Coronary angiography findings in lung injured patients with sulfur mustard compared to a control group.

Aims and Objectives: We evaluated the incidence of coronary artery disease (CAD) in Sulfur mustard (SM) exposed veterans. We also evaluated the relationship between exposure to SM and angiography findings and compared angiography findings of SM exposed individuals with unexposed ones after two decades from the time of exposure to SM. Materials and Methods: A case-control study was conducted on 200 consecutive patients (100 SM exposed vs. 100 unexposed) undergoing angiographic assessments due to CAD. Results: The coronary angiography findings between two groups were significantly different ( P < 0.001). Ninety two (92%) patients in SM exposed group and 82 (82%) in unexposed group had abnormal findings in their coronary arteries ( P = 0.031). Conclusions: The incidence of CAD and angiographic changes were significantly increased with exposure to SM. Further studies on cardiovascular effects of SM are needed.

Correlation between the degree of air trapping in chest HRCT and cardiopulmonary exercise test parameters: could HRCT be a predictor of disease severity?

The purpose of this study was to examine whether the degree of air trapping in high resolution computed tomography [HRCT] of patients with histories of sulfur mustard gas exposure during suspended full expiration correlated with various parameters of the cardiopulmonary exercise test as the gold standard for assessment of pulmonary function. In this analytic study 75 male patients, each with a history of sulfur mustard gas exposure, were investigated. Each participant underwent an incremental cardiopulmonary exercise test, pulmonary function test and arterial oxygen saturation for hemoglobin measurement. For HRCT examination, both lungs were divided into three parts [upper, middle, and lower] and in each part images were separately observed from the involved area point of view [<25% = 6/24; >/= 25%= >/= 6/24]. A total of 49.3% of the patients of >/= 25% or < 25% were 41.1 +/- 6.8 and 39.7 +/- 4.0 years, respectively [P=0.281]. In our study there was no significant difference in pulmonary function test findings [FEV1, FVC and FEV1/FVC] between the two groups. There was no significant correlation with air trapping of >/= 25% and any of the exercise test parameters. Also, no correlation was found between significant air trapping and exercise test finding in maximum exercise and anaerobic situations. No correlation was found between HRCT and cardiopulmonary exercise test findings. HRCT is neither pathognomic of the disease nor a good predictor of disease severity but it might be suggestive of mustard lung injuries

Multiple large cherry angiomas after exposure to sulfur mustard gas in Iranian veterans in Iraq-Iran war: a historical cohort study

Sulfur mustard [SM] is a blistering agent which has been used as a chemical warfare agent in many wars since 1917. It has been used several times by Iraqi forces during Iraq Iran war [1980-88]. Lungs, skin and eyes are the three major targets affected by SM. We had observed an increased number of cherry angiomas, benign vascular tumors, in Iranian veterans after exposure to SM, so we decided to assess number and size of cherry angiomas in Iranian veterans several years after exposure to SM. In this historical cohort study, 99 veterans exposed to SM were compared to 52 non-exposed individuals. Participants were examined for number and maximum size of cheny angiomas and the findings were compared between the two groups. All participants were male. The age range in case group was from 30 to 60 years [mean +/- SD: 42.7 +/- 7.6] and in control group was from 30 to 65 years [mean +/- SD: 39.9 +/- 9.9]. In case group, number of angiomas and maximum size of them were significantly greater than those in control group [P=0.001 and P=0.0001; respectively]. There was a direct correlation between number of angiomas and maximum size of them in case group [P=0.0001]. Most of lesions were located in trunk and upper extremities. SM seemed to be responsible for the presence of multiple cherry angiomas in veterans several years after exposure. Maximum size of angiomas in veterans was significantly greater than those were observed in non-exposed individuals

Development of bronchiectasis; a late sequela of mustard gas exposure

Bronchiectasis following inhalation of chemical gases, mainly ammonia, has been occasionally reported in literature. The widespread use of sulfur mustard gas, as a warfare agent by Iraqi forces, during the Iran-Iraq war, has resulted in chronic lung diseases including bronchiectasis, among Iranian veterans exposed to this agent. In this cross-sectional clinical study, we present 16 proven cases of bronchiectasis following a single episode of inhalation of sulfur mustard gas. Both diffuse and focal forms of bronchiectasis were encountered in this group of patients. In the majority of patients, pulmonary function tests showed either obstructive or mixed obstructive and restrictive patterns. The lesions were more frequently in the lower lung lobes. Bronchiectasis is a relatively common chronic pulmonary sequela of sulfur mustard gas injury. The observation that only a subset of victims exposed to mustard gas have developed bronchiectasis underlines the hypothesis that individual susceptibility is important for development of bronchiectasis

Development of malignant melanima following exposure to sulfur mustard gas

Two cases of cutaneous malignant melanoma were observed in two Iran-Iraq war victims exposed to chemical warfare [sulfur mustard gas]. In both cases melanoma developed on healed areas of mustard gas exposure after several months. The clinical course was unusually dramatic in both cases. Both cases died of aggressive clinical course. Possible etiologic role of mustard gas in the development of malignant melanoma is discussed

Transient decreased serum testosterone after exposure to mustard gas

The effects of exposure to chemical weapons containing sulfur mustards on the serum levels of total and free testosterone, gonadotropins and prolactin was investigated in young Iranian men. In the first five weeks after injury both serum total and free testosterone were significantly decreased as compared to control values. Three of 13 men had total testosterone below 300 ng/dL; and two of six had subnormal serum free testosterone concentrations. By the fifth week after exposure serum free testosterone did not change; however there was further fall in mean serum total testosterone and 70% of men had subnormal values. Both serum total and free testosterone concentrations returned to normal values by the 12th week after injury. There was a significant rise in serum FSH and prolactin by the fifth week and in serum LH by the fourth week after exposure. These data suggest that injury by the chemical warfare containing sulfur mustard may cause acute inhibition of testosterone secretion from the testis leading to a significant decline in serum total and free testosterone and some increase in gonadotropin concentrations. The inhibition seems to be transient and hormone levels return to normal by 12th week after injury

Chemical weapons may trigger vernal conjunctivitis in snscep live subjects three case report

Six atopic patients have shown new allergic reactions after exposure to chemical weapons, three of them as vernal conjunctivitis. ELISA titers for allergen- specific IgE and skinprick test [for common enviromental allergens] were used. According to our observations, it has been supposed that chemical weapons may trigger some related mechanism especially in the eyes in atopic patients due to their genetic and physiopathological characteristics