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Cardiovascular and Thoracic Research - Volume:2 Issue: 1, Apr 2010

Journal of Cardiovascular and Thoracic Research
Volume:2 Issue: 1, Apr 2010

  • 60 صفحه،
  • تاریخ انتشار: 1389/06/05
  • تعداد عناوین: 10
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  • Leila Javadi, Masood Pezeshkian, Abbas Afrasiabi, Alireza Garjani, Leila Roshangar, Zahra Golmohammadi, Mohammad Nouri Page 1
    Background
    Ischemia- reperfusion is the common cause of apoptosis in most of cells specially myocytes. Prevention andreduction of apoptosis in myocardium can be one of the main medical goal before surgical operation، angioplasty and after infarction. Erythropoietin receiving effect 24 hours before hypoxia beginning on myocytes apoptosis rate and inflammatory process following half an hour hypoxia and 1. 5 hour reperfusion are aims of this study.
    Methods
    40 Rats were divided randomly into two groups. 24 hours before surgical operation، 5000 Iu/Kg erythropoietinwas injected to experimental group. During operation 12 rats from experimental group and 11 rats from control group were lost. After anesthesia، using ligation in left coronary artery for 30 minutes hypoxia and 1. 5 hours reperfusion were applied. Then Thorax was opened and after bleeding، the animal’s heart was isolated and two tissue samples of infarct and non infarct area were separated and fixed. Then blood serum samples separated and incubated in -760C. Apoptosis intensity in heart tissue was measured by tunel method، CK-MB level by method and DGKC، hsCRP by Elisa using Immunodiagnostic kit. The results were calculated Mean± SD. Then using paired student’s t- test their difference were shown. Level of statistical significant was considered P< 0. 05.
    Results
    Activity level of CK-MB (1550U/L to 340) in experimental group was less than control group (P<0. 000). hs- CRP serum rate was 450 and 225 ng/ml in control and experimental group respectively (P<0. 000). Apoptosis index in infarct area was 11. 5 and 4. 8% in control and experimental group respectively (P<0. 000). This difference was seen in non infarct area.
    Conclusion
    5000 IU/Kg injection of erythropoietin before ischemia reperfusion، reduce cell injury and control inflammation process in hypoxia and control myocytes apoptosis in infarct and non infarct area.
  • Rezvaneya Salehi, Azin Alizadehasl, Mohammad Rostamzadeh, Farnaz Sepasi, Mohsen Abbasnejad Page 9
    Background
    To evaluate systolic and diastolic dysfunction of left ventricle in patients with first anterior myocardial infarction and its relation to one month mortality after myocardial infarction; in this study mitral annulus motion velocity that was recorded by Tissue Doppler Imaging (TDI).
    Methods
    The study included 111 consecutive individuals, 81 patients with first anterior myocardial infarction, (in wich 72 patients who survived and 9 patients dead one month after admission), 30 individuals which matched with the studying group selected as a control group. Longitudinal function of left ventricle was evaluated by the use of mitral annular velocities in this study.
    Results
    Patients with myocardial infarction showed significant reduction in peak systolic, early diastolic and late diastolic annular mitral velocities comparing with control group in all studied segments. There was a good correlation between Left Ventricle Ejection Fraction (LVEF) and all mitral valve annular velocities. Also Myocardial Performance Index (MPI) more than 0.8 and (Regional Wall Motion Scoring Index (RWMSI) more than 1.77 had high sensitivity (0.94 and 0.96 respectively) in predicting death in follow-up period.
    Conclusion
    Reduced peak systolic mitral annulus velocity is an expression of regionally reduced systolic function. Reduced peak early and late diastolic velocities reflect regional diastolic dysfunction. Also Regional wall motion score index and myocardial performance index can be useful in predicting death after myocardial infarction.
  • Yalda Jabbari Moghaddam, Shamsi Ghaffari Bavil, Khosrou Abavisani, Rahim Sayyah Melli, Mohammad Reza Ghaffari Bavil, Giti Seyyed Ghiasi Page 17
    Background
    Adenotonsillar hypertrophy (ATH) is the most common cause of upper airway obstruction and obstructive sleep symptoms in children. The aim of this study is to compare pre-adentonsillectomy echocardiographic findings with postoperative findings.
    Methods
    Fifty-five children with adnotonsillar hypertrophy and obstructive-sleep apnea symptoms (aged 4 to14 years, 35 males, 20 females) were randomly selected from Aug 2007 to November 2008. Preoperatively echocardiography was performed for all patients by the same pediatric cardiologist. Patients with positive findings were followed and again echocardiography was performed separately one month and six months after operation.
