Therapeutic Outcomes of Pectoralis Major Muscle Turnover Flap in Mediastinitis

BACKGROUND: This study aimed to evaluate the therapeutic results and safety of pectoralis major muscle turnover flaps in the treatment of mediastinitis after coronary artery bypass grafting (CABG) procedures. METHODS: Data regarding 33 patients with post-CABG deep sternal wound infections (DSWIs) who underwent pectoralis major muscle turnover flap procedures in the Emam Reza and Ghaem Hospitals of Mashhad, Iran were reviewed in this study. For each patient, age, sex, hospital stay duration, remission, recurrence, and associated morbidity and mortality were evaluated. RESULTS: Of the 2,447 CABG procedures that were carried out during the time period encompassed by our study, DSWIs occurred in 61 patients (2.5%). Of these 61 patients, 33 patients (nine females [27.3%] and 24 males [72.7%]) with an average age of 63+/-4.54 years underwent pectoralis major muscle turnover flap placement. Symptoms of infection mainly occurred within the first 10 days after surgery (mean, 10.24+/-13.62 days). The most common risk factor for DSWIs was obesity (n=16, 48.4%) followed by diabetes mellitus (n=13, 39.4%). Bilateral and unilateral pectoralis major muscle turnover flaps were performed in 20 patients (60.6%) and 13 patients (39.4%), respectively. Complete remission was achieved in 25 patients (75.7%), with no recurrence in the follow-up period. Four patients (12.1%) needed reoperation. The mean hospitalization time was 11.69+/-6.516 days. Four patients (12.1%) died during the course of the study: three due to the postoperative complication of respiratory failure and one due to pulmonary thromboembolism. CONCLUSION: Pectoralis major muscle turnover flaps are an optimal technique in the treatment of post-CABG mediastinitis. In addition to leading to favorable therapeutic results, this flap is associated with minimal morbidity and mortality, as well as a short hospitalization time.

Evaluation of 95 cases with mediastinal tumors

Introduction: Mediastinum contains different vital structures that are located in the anterior and middle or posterior compartments. Various types of mediastinal masses or tumors can be seen in the mediastinum

Materials and Methods: This case series study was performed on 95 patients who had referred to Mashhad University of Medical Sciences between 1990 and 2010 were reviewed. The Inclusion criteria were as follows: Having primary mediastinal masses; Exact tissue pathology; Having received suitable treatment as well as having completed a 3-year follow-up after surgery; The major variables were age, sex, clinical symptoms, mass location, diagnostic procedures, imaging studies, tissue pathology, postoperative complications, mortality and a long-term survival. The patients were followed up for 3 years after the surgery

Results: Ninety-five patients enrolled in the study with M/F=51/44 and the mean age of 35.4 +16.52 years. Moreover, anterior mediastinum was the compartment mostly involved in case of 66 patients with the lymphoma [n=39] as the most prevalent tumor of anterior mediastinum. Mediastinal cysts [n=10] in the middle part and neurogenic tumors [n=19] in the posterior mediastinum were the other prevalent tumors in the patients' compartments. Transthoracic Needle Biopsy was used in the diagnosis of 37 cases. Furthermore, 43 patients underwent surgery alone, 7 cases underwent surgery followed by receiving adjuvant therapy and 45 cases received adjuvant therapy alone. Complications emerged in 15 cases and 9 patients expired before the completion of the 3-year follow-up. Three of the mortalities happened during the patients' hospital treatment

Conclusion: In case of anterior mediastinum, pre-operation clinical diagnosis is essential while most of the posterior mediastinal tumors do not require any preoperation clinical diagnosis. Surgery, surgery-chemoradiotherapy and chemoradiotherapy are the major methods of treatment for such tumors. For another thing, male gender was defined as a poor prognostic factor

Sentinel node mapping for intra-thoracic malignancies: systematic review of the best available evidence

Introduction: Sentinel node mapping is a new technique of lymph nodal staging in solid tumors, which can decrease the morbidity of regional lymph node dissection considerably. Intra-thoracic tumors including non-small cell lung cancer [NSCLC] and esophageal carcinoma [EC] are among the solid tumors in which sentinel node [SN] mapping has been applied. In the current systematic review, we gathered the best available evidence [systematic reviews] in this regard and presented the results in a systematic review format

