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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  [14 journals]
  • Post-Intubation Tracheoesophageal Fistula; A Nine-Year Experience

    • Abstract: Introduction: Tracheoesophageal fistula (TEF) is a rare condition, which could be life-threatening if diagnosed late or mismanaged. Post-intubation TEF is the most common form of acquired, non-malignant TEF and is usually associated with tracheal stenosis, which makes the treatment more challenging. Here, we present our experience of managing 21 patients with post-intubation TEF.   Materials & Methods: Twenty one patients including seven women and fourteen men with mean age of 38.05 years, who had post-intubation TEF were managed in our center (Massih Daneshvari Hospital, Tehran, Iran) during 2004-2013. None of the patients were operated before weaning from mechanical ventilation. Single division and closure of the fistula was performed in one patient who did not have accompanying tracheal stenosis. One-stage surgical repair including tracheal resection, anastomosis, primary closure of the esophageal defect, and muscle flap Interposition was the main treatment method in all other cases. Patients were followed up for at least two years. Results: Excellent and good results achieved in 85.7% of our patients. Major complications including permanent vocal cord paralysis and recurrence of tracheal stenosis necessitating T-tube insertion occurred in two patients (9.5%). Severe cachexia and sepsis secondary to sputum retention resulted in one mortality (4.8%). Conclusion: Surgery might provide the best treatment results along with low mortality and morbidity rates in post-intubation TEFs if performed within the proper time.
      PubDate: Thu, 31 Aug 2017 19:30:00 +010
       
  • The Relationship between Serum Uric Acid and Severity of Chronic
           Obstructive Pulmonary Disease ...

    • Abstract: Introduction: Some evidence exists about the possible relationship between the serum uric acid (UA) and exacerbation of the chronic obstructive pulmonary disease (COPD). Present study intended to compare the COPD-related variables and the one-year outcome between the two groups of patients with the high and low UA. Material and Methods: This cohort study consisted of 112 patients with COPD exacerbation. The participants were categorized into low (i.e., Afterwards, the patients were followed up for one year and some other variables such as taking oral antibiotic for respiratory infections, admission to hospital or ICU due to COPD exacerbation, and survival were documented monthly. Results: The mean serum level of creatinine was significantly higher in the high UA group (1.1±0.4 mg/dL) than the low UA group (1.01±0.1 mg/dL) (P=0.02). No significant difference was observed between the two groups regarding the GOLD classification, FEV1, oxygen saturation, pCO2, and echocardiographic indices. In the one-year follow-up, 42 cases (82.4%) of the high UA group and 39 patients (63.9%) of the low UA group reported taking oral antibiotics, which was indicative of a significant difference (P=0.03). Hospital admission was likewise significantly higher in the high UA group (30 patients, 58.8%) than in the low UA group (23 cases, 37.7%) (P= 0.03). Conclusion: Those patients with the UA level of ≥ 6.5 mg/dL experienced more hospital admission and were more likely to take oral antibiotics for respiratory infections during a year. However, UA did not correlate with FEV1 or COPD severity.
      PubDate: Thu, 31 Aug 2017 19:30:00 +010
       
  • Outcomes of On-pump Coronary Artery Bypass Grafting in Patients with
           Metabolic Syndrome in ...

    • Abstract: Introduction: Metabolic syndrome (MS) is considered as an important risk factor for advanced coronary artery disease. This condition can increase the mortality and morbidity in the patients undergoing coronary artery bypass graft (CABG) surgery. The aim of the study was compared mortality and morbidity after off Pump- CABG surgery between patients with and without the Metabolic syndrome. Materials & Methods: This prospective cross-sectional study was conducted on 120 patients, who underwent off-pump CABG surgery between October 2014-October 2016. The participants were equally divided into two groups including the patients with and without MS (MS and non-MS, respectively). Results: According to the results, 68 (56.6%) patients were male. Furthermore, out of the 60 participants with MS, 36 (60%) cases were male. The mean ages of the MS and non-MS groups were 64.96±9.6 and 65.62±10.6 P=0.6 years, respectively. No statistically significant difference was observed between the two groups in terms of the mortality and morbidity (e.g., surgical wound infection, length of Intensive Care Unit and hospital stay, atrial fibrillation rhythm, and bleeding in the first 24 h). The intubation time in patients with Metabolic Syndrome was significantly higher than patients without Metabolic Syndrome (6.66 ± 1.97 vs 5.83 ± 1.93 respectively; P=0.007) Conclusion: Metabolic syndrome was not associated with higher mortality and morbidity after CABG surgery compare to patients without Metabolic syndrome, although patients with Metabolic syndrome had higher risk for long intubation time.
      PubDate: Thu, 31 Aug 2017 19:30:00 +010
       
  • Recurrent Venous Thromboembolism as the Initial Clinical Presentation of
           Gastric Cancer: A Case ...

