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   2014| January-June  | Volume 8 | Issue 1  
    Online since July 22, 2014

 
 
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ORIGINAL ARTICLES
Evaluation of diffusing capacity of the lung for carbon monoxide normalized per liter alveolar volume as a parameter for assessment of interstitial lung diseases
Nermine M Riad, Hala M Salem, Haytham S Diab
January-June 2014, 8(1):51-56
DOI:10.4103/1687-8426.137352  
Introduction The single-breath (SB) diffusing capacity for carbon monoxide (DLCO) is the most clinically useful routine pulmonary function test after spirometry and lung volumes. The DLCO is the product of two measurements during breath holding at full inflation: (i) the rate constant for carbon monoxide uptake from alveolar gas and (ii) the accessible alveolar volume (VA). DLCO divided by VA (DLCO/VA), also called Krogh factor, reflects physiology more appropriately. It reflects the diffusing capacity in the available alveolar spaces. AimThe aim of the study was to assess the validity of DLCO/VA interpretation in patients with interstitial lung diseases. Patients and methods This study involved 53 patients diagnosed as interstitial lung disease who presented to our pulmonary function laboratory in the Chest Department at Ain Shams University Hospital. Spirometry and DLCO-SB technique were performed. Results Fifty-three patients with mean age of 47.11 ± 13.7 years were included, 20 women and 33 men. The study showed positive correlation between age and forced vital capacity (FVC) and negative correlation between age and residual volume (RV). Height was significantly statistically related to DLCO, DLCO/VA, and total lung capacity (TLC)-SB. FVC showed no correlation with both DLCO and DLCO/VA. However, it was positively correlated with TLC-SB, VA, RV, and functional residual capacity. The mean of DLCO was 45.62 ± 17.19 and of DLCO/VA was 76.5 ± 31.7. DLCO showed a significant relationship with the following parameters: DLCO/VA, TLC, and RV/TLC. DLCO/VA showed positive statistical correlation with DLCO and TLC and negative correlation with VA. VA was positively correlated with TLC, FVC, and RV. However, it was negatively correlated with DLCO/VA. Conclusion DLCO and DLCO/VA should be interpreted coherently with each other especially in restrictive lung diseases; in addition, VA and TLC-SB give a good guide for lung volume in interstitial lung disease.
  5,670 365 1
Early detection of malignant pleural mesothelioma
Hussein F Mahmoud
January-June 2014, 8(1):1-9
DOI:10.4103/1687-8426.137342  
Malignant pleural mesothelioma (MPM) is a rare tumour. Exposure to asbestos is a well-established aetiological factor for MPM. Patients typically present with shortness of breath due to pleural effusion or chest pain in a more advanced stage. The diagnosis is usually suggested by imaging studies (unilateral pleural thickening; pleural effusion). An occupational history must be obtained. Cytological examination of the effusion can be diagnostic, but often shows equivocal results. Therefore, histology, including immunohistochemistry, is the gold standard. Thoracoscopy, a video-assisted surgical procedure or open pleural biopsy in a fused pleural space may be necessary to provide sufficient material for accurate histological diagnosis. There are three main histological types (epithelial, sarcomatous and mixed) with ∼60% being epithelial. Data suggest the possible contribution of serum mesothelin-related proteins and osteopontin along with others as useful markers to support the diagnosis of mesothelioma; however, the precise role of these markers is yet to be defined.