Material and methods: We searched MEDLINE and SCOPUS since the inception till 13 December 2014 using the following keywords: [lung OR esophagus OR esophageal] AND sentinel AND [systematic review OR meta-analysis OR metaanalysis]. No language limit was imposed on the search strategy. Systematic reviews and meta-analyses on SN mapping in EC or NSCLC were included in the current study. Narrative review articles were excluded from the study

Results: Overall five systematic review were included. One of the included studies was on SN mapping in NSCLC and four were on EC. Overall detection rate and sensitivity for EC and NSCLC were high and both were related to mapping technique, pathological involvement of the mediastinal nodes, size and location of the tumors

Conclusion: SN mapping is feasible and highly accurate in EC and NSCLC. Attention to the technique [using radiotracers, peri-tumoral injection] and restriction of the patients to less advanced cases [cN0 and T1, 2] would ensure the best results with high detection rate and sensitivity

[ case report of peripartum cardiomyopathy with cardiogenic shock]

Peripartum cardiomyopathy is a relatively rare disease, which can cause devastating consequences; therefore it should be diagnosed correctly and treated promptly. The disease is still an important clinical problem, because only half of the patients or maybe a little more show recovery of left ventricular function, despite conventional treatment for heart failure. The etiology of this disease is still unknown and characterized by an acute development of left ventricular dysfunction and heart failure in the last month of pregnancy or within the first 5 months after delivery. The prognosis of this condition is very poor in some cases, so that it progresses to irreversible heart failure and heart transplantation or death. In the presented patient, fulminate onset and progression to cardiogenic shock and finally complete and rapid improvement was highly significant. In this article, we report a 25-year-old woman with severe manifestations of heart failure, severe left ventricular dysfunction, and severe mitral regurgitation after cesarean section, who showed complete improvement with conventional treatment of heart failure and mechanical support

Determination of the effects of digoxin on the right ventricular function in patients undergoing pneumonectomy

Introduction: Pneumonectomy is the standard treatment of lung cancer, even though patients should undergo several evaluations before surgery; deterioration of cardiopulmonary function after pulmonary resection is inevitable. We have evaluated the effects of digoxin on the improvement of right ventricular function and prevention of probable complications after lung resection surgery

Materials and Methods: All patients who were candidate for pneumonectomy or extensive lobectomy in Ghaem hospital from 2010 to 2012 were enrolled into this study and were divided into two groups randomly. The first group [group D] received digoxin during surgery and in the second group [group C] normal saline was administered as placebo. Echocardiographic evaluation of the patients was accomplished the day before and the day after surgery

Results: Among 20 patients in each group, male to female ratio was almost 2:1 and mean age was 63.8 [ranged 46-83 years]. The most common cause of pneumonectomy was lung cancer. Comparison of the preoperative demographic variables, blood biochemistry, pulmonary function tests, echocardiographic and blood gas indexes showed no statistically significant differences between two groups. But postoperative evaluations showed a significant improvement in left ventricular ejection fraction in group D. Right ventricular systolic and diastolic diameters and pulmonary artery pressure were decreased significantly as well

Conclusion: According to our results, we suggest a single dose of digoxin during lung resection surgery to improve cardiac performance after pneumonectomy

comparison of the complications between two surgical techniques of esophageal cancer

Introduction: Esophageal cancer is a common gastro intestinal malignancy. One of the most common techniques of surgery in esophageal cancer is transhiatal esophagectomy with esophagogastric anastomosis in the neck. This technique is accompanied by complications like chronic gastero-esophegeal reflux and late stenosis. This study was designed to compare the risk of complications after two surgical techniques for esophageal cancer: esophagogastric anastomosis with partial fundoplication and esophagogastric anastomosis without it

Materials and Methods: In this retrospective cohort study, 100 patients with distal two thirds of esophageal cancer who underwent transhiatal esophagectomy in Ghaem and Omid hospitals Mashhad University of Medical Sciences from 2005 to 2010 were included. Esophagogastric anastomosis to the posterior gastric wall was performed with a partial gastric fundoplication in the first group but simple routine anastomosis was done to the posterior gastric wall in the second group

