Journal of Cardio -Thoracic Medicine
Volume:1 Issue: 1, Spring 2013

Data on imaging findings in pulmonary complications of chemical agents is scarce. The current study aimed to evaluate radiological findings of late onset pulmonary complications in chemical warfare victims (CWV) and to guide pulmonologists in diagnosis of these subjects. Ninety- three male CWV were enrolled in this prospective study, 20-25 years (mean=23) after exposure. Demographic and clinical data were recorded. High resolution computed Tomography (HRCT) of the lung was performed during inspiration and expiration and was double reported blindly by two radiologists. Final diagnosis was made according to HRCT findings. The HRCT findings, final diagnosis, and distribution of the abnormalities were compared between subjects whom had been exposed to more complex chemical agents used during the second half of the war and simpler agents during the first half. The most frequent HRCT findings were air trapping (56.7%) and mosaic attenuation (35.1%). The distribution of abnormalities was mostly local (79.4%) and bilateral (73%) especially in lower regions (61.3%). The diagnosed respiratory diseases included bronchiolitis obliterans (43%), chronic obstructive pulmonary disease (COPD) (27.9%), asthma (23.6%), bronchiectasis (13.9%) and interstitial lung disease (ILD) (9.6%). Frequency of subjects involved in the second half of the period of war was more than the first period (P-value < 0.05) but the HRCT findings were similar. Bronchiolitis obliterans with picture of focal bilateral air trapping was the most common finding in CWV but asthma appeared to have become a new problem in these subjects.

Chronic Obstructive Pulmonary Disease (COPD) secondary to sulfur mustard exposure, known as mustard lung, is an important late pulmonary complication. The BODE (Body mass index, Obstruction, Dyspnea, and Exercise) index has been established as a valuable tool for determining the adverse consequences of COPD. The aim of this study was to evaluate the role of the BODE index in patients with mustard lung. Eighty-two consecutively stable patients with mustard lung with all levels of severity were entered this study. The following parameters were recorded in all patients: standard spirometry, pulse oximetry, health-related quality of life, the BODE index. Additionally, the severity of COPD was determined by GOLD (Global initiative for chronic Obstructive Lung Disease) staging. The correlation of the BODE index with pulmonary parameters was determined. The mean age of the patients was 47.30±7.08 SD years. The mean BODE index was 3.16±2.25 SD. There was a statistically significant inverse correlation between the BODE index and oxygen saturation (r=-0.30, p=0.007). Also a statistically significant correlation was found between the BODE index and quality of life (r=0.80, p=0.001). The BODE index was not correlated with age of the patients and duration of disease. The results of this study showed that the BODE index is correlated with important clinical parameters and can be used in clinical practice

Tracheal stenosis is normally caused by trauma, infection, benign and malignant tumors, prolonged intubation or tracheostomy. The best treatment for tracheal stenosis is resection and anastomosis of trachea. Yet the major surgical complication of tracheal surgery is postoperative stenosis. The goal of this paper is to study the result of tracheal stenting as a replacement therapy for patients suffering from tracheal stenosis who are not good candidates for surgery. This study presents the results of stenting in patients with: Inoperable tumoral stenosis,Non-tumoral stenosis being complicated due to prior surgeries,Inability to undergo a major surgery.The study was performed between September 2002 and July 2011 and poly flex stents were used by means of rigid bronchoscopy. A total of 25 patients received stents during this study. Among them 15 patients suffered from benign and 10 suffered from malignant tracheal stenosis. The patients were followed up for at most 12 months after the stenting operation. The mean age of the patients was 35 years. The most common cause of stenosis was prolonged intubation (75%). The most common indication for stenting was the history of multiple tracheal operations. The most common complication of stenting and cause of stent removal was formation of granulation tissue. 30% of patients with benign tracheal stenosis were cured and about 10% improved until they could stand a major operation. Ten patients in benign group and 2 patients in malignant group (20%) needed T-Tube insertion after stent removal but other patientcure by stenting. In benign cases stenting is associated with recurrence of symptoms which requires other therapeutic techniqus, so the stenting may not be named as a final solution in benign cases. However, this technique is the only method with approved efficacy for malignant cases with indication.

