Physiologic function of mediastinum space.

The mediastinum forms the central part of the thoracic cavity that is surrounded by pleural space on the two sides, thoracic vertebrae at the posterior, thoracic inlet on the top, and diaphragm at the bottom. It encompasses cardiopulmonary organs and organ systems. Pathological dysfunction or deformity in any part of the mediastinum can have adverse cardiovascular and respqiratory effects. Pectus excavatum and pectus carinatum are the most common congenital chest deformities that are characterized by sternal depression and protuberance of the sternum, respectively. Together, these account for 90% of chest wall deformities. Patients are known to be represented with respiratory distress and cardiovascular dysfunction. The aim of the review article is to present the anatomical and physiological role of the mediastinum in association with important parts of the thoracic cavity and pathological dysfunction of the mediastinum (cardiopulmonary system) due to pectus excavatum and pectus carinatum.

Acute Progressive retro-peritoneal hematoma in COVID19 patients with sub cutaneous ecchymosis.

Introduction: and importance: COVID19 is a multifunction disease where hematological disorders are reported. Coagulopathy is seen in these patients, indicated by thromboembolic events. Case presentation: We present case of 11 COVID19 who were presented with localized skin ecchymosis lesions in different areas of the body and retroperitoneal hematoma in the posterior wall of the abdomen and chest. Clinical discussion: Increased INR and bleeding and ecchymosis in Corona patients require discontinuation of anticoagulants and, FFP, essential and tri amino injections are needed. Conclusions: Diagnosis and management of hematoma is important to avoid fatality.

Acute retroperitoneal hematoma following severe Covid-19 and the use of anticoagulants.

Introduction: and Importance: Severe COVID19 patients under anticoagulant therapy are at the risk of developing hematoma. Case presentation: We present case of 11 COVID19 who were presented with localized skin ecchymosis lesions in different areas of the body and retroperitoneal hematoma in the posterior wall of the abdomen and chest. Clinical discussion: Cases of hematoma with severe COVID19 patients under anticoagulant therapy are reported in several case studies, particularly in geriatric population with the previous history of blood and/or cardiac disorders. Conclusion: These patients should be carefully monitored for hematomas by skilled nurse and practitioner and timely treated and monitored.

Uterine artery embolization technique for treatment of a huge multi myomatous uterus in a virgin woman.

Introduction: Uterine artery embolization is a non-surgical method performed for large and numerous fibroids to preserve the fertility. Case presentation: The patient is a 36-year-old virgin woman with menometrorrhagia, abdominal pressure, constipation, bilateral abdominal pain, frequent urination and a compressive effect on the intestines was reported to our center. She was diagnosed with uterine fibroids. Discussion: Because the type of uterine masses and possibility of uncontrollable bleeding during myomectomy and hysterectomy, uterine vascular embolization by supra selective angiography to preserve the uterus was performed. Due to fever, pain and vaginal discharge, she was hospitalized again and hysterotomy was performed without any reported complications. Conclusion: Uterine artery embolization is a safe method, however reduction and loss in ovarian function can be seen with the treatment. Measurement of follicle stimulating hormone and anti-Müllerian hormone before and after the treatment is important.

The use of remdesivir among pregnant women and associated clinical outcomes in mother and the child.

Introduction: and importance: Management of COVID19 has imposed a global challenge for hospitals, clinicians and patients. The use of medicines to treat clinical symptoms are likely to have adverse effects. COVID19 during pregnancy can be additional challenge since the CT scan cannot be performed in pregnant women. Case presentation: We reported the case series of use of remdesivir among 23 pregnant women. 5 of these women underwent cesarean section. Clinical discussion: Anticoagulants and dexamethasone were also used to treat these patients. Conclusions: However, consultancy with the experienced and specialized doctor and timely management and monitoring of the mother and baby is required for effective outcomes.

Early percutaneous tracheostomy in COVID19 patients with failed intubation: A case series.

