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Background: Ultrasound and fine needle aspiration biopsy (FNAB) play a primary role in determining the nature of nodules. Objectives: The aim of our study is to determine the diagnostic accuracy, sensitivity, and specificity of artificial intelligence-thyroid imaging reporting and data system (AI-TIRADS) in differentiating malignant from benign nodules to establish the treatment plan for patients and avoid unnecessary FNAB. Methods: This cross-sectional study was conducted between September 2020 and September 2021 (one year). Patients (n = 133) who had an indication for surgery due to nodular thyroid disease and were referred to the therapeutic training center of 5 Azar and Falsafi private section hospitals, Gorgan, Iran, were included. The diagnostic accuracy of FNAB and AI-TIRADS was calculated. Results: The mean age of patients with malignant pathology (39.65 ± 11.69) was lower than that of patients with benign pathology (44.14 ± 13.54), which was statistically significant (P = 0.042). Fifty-two out of 72 nodules less than 25 mm were malignant, demonstrating a higher prevalence of benign pathology in larger nodules. A pooled analysis of thyroid reporting (TR) = 2 and TR points ≥ 7 for their power in predicting the final pathology outcome showed figures of 0.97,0.93,0.97, and 0.97 for sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), respectively, with an overall pooled accuracy of 0.97 for these two groups of sonographic results. Conclusions: We concluded that AI-TIRADS has a high sensitivity and diagnostic accuracy in differentiating benign from suspicious nodules. [ABSTRACT FROM AUTHOR]

Background: Autosomal dominant polycystic kidney disease (ADPKD) is a multisystem disorder characterized by progressive renal cysts formation and extra-renal manifestations. Infection within the cysts and abscess formation are rare but life threatening if left untreated. We present a rare case of peritonitis presentation due to intraperitoneal rupture of an infected cyst in a woman with polycystic kidney disease. Case description: A 42-year-old woman presented with constant progressing abdominal pain and vomiting. She complained of abdominal distention, bloating, and a change in bowel habits from two days ago. On physical examination, bilateral enlarged masses of flanks, generalized tenderness, and distention of the abdomen were found. The patient received conventional therapy. After appropriate fluid and electrolyte management and rescue care, appropriate antibiotics were prescribed, and laparotomy was performed. The rupture of an infected cyst of the right polycystic kidney into the peritoneal cavity was the cause of peritonitis in this patient. She successfully underwent a right radical nephrectomy (32×21cm, and 3,300 gr). The postoperative period was uneventful and the patient was discharged from the hospital after a week. Conclusion: Antibiotic therapy is the first step in the treatment of renal cyst infection. When primary antibiotic therapy fails, drainage of the infected cyst is recommended. In medically fit patients for surgery and patients who present with complications of the infected cyst, radical surgery and nephrectomy is the procedure of choice. The best outcome is achieved after nephrectomy. [ABSTRACT FROM AUTHOR]

Background and objectives: Surgical site infection (SSI) after colorectal surgery and its negative clinical outcomes remain significant problems. This study aimed to determine the incidence of SSI after colorectal surgery and associated risk factors in the 5 Azar Hospital of Gorgan, Iran. Methods: A cross-sectional study was performed on patients undergoing emerging or elective colorectal surgeries from 2011 to 2019 in the 5 Azar Hospital of Gorgan, Iran. The subjects were followed up for 30 days. Data were collected through pre and postoperative examinations and telephone follow-ups. Univariate analyses were performed to identify risk factors. Results: A total of 240 patients were enrolled in the study, and the overall SSI incidence rate was 23.3% (56 patients). Univariate analyses indicated that corticosteroids use [risk ratio (RR)=3, 95% confidence interval (CI): 1.62-5.54], segmental resection with anastomosis (rR=2.28, 95% CI: 1.12-4.63), anemia (RR=4.52, 95% CI: 3.11-6.59), diabetics (RR=2.68, 95% CI: 1.73-4.14), and opium use (RR=1.87, 95% CI: 1.17-2.99) were risk factors for SSI. Conclusion: Based on our findings, the incidence of SSI after colorectal surgery is relatively high in the study area, which requires tailored approaches and careful reconsideration of the whole operation procedure. Moreover, the use of corticosteroids, type of intervention, anemia, diabetes, and opium use may be associated with the incidence of SSI after colorectal surgery. Therefore, cases with such a profile should be closely monitored after the surgery. [ABSTRACT FROM AUTHOR]

