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سال:1390 | دوره: | شماره: |تعداد مقالات:13

We are pleased to inform you that Prof. Peter Barnes from London Imperial College and Dr. Irfan Rahman from University of Rochester accepted our invitation to join the Tanaffos Journal Editorial Board team.Prof. Peter Barnes is Professor of Thoracic Medicine and Head of Airway Disease at the National Heart and Lung Institute and Honorary Consultant Physician at Royal Brompton Hospital, London.

INTRODUCTION There are currently more than 1.3 billion tobacco smokers in the world according to the World Health Organization (WHO) (1). It has been demonstrated that cigarette smoking is the most important risk factor for the development and progression of chronic obstructive pulmonary disease (COPD), and accounts for about 80% of COPD cases (2, 3).COPD, a term referring to two respiratory system diseases: chronic bronchitis and emphysema, is characterized by an airflow limitation that is not fully reversible. The airflow limitation is usually both progressive and related to the abnormal inflammatory response of the lungs to inhaled noxious particles or gases (4, 5).

Background: Postoperative pulmonary complications and pain are important causes of postoperative morbidity following thoracotomy. This study aimed to compare the effects of fast track and conservative treatment regimens on patients undergoing thoracotomy.Materials and Methods: In this randomized controlled clinical trial, we recruited 60 patients admitted to the thoracic ICU of Imam Reza Hospital in two matched groups of 30 patients each. Group 1 patients received fast track regimen randomly; whereas, group 2 cases randomly received conservative analgesic regimen after thoracotomy and pulmonary resection. The outcome was determined based on the incidence of pulmonary complications and reduction of post-thoracotomy pain in all patientswith forced expiratory volume in one second (FEV1)<75% predicted value which was measured while the patients were in ICU. The length of ICU stay, thoracotomy pain, morbidity, pulmonary complications and mortality were compared in two groups.Results: A total of 60 patients, 45 (75%) males and 15 (25%) females with ASA class I-III were recruited in this study.Postoperative pulmonary complications were observed in 5 (16.7%) patients in group 1 versus 17 (56.7%) patients in group 2. There were statistically significant differences in development of postoperative pulmonary complications such as atelectasis and prolonged air leak between both groups (P<0.001 and P=0.003). There was also a statistically significant difference in the rate of preoperative FEV1 (p=0.001) and ASA scoring (p=0.01) and value of FEV1<75% predicted in the two groups. The difference in length of ICU stay in two groups was statistically significant (P=0.003 and P=0.017 in FEV1<75% group). Four patients in group 1 and 9 patients in group 2 had FEV1reduced to less than 75% of predicted value (p=0.03).Conclusion: Using fast track regimen reduced postoperative pain and incidence of some pulmonary complications significantly when compared to the conservative regimen following thoracotomy and various lung surgeries.

Background: The efficacy of second line chemotherapy for relapsed non small cell lung cancer has been established. In this study, we evaluated the efficacy and toxicity of maintenance therapy with docetaxel in patients with non-small cell lung cancer who were stabilized with first line chemotherapy and had good performance status before relapse. The primary objective was to determine one-year survival and the other objectives were evaluation of adverse effects and time to progression.Materials and Methods: Eighteen patients with lung cancer were included in this study. All patients were at stage III and IV, without distant metastasis or neuropathy. All patients had been treated with platinum based regimen initially and were responsive or stable with no progression. The patients were treated with docetaxel 75 mg/m2 for a total of 4 cycles repeated every 3 weeks.Results: All patients accomplished 4 chemotherapy cycles and a total of 72 cycles were administered. The mean time of progression free survival (PFS) was 9-10 months and one- year survival (OS) was 94.4% without any significant adverse effect necessitating medical intervention. The mean survival time of patients was 18 (12-20) months.Conclusion: Using docetaxel as consolidation chemotherapy in patients with non small cell lung cancer can prolong time to progression of disease and probably patients' survival without significant adverse effects or negative impact on the quality of life.

