Publications by authors named "Kambiz Sheikhy"

24 Publications

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Postintubation Multisegmental Tracheal Stenosis, a 24-Year Experience.

Ann Thorac Surg 2020 Nov 21. Epub 2020 Nov 21.

Tracheal Diseases Research Center (TDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran. Electronic address:

Background: Management of Multisegmental Tracheal Stenosis (MSTS) is challenging. In this 24-year longitudinal single-center study, we present an algorithmic treatment approach.

Methods: A retrospective analysis of 2167 patients with post-intubation tracheal stenosis indicated 83 (3.83%) patients with MSTS. Patients were assigned to four management groups according to the length, location, and severity of stenoses, tracheal infection/mucositis, laryngeal function, symptoms, general condition, and comorbid diseases. Type-1 (n=13): one-stage resection of both strictures, Type-2 (n=6): two-stage resection of both strictures, Type-3 (n=40): resection of one stricture and non-resectional management of the other one, Type-4 (n=24): non-resectional management of both strictures. Outcomes were categorized as Good, Acceptable, or Poor. Univariate analyses for factors predictive of recurrence and outcome were performed.

Results: Follow-ups were completed in 70 (84.34%) patients (median 22.5 months). Outcome was assessed as Good in 56 (82.35%), Acceptable in 10 (14.71%), Poor in 2 (2.94%), and mortality in 2 (2.94%) patients. The median length of airway resection was 46, 67.5, and 40 mm in Types 1-3, respectively. Only 11 (13.25%) patients had no history of tracheostomy or tracheal surgery. By univariate analysis, a shorter intubation period was associated with Good outcome (p=0.017). No factors predictive of recurrence or outcome were ascertained.

Conclusions: MSTS, generally caused by performing an inappropriate tracheostomy, is an iatrogenic disease that can be prevented. Although resection of both strictures may be feasible and is associated with Good results, in the majority of cases, a combination of surgical resection and non-resectional methods are sufficient to achieve Good results.
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http://dx.doi.org/10.1016/j.athoracsur.2020.10.026DOI Listing
November 2020

Idiopathic Subglottic Tracheal Stenosis in Identical Twin Sisters.

Iran J Otorhinolaryngol 2019 Jul;31(105):243-245

Tracheal Diseases Research Center (TDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Introduction: Idiopathic subglottic tracheal stenosis is a rare inflammatory disease of the trachea; most commonly affects females within the age range of 20-50 years. No etiologic factor has yet been identified for this rare tracheal disease and therefore it should be diagnosed after the exclusion of other inflammatory, traumatic, and autoimmune diseases of the trachea. The familial or genetic predisposition to this disease is still unknown although one published report in the literature showed some familial predisposition.

Case Report: A 41-year old woman presented with progressive dyspnea and stridor. The bronchoscopic evaluation revealed subglottic tracheal stenosis; however, there was no significant etiology of this disease after complete evaluations. Therefore, the idiopathic subglottic stenosis was the final diagnosis. After two years, her identical twin sister presented with the same signs and symptoms. There was also no etiology for her tracheal stenosis. The first patient was managed surgically through cricotracheal resection. However, the second sister didn't need surgical resection due to the mild to moderate tracheal stenosis.

Conclusion: The obtained results of our cases along with the previously reported family cases can potentiate the hypothesis that there is some genetic predisposition to the development of this disease.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6666938PMC
July 2019

Abdominal Compartment Syndrome in Critically Ill Patients.

Open Access Maced J Med Sci 2019 Apr 13;7(7):1097-1102. Epub 2019 Apr 13.

Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: Abdominal compartment syndrome patients suffer severe obstacles such as kidney failure and shock. To evade further complications, identifying the abdominal compartment syndrome (ACS) and Intra-abdominal hypertension (IAH), in critically ill individuals and hospitalised in the intensive care unit (ICU) is obligated.

Aim: The current study intended to study the abdominal compartment syndrome and the concomitant risk factors among hospitalised patients in ICU, by using the Intra-abdominal pressure test.

