Tehran University Medical Journal

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Cardiopulmonary resuscitation (CPR) is one of the most important skills that every body must know it in medical services. In educational hospitals, the (Newly-arrived residents are in first cell for management of victims, specially in emergency rooms and at nights. Their knowledge and ability for successful CPR have a direct relation with prevalence of total mortality and morbidity. This research has assessed the knowledge and attitude of the new residents about CPR, and for answering to this question: "Is the CPR workshops necessary for all of the new residents in the beginning of their courses". All of the 506 new residents were examined simultaneously in 2 separate years with a questionnaire consist of 50 questions about their CPR secence and skills and 8 questions about their attitude in CPR. These informations were analyzed by SPSS and EPI6 softwares. The mean correct answers were 55%±11.8. The best results were about arrythmias (68.6%) and airway management (63.6%) and the worst were about IV access (43.1%) and pediatric CPR (31.5%). These findings were similar in 2 sequential years. Their knowledge had significant relation with sex (P=0.002), their original university (P=0.031), their residency course (P=0.024) and their residency reception scores (P<0.001). Males and knowledge more than females. The max scores were from Kerman (62%) and Beheshti universities (60.5%) and the min score were from Hamadan (48%) and Kashan universities (37%). The orthopedic (62.5%) and urologic residents (61.6%) had the most knowledge and the gynecology residents (53.8%) had the least. The knowledge had no relation with the time of graduation. About their attitude in CPR: Their knowledge was moderate (65.8%), their abilities was moderate (58%) and their education about CPR in MD course had been low (51.5%). Their references for education had been individual studies (74.6%), CPR workshop had not been condected in the most universities (92.7%). knowledge about CPR is low (55.8%) and must be 100%. In advanced centers, continuous educations in CPR is essential. Residents with low scores have accepted in courses that have more CPR situations. Difference in knowledge of residents from different universities, show the different educations. Primary knowledge was low and after years, this is lower. Attitude of residents show the low knowledge, low ability, low education in MD, courses.

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This is a mortality study in internal medicine wards of Amir-Alam Hospital, since the beginning of 1374 to end of 1376. Here, we reviewed, prevalence of disease lead to death, the ward and invasive interventions and duration of admission of patients before death. In this study, records of 85 patients were reviewed. 68.2% of patients were men and 31.8% women. Mean of age was 61.6% with minimum of 18 and maximum 95 years. The most prevalent diseases leading to death were cardio vascular (41.2%), cancer 29.4%, GI tract diseases (10.6%), pulmonary diseases (8.3%), CNS (7.1%), hemathologic (4.7%), DM (3.5%). Mean duration of stay in hospital before death was 6.6 days (max 30-min 1). This figure in different wards were: ward 1 (7 days), ward 2 (11 days), ward 3 (5.9 days) ICU (5 days) and CCU (4.7 days). 90.5% of patients died due to their diagnosed illnesses. Invasive tests and intervations were performed in 40% of them. As a whole 35 patient were died in CCU. This research and others like it showes the failures of our patient management system and can guide us in approaching to better medical care.

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Introduction: In the patients with smear-positive pulmonary tuberculosis (TB) bacteriologic assessment of sputum for detection of acid bacilli (AFB) Has essential role. This evaluation is accomplished by direct sputum smear & sputum culture. These examinations must be done in regular and preferably monthly after beginning of treatment. These tests have two important aims, including, determining of treatment efficacy & duration of isolation.
Methods and Materials: Most of the studies have that classic six month regimen led to sputum smear conversion & negative sputum culture in 85% of patient. This treatment regimen has two phases, including, attack phase and maintenance phase. In the attack phase we use four drugs, including, Isoniazid (INH), Rifampin (RMP), Pyrazinamide (PZA) and Ethambutol (EMB) for the first 2 months and if necessary until the end of third month. In the maintenance phase we use INH and Rif for the remaining of treatment course. The main objectives of this study were to determine the time needed for smear conversion and assessment of probable factors which may influence the smear conversion until 4 months after beginning of therapy. The factors that were assessed, were, Age, nationality, sex, clinical symptoms, underlying diseases, chest radiography (number of cavities), smoking, drug abuse and concentration of AF13 in the sputum Generally, we did this cross sectional study on the patient's records, who had been observed in Imam Khomeni Hospital, west health service center and masih daneshvary hospital between.
Results: This study showed that from totally 218 patients, 138(74.6%) patients had sputum conversion at the first 2 months of treatment and until the end of 3rd & 4th month this rate reached to 83.3% respectively. So in the end of fourth month only 32(14.7%) patients did not show sputum smear conversion. On the other hand this study showed that two factors including presence of cavities in chest radiography & concentration of AFB in the sputum are influencing this rate strongly.
Conclusion: Role of other factors such as age, nationality , Smoking, diabetes mellitus and weigh loss are controversial and another studies are necessary for confirming their roles. Other factors including sex, clinical symptoms has not been show to be important. Some factors such as drug abuse and immunosuppresive therapy has not been assessed in this study, because number of cases were not enough for statistical analysis.

