[Show abstract][Hide abstract]ABSTRACT: Lung transplantation has evolved from an experimental procedure to a viable therapeutic option in many countries. In Iran, the first single-lung transplantation was performed in the year 2000, more than 3 decades after the first successful procedure in the world, and the first double-lung transplantation was performed in the year 2006.
To describe our 8-year experience in lung transplantation.
During 8 years, we performed 24 lung transplantation procedures. Underlying lung diseases were pulmonary fibrosis in 16 patients (66.6%); chronic obstructive pulmonary disease in 2 (8.3%); bronchiectasis in 5, including 2 patients with cystic fibrosis (20.8%), and alveolar microlithiasis in 1 (4.16%). Data for all patients were collected and analyzed. Procedures were carried out using standardized methods. The induction suppression regimen consisted of cyclosporine and methylprednisolone. Maintenance immunosuppression drugs were cyclosporine and mycophenolate mofetil, and tapering dosage of prednisolone. Patients were followed up with physical examinations, 3 times a week, as well as and cycle ergometry 3 times a week and spirometry and laboratory tests once a week and chest radiography per needed for up to 3 months posttransplantation.
The longest survival time was 7.2 years, in a 60-year-old patient with idiopathic pulmonary fibrosis. Fourteen patients died, 8 as a result of hemodynamic instability and/or hemorrhage, 1 as a result of bone and fat emboli, 3 after cessation of drug and 2 of them after infection.
Although lung transplantation is a complex procedure it can be performed in developing countries such as Iran.
[Show abstract][Hide abstract]ABSTRACT: The majority of transplantations depend solely on cadaveric organs. In recent years, special focus has been directed toward brain-dead patients in Iran, but it seems that there is limited information regarding the characteristics of cadaveric organ donation in our country.
This is a retrospective analysis of data of our Organ Procurement Unit (OPU), which is one of the most active organ procurement units in Iran. We incorporated the data on all organ donations from brain-dead patients between 2004 and 2008 into the present study. Demographic characteristics of the patients along with data regarding brain death and organ donation were extracted from already registered data on patients.
Among 93 brain-dead patients registered in the database of the OPU, organs were retrieved from 85% (n = 79). Out of the 14 patients from whom no organ was retrieved, the cause for this failure was death before donation in 85% (n = 12). The numbers of donated organs varied between zero and six (mean +/- standard deviation = 3.1 +/- 1.7). The most donated organs in terms of frequency and count were: right kidney (n = 68; 73.1%), left kidney (n = 67; 72%), liver (n = 63; 67.7%), heart (n = 40; 43%), pancreas (n = 5; 5.4%), and lung (n = 4; 4.3%).
The overall organ retrieval rate from brain-dead patients by this OPU was comparable to that of developed countries; however, we still believe we can improve this rate/scale.
[Show abstract][Hide abstract]ABSTRACT: Aspergillosis is one of the most important opportunistic infections after organ transplantation. Early diagnosis and initiation of appropriate antifungal therapy are key factors for better prognosis.
We reviewed the medical records of patients with solid organ transplantation with evidence of Aspergillus infections from December 2001 to January 2008, evaluating patient demographics, time of onset after transplantation, risk factors, radiologic appearance, diagnostic criteria, antifungal therapy, and outcome.
We observed aspergillosis in 8 lung, 3 kidney, and 1 heart recipient, with overall mean age of 40.6 years. Seven cases of Aspergillus tracheobronchitis were diagnosed in lung transplant recipients, all of them in the first 6 months after transplantation. All patients responded to antifungal therapy and bronchoscopic debridement. We observed 5 cases of invasive pulmonary aspergillosis. Three patients survived in response to antifungal treatment. The two patients who died were treated with a combination of itraconazole and amphotericin B, whereas all cured patients had been treated with voriconazole alone or in combination with caspofungin.
It seems that the prognosis of aspergillosis in solid organ recipients is improving with new treatment regimens, particularly if they are used in early stages of infection.
