اخبار فوری
- 1404/05/29 بررسی وضعیت پروژههای سلامت شرق گیلان
- 1404/05/29 بررسی روند توسعه زیرساختهای سلامت منطقه غرب گیلان
- 1404/05/29 وبینار علمی آموزشی با محوریت فرزندآوری سالم و جوانی جمعیت برگزار شد
- 1404/05/28 برگزاری دومین ملاقات مردمی رئیس دانشگاه علوم پزشکی گیلان در مردادماه ۱۴۰۴
- 1404/05/28 در راستای گرامیداشت هفته دفاع مقدس؛ اعزام کارکنان دانشگاه علوم پزشکی گیلان به مناطق راهیان نور
- 1404/05/26 بازدید رئیس دانشگاه علوم پزشکی گیلان از سرای دانشجویان متأهل بهار
- 1404/05/26 مقاومت دیروز، نسخه پیروزی امروز است
- 1404/05/26 تسریع در بهرهبرداری از بیمارستان ۴۲۱ تختخوابی لاکان
- 1404/05/26 تقدیر رئیس دانشگاه علوم پزشکی گیلان از آزادگان و خانوادههای ایثارگر
- 1404/05/26 پیام تبریک رئیس دانشگاه علوم پزشکی گیلان به مناسبت سالروز بازگشت آزادگان سرافراز
Thoracic surgeon role in diagnosis of sarcoidosis
Sarcoidosis and Granulomatous mastitis
سارکوئیدوز در کودکان
مروری بر اشکال بالینی سارکوئیدوز جلدی و سیمای سارکوئیدوز جلدی در گیلان
ابتلای قلب در سارکوئیدوزیس
تظاهرات بالینی سارکوئیدوزیس ریوی
بررسی و تعیین جهش در آللrs2076530 ژنBTNL2 در بیماران مبتلا به سارکوئیدوز مراجعه کننده به بخش ریه بیمارستان دکتر علی شریعتی
Sarcoidosis, a report from Guilan province 2001-09
Surgical Management of Bilateral Bronchiectases: Results in 29 Patients Asian Cardiovasc Thorac Ann 2006;14:219-222
Contribution of viruses, Chlamydia spp. and Mycoplasma pneumoniae to acute respiratory infections in Iranian children'. Journal of Tropical Pediatrics
Carcinoid tumor of the lung with Cushing syndrome: A case report and review of literature :Archive of Iranian medicin2007.:No=1 ;vol=10:94-9615
One-stage procedure for lung and liver hydatid cysts. Asian Cardiovasc Thorac Ann. 2008 Oct;16(5):392-5
Clinical presentation, diagnosis and treatment in 31 cases Iranian Red Crescent Medical Journal 2008 10(3),233--237)13
Thymoma with pancytopnia :A case report and review of literature. Iranian Islamic Repuplic 2007 :No=2 ;vol=21page=115-11112
Report A case of Castelman,s Disease in a 35-Year-Old Girl With Giant Mediastinal Mass. journal of tanaffos2009
BRONCHOSCOPIC EXTRACTION OF A HYDATID MEMBRANE IN A 26 YEAR OLD WOMAN WITH RECURRENT PNEUMONIA- Iranian Red Crescent Medical Journal. 200910
PULMONARY FUNCTION TEST RESULTS IN PATIENTS WITH ULCERATIVE COLITIS, Iranian Red Crescent Medical Journal,20099
Intralobar Pulmonary Sequestration with Aspergilloma and a Large Aberrant Artery in a 35 Year Old Man. J Cardiovasc 2010 Thorac Res; Vol.2 (1): 43-46
Results of chest wall resection and reconstruction in162 patients with benign and malignant chest wall disease. J Thorac Dis 2010; 2:81-857
Respiratory findings in dental laboratory technicians in Rasht (North of Iran), TANAFFOS ,20116
Giant Mediastinal thymolipoma in a 35-Year-Old Women J Cardiovasc Thorac Res 2011; 3 (2): 67- 705
Mediastinal teratoma with pulmonary involvement and presenting with expectoration of hair,sebum and teeth, Archives of Iranian Medicine2011
HsCRP in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease. Iranian red Crescent Medical journal. 2011; 13(10):713-7182
Pulmonary Botryomycosis Mimicking Bronchogenic Carcinoma of the Lung . Tanaffos 2013 ; 12(3) : 62-64
Knowledge and attitude of physicians And nurses about sleep apnea disorder, ERS Congress, 2007
Effects of atorvastatin in asthmatic patients under treatment with high dose inhaled or oral steroid-21st ERS Congress2010- .-oral presentation Preval
UPPER THIRD WIDTH IN PA CHEST FIL DOSE NOT DIRECTLY CORRELATED WITH OBSTRUCTIVE PATTERN IN SPIROMETRY -THE 5 INTERNATIONAL CONGRESS ON PULMONARY DISEA
A casepresentation of pulmonary Botryomycosis which mimic of lung mass(First Iranian Reported case)- THE 5 INTERNATIONAL CONGRESS ON PULMONARY DISEASE
a SURVEY ON DIFFERENT CAUSES OF HEMOPTYSIS IN RAZI HOSPITALIN RASHT 2006-2010 THE 5 INTERNATIONAL CONGRESS ON PULMONARY DISEASE-INTENSIVE CARE AND TB2
Upper Third Width In Posteroanterior (pa) Chest Film Correlate With Obstructive Pattern In Spirometry. Am J Respir Crit Care Med 185;2012:A2026
Clinical Finding, Diagnosis And Outcome Of Patients With Complicated Pulmonary Hydatid Cyst.THE 5 INTERNATIONAL CONGRESS ON PULMONARY DISEASE-INTENSI
ماستیت گرانولوماتوز پستان ،گزارش یک مورد.همایش کشوری سارکوئیدوز.گیلان.2و 3خرداد 1392.پوستر
سارکوئیدوز و سل . همایش کشوری سارکوئیدوز .گیلان. 2و3 خرداد 1392
سارکوئیدوز ریوی. همایش کشوری سارکوئیدوز. گیلان.2و3 خرداد 1392
جنبه های پاتولوژیک و آزمایشگاهی سارکوئیدوزیس. همایش کشوری سارکوئیدوز. گیلان .2و3 خرداد 1392
Granulomatous Mastitis:A Histopathologic Review of 99 Cases.Sarcoidosis Congress Guilan.2013.Poster
Prevalence of Sarcoidosis In A Referral Bronchoscopy Center.Sarcoidosis Congress Guilan.2013.Poster
Sarcoidosis , A Report From Guilan Province (2001-09). Sarcoidosis Congress Guilan.2013.Poster
Thoracic Surgeon Role In Diagnosis of Sarcoidosis.Sarcoidosis Congress Guilan.2013
Sarcoidosis And Granulomatous Mastitis.Sarcoidosis Congress Guilan.2013
Sarcoidosis , A Report From Guilan Province (2001-09).Sarcoidosis Congress Guilan.2013
Classification and Management of Subcutaneous Emphysema: a 10-Year Experience,Indian J Surgery,04 October 2013
One Stage Operation for Five Giant Hydatid Cysts of Both Lungs and Liver in a 20-Year-Old Female
Reconstruction of Chest Wall Using a Two-Layer Prolene Mesh and Bone Cement Sandwich
GERD related micro-aspiration in chronic mustard-induced pulmonary disorder
Cardiopulmonary exercise text findings in Symptomatic mustard gas exposed cases with normal HRCT
بررسی اثر برداشتن تیموس در میزان بهبودی بیماران مبتلا به میاستنی گراویس با و بدون تیموما.فصلنامه طب جنوب
تاثیر آتورواستاتین بر شاخص های کنترل آسم مزمن در بیماران تحت درمان با دوز بالای استروئید استنشاقی یا استروئید خوراکی.مجله دانشگاه علوم پزشکی گیلان
روش های تشخیص سل فعال ریوی مجله علمی سازمان نظام پزشکی جمهوری اسلامی ایران، دوره 31 ، شماره 2، تابستان 1392 : 152 - 1
Fatigue, quality of life and health status in sarcoidosis
Sarcoidosis: joint, muscle and bone involvement
Clinical usefulness of nuclear imaging techniques in sarcoidosis
Rehabilitation programmes in sarcoidosis: a multidisciplinary approach
Results of Short- and Long-Segment Cardioesophageal Myotomy for Achalasia
Clinical presentation and operative repair of Morgagni hernia
Stiff Man Syndrome with Invasive Thymic Carcinoma
Clinical presentation and operative repair of Morgagni hernia
Surgical Management of Bilateral Bronchiectases: Results in 29 Patients Asian Cardiovasc Thorac Ann 2006;14:219-222
Contribution of viruses, Chlamydia spp. and Mycoplasma pneumoniae to acute respiratory infections in Iranian children'. Journal of Tropical Pediatrics
Carcinoid tumor of the lung with Cushing syndrome: A case report and review of literature :Archive of Iranian medicin2007.:No=1 ;vol=10:94-9615
One-stage procedure for lung and liver hydatid cysts. Asian Cardiovasc Thorac Ann. 2008 Oct;16(5):392-5
Clinical presentation, diagnosis and treatment in 31 cases Iranian Red Crescent Medical Journal 2008 10(3),233--237)13
Thymoma with pancytopnia :A case report and review of literature. Iranian Islamic Repuplic 2007 :No=2 ;vol=21page=115-11112
Report A case of Castelman,s Disease in a 35-Year-Old Girl With Giant Mediastinal Mass. journal of tanaffos2009
BRONCHOSCOPIC EXTRACTION OF A HYDATID MEMBRANE IN A 26 YEAR OLD WOMAN WITH RECURRENT PNEUMONIA- Iranian Red Crescent Medical Journal.
