Journal of Cardio -Thoracic Medicine
Volume:2 Issue: 3, Summer 2014

Esophageal cancer is a common gastro intestinal malignancy. One of the most common techniques of surgery in esophageal cancer is transhiatal esophagectomy with esophagogastric anastomosis in the neck. This technique is accompanied by complications like chronic gastero-esophegeal reflux and late stenosis. This study was designed to compare the risk of complications after two surgical techniques for esophageal cancer: esophagogastric anastomosis with partial fundoplication and esophagogastric anastomosis without it. In this retrospective cohort study, 100 patients with distal two thirds of esophageal cancer who underwent transhiatal esophagectomy in Ghaem and Omid hospitals Mashhad University of Medical Sciences from 2005 to 2010 were included. Esophagogastric anastomosis to the posterior gastric wall was performed with a partial gastric fundoplication in the first group but simple routine anastomosis was done to the posterior gastric wall in the second group. In a retrospective cohort study 100 patients entered the study with 59 male & 41 female and with a mean age 54.6±6.4 years. Squamous cell carcinoma was observed in 77% of the patients and adenocarcinoma was reported in 23% of them. Seventy-two percent of tumours were located in distal third and 28% were in middle third of esophagus. Esophagogastric anastomotic leakage was observed in 3 cases of fundoplication group and 7 cases of simple anastomosis technique (P=0.182) so there was no significant difference between the two groups. Benign anastomosis stricture was reported in one of the patients who underwent esophagogastric anastomosis with fundoplication, but it was observed in 8 cases with simple anastomosis technique (P=0.03) so there was a significant difference between the two groups. Esophagogastric anastomosis with partial fundal fundoplication is a safe technique with low incidence of anatomic leakage and late stenosis.

Pulmonary arterial hypertension (PAH) is a late progressive sclerodermarelated complication, which can lead to right heart failure and cor pulmonale. Given that cardiac catheterization is a diagnostic method of choice for PAH, and considering the high risks of this method, the purpose of this study was to evaluate the relationship between serum Pro‐Brain natriuretic peptide (Pro‐BNP) Levels and PAH in patients with limited scleroderma. In this cross sectional study, during June 2011‐ Dec 2013, referring patients to two major educational hospitals, Mashhad‐ Iran, with scleroderma, who were afflicted with the disease for at least two years (or more), were enrolled in the study if they met the inclusion and exclusion criteria. All the patients underwent echocardiography to determine the pulmonary artery pressure (PAP). Afterwards, the subjects were referred to a lung center for performing body plethysmography, carbon monoxide diffusing capacity (DLCO), and 6‐ minute walk test (6MWT). Pro‐BNP Serum level was determined using flourescent immune assay method. The present study included 20 patients (18 female subjects) with the mean age of 43.28±9.56 yrs, and the mean pro‐BNP level of 138 pg/ml. The logarithmic correlation between PAP values, Forced Vital Capacity /DLCO ratio, and pro‐BNP level, which was measured using Pearson's correlation coefficient, showed a significant association among these variables(respectively, r=0.76, P0.001; r=0.677, P=0.011). Moreover, the DLCO decrease was associated with increasing pro‐BNP level, though this relationship was not significant. This study showed that there was a significant relationship between the serum levels of pro‐BNP marker and increased PAP in the echocardiography, DLCO reduction, and FVC/DLCO increase. In fact, this serum marker can be used in patients with systemic scleroderma (SSc) to evaluate the status of PAH.

Pulmonary hyperinflation in patients with chronic obstructive pulmonary disease (COPD) can increase the breathing rate and reduce diaphragmatic movements by pushing the diaphragms downward and limiting their movements; this, in fact, can affect the breathing process. The purpose of this study was to compare diaphragmatic movements in COPD patients and healthy ones and to evaluate the relation of diaphragmatic movements and COPD severity in patients. This cross- sectional study was performed in Ghaem hospital,Mashhad Iran. Twenty-five COPD patients (case group) were selected, based on the inclusion and exclusion criteria. The patients’ demographic and clinical characteristics along with factors related to pulmonary function were recorded. Patients were referred for sonography after pulmonary evaluation. The status of the left portal vein or one of its branches at the end of a deep expiration and a deep inspiration was considered as a marker. Twenty-five healthy non-smoker subjects, who were matched with the patients in terms of age and sex, were studied as the control group for the comparison of sonographic findings of the diaphragms. The current study included 25 healthy subjects and 25 COPD patients, with the mean age of 59.2±12 years; approximately 84% of the subjects were males. Evaluation of the rate of diaphragmatic movements by sonography showed the mean of 42.08±12.15mm and 73.28±15.19mm in the case and control groups, respectively, which showed a statistically significant difference between them (P=0.02). Statistical analysis indicated the relationship between the rate of diaphragmatic movements with factors related to airway obstruction. However, no relationship was observed between the rate of diaphragmatic movements and the factors associated with pulmonary hyperinflation or air retention. The rate of diaphragmatic movements as a parameter for determining exercise capacity in COPD patients could help with a better understanding of activity limitations in these patients

