Tanaffos Respiration Journal
Volume:6 Issue: 2, Spring 2007

Multiple myeloma (MM) is a common hematologic malignancy. Pleural effusion is a rare presenting feature of multiple myeloma which carries a poor prognosis. Few cases of multiple myeloma with pleural involvement have been reported in the medical literature. We report a patient with MM diagnosed by cytologic examination of pleural fluid. Our patient was a 64- year old man with multiple myeloma who was receiving chemotherapy. He had developed dry coughs and exertional dyspnea about a month prior to the admission. Radiographic examination showed left pleural effusion with mediastinal shift to the opposite side. Diagnostic thoracentesis of pleural fluid was performed for the patient. Pathologic examination of pleural fluid showed plasmocytes and plasmablast type mononuclear cells with atypical nuclei, consistent with the diagnosis of pleural effusion due to multiple myeloma. In view of multiple etiologies of pleural effusion in malignant diseases, rare etiologies should also be considered in order to treat the effusion appropriately. (Tanaffos 2007; 6(2): 68-72)

Fiberoptic bronchoscopy is a diagnostic method for respiratory diseases. At present, its diagnostic yield has been increased by different cytologic and histologic procedures by convention. This study was conducted to evaluate the concordance and agreement between cytologic and histologic findings in conventional diagnostic bronchoscopic methods (washing and biopsy) for lung malignancies. This was a cross-sectional study performed on 2076 cases of bronchial biopsy and bronchial washing between 1996 and 2003. Of 2163 patients who underwent fiberoptic bronchoscopy after omitting 87(4%) cases due to unsatisfactory specimens, 2076 cases were studied including 832 (36.9%) females and 1244 (63.1%) males in the age range of 2 to 100 years, (mean age 57.7±16.3 yrs). Male to female ratio was 1.5. Malignancy was diagnosed in 657(31.6%) biopsy and 283(13.6%) cytology specimens. Two hundred and sixty-five cases had malignant lesions according to both bronchial biopsy and bronchial washing; therefore, Kappa coefficient in both methods was 46.7% (P value = 0.000). Concordance rate was 77.4%. Ninety-seven point three percent of malignant cases were diagnosed by biopsy and 41.9% by cytology. Cytology contributed to an additional diagnostic rate of 2.6%. Kappa agreement is classified as fair and although there is a very good concordance between the two sampling techniques, the diagnostic yield of cytology for malignancy must be improved by combination of multiple assays. (Tanaffos 2007; 6(2): 46-50)

In spite of established guidelines developed by the American Thoracic Society (ATS), Infectious Disease Society of America (IDSA) and Centers for Disease Control (CDC), there is no consensus among physicians regarding hospitalization and choice of antibiotics for management of community-acquired pneumonia (CAP).This study was conducted to determine the percentage of patients appropriately assessed for admittance and the antibiotic treatment selections that were in accordance with the established guideline criteria. This retrospective chart review study was conducted at the National Research Institute of Tuberculosis and Lung Disease (NRITLD), Masih Daneshvari Hospital during 2005-2006. Patients with a definite diagnosis of CAP were selected and entered the study. The previous IDSA, ATS and CDC guidelines and the more recent IDSA/ATS CAP guidelines were all used to evaluate the management of patients admitted with CAP. Patients were excluded if information was not sufficient. A total of 31 patients were reviewed. Of the 31 patients included in the study, 24 (77%) could have been treated with outpatient regimens. Six of 31 cases (19%) had been treated with regimens consistent with all three (IDSA, ATS, and CDC) guidelines. Twelve of 31 cases (39%) had corresponded to the previous treatment recommendations from ATS. The management of the remaining 13 patients (42%) had not corresponded to any of the mentioned guidelines. When compared to the recently published joint guidelines of ATS/IDSA, 12 of 31 cases (39%) had appropriately corresponded to the treatment recommendations. According to this study only one fifth of the cases reviewed could have been treated on an inpatient basis. Considering the standard guidelines 42% of the patients did not follow the recommendations from evidence-based guidelines. The enforcement of guideline usage through education and surveillance in university hospital settings may be required. We suggest the use of evidence-based medicine in the treatment of CAP. (Tanaffos 2007; 6(2): 32-37)