  4,377 390 1
Role of multislice computed tomography in evaluation of thoracic lymphadenopathy
Adel Rezk, Sameh Hafez, Alaa Abd Al-Hamid, Ahmed Youssef Shaaban Gad, Mohamed Khamis
January-June 2014, 8(1):17-22
DOI:10.4103/1687-8426.137347  
Background Mediastinal masses and lymphadenopathy are often incidentally detected on chest radiograph. Despite diagnostic limitations, the chest radiograph is also important for detecting and localizing mediastinal masses and lymphadenopathy when suspected clinically. Multislice computed tomography (CT) has transformed CT from a transaxial cross-sectional technique to a three-dimensional imaging modality. Aim The aim of this study was to assess the role of multislice CT in evaluation of thoracic lymphadenopathy (lymph node). Patients and methods The present study was conducted on 25 patients with thoracic lymphadenopathy on plain chest radiograph or clinically suspected with unremarkable chest radiograph recruited from the main university hospital of Alexandria. All patients were subjected to detailed history taking, full clinical examination, and conventional radiograph and multidetector CT of the chest with intravenous contrast, using four and six multidetector CT scanners, GE Lightspeed and Simens Emotion 6, respectively. The scan parameters used were 120 kVP and less than 240 mA per slice; tube rotation was 0.75 s and slice thickness was 1.25 mm. Fiberoptic bronchoscopy with transbronchial needle aspiration biopsy was performed according to radiological and bronchoscopic landmarks for cytological examination and histological examination. Results In this study, metastatic lymphadenopathy was encountered in nine patients, pulmonary tuberculosis in four, lymphoma in eight, and sarcoidosis in four. The diagnosis was confirmed by transbronchial needle aspiration biopsy and percutaneous needle aspiration from the peripheral lymph node. Conclusion Multislice CT of the chest is considered as a simple, safe, and minimally invasive procedure.
  4,093 321 1
The efficacy of fiberoptic bronchoscopy through laryngeal mask airway in pediatric foreign body extraction
Ashraf Madkour, Ahmed Elmansoury, Samar Sharkawy
January-June 2014, 8(1):57-63
DOI:10.4103/1687-8426.137354  
Background The use of fiberoptic bronchoscopy (FOB) through laryngeal mask airway (LMA) in children allows the use of an adult-size bronchoscope with its grasping tools; thus, it may aid in foreign body (FB) extraction. Aim We aimed to evaluate the efficacy of FOB through LMA in pediatric FB extraction. Patients and methods We prospectively recruited all children (≤16 years) who presented to or were referred to the Department of Pulmonary Medicine, Ain Shams University Hospital, with a clinical suspicion of FB inhalation between June 2012 and June 2013. All the patients were subjected to FOB through LMA under general anesthesia. Rigid bronchoscopy (RB) was available to extract any FB that could not be removed. Results Of the 49 children suspected to have FBs, 41 FBs were identified in 28 boys and 13 girls, mean age 5.9 years (9 months to 16 years). FBs were more often lodged in the right side than in the left one (48 vs. 38%) and with predominance of organic FBs (75.6%), mainly seeds (60.9%). Successful extraction by the current technique was achieved in 34 of 41 (82.9%) FBs identified. Extraction of six of seven FBs that could not be removed was successful with the use of RB and open thoracotomy was required in one case. Noncritical complications related to FOB through LMA included laryngeal edema, transient hypoxia, gastric distension, mild hemoptysis, and fever, which occurred in five, five, four, three, and two patients, respectively. One critical complication (stridor) occurred that was related to RB. Conclusion In conclusion, FOB through LMA is safe and effective in pediatric FB retrieval under general anesthesia with RB backup.
  2,575 184 -
Evaluation of bronchoscopic placement of tracheobronchial silicone stents: an Ain Shams University Hospital experience
Emad Korraa, Ashraf Madkour, Amany Todary, Khaled Wagieh
January-June 2014, 8(1):38-43
DOI:10.4103/1687-8426.137350  
Introduction Therapeutic rigid bronchoscopy with tracheobronchial stenting using silicone stents is a well-established procedure in the management of malignant and benign tracheobronchial stenosis. However, there is limited experience with this technique in Egypt. Aim This study aimed to retrospectively evaluate the results of our experience with bronchoscopic placement of tracheobronchial silicone stents. Materials and methods Between January 2007 and December 2011, 44 Dumon stents were inserted in the central airways of 40 patients using rigid bronchoscopy under general anesthesia. Data related to stent application were collected from patient's records. Results Of the 40 patients with either benign (20) or malignant (20) tracheal stenosis, stents were indicated in stabilizing airway patency after tumor debulking, counteracting extrinsic compression, sealing malignant fistulas, and treating complex-type benign strictures in 22.5, 27.5, 7.5, and 42.5% of patients, respectively. One stent was placed in 36 (90%) patients and two stents in four (10%) patients. Four (10%) patients required two stent procedures for adequate airway stabilization. Procedural complication in the form of trivial perforation of the bronchial wall occurred in one (2.5%) patient. Stent migration occurred in 10% of the patients, granuloma formation in 17.5%, tumor ingrowth in 7.5%, and stent obstruction by mucus secretions in 7.5% during the first 3 months after stent insertion, with an overall complication rate of 45%. All complications were non-life-threatening and all were reversibly managed. There was no mortality resulting from stent placement recorded during the first 3 months after stent insertion. Conclusion This study showed that bronchoscopic placement of Dumon silicone tracheobronchial stent is easily applied and effective in the maintenance of airway patency in malignant and benign tracheobronchial stenosis. Non-life-threatening stent-related complications occur but are easily managed.
