Tanaffos Respiration Journal
Volume:8 Issue: 1, Winter 2009

Numerous causes can lead to chronic inflammatory lesions of the lower respiratory airways including those recognized as chronic obstructive pulmonary disease (COPD), of which tobacco smoke has been established. Air pollution and smokes from indoor and outdoor origins are among the possible causes. However, further investigations are required on this issue. Amongst those who underwent diagnostic bronchoscopy in the pulmonary endoscopy unit, Tehran University of Medical Sciences from April 1975 to March 2000, 102 patients revealed generalized chronic changes of the airways with significant anthracotic deposits. Their clinical manifestations, demographic data, radiological, biopsy and bronchial washing findings were evaluated and compared with a similar number of contemporary cases without anthracotic lesions but with a variety of established pathologies. Clinically, the patients with anthracotic airway lesions were already respiratory cripples. Females (n=60) had been exposed to long-term indoor smoke inhalation while baking home-made bread. Males (n=42) had a variety of occupations that entailed heavy smokes. Those without bronchial anthracosis had no similar histories. Long-term smoke inhalation can cause chronic anthracotic bronchopathies leading to respiratory invalidism. The problem seems to be extensive and has not confined to Iran. Further worldwide studies are required to address different aspects, including prevention of these ailments.

Idiopathic pulmonary fibrosis (IPF) is associated with histological appearance of usual interstitial pneumonia. These fibrotic changes in lung interstitium are mostly attributed to cytokine production such as TGFβ which stimulate migration and differentiation of fibroblast to myofibroblasts. The polymorphism of TGFβ gene was found to be associated with development of IPF. We investigated whether TGFβ1 gene polymorphism in codon 10 is associated with interstitial pulmonary fibrosis in Iranian population. The different genotypes of TGFβ1 at (+ 870) position (in codon 10) was studied in41 cases and 83 control subjects. The allele specific PCR method was used for genotyping. In the patient group, the frequency of T allele (NO: 58) was 70.7% and C allele (NO: 24) was 29.3%. The frequency of TT genotype (NO: 20) was 48.8%, followed by T/C (NO: 18) 43.9% and CC (No. 3) 7.3% while in the control group, the frequency of T allele (N:117) was approximately 70.5% and C allele (NO: 49) was 29.5%. The frequency of TT genotype in control group (NO: 41) was 49.4%, followed by T/C (NO: 35) 42.2% and C/C (NO: 7)8.4% In comparison with the control group, there was no association between TGFβ1 codon 10 T/C polymorphism in our cases with IPF.

Estimating the severity of disease and prognosis for patients hospitalized in intensive care units may be important in selection of diagnostic procedures and treatment regimens. For this purpose, various ranking methods have been used in these units which have their benefits and shortcomings. In this study, all patients admitted to the respiratory intensive care unit (RCU) of Labbafi Nejad Hospital during the year 2005 with no signs of cardiac disease or history of cardiopulmonary resuscitation were evaluated. All patients had their serum troponin level checked in the first hour of hospitalization in the unit and upon first medical examination acute physiologic and chronic health evaluation (APACHE) II scores were determined for them. In total, 87 patients were eligible for entering the study. There were significant correlations between serum troponin levels and APACHE II score (p=0.0001). There was also a significant correlation between elevated troponin levels and mortality rate. Multivariate statistical analysis showed that APACHE II scores and serum troponin levels each are independent variables affecting prognosis among hospitalized patients in the respiratory intensive care unit. Determination of serum troponin levels in non-cardiac patients admitted to respiratory intensive care unit can be a helpful prognostic factor.

Air pollution is a major horror in many cities in Iran especially in Tehran. The cost of traffic congestion in the capital is put at two billion hours of time wasted each year. Tehran has also recorded SO2 levels four times the standard prescribed by the World Health Organization. Tehran is the capital of the Islamic Republic of Iran with almost 11 million inhabitants (one sixth of the country’s population), and is the most densely populated city of the country. The purpose of this research was to investigate the effects of air pollution on cardiorespiratory system. We assessed the relationship between the levels of air pollutants and emergency visits for asthma and cardiovascular diseases in Tehran, Iran. Two research questions investigated in this study were as follows: a) Which criteria elements of hazardous toxic air pollution were associated most strongly with the level of hospital admissions for cardiorespiratory conditions? b) What proportion of the variation in hospital admissions for cardiorespiratory conditions was explained by variations in levels of air pollution? During a 12-month period (from April 2004 to March 2005), the concentrations of 5 air pollutants (CO, NO2, O3, SO2 and PM10) were measured in four stations located in north, west, south and central part of Tehran. The level of air pollution was calculated according to PSI (Pollution Standard Index). Based on the results obtained during the study period, concentration of CO was reported as “above standard” on most of the days, leading to an “unhealthy” situation. 51.9% of measurements were made at PSI≤100 and standard conditions. 34.7% of measurements were at “unhealthy” levels with PSI= 101- 200. 13.2% of measurements were in “very- unhealthy” conditions with PSI= 201- 300. and 0.2% of measurements were recorded in one station and in a “hazardous” condition with PSI>300. For ozone (O3), all measurements were at standard conditions, PSI≤100. The concentration of SO2 on most of the days was at “standard” condition. Only 6% of the measurements (2 samples) were at “unhealthy” or “hazardous” levels, PSI=101-200.Regarding particulate matter (PM10), all samples were evaluated as 88.7% of the measurements were at standard conditions with PSI≤100 while 11.3% of the measurements showed “unhealthy” condition with PSI=101-200. It was observed that carbon monoxide and particulate matter were the main air pollutants in Tehran that had levels higher than standard values. The results showed that the number of admissions because of cardiopulmonary complaint was positively correlated with concentration of all studied pollutants except for ozone (O3). The main source for these air pollutants was motor vehicles. It is notable that atmospheric condition along with geographical situation of Tehran help augment the air pollution in this city. Thus, in addition to encouraging the use of CNG as the combustion material for cars, buses and minibuses, other extensive measures should be implemented in this regard.

