Case of tracheal diverticulum and bronchiectasis

Tracheal diverticulum is a rarely encountered entity usually diagnosed incidentally on CT scan. It may be asymptomatic or may present with recurrent respiratory infections or other symptomatology. Here we report a 59-year-old baker presented with shortness of breath, cough, and sputum production that had tracheal diverticulum in association with bronchiectasis on HRCT which has rarely been reported in the literature

[Effect of home-based pulmonary rehabilitation on fatigue in patients with COPD]

Fatigue is a premature symptom in patients suffering from chronic obstructive pulmonary disease. This study aimed to determine effect of the home-based pulmonary rehabilitation on fatigue among patients with COPD. In this clinical trial, 36 patients were recruited among from 100 patients with COPD according to inclusion criteria in Masih Daneshvari hospital in 2010. Participants were allocated into two control and intervention groups using random block sampling. In the intervention group, the pulmonary rehabilitation program was implemented during three educational sessions in three consecutive days. Fatigue was measured using the Fatigue Severity Scale [FSS] before and seven weeks after discharge. Data were analyzed using descriptive and inferential statistical tests [Independent and paired t-test, chi-square and covariance analysis]. At baseline, the mean scores of fatigue were 47.11 and 47.50 in the experimental and control groups, respectively [P=0.902]. After the intervention, the mean scores of fatigue reached 21.94 and 54.64 in the experimental and control groups, respectively [P<0.001]. According to results of the study, home-based pulmonary rehabilitation nursing could decrease fatigue in patients with COPD

Idiopathic bronchiolitis obliterans organizing pneumonia: case review

Bronchiolitis obliteans organizing pneumonia [BOOP] is characterized clinically by a subacute or chronic respiratory illness. The purpose of this study was to describe clinical and radiologic features of Idiopathic [cryptogenic] bronchiolitis obliterans organizing pneumonia. We retrospectively reviewed 11 patients with biopsy proven BOOP at Masih Daneshvari Hospital, for whom well documented clinical and radiographic data were available. The final diagnosis of BOOP was validated if the followings were present. 1] Negative sputum or bronchoalveolar lavage [BAL] analysis for Mycobacterium tuberculosis 2] Open lung biopsy [OLB] or trans-bronchial lung biopsy [TBLB] findings characteristic of BOOP. 3] Negative findings for systemic disorders or associated primary pulmonary lesions such as cancer. 4] Prompt response to steroid therapy. The mean age of patients with BOOP in this case series was 46.3 +/- 24.6 yrs. [range 32-70]; the male/female ratio was 7/4. The clinical pattern in BOOP presentation was more similar to classic sub-acute infectious process: dyspnea in 9 patients [81.8%], fever in 5 [45.4%], and cough in 6 [54.5%]. The symptoms were usually mild. Physical examination showed sparse crackles in 5 patients [45.4%] and wheezing in 7 [63.6%]. The most frequent radiologic patterns were ground glass appearances [63.6%] and diffuse infiltration associated with reticular pattern [27.2%]. In 6 patients chest images showed bilateral distribution. The clinical and radiological manifestation of BOOP in our patients did not differ from other reports. BOOP cases may present a distinct entity like pneumonia. Physicians in charge of these patients were all surprised of BOOP diagnosis by tissue examination. Trans- bronchial lung biopsy specimens along with strongly suggestive clinical and radiologic findings in many cases were adequate for making the diagnosis. We suggest that the diagnosis of BOOP must be considered in any immunocompetent patient with pneumonia with poor or no response to antibiotic therapy

Malignant mesothelioma: a study of sixty-six cases

This study was conducted to review the epidemiology, and biochemical data of pleural fluid to assess the potential contribution to occupational risk of patients with malignant mesothelioma [MM] in Iran. Hospital files of patients with MM of the pleura in Masih Daneshvari Hospital were reviewed between 1997 and 2004 and were evaluated in a cross-sectional study. 66 patients [49 men and 17 women] with a mean age of 53.8 +/- 4.2 yrs were selected. Probable or known occupational contacts were detected in 8 [12.1%] patients. The diagnosis was confirmed by closed pleural biopsy in 26[39.4%] cases. Statistical analysis showed significant cut-off for LDH and glucose level in pleural fluid analysis. Detailed occupational history must not overemphasize blind biopsy as the first diagnostic approach for MM of pleura and pleural fluid glucose as well as LDH had characteristic levels respectively

Churg strauss syndrome after introducing oral steroid to inhaler - a report of three cases

The tetrad of bronchial asthma, severe sinusitis, nasal polyp, eosinophilia, and systemic vasculitis is the main feature of allergic granulomatosis and angitis [Churg- Strauss Syndrome]. This vasculitis is usually seen idiopathic in patients with a long history of asthma; oral steroids using steroid inhalers, vaccination and desensitization might be triggering factors. Drugs such as leukotriene receptor antagonists [LTRAS], penicillin, sulphonamides, anticonvulsants and thiazides have also been implicated. By presenting the cases in this article, the authors suggest that some cases of CSS may be partially or totally suppressed by corticosteroid therapy of asthma for long periods and replacing oral steroid by inhaler will reveal a pathologic condition of CSS, called frustes CSS forms. We report three subjects with asthma who had been receiving previously multiple corticosteroid courses for control, but when systemic corticosteroids were discontinued or switched over to steroid inhaler, the patients developed a similar syndrome

Short outcome and evaluation of hemoptysis in patients with old pulmonary TB

Data concerning the evaluation of hemoptysis in patients affected by Tuberculosis backs to 1940-1960. Remarkable advances in anti TB agents together with effective treatment strategies such as DOTS [Directly Observed Treatment Short Course] has made the feature of the disease to be less associated with severe complications like hemoptysis due to bronchiectasis or fibrocavernous lesions. The objective of this study was to evaluate the short outcome of the patients with hemoptysis due to old tuberculosis and also the relation of the severity of hemoptysis with length of stay [LOS] in hospital and the severity of the pulmonary lesion in high quality imaging techniques. Forty-five patients with old TB and cardinal sign of hemoptysis were evaluated and after excluding the mycetoma and suggestive tumor formation, the coefficient correlation between the severity of hemoptysis and the LOS and also the correlation of the severity of hemoptysis and different pictures of pulmonary lesions in CT- scan were evaluated with Spearman's rho statistical analysis. All patients were discharged except one who had died because of the reasons other than asphyxia due to hemoptysis. One patient had undergone bronchial artery embolization. Pulmonary resection had been performed in none of the patients. According to the non-parametric coefficient correlation analysis, there were significant correlations between age and the first evidence of residual TB in the lung parenchyma [P=0.00, Spearman rho 0.00] and also between severity of hemoptysis and pulmonary lesions in CT scan at the level of 0.05; but no correlation was observed between the LOS and the severity of hemoptysis [P=0.0769] Hemoptysis due to old destructive pulmonary TB usually has a benign course. This is probably due to lung fibrosis and scarring caused by a prolonged inflammatory process which has led to an increase in vascular anastomosis. In old TB the source of bleeding is usually brochiectatic lesions which are directly correlated with the radiologic features found in chest- x- ray. The authors believe that although pulmonary resection in patients with life threatening hemoptysis is of considerable attention, conservative management of hemoptysis associated with arrested pulmonary TB is the first option