Objective(s): Lymph node metastases are the most significant prognostic factor in localized non-small cell lung cancer (NSCLC). Identification of the first nodal drainage site (sentinel node) may improve detection of metastatic nodes. Extended surgeries, such as lobectomy or pneumonectomy with lymph node dissection, are among the therapeutic options of higher acceptability. Sentinel node biopsy can be an alternative approach to less invasive surgeries. The current study was conducted to evaluate the accuracy of sentinel node mapping in patients with NSCLC using an intraoperative radiotracer techniques. Methods: This prospective study was conducted on 21 patients with biopsy-proven NSCLC who were candidates for sentinel node mapping during 2012-2014. All patients underwent thoracoabdominal computed tomography, based on which they had no lymph node involvement. Immediately after thoracotomy and before mobilizing the tumor, peritumoral injection of 2mCi/0.4 mL Tc-99m- phytate was performed in 4 corners of tumor. After mobilization of the tumoral tissues, the sentinel nodes were searched for in the hillar and mediastinal areas using hand-held gamma probe. Any lymph node with in vivo count twice the background was considered as sentinel node and removed and sent for frozen section evaluation. All dissected nodes were evaluated by step sectioning and hematoxylin and eosin staining (H&E).The recorded data included age, gender, kind of pathology, site of lesion, number of dissected sentinel nodes, number of sentinel nodes, and site of sentinel nodes. Data analysis was performed in SPSS software (version 22). Results: The mean age of the patients was 58.52±11.46 years with a male to female ratio of 15/6. The left lower lobe was the most commonly affected site (30.09%). Squamous cell carcinoma and adenocarcinoma were detected in 11 and 10 subjects, respectively. A total of 120 lymph nodes were harvested with the mean number of 5.71±2.9 lymph nodes per patient. At least one sentinel node was identified in each patient, resulting in a detection rate of 95.2%. The mean number of sentinel nodes per patient was 3.61±2. Frozen section results showed 100% concordance with the results of hematoxylin and eosin staining. Conclusion: Based on the findings, sentinel node mapping can be considered feasible and accurate for lymph node staging and NSCLC treatment. [ABSTRACT FROM AUTHOR]

Introduction: Surgical approaches for the management of pulmonary aspergilloma have been accompanied with high levels of morbidity and mortality. However, these therapeutic options are still favored over other approaches for the treatment of pulmonary aspergilloma. The present study was conducted to describe the characteristics of 30 patients with aspergilloma who referred to Ghaem Hospital in Mashhad, Iran, during 2017-2018. Material and Methods: This retrospective study was conducted on 30 patients (i.e., 21 males and 9 females) with pulmonary aspergilloma who were treated via surgery. The patients were examined based on their age, gender, clinical symptoms prior to surgery, affected pulmonary lobe, surgical method, and postoperative complications. Results: The mean age of the patients was 48.13±5.2 years. Hemoptysis (90%) was the most common symptom of pulmonary aspergilloma, followed by productive cough and drug-resistant pneumonia. The most common problematic lobes included left upper lobe and right upper lobe. Regarding the surgical method, 21 and 9 patients underwent lobectomy and segmentectomy, respectively. After the surgery, residual space, wound infection, and bronchopleural fistula were observed in 5 (16.7%), 3 (10%), and 2 (6.7%) cases, respectively. Furthermore, only one patient passed away. Conclusion: As the findings indicated, the methods of surgery (i.e., lobectomy and segmentectomy) were effective in the treatment of pulmonary aspergilloma. [ABSTRACT FROM AUTHOR]

