Tanaffos Respiration Journal
Volume:5 Issue: 2, Spring 2006

Differentiation of benign from malignant mesothelial proliferations is a major problem in the pathology of the serosal membranes, particularly in small biopsy specimen.This study was conducted for the evaluation of proliferative marker for distinction between malignant mesothelioma (MM) and mesothelial hyperplasia (MH). Thirty six cases of malignant mesothelioma (MM) with the mean age of 62.94 years (range: 36-80 years, M/F: 3.58) and 22 cases of mesothelial hyperplasia (MH) were evaluated for proliferative status by immunohistochemical (IHC) method with monoclonal antibody, Ki-S5 (Ki-67); the labeling indices (LI) were evaluated. Average count revealed a significant increase in MM as compared with reactive MH (p value <0.0001). Considering a threshold of 9% for ki-67, a sensitivity of 88% and specificity of 94% were resulted. Proliferative marker of Ki-67 can be useful in distinction between malignant mesothelioma and mesothelial hyperplasia (p-value <0.0001). (Tanaffos 2006 5(2); 9-12)

Selection of an optimal method for the safe preoperative airway management is the base of a successful general anaesthesia. To achieve this goal various methods and devices are used including endotracheal tube and laryngeal mask airway, each has its own advantages and disadvantages. In this study, we compared a new supraglottic instrument (cobra perilaryngeal airway) with laryngeal mask airway (LMA), considering each one''s abilities specially their role in preventing intraocular pressure rise during insertion. In a prospective randomized clinical trial 200 ASA class I, II patients with no history of glaucoma, cardiovascular or respiratory diseases and susceptibility to difficult intubation were randomly divided into two similar groups (100 subjects each). None of them (age range 6-70 yrs) received premedication after preoxygenation and induction with sodium thiopental, fentanyl and atracurium. The patient was ventilated manually then one of the devices was inserted. After assurance of the correct position, its cuff was filled with air. In this study various factors including intraocular pressure (IOP), systolic blood pressure (SBP), SPO2, end tidal CO2 (ETCO2), heart rate, peak airway pressure and end expiratory tidal volume were recorded exactly before the induction (time 1), after the induction (time 2), 5 minutes after the induction (time 3), 15 minutes after the induction (time 4), and 5 minutes after releasing the device (time 5). Cuff pressure was measured immediately after insertion and at the end of operation. Quality of insertion (1: simple 2: relatively simple 3: difficult 4: unsuccessful), their complications (bleeding, no bleeding) and sore throat 2 and 24 hours after the operation were detected by interview. Fitness of LMA or Cobra PLA on airway for prevention of air leakage were recorded as well. Qualitative data with chi-square and quantitative data with t-test and SPSS software (version 11) were analyzed. There was no clinical significant difference between the two groups regarding age, sex, ASA class, weight, duration of surgery, SPO2, heart rate and blood pressure. Cobra PLA offered advantages in regard to easy insertion (p=0.005), sore throat (p<0.0001) and bleeding (p<0.0001). Mean rise of intraocular pressure and mean increase of systolic blood pressure (at the time 3) was higher in LMA (p=0.02). Regarding ETCO2 (p=0.0001), peak airway pressure (p<0.0001), ability to fitness on airway (p=0.01) and cuff pressure (p<0.0001) cobra significantly offered advantages over LMA. Cobra PLA is a useful device for airway management in general anaesthesia during mechanical ventilation with minimal post-up complication and simplicity of usage offering high potential ventilation. More studies are required in regard to use of Cobra tube in different ages. (Tanaffos 2006; 5(2): 13-19)

Venous thromboembolism (VTE) is known to be a major cause of morbidity and mortality among hospitalized patients. The American College of Chest Physicians (ACCP) published their seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy in 2004, with recommendations for venous thromboembolism prophylaxis. Despite these recommendations, appropriate thrompoprophylaxis is underused. This study was performed to examine the frequency and adequacy of thromboprophylaxis in hospitalized patients in three primary-tertiary teaching hospitals in Urmia, Iran. We carried out a cross-sectional prospective study on 436 patients hospitalized in three teaching hospitals in Urmia, Iran. Information was obtained from medical-nursing records and patient observation and was compared with the recommended guidelines of the ACCP. The appropriateness of diagnoses was not evaluated. Of 436 patients, 352 subjects required thromboprophylaxis and the total proportion of them who underwent some form of thromboprophylaxis was 16.7% with only 9.9% receiving ACCP recommended prophylaxis. Prophylaxis rate was: 29.7% in medical wards, 27.8% in ICU, 11.0% in surgical wards overall and14.7% postoperatively. Low dose heparin was the most common type of prophylaxis. Despite the widely disseminated, evidence-based recommendations, venous thromboembolism prophylaxis is underused in our hospitals. It is more commonly neglected in our hospitals than those in Western countries. We think that in most other developing countries, this condition is similar. Therefore, the consensus statements alone are insufficient to ensure the routine use of prophylactic strategies in clinical practice. In addition to the statements, other strategies are required to solve the problem. (Tanaffos 2006; 5(2): 21-26)