Material And Methods: One hundred and twenty-five hospitalised patients at ICU entered the current survey. Abdominal pressure was measured by standard intravesical technique. The SPSS 21 analysed the preoperative and intraoperative factors such as demographic records and comorbidities.

Results: Seventy-three (58.4%) participants were males and 52 (41.6%) were women in the mean age of 55.1 ± 18.3 years. Eighty-nine patients (71.2%) showed normal intra-abdominal pressure since 31 patients (24.8%), and 5 patients (4%) developed IAH and ACS. The intra-abdominal pressure (IAP) applied to Glasgow Coma Scale (GCS), Acute Physiology, shock, Systemic Inflammatory Response Syndrome (SIRS), central venous oxygen saturation and Chronic Health Evaluation (APACHE II) score (P < 0.05). Patients with high IAP have shown a higher mortality frequency, compared to others (P < 0.05).

Conclusion: Current findings showed a correlation between IAP hospitalised patients in ICU and shock, SIRS, APACHE II, central venous oxygen saturation and GCS. Intra-abdominal pressure test, as a valuable prognosis test for the abdominal compartment syndrome (ACS) and Intra-abdominal hypertension (IAH), may offer better results when added to the routine medical checkup of ICU patients.
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http://dx.doi.org/10.3889/oamjms.2019.228DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6490480PMC
April 2019

Fatal Outcome of Ruptured Pulmonary Hydatid Cyst.

Tanaffos 2018 Feb;17(2):138-141

Tracheal Diseases Research Center, NRITLD, Shahid Beheshti University of Medical Sciences. Tehran, Iran.

Most authors believe that the optimal treatment for pulmonary hydatid cyst is surgery. Albendazole has been used as a prophylactic measure for reducing recurrence rate but there are some controversies about this strategy. Some researchers have described the increased risk of spontaneous rupture of cysts following albendazole treatment. In this case report, we present a case of spontaneous rupture of pulmonary hydatid cyst with fatal outcome that may be the adverse cause of albendazole.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6320564PMC
February 2018

ECMO-assisted resection of huge thoracic mass.

J Cardiovasc Thorac Res 2018 21;10(3):174-176. Epub 2018 May 21.

Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Some advanced thoracic malignancy cannot be resected safely by using of conventional ventilation, so some sort of cardiopulmonary support is needed for hemodynamic and ventilation management of the patient. Using extracorporeal membrane oxygenation (ECMO) in comparing with cardiopulmonary bypass has some advantages. Three patients with huge thoracic tumors with different ages experienced major surgery in our center by using ECMO in order to face major complications mainly due to the size of mass to achieve better hemostatic stabilities, lower bleeding, and injuries to main airways and secure oxygenation. This is the first case series in Iran, as our best knowledge that explains cases of huge chest mass which were operated perfectly by using ECMO and short ICU stay and interestingly no major complications.
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http://dx.doi.org/10.15171/jcvtr.2018.28DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6203866PMC
May 2018

Corrigendum to "Potential circulating miRNA signature for early detection of NSCLC" [Cancer Genetics 216-217 (2017) 150-158].

Cancer Genet 2018 12 15;228-229:127. Epub 2018 Jun 15.

Lung Transplantation Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

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http://dx.doi.org/10.1016/j.cancergen.2018.05.002DOI Listing
December 2018

Potential circulating miRNA signature for early detection of NSCLC.

Cancer Genet 2017 Oct 7;216-217:150-158. Epub 2017 Aug 7.

