Comparison of academic and nonacademic surgeons in treatment planning for CIII borderline case

Objectives In borderline class III malocclusions, the patients can be successfully treated by the orthodontic or surgical modalities, however; there is no consensus about the method with the best results regarding functional and esthetic parameters. The present study aimed to assess the treatment plans provided by academic and non-academic surgeons regarding borderline class III patients.Methods In this cross-sectional descriptive study, diagnostic records of 20 borderline class III patients were assessed by 8 academic and 8 non-academic surgeons. The treatment plans suggested by the surgeons for patients were compared with the standard treatment plan based on case presentation. The data were analyzed by paired t-test, Wilcoxon test, Kappa coefficient, independent t-test and Chi-square test.Results No significant differences were found between academic and non-academic orthodontists when suggesting orthodontic treatment (p=0.54), orthognathic surgery (p=0.1), single or double jaw orthognathic surgery (p=0.68) and the treatment plans in total (p=0.78) when compared with the standard treatment plan. The mean rate of agreement between the standard treatment plan and the academic and non-academic surgeons’ treatment plan for borderline class III patients was 75.0%±17.41% and 80.0%±17.73% for the orthodontic treatment plan, 80.0%±7.56% and 80.0%±17.73% for the surgical treatment plan, 70.55%±9.4% and 68.61%±9.08% for single or double jaw orthognathic surgery treatment plan, and 79.83%±7.76% and 80.63%±9.79% for the treatment plans in total, respectively.Conclusion Academic and non-academic surgeons both showed higher agreements with the standard treatment plan when suggesting orthodontic and orthognathic surgery treatment plans for borderline class III patients

A comparative study of stored arterial versus venous blood collected using the acute normovolemic hemodilution method in coronary artery bypass grafting patients in Iran

Background In the present study, arterial and venous blood was collected from patients who were candidates for elective coronary artery bypass grafting (CABG); the blood was stored for 28 days and cellular, biomechanical, and hematological changes in blood were compared to determine whether stored arterial blood is superior to stored venous blood. Methods The present follow-up comparative study included 60 patients >18 years of age, with hemoglobin >14 mg/dl and ejection fraction >40% who were candidates for CABG. After induction of anesthesia, 250 ml of arterial or venous blood was drawn from patients (arterial blood group and venous blood group). Laboratory blood samples were taken at specified times from the collected blood and re-injected into the patients after CABG. Results Significant differences were observed in pH, partial pressure of carbon dioxide (PCO2), partial pressure of oxygen (PO2), bicarbonate (HCO3), and glucose values at several time points between the groups. Other parameters such as urea and creatinine did not show any significant differences between the groups. Conclusions Twenty-eight days of storage can have a negative effect on some of the cellular, biochemical, and hematological components of arterial and venous blood; however, the quality of stored arterial blood and venous blood does not differ significantly

Rare post-operative complications of large mediastinal tumor resection

Background: There are some reports in the literature, which suggest that cardiac tamponade drainage may transiently affect systolic function and also cause acute respiratory distress syndrome (ARDS). We did not find any reports of acute ventricular failure and ARDS secondary to mediastinal tumor resection without tamponade. Case Report: Here we report a 48-year-old woman presenting with massive pericardial effusion without tamponade in whom tumor was resected through median sternotomy using cardiopulmonary bypass. ARDS and acute heart failure were two rare complications that happened at the end of the operation secondary to a sudden decompression of the heart from tumor pressure. Conclusion: ARDS and acute heart failure are two rare complications, which can happen after large mediastinal tumor resection.</p

Sleep Quality after Coronary Artery Bypass Graft Surgery: Comparing Pulsatile and Nonpulsatile Pump Flow

