Tanaffos Respiration Journal
Volume:7 Issue: 4, Autumn 2008

Due to the diversity of surgical techniques and great differences in the incidence of pulmonary hydatid cysts around the world, the most appropriate surgical technique has not yet been substantiated. We presented the results of a single surgical technique in a consecutive group of patients and described the technical details.Methods and Materials: The study was conducted during an 8-year period on 125 patients with a mean age of 33.1 yrs that were suffering from pulmonary hydatid cysts. The surgical procedure included: thoracotomy, opening the cyst, removing all its contents, removal and suturing the bronchial openings. The pericyst cavity left open into the pleural space. Surgical complications, morbidity and mortality rates were evaluated. In addition, the recurrence rate was assessed post-operatively by periodic chest radiographs. There were a total of 181 cysts in 125 patients; 156(86.2%) cysts were operated via the above-mentioned technique and for 25 cysts due to destruction of parenchyma, lobectomy (n=9) or segmentectomy (n=2) was performed. Complications included prolonged air leakage in 4, persistent pleural effusion in 1 and pulmonary embolism in 1patient. There were five recurrences (2.8%) and 1 death due to pneumonia and sepsis. Thoracotomy, evacuation of the endocyst and closure of the bronchial openings comprise an appropriate surgical technique for the treatment of hydatid cysts of)

Pulmonary embolism (PE) results in significant morbidity and mortality. Due to lack of awareness among physicians in this regard or non-availability of objective tests the diagnosis of PE is difficult. Clinical features are nonspecific and all diagnostic tests have certain limitations. The purpose of this study was to evaluate chest radiographic findings in diagnosed cases of acute pulmonary embolism. We conducted a retrospective, chart review study on chest radiographs of all patients admitted to Masih Daneshvari Hospital in Tehran, Iran with a diagnosis of acute PE from April 2005 to February 2006. Fifty-one consecutive patients were diagnosed with acute pulmonary embolism by single detection CT scan, perfusion scan and echocardiography. Three radiologists interpreted the chest radiographs. We found only 2 normal chest radiographs (4%) and the other 48 (96%) were abnormal. The most common abnormalities were pleural effusion (60%), pulmonary artery enlargement (56%), and parenchymal pulmonary infiltration (54%). Although chest radiography cannot be used for diagnosing or excluding PE, it contributes to non-invasive diagnostic assessment of PE through the exclusion of diseases

Operations such as anterior or posterior releases can be used to decrease the magnitude of spinal curves. Concave rib osteotomy is an example of posterior release. Pulmonary complications are the main complications of this operation and the major cause of related morbidities. In this study, the frequency of pulmonary complications was evaluated. Pulmonary complications of concave rib osteotomies were studied in a series of 14 patients at Sina Hospital in a 2-year period (2001-2003). Eight patients were females and 6 were males. During the operation, 3 cases of pleural tear were detected and chest tubes were inserted for them. No cases of pneumothorax and only 1 case of asymptomatic pleural effusion were detected postoperatively. This operation is a simple procedure. If the valsalva maneuver is used and pleural tears are detected intraoperatively, pulmonary morbidities will not increase

In this study we evaluated lung volumes, volume changes relative to Cobb angle and correlation of volume changes with Cobb angle changes before and after the surgery. Eighteen non-smoker patients with idiopathic scoliosis were included in this descriptive observational study. Cobb angle, lung volume and flow were measured before and after the surgery. To assess height and weight changes during the follow-up period, we used the percent relative to normal (percent predicted) instead of absolute volumes. Eighteen of 30 selected patients were included. The mean follow-up period was 34.5±19.6 months. Dynamic volume changes of lung were: VC= -13.4 SD=8.6 (p<0.005); FVC=-9.22 SD=14 (p<0.001); FEV1=9.8 SD=15 (p<0.001). There was a weak correlation between the mean value of dynamic volume changes and the mean changes in Cobb angle after the surgery. There was a weak correlation between Cobb angle and dynamic volume of lung before the surgery. In this study there was a significant decrement of dynamic lung volumes after corrective surgery for thoracic curve scoliosis.