Lung Transplantation Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Circulating microRNAs (c-miRNAs) are promising biomarkers for screening, early detection and prognosis of cancer. The purpose of this investigation was to identify a panel of c-miRNAs in plasma that could contribute to early detection of non-small cell lung cancer (NSCLC). We profiled the expression of 44 unique plasma miRNAs in training set of 34 NSCLC patients and 20 matched healthy individuals by miRCURY LNA™ Universal RT microRNA PCR Panel and calculated dysregulation fold changes using the 2-ΔΔCt equation. Selected plasma miRNAs were then validated by SYBR green q-RT PCR using an independent validation set of plasma samples from NSCLC patients (n: 72) and NC (n: 50). In the validation set, the receiver operating characteristic (ROC) curves were generated for four miRNAs. In the training set, 17 miRNAs were significantly up-regulated and nine were down-regulated in the plasma from NSCLC patients versus matched normal controls. Four miRNAs (miR-21, miR-328, miR-375 and miR-141) were selected for validating their diagnostic value in the testing set. ROC plot analysis showed that a high specificity (98%) and sensitivity (82.7%) in miR-141 in comparing early NSCLC patient and controls. So among these four plasma miRNAs only miR-141 could be promising biomarkers for early detection of NSCLC. In addition to, we found a significant positive correlation between stage and miR-21 expression level (95% CI: 0.687-0.863; p-value < 0.0001). Considering the accessibility and stability of circulating miRNAs, plasma miR-141 is a useful biomarker early detection of NSCLC as a supplement in future screening studies.
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http://dx.doi.org/10.1016/j.cancergen.2017.07.006DOI Listing
October 2017

Item Selection and Content Validity of the Risk Factors of Post-Intubation Tracheal Stenosis Observation Questionnaire for ICU-Admitted Patients.

Tanaffos 2017 ;16(1):22-33

Tracheal Diseases Research Center (TDRC), National Research Institute of Tuberculosis and Lung disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: Laryngotracheal stenosis as a late complication of prolonged endotracheal intubation is a life-threatening event. In order to determine the related risk factors for this complication, which may vary among different countries, designing a valid questionnaire is necessary. The aim of this study was to select the items and evaluate the face and content validities of a questionnaire developed for assessment of risk factors of post-intubation tracheal stenosis (PITS) in patients admitted in the intensive care unit.

Materials And Methods: A mixed method study design was used in four steps in 2015, i.e., 1) a literature review, 2) focus groups with five experts in the field, 3) consultations with intensive care unit (ICU) specialists and thoracic surgeons, and 4) evaluation of content and face validity with 15 experts in a scientific panel using two self-administered questionnaires. Content validity index (CVI) was computed for individual items as well as the overall scale.

Results: We extracted the items from different sources of information. An initial version of the 52-item questionnaire was developed and classified into four domains including patient characteristics, intubation features, equipment-drugs, and complications. The items with an excellent modified kappa were included in the questionnaire. Five questions received more criticism instead of support and were removed (Item-CVI<0.55, fair modified kappa). The ones with an Item-CVI > 0.60 and a good modified kappa were revised, merged, or retained. The new 43-item questionnaire found a scale-level CVI, averaging (Scale-CVI/Ave) of 0.91.

Conclusion: The PITS risk factors questionnaire was developed and validated through item selection, expert opinions, and content validity index.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5473379PMC
January 2017

Reconstruction of Chest Wall by Cryopreserved Sternal Allograft after Resection of Aneurysmal Bone Cyst of Sternum.

Case Rep Surg 2017 19;2017:9135657. Epub 2017 Feb 19.

Department of Thoracic Surgery, Lung Transplant Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

A 20-year-old female was referred to our hospital due to deformity and bulging in anterior aspect of chest wall in sternal area. Chest X-ray and CT scan confirmed a large mass with destruction of sternum. Pathologic diagnosis after incisional biopsy was compatible with aneurysmal bone cyst. We resected sternum completely and reconstructed large anterior defect by a cryopreserved sternal allograft. In follow-up of patient there was no unstability of chest wall with good cosmetic result.
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http://dx.doi.org/10.1155/2017/9135657DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5337383PMC
February 2017

Thoracoscopic Thymectomy for Myasthenia Gravis: Seven Years of Clinical Experience.

Tanaffos 2016 ;15(3):175-179

Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: Myasthenia gravis (MG) is an autoimmune disease affecting patients' quality of life and necessitating long-term medical therapy. The efficacy of thymectomy for treatment of MG has been well established. Although several techniques have been used for thymectomy, there has been controversy over the best method with highest rate of improvement. Herein, we discuss our seven years of clinical experience with thoracoscopic thymectomy for MG.