INTRODUCTION: COVID19 and pulmonary dysfunction leading to acute respiratory distress syndrome (ARDS). CASE STUDY PRESENTATION: Herein we presented the cases of failed intubation that was replaced by early percutaneous dilational tracheostomy. The procedure is safe for the patients, doctors and clinical staff. CONCLUSION: Additionally, we report mucormycosis after COVID19 treatment that was potentially due to immunosuppressive drugs.

Radical extrapleural pneumonectomy with bronchial fistula by pulmonary function test evaluation technique.

INTRODUCTION: and importance: Pulmonary Function Tests (PFTS) is an important tool in the assessment of pulmonary pathologies and preoperative evaluation. Case presentation: A 54-year-old man with history of massive pleurisy in the left thorax, treated by placing chest tube and drainage of bloody effusion, was readmitted for epithelioid mesothelioma. He was then presented with pneumothorax due by a refractory bronchial fistula while having a plural catheter. Based on the consultation, the whole-body bone scan was conducted, and findings demonstrated epithelioid mesothelioma (stage 1) with the refractory fistula for which the patient was candidate for thoracic surgery. Decreased lung capacity was seen by Pulmonary Function Testing - PFTS. CLINICAL DISCUSSION: The novel PFTS Evaluation Technique was designed to measure the true pulmonary capacities in order to evaluate the pulmonary post-operative tolerance. In this technique the chest tube was placed for 4 weeks until the patient reaches mediastinal fixation then the measurements by PFTS were carried out in two steps. First, using an open chest tube and second, using a clamped chest tube. In both steps, the pulmonary capacities were measured and provided to the pulmonologist for consultation. CONCLUSION: In this case, after acquiring the approval of the specialist depended on PFTS after PFTS Evaluation Technique, the radical extra pleural pneumonectomy surgery was conducted, and the patient was discharged with a good general appearance and treated fistula.

Cardiopulmonary bypass for resection of pancoast tumor with mediastinal extension and involvement of right bronchial branch: A case report.

INTRODUCTION: and importance: Pneumonectomy is commonly associated with cardiopulmonary complications. Pneumonectomy in Pancoast tumor with mediastinal extension and no metastasis could be successful and efficient. CASE PRESENTATION: Herein, we report a successful pneumonectomy of a 54-year-old man with pancoast tumor along with the involvement of mediastinal space including right hilum of the lung, right bronchial, inferior vena cava vein and pericardium. CLINICAL DISCUSSION: Based on the bronchoscopy and biopsy, the complete involvement of right bronchial tree was reported and non-small cell carcinoma was diagnosed in pathology. CONCLUSION: To reduce the complications of the surgery, the cardiopulmonary pump machine was used during the operation.

Unilateral repair of tracheoesophageal fistula with dilatation of incomplete subglottic stenosis.

A case of TEF along with subglottic stenosis in a patient as a result of prolong intubation. We performed left unilateral tracheal repair to avoid injury to left recurrent laryngeal nerve followed by endoscopic balloon repair of stenosis. Due to critical condition of the patient and COVID-19 infection, she expired.

Early percutaneous dilational tracheostomy in COVID-19 patients: A case report.

The need of intubation and mechanical ventilation is associated with poor prognosis in COVID-19 patients. Herein, we present two cases of patients with COVID-19 where intubation and mechanical ventilation failed, and therefore, percutaneous dilatational tracheotomy was performed. The usage of PDT was associated with faster and better recovery in these patients.

Delayed presentation of left traumatic diaphragmatic hernia with displacement of spleen and stomach to left hemi thorax.

We presented a case of late onset of left traumatic diaphragmatic hernia with displacement of spleen and stomach to the left hemi thorax, a year after the trauma. Gastric and respiratory complications along with herniation should be immediately managed, in order to reduce the risk of cardiac arrest and mortality.

An unusual displacement of the cervical plate to the inner surface of the hypopharynx.

Unlocking and penetration of the screws and displacement or breakage of the plates are some commonly reported complications associated with the cervical implants. It is imperative to provide immediate surgical intervention along with a complete workup. Timely diagnosis and management can reduce further complications and morbidities.