Comparision between effects of bicarbonate and acetate dialysates on spirometry parameters in patients with chronic renal failure undergoing hemodialysis

Chronic renal failure causes impairment of all body organs including heart and lungs. Main problem in these patients are pulmonary edema due to increased permeability of capillaries, intravascular and interstitial volume overload, hypertension and heart failure. These changes cause altered physiologic and mechanical function of lungs. The objective of this study is evaluating the effect of dialysates and other intervening factors on spirometry parameters. This cross-sectional study was performed on 41 patients with chronic renal failure in September and October 2006 in Labbafi Nejad Hospital, Tehran. Patients were randomly divided to bicarbonate and acetate groups. Prior to and after hemodialysis, patients were meticulously weighed and spirometry parameters [FVC, FEV1, FEV1/FVC%. FEF 25-27] were measured. Biochemical indices were checked. Spirometry parameters were analyzed using t-test, and p-value less than 0.05 was considered statistically significant. We compared 29 patients undergoing dialysis with bicarbonate and 21 patients on dialysis with acetate. Respiratory function improvement in spirometry parameters was only significant in patients undergoing dialysis with bicarbonate dialysate, and when results were compared according to gender, they were statistically significant only in men. This improvement was meaningful in FEF [25-27%], FEV1, FVC. Post dialysis weight loss and serum chemistry had no significant correlation with improvement of spirometry parameters. Dialysis with bicarbonate dialysate causes significant improvement in spirometry parameters and respiratory function in men

Evaluation of serum immunoglobulins and their relevance to chronic lung disease in mustard gas victims

Despite the fact that 8 years has elapsed since the end of the imposed war, chemically injured victims are still suffering from various long-term complications, most of them respiratory in nature. The progressive nature of respiratory problems in these patients suggests that the immune system must be involved to initiate a cascade which ends up causing lung injuries. To evaluate this, humoral immunity was assessed in 179 mustard gas victims in 1992. The patients were followed up for the next 4 years. These included 172 male and 7 female patients with a mean age of 33 years and an average of 6.1 years post-exposure to mustard gas. After physical examination and spirometric evaluation, these patients were divided into 3 groups based on the severity of their respiratory problems, i.e. "severe" [group 1], "moderate" [group 2] and "mild" [group 3]. IgG, IgA, C3 and C4 were measured using SRID technique and IgE by ELISA. The results in each group were compared with the control group consisting of 49 healthy, randomly selected volunteers. Mean age was 32 years in this group. The results indicate that there is a significant fall in IgG, IgA, C3 and C4 levels in group 3 [p=0.009, 0.01, 0.004, and 0.002, respectively] as compared to the control group. IgG had also dropped significantly in groups 2 and 1. On the other hand in group 3.19.6% and 15.2% of patients had lower than normal IgG and IgA levels, respectively. In group 2, 7.7% of patients had low IgG and 5.8% had low IgA levels. These figures were 10% and 3.8% for IgG and IgA in group 1. Of a total of 7 patients in group 3 with low IgA levels, four patients also had low IgG levels. Two of these patients gradually developed more serious respiratory problems and were classified as group 1 after two years. We concluded that: 1] mildly injured patients [group 3] have lower IgG and IgA as well as C3 and C4 levels, and 2]among these patients those who demonstrate low IgG levels are more prone to develop progressive respiratory problems in the future

Comparison of acute bronchodilatory effects of inhaled salbutamol and combivent in mustard gas victims

A randomized cross-over study was conducted to evaluate the effects of inhaled salbutamol alone vs.a combination of salbutamol plus ipratropium bromide administered by a single metered-dose inhaler. The patient material comprised fourteen mustard gas casualties, suffering from moderate to severe chronic obstructive pulmonary disease. The mean age was 34 +/- 2.7 years and mean baseline FEV1<65% predicted. The patients were randomized on two separate days to receive either two puffs of salbutamol [200 micro g] or two puffs of salbutamol plus ipratropium [Combivent] by inhalation. On study days, forced expiratory volume in one second [FEV1], forced vital capacity [FVC], and maximal mid-expiratory flow rate [MMEF], were measured at administration. The results obtained show that Combivent produces a significantly greater increase in all three parameters measured, and that the greatest differences observed were at 180 minutes after drug inhalation. We observed that the combined inhalation of salbutamol and ipratropium provided greater bronchodilation than salbutamol alone

effects of captopril on pulmonary hypertension in patients with chronic obstructive lung disease

We studied the effect of captopril, an angiotensin converting enzyme [ACE] inhibitor, on hemodynamics and pulmonary arterial pressure of six chronic obstructive pulmonary disease [COPD] patients with pulmonary hypertension [Pulmonary arterial pressure > 20mmHg]. Pertinent data were measured before and after taking captopril, 50mg daily in the first week, followed by I50mg daily for the next three weeks. After treatment with captopril no significant changes were noticed in pulmonary arterial pressure [PAP], pulmonary arterial wedge pressure [PAWP], right atrial pressure [RAP] or right ventricular end diastolic pressure [RVEDP], although arterial oxygen partial pressure [PaO[2]] and vital capacity [VC] showed a significant increase [p < 0.02]. We conclude that hypoxic pulmonary hypertension is potentially resistant to therapy with captopril

An unusual manifestation of giant cell in terstitial pneumonia

Interstitial lung disorders [I L D] consist of a long list of diseases including idiopathic pulmonary fibrosis [IPF]. The diagnosis could be established by ruling out known causes of lung fibrosis. Some of the investigators have classified IPF according to their pathological findings, although others have doubted the usefulness of such classifications. In the present article, we present a case of giant-cell interstitial pneumonia [GIP] with unusual x-ray finding of cavitation and review the present literature