فهرست مطالب

Cardio -Thoracic Medicine - Volume:5 Issue: 2, Spring 2017

Journal of Cardio -Thoracic Medicine
Volume:5 Issue: 2, Spring 2017

  • تاریخ انتشار: 1396/03/17
  • تعداد عناوین: 8
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  • Sharzad Lari, Davood Attaran, Farveh Vakilia, Mostafa Kamandi, Hamideh Feiz Disfani * Pages 558-563
    Introduction
    Noninvasive positive pressure ventilation (NIPPV) has become an integral tool in the management of acute hypercapnic respiratory failure (AHRF) in chronic obstructive pulmonary disease (COPD). This study was performed to evaluate the early effects of NIPPV on pulmonary artery pressure (PAP), serum N-terminal pro BNP (NT-proBNP), and ventilatory parameters in the COPD patients with AHRF.
    Materials and Methods
    This quasi-experimental study was conducted on 20 COPD patients with AHRF. The participants received the standard treatment in addition to NIPPV. There was no contraindication for NIPPV. Arterial blood gas analysis, Doppler echocardiography (for measuring PAP), and plasma NT-proBNP measurements were performed before and after NIPPV.
    Results
    According to the results, the mean age of the participants was 54.57±15.43 years. Furthermore, the mean pressures of carbon dioxide (PCO2), NT-proBNP levels, and PAP were 72.33±13.96 mmHg, 4333.90±6542.20 pg/ml, and 47.5±6.38 mmHg, respectively. After one week of NIPPV, there were statistically significant differences among the mean pH, PaCO2, PAP, and NT-proBNP (P
    Conclusion
    As the findings of the present study indicated, the application of NIPPV in the COPD patients with AHRF can not only improve arterial blood pH and carbon dioxide tension, but also instantly decrease NT-proBNP levels and PAP.
    Keywords: Brain Natriuretic Peptide Chronic Obstructive Pulmonary Disease, hypercapnic respiratory failure, noninvasive positive pressure ventilation
  • Bhupendra Jain *, Nikhilesh Pasari, Ashwin Songra, Ashok Bajpai Pages 564-568
    Introduction
    More than 90% of the deaths caused by chronic obstructive pulmonary disease (COPD) occur in the low- and middle -income countries. The main aim of this study was to investigate the lipid profile levels in COPD patients and examine the correlation of total cholesterol, triglycerides, low-density lipoproteins, high density lipoproteins, and LDL/HDL risk ratio with COPD stages that are developed by the global initiative for chronic obstructive lung disease (GOLD)
    Materials and Methods
    A total of 100 COPD patients including 25 COPD non-smokers were enrolled in this study. The diagnosis of COPD was carried out by using the spirometry following the GOLD guidelines (post-bronchodilator forced expiratory volume (FEV1)/forced vital capacity (FVC) ratio
    Results
    According to the results, the majority 53 patients (53%) were in age group 40 to 60 years with mean age of 60.46 11.56. Most of the patients had moderate to severe airflow obstruction (GOLD stages II and III). The severity of COPD had no significant correlation with the triglycerides, LDL, HDL, and LDL/HDL risk ratio. The mean total cholesterol levels in the stages I and IV were 151.92±32.82 and 128.50 ±21.46 mg/dL, respectively, which was statistically significant (P=0.04).
    Conclusion
    The present study indicates that there was no significant correlation between various lipid profile parameters and severity of COPD.
    Keywords: Obstructive Pulmonary Disease, Chronic Obstructive Lung Diseas, Lipid profile, Spirometry
  • Reza Bagheri *, Seyed Ziaollah Haghi, Nazanin Hazrati, Mahdi Silanian Toosi, Mitra Ahadi Pages 569-574
    Introduction
    Surgery is the first therapeutic option for esophageal cancer. There is controversy over the selection of the best surgical approach. Regarding this, the present study aimed to compare the minimally invasive and open esophagectomy in terms of their short-term outcomes and preoperative complications.
    Materials and Methods
    This randomized clinical trial was conducted on 61 patients in Ghaem Hospital, Mashhad, Iran, within 2011-2013. The patients were assigned into two groups based on the type of therapeutic approach they received. The minimally invasive esophagectomy (MIE) and open esophagectomy (OE) groups consisted of 31 and 30 patients, respectively. For the purpose of the study, we collected such data as age, gender, site of lesion, bleeding, duration of surgery, rate of switch to open approach, post-operative morbidity, duration of hospital stay, and mortality rate.
    Results
    According to the results of the study, 60.7% of the participants were male. The mean age of the patients was 62.39±11.91 years. There was no significant difference between the two groups regarding the site of lesion (P=0.014) and stage of tumor (P=0.108). No significant difference was observed between the MIE and OE groups in terms of the blood transfusion (P=0.981). Considering the complications, there was one case of fistula in the MIE group; furthermore, one and two cases of wound infection and pleural effusions were observed in the OE group, respectively. There were no significant differences between the two groups in terms of the post-operative complications, namely fistula, pleural effusions, and wound infection (P=0.492, P=0.238, and P=0.492, respectively). The MIE group had longer operation time (P≤0.001). There was one patient in the MIE group converted to open approach. The duration of hospitalization was significantly longer in the OE group, and there was no mortality.
    Conclusion
    As the findings of the present study demonstrated, the MIE outcomes were comparable with those of the OE with improved short-term outcomes.
    Keywords: Esophageal Cancer, Minimally invasive surgery, thoracoscopic esophagectomy