PULMONARY FUNCTION TEST RESULTS IN PATIENTS WITH ULCERATIVE COLITIS, Iranian Red Crescent Medical Journal,20099
Intralobar Pulmonary Sequestration with Aspergilloma and a Large Aberrant Artery in a 35 Year Old Man. J Cardiovasc 2010 Thorac Res; Vol.2 (1): 43-46
Results of chest wall resection and reconstruction in162 patients with benign and malignant chest wall disease. J Thorac Dis 2010; 2:81-857
Respiratory findings in dental laboratory technicians in Rasht (North of Iran), TANAFFOS ,20116
Giant Mediastinal thymolipoma in a 35-Year-Old Women J Cardiovasc Thorac Res 2011; 3 (2): 67- 705
Mediastinal teratoma with pulmonary involvement and presenting with expectoration of hair,sebum and teeth, Archives of Iranian Medicine2011
HsCRP in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease. Iranian red Crescent Medical journal. 2011; 13(10):713-7182
Pulmonary Botryomycosis Mimicking Bronchogenic Carcinoma of the Lung . Tanaffos 2013 ; 12(3) : 62-64
Classification and Management of Subcutaneous Emphysema: a 10-Year Experience,Indian J Surgery,04 October 2013
One Stage Operation for Five Giant Hydatid Cysts of Both Lungs and Liver in a 20-Year-Old Female
Reconstruction of Chest Wall Using a Two-Layer Prolene Mesh and Bone Cement Sandwich
Hepatitis C and pulmonary fibrosis
Comment on incidence of cancer in Iranian sulfur mustard (SM)
GERD related micro-aspiration in chronic mustard-induced pulmonary disorder
Cardiopulmonary exercise text findings in Symptomatic mustard gas exposed cases with normal HRCT
Results of Short- and Long-Segment Cardioesophageal Myotomy for Achalasia
Stiff Man Syndrome with Invasive Thymic Carcinoma
Clinical presentation and operative repair of Morgagni hernia
Knowledge and attitude of physicians And nurses about sleep apnea disorder, ERS Congress, 2007
Effects of atorvastatin in asthmatic patients under treatment with high dose inhaled or oral steroid-21st ERS Congress2010- .-oral presentation Preval
UPPER THIRD WIDTH IN PA CHEST FIL DOSE NOT DIRECTLY CORRELATED WITH OBSTRUCTIVE PATTERN IN SPIROMETRY -THE 5 INTERNATIONAL CONGRESS ON PULMONARY DISEA
A casepresentation of pulmonary Botryomycosis which mimic of lung mass(First Iranian Reported case)- THE 5 INTERNATIONAL CONGRESS ON PULMONARY DISEASE
a SURVEY ON DIFFERENT CAUSES OF HEMOPTYSIS IN RAZI HOSPITALIN RASHT 2006-2010 THE 5 INTERNATIONAL CONGRESS ON PULMONARY DISEASE-INTENSIVE CARE AND TB2
Upper Third Width In Posteroanterior (pa) Chest Film Correlate With Obstructive Pattern In Spirometry. Am J Respir Crit Care Med 185;2012:A2026
Clinical Finding, Diagnosis And Outcome Of Patients With Complicated Pulmonary Hydatid Cyst.THE 5 INTERNATIONAL CONGRESS ON PULMONARY DISEASE-INTENSI
A Giant Chest Wall Lipoma in a Thirty-Month-Old Girl: A Case Report and Review of Literature
Epidemiology of Mediastinal Tumors during Six Years (2006-2012) Rasht City
Perforated Jejunaldiverticula in a Patient with Multiple Giant Diverticula of The Duodenum and Jejunum :A Case Report
Complications during and one Month after Surgery in the patients who Underwent Thoracoscopic Surgery
Comparison between Pleurodesis Effects with Bleomycin and Tetracycline on the Management of Patients suffering from malignant pleural Effusion in the Rasht Hospitals
ABSTRACT
Pleural effusion is developed in %17 of patients with malignancies. Malignant pleural effusions are commonly managed with
tube thoracostomy drainage followed by chemical pleurodesis. Both tetracycline and bleomycin have been shown to be safe &
effective for intrapleural instillation, although neither agent has definitively proved better than the other. The aim of the
present study was to compare the efficacy of these two agents in terms of response rate. A prospective, randomized trial was
carried out in Rasht Hospitals. Between July 2011 and January 2013, 118 patients with malignant pleural effusion were
allocated to receive either intrapleural tetracycline (1.5 g) or bleomycin (1 U/kg) after drainage by tube thoracostomy.
Response was evaluated at 4 and 8 weeks after pleurodesis. Demographic, clinical and fluid parameter findings were
comparable in both groups. No statistically significant differences were found in terms of efficacy for two drugs used. Overall,
11 (18.64%) and 15 (25.42%) patients had a recurrence of pleural effusion during follow-up in the tetracycline and
bleomycin arms, respectively. Considering the comparable efficacy of both agents used for pleurodesis and no superiority of
one over the other in this trial, we suggest that economic costs and drug availability should be considered in selection of a
sclerosing agent hence Tetracycline is more acceptable.
Key words: Bleomycin, Pleural Disease, Maligmant Pleural Effusion, Pleurodesis, Tetrac
Complications during and one Month after Surgery in the Patients who Underwent Thoracoscopic Surgery
ABSTRACT
Thoracoscopy is a new method in surgery whose role is expanding in diagnosis and a wide range
of treatment of chest disorder. Thoracoscopy has many diagnostic and therapeutic benefits and
Knowing about the complications of this diagnostic and therapeutic method that is being used
broadly seems necessary. In this study, complications during and one month after surgery in the
patients who underwent thoracoscopy were reviewed. Materials and methods: This prospective
study was performed in 66 patients who underwent thoracoscopic surgery (VATS) between
March 2012 and March 2013 at the rasht hospitals. Patients were assessed after surgery for one
month follow–up. Findings: 66 patients were evaluated between March 2012 and march 2013.
Most patients were male. The mean age of patients was 43.37±17.31 (range, 5 to 82).
Intraoperative complications were as follow: Conversion from VATS to open Thoracotomy in 5
patients (7.6%), bleeding in 3 patients (5.4%) and Heart complication in 2 patients (3%).
postoperative complications were as follows: Air leak in 9 patients (13.6%), atelectasis in 4
patients (1.6%), pneumothorax in 2 patients (%3), heart complications in 2 patients (%3),
Empyema in 1 patient (5.1%). the median VAS score in patients was 4. Only 1.5% of the patients
who underwent thoracoscopy led to death. Conclusion: In our study, patients with pleural
effusion with unknown origin, palmer hyperhidrosis, empyema, trauma, and hemothorax
underwent thoracoscopy. The results showed that complications during and after surgery were
minimal and most patients had low postoperative pain.
Key words: Thoracoscopy, Thoracotomy, Air leak, Indication, Complication
Epidemiology of Mediastinal Tumors during Six Years (2006-2012) in Rasht City
Abstract
Mediastinal masses are relatively uncommon and
continue to be an interesting diagnostic and
therapeutic challenge to thoracic surgeons. Although
they tend to be more common in young and middleaged
adults, numerous types of mediastinal tumors
and cysts affect people of all age groups.
Epidemiologic survey of mediastinal tumors can get
important information for physician and health
experts. In this retrospective descriptive cross
sectional study, documents of 109 patients with
primary diagnosis of mediastinal tumor managed in
the Razi hospital between march 2006 and march
2012 were reviewed. 8 cases were excluded.
Statistical analysis was done with SPSS (version 16).
This study was carried out on 101 patients, the mean
age was 35.84±1.71 years and 56.4% of them were
male. The most common mediastinal tumors were
Non-Hodgkin lymphoma (30.7%), Thymoma
(13.8%) and Hodgkin lymphoma ( 12.9%)
respectively. 78.2% of tumors was in the anterior
mediastinum. the most common symptoms were
Cough and dyspnea; open biopsy was the most
diagnostic method; CXR and CT scan were the most
common imaging studies. There were seen
significant differences between type of tumor and
location of them (P<0.001). In addition, no
significant differences were seen between different
location of tumor and age (P=0.4) and gender
(P=0.82). This study showed that mediastinal tumors
were common in young male adults. cough and
dyspnea were the most common symptoms. In
addition, lymphoma and Thymoma were the most
common mediastinal tumors that were similar to
previous studies.
Keywords: Prevalence, mediastinum, tumor
Posterior Mediastinal Cyst
19-year-old man was admitted to our department with
right side chest wall pain, chronic cough and dyspnea. The
postero-anterior chest X-Ray revealed posterior mediastinal
mass. The patient was in good general condition. All clinical
examinations and laboratory tests were normal. Thoracic computed
tomography revealed a cystic, mass in the posterior mediastinum.
The mass measured 11.5 cm × 8.5 cm with water attenuation
and unenhanced wall, (Figure 1). Serological tests for hydatid
disease (anti-hydatid antibodies by ELISA, indirect hemagglutination
and immuno-electrophoresis) were negative. A right postero-
lateral thoracotomy was performed through the sixth intercostal
space. During exploration, a cystic mass was discovered in
an extrapleural location in the middle portion of the thoracic cavity
attached to the spinal cord. As cystic lesion was found in the
pleural cavity, we covered the cyst with sponge saline wet. When
the lesion was accidentally opened during the procedure, daughter
cysts were seen. The cyst was irrigated with hypertonic saline solution
Germinative laminated membrane and daughter cysts were
removed (Figures 2, 3). Gross and histopathologic examinations
hydatid cyst. The patient was given 800 mg daily of albendazole
for 3 months postoperatively. Post-operative ultrasound scan
showed no hydatid cyst in liver. The patient’s postoperative course
was uneventful and he was discharged six days later. On followup,
regular chest X-Ray showed no evidence of recurre
Surgical Management of pleural Complications of Lung and Liver Hydatid Cysts in 34 Patients
The aim of this retrospective study was to review pleural complications and results of surgical management of patient with hydatid disease. Between 2000 and 2010, 34 patients among 260 patients with hydatid disease, were diagnosed with pleural complications. Findings are presented in relative frequencies tables. The most common pleural complication was empyema in 9 patients. The most common procedure was cystotomy, evacuation and decortication in 25 patients. In endemic area, pleural complications of hydatid cyst should be considered for differential diagnosis. And because of higher morbidity and mortality, surgical treatment should be carried out before complications.
The Effect of Thoracoscopic Sympathectomy on the Quality of Life and the Functional outcome of the Patients with Primary Palmar Hyperhidrosis
ABSTRACT
Hyperhidrosis is a disorder of excessive sweat production. It can profoundly affect the quality of life and the
functional outcome of the patients with severe impairment of daily activities, social relationships and occupational
activities. The purpose of this study was to evaluate the effect of thoracoscopic sympathectomy at the T2-T4 levels
on the quality of life and the functional outcome of the patients with palmar hyperhidrosis. This retrospective study
includes 75 patients with palmar hyperhidrosis referred to the Razi Hospital from 2007 to 2011 and underwent
thoracoscopic sympathectomy at the T2-T4 levels. The Quality of life of the patients was evaluated using the
Dermatology Life Quality index(DLQI) and questionnaire form for functional outcome, while the pain of the
patients was evaluated using the visual analogue scale (VAS) before and 6 months after operation. Results: The
mean age of the patients was 26 years. The number of men was nearly equal to women. After operation, 73 patients
(97.3%) had complete remission and 2 patients (2.7%) had partial remission. The Quality of life and the functional
outcome of the patients improved significantly after operation (P<0.001). The most common complication was
compensatory hyperhydrosis occurred in 41.3% of cases. Thoracoscopic sympathectomy is an effective and safe
therapeutic modality for palmar hyperhydrosis. This operation improves the quality of life and the functional
outcome of the patients significantly.
Keywords: Hyperhidrosis, Thoracoscopy, Sympathectomy, quality of life.
Ultrasound Guided Port-A-Cath Implantation
Abstract
Purpose: The use of port catheters is well accepted in the management of patients with malignancy.
In this study, we compare the technical success and the complication rates of ultrasound
guided Port-A-Cath implantation with doing this procedure by using the anatomical landmark
method. Methods: In a retrospective study, from 2006 to 2009, medical files of 104 patients who
had undergone Port-A-Cath implantation were reviewed. The indication for port catheter implantation
was malignancy in all cases. Among our patients, Port-A-Cath implantation was done in 63
patients by using landmark method and in 41 patients by guidance of ultrasound. All patients had
been observed for complications including pain, port infection, and port thrombus, thrombus of
central veins, skin necrosis, and success in using of Port-A-Cath for at least one month following
the procedure, in the vascular clinic. Results: in landmark method group, 2 catheters were nonfunctional
just after placement (3.2%) while all Port-A-Caths in ultrasound-guided group were
functional. Ten patients (15.9%) in land mark group and 1 patient (2.4%) in ultrasound-guided
group were complicated. The difference between complication rate in anatomic landmarks method
and ultrasound-guided method was statistically significant (p < 0.04). There was no significant
difference in two groups in duration of port placement (p < 0.345), age (p < 0.444), site of
port placement (p < 0.244) or type of malignancy (p < 0.18). Conclusion: Considering high rate of
success and low complications in placement of Port-A-Cath with ultrasound guidance, this method
is superior to the land mark method in patients with malignancy.
Keywords
Ultrasound Guided, Port-A-Cath, Implantation
Cervical Esophageal Perforation: A 10-Year Clinical Experience in North of Iran
Abstract Perforations of the cervical esophagus are
infrequent severe conditions associated with a high rate of
morbidity and mortality if misdiagnosed. The diagnosis
and management of cervical esophageal perforation
remains a challenging clinical problem. We aimed to
present our experience of the etiology, presentation, management
and outcome of cervical esophageal perforation in
a 10 years period. In this cross-sectional study, we
reviewed the records of all patients with a diagnosis of
cervical esophageal perforation admitted at the teaching
Razi Hospital of Rasht, north of Iran, between 2001 and
2011. 26 patients (15 male) were studied with mean age of
47.6 ± 13.78 years, a range from 10 to 68 years. Only 16
(61.5 %) of patients were referred within 24 h of injury.