Background: Thymoma is the most common tumor of the anterior mediastinum that has the most effective treatment, as it can be completely resected. In patients with advanced stage, phrenic nerve involvement can be seen and suggested treatment for these patients is unilateral phrenic excision and diaphragm plication. However in patients with myasthenia gravis, there are concerns in relation to this method of treatment. The aim of this study is to evaluate the effects of plication of the diaphragm on complications of phrenic nerve excision in thymoma patients with and without myasthenia gravis involving the phrenic nerve. Materials and Methods: A retrospective cohort study was performed on 26 patients with thymoma; half of the patients had myasthenia gravis and the other half did not have myasthenia gravis. We performed diaphragm plication in 7 patients in each group with excision of phrenic nerve. Patients were evaluated based on preoperative and postoperative variables. Results: The patients' age (P=0.943), sex (P=0.999), blood loss during surgery (P=0.919), need for transfusion during surgery (P=0.999), short term complications (P=0.186), need for tracheostomy (P=0.27) and mortality (P=0.09) differences were not significant. However, the average duration of ICU stay (P=0.001) and intubation in ICU (P=0.001) in patients who had myasthenia gravis was more than patients without myasthenia gravis. These values were less in patients with myasthenia gravis and diaphragm plication than patients with myasthenia gravis and no diaphragm plication. Conclusion: Excision of the phrenic nerve in patients with myasthenia gravis associated with thymoma and phrenic nerve involvement is appropriate. [ABSTRACT FROM AUTHOR]

Background Malignant pleural effusion continues to be a common problem in patients with metastatic disease. This study was conducted to compare the efficacy and safety of bleomycin pleurodesis with povidone-iodine pleurodesis through a chest drain as palliative treatment for recurrent malignant pleural effusion. Methods Sixty cancer patients (36 males and 24 females) with recurrent malignant pleural effusion were enrolled in a prospective randomized trial. Thirty patients received povidone-iodine pleurodesis and 30 received bleomycin pleurodesis. Age, sex, side of the primary pathology, treatment outcome (recurrence and relapse time), and complications were analyzed. Results The mean age was 59.63 ± 7.68 years in the povidone-iodine group and 57.97 ± 9.27 years in the bleomycin group (p = 0.452). The complications were identical in both groups: 2 (6.7%) patients had chest pain, 2 (6.7%) had fever, and one (3.3%) had hypotension. There was a good response to therapy in 20 (66.7%) patients in the bleomycin group and 25 (83.3%) in the povidone-iodine group (p = 0.136). Conclusion The results of this study indicate that povidone-iodine should be considered as a selective chemical agent to perform pleurodesis in patients with recurrent malignant pleural effusion because it has the same effect but costs less than bleomycin. [ABSTRACT FROM AUTHOR]

Introduction: Lung cancer is the disease of modern era, and the rate of lung cancer mortality is three times as high as that for prostate cancer and twice as high as the rate for breast cancer. We aimed to analyze the results of pulmonary resection in patients with NSCLC by minimally invasive thoracoscopy. Material and Methods: We studied 10 patients with NSCLC scheduled for surgical resection by minimally invasive video-assisted thoracoscopic surgery (VATS) in Ghaem Hospital, Mashhad, Iran, during March, 2015-February 2016. The patients were analyzed with respect to age, gender, pathology, surgery type, surgical complications and turning into open surgery, hospital-acquired complications, and mortality rate six months and one year post-operation. Results: We found that 60% of the patients were male. The patients were within the age range of 47-75 years. The analysis of lesion location showed that most lesions were in the lower lobe of the left lung (50%). None of the VATSs turned into open thoracotomy surgeries. Postoperative complications were observed in 3 (30%) patients. Further, 5 (50%) patients had squamous cell carcinoma (SCC), 4 (40%) of the patients had adenocarcinoma, and 1 (10%) had LCC. The surgical mortality analysis of the patients showed that only one male patient (a 72-year-old patient) died five days after wedge resection due to myocardial infarction. In the sixmonths and one-year follow up of the nine remaining patients, no cases of death had occurred. Conclusion: It seems that pulmonary resection by minimally invasive VATS has considerable advantages compared to open surgery, including higher effectiveness, shorter intensive care unit (ICU) stay, higher survival rate, and greater patient satisfaction. [ABSTRACT FROM AUTHOR]