  2,354 143 2
Correlation between computed tomography of the chest and medical thoracoscopic findings in primary pleural tumors
Tarek Safwat, Samar Sharkawy, Amr Shoukri, Suzan Mohamed
January-June 2014, 8(1):32-37
DOI:10.4103/1687-8426.137349  
Background Malignant pleural mesothelioma (MPM) is an aggressive tumor arising from the mesothelial cells lining the pleura. It commonly presents with unilateral pleural effusion with variable degree of pleural thickening and nodularity. MPM usually develops on the parietal pleura, and involvement of the visceral pleura indicates more advanced stage. Treatment of MPM should not be started before correct diagnosis and staging with computed tomography (CT) and thoracoscopy. Aim of the study The aim of this study was to assess the correlation between findings on chest CT and those on thoracoscopy and to evaluate the sensitivity of chest CT to identify malignant pleural lesions. Patients and methods Patients with suspected MPM and indicated for medical thoracoscopy for diagnostic confirmation were enrolled in the present study. Twenty patients with confirmed diagnosis after tissue biopsies with medical thoracoscopy were selected. Comparison and correlation between CT findings and medical thoracoscopic findings were made. Results Thoracoscopy showed parietal pleural invasion in all patients, whereas noncontrast chest CT showed parietal pleural lesions in 14 patients (70%). Visceral pleural involvement was evident in 13 patients (65%) on thoracoscopy, but chest CT detected only one case (5%) with visceral pleural involvement. Three patients (15%) were found to have fibrous septations on thoracoscopy, compared with only one patient (5%) on chest CT. The sensitivity of noncontrast chest CT in the detection of MPM was 70%. Conclusion Although the sensitivity of noncontrast chest CT in the detection of MPM is high, thoracoscopy is needed not only to confirm the diagnosis but also to assess the different parts of the pleura and to allow proper staging of the disease.
  2,149 183 1
Evaluation of the cardiopulmonary status using a noninvasive respiratory profile monitor in chronic obstructive lung disease patients during low-ventilation strategy
Adel M Saeed, Gehan M El Asaal, Hesham A Abd El Halim, Shaymaa A Ahmad
January-June 2014, 8(1):44-50
DOI:10.4103/1687-8426.137351  
Background Patients with chronic obstructive pulmonary disease (COPD) patients are susceptible to complications, especially volutrauma, during the period of mechanical ventilation; low ventilation is a safe strategy to avoid these complications. Noninvasive capnography is a suitable technique for monitoring and assessing the cardiac and the pulmonary status of these patients during the period of mechanical ventilation. ObjectivesAssessment of the cardiac and the pulmonary status of two COPD patient groups receiving mechanical ventilation with a low tidal volume strategy using a noninvasive CO 2 respiratory profile monitor (volumetric capnography). Patients and methods Forty patients were recruited in the respiratory ICU of Abbassia Chest Hospital; these patients were divided into two groups: 20 COPD patients with the predominant pathology of chronic bronchitis (CB) and 20 patients with the predominant pathology of emphysema disease, who presented with clinical and radiological evidence of chronic obstructive lung disease and were in need of mechanical ventilation. All the patients in the study were followed up three times per day until weaning; data were recorded on admission, after 24 h and before weaning using volumetric capnography. Results There was significant correlation between EtCO 2 and arterial PCO 2 during the whole period of mechanical ventilation in CB and emphysematous patients; the mean dead-space fraction was significantly higher in the emphysema group than in the CB group. There was a significant negative correlation between the mean values of Vd/Vt and the pulmonary capillary blood flow on admission and after 24 h in the emphysema group. The mean cardiac output, the mean stroke volume, and the pulmonary capillary blood flow increased significantly before extubation in the CB group, in contrast to the emphysema group in which there was an insignificant difference. Conclusion Volumetric capnography could be helpful in assessing the severity of functional disturbances, and the use of more refined noninvasive parameters will be of value in managing and monitoring COPD patients during the whole period of mechanical ventilation.
