[ rare case report of endobronchial actinomycosis with severe hemoptysis]

Endobronchial actinomycosis is an uncommon disease with symptoms of cough, hemoptysis and endobronchial obstruction. It can imitate the presentations of pulmonary tuberculosis or cancer. A 68 year-old male was referred with the complaint of fever, cough and severe hemoptysis. His weight loss during the last 3 months was 8 kgs. Blood tests indicated mild leukocytosis and increased sedimentation rate. In his chest radiography, opacity was observed in the left lower pulmonary lobe. Fiberoptic Bronchoscopy revealed a nodular lesion in the lateral segment of left lower lobe. Pathologic diagnosis confirmed the presence of actinomycosis. Although endobronchial actinomycosis is uncommon, it is included in the differential diagnosis of endobronchial obstructive lesions, especially bronchogenic malignant tumors and bronchial tuberculosis. In areas with high incidence of tuberculosis, endobronchial actinomycosis can mimic its symptoms

[Evaluation of asthma improvement after endoscopic sinus surgery for nasal polyposis]

Asthma is characterized by airway inflammation, airway hyper responsiveness, and reversible airflow limitation. The prevalence of this disease has increased over the past two decades to approximately 5 to 10% of the population. The presence of nasal polyposis in asthma patients is associated with an increase in asthma severity. We studied the efficacy of endoscopic sinus surgery of nasal polyposis in improvement of asthma. We performed a prospective, cross-sectional study from 2001 until 2006. Fifty patients with severe persistent asthma and nasal polyposis were included. The severity of asthma [with NHLBI and NAPP criteria] and FEV1 before and after endoscopic nasal polypectomy were recorded. We used paired simple T test for comparison of means using SPSS software. The mean age of our patients was 32.5 +/- 14.3 years and male to female ratio was 2/3. From 50 patients with asthma and nasal polyposis, 38 cases showed significant improvement in asthma severity and FEV1. Mean values of FEV1 before and after endoscopic sinus polypectomy were 1.68 L and 2.52 L respectively. Opening of the upper airway with resulting improvement of breathing following endoscopy sinus polypectomy can decrease the severity of asthma. We recommend to seek for nasal polyposis in patients with severe asthma and to consider endoscopic sinus surgery in these cases

comparison between radiologic manifestations in adults with smear positive and smear negative pulmonary tuberculosis

Iran with the rate of 17.9 cases in 100000 population had the seventeenth grade of tuberculosis incidence in 1998, indicating high prevalence rate of disease. Rapid diagnosis of disease is important for treatment of patients with tuberculosis and prevention of distribution in the community. This study was carried out to compare the radiologic manifestations of lung in smear negative and smear positive patients. This descriptive study performed from 2004 to 2007 on patients referring to Imam Reza Hospital, Mashhad University of Medical Sciences. Sputum smear was examined for patients suspected to pulmonary tuberculosis. Positive smear for BK cases, were considered as smear positive patients. Bronchoseopy was performed for patients whose smears were negative for 3 times. Patients whose disease was confirmed with BAL or biopsy were supposed as smear negative patients. Finally, we collected information of 58 patients with smear positive tuberculosis and 64 patients with smear negative tuberculosis and compared radiologic manifestations of the two groups by chi-square and t test. In this study, there were 122 patients including 63 females [51.63%] and 59 males [48.36%]. Patients' age range was 16-90 years old with the mean of 56.37 [SD - 18.8]. The most common radiologic manifestation was Airspace consolidation, seen in 52 patients [42.6%] including 19 patients with smear positive and 33 patients with smear negative. Other radiologic features according to their prevalence consisted of: Airspace consolidation and Volume loss in 24 patients [19.7%] including 8 smear positive and 16 smear negative, Airspace consolidation and Bronchogenic spread in 17 patients [13.9%] including 16 smear positive and 1 smear negative, Airspace consolidation and Cavitation in 16 patients [13.1%] including 12 smear positive and 4 smear negative and Intrestitial opacities [Miliary] in 13 patients [10.5%] including 3 smear positive and 10 smear negative. Generally, in 85 percent of patients with cavitary pulmonary tuberculosis, smear of sputum was positive, but just in less than 35 percent of patients with collapse and less than 25 percent of patients with intrestitial pattern, smear of sputum was positive

