Medical Journal of Mashhad University of Medical Sciences
Year:2007 | Volume:50 | Issue:95|Papers Count:25

Introduction: Radionuclide scanning of the heart has incremental value in diagnosis and risk stratification of coronary artery disease. Gated myocardial perfusion SPECT is a new method and the state of the art in coronary artery disease detection. This study was done to evaluate estimation of LV volume, wall motion diameters and ejection fraction by gated myocardial perfusion scan and make a comparison with trans thoracic echocardiography.Material and Methods: In this cross-sectional descriptive study during Sep 2001-Dec 2002, 68 patients suspected of IHD who were referred to nuclear Medicine Department of Imam Reza Hospital in Mashhad University of Medical Sciences were under taken gated myocardial perfusion SPECT, and then referred to echocardiography unit for trans thoracic echocardiography. LV volume, ejection fraction, regional wall motion in different views of 2D-echo was recorded and the results were compared by descriptive statistics.Results: This study was performed on 68 patients. The mean age of patients was 52.8 (min: 38, Max: 75). 54% of patients were male and 46% were female. Mean end systolic volumes of LV was 32.4ml (sd: 37.1) estimated by echocardiography and 68.3ml (sd: 52.2) stimated by radionuclide scan (pv: 0.00). Mean end diastolic volume of LV was l29.6ml (sd: 45.8) in echocardiography and l43.7ml (sd: 46.23) in radionuclide scanning (pv: 0.00). Mean ejection fraction value of LV was 54.6 (sd: 12.44) estimated by echocardiography and 54 (sd: 12.94) by radionuclide scan (pv: 0.00).Conclusions: Left ventricular end systolic and diastolic volumes and ejection fraction, obtained by gated myocardial perfusion scan and echocardiography, had significant statistic correlations and estimation of LV wall motions and ejection fraction by gated SPECT was as echocardiography.

Introduction: Nowadays, as many of the problems confronting kidney transplantation have been solved, the number of operations has increased dramatically. So, resource utilization and financial issues have been cited as a new problem for transplantation centres. This study was done to find and assess the factors which can reduce the hospitalization period, while this factor claims the biggest share of the total cost of the treatment process.Material and Methods: In this retrospective study, done in kidney transplantation word of Imam Reza Hospital, the medical history of 170 kidney transplantation recipients and. donors, whose operations were performed between 2000 and 2002, were studied. Collected information of recipient's characteristics included gender, age, reason for kidney failure, weight, height, blood group, dialysis period, transplantation history, immunosuppressant regimes, complications after operation, and hospitalization after the first discharge due to transplantation operation complications; and for the donors, age, sex and blood group of the donor and the type of donor (cadaver or living) and the relationship between the recipients and the donors were gathered in a questionnaire and analyzed by descriptive statistics and T-test.Results: A mong all pre-transplant variables only length of dialysis before transplantation and the relationship between donors and recipients were found to be independently significant in predicting the increased hospitalization period and consequently charges.Conclusion: It is shown that by reducing the waiting time and performing more operations on relative donors and recipients, we can significantly decrease hospitalization period and as a result the cost of treatment.

Introduction: Undescended testes is seen in 3.4% male neonates and 20% of these testes are nonpalpable. This study was done to evaluate the diagnositic and therapeutic effects of laparoscopy in children and young adults nonpapable testes.Material and Methods: This descriptive study was done in Urology Department of Ghaem Hospital. 15 patients aged 9 months to 31 years and 19 Testes were studied. Through a 5 or 10mm incision above umbilicus, 5 or 10 mm Hasson trocar was inserted under vision. 5 or 10 mm telescope was used to see whether the testis was present or not. If not, the operation was ended. Otherwise, the process followed by standard orchidopexy or laparoscopic orchidopexy or laparoscopic orchidectomy. Results: 2 cases did not have testis (19 & 3 years), 9 cases had unilateral NPT (7 rights, 2 left); three bilateral, and the last one, a case of testicular feminization with karyotype of 46 XY and chief complaint of amenorrhea. 4 cases had standard orchidopexy and in the last three, one stage laparoscopic orchidopexy was done. In the testicular feminization case laparoscopic orchidectomy. All testes brought into the subdartus fascia, they remaind in the scrotume without athrophy.Conclusion: Laparoscopy is the best tool for diagnosis of non palpable testis. Laparoscopic orchidectomy is also the choice treatment for testicular feminization. Laparoscopic orchidopexy is feasible and can be a duplicate of open orchidopexy.

