Mediastinal neuroendocrine carcinoma of unknown origin presenting with superior vena cava syndrome [SVCS]: a case report

Primary neuroendocrine carcinoma [NEC] of the mediastinum is a rare type of carcinoma. According to the literature, only five cases of this condition have been reported so far. In this paper, we present a rare case of mediastinal NEC of unknown primary site. The patient was a 34-year-old man with mediastinal NEC, who presented with chronic dry cough and a right-sided mediastinal mass one year prior to hospital admission [winter 1391]. His condition was confirmed by cervical lymph node biopsy. The patient refused to undergo chemotherapy treatment. During the hospital admission, the patient presented with severe dyspnea and signs of superior vena cava syndrome. Contrast-enhanced CT scan of the chest revealed a large heterogeneous mass extended from the right superior mediastinum to the right lung base with the encasement of the superior vena cava. After radiotherapy, the patient?s symptoms subsided and he underwent etoposide and cisplatin chemotherapy. After a 20-month patient follow-up, the subject remained alive and symptom-free

Clinical and para-clinical presentations of endobronchial tuberculosis

Introduction: Tuberculosis [TB], with different types of respiratory tract involvements, has a high rate of mortality all around the world. Endobronchial involvement, which is a slightly common tuberculous infection, requires special attention due to its severe complications such as bronchostenosis. Aim of study of this study was describes, one type of pulmonary tuberculosis with less diagnosed and delayed treatment. High suspicious needs to diagnose and may be need bronchoscopy for confirmed the diagnosis. It can be associated with sever complication and early diagnosis and treatment are necessary for prevention of adverse effect

Materials and Methods: This retrospective study was conducted in a teaching hospital during 2005-2010. Patients diagnosed with endobronchial tuberculosis through bronchoscopic biopsy were included in the study. Diagnosis was confirmed by observation of caseous necrosis, bronchial lavage fluid or positive acid-fast staining in tissue samples obtained through bronchial biopsy. Moreover, demographic information, endobronchial view, lab tests, as well as clinical and radiographic findings were reviewed and evaluated retrospectively

Results: A total of 20 cases were confirmed with endobronchial tuberculosis, 75% of whom were female with the mean age of 60 years. The results showed that the most common clinical symptom was cough [80%], the most common finding in the chest X-ray was consolidation [75%], and the most common bronchoscopic feature was anthracosis [55%]

Conclusion: TB is still a major concern, particularly in the developing countries. Thus, in order for early diagnosis and prevention of this disease, we need to pay meticulous attention to its clinical manifestations and bronchoscopic features

relationship between diaphragmatic movements in sonographic assessment and disease severity in patients with stable chronic obstructive pulmonary disease [COPD]

Introduction: Pulmonary hyperinflation in patients with chronic obstructive pulmonary disease [COPD] can increase the breathing rate and reduce diaphragmatic movements by pushing the diaphragms downward and limiting their movements; this, in fact, can affect the breathing process. The purpose of this study was to compare diaphragmatic movements in COPD patients and healthy ones and to evaluate the relation of diaphragmatic movements and COPD severity in patients

Materials and Methods: This cross- sectional study was performed in Ghaem hospital, Mashhad Iran. Twenty-five COPD patients [case group] were selected, based on the inclusion and exclusion criteria. The patients' demographic and clinical characteristics along with factors related to pulmonary function were recorded. Patients were referred for sonography after pulmonary evaluation. The status of the left portal vein or one of its branches at the end of a deep expiration and a deep inspiration was considered as a marker. Twenty-five healthy non-smoker subjects, who were matched with the patients in terms of age and sex, were studied as the control group for the comparison of sonographic findings of the diaphragms

