BackgroundAcute coronary syndrome (ACS) refers to a spectrum of symptoms compatible with acute myocardial ischemia. Plasma markers of inflammation have been recently identified as diagnostic aid and risk predictors. The present study, conducted in Slemani Cardiac Hospital (SCH), Sulaimaniyah, Iraq aimed to recognize some risk factors for ACS in Iraqi adults younger than 40.MethodologyThis is a prospective case-control study of 100 patients with ACS vs. a control group of 100 healthy volunteers. The study began at 1st January 2014 and ended at 31st December 2016. All patients were subjected to full history taking, clinical examination including measurement of waist circumference and body mass index (BMI). Investigations included electrocardiography (ECG), echocardiography, full blood count, measurement of lipid profile and C-reactive protein (CRP). The patients were managed by percutaneous coronary intervention (PCI).ResultsThe mean age of the patients was 36 years (range 28–40). Eighty-five% of patients were male. The mean BMI (29 kg/m2) and waist circumference (98 cm) of the patients were higher than the controls (24 kg/m2 and 72 cm respectively). The leukocytes, lymphocytes and neutrophil counts as well as CRP in both groups were within the normal range. The most prevalent risk factor was obesity (n = 86). Other risk factors were smoking (n = 62), hypertension (n = 26), diabetes mellitus (n = 22) and positive family history of ACS (n = 24). Most patients (n = 83) had multi-vessel coronary artery disease (2–3 vessels).ConclusionACS in young adults is an increasing health problem. Obesity was found to be the most prevalent risk factor.

Background/Aim:Anastomotic leak after esophagectomy is one of the most challenging complications resulting in a high morbidity and mortality and prolonged hospitalization. The study intended to assess the outcome of endoluminal self-expanding stent in the treatment of this problem.Settings and Design:Department of Thoracic and Cardiovascular Surgery, Arhus University Hospital, Skejby, Arhus, Denmark. A retrospective study.Patients and Methods:From January 2007 to December 2010, 209 patients underwent esophagectomy for malignant disease of the esophagus or the cardia. Twenty patients developed anastomotic leak. Treatment consisted of conservative measures, surgery, and stent placement. Details of treatment, clinical outcome, complications, and mortality were evaluated.Statistical analysis:None.Results:One hundred and forty-seven patients (70.3%) had carcinoma of the cardia, whereas 62 patients (29.7%) had esophageal carcinoma. Twenty patients (9.5%) developed anastomotic leak; small (<1 cm) in two patients (10%); managed conservatively and bigger than 1 cm in 15 patients (75%); treated with an esophageal stent (Hanaro stent, DIAGMED Healthcare, Thirsk, YO7 3TD, United Kingdom). In three patients (15%), perforation of the staple line of the intrathoracic gastric conduit was found and managed by reoperation. Functional sealing of anastomoses after stent placement could be achieved in 10 patients (67%). Stent-related morbidity developed in five patients (33%): Migration of the stent, n=3 and tracheoesophageal fistula, n=2. Stents were smoothly removed 3 weeks after discharge. The mean hospital stay was 25 days. There was only one stent-related death (6.6%).Conclusion:Endoluminal stent implantation is an effective and safe option in the management of postesophagectomy leaks.

here are 3 radiologic signs considered diagnostic of ruptured pulmonary hydatid cyst (PHC): perivesicular pneumocyst, double-domed arch, and water lily. 1 Apart from these, every localized radiologic density seen in any patient more than 3 years of age in an endemic area should be looked on as a possible ruptured hydatid cyst (HC). 1 Nevertheless, situations in which the diagnosis of ruptured PHC is difficult are far from being rare in countries of high endemicity. 1-3 Thus a preliminary bronchoscopy is a perfectly justifiable step in the diagnostic work-up. 1 Herein, we report 3 selected cases of Iraqi patients with ruptured PHC in whom definitive diagnoses were made with the use of the flexible fiberoptic bronchoscope (FOB). Clinical SummariesPATIENT 1. A 36-year-old man presented with a 1-week history of cough, expectoration of greenish sputum, fever, right-sided pleuritic chest pain, and hemoptysis. Physical examination showed no abnormalities. The chest films (Figures 1 and 2) revealed a rounded opacity in the superior segment of the right lower lobe. FOB revealed a whitish material (laminated membrane of ruptured PHC) in a subsegmental orifice of the apical lower segmental bronchus.

Congenital agenesis of the hemi-diaphragm (AHD) in adults is rare and exceedingly so on the right side. Since its first recognition in 1959, no more than 9 cases have been published in the English literature by the year 2016. “Partial diaphragm agenesis” is actually large congenital diaphragmatic hernia (CDH) rather than true AHD. Respiratory compromise is the likely presentation, however, patients may survive for years without symptoms. Despite a straightforward clinical and radiographic diagnosis of AHD, the best method of repair is controversial. Herein, we present a case of complete right-sided AHD in a man of 54 diagnosed on surgical exploration 16 years earlier. Despite trans-thoracic mesh repair, the patient experienced just a modest improvement of his shortness of breath (SOB). Though the liver persisted high in the chest as shown by serial CT scans of the chest, polypropylene mesh was effective in preventing further visceral herniation. Adult patients with right-sided AHD always deserve operative intervention to avoid the potential complications.

The carotid body is a small structure weighing 12 mg located in the adventitia of carotid artery bifurcation acting as a chemoreceptor. Carotid body tumour (CBT); formerly known as chemodectoma is a rare, highly vascular, mostly benign tumour arising from the paraganglia of carotid body; hence, the name (carotid paraganglioma). The high vascularity and proximity to cranial nerves and major vessels make this tumour a surgical challenge. Abundant literature has been written about CBT in the last century with a continuous debate regarding its etiology, natural history, biological behavior, proper technique of excision, and the morbidity and mortality associated with its resection. The purpose of this review article is to simplify understanding the basic and clinical aspects of this challenging neoplasm.