Blunt thoracic aorta injury is one of the most fatal injuries in multiple trauma patients and most of these injuries lead to death at the scene. Some patients remain undiagnosed because of the lack of specific symptoms for these injuries. Hemoptysis as a presentation of a neglected blunt aortic trauma is a very rare condition. In this study, we present a case with a 7-month delay in presentation and diagnosis. A 49-year-old man with a complaint of intermittent hemoptysis was presented to the clinic. He had a history of chest trauma following falling 7 months ago. His physical examination was unremarkable. On Computed Tomography Angiography (CTA) pseudoaneurysm of the descending aorta was detected and the patient was treated urgently with a stent graft. Blunt thoracic aorta injury may occur following deceleration traumas. Descending aorta is the most involved segment but other segments may be involved as well. Bleeding can be stopped by tamponading the aorta with its overlying pleura. In some cases, pseudoaneurysms are formed and may remain undiagnosed for a long time after index trauma. CTA is the most useful diagnostic study and when the diagnosis is made, urgent treatment is mandatory. Although endovascular repair has significantly lower mortality and morbidity, open surgical repair may be inevitable in some cases. Thoracic aorta injury should be suspected in any patient with severe deceleration trauma and CTA should be used promptly for the diagnosis and treatment of these potentially fatal injuries. • Blunt thoracic aorta injury is the second cause of mortality in trauma patients. • Diagnosis of blunt aortic injury in asymptomatic patients needs a high grade of clinical competence. • CT angiography should be performed for any case whose trauma mechanism is suspicious for blunt thoracic aorta injury. • Some of the undiagnosed blunt aortic injury patients may become symptomatic several months after initial trauma. • Although very rare, hemoptysis may be the result of an aortic pseudoaneurysm eroding the bronchial wall. • Endovascular repair has a lower mortality and morbidity in the treatment of blunt thoracic aorta injury. [ABSTRACT FROM AUTHOR]

Introduction: Esophageal cancer is among the most common malignancies. Hospital mortality in the past decade reduced; but its morbidity is still high. Pulmonary complications are the most common complications after esophageal resection. In this study we examined the effect of steroids administration during surgery to reduce postoperative morbidity with a focus on respiratory complications. Material and Methods: Patients with esophageal cancer who underwent transhiatal esophagectomy, randomly divided into two groups to thirty patients: The intervention group (received 125mg methylprednisolone sodium succinate). After surgery, patients admitted in the ICU for a day. Oral feeding initiated on day 7th and patients discharged home on the day 8th or 9th. Postoperative complications included anastomotic fistula, wound infection in the neck and abdomen and pulmonary complications. We analyzed pulmonary complications included pneumonia, Acute lung injury (ALI) or acute respiratory distress syndrome (ARDS) occurred before the seventh day. The leukocyte counts and CRP levels measured on the 2nd and 7th days after surgery. Results: 60 patients enrolled in the study. Incidence of ARDS, ALI and pneumonia in the control group was 3, 5 and 2 and in steroid group 1, 1 and 1 respectively. CRP levels and blood leukocyte count was similar in two groups on the second day but seventh day values and difference between the two levels between the second and seventh days were significantly different between the two groups (p<0.001). Conclusion: Intraoperative single dose corticosteroids are effective in preventing pulmonary complications after transhiatal esophagectomy. Methylprednisolone reduced the increase in CRP levels after surgery and decreased blood leukocyte count more in postoperative period. [ABSTRACT FROM AUTHOR]

Introduction: Chronic pancreatitis is defined as a persistent pancreatic inflammatory disease. In chronic pancreatitis, recurrent episodes of inflammation lead to the replacement of pancreatic parenchyma with fibrotic connective tissue. Chronic pancreatitis pain, which may initially mimic acute pancreatitis, is severe, frequent, and continual and has a major impact on the quality of life and social functioning of patients. The standard treatments for this disease are endoscopy, surgery, splanchnic nerve denervation, thoracoscopic splanchnicectomy (TS), and video-assisted thoracoscopic surgery (VATS). Considering the advantages of the single-port method, we attempted to describe the post-treatment conditions of the patients undergoing this therapeutic approach. Materials & Methods: Ten chronic pancreatitis patients with severe resistant pain volunteered to enter the study. We recorded the data on patients' age, gender, pre-operative pain level, surgical complications, and post-operative pain level (two weeks after surgery) were recorded. Visual analogue scale (VATS) was used for pain assessment and paired sample t-test was performed for statistical evaluation of response to the treatment for pain. Results: The participants included one female and nine male patients with the mean age of 53.3±0.8 years. The mean duration of severe pain before the onset of treatment was 13 months (range: 6 to 20 months). The pain level was determined 3 to 5 days before the operation and re-graded two weeks post-operation. Pre- and post-operative pain scores showed a significant reduction in the severity of pain before and after surgery (P<0.004). Conclusion: Single-port technique is recommended as a safe way to reduce pain in patients with chronic pancreatitis. [ABSTRACT FROM AUTHOR]