The etiology was iatrogenic in 15 cases (57.69 %), foreign
body ingestion in 7 cases (26.9 %), and penetrating traumatic
injury in 4 cases (15.4 %). The common clinical
manifestations of perforation were neck pain in 22 cases
(84.6 %), fever in 19 cases (73.1 %), and subcutaneous
emphysema in 12 cases (46.2 %). Barium and gastrografin
swallow were performed in 57.7 and 23.1 % of patients,
respectively and flexible esophagoscopy was used in
23.06 %. Most of patients (65.4 %) were managed by
primary repair. Overall, mortality rate was 7.7 %. Our
study demonstrates that the most common cause of cervical
esophageal perforation is iatrogenic injury. Clinical suspicion
is most important problem. Furthermore, Diagnosis is
mainly made by Barium and gastrografin swallow. For a
successful outcome, primary repair is a preferred treatment
for most perforation patients.
Keywords Cervical esophageal perforation, Etiology ,
Presentation , Management , Outcome
The Clinical Finding, Diagnosis and Outcome of Patients with Complicated Lung Hydatid Cysts
ABSTRACT
Rupture of a hydatid cyst may cause some unique problems in children and adult. The clinical presentation
and the preoperative diagnosis and postoperative complications depend on whether the cyst is intact or
ruptured. The aim of this study was to review the problems of the ruptured pulmonary hydatid cysts. Between
1996 and 2009, 58 patients with a total of 74 ruptured lung hydatid cysts were operated. The medical records
for 58 patients of pulmonary hydatidosis were retrospectively investigated. Data related to symptoms,
preoperative diagnosis and complications, surgical procedures, postoperative morbidity, hospitalization time,
and cyst recurrence were collected. 42 patients (72.41%) were male. the median age of patients was 32 years
(range, 4 to 69 years). Clinical symptoms were as follow: Productive cough in 47 patients (81%), Dyspnea in
42 patients (72.41%), chest pain in 31 patients (53.44%) and hemoptysis in 13 patients (22.41%).
Assessment of clinical findings, chest roentgenograms, thoracic computed tomography, led to the correct
preoperative diagnosis of pulmonary hydatid disease in 52 patients (89.65%). Right lower lobe was the most
common location of cyst in the lungs (63%). In 42 cases (72.41%) rupture of cyst occurred into
tracheobronchial tree and in 10 patients (17.24%) rupture of cyst occurred into pleural space. recurrent
pneumonia occurred in 6 patients (10.34%). Postoperative complication was occurred in 20 patients
(34.48%). Reoperation performed for bronchopleural fistula in 2 patients and bilo-pleural fistula in 1 patient.
Recurrence occurred in 1 patient which treated with albendazol. Hospital mortality was not occurred. Surgery
is the primary mode of treatment for patients with pulmonary hydatid disease. Complicated cases have higher
rates of preoperative and postoperative complications and require longer hospitalization time and more
extensive surgical procedures. Immediate treatment should be performed in any patient who is diagnosed with
pulmonary hydatid cysts.
Keywords: Echinococcosis, hydatid disease, complicated cysts, intact cysts.
Approach to Patients with Severe Asthma: a Consensus Statement from the Respiratory Care Experts’ Input Forum (RC-EIF), Iran
ABSTRACT
Challenges in the assessment, diagnosis and management of severe, difficult-to-control asthma are increasingly regarded as
clinical needs yet unmet. The assessments required to determine asthma severity, comorbidities and confounding factors,
disease phenotypes and optimal treatment are among the controversial issues in the field.
The respiratory care experts’ input forum (RC-EIF), comprised of an Iranian panel of experts, reviewed the definition,
appraised the available guidelines and provided a consensus for evaluation and treatment of severe asthma in adults.
A systematic literature review followed by discussions during and after the forum, yielded the present consensus. The expert
panel used the appraisal of guidelines for research and evaluation-II (AGREE-II) protocol to define an initial locally-adapted
strategy for the management of severe asthma.
Severe asthma is considered a heterogeneous condition with various phenotypes. Issues such as assessment of difficult-tocontrol
asthma, phenotyping, the use of blood and sputum eosinophil count, exhaled nitric oxide to guide therapy, the
position of anti-IgE antibody, methotrexate, macrolide antibiotics, antifungal agents and bronchial thermoplasty as well as
the use of established, recently-developed and evolving treatment approaches were discussed and unanimously agreed upon
in the panel.
A systematic approach is required to ensure proper diagnosis, evaluate compliance, and to identify comorbidities and
triggering factors in severe asthma. Phenotyping helps select optimized treatment. The treatment approach laid down by the
Global Initiative for Asthma (GINA) needs to be followed, while the benefit of using biological therapies should be weighed
against the cost and safety concerns.
Key words: Severe asthma, Definition, Comorbidities, Treatment, Phenotyping, Consensus statement, Iran
Correlation of the Ratio of Upper Third to Lower Third Circumferences of the Chest with Obstructive Pattern in Spirometry
Background: Obstructive Lung Diseases (OLDs), could lead to progressive hyperinflation of the lungs that cause increased work of breathing, impaired gas exchanges and functional limitations in patients. In this study, thoracic circumference of patients in upper and lower third were measured directly and the association of the upper to lower third width of chest with spirometric parameters was evaluated.
Materials and Methods: In this cross-sectional study, five hundred twenty nine consecutive patients, with obstructive pattern in spirometry (FEV1/FEVC<70% and FEV1<80%), and 143 controls with normal spirometry were entered. Demographic and clinical data including age, sex, smoking, type, duration and severity of disease and spirometric characteristics were recorded. Upper Third circumference of Chest (UTCC) at axillary level, and Lower Third circumference of Chest (LTCC) at lower rib edge, were measured with an ordinary tape meter.Asthma Control Test (ACT) questionnaire for asthmatic and COPD Assessment Test (CAT) questionnaire in COPD patients were completed.
Results: We found that in patients with UTCC/LTCC ratio > 0.8, UTCC had significant correlation with FEV1 and FEV1/FVC (R: 0.069, 0.055); Moreover significant correlation was found in UTCC, LTCC and UTCC/LTCC ratio with ACT score in this subgroup (R: -0.123, -0.092, -0.124)On the other hand in patients with UTCC/LTCC ratio > 0.9 , UTCC and LTCC had significant correlation with FEV1 (R: 0.07, 0.051).
Conclusion: UTCC/LTCC ratio > 0.8, may be a predictor of obstructive pattern in patients. This is more important in some occations, for example during preoprative evaluation of a patient in an emergency conditions which there is no enough time for performing appropriate diagnostic tests such as spirometry to reveal the type and severity of obstructive pulmonary diseases.
Key words: Spirometry; Lung Diseases, Obstructive
Materials and Methods: In this cross-sectional study, five hundred twenty nine consecutive patients, with obstructive pattern in spirometry (FEV1/FEVC<70% and FEV1<80%), and 143 controls with normal spirometry were entered. Demographic and clinical data including age, sex, smoking, type, duration and severity of disease and spirometric characteristics were recorded. Upper Third circumference of Chest (UTCC) at axillary level, and Lower Third circumference of Chest (LTCC) at lower rib edge, were measured with an ordinary tape meter.Asthma Control Test (ACT) questionnaire for asthmatic and COPD Assessment Test (CAT) questionnaire in COPD patients were completed.
Results: We found that in patients with UTCC/LTCC ratio > 0.8, UTCC had significant correlation with FEV1 and FEV1/FVC (R: 0.069, 0.055); Moreover significant correlation was found in UTCC, LTCC and UTCC/LTCC ratio with ACT score in this subgroup (R: -0.123, -0.092, -0.124)On the other hand in patients with UTCC/LTCC ratio > 0.9 , UTCC and LTCC had significant correlation with FEV1 (R: 0.07, 0.051).
Conclusion: UTCC/LTCC ratio > 0.8, may be a predictor of obstructive pattern in patients. This is more important in some occations, for example during preoprative evaluation of a patient in an emergency conditions which there is no enough time for performing appropriate diagnostic tests such as spirometry to reveal the type and severity of obstructive pulmonary diseases.
Key words: Spirometry; Lung Diseases, Obstructive
EVALUATION OF CHEST TRAUMA IN PATIENTS ADMITTED TO RASHT POURSINA HOSPITALS IN 2013
ABSTRACT
The purpose of this study is to review the epidemiology and the severity of patients with chest
trauma damage. In this descriptive study, data of patients with chest trauma in 2013 who
admitted to Poursina hospital in Rasht the patients in terms of demographic characteristics, type
of trauma, associated injuries, length of hospitalization, ISS and mortality were evaluated.
According to research findings, chest internal injuries were, % (50.2) were the most leading
damages which lead to hem pneumothorax% (28.6). % 79.5 patients recovered with supportive
measures and the most common mechanism of injury was motor vehicle accident. (% 58.4) In
this study, men had higher ISS and higher ISS in patients led to long hospitalization as well astube thoracotomy, mortality was higher in the group with higher ISS. Mortality in this study was
7.3%. In general, chest trauma was more in men. Vehicle accident and falling down are the most
common mechanism of chest injury. Patients with high ISS had more days of hospitalization,
need for intervention and more deaths.
Key words: Chest trauma, Poursina center of Rasht, ISS, blunt trauma
The purpose of this study is to review the epidemiology and the severity of patients with chest
trauma damage. In this descriptive study, data of patients with chest trauma in 2013 who
admitted to Poursina hospital in Rasht the patients in terms of demographic characteristics, type
of trauma, associated injuries, length of hospitalization, ISS and mortality were evaluated.
According to research findings, chest internal injuries were, % (50.2) were the most leading
damages which lead to hem pneumothorax% (28.6). % 79.5 patients recovered with supportive
measures and the most common mechanism of injury was motor vehicle accident. (% 58.4) In
this study, men had higher ISS and higher ISS in patients led to long hospitalization as well astube thoracotomy, mortality was higher in the group with higher ISS. Mortality in this study was
7.3%. In general, chest trauma was more in men. Vehicle accident and falling down are the most
common mechanism of chest injury. Patients with high ISS had more days of hospitalization,
need for intervention and more deaths.
Key words: Chest trauma, Poursina center of Rasht, ISS, blunt trauma
Giant Pedunculated Colonic Lipoma Causing Colo-Colic Intussusception and a Rectal Bleeding
Abstract
Intussusception is less common in adults than in children. Intussusception in adults is associated with an identifiable etiology in 90% of cases. Lipoma of the large intestine is rare; with a reported incidence ranging between 0.2% and 4.4%. Small Lipomas are usually asymptomatic, but giant Lipomas are often presented as abdominal pain, vomiting, diarrhea, bleeding and Intussusception. We present a case of 45-year-old man in our emergency room with intermittent abdominal cramps, rectal bleeding for eight days. Physical examination showed tenderness in the left lower abdominal quadrant. Blood found in rectal examination. Colonoscopy in two periods revealed an ulcerative mass in the proximal of descending colon. A CT scan showed a coil spring appearance highly suspicious for Intussusception of the descending-colon, a laparotomy was performed. The Intussusception was found in the descending colon, with extended left hemicolectomy, en-bloc resection was performed with end-to-end anastomosis. After surgical resection, the histo pathologic examination of the specimen showed the configuration of pedunculatedlipoma with tip ulceration, measuring 9x5x 6 cm in diameter. Patient discharged on day five post-operative with good condition.
Keywords: Colonic Lipoma; Intussusception; Colonoscopy; Hemicolectomy; En-Bloc resection
Granulomatous mastitis: Presentations, diagnosis, treatment and outcome in 206 patients from the north of Iran
Objectives: The aim of this study is to review the clinical presentations, diagnostic methods, treatment
options and outcome of patients with Granulomatous Mastitis (GM).
