Tanaffos Respiration Journal
Volume:4 Issue: 3, Summer 2005

The incidence of suicide attempt has been increasing in recent years. Presenting a group of patients who attempted suicide, underwent ventilatory support and developed postintubation airway stenosis (PIAS) may help us in prevention and better understanding of this complication. Among patients who referred to our center for treatment of PIAS, those who had been intubated for suicide attempt were investigated in a prospective study. Information was entered in a questionnaire and regular follow ups were done in a 15-month period (April 2003 to July 2004). Among 100 patients with PIAS, 19 enrolled in this study including10 females and 9 males (mean (±SD) age, 25.3 (±9.96) yrs; ranging from 17 to 56 yrs). Type of disease and reasons of suicide were categorized by a psychologist as follows: Eleven patients with psychosocial stress along with an immature personality back-ground, 7cases of psychological disorders and one with an unknown cause.Direct causes of committing suicide included family problems in 10 cases, lovesick in 2, addiction in 3, depression in 6 and social problems in 2 cases (some patients mentioned two reasons and one refused to mention the reason).Mean time of intubation was 14.78 days (3-30 days), and the mean length of stenosis was 35.12 mm (20-50 mm), 8 patients underwent tracheostomy. Three patients were treated with bronchoscopic dilation and 16 underwent laryngotracheal resection and reconstruction. There were 8 cases of recurrence after resection among which 4 were treated by second resection, 2 recovered by bronchoscopic dilation and 2 managed by stenting. This group of patients (study group) was compared with a similar group of patients in whom the causes of intubations were different (control group). Incidence of post- surgical recurrence (p=0.011) and the length of stenosis (p=0.01) were higher in the study group. In our patients, social problems such as unemployment, illiteracy and singleness were the more frequent causes of suicide compared with psychological disorders. Patients who undergo mechanical ventilation due to suicide and develop PIAS could be treated by tracheal resection and reconstruction; although the incidence of post- surgical recurrence is higher in them compared with the other groups of patients with PIAS. (Tanaffos 2005; 4(15): 11-16)

In order to determining spirometric reference values in healthy, nonsmoker adult subjects, this study was performed on populations dwelling in the centre of Iran, Kashan city. The area was selected as the representative of a less polluted area in Iran, as we intended to exclude possible effects of air pollution on spirometric values. The study was performed on 550 subjects (295 Males, 255 Females) aged 17 to 82 years, randomly selected from the general population, and assessed anthropometrically for age and height by using stepwise regression analysis. The prediction equations were calculated on the basis of age and height for forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and forced expiratory flow during the middle half of the FVC (FEF25-75%). Comparisons with predictions of other Caucasians studies are reported. A Comparative study of FVC and FEV1 values of our subjects, standardized for age and height was much closer to FVC and FEV1 of other studies. The prediction equations (based on age and standing height) for FVC (liters) in males: -5.546 + 0.065 height – 0.027 age; and females –3.214+ 0.046 height – 0.023 age; FEV1 (liters) in males: -2.853 + 0.046 height – 0.029 age; and females: - 2.430 + 0.039 height- 0.024 age; for FEF25-75% in males: + 1.987 + 0.027height – 0.044 age; and females: - 0.769 + 0.037 height – 0.033 age. A comparison between equation from the present study and other available reference data shows that our prediction values were similar to those previously reported. The present regression equations for predicted values of lung function measurements may be regarded as the definitive norms for adult population dwelling in the centre of Iran and will be useful for diagnostic and research purposes. (Tanaffos 2005; 4(15): 19-26)

Total serum IgE measurement and skin prick tests are the most common tools for allergy diagnosis. This investigation was conducted to evaluate total serum IgE and skin prick test relationship in Iranian atopic children with respiratory manifestations. A history of allergic rhinitis, bronchial asthma and atopic dermatitis was obtained in 232 children (aged 1 to 15 years). Skin prick testing was performed using commercial preparation of the common allergens. The patients’ sera were also analyzed for determining total IgE. More than 95% (n=221) of the patients had positive skin prick test (mean wheal diameter ³3mm) to one allergen or more. Among the patients 46% (n=107) had elevated total serum IgE levels (³150 IU/ml). The study showed close relationship of skin test positivity with reported allergic symptoms, but no correlation was found between total IgE and skin prick test. This study revealed that skin testing and total serum IgE measurement may be considered complementary to one another in diagnosing allergic respiratory disorders. (Tanaffos 2005; 4(15): 27-31)