Introduction: Thyroid diseases particularly nodular lesions are among the most common diseases of human. Approximately 5% of the populations have palpable thyroid nodules which are detected in the routine Autopsy. Nearly 95% of thyroid nodules are benign wherease malignant nodules include 5% of them. Fine needle aspiration (FNA) has been recognized as a simple, inexpensive and available procedure for rapid diagnosis. The objective of this study was to determine the value of FNA in thyroid diagnosis.Material and Methods: In this retrospective research, 536 patients with thyroid nodules reffered for FNA or hospitalized for thyroid surgery in Imam Reza Hospital from March 2002 until March 2005 were studied. Individual and laboratory data were gathered in a questionnaire and analyzed by descriptive statistics.Results: This study included 107 men and 429 women and the average age of patients was 40 years. Out of 536 patients 12.7% had malignant, 70.3% benign and 8.6% yield suspicious results and 2.4% of FNAs were insufficient. Comparing the results of FNA and biopsy, FNA had the specificity of 89.5%, sensitivity of 91.5%, and accuracy of 93.7%; negative and positive predictive values were 80.9% and 95.5% respectively.Conclusion: These results reemphasized that, FNA is a simple and non invasive procedure and if performed carefully and evaluated by an expert pathologist is of high sensitivity and specificity.

Introduction: Chest wall tumor is an uncommon malignancy; and incomplete diagnosis and resection and inability to reconstruction of expanded chest wall defect after resection, Causes mortality and morbidity in patients. Academic surgery provides the best choice for the patients, and surgery technique should be based on the individual characteristics. This study was done to evaluate the surgery results of chest wall tumors and to report the operated cases.Material and Methods: The descriptive research was performed in Tehran Valiasr Hospital and Ghaem Hospital (Mashhad University of Medical Sciences) from 1995 to 2003 (9 years) and 61 patients have been evaluated in retrospective study. Individual, clinical, laboratory, treatment and complication data were gathered in a questionnaire and analyzed by descriptive statistics.Results: 28 (45.9%) patients had primary chest wall malignancy, 4 (6.55%) patients had metastatic tumors, 10 (16.39%) patients had benign tumors, 16 (26.22%) patients had inflammatory disease and 3 (4.9%) had undiagnosed pattern.Conclusion: Results of our study and also review of other articles recommended that wide enblock excision of chest wall tumors with appropriate reconstruction is the best method of treatment.

Introduction: Iron deficiency is the most common cause of anemia worldwide, however a significant number of these patients remain undiagnosed. Based on the high frequency of iron deficiency anemia and H. pylori infection in Iran, This study was done to evaluate their correlation.Material and Methods: This descriptive study was done in Imam Reza Hospital in the year 2005. 184 patients mostly with GI system complaints were referred for determination of serum anti H.pylori IgG and IgA levels. In addition, we performed complete cell blood count and serum ferritin concentration tests for all the patients. Individual, cell blood count and serum ferritin concentration data were gathered in a questionnaire. Statistical analysis was performed by SPSS software and descriptive statistics.Results: Our results showed that in 77.8% of our patients at least one of serum anti H. pylori IgG or IgA antibodies were positive. The rate of positive serology was increased in higher age groups.Patients' gender did not influence the results. Serum ferritin level did not show any correlation with H. pylori infection and the frequency of iron deficiency anemia was not higher in infected individuals.Conclusions: Although many studies have shown positive correlation between H. pylori infection and iron deficiency anemia, few studies have not confirmed these findings. Our study does not support this correlation, as well. Due to high frequency of both iron deficiency anemia and H. pylori infection in Iran, further large scale studies are recommended.