Results: In a retrospective cohort study 100 patients entered the study with 59 male and 41 female and with a mean age 54.6 +/- 6.4 years. Squamous cell carcinoma was observed in 77% of the patients and adenocarcinoma was reported in 23% of them. Seventy-two percent of tumours were located in distal third and 28% were in middle third of esophagus. Esophagogastric anastomotic leakage was observed in 3 cases of fundoplication group and 7 cases of simple anastomosis technique [P=0.182] so there was no significant difference between the two groups. Benign anastomosis stricture was reported in one of the patients who underwent esophagogastric anastomosis with fundoplication, but it was observed in 8 cases with simple anastomosis technique [P=0.03] so there was a significant difference between the two groups

Conclusion: Esophagogastric anastomosis with partial fundal fundoplication is a safe technique with low incidence of anatomic leakage and late stenosis

Role of conservative management in neck trauma: a case series study

Introduction: Given the fact that neck is a vital component of one's anatomy, injuries of this organ may be accompanied by fatal complications. In this article, we aimed to evaluate the etiology of neck trauma, simultaneous injuries of other organs, therapeutic methods for neck trauma, associated complications, length of hospital stay, at Ghaem Hospital over 10 years

Materials and Methods: In this retrospective study, we evaluated all cases of neck trauma at Ghaem hospital during 1994-2013. Patients were allocated into two groups of blunt and penetrating injuries. Trauma zone, therapeutic methods, coexisting injuries of other organs, associated complications, length of hospital stay, and mortality rate were evaluated in these two groups

Results: In this study, 75 [75%] and 25 [25%] cases were penetrating and blunt, respectively. Overall, 45% of the subjects had other simultaneous injuries and central nervous system injury accounted for the majority of cases. Zone II of the neck was involved in 89% of penetrating neck injuries and 70% of these subjects underwent surgery; conservative management was applied for 30% of the cases. Mortality rate was estimated at 3% for penetrating neck injuries and mean length of hospital stay time was 6 +/- 2 days. Moreover, 68% of blunt neck injuries were explored. The most common cause of surgery was vascular exploration [68%] and the most common surgical intervention was vein ligation [64%]. Mortality rate for blunt neck injuries was estimated at 5.2%, and mean mortality rate was 3.5% in both groups

Conclusion: Considering the severity of complications associated with neck injuries, early neck exploration is suggested for unstable cases or individuals with injuries deeper than the platysma. In addition, the role of diagnostic techniques such as helical computed tomography and interventional angiography was emphasized in the current study

role of tracheal stenting as an alternative treatment in cicatricial and non-operable tracheal stenosis

Tracheal stenosis is normally caused by trauma, infection, benign and malignant tumors, prolonged intubation or tracheostomy. The best treatment for tracheal stenosis is resection and anastomosis of trachea. Yet the major surgical complication of tracheal surgery is postoperative stenosis. The goal of this paper is to study the result of tracheal stenting as a replacement therapy for patients suffering from tracheal stenosis who are not good candidates for surgery. This study presents the results of stenting in patients with: Inoperable tumoral stenosis,Non-tumoral stenosis being complicated due to prior surgeries,Inability to undergo a major surgery. The study was performed between September 2002 and July 2011 and poly flex stents were used by means of rigid bronchoscopy. A total of 25 patients received stents during this study. Among them 15 patients suffered from benign and 10 suffered from malignant tracheal stenosis. The patients were followed up for at most 12 months after the stenting operation. The mean age of the patients was 35 years. The most common cause of stenosis was prolonged intubation [75%]. The most common indication for stenting was the history of multiple tracheal operations. The most common complication of stenting and cause of stent removal was formation of granulation tissue. 30% of patients with benign tracheal stenosis were cured and about 10% improved until they could stand a major operation. Ten patients in benign group and 2 patients in malignant group [20%] needed T-Tube insertion after stent removal but other patientcure by stenting. In benign cases stenting is associated with recurrence of symptoms which requires other therapeutic techniqus, so the stenting may not be named as a final solution in benign cases. However, this technique is the only method with approved efficacy for malignant cases with indication

