Pulmonary Sequestration Infant with Unusual Presentation: A Case Report

Background: Pulmonary sequestration (PS) is characterized by a separate segment of the lung that receives anomalous vascular supply separate from the pulmonary arteries. Here we report the case of a 4-year-old girl with dyspnea and recurrent pneumonia who was finally diagnosed as a case of PS. Case presentation: A 4-year-old girl was admitted to Imam-Reza hospital, Mashhad city, Iran, with a history of coughing and dyspnea from two years ago. On the CXR, consolidation can be seen in the left lower lobe. As there was a high likelihood of aspiration or pneumonia following her past medical history, the patient underwent bronchoscopy. More investigation with HRCT revealed vascular anomaly. CMRI (Cardiac Magnetic Resonance Imaging) showed no cardiac abnormality. More findings showed a large collateral artery originated from left lateral side of abdominal aorta. This collateral artery went upward to the LLLL (the Lower Lobe of Left Lung) and anastomosed directly with two large posterior segmental tributary of the left lung pulmonary veins. Hyper-vascular pattern of both lungs was also observed in the MRI. Conclusion: To avoid misdiagnosis, PS should be considered in differential diagnosis in infants with chronic cough and dyspnea. These patients should be referred to a tertiary center to receive appropriate treatment

Cervico mediastinal teratoma in adult: A very rare presentation

Teratoma is a rare presentation in adult, specifically in cervico-mediastinal region. We reported two adult patients with diagnosis of cervico-mediastinal teratoma and operated them. In adult patients who present with cervico-mediastinal mass, benign teratoma could be one of a differential diagnosis although it is a rare presentation

Asymptomatic Diaphragmatic Hernia Diagnosed after Six Years Following Esophagectomy: A Case Report

Diaphragmatic hernia, secondary to transhiatal esophagectomy, appears to be a relatively infrequent diagnosis. Patients may be asymptomatic or present with various symptoms. Diagnosis of this condition requires a high index of suspicion. The most common cause of diaphragmatic hernia is widened esophageal hiatus during surgery; therefore, narrowing the hiatus can prevent conduit herniation. Herein, we present the case of a 65-year-old man, who underwent transhiatal esophagectomy and gastric pull-up for squamous cell carcinoma six years ago. The patient was asymptomatic and diaphragmatic hernia was detected unexpectedly in the surveillance follow-up interval. In the present report, we also aimed to discuss the risk factors, as well as preventive and treatment methods

Delayed Esophageal Pseudodiverticulum after Anterior Cervical Spine Fixation: Report of 2 Cases

Introduction: Although perforation of the esophagus, in the anterior cervical spine fixation, is well established, cases with delayed onset, especially cases that present pseudodiverticulum, are not common. In addition, management of the perforation in this situation is debated.  Case Report:   Delayed esophageal pseudodiverticulum was managed in two patients with a history of anterior spine fixation. Patients were operated on, the loose plate and screws were extracted, the wall of the diverticulum was excised, the perforation on the nasogastric tube was suboptimally repaired, and a closed suction drain was placed there. The NGT was removed on the 7th day and barium swallow demonstrated no leakage at the operation site; therefore, oral feeding was started without any problem.  Conclusion:  In cases with delayed perforation, fistula, or diverticulum removal of anterior fixation instruments, gentle repair of the esophageal wall without persistence on definitive and optimal perforation closure, wide local drainage, early enteral nutrition via NGT, and antibiotic prescription is suggested

Numerical, Experimental and Analytical Studies on Fluid Flow through a Marsh Funnel

This paper presents the application of computational fluid dynamics technique in civil and underground industries to evaluate fluid behaviour in a Marsh funnel. The numerical approach, based on computational fluid dynamics, simulated an incompressible two-phase Newtonian flow by means of the Volume-of-Fluid method. A complementary analytical proposed which provided a quick, field-ready method to assess the fluid field in the Marsh funnel. A supplemental experimental effort evaluated the results obtained from both the analytical calculation and numerical simulation. Results showed that the application of computational fluid dynamics technique gives the desired results in studying fluid flows in civil and underground industries. Proposed analytical solution is also capable of accurately predicting the fluid flow and thus can complement the experimental and numerical approaches. Further, the proposed analytical approach can be an alternative method for faster evaluation of fluid, although it needs to be calibrated with either the numerical or the experimental studies.QC 20171117</p

Delayed Presentation of Traumatic Diaphragmatic Hernia: The Evaluation of Surgical Treatment Results

