Journal of Cardio -Thoracic Medicine
Volume:2 Issue: 2, Spring 2014

Unfortunately, last winter, we lost one of the leaders of Radiotherpy-Oncology in Iran, Professor Mohammad Hossein Salehi. He was an excellent teacher, a supportive friend and an experienced physician.Professor Salehi was born on April 21, 1941 in Shirvan. After graduating from high school, he continued his education in Mashhad Medical School. In 1968 he completed Medical School and began the Residency Program of Radiology in Mashhad Medical School. Soon after, due to the lack of Radiotherapists in Mashhad and his eager to set up a Radiotherapy services in Mashhad, Dr. Salehi moved to England. He passed the Residency of Radiotherapy from 1972 to 1975 in the Royal Marsden Hospital, London and earned his Diploma in Medical Radiotherapy (D.M.R.T) from the England Royal College and finished his fellowship (F.R.C.R). After moving back to Iran in the same year and acquiring the Iranian National Board of Radiology, he started to work as Assistant Professor of Radiotherapy in Ghaem Hospital, Mashhad University of Medical Sciences, Iran. He arranged and established the first Radiotherapy Department in Mashhad in 1976. He was the Head of Radiotherapy-Oncology Department from 1976 to 2006.He was appointed as Associate Professor and after Professor of Radiotherapy-Oncology in 1985 and 1993, respectively. Professor Salehi was an active member of the Iranian National Board of Radiotherapy for 30 years. He was awarded as” The Best Professor “for 3 times.Beside his valuable clinical and educational activities, he was interested in medical research. He has published more than 20 articles and supervised about 25 theses. After 40 years continuous activity, Professor Salehi was retired in 2010. Unfortunately Professor Salehi passed away on January 23, 2014 after a four-year battle with metastatic colon cancer. His strength, wisdom, guidance and kindness will be missed by all who knew him.

To recognize the predisposing factors in tuberculosis as an endemic infection in Northeast province of Iran, this study was aimed to evaluate whether HumanT-lymphocyte type 1 (HTLV-I) as an immunosuppressive factor increases the risk of tuberculosis. A Case-control study was conducted in 278 tuberculosis patients from 2007 to 2010, in Mashhad, Iran. Tuberculosis has been diagnosed by gold standard tests like sputum culture, bronchoalveolar lavage (BAL) culture or cytology. For detection of HTLV-I antibody, Enzyme Linked Immunosorbant Assay method and western Blot as the confirming test were performed. Then 276 healthy cases were matched for gender and age. The mean age of tuberculosis patients was 49.67±21.36 years and for control cases was 48.36±20.74. In patients group, 114 (41.6%) were male, 160 (58.4%) were female and in controls 123 (44.6%) were male and 153 (55.4%) were female. Pulmonary tuberculosis was presented in 84.2% of the patients. The frequency of HTLV-1 was 2.9% and 3.3% in patients and controls, respectively.HTLV-I frequency was higher in male patients and it increased by age. Regarding to this study, HTLV-I infection is not stand-alone sufficient for increasing the risk of tuberculosis.

Arterial gas derangement could change urinary sodium excretion in Chronic Obstructive Pulmonary Disease (COPD) patients.There are very few and conflicting data in regards to the measurement of fractional excretion of sodium in COPD patients. The main aim of this study was to assess the relationship between renal fractional excretion of sodium(FeNa) with arterial blood gas and spirometric parameters in COPD. This study was a cross-sectional study performed on 40 consecutive stable COPD outpatients in 2 main general hospitals (Emam Reza, Ghaem) in Mashhad/Iran between 2011 and 2012. We investigated the relationship of renal FeNa with arterial blood gas parameters including HCO3, PH, PaCO2 and PaO2, and spirometric parameters. Analysis was done by SPSS v16 with a statistically meaningful p value of less than 0.05. Mean age was 65.97±10.77 SD years and female to male ratio was 0.26. A renal FeNa of less than 1% was presented in 27% patients. There was a significant, positive relationship between renal FeNa and PaO2 (P=0.005, r=0.456). The correlations between PaCO2, HCO3, PH and spirometric parameters were not seen (P>0.05), but there was a significant relationship between Urine Na and PaO2. Outstanding, it seems likely that kidneys of COPD patients are responsible for sodium retaining state particularly in the presence of hypoxemia. This study indicates that in COPD patients, PaO2 but not PaCO2 is related to renal FeNa which shows the probable role of hypoxemia on sodium output in COPD patients. However, some caution is needed for interpretation of the probable role of hypercapnia on sodium retention in COPD.

Pulmonary involvement is the most common cause of mortality and disability in patients with systemic sclerosis and it significantly affects the quality of life in these patients. Therefore, early diagnosis and treatment of pulmonary involvement seems necessary in patients with SSc. In this study, we aimed to assess the health-related quality of life (HRQoL) in patients with Scleroderma-Interstitial Lung Disease (SSc-ILD) and its relationship with pulmonary function parameters. Considering the inclusion and exclusion criteria, 25 patients with SSc-ILD were enrolled in this cross-sectional study from April 2012 to June 2013. Full tests of lung function, including body plethysmography and diffusing capacity of the lungs for carbon monoxide (DLCO), 6-minute walk distance (6MWD), and pulse oximetry were performed. The HRQoL was assessed using St. George’s and CAT questionnaires; also, dyspnea was evaluated for all the patients, using modified medical research council (MMRC) scale. Afterwards, the relationship between the total scores of HRQoL questionnaires and the severity of lung disease was analyzed, based on the recorded variables. The mean age of the patients was 40.36±9.50 years and the mean duration of the disease was 7.16±4.50 years. A statistically significant inverse correlation was observed between 6MWD (r=-0.50, P=0.01), DLCO (r=-0.67, P<0.001), and CAT total score. In addition, there was a statistically significant negative association between CAT score and total lung capacity (r=-0.46, P=0.01). Finally, a significant direct relationship was observed between the total scores of CAT and St. George’s questionnaires (r=0.75, P<0.001). The results of this study showed that CAT questionnaire is a suitable tool for assessing the quality of life in SSc patients; moreover, it is significantly related to the factors associated with pulmonary function. Therefore, the CAT questionnaire may be used to track pulmonary function in SSc patients.

