ABSTRACT
Chronic thromboembolic pulmonary hypertension [CTEPH] is a serious and underdiagnosed disorder with significant morbidity and mortality. It is thought to result from single or recurrent pulmonary thromboemboli arising from the sites of venous thrombosis, often from the lower limbs. Surgical correction of anatomical obstructions [endarterectomy of pulmonary artery] is the treatment of choice in these patients, and the patients outcomes are good. The mortality rate in some centers is about 5%, but in others it is up to 30%. We started pulmonary endarterectomy in Shaheed Rajaie Heart Center [RHC] in Iran four years ago. Pulmonary thromboendarterectomy is performed under hypothermia and total circulatory arrest with cardiopulmonary bypass. All patients are evaluated in our hospital for known risk factors of deep vein thrombosis and pulmonary emboli. Right heart catheterization and measurement of pulmonary artery pressure and vascular resistance are performed in some of the patients and left heart catheterization in those who are over 45 years of age. CT angiography of the pulmonary artery with multi-slice CT scan is done in all patients before and after endarterectomy. Patient selection for successful endarterectomy is based on CT angiography and perfusion lung scan with consideration of pulmonary vascular resistance in some cases. During a 4-year period, 15 patients [5 female and 10 male] underwent this type of surgery in RHC. Their mean age was 35.87 [min. 18, max. 55] years old. The mean pulmonary artery systolic pressure by echocardiography was 87.60 mmHg [min. 55mmHg, max. 140 mmHg, SD 23.26 mmHg] and the mean pulmonary artery pressure was 46.43mmHg [min. 23 mmHg, max. 60 mmHg, SD 11.70 mmHg]. Mean surgery time was 5.33 hours [min. 4hrs, max. 14 hrs, SD. 2.46 hrs], mean bypass time was 138 minutes [min. 84, max. 220, SD=43.28 minutes], mean intubation time was 49.88 hours [min. 7 hrs, max. 216 hrs, SD 61.66 hrs], and intensive care unit stay time was 5.43 days [min. 3, max. 9, SD=1.98]. Two fatalities occurred due to bleeding and shock. The mortality rate was 20%. IVC filters were placed in a minority of the patients who had clear-cut evidence of lower extremity deep vein thrombus as a cause of pulmonary thromboembolic events. Pulmonary endarterectomy is the treatment of choice in CTEPH with an acceptable mortality rate and a good prognosis. It is possible to perform this procedure without recourse to more sophisticated evaluations with an acceptable mortality rate in patients who have segmental lobar or main pulmonary artery organized clot
ABSTRACT
Depression is a prevalent psychiatrical disease and among the most disabling psychiatrical health problems in various societies. It has been estimated that, till the year 2020, depression will be the second prevalent disease after cardio-vascular disease and will include 15% of the human diseases. This study was carried out to determine the effect of hydroalcoholic extract of Mentha piperita [complement treatment] on patient's depression severity. This is a triple blind random clinical trial research carried out on depressed patients referred to the Shahid Mofateh Clinic of Yasouj city during 2007-2008. The patient's depression severity was evaluated by Beck questionnaire and they were divided into 5 groups as random allocation and each group consisted of 24 persons. Then, Hydroalcoholic extract of Mentha piperita was given to four groups at the rate of 10.0mg, 50.0mg, 100.0mg and 200.0mg respectively per day and the fifth group received placebo. The treatment was continued for a period of two months. After this period, again the depression rates of patients were evaluated with the help of same questionnaire and were compared with the rates before the intervention. Collected data were analyzed with the help of descriptive tests, x[2] statistical test, one way variance analyzed and variance with repeated measurements. The results of the study indicated that the highest anti depression effect was seen in those patients who received 100.0mg and 200.0mg of the extract and the lowest rate allocated to the groups of 50.0mg, placebo group and 10.0mg respectively. Statistical analysis using repeated measurements confirmed the difference at the level of 0.1 between the mean of depression rate of the five research groups before and after intervention [p=0.078]. Based on the results of the current study, spearmint juice at the rate of 100.0mg and 200.0mg can be used as supplement in treatment of depressed patients. However, more studies are needed to find out the proper dose of the extract