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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.

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.

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.

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.

Background Bronchial avulsion is a serious complication of blunt chest trauma, which can be easily missed on initial presentation of a patient with multiple injuries. Missing the diagnosis may increase the risk of mortality and morbidity.Methods We evaluated the outcome of 10 patients with bronchial injury following blunt chest trauma, who underwent bronchial anastomosis in Quaem Hospital, Mashhad, Iran and Imam Khomeini Hospital, Tehran, Iran, from 2001 to 2012. There were 8 men and 2 women with a mean age of 23.1?±?4.72 years. Associated injuries were ruled out in all cases. Demographic characteristics, anatomical location of the injury, mechanism of injury, complications of bronchial anastomosis, and one-year follow-up of the patients were studied.Results Eight patients had injury to the right main bronchus and 2 had injury to the left main bronchus. The time between surgery and diagnosis ranged from immediately to 6 months after injury. One death occurred in the operating room immediately after injury, due to asphyxia. The other 9 patients underwent successful anastomosis of the avulsed bronchus. There were 7 complications after repair, which were managed by a conservative approach. In one year of follow-up, one patient with residual stenosis underwent stent placement.Conclusion Early diagnosis of major airway injury is an important factor in successful management and a favorable outcome. With improvements in surgical technique, regular follow-up, and effective management of complications, we can expect successful bronchial repair to save the lung, even with a late diagnosis.

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.

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.

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.

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.