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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  [11 journals]
  • Prevalence of Traditional Cardiovascular Risk Factors in Low Socioeconomic
           Group in Birjand, ...

    • Abstract: Introduction: The assessment of cardiovascular risk factors in low socioeconomic population is significant. The present survey aimed at investigating  the prevalence of cardiovascular risk factors among  citizens who are under the supervision of Imam Khomeini Relief Foundation (IKRF). Materials and Methods: The present  study was done on 1008 individuals under  IKRF in Birjand in 2007 through multi stage random sampling . A questionnaire was used for data collection. Demographic characteristics such as age, sex, tobacco use and previous  history of cardiac risk factors were recorded. Blood pressure, waist  circumference, weight  and height   were measured by two trained nurses. Fasting blood sugar (FBS), serum lipids (cholesterol, triglyceride, HDL and LDL) were measured after 12 hour overnight fasting. Chi-square .and  T test were used for data analysis at the significant level 0.05 using SPSS software( version 15). Results: Mean age of  the patients was 39±16.8 years. The most common risk factor  was dyslipidemia ( 72% ).Prevalence of  hypercholesterolemia and hypertriglyceridemia  was 43/2% and 12.7% , respectively. Overweight and obesity were diagnosed in 32.1%  . Prevalence of hypertension  and diabetes  mellitus  was  13.1%  and  6.3%, respectively . Cigarette smoking was diagnosed  in 9.8 %of the participants. The Prevalence of cardiac risk factors were more in female , except hypertension was equal in male and female. Conclusion: Dyslipidemia ,obesity ,and HTN were the most prevalent risk factors in IKRF  supported  group ;as a low socioeconomic status one .Thus , effective educational  programs for all the community and screening of cardiac risk factors must be done in all individuals ,particularly  in those having  a low socioeconomic status.
      PubDate: Sun, 07 Dec 2014 20:30:00 +010
       
  • Screening for Celiac Disease Using Anti_tTG in Patients with Esophageal
           SCC between 2004 and 2009

    • Abstract: Introduction: Esophageal Squamous-Cell Carcinoma (SCC) is one of the most common malignancies in Iran. To reduce the incidence of esophageal SCC, it is important to recognize the controllable risk factors and prevent them. Celiac disease is widely known as a possible risk factor for esophageal SCC.  Thus, we decided to assess the prevalence of celiac disease in esophageal SCC patients in Iran in order to find the correct correlation between the two diseases. Material and Methods: One hundred and forty-three cases of esophageal SCC were examined for anti tissue transglutaminase antibody (anti-tTG) between the years 2004 and 2009 in Ghaem Hospital of Mashhad University of Medical Sciences, Iran. The enzyme-linked immunosorbent assay was the test of choice in this study since it provides the sensitivity and specificity needed for the diagnosis and screening of celiac disease. The results of this test were compared with those of the control group which were compatible in terms of sex and age. Data were analyzed through SPSS software and statistical analysis such as x2, exact x2 and T-test. Results: In SCC group roughly 80.4% showed negative results for anti_tTG (<20) while 19.6% showed positive results (>20) and in control group approximately 92.1% showed negative results for anti_tTG while 7.9% showed positive results. Accurate analysis of the results of the SCC group through X Square test indicated a more significant prevalence of positive anti_tTG in the patients with esophageal SCC who were under the age of 40 years old (P-value=0.005) than other age ranges. Conclusion: There seems to be a certain correlation between celiac disease (positive anti_tTG) and esophageal SCC; that is to say, celiac disease might play a role in the earlier manifestations of esophageal SCC.
      PubDate: Sun, 07 Dec 2014 20:30:00 +010
       
  • The Role of Pyloromyotomy on Gastric Drainage in Esophagectomy and Gastric
           Pull-up Procedures: ...