IPF is the most common form of interstitial lung disease. IPF is a clinico-pathological syndrome characterized by cough, exertional dyspnea, basilar crackles, a restrictive pattern on pulmonary function test (PFT) and honey comb pattern on HRCT. Since there are no exact data on IPF in Iranian patients and also the controversy that exist in this regard we decided to study the IPF cases in regard to epidemiologic, clinical features, radiologic manifestations and diagnosis in Masih Daneshvari Hospital during 1998-2001. This study was a descriptive retrospective study on files of IPF patients in Masih Daneshvari Hospital during 1998-2001. Although the total number of patients was 98, only 50 cases that had clinical and pathological findings compatible with IPF were included in the study. Twenty-seven (54%) were males and 23 (46%) were females. Mean age was 56.25±15.86 yrs. The most common clinical signs and symptoms were dyspnea (100%), cough (90%) and crackle (90%). HRCT findings were abnormal in all patients. Eighteen percent were smokers and the most common occupational exposure was through agriculture. 82.2% of patients had restrictive pattern on PFT. Seventy percent of patients had transbronchial lung biopsy (TBLB), 26% had open lung biopsy (OLB) and 4% had video-assisted thoracoscopy (VATS). Age of patients with IPF in our study is one decade lower than in Western countries. HRCT and TBLB assist significantly in the diagnosis of IPF and limiting the surgical procedures to only a limited number of cases. (Tanaffos 2006; 5(2): 27-32)

Diagnostic upper gastrointestinal (GI) endoscopy without sedation in selected patients has become more common over the past few years, none-the-less sedatives are avoided in the elderly. We studied the effect of rapid esophagogastroduodenoscopy (EGD) without sedation on patients with COPD to determine the critical hypoxemia during endoscopy. In a prospective study, easy EGD was performed electively in 74 patients with COPD (FEV1, FVC, and FEV1.FVC<60%) during 25 months in Masih Daneshvari Hospital. All patients had continuous monitoring and recording of arterial oxygen saturation with pulse oximeter. Patients had similar characteristics concerning age, gender, cardio-pulmonary function and other interventional factors. Hypoxemia during the procedure was also registered. It is noticeable that easy endoscopy refers to performing EGD in less than 10 minutes without sedation. This study showed that during non-sedated EGD, SaO2 dropped to less than 90% in 23% (16 cases) of patients with COPD. None-the-less following administration of oxygen during the procedure, PaO2 tended to normal values and therefore the procedure was continued without interruption in all cases. This study showed that easy endoscopy in COPD patients with normal cardiac function may be considered as a safe procedure with no complication. (Tanaffos 2006; 5(2): 33-39)

Respiratory tract mucus plugging and Pseudomonas aeruginosa (PA) colonization in cystic fibrosis patients can influence the health indices, morbidity and mortality.Our aim was to evaluate the relation between pulmonary infection with PA and its effects on respiratory function test and some health-related parameters. This study was a cross-sectional study. Thirty CF patients, who were admitted to GI department of Children Medical Center because of gastrointestinal and/or pulmonary disturbances, were enrolled in this study. Management began by taking a medical history, physical examination, sputum or pharyngeal swab for culture and antibiogram, spirometric assessment for cooperative children (over 6 years old) and filling out a questionnaire for the abovementioned items and some health related parameters (weight, mean hospital stay days, mean absent days from school, and mean ICU admission time during the last year). The mean (±SD) age was 6.39 (± 5.88) years (11 females, 19 males). Pseudomonas aeruginosa grew in sputum or pharyngeal swab of 13 cases (43.3%), did not grow in 12 cases (40 %) and other organisms grew in 5 cases (16.7 %). Mean of hospitalization period was higher in cases with positive culture (31.83 Vs 13.08 days, Paired sample t-test, P= 0. 005). Mean (±SD) predicted FEV1 % was 34.6 (± 28.0), but this difference was not significant in age, age of diagnosis, days of ICU hospitalization, absent days from school, days of using respiratory assistance equipments, days of antibiotics administration during the last year, body weight, predicted FEV1 %, predicted FEV1/FVC% and predicted FEF 25-75 %. Prevention and early treatment of PA colonization can reduce hospital stay and its cost. Further large controlled trials are required in this regard. (Tanaffos 2006; 5(2): 41-48)