Considering the effect of pentoxifylline on the immune system and reducing oxidative stress and also the anti-oxidative properties of captopril, these drugs are indicated for prevention and treatment of delayed pulmonary complications due to exposure to sulfur mustard (SM). Therefore, we decided to study the effect of slow release pentoxifylline and captopril on SM-induced delayed pulmonary complications in animal models. Pentoxifylline and captopril were administered for two weeks to mice exposed to sulfur mustard. Biochemical and pathological analyses included: hydroxyproline assay, alveolar space percentage and severity of inflammatory cell infiltration. The results were compared between groups using ANOVA statistical test. Hydroxyproline content of the lungs was significantly lower in the negative control group in comparison to positive control, captopril intervention and pentoxifylline intervention groups. There was no significant difference between groups in image analysis figures. However, there was a significant difference in extent of fibrosis, inflammation, and lymphocyte and PMN percentage between different groups. Pentoxifylline only resulted in decreased pulmonary inflammation without any effects on other indices. On the other hand, increase in hydroxyproline content of the lung in the captopril group compared to controls showed that captopril had accelerated the process of fibrosis. Hence, more research is recommended to study the effect of captopril on pulmonary fibrosis.

Atelectasis of the middle lobe or lingula of the lung is defined as middle lobe syndrome. On chest x-ray it is demonstrated as a wedge shaped density with anterior-inferior extension from the hilum. Although many etiologies have been implicated, this syndrome is one of the most common complications of asthma. A simple descriptive study was conducted on 11 patients with an age range of 0-18 yrs. They were admitted to Masih Daneshvari Hospital during 2000-2007 with the diagnosis of lingula or middle lobe atelectasis (of more than one month duration) and / or recurrent consolidation (2 times or more). The study group consisted of 6 boys (54.5%) and 5 girls (45.5%). All patients were clinically symptomatic at the time of admission. Cough was the chief complaint (7patients, 63.6%). The mean age at the time of initial diagnosis was 7.3 yrs (SD: 1.6).The most common findings on pulmonary CT-scan were infiltrations (3 cases, 27.3%) and atelectasis (3 cases, 27.3%). Non-obstructive causes were the most frequent etiologies which included asthma (n=3, 27.3%), pneumonia (n=2, 18.2%) and bronchiectasis (n=2, 18.2%).Among the obstructive causes, an undefined tumor (1 case, 9.1%) was to mention. Nine cases (81.8%) had negative blood cultures and 9 cases (81.8%) had AFB negative sputum smears (3×). Bronchoscopy was performed in 4 (36.4%); which showed rapid improvement after fiberoptic bronchoscopy (FOB). Medical treatment was planned for 9 children who demonstrated quick recovery. Surgery (lobectomy) was conducted in only 1 patient. Patients with right middle lobe syndrome (RMLS) had airway hypersensitivity, which is supported by the fact that asthma is very severe in this group of patients. Despite its low incidence, it should be considered very carefully and cautiously since it is associated with many severe complications. Therefore in undiagnosed suspected cases, in addition to a meticulous history taking, detailed diagnostic and therapeutic measures are recommended.

