Journal of Cardio -Thoracic Medicine
Volume:1 Issue: 2, Summer 2013

Indomethacin increases generation of mitochondrial reactive oxygen species (ROS) which have a crucial role in the indomethacin-induced gastric ulcer. Coenzyme Q10 has an antioxidant activity on mitochondria and cell membranes and protects lipids from oxidation and is essential for stabilizing biological membranes. Superoxide dismutase (SOD) acts as one of the defense mechanisms against free radicals. When the generation of ROS overwhelms, the antioxidant defense, lipid peroxiation of cell membrane occurs and cause cell damage. Male adult Wistar rats were divided into A and B groups. The rats in group A were then further divided into three subgroups of 6 animals each and received one of the following treatments: Animals in the first subgroup received saline. Animals in the second subgroup received saline and indomethacin. Animals in the third subgroup received vitamin C and indomethacin. The rats in group B were also further divided into 3 subgroups of 6 rats each and treated with one of the following treatments: Animals in first subgroup received 1% Tween 80 as vehicle. Animals In second subgroup received 1% Tween 80 and indomethacin. Animals in third subgroup received CoQ10 and indomethacin. Four hours after the last treatment, animals were killed and the stomachs removed were cut and gastric mucosal lesions were examined). Ulcer indexes were determined and SOD activity measured in plasma Pretreatment with both vitamin C and coenzyme Q10 was associated with attenuation of ulcer index and increased SOD activity compared with animals treated with indomethacin alone (P<0.001). This effect of CoQ10 may be due to its electron donating property that inhibits the decrease in SOD activity in gastric tissue (replenishment of endogenous SOD) and inhibiting lipid peroxidation.

Different etiologies of pleural effusion are diagnosed based on serum and plural fluid characteristics. The aim of this study was to assess and compare the serum and pleural fluid protein to lactate dehyrogenase (Pr/LDH) ratio in exudative pleural effusions. This study was conducted on 60 patients with exudative pleural effusion including: 20 cases with parapneumonic, 20 cases with Tuberculosis (TB), and 20 cases with malignancy. The serum and pleural Pr/LDH were measured and compared among 3 groups. The mean age of the patients was 55±19SD (years) and male to female ratio was 36/24. There was no statistically significant difference in mean age of the patients among 3 groups (p=0.08). There were statistically significant differences in serum and pleural Pr./LDH ratios among groups (p=0.04 and p= 0.1, respectively). Additionally the comparisons of serum and pleural Pr./LDH ratios between malignancy and tuberculosis groups were significant (p=0.02 and p=0.001, respectively). The serum and pleural Pr./LDH ratios were higher in TB group. The results of our study showed that serum and pleural Pr./LDH ratio can be used in differentiating the etiology of exudative pleural effusion, but needs to be confirmed by larger study.

yasthenia gravis is an autoimmune disorder resulting from a decreased number of active acetylcholine receptors at the neuromuscular junction. Thymectomy is one of its current treatments. Due to sensitivity of myasthenic patients to non-depolarizing muscle relaxants and also the interaction of this medication with anti-cholinestrase drugs, determining the dosage of non-depolarizing muscle relaxants for induction of anesthesia is one of the hurdles in thymectomy. 20 myasthenic patients undergoing transsternal thymectomy were enrolled into the study.They were divided into two groups randomly, and received either 0.25 mg/kg or 0.50 mg/kg of atracurium to facilitate tracheal intubation. Neuromuscular blockade was measured using train of four (TOF) mode of neuromuscular stimulator 15 minutes after administration of atracurium and then each 5 minutes till entered the recovery phase. The time between injection of atracurium and the recovery phase was compared between the two groups. The two groups were similar with respect to age and gender. The time from the onset of myasthenia gravis to surgery, dosage and duration of pyridostegmine used preoperatively were not significantly different between the two groups.The time from administration of atracurium to recovery phase was not significant between the two groups (P=0.24). There was no difference between two different doses of atracurium regarding entering the recovery phase, and as the effects of non-depolarizing muscle relaxants are unpredictable in myasthenic patients, we recommend the lower dose to prevent profound skeletal muscle weakness and postoperative complications