    • Abstract: Introduction: Gastric drainage disorder is one of the complications of gastric pull-up and esophagectomy after surgery which might lead to esophageal cancer and benign strictures. The aim of this study was to determine the role of pyloromyotomy on gastric drainage. Material and Method:  In this prospective randomized controlled clinical trial study, we recruited 51 patients in two matched groups. Twenty-seven patients in group one had no pyloromyotomy and 24 patients in group two had pyloromyotomy after transhiatal esophagectomy and gastric pull-up procedure. The outcome was measured as the incidence of gastric outlet compromise which was diagnosed 12 months after esophagectomy and gastric pull-up. Regurgitation, fullness, respiratory distress, coughing and, clinical delayed gastric emptying were observed and compared in two groups by radioisotope gastric emptying scanning. A total number of 51 patients, 19 (37.25%) male and 32 (62.75%) female were included in this study. The overall incidence of delayed gastric emptying was 19 /51 (37.25%). Pyloromyotomy did not reduce the incidence of delayed gastric emptying; Ten patients (37%) in group one vs. 9 patients (37.5%) in group two (p= 0.97). There was no significant statistically difference in the length of hospital stay in either group (group 1= 11 days versus 12 days in group 2, p=0.41). There was no statistical difference in anastomotic leak or anastomotic stricture (p= 0.72). Mortality was two (one patient 3.7% in group 1 and one patients 4.2% in group 2). The incidence of regurgitation, increased gastric emptying were no different in both groups. Conclusion:  Pyloromyotomy can not reduce the incidence of delayed gastric emptying after transhiatal esophagectomy, and vagotomy.
      PubDate: Sun, 07 Dec 2014 20:30:00 +010
       
  • Improvement of Atrial Flutter Rhythm after Removal of Infected Permanent
           Pace Maker Lead.

    • Abstract: Pace maker infection had multiple risk factors. Presentation most often is similar to infected endocarditis. Diagnosis is made by blood cultures. Trans esophageal echocardiography is used for confirmation. The most common microorganisms are staphylococcus speciesis. Complete pace maker removal is only definite treatment. We presented a case of infected pacemaker lead who presented with fever, nephritic syndrome. She had intermittent atrial flutter rhythm.  A total infected pacemaker system was removed under cardiopulmonary bypass support but the lead was attached hard to septal leaflet of tricuspid valve and leaflet repair was needed. Atrial flutter rhythm converted to sinus rhythm after incidentally interrupting macroreentrant circuit by tricuspid leaflet surgery.
      PubDate: Tue, 02 Dec 2014 20:30:00 +010
       
  • Malignant Fibrous Histiocytoma of the Lung: a case report

    • Abstract: Malignant fibrous histiocytoma( MFH) is the most common soft tissue sarcoma that occurred predominantly in the retro peritoneum and extremity. MFH of lung is very rare.Diagnosis is essentially with histologic examination but invasion of the chest wall or other organ established the malignant nature. We report a case of 77-year-old male presented with history of dyspnea and non-massive hemoptysis. Computed tomography (CT) scan of chest showed a lobulated mass that was involved the hilum of lung. Inferior pulmonary artery was invaded. Final histological diagnosis was MFH. The patient underwent a left pneumonectomy with dissection of the regional lymph nodes.Although MFH of lung is very uncommon, it must be considered in differential finding of lung tumor. Complete surgical resection is the essential approach.
      PubDate: Tue, 02 Dec 2014 20:30:00 +010
       
