سال:1398 | دوره: | شماره: |تعداد مقالات:8

Introduction: The use of anticoagulant and antiplatelet medications, especially warfarin and clopidogrel, is on a growing trend. Warfarin usage is commonly accompanied by hemorrhagic complications resulting in a noticeable mortality rate. Patients anticoagulated with warfarin suffers from intracranial hemorrhage after a head injury. Material and Methods: For the purpose of the study, the relevant articles published from 1966 to January 2017 were searched in several databases, including of Medline, Scopus, Google Scholar, and MEDLINE (through PubMed). The search process was performed using the following medical subject headings: “ Warfarin” combined with “ Warfarin-associated hemorrhage” , “ Head injury and warfarin-related intracranial hemorrhage” , “ Intracerebral hemorrhage” , and “ Treatment of coagulopathy” . Results: The search process resulted in the inclusion of 242 articles. According to the results of the reviewed studies, the best treatments for the reversal of coagulopathy in warfarinised patients in elective or urgent conditions following a head injury are prothrombin complex concentrate (PCC) and fresh frozen plasma, along with vitamin K, based on the discretion of the treating physician. Conclusion: According to the studies, the administration of PCC or any other treatments with a similar or close formulation to PCC is significantly more effective and faster in the reversal of coagulopathy and reduction of international normalized ratio in comparison with the use of fresh frozen plasma or other therapies in warfarinised patients admitted with serious intracranial hemorrhage following a head injury. Delivery of an effective treatment to these patients can be accomplished by planning for medical interventions, decreasing time delays for operations, and selecting a suitable or alternative treatment.

Percutaneous coronary intervention with stenting is considered recently as the most common procedure for the treatment of symptomatic coronary. The article reviewed 41 studies published during 1997-2019 on intracoronary brachytherapy for in-stent restenosis of a drug-eluting stent. Intracoronary radiation therapy was finally confirmed in the setting of in-stent restenosis using as adjunctive therapy. Irradiation dose to vessels may result in fibrosis, which can, in turn, cause the late formation of an aneurysm due to the weakness of the vessel wall. Intracoronary brachytherapy is a critical treatment which should not be ignored.

Introduction: Lung resection surgery is a challenge to thoracic surgeons. The outcome of this surgery depends on patients’ tolerance for reduced lung volume and hemodynamic alterations. The present study aimed to investigate the changes in blood gases and hemodynamic parameters in patients undergoing lung resection surgery and the associated clinical implications. Material and Methods: This study included 25 candidates for lung resection surgery. After thoracotomy, the isolation of pulmonary artery (PA) and veins was performed as usual. Blood samples were taken from the PA and radial artery simultaneously before PA clamping, as well as 5 and 20 min after clamping the PA. The systemic and PA pressure was also measured. All patients were followed up, and arterial blood gas and pulmonary function tests were performed 3-6 months after the surgery. Results: Cough (56%) and hemoptysis (56%) were the most common symptoms. Squamous cell carcinoma (56%) was identified as the most prevalent pathology. Lobectomy was the most common procedure performed on the patients. No change was observed in blood gases before and after the clamping of the PA. There was a significant increase in the mean PA pressure (P<0. 001), while the mean arterial pressure showed no significant change (P=0. 457). The pulmonary function tests showed a significant decrease in vital capacity, forced vital capacity, and forced expiratory volume in 1 sec at the postoperative follow-up. The patients with a pre-operative partial pressure of carbon dioxide (PCO2) of > 45 mmHg had more postoperative complications than those with a PCO2 of ≤ 45 mmHg (P=0. 047). Conclusion: Given the lack of any significant changes in the PCO2 and oxygen saturation following the lung resection surgery, it seems that this parameter is not a limiting factor for deciding on operability in patients with lung lesions having an acceptable preoperative partial pressure of oxygen. However, the patients with a PCO2 of > 45 mmHg should be categorized as a high-risk group since they have significantly higher postoperative complications/morbidity.

Introduction: Surgical approaches for the management of pulmonary aspergilloma have been accompanied with high levels of morbidity and mortality. However, these therapeutic options are still favored over other approaches for the treatment of pulmonary aspergilloma. The present study was conducted to describe the characteristics of 30 patients with aspergilloma who referred to Ghaem Hospital in Mashhad, Iran, during 2017-2018. Material and Methods: This retrospective study was conducted on 30 patients (i. e., 21 males and 9 females) with pulmonary aspergilloma who were treated via surgery. The patients were examined based on their age, gender, clinical symptoms prior to surgery, affected pulmonary lobe, surgical method, and postoperative complications. Results: The mean age of the patients was 48. 13± 5. 2 years. Hemoptysis (90%) was the most common symptom of pulmonary aspergilloma, followed by productive cough and drug-resistant pneumonia. The most common problematic lobes included left upper lobe and right upper lobe. Regarding the surgical method, 21 and 9 patients underwent lobectomy and segmentectomy, respectively. After the surgery, residual space, wound infection, and bronchopleural fistula were observed in 5 (16. 7%), 3 (10%), and 2 (6. 7%) cases, respectively. Furthermore, only one patient passed away. Conclusion: As the findings indicated, the methods of surgery (i. e., lobectomy and segmentectomy) were effective in the treatment of pulmonary aspergilloma.