Malnutrition is an effective factor in respiratory muscles dysfunction in patients with chronic obstructive pulmonary disease (COPD). The present study was performed to evaluate the effect of improved nutrition on inspiratory muscles in patients with advanced COPD. Total of 33 patients suffering from emphysema were studied during a 3-year period using a quasi experimental (before- after study) method. All of them had forced expiratory volume in one second (FEV1) <30% and had received Atrovent, Salmeterol, Becotide (in maximum doses) and oxygen therapy for at least one year. Initially, FEV1 and airways resistance of patients were measured using body plethysmography. After a 35 Kcal/kg diet including 20-40% fat, 40% protein and 20% carbohydrates, these patients were followed by monthly scheduled visits. Spirometric parameters were measured again 3 and 6 months later and the results were analyzed using Freedman method. Pulmonary function tests of the under study patients at the beginning, 3 and 6 months later were as follows respectively; FEV1; 18.3%, 19.57%, 20.95%, airways resistance; 65.3%, 63.7%, 64.9% and maximal inspiratory pressure (MIP); 2.59, 3.062 and 3.29 cmH2O. There was a significant difference in FEV1 and MIP of patients in 3 and 6 months period (P<0.05). Meanwhile, there was no significant difference in airways resistance of patients (P=0.08). Improved nutrition results in increased MIP and FEV1 without changing in other indices (i.e. constant airways resistance indicates constant treatment status of the patient). Thus, an appropriate nutritional diet including sufficient calorie with small frequent meals at least for six months can increase FEV1 by reinforcing inspiratory muscles resulting in improved pulmonary function. (Tanaffos 2005; 4(15): 33-36)

Determination of adenosine deaminase (ADA) activity is one of the most promising markers in diagnosing of tuberculous pleural effusion. ADA has two main isoenzymes: ADA1 and ADA2.The ADA2 is the predominant isoform in tuberculous pleural effusion, suggesting its important role as a diagnostic marker.This study was conducted to determine the diagnostic value of ADA and ADA2 measurement in tuberculous pleural effusion. Total ADA and ADA2 isoenzyme activities were measured in 93 case of pleural effusion, including tuberculosis (26males/5females), malignancy (22males/8females), empyema and para-pneumonic (11males/4females), transudate (6males/4females), rheumatoid arthritis and idiopathic (4males/3females). ADA levels were determined by Giusti and Galanti methods. ADA2 was measured with a potent inhibitor of ADA1 isoenzyme. Total ADA and ADA2 activities in tuberculous exudates were 96.6±29.1 and 74.4±29 U/L, respectively. With diagnostic thresholds of 46 and 42 U/L, the sensitivities of ADA and ADA2 for tuberculous exudates were 100% and 97%; their specificities 82 and 88%; and their efficiencies 88% and 93.5%, respectively. All tuberculous exudates, 2 neoplastic, 8 para- infective (including 4 empyemas) and one rheumatoid arthritis had total ADA levels >46 U/L; of these, only one lymphoma and one rheumatoid arthritis had ADA2/ADA activity ratio >50%. Considering simultaneous criteria of total ADA more than 46U/L, ADA2 >42 U/L and ADA2/ADA more than 50%, we had only two false positive results, rising the specificity up to 96%. 1. ADA2 is a more efficient diagnostic marker for Tuberculous pleural effusion compared with total ADA.2. Overall, diagnostic value of ADA would be enhanced by the determination of its isoenzymes, especially for distinguishing between the tuberculous and para-infective effusions. (Tanaffos 2005; 4(15): 37-42)

