial lesions that admitted during 1994-99 in our hospital were investigated. A total number of 210 patients including 14 with benign tumors, 77 with malignant tumors, 11 with metastatic lesions, 14 with undefined prognosis tumor, and 94 with other lesions who seek laser therapy were investigated. The most common signs and symptoms among these patients were cough, dyspnea, hemoptysis, and obstructive pneumonitis. Improvement in airway obstruction following the application of laser therapy was assessed based on clinical signs and symptoms, arterial blood gas indices and spirometric results. After performing laser therapy, cough in 95.1% of patients, dyspnea in 97.7%, hemoptysis in 89.4% and obstructive pneumonitis in all of these patients showed a significant improvement. Obstruction was relieved in more than 95% of the patients; however, this rate reached to 100% in lesions of trachea and main airways. 98% of 263 obstruction sites were relieved immediately after procedure, and 34.6 % of these cases were completely treated by laser therapy. Complications of laser therapy were observed only in 2 of these patients, that resulted in death in one case. The results of our study were consistent with the previous studies regarding the efficacy and safety of Nd-YAG laser therapy in endobronchial lesions.

Lung abscess is a rare and jeopardizing disease particularly in children. Early diagnosis of the disease can prevent further complications. Delay in diagnosis not only increases the mortality, but also can lead to severe complications along with the need for surgical intervention. Hence, we decided to evaluate the clinical and para-clinical features of our cases to estimate the magnitude of the problem. Data was obtained based on a retrospective study from 1992 to 2004, during a 12-year period in our centre. All the children who were admitted in NRITLD with lung abscess were enrolled in the study. Data was collected and analysed considering their age, gender, underlying disease, and aspiration history. A total of 17 children were identified including 12 boys and 5 girls. 12(70%) children were under 10 years of age. Nine had a history of interstitial lung disease while 12 children had history of aspiration. The most common complaints were cough (94%), fever (82%), and sputum (82%). Leukocytosis was observed in 76.5% of the cases while 70% showed shift to the left in their blood analysis. 60% of the cases were diagnosed only by CT-scan without any other evaluation. Gram positive organisms (Streptococcus pneumonia 11.6% and Staphylococcus aureus 5.8%) were the most prevalent organisms involved in our cases. According to this study, lung abscess is more prevalent in boys. The most common symptoms are cough, fever, and sputum. Furthermore, we suggest CT scan for diagnosing the disease because of its valuable role in detecting lung abscess in early stages.)

HIV is the most common risk factor for reactivation of latent TB and is associated with increased rate of progression of infection to disease.Radiological presentation of TB is variable in both HIV (-) and HIV (+) patients but is more in the latter. In this study we describe and analyze radiological presentation of TB/HIV patients in Massih Daneshvari hospital in IRAN. We registered the demographic, clinical and laboratory information of TB/HIV patients in Massih-Daneshvari hospital between 2002-2003. Inclusion criteria were standard serologic test for HIV (Two positive Elisa test and one positive westernblot test) and proof of TB with clinical and mycobacteriologic or pathologic criteria. Chest x-ray was reported by pulmonary imaging specialist and was divided to two category: Typical (fibrocavitary infiltration in posteroapical segment of upper lobes) and atypical (opacity in middle and lower lobe, hilar and mediastinal adenopathy, pleural effusion, diffuse nodular opacity and normal X-ray). Findings were analyzed using SPSS version 10.5. 15 patients, 13 men (86.7%) and 2 women were included. Mean (±SD) of CD4 count was 229.15 ± 199.45. 53.3% of patients had adenopathy, 26.7% had pleural effusion. Only one patient had cavitary disease.Radiographic pattern was typical in one (6.7%) and atypical in 93.3% of patients.In regard to severity of radiological presentation, mild; moderate and severe pattern was seen in 40%, 26.7% and 33.3% respectively.There was no correlation between severity of radiological presentation and death (p=0.8) and severity of radiological presentation and CD4 count (p=0.53). In this study, it was shown that in spite of some other studies, radiological presentation had not direct correlation with CD4 count; thus, in HIV+ patient, we must consider TB in all atypical radiological presentation regardless of CD4 count.