    • Abstract: Pulmonary thromboembolism (PTE) is a clinically critical disease, misdiagnosis or delayed diagnosis of which can lead to increased rate of mortality. For prevention of recurrence of PTE, recognition of its risk factors or underlying diseases is of great importance. PTE is common in patients with cancer and has high morbidity and mortality rates. Although cancer is a lethal condition, PTE accelerates death in these patients. In the current study, we reported the case of a 50-year-old male presenting with dyspnea, pleuritic chest pain, and non-massive hemoptysis indicating pulmonary embolism. Anticoagulant therapy was initiated, but after 12 days of treatment, new deep vein thromboses in the left upper and right lower limbs were diagnosed. However, no specific risk factors or laboratory abnormalities were detected. History of weight loss during the recent months encouraged further investigation for ruling out malignancy, which led a diagnosis of gastric adenocarcinoma. He did not have any complaints of gastrointestinal disorders.
      PubDate: Thu, 31 Aug 2017 19:30:00 +010
       
  • Heart Carcinoid Disease with Patent Foramen Ovale Treated by Mini
           Sternotomy

    • Abstract: This case report was an attempt to present the importance of diagnostic echocardiography and closure of a patent foramen ovale in carcinoid heart disease. Herein, we present a case of a 48-year-old woman with a carcinoid metastasis presenting with tricuspid regurgitation, pulmonic stenosis, patent foramen ovale, and borderline left ventricular ejection fraction on an echocardiogram. Surgical intervention included closing the patent foramen ovale and replacing the tricuspid valve via mini-sternotomy. The tricuspid valve was repaired and the ejection fraction was preserved. The patient had an uncomplicated post-operative course. As indicated in this report, closing the patent foramen ovale along with fixing malfunctioning valves can improve the ejection fraction and the associated symptoms.
      PubDate: Thu, 31 Aug 2017 19:30:00 +010
       
  • Apical Hypertrophic Cardiomyopathy in a Case with Chest Pain and Family
           History of Sudden ...

    • Abstract: Hypertrophic cardiomyopathy (HCM) is the most common genetic cardiovascular disease, which is caused by a multitude of mutations in genes encoding proteins of the cardiac sarcomere (1). Apical hypertrophic cardiomyopathy (AHCM) is an uncommon type of HCM. The sudden cardiac death is less likely to occur in the patients inflicted with AHCM (2). Herein, we presented the case of a 29-year-old man with AHCM, who had typical exertional chest pain without any cardiovascular risk factors, except for a sudden cardiac death in his older brother at the age of 28 years. After performing complete clinical and paraclinical evaluations, the patient underwent optimal medical treatment with beta-blocker agents without any symptoms.
      PubDate: Thu, 31 Aug 2017 19:30:00 +010
       
  • Right-sided Infective Endocarditis with Multiple Large Vegetations in a
           Case of Ventricular ...

    • Abstract: Herein, we present the case of a 10-year-old child suffering from right-sided infective endocarditis with ventricular septal defect. Echocardiography revealed multiple rare large vegetations on the pulmonary valve extending into pulmonary artery along with a large vegetation over the septal leaflet of the tricuspid valve. 
      PubDate: Thu, 31 Aug 2017 19:30:00 +010
       
  • An Unusual Presentation of Granulomatosis with Polyangiitis

    • Abstract: The granulomatosis with polyangiitis (GPA), formerly known as Wegener’s granulomatosis, is a pauci-immune vasculitis involving small- and medium-sized blood vessels. Classically, the patients inflicted with this disease present with a triad of necrotizing granulomatous inflammation of the respiratory tract, cutaneous necrotizing vasculitis, and glomerulonephritis (GN). The antinuclear (ANA) and anti-neutrophil cytoplasmic antibodies (ANCA) are considered as relatively specific markers of the disease. Herein, we presented the case of a patient who initially presented with sepsis but did not respond to the conventional antibiotics and later diagnosed with GPA.The granulomatosis with polyangiitis (GPA), formerly known as Wegener’s granulomatosis, is a pauci-immune vasculitis involving small- and medium-sized blood vessels. Classically, the patients inflicted with this disease present with a triad of necrotizing granulomatous inflammation of the respiratory tract, cutaneous necrotizing vasculitis, and glomerulonephritis (GN).The antinuclear (ANA) and anti-neutrophil cytoplasmic antibodies (ANCA) are considered as relatively specific markers of the disease. Herein, we presented the case of a patient who initially presented with sepsis but did not respond to the conventional antibiotics and later diagnosed with GPA.
      PubDate: Thu, 31 Aug 2017 19:30:00 +010
       
  • Upper Extremity Ischemia Complicating Ulcerative Plaque in Descending
           Aorta

    • Abstract: A 54-year-old female patient was presented with upper extremity ischemia. Further investigation revealed ulcerated atherosclerosis plaque in aorta with intramural hematoma and clot formation. The subject underwent a successful surgical resection of mass with the assistance of cardiopulmonary bypass and total circulatory arrest.
      PubDate: Tue, 28 Feb 2017 20:30:00 +010
       
 
 
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