Publications by authors named "Reza Ershadi"

8 Publications

  • Page 1 of 1

Uncommon Location of a Giant Pericardial Cyst: A Case Report.

Iran J Med Sci 2021 Jul;46(4):308-311

Department of Thoracic Surgery, Valiasr Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Pericardial cysts (PCs) are uncommon benign congenital anomalies residing in the middle mediastinum. The location of PCs is diverse with 70% of cases in the right cardiophrenic angle, 22% in the left cardiophrenic angle, and 8% in the posterior (as in our case) or superior anterior part of the mediastinum. In 2019, a 54-year-old woman was referred to the emergency department of Imam Khomeini Hospital Complex (Tehran, Iran) suffering from progressive shortness of breath. The chest computed tomography scan showed an unusual giant cystic lesion occupying >50% of the right hemithorax. The cystic lesion was primarily located in the posterior mediastinum. The patient underwent video-assisted thoracoscopic surgery (VATS), and the cyst was completely resected from the mediastinum. During past decades, several cases of PCs have been reported in different age and sex groups. Here, we present a case of a giant pericardial cyst (PC) located in the posterior mediastinum. The cyst was successfully resected using VATS. Only one other study has reported a PC in the posterior mediastinum.
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http://dx.doi.org/10.30476/ijms.2021.88408.1911DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8288494PMC
July 2021

Giant solitary fibrous tumor of the pleura.

J Surg Case Rep 2018 Nov 1;2018(11):rjy270. Epub 2018 Nov 1.

Department of Thoracic Surgery, Valiasr Hospital, Tehran University of Medical Science, Tehran, Iran.

Introduction: Solitary fibrous tumors of the pleura (SFTP) are rare mesenchymal tumors representing <5% of all tumors of the pleura. Literature reveals only two case series and a few solitary reports.

Case Report: A 68-year-old male presented to our hospital after experiencing exertional dyspnea. A chest CT revealed a giant heterogeneous mass. CT-guided transthoracic core needle biopsy demonstrated SFTP. The well-circumscribed, encapsulated resected mass was measured to be 30 cm × 21 cm × 15 cm and weighed 6900 g.

Discussion: SFTP are a rare pathology of the pleural cavity, which most of the time develop from submesothelial fibroblasts of the visceral pleura. Due to their non-characteristic clinical picture, SFTP are usually diagnosed in the later stages of the development. A significant issue in the management of giant SFTP is radical resection of the tumor to relieve compression of the lung parenchyma and other mediastinal structures.

Conclusion: SFTP are rare neoplasms that fortunately are benign 80% of the time. Only a few cases of giant SFTP that cover almost the entire pleural space are described in the literature. This report represents one of the largest resected SFTP reports in the literature.
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http://dx.doi.org/10.1093/jscr/rjy270DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6210664PMC
November 2018

First Iranian Experience of the Minimally Invasive Nuss Procedure for Pectus Excavatum Repair: A Case Series and Literature Review.

Iran J Med Sci 2018 Sep;43(5):554-559

General Thoracic Surgeon, General Thoracic Surgery Ward, Tehran University of Medical Sciences, Tehran Iran.

Pectus excavatum is the most common congenital deformity of the chest wall. The most frequently used techniques include Ravitch (costochondral resection) and Nuss (minimally invasive pectus repair of pectus excavatum [MIRPE]). The Nuss technique includes using temporary metallic bars without costochondral resection to correct the chest wall deformity. Modified MIRPE can be learned easily and performed safely with few complications. There are no reports of successful MIRPE in Iran, although the Ravitch technique is well known. In the present study, we report the first Iranian experience with the modified Nuss procedure in 5 patients with pectus excavatum (age range=13-48 y). All the patients suffered from low self-esteem, and one of them complained of low exercise capacity and occasional chest pain. With single-lung ventilation and sternal elevation, an introducer was entered into the right thoracic cavity and retrosternal tunneling was performed under thoracoscopic vision. The introducer was passed to the left thoracic cavity and exited on the left thoracic wall. A titanium plate bar was implanted and fixed with stabilizers. There were no cases of mortality, and all the patients were discharged in good conditions within 2 weeks. Postoperative complications consisted of 1 case of pneumothorax and 2 cases of fixed bar protrusion. The present case series indicated that a skilled thoracoscopic surgeon is able to do the Nuss procedure in Iranian patients with symmetrical pectus excavatum with few complications. However, mixed or redo cases require more expertise.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6123557PMC
September 2018

