فهرست مطالب shapoor shirani

Herein, we present a case with clinical and laboratory manifestations of infectious endocarditis but in echocardiography, the ventricular septal defect and bicuspid aortic valve were detected without any vegetation. However, an aortic root pseudoaneurysm was first suspected in transesophageal echocardiography and then confirmed in computed tomography angiography of the aorta that points to importance of searching infectious endocarditis complications even in absence of vegetation.

Nowadays, the early diagnosis of tumoral diseases is more possible and accurate with multiple diagnostic imaging modalities such as chest X-ray, echocardiography, computed tomography, and magnetic resonance imaging, especially for cardiac tumors which are usually asymptomatic, even in large sizes. In cardiac masses, the patients’ presentations are non- specific and dependent on the tumor size and site as well as its compressive effect on the adjacent structures. On the other hand, the first and last signs could be sudden cardiac death. However, cardiac masses are either benign or malignant and metastatic in their malignant type, and their definite diagnosis is only possible by surgical tumor resection and tissue biopsy. In this paper, we describe an old patient with severe pericardial effusion and an unusual intrapericardial tumor in transthoracic echocardiography, representing a rare case of a giant ectopic thymoma after surgical resection and pathologic assessment.

Among the therapeutic options for achalasia are pneumatic dilatation (PD)، an appropriate long-term therapy، and botulinum toxin injection (BT) that is a relatively short-term therapy. This study aimed to compare therapeutic effect of repetitive pneumatic dilation with a combined method (botulinum toxin injection and pneumatic dilation) in a group of achalasia patients who are low responder to two initial pneumatic dilations. Thirty- four patients with documented primary achalasia that had low response to two times PD (<50% decrease in symptom score and barium height at 5 minute in timed esophagogram after 3month of late PD) were randomized to receive pneumatic dilation (n=18) or botulinum toxin injection and pneumatic dilation by four weeks interval (n=16)، PD and BT+PD groups respectively. Symptom scores were evaluated before and at 1، 6 and 12 months after treatment. Clinical remission was defined as a decrease in symptom score ≥ 50% of baseline. There were no significant differences between the two groups in gender، age and achalasia type. Remission rate of patients in BT-PD group in comparison with PD group were 87. 5% vs. 67. 1% (P = 0. 7)، 87. 5% vs. 61. 1% (P = 0. 59) and 87. 5% vs. 55. 5% (P = 0. 53) at 1، 6 and 12 months respectively. There were no major complications in either group. The mean symptom score decreased by 62. 71% in the BT-PD group (P < 0. 002) and 50. 77% in the PD group (P < 0. 01) at the end of the first year. Despite a better response rate in BT+PD group، a difference was not statistically significant. A difference may be meaningful if a large numbers of patients are included in the study.

Endovascular aortic repair (EVAR), as a new and less invasive method for treatment ofaortic aneurysms, has shown lower short term complications than routine open surgical repairs. Inthis report we present our results with the first consecutive series of this technique in our patients.
From Dec. 2006, we began a prospective case series of EVAR patients for the first time inIran, and so far, 15 consecutive patients (1 female, 14 male) with the mean age of 66 years (range36 to 89 years old) underwent endovascular aortic aneurysm repair (3 thoracic, 11 abdominal, 1combined thoracic and abdominal) with Medtronic “Talent” or “Valiant” stent grafts. In-hospitaland one month follow up results are reported as short-term outcome.
Results:All 12 abdominal aorta aneurysms (AAA) were infrarenal with an acceptable proximal neck. Ineight patients, associated iliac aneurysms were seen. For 11 AAA patients, routine modular stentgrafts were used and in one case, unilateral stent graft was implanted because of difficulty ofcontrolateral stent graft implantation. Four thoracic aorta aneurysms (TAA) were repaired withValiant stent grafts. One of them was a Marfan patient with recent Bentall surgery and two werepost-surgery saccular aneurysms. In all 15 cases, stent graft implantation was done successfully. Infive cases, mild type II endoleak was seen at the end of the procedure, which was no longerpresent on one month follow up. One patient had post- procedure cerebral stroke with delayed
mortality. No other major complications were seen in 1 month follow up in the other 14 cases.Minor complications like vascular access hematoma, anemia and increased creatinine were
controlled on hospital stay period in some cases. Control CT angiography in some patients
revealed no endoleak or aneurysm enlargement and 6 and 12-month follow up assessment will bedone for mid-term results.
Endovascular repair of aortic aneurysm is feasible and safe for suitable cases based on bothclinical and radiologic findings. Good case selection, good device selection and suitable follow up