Anterior trans cervicothoracic approach for complete resection of cervicothoracic mediastinal neurogenic tumors

Introduction: Neurogenic mediastinal tumors comprise a wide range of benign and malignant diseases. A group of these tumors, located at thoracic apex, sometimes spread to cervical spaces causing numerous surgical difficulties. In thoracotomy approaches, due to proximity of the tumors to major blood vessels, complete removal of these tumors from cervical spaces is impossible or may cause intraoperative severe bleeding or other dangerous incidents Because of the adjacent major vessels that are not visible. The aim of this study is to report cases of surgical treatment of such tumors using Anterior Trans Cervicothoracic Approach [ATCA]

Materials and Methods: All patients with neurogenic tumors and cervicomediastinal [CM] spread who underwent surgey with ATCA technique during 2005-2011 were included in our study. Then they were evaluated in terms of age, sex, clinical symptoms, radiological and pathological findings, technical success rate of the surgery, surgical complications and first-year relapse rate after the surgery

Results: Our study included 10 patients from whom 9 were female and 1 was male [M/F= 1/9] and the mean age was 27 years. The most common symptoms were pain and feeling of a lump. All patients were operated by this technique successfully. The most common pathological finding was neurofibroma [in 5 patients] and surgical complications occurred in 2 patients [20%] [Wound infection in 1 patient and brachial plexus injury in another patient]. There was no mortality. Disease relapse was reported in 1 patient ganglioneuroblastoma who underwent surgical resection for the second time

Conclusion: Considering the successful removal of the tumors and favorable exposure of major vessels in cervicomediastinal spaces, this technique is recommended to resect mediastinal tumors with spread to cervical spaces. However, a more definite conclusion requires further studies

[Therapeutic effects of diaphragmatic plication for acquired unilateral non-malignant diaphragm paralysis in twenty patients]

Acquired paralysis of the diaphragm is a condition caused by trauma, surgical injuries, [lung cancer surgery, esophageal surgery, cardiac surgery, thoracic surgery], and is sometimes of an unknown etiology. It can lead to dyspnea and can affect ventilatory function and patients activity. Diaphragmatic plication is a treatment method which decreases inconsistent function of diaphragm. The aim of this study is to evaluate the outcome of diaphragmatic plication in patients with acquired unilateral non-malignant diaphragmatic paralysis. From 1991 to 2011, 20 patients with acquired unilateral diaphragmatic paralysis who underwent surgery enrolled in our study in Ghaem Hospital Mashhad University of Medical Science. Patients were evaluated in terms of age, sex, BMI, clinical symptoms, dyspnea score [DS], etiology of paralysis, diagnostic methods, respiratory function tests and complication of surgery. Some tests including dyspnea score were carried out again six months after surgery. We evaluated patients with SPSS version 11.5 and Paired t-test or nonparametric equivalent. Twenty patients enrolled in our study. 14 were male and 6 were female. The mean age was 58 years and the average time interval between diagnosis to surgical treatment was 38.3 months. Acquired diaphragmatic paralysis was mostly caused by trauma [in 11 patients] and almost occurred on the left side [in 15 patients]. Diagnostic methods included chest x-ray, CT scan, ultrasonography and sniff. Test prior to surgery the average FVC was 41.4 +/- 7 percent and the average FEV[1] was 52.4 +/- 6 percent and after surgery they were 80.1 +/- 8.6 percent and 74.4 +/- 1 percent respectively. The average increase in FEV[1] and FVC 63.4 +/- 4, 61.1 +/- 7.8. Performing surgery also leads to a noticeable improvement in dyspnea score in our study. In patients with acquired unilateral non-malignant diaphragm paralysis diaphragmatic plication is highly recommended due to the remarkable improvement in respiratory function tests and dyspnea score without mortality and acceptable morbidity

Thoracoscopic splanchnicectomy for pain control in unresectable pancreatic cancer

