Mashhad University of Medical Sciences
Journal of Cardio-Thoracic Medicine
2345-2447
2322-5750
8
3
2020
09
01
Off-Pump Versus On-Pump Coronary Artery Bypass Graft Surgery, prospective cohort study
645
650
EN
Mohammad
Abbassi Teshnisi
0000-0002-3695-1030
Cardiac Surgeon, Department of Cardiac Surgery, Mashhad University of Medical Sciences, Mashhad, Iran.
abbasim@mums.ac.ir
Gholamreza
Safarpoor
0000-0000-0000-0000
CardiacSurgeon, Department of Cardiac Surgery, Faculty of Medical Science, Farshchian Heart Center, Hamedan University of Medical Sciences, Hamedan, Iran
safarpoor@umsh.ac.ir
Atefeh
Ghorbanzadeh
General Physician, Mashhad University of Medical Sciences, Mashhad, Iran.
ghorbanza901@mums.ac.ir
Mohamadreza
Akbari
General Physician, Mashhad University of Medical Sciences, Mashhad, Iran.
mohamadrezaakbari@gmail.com
Kayhan
Mizani
Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
mizanik921@mums.ac.ir
Mahsa
Moallemi
Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
moallemim921@mums.ac.ir
Omid
Javdanfar
0000-0000-0000-0000
Resident of Cardiac Surgery, Department of cardiac surgery, Mashhad University of Medical Sciences, Mashhad, Iran.
omidjavid37@yahoo.com
Aliasghar
Moeinipour
0000-0002-4208-800X
Cardiac Surgeon, Department of Cardiac Surgery, Mashhad University of Medical Sciences, Mashhad, Iran.
moinipoora1@mums.ac.ir
10.22038/jctm.2020.50378.1285
<strong>Introduction:</strong> Coronary artery bypass grafting is a surgical operation that bypasses atherosclerotic coronary vessels and restores blood flow to the ischemic zone of hearts. And two different conventional methods are ON-pump CABG, and Off-pump CABG. Altogether, the efficacy and safety of these two types of surgical procedures are still under debate. In this study, we aim to compare the efficacy, safety, and cost-effectiveness of these two different methods in admitted patients to Imam Reza Hospital in Mashhad in Iran during 2006 to 2016.<br /> <strong>Materials and Method:</strong> In this prospective cohort study, 533 patients who underwent CABG in Imam Reza hospital in Mashhad during 2006 to 2016 were identified. The data was collected using hospital records including demographic data, chief complaint, history of previous disease, ejection fraction, number of graft, blood transfusion, time of anesthesia, time of surgery, days of hospitalization, days of ICU stay, needs for reoperation, post-operative complication, expenses of hospitalization.<br /> <strong>Results:</strong> Of 533 patients were 347 patients of whom male. The mean age was 59.53±10.21 and the mean BMI was 26.38±5.4. The most common chief complaint of the patients was chest pain. 38 patients of 533 cases underwent on-pump surgery and 495 underwent off-pump technique. There were no significant differences for age, and gender. The prevalence of HTN, diabetes, MI, and hyperlipidemia had no differences among two groups. Renal failure was more common in on-pump group; whereas, pulmonary disease was more common in off-pump group. On-pump surgery required significantly longer hospitalization and ICU care. Also needs for reoperation was more common among on-pump surgery. Total expenses were significantly higher in on-pump group.10.5% of those who underwent on-pump surgery died after surgery. This rate was only 3.1% among off-pump group.<br /> <strong>Conclusion:</strong> In this study we showed that, the patients who underwent on-pump surgery, required longer hospitalization, and ICU care. Total expenses were significantly higher in on-pump group. In addition, the mortality rate of on-pump group was significantly higher than the off-pump group. Also needs for reoperation was more common among on-pump surgery. Altogether, it seems that off-pump surgery is safer with low expenses than on-pump CABG.