Background: In healthy teenagers, obesity and physical inactivity are the two main factors that affect respiratory function.The aim of this study was to evaluate the effect of aerobic exercise training on improving lung function in overweight and obese students.Materials and Methods: Thirty overweight or obese subjects with poor endurance performance and mild deterioration of respiratory indices (forced expiratory volume and forced expiratory volume in 1 second<90% predicted) were randomly assigned into control (age: 16.6±0.83 years, height: 167±5.05 cm, weight: 80.44±7.65 kg) and intervention groups (age: 16.5±0.83 years, height: 166±6.7 cm, weight: 79.62±9.33 kg).The intervention group preformed 24 weeks of continuous treadmill running (3 days a week). Respiratory indices were measured pre, mid and post exercise. Independent t test, paired t test, Pearson's correlation test and repeated measure were used for analyzing the data.Results: In the intervention group, post exercise respiratory indices were significantly higher than the pre exercise values, and did not reach the predicted values. No significant differences were found in pre, mid and post exercise respiratory indices in the control group. In the intervention group, improvements in respiratory indices were positively correlated with maximum voluntary ventilation (MVV) improvement but not with BMI reduction. No significant differences were detected between the 2 groups in terms of pre, mid and post exercise measures of BMI, weight, height, and respiratory indices.Conclusion: In overweight and obese teenagers, appropriate aerobic exercise training can partly improve lung function by strengthening the muscles of respiration. However, in order to achieve the predicted values of lung function, a further increase in activity duration and decrease in BMI is necessary.

Background: The purpose of this cross-sectional study was to estimate the number of individuals with chronic bronchitis and/or chronic obstructive pulmonary disease in Isfahan. Our study results were compared with those of previous studies in Iran and similar studies in other countries.Materials and Methods: As a part of a population-based, cross-sectional study, 2, 200 randomly selected individuals aged 40 years or older were asked to take part in the survey; among whom, 1308 individuals (59.45%) agreed to fill out the respiratory questionnaire. This group consisted of 636 (48.6%) males and 672 (51.4%) females.Spirometric measurements were performed in 279 cases. COPD was defined by the "Global Initiative for Obstructive Lung Disease" criteria.Results: One hundred-seven individuals (8.1%) fulfilled the clinical criteria for chronic bronchitis as the main sign of COPD.Multivariate analysis revealed that age and smoking were independent predictors for chronic obstructive pulmonary disease.Conclusion: It is concluded that the prevalence of chronic bronchitis symptoms is approximately the same in our population as compared with western countries. The frequency of clinical chronic bronchitis has risen in comparison to a previous study in Isfahan.

Background: Pulmonary hypertension (PH) is a significant cause of morbidity and mortality in patients suffering from pulmonary parenchymal diseases. Diagnosis of PH has always been a major clinical dilemma due to its non-specific clinical manifestations. However, diagnosing PH and determining its severity are essential for the prognosis and treatment planning in PH patients. This study aimed at evaluating the correlation between the pulmonary artery diameter (PAD) in the CT-scan and pulmonary artery pressure (PAP) in echocardiography of patients.Materials and Methods: PAD was evaluated in the CT-scan of 117 patients suffering from interstitial lung disease (ILD) and the correlation between PAD and PAP was studied. A receiver operating characteristic curve (ROC curve) which is indicative of the precision of the diagnostic test was drawn to find the cut off point for the MPAD representing PH. The area under the curve was also calculated in order to define the discriminative power of the test.Results: PAP higher than 25 mmHg was considered as PH. PAD over 29 mm reported in the CT-scan for the diagnosis of PH in ILD patients had sensitivity of 63% and specificity of 41.5%. No significant linear correlation was found between PAD and PAP (P-value=0.17, r=0.15). The area under the ROC curve was calculated to be 0.49 in the cutoff point of 29 mm for determining PH (CI 95%=0.38-0.60, P=0.89).Conclusion: ROC curve showed a weak discriminative power. PAD had low sensitivity and specificity in the CT-scan for the diagnosis of PH. Therefore, we conclude that CT-scan alone is not helpful in finding PH cases and further examinations are required.

Background: Smoking cessation is an effective intervention for cancer prevention. For some reasons many smokers cannot attend quit programs and they prefer to have a consultation over the phone. In this study we share our experience regarding setting up a quit-line for smoking cessation for the first time in Iran.Materials and Methods: Two general practitioners were trained to give consultation over the phone via quit line in Tehran.The quit program consisted of 4 sessions with 1 week interval. Our telephone counseling was both reactive and proactive from 8 AM till 5 PM during the years 2005-2008. In reactive counseling, the smoker initiates the call and speaks with a counselor about his/her current concerns. In proactive counseling, the counselor calls the smoker and provides counseling in a systematic manner. Smoking status was determined based on smokers’ self-report and regular follow-ups were conducted after quitting. Some cases were randomly selected for CO respiratory test in order to confirm their abstinence.Results: A total of 480 cases entered the cessation program out of which, 80% were males. The mean age was 38.5±7.9 years, 72.7% of participants were married, 75.2% of subjects were educated and 51.3% of cases had high nicotine dependence. A total of 332 cases received a brief advice on quitting, 148 people continued their active participation to complete the course and 122 cases (82.4%) quitted smoking. The sustained abstinence rate after 1, 3, 6 and 12 months was 59%, 41%, 31% and 18%; respectively.Conclusion: This method is an appropriate and accessible method which can be suggested to smokers during smoking cessation counseling.

