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

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.

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

Atypical radiological findings in patients with Hydatid cysts of the lung, study of 1024 cases

Introduction: The objective of this study was to give a description of the most prominent atypical radiological presentations of lung hydatidosis

Materials and Methods: All patients diagnosed with pulmonary hydatidosis by surgical exploration were included in this study. Standard chest roentgenogram and computed tomography CT] were evaluated before surgery for lung cysts or unknown lesions. Radiological findings were divided into two categories: 1- Typical hydatid cysts that were previously presented by imaging as a hydatid cyst in the form of an intact cyst, water lily sign and crescent sign. 2- Atypical hydatid cysts that were not similar to typical previously mentioned hydatid cysts

Results: During a 26-year period, 1024 subjects with pulmonary hydatidosis were diagnosed and operated on. Chest X-rays [interpreted in 832 cases] showed perforated cysts in 190 [23%] and atypical findings such as mass, alveolar type infiltration, abscess and collapse in 113 [13%] patients. Seventy-nine patients had a thoracic CT scan in which atypical cysts were detected in 32 subjects [40.5%] such as: thick wall cavity in 9 patients [28%], solid masses in 7 [21%], abscesses in 6 [18%], consolidation in 3 [9%], fungus balls in 3 [9%], collapse [atelectasis] in 2 [6%] and round pneumonia in 2 [6%]. Cavity was significantly more frequent in the right lung [90%] and mass-like opacity was significantly more frequent in the lower lung field [100%]

Conclusion: Hydatid cysts should be considered for most of localized radiological pictures of the lung without respect to localization, size and count of lesions

[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

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