Diagnostic methods of active pulmonary TB

Tuberculosis is considered a major cause of morbidity and mortality worldwide. According to the WHO report 9.4 million individuals were suffering from active TB in 2009 [1]. Diagnostic methods for active pulmonary TB include: clinical suspicion, tuberculin skin test, acid fast bacilli stain, cultures for maycobacterium, and in recent years NNA [nucleid acid amplification]. An ideal test for pulmonary active tuberculosis should be easily performed with rapid results, it should have high sensitivity and specificity, low cost,technically easy to operate and reproducible results in a variety of settings, have the possibility of drug-susceptibility testing and could distinguish Mycobacterium tuberculosis from other mycobacteria. Direct smear sputum microscopy is the primary method for diagnosing pulmonary tuberculosis but it lacks enough sensitivity and only about 44% of all new cases are detected by this method [2]. Culture technique is still seen as the gold standard for active TB. Although, the sensitivity and specificity of culture is high, this method is slow and time consuming and needs special laboratory equipments [3,4,5]. It not only provides the detection of various mycobacterial species but also the examination of drug sensitivity. It also provides the examination of genotype for epidemiological purposes if needed. Nucleic acid amplification tests [NAATs] can be performed in one day. But NAAT are not [fully] standardized and the diagnostic accuracy is highly heterogeneous, and need experienced personnel and expensive equipments

Results of short- and long-segment cardioesophageal myotomy for achalasia

We report the results of a short- and long-segment cardiomyotomy for relief of the symptoms of achalasia. From 1997 to 2009, 41 patients [22 men, 19 women] with achalasia underwent cardiomyotomy. Patients were divided into 2 groups [short-segment group [SSG] and long-segment group [LSG]]. SSG include 22 patients with laparotomy and 8-cm short-segment myotomy and Dor fundoplication. LSG includes 19 patients with thoracotomy and 12-cm long-segment myotomy and Belsey partial fundoplication. Median follow up was 48 months [range: 12-70 months]. Postoperative dysphagia improved in 20 patients in SSG and in 17 patients in LSG [P < 0.001]. Slow emptying sensation improved in 19 patients in SSG and in 16 patients in LSG postoperatively [P < 0.001]. Heartburn was present in 2 patients in SSG and 3 patients in LSG postoperatively [P = 0.179]. Radiologically, barium stasis decreased significantly from 88% to 25% in SSG and from 85% to 30% in LSG. The lower esophageal sphincter [LES] gradient decreased from 32 to 10 mmHg in SSG and from 34 to 14 mmHg in LSG [P < 0.001]. Short-segment cardiomyotomy reduces the LES gradient and relieves obstructive symptoms

One stage operation for five giant hydatid cysts of both lungs and liver in a 20-year-old female

Echinococcosis remains a significant health hazard in endemic areas, including the Middle East, Mediterranean countries and Central Asia. Pulmonary disease appears more commonly in younger individuals but bilateral pulmonary involvement is relatively rare. Concomitant pulmonary and liver hydatid disease may occur in 4% to 25% of patients with hydatidosis. A previously healthy 20-year-old femal from north of Iran without any previous history of lung or liver disease presented with complaints of right upper quadrant and right side chest pain and a low grade fever for the past one month. In imaging studies, one cyst in the left lung, two cysts in the right lung and two cysts in the liver were found. Since the cysts were symptomatic, it was decided to treat these cysts surgically. The patient underwent bilateral anterolateral thoracotomies and phrenotomy under general anesthesia and all cysts were evacuated. The patient was discharged in good condition

Giant mediastinal thymolipoma in 35-year-old women

The patient was 35-year-old women with a six month history of difficulty breathing and chest pain. An anterior-posterior chest radiograph revealed a widened mediastinum with small lung volumes. During his diagnostic evaluation, a computed tomographic scan was performed and with huge mass in the anterior mediastinum with extension to the left and right side of pleural space. With postero-lateral thoracotomy the huge mass was resected. The patient discharged with good condition

Respiratory findings in dental laboratory technicians in Rasht [north of Iran]

There are several occupations that can expose people to some air pollutants. Dental technicians are exposed to inorganic dust and chemical vapors when making dental prosthesis that can put them at risk for respiratory problems. This study was performed to assess respiratory dysfunction in a group of dental technicians. This was a cross-sectional study designed to ascertain the prevalence of respiratory disorders in dental laboratory technicians in Rasht, a city located in north of Iran. A Structured questionnaire was adapted according to the European Community Respiratory Health Survey questionnaire and used to elicit information regarding sociodemographic characteristics and medical status of the study participants. The ventilation status, protective measures and direct exposure to materials in the laboratories were directly observed by the observers and subjects underwent respiratory tests and chest x-ray. The mean age of dental technicians was 31.31 yrs [range 18-56 years] and 83% were males with a mean dental work experience of 9.04 years. In 54.8% of cases, the work environment did not have air conditioning system. The most common signs and symptoms were cough [38.1%] and wheezing [16.7%]. There was a significant correlation between smoking and respiratory signs. Restrictive airway pattern and air trapping were two prevalent findings which were observed in 85.7% and 33.3% of the subjects. Cigarette smoking had a negative effect on FEV1, FEF[25%-75%], and TLC causing a significant reduction in all three parameters [p<0.05]. The most prevalent finding was interstitial opacity which was observed in 10 individuals [23.8%]. This finding was not significantly associated with age, gender, cigarette smoking, or daily work hours. However, there was a significant statistical association between work experience and interstitial opacity. The prevalence of respiratory dysfunction and chest x-ray findings were high as in several similar studies. In order to reduce the hazards of respiratory disorders in risky occupations and provide dental workers with technical preventive measures, a more comprehensive study should be conducted throughout the country and further evaluations through biopsy and CT-scan need to be performed in suspicious cases when necessary

Intralobar pulmonary sequestration with aspergilloma and a large aberrant artery in a 35 year old man

A 35 year old man presented with a 4 month history of cough, hemoptysis, malaise, and fever [>38[degree]C] and moderate [6 kg] weight loss. Investigations with CT scan of the chest revealed a cavitary lesion in the lower lobe of the left lung suggesting the presence of a pulmonary aspergillorna, the remaining lung fields being clear. There was no history of any pulmonary infections. Surgical excision of the affected lobe was performed .During surgical exploration we found that the affected lobe receives its blood supply by a large artery from the thoracic aorta. During follow up his clinical status is excellent