Coronary Artery Bypass,Grafting Cardiopulmonary Bypass,Off- Pump Mortality Rate
https://jctm.mums.ac.ir/article_16450.html
https://jctm.mums.ac.ir/article_16450_80f1a39bdbd0e274a304e38f9a35f810.pdf
Mashhad University of Medical Sciences
Journal of Cardio-Thoracic Medicine
2345-2447
2322-5750
8
3
2020
09
01
Prognostic Impact of Thrombolysis in Myocardial Infarction Risk Index on Hospitalization Mortality of Patient with Acute Pulmonary Embolism
651
656
EN
Ahmad
Separham
0000-0001-7011-9507
Cardiologist, Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
aseparham@gmail.com
Bahram
Sohrabi
Cardiologist, Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
bahram71@gmail.com
Javad
Mohammadalizadeh
0000-0003-2463-4246
Cardiologist, Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
javad.dost@gmail.com
10.22038/jctm.2020.49497.1277
<strong>Introduction: </strong>Acute pulmonary embolism (PE) is one of the deadly cardiovascular diseases. One of the indexes proposed in these patients for risk stratification is the Thrombolysis in Myocardial Infarction (TIMI) risk index (TRI), which includes three parameters of systolic blood pressure, age, and heart rate. This study aimed to evaluate the predictive value of TRI on in-hospital and 30-day mortality of PE patients.<br /> <strong>Materials and Methods: </strong>This cross-sectional study included 345 patients who were diagnosed with acute PE in Madani Heart Center from January 2012 to January 2017. Demographic characteristics, hemodynamic findings upon first admission, type of treatment (i.e., thrombolytic, anticoagulant, or surgery), as well as in-hospital and 30-day outcomes were recorded for all patients. The TRI and simplified Pulmonary Embolism Severity Index (PESI) were calculated for all patients.<br /> <strong>Results: </strong>The overall and in-hospital mortality rates were 8.7% and 8.1%, respectively. The mortality group were significantly older and had significantly higher heart rates, cardiac troponin levels, simplified PESI scores, and TRI followed by lower systolic blood pressure and O2 saturation. Moreover, the TRI obtained specificity, sensitivity, positive, and negative predictive values of 98.78%, 25.25%, 89.29%, and 76.66%, respectively, using receiver operating characteristic curves and a cut-off value of 36.73. Using the multiple logistic regression analysis we found that TRI>36.73, older age, higher heart rate and lower SBP could predict 30-day mortality. <br /> <strong>Conclusion: </strong>Theresults showed that the risk of in-hospital mortality is higher with an increase in TRI. Furthermore, despite the high specificity, lower sensitivity limits its utility.
Pulmonary Embolism,Mortality,Thrombolysis
https://jctm.mums.ac.ir/article_16361.html
https://jctm.mums.ac.ir/article_16361_4f5496b82ee6b65ac570c35b85aa63de.pdf
Mashhad University of Medical Sciences
Journal of Cardio-Thoracic Medicine
2345-2447
2322-5750
8
3
2020
09
01
Evaluation of Clinical background and yield of chest tube thoracotomy in hydropneumothorax , a pulmonologist point of view.
657
661
EN
Mayur
Devraj
0000000170411399
Pulmonologist, Department of Chest & TB, VMCH &RI Madurai
mayurrdevraj@gmail.com
Deepali
Gaikwad
Radiologist, Department of Radiodiagnosis, SMBTIMS&RC Nashik
drdeepaligaikwad89@gmail.com
10.22038/jctm.2020.48907.1275
<strong>Introduction: </strong>The enlightenment of Hydro-pneumothorax arrived in former times of primitive Greece. It is a term which explains simultaneous existence of both free air and fluid (i.e., pneumothorax and hydrothorax) in the pleural space.The goal was to contribute and update the knowledge of clinical aspect as well as yield of diagnostic modalities in handling the cases of Hydropneumothorax.<br /> <strong>Materials and Methods:</strong> Diagnosed cases of hydropneumothorax from casualty and routine OPD are considered. Detail of clinical background entered. Patients were subjected for analysis of sputum, blood and pleural fluid. Radiological investigation was done. Patients underwent tube thoracotomy procedure and observed till resolution.<br /> <strong> Results:</strong> Total 97 subjects had participated. Among them 76(78.35%) were men and 21 (21.64%) women. 91(93.85%) subjects had shortness of breath. 34 subjects (35.05%) had tuberculosis in the past. Sputum smear AFB was positive in 19 subjects (19.58%). Plural fluid GeneXpert MTB was detected in 11 subjects (11.34 %) and MGIT Culture positive in 23(23.71%) subjects. Plural fluid gram stain culture was conclusive in 24 (24.74%) subjects. Pleural fluid ADA was raised in 74 (76.28%) subjects. Hypoxemia was observed in 46 (47.42%). In 38 (39.19%) cases chest tube was removed between 31 to 60 days.<br /> <strong> Conclusion:</strong> Tuberculosis turns up as the most common aetiology of hydropneumothorax and duration required for resolution is uncertain. Evaluation of pleural fluid (cytology, microbiological culture, biochemical measure) and Computed tomography were essential to reach aetiology of condition. Chest tube thoracotomy remains most practiced modality of treatment in hydropneumothorax. However advanced techniques have promising outcome and it’s an opportunity to research further.
