Emergency Surgery for Acute Dissection of the Ascending Aorta

Background: Aortic dissection is a nonprevalent disease and its late diagnosis can be life-threatening with a high mortality rate.The timely treatment of this disease can increase the survival rate considerably.Objectives: The aim of this study was to provide a surgery report of patients with aortic dissection operated in a community hospital.Methods: In this descriptive study, the mortality rate and operation events of five patients with an acute aortic dissection referredto a community hospital were reported during the period of 2011 to 2015.Results: In this study, 5 patients with aortic dissection referred to the cardiology emergency ward of the hospital were operated.Twoof five patients were males; one of them had the Marfan’s disease and another one had the bicuspid aortic valve. The remainderswere females; the first case was an old woman with a traumatic chest injury who died during the operation due to arrhythmia. Thesecond case was a 42-year-old pregnant woman suspicious to Marfan’s disease with a history of sudden death in her brother. Thethird woman was a case of aneurysm of ascending aorta with a bicuspid aortic valve.Conclusions: The findings of this study show that early diagnosis and timely operation can increase the survival rate of patientswith an aortic dissection

Coronary Artery Bypass Graft in Six Members of a Family: A Case Series

Abstract: Coronary artery disease (CAD) is a multifactorial problem. Although hyperlipidemia (HLP), diabetes (DM), and hypertension (HTN) are known as the familial and cardiac risk factors, CABG is rare in the several members of a family. We reported the six members of a family who presented with MI and/or advanced angina pectoris during the 6 years. CABG(Coronary artery bypass graft) considered for all patients due to involvement in main coronary arteries and clinical presentation. The ejection fraction (EF) was varied between 25% to 70%. Beating heart cardiopulmonary bypass (beating heart CPB) and off-pump were chosen as surgical method. The mean duration of surgery was about 4 hours. The only post-operative complication was deep wound infected in a young man who was smoker and drug abuser. According to family relationship of patients and the high effect of genetic penetration, we presume the gene influence to incidence CAD and potential to undergoing CABG, in members of a special family

Bilateral Pulmonary Artery, Inferior Vena Cava, and Cardiac Echinococcosis: A Rare Presentation of Zoonotic Diseases

Introduction:Cystic hydatidosis is a zoonoticdisease thatis mostly observedin the Mediterranean region. This infectious disease may present throughdifferent manifestations that may delay the diagnosis and cause various complications for the patients. Most of the cases are usually diagnosed by imaging studies and the related management could be medical or surgical depending on the patient’s clinical condition and disease severity. Case presentation:In the present report, we present the case ofa 50-year-old female patient with a positive history of liver and splenichydatid cysts with hemoptysis and dyspnea. The diagnosis of pulmonary and cardiac involvement wasmade usingcomputed tomography angiography. Despite the immediate surgery, the patient died from hemorrhage after 3 days. Conclusion:Themanagement of pulmonary embolism due to Echinococcus highly depends on the clinical judgment and the outcomes are subject to the history and extent of the involvement

A Case of Mitral Valve Replacement with Neurologic Manifestations during Pregnancy

Introduction: Cardiopulmonary bypass in pregnant patient is considered a high-risk procedure.  Maternal mortality is similar to that of the non-pregnant females about 1.5-5%. Variations in the timing of surgical intervention, gestational age, maternal health sta­­­­tus, perfusion protocol, and pharmacologic therapy are all factors that can influence fetomaternal outcome. Case Report: We present a case of 26- year- old pregnant woman (G1, Ab0, D0) in gestational age of 36 weeks with sudden CVA and neurological sequelae (disartheria, paresthesia of right side of face). In her past medical history, she had no positive history of neurologic problems, diabetes mellitus, hyperlipidemia or cardiovascular diseases. Left perisylvian encephalitis was reported in her brain MRI. In trans-thoracic echocardiography moderate Mitral Regurgitation (MR), severe mitral stenosis with gradient of 9mmHg, and valve surface of 1cm2 was observed. In obstetrics consultation, a healthy male fetus with approximate gestational age of 37 weeks was reported. Finally the pregnancy ended by caesarean section under general anesthesia, with presence of cardiologist and a healthy newborn was delivered at age of 37 weeks. Four days after caesarean section, Mitral Valve Replacement (MVR) was measured which proceeded successfully. Conclusion:Due to the risk of further neurological complications in a pregnant mother who suffers from mitral valve stenosis, provided the gestational age permits harmless termination of pregnancy, it is possible to perform the mitral valve replacement procedure during the same hospital stay after termination of pregnancy

Comparing the Safety and Efficacy of Two Different Synbiotics in the Treatment of Infantile Functional Constipation Resistant to Non-Pharmacological Therapy: A Randomized Clinical Trial

