Tanaffos Respiration Journal
Volume:1 Issue: 1, Winter 2002

Central respiratory drive is of paramount importance in control of ventilation. The central drive is exquisitely sensitive tochanges in CO2/H+ concentration. New data show that the fast- acting neurotransmitter acetylcholine is essential in theCO2/H+ ventilatory response as well as in generating the central drive. Ret gene and MASH-1 are essential indevelopment of the parasympathetic system and thus in the central respiratory drive. Clinical states of hypoventilationmost likely have a genetic defect affecting the cholinergic system.This article will review briefly the site and mechanismsof action of CO2 centrally, the neurotransmitters involved in the process, the gene(s) involved in the process and clinicalstates where there are abnormalities in the system and inevitably hypoventilation results.(Tanaffos 2002;1(1):9-13 )

We studied pneumothorax as a complication of transthoracic CT-guided needle aspiration biopsy, and itscorrelation with different variables were determined.

This cross-sectional study was performed on 145 consecutive patients, aged 9-87 years (mean55.3+17.6; M/F=1.6), during a 6-month period. We reviewed the pathology results of 150 biopsy specimens obtained fromthe cases, and assessed the effect of lesion size, depth, patient age and patient emphysema on pneumothorax rate.

Lesion size ranged 1-18 cm (mean 6.5+3.4 cm). 95 lesions had zero distance from the chest wall, which were alltaken into account in our calculations.Pneumothorax rate was 6 percent, and we found that lesion depth (p <0.05), lesion size(p=0.069), patient age (p=0.058,) and presence of emphysema (p <0.001) are significantly associated with increasingpneumothorax rate (CI=90%).

Lesion depth, lesion size, patient age, and emphysema significantly increase the rate of pneumothorax duringtransthoracic CT-guided needle biopsy.(Tanaffos 2002;1(1):15-21)

Asthma is the most common respiratory disease among children, which is widely underdiagnosed. Thisepidemiological study was performed between 1998 and 1999 in Boroojerd to determine the prevalence of asthma andits risk factors among school-aged children.

The ISSAC written questionnaires were used.

A total of 1287 of 1331 questionnaires (96.7%) were returned. Prevalence of physician diagnosis of asthma,asthma ever, current asthma, and episodically nocturnal cough with chest tightness were 1.5%, 21.1%, 5.7%, and 16.6%respectively. Main risk factors for childhood asthma included: familial history of asthma, large family size, history ofsevere respiratory infection in early childhood, paternal smoking, and keeping birds at home.

There is a high prevalence rates for asthma among 7-12 year old children in non-pollutant towns such asBoroojerd.(Tanaffos 2002;1(1):22-27)

Reemergence of tuberculosis along with multi drug- resistant strains has made both the treatment of affected patients and the progress of eradication programs a real struggle. Most second –line drugs are toxic and expensive and it is necessary to search for effective anti-tuberculosis drugs which are safer and less expensive. Due to their structure and production of β-Lactamase enzyme, mycobacteria are considered as β -lactam resistant. we study the effects of β -Lactamase inhibition on the susceptibility of mycobacterium to β -Lactamase, changes in Minimal Inhibitory Concentration (MIC) of four cephalosporins; cephapirin, ceftriaxone, cefotaxime, and cefoperazone in the presence of sulbactam in both sensitive and resistant mycobacteria. β –Lactamase production was assessed with the Nitrosfin method and all strains were β-Lactamase. Resistant strains showed less sensitivity to β -Lactamas and both groups were most sensitive to cephapirin. Equal doses of sulbactam added to the cephalosporins reduced their MICs from zero to 16 times. MIC reduction was more pronounced with ceftriaxone in the sensitive group and with cefoperazone in the resisitant group. Althoughantimycobacterial effects of β -lactamase such as cephalosporin in combination with β -Lactamase inhibitors, could not be compared with first- line anti TB drugs. We are still hopeful these drugs with the least side effects could be considered as the second- line anti TB drugs in near future.(Tanaffos 2002;1(1):28-35)

Tracheal intubation is a very common procedure for maintaining patency of airway in critically ill patients.Intubation may lead to local complications such as tracheal destruction and post-intubation stenosis. There are twodifferent therapeutic approaches for such patients. The first one is surgical end-to-end anastomosis suitable for severedestructions and fibrosis formations. The second and novel method is utilization of Nd-YAG Laser that can correctintraluminal airway lesions including webs, granulation tissues and fibrous bands. Nd-YAG laser employment decreaseshospitalization period, complications and, expenses; in addition, it saves medical staff’s time and energy.

An uncontrolled clinical trial was performed in post-intubation tracheal stenosis casesadmitted to “National Research Institute of Tuberculosis and Lung Disease” (NRITLD) between 1994 to 1999.Bronchoscopy was performed for all patients, and those with the following inclusion criteria underwent Laser therapy:length of stenosis less than 2 cm, tracheal lumen diameter more than 5mm, and granulation tissue type lesions. Patientswho did not meet the aforementioned criteria were referred for surgical interventions. Laser therapy was employed byfiberoptic bronchoscopy under local anesthesia. For those patients with tracheal lumen diameter between 5-10 mm rigidbronchoscopy was performed under general anesthesia.

