فهرست مطالب

Cardiovascular and Thoracic Research - Volume:1 Issue: 4, Dec 2009

Journal of Cardiovascular and Thoracic Research
Volume:1 Issue: 4, Dec 2009

  • 62 صفحه،
  • تاریخ انتشار: 1389/03/20
  • تعداد عناوین: 10
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  • Naser Safaie, Ahmadreza Jodati, Babak Kazemi, Hossein Montazerghaem Page 1
    Background
    Epidemiologic studies on civilian vascular trauma in developing countries are rather few. Although Iran encounters vascular injury far more frequently than developed countries, the predominance of blunt trauma with associated complex injuries continues to pose problems for clinicians. The present paper retrospectively reviews a tertiary referral center experience of extremity vascular trauma.
    Methods
    All individuals who presented to the Imam Khomeini Hospital, Tabriz/Iran, with a vascular injury between March 1998 and February 2000 were retrospectively identified from a trauma database. The aim was to study the etiology, signs and symptoms, pattern of injuries, the implemented treatment strategies, and the mortality and morbidity rates due to vascular trauma in our population.
    Results
    During the study period, 124 patients (5 female) with a mean age of 23 years (7-65 years) sustained vascular injuries. The most common injury was arterial and isolated venous injuries were seen in only 15 cases. Penetrating injuries were the causes in 63% of patients, blunt trauma in 21%, and both in 16% of the rest. The commonest injured artery and vein were the femoral artery and the popliteal vein, respectively. All of the patients underwent surgical repair in 1-48 hours (mean 9.5 hours) after trauma, with the most common procedure being the end-to-end anastomosis. Three underwent primary amputation and 3 required secondary amputation, mostly due to infection. The mortality rate was 3.2% (4 cases) with a median hospital stay of 13 days.
    Conclusion
    Most vascular injuries due to limb trauma can be managed successfully unless associated with severe damage to bones, nerves or soft tissues. The injury patterns emerging from the present study will hopefully help all medical personnel to recognize the potential for vascular injury in a trauma setting.
  • Shahryar Hashemzadeh, Khosrow Hashemzadeh Page 7
    Background
    Lung cancer is the most common cause of cancer death worldwide with more than 1.3 million people dying of the disease annually. In Asia, the incidence and mortality rates of lung cancer are generally lower than those in western countries. We aimed to obtain cancer incidence data from the East Azerbaijan, Iran; to select the target populations for our future cancer field studies.
    Methods
    Diagnosed primary lung cancer cases and pleura and trachea during five years (2002-2006) were collected from the hospital or private pathology laboratories in East Azerbaijan and analyzed using SPSS 13.0 after metastatic and same cases exclusion.
    Results
    In this study 159314 pathology records were studied in hospitals and laboratories; 12083 of them were cancer cases. 9166 of them were primary cancer patients and Azerbaijan residents. A total of 469 new lung cancer cases (81% male, 19% female) were diagnosed during the years 2002–2006, the age-adjusted incidence rate (ASR) per 100,000 being 16.6 for males and 4.2 for females. Squamous cell carcinoma was the most common histological type (58.5%), the proportion of adenocarcinoma being 27.6%, small cell carcinoma 12.6% and large cell carcinoma 0.6%. ASR was calculated for cancer of pleura (0.4, 0.3) and for cancer of trachea (0.2, 0.1) per 100000 in male and female, respectively.
    Conclusion
    This study is the first report of respiratory tract cancer incidence in East Azerbaijan. The results of the present study are statistic analysis of the cancer prevalence and incidence in Iran which mainly correspond with the international reports and is a scientific tool we want to offer to all those who work in the prevention, care and treatment of cancer in Iran.
  • Reza Ghotaslou, Sohrab Negargar, Khosrow Hashemzadeh, Ata Mahmoodpoor, Mohsen Safarpour Page 13
    Backgraound: Venous and arterial catheters are used ordinary for continuous hemodynamic evaluation in cardiac surgery intensive care units. The catheters are one of the most important risk factors for nosocomial infection and mortality of hospitalized patients. The aim of this study was to evaluate the rate of bacterial colonization of intravascular catheters and catheter related bloodstream infection in Shahid Madani intensive care unit.
    Methods
    150 admitted patients that had intravascular catheter for more than 48 hours were enrolled in this study during one year period. The tip segment of catheters and insertion site cultures were assessed.