Results: The current study included 25 healthy subjects and 25 COPD patients, with the mean age of 59.2 +/- 12 years; approximately 84% of the subjects were males. Evaluation of the rate of diaphragmatic movements by sonography showed the mean of 42.08 +/- 12.15mm and 73.28 +/- 15.19mm in the case and control groups, respectively, which showed a statistically significant difference between them [P=0.02]. Statistical analysis indicated the relationship between the rate of diaphragmatic movements with factors related to airway obstruction. However, no relationship was observed between the rate of diaphragmatic movements and the factors associated with pulmonary hyperinflation or air retention

Conclusion: The rate of diaphragmatic movements as a parameter for determining exercise capacity in COPD patients could help with a better understanding of activity limitations in these patients

Effects of Ramadan fasting on spirometric values and clinical symptoms in asthmatic patients

Ramadan is the 9th Islamic lunar month during which Muslims avoid eating and drinking from sunrise to sunset. The effect of Ramadan intermittent fasting on asthma control is controversial. The aim of this study was to investigate the effects of Ramadan fasting on the spirometric variables and clinical symptoms on well-controlled asthmatic patients during Ramadan. A cohort study was conducted in Mashhad, Khorasan Razavi, Iran. Twenty-nine [19 females and 10 males] well-controlled asthmatic patients aged 47 [12] years completed the study. The average duration of fasting was 26.5 days. Assessment of spirometric variables [daily peak expiratory flow, peak expiratory flow variability, peak expiratory flow home monitoring] as well as asthma clinical symptoms including dyspnea, cough, wheezing, and chest tightness were carried out. No significant changes in clinical symptoms were reported in asthmatic patients at the end of Ramadan fasting. Among spirometric variables, only peak expiratory flow improved after Ramadan [p<0.05]. There was a reduction in the mean peak expiratory flow variability from 13% at the first week of fasting to 10% at the fourth week [p<0.05]. In well-controlled asthmatic patients, Ramadan fasting resulted in improvement in peak expiratory flow and peak expiratory flow variability

Acute Datura Stramonium poisoning in east of Iran - a case series

Datura Stramonium [DS] is a common weed along roadsides, in cornfields and pastures and in waste areas. It belongs to the family Solanaceae and its toxic components are tropane belladonna alkaloids. It has been used voluntarily by teenagers for its hallucinogenic effect. The plant is named in Iran as Tatoore. Symptoms and signs of acute D. Stramonium poisoning usually are similar to anticholinergic syndrome. This study is done in order to clarify the status of this poisoning in our region. This study is a case series on all patients admitted to Imam Reza Hospital, Mashhad, Iran, with acute D. Stramonium poisoning between 2008 and 2011. We observed their symptoms, signs, routine laboratory test results and treatment used to control their symptoms. There were 19 patients included in our study. Children were poisoned more commonly than teenagers and poisoning in adults was rare. All of the children ingested the plant accidentally. The most presenting symptom was irritability and the most common sign was sinus tachycardia. There was not any presentation of seizure or coma. Most of the symptoms were controlled by parenteral benzodiazepines and there were no need to use of cholinergic agents such as physostigmine. Our study showed most of D. Stramonium poisoned population in our region are children. We suggest decreasing accessibility to the plant in order to decrease the incidence of its poisoning

Tissue PCR diagnosis of patients suspicious for tuberculous pleurisy

This study planned to assess the value of PCR IS6110 assay in tissue specimens of needle pleural biopsy in patients suspicious to pleural tuberculosis. Sixty eight patients with lymphocytic exudative pleural effusion underwent pleural biopsy. Tissue samples were sent for pathologic examination and PCR IS6110 assay. The results of PCR reported as positive/ negative and assessed according to the current gold standard pathologic diagnosis. Twenty nine patients had tuberculous and 12 had malignant pleural involvement, respectively. The remaining 27 samples were reported as non-specific pleurisy. Results of PCR were positive in 35 out of 68 total subjects and in 19 out of 29 TB patients. Sensitivity and specificity of PCR were calculated as 67.9% and 62.5%, respectively. An acceptable sensitivity and specificity for PCR examination of pleural tissue can serves it as a useful adjunct in undergoing needle pleural biopsy for possibility of tuberculosis