Anesthetic management in complex arch surgery: debranching of innominate and left common carotid arteries in extensive aortic dissection without cardiopulmonary bypass

Aortic dissection begins with the formation of a tear in the aortic intima, and it directly exposes an underlying diseased medial layer to the driving force of the intraluminal blood. This blood penetrates the diseased medial layer and cleaves the media longitudinally, thereby dissecting the aortic wall. Herein, we report the case of a 38-year-old woman, who presented with chest pain and dyspnea. After physical examination, laboratory evaluation, echocardiography, and CT-angiography, extensive aortic dissection was diagnosed involving the innominate and left common carotid arteries. Accordingly, the debranching of the aortic arch arteries was performed. During the procedure, the patient was monitored with bilateral regional cerebral tissue oximetry. The patient did not show any signs of complications either in the postoperative period or at postoperative three-month weekly follow-up or at subsequent monthly follow-up for the past year

Off-pump coronary bypass grafting causing stunned myocardium

The term "stunned myocardium" refers to abnormalities in the myocardial function following reperfusion and is common in on-pump coronary artery bypass grafting [CABG] and is exceedingly rare in off- pump CABG. A 53-year-old man presented with unstable angina due to the severe stenosis of the left anterior descending coronary artery [LAD] and the obtuse marginal. Laboratory findings and Chest X-ray revealed nothing abnormal. The intraoperative course was uneventful. The patient left the operating room without any inotropic support. Six hours later, however, he developed low cardiac output .At exploration, cardiac tamponade was excluded and flowmetry showed that the graft had adequate function. Cardiac enzymes were normal. High-dose adrenalin and Dobutamine were administrated and an intra-aortic balloon pump was used. After hemodynamic stabilization, the patient left the Intensive Care Unit without an intra-aortic balloon pump and inotropic support. On the fifth postoperative day, coronary angiography showed patent grafts and correct anastomotic sites. On the seventh postoperative day, the akinetic lateral wall of the left ventricle changed to dyskinesia. Finally after hospital discharge on the thirtieth postoperative day, an echocardiogram showed normal left ventricular function without regional wall motion abnormalities.

[Frequency of suicidal ideation in high school students in Abdanan, Ilam Province]

The purpose of this study was to determine the prevalence of suicidal ideation [SI] and the related factors in high school students in Abdanan, Ilam province. This cross-sectional study enrolled 571 high school and pre-university students through multistage sampling in 2004, in Abdanan. Subjects were evaluated for suicidal ideation using Beck's Scale for Suicidal Ideation, and by a demographic questionnaire that collected study variables [history of suicidal attempt, substance use, smoking, death of relatives]. Frequencies of severe suicidal ideation was 122 persons [21.4%]; moderate suicidal ideation, 109 [19.2%]; and no suicidal ideation was 339 [59.4%]. Distribution of the subjects with suicidal ideation differed significantly by gender, school grade, major, history of psychiatric disorders, death of a relative in the past year, physical illness, history of suicidal attempt, parents' separation, and use of substance and cigarette. Identifying suicidal ideas and the related factors is the first step in interventional studies and it appears that future studies should consider designing an appropriate intervention in that regard