فهرست مطالب محمد جبلی

Anomalous origin of the right coronary artery from the left anterior descending artery is extremely rare. It is usually asymptomatic but can be associated with a risk of myocardial ischemia and sudden death.

This paper presents the case of an elderly male with exertional dyspnea. He underwent diagnostic measures including coronary artery angiography which showed severe stenotic three-vessel disease and right coronary artery anomaly. He underwent coronary artery bypass grafting and discharge home in good condition.

Although the abnormal origin of the right coronary artery from the left anterior descending artery is a rare anomaly, due to causing chest pain and the possibility of sudden death, it is considered important. For a definite diagnosis of this anomaly coronary angiography is useful.

The care of patients with CIEDs during perioperative period poses unique challenges to ensure a high degree of patient safety. Currently, there are no randomized controlled trials in this area; therefore, many of the recommendations are based upon the observational studies and expert consensus. Regarding to continuing evolution in CIEDs technology, there are no simple rules to manage them perioperatively. Also, creation of a uni perioperative care algorithm for the patients with CIEDs is complicated by the diversity of devices which currently is manufactured by the different companies. The purpose of this document is to provide a general approach in management of these Patients perioperatively which is based upon the reviewing articles and use expert advisories have been developed by some well-known international societies such as HRS (heart rhythm society), ASA (American society of anesthesiology), STS(the society of thoracic surgeons) and etc ... It is intended to provide guidance to the health care professionals who care for patients with CIEDs during perioperative period and Its important to remember that there are no absolutes with regard to many clinical situations and the ultimate judegement regarding care of a particular patient must be made by the physician in light of all the circumstances presented by the patient and procedure type. The topic discusses the potential problems that can occur in these patients during the perioperative setting and gives some recommendations for the appropriate evaluation and management of the CIEDs during the procedure and postoperative care.

Sharing organizational results or achievements with employees causes a sense of economic ownership and subsequently mental (psychological) ownership of people. The aim of present study is to design a model of manager's job ownership. Research method of present study is a qualitative way based on grounded theory. Population of study consists from managers of Ilam state university. Sampling way was a theoretical way through snowball method, based on which 20 interviews were done with managers. Results of these interviews were considered as primary themes collected through open coding process, and some issues were extracted among them. After that, the links among issues were obtained through axial coding process and finally selective coding process was performed. During this study, cause and effect factors for manager's job ownership were categorized into internal factors (ambitiousness, sense of competence) and external factors (personal greed, job satisfaction). Identified interferer factors are social and economic problems, organization's structural problems, and cultural ones. Positive outcomes from sense of job ownership would lead to increase of job success, sense of job security, job commitment, and negative outcomes are monopoly of authority(power), rise of conflicts within organization and reduction of growth chance.

The occurrence of Atrial Fibrillation (AF) is linked to an increased inflam-matory response after cardiac surgery that is significantly decreased by anti-inflammatory treatments. The present study aimed at administrating Colchicine as a way to reduce the incidence of post- Coronary Artery Bypass Graft (CABG) atrial fibrillation. In this double-blind، parallel clinical trial، 216 patients with coronary artery disease who underwent CABG surgery، by using a table of random numbers are divided into intervention and control groups to receive placebo or Colchicine. The clinical and surgical characteristics of the patients in two groups were similar. The intervention group received 1. 0 mg of Colchicine tab، the night before surgery and on the morning of surgery. This drug followed by 0. 5 mg twice a day for five days after surgery. On the other hand patients in the control group received only placebo (ineffective pill with similar size to Colchicine). After operation two groups were compared regarding important outcomes such as postoperative arrhythmia، ICU stay and hospital stay. The data were assessed using SPSS software (version 17) and t-test and 2 statistical tests. One hundred fifty six men and sixty women with a mean age of 59. 9±9. 3 years were enrolled in the study in two Colchicine and placebo groups (each consisting of 108 patients). The incidence of postoperative atrial fibrillation was 14. 8% in the Col-chicine group and 30. 6% in the control group (P= 0. 006). ICU stay in the Colchicine group were 2. 4±1. 3 days versus 3. 1±1. 5 days in controls (P< 0. 001) and hospital stay in the Colchicine group were 6. 6±1. 5 days versus 8. 1±2. 0 days in controls (P< 0. 001). Colchicine is an anti-inflammatory medication and has very few side effects at low doses. According to the 48% reduction in the incidence of atrial fibrillation in Colchicine patients undergoing coronary artery bypass grafting surgery، this drug can be prescribed as a prophylaxis for prevention of post-CABG atrial fibrillation.

Myocardial protection is one of the most important determinants of the result of CABG operation. The benefit of aminophylline has been proved in addition to antegrade cardioplegia but has not been studied plus Antegrade and retrograde cardioplegia. This study was designed to evaluate the effects of aminophyliine as a cardioprotective agent for patients undergoing on-pump CABG with antegrade and retrograde cardioplegia. In this double-blinded randomized clinical trial, 40 patients were randomly assigned to receive either IV aminophylline (5,g/kg) (n=20) or saline (n=20) before anesthesia induction. Troponin T level was measured 30 minuets, 2 hours and 24 hours after aortic clamping. For data analysis, t-test, chi-square and Mann-Whitney test was used. Troponin T level was significantly lower in aminophylline group 30 minutes (P=0.03) and 2 hours (P=0.01) after aortic cross clamp. No difference was observed with clinical Parameters. Pretreatment with aminophylline reduces myocardial injury at sub-clinical level, particularly to benefit the ante-retrograde cardioplegia alone.