Material and methods: In a retrospective study, we indentified 206 women who met the required histological
criteria of (GM).
Results: Thirty eight (18%) of these women had taken antibiotics before their diagnosis of GM. The most
common symptoms in remaining 168 symptomatic women were breast mass. The most common ultrasonographic
and mammographic finding was large irregular hypo echoic masses and an irregular
mass, respectively. As a diagnostic tool, fine needle aspiration (FNA) was performed in 33 (19.5%) and
core needle biopsy with or without ultrasound was done in 92 (55%) of patients while successful rate was
13 (39%) and 87 (94.5%), respectively. The remaining 43 (25.5%) of women underwent surgical excisions.
Only 6 (3%) patients improved with antibiotics and 200 (97%) of women who did not respond to antibiotics,
were treated with steroid and among them 144 (72%) improved. Treatment with combination of
methotrexate and steroid was done in 56 (28%) patients and was effective in 40 (71%) of them. Sixteen
(8%) patients were treated with a combination of steroid and bromocriptine which was effective in 5
(31%) patients. A wide surgical excision was performed in 11 (5.5%) patients who were nonresponsive to
steroid and methotrexate and bromocriptine therapy.
Conclusion: Our findings indicate that clinical and imaging findings of (GM) have overlapped with malignancy.
The best diagnostic method is core needle biopsy. Corticosteroids are in the first line of
treatment with a good therapeutic response.
Zenker’s Diverticulum: Report Rare Presentation and Management of Six Cases
Abstract
Background: Zenker’s diverticulum is very uncommon and a reported prevalence ranging between 0.01 to 0.11% and typically occurs in middle-aged and elderly patients. The purpose of this study was to report of rare presentation and surgical procedures of six cases with Zenker’s diverticulum.
Materials and Methods: In this retrospective study, signs, symptoms, imagines feature and surgical approaches of six cases with Zenker’s diverticulum were recorded from 2000 to 2014in the Razi Hospital- Rasht- Iran of Guilan University Medical Science (GUMS).
Results: Four of patients were male. Age of patients was 65 to 80 years. Three of patients came with dysphasia, aspiration , halitosis, and malnutrition and regurgitation ,one of this patient have three period of aspiration pneumonia .One of patients came with endoscopic diverticulotomy with perforation and one with food marital retention and neck mass and one referred with diverticulitis. Two cases underwent flexible endoscopic diverticulotomy one failed and another one complicated with perforation. The most common surgical approaches was diverticulectomy and myotomy. Complication and mortalities was zero. Outcome was good.
Conclusion: Zenker’s diverticulum have to be considered in the differential diagnosis of dysphagial and neck. The treatment of choice is complete excision with surgery or endoscopy.
Keywords: Zenker’s diverticulum; Endoscopic diverticulotomy; Myotomy; Diverticulectomy; Endoscopic stapling diverticulotomy; Flexible endoscope
Complicated Hydatid Cysts of the Lung: Is Capitonnage Better than Uncapitonnage Method? Comparison Between Capitonnage and Uncapitonnage Technique in the Complicated Hydatid Cysts of the Lung
Abstract
After evacuation of the cyst, the residual cavity, always has some bronchial openings, must be managed appropriately. About residual cavity in complicated and noncomplicated hydatid cysts and capitonnage there is controversy. The aim of this study is to comparison advantages of capitonnage and non-capitonnage in the complicated hydatid cystof the lung because there is not enough research in this issue. This study is a retrospective descriptive cross-sectional study that was done on patient with impending to perforation and complicated pulmonary hydatid cyst. Demographic information consist of: age, sex, home place, career contact with livestock and clinical data consist of: Hospital stay, complications and mortality was noted. All data analyzed with SPSS. In our study was surveyed 75 patient in tow group with Capitonnage (CTG) (36) and Uncapitonnage (UCTG) (39). Mean age and standard deviation in (CTG) was (30±17.1) years and patient (UCTG) was (37.3±18.5) years. There were not significantly different between number of gender in 2 groups (p = 0.08). Hospital stay in our study in (UCTG) was 6.49±1.05 and in (CTG) 3+0.75±0.65 (p<0.0001). Post-operative broncho pleural fistula in (CTG) was 8.3% and in (UCTG) was 23.1 (p = 0.48) and post-operative air leak in (UCTG) was 25.6% and in (CTG) was 8.3% (p = 0.48). Mean average day for removal chest-tube in (UCTG) was 4.6 ± 0.99 day and in (CTG) was 2.64±0.59 day (p<0.0001) and also cumulating the fluid in cavity in (UCTG) was 3.79±0.61 and in (CTG) was 1.61± 0.49 month (p<0.0001). Post-operative air leak in (UCTG) was 25.6% and in (CTG) was 8.3% (p = 0.48). Mortality was not seen in two groups. Our study shows that capitonnage have less post-operative complications than uncapitonnage and is preferred method in surgery of complicated pulmonary hydatid cyst.
Giant Right Coronary Artery Aneurysm Mimicking a Mediastinal Cyst With Compression Effects: A Case Report
Abstract
Introduction: Giant coronary artery aneurysm is an extremely rare form of coronary artery disease. The most common cause of
coronary artery aneurysms is atherosclerosis. Although it is usually asymptomatic, it may have various clinical presentations, including
angina, myocardial infarction or sudden death.
Case Presentation: A 32-year-old woman presented with edema of the upper and lower limbs, palpitation, and chest pain, and
was diagnosed with a giant right coronary artery aneurysm that had initially mimicked a mediastinal cyst. Although computed
tomography (CT) suggested a mediastinal cyst, trans-thoracic echocardiography revealed an extra pericardial cyst. The definitive
diagnosis of right coronary artery aneurysm was made based on CT angiography and coronary angiography findings. As treatment,
aneurysmectomy was performed, and she was discharged on the sixth postoperative day with good general health condition.
Conclusions: Coronary artery aneurysm should be a differential diagnosis in cases of mediastinal cyst and mass lesion.
Keywords: Mediastinal Cyst, Echocardiography, Coronary Aneurysm, Coronary Angiography
Primary Hydatid Cyst of the Rib: Present as a Chest Wall Mass
Abstract
Background: Hydatid disease is a parasitic infestation of the humans that caused by echinococcus granulosus and can produce tissue cyst everywhere in body. The most common locations for development of a parasitic cyst are the liver (75%) and the lung (15%). Skeletal involvement in eccinococcal infection is a relatively rare condition and is seen in only 1-4% of cases and few reports from the medical literature have presented rib hydatidosis which clinically mimics benign or malignant cystic tumors at initial presentation and because of its unusual presentation, its diagnosis may easily be missed.
Case presentation: A 19-year-old Iranian male patient presented with a 7-month history of a painful chest wall mass. Computed tomography and chest X-Ray showed a mediastinal and chest wall mass with rib erosion. The surgery allowed both diagnosis and treatment. The patient underwent a right posterolateral thoracotomy. Daughter cysts were seen when the lesion was incidentally opened. Cystic portion of mediastinal and chest wall mass and involved rib was resected. The mass histologically diagnosed as hydatid cyst. Albendazol (800mg daily) was administered for three months postoperatively. The patient was discharged at postoperative 5th day in a state of complete recovery. Follow up at 1 year postoperatively demonstrated no recurrence of the chest wall mass.
Conclusion: Primary chest wall hydatid cyst is an extremely unusual condition and should be included in the differential diagnosis of chest wall masses especially in endemic areas.
Keywords: Hydatid cyst; Echinococcus granulosus; Chest wall mass; Rib hydatidosis
Primary Tuberculosis of the Thyroid Gland Presenting as a Cystic Lesion: Report Two Cases
Abstract
Tuberculosis of thyroid gland (TTB) is extremely uncommon. The incidence is low even in countries where the prevalence of tuberculosis (TB) is endemic and high. The diagnosis is often difficult as the clinical presentation has no distinct characteristics. We report two case of Primary Tuberculosis of the thyroid gland (PTTB) ,one was A 56-year-old man with a lump on the left side of his lower neck. He noticed the swelling 12 weeks prior to presentation and it had been gradually increasing in size. Another was, a 72-year-old man presented with history of left thyroid lobe swelling for 5-7 month, which was gradually increasing in size Ultrasonography disclosed nodules of the left lobe with cystic change. Thyroid function tests were in the normal range, there were no signs of inflammation. There was no evidence of tuberculosis in any other organ.FNA from left lobe of thyroid was performed which yielded purulent aspirate. Smears examined show degenerated inflammatory cells in a necrotic background No follicular epithelial cells were seen. The patients had surgery in which the left lobe was removed. Microscopic examination of the thyroid parenchyma revealed necrotizing epithelioid granulomas with Langhans giant cells. The diagnosis of thyroid tuberculosis was therefore made. The patients was put on isoniazid, rifampicin, ethambutol and pyrazinamid for 2 months and was subsequently given isoniazid and rifampicin for 4 months with a favourable outcome. Although seldom rare presentation of (TTB) observed, tuberculosis should be kept in mind in the differential diagnosis of nodular or cystic lesions of the thyroid.
Keywords: Tuberculosis; Thyroid gland; Inflammation; Isoniazid; Rifampicin; Ethambutol; Thyroid Lobe; Immunity; Lymph node; Thyroid cancer
The role of thoracoscopy in management and outcome of stage II thoracic parapneumonic empyema: review of 148 cases
Abstract
Background Various methods are available for the management
of stage II thoracic parapneumonic empyema (TPE). The
aim of this study was to determine the better method for the
management of stage II TPE.
Material and methods We conducted a retrospective study on
patients with diagnosis of TPE during 2005–2014.
Demographic and clinical data of patients were recorded and
analyzed.
Results A total of 148 patients (112 males, 36 females)
underwent therapeutic procedures for stage II TPE. The most
common diagnostic tool for TPE was posteroanterior and lateral
chest films. Tube thoracostomy with antibiotic therapy
and therapeutic thoracocentesis were the primary treatment
in 80 patients, of which 12 responded. One hundred twentyeight
patients underwent video-assisted thoracoscopic surgery
(VATS) and 118 of them responded. Thirty patients underwent
thoracotomy with breakdown of adhesions and decortications
that was successful in 86 % of them. Average hospitalization
in tube thoracostomy, thoracotomy, and thoracoscopy groups
was 10, 8, and 6 days, respectively.
Conclusion Our study showed the high failure rate of simple
drainage as the first procedure for the treatment of thoracic
empyema. Moreover, our study showed the association of
VATS with shorter duration of hospitalization, reduction in
complications and mortality rate, and wound infection in the
patients, so VATS may be considered as the first choice in the
management of stage II TPE. In addition, decortication can be
used in any patient with multiloculated empyema because of
its high success rate.
Keywords Thoracic empyema . Video-assisted
thoracoscopy . Thoracotomy
Thymic Cyst with Rare Clinical Presentations: Report of Ten Cases over 13 Years
Abstract
BACKGROUND: Thymic cysts of the mediastinum are uncommon. The incidence rate of thymic cysts is between 1 to 4.8 %. They usually present as an asymptomatic mediastinal mass. The purpose of this study was to report some rare presentations of ten cases with thymic cyst.
METHODS: In this retrospective study, signs, symptoms, imaging features and surgical approaches of ten cases with mediastinal thymic cyst were recorded between 2000 and 2013 in the Razi Hospital of Rasht, Iran.
RESULTS: Age of patients was between 12 and 60 years. Three patients presented
with hydrothorax. Two cases were found incidentally. One patient with hydropneumothrax, one with infected thymic cyst and one with neck mass were observed. Other signs were palpitation, chest pain and dyspnea. The most common surgical approaches were median sternotomy in four cases and postero-lateral thoracotomy in three cases. Complication happened in one patient with left phrenic nerve damage. There were no mortalities.
CONCLUSION: Thymic cysts should be considered in the differential diagnosis of the mediastinal and cervical masses. The treatment of choice is complete excision of the cyst.
