Silent pulmonary artery dissection in a patient with old pulmonary balloon valvuloplasty

Percutaneous pulmonary balloon valvuloplasty [PBV] remains the treatment of choice for pulmonary stenosis [PS]. This procedure is effective, safe and gives excellent results. Pulmonary artery [PA] dissection is a rare complication of PBV. This report is a case of an asymptomatic 17-year-old male with a history of PBV due to severe PS dating back to fifteen years ago. During recent echocardiography, an intimal flap was detected in the main PA and entry site was clearly seen by contrast study

Cardiac variables as main predictors of endotracheal reintubation rate after cardiac surgery

Reintubation in patients after cardiac surgery is associatedwith undesirable consequences. The purpose of the present study was to identify variables that could predict reintubation necessity in this group of patients. We performed a prospective study in 1000 consecutive adult patients undergoing cardiac surgery with cardiopulmonary bypass. The patients who required reintubation after extubation were compared with patients not requiring reintubation regarding demographic and preoperative clinical variables, including postoperative complications and in-hospital mortality. Postoperatively, 26 [2.6%] of the 1000 patients studied required reintubation due to respiratory, cardiac, or neurological reasons. Advanced age and mainly cardiac variables were determined as univariate infra- and postoperative predictors of reintubation [all p values < 0.05]. Multiple logistic regression analysis revealed lower preoperative [p = 0.014; OR = 3.00, 95% CI: 1.25 - 7.21], and postoperative ejection fraction [p = 0.001; OR = 11.10, 95% CI: 3.88 - 31.79], valvular disease [p = 0.043; OR = 1.84, 95%CI: 1.05 - 3.96], arrhythmia [p = 0.006; OR = 3.84, 95%CI: 1.47 - 10.03], and postoperative infra-aortic balloon pump requirement [p = 0.019; OR = 4.20, 95%CI: 1.26 - 14.00] as the independent predictors of reintubation. These findings reveal that cardiac variables are more common and significant predictors of reintubation after cardiac surgery in adult patients than are respiratory variables. The incidence of this complication, reintubation, is low, although it could result in significant postoperative morbidity and mortality

Evaluation of cardiovascular diseases and their risk factors in hospitalized patients in east Azerbaijan province, northwest Iran: a review of 18323 cases

Coronary artery disease [CAD] is accountable for more than 30% of deaths worldwide and is, thus, deemed the most important factor in terms of disease burden around the globe. This study aimed to evaluate CAD and its risk factors in hospitalized patients in the East Azerbaijan Province, northwest Iran, from 2006 to 2007. Data on 18.323 patients hospitalized due to cardiovascular diseases were collected to evaluate the diseases and their risk factors in 15 hospitals in the East Azerbaijan Province, northwest Iran. We assessed the main diagnosis of cardiovascular disease on admission in each hospital. Also, types of interventional and surgical procedures were assessed and all these variables were compared between men and women. The study population consisted of 56.6% male and 43.4% female patients. The median and range between quartile 1 and 3 [Q1-Q3] ages of the males and females were 59 [49-70] and 62 [51-71] years, respectively. Ischemic heart diseases were diagnosed in 68.4%, electrophysiological disorders in 6.5%, and valvular heart diseases in 4.5% of the patients. The frequencies of the studied risk factors were as follows: cigarette smoking [47.5%]; hypertension [66.95%]; diabetes mellitus [35.9%]; and history of cerebrovascular accident [16.4%] and renal disease [13.4%]. Medical therapy was performed in 79.23%, surgery in 6.28%, and cardiovascular interventional therapy in 13.99% of the patients. The in-hospital mortality rate was 1.57% [1.42% in the males and 1.76% in the females; p value = 0.009]. The most frequent known risk factors in the hospitalized patients were smoking, alcohol consumption, and diabetes. In the northwest of Iran, age at hospitalization due to cardiovascular diseases is slightly lower than that in the Western populations; however, sex distribution, diagnoses, and treatment modalities are not significantly different from those reported in Western countries

Relationship between gender and in-hospital morbidity and mortality after coronary artery bypass grafting surgery in an Iranian population