A 13-year-old boy with no risk factors for lung cancer presented with a massive left-sided pleural effusion and a mediastinal shift on chest radiography and computed tomography. A chest tube drained bloody pleural fluid with an exudative pattern. A pleural biopsy and wedge biopsy of the left lower lobe revealed mucinous adenocarcinoma in the left lower lobe wedge biopsy and metastatic adenocarcinoma in the pleural biopsy. The patient is currently undergoing chemotherapy. Radiotherapy is planned after shrinkage of the tumor. Adenocarcinoma of the lung is very rarely seen in teenagers or children, especially in the absence of risk factors. [ABSTRACT FROM AUTHOR]

Hydatid cyst is a parasitic disease that is endemic in Mediterranean areas, South America, North Africa, Australia, and Iran. Although the liver and lung are the most common involved organs, but the other organs in human body also can be involved by hydatid cyst. Chest wall involvement by hydatid cyst is a rare condition, which may be misdiagnosed as chest wall tumor in the endemic areas. Herein, we presented a case of primary chest wall hydatid cyst mimicking chest wall tumor. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: Gall stone is an important health problem in the world for which different risk factors have been characterized. Gall stone and cardiovascular disease have common risk factors. Homocysteine is accepted as one of the risk factors for cardiovascular disease. We aimed to study the effect of homocysteine level on gall stone formation. Methods: 54 patients with gall stone-related diseases and 54 patients without stone (control group) were studied from January 2007 to December 2008. Control group consisted healthy subjects with ultrasound proven normal gallbladder. Serum homocysteine level was checked in both groups. Homocysteine level of equal or more than 15 mmol/l was considered as abnormally high. Results: Cases included 43 women (79.6%) and had mean age of 50.76±15.23 years. Homocysteine level was significantly higher in patients with gallstone in comparison to control group (p=0.014). Risk of gall stone increased 3.4 times in persons who have homocysteine level equal or greater than 15mmol/l (p=0.019). The mean level of homocysteine was higher in men than women (p=0.03). The mean level of homocysteine did not differ significantly in patients with simple gallstone and patients with gallstone-related inflammation disorders (cholecystitis, cholangitis, and pancreatitis). Additionally, one unit increase in BMI level was associated with 1.12 times increase in the risk for gall stone formation (p=0.035). Conclusion: The homocysteine level is increased in patients with gall stone-related diseases. Homocysteine may be considered as a risk factor of gall stone formation. [ABSTRACT FROM AUTHOR]

Background: Appendicitis is more common during the second and third decade of life and appendectomy scar is important in terms of cosmetic issues. The scar is an important factor in the patient's satisfaction. Conventional teaching has an emphasis on the closure of skin incision with "separate" sutures. The aim of this study was to reconsider this dogma. Methods: Among 321 patients with acute appendicitis who came to the emergency unit of Imam Khomeini Hospital in Tehran, Iran since april 2007 till april 2008, 278 (86.6%) patients had uncomplicated appendicitis and were enrolled in our clinical trial. The patients were randomly assigned to two groups of interrupted suture closure (n=139) and subcuticular suture closure (n=139). Anesthesia method and surgical technique were similar between the two groups. All patients were followed up post-operatively (four weeks) for the presence of infectious drainage, pain, erythema, swelling and warmness at the surgical site. Results: The patients' sex and their mean age were not statistically different between the groups. There was no significant difference in the frequency of surgical site complications between the two groups (five cases in the "interrupted" group and eight cases in the "subcuticular" group; p=0.415). Conclusion: This study showed that appendectomy incision closure with subcuticular sutures did not increase the risk of wound complications. From the point of better cosmetic outcome of subcuticular sutures, this method may be the method of choice for the closure of appendectomy incisions in uncomplicated appendicitis. [ABSTRACT FROM AUTHOR]

