Tehran University Medical Journal

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Spontaneous pneumothorax is a medical condition that potentially may be dangerous. Although several methods for management of this problem have been propounded, there is a great disagreement among the specialists about how to treat it and when more invasive treatments are indicated.
Materials and Methods: This study carried out in two phases. In first phase, 26 patients who had admitted to Imam Khomeini hospital from March 20, 1996 to March 19, 2000 and 50 patients admitted to Baqiatallah hospital between March 20, 1992 and March 19, 2002 with the diagnosis of spontaneous pneumothorax were studied retrospectively. In second phase, these patients were followed up.
Results: 39 patients (51.3%) had primary spontaneous pneumothorax, 35 patients (46.1%) secondary spontaneous pneumothorax and 2 (2.6%) neonatal spontaneous pneumothorax. 67 patients were male and 9 patients were female (male to female ratio: 7.5/1). Mean age of the patients was 35±20 years. Age peaks were the age group between 20 to 25 years old and age group more than 60 years old. Conducted treatments were observation in 3.9%, simple aspiration in 2.6%, thoracostomy alone in 81.6%, thoracostomy and chemical pleurodesis in 2.6%, thoracotomy and mechanical pleurodesis in 3.9%, thoracotomy and pleurectomy in 5.3% of cases. Mean duration of hospitalization was 8.9±7.3 days. Relapse of pnemothorax was seen in 36.9% of the followed patients. Mortality was 17.4% and all died patients had secondary spontaneous pneumothorax.
Conclusion: It seems that the management of spontaneous pneumothorax should be re-evaluated and the exact indications for conservative or more invasive methods of treatment should be defined.

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Background: The purpose of this study was to measure isokinetic maximum and average peak torque of internal and external rotators of glenohumeral joint in volley ball and tennis players
Methods: This study was performed on 17 professional female athletes (7 tennis players &10 volleyball players) with age ranged 18-28 years. The subjects had played in a skilled team for more than 3 years. They were free from injury to their dominant shoulder in the past year. Subjects performed a five minute warm up by shoulder wheel and Maximum average Peak Torque (APT) were obtained unilaterally by a Biodex System 3 with the arm of players in 90 degree abduction at 120,180 & 210 o/s. Players performed five trails of concentric movements with 30 second rest between them.
Results: Maximum and average of maximum torques of shoulder rotator, in both groups, expect for internal rotators of tennis players, reduced by increase of movement speed (P<0.05). There are not significant difference between two groups in maximum, average of maximum torques and normalized data (ratio of maximum torque to weight). There is significant difference between two groups in percentage of APT of External rotator / Internal rotator ratio at 210 o/s (P<0.05).
Conclusion: Volleyball and tennis have no effect on isokinetic strength of shoulder rotators. In high speed, ratio of External rotator / Internal rotator is reduced. This indicates that increase in movement speed increase internal rotator in comparison to external rotator in these professional female athletes.

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Background: Aeromedical transport provides immediate advanced medical treatment for certain critically ill and injured patients, bringing about rapid treatment and decreasing the time of hospitalization. With the great expense of helicopter emergency medical services (HEMS), research and review of experience is conducted to determine areas in which the enforcement of standards will enable the effective and optimal use of HEMS.
Methods: We examined peer-reviewed published articles in French, English and Persian journals and medical texts to determine the best use of, and standards for, HEMS.
Results: We found that HEMS effectively improves health care in three categories of services: the rapid transportation of medical personnel/equipment to an accident and of patients to the hospital (primary response) meeting road ambulances at an intermediate point coming from a hospital or accident to transport patients to a hospital (secondary response) the planned urgent inter-hospital transfers of critically ill patients for specialized care (tertiary response). HEMS standards have been set for: the flight equipment and crew, the types of emergencies to which HEMS should respond, the optimal length of time for each part of the mission (call out time, response time, on-scene time, transport time, and total rescue time) and the affect on patient survival. Some other standards include: algorithms for patient screening, flight heights for different diseases and injuries, rooftop and parking garage helipad at hospital, approach of flight paths and the facility at the touchdown area. HEMS standard medical equipment includes those needed for telemedicine and basic and advanced life support. Standard drugs on board the HEMS vehicle depends on the type of the missions selected for HEMS. The area of medical crew members, as well as their fundamental and the continuing training, also has standards that must be met. The standard scoring system for severity of injury, and finally, the standard method for the annual calculation of the cost and benefit of using HEMS in a specified region have also been considered.
Conclusion: As trauma is a common reason for requesting HEMS in Iran, the decrease in "Golden Hour" response time for trauma patients is a priority. HEMS is expensive and enforcing standards also requires increased effort and expense. Nevertheless, both can reduce the morbidity, mortality and expense for longer hospital stays. Thus, the proper telemedicine and life support equipment and drugs, as well as algorithms for patient screening can improve HEMS efficacy. Furthermore, enforcing proper communication and record keeping regarding trauma severity for HEMS missions allows hospitals to predict the proper immediate treatment for incoming patients and its future need for HEMS services.

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Asthma is a chronic inflammatory disorder of the airways, associated with airway re-modeling and hyperresponsiveness. It is expressed that asthma influences about 300 million people around the world, which is estimated to increase to about 400 million by 2025. The prevalence rate is 15 to 20 percent in children and 5 to 10 percent in adults, while its trend is still increasing. Inflammation plays an important role in the patho-physiology of asthma, which involves an interaction of different types of the immune cells and mediators. It leads to a number of pathophysiology changes, including bron-chial inflammation, airway obstruction, and clinical episodes such as cough, wheeze and shortness of breath. Asthma is now greatly being introduced as a heterogeneous disorder and it is pointed out to the role of T cells, including Th1, Th2, Th17, and regu-latory T cells. Other immune cells, especially neutrophils, macrophages and dendritic cells, as well structural cells such as epithelial and airway smooth muscle cells also pro-duce disease-associated cytokines in asthma. Increased levels of these immune cells and cytokines have been recognized in clinical samples and mouse models of asthma. Different cytokines, including pro-inflammatory cytokines (such as TNFα, IL-1, and IL-6), T helper 2 cytokines (such as IL-4, IL-5, IL-9, IL-13), and growth factors (such as GM-CSF, PDGF) play a role in the pathogenesis of asthma. Indeed chemokines (such as MPC-1, RANTES , MIP-1) and the chemokine receptors (such as CCR3, CCR4, CCL11, CCL24, and CCL26) play an important role in the recruitment of circu-lating inflammatory cells into the airways in asthmatic patients and also is related with increased T helper 2 cytokines after inhaled allergens. Among new approaches, treat-ment of asthma with anti-cytokine drugs such as antibodies blocking IL-4, IL-5, IL-9 could reduce recruitment inflammatory cells into the airways and remodeling. The final perspective of asthma treatments would be to alter from the symptomatic treatments to disease modifying.

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