It has been suggested that some micronutrients have antioxidant and immunomodulating effects on the treatment of mycobacterial disease. In this study, we investigated the effect of vitamin E and selenium supplementation on clinical responses in tuberculosis patients. Thirty-five patients with pulmonary tuberculosis diagnosed on the basis of a positive sputum smear for acid fast bacilli or culture for Mycobacterium tuberculosis were selected. Serial sputum examinations were performed before the diagnosis and at the end of every 15 days, during two months of therapy; chest X-ray of all patients were also evaluated. In a setting of double-blind, placebo-controlled trial, the patients were divided into two groups. Group I(n=17) received combination of vitamin E and selenium which composed of 140 mg of α-TE and 200 μg selenium per day, and group II received placebo. All patients in both groups received the same antituberculosis standard therapy. Clinical examination and assessment of micronutrient levels were carried out before and after 2 months of intervention. In group I, elimination of tubercle bacilli from sputum occurred earlier than in group II (6 weeks versus 8 weeks, respectively; p= 0.001). At the end of the 2nd and 6th month of therapy, the median reduction in cavity surface area on chest X-ray in group I was significantly more than group II (2nd month: 1.5(0.0-4.5 versus 9.0(4.0-18.0);p= 0.03, and 6th month: 0.0(0.0-2.3) versus 6.3(1.0-15.8); p<0.05, respectively). Vitamin E plus selenium supplementation may improve the microbiological and radiological outcomes of the treatment in patients with pulmonary tuberculosis. (Tanaffos 2006; 5(2): 49-55)

Broncholithiasis is often seen after chronic granulomatosis diseases such as tuberculosis and histoplasmosis and leads to a wide spectrum of signs and symptoms; including hemoptysis which often needs surgical management. The goal of this study is evaluation of surgery in patients with tuberculous broncholithiasis presenting with hemoptysis. In this study, all patients with tuberculous broncholithiasis whom had been operated on between 1991 and 2005 and their follow-up period was at least 6 months and at most 9 years were included and studied in regard to age, sex, clinical symptoms, diagnostic methods, type of surgical procedure, complications, and mortality rate. Overall, 5 patients were studied; (M/F=2/3, mean age=31 years), 40% with severe and 60% with mild to moderate and recurrent hemoptysis. Lesion was at the left lung in 80% and at the right lung in 20% of patients. In 60% of patients some degrees of bronchiectasis were seen, in 80% the lesion was visible in bronchoscopy and endoscopic removal of lesion failed in all cases. Sixty percent of patients underwent pulmonary resections and in 40% broncholithectomy was done. In follow-up, patients with pulmonary resection have had no problem till now, but in patients with broncholithectomy due to the late occurrence of bronchiectasis, re-operation and pulmonary resection were unavoidable. No mortality was reported in our patients. Regarding the risks of hemoptysis, excellent results of surgery and possible occurrence of late bronchiectasis after broncholithectomy, the results of our study showed that the procedure of choice for these lesions is pulmonary resection distal to lesion and saving as much of parenchyma as possible. Broncholithectomy should be done only in patients in whom pulmonary resection is not technically possible. But because of very low occurrence of this complication, further studies are required in this regard. (Tanaffos 2006; 5(2): 57-63)

Late onset systemic lupus erythematosus (SLE) after 50-year-old is rare. We report a case of 84-year-old woman presenting with systemic lupus revealed by pleural effusion associated with renal involvement. The pleural effusion, renal abnormalities and the immunological abnormality improved within 4 weeks after prednisone therapy (1 mg/kg/day).The late onset lupus differs from those with early onset, in terms of mild clinical presentation and favourable prognosis. Our observation is exceptional due to the very late onset of the lupus and involvement of a major organ, the kidney, which is usually exceptional in this age. (Tanaffos 2006; 5(2): 65-67)

Congenital thoracic ectopic kidney is a very rare developmental anomaly and the rarest form of all ectopic kidneys. it is usually asymptomatic and discovered incidentally in routine chest radiography. We report an 18-month old boy with right congenital diaphragmatic hernia with thoracic ectopic kidney and positional respiratory symptoms. Chest X- ray revealed opacity at the base of right lung. Dimercaptosuccinic acid (DMSA) scan showed right thoracic kidney.Hereby we discuss the features of congenital right thoracic ectopic kidney and review the literature in this regard. (Tanaffos 2006; 5(2): 69-72)