Introduction Cardiac complications are the second most common cause of morbidity and mortality in patients subjected to thoracic surgery after respiratory complications. Postoperative arrhythmia is one of the most common cardiac complications in these patients. It leads to morbidity, increased hospitalization, and high costs for patients. Aim To determine the incidence of atrial fibrillation after lung resection and determine the underlying factors and predictors of this problem. Material and methods The participants in this study were composed of all patients who were subjected to lung resection surgery in the past 4 years. The demographic data of the patients and possible postoperative complications, including the incidence of atrial fibrillation, were extracted from patient records. The statistical analysis of data was performed after data collection. Results The incidence of postoperative atrial fibrillation (POAF) in the present study was 7.6% ( n = 20), mostly in patients who had a lung parenchyma resection. It occurred due to malignancy ( n = 16), squamous cell carcinoma ( n = 9), adenoid cystic carcinoma ( n = 5), and metastasis ( n = 2). The POAF occurred in 34.2% of pneumonectomy cases and 4.5% of lobectomy cases, out of whom 60% were male. There was a significant difference between the two groups of arrhythmia and non-arrhythmia groups regarding the age range. The mean ages of patients with and without arrhythmias were 56.45 ±18.2 and 44.76 ±17.2, respectively. Conclusions Pulmonary malignant pathologies are more likely to develop POAF due to the need for lung resection and possibly mediastinal lymphadenectomy that stimulates the heart and pericardium and the vagus nerve.
Introduction: Hydatid disease is a zoonotic disease caused by Echinococcus. Surgery remains the gold standard approach of treatment. Aim: This study reports on 10 years of experience on surgical management of 78 cases of pulmonary hydatid disease and compares the rates of post-surgical complications between three approaches. Material and methods: Three different surgical approaches -the Ugon method, cystectomy and lobectomy -were performed for pulmonary hydatid disease treatment during a 1-year follow-up program. The relationships between patient's age, sex, cyst location and surgical approach and occurrence of post-surgical complications were first assessed. Then post-surgical complications between these three methods were compared. Results: From 78 patients, 51.5% were female and 48.5% were male (whose average age was 36.1). Hydatid cysts were found in the right (43.58%) and left (37.17%) lung while 19.23% of patients had bilateral cysts. Patient's age, sex and cyst location did not have any significant effect on the occurrence of complications. Post-surgical complications were only dependent on the surgical approach. 23% of the patients had post-surgical complications (including air leak, fistula, empyema, seroma and wound infection) and air leak was the most frequent one. Conclusions: Since complications were only dependent on the surgical method, the rate of post-surgical complications were compared between the three approaches. Cystectomy and lobectomy had similar rates of complications, which were lower than that of the Ugon method. It can be concluded that cystectomy is the method of choice for management of pulmonary hydatid disease, with the lowest rate of complications.
Introduction: Spinal anesthesia is the method of choice for cesarean section. In opioid-dependent mothers, more narcotic is necessary for analgesia. In this study, low dose bupivacaine was used to reduce adverse effects, and high dose fentanyl was used to improve analgesia. Methods:This randomized double-blinded study was performed on 60 opioid-dependent pregnant females in 2 similar groups. In the high-dose bupivacaine with low-dose fentanyl (HBLF) group, 10 mg of bupivacaine and 25 µg of fentanyl, and in the low-dose bupivacaine with high-dose fentanyl (LBHF) group, 6 mg of bupivacaine and 50 µg of fentanyl were used for spinal anesthesia. The blood pressure, heart rate, itching, nausea and vomiting, Apgar score at 1 and 5 minutes, and surgeon and patient satisfaction were evaluated during the study. The sensory block onset and reverse were measured to T5 and T12, respectively. The patient's pain was assessed by a verbal analogue scale (VAS) every half an hour. The time of analgesic was determined from anesthesia injection to verbal analogue scale of > 4. The information was analyzed using the SPSS v16 software and P < 0.05 was considered significant. Results:The demographic data and pre-anesthetic hemodynamic status were similar. The blood pressure was decreased in both groups (P = 0.019), yet there was no significant difference between the 2 groups (P = 0.43). There was no difference in heart rate (P = 0.33), itching, nausea, and vomiting, Apgar score at 1 and 5 minutes, and surgeon and patients' satisfaction, (P value was 0.47, 0.54, 0.85, 0.86, 0.92, and 0.09, respectively). The block onset to T5 in the HBLF group and LBHF group was 4.4 ± 0.9 and 5.3 ± 0.9 minutes, respectively (P = 0.002). The sensory block reverse to T12 in the HBLF group and the LBHF group was 141.2 ± 28.9 and 122.3 ± 24.5 minutes, respectively (P = 0.03). Also, the time of the first analgesic in the HBLF group and the LBHF group was 248.2 ± 31.4 and 282.1 ± 28.6 minutes, respectively (P = 0.02).Conclusions: There was no difference between low-dose and high-dose narcotic groups in complications and satisfaction. In the opioid-addicted mothers, the sensory block at high-dose bupivacaine (10 mg) and low-dose fentanyl (25 µg) was faster and longer. On the other hand, the duration of analgesia in the low-dose bupivacaine (6 mg) and high-dose fentanyl (50 µg) was higher.