Materials And Methods: We evaluated all patients who were operated on with preoperative diagnosis of non-thymomatous MG from 2007 to 2013 in Masih Daneshvari Hospital (Tehran, Iran). All patients underwent thoracoscopic thymectomy, and rates of remission and cumulative improvement were compared to those reported by other studies.

Results: Thoracoscopic thymectomy was performed in 34 patients with MG. The rate of complete remission and cumulative improvement at the end of the third year was 44.1% and 85.3%, respectively. Patients who were operated early after the diagnosis showed higher improvement rate, although it was not statistically significant (P=0.065).

Conclusion: Thoracoscopic thymectomy is a safe procedure for treatment of MG with comparable results to other techniques. Thymectomy soon after the diagnosis may be associated with higher improvement rate.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5304962PMC
January 2016

Right Ventricular Perforation with the Body of Swan-Ganz Catheter during Lung Transplantation by ECMO Support: A Case Report.

Tanaffos 2017 ;16(3):240-244

Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.

A 46-year-old woman with a 12-year history of lymphangiomyomatosis (LAM) was admitted for lung transplantation in January 2017. We decided to apply veno-arterial extracorporeal membrane oxygenation (ECMO) to manage arrhythmia and hypotension during lung transplantation, since it was not controllable with inotropic drugs. After transplanting the right (first) lung and at the time of left pneumonectomy, the body of the Swan-Ganz catheter was suddenly observed to be protruding from the right ventricular (RV) wall. The catheter was found folded at part of its body and ran out 0.5 cm from the RV. The protruding part of the catheter was inserted before the perforated part of the cardiac muscle was repaired in order to control the bleeding. ECMO was used throughout the rest of the procedure and the patient was transferred to the intensive care unit (ICU) in good condition before being weaned from the ventilator after 16 hours. It seems that gentle manipulation, concurrent use of transesophageal echocardiography (TEE), insertion of the appropriate length of the catheter into the heart chambers, and a softer material in the structure of the catheters would be helpful to prevent these kinds of potentially fatal complications.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5960229PMC
January 2017

Normothermic Ex Vivo Lung Perfusion in Brain-dead Donors Reduces Inflammatory Cytokines and Toll-like Receptor Expression.

Iran J Allergy Asthma Immunol 2016 Oct;15(5):340-354

Lung Transplant Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran AND Directors of Organ Transplantation and Special Diseases Office, Ministry of Health and Medical Education, Tehran, Iran.

Inflammatory responses and innate immunologic reactions play an important role in the respiratory system. Ex vivo lung perfusion (EVLP) is considered a novel method in the evaluation and reconditioning of donor lungs prior to transplantation. However, EVLP's effect on inflammatory and metabolic markers of human lung tissue is unknown.  This study investigated how the performance of EVLP on brain-dead (BD) donor lungs affects the production and release of inflammatory cytokines (IL-6, IL-8, and TNF-a), inflammatory cells and toll-like receptors (TLR) -2, 4. This study was conducted with an animal subject for qualification of EVLP team and then EVLP was performed on 4 human cases referred to Masih Daneshvari Hospital (Tehran,Iran), from May 2013 to July 2015. Two of these cases, who had acceptable lung function parameters, were enrolled in this study for immunologic investigations. Bronchoalveolar lavages (BAL) were taken before and after EVLP. Cytokines were quantitatively measured before lung retrieval, at the end of the lung removal, at the start of EVLP, and at the end of the each hour of EVLP. TLR expression was measured on the cells obtained by flow cytometry. TNF-a, IL-6 and IL-8 decreased in each stage of washing perfusate in both cases, and the level of cytokines in serum was in the normal range. Flow cytometry analysis revealed a decreasing expression of CD3, CD4/8, CD19, and CD16+56, as well as TLR-2 and TLR-4 in both cases. Intra-capillary pools of pro-inflammatory cytokines (IL-6, IL-8, and TNF-a) were determined to contribute to the lung injury during prolonged lung perfusion. This raises the possibility that EVLP donor lungs could be less immunogenic than standard lungs. However, to assess EVLP's effects on lung grafts and optimize recipient outcomes, further studies with a sufficient number of lungs are required.
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October 2016

Cured Transudative Pleural Effusion: A Case Report.

