The presence of tumor thrombus in the right atrium is frequently the result of direct intraluminal extension of infra-diaphragmatic malignancy into the inferior vena cava (IVC) or supradiaphragmatic carcinoma into the superior vena cava (SVC). Right atrial tumor thrombus with extension into both SVC and IVC has not been reported in the literature. We present a patient who presented with symptoms of right atrial and SVC obstruction. Imaging revealed presence of a thrombus in the right atrium, extending to the SVC and IVC, with the additional findings of a left adrenal mass and multiple liver lesions. The histopathological examination of the right atrial mass revealed metastatic adenocarcinoma cells. The patient was given a presumptive diagnosis of metastatic adenocarcinoma, most likely adrenal in origin, with multiple hepatic lesions suspicious for metastasis. The clinical outcome of the patient was not favorable; the patient succumbed before the adrenal mass could be confirmed to be the primary tumor. This case highlights that in patients manifesting with EXTENSIVE cavoatrial thrombus as, the existence of primary carcinoma should be considered especially in the adrenal cortex or in the lung.

Introduction: The incidence of myocardial infarction (MI) during pregnancy is 6 cases per 100000 births which occur more commonly at third trimester. Its maternal morbidity is 19-37% and fetal mortality is 9-13%. Anterior wall is the most common location of myocardial infraction (78%). The risk factors for myocardial infarction during pregnancy included: maternal age >35 year, hypertension, diabetes, smoking, preeclampsia, infections, and thrombophilia. On the other hand, pregnancy is a predisposing factor for coronary artery dissection. In this study, a case of myocardial infarction during pregnancy was reported.Case report: The patient was a 37 year old pregnant woman with second pregnancy who was admitted with diagnosis of acute anterior ST elevation Myocardial infarction at 37th weeks of gestation. She had received fibrinolytic agent. After performing angiography in referral center, regarding to that the lesion was thrombotic and with good distal run off, antiplatelet and anticoagulant agents was administrated for her. After 12 hours, active labor started, probably because of retroplacental bleeding, and vaginal delivery was performed. With some days delay, percutaneous coronary intervention (PCI) was done on the dissected lesion of Left anterior descending artery by using of drug-eluting stent (DES). After 50 days, implantable cardioverter-defibrillator (ICD) was implanted for her because of low left ventricular systolic function.Conclusion: If myocardial infarction occurs in pregnancy, invasive approach (angiography and Coronary stenting and then, continuing the antiplatelet agent is best choice for re-run off. In this patient, according to the angiography result, some thrombosis in LAD artery with good distal run off, antiplatelet and anticoagulant agents were administrated for her and after some days delay, angioplasty was done. If acute myocardial infarction occurs in the center without the procedures of invasive intervention, if the mother's life is threatened, at first, fibrinolytic should be used and then, invasive intervention be performed.

Objectives: The aim of this study is comparative effects of granisetron on angiogenesis in male and female rats adopting AIR pouch as an experimental model.Methods: AIR pouch type carrageenan-induced inflammation model on the back of the male and female wistar rats was used. To induce an AIR pouch, rats were anesthetized; 20 ml and 10 ml of sterile AIR were injected subcutaneously on the back on day 0 and day 3 respectively. On day 6, inflammation was induced by injection of 1 ml of carrageenan 1% into pouches. Treatment groups received 1 ml granisetron by doses of 50 - 200 mg / pouch. Three days after the injection of carrageenan solution, the rats were sacrificed by halothane overdose. The pouches were flushed with PBS and granulation tissues that formed were dissected and weighed. For measuring of angiogenesis in granulation tissue, drabkin reagent was added to the granulation tissues and after homogenization, centrifuging and filtering, the hemoglobin value in the supernatant was determined spectrophotometrically by measuring absorbance at 540 nm and compared against a standard curve of hemoglobin.Results: Granisetron did not change angiogenesis in female rats. In male rat granisetron (50, 100 & 200 mg) decreased significantly (P<0.05, P<0.001 & P<0.05) hemoglobin level respectively.Conclusion: The study confirms that the degree of angiogenesis induced in wistar rat AIR pouch model and the effects of granisetron on angiogenesis is gender-dependent, suggesting that gender may be a key consideration in the design of angiogenesis experiments.

Background: Persistent AIR leaks occur after Spontaneous pneumothorax both primary and secondary, and after lungs trauma and lung surgeries are sever problems encountered chest surgeons with. Persistent AIR leak causes longer patients hospitalization. Materials and Methods: We used autologous blood pleurodesis in patients with persistent AIR leak for 30patients with more than 8 days AIR leaks, during a three years period 1377-1380 (1999-2002). Results: The patients had 19 years up to 70 years old. Eight patients had thoracotomy and lobectomy and/or segmentectomies 6 with primary pneumothorax, 10 with secondary pneumothorax, and four with penetrated or blunt thoracic traumas. Blood was obtained from femoral or brachial veins and 70-150 mls. Injected in chest tubes. Chest bottle was first lied 80cm higher than body levels. After 24 hours repositioned in normal levels, and patients were supervised. Via chest tube we injected blood 70-100ml.for young patients, and 100-150 ml for older patients into intra pleural space. There were no clamped chest tubes. There were no pain, respiratory distress, fever, or cough in pleurodesized patients. The only patients complaint was local pain in femoral vein or brachial vein because blood sampling and blood obtaining, although there was no local visible complication as hematoma or bleeding. After 48 hours in 24 patients AIR leak ceased. In six patients because persistent AIR leak autologous blood pleurodesis repeated, two patients after 48hours AIR leak ceased, remaining four patients underwent for thoracotomies. success rate was 86.6%.Conclusion: According above success rate we suggest autologous blood pleurodesis in patients with persistent AIR leak is a reliable, effective, and no complicated procedure for persistent AIR leaks.

