TANAFFOS
Year:2003 | Volume:2 | Issue:6|Papers Count:17

The first surgical resection of single lung metastases was reported by Weinlechner in 1882. This metastatectomy was done for discrete pulmonary metastases which were discovered during resection of a chest wall sarcoma (1). The patient died on the first day after surgery. One year later, Kronlein performed same operation successfully (2). During surgery of a recurrent sarcoma of the chest wall in an 18-year-old girl, he noticed pulmonary metastases in the size of a walnut. He removed it with a wedge resection and the patient survived for 7 years later but unfortunately died due to a second recurrence. In spite of this successful metastatectomy, there was a long period of suspicion about metastatectomy among physicans. It was considered that the presence of metastasis indicates spreading of the disease so that, surgery is not useful. In spite of this belief, many efforts were done for surgical treatment of patients with pulmonary metastases (3,4). The advent of chemotherapy during 1960-70 caused an important impact on the treatment of pulmonary metastases. The majority of patients suffering from different malignancies survived for a longer period of time by this method, and some of them referred with solitary and removable pulmonary metastasis. In addition, the surgical methods were improved, and postoperative mortality was decreased.Nowadays, pulmonary metastasectomy is a part of treatment in most malignancies, and controversies are only with regard to operation indication and selection of patients. This procedure had good results in numerous reports (5- 10). Nevertheless, the total cure rate is around 20%, and successful results have been reported mainly in selected patient groups. Thus, we do not recommend metastasectomy as a routine procedure in all patients who have metastases. With good selection of patients and surgical approaches, nearly one third of all patients presenting with pulmonary metastases as the only site of the disease may benefit from resection of their metastases.

ackground: The present study was conducted to examine adverse pulmonary effects of exposure to cotton dust in Isfahan.Materials and Methods: All employed workers of Bafnaz textile factory were studied by medical interview, physical examinations, and spirometry in symptomatic subjects. Frequency tables were used to extract major symptoms and pulmonary illnesses. Logistic regression analysis was used to evaluate relationships between illnesses and possible risk factors.Results: All workers had some potential exposure to cotton dust; mean employment duration was 18.20±5.34 years. Prevalence of chronic cough, chronic bronchitis, asthma, and byssinosis was 2.4%, 30.8%, 9.2%, and 3.9% respectively. Odds ratios (OD)and 95% confidence interval (CI)for prevalence of chronic bronchitis and byssinosis in those working in most dusty jobs, after adjustment for age, smoking habit and duration of employment were; 1.77 ( 1.10-3.04), and 1.41 (1.33-2.63) respectively. In these textile workers, chronic respiratory symptoms and disorders were associated with job category after correction for age and smoking habits.Conclusion: These data support the evidence for an increased prevalence of respiratory disease in populations exposed to cotton dust.

Background: Deep Vein Thrombosis (DVT) and Pulmonary Thromboembolism (PTE) are one of the frequently missed and lethal complications in admitted patients. Unfortunately, in spite of the presence of consensus about prevention of DVT, these guidelines are not applied in most hospitals. Death rates from DVT and PTE are more than those of road accidents and breast cancer. Our study aimed to analyze the situation of DVT/PTE prevention in hospitals of Tabriz.Materials and Methods: Based on 75000/ year admission, we studied the records of 17 teaching wards in 7 hospitals systematically. At least 50 records from each ward were reviewed. Records with insufficient data; admissions of less than 3 days; heparin treated cases; uremic and cirrhotic patients; those with bleeding tendencies, and ENT, ophthalmology, pediatric wards were excluded. 1557 records were collected, and risk of DVT (low-moderate-high-very high) along with appropriate prevention method was stratified according to ACCP 1998 guideline for surgical ward. For stratification of risk factors in medical wards, comparable rate of prevalence of DVT/PTE was used for every medical condition.Results: Highest rate of DVT prevention was related to cardiology unit (63.4%) and lowest rate to thoracic surgery unit (2.7%). Appropriate prevention methods were related to cardiology (73.1%), pulmonary ICU (51.4%), and gynecology (42.3%). Inappropriate methods were related to neurology ICU, neurosurgery, and orthopedic wards (0%).Conclusion: This study shows that in spite of the presence of guidelines for prevention of DVT, and the importance of this in decreasing costs and mortalities, application of appropriate method in most wards is far from reality, and continuous learning of physicians about prevention of DVT and regular control of medical records by medicare is strongly recommended in order to reach a good endpoint.