Introduction: Because of high prevalence and morbidity of UTI in children, early diagnosis and on time treatment are essential; but confirmation of UTI diagnosis needs a urine culture which takes at least 48 hours. The aim of this study was to ascertain predictive values of urinalysis in the diagnosis of UTI.Material and Methods: In this descriptive study the recorded files of 59 febrile patients, 30 patients with positive urine culture and 29 patients with negative urine culture, hospitalized in Imam Reza Hospital from 2003 to 2004, were evaluated. Age, sex, results of UIA including pyuria, hematuria, urine nitrite test and urine culture were gathered and analyzed using descriptive statistics.Results: In this study sensitivity and specificity of nitrite test in diagnosis of UTI were 46.7% and 89.7% respectively. Sensitivity and specificity of pyuria were 76.7% and 48.3% respectively. Sensitivity and specificity of UIA in diagnosis of UTI in children under 2 years old were 85% and 70%, but in patients older than 2 years old were 100% and 35% respectively.Conclusion: This study indicated that non active UIA in children older than 2 years old rules out UTI in nearly 100% of cases.

Introduction: Knee osteoarthritis is a common condition having an increased prevalence with age. Non-pharmacological interventions are frequently and widely used and strongly recommended in the management of patients with osteoarthritis. Lateral-wedged insoles have been shown to help clinical pain associated with medial compartment osteoarthritis. Yet, it has been shown ineffective in some studies. This study was done to compare the effect of laterally elevated wedged insoles with neutrally wedged insole an the symptom of patients with medial knee osteoarthritis.Material and Methods: This double-blind clinical-trial study was done in Rheumatology ward of Imam Reza Hospital in the years 2004-2005. 118 patients were randomly drivided into 2 groups. Case group (57 patients) received laterally wedged insoles and control group (61 patients) received neutrally wedged insoles for two months. Edinburg knee functional scale was used. At the end of month 2, Patients were asked about the severity of knee pain within the last 2 days and the amount of anti-inflammatory drugs taking within the 2 weeks ago and another Edinburg knee functional scale completed. Analysis of data was performed with SPSS version 11.5. The results were compared by using student's t test, chi-square and Mann Whitney tests.Results: Of the 150 patients enrolled, 118 (49 famel and 8 male in laterally wedged insole group and 52 famel and 9 male in neutrally wedged insole group) completed the study. There was good baseline balance between the groups, in respect of self reported knee pain, Edinburg knee functional scale and anti-inflammatory drugs taking by the patients. At the end of the study there was statistically significant difference in severity of knee pain in each of the groups from baseline. (P<0.001 in laterally wedged insole group and p=0.012 in neutrally wedged insole). However there was statistically significant difference in severity in severity of knee pain between the groups (P<0.001). edinburg knee scale had statistically significant difference from baseline in laterally wedged insole group (P<0.001), while there was no statistically significant difference in neutrally wedged insole group (P=0.645). there also was statistically significant difference from baseline in laterally wedged insole group on taking anti-inflammatory drugs (P=0.001), but not in neutrally wedged insole group (p=0.941).conclusion: laterally elevated wedged insole was shown to be more effective in reduction of symptoms in osteoarthritic patients.

