Tanaffos Respiration Journal
Volume:1 Issue: 3, Summer 2002

Interventional bronchoscopy is a new and non-surgical diagnostic, therapeutic and palliative approach to patient with bronchial pathologies. It consists mostly of rigid endobronchial broncoscopy under general anesthesia, with the use of (1)Nd-YAG or KTP laser (2)Cryotherapy (3)Endobronchial prostheses (4)Photodynamic therapy (5)Brachytherapy and, (6)Thermocoagulation. The idea is to treat by non-surgical measures, most of the early stage tracheobronchial cancer (insitu or microinvasive). The other utility is to associate this technique as an adjuvant treatment with chemo-radiotherapy in advance lung carcinoma. Treatment of benign structural or endobronchial pathologies as well as control of hemoptysis and foreign body removal are the other indications. In the future, interventional bronchoscopy will be a leader to diagnose and treat bronchial diseases. (Tanaffos 2002; 1(3): 13-18)

Chronic bronchitis is expected to be less prevalent among Iranian women, since smoking is uncommon among them, however, recent reports disagreed this claim. Traditional baking and cooking with biomass fuel (wood fuel being the most commonly used) is still common in our villages and small towns. These seem to be contributive factors for high prevalence rate of chronic bronchitis among women. We conducted a case-control study to identify the possible risk of indoor smoke and biomass combustion. We compared 100 chronic bronchitis cases with 100 age-matched controls. The odds ratio (OR) was used as the basic statistic to evaluate risk. Chronic bronchitis was associated with cigarette smoking (OR=6.10; p=0.009), water-pipe smoking (OR=4.41; p=0.014), household baking (OR=4.90; p=0.002), using wood for baking (OR=3.04; p=0.000), using wood for space heating (OR=2.36; p=0.009), using wood for cooking (OR=7.17; p= 0.000), and using kerosene fuel for cooking (OR= 4.63; p=0.000). Results have revealed that among women in Chahar- Mahal- Bakhtiari, wood and other biomass fuels used for cooking, baking and heating are associated with chronic bronchitis. Changing to safer alternative fuels for cooking and heating would ameliorate the impacts of chronic bronchitis. (Tanaffos 2002; 1(3); 19-23).

Serous otitis is due to eustachian tube dysfunction and accumulation of fluid in the middle ear cavity. Otitis media with effusion (OME) is common among children and can cause hearing loss. Smoking is a common predisposing factor of this condition. The present study was conducted with the aim of determining the effects of smoking on the prevalence of OME among children residing in urban area of Tehran between 1996 and 1998. This cross-sectional study performed on 3833 pre-school and school-aged children which their age ranged from 2 to 11 years. Children were examined with pneumatic otoscope and tympanometry was performed; meanwhile, their parents were asked to complete a questionnaire. The incidence of OME was 9.1% and 14.1% in pre-school and school-aged children; respectively, and was higher among children with smoker parents. Parental smoking is a preventable predisposing factor for OME; meanwhile, there are significant statistical differences between healthy and sick children regarding their parents pack-years smoking. (Tanaffos 2002;1(3): 25-28)

Tuberculosis is a major cause of infectious disease mortality all over the world. Multidrug resistant tuberculosis (MDR-TB) is a major problem in the management of tuberculosis. With recent advances in understanding the immunopathogenesis of tuberculosis, the use of various cytokine therapies has been suggested. The objective of this study was to evaluate the efficacy of parenteral INF– for treating MDR-TB patients. To conduct the study, 12 MDR- TB patients hospitalised in the clinical mycobacteriology ward of Massih Daneshvari hospital were selected randomly between October 2000 and March 2001. All had chest involvement in radiography, so they were smear and culture positive on two occasions. All had at least resistance to isoniazid and rifampin in antibiogram. They were divided in two groups. One group received INF-; (3,000,000U, three times a week, subcutaneously) in addition to anti-TB drugs, and the other group received only anti -TB medications as control group. Results indicate that the mean (+SD) degree of sputum smear positivity at the beginning of therapy was 2.4+0.89 in the case group and 2+0.89 in the control group which showed no significant difference (p= 0.132). Also, at the beginning of our study, there was no significant difference in the degree of sputum culture positivity between the two groups. At the end of the 8th week, all cases became smear and culture negative, but all control subjects remained smear and culture positive (p= 0.017). At the end of the 6th month; however, only two cases remained smear negative, one remained culture negative and the rest became positive. All control subjects had positive culture results (p= 0.693). We conclude that cytokines have at least temporary effect on disease remission and can be used as adjunctive therapy. (Tanaffos 2002;1(3):29-34)