Background: Cigarette smoking is considered as the commonest preventable cause of morbidity and mortality.Materials and Methods: The present study shows that over a 2- year period, a total of 743smokers have been registered in monthly therapeutic and training courses of Smoking Cessation Clinic. They have received audio-visual training and behavioral therapy. For Nicotine Replacement Therapy (NRT), nicotine dependence of the patients was assessed by Fagrostrom Tolerance Test in the beginning of each course.Results: The test scores of 170 people (31.2%) were less than 7 (low nicotine dependence), and 376 individuals (68.8%) had scores of 7 or more (high nicotine dependence). At the end of the course, 90% from the first group and 87.5% from the second group had successfully quitted smoking. In the above-mentioned groups, 23.5% from the first group and 48.9% from the second one received not only behavioral therapy but also NRT. However, it is noteworthy that all the smokers with respect to the training provided during the course were prescribed NRT while its usage was up to the patient. This means that half of the second group (51.1%) had succeeded to quit smoking only by means of education and behavioral therapy without any NRT.Conclusion: The role of this kind of training in implementing smoking cessation program is essential.

Introduction: Chemical weapons, (mainly mustard gas-MG) were heavily used by Iraq against Iranian soldiers between 1984-1986. It has acute effects on respiratory tract in the form of tracheobronchitis and ARDS, whereas chronic respiratory complications include chronic bronchitis, bronchiectasis, asthma and pulmonary fibrosis. There are few reports about human victims. Some of them describe acute effects while our purpose is to define chronic sequelae and their microbiologic, radiologic and physiologic behavior.Materials and Methods: Fourty four chemical weapon injured patients with moderate to severe disability were selected by AMA criteria (1). All of them underwent history taking and physical examination, ABG, spirometry, CXR, HRCT, bronchoscopy and BAL for cytology and quantitative culture.Results: Of fourty four patients; 29(66%) had diagnosis of chronic bronchitis by ATS criteria (2), 8 (18%) and 7 (16%) had diagnosis of bronchiectasis and asthma respectively. The most common HRCT finding was ground glass appearance. In one-fourth of patients BAL culture was positive and revealed unusual organisms (S.aureus, S.coagulase negative, E.coli)., BAL neutrophils were increased in bronchiectatic group (258±136 hpf) vs. (96±49 hpf), (148±133 hpf) (p<0.01 p). Bronchiectatic patients were younger than the other groups (35.5±6.1 yr) vs. (43.5±5.2 yr), and (42.3±5.2 yr) (p<0.01).Conclusion: The most common respiratory complication of MG is chronic bronchitis. Unusual microorganisms should be considered in the treatment of pulmonary infections. Persons who are exposed to mustard gas at younger age maybe more prone to development of bronchiectasis.

Background: Diabetes mellitus is the most common endocrine disease. Most of the patients suffering from diabetes mellitus complain of hearing loss. Since the previous studies made in this regard were not complete, this study was further conducted in order to evaluate the adverse effects of diabetes mellitus on the hearing ability of the diabetic individuals referring to the clinics of the Medical Universities of Tehran, during 1994-2001 (1373-1380).Materials and Methods: This investigation was a prospective analytical study carried out on two groups of population in Tehran. The first group consisted of 1500 diabetic patients (case group), and the second group consisting of 1400 normal individuals (control group). The age of the studied population was between 15-55 years. The “case group” consisted of “Diabetic Mellitus Confirmed” patients who were randomly chosen and were willing to cooperate with this study. Initially all of the patients were interviewed and later underwent complete physical examination, audiometry (pure tone, speech, impedance), and “Auditory Brainstem Evoked Response” (ABR) evaluations. The “control group” consisted of individuals that had visited the clinics due to different reasons and according to the standards of the “International Diabetes Federation” they were considered as “Not having Diabetes”. They were also willing to participate in this study. Similar audiometric examinations were performed on this group. Finally the examination results of the two groups were compared.Results: The following results were obtained in this study: 1- The existence of a specific and distinct hearing loss in high frequencies (4-8KHz) between the case and control groups (p<0.05).2- Presence of a significant difference in the hearing level of the NIDDM patients in the high frequencies as compared to the control group (p<0.01).3- There was a distinct hearing loss in the “Complicated Diabetic Patients” in the high frequencies as compared to the normal control group (p=0.01).4- Patients with short term diabetes mellitus had normal level of hearing, but in patients suffering from long term diabetes mellitus, there was a significant hearing impairment in the high frequencies (4-8 KHz) as compared to the control group (p<0.005).Conclusion: Due to the prevalence of diabetes mellitus in the community and the presence of sensorineural hearing loss (especially bilateral) in the high frequencies in a significant number of studied patients, it’s recommended to carry out a complete diagnostic audiometric evaluation in all the diabetic patients and to repeat the auditory tests regularly every year. With this method, we can not only be informed of the “Hearing status” of the patient but also use the results as a guideline and outlook for a better control of diabetes and its related complications.

