Mashhad University of Medical SciencesJournal of Cardio-Thoracic Medicine2345-24473220150501The Six-minute Walk Test (6MWT) for the Evaluation of Pulmonary Diseases284287437410.22038/jctm.2015.4374ENLeila GhofranihaPulmonologist, Cardio-Thoracic Surgery & Transplant Research Center, Emam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.Zahra Dalir SaniPulmonologist, Lung Disease Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IranFarrveh VakilianCardiologist, Emam Reza, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IranMohamad KhajedalooyiCommunity Medicine Specialist, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IranZahra Javid ArabshahiInternist, Lung Disease Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IranJournal Article20150227The six-minute walk test (6MWT) is a well-tolerated test which reflects daily activities and can be easily used in clinical practice. The 6MWT provides information about functional capacity, response to therapy and prognosis across a range of chronic cardiopulmonary conditions. <br/>Moreover, the 6MWT is sensitive to the common therapies used for chronic obstructive pulmonary disease, such as pulmonary rehabilitation with supplemental oxygen, long-term use of inhaled corticosteroids and lung volume reduction surgery. <br/>Several studies have investigated the role of 6MWT in the evaluation of pulmonary disease and cardiac disorders. This article aimed to review the significance of 6MWT in pulmonary diseaseMashhad University of Medical SciencesJournal of Cardio-Thoracic Medicine2345-24473220150501Delayed Presentation of Traumatic Diaphragmatic Hernia: The Evaluation of Surgical Treatment Results288292437510.22038/jctm.2015.4375ENAli SadrizadehThoracic Surgeon, Cardio-Thoracic Surgery & Transplant Research Center, Emam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IranGhodratollah MaddahGeneral Surgeon, Endoscopic & Minimally Invasive Surgery Research Center, Ghaem Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IranMarziyeh Nouri DaloueeThoracic Surgeon, Endoscopic & Minimally Invasive Surgery Research Center, Ghaem Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IranAta’ollah RajabnejadMedical Student, Ghaem Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IranJournal Article20141227<strong>Introduction</strong>: Diaphragmatic hernia could be caused by congenital disorders, blunt trauma or penetrating injuries. The diagnosis of traumatic diaphragmatic hernia is normally neglected during the first presentation leading to late complications and considerably increased mortality and morbidity among the patients. <br/><strong>Materials and Methods:</strong> In this retrospective, descriptive study, we reviewed the medical records of patients presented with traumatic diaphragmatic hernia who had undergone surgical operations between 1982-2015 in Ghaem Hospital and Omid Hospital affiliated to Mashhad University of Medical Sciences, Iran. The studied variables included age, gender, clinical symptoms, location of hernia, involved organs, type of imaging modalities, surgical techniques, length of hospital stay, mortality rate and surgical complications. <br/><strong>Results:</strong> In this study, 38 patients were diagnosed with traumatic diaphragmatic hernia consisting of 28 men and 10 women. In total, 79% and 21% of the patients suffered from penetrating trauma and blunt trauma, respectively. In addition, left-sided, right-sided and bilateral hernias were present in 33%, 4% and 1% of the patients, respectively. The most frequently herniated organ was the stomach, and the most common clinical symptoms were abdominal pain (84%) and dyspnea (53%). Initially, chest radiographs were performed on all the patients, and thoracotomy was performed to repair diaphragmatic tears in all the cases (100%). In this study, 3 patients had previously undergone Hartmann’s operation for gangrenous herniated colon, and devolvulation of gastric volvulus had also been performed on 3 patients. The main post-operative complications were reported to be pneumonia and respiratory insufficiency (2 cases), and the mean length of hospital stay was 6 days (5-8 days) which was longer (1-2 months) in patients with gangrenous bowel (3 patients). Furthermore, no mortality was reported during the course of hospitalization in these patients. <br/><strong>Conclusion:</strong> According to the results of this study, patients presented with blunt or penetrating traumas to the upper abdomen or lower chest require urgent attention as to immediately rule out