Recent advancements in the fields of antibiotic therapy, vaccination and general health have decreased the number of surgical interventions for the treatment of bronchiectasis. On the other hand, improvements made in the field of lung surgery prompt some physicians and patients to pursue surgical treatment. We assessed the results of surgical treatment of bronchiectasis and compared them with the results of medical treatment during the same period of time. The study population consisted of all patients who had referred to Masih Daneshvari Hospital and were admitted for treatment of bronchiectasis during a period of seven and a half years (March 1999 to September 2006).In this descriptive study, surgical or non-surgical treatment was adopted according to the usual indications for the treatment of bronchiectasis. Response to treatment was evaluated by referring to the patient’s medical records and out-patient visits. The results were categorized into the following categories:Good: Sputum production and other major signs completely disappeared. Satisfactory: Signs and symptoms did not totally disappear, but the patient was satisfied with the treatment results. Poor: No significant change was seen after the treatment. Technique of surgery was postero-lateral thoracotomy under one lung ventilation and lobar or segmental resections. Medical treatment consisted of physiotherapy, antibiotic administration and vaccination against influenza and pneumococcus. Statistical analysis was performed using Access and SPSS software. Fisher exact and chi square tests were used for qualitative comparison of the results. The mean duration of follow- up was 35.9 months (range 1-96 months). Eighty – three patients were studied (48 females, 35 males, mean age 37.8 years, range: 8-71 years); 40 patients underwent surgery while 43 underwent medical treatment. The results of surgery were good in 16(55.2%), satisfactory in 10 (34.5%) and poor in 2 (6.9%) patients. The results of medical treatment were good in 4 (13.8 %), satisfactory in 11(37.9 %), and poor in 13 (44.8%) patients. Good results were significantly more (P=0.002) and poor results were significantly less (P=0.002) after surgical treatment. In each group, one death occurred during the treatment course. Fourteen patients in the medical group and 11 patients in the surgical group were lost during the follow-up period. When indicated, surgical therapy offers advantages over medical therapy in the treatment of bronchiectasis.

This study aimed to assess whether total cholesterol (CHOL), low-density lipoprotein cholesterol (LDL), and high-density lipoprotein (HDL) are sensitive markers for discriminating between transudative and exudative pleural effusions (PE). In this study CHOL, LDL, HDL, TG, protein and LDH were analyzed in PE and serums of 119 patients with pleural effusion out of which 49 had transudative and 70 had exudative pleural effusion. Sensitivity, specificity, and area under the curve (AUC) of CHOL, LDL and HDL were measured by receiver operating characteristic curve (ROC). Pleural fluid CHOL, LDL and HDL levels were significantly lower in the transudate group compared to the exudate (29.6 ±16.3 mg/dl versus 65.24 ± 25.9 mg/dl, p<0.001; 17 ±14.8 mg/dl versus 43.94 ± 21.6 mg/dl, p<0.001; and 9.2 ± 4.8 mg/dl versus14.9 ± 6.3 mg/dl, p<0.001, respectively). Sixty-seven percent of cases with pleural transudates were secondary to heart failure, while 41% and 39% of those with pleural exudates were of parapneumonic effusion and neoplastic origin, respectively. Pleural fluid CHOL, LDL and HDL levels were significantly higher in malignant pleural effusion (71.5±18.6, 48.1±17.4 and 16.1±6.6mg/dl, respectively), and in parapneumonic effusion (70.7±28.5, 49.4±22.4 and 14.7±6.4 mg/dl, respectively) than in heart failure (30.6±11.9, 17.5±10.4 and 9.6 ±5.4 mg/dl, respectively). The optimum cut-off value for pleural fluid CHOL level of ≥38 mg/dL had a sensitivity of 87% and 80% specificity, for LDL pleural fluid level a cut-off value of ≥ 22.5 mg/dl had a sensitivity of 87% and 78% specificity, and for HDL pleural fluid a cut-off value of ≥ 10.5 mg/dl had a sensitivity of 70% and 69% specificity. AUC values were 0.906, 0.883, and 0.783, for CHOL, LDL, and HDL of pleural fluid, respectively. We conclude that pleural fluid CHOL, LDL and HDL are significantly increased in exudative effusions compared to the transudative ones. Measurement of CHOL, LDL and HDL concentrations in pleural effusions is useful in distinguishing exudates from

Cigarette smoking is the first preventable cause of morbidity and mortality in the world and can result in various diseases, disability and death. International studies have reported that about half of the smoking-related deaths occur in the middle ages. We decided to assess the age of death among smokers and non-smokers in this study. This descriptive cross-sectional study was conducted at Tehran Behesht-e-Zahra Cemetery between September 2005 and March 2006. To estimate the sample size, a pilot study was performed on 112 deaths in March 2005 and based on the results; the sample size was estimated to be 2500. Five days of each month were selected randomly. On these days a physician (co-author) visited the Cemetery office and collected the data with the help of office operator. Information was obtained from first-degree relatives of the deceased after obtaining consent. The under-study variables were age at the time of death and cigarette use. Data were analyzed by SPSS software version 11 and using ANOVA test. A total of 7858 cases were studied out of which 57.3% were males. There were 63.1% (4960) non-smokers, 25.1% (1971) smokers and 11.8% (927) ex-smokers. The mean age of death among total under-study population was 56.8 yrs (55.1 yrs in males and 57.6 yrs in females). The mean age of death was 57.9 yrs among non-smokers, 50.1 yrs among smokers and 56.8 yrs among ex-smokers (p=0.00). Results showed that age of death was lower among smokers but we could not determine a direct correlation between cigarette smoking and death in these