Introduction: Tuberculous spondylitis is an uncommon form of extra-pulmonary TB. Delay in establishing diagnosis and management causes spinal cord compression and spinal deformity.We studied to determine clinical and radiological presentations of this dangerous form of TB diseases.Materials and Methods: During 2002-3 years, all patients over 14 years old who hospitalized with a probable diagnosis of TB spondylitis were evaluated. Everybody with mycobacteriologic or pathologic confirmation was enrolled in study.Results: fourteen patients met our inclusion criteria. The mean age (±SD) was 39(±16) year. 57% were male. Treatment delay was 8.3 months. Fever reported in 7(50%) patients. Local tenderness was reported in 92.6% of cases. PPD was positive in half of the patients. The most regions involved were T8-T12 (43%) and L1-L3 (36%) respectively. Sputum smear was surprisingly positive in 50% of cases. Most of the patients had received anti-TB drugs for 9-12 months.Conclusion: CT guided aspiration and biopsy of spine lead to correct diagnosis in 93% of patients. Simultaneous pulmonary involvement is evident in half of them.

Background: At the present time among various infectious diseases, tuberculosis is considered as one of the leading causes of death in adult population. These death rates are even higher than those caused by AIDS and Malaria.The diagnostic and therapeutic failure of the physicians results in the emergence of Multi-Drug Resistance (MDR). On the other hand, the best approach for controlling this situation is by implementing Directly Observed Treatment Short Course (DOTS) strategy. The requisite for reaching DOTS aims and objectives is through the cooperation and participation of all sections that are involved in offering health and medical services including private physicians. This cooperation requires the physicians to have satisfactory knowledge and assenting attitude towards these programs. This research was conducted with the aim of studying the level of knowledge and attitude of private general physicians, in regard to the National TB Programs (based on DOTS strategy).Materials and Methods: This cross-sectional study was carried out on 340 general physicians working in the private sector of Karaj city. The cases were chosen by random sampling method.Results: Also 66% of the physicians believed that TB is still recognized as a major health problem and issue worldwide. More than 75% of them have considered TB a serious threat to Iran. Only 1.8% of the general physicians had satisfactory level of knowledge. Meanwhile, 89.1% of them had a positive attitude towards National TB programs. Only 27.1% of physicians knew the most important symptom of pulmonary TB and about 43% recalled the short course of four-drug treatment.Conclusion: Majority of the general physicians had a positive attitude towards the National TB Program. But only few percent had satisfactory level of knowledge in this regard.

Eosinophilic pneumonia is a rare disease in children and should be considered in differential diagnosis of bilateral pulmonary infiltration associated with peripheral blood eosiniphilia.In this report, a 13- year-old boy is presented with pulmonary involvement. He had an 8- year history of dry cough with fever and had received anti tuberculosis treatment for four times with diagnosis of smear negative pulmonary tuberculosis, but showed no evidence of clinical and radiological improvement. Bacteriologic evaluation for tuberculosis, tuberculin test, and PCR for M. tuberculosis was all negative. Pulmonary function tests of the patients revealed a restrictive pattern. Complete blood count demonstrated eosinophilia several times. The patient underwent bronchoscopy, which showed eosinophilia in bronchial secretions and open lung biopsy was performed, which confirmed the diagnosis of chronic eosinophilic pneumonia. Oral prednisolone was administered for the patient for 4 weeks. His clinical condition improved, and control radiography was indicative of improvement in pulmonary lesions.