diaphragmatic hernia in order to prevent later complications and mortality and morbidity among these patients.Mashhad University of Medical SciencesJournal of Cardio-Thoracic Medicine2345-24473220150501Spirometric Parameters: Hemodialysis Compared to Peritoneal Dialysis293296437610.22038/jctm.2015.4376ENFariba RezaeetalabPulmonologist, Lung Disease Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Ir0000-0003-3836-0944Abbasali ZeraatiNephrologist, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IranAmir Hosein FadaeianFellowship of Cardiology, Faculty of Medicine, Mashhad University of Medical Sciences, IranMina AkbariradResident of Internal Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IranGhazaleh AzamiResident of Internal Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IranShahrzad Shahrzad MohamadZadeh LariPulmonologist, Cardio-Thoracic Surgery & Transplant Research Center, Emam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.Amir Mohamad Hashem AsnaashariPulmonologist, Lung Disease Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IranJournal Article20150127<strong>Introduction:</strong> Renal failure affects the mechanical and the ventilatory function of the lungs. A few studies have evaluated the ventilatory and pulmonary function in dialysis patients. The present study aimed to compare Pulmonary Function Test (PFT) results in patients undergoing Hemodialysis (HD) and Peritoneal Dialysis (PD). <br/><strong>Materials and Methods:</strong> We conducted a cross-sectional study on 50 patients with hemodialysis (HD) and 50 cases with PD who underwent PFT in Ghaem and Imam Reza hospitals Mashhad, Iran from November 2010 to July 2012. Spirometric parameters including forced expiratory volume in 1s (FEV1), FEV1/forced vital capacity (FVC), forced expiratory flow 25-75% (FEF) and peak expiratory flow (PEF) were compared between the two groups of patients. <br/><strong>Results</strong>: Approximately 68% of the HD patients, 66% of the PD patients, and 67% of all the studied cases showed a normal spirometric pattern. Moreover, there were no significant differences between the two groups considering the mean of the aforementioned spirometric parameters(restrictive ,obstructive pattern) (P=0.969). However, an insignificant inverse correlation was observed between the duration of dialysis with FEV1 (r=0.381, P=0.008), FVC (r=-0.298, P=0.04), FEF 25-75% (r=0.43, P=0.003), PEF (r= 0.349, P=0.02) and FEV1/FVC (r=-0.363, P=0.01,) in the HD patients and between the patients’ age with FEV1/FVC (r=0.03, P=0.02) in the PD patients. <br/><strong>Conclusion</strong>: This study showed no significant difference in pulmonary function in hemo and peritoneal dialysis,so according this result ,both of the dialysis had the same affect on the lung function.Mashhad University of Medical SciencesJournal of Cardio-Thoracic Medicine2345-24473220150501Expression of Epidermal Growth Factor Receptor and the association with Demographic and Prognostic Factors in Patients with Non-small Cell Lung Cancer297302437710.22038/jctm.2015.4377ENReza BasiriPulmonologist, Lung Diseases Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IranAmir Hossein JafarianPathologist, Cancer Molecular Pathology Research Center, Department of Pathology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IranMehdi KarimiResident of Internal Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IrShahrzad Mohammadzadeh LariPulmonologist, Cardio-Thoracic Surgery & Transplant Research Center, Emam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.Seyyed Mortaza HaghgooDepartment of Clinical Biochemistry, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, IranJournal Article20150227<strong>Introduction:</strong> Growth, proliferation, survival, and differentiation are the prominent characteristics of cells, which are affected by cancer. Epidermal growth factor receptor (EGFR) plays a pivotal role in the effective control of these features. Given the significance of EGFR signaling pathway in non-small cell lung cancer (NSCLC), EGFR expression is influential on these cell characteristics. In this paper, we studied EGFR expression and its association with demographic factors, clinicopathological features, and prognosis of NSCLC patients. <br/><strong>Materials and Methods:</strong> In this retrospective cohort study which was done during 2009-12 at Ghaem Hospital, Mashhad, Iran. EGFR expression was evaluated in 96 patients with formalin-fixed, paraffin-embedded NSCLC tissues (43 adenocarcinomas, 48 squamous-cell carcinomas, and 