  • Analysis of 95 cases with Mediastinal tumors

    • Abstract: Introduction: Mediastinum contains different vital structures that are located in anterior, middle or posterior compartment. Various types of mediastinal masses or tumors can be seen in mediastinum. Methods and Materials: This study was performed on 95 patients referred for treatment to Mashhad university of Medical sciences. Inclusive criteria were patients with primary mediastinal masses, exact tissue pathology, received suitable treatment and complete 3 years follow up after surgery. Variables were age, sex, clinical symptoms, mass location, diagnostic procedures, imaging studies, tissue pathology, postoperative complications, mortality and long term survival. Patients were followed up for 3 years after surgery. Results: 95 patients enrolled the study, with M/F=51/44, with the mean age of 35.4+16.52 years. Anterior mediastinum was the most involved compartment with 66 patients, and lymphoma (n=39) was the most common tumor of anterior mediastinum. Mediastinal cysts (n=10) in the middle part and neurogenic tumors (n=19) in the posterior mediastinum were the most common tumor in their compartment. TTNB used for diagnosis of 37 cases. 43 patients underwent surgery alone, 7 cases underwent surgery then received adjuvant therapy and 45 cases received adjuvant therapy alone. Complication was seen in 15 cases and 9 of the patients died before 3 years follow up completion. 3 of 9 mortality happened in hospital during treatment. Conclusions: Mediastinal tumors are among uncommon tumors. In anterior mediastinum preoperation clinical diagnosis is necessary and most of posterior mediastinal tumors do not need preoperation clinical diagnosis. Surgery, surgery-chemoradiothrapy and chemoradiothrapy are the main treatments of these tumors.  Male gender was defined as a poor prognostic factor.
      PubDate: Tue, 02 Dec 2014 20:30:00 +010
       
  • Role of Conservative Management in Neck Trauma: A Case Series Study

    • Abstract: Introduction: There are significant gender differences in the epidemiology and presentation of cardiovascular diseases (CVDs), physiological aspects of CVDs, response to diagnostic tests or interventions, and prevalence or incidence of the associated risk factors. Considering the independent influence of gender on early dire consequences of such diseases, this study was conducted to investigate gender differences in patients' beliefs about biological, environmental, behavioral, and psychological risk factors in a cardiac rehabilitation program. Materials and Methods: This study has cross sectional design. The sample was composed of 775 patients referred to cardiac rehabilitation unit in Imam Ali Hospital in Kermanshah, Iran. The data were collected using clinical interview and patients’ medical records. The data were analyzed using descriptive statistics such as mean, standard deviation, and chi-square test​​. To do the statistical analysis, SPSS version 20 was utilized. Results: As the results indicated, there was a significant difference between the beliefs of men and women about risk factors of heart disease (X2= 48.36; P<0.01). Men considered behavioral (55.1%) and psychological (33.7%) risk factors as the main causes of their disease, respectively. On the other hand, women regarded psychological (38.2%) and behavioral factors (26.6%) as the most common causes of cardiac conditions, respectively. Both men and women considered stress as the most important heart disease risk factor (21% and 22.3%, respectively). Also, women were less aware of the risk factors, compared to men. Conclusion: From the patients’ perspective, psychological and behavioral risk factors were the most important causes of cardiovascular diseases (CVDs); moreover, stress was the most influential risk factor for developing cardiac diseases. Thus, learning to control and manage these risk factors can help to prevent the development of CVDs and reduce the occurrence of subsequent cardiac events.  
      PubDate: Fri, 31 Oct 2014 20:30:00 +010
       
  • Gender Differences in Patients' Beliefs About Biological, Environmental,
           Behavioral, and ...

    • Abstract: Introduction: There are significant gender differences in the epidemiology and presentation of cardiovascular diseases (CVDs), physiological aspects of CVDs, response to diagnostic tests or interventions, and prevalence or incidence of the associated risk factors. Considering the independent influence of gender on early dire consequences of such diseases, this study was conducted to investigate gender differences in patients' beliefs about biological, environmental, behavioral, and psychological risk factors in a cardiac rehabilitation program. Materials and Methods: This study has cross sectional design. The sample was composed of 775 patients referred to cardiac rehabilitation unit in Imam Ali Hospital in Kermanshah, Iran. The data were collected using clinical interview and patients’ medical records. The data were analyzed using descriptive statistics such as mean, standard deviation, and chi-square test​​. To do the statistical analysis, SPSS version 20 was utilized. Results: As the results indicated, there was a significant difference between the beliefs of men and women about risk factors of heart disease (X2= 48.36; P<0.01). Men considered behavioral (55.1%) and psychological (33.7%) risk factors as the main causes of their disease, respectively. On the other hand, women regarded psychological (38.2%) and behavioral factors (26.6%) as the most common causes of cardiac conditions, respectively. Both men and women considered stress as the most important heart disease risk factor (21% and 22.3%, respectively). Also, women were less aware of the risk factors, compared to men. Conclusion: From the patients’ perspective, psychological and behavioral risk factors were the most important causes of cardiovascular diseases (CVDs); moreover, stress was the most influential risk factor for developing cardiac diseases. Thus, learning to control and manage these risk factors can help to  prevent the development of CVDs and reduce the occurrence of subsequent cardiac events.
      PubDate: Fri, 31 Oct 2014 20:30:00 +010
       