Poor postoperative sleep quality is a common problem in patients undergoing coronary artery bypass graft surgery (CABG). The purpose of this study was to compare the effect of pulsatile and nonpulsatile pump flow on sleep quality of these patients. In this clinical trial, 52 patients undergoing on pump CABG surgery with the roller pump were randomly divided into two equal groups of 26 patients: group 1 using pulsatile pump flow and group 2 nonpulsatile pump flow while the heart was arrested. Sleep score of both groups was evaluated by Pittsburgh Sleep Quality Index questionnaire 2 days before operation and 1 month after operation, and they were compared with each other. Analysis was performed with SPSS software version 22 (SPSS for Windows Inc., Chicago, IL) using the independent t-test, chi-square test, and Fisher exact test. Both groups were the same in demographic characteristics and risk factors such as age, gender, diabetes mellitus, hypertension, hyperlipidemia, smoking, body mass index, and preoperative ejection fraction. Operation data showed no difference between two groups considering cardiopulmonary bypass time and cardiac arrest time. Preoperative sleep quality score of both groups had no significant difference (p = .84). One month postoperative sleep quality score of the pulsatile group was significantly better than that of the nonpulsatile group (p = .04). Using pulsatile flow cardiopulmonary bypass can effectively decrease postoperative sleep disorders in comparison to nonpulsatile flow

Does topical tranexamic acid reduce postcoronary artery bypass graft bleeding?

Background: Postoperative bleeding is a common problem in cardiac surgery. We tried to evaluate the effect of topical tranexamic acid (TA) on reducing postoperative bleeding of patients undergoing on-pump coronary artery bypass graft (CABG) surgery. Materials and Methods: One hundred and twenty-six isolated primary CABG patients were included in this clinical trial. They were divided blindly into two groups; Group 1, patients receiving 1 g TA diluted in 100 ml normal saline poured into mediastinal cavity before closing the chest and Group 2, patients receiving 100 ml normal saline at the end of operation. First 24 and 48 h chest tube drainage, hemoglobin decrease and packed RBC transfusion needs were compared. Results: Both groups were the same in baseline characteristics including gender, age, body mass index, ejection fraction, clamp time, bypass time, and operation length. During the first 24 h postoperatively, mean chest tube drainage in intervention group was 567 ml compared to 564 ml in control group (P = 0.89). Mean total chest tube drainage was 780 ml in intervention group and 715 ml in control group (P = 0.27). There was no significant difference in both mean hemoglobin decrease (P = 0.26) and packed RBC transfusion (P = 0.7). Topical application of 1 g TA diluted in 100 ml normal saline does not reduce postoperative bleeding of isolated on-pump CABG surgery. Conclusion: We do not recommend topical usage of 1 g TA diluted in 100 ml normal saline for decreasing blood loss in on-pump CABG patients

The effect of progressive muscle relaxation on sleep quality and postoperative pain in patients undergoing heart valve replacement surgery

Background and aims: To investigate the effect of progressive muscle relaxation on sleep quality and postoperative pain in patients undergoing heart valve replacement surgery. Methods: In this quasi-experimental study, 60 patients undergoing surgery that enter were randomly divided into the muscle relaxation (n=30) or control group (n=30). Data were collected by Pittsburgh Sleep Quality Index and McGill Pain Questionnaire before and after the intervention. Patients in the control group received routine care, but patients in the muscle relaxation group performed a progressive relaxation technique twice a week for one month. Results: Most of the male participants in both groups had diplomas. There is no significant difference between the two groups of relaxation and control regarding age, gender, occupation, and education levels. The mean sleep quality score in the control group was not significantly reduced after the intervention. However, the mean sleep quality in the relaxation group before 13.90±2.23 and after the intervention was 8.03±2.01 significantly decreased (P<0.001). Also, the pain score was significantly reduced after the progressive relaxation group in the intervention group (P<0.001). Although the two groups were the same in all the dimensions of sleep quality before the intervention, significant differences were observed between groups after the intervention in all the dimensions. Conclusion: Progressive muscle relaxation has an influential role in the pain decrease and sleep quality of patients undergoing heart valve replacement surgery and can be used as a safe and cost-free method for patients. Keywords: Pain, Sleep quality, Progressive muscle relaxation, Valve replacemen