Journal of Cardio -Thoracic Medicine
Volume:7 Issue: 1, Winter 2019

  The use of anticoagulant and ant platelet medications, especially warfarin and clopidogrel, is on a growing trend. Warfarin usage is commonly accompanied with hemorrhagic complications resulting in a noticeable mortality rate. Patient's ant coagulated with warfarin suffers from intracranial hemorrhage after a head injury. For the purpose of the study, the relevant articles published from 1966 to January 2017 were searched in several databases, including of Medline, Scopus, Google Scholar, and MEDLINE (through PubMed). The search process was performed using the following medical subject headings: “Warfarin” combined with “Warfarin-associated hemorrhage”, “Head injury and warfarin-related intracranial hemorrhage”, “Intracerebral hemorrhage”, and “Treatment of coagulopathy”. The search process resulted in the inclusion of 242 articles. According to the results of the reviewed studies, the best treatments for the reversal of coagulopathy in warfarinised patients in elective or urgent conditions following a head injury are prothrombin complex concentrate (PCC) and fresh frozen plasma, along with vitamin K, based on the discretion of the treating physician. According to the studies, the administration of PCC or any other treatments with a similar or close formulation to PCC is significantly more effective and faster in the reversal of coagulopathy and reduction of international normalized ratio in comparison with the use of fresh frozen plasma or other therapies in warfarinised patients admitted with serious intracranial hemorrhage following a head injury. Delivery of an effective treatment to these patients can be accomplished by planning for medical interventions, decreasing time delays for operations, and selecting a suitable or alternative treatment.

Percutaneous coronary intervention with stenting is considered recently as the most common procedure for the treatment of symptomatic coronary. The article reviewed 41 studies published during 1997-2019 on intracoronary brachytherapy for in-stent restenosis of a drug-eluting stent. Intracoronary radiation therapy was finally confirmed in the setting of in-stent restenosis using as adjunctive therapy. Irradiation dose to vessels may result in fibrosis, which can, in turn, cause the late formation of an aneurysm due to the weakness of the vessel wall. Intracoronary brachytherapy is a critical treatment which should not be ignored.

  Lung resection surgery is a challenge to thoracic surgeons. Outcome of surgery depends on patients’ tolerance to reduced lung volume and hemodynamic alterations. The present study aimed to investigate the changes in blood gases and hemodynamic parameters in patients undergoing lung resection surgery and the associated clinical implications. This study included 25 candidates for lung resection surgery. After thoracotomy, isolation of pulmonary artery (PA) and veins were performed as usual. Blood samples were taken from the PA and radial artery simultaneously before clamping, as well as 5 and 20 min after clamping the PA. The systemic as well as PA pressure was also measured. All patients were followed up, arterial blood gas and pulmonary function tests were performed 3-6 months after the surgery. Cough (56%) and hemoptysis (56%) were the commonest symptom. Most prevalent pathology was squamous cell carcinoma (56%). Lobectomy was the most common procedure performed on the patients. No change was observed in blood gases before and after the clamping of the PA. There was a significant increase in the mean PA pressure (P<0.001), while the mean arterial pressure showed no significant change (P=0.457). The pulmonary function tests showed a significant decrease in VC, forced vital capacity, and FEV1 at the postoperative follow-up. The patients with a pre-operative PCO2 of >45 mmHg had more postoperative complications than those with a PCO2 of ≤45 mmHg (P=0.047). Given the lack of any significant changes in the PCO2 and oxygen saturation following the lung resection surgery, it seems that this parameter is not a limiting factor for deciding on operability in patients with lung lesions having an acceptable preoperative PO2 level. However, the patients with a PCO2 of >45 mmHg should be categorized as high-risk group since they have significantly higher postoperative complications/morbidity.

Surgical approaches for the management of pulmonary aspergilloma have been accompanied with high levels of morbidity and mortality. However, these therapeutic options are still favored over other approaches for the treatment of Pulmonary Aspergilloma. In this study, we aimed to describe the characteristics of 30 patients with aspergilloma who referred to Ghaem hospital between 2017-2018 and describe their results. This retrospective study was conducted on 30 patients (i.e., 21 males and 9 females) with pulmonary aspergilloma who were treated via surgery. The patients were examined based on their age, gender, clinical symptoms prior to surgery, affected pulmonary lobe, surgical method, and postoperative complications. The mean age of the patients was 48.13(5.2) years. Hemoptysis (90%) was the most common symptom of pulmonary aspergilloma, followed by productive cough and drug-resistant pneumonia. The most common problematic lobes included left upper lobe and right upper lobe. Regarding the surgical method, 21 and 9 patients underwent lobectomy and segmentectomy, respectively. After the surgery, residual space, wound infection, ad bronchopleural fistula was observed in 5 (16.7%), 3 (10%), and 2 (6.7%) cases, respectively. Furthermore, only one patient passed away. As the findings indicated, the methods of surgery (i.e., lobectomy and segmentectomy) showed effective treatment for patients.