Background: The respiratory tract has been the most commonly affected site of illness in HIV-infected patients. The current study was done to identify the frequency of respiratory complications in a consecutive case series of HIV-positive patients in Iran.Materials and Methods: This study was a retrospective analysis at the national academic reference medical center of Imam-Khomeini Hospital, in Tehran, Iran. The study included 199 new admissions for 177 HIV-infected patients between 2000 and 2005.Demographic characteristics, risk factors for HIV infection, respiratory complications, and CD4+lymphocyte counts were evaluated in these patients.Results: All patients were males. The mean age was 35 years (age range: 15 to 63 years). Among 34 cases with available CD4+ lymphocyte count results, 70.6% had results<200 cells/mm3. Nearly half the patients (47.7%) had respiratory symptoms. The most common pulmonary complications were cough (86.3%), sputum (71.6%), dyspnea (54.7%), and hemoptysis (10.5%). The most common diagnosis was pulmonary tuberculosis (27.1%), followed by other bacterial pneumonias (16.6%) and pneumocystis carinii pneumonia (4.5%). Intravenous drug users who had history of incarceration had the highest risk factors for Mycobacterium tuberculosis infection (59%), and other bacterial pneumonias (52%).Conclusion: Our study demonstrates that respiratory complications are highly frequent in HIV patients in Iran and that pulmonary tuberculosis is still a common complication in HIV infected patients, despite the availability of effective treatment. Results suggest the need for more effective preventive and prophylactic measures, wider use of antiretroviral treatment and effective chemotherapy for Iranian patients with HIV/AIDS.

Herniation of an emphysematous bulla is extremely rare. A 55-year-old male patient presented with complains of shortness of breath and cough for the last 10 years which had exacerbated in the last two days. The patient was a diagnosed case of chronic obstructive pulmonary disease. Chest x-ray showed bilateral hyperinflated lung fields along with loss of lung markings in left upper lobe and a thin white line in right upper lobe suggestive of wall of bulla. High resolution computed tomography of the chest revealed anterior herniation of a pulmonary bulla from left to right side across midline. Patient was put on antibiotics, hydrocortisone and aminophylline by intravenous route and nebulization of steroid and bronchodilator.However, the patient expired after 5 days following admission.

A syndrome associating an upper-lobe emphysema and pulmonary fibrosis of the lower lung was recently characterized. Few cases were identified in the literature. We report a case of a 68 year- old smoker man presented for exacerbation of a severe dyspnea. Physical examination revealed basal crackles and finger clubbing. Blood gas analysis showed hypoxemia. Chest radiography showed features compatible with emphysema of the upper lobes and fibrosis of the basis. Chest computed tomography confirmed chest radiography’s findings and revealed fibrosis. The diagnosis of idiopathic pulmonary fibrosis was made. Pulmonary function tests showed obstructive pattern. Systolic pulmonary arterial pressure was elevated up to 87 mm Hg on heart ultrasonography.The authors emphasize the importance of the diagnosis of this entity made through chest computed tomography and the fact that it is characterized by severe impairment of gas exchange, the high prevalence of pulmonary hypertension and poor survival.

Scimitar syndrome is a rare clinical syndrome which consists of anomalous right pulmonary venous return to the inferior vena cava. Scimitar syndrome classically involves the right lung and is most commonly reported in very early infancy. However, it is occasionally seen in adults. We present a 38 year-old woman complaining of dry cough and exertional dyspnea during moderate exercise with right lung scimitar syndrome. The chest radiography showed increased radiolucency of the left lung and heart dextroposition with a characteristic appearance of scimitar sign which is a curvilinear density in the right middle and lower pulmonary fields resembling a curved Turkish sword.

WHAT IS YOUR DIAGNOSIS?A twenty-year-old woman was admitted due to non-massive hemoptysis and low grade fever from a few days earlier. She reported productive cough, no chills, no chest pain and no shortness of breath. On admission, she was stable with mild fever and no respiratory distress or tachypnea; the remainder of physical examinations was normal.She mentioned a history of diabetes mellitus type one (DM1) since a few years ago. Surprisingly, she was on oral agents for DM1. She was well until approximately a month ago when she developed episodes of unconsciousness and she was admitted to a hospital with diabetic ketoacidosis. After intensive care, the patient was discharged in an improved condition.She was a single employee, with no travel history in recent months. She was neither a drinker nor a smoker and was not using any illicit drugs. Allergic history was unremarkable.Laboratory analysis showed normal complete blood cell and differential counts, electrolyte levels and renal and liver function tests with 250 mg/dl random glucose level. Analysis of arterial blood gases revealed no acidosis and urinalysis showed no ketonuria.