Cigarette smoking is the first preventable death in the world. The number of cigarettes smoked per day and the years of smoking are considered as the main risk factors in causing the related disease, mortality, and morbidity.Since it seems that the age at which smoking is started has decreased in our society, it is important to recognize the cause and factors that affect the tendency towards cigarette smoking in this period of life. This research was conducted according to WHO questionnaire and Global Youth Tobacco Survey project (GYTS). A total of 1119 high school students were chosen randomly from different educational districts of Tehran from the year 2002 to 2003 and questioned in this regard. 28.2% of students (25.2% female and 30.8% male) smoked occasionally and 4.4% of them (1.5% female and 6.06% male) smoked daily. 67.7% of smoker students started smoking before the age of 15 and 88.7% of them before the age of 17. The most important reason for smoking among 55.3% of students was curiosity and leisurely smoking was observed in 19.3%. Also, presence of a smoker in the family is one of the effective factors that affects the initiation of smoking in students; this was statistically significant (p= 0.000). According to the results of this research, students must be properly trained by appropriate methods in this regard in order to prevent the initiation of smoking in school-aged children.

Damaging of the lung function in patients with cystic fibrosis is the most frequent cause of death in these patients. Recently, Burkholderia cepacia has been emerged as an important opportunistic pathogen in these patients; because of its increased isolation from patients with cystic fibrosis since late1970s, the capacity for spread of infection among the cystic fibrosis patient community, its role in damaging lung functions, and its innate multiantibiotic resistance. These different aspects make isolation of Burkholderia cepacia an important task in cystic fibrosis health care settings. We examined the capacity of Burkholderia cepacia selective agar (BCSA) as a medium for primary isolation of Burkholderia cepacia samples. Biochemical tests were used to confirm the identification. Burkholderia cepacia strains were isolated from 6 out of 53 respiratory samples as confirmed with biochemical tests. Results of the present study suggest that BCSA can be used as a selective medium with high specificity for primary isolation and identification of Burkholderia cepacia complex bacteria.)

Bronchiectasis, dilatation of bronchi with diameter more than 2 mm is a septic and inflammatory process of the lung, caused by infections and systemic or local defense abnormalities of tracheobronchial tree that may lead to destruction of bronchial wall. Infections usually cause inflammatory reaction and destruction of bronchial wall, this further leads to more disturbance in local defense and a vicious cycle of inflammation and bacterial colonization occurs. These bacteria divided to Potentially Pathogen Microorganism (PPM) or non-PPM. The purpose of this study was to find microbiologic pattern and associated (risk) factors in Iranian population and use of more narrow spectrum antibiotics. Forty patients with proven diagnosis of bronchiectasis by HRCT in a clinically stable condition fulfilled the inclusion criteria. Fiberoptic bronchoscopy was performed just after spirometry and BAL sampling was achieved. Cut off point of 10000 CFU was considered for positivity of culture media. S. pneumoniae was the predominant pathogen. There was 85% rate of colonization by PPM. We found FEV1< 80% and FVC< 80% as risk factors for bacterial colonization by PPM and S. pneumoniae. Age of diagnosis<20 years was the additional risk factor for colonization of S. pneumoniae. Cystic bronchiectasis was predominant type of lesion and was more common in women. We have found some differences regarding the rate of colonization, number of patients with airflow limitation, and the predominant pathogen as compared with Western societies.)

Pulmonary alveolar proteinosis (PAP) is a rare disease in which surfactant accumulates abnormally in the pulmonary alveolar walls and causes respiratory symptoms. The only known effective treatment for PAP is pulmonary lavage. We have reported an 11- year-old girl with pulmonary alveolar proteinosis who underwent pulmonary lavage with normal saline under general anesthesia by a new method (using an univent tube for pulmonary blockage, ventilating one lung, and concurrently passing a catheter from out of the tube for lavage). The general condition and vital signs of the patient were normal during lavage and in follow up. Three weeks later, her opposite lung was lavaged too. The results were favorable.