  Since there has been a dearth of research on the assessment of CYP2C19 polymorphism in the east of Iran (Khorasan provinces), this study aimed to detect, CYP2C19*2 and CYP2C19*3 allele frequencies among patients with coronary artery disease. The participants were selected among those referring to Emam Reza Hospital, Mashhad, Iran. Furthermore, the current research was motivated to elucidate the association of CYP2C19 polymorphism with the severity and pattern of coronary artery disease.
Material and This study was conducted on 84 patients who were subjected selective coronary angiography. The participants of the present study were from Khorasan, Iran. The Genotyping of extracted crude DNA for CYP2C19*2 (rs4244285) and CYP2C19*3 (rs4986893) alleles was performed through PCR-RFLP method. The obtained results of the current study revealed three different allelic band patterns. Out of the 84 individuals, 71 were homozygous for the wild type allele in both exon 5 and exon 4 (wt/wt; 84.5%), 15 were homozygous for the CYP2C19*2 polymorphism (*2/*2;14.3%), and 1 subject was homozygous for the CYP2C19*3 (*3/*3; 1.2%). No subjects were heterozygous for the CYP2C19*2 (wt/*2; 0.0%) or CYP2C19*3 (wt/*3; 0.0%) or heterozygous for the CYP2C19*2 and the CYP2C19*3 mutations (*2/*3; 0.0%). The findings of the current study confirmed the existence of CYP2C19 polymorphism among people of Khorasan.

  The interaction between the doctor and the patient achieved when the physician is able to communicate effectively with the patient. Iowa Satisfaction with Anesthesia Scale is a tool for this purpose. Given that ISAS is originally in English and understudy in Iran, we decided to translate this scale into Persian and evaluate its validity and reliability. Our aim in this study is translating, validity and reliability of ISAS. This study is an observational study with a correlational design that adopts an analytical approach. The population consisted of all patients undergoing surgery at Imam Reza Hospital out of whom 162 patients met the inclusion criteria, i.e. aged 18 years and above, transferred from the OP to ICU, exposed to general anesthesia and signed the consent form. Patients completed the questionnaire in 5 minutes. The mean (maximum-minimum) age of the patients was 57.39 (18-87). As for gender, 102 (63%) of patients were male and 56 (34.6%) were female. About 4 (2.5%) of the data went missing. Cronbach's Alpha was 0.85. The correlation analysis showed that Iowa scale was significantly correlated with RP (P = 0.007), BP (P = 0.002), RE (P = 0.007) and GH (P = 0.012). The PSQ questionnaire had a significant correlation with the LOWA questionnaire (p < 0.001). Validity and reliability of the Persian version of Iowa Satisfaction with Anesthesia Scale (ISAS) in Iran are excellent.

  Cystic hydatidosis is a zoonoticdisease thatis mostly observedin the Mediterranean region. This infectious disease may present throughdifferent manifestations that may delay the diagnosis and cause various complications for the patients. Most of the cases are usually diagnosed by imaging studies and the related management could be medical or surgical depending on the patient’s clinical condition and disease severity. In the present report, we present the case ofa 50-year-old female patient with a positive history of liver and splenichydatid cysts with hemoptysis and dyspnea. The diagnosis of pulmonary and cardiac involvement wasmade usingcomputed tomography angiography. Despite the immediate surgery, the patient died from hemorrhage after 3 days. Themanagement of pulmonary embolism due to Echinococcus highly depends on the clinical judgment and the outcomes are subject to the history and extent of the involvement.

We present the case of a 19-year-old boy with a history of breathlessness and blunt chest trauma one year ago. Figure 1 show CT scan of patient. Figure 2: show bronchoscopic of patient. Figure 3 and 4 show intra operative view and Fig 5 show CXR of patient after surgery