Introduction: Hyperthyroidism is a state of high bone turnover, but there is controversy about its effects on bone mineral density. It is more common in females (F: M ratio 10:1). Since post-menopausal women are potentially at risk for osteoporosis because of aging and estrogen deficiency and because hyperthyroidism is more common in females, this study was done to determine the effects of hyperthyroidism on bone mineral density (BMD) in premenopausal thyrotoxic women.Material and Methods: In this case- control study 50 women with untreated hyperthyroidism (age-range 20-50 yr) from out patient endocrine clinics in the years 2004- 2005 were selected. Patients who used drugs or had diseases that affect bone mineral density were excluded. After history taking and physical examination, thyroid function tests, PTH, phosphorus, calcium, alkalin phosphatase, fasting plasma glucose and creatinine were measured and then bone densitometry by LUNAR (DPX-IQ) device was performed. One hundred and ten age-and weight - matched healthy women from participants in Iranian Multicenter Osteoporosis Study (IMOS) were selected as controls. SPSS version 11.5 was used for data analysis and P value less than 0.05 cosidered as significant. Results: Mean of age, height and weight was similar in patients and controls. Forty seven cases (94%) had Graves' disease and 3 cases (6%) had toxic solitary adenoma. Mean duration of disease before diagnosis was 6.02±4.38 months. There was no significant difference in mean of bone mineral density in vertebral column (p=0.83) and also in femural neck (p=0.74) between patients and controls. There was no correlation between bone mineral density in vertebral column and also in femural neck with serum levels of T4, T3, TSH and FT4I. There was no correlation between bone mineral density and duration of disease before diagnosis and also between bone mineral density and age.Conclusion: Hyperthyroidism is a known state of high bone turnover, but in hyperthyroid premenopausal women with disease of short duration and without other risk factors of low bone mass, bone densitometry could not be recommended as a required routine measurement.

Introduction: Dislocation displasia of the hip (DDH) is one of the most common congenital deformities and early physical examination is the best method for diagnosis. Ortolani and Barlow are two famous tests suggested by almost all of text books and research for early diagnosis of DDH. This study was done to evaluate their usage in neonatal physical examination.Material and Methods: This descriptive study was done in labor wards and Neonatal wards of Mashhad Medical University Centers. 184 neonates in center A and 229 neonates in center B were studied. Midwifery students were taught about clinical examination and Ortolani and Barlo tests. They divided in to two groups and their 3-month attempt in this field was observed. Data was gathered in a questionnaire and analyzed by SPSS, descriptive statistics and frequency distribution tables.Result: Evaluation of 235 neonates who were born in two hospitals of Mashhad University (A center=131, B center=104) showed that only 0.85% of neonates have been evaluated by gynecologist, and 23.6% by podiatrist. 24.26% of neonates were out of controls that were not used in the study.Conclusion: This study showed the danger alarm of increasing risk for neglected DDH. Teaching, and emphasizing on performance of these two tests can decrease handicapped population rate, cost of treatment and rehabilitation.

Introduction: Succinylcholine is a depolarizing muscular relaxant with rapid onset and short-acting effect. It is of considerable usage in emergency conditions and short - term surgeries; but has several side effects, a great deal of which will be reduced by prevention of fasciculation.Material and Methods: This clinical- trial stady was done in the year 2006 In Ear, Nose, Throat department of Imam Reza Hospital. 40 patients with ASA I and ENT operations categorized randomly into two similar groups. Control group received sufentanyl 0.2 mg/kg, propofol 2.5 mg/kg and succinylcholine 1.5mg/kg. In case group lidocaine 1mg/kg and after 1 min succinycholine was administered. Incidence and severity of fasciculation and quality of intubation were evaluated. Data was analyzed by descriptive statistics, T-test, c-square, valis, and c2.Results: Demographic parameters were not different significantly according c2 test. There was significant difference regarding the incidence of fasciculation but there was no significant difference with respect to the intensity of fasciculation and quality of intubation.Conclusion: This study showed that lidocaine 1mg/kg before induction decreases succinylcholine-induced fasciculation.

