role of VATS [Video assisted thoracic surgery] in the evaluation of patients with undiagnosed exudative pleural effusion

Video assisted thoracic surgery [VATS] is a new minimal invasive diagnostic and therapeutic method in lung diseases that provides a perfect view of pleura and pericardium to perform a diagnostic biopsy from the pathologic site. This study aimed to evaluate the diagnostic value of VATS in pleural effusion with an unknown cause. In this descriptive study, carried out from 1999 to 2007 in thoracic surgery department of Ghaem Hospital, sixty five patients with undiagnosed exudative pleural effusion underwent VATS for tissue diagnosis, and six months follow up was performed. Age and sex, pathology and diagnostic accuracy rate collected by questionnaire and processed using the SPSS software by descriptive statistics and frequency distribution table. Among 65 patients, 33.8% were female and 66.2% were male. Mean age was 58.90 +/- 14.57 years. The most common clinical symptom was dyspnea which was seen in 87.7%. Pleural effusion was clear yellow in 55.4% and bloody in 44.6%. Malignant cytology was reported only in one case [1.5%]. Transthoracic needle biopsy showed pleuritis in 86.2%, fibrosis in 10.8% and it was suspicious in 3.1%. VATS was diagnostic in 95.4% and exact diagnosis wasn't obtained only in 3 cases [4.6%]. Open biopsy was performed in these cases that indicated Mesotelioma in two cases, another case with the history of CABG was treated after 6 months of follow up. The most common diagnosis was metastatic carcinoma, which observed in 37 cases [56.9%]. VATS diagnostic accuracy rate in this study was 95.4%. No complication was seen in 98.5% and only one case had bleeding [1.5%]. Mortality rate, because of VATS complications, was not seen. According to the safety, high sensitivity and specificity of VATS, it is suggested as a good diagnostic method in pleural effusion with an unknown cause

[Congenital nasolacrimal duct obstruction and its risk factors in premature neonates]

To determine the frequency of congenital nasolacrimal duct obstruction [CNLDO] in premature newborns and its correlation with gestational age [GA], sex, family history and chronological age. This study was performed on infants who were referred for retinopathy of prematurity from 2002 to 2003. Cases of CNLDO were visited again three and six months later. This study was conducted on 60 preterm infants [26 male, 34 female] with gestational age of 33.2 +/- 1.3 weeks [range 25-36] and age of 3.8 +/- 0.9 months [range 1.5-6] at first presentation, of which 13 had CNLDO [9 unilateral and 4 bilateral]. Overall, 17 out of 120 ducts [14.1%] were obstructed. There was no correlation between CNLDO and sex, family history or gestational age. Three months later 58.4% of the obstructions were cleared and at the 6 month visit, 25% of residual obstructions were cleared, such that the total remission rate at 6 months was 83.4%. In premature newborns with CNLDO, the rate of spontaneous clearing of the obstruction is greater than 80% during the first 6 months

[Cloverleaf skull syndrome associated with cleft palate]

To report a case of cloverleaf skull syndrome with cleft palate. We report a 20-day-old boy with cloverleaf-shaped skull deformity, very constricted cranium and prominent temporal bones associated with severe proptosis, maked lid retraction, conjunctival chemosis, exposure keratitis, corneal opacity and cleft palate. CT-scan dislosed fusion of the coronal, sagittal and lambdoidal skull sutures with shallow orbits. To control the exposure keratitis, bilateral tarsorrhaphy was performed temporarily and the patient was referred to the neurosurgery service. To the best of our knowledge this is the first report on the association of cleft palate with cloverleaf skull syndrome. After performing preliminary measures for preservation of the cornea, patients should be referred to neurosurgeons or plastic surgeons

Manegment of malignant esophagorespiratory fistula

The development of a malignant esophagorespiratory fistula is a devasting complication. The only effective treatment is to exclude the fistula from the alimentary tract. This may be achieved by intubation or esophageal bypass, and we describe our experience with these two procedures. To assess the results of therapy, we reviewed our experience in 8 patients with esophagorespiratory fistula due to esophageal carcinoma from 1994 to 2002 at Omid and Ghaem Hospitals. Age ranged from 45 to 73 years [median 57.7 years] the male / female ratio was 3:1. Primary tumor site was squamous cell carcinoma of midesophagus in all patients. All patients experienced an approximately equal average weight loss of 10kg. Three patients were intubated by a traction [pull-through] technique with plastic stent named Mousseau-Barbin tube and the other five patients were treated by substernal gastric bypass of the excluded esophagus. There was one cervical anastomotic leak in the bypass group that healed conservatively and also one hospital death in the bypass group [hospital mortality rate 20%]. Due to pulmonary infection, with no hospital death in the intubated group. The mean hospital stay in the intubation group was 13 days and in the bypass group was 19 days. All patients in both groups had acceptable quality of remaining life and were able to eat soft or regular diet without any serious pulmonary complications. The mean survival in the intubated group was 125.5 days [range 105 to 145 days] and in bypass group 137.5 days [75 to 180 days]