Journal of Cardio -Thoracic Medicine
Volume:5 Issue: 4, Autumn 2017

Boerhaave syndrome (BS) is a spontaneous esophageal perforation and is a life-threating but uncommon disorder. This syndrome involves a transmural perforation and typically occurs after forceful emesis. The prognosis is dependent on rapid diagnosis and correct management. The classic presentation of BS consists of vomiting, subcutaneous emphysema, and lower thoracic pain. However, significant symptoms and signs rarely occur, about one-third of all patients are clinically atypical. Thus, BS should be suspected in patients presenting any sudden thoracoabdominal pain with a history of emesis. The chest radiograph is the most helpful diagnostic aid, in addition to CT scans for further evaluations.When the clinical condition allows for a less invasive approach, non-operative treatment should be considered, with or without the use of an endoscopic stent or placement of internal or external drains. The best prognosis of Boerhaave's syndrome is associated with early diagnosis and surgical care within 12 hours of perforation.

Diagnosis of peripheral pulmonary nodules is confusing; therefore, an accurate and safe lung biopsy can prevent unnecessary invasive diagnostic procedures. This study soughtto study the diagnostic yield, sensitivity, specificity, and negative and positive predictive values (NPV and PPV) of radial probe endobronchial ultrasound (EBUS)-guided biopsy for peripheral pulmonary lesions.
Patients referred to the Division of Pulmonary Medicine for evaluation of peripheral pulmonary lesions were subjected to radial probe EBUS-guided transbronchial lung biopsy under conscious sedation after reviewing positron emission tomography scan/computed tomography results. The obtained specimens were considered diagnostic when the cytological, histopathological, or microbiological diagnosis was consistent with the clinical presentations.
Totally, 14 procedures were performed on 13 patients with mean lesion size of 30.42 mm. Mean distance between the lesion and pleura was 1.17±0.68 cm, and the diagnostic yield of this technique was 78.57%. Furthermore, the sensitivity, specificity, and NPV were 70% (range: 34.75 to 93.33), 100% (range: 39.76 to 100), and 57.14% (range: 18.41 to 90.10), respectively. This procedure was not associated with any major complications.
Radial probe EBUS with satisfactory diagnostic yield and low complication rate is a promising tool for early diagnosis of lung cancer.

Chronic pancreatitis is defined as a persistent pancreatic inflammatory disease. In chronic pancreatitis, recurrent episodes of inflammation lead to the replacement of pancreatic parenchyma with fibrotic connective tissue. Chronic pancreatitis pain, which may initially mimic acute pancreatitis, is severe, frequent, and continual and has a major impact on the quality of life and social functioning of patients. The standard treatments for this disease are endoscopy, surgery, splanchnic nerve denervation, thoracoscopic splanchnicectomy (TS), and video-assisted thoracoscopic surgery (VATS). Considering the advantages of the single-port method, we attempted to describe the post-treatment conditions of the patients undergoing this therapeutic approach.
Ten chronic pancreatitis patients with severe resistant pain volunteered to enter the study. We recorded the data on patients’ age, gender, pre-operative pain level, surgical complications, and post-operative pain level (two weeks after surgery) were recorded. Visual analogue scale (VATS) was used for pain assessment and paired sample t-test was performed for statistical evaluation of response to the treatment for pain.
The participants included one female and nine male patients with the mean age of 53.3±0.8 years. The mean duration of severe pain before the onset of treatment was 13 months (range: 6 to 20 months). The pain level was determined 3 to 5 days before the operation and re-graded two weeks post-operation. Pre- and post-operative pain scores showed a significant reduction in the severity of pain before and after surgery (P Single-port technique is recommended as a safe way to reduce pain in patients with chronic pancreatitis.

Since 1954, after the first surgical repair of tetralogy of Fallot (TOF), several innovations have occurred in cardiac surgery, especially in children. One stage complete repair of TOF is currently possible even in infancy; however, complications such as hypoxemia, arrhythmia, cardiac dysfunction, sudden death, and valvular disorders may happen. In this study, we evaluated the results of complete surgical repair of TOF with pulmonary stenosis.
Material and We assessed 74 cases of TOF with pulmonary stenosis that underwent surgery in Cardiac Surgical Ward of Imam Reza Hospital, Mashhad, Iran from 2008 to 2010.
Mean age was 5.74±3.31 years and more than half of the patients were male. Mean perfusion and cross-clamping times were 55.45±15.06 and 42.63±9.07 min,respectively. The most common coexisting anomaly was atrial septal defect. Further, 83.7% of the patients were symptomatic, and history of spell attacks was positive in 24.3% of the cases. Arrhythmia was reported in 28.4% of the patients. Mortality rate was 12.2% in our study, which was higher in younger patients (P=0.022) or those with lower weight (P=0.008), longer perfusion time during cardiac surgery (P=0.009), or presence of associated cardiac anomalies (P=0.030).
Outcomes and mortality rate of one-stage surgical repair of TOF with pulmonary stenosis was acceptable in our center, and arrhythmia was the most common postoperative complication

There are different approaches to reduce the amount of blood loss and allogenic transfusion in cardiac surgery. Regarding this, the present study aimed to evaluate the blood sparing effect of acute normovolemic hemidilution (ANH) combined with intrao-perative tranexamic acid in patients undergoing off-pump coronary artery bypass (OPCAB).
Material and This study was conducted on 80 consecutive patients scheduled for elective OPCAB. The patients were randomly subjected to tranexamic acid treatment (TA group) or to tranexamic acid plus ANH (ANH group). All data, including demographic information, allogenic transfusions (based on a prior defined criteria), amount of postoperative bleeding, and major complications, were recorded.
According to the results, the two groups were comparable in terms of the demographic data and intraoperative variables. The mean values of postoperative bleeding were 483±125 and 580±201 mL in the TA and ANH groups, respectively, indicating no significant difference between them in this regard. Total transfused packed red blood cells (PRBC) used in the TA and ANH groups were 15 and 20 units, respectively, which revealed no significant difference between the two groups in this respect (P=0.23). Furthermore, 12 and 10 patients in the TA and ANH groups were transfused with PRBC, respectively. Moreover, the two groups showed no significant difference in terms of the postoperative hematological variables (P>0.05).
As the findings of the present study indicated, ANH was not effective in reducing postoperative bleeding and the need for allogenic blood products in the patients undergoing OPCAB.

Silent myocardial infarction is a little-known phenomenon, the mechanisms of which have still remained unclear. Herein, we presented the case of a middle-aged man suffering from silent myocardial infarction who presented with homonymous hemianopia and no other major cardiovascular risk factors, except for stage 1 hypertension.

Severe internal carotid artery (ICA) stenosis is a common cause of cerebrovascular accident (CVA) in middle-aged patients. Contralateral carotid occlusion (CCO) in patients with severe ICA stenosis is associated with high risk of CVA. Carotid endarterectomy (CEA) is associated with more complications in patients with CCO than those without CCO. In this study, we present the case of a 61-year-old patient who presented with multiple transient ischemic attack and severe ICA stenosis associated with CCO and occlusion of vertebral arteries. The patient was treated successfully with carotid angioplasty and stenting.

A 54-year-old female patient was presented with upper extremity ischemia. Further investigation revealed ulcerated atherosclerosis plaque in aorta with intramural hematoma and clot formation. The subject underwent a successful surgical resection of mass with the assistance of cardiopulmonary bypass and total circulatory arrest.