Introduction: Pulmonary tuberculosis is one of the most known human diseases and has a long history. Regarding the fact that its prevalence among Iranians is relatively high, several programs have been designed in order to control this disease. The objective of this study was to determine weather there is any relationship between pulmonary tuberculosis and cigarette smoking as an independent risk factor. Material and Methods: This study was a case control survey done in Pulmonary Ward of Imam Reza Hospital from January 2003 to March 2006. 64 males with tuberculosis were compared with 64 non-tuberculotic males in the same range of age Data was gathered with a direct questionnaire and analyzed with SPSS software.Results: The results derived from this study indicated that the percentage of smokers was 59.4% in the case group who had pulmonary tuberculosis; while it turned to be 37.5% in the control group.These was a significant difference between two groups in smoking duration, number of cigarettes smoked per day and the age about which the smokers started smoking.Conclusion: The study showed that smoking is an independent risk factor for pulmonary tuberculosis infection. Regarding other studies that revealed the role of cigarette smoking in suppressing the immune system, it is highly advised to design effective programs for cigarette quitting to reduce the rate of tuberculosis in the society.

Introduction: Central Nervous System (CNS) infections especially meningitis is a medical emergency that once suspected should be proved through Lumbar Puncture (LP) and cerebrospinal Fluid (CSF) analysis. On the other hand due to life–threatening complications such as brain herniation in the people older than 60, the procedure safety is debated. This study was done in order to determine the necessity of the Lumbar Puncture (LP) in the patients older than 60 years old who are suspected to meningitis.Material and Methods: This descriptive study was done in Infectious Clinic of Imam Reza Hospital, Mashad, Iran from fall 2003 to fall 2005. 90 patients who were suspected to meningitis and undergone brain CT scanning and LP were studied. The results of patient's history, physical examination, demographic information, CT scanning and LP all collected in a questionnaire and analyzed by spss and statistics examinations.Results: Among 90 patients suspected of meningitis who underwent Brain CT-scan and LP, 81 suffered from loss of consciousness, 2 were chronic course and 7 without clinical LP contraindication other than age. 75 had normal CT-scan and 15 had abnormal CT-scan, amongwhich was no space occupying lesion with mass effect or midline shift. Final diagnosis was acute bacterial meningitis in 14 cases and aseptic meningitis in 7 cases and other causes of meningitis in 7 cases, Encephalitis in 1, and 61 cases other CNS infection.Conclusion: Despite other clinical contraindications for LP in most of the patients, in 75 cases (83%) brain CT-scan was normal and in only 15 cases (17%) there was abnormal CT-scan among which none was a contraindication for LP (i.e space occupying lesion with mass effect or midline shift). Therefore the role of «age over sixty» as an absolute indication for Brain CT-scan, regarding the existing medical facilities and conditions in our country, did not seem acceptable.

Introduction: During the last decades, the incidence of fungal infection has been increased in many countries. Because of the increasing resistantce to antifungal agents, determination of an efficient strategic plan for treatment of fungal diseases is an important issue in clinical mycology.Material and Methods: Many methods have been introduced and developed to determine invitro susceptibility tests. During the recent years, flow cytometry has been developed to solve the problem, and many papers have documented the usefulness of this technique. This study was done to evaluate the invitro susceptibility of standard PTCC strain and some clinical isolates of Candida evaluated by macrodilution broth method according to NCCLS guidelines and flow cytometry susceptibility test. This descriptive study was done in Iran Medical University. Clinical isolates of Candida were treated by Amphotericin B, Clotrimazole, Fluconazol, Ketoconazol and miconazole and then evaluated by flow cytometry and microdilution. Data was gathered in a questionnaire and analyzed by descriptive statistics.Results: The data indicated that macrodilution broth methods and flow cytometry have the same results in determination of MIC for amphotericin B, clotrimazole, fluconazole, ketoconazole and miconazole in Candida albicans PTCC5027 as well as clinical candida isolate, such as C.albicans, C.kefyr, C.glabrata, c.parapsilosis and C. dubliniensis.Conclusion: Comparing the result obtained by macrodilution broth and flow cytometry methods revealed that flow cytometry was more convenient and faster than broth methods. It is suggested that flow cytometry susceptibility test can be used as a powerful tool in determination of MIC and administration of the best antifungal drug in treatment of patients with Candida infections especially systemic candidacies.