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Renal transplantation is ideal treatment of chronic renal failure. Pulmonary infection is a common and serious post transplant infection requiring hospitalization and is associated with high mortality. Increased susceptibility to infection is due to a decrease in the patients' immunological response caused by immunosuppression through drug administration, and by other influences.
Materials and Methods: This study was case series and prospective, from July 2001 to July 2002 in Imam Khomeini hospital of Tehran.
Results: 164 renal transplant recipients were studied, 14 patients (8.5%) had pulmonary infection, 11 of them (78.6%) were female and 3 (21.4%) were male. The mean age of them was 42.6 years. The patients were followed up for 9 to 12 months. All patients were on triple immunosuppressive regimens. The interval between transplantation and the appearance of pneumonia was 2 months to 10 years. The time of beginning infection in 3 cases (21.4%) was between 1 to 6 months post transplantation, 11 cases (78.6%) were occurred beyond 6 months after transplantation. In 7 cases (50%), pulmonary infection was occurred during first year after transplantation. None of the 14 patients developed pulmonary infection in first month after transplantation. BAL were used in 6 cases (42.8%) of pulmonary infection, and organism were detected in 5 of them (83.3%). The most common clinical feature was fever. Six cases were due to mycobacterium tuberculosis (42.9%), this organism was the most common ethiology of pneumonia. In this study tuberculosis was seen in 3.6% of renal transplant recipients. One patient had pulmonary mucormycosis. All patients with pulmonary TB were cured, and other cases with unknown case, were cured with empirical treatment.
Conclusion: Our finding indicate the invasive diagnostic procedures are required in order to earlier and reliable diagnosis and then better outcome of transplantation.

 

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Background: Pulmonary involvement is a common and serious complication of rheumatoid arthritis. This cross sectional study sought to determine the prevalence of pulmonary disease in patients with rheumatoid arthritis on the basis of history, physical examination, chest X-ray and PFT.

Materials and Methods: 103 patients (81 Women, 22 Men) fulfilling the ACR (American College of Rheumatology) criteria for RA (Rheumatoid arthritis) were consecutively included in a cross sectional study. Detailed medical (including respiratory symptoms and the disease activity symptoms) and drug and occupational histories and smoking were obtained. All patients underwent a complete pulmonary and rheumatologic examination and conventional chest radiography. All patients underwent PFT that comprised spirometry and body plethysmography.Results for PFTs were expressed as percentage of predicted values for each individual adjusted for age, sex, and height.

Results: On the basis of history: Their mean age was 43.3 ± 2.6 years (range: 17-74) and the mean duration of the disease was 69.3 ± 15.6 months. Rheumatoid factor was positive in% 61.2. No patients were 0.5Pack/Year smoker in whole life. Prevalence of pulmonary involvement based on radiographic and pulmonary function test detected in 41 patients (39/7%). The most frequent respiratory clinical finding was dyspnea (33%), (NYHA grade I in 17.5% and NYHA grade II in 15.5%), Cough (with or without sputum) in 13.6 %, Crackle was the most sign in pulmonary examination (5.8%). Chest X-ray was abnormal in 13.3 % that the most common finding in this study was reticulonodular pattern in 20 patients (19.4 %), and pleural effusion detected in 7 patients (6.7%). PFT was abnormal in 30 patients (29.1 %). A significant decrease of FEF 25%-75% below 1.64 SD. Small airway involvements was the most abnormal finding of PFT. No relation between rheumatoid arthritis disease activity (ESR>30, Morning stiffness>30', Anemia, thrombocytosis) with pulmonary disease was seen.