Complete cricotracheal transection due to blunt neck trauma without significant symptoms.

J Surg Case Rep 2017 Jun 20;2017(6):rjx111. Epub 2017 Jun 20.

Department of  Thoracic Surgery, Valiasr Hospital, Tehran University of Medical Science, Tehran, Iran.

Laryngotracheal injuries are relatively rare but their mortality rate is fairly high. Complete disruption of trachea is extremely rare and a systematic approach is needed for early diagnosis and favourable outcome. The patients symptoms and physical signs do not necessarily correlate with the severity of the injuries and this case report highlights it. This is a case report of 25-year-old man who arrived to the emergency department 8 h after a motor accident in which a rope was wrapped around his neck. Because of the good general and respiratory condition of the patient on admission, the pathognomonic signs of laryngeal injury were not noticed. A computed tomographic scan showed distortion of cricotracheal framework. Flexible bronchoscopy showed cricotracheal transaction. Immediately, the endotracheal tube was advanced distal to the transection site under bronchoscopic guide and then after neck exploration primary end-to-end cricotracheal anastomosis was performed.
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http://dx.doi.org/10.1093/jscr/rjx111DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5499895PMC
June 2017

Transplantation of the decellularized tracheal allograft in animal model (rabbit).

Asian J Surg 2018 Jul 27;41(4):328-332. Epub 2017 Mar 27.

Department of Thoracic Surgery, Valiasr Hospital, Tehran University of Medical Science, Iran.

Background: It has been difficult to perform tracheal allotransplantation without immunosuppression. To determine whether decellularized trachea can be used in tracheal replacement, we evaluated the viability of decellularized tracheal allografts in a rabbit model of immunosuppressant-free transplantation.

Method: Half allograft (Group 1, n = 7) was harvested from adult New Zealand white rabbits, subjected to a detergent-enzymatic method (containing sodium deoxycholate/DNase lavations) of decellularization for as many cycles as needed, and the other half was stored in phosphate-buffered saline at 4°C as a control (Group 2, n = 7). Bioengineered and control tracheas were then implanted in 14 age-matched rabbits.

Results: In Group 1 (decellularized), all rabbits survived, whereas in Group 2(control), all rabbits died of airway obstruction between 20 days and 45 days after operation. Histologically, the decellularized allografts displayed complete regeneration of epithelium and cartilage, but the fresh allografts showed inflammatory changes, no epithelium, and no cartilage.

Conclusions: Complete regeneration of epithelium and cartilage tracheal rings occurred after the implantation of decellularized tracheal allografts without immunosuppression. We demonstrate that the decellularized process reduces the allogeneic response to the trachea. Therefore, we believe that the decellularized tracheal allograft is an excellent choice for tracheal replacement. To our knowledge, this is the first study to observe the long-term (1 year) prognosis of this transplanted trachea.
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http://dx.doi.org/10.1016/j.asjsur.2017.02.007DOI Listing
July 2018

Primary mediastinal synovial sarcoma: A rare case report.

Int J Surg Case Rep 2016 3;27:169-171. Epub 2016 Sep 3.

Department of Thoracic Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Science, Iran.