Severe pain is a major problem in patients with unresectable pancreatic cancer. The goal of this study is to evaluate the effects of Thoracoscopic Splanchnicectomy [TS] on pain control in these patients suffering from unresectable pancreatic cancer Between years 2000 to 2011, 20 patients suffering from unresectable pancreatic cancer underwent TS due to severe pain. They were studied in terms of age, sex, location of pancreas tumor, history of previous surgery, response to treatments for pain control [assessed with VAS scoring system] and complications of surgery Male to female ratio was 14/6 with a mean age of 63 years. The most common tumor site was at the pancreas head [in 8 patients]. The most cause of unresectability was local expansion to critical adjacent elements [in 10 patients]. Surgery was performed successfully in all patients. Postoperative complication included only pleural effusion on the left side which was cured by proper treatment. There were no post-op mortalities. Fifteen patients had acceptable levels of pain at the end of a six month follow-up period TS provides good pain control, little side effects and minimal invasiveness, the technique is recommended for pain control in patients with unresectable pancreatic cancer

Production of holmium-166 DOTMP: a promising agent for bone marrow ablation in hematologic malignancies

Therapeutic radiopharmaceuticals are radiolabeled molecules to deliver sufficient doses of ionizing radiation to specific disease sites such as bone metastases, brain and liver tumors and bone marrows malignancies including multiple myeloma. Among some therapeutic radiopharmaceuticals, 166Ho-1, 4, 7, 10-tetraazacyclo dodecane-1,4,7,10 tetraethylene phosphonic acid [166Ho-DOTMP] is used for delivering high doses to bone marrow. In this research production, quality control, pharmacokinetics and biodistribution studies of 166Ho-DOTMP with respect to its radiochemical and in vivo biological characteristics have been presented. Holmium-166 was produced by irradiation of holmium oxide [Ho2O3, purity>99.8%] at a thermal neutron flux. 166Ho-DOTMP complex was obtained in very high yields [radiochemical purity>99%] under the reaction conditions employed. Radiochemical purity and the stability of the 166Ho-DOTMP complex in human serum were assayed. Wild type rats were used for biodistribution and imaging studies of this agent. 166Ho produced by irradiation of holmium-165 oxide demonstrated high radionuclide purity. 166Ho-DOTMP was obtained in very high yield [radiochemical purity>99%] and the complex exhibited excellent in vitro stability at pH-7 when stored at room temperature and human serum. Biodistribution studies in rats showed favorable selective skeletal uptake with rapid clearance from blood along with insignificant accumulation of activity in other non-target organs. The scintigraphic image recorded in rat at 3 h after the injection of the 166Ho-DOTMP radiopharmaceutical revealed that 166Ho-DOTMP rapidly accumulated in skeleton especially in the thigh bones. Biodistribution, stability, imaging and pharmacokinetics studies of 166Ho-DOTMP radiopharmaceutical in this research showed favorable features such as; rapid and selective skeletal uptake, fast clearance from blood and almost no uptake in any other major organs. Our research demonstrated that 166Ho-DOTMP has promising features suggesting good potential for efficient use of this radiopharmaceutical for bone marrow ablation in different hematologic malignancies including multiple myeloma

[Esophagogastric mesenchymal tumors: analysis of 24 patients]

Gastrointestinal mesenchymal tumors are classified as tumors that originate from smooth muscles. Gastrointestinal stromal tumors [GIST] are the most common types of the proposed tumors and can be seen in the GI tract from the esophagus to the anus, but they are mostly seen in the stomach. Mostly from the stomach and asymptomatic, the majority of patients would benefit from surgery as the best method of treatment. In this retrospective study we evaluated the data of patients with the diagnosis of esophageal or gastric mesenchymal tumors admitted in Ghaem and Omid Hospitals affiliated to Mashhad University of Medical Sciences in Iran, from 1992 to 2010. We analyzed factors such as age, sex, presenting symptoms and signs, diagnostic methods, types of pathology, types of treatment, morbidity, mortality and 3-year survival rates. Twenty four patients [16 male, 8 female] with a mean age of 50 were included in the study. The common site of tumor was gastric fundus. The most common symptom at the time of diagnosis was epigastric fullness which was observed in almost 50% of the patients. The most common type of surgery in the patients was subtotal gastrectomy and no hospital mortality was recorded. Paralytic ileus was the commonest complication seen in five patients [20.5%]. Adjuvant therapy had been performed in eight patients [33.1%]. Following the patients three years postoperatively, there were only three deaths [12.45%]. Regarding to the low mortality and morbidity of the surgeries, surgical treatment, if tolerated, is recommended for all Esophagogastric mesenchymal tumors patients