Conclusion: This study suggests a high prevalence of lung involvement in patients with rheumatoid arthritis.Therefore we recommend a complete investigation in patients with RA with any respiratory symptom.

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Background: Both hypoxia and hypocapnia can cause broncho-constriction in humans, and this could have a bearing on performance at high altitude. The objective of this study was to examine how pulmonary ventilatory function during high-altitude trekking.
Methods: This study was a before and after study on spirometric parameters at Base line (1150 m above sea level), and after ascending at 4150 m above sea level. This study was performed in summer 2004 at Cialan Mountain in Iran. Fifty six healthy male University student volunteers were enrolled in the study. Respiratory function was assessed in participants before ascending at baseline (1150 meter) and after ascending at 4150 meter in Cialan Mount with a Spirolab II. Spirometric parameters changes were compared using paired t-test statistical analysis computations were performed by spss 11.5 and p≤0.05 was considered significant.
Results: The mean age and body mass lindex of our subjects were 22.9±5.3 years and 21.5±2.5, respectively. Forced vital capacity (FVC) was significantly decreased with increasing altitude from baseline level (P<0.01). Forced expiratory volume in 1 second to forced vital capacity ratio (FEV1/FVC) and maximal midexpiratory flow rate (FEF 25-75%) were significantly increased with increasing altitude (P=0.001). There was no significant change in forced expiratory volume in 1 second and peak flow (P>0.05). FVC fell by the average of 7.1% at 4150m (2.4% per 1000m increased altitude) in comparison to 1150m.
Conclusion: The changes in some pulmonary ventilatory parameters were proportional to the magnitude of change in altitude during a high-altitude trek.

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Background: The Fontan operation is the definitive operation for palliation of complex congenital heart disease with single –ventricle physiology. The use of the extra cardiac conduit has recently been gaining popularity. The purpose of this study was to compare the outcomes of extra cardiac conduit Fontan procedure (off-pump technique) and that of traditional technique (lateral tunnel technique) in which cardiopulmonary bypass is routinely used.
Methods: Forty one patients in different age groups underwent extra cardiac conduit Fontan procedure between April 2001 and December 2004. Data were collected from ICU sheets, files and during follow up visits. Under general anesthesia and through median sternotomy, using two temporary decompressing shunts, superior vena cava implanted on right pulmonary artery and a conduit interposed between transected inferior vena cava and main pulmonary artery. Fenestration was done in almost all patients and previous shunts were closed if there were any.
Results: Of our patients, 13 were female and 28 were male. Mean age of the patients was 11.1 years (SD=7.8).In 24.4% of cases Fontan procedure was done as the first palliative surgery and in 75.6% of them there was previous history of palliative procedures. In 6 patients (14.6%) we were constrained to use cardiopulmonary bypass which was predictable or necessary in 50% of cases. There was no reoperation due to post operative bleeding. Two cases suffered from prolonged plural effusion. Our in-hospital mortality was 9.8%. During 2-24 months follow up, we found two cases who were in NYHA functional class II and one case in functional class I.
Conclusion: Extra cardiac conduit Fontan procedure could be used in a safe way. The results of this study were comparable and even in some cases better than that of the traditional technique.

