Tanaffos Respiration Journal
Volume:13 Issue: 1, Winter 2014

The symptoms and functional limitations due to obstructive lung disease (OLD) are the direct results of airway and lung parenchymal destruction. In these conditions, airflow obstruction leads to increased work of breathing, and gas exchange abnormalities. Hyperinflation, which is inferred from a standard chest radiograph (CXR), may imply increased total lung capacity that can be seen in patients with OLD. Based on experimental observations in OLD patients, we proposed that upper third width in posterioranterior (PA) CXR could be used as a rapid screening method for suggestion of OLD. In this cross-sectional study, 99 patients admitted to the Respiratory Ward of Razi Medical Center, a teaching referral hospital affiliated to Guilan University of Medical Sciences (GUMS), were entered in the study. The inclusion criteria were any FEV1 with FEV1/FVC <70% or FEV1/FVC>70% with MMEF 75/25 <65%. All cases with diagnostic possibilities other than OLD were excluded. The PA and lateral CXR were performed and 13 measurements – including previous well-known measurements and our proposed new ones- were made by an ordinary ruler on the films. There was no significant correlation between the upper third width and superior/inferior (sup/inf) ratio with spirometric indices in patients. When considering only patients with FEV1/FVC <70%, middle third proportion width had a significant correlation with FEV1/FVC. In subgroup analysis when considering sup/inf ratio > 0.8, superior and inferior third widths were correlated with FEV1/FVC and when considering sup/inf ratio > 0.9, sup/inf ratio was significantly correlated with FEV1/FVC and FEV1. The sup/inf ratio >0.9 in PA CXR, may be a predictor of obstructive pattern in OLD patients. For better correlation determination, larger and more extensive studies are needed.

Spirometry as a non-invasive and inexpensive test is widely used for occupational health evaluations. Bronchodilator test is used for the assessment of airflow limitation and increase in forced expiratory volume in 1 second (FEV1) or forced vital capacity (FVC) is considered as a positive response. This study was performed to assess the response of forced expiratory volume in 6 seconds (FEV6), forced expiratory volume in 3 seconds (FEV3), and forced expiratory time (FET) to bronchodilator administration. In this cross-sectional study, the response of FEV3, FEV6, FEV1/FEV3, FEV1/FEV6 and FET to bronchodilator administration was assessed in subjects referred to Yazd occupational medicine clinic regardless of their diagnosis. The average increase in spirometric parameters (i.e. FVC, FEV1, FEV1/FVC, FEV3, FEV6, FEV1/FEV3, FEV1/FEV6 and FET) was measured. The difference between baseline and post-bronchodilator spirometries was assessed by calculating absolute change and change from baseline as well. Data analysis was done by Student’s t test, chi square test and Pearson's correlation test. Totally 104 subjects were entered in the study. FEV1 showed the highest response to bronchodilator. FVC response to bronchodilator was correlated with FET, but such correlation was not observed for FEV6 and FEV3. The mean increase in FEV6, FEV3, and FET after bronchodilator administration was 50.90 ml (2.23%), 110.51 ml (3.08%) and -1.85 s, respectively. FVE6 can be used as a substitute for FVC for the assessment of bronchodilator response without the need for FET adjustment.

The expressions of estrogen receptor (ER) and cell surface receptor, Tyrosine Kinase Human Epidermal Growth Factor Receptor 2 (HER 2), have emerged as the most important molecular biomarkers determining the breast cancer prognosis. In this study, interactions between ER and HER2 were assessed to determine if they modulate tumor characteristics. Tissue samples from 120 patients with early stage breast cancer receiving adjuvant chemotherapy were reviewed to evaluate ER and HER2 status quantified by immunohistochemistry and fluorescence in situ hybridization, and the correlation of ER and HER2 with patient characteristics and tumor pathology was studied. A total of 37(30.8%) and 80(66.6%) out of 120 samples were HER2 (3+ by immunohistochemistry or positive by fluorescent in situ hybridization) and ER positive (by immunohistochemistry), respectively. ER-negative tumors were significantly more likely to be HER-2 positive than were ER-positive tumors (21.25%; odds ratio, 0.270; 95% CI, 0.119 to 0.612; P=0.002). ER positivity was associated with <2 cm tumor size and higher histological grade (P=0.007 and 0.019, respectively). No significant correlation was seen between the coexpression of HER2 and ER and tumor characteristics. HER2 positive tumors were less common compared to ER positive tumors in early stage breast cancer Iranian patients. Also, higher histological grade among ER negative tumors showed higher aggressiveness of the tumor. Future studies are needed to evaluate the effect of receptor status on prognosis.