Introduction: Heart transplant is the ultimate treatment for patients with end-stage heart failure. Aim: To assess 50 heart transplant patients for underlying diseases, transplantation outcome and mortality rate during a 5-year follow-up program. Material and methods: Fifty heart transplant patients who underwent heart transplantation from 2012 to 2017 were assessed for underlying diseases, organ rejection, duration of hospitalization, extubation time, cardiac output and survival. Biopsy samples were obtained after surgery for evaluation of rejection. Results: Dilated cardiomyopathy (DCM) and ischemic cardiomyopathy (ICM) were the most common underlying diseases with prevalence of 56% and 12%, respectively. Significant improvement in ejection fraction was observed following heart transplant. Minimum and maximum extubation and hospitalization times were 3-408 hours and 1-51 days, respectively. Organ rejection evaluation 10 days after heart transplantation revealed that 50% of patients did not show any rejection while 10% had severe rejection. At 30 days post-operatively the number of patients with grade III rejection decreased to 2% while 56% of patients had no sign of rejection. The 5-year survival rate was 66% while infection and arrhythmia were the most common causes of death. Conclusions: DCM and ICM are considered the most prevalent underlying diseases in heart transplant candidates. Ejection fraction reached normal ranges following transplant, which provides good quality of life. Low incidence of severe acute rejection demonstrates the effectiveness of our immunosuppressive therapy. In the cases of increased rejection, the patient's immunosuppressive regimen was re-assessed accordingly.
Objectives: Polycystic ovary syndrome (PCOS) is considered as one of the causes of infertility. Anti-Mullerian hormone (AMH) is 2-3 times higher in patients with the PCOS compared to others. The present study aimed to survey the association between basal AMH levels and ovarian response in infertile PCOS patients. Materials and Methods: In this cross-sectional study, 70 infertile PCOS women were enrolled referring to Milad Infertility Center (Mashhad, Iran) from May 2011 to April 2012. The basal blood level of AMH was evaluated. The patients received 5 mg of letrozole from the fifth cycle day (for 5 days) and then received 150 units of gonal F in the form of the recombinant follicle-stimulating hormone (FSH) on the ninth day of the cycle. Five thousand units of human chorionic gonadotropin (hCG) were prescribed for the patients who had one follicle of ≥ 18mm. Then, they should have had intercourse 36 hours later. After ovulation induction (OI) on the 10th cycle day, the second serum sample of AMH was taken. Results: Changes of AMH did not have a significant relationship with the ovarian response, namely, it was lower in patients with positive ovarian response compared to those without any ovarian response. In addition, the basal level of AMH in patients with a positive response (3.91 ± 2.14) had no significant difference with the secondary AMH (3.27 ± 2.39) after the OI (P = 0.19). Conclusions: Generally, the AMH was not a predictor of ovarian response in PCOS patients and the amount of AMH reduced after the treatment. This effect was maybe related to letrozole and gonadotropin.
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