[Comparative evaluation of resistance among extracorporeal roeder, meltzer and hemolock knots in intestine of sheep]

Despite advances in different techniques of suturing and their alternatives, controversies exist in their indications in laparoscopic surgeries. Due to difficulties exist with laparoscopic suturing knots the hemolock technique was introduced in this study. The objective of this study was to compare resistance among extracorporeal Meltzer and Roeder knot and hemolock in laparoscopic surgery. In this quasiexperimental study 205 intestines of sheep [20 cm length] sutured with Meltzer's [43 cases, 20%], Roeder's [44 cases, 20.5%] and hemolock [128 cases, 59.5%] methods. Resistance of these methods were evaluated with sphygmomanometer. Furthermore, side effects of sutures were evaluated. Mean pressure tolerance of Roeder's knot method [196.0 +/- 50.9 mmHg] Meltzer knot [193.8 +/- 49.22 mmHg] and hemolock clips [247.03 +/- 42.47 mmHg] were determined. Mean pressure tolerance was significantly higher in hemolock [p<0.001] compared to the other ones. Frequency of suture displacement was 52% [22 cases] in Roeder, 68% in Meltzer [23 cases], and 47% [37 cases] in hemolock. With respect of the results of this study and easy use of hemolock and due to its high pressure resistance, hemolock can be considered as a safe and good substitute for extracorporeal knots in laparoscopic surgeries

Pulmonary langerhans cell histiocytosis presenting as simultaneous bilateral spontaneouse pneumothorax in a non-smoker patient

Pulmonary Langerhans Cell Histiocytosis [PLCH] is a rare idiopathic disorder that primarily affects young adult cigarette smokers. Affected patients often present with cough and dyspnea and about 20% of patients present with or later develop pneumothorax. It is striking that more than 90% of patients are smokers. We report a very unusual case of PLCH in a 20-year- old male patient with no smoking history in whom a life- threatening complication such as simultaneous bilateral pneumothorax was the presenting feature. The final diagnosis was made by open surgical biopsy and recurrent pneumothoraces necessitated surgical management with pleurodesis. We emphasize the early use of pleurodesis in managing patients with PLCH and spontaneous pneumothorax

Pulmonary metastases: results of surgical resection in 60 cases: treatment modalities other than surgery are needed

Pulmonary metastases occur in 30% of all oncology patients. Surgical resection of lung metastases is a widely accepted procedure but long-term results are disappointing with a 5-year survival rate of 20-40% and the results vary with the histologic type of the primary tumor. Due to unavailability of any study regarding pulmonary metastasectomy in Iran and emergence of new treatment modalities, reassessment of our current practices is essential. We performed a retrospective study of 60 cases of pulmonary metastasectomy during a 5-year period in one of the major thoracic surgery centers in Tehran [Imam Khomeini Hospital]. Bilateral metastases were present in 23% of cases, number of metastases in each patient ranged from 1-12. Average disease-free interval was 12 months, pneumonectomy rate was 21.7% mostly as a second or third attempt and finally, recurrence or death following initial metastasectomy occurred in 12-18 months in most patients. These results confirm that surgery remains unsuccessful in obtaining long-term survival or cure in most patients with pulmonary metastases and treatment strategies other than surgery, such as radiofrequency ablation are needed to avoid performing multiple operations in these patients and improving their quality of life