Aberrant Right Subclavian Artery: A Life‑threatening Anomaly that should be considered during Esophagectomy

Aberrant right subclavian artery (ARSA) is a rare anomaly, in which the right subclavian artery arises directly from the aortic arch instead of originating from the brachiocephalic artery. This anomaly should be taken into consideration during surgical procedures around esophagus, such as esophagectomy. Any unintentional injury of this artery during surgical procedures could be extremely life threatening. A 56‑year‑old woman presented with dysphagia, with concurrent aberrant subclavian artery and esophageal cancer. The transhiatal esophagectomy was performed successfully since the anomaly was preoperatively diagnosed using computed tomography scan. The presence of ARSA during esophagectomy may be challenging, but if diagnosed preoperatively, the precise and diligent dissection of the retroesophageal space during esophagectomy, may prevent any injury to the aberrant artery and consequent complications.Key words: Aberrant subclavian artery, esophageal cancer, esophagectomy, lusori

Esophageal cancer in northwestern Iran

Background: Esophageal cancer (EC) is one of the most frequent and serious cancers worldwide, but its geographic distribution is disparate. Northern Iran is known as one of the hot spots for EC, but there is inadequate evidence available regarding its characteristics in northwestern region of Iran. Therefore, this study aimed to describe some demographic and histopathologic features of EC in this region of Iran. Materials and Methods: 166 hospital referral patients from a hospital in the northwestern region of Iran who underwent endoscopic biopsy for the chief complaint of dysphagia or odynophagia, and were admitted with the pathologic diagnosis of esophageal cancer during 3 years were enrolled in this study. Results: The mean age of the patient was 61.8 \ub1 12.0 years old. Male/female ratio was 0.84. With respect to the site of tumor, tumor was located in cervical esophagus in 7 cases (4.2%), upper thoracic in 5 patients (3%), middle thoracic in 64 patients (38.6%), lowers thoracic in 68 cases (41%), and cardia in 22 cases (13.2%). There was a significant difference among the site of tumor in different age groups (P = 0.021) and different sex groups (P = 0.001). In men, EC usually involves the lower parts, whereas in women it usually involves the upper parts of esophagus. Squamous cell carcinoma was the most common type of EC in all age groups, but the prevalence rate of adenocarcinoma seems to increase with age (P = 0.045). Conclusions: Demographic and histopathologic pattern of esophageal cancer in northwestern region of Iran is different from its histopathologic pattern in western countries in accordance with other reports from Golestan province in north-eastern region of Iran

The Role of Thoracoscopy in the Diagnosis of Pleural Effusion of Unknown Origin

BACKGROUND AND OBJECTIVE: Video-assisted thoracoscopic surgery is preferred over conventional methods, such as pleural biopsy, in the diagnosis and treatment of patients with pleural effusion. Considering that Imam Khomeini Hospital is facing a large volume of patients with pleural effusion of unknown origin referred from other centers, the present study was conducted to investigate the role of thoracoscopy in the diagnosis of pleural effusion of unknown origin. METHODS: In this prospective study, 31 patients with pleural effusion of unknown origin, whose disease was not diagnosed using conventional methods such as imaging, thoracentesis or pleural biopsy, were treated with video-assisted thoracoscopic surgery (VATS) at Imam Khomeini Hospital in Urmia. FINDINGS: The most common symptoms were dyspnea in 18 patients followed by chest pain in 8 patients and cough in 5 patients. Histological findings reported cancer in 19 patients, pleuritic in 10 patients and tuberculosis in 2 patients. Among the patients with malignant pleural effusion, the most common causes were metastatic carcinoma (42.1%) adenocarcinoma (26.3%) and mesothelioma (7.5%). In general, VATS was unable to definitively diagnose the disease in 5 patients. The diagnostic function of VATS was 83.9% in patients with pleural effusion of unknown origin (CI-95%= 71–96.8).   CONCLUSION: The results showed that thoracoscopy along with imaging can be helpful in detecting pleural effusion with unknown origin

Esophageal cancer in northwestern Iran

Background: Esophageal cancer (EC) is one of the most frequent and serious cancers worldwide, but its geographic distribution is disparate. Northern Iran is known as one of the hot spots for EC, but there is inadequate evidence available regarding its characteristics in northwestern region of Iran. Therefore, this study aimed to describe some demographic and histopathologic features of EC in this region of Iran. Materials and Methods: 166 hospital referral patients from a hospital in the northwestern region of Iran who underwent endoscopic biopsy for the chief complaint of dysphagia or odynophagia, and were admitted with the pathologic diagnosis of esophageal cancer during 3 years were enrolled in this study. Results: The mean age of the patient was 61.8 ± 12.0 years old. Male/female ratio was 0.84. With respect to the site of tumor, tumor was located in cervical esophagus in 7 cases (4.2%), upper thoracic in 5 patients (3%), middle thoracic in 64 patients (38.6%), lowers thoracic in 68 cases (41%), and cardia in 22 cases (13.2%). There was a significant difference among the site of tumor in different age groups (P = 0.021) and different sex groups (P = 0.001). In men, EC usually involves the lower parts, whereas in women it usually involves the upper parts of esophagus. Squamous cell carcinoma was the most common type of EC in all age groups, but the prevalence rate of adenocarcinoma seems to increase with age (P = 0.045). Conclusions: Demographic and histopathologic pattern of esophageal cancer in northwestern region of Iran is different from its histopathologic pattern in western countries in accordance with other reports from Golestan province in north-eastern region of Iran

Human Cystic Echinococcosis in West Azerbaijan, Northwest Iran: A Retrospective Hospital Based Survey from 2000 To 2009

Background: The aim of this study was to determine the prevalence of hydatidosis in west Azerbaijan, Iran during a 10 year period (2000-2009).Methods: We surveyed medical records of infected patients with hydatid cyst who had been oper­ated in four hospitals in Urmia City, the capital of West Azerbaijan Province, Iran. Several parame­ters were analyzed including age, sex, place of residency, hospitalization time, and the location of cysts.Results: Of 294 cases, 53.3% were female and 46.7% were male with the mean age of 39.4 years (5–93). The average number of operated cysts per year was 29.4 (0.98/100,000 of population). The most affected age group was 20-30 year olds (18.7% of the cases). Cysts were localized in liver and lung in 57.5% and 21.8% of cases respectively and the average hospitalization time was 9 days. Single organ involvement was seen in the majority of patients and 28 (9.5%) cases had multiple involve­ment. The distribution of residence in patients showed 108 (36.9%) of them to have urban origin and 185 (63.1%) were rural residents. The lowest number (n=17) and the highest number of opera­tion (n= 48) recorded in 2000 and 2007, respectively.Conclusion: The prevalence of hydatidosis is high in this city and further studies are needed for evalua­tion of economic burden and risk factors for CE in this regio