Many previous studies have investigated the influence of gender on coronary artery bypass grafting surgery [CABG] outcomes. Despite the great volume of reports on this issue, it is still not clear whether it is the gender of the patient or pre-existing comorbid conditions that is the best predictor for the different outcomes seen between men and women. Multiple studies have shown that women are at higher risk of postoperative complications than men, particularly in the perioperative period. The goal of this study was to determine whether sex differences exist in preoperative variables between men and women, and to evaluate the effect of gender on short-term mortality and morbidity after CABG in an Iranian population. Data were collected prospectively from 690 consecutive patients [495 men and 195 women] who underwent isolated CABG. Preoperative, intraoperative, and postoperative variables, major complications and death were compared between the male and female patients until hospital discharge using multivariate analysis. Women were older [P = 0.020], had more diabetes [P = 0.0001], more obesity [P = 0.010], a higher New York Heart Association functional class [P = 0.030], and there was less use of arterial grafts [P = 0.016]. Men had more tobacco smokers [P = 0.0001] and lower preoperative ejection fractions [EF] [P = 0.030]. After surgery, women had a higher incidence of respiratory complications [P = 0.003], higher creatine kinase [CK] - MB levels [P = 0.0001], and higher inotropic support requirements [P = 0.030]. They also had a higher incidence of decreased postoperative EF versus preoperative values [P = 0.020]. The length of ICU stay, incidence of return to ICU and postoperative death, were similar between men and women. Nevertheless, after adjusting for age and diabetes, female gender was still independently associated with higher morbidity in patients over 50 years of age. Women had more risk factors, comorbidities, and postoperative complications. Women older than 50 years of age were at a higher risk of postoperative complications than men. This difference decreased with younger age. In-hospital mortality rates were not influenced by sex, as there was no difference found between the two groups [2.5% women vs. 2.2% men; P > 0.05]

Evaluation of anthropometric indices of patients with left ventricle dysfunction fallowing first acute anterior myocardial infarction

In the current study, we evaluated the effect of anthropometric indices on ejection fraction following first acute anterior myocardial infarction. In an analytic-cross sectional study, 50 patients with acute anterior myocardial infarction and abnormal anthropometric indices [Body Mass Index [BMI] >/= 30, Waist Hip Ratio [WHR] >/= 1 and >/= 0.85 in males and females respectively and Waist Circumference [WC] >/= 102 cm and >/= 88 cm in males and females respectively] were recruited as case group and 50 patients with acute anterior myocardial infarction and normal anthropometric indices as control group. Subsequently, the relation between anthropometric indices and left ventricle dysfunction was evaluated and compared between two groups. 77 people of the studied patients were male and 23 female with the mean age of 59 +/- 1.2 years and an age range of 32-90 years. To evaluate the left ventricle function, the mean ejection fraction of the patients was measured as 34.3 +/- 7.2% and 44.8 +/- 6.3% in patients with abnormal anthropometric indices and patients with normal anthropometric indices respectively [P= 0.0001]. Calculation of the correlation coefficient between ejection fraction and BMI, WHR and WC in males and females revealed a moderate reverse [r=-0.521 to r=-0.691] and statistically significant [P= 0.0001] relations which was of more strength in females. Anthropometric indices including BMI and waist circumference influence cardiac function following myocardial infarction.

Comparison of the length of hospital stay between the patients with atrial fibrillation treated with amiodarone and patients with normal sinus rhythm after coronary artery bypass graft

Postoperative atrial fibrillation occurs in 20% to 40% of patients undergoing coronary artery bypass grafting [CABG] and contributes to increasing length of stay and hospital cost. The purpose of our study was to compare the length of hospital stay between patients of postoperative atrial fibrillation treated with amiodarone [experimental] and those with normal sinus rhythm [NSR] [Control] after CABG. From October of 2008 to October 2010, our experimental group including 26 patients was treated with amiodarone in Tabriz Madani Heart Center. The background variables, length of atrial fibrillation, and length of hospital stay were recorded. The experimental group was compared with a control group of 50 patients. The two groups were the same in terms of age, gender, ejection fraction, vascular diseases and risk factors. The hospital stay duration was 8.0 +/- 1.6 and 7.4 +/- 1.4 days [p = 0.08] for experimental, and control groups respectively. Atrial fibrillation occurred mainly [60%] on the second postoperative day. 25 patients out of 26 patients [96%] returned to NSR after starting the amiodarone protocol and the length of hospital stay in the experimental group was not significantly different from that of the control group. Thus, treating with Amiodarone in postoperative atrial fibrillation can reduce hospital stay duration compared to that of normal sinus patients.

association between epicardial adipose tissue and coronary artery disease: an echocardiographic cut-off point

