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Journal of Cardio-Thoracic Medicine
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  This is an Open Access Journal Open Access journal
   ISSN (Print) 2345-2447 - ISSN (Online) 2322-5750
   Published by Mashhad University of Medical Sciences Homepage  [12 journals]
  • Primary sternal osteomyelitis: a case report and literature review

    • Abstract: Primary sternal osteomyelitis is a rare, yet potentially devastating presentation. Sternal osteomyelitis and underlying mediastinal infection is far more common in patients post cardiac surgery. In this group incidence has been reported as 1-2%; however, reported mortality ranges between 14-47%. A 55 year old male presented to the emergency department with a 2 week history of anterior chest wall pain and swelling.
      PubDate: Fri, 01 Apr 2016 19:30:00 +010
       
  • Primary Sternal Osteomyelitis: A Case Report and Review of the Literature

    • Abstract: Primary sternal osteomyelitis is a rare clinical entity generally caused by Staphylococcus aureus or Pseudomonas aeruginosa.Although rare it carries significant morbidity including spread to mediastinal structures and even mortality. Diagnosis is generally made on clinical suspicion in a patient with and anterior chest pain and swelling, fever and raised inflammatory markers. Management is generally aggressive surgical debridement and intravenous antibiotics. Hyperbaric oxygen can be used where available and reconstructive options need to be considered in those with extensive dissection. Herein we report the case of a 55 year old male with no previous chest surgery or trauma who presented with primary sternal osteomyelitis.
      PubDate: Mon, 29 Feb 2016 20:30:00 +010
       
  • A Report on Emergent Pulmonary Embolectomy

    • Abstract: Introduction: Pulmonary embolism is one of the leading causes of mortality in patients.The mortality rate of this disease can be significantly reduced with appropriate treatment. Surgical intervention can be highly effective for the treatment of acute massive pulmonary embolism. This article presents a report on the experience of acute pulmonary embolectomy. Materials and Methods: Demographic data, rate of mortality, as well as surgical and post-operative complications were recorded and analyzed. Results: In general, 12 patients with mean age of 60±13.39 year were included in the study. None of the patients had significant arrhythmia during the surgery, but 25% suffered from post-operative arrhythmia. Moreover, electrical cardioversion was administered to 8% of the patients, 8% received pharmaceutical interventions, and the rest of the patients sustaining arrhythmia (9%) survived with specific metabolic correction. The diagnosis of acute pulmonary embolism was correct in 100% of the patients, with 33.3% of the cases suffering from this disease due to recent surgeries. In 41.6% of the patients, blood clots were observed in the pulmonary artery, right atrium, and right ventricle. The three-month follow-up of the patients showed that 83.3% of the cases were alive. There were two cases of mortality, one of which occurred at the end of surgical procedure and the other one happened in the intensive care unit. The results of independent t-test did not indicate any significant relation between mortality and ejection fraction of the patients (P=0.189). Moreover, there were not any significant differences between the patients’ pre- and post-operative laboratory tests (P˃0.05). Nonetheless, hemoglobin and hematocrit levels were significantly different pre- and post-operation (P=0.0001). Conclusion: Our data suggest that acute pulmonary embolism can be treated successfully with favorable outcome and a mortality rate of approximately 16.6%, if evaluation and diagnosis are done as soon as possible in patients who require surgical intervention.
      PubDate: Mon, 29 Feb 2016 20:30:00 +010
       
  • Asymptomatic Diaphragmatic Hernia Diagnosed after Six Years Following
           Esophagectomy: A Case Report

    • Abstract: Diaphragmatic hernia, secondary to transhiatal esophagectomy, appears to be a relatively infrequent diagnosis. Patients may be asymptomatic or present with various symptoms. Diagnosis of this condition requires a high index of suspicion. The most common cause of diaphragmatic hernia is widened esophageal hiatus during surgery; therefore, narrowing the hiatus can prevent conduit herniation. Herein, we present the case of a 65-year-old man, who underwent transhiatal esophagectomy and gastric pull-up for squamous cell carcinoma six years ago. The patient was asymptomatic and diaphragmatic hernia was detected unexpectedly in the surveillance follow-up interval. In the present report, we also aimed to discuss the risk factors, as well as preventive and treatment methods.
      PubDate: Mon, 29 Feb 2016 20:30:00 +010
       
  • The Correlation between Left and Right Ventricular Ejection Fractions in
           Patients with Ischemic ...

    • Abstract: Introduction: The correlation between right and left ventricular ejection fractions (RVEF and LVEF, respectively) has been studied in only a small number of patients with a marked decrease in RVEF and LVEF. The aim of the present study was to compare LVEF and RVEF in patients with ischemic heart disease. RVEF and LVEF were measured by Cardiovascular Magnetic Resonance (CMR) imaging. Materials and Methods: This observational study was done in Ghaem general hospital in 2014.  LVEF and RVEF were measured in a series of 33 patients with ischemic heart disease, undergoing CMR for the evaluation of myocardial viability. The correlation between RVEF and LVEF in patients with ischemic heart disease was studied, using Pearson product-moment correlation coefficient analysis.   This study was done in Ghaem general hospital in 2014 with simple sapling. Results: Right ventricular end diastolic volume (186.33±58.90) and left ventricular end diastolic volume (121.72±61.64) were significantly correlated (r=0.223, P=0.005). Moreover, there was a significant correlation between right ventricular end systolic volume (88.18±40.90) and left ventricular end systolic volume (140.96±35.33) (r=0.329, P=0.000). The most significant association was observed between RVEF and LVEF (r=0.913, P=0.000). Conclusion: Based on the findings, RVEF and LVEF were significantly correlated in patients with ischemic heart disease, although this association was not always present in all cardiac patients. The cause of this discrepancy is still unknown.
      PubDate: Mon, 29 Feb 2016 20:30:00 +010
       
