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1.  IL-17 Enhances Chemotaxis of Primary Human B Cells during Asthma 
PLoS ONE  2014;9(12):e114604.
IL-17 is a pro-inflammatory mediator that is believed to play a critical role in regulating tissue inflammation during asthma, COPD, as well as other inflammatory disorders. The level of expression of IL-17 has been shown to be upregulated in lung bronchial tissue of asthmatic patients. Several reports have provided further evidence that this cytokine could play a key role in enhancing the migration of inflammatory as well as structural cells of the bronchial lung tissue during asthma and COPD. B cell infiltration to sites of inflammation during inflammatory disorders such as bowel disease, asthma and COPD has been reported. Accordingly, in this study we hypothesized that IL-17 may exert a chemotactic effect on primary B cells during asthma. We observed that B cells from asthmatic patients expressed significantly higher levels of IL-17RA and IL-17RC, compared to those of healthy subjects. Using an in-vitro migration assay, B cells were shown to migrate towards both IL-17A and IL-17F. Interestingly, blocking IL-17A and IL-17F signaling using either anti-IL-17R antibodies or MAP kinase inhibitors prevented in vitro migration of B cell towards IL-17. These observations indicate a direct chemotactic effect of IL-17 cytokines on primary peripheral blood B cells with higher effect being on asthmatic B cells. These findings revealed a key role for IL-17 in enhancing the migration of B cells to the lung tissue during asthma or COPD.
PMCID: PMC4262428  PMID: 25494178
2.  A novel technique for the reconstruction of resected sternoclavicular joints: A case report with a review of the literature 
Annals of Thoracic Medicine  2013;8(1):60-63.
Sternal metastasis in thyroid cancer is an uncommon occurrence with only a handful of cases of chest wall resections being done. Sternal reconstruction for both primary and secondary tumors has been performed using various techniques and materials such as the mesh, methyl acrylate resin, and steel plates; however, this is a case of papillary thyroid cancer involving the sternum in a 50-year-old woman who had resection of the sternum with reconstruction using titanium bars and clips (STRATOS system) fixed to the clavicles with an underlying Proceed mesh. STRATOS system showed good recovery postoperatively. The functional results were excellent with the patient being able to perform all daily activities unassisted after 1 month and almost complete range of motion with acceptable limitations in power of the shoulder muscles after 2 months. We have reviewed all the English language publications of the subject by doing Medline search for the last 25 years and we present here the surgical management of this pathology with our novel approach by using the titanium steel bars to stabilize both medial aspects of the resected clavicles as a promising therapy for manubrial reconstruction and clavicular fixation.
PMCID: PMC3573561  PMID: 23440949
Reconstruction; sternum; stratos; thyroid; titanium
3.  The use of thoracoscopy to enhance medical students’ interest and understanding of thoracic anatomy 
Annals of Thoracic Medicine  2012;7(3):145-148.
To develop a video-based educational tool designed for teaching thoracic anatomy and to examine whether this tool would increase students’ stimulation and motivation for learning anatomy.
Our video-based tool was developed by recording different thoracoscopic procedures focusing on intraoperative live thoracic anatomy. The tool was then integrated into a pre-existing program for first year medical students (n = 150), and included cadaver dissection of the thorax and review of clinical problem scenarios of the respiratory system. Students were guided through a viewing of the videotape that demonstrated live anatomy of the thorax (15 minutes) and then asked to complete a 5-point Likert-type questionnaire assessing the video's usefulness. Apart from this, a small group of entirely different set of students was divided into two groups, one group to view the 15-minute video presentation of thoracoscopy and chest anatomy and the other group to attend a 15-minute lecture of chest anatomy using radiological images. Both groups took a 10-item pretest and post-test multiple choice questions examination to assess short-term knowledge gained.
Of 150 medical students, 119 completed the questionnaires, 88.6% were satisfied with the thoracoscopic video as a teaching tool, 86.4% were satisfied with the quality of the images, 69.2% perceived it to be beneficial in learning anatomy, 96.2% increased their interest in learning anatomy, and 88.5% wanted this new teaching tool to be implemented to the curriculum. Majority (80.7%) of the students increased their interest in surgery as a future career. Post-test scores were significantly higher in the thoracoscopy group (P = 0.0175).
Incorporating live surgery using thoracoscopic video presentation in the gross anatomy teaching curriculum had high acceptance and satisfaction scores from first year medical students. The video increased students’ interest in learning, in clinically applying anatomic fact, and in surgery as a future career.
PMCID: PMC3425046  PMID: 22924072
Medical students; thoracic anatomy; thoracoscopy
4.  Surgical management of retrosternal goiter: Local experience at a university hospital 
Annals of Thoracic Medicine  2012;7(2):57-60.
Retrosternal goiter (RSG) is a term that has been used to describe a goiter that extends beyond the thoracic inlet. Surgery plays an important role in the treatment of these patients, but whether all or selected patients with RSG should undergo this operation remains controversial. Our aim is to look into the demographics, presentation, and treatment of patients with RSG and essentially to determine the role of surgery in its treatment.
Retrospective study, teaching hospital-based.
