Tadjeddein A, Khorgami Zh,
Volume 65, Issue 1 (5 2008)
Abstract
Background: Respiratory failure and crisis is one of major complications of thymectomy
in myasthenia gravis patients. There are different medication regimes for preparing these
patients for surgery and reducing post-operative side effects. The goal of this study is to
compare respiratory complications of oral vs. Parenteral preoperative administration of
anticholinesterase agents for thymectomy in myasthenia gravis patients.
Methods: This randomized controlled trial included 101 patients in class IIA or IIB of
myasthenia gravis according to the Osserman classification system. The control group
fasted for eight hours before surgery and oral anticholines-terase agents were replaced
with parenteral ones. The case group also fasted for 8 hours before surgery, but
pyridostigmine was continued at its usual dose until the time of operation and the last
dose was given to patients with a small amount of water in the operating room on the
operating bed.
Results: There was no statistically meaningful difference between the two groups in
terms of age, sex and pathologic findings. In comparison, the mean hospital stay for the
case group was 3.98 days and 6.34 for the control group (p value = 0.003). There were
eight cases of respiratory crisis or failure (16%) in the control group but only 1 case (2%)
was observed in case group (p value = 0.014). Only one patient in the case group required
re-intubation after the surgery however, six patients in control group were re-intubated
(p value = 0.053). Plasmapheresis was required for five patients in the control group and
one patient in the case group (p value = 0.098). Tracheostomy was performed on two
patients in the control group to accommodate prolonged intubation, but none of the case
group required this procedure.
Conclusion: This study shows that continuing oral anticholinesterase agents up to the
time of operation, with the last dose at the operative theater, lowers the incidence of postoperative
myasthenia crisis and respiratory failure, need for plasmapheresis and shortens
the hospital stay. This method may also decrease the need for re-intubation, mechanical
ventilation and tracheostomy, thus decreasing the chance of death resulting from
complications of the thymectomy.
Nahvi H, Mollaeian M, Kazemian F, Hoseinpoor M, Keiani A, Khatami F, Khorgami Z, Goodarzi M, Ebrahim Soltani A, Ahmadi J,
Volume 65, Issue 6 (3 2007)
Abstract
Background: Oral clefts are among the most common congenital anomalies. Infants with oral clefts often have other associated congenital defects, especially congenital heart defects. The reported incidences and the types of associated malformations and congenital heart defects vary between different studies. The purpose of this study was to assess the incidence of associated congenital heart defects in children with oral clefts.
Methods: All infants with cleft lip and palate referred to the Children's Medical Center and Bahramy the teaching Hospitals of the Tehran University of Medical Sciences from 1991 to 2005 were prospectively enrolled in this study group. All patients were examined and noted by an academic cleft team contain a pediatrician and a pediatric surgeon, and received cardiac consultation and echocardiography by a pediatric cardiologist. non cardiac associated anomalies, still born and patients without echocardiography were excluded from the study. Data including age, gender, exposure to contagions and high risk elements ,consanguinity and familial history of oral cleft, type of oral cleft, results of cardiac consultation and echocardiography and associated cardiac anomalies were cumulated and analyzed by SSPS version 13.5
Results: Among the 284 infants with oral clefts, 162 were male (57%) and 122 were female (43%). Seventy-nine patients (27.8%) had cleft lip, 84 (29.5%) had cleft palate and 121 (42.6%) had both cleft lip and palate. Of all the patients, 21.1% had congenital heart defects. the most common type Of these congenital heart defects(28.3%) was atrial septal defect.
Conclusions: For patients with cleft lip and palate, we recommend preoperative cardiac consultation, careful examination and routine echocardiography for associated cardiac anomalies, as well as appropriate management and prophylactic antibiotic therapy for those with associated congenital heart anomaly.