Keywords: Thymic cysts; Mediastinal mass; Hydropneumothorax; Mediastinal cyst
Managements and Outcome of Complicated Liver Hydatid Cysts
Background: Hydatid Disease (HD) still remains an important health problem in developing
countries. In this study we evaluated the clinical features, management and outcome of patients
with complicated liver (HD).
Methods: In a retrospective study, we reviewed the records of patients with liver (HD) operated in
our department from January 2004 to January 2015. Number of cysts, location, signs and symptoms,
operative procedures, postoperative complications, and hospital stay were collected.
Results: A total of 352 patients were operated for liver (HD).73 (20%) of the Patients were complicated.
41 patients were male and 32 were women. The most common preoperative complications were
intrabiliary rupture (33%) and suppuration (22%). The most common presentations were chest
and abdominal pain (72.5%) and fever (56%). Surgical procedures were unroofing and drainage in
(22%), peri cystectomy, drainage, choledochotomy, choledochoduodenostomy, tube placement and
sphincterplasty in (46.5%) of patients with in intrabiliary rupture were. In interapleural rupture were
Thoracotomy, pherenotomy, liver cystotomy, drainage (7%) and pulmonary parenchymal rupture
were Thoracotomy, decortication, liver cystotomy and drainage (5.5%). Intraperitoneal rupture
cases underwent laparotomy, evacuation, irrigation and drainage (5.5%). One patient (1.36%) died.
postoperative morbidity rate was 55%.
Conclusion: Complicated liver hydatid cysts show different manifestations and surgical management
is difficult. Although postoperative complications are high, they can be managed successfully with
favorable results.
Keywords: Hydatid disease; Complications; Surgery; Pherenotomy
Costochondral Exostoses Mimicking as a Posterior Mediastinal Mass: A Case Report
Abstract
Exostosis (Osteochondroma) is a rare tumor in the rib, but in the mediastinum it is extremely
rare. Herein, we report a case of 32-year old male patient with a symptomatic solitary costal
exostosis in the left hemi thorax mimicking a mediastinal mass. The chest X-ray and magnetic
resonance imaging (MRI) of the chest revealed a bone density structure that had originated from
the costochondral junction of the left 10th and 11th ribs and protruded into the thoracic cavity.
Exploratory thoracotomy showed that the exostosis had scratched the adjacent aorta, diaphragm
and spinal column in the paravertebral sulcus. An 8 × 6 cm mass with long rib segment including
the exostosis was excised. Surgical resection is indicated for definitive diagnosis and prevention
of complications and malignancy. Surgical excision and histopathology confirmed the diagnosis
of exostosis (osteochondroma).
Efficacy and Safety of Povidone‑iodine Pleurodesis in Malignant Pleural Effusions
Introduction: Malignant pleural effusion (MPE) is determined by the detection of malignant cells in pleural fluid or pleural tissue. Neoplasm
of lung, breast, ovary and lymphoma are the causes of more than 75% of MPE. Pleurodesis is a usual technique in the management of MPE to
achieve a symphysis between two layers of the pleura, and various chemical agents have been used in an attempt to produce pleurodesis. With
regard to complications and limitations of these sclerosing agents, efficacy and safety of povidone‑iodine have been investigated in this study.
Materials and Methods: Between June 2014 and June 2016, 63 consecutive patients were admitted to the Department of Thoracic Surgery
because of symptomatic MPE. After insertion of a chest tube, pleurodesis with instillation of povidone‑iodine was performed. Thyroid and renal
function tests were checked, and success rate as well as recurrence of MPE was monitored in the next follow‑up visits. Results: The complete
response to this procedure was about 53.57%, and failure of treatment was 10.71% with efficacy of 82.2%. The most common complication
was pain during instillation (26.9%). Changes in thyroid and renal function tests were not significant. Conclusion: Povidone‑iodine is a safe
and effective agent with minor side effects in pleurodesis of patients with MPEs and can be used as an accessible and low‑cost alternative
than other sclerosing agents.
Keywords: Malignant pleural effusion, pleurodesis, povidone‑iodine
Report a Case of Huge Zenker’s Diverticulum with Date Nucleuses Impaction in and with Aspiration Pneumonia
Abstract
A Zenker’s diverticulum is the rarest type of gastrointestinal diverticulum and is located immediately above the upper esophageal sphincter and typically
presents in the elderly population with dysphagia regurgitation, halitosis, and malnutrition. Here we report cases of large Zenker’s diverticula with malnourished
secondary to dysphagia, regurgitation, hoarseness, or halitosis, profound weight loss, anemia, cough and aspiration pneumonia. She underwent an open
resection of the Zenker’s diverticulum and myotomy and discharged with good condition.
Multiple and Bilaterally Pulmonary Hydatid Cystic Mimicking Metastatic Lesions
Abstract
Hydatid cyst is a parasitic infestation of the humans that caused by echinococcus infection. This infection is considerable significantly aspublic health
problem. The most common locations for development of a hydatid cyst are the liver (75%) and the lung tissue (15%). Few reports from the medical literature
have presented pulmonary hydatidosis which clinically mimics metastaticmalignant tumors at initial clinical finding. Because of its unusual presentation, the
diagnosis may easily be missed with clinical presentations and imaging. Because of this problem, hydatid cyst of lung should be in difrienciated diagnosis of
others pulmonary diseases.
Case presentation: A 56 year-Old Iranian female patient presented with a 2-month history of chest pain, loss of appetite, weight loss, and dyspnea was
referred to our hospital. Computed tomography of the chest and chest X-Ray shows multiple nodules in both lungs .The open surgery allowed diagnosis. The
patient underwent a left anterolateral thoracotomy. When the lesion was incidentally opened, laminated membrane and daughter cysts were seen in three
of nodules. The histologically diagnosed also was hydatid cyst. Postoperatively, Albendazol (800mg daily) was administered for three cores of 28 day. The
patient was discharged after five day post operatively with well conditions. In six month postoperatively follow up; there was no recurrence of hydatid cyst
in the lungs and others organs.
Conclusion: Multiple bilateral pulmonary hydatid cyst is an extremely unusual condition and should be included in the differential diagnosis of multiple
bilateral pulmonary mass especially in endemic areas.
Report a Case of Two Spiral Rebars Impalement Injury Throughout Left Hemithorax and Neck
Abstract
Thoracic trauma can cause significant mortality and morbidity. Traumatic thoracic injuries are accompanied by abdominal, head and extremity injuries.
Thoracic trauma is divided into two groups; penetrating and blunt. Penetrating traumas are primarily caused by gunshots and sharp objects. The lungs are
the most commonly injured organ in penetrating thoracic trauma. Impalement of chest is an uncommon injury and one of the most severe types of penetrating
thoracic injuries. Only a few cases have been reported in which the patient recuperated without sequelae. Impalement chest trauma are usually fatal, therefore
few cases have been reported in the literature review. These injuries usually occur unilaterally. Our case report is about rebar impalement into unilateral
hemithorax after falling down without any mortal injury and only a minor laceration of pericardium, lung, and the great vessels of subclavian. The fact is that
such injury (as our case) without any intrathoracic catastrophic event is rare.
Primary Isolated Hydatid Cyst in Trapezes Muscle: A Extremely Rare Site
Abstract
Introduction: Hydatid cyst is a condition commonly affecting liver and lungs caused
most commonly by Echinococcusgranulosus whereas musculoskeletal hydatidosis is very rare.
Intramuscular hydatid cysts Usually are secondary and resulting from the spread of cysts from
other organs, either spontaneously rupture or after spreading from operations for hydatidosis in
other regions.
Case presentation: We present an unusual case of a primary hydatid cyst found in the base
of neck in the trapezes (latismous muscle), muscle on the right side of neck in a woman with a
non-specific clinical presentation. Ultrasound findings revealed a multilocular intramuscular solid
and cyst lesion in the anterior aspect of trapesous (latismous muscle) muscle. We removed the
entire part of solid and cyst lesion surgically. Macroscopic and microscopic histopathological
examinations confirmed the diagnosis of muscular hydid cyst.
Conclusion: In regions where hydatid disease is endemic, a cystic lesion in any part of the
body should be considered a hydatid cyst until proven otherwise. The best treatment is the total
excision of the cyst with an intact wall.
RAREEMERGENCY PRESENTATIONIN DELAYED DIAPHRAGMATIC HERNIA ANDTOTAL ORPARTIAL RECONSTRUCTION OF HEMIDIAPHRAGM WITHPROLENEMESH:IN FIVE CASES.
Diaphragmatic rupture (DR) is a life-threatening condition and often results from either blunt or penetrating trauma. (DR) is usually associated
with abdominal trauma however, it can occur as isolated injury. Acute traumatic rupture of the diaphragm may be silent and there is often a delay
between the injury and the diagnosis. Tension gastrothorax(TGT), tension colothorax(TCT) and tension hepatothorax(THT)are life-threatening
conditions and present dramatically with acute and severe respiratory distress. It develops when an intra-thoracichreniation of stomach,liver or
colon through a diaphragmatic defect. Massively distended stomach and colon by trapped air or uid causing mediastinaldisplacement.
(TGT),(TCT)and (THT)is often missed as tension pneumothorax and managed as such leading to increased morbidity and mortality. Immediate
clinical and radiographic evaluation should lead to accurate diagnosis followed by emergency decompression of the stomach,colon and liver.
Reduction of herniated viscera must be done with laparotomy and repair of the diaphragmatic defect.Here we present ve cases
with(TGT),(TCT)and (THT).We have performed transthoracic decompression of stomach and colonin three caseswith chest tube insertion and
emergencylaparatomy. In two cases,right sideemergency thoracotomy was performed. The aim of this report is to show our experiences in
diagnosis,emergency management and repair of large defect of diaphragm. Because these unusualemergency condition, tension(GT),(TCT)and
(THT) andreconstruction of large diaphragmatic defects with synthetic prosthesis has not been well characterized in emergency presentations of
delay diaphragmatic hernia andare still a challenging issuein the literature reviews
Repot of Huge Primary Mediastinal Carcinoid Tumors with Horsiness
A carcinoid tumor can occur in a variety of sites, including the mediastinum. Carcinoid tumor arising from the mediastinum is invariably
related to the thymus. Isolated origin of mediastinal carcinoids is rare, especially in the posterior mediastinum. Only two cases of posterior
mediastinal carcinoids have been reported so far. These were assumed to be arising from ectopic thymus tissue. We report a case of a
48-year-old man who presented with dyspnoea, horsiness and dry cough due to giant carcinoid tumor of the posterior mediastinum, the
pedicle originating from the posterior mediastinum, not related to the thymus. She underwent thoracotomy and resection that provided
relief. The Microscopic and immunochemical studies revealed extrathymic and show more pronounced cytologic atypia, increased mitotic
activity (approximately 3-/ 410 HPF), Grade II) Grade II or (intermediate grade neuroendocrine neoplasm (a typical carcinoid).
Report a Case of Giant Thymolipoma of Mediastinum and Neck Which Initially Misdiagnosed as Liposarcoma on Core-Needle Biopsy
Thymolipomas are rare benign tumors, constituting one of the differential diagnoses of an
anterior mediastinal mass. These tumors may run an indolent, asymptomatic course, often achieving
massive dimensions before presentation. Once Symptomatic, respiratory symptoms predominate.
We report a case of thymolipoma in a 30 years old male complaining of heaviness and constricting
type of chest pain and neck swelling of 1 year duration. CT scan findings were a space occupying
lesion in the anterior mediastinum and extend to right side of mediastinum, neck and left side hemithorax. The tumor was completely excised through ‘Postero
lateral thoracotomy’. Histopathological examination confirms the
diagnosis Thymolipoma. This is the second case we have reported
from our institution (4).