Tanaffos 2016 ;15(2):121-123

Tracheal Diseases Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Echinococcosis or hydatid disease is a helminthic infection caused by larvae of tapeworm Echinococcus granulosus. While the cysts can involve all organs, liver is the most common site of infection and the lungs are the second most commonly involved organ in young adults. In addition to endemic areas its incidence is growing all around the world due to the ease of transcontinental travel. Disease presentation varies and usually is due to mass effect or dysfunction of the involved organ and surgical resection is the recommended treatment. Here we present the case of a young man with primary pulmonary echinococcosis with involvement of the entire right lung.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5127615PMC
January 2016

Ex Vivo Lung Perfusion: Establishment and Operationalization in Iran.

Exp Clin Transplant 2017 Feb 14;15(1):82-88. Epub 2016 Oct 14.

From the Lung Transplant Research Center, National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Objectives: Although the number of lung transplants is limited because of general shortage of organ donors, ex vivo lung perfusion is a novel method with 2 main benefits, including better evaluation of lung potential and recovery of injured lungs. The main aim of this study was to establish and operationalize ex vivo lung perfusion as the first experience in Iran.

Materials And Methods: This was a prospective operational research study on 5 cases, including 1 pig from Vienna Medical University and 4 patients from Masih Daneshvari Hospital. All organ donations from brain dead donors were evaluated according to lung transplant or ex vivo lung perfusion criteria from May 2013 to July 2015 in Tehran, Iran. If a donor did not have any sign of severe chest trauma or pneumonia but had poor oxygenation due to possible atelectasis or neurogenic pulmonary edema, their lungs were included for ex vivo lung perfusion.

Results: A successful trend in the difference between the pulmonary arterial Po2 and the left atrial Po2 was observed, as well as an increasing pattern in other functional parameters, including dynamic lung compliance and a decreasing trend in pulmonary vascular resistance.

Conclusions: These initial trials indicate that ex vivo lung perfusion can lead to remarkable progress in lung transplant in Iran. They also provide several important pieces of guidance for successful ex vivo lung perfusion, including the necessity of following standard lung retrieval procedures and monitoring temperature and pressure precisely. The development of novel methods can provide opportunities for further research studies on lungs of deceased donors and lead to undiscovered findings. By keeping this science up to date in Iran and developing such new and creative methods, we can reveal effective strategies to promote the quality of donor lungs to support patients on transplant wait lists.
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http://dx.doi.org/10.6002/ect.2015.0354DOI Listing
February 2017

The Role of Systemic Steroids in Postintubation Tracheal Stenosis: A Randomized Clinical Trial.

Ann Thorac Surg 2017 Jan 29;103(1):246-253. Epub 2016 Jul 29.

Tracheal Diseases Research Center (TDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran. Electronic address:

Background: Most patients with postintubation tracheal stenosis are not ideal candidates for airway resection at presentation and their airways must be temporarily kept open by repeated bronchoscopic dilation (RBD). Meanwhile, some sufficiently recover by RBD without further airway resection requirement. We hypothesized whether systemic corticosteroids could lengthen RBD intervals, decrease the number of patients who eventually need airway resection, and shorten the required length of airway resection.

Methods: Between February 2009 and November 2012, a randomized double-blind clinical trial with a 1:1 ratio (corticosteroids group [group C], prednisolone 15 mg/day; placebo group [group P]) was conducted on 120 patients without tracheostomy or T tube and in no ideal situation for airway resection at presentation, whose precipitating injury had occurred recently. All underwent RBD until they became asymptomatic or prepared for airway resection. Asymptomatic patients received the capsules (prednisolone or placebo) for 6 months; others discontinued them before surgery. Those requiring RBD at short intervals underwent tracheostomy or T tube placement and were then excluded. Follow-up terminated 6 months after airway resection or capsule discontinuation.