    Results
    All the patients’ parents complained about severe open mouth snoring, agitated sleep and hyperpnoea. No complaints of apnea were reported. Tonsillar grades of all cases were of III or IV. The preoperative mean pulmonary arterial pressure levels of the 4(7.3%) children were higher than normal range (25mmhg) and it significantly decreased after operation (P<0.0001 Npar test) (Preoperative MPAP = 32 ±3 mmHg, and six months postoperative follow up, MPAP=11±5 mmHg). The preoperative tricuspid regurgitation pressure level of 7 children was higher than normal range and it decreased significantly after operation (p<0.0001 preoperative TR=34±8 mmHg postoperative TR=19±6mmhg) Acceleration time / Ejection time (AC/ET) in these 7 patient were lower than 0.4.
    Conclusion
    This study showed that chronic symptomatic obstructive hypertrophy of adenotonsillar tissue results in higher tricuspid regurgitation pressure and mean pulmonary arterial pressure, which could be relieved by adenotonsillectomy.
  • Mohammad Assadpoor Piranfar, Amir Hamzeh Pordal, Mohammad Reza Beyranvand Page 23
    Background
    Heart failure is the final complication of many diseases and an important cause of morbidity and mortality. N- Terminal B- type Natriuretic Peptide (NT-Pro BNP) is a new diagnostic tool for evaluation of the severity of heart failure and for differentiation between systolic function of left and right heart. In addition, plasma level of NT-Pro BNP serves as a good guide in the management and follow-up of patients under treatment for heart failure.
    Methods
    Patients with left side heart failure who referred to Taleghani hospital were consecutively recruited for this study. Diagnosis of heart failure was done through clinical evaluation and echocardiographic procedure. The severity of heart failure was determined according to New York heart association (NYHA) classification and clinical stage for each patient. Three ml citrated venous blood was obtained from the subjects and all samples were sent to the Endocrine and Metabolism research center laboratory of Shahid Beheshti Medical Medical University for evaluation of plasma NT-ProBNP level by enzyme-linked immunoabsorbent assay (ELISA) technique. Patients with acute coronary syndrome, severe valvular stenosis, severe lung disease, liver cirrhosis, primary hyperaldesteronism, hyperthyroidism, acute respiratory distress syndrome (ARDS), and candidates for heart transplantation were excluded. Plasma level of NT- ProBNP for each classification of NYHA and clinical stages and left ventricular ejection fraction (LVEF) were evaluated.
    Results
    Seventy nine patients, with a mean age of 63.1± 14 years were included in the study. Fifty-five (69.6%) subjects were male. Forty-eight patients (60.8%) were hypertensive, twenty- two patients (27.8%) were diabetic and sixty- four patients (81.0%) suffered from ischemic heart disease (IHD). The mean plasma level of NT- ProBNP in subjects aged 60 years or more was higher than younger subjects, (485. 8± 418.6 versus 308. 7± 300.5), (P= 0.033). The evaluation of NT- Pro BNP plasma levels showed correlation with decreased ejection fraction (P= 0.0 13), clinical stages (P< 0.001), and function class according to NYHA classification (P< 0.001).
    Conclusion
    Plasma levels of NT- Pro BNP were elevated proportional to decrease in ejection fraction and systolic function of left ventricle in patients with heart failure. Measurement of NT- Pro BNP is a good laboratory indicator for detection of left ventricular failure and its severity.
  • Azin Alizadehasl, Farnaz Sepasi, Mehrnoosh Toufan Page 29
    Background
    Acute myocardical infarction (AMI) in young patients has different characteristics from that in older. The purpose of the present study was to assess the risk factors, presenting symptoms, features of coronary angiographic (CAG) and echocardiographic findings, complications and in-hospital mortality of young patients with AMI in a referred teaching heart center compared with those of older patients.
    Methods
    A descriptive-analytic study was conducted involving 100 young (35 years and below) and 100 older (over 35years) patients with clinical diagnosis of AMI. The differences in the risk factors, clinical characteristics and CAG and echocardiographic findings were analyzed between the two groups between January 2000 and September 2009.
    Results
    Compared with the older patients, the risk factor of positive family history was more frequently found among the young patients. Hypertension and diabetes mellitus were more prevalent risk factors in non-young patients. Smoking and Dyslipidemia (DLP) were prevalent risk factors in the both. In the young patients low-density lipoprotein cholesterol (LDL-C), the levels of erythrocyte sedimentation rate (ESR), and white blood cell (WBC) count were significantly higher, while lower high-density lipoprotein cholesterol (HDL-C) and higher BUN were found in the elderly patients. Echocardiographic findings showed lower LVEF in older patients. Angiography identified higher incidence of no-vessel or one-vessel disease in the young patients (43.8% vs 30.1%). Young patients with AMI Conclusionhad lower morbidity rate than older patients with the same mortality. : Positive family history is the major risk factor rather than smoking and dislipedemia for AMI among individuals below the age of thirty five, who often have milder coronary artery stenosis than elderly patients. Alcoholism as a social habit is more highlightedly prevalent in the young adult MI. Young patients seem to have lower morbidity, with the same mortality.