    Results
    The rate of colonization was 13(8.7%). The isolated bacteria were Escherichia coli(23.1%), Pseudomonas aeroginosa(23.1%) staphylococcus aureus(7.7%), coagulase negative staphylococcus(7.7%), Proteus vulgaris(7.7%), Stenotrophomonas maltophilia(7.7%), Candida albikans(7.7%), nonfermentative gram negative bacilli(7.7%) and Acinetobacter spp(7.7%).
    Conclusion
    The rate of catheter colonization was acceptable in comparison to the other studies. The most common isolated bacteria were Escherichia coli and Pseudomonas aeroginosa. In this study, the important risk factors were duration of catheter use, duration of hospitalization and positive blood culture.
  • Firooz Salehpoor, Amir Mohammad Bazzazi Page 17
    Background
    Thoracic spine fractures and their operation have many undesirable problems and complications including pneumothorax, hemothorax, chylothorax, trachea and esophagus injuries, mediastinum hematoma, rib and sternum fractures and injuries of major vessels. This study surveys the incidence of the above mentioned complications.
    Methods
    50 hospitalized patients in the trauma ward of Tabriz Imam Hospital from 2005 to 2010 were studied retrospectively. These patients had Thoracic spine fractures needing stabilization and fusion.
    Results
    78% of the patients were male and 22% female with the mean age of 34. The most common cause of trauma was motor vehicle accidents (56%). Rib fracture was reported in 18% of the patients, pneumothorax in 10 % and lung contusion in 12%. No cases of chylothorax, major vessels and trachea and esophagus injuries or complications related to the operation were reported.
    Conclusion
    Patients with thoracic spine fractures considering the extended injuries associated with primary trauma and complications related to operation in thoracic region need the cooperation of diverse specialists.
  • Javad Sarrafzadeh, Mostafa Nejatian, Sabahat Saebnazar Page 23
    Background
    Uncompleted Cardiac Rehabilitation (CR) schedule may lead to recurrence of cardiac events and its-related re-hospitalization, decreased quality of life and increased risk of co-morbidities. Current study came to address the effects of a complete exercise-based CR program on physical function and cardiac parameters to clarify whether different sessions could result in better health condition.
    Methods
    Data were collected prospectively on 16 consecutive patients who underwent coronary artery bypass graft surgery and enrolled in an exercise-based CR program. The charts of the patients who attended 10 sessions of CR were reviewed as the case group (n = 8) and those who participated in at least 20 sessions of program were reviewed as the control group (n = 8). Both groups received services of a multi-disciplinary CR and cardiac parameters were measured at baseline, as well as at the completion of 10 and 20 sessions.
    Results
    It was revealed significant increases from baseline to follow-up for metabolic equivalents in both groups after attending CR programs; however increases of this index were higher following 20 sessions adjusted for baseline characteristics. Resting heart rate was significantly decrease in the group underwent completed CR program in the presence of main confounders; however this parameter was significantly unchanged in another group.
    Conclusion
    Participation in complete CR program is necessary to make achieving optimal improvement in vital indices such as metabolic equivalents and resting heart rate and therefore incomplete CR sessions may not warrant this efficacy.
  • Mahmood Nazarpoor Page 29
    Background
    Two common acquisition strategies in MRI are Centre out Phase-Encoding (COPE) and Linear Phase-Encoding (LPE).
    Purpose
    The objectives of this study were to (1) to investigate the effect of concentrations (0.8 and 1.2mmol/L) and different velocities on signal intensity (SI) strength, (2) to find the inflow effect at different velocities at the two concentrations using the LPE and COPE acquisitions, and (3) to recommend the best acquisition for measuring perfusion with MRI using inversion recovery T1-weighted images.
    Methods
    A flow phantom was designed to produce four different steady state flows at the same time. The stationary state can be obtained when the water flow was stopped. All studies were carried out using a 1.5T clinical MR scanner. Mean SI was obtained in ROIs. The inflow correction factor can be calculated from the SI of the steady state flow divided by the SI of the stationary state at the same position in the image.
    Results
    The results show that an increase in concentration and the velocity is associated with increase in the inflow correction factor for the both acquisitions. But the inflow has less effect on SI with the COPE than the LPE acquisition. In addition, the correction value depends on concentration.