Hydropneumothorax,Tuberculosis,tube thoracotomy,plural fluid,Intercostal drainage tube
https://jctm.mums.ac.ir/article_16449.html
https://jctm.mums.ac.ir/article_16449_636d53bc954049688e85fa0493dc3f82.pdf
Mashhad University of Medical Sciences
Journal of Cardio-Thoracic Medicine
2345-2447
2322-5750
8
3
2020
09
01
Aortic Valve replacement with Reduction Aortoplasty with Mesh Prosthesis in 75 years old with Sever aortic Regurgitation with Aortic Aneurysm
662
665
EN
Hamid
Hoseinikhah
0000-0003-1812-9200
Cardiac Surgeon, Department of Cardiac Surgery, Faculty of Medical Science. Mashhad University of Medical Sciences, Mashhad, Iran.
hoseinikhahh@mums.ac.ir
Mohammad
Abbassi Teshnisi
0000-0002-3695-1030
Cardiac Surgeon, Department of Cardiac Surgery, Faculty of Medical Science. Mashhad University of Medical Sciences, Iran.
abbasim@mums.ac.ir
Omid
Javdanfar
0000-0000-0000-0000
Resident of Cardiac Surgery, Department of Cardiac Surgery, Faculty of Medical Science, Mashhad University of Medical Sciences, Mashhad, Iran
omidjavid37@yahoo.com
Aliasghar
Moeinipour
0000-0002-4208-800X
Cardiac Surgeon, Department of Cardiac Surgery, Faculty of Medical Science. Mashhad University of Medical Sciences, Mashhad, Iran.
moinipoora1@mums.ac.ir
10.22038/jctm.2020.50626.1288
Although classic and standard procedure for patients with ascending Aorta aneurysm with Sever aortic Regurgitation is Bentall surgery but in some selected cases this complex surgery was not performed with different reason like advanced age and coexisting comorbidity involving renal and hepatic and lung Function. In our cases 75 years old man with chronic renal failure ( Cr= 3.2 ) who was known case of sever aortic Regurgitation and Ascending Aortic Aneurysm with 5.5 diameter.replacement of Aortic Valve with Biologic Prosthesis Aortic Valve and Reduction Aortoplasty with Mesh prosthesis was done successfully with good result with early follow up.