In patients with uncomplicated primary hypertension (HTN), angiotensin converting enzyme inhibitors (ACEIs) are considered as monotherapy. In some studies, cough was not related to age, sex, underlying disease, or drug dosage. However, in previous studies, the incidence of cough was greater in females than males. The aim of this study is to determine the incidence of captopril-induced cough in patients with HTN and to evaluate some associated parameters such as sex and age. In this cross-sectional epidemiologic study, 877 patients with new onset HTN, referring to our outpatient clinic, were assessed and underwent treatment by captopril as first-line medical treatment. All patients were enrolled in four different age groups (<35, 36-45, 46-55 and >55 years old) and comparison was made between the groups. The overall incidence of captopril-induced cough was 15.5%, with a significant difference between females and males and obviously a higher rate in females (P=0.017). In addition, cough was significantly more common in females than males in 36- to 45-year-old group (46.42% vs. 24.71%). The incidence of cough after treatment with captopril decreased by increasing age of patients and this reduction in both male and female patients was statistically significant (P<0.001). A persistent, dry cough in a hypertensive patient, treated by captopril, should be considered as an adverse effect of ACE inhibitor therapy. Our study demonstrated the higher incidence of cough in female patients, receiving captopril. Thus, identification of this adverse effect may prevent unnecessary treatment of patients using captopril.

Response to tracheal tube during emergence of general anesthesia is a main concern. We aimed to compare the effect of Remifentanil and Lidocaine on response to tracheal tube during emergence of general anesthesia. In this randomized clinical trial, we enrolled 80 consecutive patients with American Society of Anesthesiology (ASA) physical status I–II, who underwent general anesthesia for general surgery in Amir-Al-Momenin Hospital on Zabol University of medical sciences from May 2011 to September 2011. Patients received either i.v. lidocaine 1.5 mg /kg (Group L) or 0.5mic/kg/min of Remifentanil (Group R) for emergence from anesthesia. The frequency of cough during emergence from general anesthesia was significantly higher in Group L than in Group R (70.7% vs. 40.3%, P=0.014). Also the grade of cough during the emergence was significantly higher in Group L than in Group R (P=0.013).The difference between two groups regarding sedation level, visual analogue scale (VAS), and pethidine consumption were not significant (P=0.08). we specified Remifentanil reduces cough during the emergence from general anesthesia more effective than Lidocaine in patients undergoing general surgery. In addition, Remifentanil and i.v. lidocaine revealed comparable impact regarding VAS scoring, sedation level and pethidine consumption.

Coronary artery disease (CAD) is the most common type of heart disease, with a mortality rate of 385,000 person per year in the United States. There are two main methods for CAD treatments: angioplasty and bypass surgery. Coronary Artery Bypass Grafting (CABG) is one of the greatest surgical operations of the 20th century and it is presented as most effective and long-term therapies in the treatment of ischemic heart disease. There are two different methods of CABG; on-pump and off-pump. While off-pump CABG is a newer method, it decreases stroke and maintains higher mental function. We conducted the assessment of patients’ outcome that underwent on- or off-pump CAGB with hemodynamic instability. In this cross-sectional study, we evaluated cardiogenic shock patients with CABG who referred to Ghaem hospital for emergency operation from January 2012 to November 2013. We collected medical records archive from this hospital and all patient's information including demographic data, clinical variables, and past medical history separately. We performed on and off-pump CABG surgery for the patients. In on pump group, we performed beating on pump method, without aortic cross clamping. Twenty-eight patients who underwent CABG in two forms: on-pump and off-pump were studied. The minimal age of the patients was 34 and the maximal was 78. Patients’ weight had a range between 60 to 95 kg. The minimum used graft were two and the maximum were five. Ejection fraction was diversified between 15% (min) and 50% (max). Operation time ranged 1.50 to 5.50 hours. The ICU stay time was between 2(min) to 11 (max) days. Finally death was occurred in 5(17.9%) of patients. Our findings showed that CABG with beating heart could increase the survival of hemodynamic unstable patients in comparison with off-pump CABG

Endoscopic radial artery harvesting (ERAH) is a feasible and attractive minimally invasive approach for conduit procurement, however there have been concerns about a potential neurological damage occurring at the harvest limb site secondary to injury of the radial nerve during endoscopic harvesting. We present a case of ERAH in which we evaluated intraoperatively the characteristics of radial nerve conduction by means of electroneuromyography (ENM) during harvesting. No pathological changes of nerve conduction were detected at the harvest limb site during surgery and postoperatively, thereby supporting the benefits of the endoscopic approach in terms of neurological outcomes following radial artery procurements with a less invasive approach.

A 37 - year- old man came to the hospital with a history of penetrating thoracoabdominal trauma due to gunshot wound in 10 days before. He underwent laparatomy and hepatorrhaphy in that time and right sided chest tube was inserted. Chest CT scan revealed metallic foreign body in lung tissue due to bullet burst. Right thoracotomy was performed and metallic foreign body extracted from lung tissue