5 large-cell carcinomas) using immunohistochemistry (IHC). Data analysis was performed by SPSS version 20.0. <br/><strong>Results:</strong> Out of 96 specimens, approximately 53% were classified as positive for EGFR expression. The study group consisted of 68% (N=65) male and 32% (N=31) female subjects, with the mean age of 61.1±9.03 years. There was no difference between EGFR-positive and EGFR-negative patients in terms of the overall survival rate (P=0.49). In addition, no association was observed between tumor histology and EGFR expression (P=0.08), while EGFR-positive adenocarcinoma (N=28, 29%) was more prevalent compared to other subtypes of NSCLC. Moreover, there were no differences between tumor subtypes and the overall survival rate of the patients (P=0.21), and no association was found between EGFR expression and the patients’ demographic factors (e.g. age and gender). <br/><strong>Conclusion:</strong> The results of this study indicated that EGFR expression could not be a prognostic marker in NSCLC patients; however, it seems that using standardized IHC scoring is likely to yield more reliable data in this regard.Mashhad University of Medical SciencesJournal of Cardio-Thoracic Medicine2345-24473220150501The Diagnostic Value of End-tidal Carbon Dioxide (EtCO2) and Alveolar Dead Space (AVDS) in Patients with Suspected Pulmonary Thrombo-embolism (PTE)303308437810.22038/jctm.2015.4378ENReza BasiriPulmonologist, Lung Diseases Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IranEhsan Kamali YazdiResident of Internal Medicine, Department of Internal Medicine, Ghaem Hospital, Mashhad University of Medical Sciences,Mashhad, IranAzita BizhaniStudent Research Committee, Mashhad University of Medical Sciences,Mashhad, IranAlireza Sepehri ShamlooInternist,Razavi Hospital,Mashhad,IranJournal Article20141225<strong>Introduction:</strong> Capnography, is an easy, fast and practical method which its application in the diagnosis of Pulmonary Thromboendarterectomy (PTE) has recently been studied. This study aimed to assess the diagnostic value of end-tidal CO2 (ETCO2) and the alveolar dead space (AVDS) in the diagnosis of patients suspected to PTE who have been referred to the emergency department. <br/><strong>Materials and Methods</strong>: This cross-sectional study was conducted during one year in the emergency department of Ghaem Hospital on patients with suspected PTE who scored less than 4 for the Wells’ criteria during the initial evaluation. After excluding other differential diagnoses, all patients underwent CT pulmonary angiography (CTPA) to confirm PTE. Following that, arterial blood gas sampling, ETCO2 and AVDS were requested for all the patients based on capnography. Data analysis was performed using descriptive statistical tests in SPSS software version 11.5. The sensitivity, specificity, and positive and negative predictive values of AVDS and ETCO2 were measured based on (CTPA) results. <br/><strong>Results</strong>: The study was performed on 78 patients (mean age of 47.08± 15.6 years, 43 males/35 females) suspected to PTE. According to the results of CTPA, 37 patients did not develop PTE while 41 patients were with PTE. There was no significant difference between the two groups in terms of age and gender (P=0.999), while a statistically significant difference was found between the mean values of ETCO2 and AVDS between the two groups (P<0.001). The best cut-off points for PTE diagnosis were 0.17 (based on AVDS, with sensitivity and specificity of 78.0% and 56.8%, respectively), and 26.5 (based on ETCO2, with sensitivity and specificity of 67.6% and 75.6%, respectively). In addition, the negative predictive values for AVDS and ETCO2 were estimated as 70.0% and 71.43%, respectively. <br/><strong>Conclusion:</strong> According to the results of this study, capnography could be effective to promptly rule out PTE in emergency situations. Given its negative predictive value to rule out PTE, ETCO2 is considered as the most valid criterion among capnography parameters.Mashhad University of Medical SciencesJournal of Cardio-Thoracic Medicine2345-24473220150501The Effects of Pantoprazole on the Treatment of Palpitation in Patients with Gastro esophageal Reflux Disease (GERD): A Case Series309312438110.22038/jctm.2015.4381ENMajid JalalyazdiCardiologist, Emam Reza General Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IranAzadeh Mahmoudi GharaeeResident of Emergency Medicine, Emam Reza General Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IranJournal