EVALUATION CHEST TUBE IN PATIENT WITH RIB FRACTURE UNDERGO MECHANICAL VENTILATION IN ICU AND OPERATION ROOM IN POORSINA HOSPITAL AND ARIA HOSPITAL FROM SEP2014 TO AUG2016 IN RASHT
Introduction: Trauma is the most common cause of death in people 1-44 years old, and the third cause of death without consider of age. thoracic traumas are considered as one of the major causes of death of 10 to 30% of the total traumas and it accounts for 25% of deaths caused by trauma. Rib fracture as one of the consequences of thoracic trauma includes about 7 to 40% of the trauma hospitalizations. the treatment of delayed pneumothorax in positive pressure ventilation as one of the rib fracture complications is controversial in scientific texts,and we want to critique it.
Material and Method: The current research is a retrospective cohort study that was accomplished in patient with rib fracture referred to Pour Sina and Arya hospital in Rasht during two years, who were candidate for mechanical ventilation (for surgery or hospitalization in the ICU). Researcher-made questionnaire was used as tool to collect data, which it included two parts of demographic information (age, gender, etc.) and the information related to chest trauma (type of trauma, number of broken ribs, damage to other organs at the same time, length of hospitalization, need for ventilation, complications of embedding and removing chest tube thoracostomy). The validity of questionnaire was approved by professors of surgical department. The collected data were analyzed using descriptive statistics and Chi-square test, Mann-Whitney test and by using SPSS 22 software.
Results: In this study, 140 patient with rib fracture who were candidate for mechanically ventilation were examined in the two groups with chest tube thoracostomy (n = 65) and without chest tube thoracostomy (n = 75).mean of hospitalization in patients with chest tube thorachostomy was one day longer than that in patients without chest tube thoracostomy. In the group without chest tube thoracostomy, majority of people (78.7%) needed less than 24 hours of mechanical ventilation and in patients with chest tube thoracostomy, majority of patients (41.5%) needed more than 72 hours of mechanical ventilation, In addition, 12.3% of infection was observed in the chest tube thoracostomy, and 20% of the patients experienced symptomatic pneumothorax, after removing chest tube thoracostomy that majority of them (84.6%) were under mechanical ventilation for more than 72 hours before removing chest tube thoracostomy. In the group without chest tube thoracostomy, 77.3% of patients had no complications during and after general anesthesia and mechanical ventilation and 22.7% of patients experienced asymptomatic pneumothorax less than 10% of lung volume (within 48 hours in chest radiography), who were improved under conservative treatment.
Conclusion: According to the results of the research, it can be said that the lack of using chest tube thoracostomy in patients with rib fracture, who were candidate for mechanical ventilation is followed by less complications. and we recommended, close observation without chest tube thorachostomy in patients with rib fracture, who were candidate for mechanical ventilation.
STUDYING THE PREDICTING ROLE OF HIGH RESOLUTION C T SCAN FINDINGS IN THERAPEUTIC PATH OF SPONTANEOUS PNEUMOTHORAX BY PATIENTS REFERRING TO RAZI AND ARIA HOSPITALS OF RASHT IN 2012-2016
Introduction: Pneumothorax is applied to the entering of air or gas into the peripheral space (pleural space) and creating a positive pressure in it; it can disrupt the performance of ventilation and oxygenation, and potentially threaten life. So far no detailed statistics has been collected in Iran on the prevalence of this disease. The present study was done to investigate the predicting role of the high resolution CT scan findings in the therapeutic path of spontaneous pneumothorax in patients referring to the Aria and Razi hospitals of Rasht during September 2013 to 2016.
Research method: This study is a retrospective cohort study. The files of all patients referred to the Aria and Razi hospital of Rasht were examined; after rejection of specified causes of pneumothorax they were hospitalized based on diagnosing spontaneous pneumothorax. Then based on having or not having a CT scan the patients were divided into spontaneous pneumothorax with HRCT and spontaneous pneumothorax without performing HRCT; they were followed up for one year through the registration of medical records, repeated references or via a phone call in terms of the incidence of relapse and the relapse side. The information of all patients was registered including age, sex, stature, history of tobacco use, status of the Dystrophic lesions (number and severity), involved side, pneumothorax volume, primary shortness of breath, breathing distress, heart rate etc. The therapeutic path was studied in the first group of patients having HRCT Scan and in the second group without HRCT Scan. An analysis of the variables was done using the Chi-square test and the significance level was considered 0.05.
Results: In this study, 80.1% of the patients under study were male and their average age was 42 years. 40.2% of the studied patients used HRCT. Patients who have suffered from a spontaneous pneumothorax for the first time were of 63.3% frequency and those who were exposed to relapse were of 36.7% frequency. Also using statistical analysis of Chi-Square there was observed a significant difference between the two groups (P = 0.001). Using statistical analysis of Chi-Square, between the two groups of individuals suffering from PSP, those whose 49.7% had done HRCT and those whose 50.3% had not done it, a significant statistical difference was observed (P = 0.001).
Discussion and conclusion: It seems that respecting the importance of the question, dealing with patients with spontaneous pneumothorax in our country needs to pay more serious attention; with understanding more and better this disease it should be tried as much as possible to use less costly therapies and less invasion like HRCT.
A COMPARISON OF CLINICAL OUTCOMES OF DEBRIDEMENT AND BIOPSY PROCEDURES VERSUS WIDE EXCISION IN CHEST WALL TUBERCULOSIS TREATMENT AT TEACHING RAZI HOSPITAL OF RASHT DURING 2006 TO 2015
Background: Chest wall tuberculosis (CWTB) is rare and its clinical presentation, may be mistake with a pyogenic abscess or chest wall tumor. A diagnosis and treatment of chest wall tuberculosis (CWTB) is both difficult and controversial. There is not a safe and convenient method for surgical treatment of chest wall tuberculosis. The aim of this study was to discuss on the optimal diagnosis and treatment of (CWTB). Methods: During a 10-year period (2006–2015), 35 cases with chest wall tuberculosis were managed by our team. Patients’ medical records were retrospectively reviewed. After confirming the diagnosis by histopathological examination, patients underwent surgical management with two methods, wide resection with reconstruction and wide debridement Results: There were 29 male and 6 female patients. Patients’ age ranged from 22 to 79 years. Cough was the most common clinical complaint in this study, followed by pain and tenderness, withdrawal of pus and bloody sputum. 21 patients had abscess and 14 patients had a chest wall mass and 8 present with osteomyelitis. Diagnosis confirmed with needle aspiration in 11 patients, biopsy in 15 patients and biopsy+aspiration in 9 patients. Surgical procedure was drainage with debridement in 17 patients, wide resection in 18 patients. Fistula formation were detected in 8 patients after debridement and 1 patient after wide resection (p=0.0002). The median length of stay in debridement group was 4 days and in resection group was 7 days. The recurrence was occurred in 4 cases after debridement and none case after resection. The highest percentage of chest lesions occurred in the anterior (54.3%), lateral (31.4%) and posterior (14.3%). There was no lesion infection in patients with wide excision, while it was observed in debridement group in 11.8% of patients. Tuberculosis medication was used 9 months after debridement and 6 months after resection (p = 0.625). There was no mortality in both groups. Conclusion: chest wall tuberculosis mimics symptoms and signs of chest wall tumors or abscesses. The combination of symptoms and radiographic findings suggests the pathologic diagnosis of tuberculosis. Wide resection and reconstruction are shown to have lower rates of fistula formation. Medical treatment must be started immediately after surgery and resection is a better surgical technique with less complications and recurrence.
Report of Rare Emergency Presentations and Management of Delay Diaphragmatic Hernia in Five Cases
Diaphragmatic Ruptures (DR) is a life-threatening condition. (DR) are quite uncommon and often result from either blunt or penetrating trauma. (DR) are usually associated with abdominal trauma however, it can occur in isolation. Acute traumatic rupture of the diaphragm may go unnoticed and there is often a delay between the injury and the diagnosis. Tension Gastro Thorax (GT), Colo Thorax (CT) and Hepato Thorax (HT) is a life-threatening condition and presents dramatically with acute and severe respiratory distress. It develops when an intrathoracic herniation of stomach, liver or colon through a diaphragmatic defect. Massively distended stomach and colon by trapped air or fluid causing mediastinal displacement. Tension GT, CT and HT is often missed as tension pneumothorax and managed as such leading to increased morbidity and mortality. Immediate clinical and radiographic evaluation should lead to accurate diagnosis followed by emergency decompression of the stomach, colon and liver. Reduction of herniated viscera must be done before laparotomy and repair of the diaphragmatic defect. We present five cases with tension (GT), (CT) and (HT). We performed transthoracic decompress of stomach and colon in three case with chest tube insertion because other methods were not successful for decompressions and emergency laparotomy. In two cases right side emergency thoracotomy was performed. Because of this unusual condition, tension (GT), (CT) and (HT) has not been well characterized in traumatic diaphragmatic hernia in the literature reviews.
Report of Cases of Ruptured Pulmonary Hydatid Cysts with Complications of Hydro/Tension Pneumothorax
Abstract
Tension pneumothorax is very rare complications of the pulmonary hydatid cyst and its diagnosis and treatment is still a complex of problem. We report
four cases of tension pneumothorax, of which, two cases were referral to our hospital from local hospital with complaints of chest pain, cyanosis and dyspnea.
Chest radiograph showed tension pneumothorax with mediastinal shift, and tracheal displacement. They had persistent air leaks with lung collapse despite
insertion of chest tube. CT-scan of chest, performed in our center, showed lung was collapsed with air fluid level. All patients underwent bronchoscopy after
stabilizing cardiovascular problems. Patients were taken to the operating room. During operation and exploration, ruptured pulmonary hydatid cysts were
found in all four patients with a lot of debris and laminated membrane in the pleural space. Histopathological examination confirmed the diagnosis of hydatid
cyst. Patients were discharged in good condition after 6 to 8 days of post operative period with the advice of Albendazole [800mg] daily. Ruptured pulmonary
hydatid cyst should be kept in mind in the differential diagnosis of tension pneumothorax and surgical intervention should be performed as early as possible.
Multiple and bilaterally pulmonary hydatid cystic and liver mimicking metastatic lesion from ovarian malignancy
Hydatid cyst is a parasitic infections of the humans that caused by echinococcus infection. This infection is considerable problem of public health. The most common locations in human body of a hydatid cyst are the liver (75%) and the lung tissue (15%) in the review of medical literature there was a few reports from bilaterally pulmonary hydatidosis which clinically mimics metastatic malignant tumors at initial clinical finding. Because of unusual presentation, the diagnosis with clinical presentations and CT-scan and CXR may easily be missed. For of this missed diagnosis problem, multiple and bilaterally hydatid cyst of lung should be in difrienciated diagnosis of others pulmonary diseases.
Case report: A 23 year-Old Iranian female patient presented with a six months history of fever, chest and abdominal pain, loss of appetite, weight loss, cough, night sweating and dyspnea was referred to our hospital. Chest X-Ray and Computed tomography of the chest shows multiple nodules in both lungs. Computed tomography of the abdomen and pelvic shows multiple cystic and solid lesions. Laparotomy allowed diagnosis. When the lesion of pelvic was incidentally opened, laminated membrane and daughter cysts were seen in two of pelvic lesions. The histological diagnosed also was hydatid cyst. Postoperatively, Albendazol (800mg daily) was administered for three cores of 28 days. The patient was discharged after five days post operatively with well conditions. In six months postoperatively follow up; there was regression of hydatid cysts in the lungs and others organs.
Conclusion: Multiple bilateral pulmonary hydatid cyst with cavitation and abdominopelvic mass is an extremely unusual condition and should be included in the differential diagnosis of multiple bilateral pulmonary hydatid cyst, especially in endemic areas.