Data concerning the evaluation of hemoptysis in patients affected by Tuberculosis backs to 1940-1960. Remarkable advances in anti TB agents together with effective treatment strategies such as DOTS (Directly Observed Treatment Short Course) has made the feature of the disease to be less associated with severe complications like hemoptysis due to bronchiectasis or fibrocavernous lesions.The objective of this study was to evaluate the short outcome of the patients with hemoptysis due to old tuberculosis and also the relation of the severity of hemoptysis with length of stay (LOS) in hospital and the severity of the pulmonary lesion in high quality imaging techniques. Forty-five patients with old TB and cardinal sign of hemoptysis were evaluated and after excluding the mycetoma and suggestive tumor formation, the coefficient correlation between the severity of hemoptysis and the LOS and also the correlation of the severity of hemoptysis and different pictures of pulmonary lesions in CT- scan were evaluated with Spearman''s rho statistical analysis. All patients were discharged except one who had died because of the reasons other than asphyxia due to hemoptysis. One patient had undergone bronchial artery embolization. Pulmonary resection had been performed in none of the patients. According to the non–parametric coefficient correlation analysis, there were significant correlations between age and the first evidence of residual TB in the lung parenchyma (P=0.00, Spearman rho 0.00) and also between severity of hemoptysis and pulmonary lesions in CT scan at the level of 0.05; but no correlation was observed between the LOS and the severity of hemoptysis (P=0.0769) Hemoptysis due to old destructive pulmonary TB usually has a benign course. This is probably due to lung fibrosis and scarring caused by a prolonged inflammatory process which has led to an increase in vascular anastomosis. In old TB the source of bleeding is usually brochiectatic lesions which are directly correlated with the radiologic features found in chest- x- ray. The authors believe that although pulmonary resection in patients with life threatening hemoptysis is of considerable attention, conservative management of hemoptysis associated with arrested pulmonary TB is the first option. (Tanaffos 2005; 4(15): 43-48)

Foreign body aspiration continues to be a major problem and one of the most important reasons for mortality and morbidity particularly sudden death among children. Therefore, this study was conducted to evaluate the clinical and paraclinical features and also the treatment of children who admitted in this center as the result of foreign body aspiration and underwent bronchoscopy to remove aspirated material. This was a cross sectional study conducted on children under the age of 15 who admitted and registered in NRITLD with the diagnosis of foreign body aspiration and underwent bronchoscopy. Children were analyzed based on their age, gender, primary diagnosis, characteristic of the foreign body, the interval between aspiration and starting treatment, radiological findings, and the severity of airway injuries. Forty-seven children under the age 15 were evaluated in this study in a five-year period between 1998 and 2004. Sixty-three percent of them were boy and 37% were girl. Thirty (63%) children were found to be younger than 3 years old. Moreover in 63% of the cases the primary diagnosis before referring to this center was not foreign body aspiration. Hence, as the result of misdiagnosis and delay, 50% of children had injuries in their airways. The most common aspirated foreign body was organic materials (82%) and the most common radiological finding was hyperinflation in the chest x-ray. This study showed that early diagnosis and treatment of foreign body is a critical factor to prevent further airway complications in children. According to the results of this study ragid bronchoscopy is the most effective procedure for treatment of foreign body aspiration in children. (Tanaffos 2005; 4(15): 49-52)

Requirements of cardiopulmonary resuscitation must be always prepared and available in emergency ward as the result of acute condition of patients hospitalized in this ward and risk of possible exacerbation in them. Equipping the emergency ward and recruiting expert personnel can effectively reduce the rate of hospital related morbidity and mortality. This was a descriptive cross sectional study conducted to evaluate the expertise of the resuscitation team staff, personnel network, and availability of drugs and equipments during cardiopulmonary resuscitation. A questionnaire was used including two main parts. The first part included the data regarding age, sex and underlying diseases and the second part consisted of 67 questions in terms of expertise of the resuscitation team while resuscitating and had 71 scores. The nurse in the resuscitation team was spending an obligatory period of work (Tarh) in 64.4% and the physician was a resident in 91% of the cases. Defibrillator apparatus was in a good condition and working properly in all cases and the period of time using defibrillator from the moment of cardiopulmonary arrest to performing the first shock, was 0.5 to 4 minutes. Regarding availability, amiodarone was least available during resuscitation. According to this study, resuscitation team members in emergency wards of selected centres were not optimally expert in this regard. More researches are recommended in the field of resuscitation and training courses must be held every six months for all members of the treatment team. (Tanaffos 2005; 4(15): 53-56)

We experienced a case of 58-year-old female with solitary fibrous tumor of the pleura, which had been resected by the video-assisted thoracoscopic surgery for definitive diagnosis.Solitary fibrous tumors of the pleura are rare and have confusing pathological characteristics, which have been elucidated by the advancement of the immuno-histochemical analyses.We report the case of this ailment with reference to other relevant literature. (Tanaffos 2005; 4(15): 57-59)