[Serum and pleural fluid albumin gradient in differentiation of exudate and transudate cuases]

Pleural effusion is the accumulation of excessive fluid in the pleural space. One way for detection of its etiology is to examine the fluid for its exudative or transudative origin. Until now, the best criterion is Light Criteria; following by is serum and pleural albumin gradient. This study was done to examinate the possibility of using albumin gradient as first criteria instead of Light Criteria. In this descriptive study 100 patients with pleural efftision, detected by plane chest X-ray were studed. Light Criteria and albumin gradient for each patient was obtained. Regarding to final diagnosis, results from albumin gradient and Light Criteria were compared. Individual and laboratory data were gathered in a questionnaire and analyzed using SPPS software and descriptive statistics. Based on the clinical diagnosis. 70 patients had an exudative pleural effusion and 14 transudative pleural effusions. Nine patients had no final diagnosis, one patient died before preparation of final diagnosis and six patients had pulmonary emboli that can produce both exudative and transudative pleural effusion. In patients with final diagnosis, 77 had exudative and 13 had transudative fluid. By albumin gradient 41 had exudative and 49 transudative fluid. Light criteria could diagnose 69 of all 70 exudative fluid and 11 of 14 transudative fluid, properly. In albumin gradient method it was 41 and 14, respectively. In according to our study albumin gradient is not suitable as first criteria to differentiate exudative and transudative pleural effusion. In cases that the pleural fluid has a transudative feature in clinic, but an exudative characteristic according to Light Criteria, albumin gradient is a useful criterion for exact diagnosis

[Evaluation of chest radiography in primary lung cancer]

Primary lung cancer is the most common lethal carcinoma in both male and female. Unfortounately, signs and symptoms of lung cancer are non-specific. The most common manifestations are coughing, hemoptysis, dyspnea, chest pain, weight loss and hoarseness. Twenty five percent of patients are asymptomatic and are diagnosed with the abnormality of CXR. The aim of this study was evaluation of outcome of chest radiography in patients with lung cancer. This descriptive study was done in Imam Reza Hospital during the year 1383. As CXR is accessible, easy and low cost, it is suggested as the first step in lung cancer diagnosis. 100 known cases of lung cancer were evaluted. Fiberoptic bronchoscopy and bronchial or parenchymal biopsy plus culture and regular laboratory tests were done for all patients before entering the study. Data was collected in questionaire and Analyzed by descriptive statistics. The mean age of patients was 62 years. The highest frequency was found in the 6[th] decade, 77% were smokers. Right lung involvement as revealed by plain and lateral chest radiography was found to be more frequent. The most common abnormal radiographic finding was bronchial obstruction [collapse, atelectasis, obstructive pneumonia]. Since lung cancer is so lethal, early diagnosis would have great influence on disease process and treatment result. Chest radiography is a chip, easy available diagnostic method, highly recommended to at-risk patients

Study of clinical findings and neuroimaging aspects in Wilson disease

Introduction: Wilson disease or hepatolenticular degeneration is a genetic disorder with an autosomal recessive pattern of inheritance. It is due to an error of copper metabolism, the major presentations are changes in liver, central nervous system, eyes and occasionally other organs. Eary diagnosis is very important, because of its known treatment, in addition late diagnosis is associated with irreversible changes. Our purpose was study of clinical presentations and neuroimaging findingsof wilson disease

Material and Methods: This was a descriptive study in the neurology department Of Ghaem hospital since autumn 2000 to winter 2004. This study included patients with primary presentation of neurologic and psychiatric symptoms or who were diagnosed by case finding in family

Results: There were 23 cases and 15 of them were men.Chief complaints were: movement disorder, psychiatric disorders,speech disorder and slowing of movement in order. Seizure, amen-orrehea and esophagial varicose had high prevalance among our cases.Brain MRI disorders were seen in 95.3% of cases

Conclusion: The incidence of seizure and amenorrhea among our cases was more than previous studies. Because of high incidence of esophagial varicose in patients with primary symptoms of nervous system we recommend esophagoscopy for all patients should be done. This study showed there was no relationship between severity of symptoms and brain MRI disorders. MRI disorders may be seen in patients in presymptomatic stage. According to this we recommend brain MRI can be used as an ancillary diagnostic test