A 50 years old man with biopsy-proved cirrhosis of liver, post HCY infection was on Peginterferon alfa 2-a (PEGASYS) and ribaver in (COPEGUS) since nine months ago.Pegylated interferon alfa 2a administered once weekly 180 microgram and ribaverin 800 mg/ day. HCY-RNA was undetectable at week 24 (Response) and alanine aminoteransferase concenteration was normalized in week 12. According to genotyping result the patient was categorized in difficult- to - treat group (genotype I-a and cirrhosis).Treatment planning and patient condition was stable until ten days ago; when he began to have fatigue, fever, malaise and caugh without production.On more examination of the patient he had lost one and half kilogram in weight. And suffering of exertional dyspenca and had low grade fever. The pulse rate was 115, the blood pressure was 130170 mmHg. The urine was positive for protein (+) and in CBC hyper leukocytosis and neutrocytosis (19000-75%) with 10% bandemia was reported. A chest X.Ray showed many pulmonary nodules, mostly in the right side and unilaterally blunt costodiaftagmatic angel. A C.T. Scan of the thorax showed some nodules without cavitatoin and calcification with alveolar infiltration in the lower part of right lung.Blood culture was obtained and the patient referred to a general hospital, but he refused hospitalization, and continued medical approach and treatment at home.PPD skin test was 8mm without induration and sed rate 85mm in the first hour. Sputum test for MTuberculosis Bacilli was negative ANA, C3, C4 were at normal range, SGOT 45, SGPT 47. Cryoglobuline positive and gammapathy was reported. Ultra sonography of kidneys was normal. A laboratory report clarified the diagnosis.

Introduction: Abetalipoproteinemia is a rare disorder of lipoprotein metabolism, which causes low levels of cholesterol and absence or very low levels of LDL and VLDL. This rare autosomal recessive disorder is characterized by lipid malabsorption, spinocerebellar degeneration, acanthocytosis and retinopathy. In this study two cases of this disorder presented with severe malabsorption and abdominal distention, which mimicked celiac and fibrocystic diseases were reported.

Introduction: There are a number of systemic-to-pulmonary artery shunts being performed by various surgeons. Currently the most widely used systemic-pulmonary shunt is the modified Blalock-Tausig shunt. This shunt is highly effective even in neonates with small pulmonary arteries. The case ofa 15-year-oldgirl in whom the internal thoracic artery was used to create a systemic-pulmonary artery shunt after the failure of a previous Blalock-Tausig shunt is reported. This was the first report of such a case in which the internal mammary artery was used to establish systemic to pulmonary arterial flow in Iran.

Introduction: Sinus histiocytosis with massive lymphadenopathy (SHML) or Rosai-Dorfman disease (RDD) is a rare benign histiocytic disease of unknown etiology, usually associated with lymph node enlargement in various superficial or deep sites.It usually shows a prolonged clinical course with occasional exacerbation and remission phases. In this article case of RDD in a 5-year-old male with large right inguinal and bilateral cervical lymphadenopathies were, occasional fever and anemia was described. The clinical presentation, histopathologic characteristics, and treatments of RDD were discussed.

