Journal of Cardio -Thoracic Medicine
Volume:3 Issue: 1, Winter 2015

Mediastinum contains different vital structures that are located in the anterior and middle or posterior compartments. Various types of mediastinal masses or tumors can be seen in the mediastinum. This case series study was performed on 95 patients who had referred to Mashhad University of Medical Sciences between 1990 and 2010 were reviewed. The Inclusion criteria were as follows: Having primary mediastinal masses; Exact tissue pathology; Having received suitable treatment as well as having completed a 3-year follow-up after surgery; The major variables were age, sex, clinical symptoms, mass location, diagnostic procedures, imaging studies, tissue pathology, postoperative complications, mortality and a long-term survival. The patients were followed up for 3 years after the surgery. Ninety-five patients enrolled in the study with M/F=51/44 and the mean age of 35.4+16.52 years. Moreover, anterior mediastinum was the compartment mostly involved in case of 66 patients with the lymphoma (n=39) as the most prevalent tumor of anterior mediastinum. Mediastinal cysts (n=10) in the middle part and neurogenic tumors (n=19) in the posterior mediastinum were the other prevalent tumors in the patients’ compartments. Transthoracic Needle Biopsy was used in the diagnosis of 37 cases. Furthermore, 43 patients underwent surgery alone, 7 cases underwent surgery followed by receiving adjuvant therapy and 45 cases received adjuvant therapy alone. Complications emerged in 15 cases and 9 patients expired before the completion of the 3-year follow-up. Three of the mortalities happened during the patients’ hospital treatment. In case of anterior mediastinum, pre-operation clinical diagnosis is essential while most of the posterior mediastinal tumors do not require any pre-operation clinical diagnosis. Surgery, surgery-chemoradiotherapy and chemoradiotherapy are the major methods of treatment for such tumors. For another thing, male gender was defined as a poor prognostic factor.

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 frequency of celiac disease in esophageal SCC patients in North east of Iran in order to suggest correlation between two diseases. In a Cross-sectional study 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 and Omid Hospitals 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. 19.6% patients (SCC) had positive anti-tTG (>20) which was significantly different to 7.9% in control group (p -value=0.005). Comparing age groups of patients for positive anti_tTG using exact x square test showed significant difference in patients with. There seems to be a correlation between positive anti_tTG and esophageal SCC; that is to say, celiac disease might play a role in the earlier manifestations of esophageal SCC.

The overlap syndrome, consisting ofobstructive sleep apnea hypopnea syndrome (OSAHS) and chronic obstructvie pulmonary disease (COPD) is a major problem in COPD patients. OSHAS corresponds to the likelihood of systemic hypertension.The present study was aimed to evaluate the association between apnea-hypopnea index and diastolic blood presssure (DBP) in overlap patients. We conducted a cross-sectional study involving overnight polysomnography after measurment of resting diastolic blood pressure (DBP) in patients with overlap syndrome in Sleep Laboartory of Imam Reza Hospital, Mashhad, Iran from October 2011 to December 2012. Participants were divided into four subgroups regarding to their Apnea-Hypopnea Index (AHI) (AHI <5, AHI: 5-15, AHI: 15-30 and AHI >30).Descriptive statistics included age, body mass index (BMI), OSA, Apnea-Hypopnea Index (AHI), DBP, and neck circumference. Sixty participants ranged between from 46 to 82 years old were entered into this study. There was statistically significant difference in mean DBP among different AHI subgroups (80±0.50, 95±0.60, and 105±0.65, respectively) (p<0.001).Additionally, there was statistically significant correlation between AHI and DBP (r= 0.60, p=0.01). According to the findings of our study, DBP is an imprtant cardiovascular concern in COPD patients with OSAHS and has a direct correlation with AHI.

Studying the prevalence of cardiovascular risk factors in low socioeconomic groups is of great importance. People who are under the supervisioin and care of Imam Khomeini Relief Foundation are the most deprived in Iran. The present survey aimed at investigating the prevalence of traditional cardiovascular risk factors among the citizens who are under the supervision of Imam Khomeini Relief Foundation (IKRF). Mathrials and This cross-sectional study was done on 1008 individuals protected by the IKRF in Birjand in 2008 through multi-stage, random sampling Demographic were recorded. Furthermore, blood pressure, waist circumference, weight and height were measured by two trained nurses. Fasting Blood Sugar (FBS) and serum lipids were measured within 12 hours of overnight fasting. Chi-square and T-test were used for data analysis at the significant level of 0.05 using SPSS software (version 15). The mean age of the subjects was 39±16.8 years and the most common risk factor proved to be dyslipidemia (72%). The prevalence of hypercholesterolemia and hypertriglyceridemia was 43/2% and 12.7% respectively. Obesity was detected in 32.1%. The prevalence of hypertension (HTN) and diabetes mellitus (DM) appeared to be 13.1% and 6.3% respectively. Smoking was distinguished in 9.8 % of the participants. The prevalence of high Cholestrol (P=0.001),high LDL(p=0.01),low HDL(P<0.001),overweight and obesity(P<0.001) was higher in female, but prevalence of smoking was higher in male(P<0.001). Dyslipidemia, obesity and HTN were the most prevalent risk factors in IKRF supported groups with a low socioeconomic status. Thus, it is necessary to hold effective certain educational programs for all the community. Moreover, the screening of cardiac risk factors must be done for all individuals, particularly for those with a low socioeconomic status.