Results: There were 105 patients (72 male; 50 in group C), aged 15 to 64 years, who completed their follow-up. There was no significant difference between the two groups in age, sex, history of tracheostomy, intubation cause and duration, time interval between intubation and initial bronchoscopy, length of stenosis, and subglottic involvement. Our study showed a trend for RBD with longer intervals (22 days), and fewer operations, 17% (28 of 50 versus 40 of 55) in group C, although statistically insignificant. Furthermore, the required airway resection length became significantly shorter (5.3 mm) in group C.

Conclusions: Early low-dose systemic corticosteroids can be beneficial in postintubation tracheal stenosis management.
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http://dx.doi.org/10.1016/j.athoracsur.2016.05.063DOI Listing
January 2017

Different and Unpredictable Clinical Outcome of Ruptured Pulmonary Hydatid Cysts.

Tanaffos 2015 ;14(3):217-21

Zabol University of Medical Sciences. Zabol, Iran.

Most authors believe that the best treatment for pulmonary hydatid disease is surgical evacuation. Although albendazole has been used prophylactically before surgery, there are many reports about increased incidence of the rupture of cyst after albendazole therapy, which can cause some complications. In this case report we present a patient with bilateral pulmonary hydatid cyst that was ruptured after using albendazole and different strategies were used for management of each cyst.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4745192PMC
February 2016

Experimental replacement of esophagus with a short segment of trachea.

J Surg Res 2016 Mar 23;201(1):94-8. Epub 2015 Oct 23.

Department of Clinical Science, Surgery and Radiology Section, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran.

Background: Segmental resection of esophagus with primary anastomosis is prohibited because of the risk of dehiscence. We previously have shown that replacement of a segment of cervical esophagus with a tracheal segment of the same length could successfully be performed in a canine model. In this study, we sought to assess the feasibility of replacement of the esophageal defect with a shorter segment of trachea.

Methods: In five mongrel dogs weighting 20-30 kg, under general anesthesia and after a cervical incision, 8 cm of the cervical esophagus was resected and replaced by a 4-cm segment of the adjacent trachea. The animals were evaluated clinically for signs and symptoms of stenosis and dehiscence and then euthanized after 2 mo of follow-up.

Results: All dogs recovered from surgery and started regular diet on the seventh postoperative day. No clinical or endoscopic sign of stenosis or voice change was seen. Squamous metaplasia and atrophy of mucosal glands and cartilage were detected in the histopathologic examination of the replaced segments.

Conclusions: Replacement of a cervical esophageal defect with a shorter segment of trachea can be performed successfully in dogs. This procedure can be potentially used for the treatment of cervical esophageal lesions in humans.
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http://dx.doi.org/10.1016/j.jss.2015.10.017DOI Listing
March 2016

Ten years' experience in surgical treatment of right middle lobe syndrome.

Ann Thorac Cardiovasc Surg 2015 2;21(4):354-8. Epub 2015 Mar 2.

Tracheal Diseases Research Center, National Research institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Purpose: In this study we present the clinical, radiological, pathological, bronchoscopic and surgical results of 40 patients with diagnosis of middle lobe syndrome who were referred to our thoracic surgery unit for surgical intervention in a 10 years period.

Methods: Forty patients with obstructive and non-obstructive causes of middle lobe syndrome referred to our thoracic surgery unit. Clinical data were collected from the patients' records in a ten years period. This study evaluates diagnostic approaches and surgical treatments in right middle lobe syndrome.

Results: We studied 23 females (57.5%) and 17 males (42.5%) with a mean age of 31.7. Clinical findings were cough 95%, sputum 80% and intermittent hemoptysis in 50% of patients. Middle lobe collapse was seen in CT scan of all patients. Bronchiectasis was the most common pathologic finding (55%). Tuberculosis was not rare and was final pathology in 20% of patients. In three patients ruptured hydatid cyst was final finding. Surgery was done without mortality and with only minor complications.

Conclusion: Lobectomy of right middle lobe is a good therapeutic option in these patients. Due to high prevalence of tuberculosis and hydatid cyst in Middle Eastern countries these two must be considered as causes of middle lobe syndrome.
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http://dx.doi.org/10.5761/atcs.oa.14-00273DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4904871PMC
June 2016

Hemoptysis as a complication of capitonnage for management of pulmonary hydatid cyst.