The quality of life in patients with chronic obstructive pulmonary disease (COPD) is associated with poor pulmonary function, respiratory symptoms, incapacity to perform daily activities, as well as mental and cognitive disorders. Although there exists some evidence regarding the effect of socioeconomic status on the quality of life in the general population and those with chronic diseases, research is scarce on this issue in COPD patients. This study aimed to investigate the association between income and quality of life in COPD patients. In a case-control study, 131 subjects were selected through systematic sampling from all COPD patients admitted to the pulmonology Clinic of the Baqiyatallah Hospital during the year 2006. Subjects were then divided into three groups based on their household monthly income as follows: group I (n=52), income <2,000,000 Rials; group II (n=62), income between 2,000,000 and 3,000,000 Rials; and group III (n=17), income >3,000,000 Rials. The groups were matched with regard to gender, age, educational background, marital status, comorbidity burden, and insurance coverage. Spirometric measures and quality of life (SF-36) were compared between the groups. The overall quality of life and physical health subscale were significantly different between the groups (p<0.05). Other parameters of SF-36 including physical functioning, role limitation due to physical problems, bodily pain, social functioning, general mental health, role limitation due to emotional problems, vitality, and mental health exhibited no significant difference between the groups (p>0.05). Quality of life and physical function of COPD patients are significantly correlated with their socioeconomic status. Future prospective studies are needed to find potential causative associations between the level of income and life quality in these patients. (Tanaffos 2007; 6(2): 38-45)

Serum C-Reactive Protein (CRP) is increased in patients with chronic obstructive pulmonary disease (COPD). It is used as a predictive factor for extra-pulmonary complications determining the prognosis of disease. It has not yet been defined whether this increase is due to the disease itself or is accompanied by ischemic heart disease and cigarette smoking. Thus, we decided to measure the serum CRP level in COPD patients without ischemic heart disease and also in healthy subjects by enzyme-linked immunosorbent assay (ELISA) and then we evaluated its relation with cigarette smoking, severity of dyspnea, exacerbation episodes, severity of disease and use of inhaled steroids. A comparative-descriptive study was performed on 45 stable COPD patients in 2006. All understudy patients were males.The exclusion criteria included ischemic heart disease and other causes of CRP increase. The control group consisted of 45 healthy men. The samples were selected consecutively. The serum CRP was measured by ELISA (high sensitive). Data were analyzed by SPSS software version 13. Mann-Whitney test showed significant difference between serum CRP levels of COPD patients without ischemic heart disease (52.49 ng/ml) and healthy subjects (28.51 ng/ml) (p=0.01).There was a significant difference between the serum CRP level and the severity of dyspnea in COPD patients (p=0.04). No significant difference was detected between CRP level and the severity of disease, exacerbation episodes and use of inhaled steroids. Moreover, there was no significant difference between serum CRP and cigarette smoking in COPD patients and healthy subjects. The results showed that COPD itself can increase the serum CRP without ischemic heart disease and cigarette smoking. Since CRP is known as a systemic inflammatory marker and a major factor causing extrapulmonary complications, we hope this marker be applied for follow-up of patients, evaluation of treatment methods and their efficacy. (Tanaffos 2007; 6(2): 51-55)