Introduction: Since there has been a dearth of research on the assessment of CYP2C19 polymorphism in the east of Iran (Khorasan provinces), this study aimed to detect, CYP2C19*2 and CYP2C19*3 allele frequencies among patients with coronary artery disease. The participants were selected among those referring to Emam Reza Hospital, Mashhad, Iran. Furthermore, the current research was motivated to elucidate the association of CYP2C19 polymorphism with the severity and pattern of coronary artery disease. Material and Methods: This study was conducted on 84 patients who were subjected selective coronary angiography. The participants of the present study were from Khorasan, Iran. The Genotyping of extracted crude DNA for CYP2C19*2 (rs4244285) and CYP2C19*3 (rs4986893) alleles was performed through PCR-RFLP method. Results: The obtained results of the current study revealed three different allelic band patterns. Out of the 84 individuals, 71 were homozygous for the wild type allele in both exon 5 and exon 4 (wt/wt; 84. 5%), 15 were homozygous for the CYP2C19*2 polymorphism (*2/*2; 14. 3%), and 1 subject was homozygous for the CYP2C19*3 (*3/*3; 1. 2%). No subjects were heterozygous for the CYP2C19*2 (wt/*2; 0. 0%) or CYP2C19*3 (wt/*3; 0. 0%) or heterozygous for the CYP2C19*2 and the CYP2C19*3 mutations (*2/*3; 0. 0%). Conclusion: The findings of the current study confirmed the existence of CYP2C19 polymorphism among people of Khorasan.

Introduction: The interaction between the doctor and the patient is achieved when the physician is able to communicate effectively with the patient. Iowa Satisfaction with Anesthesia Scale (ISAS) is a tool designed for this purpose. The ISAS is designed originally in English and it is under study in Iran; therefore, this study aimed to translate this scale into Persian and evaluate its validity and reliability. Material and Methods: This observational study with a correlational design adopted an analytical approach and was conducted in 2016. The population consisted of patients undergoing surgery at Imam Reza Hospital. In total, 162 patients who met the inclusion criteria were enrolled in the study. The inclusion criteria were patients: 1) aged 18 years and above, 2) transferred from the operating room to intensive care unit, 3) exposed to general anesthesia, and 4) willing to participate in the study. The validity and reliability of the Persian version of the questionnaire were assessed in this study. Results: The patients completed the questionnaire in 5 min. The mean age of the patients was 57. 39 years (range: 18-87 years), and 102 (63%) patients were male. Moreover, about 2. 5% of the data went missing and the Cronbach's Alpha was obtained at 0. 85. The patients completed the questionnaire in 5 min. The mean age of the patients was 57. 39 years (range: 18-87 years), and 102 (63%) patients were male. Moreover, about 2. 5% of the data went missing and the Cronbach's Alpha was obtained at 0. 85. In addition, the correlation analysis showed that Iowa scale was significantly correlated with the physical role (PR) (P=0. 007), body pain (BP) (P=0. 002), emotional role (ER) (P=0. 007) and general health (GH) (P=0. 012). Furthermore, the Patient Satisfaction Questionnaire had a significant correlation with the IOWA questionnaire (P<0. 001). Conclusion: The validity and reliability of the Persian version of Iowa Satisfaction with Anesthesia Scale were confirmed in the Iranian context.

Cystic hydatidosis is a zoonotic disease that is mostly observed in the Mediterranean region. This infectious disease had different manifestations, which may lead to a delay in diagnosis process and various complications for the patients. Most of the cases are usually diagnosed through imaging techniques and its related management could be medical or surgical depending on the patient’ s clinical condition and disease severity. This case study is a report of a 50-year-old female patient with a positive history of liver, splenic hydatid cysts, hemoptysis, and dyspnea. The diagnosis of pulmonary and cardiac involvement was made using computed tomography angiography. Despite the immediate surgery, the patient died from hemorrhage after 3 days. The management of pulmonary embolism induced by Echinococcus highly depends on the clinical diagnosis. Moreover, the success of the surgery outcomes is related to the history and level of disease severity.

We present the case of a 19-year-old boy with a history of breathlessness and blunt chest trauma one year ago. Figure 1 shows the computed tomography scan of the patient. Figure 2 displays the subject's bronchoscopic view. Figures 3 and 4 depict intra-operative view, and Figure 5 shows the chest X-ray of the case after surgery.