Tanaffos 2014 ;13(3):46-8

Tracheal Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.

The surgical approach to hydatid cyst of the lung is based on complete removal of the parasite, and management of the residual pericyst cavity. For the latter, capitonnage is a recognized method, by which the walls of the evacuated pericyst cavity are approximated with multiple sutures. Capitonnage without suturing and ligation of bronchial openings individually may lead to postoperative air leakage with resultant pneumothorax or pneumatocele. The pulmonary parenchyma may also become distorted. Herein, we report another complication of capitonnage: presence of large amounts of unabsorbed suture material acting as foreign body within the residual pericyst cavity, leading to chronic infection and hemoptysis.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4338052PMC
February 2015

Diagnostic Yield of Medical Thoracoscopy in Undiagnosed Pleural Effusion.

Tanaffos 2015 ;14(4):227-31

Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: One of the most common indications for pleuroscopy is undiagnosed pleural effusion, which comprises about 25% of all cases of pleural effusions, which remain undiagnosed despite primary tests. Pleuroscopy was performed for the first time in Iran in Masih Daneshvari hospital located in Tehran. The aim of this study was to assess the diagnostic yield of pleuroscopy performed in this center in Iran.

Materials And Methods: Three-hundred patients with undiagnosed pleural effusions were enrolled in this study. For all patients, primary tests including pleural effusion analysis, cytology and closed pleural biopsy (if needed) were conducted and all of them were inconclusive. The semirigid thoracoscopy (pleuroscopy) was performed for all patients for diagnostic purposes.

Results: Eighty-seven percent of the peluroscopies were diagnostic and 67% of them were diagnosed as malignancy while the rest were diagnosed as tuberculosis. Only 11 patients developed minor complications.

Conclusion: In conclusion, pleuroscopy is a safe procedure when performed by a skilled and experienced practitioner; it has a high diagnostic yield and results in only minor complications.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4841988PMC
April 2016

The role of T-tubes in the management of airway stenosis.

Eur J Cardiothorac Surg 2013 May 18;43(5):934-9. Epub 2012 Sep 18.

Tracheal Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Objectives: When the T-tube is inserted as a temporary stent, it is unclear whether keeping it longer in place has any benefit on the outcome.

Methods: Among 1738 patients with airway stenosis (1996-2011), 134 underwent T-tube placement (mean duration = 14.3 months); temporarily while waiting for an appropriate time for surgery in 53 (Group 1), as an adjunct after a complex laryngotracheal resection in 27 (Group 2), after surgical failure in 43 (Group 3) and permanently in 11 unresectable strictures (Group 4). A logistic regression model was used for statistical analysis.

Results: Seventy percent of patients were males (age = 33.6 ± 17 years). The main cause was postintubation/post-tracheostomy stenosis in 87% of patients. The stenosis (29.6 ± 14 mm, 5-80 mm) was located in the subglottis in 33%, trachea in 47% and both in 20% of cases. To assess the effect of T-tubes on stabilizing the airway after decannulation, 50 patients who still had a T-tube at the end of follow-up or for <1.5 months were excluded. Of the remaining 84, 31.5, 91.5 and 32.5% of patients in Groups 1, 2 and 3 were stable at least 3 months after decannulation. Moreover, 70% of those who were decannulated at or before 6 months and 53.7% of those who were decannulated after 6 months underwent another intervention (P = 0.17). The age, sex, cause, site of stenosis and even duration of T-tube insertion (P = 0.07) showed no significant effect on the decannulation outcome.

Conclusions: Although it seems that keeping the T-tube in place for >6 months may increase the chance of successful decannulation, it was not confirmed in our study.
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http://dx.doi.org/10.1093/ejcts/ezs514DOI Listing
May 2013

A successful third resection-anastomosis in a tracheal restenosis.

Interact Cardiovasc Thorac Surg 2012 Jul 28;15(1):174-5. Epub 2012 Mar 28.

Tracheal Diseases Research Center, NRITLD, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences and Health Services, Tehran, Iran.