Article20141227<strong>Introduction:</strong> Atrial arrhythmia is a common complication in patients with gastro esophageal reflux disease (GERD). The treatment of palpitation is relatively problematic in these patients, especially if there is not enough evidence of cardiovascular or systemic diseases. The esophagus is in close proximity to the left atrium posterior wall. Hypothetically, locally released cytokines from esophageal injuries could stimulate the left atrium and produce premature atrial contractions. In this study we aimed to evaluate the effects of pantoprazole on palpitation in patients with reflux palpitation. <br/><strong>Materials and Methods:</strong> This study was conducted on patients presented with palpitation and symptom of GERD from January 2014 to June 2014 in the General Clinic of Imam Reza Hospital. In order to establish the precise effects of pantoprazole on the treatment of palpitation in GERD patients, pantoprazole was added to the beta-blockers during treatment, and the patients were followed-up for one month. <br/><strong>Results:</strong> In total, 10 patients within the age range of 21-35 years with a history of palpitation were enrolled in this study. The mean age of the subjects was 25 years, and the study group consisted of 6 men and 4 women. After a one-month follow-up, a significant reduction was observed in the palpitation of these patients (P<0.001). <br/><strong>Conclusion:</strong> According to the results of this study, addition of pantoprazole to the treatment of palpitation was effective in patients with a history of GERD. Therefore, pantoprazole could be used as an effective adjunctive treatment for palpitation.Mashhad University of Medical SciencesJournal of Cardio-Thoracic Medicine2345-24473220150501The Improvement of the Atrial Flutter Rhythm upon the Removal of the Infected Permanent Pacemaker Lead313315438210.22038/jctm.2015.4382ENAli AzariCardiac Surgeon, Cardiovascular Research Center, Ghaem Hospital Facultyof Medicine, Mashhad University of Medical
Sciences, Mashhad, IranAlireza Heidari BakavoliFellowship of Electrophysiology, Cardiovascular Research Center, Ghaem Hospital Faculty of Medicine,
Mashhad University of Medical Sciences, Mashhad, IranLeila BigdeluCardiologist, Cardiovascular Research Center, Ghaem Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IranJournal Article20140519Pacemaker infection has multiple risk factors. Its presentation is most often similar to infected endocarditis and the diagnosis is made through studying blood cultures. Transesophageal echocardiography can confirm the diagnosis. The most common microorganisms are staphylococcus speciesis. As a matter of fact, complete pacemaker removal appears to be the only definite treatment. We presented a case of infected pacemaker lead which was firstly referred with fever and nephritic syndrome. She had intermittent atrial flutterrhythm. Therefore, a total infected pacemaker system was removed under cardiopulmonary bypass support. Yet, the lead was firmly attached to the septal leaflet of tricuspid valve while leaflet repair was needed. As a result, atrial flutter rhythm was converted into sinus rhythm after an incidental interruption of the macroreentrant circuit in the process of the tricuspid leaflet surgery.Mashhad University of Medical SciencesJournal of Cardio-Thoracic Medicine2345-24473220150501Tricuspid Valve Endocarditis in an Intravenous Drug Abuser: A Case Report316318438310.22038/jctm.2015.4383ENHamid HoseinikhahCardiac Surgeon, Department of Cardiac Surgery, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, IranAliasghar MoeinipourCardiac Surgeon, Department of Cardiac Surgery, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, IranJournal Article20150115Recently, there have been more reports of cardiac valve infections due to the increasing number of intravenous (IV) drug abusers and chronic renal failure patients. Among cardiac valves, tricuspid valve is most commonly affected in the course of endocarditis. <br/>Appropriate management of these patients is a challenging and controversial issue in the field of cardiac surgery. Treatment options in such cases include IV antibiotics, surgical excision alone, and surgical excision with the re-implantation of prosthetic valve. <br/>In this study, we present a case of tricuspid valve endocarditis (TVE), confirmed by echocardiography, in a young IV drug abuser. Tricuspid valve replacement was performed by using a biological prosthesis with remarkable results in the early and long-term follow-up of the patient.