  • No-Reflow Phenomenon in Patients with ST-Elevation Acute Myocardial
           Infarction, Treated with ...

    • Abstract:   Introduction: No-reflow phenomenon in coronary vessels, manifested in some patients with reperfused acute myocardial infarction (MI), is associated with poor clinical and functional outcomes. Therefore, evaluation of predisposing risk factors can be helpful in risk assessment and identification of patients at higher risk. Herein, we aimed to study the predictive factors for the development of no-reflow phenomenon in patients with ST-elevation acute MI (STEMI), following primary percutaneous coronary intervention (PCI). Materials and Methods: Overall, 141 patients with STEMI, treated with primary PCI, were enrolled in a cross sectional study.. Angiographic data associated with no-reflow phenomenon including thrombolysis in MI (TIMI) were evaluated. Patients were divided into study and control (TIMI grade 3) groups. Demographic, clinical and laboratory  (lab) data including cardiovascular risk factors (e.g., diabetes, hypertension, hyperlipidemia , smoking), door-to-balloon time, serum creatinine and glucose levels, white and red blood cell counts (WBC and RBC counts, respectively), mean platelet volume (MPV), and red cell distribution width (RDW) were evaluated in both groups. Results: The mean age of the patients was 60.3±11.9 years. No-reflow was observed in 35 (24.8%) cases. WBC count, MPV , serum creatinine, BS, and high-density lipoprotein (HDL) levels were significantly correlated with TIMI flow Conclusion: Certain lab indices including MPV, WBC count, creatinine and HDL levels played significant independent roles in the no-reflow phenomenon. Thus, measuring such parameters might be helpful in predicting the risk of this condition in patients; however, further studies are required.  
      PubDate: Fri, 31 Oct 2014 20:30:00 +010
       
  • The Evaluation of Survival in Patients Who Need Intra aortic Balloon Pump
           (IABP) after Cardiac ...

    • Abstract: Introduction: Insome cases, assist devices are required to ensure an adequate cardiac output after cardiac surgery. Intra-aortic balloon pump (IABP) is the most commonly used cardiac assist device, which provides first-line support for patients with heart failure. The aim of this study was to determine factors affecting the mortality rate of patients receiving IABP. Materials & Methods:  In this retrospective cohort study 235 patients requiring LABP support were analyzed over 14 years period (between January 1999 and December 2013) from which 137 patients survived the 30 days follow-up. Perioperative and demographic factors such as age, weight, underlying disease, ejection fraction, ventricular aneurysm and cardiopulmonary bypass and cross clamp time were recorded and analyzed.   Results: The overall operative mortality was reported to be 41.7%. Male-to-female ratio was 131:104 and the mean age of the subjects was 57.58 ± 11.07 years. Early mortality rate was higher among young subjects and those with prolonged CBP (162.71±35.25, P<0.001) and ACC (129.94±54.39, P<0.001). In addition, mortality rate was higher among females (P=0.04). Patients’ weight, comorbidity, preoperative ejection fraction, ventricular aneurysm and stenosis of the left main coronary did not affect the mortality rate (P>0.05). Conclusion: IABP is a simple, effective method for temporary cardiac support, especially for aged patients. In addition, lower duration of surgery is associated with better surgical outcomes.
      PubDate: Fri, 31 Oct 2014 20:30:00 +010
       
  • Metabolic Syndrome in Chemical Warfare Patients with Chronic Obstructive
           Pulmonary Disease