Keywords: computed tomography, hydatid cyst, echinococcus infection, endobronchial lesion, albendazole, antihelminthic therapy, pulmonary infection,
Simultaneous multiple organs immature teratomas: a case report and literature review
Primary simultaneous multiple organs teratomas are extremely rare. They usually arise in the gonads, and only 1–3 % of
them arise in the mediastinum. We present a case of simultaneous multiple organs immature teratomas who was admitted
to Razi hospital because of cough, dyspnea, and left-side supraclavicular mass. Computed tomography (CT) showed a big
mass with multiple high densities, nodular, semi-solid, heterogenic structures on the left side of the neck, left-side anterior
mediastinum, right-side middle mediastinum and right-side suprarenal region. CT-guided needle biopsy was performed and
histopathological study showed immature teratoma. After performing neoadjuvant therapy, the tumors were removed. The
patient underwent chemo radiation therapy on the mediastinum and abdomen. On 6-months follow-up, he was
asymptomatic. This case is being reported because of the rarity of multiple organs immature teratomas and informing other
clinicians about managing these cases.
Isolatedextra Hepatic and Extra Pulmonary Hydatid Cyst: Report of 33 Rare Cases
Background: Hydatid disease is a parasitic infestation caused by Echinococcus granulosus and caused by the larval stage of the Echinococcus tapeworm
and it primarily affects the liver and lung but involvement of other organs is also possible secondary to peritoneal seeding or hematogeneous dissemination.
About extra hepatic and pulmonary hydatid cyst (EHPHC) there are not basic studies. we want to discuss this entity and review the literatures.
Materials and methods: A systematic retrospective review was performed for all extra hepatic and pulmonary hydatidcyst (EHPHC) patients treated in
our province between 1990and 2016. Inclusion criteria in this study, was all patients with (EHPHC) organ involvement without simultaneously involvement liver
and lung by hydatid cyst. Final diagnosis confirmed with pathologist. The patient’s records were studied for gender, age, site of involvement, diagnosis and
results of treatment. All data was analyzed by using SPSS version 21.
Results: In this study record of 33 patients who were evaluated within this period, were reviewed. 21 patients were male and 12 patients were
female. Age of patients was 25 to 56 years old. Hydatid cyst of spleen was the most common all of (EHPHC). Others were Kidney, pancreas, soft tissue and
mediastinum. The most common tools for diagnosis was U/S and CT-scan. All patients with hydatid cyst of spleen underwent splenectomy. Others (EHPHC)
underwent radical resection. Albendazole used in all patients just post operation. Outcomes of surgery were good and no recurrences were occurred.
Conclusion: Although liver and lung are the most commonly involved organs, in 10% of cases it occurs in other locations. Hydatid cysts should be included
in the differential diagnosis of any cystic mass of all organs in body, especially in endemic regions. Total remove of the cyst component without any spillage
is the best treatment option.
Ruptured Hydatid Cyst of Liver and Huge Pulmonary Hydatid cyst: Presented as Acute Abdomen with Severe Anaphylaxis Shock: A Rare Presentation
Hydatid disease can involve various organs of the body and may develop in any organ member But most often in the liver (77%-50%) and lungs (35%-
18%), and sometimes in other organs. Liver and hepatic hydatid cysts occur in 25% of cases in 4%. The clinical signs and symptoms of hydatid cyst depend
on the locations that are involved (deep or superficial,right or left lobe), size, adjacent organs, and complications such as infection or cyst rupture. Rupture
of the cyst may occur after trauma or spontaneously due to suddenly increased intracystic pressure. When a hydatid cyst is broken down in the peritoneum,
catastrophic complications such as abdominal pain, chewing gum, anaphylaxis, and sudden death may occur. We have a 40-year-old woman with anaphylactic
shock, Such as severe abdominal pain, tachycardia, hypotension and massive erythema, and rapidly intubating and then severely care unit forresuscitation.
With the primary suspicion of peritonitis, open laparotomy was performed. During the surgery, hydatid cyst elements were observed within different parts of
the abdomen. One ruptured cyst was seen in the posterior of theright lobe of liver which invades to the diaphragm. The cyst cavity was irrigated with saline,
pericystectomy and Capi tonnage. The abdominal cavity was washed twice with providing –iodine10% of the solution at 10-minute intervals. One huge cyst
was also detected in the upperlobe of right lung on postoperative chest radiography. one week latter patient under went thoracotomy for lung cyst. Patient
discharged with good conditions. Conclusion:The rupture of a hydatid cyst into the abdominal cavity is rare and anaphylaxis shock is extremely rare. This
condition missed with acute abdomen in endemic areas, especially in young patients and must be in the differential diagnosis of the acute abdomen
An investigation into symptoms, diagnosis, treatment, and treatment complications in patients with retrosternal goiter
Introduction: Retrosternal goiter refers to any thyroid enlargement in which over 50% of the thyroid permanently located under the
thoracic inlet or the lower pole of thyroid is not palpable with the neck in hyperextended position. Due to the increasing number of
surgical procedures of retrosternal goiter, the present study was carried out to examine the symptoms, diagnosis, treatment, and
treatment complications in retrosternal goiter patients. Materials and Methods: Data related to demographic data (age and gender),
clinical symptoms (dyspnea, dysphagia, dysphonia, lumps in neck, and hoarseness), methods of diagnosis (computed tomography [CT],
chest X‑ray [CXR], ultrasonography, and magnetic resonance imaging), and postoperative complications (bleeding, early and late
dysphonia, early and late dyspnea, transient and permanent hypocalcemia, transient, and permanent recurrent laryngeal nerve paralysis)
were collected. Results: According to the results 71.4% of patients were women and most of the participants (67.1%) aged 45–60 years.
Mass in the neck was the most frequent symptoms before surgery (88.6%). The most common incision for thyroidectomy (95/7%)
was neck Collar incision. Diagnosis method in 82.9% and 17.1% of cases was, respectively, based on CT scans with CXR and CT scans
with CXR and ultrasound. According to the postoperative pathologic findings, 58.5% of the cases were multinodular goiter, 22.9%
were papillary cell carcinoma, 7.1% were medullary carcinoma, 5.7% were anaplastic carcinoma, 5.7% were thyroid lymphoma, and
only 1.4% were thyroid adenoma. Postoperative complications occurred in 47.14% of patients. Most common complication was early
transient dysphonia. Conclusion: This study recommends that retrosternal goiter should be operated early under suitable conditions,
and the best diagnosis tool and best surgery methods are CT scan and surgery with collar incision, respectively.
Rare Presentations and Repair of Delayed Traumatic Diaphragmatic Rupture: Report of 39 Cases Over 10 Years
Background: Diaphragmatic rupture is a life threatening condition, which may be due to severe
penetrating or blunt trauma to the chest or abdomen. Considering that delayed diaphragmatic
rupture has no clinical symptoms, results of diagnostic methods are restricted to the case report
studies, also lack of early diagnosis of it in patients with multiple trauma and diversity of therapeutic
methods, we decided to investigate the etiology, clinical symptoms, diagnostic and therapeutic
methods of patients with delayed diaphragmatic rupture.
Methods: In this retrospective study, we reviewed the data of all patients with diagnosis of delayed
traumatic diaphragmatic rupture in surgical wards of Razi, Poursina and Aria hospitals of Rasht,
Iran, between March 2006 and September 2016. Demographic and clinical data of patients were
recorded. Finally, normality of the variables distribution was tested by using the one sample
Kolmogorov-Smirnov test.
Results: Patientsincluded in this study, 24 (61.5%) male and 15 (38.4%) female. The age of patientswas
10 to78 years old and the mean age was 38.84±18.54 years. Traffic crashes were the most common
cause of traumatic diaphragmatic rupture in our study (41.0 %). Dyspnea was the most common
symptom in our subjects (79.4%); Intestinal obstruction in 5 patients and Tension gasterothorax in
4 patients. 84.6% of our patients had right sided traumatic diaphragmatic rupture. The mean size
of rupture in our subjects was 11.16±4.52 centimeters. Omentum was the most herniated organ
(31.1%). Chest x-ray and computed tomography scan were used in all of our subjects for diagnosis of
diaphragmatic rupture. The mean duration between trauma and surgery was 70.39±99.38 months.
The mean duration of hospitalization was 7.92±5.05 days. The most common surgical method which
was used for treatment of delayed diaphragmatic rupture in our patients was thoracotomy (74.3%).
In the recent study, primary treatment of diaphragm was performed in 32 patients, partial mesh in
5 and complete mesh in 2 of patients.3 (5.2%) of our subjects died.
Conclusion: Diagnosis of diaphragmatic rupture is difficult and has a clinical suspicion in high risk
patients. So using of radiological modalities for diagnosis and treatment of it is necessary. Moreover,
delayed diaphragmatic rupture and diaphragmatic hernia should be considered in patients with
recent blunt trauma and gastrointestinal or respiratory complaints.
Posterior Mediastinal Hydatid Cysts Associated with Destruction of the Rib, Vertebral Column and Compress Spinal Cord (Dumbbell Hydatid Cyst)
Primary Mediastinal localization of hydatidosis is very rare. Destruction of the Rib and Vertebral Column in Primary posterior Mediastinal hydatidosis is
extremely rare and represents an uncommon but significant manifestation of hydatid disease (HD). We report a case of posterior Mediastinal hydatidosis with
intraspinal extension and Destruction of the Rib and Vertebral Column in the thoracic region causing spinal cord compression. The presenting symptoms were
back pain, posterior chest wall pain, back pain progressive difficulty in walking with radiation to right lower limp and was atypical and the diagnosis was
established preoperatively on the basis of computer tomography (CT-scan) and magnetic resonance imaging. The patient underwent surgery by thoracic and
neurosurgeon in one stage and resulting in complete recovery and is no recurrence happened after 18 months follow-up.
Investigating Frequency of Different Types of Spontaneous Pneumothorax Treatment Methods
Introduction: Pneumothorax is a relatively common respiratory disorder with a high level of incidence and recurrence and can happen in different clinical conditions and at any age. Due to the importance of treatment types in these patients, the present study was carried out in order to examine the frequency of different types of spontaneous pneumothorax treatment methods among patients admitted in Razi and Arya hospitals of Rasht over 2009-14.
Materials and methods: The present study was a cross-sectional descriptive investigation which was conducted on 204 (77.9%) of patients with spontaneous pneumothorax. The patients were diagnosed with pneumothorax and hospitalized according to the clinical symptoms (pleuritic chest pain, severe shortness of breath, hearing hyperresonance, decreased fremitus, and decreased breath sounds), chest x-ray, and CT scan. The patients’ characteristics were recorded in a questionnaire and then analyzed using SPSS 22.0.
Results: Out of the participating patients, 163 (79.9%) were men and the rest were women (male to female ratio was about 4 to 1). The patients’ mean age was 44.29±20.33 years, and the most common treatment methods were respectively chest tube in 41.7% of the cases and chest tube and thoracotomy in 29.9% of the cases. Moreover, recurrence was not observed in thoracotomy and VATS methods, while it was seen among patients who had been treated by chest tube method.
Conclusion: According to the results of the present study, it can be concluded that since inserting chest tube is associated with a high rate of recurrence and thoracotomy causes a high level of pain and long hospitalization. necessary facilities and equipment should be provided by hospitals in order to employ VATS because of its high reliability, fewer complications, and low costs compared to other methods including chest tube and thoracotomy.
Interapleural Ruptured Hydatid Cyst of Liver Presented as Pleural Effusion with Multiple Daughter Cysts
Hydatid disease still remains an important health problem in Iran. Although it can be found in
any part throughout the body, it is more common in the liver (75%) and lung (25%). Intrapleural
rupture of Pulmonary Hhydatid Cyst (PHC) is a rare but dangerous complication.