  2,168 138 1
Pulmonary hypertension in idiopathic pulmonary fibrosis
Amany Omar Mohammed, Azza Farag Said El-Tooney, Nasser Mohammed Taha, Hosny Sayed Abdel Ghani, Zainab Hassan Saied
January-June 2014, 8(1):23-31
DOI:10.4103/1687-8426.137348  
Background Pulmonary hypertension (PH) is a common finding in patients with idiopathic pulmonary fibrosis (IPF) and is associated with increased morbidity and mortality. AimThis study was designed to detect the prevalence of PH in patients with IPF and to determine the correlation between pulmonary function test (PFT) parameters, radiological and echocardiographic findings, and PH among these patients. In addition, the effect of therapy for 1 month (long-term oxygen therapy ± drugs) on PH was evaluated. Patients and methods PFTs, the composite physiologic index, multidetector chest computed tomography, and echocardiography were performed on 60 IPF patients (10 men and 50 women, mean age 51 years). Fifteen healthy age-matched and sex-matched volunteers were also studied as a control group. Results PH was present in 46 (76.6%) patients of IPF. There was a high negative correlation between parameters of PFTs and composite physiologic index and the mean pulmonary arterial pressure (mPAP). In contrast, there was a significant positive correlation between mPAP and main pulmonary artery diameter on computed tomography. There was also a positive correlation between echocardiographic findings and mPAP. There was no significant improvement of PH between those patients treated with drugs and oxygen and those on oxygen therapy alone. Conclusion PH is common in patients with IPF. There is an inverse relationship between lung function measures and PH and a direct one with radiological and echocardiographic findings. The short-term use of oxygen therapy with or without drugs had no effect on PH in patients with IPF.
  1,856 152 -
The role of matrix metalloproteinases 2 and 9 in obstructive sleep apnea
Hoda A Youssef, Alaa El-Dine O Shalaby, Olfat G Shaker, Irene M Sabry, Eman A Mahmoud
January-June 2014, 8(1):10-16
DOI:10.4103/1687-8426.137346  
Background Obstructive sleep apnea (OSA) is a common condition that is characterized by intermittent and recurrent pauses in respiration results in multiple cycles of hypoxia/reoxygenation with an increased production of reactive oxygen species. Aim The aim of the study was to evaluate serum levels of matrix metalloproteinase (MMP) 2 and MMP-9 as markers of oxidative stress in obese patients with OSA. Patients and methods Study was performed on 30 obese patients who had been referred to the Chest Department of Kasr Al-Aini Hospital for clinical suspicion of OSA to perform polysomnography. They were classified into two groups: cases group that consisted of 20 obese patients who were diagnosed as OSA and controls group that consisted of 10 obese individuals, without OSA. The two groups were subjected to the following: complete history taking, clinical examination, Epworth sleepiness scale, BMI (in kg/m 2 ), polysomnographic study, spirometry, laboratory examination for estimation of arterial blood gases, and serum levels of MMP-2 and MMP-9 measurements using ELISA. Results In a comparison between cases and controls regarding serum levels of MMP-9, it was found that the mean value of MMP-9 among cases was 169.7 ± 135.22, which was higher than in controls as the mean value was 87.29 ± 34.01, and the difference was statistically significant. MMP-2 also was higher in cases than in controls. However, the differences were statistically insignificant. Conclusion MMP-9 could be used as a marker of oxidative stress in OSA. Egypt J Broncho
  1,808 172 1
Primary paraganglioma of the lung: A case report
Tamer Ibraheem, Hisham ElGhazaly, Ashraf Madkour, Ahmed Elnori
January-June 2014, 8(1):64-65
DOI:10.4103/1687-8426.137357  
Background Primary pulmonary paraganglioma is an uncommon neuroendocrine tumor of the lung, mostly discovered accidentally. Case presentation We present the case of an 18-year-old female patient with multiple pulmonary nodules discovered accidentally during investigations of another presentation. Conclusion This case report describes a low-grade, malignant primary pulmonary paraganglioma that presented specific characteristics upon computed tomography imaging.
  1,657 118 1
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