    • Abstract:   Introduction: Sulfur mustard (SM), a toxic alkylating gas, can cause serious long-term pulmonary complications such as chronic obstructive pulmonary disease (COPD). Metabolic syndrome (MetS) is one of the important comorbidities of COPD. This study was designed to evaluate the frequency of metabolic syndrome in Iranian chemical warfare patients (CWPs) with COPD. Materials and Methods: Thirty CWPs with a mean age of 46.93± 6.8 were enrolled in this study. The following parameters were studied in: complete pulmonary function tests, health-related quality of life, serum triglycerides (TG), high density lipoprotein (HDL) and fasting blood sugar (FBS) levels. Additionally, 32 COPD patients and 56 healthy persons were considered as control groups who were matched to CWPs. Results: We found a statistically significant difference in the frequency of MetS between the COPD patients and the healthy control group (p=0.04). Additionally, we observed a statistically significant difference in the mean HDL levels among these groups (p=<0.001). In the CWPs, the frequency of MetS was significantly decreased in severe to very severe stages (p<0.001). Conclusion: Our data indicate that metabolic syndrome is frequent in chemical warfare patients, and special attention to this condition in mild to moderate stages is recommended.
      PubDate: Fri, 31 Oct 2014 20:30:00 +010
       
  • The Impact of Treatment on Serum Level of Procalcitonin in Patients with
           Active Pulmonary ...

    • Abstract: Introduction: About one third of the world's population is infected with tuberculosis (TB) and each year, about 1.5 to 2 million people die from TB. Procalcitonin (PCT) is an inflammatory marker that its level has variable results. There are some discussions in the utilization of PCT as a diagnostic marker in active pulmonary TB. The aim of this study was to compare serum PCT before and after treatment in patients with pulmonary TB. Materials and Methods: This conducted on patients with pulmonary TB. Data were collected using a check list. The serum level of PCT was measured by ELISA test at the beginning and after six months of treatment. All data were analyzed using SPSS 16. Results: Forty-two patients with active pulmonary TB entered in this study. The mean age of the patients was 45.48 ± 12.54 years and 54.8% of them were male. Most of the patients (59.5 %) were rural inhabitants. There was a family history of TB in 26% of patients. The most common symptom (45.2%) was cough. Mean PCT prior to treatment was 1.25 ± 0.98 ng/ml. and 81% of the patients had PCT higher than 0.5 to 5. After treatment PCT level reduced significantly (P<0.001). The mean erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) before treatment were 45.88 ± 21.87 and 7.16 ± 3.98 respectively that were reduced significantly after treatment (P<0.001). Neutrophil counts before treatment was 6221 ± 3161 Cells per ml. and decreased statistically significant after treatment (P=0.01). Conclusion: Our results showed that the PCT levels in pulmonary TB were high in active disease and reduced after treatment. PCT level may be used for follow-up as a discriminative marker between active and cured pulmonary TB and predict treatment response, although the PCT assay cannot be substituted for microbiological and pathological data.
      PubDate: Fri, 31 Oct 2014 20:30:00 +010
       
  • A Rare Case of Sudden-Onset Respiratory Distress in an Infant

    • Abstract: Chylothorax is an unusual cause of pleural effusion after the neonatal period in children without a previous history of cardiothoracic surgery. Determination of the causes of this condition can be often challenging. Herein, we present a case of a 6-month-old male infant, presenting with sudden severe breathlessness, which was later diagnosed as spontaneous left-sided chylothorax.
      PubDate: Fri, 31 Oct 2014 20:30:00 +010
       
  • Congenital Aortocaval Fistula from Right Subclavian Artery to Superior
           Vena Cava in an Adult ...

    • Abstract: Congenital   aortocaval   fistula in association with complex congenital heart disease has never been described before. We represent an adult with tetralogy of fallot and an undiagnosed subclavian artery to superior vena cava fistula in previous catheterisms. He underwent surgical correction, successfully. After 8 months post operation he was doing well with improved functional capacity and no cyanosis.
      PubDate: Fri, 31 Oct 2014 20:30:00 +010
       
 
 
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