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Background: Tetralogy of Fallot is the most common cyanotic congenital heart disease. The systolic and diastolic function in both ventricles is altered even after successful corrective surgery for this defect with a transannular patch. Pulmonary regurgitation, a common complication after this treatment, is usually well tolerated in childhood. The aim of this study was to assess the combined diastolic and systolic function of both ventricles using the Doppler-derived myocardial performance index (Tei index) in patients who underwent surgical repair of tetralogy of Fallot using a transannular patch. In this article we discuss the impact of pulmonary regurgitation on right ventricular function and clinical outcome, the role of echocardiographic imaging, and current management strategies for patients with pulmonary regurgitation after this treatment.
Methods: Sixty eight patients with tetralogy Fallot were studied in Shahid Rajaie referral Cardiovascular Center during 2003-2005. The studied population, 36 male and 32 female with a mean age of 7.5±4 years and a history of corrective surgery for tetralogy of Fallot using a transannular patch. These patients were randomly selected and assessed by Doppler echocardiography.
Results: Fifty-seven patients (84%) had mild to moderate pulmonary regurgitation, whereas 11 patients (16%) had severe pulmonary regurgitation. Right ventricular Tei index was significantly increased in patients with severe pulmonary regurgitation compared those with mild to moderate pulmonary regurgitation (0.54±0.18 vs 0.24±0.11, P<0.01). Left ventricular Tei index was increased in patients with severe pulmonary regurgitation compared those with mild to moderate pulmonary regurgitation (0.46±0.22 vs 0.32±0.14, P<0.05).
Conclusions: The findings of this study suggest that pulmonary regurgitation is a serious complication after repair of tetralogy of Fallot with a transannular patch. Delaying surgery in such patients risks irreversible ventricular function.

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Background: Depending on the lung volume in radiotherapy fields, breast cancer radiotherapy has documented side effects on pulmonary function, which can be determined by pulmonary function tests. Central lung distance (CLD), the distance from the chest wall to the edge of the field at the central axis, is an indicator of lung volume within the radiotherapy fields. In this study, we aim to detect the relationship between CLD and pulmonary function tests.

Methods: In this study we included 50 patients with breast cancer receiving postoperative adjuvant radiotherapy at Imam Hossein Hospital, Tehran, Iran. The patients received radiotherapy with a total dose of 4800-5000 cGy. For all patients, the central lung distances were measured using simulation of tangential fields, in addition to determination of pulmonary function, including force vital capacity (FVC) and forced expiratory volume in 1 s (FEV1) determined before radiotherapy, one month and three months after radiotherapy.

Results: There is no significant statistical difference between the FEV1 and FVC values before radiotherapy and those measured one month after radiotherapy however there was a significant statistical decrease in the FEV1 and FVC before radiotherapy and those measured three months after radiotherapy (P<0.001 and P<0.006, respectively). There is a positive statistical correlation between the change in the FEV1 three months after therapy and the CLD (r=0.71, p<0.01) and that of the FVC three months after therapy and the CLD (r=0.59, p<0.01). Linear regression for the prediction of FEV1 and FVC three months after radiotherapy was designed according to the CLD, FEV1 and FVC values before radiotherapy.

Conclusions: Three months after breast radiotherapy, the FEV1 and FVC values decrease, and the CLD is a proper predictor of these changes.

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Background: The Ross procedure has been known as a good method for aortic valve replacement. Pulmonary allograft postoperative stenosis subsequent to the Ross procedure has been noted as an important disadvantage of this technique, although risk factors related to this complication are not clearly recognized. In this study we evaluate the risk factors of pulmonary allograft stenosis after Ross procedure.
Methods: This retrospective cohort study was carried out on 42 patients who underwent the Ross procedure. Left ventricular outflow tract obstruction was repaired using pulmonary allografts 22.7±2.5 mm in diameter. Echocardiographic and clinical examinations were performed for all patients at six and 12 months after surgery. Echocardiographic data as well as data related to the allografts were recorded.
Results: The mean age of the patients was 28.5±10 years. Postoperative pulmonary valve stenosis was detected in 13 patients (31%). Nine patients (21.4%) had mild stenosis and four patients (9.5%) had moderate stenosis. No relationship was detected between the degree of stenosis and the size of allograft (p=0.08). There was a significant correlation between postoperative pulmonary stenosis and donor age (p=0.04). Predictive variables of pulmonary allograft stenosis after the Ross procedure were low donor and recipient age (p=0.03 and 0.05, respectively).
Conclusions: This study shows that the Ross procedure has a rather low incidence of postoperative stenosis and is a suitable substitute for aortic valve replacement. Low donor age is associated with pulmonary allograft stenosis formation, perhaps due to greater viability of tissue cells from younger donors.