Asthma is the most common, chronic, childhood disease. Its chronic nature and long-term treatment decrease the quality of life of children and significantly affect the family function. This study was conducted to assess the impact of family empowerment on the quality of life of school-aged children with asthma. This was a quasi-experimental study. Forty-five asthmatic children (7-11 years) and their parents referred to the Pediatric Asthma Clinic in Masih Daneshvari Hospital were selected using convenience sampling and were randomly divided into case (n=14) and control (n=16) groups. Data collection tools included a demographic information questionnaire and Pediatric Asthma Quality of Life Questionnaire with standardized activities (PAQLQ). The validity and reliability of the questionnaire were tested. The family empowerment program for the intervention group included lectures, group discussions and demonstration of educational films. The questionnaires were filled out pre- and post-test. There were no significant differences before the intervention between the test and control groups in terms of demographic characteristics and PAQLQ scores. While, independent t-test showed significant differences between the two groups in PAQLQ total score and the subscale scores before and after the intervention (P<0.05). Paired t-test showed significant differences before and after the intervention in the case group in terms of PAQLQ total score and the subscale scores (P<0.001). Considering the positive impact of of family empowerment program on the quality of life of school-aged children with asthma, this program is recommended for proper control and management of disease and decreasing the complications in asthmatic patients of all age groups.

collagen vascular diseases (CVDs) are well known causes of pulmonary involvement, leading to significant morbidity. The purpose of this study was to identify several thoracic computed tomographic findings of CVDs. The study included 56 patients (15 males and 41 females) with histopathologically and clinically proven CVDs who were identified retrospectively. The presence, extent and distribution of various CT findings were evaluated by a radiologist. Lung parenchyma (96.4%) was the most common area of involvement. The lower lobes (89.2%) were the most frequent sites of involvement. The predominant CT patterns were reticulation (55.3%), peripheral subpleural interlobular septal thickening (51.7%) and ground glass opacity (50%). The most common histopathological findings according to CT features were obliterative bronchiolitis (OB, 44.6%) and non-specific interstitial pneumonia (NSIP, 33.9%). Usual interstitial pneumonia was seen in 12.5% and organizing pneumonia in 26.7% of patients. A combination of reticular pattern, peripheral subpleural interlobular septal thickening and ground glass opacity is seen in the majority of patients with CVDs. The results indicate that OB is more prevalent than what has been reported in previous studies. The CT patterns of pulmonary fibrosis are similar to those in most other studies.

The intra-aortic balloon pump (IABP) is a mechanical device used to assist cardiac circulatory function in patients suffering from cardiogenic shock, congestive heart failure, refractory angina and complications of myocardial infarction. While using IABP in cardiac surgery is well established, there are few studies on the utility of IABP support in high-risk cardiac patients undergoing non-cardiac surgery. Major non-cardiac surgeries are associated with high rates of cardiac complications in patients with advanced coronary disease. Recent case studies have reported favorable outcomes with the use of IABP support in non-cardiac surgery in patients with severe cardiac compromise. Using IABP may reduce cardiac complications by providing hemodynamic stability.Here, we present five cases of IABP use in high-risk cardiac patients undergoing resection and anastomosis of the trachea. IABP was inserted prior to induction of anesthesia in four of the cases, while IABP insertion was withheld in one case. In the four cases where IABP support was utilized, the IABP was removed between 6-48 hours postoperatively with no complications. The patient who did not undergo IABP insertion died on the 8th postoperative day due to uncontrollable pulmonary edema and progressive myocardial infarction. We also review the literature and discuss the role of IABP use in non-cardiac surgery.

Pulmonary actinomycosis is a rare chronic pulmonary infection caused by actinomyces, a Gram–positive, microaerophilic bacterium. Pulmonary involvement other than cervicofacial or abdominopelvic actinomycosis is uncommon and often leads to a misdiagnosis of pulmonary tuberculosis or lung cancer. Endobronchial involvement is very rare in pulmonary actinomycosis. Here in, we describe the case of a 66–year–old male patient, referred with a history of massive hemoptysis since a few weeks ago. Plain chest radiograph and computerized tomographic scan revealed a dens consolidation in the right upper lobe; which was confirmed to be pulmonary actinomycosis with endobronchial involvement by transbronchial biopsy.

Massive hemoptysis is a life-threatening complication of respiratory disease. It is an emergency requiring immediate medical attention. A 58 year-old woman with bronchiectasis was admitted to the hospital following episodes of massive hemoptysis. Chest CT scan and bronchoscopy did not reveal any endobronchial lesion and bronchial artery angiography and embolization were performed successfully. Despite successful embolization, her hemoptysis recurred and the patient underwent angiography for the 2nd time; which showed normal left bronchial artery and occluded right intercostobronchial artery. Lower thoracic aortogram revealed a systemic non-bronchial artery in the right lower lung field and evidence of pulmonary shunting. Super-selective angiogram of this artery showed vascularity to lower esophagus and considerable supply of the right lower lung field with pulmonary vascular shunting. Embolization of this nonbronchial systemic artery was carried out successfully with complete occlusion. Few days after the embolization, the patient reported pleuritic and epigastric pain and also complained of odynophagia and dysphagia; which were managed conservatively. Four days later, her symptoms improved and she was discharged subsequently. At 40-day follow up, she was still symptom-free with no hemoptysis.

Lung metastasis is a rare cause of hemoptysis. Bronchial artery embolization is an effective intervention for treatment of hemoptysis with various underlying etiologies.A 28-year-old man with a known history of malignant melanoma in the neck from 6 years ago and lung metastasis from 1 year ago referred to the Emergency Department of our teaching hospital with the chief complaint of hemoptysis. Chest x-ray and pulmonary CT-scan showed multiple pulmonary nodules with different sizes in both lung parenchyma. The patient’s hemoptysis did not resolve completely in spite of appropriate medical treatment. The patient was then referred to the endovascular unit of the vascular department in our hospital and underwent bilateral bronchial artery embolization. With this procedure his symptoms resolved completely and he was discharged after a week.