Full-text Article · Jan 2009 · Transplantation Proceedings
[Show abstract][Hide abstract]ABSTRACT: Background : Hydatid disease is caused by an infection with the cestode, Echinococcus granulosus and is endmic in Iran. Medical therapy and surgical management are two main treatments. The purpose of this study is to represent our ten-year experience in surgical management of patients with complicated pulmonary hydatid disease including cysts ruptured into the pleural space or bronchi, multiplicity, hemoptysis, large size cysts and coexistence with liver cysts. Materials and Methods : Medical records of 109 patients, who underwent surgery for the treatment of pulmonary hydatid disease in Masih Daneshvari Hospital from December 1995 to October 2005, were reviewed. Among these patients, we selected our study group in accordance with the following criteria: 1) Cyst rupture into the pleural space or bronchi, 2) Occupying more than two third of the hemithorax in radiological studies, 3) Multiple cysts, 4) Massive hemoptysis, and 5) Synchronous pulmonary and liver cysts. Results : Among the 109 patients with pulmonary hydatid cyst, 82 patients (59% male and 41% female) met the above mentioned criteria. The mean age of patients was 31.7 years (range 9-80 yrs). The cyst diameter was determined by radiological imaging. The mean diameter was 6.23 cm, and 13 patients had giant cysts (occupying more than 2/3 width of the hemithorax). In this study group 55 patients had ruptured hydatid cysts, 29 had multiple cysts, 11 had significant hemoptysis and 15 had synchronous pulmonary and liver cysts. All patients had undergone surgery with or without previous medical therapy. Our procedure of choice was thoracotomy, cystectomy and closure of the bronchial openings before irrigating the cavity with silver nitrate (0.5 %) soaked sponge. Pulmonary resection was done in 8 patients due to the irreversible parenchymal damage. Post operative complications occurred in 16 (19%) patients including residual pleural space in 8, broncho-pleural fistula in 2, pleural effusion in 1, pulmonary embolism in 1, osteomyelitis of sternum in 1, laceration of diaphragm in 1, and inability to access the liver hydatid cyst after thoracotomy and post operative pulmonary insufficiency necessitating mechanical ventilation also in 1 patient. One patient died because of sepsis (she had been operated on for combined pulmonary and liver hydatid disease). In the 1 to 60 months follow up period, 2 recurrences occurred. Conclusion : Although post operative complications occurred in 19% of our patients, all were treated by conservative managements. This rate of complications was acceptable among patients with complicated hydatid disease. Our procedure of choice is draining the cyst; closing all the bronchial openings in the pericyst and leaving the pericyst cavity open into the pleural space. (Tanaffos 2007; 6(1): 19-22)
[Show abstract][Hide abstract]ABSTRACT: Abdominal tuberculosis (TB) has been considered as a fatal and untreatable disease for years. Before the discovery of effective medical therapy for TB (TBMT) there was no hope for recovery of patients with abdominal TB. Even when such a patient recovered, it was ascribed to false diagnosis and not to true cure. 1 The underlying mechanisms for this disease has not yet been totally elucidated, but the probable route of infection is the involvement of other organs especially lungs and transmission of Mycobacterium TB (MTB) through blood or swallowed sputum. Direct invasion from adjacent structures might be another route of infection. 2 In some patients, abdominal TB is a primary disease meaning that involvement of no other organ has been documented in the past or present. Also, it has been proposed that the severity of pulmonary infection has positive correlation with the extent of gastrointestinal involvement. 3 Despite dramatic decrease in the prevalence of pulmonary TB after discovery of the antituberculous drugs, there are considerable rates of incidence of abdominal TB reported from a number of countries. 4 Although any site of gastrointestinal tract could be affected, ileocecum and terminal ileum are most commonly involved. 5 The specific histopathologic presentation of TB in gastrointestinal tract is similar to other organs, that is: "caseous granulomas with central necrosis." This specific appearance, however, could not be found in all parts of gastrointestinal tract and for this reason, Arch Iranian Med. 7(1): 57 – 60; 2004 occasionally TB may not be distinguished from Chron's disease or other inflammatory conditions. 6 Clinical presentation of the disease is also so much varied that there is relatively no specific sign or symptom for diagnosis of abdominal TB. Nonspecific and vague complaints may be present from one month to one year predominating initial presentation before diagnosis is made. Prevalence of the disease is approximately equal among males and females with a peak in 3 rd and 4 th decades. The majority of patients complain of abdominal pain, weight loss, fever, weakness, and other general symptoms. A considerable percentage of patients may present with acute signs and symptoms of abdomen and therefore, emergency laparotomy should be performed. 7 Surgical operation in such cases may end in grave complications which require long and distressful hospitalization period for patients. Nowadays, general surgeons have less chance to encounter tuberculous peritonitis during their residency period, so they lack adequate experience and knowledge for management of these patients and as a consequence, they might be involved in a series of postsurgical problems. Therefore, we present our experience on the management of these patients with abdominal TB and the complications of surgical treatment. We enrolled all patients who were admitted in surgery department of Massih Daneshvari Hospital and underwent laparotomy for complications of abdominal TB in a 3-year-period (May 1997-April 2000). Data were extracted from questionnaires which in our department are completed exclusively for patients requiring operation for complications of TB. During this period, 90 patients underwent different operations for complications of TB, of which 10 cases needed laparotomy for abdominal complications of the disease. Characteristics of the patients and types of operation performed are summarized in Table 1.
Full-text Article · Jan 2004 · Archives of Iranian medicine