  • Davod Aghamohamadi, Mahmood Eidy, Hojjat Pourfathi, Hamzeh Hoseinzadeh, Behzad Aliakbari Sharabiani, Samad Golzari Page 35
    Background
    The current study is to evaluate cardiovascular effects of anesthetic medications and volatile anesthetics on cardiac stress using cardiac stress index (CSI) and rate pressure product (RPP) and to determine which of them in useful in evaluating cardiac stress after comparing results obtained from each method.
    Methods
    Forty patients, 60-80 years old, who were all performed transabdominal prostatectomy, were studied. Patients were divided into two groups; half of patients were placed in group A and the other half in group B. The study was carried out as a blinded study. CSI was measured and evaluated in group A and RPP changes were studied in group B.
    Results
    The mean CSI were 60.25±5.57, 63.05±5.54, 55.75±4.78 and 67.65±4.88 before anesthesia induction, after induction, before surgical incision and in recovery respectively. There was no meaningful difference among these four stages measurements. RPP mean in four above mentioned stages was 10.15±0.44, 9.9±0.69, 6.8±0.36 and 9.2±0.61 respectively. There was a significant difference between RPP in stages before anesthesia induction and before surgical incision (P< 0.0001).
    Conclusion
    Considering the obtained results from this study, it can be seen that even in non-cardiac surgery, the stress level is high in patients in preoperative period. This condition was not clear in RPP index case and was not in accordance with CSI, which means CSI has been able to illustrate existing stress level better and efficiently.
  • Reza Ghotaslou, Alireza Yaghoubi, Simin Sharify Page 39
    Backgraound: Nosocomial infections are a major cause of morbidity and mortality, and the Urinary Tract Infections is one of the most common sites of these infections. The aim of this study was to determine the prevalence of the Urinary Tract Infections in Madani Heart Center of Tabriz University of Medical Sciences.
    Methods
    Urine samples from 3900 patients admitted into different wards of cardiovascular teaching hospital were collected by the mid stream and catheter aspiration methods. This study carried out between 2006 to 2009.The statistically analysis were prepared by SPSS software version 16.
    Results
    In this study, 3900 urine samples for UTIs were evaluated, of which 529 (13.56 %) were declared by investigators to be microbiologically proven. The most common pathogen was E. coli (52.93%) followed other Gram negative bacteria (20.56%), Candida spp. (14.18%), Gram positive bacteria (12.33%).
    Conclusion
    Bacterial agents were 454 of 529 (85.82%) and candida spp. was 75 (14.18%). There were many factors which influence the incidence of UTIs included gender, catheter use and diabetes mellitus.
  • Manouchehr Aghajanzadeh, Ali Alavy, Gilda Aghajanzadeh, Sara Massahnia Page 43
    A 35 year old man presented with a 4 month history of cough, hemoptysis, malaise, and fever (>38°C) and moderate (6 kg) weight loss. Investigations with CT scan of the chest revealed a cavitary lesion in the lower lobe of the left lung suggesting the presence of a pulmonary aspergilloma, the remaining lung fields being clear. There was no history of any pulmonary infections. Surgical excision of the affected lobe was performed. During surgical exploration we found that the affected lobe receives its blood supply by a large artery from the thoracic aorta. During follow-up his clinical status is excellent.
  • Babak Nasiri, Azin Alizadehasl, Issa Billejani, Rasoul Abdolrahman, Mehdi Toluey Page 47
    This report presents a case of right radial artery pseudoaneurysm complicated by arterio-venous fistula and absence of ulnar artery. The patient had history of deep vein thrombosis 18 months earlier and was receiving oral warfarin anticoagulation therapy. Doppler study and angiography finding showed poor collateral supply to distal arterial bed. The etiology of this complication and its treatment is controversial
  • Mahin Seyedhejazi, Daryoush Sheikhzadeh, Behzad Aliakbari Sharabiani Page 51
    Airway management during induction of anesthesia is difficult in some metabolic disorders like mucopolysaccharidosis (MPS). In this article we report an 11 years old child with Hurler-Scheie syndrome how was admitted to operating room for thracheostomy under general anesthesia. Mask ventilation was difficult and endotracheal intubation was impossible and anesthesiologist ventilated the patients lung by inserting laryngeal mask airway. The purpose of this article is to increase awareness among anesthetists and surgeons about the anatomical and pathophysiological changes in these syndrome which may lead to severe airway problems and complications in perioperative period.