Introduction: Synovial sarcomas commonly occur in the extremities of young adults. A primary occurrence in the mediastinum is very rare with only a few reported cases in the world literature. We report a case of mediastinal synovial sarcoma. This paper is about a 47-year-old male who presented with retrosternal chest pain and shortness of breath on exertion. Imaging showed an anterior mediastinal mass. Pathological examination of the resected mass showed a biphasic neoplasm with a spindle cell component admixed with gland-like elements. The tumor showed positive staining with cytokeratin, epithelial membrane antigen and vimentin confirming the diagnosis of a biphasic synovial sarcoma.

Discussion: A wide range of neoplasms, both primary and metastatic, occur in the mediastinum, which pose considerable diagnostic difficulties. A synovial sarcoma should always be considered in the differential diagnosis, and immunohistochemistry is an important adjuvant tool in this situation.

Conclusion: This paper highlights the importance of recognizing an unusual presentation of this aggressive neoplasm to aid appropriate clinical management.
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http://dx.doi.org/10.1016/j.ijscr.2016.08.037DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5021781PMC
September 2016

Usefulness of preoperative stress perfusion imaging in predicting prognosis after liver transplantation.

Am J Cardiol 2003 Nov;92(9):1066-71

Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, 35294-0006, USA.

The role of preoperative stress single-photon emission computed tomographic (SPECT) imaging in patients with end-stage liver disease who underwent liver transplantation is not well established. We reviewed medical records of patients who had liver transplantation at our institution between January 1998 and November 2001. During this time, 339 patients (213 men, aged 51 +/- 11 years) underwent liver transplantation. Of these, 87 patients had preoperative stress SPECT imaging. Diabetes mellitus (30% vs 11%), hypertension (26% vs 12%), and coronary artery disease (15% vs 7%) were more prevalent in those with than without SPECT (p <0.01 each). The stress SPECT perfusion images were normal in 78 patients (91%) and the left ventricular ejection fraction was 72 +/- 10%. SPECT images revealed ascites in 66% and splenomegaly in 83% of patients. There were 35 total deaths (10%) and 5 nonfatal myocardial infarctions over a mean follow-up of 21 +/- 13 months. Most deaths (32 of 35) were noncardiac and sepsis was the most common cause of death. A normal SPECT study had a 99% negative predictive value for perioperative cardiac events. Kaplan-Meier survival curves showed an 87% 2-year cumulative survival rate in the total group. Thus, in patients undergoing liver transplantation, 2-year survival depends on early noncardiac events. A normal stress SPECT study identified patients at a very low risk for early and late cardiac events despite a higher risk profile. SPECT images also revealed unique findings, such as ascites and splenomegaly, which could produce image artifacts and may interfere with accurate image interpretation.
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http://dx.doi.org/10.1016/j.amjcard.2003.06.003DOI Listing
November 2003

Adenosine myocardial perfusion single photon emission computed tomographic stress testing 24-72 h after uncomplicated myocardial infarction.

Int J Cardiovasc Imaging 2002 Aug;18(4):269-72

East Carolina University, Greenville, NC, USA.

Safety of performing adenosine myocardial perfusion stress testing as early as 24 h after acute uncomplicated myocardial infarction is not known. We evaluated 31(14 females and 17 males, average age 72, range 46-89 years) consecutive patients with uncomplicated myocardial infarction, who underwent adenosine myocardial perfusion stress imaging, 24-72 h after infarction for risk stratification. Adenosine was infused at a rate of 140 microg/kg/min for 6 min. Twenty patients were presented with non-ST-elevation myocardial infarction. Eleven patients were admitted with acute ST-elevation myocardial infarction. Patients were monitored for signs of complication during and immediately after the stress test. The average time from admission to performance of stress tests was 51 +/- 19 h, ranging from the minimum of 24 h to maximum 72 h. No complications related to adenosine infusion were detected. In conclusion, our data suggest that a further large study of early adenosine myocardial perfusion SPECT imaging may be safe in a carefully selected group of patients after uncomplicated myocardial infarction.
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http://dx.doi.org/10.1023/a:1015525311510DOI Listing
August 2002
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