Reoperation due to recurrence after tracheal resection and reconstruction still seems challenging. Although recurrence may lead to serious morbidity, an appropriate surgical technique plays a significant role in the cure of these patients. We report our experience of a patient who successfully underwent a third resection and anastomosis of the trachea. We believe that the number of previous operations is not a contraindication by itself against reoperating on a patient with restenosis. Also the success rate might be acceptably high if a sufficiently healthy tracheal length remains.
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http://dx.doi.org/10.1093/icvts/ivs101DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3380980PMC
July 2012

Thyroid cancers with laryngotracheal invasion.

Eur J Cardiothorac Surg 2012 Mar 14;41(3):635-40. Epub 2011 Dec 14.

Tracheal Diseases Research Center, NRITLD (National Research Institute of Tuberculosis and Lung Diseases), Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Objectives: Management of thyroid cancers with laryngotracheal invasion is controversial.

Methods: A retrospective analysis of our database found 69 patients (38 females, mean age 59.6 ± 11.6) between March 1995 and July 2010; of them 42 (61%) were managed by non-resectional methods due to the extensive airway or regional involvement, severe co-morbidities, diffuse metastases or patient's preference. Segmental airway resection was performed in 27 (39%) patients; concurrent with thyroidectomy in 17 (Immediate group (IG)), and as a delayed procedure in 10 referred patients (Delayed group (DG)), who had previously undergone thyroidectomy with conservative airway management, like shaving procedures. Follow-up was completed in 81% of patients with a mean duration of 30 months.

Results: Tracheal or laryngotracheal resection and reconstruction was performed in 18, laryngectomy in eight and pharyngolaryngectomy in one patient. There were two anastomotic dehiscence (11.1%), one resulted in mortality (3.7%). One or a combination of bronchoscopic core-out, laser, tracheostomy and stent placement was performed in 42 non-resected patients with two mortalities (4.7%). Overall 1-, 2-, 3- and 5-year survival was 85, 85, 68 and 49% in resected group, as well as 56, 46, 40 and 31% in non-resected group (P = 0.049), respectively. Among resected group, the overall 1-, 2-, 3- and 5-year survival was 92, 92, 76 and 61% in the IG as well as 75, 75, 56 and 28% in the DG (P = 0.43).

Conclusions: Complete segmental airway resection during or even after thyroidectomy could be safely performed, might be curative and may be associated with improved survival.
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http://dx.doi.org/10.1093/ejcts/ezr131DOI Listing
March 2012

Using tracheal segments for replacement of cervical oesophagus: an experimental study.

Eur J Cardiothorac Surg 2012 Mar 18;41(3):676-9. Epub 2011 Oct 18.

Tracheal Diseases Research Center, NRITLD, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Iran.

Objectives: Segmental resection and anastomosis of oesophageal lesions are not performed as a routine clinical practice because of complications and associated problems, whereas tracheal resection and anastomosis are a routine clinical practice. In this experimental study, we resected a segment of cervical oesophagus and replaced it with a tracheal segment.

Methods: In eight dogs (mixed races), weighing 20-30 kg, ageing 1-2 years, under general anaesthesia, through a cervical incision, 5 cm of cervical trachea was separated while preserving its attachments to surrounding fibroareolar tissues. Afterwards, 5 cm of the oesophagus was resected and replaced with a prepared segment of the trachea. Oral liquids were started at the first post-operative day; the animals were kept for 2 months and then euthanized. Quality of swallowing and voice were evaluated. After an autopsy, anastomoses were examined grossly and histopathologically.

Results: No complications occurred during surgery. Swallowing function and voice were normal in all eight dogs after the operation. No sign of aspiration was seen in clinical and radiographic examinations after starting oral diet. In autopsy examination, anastomoses were patent without narrowing or abnormal mucosal changes. Remarkable histopathological findings in replaced tracheal segments were squamous metaplasia, atrophy and degeneration of mucosal glands and degeneration of cartilages.

Conclusions: Replacement of a segment of the oesophagus with an autogenous tracheal segment is a practical procedure with low complications and can probably be used for the treatment of cervical oesophageal lesions in human beings.
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http://dx.doi.org/10.1093/ejcts/ezr010DOI Listing
March 2012