Foreign body aspiration can occur in any age group, but it is more commonly seen in children. In adults, there is usually a predisposing condition that poses a risk of aspiration. If aspiration occurs, prompt diagnosis and extraction of the foreign body is needed to prevent early and late complications. We report a rare case of neglected foreign body aspiration in a 45-year-old schizophrenic opium addicted patient, which resulted in an occlusive lesion in the bronchus, mimicking bronchial carcinoma. [ABSTRACT FROM AUTHOR]

Esophageal duplication cyst is a rare congenital mediastinal cyst. Most of these cysts become symptomatic in childhood and only rare cases remain asymptomatic until adolescence. They may produce symptoms due to esophageal and respiratory system compression, rupture, and infection. A 25-year-old man presented with pulmonary infection and bronchiectasis that did not improve with medical treatment. A diagnosis of esophageal duplication cyst was made intraoperatively. [ABSTRACT FROM PUBLISHER]

Glomus tumors of the trachea are rare and benign, but most become symptomatic, so they need intervention. A 21-year-old man was evaluated due to cough and hemoptysis. Computed tomography and bronchoscopy showed a polypoid mass above the carina. The tumor was removed completely by rigid bronchoscopy. The pathologic diagnosis was glomus tumor. After one year, because of recurrence of the tumor at the same site, the patient underwent reoperation, and resection and anastomosis of trachea through a right posterolateral thoracotomy was performed. [ABSTRACT FROM PUBLISHER]

Protein C deficiency is a rare disorder associated with an increased risk of developing abnormal blood clots. Mild and heterozygous cases are usually asymptomatic and may present with recurrent thrombosis. These recurrent thrombi are usually associated with ischemic stroke or concomitant thrombosis during pregnancy and recurrent miscarriage, but arterial thrombosis is relatively uncommon. In this case report, we introduce an interesting 21-year-old female patient with a protein C deficiency, which presented with a set of symptoms related to ischemia and thrombosis in several different systems, including the colon, brain, and lower extremities. With the diagnosis of ischemic colitis, she underwent medical treatment with hydration, antibiotics, anticoagulant, and GI rest. She was discharged with a suitable response to medical treatment and good general condition. One month later, the patient presented with right upper limb paresis and speech disorder, and at the same time, he had swelling of the left lower limb. The patient was diagnosed with DVT of the common femoral vein and protein c deficiency and treated appropriately with anticoagulant (heparin 1000 lU/h) and was discharged with oral rivaroxaban after symptoms improved. In young patients with ischemic colitis without a history of previous surgery, increased coagulation should be considered, including impaired fibrinolysis and impaired microcirculation and inflammatory processes. Protein C deficiency is one of several reasons for thrombotic disorders that should be considered in these people, especially if they have a history of DVT or other vascular thromboses. • Protein C deficiency is a rare disorder leading to a hypercoagubility state. • We introduce a young protein C deficiency case with ischemic and thrombotic symptoms. • A reduced pro C level and a heterozygous mutation were observed in the reported case. • In young patients with ischemic colitis, increased coagulation should be considered. [ABSTRACT FROM AUTHOR]

Mediastinal cysts account for 20% of all mediastinal masses. Symptomatic cysts need treatment, and surgical excision is the treatment of choice. One approach to resect them is video-assisted mediastinoscopy. An 80-year-old man with cough and dyspnea at rest was referred for evaluation. Chest computed tomography revealed a mediastinal cyst. Because of his symptoms, he was a candidate for surgery, and the cyst was resected by video-assisted mediastinoscopy through a cervical incision. Video-assisted mediastinoscopy is a safe and effective approach for complete resection of mediastinal cysts. [ABSTRACT FROM PUBLISHER]