  • Association between Body Mass Index and Mitral Valve Prolapse

    • Abstract: Introduction: Body mass index (BMI) can affect cardiac morphology; however, the relationship between BMI and valvular heart diseases has not been thoroughly evaluated. This study aimed to determine the relationship between BMI and mitral valve prolapse (MVP) as one of the most common valve diseases worldwide. It can help us to better understand pathophysiology of this common disease. Materials and Methods: In this descriptive study we enrolled 200 patients with isolated MVP. This patient was referred from 2014 to 2015 to our cardiology clinic in Mashhad, Iran, with chief complaint of chest pain, dyspnea, and palpitation. This patient underwent transthoracic echocardiography. We document the patients’ height, weight, and demographics data. BMI distribution was categorized as higher and lower than 18.5 kg/m2. Chi- square and independent samples t-test were performed using SPSS version 19 to analyze the data. Results: The results showed that 92 (46%) and 108 (54%) of the samples were male and female, respectively, and their mean age was 24.29±3.75 years. Most of the patients(n=110) had low BMI (55% of the patients had BMI lower than 18.5 kg/m2). Left atrial and ventricular diameters had a significant relationship with BMI of all the underweight patients(n=110) (P=0.026 and 0.032, respectively). The main complaints were chest pain (n=55,50%) and dyspnea (n=58,64.44%) in the patients with low and normal BMI, respectively. Conclusion: Symptoms and echocardiographic features in MVP patients vary with BMI. While mitral valve annulus diameter was the same in both BMI groups, the results showed that left atrial and ventricular diameters in the underweight patients were less than those with normal BMI.
      PubDate: Mon, 29 Feb 2016 20:30:00 +010
       
  • Oral Health and Coronary Artery Disease, A Review Of Articles

    • Abstract: Atherosclerosis is the most common cause of myocardial infarction and ischemic stroke. Various risk factors have been identified for atherosclerosis. Recently, bacterial and viral organisms, which are involved in chronic inflammatory processes, have been also implicated in atherosclerosis development. Individuals with a prior history of periodontal diseases and/or tooth loss are considered to be at a higher risk for peripheral arterial disease, compared to those without periodontal diseases or tooth loss. Evidence suggests that periodontitis contributes to the overall burden of infection and inflammation and may lead to cardiovascular events and stroke in susceptible patients. In this article, we aimed to review the available data on the relationship between periodontal diseases and cardiovascular diseases, especially coronary artery disease. At least sixty papers were reviewed during 2014-15. Of these, 44 were included in our study.
      PubDate: Mon, 29 Feb 2016 20:30:00 +010
       
  • A Three-Year Experience of Medical Thoracoscopy at A Tertiary Care Center
           of Himalayan Region

    • Abstract: Introduction: Medical thoracoscopy is a minimally invasive procedure for diagnosing and treating pleural diseases. Despite its proven role in diagnostic and therapeutic purposes, it is infrequently used, which could be because of cost of equipment and lack of training. We analyzed our initial 3 years record of thoracoscopy at Himalayan Institute of Medical Sciences, a tertiary care center in Himalayan region of north India. Materials and Methods: This cross-sectional study was to analyze our experience of medical thoracoscopy which was started in Jan 2011 at our center. All patients who underwent thoracoscopy during the period between Jan 2011 to Dec 2013 were included in the study. Thoracoscopy was performed for diagnosis of undiagnosed pleural effusions. Clinical, radiological, cytological & histopathological data of the patients were collected prospectively and analysed. Results: The diagnostic yield for a pleuroscopic pleural biopsy in our study was 87.23% (41/47). Malignancy was diagnosed histopathologically in 70.2% (33/47) patients (both primary & metastatic pleural carcinoma) and tuberculosis in 10.6% (5/47). There was no mortality related to procedure. Only three patients had minor complications like subcutaneous emphysema which was mild and resolved by second post-procedure day. Pain at intercostal drain site was observed in some patients. Conclusion: Thoracoscopy is an easy outpatient procedure and an excellent diagnostic tool for pleural effusion of uncertain etiology. It has low complication rate even in settings where the procedure is just started. It should be included in the armamentarium of tools for management of pleural effusion.
      PubDate: Mon, 29 Feb 2016 20:30:00 +010
       
  • Endobronchial Tuberculosis and Chest Radiography

    • Abstract: Endobronchial tuberculosis and chest radiography I read, with interest, the article entitled “Clinical and Para-clinical Presentations of Endobronchial Tuberculosis” by Ahmadi Hoseini H. S. et al. (1) published in this journal. I would like to focus on some details about the chest X-ray of patients as elaborated by the authors in the results section. Accordingly, the findings of chest radiography in the available patients were as follows: pulmonary consolidation (75%), reduced pulmonary volume (20%), and hilar adenopathy (10%). This is an incomplete statement because the authors did not explain whether there was any normal chest radiography in the study population. In addition, it is not clear whether the X-ray examinations of the patients were normal, how many abnormal plain films yielded the presented data. On the other hand, the fact that the studied patients had no normal chest radiography is  controversial since in the literature, 10-20% of the patients with endobronchial tuberculosis are reported to have normal chest X-ray (2, 3). In fact, this is one of the problems in the diagnosis of the disease, as well as a potential cause of delayed diagnosis and treatment of the patients. Therefore, the absence of normal chest radiographs is in contrast to the available literature, and if not an error, it could be a subject of further investigation.
      PubDate: Mon, 29 Feb 2016 20:30:00 +010
       
 
 
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