Tuberculosis is a disease of global importance. Indeed, the lack of sensitive methods for the diagnosis and inappropriate therapy may lead to increased multidrug-resistance (MDR) cases. However, early detection and identification of acid fast bacilli (AFB) in clinical specimens can lead to effective intervention. The sputum specimens from 156 clinically suspected tuberculosis patients and 40 non- tuberculosis patients were digested, examined microscopically for acid- fast bacilli, and inoculated into “Mycobacterium Growth Indicator Tube” (MGIT), BACTEC –12B vial and onto Lowenstein- Jensen slants by standard procedures. The result showed that smear was positive in 82(52.5%) and negative in 74 (47.5%) of 156 clinically suspected tuberculosis patients. The culture positive rate with Lowenstein- Jensen, MGIT, and BACTEC-12B vial were 122(78%), 136(87%), and 143(91%), respectively. Thereafter, MGIT indirect and direct susceptibility tests were performed on 15 sputum-positive specimens and the results were compared with proportional method. The results have revealed that accordance with proportional method was higher in MGIT indirect (83.5%) than direct (75%) susceptibility test, the difference was significant (p< 0.05). In another set of experiments, the indirect MGIT drug susceptibility test in 25 mycobacterium tuberculosis isolates were performed and compared with proportional method. The results showed that MGIT could correctly detect susceptibility to streptomycin, ethambutol, rifampin and isoniazid for 77.8%, 33%, 77.2% and 80%, respectively. Also, the agreement with proportional method for resistance were 88% for streptomycin, 80% for ethambutol, 80% for rifampin and 89% for isoniazid. Furthermore, by combining MGIT technology with L.J media, the mean time required for culture to grow for identification test was reduced from 22-28 to 12-16 days (p<0.05). MGIT is an efficient system to be used in center/ referral mycobacteriology laboratories of developing countries along with routine solid or liquid culture media. (Tanaffos 2002; 1(3): 35-44)

Tuberculous spondylitis or Pott’s disease results in characteristic deformity. In developed counties, Pott’s disease occurs primarily in older adult rather than children. In developing countries where the infection rate is high, it occurs mainly among children. We have reviewed the hospital records of pediatrics ward with diagnosis of tuberculosis between 1995 and 2001. There were seven children with the diagnosis of Pott’s disease. The age of the patients ranged from 7 to 14 years with mean of 11.14 years. All of them were Afghans. In four cases, spine was the main affected site, in two patients disseminated tuberculosis was seen; and in 1 case, spinal involvement was associated with pulmonary tuberculosis. Of them, five patients had paraspinal abscess. Fistula was formed in the lumbar region of 2 patients. Abscess discharge was AFB smear positive only in one case. The most common involved vertebral bodies were T12 and L1; however, thoracic and lumbar vertebrae from T12 to L4 were affected. In 4 cases, spondylitis resulted in kyphosis and in two patients, spinal cord compression was detected by imaging techniques. Pott’s paraplegia was seen in one patient. All patients were treated according to DOTS strategy, and one underwent surgical drainage of abscess. After termination of initial phase and relative improvement of signs and symptoms, 5 cases were referred for surgical management and subsequently maintenance treatment was continued for 10 months. We suggest that in the endemic countries for tuberculosis, Pott’s disease in children must be taken into consideration. Imaging techniques are also valuable means for confirmation of diagnosis. (Tanaffos 2002; 1(3): 45-49)

The purpose of this study is how to use CT-guided needle biopsy for the diagnosis of pulmonary, pleural, and mediastinal mass lesions. Meanwhile, the complications of the procedure were evaluated. The pathology results of 150 biopsy specimens, which were obtained from 145 patients aged from 9 to 87 years old (55.3±17.6) referred during a one-year period were reviewed, and the frequency of pneumothorax and hemoptysis were analyzed. Lesion size ranged 1-18 cm [mean (±SD) 6.5±3.4 cm]. 95 lesions were contacted to the chest wall. Pathological studies showed that 22 specimens were benign, 61 malignant, 28 nonspecific, 17 suspicious for malignancy, and 22 insufficient for diagnosis. Risk for pneumothorax and hemoptysis was 6 and 2 percent respectively, which were much better results than previous reports. Although our low complication rate may be attributed to the large size of the lesions and their small distance from the chest wall, we still recommend CT-guided needle biopsy as a useful diagnostic method for thoracic mass lesions. (Tanaffos 2002; 1(3): 51-55)

Langerhans cell histiocytosis (LCH) is a disease of unknown etiology that presents in three forms: Letterer- Siwe disease, Hand-Schuller-Christian disease, and Eosinophilic Granuloma. It is a multifocal disease that usually affects several organs and unifocal forms are rare. Pulmonary involvement occurs in approximately 40% of cases and almost always in young adults. Lungs are rarely affected in infant patients. This report presents a 15-month-old male infant that was admitted for cyanosis and respiratory distress. Diagnostic work up revealed a primary pulmonary histiocytosis and the treatment made a significant improvement of signs and symptoms by the time of discharge. (Tanaffos 2002; 1(3): 57-61)