Asymptomatic Giant Left Atrium: Do Atrial Size Changes After Successful Valve Replacement? 7-Years Follow-up Case Report

Background: Giant left atrium (GLA) associated with mitral valve surgery reported to have a mortality ranging from 8% to 32%. Most of the patients are symptomatic with that of shortness of breath, dysphagia, palpitations, chest pain, and thromboembolic events. Asymptomatic giant enlargement of the left atrium is rare. Either we must do or not do a reduction arterioplasty at the time of the mitral valve surgery is a controversy in the literature.Case Report: The patient had mitral valve replacement with a with a 31 mm carbomedics mechanical valve prosthesis 7 years past during her last visit. No reduction arterioplasty was done with a valve operation. Her 7-years close follow-up was uneventful. In the last visit, echocardiography and spiral chest computerized tomography scanning were requested. In both of the requested images giant left trial enlargement was seen, but the patient was without symptoms regarding her giant left atrium.Conclusions: In this case report, it seems that if we want left atrial size decline, it is necessary to have reduction arterioplasty during mitral valve surgery. However, it does not mean a definite therapeutic efficacy, especially when considering future symptoms

The Effects of Sex Hormones on Liver Regeneration after Liver Trauma in Animal Model

Background: The surgical management of liver injuries remains a great challenge for the traumatologists and general surgeons. We hypothesized that administration of 17 â-estradiol, a female sex hormone, improves hepatocellular healing after liver trauma.Methods: In an experimental model, 60 rats were divided into six subgroups: A (male control), B (male and estradiol), C (castrated male and estradiol), D (female control), F (female and estradiol), and G (oopherectomized female). After inducing liver trauma, estradiol subgroups received 3 doses of intravenous 17 â-estradiol (1 mg/kg) every 8 hours. 2 weeks post trauma, animals were sacrificed and hepatocellular regeneration was measured with the help of stereologic parameters of regeneration. Hepatocellular healing was compared between previous left lobe samples and the new post-traumatic right lobe samples.Results: Stereological parameters of rats receiving 17 b-estradiol after trauma was much better regarding mean angiogenesis point counting and volume density, compared with non-receiver groups after 2 weeks of trauma (P < 0.005). There was no significant difference for hepatocyte nucleus, hepatocyte point counting and volume density between estradiol receiver and non-receiver groups. In a comparison between subgroups, female sex had the same effect as giving estradiol. Oopherectomized female rats had more fibrogenesis but less angiogenesis (P < 0.005). Fibrogenesis was more in groups that were estradiol non-receiver (P < 0.005). In an explicit comparison of control females and males, estradiol infused males and females, and castrated male or oopherectomized female groups showed that stereological parameters of hepatocyte and hepatocyte nucleus were lower in female subgroups, but angiogenesis was better for female groups except for oopherectomized females.Conclusions: This study did support the administration of exogenic female hormone as an approach to augment the angiogenesis as a good index of regeneration for traumatic liver in rats

Pre and post-thoracostomy chest x-ray taking; do we must do?

The prevalence of collision accidents is high inIran, a developing country. Currently, a plainchest radiograph is routine 6 to 8 hours afterchest tube removal. In recent years, there have beendoubts about the necessity of routine post-removal chestx-ray (CXR) in the absence of clinical symptoms. In children,this is especially imperative because they are moresensitive to radiation exposure. This study conducted toevaluate the role of the plain chest radiograph in traumapatients after thoracostomy tube removal. If post-removalplain radiography has a little diagnostic value, eliminationis important both economically and from a healthpoint of view.Methods: This study takes the records of all patients withchest tubes after trauma and during 16 months period.Patients’ records listed up to 12 hours after thoracostomyremoval. Routine chest x-rays (CXR) also evaluated. Finalclinical decision variables and relation to clinical findingsor radiographs also recorded. These decisions defined asmore observation, re-thoracostomy or discharge. Dataanalyzed using R software. Chi-square and Fisher’s exacttests used for comparison between two clinical and radiographicdiagnosis variables considering three clinicaldecision outcome variables. A P-value <0.05 was statisticallysignificant.Results: Of the 58 chest tubes with the indication for removal,only one patient needed further observation clinicallyafter removal. The coincident chest x-ray (CXR) led torecurrent chest tube insertion. All thoracostomies had performedby a trained resident or surgeon. Considering variableclinical decisions, a comparison of the diagnostic valueof chest x-ray (CXR) to clinical examination did not differstatistically. The null hypothesis says the independence ofthe two decision methods thoroughly rejected (chi-squaredof 58 and a P = 0.018). Six-hour chest x-ray (CXR) was posteroanteriorin 28 patients and anteroposterior in 30. Thesetwo techniques of chest x-ray (CXR) had no significant correlationwith clinical decisions. Chest x-ray (CXR) imagingin the absence of clinical symptoms did not make any differencein clinical decision-making. The low incidence ofcomplications may be due to the thoracostomy techniquedone by a surgeon or a trained resident.Conclusion: The study should be done on a larger sampleand prospectively. Neither pre-removal chest x-ray(CXR) nor post-removal chest x-ray (CXR) appears to beneeded. An x-ray can be helpful in cases where there areclinical symptoms