In this case report, we described a 74-year-old female patient with major complaint of respiratory problems and dyspnea after meal. Chest X-ray of the patient revealed a gianttype IV hiatal hernia. Preoperative evaluations of the patient included esophagoscopy, esophageal manometry, barium swallow, and CT-scan. Repair of the hernia was performed using a dual mesh on the diaphragm and partial anterior fundoplication (Dor fundoplication). After a six-month follow-up, the overall condition of the patient issatisfactory, exceptmild intermittent dysphagia due to esophageal dysmotility. [ABSTRACT FROM AUTHOR]

Herein, we present the case of a 45-year-old woman with midesophageal diverticula, who had complaints of dysphagia and regurgitation. Diagnosis was confirmed by endoscopy and barium swallow. The patient underwent right posterolateral thoracotomy with excision of diverticula and repair of the muscular layer along the site of diverticula. Five days following the operation, barium swallow with the passage of the contrast material through distal esophagus showed no diverticula. After five months, the patient remained asymptomatic. [ABSTRACT FROM AUTHOR]

Herein, we present the case of a 45-years-old woman with a foreign body (dental prosthesis) ingestion lodged in the esophagus(Figure.1). The foreign body was extracted by rigid esophagoscopy after severe manipulation. In 24 hours, the patient became febrile with emphysema in the neck. laboratory data showed leukocytosis and CT scan revealed signs of esophageal perforation(Figure.2). Surgical exploration and drainage of the neck and mediastinum performed through a collar incision in the neck extended to the anterior of SCM in both sides, but we didn't perform feeding jejunostomy. We inserted one corrugated drain in every side of the neck(Figure.3).Patient was NPO for two weeks and brief total parenteral nutrition (TPN) provided her calory.Finally,we succeeded to fistulized the perforation to the skin and control the mediastinitis(Figure.4).Patient regained oral feeding gradually after two weeks NPO. The follow-up esophagogram revealed the passage of the contrast to the distal esophagus with no leak and fistula.Early recognition of perforation could interrupt major operation to control catastrophic complication. [ABSTRACT FROM AUTHOR]

A 37 - year- old man came to the hospital with a history of penetrating thoracoabdominal trauma due to gunshot wound in 10 days before. He underwent laparatomy and hepatorrhaphy in that time and right sided chest tube was inserted. Chest CT scan revealed metallic foreign body in lung tissue due to bullet burst. Right thoracotomy was performed and metallic foreign body extracted from lung tissue. [ABSTRACT FROM AUTHOR]

A 42-year-old woman was admitted to the hospital because of odynophagia and neck pain after swallowing a piece of bone. Anteroposterior (AP) and lateral neck X-ray showed the foreign body. Rigid esophagoscopy under general anesthesia was performed and foreign body extracted by rigid esophagoscopy. [ABSTRACT FROM AUTHOR]

A 25-year-old man was admitted in hospital due to right side hemopneumothorax secondary to car accident. A chest tube was inserted. During the hospitalization days, chest CT scan revealed a 3cmx3 cm oval-shaped density located in the right upper lobe. Since he was in a good general condition, he was discharged from hospital after removal of chest tube and a follow-up chest CT-scan was recommended. In the chest CT scan that was performed 3 months later (Figure 1), the oval-shaped density was increased in size. There was no endobronchial lesion in bronchoscopic evaluation. Surgery was recommended He was underwent thoracotomy and the lesion was resected (Figure 2). It was post-traumatic pulmonary hematoma (Figure 3). [ABSTRACT FROM AUTHOR]