Aortic Aneurysm,Aortic Surgery,Aortic Valve
https://jctm.mums.ac.ir/article_16350.html
https://jctm.mums.ac.ir/article_16350_c9b89b91bd468a4785084460774741c6.pdf
Mashhad University of Medical Sciences
Journal of Cardio-Thoracic Medicine
2345-2447
2322-5750
8
3
2020
09
01
Mediastinal epidermoid cyst in an old man with recurrent pneumonia: A case report
666
669
EN
Alireza
Omranzadeh
0000-0002-7829-0162
Medical student, Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
omranzadeha@mums.ac.ir
Seyed Morteza
Hoseini Jebeli
0000-0001-8352-1239
Resident of Radiology, Mashhad University of Medical Sciences, Mashhad, Iran
hoseinijm961@mums.ac.ir
Alireza
Ghodsi
0000-0002-2020-4639
Medical student, Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
ghodsia921@mums.ac.ir
Masoud
Mahdavi Rashed
0000-0003-4594-9095
Radiologist, Mashhad University of Medical Sciences, Mashhad, Iran
mahdavirm@mums.ac.ir
10.22038/jctm.2020.50173.1282
Mediastinal epidermoid cyst is a rare condition that is considered as a congenital disorder. Various manifestations from asymptomatic cases to serious symptoms may be found in these patients. However, some cases may be diagnosed incidentally. Here, we report an old man with recurrent pneumonia who demonstrated symptoms of respiratory distress and chest pain. The high resolution computed tomography (HRCT) and subsequent magnetic resonance imaging (MRI) showed a hypodense mass with internal calcification. CT-scan guided transthoracic needle biopsy confirmed diagnosis of mediastinal epidermoid cyst. The mass was resected through open surgery and patient’s symptoms were subsided.<br />
Epidermoid cyst,mediastinum,Pneumonia
https://jctm.mums.ac.ir/article_16448.html
https://jctm.mums.ac.ir/article_16448_26ac99c22442db790442a31025814ef4.pdf
Mashhad University of Medical Sciences
Journal of Cardio-Thoracic Medicine
2345-2447
2322-5750
8
3
2020
09
01
Posterolateral thoracotomy Approach for an Ectopic Mediastinum Thymoma: A Case Report
670
674
EN
Narindra Njarasoa Mihaja
Razafimanjato
0000-0002-6534-351X
Thoracic Surgeon, Department of Surgery & Division of Thoracic Surgery, Teaching Hospital of Joseph Ravoahangy Andrianavalona. Faculty of Medecine, University of Antananarivo. Madagascar
razafesteban@yahoo.fr
Guillaume Odilon
Tsiambanizafy
0000-0003-3338-6395
Thoracic Surgeon, Department of Surgery & Division of Thoracic Surgery, Teaching Hospital of Joseph Ravoahangy Andrianavalona. Faculty of Medecine, University of Antananarivo. Madagascar
tsiambanizafy.guillaume@gmail.com
Tsiry Dama Ntsoa
Ravelomihary
Thoracic Surgeon, Department of Surgery & Division of Thoracic Surgery, Teaching Hospital of Joseph Ravoahangy Andrianavalona. Faculty of Medecine, University of Antananarivo. Madagascar
damaravelomihary@gmail.com
Andriambelo Tovohery
Rajaonera
Anesthesiologist, Department of Anesthesiology, Resuscitation and Intensive Medicine, Teaching Hospital of Joseph Ravoahangy Andrianavalona, Faculty of Medecine, University of Antananarivo. MadagascarDepartment of Anesthesiology, Resuscitation and Intensive Medicine
randriambelotovohery@yahoo.fr
Hanitrala Jean Louis
Rakotovao
0000-0003-4066-4939
Thoracic Surgeon, Department of Surgery & Division of Thoracic Surgery, Teaching Hospital of Joseph Ravoahangy Andrianavalona. Faculty of Medecine, University of Antananarivo. Madagascar
rakotojl@yahoo.fr
10.22038/jctm.2020.48733.1274
Thymic epithelial neoplasms are commonly aetiology of the anterior mediastinum masses in adults. It represents 20–30% of all mediastinal tumours in adults. Ectopic thymomas usually affect the neck, mediastinal compartments, lung, and pleura, arising from aberrant thymic tissue. For giant thymoma, there is still no consensus on the surgical approach. We herein report a patient with a giant thymoma that was successfully resected through a large right posterolateral thoracotomy. We report a rare case of a giant thymoma in the posterior mediastinal. Our patient underwent a conventional posterolateral thoracotomy to remove the mass. This latter was histologically diagnosed as a WHO classification type AB thymoma and Masaoka stage I.<br /> The choice of surgical approach of mediastinal tumor is based on the tumour topography, the assessment of tumour extension and extirpation, the surgeon's experience and clinical symptomatology. A multidisciplinary approach is mandatory to achieve good results.