An important problem with chronic hepatitis C is indolent course of disease, however, given sufficient time, chronic hepatitis C many progress to cirrhosis, hepatocellular carcinoma and it is estimated that the number of deaths caused by chronic hep C and related diseases will triple in the next decade. One of the various extrahepatic manifestations of chronic hep C is essential mixed cryoglobulinemia. This syndrome is a systemic vasculitis with remarkable manifestations including: pupura, neuropathy, glomerulonephritis, hepatosplenomegaly.Nephritic synd is the most common manifestation of cryoglobulinemia but in spite of positive cryoglobulin of serum of patient. There was no marks of kidney involvement. Cryoglobulinemia is found in one third of patients with HCV; but only 1-2% of these patients develop essential mixed cryoglobulinemia. This patient had no symptoms and Signs of renal disorder and besides had no purpura with a normal complementemia , indicated his pulmonary manifestation is not due to HCV infection.On clinical examination he had one and half kg weight loss. Low grade fever, exertional dyspenea and in last CBC report there was a hyperleukocylosis (19000) with neutrocytosis (75%) and 10% bandemia.B and neutrophils are younger forms than segmented neutrophils. Band neutrophils account for less than 4% of total circulatory neutrophyls. Bandemia (greater that 7%) suggests that bone marrow is releasing granulecytes early; and suggests that severe infectious process is happened (severe sepsis). Especially when it is associated with hyperleukocytosis.Chest. X. Ray of patient showed many pulmonary nodules and alveolar infiltration in C.T.Scan imaging, indicated a severe infection in the right lung with a plural reaction in the same side (pleural effusion).Non- infectious processes like pulmonary infarction, eosinophylic pneumonia and lung vasculitis are unlikely (due to CBC test and normal ANA, C3 and C4) Strongyloidiasis; disseminated form, without peripheric eosinophylia is not acceptable. Rhodococus infection a zeonosis of horses and humans in immunocompremised patient (Post HCV cirrhosis) because of absence of contact with horse in his history of patient is not suggested. Bartonellosis has been reported with pulmonary nodules in immuno compremised patients. Mycobacterial infections may occur in immunocompotent and immunocompremised patients, but the nodules if present would appear with cavitation. Cryptococcus also was unlikely, there was no history of contact with birds; and patients with cryptococcus infection have a very high temperature (42°c) permitting fungus growth. And lung infection is usually with meningitis. Pulmonary Candidacies usually is following of disseminated candidiasis and pulmonary nodules in this infectionis milliaryform and patients with candidias is have the history of antibiotic- therapy with neutropenic picture in white blood cell count.Nocardiosis is another diagnosis that would explain illness. The organism usually involves the lungs, so pulmonary infection is common form of disease. This organism is an Actinomycete with branching filaments, usually Gram positive on Gram's staining and variable results on acid fast staining. Pulmonary nodules are found in majority of cases. These nodules may be associated with pleural effusions. Nocardia is an infection of both immunocompromised and immunocompotent patients. And in patients with some immunologic disorders like our patient; HIV- infected persons and in persons with renal transplantation, the incidence of disease is high. Nocardia infection can occur in healthy persons, COPD, AIDS, cirrhosis and some other diseases. So The main considerations diagnosis in this case are Mycobacteriosis (T.B and none T.B infection) and Nocardiosis and diagnostic procedure is pleural effusion aspiration and bronchoalveolar lavage, gram staining of samples and cultures of specimens for nocardia and mycobacterium.Conclusion& Results: Diagnosis of Nocardiosis is based on culture. Smear of sputum and Gram staining that shows organism as weakly acid fast filaments, but partial acid fast staining is a specific staining that rules out other species of Actinomycetes. In this case, the lungs involvements were not due to extraliver manifestation of HCV infection. The two main diagnostic consideration in this case are Mycobacteriosis and Nocardiosis, but in needle pleural aspiration and smear and culture of sputum nocardia grew as weakly acid fast filaments and eventually the organism broke down in pleomorphic cocobacilli; a process necessitates for confirming the growing of nocardia. Because of an opportunistic infection following HCV cirrhosis it is necessary to determine the extention and metastatic spread of infection. But there was no signs and symptoms of extention of nocardia infection. The patient received co-trimoxazole and tolerated it well. After 4 week treatment, patient's situation was much better and he was told to continue the medicin for nine months. With suspicious of association of Nocardia with Pneumocystice Carinii and Listeriosis co-trimoxazol covers all of these infections.