Background: Recent evidence emphasizes the positive effect of probiotics and synbiotics in the treatment of functional constipation in childhood, but no study has surveyed the effectiveness of synbiotics in improving the clinical conditions in infants ≤6 months suffering from functional constipation, so we performed this study. Aims: Comparing the efficacy and safety of two types of synbiotics including PediLact® (Zist-Takhmir Co., Tehran, Iran) drop containing Bifidobacterium infantis, Lactobacillus reuteri, Lactobacillus rhamnosus plus fructooligosaccharides with BBCare® (Zist-Takhmir Co., Tehran, Iran) drop containing Bifidobacterium lactis BB-12 plus fructooligosaccharides in the treatment of infantile functional constipation. Study Design: This trial was performed on infants less than 6 months of age who met the ROME IV criteria for infantile functional constipation. The patients were randomly assigned to receive PediLact drop (n = 44) or BB-Care drop (n = 45) for one month and were evaluated on the seventh day and at the end of the first month. Results: A significant downward trend was revealed in the responsive rate of every clinical symptom in both intervention groups but BB-Care was more effective than PediLact in improving the frequency of weekly defecation. Both synbiotics also improved significantly all symptoms of constipation in all types of feeding methods after one week and one month of intervention (primary outcomes). There was no side effect of synbiotics through intervention (secondary outcome). Conclusions: This study shows that both synbiotics improved significantly all symptoms of functional constipation after one week and one month of intervention apart from type of feeding method in infants less than 6 months of age. Due to the greater effectiveness of BB-care in increasing stool frequency, B. lactis may play a more prominent role in this age group. This study has been registered at the Iranian Registry of Clinical Trails (IRCT20160827029535N7)

The Safety and Efficacy of Lansoprazole plus Metoclopramide among Neonates with Gastroesophageal Reflux Disease Resistant to Conservative Therapy and Monotherapy: A Clinical Trial

Background. Gastroesophageal reflux disease (GERD) is one of the most common problems in neonates. The main clinical manifestations of neonatal GERD are frequent regurgitation or vomiting associated with irritability, crying, anorexia or feeding refusal, failure to thrive, arching of the back, and sleep disturbance. Aims. The efficacy and safety of ranitidine plus metoclopramide and lansoprazole plus metoclopramide in reducing clinical GERD symptoms based on I-GERQ-R scores in neonatal GERD resistant to conservative and monotherapy. Study Design. This study was a randomized clinical trial of term neonates with GERD diagnosis (according to the final version of the I-GERQ-R), resistant to conservative and monotherapy admitted to Bahrami Children Hospital during 2017-2019. Totally, 120 term neonates (mean age 10.91±7.17 days; girls 54.63%) were randomly assigned to a double-blind trial with either oral ranitidine plus metoclopramide (group A) or oral lansoprazole plus metoclopramide (group B). The changes of the symptoms and signs were recorded after one week and one month. At the end, fifty-four neonates in each group completed the study and their data were analyzed. Results. There was no significant difference in demographic and baseline characteristics between the two groups. The response rate of “lansoprazole plus metoclopramide” was significantly higher than “ranitidine plus metoclopramide” (7.44±3.86 score vs. 9.3±4.57 score, p=0.018) after one week and (2.41±3.06 score vs. 4.5±4.12 score, p=0.003) after one month (primary outcome). There were no drug adverse effects in either group during intervention (secondary outcome). Conclusions. The response rate was significant in each group after one week and one month of treatment, but it was significantly higher in the “lansoprazole plus metoclopramide” group compared with the “ranitidine plus metoclopramide” group. The combination of each acid suppressant with metoclopramide led to a higher response rate in comparison with monotherapy used before intervention. This study has been registered at the Iranian Registry of Clinical Trails (RCT20160827029535N3)

A thirty-one-year old pregnant woman with infiltrative cardiac masses

Primary cardiac tumors are rare in all ages. Their reported prevalence ranges from 0.001 to 0.03 percent in autopsy series. 25 percent of primary cardiac tumors are considered to be malignant, the majority of which are sarcomas. On account of the late presentation of symptoms in malignant heart masses, finding locally infiltrative tumors or systemically widespread cases at initial presentation is common. We present a case of malignant heart tumor in a thirty-one-year old woman who was first examined here after the termination of pregnancy

Effect of Socio-economic factors on development of poplar plantation in Guilan province (Case Study:Somesara)

The aim of the study was to investigate the effects of economical-social factors on poplar plantation development at Somesara city. The statistical society consisted of 200 poplar planter households in 2009 to 2010 at Somesara city at minimum acrage of three hectars. The field study was conducted, using questionnaires. Simple random sampling was applied to colloct data. The data was analyzed, using SPSS software and multivariate linear regression. The results showed that 17.5 % of the variance of poplar cultivation and development related to four variables, including: first year of poplar cultivation, attending training courses, amount of governmental loans and support and first acrage of poplar cultivation

Problems of Cold Agglutinins in Cardiac Surgery: How to Manage Cardiopulmonary Bypass and Myocardial Protection

Cold agglutinins are of unique relevance in cardiac surgerybecause of the use of hypothermic cardiopulmonary bypass (CPB). Cold autoimmune diseases are defined by the presence of abnormal circulating proteins (usually IgM or IgA antibodies) that agglutinate in response to a decrease in body temperature. These disorders include cryoglobulinemia and cold hemagglutinin disease.Immunoglobulin M autoantibodies to red blood cells, which activateat varying levels of hypothermia, can cause catastrophic hemagglutination,microvascular thrombosis, or hemolysis. Management of anesthesia in these patients includes strict maintenance of normothermia. Patients scheduled for the surgery requiring cardiopulmonary bypass present significant challenges. Use of systemic hypothermia may be contraindicated, and cold cardioplegia solutions may precipitate intracoronary hemagglutination with consequent thrombosis, ischemia, or infarction. Management of CPB andmyocardial protection requires individualized planning. We describea case of MV repair and CABG in a patient with high titercold agglutinins and high thermal amplitude for antibody activation.Normothermic CPB and continuous warm blood cardioplegia weresuccessfully used