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Background: Lung leiomyoma and pulmonary arterio-venous malformation (PAVM) are both rare diseases. Occurrence of them in a patient is rare too. Because of their limited signs and symptoms and so serious complications, accurate diagnosis of both diseases is important.
Case report: We present a 73 -year old female with PAVM combine with a coincidental solid mass in left upper lobe. Because of fistula size and combination with a solid mass, the lesion is treated by left upper lobectomy.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Pulmonary resection is one of the most common thoracic surgeries Bronchial stump closure is important topic and still is controversy Bronchial stump closure with stapler is a new method that in addition to rapidity, lowering separation and dehiscence of suture line and lowering contamination of the operative site with bronchial secretions, and lowering the main complication after pulmonary resections which is sustained air leak- main factor in delaying discharge and patients dissatisfaction.
Methods: Two groups of 16 patients in a randomized clinical trial compared. In one group bronchial stump closed with stapler and the other stump closed with hand sewn method. Bronchial closing time, Operative time, time of airleak, time of chest tube, time of discharge and complication recorded and compared.
Results: In the stapler group time of bronchial closing was significantly shorter. Operative time was not different. time of air leak was not statistically different. No patients with long airleak, and the number of patients without airleak was greater. In the stapler group, time of having chest tube was statistically shorter and time of discharge in stapler group was shorter than hand sewn group.
Conclusions: Bronchial closing with stapler in pulmonary resection is a safe method and in addition to rapidity, time of chest tube and time of discharge was shorter. Although Time of air leak was not statistically different but patients in stapler groups had less Days with air leak and long air leak was zero in this group.

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Background: Asthma is a major health condition in Iran. This randomized clinical trial was aimed for the comparison of the effects of two exercise protocols (aerobic and aerobic-strength) on the pulmonary indices and quality of life of asthmatic patients.

Methods: The study was conducted in pulmonary ward of Dr Shariati Hospital in Tehran, and Research Center of Exercise Medicine of Tehran in 2009. Fifty six asthmatic patients were selected and after two weeks of education, their spirometric parameters were recorded and the St George's respiratory questionnaire was completed. Then patients were randomly assigned to two groups of A and B. For ten weeks group A did the aerobic-strength exercises and group B did only the aerobic ones at home. At the end, again their spirometric parameters were recorded and the questionnaire was completed. Finally 42 patients completed the study.

Results: After the intervention, FEV1 and FVC but not FEV1/FVC increased in group A. There were no changes in these parameters in group B. In addition, post-intervention FEV1 and FVC were significantly higher in group A than group B. All scores of St George's respiratory questionnaire were significantly improved in both groups but they were not different between them.

Conclusions: Our findings showed that regular aerobic exercises, individually or concomitant with strength exercises, could improve vital signs and quality of life of mild to moderate asthmatic patients. However, only aerobic exercises with strength ones improve spirometric parameters. Therefore, a combination of both aerobic and strength exercises could be considered in treatment protocols of asthmatic patients.

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Background: Teratomas are tumors consisting of tissues derived from more than one germ cell line. Teratomas arise, most commonly in anterior mediastinum. Intrapulmonary Teratoma are among the rarest tumors encountered in pathology, in other words they are exceedingly uncommon, with only less than 100 cases documented by 1939.

Case presentation: We describe a 19-year-old woman with a short history of retrosternal chest pain and non-productive cough due to a benign intrapulmonary mature teratoma originating from the right upper and middle lobes. The clinical, imagings and pathological features of this rare tumor are presented and the relevant literatures are discussed.

Conclusions: Intrapulmonary teratomas are rare tumors. They originate from the third pharyngeal pouch and present as cystic lesions in the majority of cases. Histologically, benign teratomas comprise of two or three primordial layers. Patients present with chest pain, dyspnea, cough, hemoptysis and trichoptysis. Any Intrapulmonary teratoma should be resected due to its potential for malignancy and rupture.