A 54-year-old woman patient admitted to emergency service with right side chest pain and
dyspnea on physical examination. The respiration rate was 22/min and breath sounds were
diminished on the right lung. In her past medical show two times right subcostal incision for
operation of liver hydatid cysts on chest radiography revealed pleural effusion on right pleural space,
and on chest tomographic examination, pleural effusion with the collapse of right inferior lung
was observed and in the effusion multiple air space was presented (Figure 1 and 2). Thoracentesis
was performed and chest-tube was inserted. Low glucose and pH and high (WBC=1,000) and
lactate dehidrogenase level of pleural fluid were suggesting its empeyama nature. At the 5th day,
chest radiograph indicated inadequate expansion of the right lung. Patient underwent to the
right posterolateral thoracotomy due to persistent of collapse of lung. Multiple lesion, laminated
membrane and daughter cysts resembling to hydatid cyst (Figure 3 and 4). After evacuation all
fluid with daughter cysts and laminated membrane, decortication was done, in current of procedure
a fistulae between liver, diaphragm and pleural space was presented. Perinotomy was performed
and cyst of liver was evacuated and a folltcathter was put in the remenant cavity of liver. He was
transferred to intensive care unit for 2 days. Albendazole therapy was initiated after an uneventful
post-operative course, patient was discharged.
Investigating air quality status and air pollutant trends over the Metropolitan Area of Tehran, Iran over the past decade between 2005 and 2014
Studies on the trend of air pollution in Tehran, Iran, as one of the most polluted metropolis in the world are scant, and today Tehran is
known for its high levels of air pollutants. In this study, the trend of air pollution concentration was evaluated over the past 10 years
(2004-2015). The data were collected from 22 stations of the Air Quality Control Company. Daily concentrations of CO, NO2, SO2, O3,
PM10 were analyzed using SPSS 16 based on the statistical method, repeated measures, and intra-group test to determine the pattern
of each pollutant changes. As a result of the 22 air pollution monitoring stations, NO2 and SO2 concentrations have been increasing
over the period of 10 years. The highest anomaly is related to SO2. The CO concentrations represent a descending pattern over the
period, although there was a slight increase in 2013 and 2014. The O3 concentrations declined in the following years. The average
concentration of PM10 has been rising during the period. Also we evaluated changes of each pollutant in different months and
calculated the number of clean, healthy, unhealthy days for sensitive, unhealthy, very unhealthy, and dangerous groups. The study
findings illustrated the necessity for larger investment in air pollution abatement. Overall, trends have been progressed to worsening,
the number of healthy days has been declined and the number of unhealthy days has been increased in recent years.
Data ontheepidemiology,diagnosis,and treatmentofpatientswithpneumothorax
This datawasacquiredusingacross-sectionaldesigninwhich
medical recordsofpatientsadmittedatAryaandRaziHospitalsof
Rasht from2006to2015wereexamined.Thepatients’ demographic
data,historyofsmokingandopium,underlyingdisease,
clinical symptomsatadmission,theutilizeddiagnosticmethod,
duration ofhospitalization, findings ofchestCTscan,typeof
pneumothorax,andtherapeutictechniquewerecollectedthrough
a questionnaire.Thecollecteddatawereencodedandanalyzed
using SPSS21.0.Smokingratewasmeasuredintheprimaryand
secondary spontaneouspneumothoraxgroupsandacquired
pneumothoraxgroup.Themostfrequentunderlyingdiseaseinthe
patients withsecondaryspontaneouspneumothorax(SSP)was
COPD thatwasobservedin41patients(51.25%).Thefrequencyof
bleb wasmeasuredinthethreegroups.Outof38patients(15.01%)
with recurrenceofpneumothorax,68.42%hadPSPtype.Chesttube
wasthemostfrequentlyusedtherapeutictechnique,whichwas
utilized 92.88%outof235patients.
Inositol Monophosphatase: A Bifunctional Enzyme in Mycobacterium smegmatis
Inositol monophosphatase (IMPase) is a crucial enzyme for the biosynthesis of phosphatidylinositol, an essential component in mycobacterial cell walls. IMPase A (ImpA) from Mycobacterium smegmatis is a bifunctional enzyme that also functions as a fructose-1,6-bisphosphatase (FBPase). To better understand the bifunctional nature of this enzyme, point mutagenesis was conducted on several key residues and their enzyme activity was tested. Our results along with active site models support the fact that ImpA is a bifunctional enzyme with residues Gly94, Thr95 hypothesized to be contributing to the FBPase activity and residues Trp220, Asp221 hypothesized to be contributing to the IMPase activity. Double mutants, W220A + D221A reduced both FBPase and IMPase activity drastically while the double mutant G94A + T95A surprisingly partially restored the IMPase activity compared to the single mutants. This study establishes the foundation toward obtaining a better understanding of the bifunctional nature of this enzyme.
Lung cancer in idiopathic pulmonary fibrosis: A systematic review and meta-analysis
Background
There are many epidemiological pieces of evidence that show IPF patients have the highest risk of lung cancer. We conducted a systematic review of all published data to define the characteristics of lung cancer that develops in IPF by performing a meta-analysis.
Method
This study was performed based on the PRISMA guideline. Documents gathered by searching through the Web of Sciences, Scopus, PubMed/Medline, OVID, and COCHRANE databases which published before 03/25/2018 that related to lung cancer in IPFs' patients. Articles were searched using standard keywords as well as Mesh and Mesh Entry and all probabilistic combinations of words using Boolean operators. Data searching, extracting and quality appraising were done by two researchers, independently. At last, Randomeffects size based on Cochrane test and I2 were used. The review protocol has been registered in PROSPERO with ID: CRD42018094037.
Results
Based on the meta-analysis conducted in 35 (0.18%) included studies, the total sample size of patients with IPF was estimated 131947 among whom 6384 had LC. The total rate of LC prevalence in IPF patients was estimated to be 13.54% (95% CI: 10.43±17.4) that was significantly 9 times higher in men vs. Women and smoker vs. non-smoker. Highest to lowest prevalence of cellular (histological) subtypes of lung cancer in IPF were SQCC (37.82%), ADC (30.79%), SmCC (20.48%), LCC (5.21%), and ADQC (4.81%), respectively. The highest and lowest stage of lung cancer in IPF patients was estimated at III and II, respectively. The highest involvement location of lung cancer in IPF patients was in the Peripheral. Also, the prevalence of the tumor region involved from the highest to the lowest was estimated to be in the RLL, LLL, RUL and LUL regions.
Conclusions
Lung cancer in IPF, most commonly SQCC, presents in elderly heavy smokers with a male, locating in peripheral regions and the lower part of lung predominance.
Nanoparticles against resistant Pseudomonas spp.
Pseudomonas spp. collected from areas where human regularly comes into contact with were tested for their susceptibility to antibiotics. Twenty-nine samples were collected and screened for Pseudomonas spp. Of the nine isolated strains Pseudomonas spp. six were resistant to antibiotics. A few were used for an antimicrobial study on the interaction with silver and zinc oxide nanoparticles individually and as a mixture. A mixture of silver and zinc oxide nanoparticles showed synergy against resistant Pseudomonas spp.
The Role of Surgeons, Endocrinologists and Oncologists in Management of Anaplastic Thyroid Carcinoma
Background: Anaplastic Thyroid Carcinoma [ATC] is an uncommon and lethal type of thyroid cancer. It accounts for only < 2 % of all thyroid cancer cases. It is the cause of about one-half of all thyroid carcinoma deaths. This cancer has a very low cure rate even with the best treatments. ATC invades adjacent structures and metastasizes extensively to cervical lymph nodes and distant organs. Tracheal invasion presents in 25% of the cases at the time of presentation that needs a tracheostomy. Only a small portion of patients can undergo surgical resection in hopes of curing it. In this study, we aimed to define the role of surgeons, Endocrinologists and Oncologists in management of anaplastic carcinoma of thyroid
Material and methods: In a retrospective study we reviewed the records of patients with [ATC] referred to our hospital Razi, Arya and Golsar Iran, Rasht city between 2004-2017. In all cases, the diagnosis was confirmed by pathological findings. The data including: symptoms, signs, diagnosis tools, surgical approaches, chemo radiation therapy and survival rate were collected and analyzed.
Results: We identified 41 patients with ATC. Twenty eight of patients were male and the remaining was female. Twenty five of patients presented with hard neck mass, 12 of these patients had sever dyspnea and dysphagia, Ten cases with hard neck mass and pain and ten of patients admit with dyspnea and strider. FNA and core needle biopsy was performed on 35 patients and anaplastic carcinoma of thyroid was documented in 29 patients and two patient revealed suspected cells in FNA. Ten patients admit with sever dyspnea and stride or that underwent tracheostomy and biopsy. The surgical intervention was conducted on 31 patients who diagnosed on FNA and core needle biopsy for [ATC]: Total thyroidectomy in 9 cases, subtotal thyroidectomy in 10 cases, debulking surgery in 12 cases and 5 cases just tracheostomy. Final pathology of all these patients was ATC. All patients referred for chemo radiation- therapy after the operation. All of our patients died between 1 to 10 months after surgery and chemoradiation therapy.
Conclusion: Surgical intervention even in early stage not increase survival but can improve the quality the life .We conclude the role of surgeon in ATC is to maintain a safe airway and tissue sample for definitive diagnosis. Endocrinologists role are early diagnosis and Oncologists can decrease the size of tumour.
Granulomatous Mastitis with Erythema Nodosum and Polyarthritis: A Rare Case Report and Review of Literatures
A 31-year-old woman was referred with a painful mass and erythema in the left breast that was initially treated with antibiotics. Three weeks later, the mass and erythema had increased and polyarthritis and erythema nodosum had developed in both legs. In our hospital,A core needle biopsy of breast and leg nodule led to a diagnosis of granulomatous mastitis with polyarthritis and erythema nodosum. High-dose prednisolone (15 mg x 3 daily) with indomethacin (25 mg x3 daily) for three week, rapidly improved the polyarthritis and the erythema nodosum. Granulomatous mastitis is a very rare, chronic inflammatory disease and only nine cases with granulomatous mastitis with erythema nodosum and polyarthritis have been described. We reviewed the literature to determine the clinical presentations, diagnosis, pathological features and treatment of granulomatous mastitis with erythema nodosum and polyarthritis. Appropriate diagnosis with steroid therapy should result in excellent outcomes.
Comparison of serum interleukin-10 level of fungal exposure among patients with pulmonary sarcoidosis and healthy people
Introduction: Sarcoidosis is a chronic systemic inflammatory disease with unknown etiology. Fungal exposure has been assumed as one of many possible causes of the disease. The prevalence of sarcoidosis is likely to be higher in the Northern Iran compared with other regions. Environmental studies have shown higher levels of fungal spores in the air of this area. Some studies have shown that fungal exposure in patients with sarcoidosis is associated with decreased levels of interleukin-10 (IL-10) serum levels. The aim of present study was comparison of the serum levels of IL-10 in patients with pulmonary sarcoidosis and healthy people. Objectives and Methods: In this current analytical, cross-sectional study, 40 patients with pulmonary sarcoidosis compared with 34 healthy individuals as a control group, who had been visited in a pulmonary referral clinic in Rasht (Guilan-Iran). Demographic data were collected by a questionnaire. Serum IL-10 levels were measured by ELISA kit. The data were analyzed by using the SPSS software (version 19). Results: The mean concentration of IL-10 serum levels were reported 10.96±9.48 pg/ml-1 and 3.77±1.47 pg/ml-1 among the patients with pulmonary sarcoidosis and healthy individuals, respectively. The significance difference was demonstrated between patients with pulmonary sarcoidosis and control group.Conclusion: The results showed that IL-10 was greater among patients who diagnosed as pulmonary sarcoidosis. There was a contrary opinion of the expectations for the role of fungal exposure as a possible cause of greater prevalence of sarcoidosis in Northern Iran. Age and stage of disease showed a significant relationship with the IL-10 serum level and requires further investigation. IL-10 might be a possible predictor of sarcoidosis along with other factors. (Sarcoidosis Vasc Diffuse Lung Dis 2018; 35: 294-298)