Severepain is a major problem in patients with unresectable pancreatic cancer. The goal of this study is to evaluate the effects of Thoracoscopic Splanchnicectomy (TS) on pain control in these patients suffering from unresectable pancreatic cancer. Between years 2000 to 2011, 20 patients suffering from unresectable pancreatic cancer underwent TS due to severe pain. They were studied in terms of age, sex, location of pancreas tumor, history of previous surgery, response to treatments for pain control (assessed with VAS scoring system) and complications of surgery. M/F = 14/6 with a mean age of 63 years. The most common tumour site was at the pancreas head (in 8 patients). The most cause of unresectability was local expansion to critical adjacent elements (in 10 patients). Surgery was performed successfully in all patients. Post-operative complication included only pleural effusion on the left side which was cured by proper treatment. There were no post-op mortalities. 15 patients had acceptable levels of pain at the end of a six month follow-up period. TS provides good pain control, little side effects and minimal invasiveness, the technique is recommended for pain control in patients with unresectable pancreatic cancer.

Significant left main coronary artery stenosis jeopardizes the entire myocardium of the left ventricle and has the worst prognosis of any form of coronary artery disease. Coronary-artery bypass grafting (CABG) has been considered as the standard therapeutic approach for such patients. There are limited data on the safety and effectiveness of percutaneous coronary intervention (PCI) in patients with unprotected left main coronary artery disease. In this study we have reported our experience on early, intermediate and long term results of LMC intervention. From Dec. 2007 to Mar. 2012, PCI with drug eluted stent (DES) or in some cases by a bare stent was performed on de-novo lesions of unprotected left main coronary artery in 50 patients. The inclusion criteria were: patients having refused CABG but with favorable anatomy for stenting; patients with poor general condition or comorbidity whom were refused by the cardiac surgeon and emergent patients for whom CABG was not accessible. The angiographic and procedural success rate was 100%. Four patients died, two because of severe heart failure, the third due to noncardiac etiology, and the fourth due to probable stent thrombosis. We have one target lesion revascularization (TLR=2%) and no reinfarction was occurred. Routine DES implantation in unprotected left main disease seems a feasible and safe method with favorable outcomes.

As off pump Coronary artery bypass grafting surgery (CABG) is a developing method in coronary cardiac surgery, most surgeons are anxious about the danger of emergency crash conversion. In this observational study we tried to show the rate and outcome of conversion. In this descriptive study about 477 coronary off-pump CABG patients were operated in Ghaem hospital in Mashhad, Iran, from Jan 2012 to Jan 2013.In this group 20 patients needed to convert to Cardiopulmonary Bypass (CPB) immediately. We analyzed these 20 patients and produced the results. There was no cerebrovascular accident (CVA) and no neurologic problems.There was one death among these 20 patients. There was one case of renal failure who was the same patient that expired. 75% of these 20 patients had hypertension and 45% had diabetes. 20 patients (4.19%) had an emergency switch to On-pump CABG and only one death occurred among 20 patients.

Aluminum phosphide (AlP) is a highly effective rodenticide which is used as a suicide poison. Herein, a 24 year-old man who’d intentionally ingested about 1liter of alcohol and one tablet of AlP is reported. Acute myocardial infarction due to AlP poisoning has been occurred secondary to AIP poisoning. Cardiovascular complications are poor prognostic factors in AlP poisoning

Dr.Mirsadraei and colleagues performed an interesting study about the lung HRCT findings in chemical warfare patients who suffering from long-term pulmonary complications. They found that air trapping and mosaic attenuation were the most common lung HRCT findings. Also they divided patients in different clinical entities according to the lung HRCT findings (Bronchiolitis Oblitrans, pulmonary fibrosis, bronchiectasis, asthma, and COPD). At present, GOLD and GINA recommend the diagnosis of COPD and asthma mainly on spirometry (1, 2). Although the HRCT may have valuable diagnostic points, but the diagnosis of COPD and asthma is according to the spirometry and relevant clinical symptoms. In this article, the authors relied only on clinical symptoms and corresponding lung HRCT findings that may have overlapping points in the diagnosis of asthma and COPD since normal lung HRCT with or without air trapping can be seen in COPD too (3). It has been proposed that saber-sheath trachea (tracheal index<2/3) is a valuable imaging diagnostic parameter in COPD (4) that can be used in interpretation of lung HRCT. In conclusion, performing spirometry and bronchodilation test besides the clinical symptoms and lung HRCT findings could be more accurate for diagnosis asthma and COPD in chemical warfare patients.