Immunoglobulin G4-Related Disease (IgG4-RD) is a systemic fibroinflammatory disease that has been proposed as a separate entity since the beginning of this century. The disease is often manifested by increased serum IgG4 levels and certain histopathological manifestations. The patient mentioned in this article is a 29-yearold man from Tajikistan, who has had a chronic cough since the beginning of 2018 without a previous history of the disease. At first, he was diagnosed with pneumonia for a long time and then underwent a lung biopsy due to exacerbation of symptoms and the spread of lung lesions in radiology but no abnormalities were found in these evaluations. The patient traveled to Iran to continue his treatment. He was re-evaluated and then the previous samples taken from the patient’ s lung tissue were re-examined. Here are the key findings in favor of diagnosing IgG4 RD. Evaluations did not confirm the involvement of other organs. He was first treated with steroids and due to recurrence of symptoms, he was treated with rituximab once which was significantly effective in improving the patient’ s clinical symptoms. In general, it can be concluded that the diagnosis of IgG4-RD is very challenging and if it has not been diagnosed and treated in time, it can lead to irreversible fibrosis and permanent loss of function of the involved organ.

Introduction: Elimination of EXTENSIVE defects of the larynx and trachea by using musculoskeletal plastics without the use of supporting materials is not always sufficient. Laser modeling of cartilage tissue is a promising technique in modern medicine. Case Report: This article presents a new method for plastic closure of an EXTENSIVE defect in the larynx and trachea with the help of costal auto-cartilage modeled by an erbium fiber laser with wavelength of 1. 56 μ, m. Conclusions: The presented method allows us to restore the anatomical integrity of the respiratory tract at the final stage of surgical treatment of patients with chronic combined laryngeal and tracheal stenosis. Presented own clinical observation.

Introduction: Solitary fibrous tumours are uncommon in head and neck region, especially in the nasal cavities and paranasal sinuses, with most cases reported in the thoracic region in the pleura. It is often considered a borderline or low-grade malignant soft tissue tumour. Complete surgical resection is currently the treatment of choice, though intracranial and orbital extension of these lesions must be carefully evaluated and navigated to ensure a safe outcome. Case Report: A 36 years-old lady presented with a long one-year history of left-sided nasal obstruction with facial pain, headaches and mild visual disturbances. She had been treated for sinusitis for a prolonged period. Clinically, there was a left nasal mass obliterating the ostiomeatal complexes and the roof of the nasal cavity. MRI showed heterogeneously enhancing mass occupying the left ethmoid sinuses extending laterally eroding the left lamina papyracea to the orbit, medially towards the right nasal cavity eroding the nasal septum, and superiorly to extend intracranially. After inconclusive biopsies were performed, the mass was excised with a combined endoscopic and open lateral rhinotomy approach with left medial maxillectomy and reconstruction of the skull base defect. The tumour was eventually reported as a solitary fibrous tumour. Conclusions: Solitary fibrous tumour is a rare differential of tumours in the sino-nasal region, diagnosed via histopathology. Although generally slow-growing, these lesions may extend the adjacent structures namely the orbit and skull base. Definitive treatment via surgical resection may be performed safely after careful radiological assessment and multidisciplinary consideration.

Long-term success of endodontic treatment is dependent on adequate and appropriate cleaning and shaping of the root canal along with proper and correct obturation of the entire prepared space. This article aims to report an exceptional non-surgical and orthograde endodontic treatment of maxillary right central incisor with an EXTENSIVE radiolucent lesion in a 17-year-old male. Six and 20-month follow-ups showed significant changes, including bone formation and periapical healing within the lesion. The patient was asymptomatic. After 20 months, complete radiographic and clinical healing of the periapical lesion was observed.

Purpose: Standardization and detailed pharmacognostical studies of Oreganum vulgare Linn. leaf for authentication and commercial utilization.Methods: Oreganum vulgare Linn. leaf was with standardization according to standard procedures described in WHO, 2011 and I.P.1996.Results: The physicochemical parameters total ash, acid insoluble ash, water soluble ash and sulphated ash were found to be 11.5%, 11%, 5, 10.5% w/w respectively. Foaming index was found be<100. The trace elements were found to be copper, lead, cadmium, zinc, cobalt, manganese, nickel and copper in ethanol extract and phytochemical screening of aqueous and ethanol extract showed the presence of carbohydrates, flavonoids, anthocyanins, phenolic compounds etc. Conclusion: The standardization parameters viz. physico-chemical parameters, macroscopy, microscopy, taxonomy, anatomy and preliminary phytochemical screening, microbial and aflatoxin count, HPTLC profile is being reported to help in authentication and development of monograph of this plant