EAT is an independent factor in coronary artery disease [CAD]. The objective of the current study was to define an echocardiographic cut-off point for EAT and to determine its diagnostic value in predicting the increase in CAD risk. Two hundred patients underwent coronary artery angiography for diagnosis of CAD and transthoracic echocardiography for measurement of EAT on the right ventricle [RV], RV apex and RV outlet tract. Sensitivity, specificity, positive predictive value [PPV] and negative predictive value [NPV] of the EAT cut-off points in the three above-mentioned areas for predicting the severity of CAD were measured. The relation between the EAT and CAD risk factors was evaluated as well. EAT was independent from gender, height, hypertension, diabetes, HDL, total cholesterol, ejection fraction, acute coronary syndrome, and the location of the coronary artery stenosis in the coronary artery in all three anatomical areas. EAT on RV and RV apex had a significant relation with CAD [P /= 10 mm and RV apex EAT >/= 8 mm had sensitivity and PPV of more than 70% in predicting coronary stenosis >/= 50% and acute coronary syndrome [ACS] and RVOT EAT >/= 13 mm is of PPV=83.5% for predicting coronary stenosis >/= 50%. EAT thickness has an acceptable diagnostic value for predicting severe coronary artery stenosis and ACS. Therefore, non-invasive EAT thickness measurement could be of great assistance to clinicians for detecting the patients at risk and helping them to undergo supplementary evaluations with invasive approaches.

Echocardiographic findings in thalassemia major: a case report and literature review

We introduce a 28-year-old woman with Thalassemia major whose clinical assessment, including two-dimensional Doppler echocardiography demonstrated severe left ventricular hypertrophy with severe biventricular enlargement and systolic dysfunction as well as severe diastolic dysfunction. We hereby address these issues from an echocardiographic point of view.

Association between diabetic retinopathy and left ventricular dysfunction in diabetic patients with unstable angina

Diabetes mellitus [DM] is associated with serious complications including macro- and microvascular problems such as diabetic retinopathy. Coronary involvement in diabetic patients is believed to be a consequence of microvascular complications. However, the available data are inconclusive and scarce. This study aimed to evaluate the probable association between diabetic retinopathy and left ventricular dysfunction in diabetic patients with unstable angina [UA]. In this cross-sectional study, 200 diabetic patients with UA [100 cases with diabetic retinopathy and 100 cases without diabetic retinopathy] were enrolled in a teaching hospital. Left ventricular ejection fraction [LVEF] as well as the frequency of cases with left ventricular dysfunction [LVEF<50%] were compared between the two groups and different degrees of diabetic retinopathy [proliferative and non-proliferative]. Patients' demographic variables were comparable between the two groups. Mean diagnosis time of DM was significantly higher in the patients with diabetic retinopathy [8.40 +/- 6.60 vs. 3.81 +/- 3.58 years; P=0.001]. Mean LVEF was significantly lower in the retinopathy group [50.50 +/- 6.91% vs. 53.07 +/- 4.87%; P=0.003]. Frequency of cases with left ventricular dysfunction was significantly higher in the group with diabetic retinopathy [31% vs. 12%; P=0.001, OR=3.33, 95%CI: 1.58-7.14]. The frequency of cases with left ventricular dysfunction was significantly yet independently higher in patients with proliferative vs. non-proliferative diabetic retinopathy. Left ventricular dysfunction is more common in diabetic patients with unstable angina and diabetic retinopathy compared with their counterparts without diabetic retinopathy

Comparison of serum homocysteine concentrations between smoker and nonsmoker patients with acute coronary syndrome in Tabriz shahid madani hospital during 2008-2009

Background: According to previous studies elevated blood total homosyteine has been suggested to be an independent risk factor for cardiovascular disease. The aim of this study was evaluation of homosyteine serum in smoker and nonsmoker patients with acute coronary syndrome [ACS]. Methods: Eighty five patients were enrolled in this study. Forty eight patients [21smoker and 27non-smoker] diagnosed with acute myocardial infarction [AMI], 37 patients [14smoker and 23non-smoker] with unstable angina [UA] that admitted in Shahid Madani Heart center in Tabriz in 2008-2009. The mean age of patients with AMI and UA were 61.83 +/- 13.78 and 59.90 +/- 11.95 years, respectively. Homocysteine serum Levels were measured by Hitachi Auto analyzer. Results: The mean age of patients with AMI was 61.83 +/- 13.78 years and in patients with UA was 59.90 +/- 11.95 years [p=0.53]. Mean serum levels of homocysteine were not significant difference between AMI and UA patients [17.61 +/- 11.25 µmol/L vs. 22.25 +/- 12.44, p=0.78]. There was also a significant correlation between high levels of homocysteine with AMI and UA diseases in comparison with normal reference values. There were not statistically significant differences in serum homocysteine levels between smoker and nonsmoker patients in both AMI and UA groups. Conclusion: The Mean levels of Homocysteine in AMI and UA groups were not significantly different. Our study showed age of smoker patients in AMI and UA groups were significantly lower than nonsmoker patients

Perioperative risk factors for prolonged mechanical ventilation and tracheostomy in women undergoing coronary artery bypass graft with cardiopulmonary bypass