Hydatid disease is a parasitic infestation which is endemic in many sheep and cattle raising areas (such as Iran) and is still an important health hazard in the world. The aim of this study was to evaluate the outcome of surgical treatment in patients with hydatid disease. This retrospective study evaluated 72 consecutive patients who presented with pulmonary hydatid cyst to Mofid Children’s Hospital from 1992 to 2007. Patients’ medical records were reviewed and their gender, age, clinical features, cyst localization, diagnostic tools, operative techniques, pathologic report, morbidity and mortality, recurrence, hospital stay and outcome of treatment were evaluated. The patient group consisted of 40(55.56%) boys and 32(44.44%) girls in the age range of 2 to 14 yrs. In general, 72 patients had a total of 87 cysts. Fifty-five patients (76.38%) had single cysts. Fifty-five lung cysts (63.21%) were in the right side, and 31(35.64%) were in the right lower lobe. Cough was the most common symptom and chest radiography gave a correct diagnosis in 68(94.44%) patients. Conservative surgical treatment was carried out in 70 children (97.22%). There were no mortality or recurrence in our cases. Due to the high accuracy of chest X-ray in diagnosis of lung hydatid cyst, it is the preferred method of diagnosis in endemic regions. Parenchyma-saving surgical procedures such as cystotomy and capitonnage as well as cyst delivering by lung expansion are the preferred methods of treatment for pulmonary hydatid disease in childhood. These methods are safe, reliable and successful.

Smoking causes 5.2 million deaths annually in the world of which 70% occur in developing countries. Hookah smoking is increasing around the world especially in the Eastern Mediterranean Region including Iran. This study was carried out to evaluate the pattern of tobacco smoking in both forms of cigarette and hookah smoking. A cross- sectional study was conducted among a random population in the main squares of Tehran in 2006. The sample size consisted of 2053 people in the age range of 10 to 80 years. Non-Probability Sampling method was used. Questionnaires designed and adapted according to WHO and IUATLD questionnaires given to these people. Forty-six percent of the sample had experienced hookah smoking. The prevalence of occasional hookah smoking in the previous year was 45%, while 10% of the participants used hookah at least once a week, 17.9% at least once a month and 17.1% at least once a year;47.2% of participants had experienced cigarette smoking. Prevalence of daily cigarette smoking was 22.7%; 22.7% of current smokers and 25.01% of non-smokers consumed hookah at least once a week. Prevalence of hookah smoking is very similar among cigarette smokers and non-smokers. In this study the prevalence of cigarette smokers was more than national data and the rate of cigarette and hookah smoking among women was higher than that of other studies in this realm. These issues need to be further investigated and more serious studies are required in this regard.

Inflammatory myofibroblastic tumor is a rare occurrence in general practice. Its biologic nature, natural history and response to different treatment modalities are obscure. We retrospectively reviewed clinical and pathological features of 5 patients with inflammatory myofibroblastic tumor of the lung observed between 1999 and 2006. Under-study patients were 3 women and 2 men with a median age of 32.6 years. All patients were symptomatic. Computed tomography (CT) scan demonstrated a mass in all cases. Four patients underwent surgery (tumor resection in 1, lobectomy in 1, bilobectomy in 1 and lobectomy with mediastinal mass debulking also in 1). Complete resection was achieved in 2 patients who are currently alive with no evidence of disease. One died due to progressive disease. Another is alive with disease after incomplete resection, and one refused any kind of surgery. There was no operative mortality. All patients were under follow-up (range, 5 to 60 months; median 39 months). This study illustrates that some inflammatory myofibroblastic tumors behave aggressively and have a poor prognosis. It also confirms that radical resection is the treatment of choice for this malignancy.

Methods of opening the airways like tracheostomy are used to provide appropriate ventilation for patients with upper airway problems. Tracheostomy may be accompanied by some complications. In the present study, we reported a 41- year-old man with progressive dyspnea and cyanosis induced by fracture of tracheostomy tube. He referred to our center and a chest x-ray was obtained showing fracture of tracheostomy tube within trachea. He underwent surgery and fractured tracheostomy was removed/ extracted. A plastic tracheostomy tube was placed for him and he discharged the day after. Fracture and aspiration of tracheostomy tube is a rare complication which requires a prompt and precise management. Patient education regarding the maintenance of tracheostomy tube for prevention of this complication is highly recommended. (Tanaffos 2009; 8(1): 75-78)

Pompe disease is a glycogen storage disease (GSD) type II. Infantile-onset Pompe disease is fatal presenting with cardiac and skeletal myopathies and has an autosomal recessive pattern of inheritance with the prevalence rate of 1 in 40,000 live births (1). Its common symptoms include cardiomegaly, hypotonia, failure to thrive (FTT) and hepatomegaly (1).The patient was a 4 kg, 11-month-old infant with the history of jaundice and recurrent seizures under treatment with phenytoin (15 mg/day) and phenobarbital (15 mg/day). He was hypotonic, cachectic and pale (Hb=9.5) when presented to the anesthesia clinic of Labbafi Nejad Hospital for bilateral lensectomy. Induction and maintenance of anesthesia were carried out via the inhalation anesthesia method (N2O/O2 and sevoflurane). Laryngeal mask airway (LMA) was placed when achieving the appropriate depth of anesthesia. Bilateral lensectomy took 2 hours. After completion of the operation, the patient regained consciousness. His vital signs were stable and he was transferred to the recovery room and then to the ward. He was discharged from the hospital the day after the operation with no complications. (Tanaffos