Patients with cyanotic heart disease may have an acceptable quality of life. However, they are invariably prone to several complications. The aim of this study is search about hematologic abnormalities in cyanotic congenital heart disease patients. In this cross sectional study every cyanotic congenital heart disease patients who was referred to the adult congenital heart disease clinic was selected and asked of any possible hyperviscosity symptoms, gingival bleeding, Epistaxis, hemoptysis, hypermenorrhagia and gouty arthritis irrespective of their age, gender and primary diagnosis in a six-month period. In this regard, 02 saturation was obtained via pulse oximetry, an abdominal ultrasound was done in order to discover any gallstones and lab tests including CBC, coagulation parameters (bleeding time(BT),clotting time(CT), prothrombin time(PT),international ratio(INR), Ferritin, blood urea nitrogen (BUN) and creatinine (Cr) were provided as well. A total of 69 patients were enrolled in the present study. The mean age of the patients was 22.44±5.72 with a minimum of 15 and the maximum of 46 years old. Twenty two (34.4%) of them were female and 45(65.6%) were male. Our patients had less hyperuricemia, there is no correlation between hyperviscosity symptoms and haematocrit level and an inverse correlation between the Ferritin level and hyperviscosity symptoms were seen.

In patients who underwent surgery to repair Tetralogy of Fallot, right ventricular dilation from pulmonary regurgitation may be result in right ventricular failure, arrhythmias and cardiac arrest. Hence, pulmonary valve replacement may be necessary to reduce right ventricular volume overload. The aim of present study was to assess the effects of pulmonary valve replacement on right ventricular function after repair of Tetralogy of Fallot. This retrospective study was carried out between July 2011 and October 2013 on 21 consecutive patients in Chamran Heart Center (Esfahan). The study included 13 male (61.9%) and 8 female (38.1%). Cardiac magnetic resonance was performed before, 6 and 12 months after pulmonary valve replacement in all patients (Babak Imaging Center, Tehran) with the 1.5 Tesla system. The main reason for surgery at Tetralogy of Fallot repaired time was Tetralogy of Fallot + Pulmonary insufficiency (17 cases) and Tetralogy of Fallot + Pulmonary atresia (4 cases). Right ventricular function was assessed before and after pulmonary valve replacement with Two-dimensional echocardiography and ttest was used to evaluate follow-up data. Right ventricular end-diastolic volume, right ventricular end- systolic volume significantly decreased (P value 0.05).Right ventricular ejection fraction had a significant increase (P value 0.05). Right ventricular mass substantially shrank after pulmonary valve replacement. Moreover, pulmonary regurgitation noticeably decreased in patients. The other hemodynamic parameter such as left ventricular ejection fraction improved but was not significant (P value= 0.79). Pulmonary valve replacement can successfully restores the impaired hemodynamic function of right ventricle which is caused by direct consequence of volume unloading in patient. Pulmonary valve surgery in children with Tetralogy of Fallot who have moderate to severe pulmonary regurgitation leads to an improvement of right ventricular function.

Cor triatriatum is an acyanotic congenital heart disease. We present a rare case of cor triatriatum sinistrum in a 6-month-old female infant who was presented with cyanosis and failure to thrive. The 2D transthoracic echocardiography and the Doppler color flow imaging showed a proximal venous chamber communicating to the distal left atrium through restrictive opening to the low-pressure, distal left atrial chamber. The Saline Contrast Echocardiography confirmed a right-to-left atrial shunt due to a minor atrial septal defect. The defect was caused by a persistent pulmonary hypertension which had raised the right atrial pressure in the infant. To the best of our knowledge, barely any such cases have been reported in the literature so far. Our report highlights the clinical utility of the Saline Contrast Echo in other cases of congenital heart diseases.

Brachial Plexus Injury (BPI) is an uncommon complication of median sternotomy capable of causing a permanent or transitory sensitivity and/or motor function impairment in the upper limbs. During a cardiac surgery through sternotomy, for the assessment of the thoracic cage configuration and the site of mediastinal structures, a broader surgical field may be required. If the sternal retractors are overstretched, the costovertebral junctions are likely to be dislocated damaging the adjacent soft tissues at the same time. Magnetic Resonance Imaging (MRI) is the modality of choice for estimating the degree of physical damage to the brachial plexus. In this paper, we intended to report the MRI findings of a chronic case of BPI following a cardiac surgery