Introduction: Diaphragmatic hernia could be caused by congenital disorders, blunt trauma or penetrating injuries. The diagnosis of traumatic diaphragmatic hernia is normally neglected during the first presentation leading to late complications and considerably increased mortality and morbidity among the patients. Materials and Methods: In this retrospective, descriptive study, we reviewed the medical records of patients presented with traumatic diaphragmatic hernia who had undergone surgical operations between 1982-2015 in Ghaem Hospital and Omid Hospital affiliated to Mashhad University of Medical Sciences, Iran. The studied variables included age, gender, clinical symptoms, location of hernia, involved organs, type of imaging modalities, surgical techniques, length of hospital stay, mortality rate and surgical complications. Results: In this study, 38 patients were diagnosed with traumatic diaphragmatic hernia consisting of 28 men and 10 women. In total, 79% and 21% of the patients suffered from penetrating trauma and blunt trauma, respectively. In addition, left-sided, right-sided and bilateral hernias were present in 33%, 4% and 1% of the patients, respectively. The most frequently herniated organ was the stomach, and the most common clinical symptoms were abdominal pain (84%) and dyspnea (53%). Initially, chest radiographs were performed on all the patients, and thoracotomy was performed to repair diaphragmatic tears in all the cases (100%). In this study, 3 patients had previously undergone Hartmann’s operation for gangrenous herniated colon, and devolvulation of gastric volvulus had also been performed on 3 patients. The main post-operative complications were reported to be pneumonia and respiratory insufficiency (2 cases), and the mean length of hospital stay was 6 days (5-8 days) which was longer (1-2 months) in patients with gangrenous bowel (3 patients). Furthermore, no mortality was reported during the course of hospitalization in these patients. Conclusion: According to the results of this study, patients presented with blunt or penetrating traumas to the upper abdomen or lower chest require urgent attention as to immediately rule out diaphragmatic hernia in order to prevent later complications and mortality and morbidity among these patients

A case report of simultaneous medullary and papillary carcinoma of thyroid

Objective. Medullary (MTC) and papillary (PTC) thyroid carcinoma are two different types of thyroid carcinoma with significant differences in origin. Their co-occurrence in a patient is a rare phenomenon. We report a patient with simultaneous presentation of both MTC and PTC

Evaluations of Factors Predicting the Need for an Extra-Cervical Approach for Intra-Thoracic Goiter

Introduction: Intra-thoracic goiter refers to the extension of enlarged thyroid tissue into the thoracic inlet. This condition can produce symptoms of compression on adjacent organs and can sometimes be accompanied by malignant transformation. Therefore surgical treatment is almost always necessary. In order to remove the pathology with the fewest post-operative complications, selection of the appropriate surgical approach is essential. In this study we aimed to detect the criteria which help us select the best therapeutic approach.   Materials and Methods: In this retrospective study, 82 patients with intra-thoracic goiter were investigated. Their data were extracted from medical records and analyzed using SPSS software.   Results: Overall 82 patients, 18 (21%) males and 64 (78%) females with mean age of 56.38 years were studied. The most common clinical symptoms were mass (95%) and dyspnea (73%). In most patients, the surgical approach was cervical (90.2%), while 9.8% of patients required an extra-cervical approach. Post-operation complications were observed in 17.1% of patients; the most common being transient recurrent laryngeal nerve paralysis (4.9%). Malignancy was reported in the histopathology of seven patients (8.5%). The most common malignant histopathology was papillary thyroid carcinoma (7.3%). Extension of the thyroid tissue below the uppermost level of the aortic arch was significantly correlated with the need for an extra-cervical approach to surgery (

Etiologic evaluation of patients with dysphagia admitted to ENT and Thorax surgery wards of Ghaem Hospital, Mashhad, Northeast of Iran

ntroduction: Dysphagia is a common chief complain of various diseases with different benign or malignant etiologies. Iran is one of countries with a high incidence rate of esophageal cancer. The aim of this study was to evaluate the common causes of dysphagia for earlier diagnosis and treatment of this disease and reduction of its morbidity and mortality rate. Materials and Methods: In this descriptive study, we analyzed the etiology of dysphagia in 200 patients who were admitted to ENT and thorax surgery wards of Mashhad Ghaem Hospital during 2005-2007. Results: Of 200 patients, 79 patients were female and 121 patients were male. The most prevalent cause of dysphagia in these patients was esophageal SCC and the most common endoscopic presentation was the ulcerative view. Other common etiologic factors were esophageal stenosis, adenocarcinoma, mediastinal tumors, achalasia, lyomyoma, sarcoma and diffuse esophageal spasm, respectively. Conclusion: According to these results, the complaint of dysphagia with or without odinophagia has particular clinical importance, especially in our country with high frequency of esophageal malignancies

CFD simulations of a semi-transverse ventilation system in a long tunnel

In the present work, a semi-transverse ventilation system in a long tunnel with a length of 4.9 km, as a complex case study, is numerically studied by performing a set of three-dimensional steady incompressible computational fluid dynamics (CFD) simulations. The ventilation system consisted of a ceiling duct connected to two axial fans at the ending portals, and a series of jet fans in the main tunnel for supporting airflow in the desired direction. To focus on what can and cannot be achieved in commissioning tests, the ventilation system’s performance in various scenarios is numerically evaluated with two different tunnel states; empty tunnel and complete traffic congestion with 1176 stationary vehicles – which is almost impossible to evaluate during a commissioning test. By considering two hypothetical locations for the extraction zone from the main tunnel (in a distance of 450 and 1000 m from one portal), it is shown that the required number of jet fans in a traffic condition drops from 57 for the first extraction location to 43 (25% decrease) when the ventilation system extracts from the second zone. We show that if only the close axial fan to the extraction zone is activated, the required number of jet fans reduces by 56% and 72% for the first and second extraction locations, respectively. This finding can provide a cheaper and easier controlling scenario for emergency ventilation