mediastinal tumour,posterolateral thoracotomy,thymic epithelial neoplasms,Thymectomy,Thymoma
https://jctm.mums.ac.ir/article_16419.html
https://jctm.mums.ac.ir/article_16419_8272cabf8aea41bd6ccb573084c553cd.pdf
Mashhad University of Medical Sciences
Journal of Cardio-Thoracic Medicine
2345-2447
2322-5750
8
3
2020
09
01
Co- infectious Cytomegalovirus and Pneumocystis Jiroveci Pneumonia in a Polyarteritis Nodosa Patient: A Case Report
675
678
EN
Fatemeh
Sharafi
Residency of internal Medicine, Lung Diseases Research Center, Mashhad University of Medical Sciences
sharafif@mums.ac.ir
Mahnaz
Mozdourian
0000000216924510
Pulmonologist, Lung Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
mozdorianmh@mums.ac.ir
Fariba
Rezaeetalab
0000-0003-3836-0944
Pulmonologist, Lung Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
rezaitalabf@mums.ac.ir
10.22038/jctm.2020.50210.1283
Our report discusses a patient diagnosed with PAN since 3 years ago. He presented with fever, chills and nonproductive cough. He was a long time receiver of immunosuppressant drugs for his underlying condition. Upon examination he was febrile, had cushingoid appearance and cackles in both lungs. Lung CT scan showed opacities in right upper lobe lung and multiple bilateral nodules and ground glass opacity along with mild thickening of pleura. A bronchoscopy was ordered to asses PCP, and without hesitation empirical therapy was started. However, his clinical condition did not improve as expected. At this time, suspecting another infection at play, a PCR and BAL specimen was ordered for CMV. After receiving the result of BAL analysis, our suspicion was confirmed for both PCP and CMV pneumonia. CMV is an important opportunistic infection in immunocompromised individuals. This case highlights this importance in immunocompromising conditions. In this setting, presence of respiratory signs and symptoms point out to PCP as the first differential diagnosis; but at the same time it’s crucial for clinicians to consider the possibility of CMV as a co-infective agent.
Co-infectious Cytomegalovirus,Pneumocystis Jiroveci,Pneumonia,Polyarteritis Nodosa Patient
https://jctm.mums.ac.ir/article_16420.html
https://jctm.mums.ac.ir/article_16420_a3f8413668f83fa4d3dab029b238a981.pdf
Mashhad University of Medical Sciences
Journal of Cardio-Thoracic Medicine
2345-2447
2322-5750
8
3
2020
09
01
Cardiac arrhythmia due to ledipasvir/sofosbuvir Iranian counterpart, commercially named as Ledibiox: A case report
679
683
EN
Alireza
Heidari Bakavoli
0000-0001-8829-3247
Cardiologist, Cardiovascular Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
heydaria@mums.ac.ir
Alireza
Ghodsi
0000-0002-2020-4639
Medical student, Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
ghodsia921@mums.ac.ir
Alireza
Omranzadeh
Medical student, Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
omranzadeha@gmail.com
Moniba
Bijari
Medical student, Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
moniba.bijari@yahoo.com
Sara
Hosseini
0000-0000-0000-0000
Cardiologist, Cardiovascular Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
hosseinis9211@gmail.com
10.22038/jctm.2020.48728.1273
Sofosbuvir is an antiviral drug that entirely revolutionized the treatment of hepatitis C. This drug has an Iranian commercial brand, which is known as Ledibiox. Several adverse events have been reported with this drug, including syncope, pancolitis, and exacerbated pulmonary arterial hypertension; however, arrhythmia rarely has been described through the literature. Here, we report a 40-year-old Caucasian man who presented with chest pain, tachycardia, blurred vision, and severe headache; whose electrocardiography showed an atrial tachycardia along with a block. It seems that Sofosbuvir toxicity can cause arrhythmia, and the drug prescription should be halted in this situation.
Arrhythmia,Cardiac,ledipasvir/sofosbuvir,Ledibiox
https://jctm.mums.ac.ir/article_16130.html
https://jctm.mums.ac.ir/article_16130_222e50ed90fa1c7138dfeeff2d212010.pdf