Inroduction: Heart failure (HF) is an important cause of morbidity and mortality in the cases of Beta-thalassemia major. The purpose of this study was to estimate HF prevalence in these patients and to assess the survivability of those who were treated with intensive chelating therapy. Design and This cross sectional study included 72 beta-thalassemia major cases, the mean age at the time of referral was 15.7±6.2 years (range 6-35 years) and were followed in a prospective 2 year study. A self-reporting symptom questionnaire was administered, a 12-lead ECG was taken and an echocardiography was obtained from all participants. Echocardiography was performed at 6 month intervals or when a new symptom developed. Risk factors (except for iron overload) in the study population were hypothyroidism and diabetes mellitus. The male to female ratio was0.75.Twelve patients had left ventricular (LV) systolic dysfunction and 57,79% had LV diastolic dysfunction whereas 11,15% had RV failure. Fifty-nine (81%) patients had cardiac disease of which diastolic dysfunction was the most common manifestation. Those with systolic dysfunction were older at presentation (22 ± 6 years versus 31 ± 4 years; P <0.001), and had the highest mean serum ferritin level (3,355 ± 1241 ng/mL versus 6,397 ± 1,613 ng/mL; P <0.001). The 2 year survival rate in patients with beta thalassemia in this study was 98%. Diastolic dysfunction is highly prevalent in even asymptomatic beta-thalassemia major patients. The high prevalence of diastolic dysfunction is indicative of a significant amount of the population who are at a high risk for HF

Aortic valve sclerosisis considered as a manifestation of coronary atherosclerosis. Recent studies demonstrated an association between aortic valve sclerosis and obstructive coronary artery disease. The purpose of this study was to evaluatethe correlation betweenaortic valve sclerosis andobstructive coronary artery disease and the extent of coronary artery disease in patients hospitalized for chest pain. A total of 230 consecutive patients were referred to the coronary angiography of GhaemMedical Center and were subjected to transthorasic echocardiography for screening of aortic valve sclerosis and coronary risk assessment. The diagnostic value of obstructive coronary artery disease for aortic valve sclerosis was calculated. The patients with obstructive coronary artery disease had a higher prevalence of aortic valve sclerosis compared to those with no coronary artery disease (P< 0.05). Aortic valve sclerosis was an independent predictor for obstructive coronary artery disease by multivariate analysis (P< 0.05). Aortic valve sclerosis had sensitivity of 47% and specificity of 79% and positive predictor value of 92%. Aortic valve sclerosis was an independent predictor for obstructive coronary artery disease in patients with chest pain and was strongly interrelated with the extent of coronary artery disease in these patients.

To assess the efficacy and safety of bronchial artery embolization in the treatment of massive hemoptysis. A retrospective study on 46 patients (26 males and 20 females) who were referred to the Razavi Hospital from April 2009 to May 2012 with massive hemoptysis and had bronchial artery embolization procedures. General characteristics of the patients including age, gender, etiology, and thorax computed tomograms, findings of bronchial angiographic, results of the embolization, complications related to bronchial artery embolization and clinical outcome during follow-up were reviewed. The etiology included previous pulmonary tuberculosis in 20 cases, previous tuberculosis with bronchiectasis in 16 cases, bronchiectasis in 6 cases, and active pulmonary tuberculosis in one case. No identifiable causes could be detected in three patients. Moreover, massive hemoptysis was successfully and immediately controlled following the embolization procedure in all patients. One patient developed recurrent hemoptysis during one month following the procedure and was treated by re-embolization. No major procedure–related complication such as bronchial infarction was identified However none of the patientsexperienced neurological complications. Bronchial artery embolization is a safe and effective means of controlling massive hemoptysis and should be regarded as the first-line treatment for this condition.

Myxoid is a common type of liposarcoma. Cardiac metastasis of sarcoma is a rare diagnosis. Transthoracic echocardiography is a useful tool for beginning the diagnosis. Curative resection of metastasis and then combination systemic chemotherapy for advanced disease is recommended. We report a 50 year old woman who presented with a cardiac metastasis of high grade round cell liposarcoma to right atrium and right ventricle. The tumor was diagnosed with computed tomography and transthoracic echocardiography. The tumor size was 10*10 cm. This is the second report of successful resection of a large intracardiac metastasis of liposarcoma.