    Conclusion
    For measuring the absolute perfusion, the velocity and concentration of contrast agent of the arterial input function should be known to find the inflow correction factor using the two acquisitions. Otherwise, the COPE is the better acquisition for measuring perfusion, because inflow has less effect on SI.
  • Mohammad Reza Mehrebani, Amrollah Bayat, Ramin Azhough, Mohammad Nazari Khanmiri, Babak Adli, Samad Beheshtirouy Page 39
    Background
    Infected femoral artery pseudoaneurysm (IFAP) is a severe complication in parenteral drug abusers, with difficult and controversial management.
    Methods
    Seventeen consecutive patients were admitted to our department with IFAP due to intravenous drug abuse. In all 17 patients proximal and distal ligation of common femoral artery was performed with drainage of the abscess and excision of the pseudoaneurysm without reconstruction. The lower limb was monitored for symptoms of acute ischemia including coldness, sensory and motor impairment, as well as changes in color and capillary refilling.
    Results
    In all 17 patients, the affected artery was ligated.Ligation of the common femoral or superficial femoral artery alone was performed in 13 and 4 of the cases, respectively. In eight cases the pseudoenurysm involved the distal, in six the mid, and in three the inferior border of the inguinal ligament. We did not have bifurcation involvement and need for triple ligation (common, superficial and profunda femoral artery). Patients were closely observed during and following surgery, and this led to revascularization in two patients who demonstrated symptoms of acute ischemia.In one of them bypass surgery was performed 24 hours after surgery and led to amputation due to failed revascularization, and the other patient was required revascularization 2 months after ligation of common femoral artery because of severe intermittent claudication of affected limb.
    Conclusions
    In the setting of complex infected femoral pseudoaneurysms in patients prone to substance abuse, our work demonstrates that ligation and excision of IFAP without reconstruction may be the preferred option.
  • Samad Ghaffari, Babak Nasiri, Leili Pourafkari Page 43
    A 36 years old woman with a history of treated pulmonary tuberculosis (TB) was hospitalized for progressively worsening dyspnea on exertion. She had severe calcification of entire aorta and evidence of old TB on chest roentgenogram. Routine laboratory tests including erythrocyte sedimentation rate (ESR) and C- reactive protein (CRP) were normal and rheumatologic panel was negative. Echocardiography showed severe aortic insufficiency. Work-up for active tuberculosis was negative. The CT scan of the chest was in favor of old tuberculosis and also showed heavily calcified aorta. She underwent aortic valve replacement. Postoperative course was uneventful. At four-year follow-up the patient is doing well. Considering her age and the absence of risk factors of atherosclerosis we postulated that porcelain aorta in this patient could be a sequel of remote tuberculosis aortitis.
  • Mohsen Sokouti, Massoud Nazemieh Page 49
    Retained surgical «lap-pack» in thoracic cavity is a rare complication of thoracic surgery, and its incidence is unknown. Because of rarity of this condition and its nonspecific clinical and radiographic presentations, the diagnosis is frequently missed. Herein we report a man who has presented by symptoms and signs of pneumonia with left upper zone consolidation on chest x -ray and bronchiectatic appearances on CT scan. He had a history of left upper lobectomy four years ago for bronchiectasis. The patient has been referred for resection of recurrent bronchiectasis. After thoracotomy, crumpled and destroyed retained abdominal lap-pack and evidence of anaerobic infection was found in pleural space. Foreign body and purulent material was removed and discovered bronchopleural fistula was closed. For chronic empyema and evidence of recurrent bronchopleural fistula, thoracoplasty was performed.
  • Khosrow Hashemzadeh Page 53
    A 37 year-old woman underwent aortic and mitral valve replacement and 3 months later developed a pseudoaneurysm from the anterior aspect of the proximal ascending aorta (AA). The pseudoaneurysm was approached through a redo-median sternotomy, on cardiopulmonary bypass (CPB), moderate hypothermia, and repaired successfully using autologous pericardium. The standard approach to such pseudoaneurysm is a CBP and hypothermic circulatory arrest prior to mid-sternotomy, and repair or replacement of the AA; but when a pseudoaneurysm arises from a narrow ostium on the anterior aspect of the AA, as in this case, it can be repaired under CPB with moderate hypothermia.