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Background: Chronic Obstructive Pulmonary Disease (COPD) is one of the most prevalent pulmonary diseases. Use of an automatic system for the detection and diagnosis of the disease will be beneficial to the patients' treatment decision-making process. In this paper, we propose a new approach for the Computer Aided Diagnosis (CAD) of the disease and determination of its severity axial CT scan images.
Methods: In this study, 24 lung CT scans in full inspiratory and expiratory states were performed. Variations in the normalized pattern of the lungs' external parenchyma were exploited as a feature for COPD diagnosis.Subsequently, a Bayesian classifier was used to classify variations into two normal and abnormal patterns for the discrimination of patients and healthy individuals. Finally, the accuracy of the classification was assessed statistically.
Results: With the proposed method, the lungs parenchymal elasticity and air-trapping were determined quantitatively. The more this feature tended to zero, the more severe air-trapping and obstructive pulmonary disease is. By analyzing CT images in the healthy and patient groups, we calculated the hard threshold for the diagnosis of the disease. Clinical results tested by the mentioned method, suggested the effectiveness of this approach.
Conclusion: In regard to the challenges of COPD diagnosis, we propose a new computer-aided design which may be helpful to physicians for a more accurate diagnosis of the disease. Moreover, this severity scoring algorithm may be useful for targeted disease management and risk-adjustment.

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Background: Sputum induction has been recently introduced as an effective and inexpensive method for obtaining high quality sputum samples in patients without spontaneous sputum. As all Iranian physicians might not be familiar with this method yet, the results of this study could be of help in this regard.

Methods: During June 2010 to January 2011, all pulmonary tuberculosis (PTB) suspected patients, with clinical and/or radiological evidence in favor of PTB who had been referred to the Pulmonary Diseases department of Imam Khomeini Medical Center were enrolled in the study, if they were without spontaneous sputum. Sputum induction was performed using ultrasound nebulized hypertonic 3% sterile saline for 20 minutes. The laboratory was requested to report if the samples were of the intended quality (Polymorphonuclear Cells/Squamus Epithelial Cells≥2). The patients' demographic data, HIV serology and chest radiological findings in favor of PTB were recorded and analyzed.

Results: In 50 patients with suspected PTB [23 men (mean age (±SD), 51.21±20.24) and 27 women (mean age (±SD) 55.40±18.00)], cough was the most common complaint. The most prevalent radiological findings were infiltration and consolidation. PPD was positive in 21 (42%) patients. Sputum induction led to obtaining proper sputum samples in 90% of the patients. Positive sputum smear and culture were seen in 13 (26%) cases.

Conclusion: Sputum induction is a cost-effective and minimally invasive method which is associated with satisfactory results for obtaining high quality sputum samples in patients without spontaneous sputum.

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Background: Scoliosis is one of the most common spinal deformities with subsequent decrease in pulmonary function. The effects of surgical correction on the pulmonary function of patients with adolescent idiopathic scoliosis are controversial. The purpose of the present study was to compare the postoperative pulmonary function changes in different surgical approaches chosen for its correction.

Methods: Sixty-five patients with adolescent idiopathic scoliosis who had undergone corrective spinal surgery in Shafa Yahyaian Hospital since 1997 to 2007 and had documented preoperative pulmonary function test report, included in our study. The patients had documented preoperative pulmonary function tests and were divided into three groups based on their surgical approach. The first group was comprised of 25 patients who had undergone posterior spinal fusion (PSF), the second group included 29 patients who had anterior and posterior spinal fusion (ASF+PSF), and the third group consisted of 10 patients who had posterior spinal fusion and thoracoplasty (PSF+ thoracoplasty). The preoperative and the final follow-up values of absolute and percent predicted forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) were compared and their relations with the undertaken surgical approach were evaluated.

Results: There were no significant correlations between the surgical approaches and changes in the pulmonary function tests (P>0.05). FVC and FEV1 values were similar to preoperative values in all groups after a minimum follow-up of two years.

