Reza Bagheri , Seyed Ziaollah Haghi , Mohammadtaghi Rajabi Mashhadi , Alireza Tavassoli , Davoud Attaran , Saeed Akhlaghi , Neusha Barekati , Maryam Esmaeeli ,
Volume 71, Issue 9 (12-2013)
Abstract
Background: Acquired paralysis of the diaphragm is a condition caused by trauma, surgical injuries, (lung cancer surgery, esophageal surgery, cardiac surgery, thoracic surgery), and is sometimes of an unknown etiology. It can lead to dyspnea and can affect ventilatory function and patients activity. Diaphragmatic plication is a treatment method which decreases inconsistent function of diaphragm. The aim of this study is to evaluate the outcome of diaphragmatic plication in patients with acquired unilateral non-malignant diaphragmatic paralysis. Methods: From 1991 to 2011, 20 patients with acquired unilateral diaphragmatic paralysis who underwent surgery enrolled in our study in Ghaem Hospital Mashhad University of Medical Science. Patients were evaluated in terms of age, sex, BMI, clinical symptoms, dyspnea score (DS), etiology of paralysis, diagnostic methods, respiratory function tests and complication of surgery. Some tests including dyspnea score were carried out again six months after surgery. We evaluated patients with SPSS version 11.5 and Paired t-test or nonparametric equivalent. Results: Twenty patients enrolled in our study. 14 were male and 6 were female. The mean age was 58 years and the average time interval between diagnosis to surgical treatment was 38.3 months. Acquired diaphragmatic paralysis was mostly caused by trauma (in 11 patients) and almost occurred on the left side (in 15 patients). Diagnostic methods included chest x-ray, CT scan, ultrasonography and sniff. Test prior to surgery the average FVC was 41.4±7 percent and the average FEV1 was 52.4±6 percent and after surgery they were 80.1±8.6 percent and 74.4±1 percent respectively. The average increase in FEV1 and FVC 63.4±4, 61.1±7.8. Performing surgery also leads to a noticeable improvement in dyspnea score in our study. Conclusion: In patients with acquired unilateral non-malignant diaphragm paralysis diaphragmatic plication is highly recommended due to the remarkable improvement in respiratory function tests and dyspnea score without mortality and acceptable morbidity.
Toba Kazemi , Tayyebeh Chahkandi , Saideh Zanjani , Davood Jafari , Seyed Ali Moezi ,
Volume 75, Issue 10 (1-2018)
Abstract
Background: The most common cause of death in thalassemic patients is cardiac involvement especially cardiomyopathy. If the early stages of heart disease in people with thalassemia are diagnosed, mortality of patients reduced significantly. In this case-control study we compare the clinical symptoms, signs and para-clinic finding in thalassemia patients with control group.
Methods: In this case-control study, thalassemia patients who had visited in special clinic of Vali-e-Asr hospital of Birjand University Medical Sciences during January of 2013 to May of 2014 compared with normal subjects. They matched by age and sex. After explaining the aims of the project, the written consent was received from both groups. Clinical examinations including history taking and auscultation of heart and lungs were performed by Pediatrician. Moreover, using the standard methods, the measurement of height, weight and blood pressure were performed. In following, electrocardiography (ECG) was taken in both groups. Also, both groups underwent transthoracic echocardiography by one cardiologist.
Results: 42 thalassemia patients and 42 healthy subjects was compared in this study. Dyspnea was the only different symptom in the two groups. (23.8% in case and 4.8% in control P=0.01) In physical examination respiratory rate (RR) is only higher in patients with thalassemia that controls, but heart rate (HR), abnormal heart and lung sounds were not different significantly between two groups. In ECG, PR interval and QTc interval in patients with thalassemia was longer than healthy subject. In echocardiography, ejection fraction was lower but left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD) and size of the right ventricle and pulmonary artery pressure (PAP) was significantly higher than those in the control group.
Conclusion: According the result of this study, dyspnea was higher in patients with thalassemia from normal subjects and PR interval and QT interval was longer in thalassemic patients. As well as the size of the left ventricle, size of right ventricle, pulmonary artery pressure were higher than normal population. Also, LV ejection fraction was lower in thalassemia than normal population.