Retrospective analysis of 537 thyroidectomies performed at King Khalid University Hospital between 2003 and 2010. The twenty-six patients with RSG were analyzed further, with regard to demographics, presentation, indications, and outcome of surgical treatment. Statistical analysis was performed, where age was expressed as mean and range, and other variables were presented as numbers and percentage.
There were 26 patients (4.8%) with RSG out of 537 thyroidectomies, who underwent an operation for removal of RSGs, in a seven-year period. The most common presentation was dyspnea (34.6%) and the surgical procedure predominantly used was total thyroidectomy. The RSGs were removed by collar incision in 96% of the cases. The final histological diagnosis revealed malignancy in 26.9% of the thyroid specimens. There was no mortality and minor complications occurred in nine patients.
The presence of an RSG is an indication for surgery owing to the lack of effective medical treatment, the higher incidence of symptoms related to compression, low surgical morbidity, and the risk of malignancy.
PMCID: PMC3339204  PMID: 22558008
Retrosternal goiter; surgery; thyroidectomy
5.  Mimicry of Minute Pulmonary Meningothelial-like Nodules to Metastatic Deposits in a Patient with Infiltrating Lobular Carcinoma: A Case Report and Review of the Literature 
Korean Journal of Pathology  2012;46(1):87-91.
Minute pulmonary meningothelial-like nodules (MPMNs) are incidentally found lesions in lung resection specimens and autopsies. MPMNs have been associated with neoplastic and non-neoplastic pulmonary conditions and occasionally with extrapulmonary diseases. We report a case of a female patient presenting with invasive lobular carcinoma of the breast and MPMNs, masquerading as metastatic deposits. We describe the morphological, immunohistochemical and ultrastructural features of MPMNs and emphasize the importance of their recognition for proper staging and treatment of patients. To our knowledge, this is the first case in the English literature describing this coexistence.
PMCID: PMC3479696  PMID: 23109985
Minute pulmonary meningothelial-like nodules; Pulmonary chemodectoma; Breast neoplasms
6.  Mediastinal Seroma Post Laparoscopic Repair of Type IV Paraesophageal Hernia 
Laparoscopic repair of paraesophageal hernia is safe and feasible and can provide comparable results for patients with type IV paraesophageal hernia. We report a rare case of mediastinal seroma in an 80-year-old gentleman who had a giant type IV paraesophageal hernia and was eventually admitted to our hospital for elective laparoscopic repair and recovered very well after surgery with resolution of the atelectatic lungs and air-fluid collection in his chest.
PMCID: PMC3133988  PMID: 21727737
Laparoscopy; mediastinal seroma; paraesophageal hernia; repair; type IV
7.  Anesthetic considerations of central airway obstruction 
Saudi Journal of Anaesthesia  2011;5(3):326-328.
Central airway obstruction (CAO) is a serious presentation of lung cancer and associated chest diseases. It presents a real challenge to the anesthesiologist because usually the patient admitted to the hospital as an emergency case with high grade dyspnea scheduled to undergo rigid bronchoscopy for diagnostic and possible therapeutic interventions. In this case report, we described the anesthetic management of a patient who was admitted to our hospital with CAO.
PMCID: PMC3168356  PMID: 21957418
Anesthesia; central airway obstruction; ventilation
8.  Continuous positive airway pressure ventilation during whole lung lavage for treatment of alveolar proteinosis -A case report and review of literature 
Saudi Journal of Anaesthesia  2011;5(1):76-78.
Pulmonary alveolar proteinosis (PAP) is a rare disease that affects young population usually in the age group of 20-40 years, characterized by the deposition of lipoproteinacious material in the alveoli secondary to abnormal processing of surfactant by macrophages. We report a case of a 15-year-old female who had history of cough with sputum for 3 days along with fever. She was seen in another hospital and was treated as a case of pneumonia where she received antibiotic but with no improvement. Computerized tomography (CT) chest showed diffuse interlobular septal thickening in the background of ground glass opacity giving a picture of crazy paving pattern which was consistent with the diagnosis of PAP. The patient was scheduled to undergo, first right-sided whole lung lavage (WLL) under general anesthesia. Endobronchial intubation using left sided 37 Fr double lumen tube. Continuous positive airway pressure (CPAP) as described in our previously published report was connected to the right lumen of the endobronchial tube. CPAP ventilation was used during the suctioning of lavage fluid phase in order to improve oxygenation. WLL was done using 5 L of warm heparinized saline (500 i.u/litre). The same procedure was repeated on the left side using 6 L of heparinized normal saline solution. In conclusion, anesthesia in alveolar proteinosis for patients undergoing WLL is challenging to the anesthesiologist. It requires meticulous preoperative preparation with antibiotics, mucolytics and chest physiotherapy. Also it requires careful intraoperative monitoring and proper oxygenation especially during the suctioning phase of the lavaged fluid. With this second case report of successful anesthetic management using the modified CPAP system we recommend with confidence the application of CPAP ventilation to improve oxygenation during WLL.
PMCID: PMC3101759  PMID: 21655022
Lactic acidosis; toluene; hyperlactemia

Results 1-8 (8)