Six to eight million people are infected with tuberculosis (TB) annually throughout the world, out of which 2 to 3 million die. BCG vaccination and its efficacy are always used in tuberculosis control planning. There are different rates of BCG vaccination efficacy in the world from 0 to 80%. BCG vaccine has different efficacy in endemic and non-endemic areas. The prevalence of tuberculosis in Iran is high; therefore it was necessary to perform a study in this regard. This was a case-control descriptive study conducted from 2001- 2003. There were 50 cases of active pulmonary tuberculosis (according to WHO definitions), and 100 controls without tuberculosis admitted for other reasons. Vaccination was done in 10 (20%) people in the case group and 36 (36%) people in the control group (OR: 43%).Thus vaccine efficacy was calculated to be 57% in this study from the equation VE=1-OR (CI: 95% between 0.04-0.81). Twenty percent of vaccinated people have been protected from active tuberculosis in this study. In this study vaccine efficacy was 57% (CI: 95% between 4-81%), and protection rate of vaccinated people against active tuberculosis was 20%. The effectiveness of BCG vaccine is not constant in all situations and old age and past history of contact with TB patients are confounding factors causing the low efficacy of the vaccine. While case control studies have limitations; thus, similar studies should be planned in different parts of our country for more accurate results. (Tanaffos 2007; 6(2): 63-67)

The control and reduction of silica dust exposure in developed countries have resulted in a remarkable decrease in morbidity and mortality due to silicosis but exposure risks have remained high in other countries. Here, we present a fatal case of silicosis in a 27 year-old man with exposure duration of less than one year. This case indicated that intense exposure to silica dust can cause significant fibrotic disease after a short latency period. (Tanaffos 2007; 6(2): 73-76)

Traumatic myocardial injury occurs in up to 55% of patients sustaining blunt chest trauma. We report two cases of myocardial infarction following blunt chest trauma in two young men due to a car accident. They were both suffering multiple trauma and were hospitalized in ICU. Diagnostic and therapeutic procedures performed for these patients are presented in this article. (Tanaffos 2007; 6(2): 77-79)

The field of thoracic surgery is a postgraduate sub-specialty of general surgery and has developed considerably in Iran during the recent decades. Nowadays, thoracic surgery procedures are performed by specialists who have been trained specifically in this field and the quality of care given is in line with international standards. This paper addresses the history of thoracic surgery in Iran.Data were collected through interview of professors, review of archives and personal albums and data present in the council of medical education. Almost 80 years ago, general surgeons used to perform thoracic surgical procedures. But closed-circuit anesthesia was not prevalent in Iran until 1940 and there was no training available in the country for thoracic surgeons. Antibiotics were not available and surgeons were not acquainted with new methods to evacuate the pleural space (chest tube and under water seal drainage). The only procedures performed were limited to management of emergencies, trauma and abscess drainage. Surgical intervention for treatment of tuberculosis in some patients was one of the factors responsible for development of this field of surgery.General surgeons trained abroad that came back to Iran were familiar with the principles of thoracic surgery and would perform it. In some army medical centers and some centers affiliated to foreign countries, thoracic surgeries were performed by Iranian or foreign physicians. Professor Yahya Adl used to perform thoracic surgeries and taught it to his residents. In 1951, Dr. Sadegh Ghazi and shortly after, Dr. Anwar Shakki started operations in Bou-Ali and Abo-Hossein Hospitals at the request of the TB charity foundation. They were the pioneers who started to perform TB, lung and thoracic surgeries. They were educated in France. The period of 1951-1961 can be considered as the initiation period of thoracic surgery as a subspecialty in Iran. Afterwards, this field was extended to the Masih Daneshvari, Sorkheh Hesar and army medical centers. In early 1950, cardiac and vascular surgeon graduates from the USA and other countries who had returned home established the field of thoracic surgery at Tehran University and other universities. Thus, official training in this field was started. In 1984, thoracic surgery became a postgraduate sub- specialty field approved by the medical education council. Thus far, over 80 physicians have graduated in this field most of which are working in academic fields throughout the country. Tehran, Shaheed Beheshti and Tabriz Universities of Medical Sciences have departments approved for training thoracic surgery fellows. In many universities and several medical centers, trained surgeons have established thoracic surgery wards and are working in this field. (Tanaffos 2007; 6(2): 80-91)