Primary tracheal schwannoma

Primary neurogenic tumors of trachea are extremely uncommon and account for only about 9% of all neoplasms of trachea. Tracheal schwannoma is among the rarest of them and there is no unanimity of opinion regarding its treatment. We report a 30 year-old woman with symptoms of airway obstruction due to primary tracheal schwannoma. She was suffering from cough and exertional dyspnea. She was admitted to the thoracic surgery ward with stridor and hemoptysis and underwent rigid bronchoscopy and biopsy. The patient then underwent primary tracheal resection and anastomosis through a cervicomediastinal approach. The diagnosis was made through histopathological examination as schwannoma

Dysphagia due to anterior cervical spine osteophyte: a case report

Degenerative changes of the cervical spine are more common in elderly, but anterior cervical osteophytes that cause problems in swallowing is rare. The most common cause of this problem is DISH disease [diffuse idiopathic skeletal hyperostosis]. Trauma is also suggested as a potential cause in osteophyte formation. We report a rare case of anterior cervical osteophyte with problems in swallowing that was caused by cervical spine trauma in during a car accident 4 years ago, treated with a cervical collar. Dysphagia was the initial symptom of the disease. Barium swallowing showed a large cervical osteophyte at the C3-C4 level with compression effect on the esophagus. X-ray, CT scan and MRI of the cervical spine confirmed the osteophyte and its correlation with the esophagus. Endoscopic study of esophagus and stomach also ruled out other disorders. Surgical osteophytectomy was performed. Up to now, only two cases of post-traumatic anterior cervical osteophyte have been cited in the literature. In this report, we introduce an unusual case of dysphagia caused by cervical spine trauma

Primary pulmonary hemangiopericytoma: a case report

Hemangiopericytoma is a mesenchymal neoplasm originating from the pericyte, a cell type that surrounds the capillaries. Its primary localization in the lung is extremely rare. A 70-year-old woman was referred to our hospital complaining of cough and non-massive hemoptysis from 2 months earlier. She was a nonsmoker with a history of close contact with sheep and a dog. On physical examination, she had reduced respiratory sounds in the left upper zone. Her chest x- ray revealed a mass in the left middle and upper zones. CT-scan of the lungs revealed a parenchymal mass with -4 to 20 [HU] densities. Hemagglutination test was negative for hydatid cyst. Fiberoptic bronchoscopy was normal; therefore, the patient underwent surgical operation. The pathology of the mass was primary pulmonary hemangiopericytoma

[ role of thoracoscopy in diagnosis of hidden diaphragmatic injuries in penetrating thoracoabdominal traumas]

Complications like chronic diaphragmatic hernia thoracoabdominal stab wound following conservative treatment, make it necessary to find a safe and exact diagnostic method. The aim of this work was to assess, accurate diagnostic value of thoracoscopy in occult diaphragmatic injuries in penetrating thoracoabdominal stab wound. In the present prospective study, from March 2005 to October 2007 at Ghaem, Emam Reza and Shahid Kamyab Hospitals of Mashhad University of Medical Sciences, thirty patients with penetrating thoracoabdominal injuries, with stable hemodynamic and no need to emergent exploration were evaluated. They underwent thoracoscopy to evaluate probable diaphragmatic injuries, which were repaired via thoracoscopy or laparatomy and all patients evaluated for chronic diaphragmatic hernia by CT-scan, 6 months later. Mean age was 26.2 years and M/F ratio was 5:1. In thoracoscopic evaluations five hidden diaphragmatic injuries [16.7%] were observed, that 3 cases [9.9%] were repaired through thoracoscopic approach and laparatomy was inevitable in 2 [6.6%] patients. Lung paranchymal laceration was seen in 2 patients [6.6%], repaired with thoracoscopy and intra abdominal injury was seen in 1 patient [3.3%], repaired with loparatomy. No complication reported after thoracoscopy and there was no evidence of chronic diaphragmatic hernia in the chest and abdominal CT-scan performed 6 months later. In this study, the diagnostic accuracy of thoracoscopy in occult diaphragmatic injuries was 100%. Because of high diagnostic accuracy rate, and minimal invasively diagnostic and treatment ability of thoracoscopy, this diagnostic method in all clinically stable patients with penetrating thoracoabdominal stab wound is recommended