Of 32 patients, 25 met the primary criteria for Laser therapy, from which 22 (88%) were completely cured.Because of poor general condition, 5 of 7 other patients who had been referred for surgery, underwent Laser therapy,therefore a total of 30 patients (93%) took advantage of this technique. Overall, 23 patients were treated only with Lasertherapy, 2 patients only with surgery and 7 patients with a combination of these two approaches.

This trial revealed that if patients with post-intubation tracheal stenosis are selected correctly, Lasertherapy can be used as a beneficial and safe method with satisfactory results. (Tanaffos 2002; 1(1):36-40).

Despite the fact that many surveys have been carried out on adverse effects of tobacco and diseasesattributable to smoking, only a few studies have described the effects of tobacco dust in tobacco-industry workers.

A total of 487 nonsmoking factory workers were randomly selected from different sections ofthe factory for this cross-sectional study. Having completed the questionnaire, they underwent spirometry and otherexaminations including DLCO, TLC, chest X-ray, and CT scan.

Five cases developed COPD (1.27%) of whom 4 (0.96%) were working in cigarette fabricating section. Of 8patients with asthma (1.92%), 3(0.72%) worked in an area where cigarettes were fabricated. Restrictive disorders werereported in 6 workers (1.42%) of whom 2 were in the sorting-blending and fabricating sections (0.48%) and 1 in tobaccopackaging (0.24%) section.

The results implied high prevalence of obstructive disorders in the workers of cigarette fabricatingsection. We have concluded that working in different sections of a cigarette factory and also working experience have nosignificant relationship with pulmonary disorders and radiologic appearance of nonsmoking workers.(Tanaffos 2002;1(1),41-45)

Tei index is an echocardiographic indicator for studying the function of ventricles. In most studies ,left Tei measurement was used to evaluate cardiac function in patients with heart failure, where its increase indicates left ventricular involvement. The following study was designed to compare right Tei index in healthy people with that of pulmonary patients in order to determine the effects of pulmonary diseases and their consequent cardiovascular complications. The study population included 78 pulmonary patients and 37 normal individuals. Doppler-echo imaging was performed by VingMed set, model CFM750 for all patients and the information was recorded in data sheets. Finally, results were analyzed by SPSS statistical software package, version 9.0. The mean (±SD) of age in the pulmonary patients and normal individuals was reported 49.28 ±19.11 and 36.57± 15.46 respectively. Meanwhile, Tei index was revealed to be independent of age, sex, ventricular geometry, pulse, and blood pressure, thus no interference resulted from intervening factors. The mean (± SD) of right Tei index was measured 0.47± 0.25 and 0.38± 0.16 in the pulmonary patients and normal individuals respectively. Regarding the difference found between Tei index of these two groups, it seems as if significant change in Tei index is strongly associated with pulmonary disease. Therefore, it is worth surveying, the correlation between Tei index and other cardiac indices in pulmonary disease.(Tanaffos 2002;1(1):46-49)

Asthma is among the most prevalent disease that may lead to both maternal and fetal complications during pregnancy. Low birth weight and prematurity have been shown to be associated with asthma in some studies. This study was designed to determine the association of asthma and pregnancy.

44 parturients with asthma exacerbation were eligible to be enrolled in this descriptive study. Variables including age, personal smoking, environmental tobacco smoke exposure, number of pregnancies, and maternal age at the time of pregnancy were all determined. Pulmonary Function Test (PFT) was performed before, after, and during the pregnancy; meanwhile, the fetal status was recorded.

The mean age (± SD) of these women was 28.3 ± 5.8 years (range, 15-40). PFT has revealed asthma exacerbation during and after pregnancy in 36.4% and 15.9% of the participants respectively. Pregnancies were led to normal childbirth in 93.2%.

Multigravidity (≥3) was associated with postpartum symptom improvement. There was a significant correlation between maternal age of ≥30 and asthma exacerbation during and after the pregnancy. (Tanaffos 2002;1(1):50-54)

Synovial sarcoma is a malignant soft tissue with varying of mesenchymal and epithelial differentiation. This tumor is usually occurs in paraarticular regions and uncommonly within the articular cavity of upper and lower extremities. On rare occasions it ossurs in areas without any apparent relationship to synovial structures such as abdominal wall, tongue, and parapharyngeal region. Primary tracheal tumors are relatively uncommon, estimated 2.7 new cases per million per year. Sarcomas are rarely seen as a primary tracheal tumor. Only one case of primary synovial sarcoma of trachea was reported. We report a case of primary synovial sarcpma of trachea in a 10 years old female. The patient underwent tracheal resection. The tumor was composed of spindle shaped cell in fascicular pattern and a few cystic structures. The tumor cells showed positive reaction for epithelial membrane antigen (EMA) and cytokeratin.