  • Ashish Avinash Baviskar *, Chandan Kumar Ray Mohapatra, Chaitanya Raut, Jayant Khandekar Pages 575-578
    Introduction
    In this study, we sought to illustrate our experience in urgent surgical management for embolized cardiac septal occlude devices resulting from trans-catheter closure of atrial septal defect and ventricular septal defect.
    Mathrials and
    Methods
    We retrospectively reviewed four patients aged 2–10 years who underwent urgent surgery due to cardiac septal occluder embolization between December 2015 and December 2016. Congenital defects were atrial septal defect (n=2) and ventricular septal defect (VSD) (n=2). Risk factors for device embolization and the need for urgent surgical retrieval/definitive management techniques for embolized device removal are discussed.
    Results
    Removal of embolized devices was performed in all the cases. Inevitably, in three patients the primary defect was closed, while in one case of VSD the device was removed without closing the defect. All the operations were completed successfully and no hospital mortality or morbidity was encountered.
    Conclusions
    Although closure of left to right shunting defects by percutaneous occluder devices has several advantages, device embolization is still a major complication. If embolized device retrieval fails with percutaneous intervention attempts, surgical management is the only method to remove embolized devices. In this circumstance, to provide an uneventful perioperative course, urgent management strategies should be well planned.
    Keywords: Atrial Septal Defect, EMBOLIZE, OCCLUDER DEVICE, Ventricular Septal Defect
  • Ramin Khamene Bagheri, Faeze Keihanian, Mostafa Ahmadi *, Samane Hasanzadeh Pages 579-582
    Rheumatic fever (RF) is a prevalent healthcare problem in the developing countries. Recurrence of this disorder is often observed in childhood and adolescence. RF can mimic the presentations of infective endocarditis, and clinicians are not really familiar with this issue. Herein, we present a case of recurrent acute rheumatic fever in a patient suspicious of acute bacterial endocarditis due to her previous RF. Finally, she was definitively diagnosed and underwent valvular replacement surgery and received prophylaxis antibiotics besides regular follow-up
    Keywords: infective endocarditis, prolonged fever, recurrent rheumatic fever
  • Juan Siordia *, Sreekumar Subramanian Pages 583-586
    Certain subsets of high-risk mitral valve patients are not suitable candidates for transcatheter therapies. The objective of this report is to present a young patient with combined mitral valve and coronary artery disease to illustrate these challenges.In this report, we present a 47-year-old man with longstanding HIV infection who was referred with severe mitral regurgitation (MR) and profound cardiomyopathy to highlight the importance of decision-making and perioperative management.A 47-year-old HIV positive man with New York Heart Association class IV congestive heart failure was found to have severe MR (mixed Carpentier Type I and IIIB pathologies). The last viral load titer of the patient was undetectable. Cardiac catheterization revealed a chronic total occlusion of the middle of left anterior descending artery, ostial obtuse marginal and 70% posterior descending artery lesion, as well as severe pulmonary hypertension (PAP of 70/30 (mean: 43)), and a pulmonary vascular resistance of 4.6 Woods units. Preoperative cardiac magnetic resonance imaging showed left ventricular ejection fraction of 20%, right ventricular ejection fraction of 30%, nonviable circumflex distribution and scattered viability in the anterior and inferior cardiac walls. He underwent a high-risk coronary artery blood grafting plus mitral valve (MV) replacement (with intra-aortic balloon pump support). The postoperative course was complicated by gastrointestinal bleeding requiring transfusion, aspiration pneumonitis, atrial flutter and difficile colitis. However, the patient recovered appropriately, and remained asymptomatic and healthy in three months follow-up postoperatively. Application of transcatheter MV or device-assisted therapies for high-risk patients with severe MR might be limited due to financial, medical or social situations. In these instances, high-risk mitral valve surgery may still be the choice treatment in the selected patients.
    Keywords: Coronary artery bypass grafting, HIV, Mitral Valve
  • Seyed Hossein Fattahi Masoom, Amir Mohammad Hashem Asnaashari *, Seyed Hossein Ahmadi Hoseini, Yavar Shams Hojjati, Aida Shams Hojjati Pages 587-590
    Unlike the primary tracheal tumors, squamous cell carcinoma of trachea is common, especially in smokers. This type of tumor has a low rate of survival and it is diagnosed too late on account of late presentation of its signs. The treatment of choice is surgical removal followed by adjuvant radiotherapy; Primary radiotherapy is the appropriate treatment in inoperable cases. In this study, we present the case with a long history of smoking, who was suffering from cough and dyspnea for a long time. During diagnostic evaluations a vegetated tumor was observed about 5 centimeters below the vocal cords. Pathologists reported the tumor as a squamous cell carcinoma, and the patient underwent an operation for resection of involved trachea.
    Through presenting this patient, we aimed to draw attention to this uncommon malignancy and recommend considering it as a probable diagnosis when evaluating a patient with treatment-resistant respiratory symptoms
    Keywords: Bronchoscopy, Squamous Cell Carcinoma, Trachea
  • Mozhgan Saeidi, Ali Soroush, Behzad Heydarpour, Saeid Komasi * Pages 591-592