Primary malignant neoplasms of the trachea are very rare and there is limited information available on this subject. Adenoid cystic carcinoma is a slow-growing malignant tracheal tumor and the best method of treatment is surgical resection. This study was conducted to evaluate patients with adenoid cystic carcinoma of the trachea who underwent surgical treatment. In this descriptive study, 9 patients treated for adenoid cystic carcinoma from 1995 to 2007 at the Mashhad Ghaem Hospital and Tehran Imam Khomeini Hospital were assessed. There were 9 patients (3 males and 6 females) with a mean age of 56.3 years. Dyspena and stridor were the most common presenting symptoms (88.8%). All patients underwent rigid bronchoscopy and biopsy. The most common site of involvement was the lower third of trachea (44.4%); 77.7% of patients underwent surgical resection. Death occurred in one patient after tracheal resection due to aspiration pneumonia (14.2%). Postoperative radiotherapy was performed in 28.4% of patients because of positive surgical margin and in 22.2% due to inappropriate location of the tumor after bronchoscopic ablation. During a three-year follow up, one patient (11.1%) had tumor recurrence. Resection with post-operative radiotherapy was performed for him. The three-year survival was 88.8%. Because of the nature of adenoid cystic carcinoma of the trachea, surgical resection is the best method of treatment. But if surgical margins are positive post-operative radiotherapy will be necessary. In patients who are not candidates for resection, radiotherapy can be an effective alternative treatment.

Tuberculosis is a major public health hazard. The tuberculin skin test is one of the diagnostic tools in this regard. Since BCG vaccination is performed during infancy in Iran, a positive tuberculin skin test (PPD) may confuse the physician. For this reason we performed this study on adults. A descriptive study was performed on 433 soldiers between 2006 and 2007. Demographic data like age, level of education, family history of tuberculosis, place of residence, cigarette smoking, and chronic cough for more than 3 weeks, were collected from each patient. All patients had a history of BCG vaccination during infancy and its scar was detected in all of them. Purified protein derivative (PPD) test was performed. A 0.1 ml of 5TU PPD solution was injected intradermally into the volar face of the forearm and after 72h transverse diameter of the induration was measured in millimeters with a transparent ruler. Induration size greater than l0mm was considered a positive reaction. All patients were followed for one year and participated again in the second phase of PPD injection after one year. Data were analyzed by using SPSS software ver.13. Paired t-test and Chi-square test were used for statistical evaluation. All soldiers were male with a mean age of 23.2±1.8 yrs. Twenty-three cases (5.3%) had positive tuberculin skin tests after one year. The highest level of education was high school diploma in 288 soldiers (66.5%). There was no significant correlation between the educational background and positivity of the tuberculin skin test (p=0.219). Twenty-two cases (5%) had a history of cigarette smoking which was significantly related to positive tuberculin skin tests (p=0.001). There was chronic cough in 44 (10.6%) soldiers which did not have any significant correlation with tuberculin skin test results (p=0.6). This study showed that the prevalence of new cases of tuberculosis was more than 5% per year. Therefore, performing tuberculin skin test in BCG vaccinated adults is important.

Pulmonary alveolar microlithiasis is a rare condition caused by deposition in the alveoli of the lungs by calcific consolidation called calcospherites. Its etiology and pathogenesis are obscure. Osteopetrosis is a heterogeneous group of inheritable conditions with a defect in bone resorption by osteoclasts.We report a case of pulmonary alveolar microlithiasis associated with osteopetrosis, which was diagnosed incidentally by bone high density and generalized osteosclerosis on chest x-ray.Association of these two diseases has not been reported before.

Kartagener''s syndrome is a rare genetic disorder, which is mostly inherited as an autosomal recessive trait. There are 4 genes with a proven pathogenetic role in Kartagener''s syndrome. It results from ciliary dysfunction and is commonly characterized by sinusitis, male infertility, hydrocephalus, and situs inversus. Since Kartagener''s syndrome causes deficiency or even stasis of the transport of secretions throughout the respiratory tract, it favors the growth of viruses and bacteria. As a result, patients have lifelong chronic and recurrent infections, typically suffering from bronchitis, pneumonia, hemoptysis, sinusitis, and infertility. We present a 27-year-old woman, a case of Kartagene''sr syndrome, with multiple pulmonary abscesses. Evaluation of sputum and tracheal secretions revealed Pseudomonas aeroginosa. Antibiotics were started and respiratory symptoms resolved and the patient was discharged in good general condition. As a conclusion, prompt and appropriate treatment of respiratory infections can minimize irreversible lung damage in