Primary Synovial Sarcoma Presenting as a Huge Mass: A Report of a Rare Case and Review of Literature.

Primary synovial sarcoma of mediastinum is very rare among soft tissue sarcomas. Only a few cases have been reported in the literatures. The best treatment is still unclear, but, surgical resection is the main therapy. In this article we report a case of a 20*20 cm (2000gr) primary giant mediastinal synovial sarcoma in a 42 year-old man. We performed radical excision of the tumor and the metastasis.

Clinical Outcomes of Modified versus Traditional Technique for the Surgery of Hydatid Cyst of the Liver: A Case Control Study.

BACKGROUND Echinococcus granulosis is a parasitic infection most commonly involving the liver. Iran is a hyperendemic area for this disease according to WHO. Despite improvements in medical and interventional radiological techniques, surgery remains the gold standard of treatment; however evidence on different surgical modalities were explained. Considering the high population of referring patients presenting to Omid and Ghaem Hospitals, Mashhad, Iran, we decided to compare the complications of our modified technique with routine technique in hydatid cyst surgery. METHODS 56 patients with hydatid cyst of the liver who underwent modified and routine surgical treatment in Ghaem and Omid Hospitals Mashhad, Iran were studied during Aug 2013- Nov 2015. 27 patients underwent modified surgical technique, whereas the remaining 27 patients were treated by using routine surgical method. These two groups of patients were compared with each other according to their postoperative length of hospital stay and resulting complications. RESULTS The mean age of our patients was 41 years. 27 patients were male and 29 were female. Our results showed no statistically significant difference regarding the incidence of postoperative complications between the two groups. However, mean length of hospital stay was significantly different between the groups (4.5 ± 1.87 and 7.6 ± 2.25 days, respectively, p < 0.001). CONCLUSION The method of modified surgery with closed cyst drainage, which does not use external drains, is a safe surgical modality in the treatment of hydatid cyst disease of the liver if applied properly on appropriate patients.

Genotyping of Echinococcus granulosus Isolates from Human in Khorasan Province, North-Eastern Iran.

BACKGROUND: Human hydatidosis is endemic in northeastern Iran. The present study aimed to investigate molecular diversity of Echinococcus granulosus isolates collected from human surgically. METHODS: Sixty human hydatid cysts (58 lung cysts and 2 liver cysts) were collected through surgery from Ghaem and Emam Reza hospitals in Mashhad University of Medical Sciences during 2015-2016. Cysts were characterized using polymerase chain reaction-restriction fragment length polymorphism (PCRRFLP) analysis of the internal transcribed spacer 1 (ITS1) gene and sequencing fragments of the genes coding for mitochondrial cytochrome c oxidase subunit 1 (cox1) and NADH dehydrogenase subunit I (nad1). RESULTS: Overall, 55 out of 60 Echinococcus granulosus cysts (91.6%) were determined as the G1 strain, 4 cases (6.6%) were determined as the G6 strain and 1 sample was not identified. CONCLUSION: Although sheep strain (G1) is dominated in human patients in Great Khorasan, the prevention of camel-dog cycle should pay attention in this region.

Surgical management of early and late esophageal perforation.

INTRODUCTION: Esophageal perforation is a rare and life-threating problem with a 10%-40% mortality rate. Early diagnosis and treatment are important for prevention of complications. Strategies for treatment of esophageal perforation have been controversial for many years, especially in cases of late presentation. METHODS: We prospectively studied 27 patients (12 male, 17 female, mean age 42.7 ± 17.8 years) who presented with esophageal perforation from 1996 to 2015, and evaluated the results of surgical treatment. The patients were divided into 3 groups according to time of presentation: early (<24 h), intermediate (24-72 h), and late (>72 h). We also considered the etiology and site of esophageal perforation, complications, and mortality. RESULTS: Surgery was performed in 5 patients in the early group, 7 in the moderate group, and 15 in the late group. Primary repair was carried out in 5 cases, primary repair and reinforcement with a flap in 10, esophageal resection and reconstruction in 8, and a T-tube stent was used in 4. Four patients developed a fistula postoperatively, and there was one death due to respiratory failure. No relationship was found between complications and the cause of perforation, time of presentation, or type of treatment. CONCLUSION: In patients without sepsis, primary repair can be an option even in those presenting late after esophageal perforation, with an acceptable result.

Albendazole therapy in human lung and liver hydatid cysts: A 13-year experience.

BACKGROUND: Cystic echinococcosis (CE) is an endemic disease in Iran. This study has aimed to report the efficacy of Albendazole therapy in patients with CE. METHOD: Among 164 patients with echinococcosis who were referred to the surgery clinic, Ghaem hospital, Mashhad University of Medical Sciences between 2001 and 2013, two were diagnosed with alveolar echinococcosis (AE) and 162 with CE; 43 of whom underwent surgery. The rest 119 patients received medical therapy by Albendazole 15 mg/kg/day for three phases. Each phase included 6 weeks of Albendazole therapy followed by 2 weeks of no medication. The patients were classified according to radiologic evaluations into four groups: (1) cured, (2) improved, (3) unchanged, and (4) worsened or relapsed. RESULTS: Patients who completed more phases had significantly greater chances of better response. Of the 56 patients who completed all three phases, 37 (66.1%) were cured, 15 (26.8%) improved, 4 (7.1%) remained unchanged, and none worsened or relapsed. [Odds ratio (OR):4.78, 95% confidence interval (CI): 2.95-7.74, P < .0001]. CONCLUSION: Albendazole can be beneficial for inoperable, multiple cysts, and multiple organs CE patients.