Background: Thyroid cancer is the most common type of endocrine cancer. We aimed to determine the incidence rates of thyroid cancer across a 10-year period (2004-2013) in Golestan, Iran. Methods: We obtained the thyroid cancer data from Golestan Population-Based Cancer Registry (GPCR). Age-standardized incidence rates (ASR) were calculated and reported per 100 000 person-years. The Joinpoint software was used to assess time trends, and average annual percent changes (AAPCs) and their corresponding 95% confidence intervals (CIs) were reported. Results: Of 326 registered patients, 83 (25.5%) were men and 243 (74.5%) were women. The mean age was 51.3 and 42.6 years for males and females, respectively. Overall, the ASR of thyroid cancer was 2.2 per 100 000 person-year (AAPC = 2.76; 95% CI: -3.68 to 9.64). The test of co-incidence showed a statistically significant difference in the incidence of thyroid cancer between men (1.3) and women (3.2) (P < 0.001). According to our results, the ASR of thyroid cancer in western parts of Golestan is higher, including Gorgan and Aliabad cities. Conclusion: Increasing trends in incidence rates of thyroid cancer were found in the Golestan province during the study period, especially in women. We found significantly higher rates of thyroid cancer in women. Geographical diversities were seen in incidence rates of thyroid cancer in the Golestan province. Our results may be helpful for designing further researches to investigate the epidemiological aspects of thyroid cancer in the Golestan province. [ABSTRACT FROM AUTHOR]

Background: Buerger's disease (thromboangiitis obliterans) may be a rare peripheral vascular disease that sometimes affects young male smokers. This study presents surgical treatment options for 315 Buerger's patients during a period of 18 years from 2002 to 2020. Methods: In this cross-sectional study, 315 newly diagnosed Buerger patients in a period of 18 years (by Census sampling) were evaluated. Data included age, sex, cigarette smoking status, clinical presentation, the affected limb (right or left, upper or lower extremities), and the performed therapeutic procedures such as angiography of limb arteries, amputation, sympathectomy, and vascular bypass surgery, which were collected in a data sheet. Vascular reconstruction was done if there were suitable inflow and outflow arteries. Sympathectomy was performed for the patients who were unsuitable for revascularization. All analyzes were performed using SPSSV.18 software package (SPSS Inc., Chicago, IL). Data are presented as frequency, mean ± variance (SD). Results: The mean age of patients was 42.6±9 years old, ranging from (26-75). There were 309 (98.1%) males and 6 (1.9%) females. The most common symptom was ulcer 252 (80%), and the most commonly involved arteries were the dorsal pedis (N=231; 73.4%) and posterior tibialis (N=225; 71.5%). Vascular bypass surgery, sympathectomy, and amputation were performed for patients who met surgical indications. Aortofemoral (N=9) and femoropopliteal (N=24) bypass procedures were done in 2.8% and 7.6% of patients respectively. Of nine patients who underwent aorto-femoral bypass procedure, 6 cases presented with leg claudication, 3 with an ulcer, and 3 with the Raynaud phenomenon. The digital loss rate was 9.6% (N=9) in toes and 1% (N=3) in fingers. Conclusion: As most of the Buerger patients have multi arterial involvement, bypass surgery or sympathectomy can't help treat these patients more than cigarette smoking or pharmaceutical therapy., (© 2022 Iran University of Medical Sciences.)

Objective: Thymectomy considered as a standard procedure in treatment of all the steps of myasthenia gravis. Video-assisted thoracoscopic surgery (VATS) thymectomy is one of the minimally invasive procedures that because of the short duration of hospitalization, less postoperative pain, and scar after surgery, nowadays it is replaced the traditional methods of surgery for patients with myasthenia gravis, but there are still differences and concerns. The aim of this study was to compare outcomes of two different techniques of surgery, VATS versus transsternal (TS) in the treatment of myasthenia gravis., Methods: In this pilot study, 42 patients with myasthenia gravis and without a thymus tumor were evaluated based on Myasthenia Gravis Foundation of America classification and drug consumption. Then, they randomly underwent two different techniques of surgery: VATS versus TS. Patients were evaluated based on preoperative and postoperative variables., Results: Duration of intensive care unit stay and hospitalization has been reduced in patients who underwent VATS thymectomy operation technique. In addition, duration of surgical procedure has been reduced significantly in these patients. These patients have less blood loss during surgery compared with TS group. The Myasthenia Gravis Foundation of America postoperative status in VATS thymectomy revealed that the number of patients with complete stable remission was higher and number of persons remained unchanged was lower in this group., Conclusions: VATS thymectomy is a safe and appropriate approach comparing with traditional methods such as TS thymectomy for patients with myasthenia gravis. This method has better results after surgery and can be used as a minimally invasive alternative method instead of TS thymectomy.