The treatment of complicated parapneumonic effusion (PPE) and thoracic empyema (TE) is controversial; and the choice of treatment after confirming the failure of simple drainage remains unclear. The purpose of this study was to compare the outcomes of intrapleural urokinase (UK) administration and video-assisted thoracoscopic surgery (VATS) as initial treatment options for PPE and TE. We retrospectively reviewed and compared the data of 20 patients with PPE and TE diagnosed between January 2010 and December 2012 at our hospital, dividing them on the basis of the initial treatment into a video-assisted thoracoscopic surgery (VATS) group (n=9) and UK group (n=11). Age was the only statistically different parameter between both groups (P=0.025); with the mean age of the VATS and UK groups being 64 and 76 years, respectively. There was no significant difference in the duration of drainage or success rate between the UK or VATS groups. Although no statistically significant differences (P=0.20) were observed, duration of hospital stay was longer in the UK group (21 and 28 day for VATS and UK, respectively). VATS for PPE and TE may shorten the duration of hospital stay.However, UK administration may be used for selective patients because it is considered to yield outcomes similar to VATS.

Pulmonary embolism (PE) is a common lethal disease that its clinical symptoms may be seen in many other diseases. Computed tomography pulmonary angiography (CTPA) is a valuable diagnostic modality for detection of PE. In addition, it can accurately detect the other diseases with clinical symptoms similar to PE. The aim of this study is to evaluate the frequency of PE and nonembolic disease with similar clinical symptoms including pulmonary, pleural, mediastinal, and cardiovascular diseases that have been detected by CTPA and to describe the importance of reporting these CT findings. In this cross‐sectional study, we evaluated the medical records of CTPA in 300 patients of suspected PE between March 2012 and February 2013 in Imam Reza Hospital and Ghaem Hospital in Mashhad University of Medical Sciences, Mashhad, Iran. Demographic information and the results of CTPA of these patients were re‐evaluated. One radiologist reviewed all of the CTPA and the results have been analyzed by SPSS‐16 software. In this study, PE was detected in 18.7% of patients. Multiple incidental imaging findings were diagnosed as follow: pulmonary consolidation (33.2%), pleural effusion (48.7%), pulmonary nodules (10%), pulmonary masses (1.3%), pneumothorax (4.7%), mediastinal mass and lymphadenopathy (9.3%), aortic calcification (42%), coronary arteries calcification (27.3%), mitral valve calcification (2 %), cardiomegaly (30.7%), and the evidences of right ventricular dysfunction (6.7%). A group of disease can cause the clinical symptoms similar to that of PE. Among them, pulmonary consolidation and pleural effusion have much higher frequency than PE. In addition, CTPA can show pathologic findings in the patients that need follow‐up. It is important to detect and report these imaging findings because some of them may change the treatment and prognosis of patient who are suspected to have PE.

Atrial fibrillation (AF) is the most prevalent cardiac arrhythmias that cardiologists and internists encounter. The goal of this article is to clarify an overview of the evidence linking inflammation to AF existence, which may highlight the effect of some pharmacological agents that have genuine potential to reduce the clinical burden of AF by modulating inflammatory pathways. In a case-control study, 50 patients with atrial fibrillation (AF) with different etiologies and 50 patients with sinus rhythm and similar bases were selected. Sampling for highly sensitive c-reactive (hs-CRP) was done on the patients presenting with AF to the Ghaem hospital between October 2006 and June 2007. Mean age of the patients was 62 years with maximum of 90 and minimum of 36 and standard deviation of 13.80. The most frequent age group was 71-80years. Fifty-four percent of patients were male and 46% were female. Mean serum hs-CRP levels in AF patients with hypertension (HTN), Ischemic heart disease(IHD), Valvular heart disease (VHD), HTN+IHD and hyperthyroidism were 8.10, 9.40, 8.68, 10.16 and 5.98 mg/Lit; respectively. There was significant difference between hs-CRP levels in hypertensive patients in the two groups (P=0.010). Similar results were observed in IHD patients, VHD patients and HTN+IHD patients in two groups (P=0.015, P=0.037, P=0.000). In addition to some risk factors like baseline cardiac diseases, aging, thyrotoxicosis, pulmonary embolism, pneumonia and cardiac surgery, there also appears to be consistent links between hs-CRP, a marker of inflammation, and the pathogenesis of AF.

Unilateral Pulmonary Artery Agenesis (UPAA) is a rare congenital anomaly during the 4 th week of gestational age. It is defined as an absence of pulmonary parenchyma and its supporting artery. A 9-year-old girl was admitted to our hospital because of chronic cough. Chest examination showed a decrement in lung sound of right hemi-thorax with expiratory wheeze. Chest radiography (CXR) revealed a semi-opaque right hemi-thorax. Chest CT with intra-venous contrast demonstrated absence of the right pulmonary artery and lung parenchyma with hyper-inflated left lung and dextro-position of mediastinum. This case emphasizes that in patients with respiratory compliant and chronic cough CXR must be done to rule out similar diagnosis other than asthma.

A 42-year-old woman was admitted to the hospital because of odynophagia and neck pain after swallowing a piece of bone. Anteroposterior (AP) and lateral neck X-ray showed the foreign body. Rigid esophagoscopy under general anesthesia was performed and foreign body extracted by rigid bronchoscopy.