Adenoid cystic carcinoma of the trachea

Primary malignant neoplasms of the trachea are very rare and there is limited information available on this subject. Adenoid cystic carcinoma is a slow-growing malignant tracheal tumor and the best method of treatment is surgical resection. This study was conducted to evaluate patients with adenoid cystic carcinoma of the trachea who underwent surgical treatment. In this descriptive study, 9 patients treated for adenoid cystic carcinoma from 1995 to 2007 at the Mashhad Ghaem Hospital and Tehran Imam Khomeini Hospital were assessed. There were 9 patients [3 males and 6 females] with a mean age of 56.3 years. Dyspena and stridor were the most common presenting symptoms [88.8%]. All patients underwent rigid bronchoscopy and biopsy. The most common site of involvement was the lower third of trachea [44.4%]; 77.7% of patients underwent surgical resection. Death occurred in one patient after tracheal resection due to aspiration pneumonia [14.2%]. Postoperative radiotherapy was performed in 28.4% of patients because of positive surgical margin and in 22.2% due to inappropriate location of the tumor after bronchoscopic ablation. During a three-year follow up, one patient [11.1%] had tumor recurrence. Resection with post-operative radiotherapy was performed for him. The three-year survival was 88.8%. Because of the nature of adenoid cystic carcinoma of the trachea, surgical resection is the best method of treatment. But if surgical margins are positive post-operative radiotherapy will be necessary. In patients who are not candidates for resection, radiotherapy can be an effective alternative treatment

Mediastinal hemangioma: a case report

Mediastinal hemangioma is a very rare tumor. It may occur at any age but the cavernous form shows a predilection in children and adolescents. Mediastinal hemangioma was diagnosed in a 15-year-old boy from Afghanistan. Cough and neck swelling were his chief complaints. Chest x- ray and CT-scan showed mediastinal widening and anterior mediastinal mass. After cervical biopsy, anterior cervicomediastinal surgery was performed. Pathological examination of the lesion revealed a mediastinal hemangioma

Surgical management of tuberculous broncholithiasis

Broncholithiasis is often seen after chronic granulomatosis diseases such as tuberculosis and histoplasmosis and leads to a wide spectrum of signs and symptoms; including hemoptysis which often needs surgical management. The goal of this study is evaluation of surgery in patients with tuberculous broncholithiasis presenting with hemoptysis. In this study, all patients with tuberculous broncholithiasis whom had been operated on between 1991 and 2005 and their follow-up period was at least 6 months and at most 9 years were included and studied in regard to age, sex, clinical symptoms, diagnostic methods, type of surgical procedure, complications, and mortality rate. Overall, 5 patients were studied; [M/F=2/3, mean age=31 years], 40% with severe and 60% with mild to moderate and recurrent hemoptysis. Lesion was at the left lung in 80% and at the right lung in 20% of patients. In 60% of patients some degrees of bronchiectasis were seen, in 80% the lesion was visible in bronchoscopy and endoscopic removal of lesion failed in all cases. Sixty percent of patients underwent pulmonary resections and in 40% broncholithectomy was done. In follow-up, patients with pulmonary resection have had no problem till now, but in patients with broncholithectomy due to the late occurrence of bronchiectasis, re-operation and pulmonary resection were unavoidable. No mortality was reported in our patients. Regarding the risks of hemoptysis, excellent results of surgery and possible occurrence of late bronchiectasis after broncholithectomy, the results of our study showed that the procedure of choice for these lesions is pulmonary resection distal to lesion and saving as much of parenchyma as possible. Broncholithectomy should be done only in patients in whom pulmonary resection is not technically possible. But because of very low occurrence of this complication, further studies are required in this regard