Conclusion: There were no significant differences between different surgical approaches for adolescent idiopathic scoliosis regarding the pulmonary function test results after at least two years of follow-up.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Isolated pulmonary valve stenosis represents 8-10% of congenital cardiac anomalies. This study was performed to evaluate the late outcomes of Balloon Pulmonary Valvuloplasty (BPV) in children with residual infundibular stenosis.
Methods : Seventy-eight patients underwent BPV in Rajaee Heart Center in Tehran Iran, from 2008-2010. The patients were divided into two groups: with and without infundibular stenosis. The group with infundibular stenosis was subdivided into two groups: with and without propranolol administration. Gradient measurement follow-ups by Doppler echocardiography were done on the first day and 1, 3, 6 and 12 months afterwards.
Results: Thirty five (44.9%) patients were male and 43 (55.1%) were female. The mean age of participants was 4.29±3.5 years and the mean weight 16.18±8.8 kg 33 patients (43%) did not show residual infundibular stenosis but 45 (57%) did so in the evaluations. There were no significant differences between the two groups regarding age, weight, sex, kind of balloon valvuplasty, balloon to body surface area ratio and pulmonary regurgitation (PR). Propranolol was administered to 27 (60%) patients with residual stenosis for six months but 18 (40%) did not receive the medication. In both groups, the gradient significantly decreased immediately after BPV (P<0.0001). In the propranolol group a constant decrease in residual gradient was seen. There was a significant relationship between balloon to body surface area ratio (387±94mm²/m²) with moderate to severe PR (P<0.015).
Conclusion: BPV is a safe and effective procedure to treat PS. Residual infundibular gradient after BPV decreases over time and propranolol helps decrease the gradient.

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Background: Perioperative administration of tranexamic acid (TA), decreases bleeding and the need for transfusion after cardiac procedures. Hence, the results may vary in different clinical settings and the most appropriate timing to get the best results is unclear. The primary objectives of the present study were to determine the efficacy of TA in decreasing chest tube drainage, the need for perioperative allogeneic transfusions and the best timing for TA administration following primary, elective, coronary artery bypass grafting (CABG) in patients with a low baseline risk of postoperative bleeding.

Methods: In this double-blind, prospective, placebo-controlled clinical trial in Seiedoshohada Hospital during 2011-2012, we evaluated 150 patients scheduled for elective, primary coronary revascularization. They were randomly divided into three groups. Group B received tranexamic 10 mg/kg prior to, Group A received tranexamic acid 10 mg/kg after cardiopulmonary bypass and group C received an equivalent volume of saline solution. Blood requirement and postoperative chest tube drainage were recorded.

Results: The placebo group (group C) had a greater postoperative blood loss 12 h after surgery (501±288 vs. 395±184 in group B and 353±181 mL in group A, P=0.004). The placebo group also had greater postoperative total blood loss (800±347 vs. 614±276 in group B and 577±228 mL in group A, P=0.001). There was a significant increase in allogeneic blood requirement in the placebo group (P=0.001).

Conclusion: For elective, first time coronary artery bypass surgery, a single dose of tranexamic acid before or after cardiopulmonary bypass is equally effective.

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Background: The purpose of this study was to determine the prevalence and associated factors for postoperative pulmonary complications (PPCs) and extubation failure in patients having undergone intracranial surgery.

Methods: In this retrospective study done in Firozgar Hospital during 2008-2010, we followed up 254 patients through a clinical questionnaire and observation of the clinical course of participants in pre- and post-operative periods.

Results: Overall, 40 (15.74%) patients had postoperative pulmonary complications. The most common PPC was pneumonia, which was seen in 24 patients (60% of complications). The average duration of ventilation in patients with PPC was significantly higher (16.8.±10 vs. 5.09±4.5 days P=0.001) than patients without the complication. The mean Glasgow coma scale (GCS) after surgery in patients with PPC was significantly lower (11.±4 vs. 13.2±3 P=0.001) than the rest of the patients. Moreover, the mean age of patients with PPC was significantly higher (64.02±14 vs. 41.6.±17 years P=0.001). Average duration of stay in ICU in patients with PPC was also higher (24.±27 vs. 8.7±0.5 P=0.001).

Conclusion: GCS before surgery and failed extubation independently of other variables were significantly associated with pulmonary complications independent of other variables.