Evaluating the effect of magnesium supplementation and cardiac arrhythmias after acute coronary syndrome: a systematic review and meta-analysis

Abstract Background Atrial and ventricular cardiac arrhythmias are one of the most common early complications after cardiac surgery and these serve as a major cause of mortality and morbidity after cardiac revascularization. We want to evaluate the effect of magnesium sulfate administration on the incidence of cardiac arrhythmias after cardiac revascularization by doing this systematic review and meta-analysis. Methods The search performed in several databases (SID, Magiran, IranDoc, IranMedex, MedLib, PubMed, EmBase, Web of Science, Scopus, the Cochrane Library and Google Scholar) for published Randomized controlled trials before December 2017 that have reported the association between Magnesium consumption and the incidence of cardiac arrhythmias. This relationship measured using odds ratios (ORs) with a confidence interval of 95% (CIs). Funnel plots and Egger test used to examine publication bias. STATA (version 11.1) used for all analyses. Results Twenty-two studies selected as eligible for this research and included in the final analysis. The total rate of ventricular arrhythmia was lower in the group receiving magnesium sulfate than placebo (11.88% versus 24.24%). The same trend obtained for the total incidence of supraventricular arrhythmia (10.36% in the magnesium versus 23.91% in the placebo group). In general the present meta-analysis showed that magnesium could decrease ventricular and supraventricular arrhythmias compared with placebo (OR = 0.32, 95% CI 0.16–0.49; p < 0.001 and OR = 0.42, 95% CI 0.22–0.65; p < 0.001, respectively). Subgroup analysis showed that the effect of magnesium on the incidence of cardiac arrhythmias was not affected by clinical settings and dosage of magnesium. Meta-regression analysis also showed that there was no significant association between the reduction of ventricular arrhythmias and sample size. Conclusion The results of this meta-analysis study suggest that magnesium sulfate can be used safely and effectively and is a cost-effective way in the prevention of many of ventricular and supraventricular arrhythmias

Outcome of penetrating cardiac injuries in southern Iran, Shiraz

【Abstract】Objective: Cardiac injuries are one of the most challenging injuries in the field of trauma surgery. Their management often requires immediate surgical intervention, excellent surgical technique and the ability to provide excellent postoperative critical care to patients. The aim of this study was to evaluate the outcome and survival rate of patients with penetrating cardiac injury in southern Iran, Shiraz. Methods: From January 2001 to June 2007, medical records of all patients suffering from penetrating cardiac injuries were reviewed and their outcomes were investigated. The inclusion criterion was the presence of a confirmed penetrating cardiac injury intraoperatively or by autopsy. Patients with blunt cardiac injuries were excluded from the study. Results: The study consisted of 37 patients, including 1 gunshot wound (2.7%), 35 stab wounds (94.6%) and 1 (2.7%) shotgun wound. The overall survival rate was 76% (28 in 37) and that in stab wound patients was 80%. The collected data of 9 expired patients revealed 11% death on arrival, 67% hypotensive, and 22% normotensive considering physiologic presentation. Paired sample test showed sig-nificant correlation between mortality and electrocardio-graphic changes, amount of retained blood in pericardium, clinical stage and physiologic condition at presentation, as well as associated injury type (gunshot more than stab wound). Conclusion: Our results show that injury mechanism and initial cardiac rhythm are significant predictors of out-comes in patients with penetrating cardiac injuries. Besides, gunshot injury and exsanguination are the most important predictive variables of mortality. Key words: Heart injuries; Wounds, penetrating; Heart arrest; Surviva