Bronchiolitis obliterans following exposure to sulfur mustard: chest high resolution computed tomography

Ghanei, Mostafa; Mokhtari, Majid; Mohammad, Mehdi Mir; Aslani, Jafar

doi:10.1016/j.ejrad.2004.03.018

Cited by 112 publications

(97 citation statements)

References 16 publications

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“…In high doses, SM exposure can lead to multiorgan involvement (3,4,8,9) and can result in death (3,6,(10)(11)(12). There are 40,000250,000 surviving victims of SM inhalation in Iran and Iraq alone, many with permanent pulmonary disabilities such as bronchiolitis obliterans (13,14).…”

mentioning

confidence: 99%

Airway Obstruction Due to Bronchial Vascular Injury after Sulfur Mustard Analog Inhalation

Veress¹,

O’Neill²,

Hendry‐Hofer³

et al. 2010

Am J Respir Crit Care Med

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Rationale: Sulfur mustard (SM) is a frequently used chemical warfare agent, even in modern history. SM inhalation causes significant respiratory tract injury, with early complications due to airway obstructive bronchial casts, akin to those seen after smoke inhalation and in single-ventricle physiology. This process with SM is poorly understood because animal models are unavailable. Objectives: To develop a rat inhalation model for airway obstruction with the SM analog 2-chloroethyl ethyl sulfide (CEES), and to investigate the pathogenesis of bronchial cast formation. Methods: Adult rats were exposed to 0, 5, or 7.5% CEES in ethanol via nose-only aerosol inhalation (15 min). Airway microdissection and confocal microscopy were used to assess cast formation (4 and 18 h after exposure). Bronchoalveolar lavage fluid (BALF) retrieval and intravascular dye injection were done to evaluate vascular permeability. Measurements and Main Results: Bronchial casts, composed of abundant fibrin and lacking mucus, occluded dependent lobar bronchi within 18 hours of CEES exposure. BALF contained elevated concentrations of IgM, protein, and fibrin. Accumulation of fibrin-rich fluid in peribronchovascular regions (4 h) preceded cast formation. Monastral blue dye leakage identified bronchial vessels as the site of leakage. Conclusions: After CEES inhalation, increased permeability from damaged bronchial vessels underlying damaged airway epithelium leads to the appearance of plasma proteins in both peribronchovascular regions and BALF. The subsequent formation of fibrin-rich casts within the airways then leads to airways obstruction, causing significant morbidity and mortality acutely after exposure.

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mentioning

confidence: 99%

Airway Obstruction Due to Bronchial Vascular Injury after Sulfur Mustard Analog Inhalation

Veress¹,

O’Neill²,

Hendry‐Hofer³

et al. 2010

Am J Respir Crit Care Med

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show abstract

“…These responses can be seen in chronic bronchitis, obstructive bronchitis, bronchiectasis, tracheoomalacia and tracheal obstruction. Any agent that could reduce inflammation and inflammatory Immunoglobulins in these patients can be used in recovery and treatment of the related complications to poisoning caused by mustard gas [14][15][16] . Other studies on the role of oxidative stress and inflammation caused by mustard gas in these patients stated that due to the proven role of oxidative stress in pathogenesis of inflammatory tissue 17 , the possibility of involvement of oxidative stress and reactive oxygen species and deficiency of defensive antioxidants of the body against them are also raised in the case of the late injury caused by mustard gas due to stability of inflammatory process in lower respiratory tracts [18] and progressive nature of the disease.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Concurrency of Colchicine and Simvastatin on Variation of Serum Immunoglobulins IgG, IgE, IgM and IgA in Mustard Gas-Wounded Patients

Emad¹,

Koushki²

2016

Biosci., Biotech. Res. Asia

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Mustard gas as a chemical weapon causes devastating effects on different tissues of the body and there is no perfect antidote against it. This gas is a very strong and nonspecific alkaline agent that is capable of causing inflammation as well as increase of immunoglobulins in the patients. This gas causes irreparable and sever damage to all the body tissues; so finding of effective medicines to treat the mustard gas-exposed patients is of great importance and is the main purpose of this study. This study was conducted as double-blind intervention during 2 months. The population society was consisted of 40 mustard gas-wounded patients. Their illness had previously been approved by Foundation of Oppressed and the Crippled and other valid government agencies. These patients were referred as OPD for treatment to pulmonary clinic related to Shiraz University of Medical Sciences (Motahari, Imam Reza and Shahid Faghihi Clinics). The studied patients in this study were divided into two groups: 1-The placebo group that included 20 patients who did not receive colchicine and simvastatin. 2-The medication group included 20 patients who received simultaneously colchicine and simvastatin with daily dosage of 1 mg/d and 10 mg/d, respectively. Then blood samples were obtained from the under studied patients and the concentration of serum immunoglobulins IgG, IgE, IgM and IgA was measured by PFT method and using Prestige 24i automate analyzer device in before and after the beginning of the treatment. The results showed that there is no significant relationship between the concentrations of IgG, IgE, IgM and IgA before and after receiving the medicines and placebo (p value: 1). The obtained results from this study indicates that both colchicine and simvastatin are not effective in patients with mustard gas toxicity and thereby it will be possible to cut the treatment with both medicines in these patients and to reduce by this way the costs related to the treatment of these patients and to ignore the continues of an useless treatment.

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“…Increased bronchovascular markings, and hyperinflation, pulmonary hypertension can be seen in CXR (12,36).…”

Section: Chest X-raymentioning

confidence: 99%

COPD Due to Sulfur Mustard (Mustard Lung)

Lari¹,

Attaran²,

Towhidi³

2012

Chronic Obstructive Pulmonary Disease - Current Concepts and Practice

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Bronchiolitis obliterans following exposure to sulfur mustard: chest high resolution computed tomography

Cited by 112 publications

References 16 publications

Airway Obstruction Due to Bronchial Vascular Injury after Sulfur Mustard Analog Inhalation

Airway Obstruction Due to Bronchial Vascular Injury after Sulfur Mustard Analog Inhalation

The Impact of Concurrency of Colchicine and Simvastatin on Variation of Serum Immunoglobulins IgG, IgE, IgM and IgA in Mustard Gas-Wounded Patients

COPD Due to Sulfur Mustard (Mustard Lung)

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