ABSTRACT
Introduction: Mediastinum contains different vital structures that are located in the anterior and middle or posterior compartments. Various types of mediastinal masses or tumors can be seen in the mediastinum
Materials and Methods: This case series study was performed on 95 patients who had referred to Mashhad University of Medical Sciences between 1990 and 2010 were reviewed. The Inclusion criteria were as follows: Having primary mediastinal masses; Exact tissue pathology; Having received suitable treatment as well as having completed a 3-year follow-up after surgery; The major variables were age, sex, clinical symptoms, mass location, diagnostic procedures, imaging studies, tissue pathology, postoperative complications, mortality and a long-term survival. The patients were followed up for 3 years after the surgery
Results: Ninety-five patients enrolled in the study with M/F=51/44 and the mean age of 35.4 +16.52 years. Moreover, anterior mediastinum was the compartment mostly involved in case of 66 patients with the lymphoma [n=39] as the most prevalent tumor of anterior mediastinum. Mediastinal cysts [n=10] in the middle part and neurogenic tumors [n=19] in the posterior mediastinum were the other prevalent tumors in the patients' compartments. Transthoracic Needle Biopsy was used in the diagnosis of 37 cases. Furthermore, 43 patients underwent surgery alone, 7 cases underwent surgery followed by receiving adjuvant therapy and 45 cases received adjuvant therapy alone. Complications emerged in 15 cases and 9 patients expired before the completion of the 3-year follow-up. Three of the mortalities happened during the patients' hospital treatment
Conclusion: In case of anterior mediastinum, pre-operation clinical diagnosis is essential while most of the posterior mediastinal tumors do not require any preoperation clinical diagnosis. Surgery, surgery-chemoradiotherapy and chemoradiotherapy are the major methods of treatment for such tumors. For another thing, male gender was defined as a poor prognostic factor
ABSTRACT
Introduction: Pulmonary arterial hypertension [PAH] is a late progressive sclerodermarelated complication, which can lead to right heart failure and cor pulmonale. Given that cardiac catheterization is a diagnostic method of choice for PAH, and considering the high risks of this method, the purpose of this study was to evaluate the relationship between serum Pro-Brain natriuretic peptide [Pro-BNP] Levels and PAH in patients with limited scleroderma
Materials and Methods: In this cross sectional study, during June 2011- Dec 2013, referring patients to two major educational hospitals, Mashhad- Iran, with scleroderma, who were afflicted with the disease for at least two years [or more], were enrolled in the study if they met the inclusion and exclusion criteria. All the patients underwent echocardiography to determine the pulmonary artery pressure [PAP]. Afterwards, the subjects were referred to a lung center for performing body plethysmography, carbon monoxide diffusing capacity [DLCO], and 6-minute walk test [6MWT]. Pro-BNP Serum level was determined using flourescent immune assay method
Results: The present study included 20 patients [18 female subjects] with the mean age of 43.28 +/- 9.56 yrs, and the mean pro-BNP level of 138 pg/ml. The logarithmic correlation between PAP values, Forced Vital Capacity /DLCO ratio, and pro-BNP level, which was measured using Pearson's correlation coefficient, showed a significant association among these variables[ respectively, r=0.76, P=0.001; r=0.677, P=0.011]. Moreover, the DLCO decrease was associated with increasing pro-BNP level, though this relationship was not significant
Conclusion: This study showed that there was a significant relationship between the serum levels of pro-BNP marker and increased PAP in the echocardiography, DLCO reduction, and FVC/DLCO increase. In fact, this serum marker can be used in patients with systemic scleroderma [SSc] to evaluate the status of PAH
ABSTRACT
Acquired paralysis of the diaphragm is a condition caused by trauma, surgical injuries, [lung cancer surgery, esophageal surgery, cardiac surgery, thoracic surgery], and is sometimes of an unknown etiology. It can lead to dyspnea and can affect ventilatory function and patients activity. Diaphragmatic plication is a treatment method which decreases inconsistent function of diaphragm. The aim of this study is to evaluate the outcome of diaphragmatic plication in patients with acquired unilateral non-malignant diaphragmatic paralysis. From 1991 to 2011, 20 patients with acquired unilateral diaphragmatic paralysis who underwent surgery enrolled in our study in Ghaem Hospital Mashhad University of Medical Science. Patients were evaluated in terms of age, sex, BMI, clinical symptoms, dyspnea score [DS], etiology of paralysis, diagnostic methods, respiratory function tests and complication of surgery. Some tests including dyspnea score were carried out again six months after surgery. We evaluated patients with SPSS version 11.5 and Paired t-test or nonparametric equivalent. Twenty patients enrolled in our study. 14 were male and 6 were female. The mean age was 58 years and the average time interval between diagnosis to surgical treatment was 38.3 months. Acquired diaphragmatic paralysis was mostly caused by trauma [in 11 patients] and almost occurred on the left side [in 15 patients]. Diagnostic methods included chest x-ray, CT scan, ultrasonography and sniff. Test prior to surgery the average FVC was 41.4 +/- 7 percent and the average FEV[1] was 52.4 +/- 6 percent and after surgery they were 80.1 +/- 8.6 percent and 74.4 +/- 1 percent respectively. The average increase in FEV[1] and FVC 63.4 +/- 4, 61.1 +/- 7.8. Performing surgery also leads to a noticeable improvement in dyspnea score in our study. In patients with acquired unilateral non-malignant diaphragm paralysis diaphragmatic plication is highly recommended due to the remarkable improvement in respiratory function tests and dyspnea score without mortality and acceptable morbidity
ABSTRACT
Chronic Obstructive pulmonary disease [COPD] is an important disease with high mortality rate worldwide. Nocturnal ventilatory changes and gas exchange disorder are common in COPD patients. These disorders do not correlate with bronchial spasm and airway resistance. Apnea - hypopnea Index [AH] represent the total Apnea and hypopnea in one hour. There are several risk factors for sleep Apnea. Obesity is the common causes. The aim of this study is the relationship between apnea-hypopnea index and body mass index in COPD patients. We assessed 40 COPD patients with sleep disorder in sleep laboratory. Exclusion criteria were pneumonia, Ischemic heart disease, lung cancer, congestive heart failure, Diabetes mellitus, systemic hypertension, hypothyroidism, central respiratory disorders, sedative drugs and opium usage. Body mass index [BMI] and neck circumference were assessed. Next, in this cross-sectional study, patients were evaluated with total nocturnal polysomnography. AHI was recorded. The data were gathered and analyzed with standard statistical method. Median BMI, AHI were 30.77 +/- 5.85110 and 15.05 +/- 16.50571 respectively. No significant correlation was found between BMI and AHI. There were no correlation between increasing weight and apnea - hypopnea in COPD patients. Thus, in Iranian population, sleep apnea may be occur in higher level of BMI