Prolonged mechanical ventilation is an important recognized complication occurring during cardiovascular surgery procedures. This study was done to assess the perioperative risk factors related to postoperative pulmonary complications and tracheostomy in women undergoing coronary artery bypass graft with cardiopulmonary bypass. It was a retrospective study on 5,497 patients, including 31 patients with prolonged ventilatory support and 5,466 patients without it; from the latter group, 350 patients with normal condition [extubated in 6-8 hours without any complication] were selected randomly. Possible perioperative risk factors were compared between the two groups using a binary logistic regression model. Among the 5,497 women undergoing coronary artery bypass graft [CABG], 31 women needed prolonged mechanical ventilation [PMV], and 15 underwent tracheostomy. After logistic regression, 7 factors were determined as being independent perioperative risk factors for PMV. Age >/-70 years old, left ventricular ejection fraction [LVEF]

Fragmented QRS complex in acute anterior myocardial infarction and coronary sinus blood flow: is there any relevance?

Patients with QRS fragmentation following myocardial infarction [MI] are at greater risk of cardiac death. Transthoracic echocardiography [TTE] can be used as a method for evaluating the coronary sinus blood flow [CSBF] and coronary sinus velocity time integral [CSVTI]. The present study reports measurement of CSBF and CSVTI by TTE in 100 acute anterior MI cases, half of them with fragmented QRS. Our study included 100 patients with acute anterior MI in whom CSBF and CSVTI were measured by the use of TTE. Fifty of all the patients had fragmented QRS complex and 50 patients were without fragmented QRS complex, while there was no difference in terms of LVEF in both groups of study. CSBF [303 +/- 126 ml/min vs. 258 +/- 121 ml/min; p-0.001] and CSVTI [14.45 +/- 2.85 ml vs. 10.85 +/- 2.69 ml; p=0.003] were significantly lower in the acute anterior MI patients with fragmented QRS in comparison with the patients with acute anterior MI without fragmented QRS. We conclude that CSBF and CSVTI can be measured by TTE in acute MI patients and these variables are reduced in acute anterior MI patients with fragmented QRS

Incidence of Cardiovascular Risk Factors in Oskoo (Northwest Iran]: an Approach through WHO CVD-risk Management Package for Low-and Medium-Resource Settings on 37,329 Adults >/=30 Years Old

The aim of this study was to determine incidence of cardiovascular disease [CVD] risk factors [hypertension [HTN], obesity, Dyslipidemia[DLP], diabetes mellitus [DM] and smoking] in Oskoo. This study was planned according to WHO protocol [WHO CVD-risk management package for low and medium-resource settings] and named [East Azerbaijan healthy heart program]. The pilot study of this program was done in Oskoo in 2007-2009. In this study, demographic data and CVD risk factors of 37, 329 adults aged>30 years old living in Oskoo were collected. In addition, blood samples of 17, 388 adults>40 years old were taken [free of charge] for assessment of serum glucose and lipid profile. The study covered 93.52% of Oskoo town population aged>30 years old. We studied 18637 male [M] [91.50% coverage] and 18692 female [F] [95.52% coverage] participants. The incidence of HTN [SBP>140 and DBP>90 mmHg] was 16.25% [M:15.08%, F: 17.29%], pre-hypertension [SBP-120-139 and DBP-80-89 mmHg] -37.78% [M:41.38%, F:34.18%], DM [fast blood glucose [FBS]>126mg/dl] was 7.45% [M:6.35%, F:8.54%], smoking was 9.40% [M: 17.00%, F:1.57%], hypercholesterolemia [>200mg/dl] was 47.64% [M:42.46%, F:52.81%] and obesity [body mass index [BMI] >27] was 50.47% [M:38.79%, F:62.09%]. Considering high incidence of CVD risk factors [except smoking] in Oskoo adults >30 years, it is recommended that this pilot study expanded to all of East Azerbaijan. Free of charge taking blood samples from people > 40 years to evaluate lipid profile and glucose levels is worthy to early detecting the prevalent

Cost-effectiveness of intraoperative transesophageal echocardiography in cardiac valve surgery

Being a unique diagnostic technique, transesophageai echocardiography [TEE] has influenced many different aspects of cardiac surgery including valve repair surgery. The cost-effectiveness of this method however is questioned considering the conditions of every region and country. In this study we aimed at answering the question if utilizing TEE throughout valve repair surgery could be cost-effective. Twenty four patients were studied within two groups of case "valve repair operation plus intra-operative TEE [10-TEE]" and control [valve replacement operation]. Variables including age, gender, left ventricle ejection fraction [LVEF], re-operation, intensive care unit [ICU] stay, hospital stay and cost were studied and compared. There was no significant difference regarding age, gender and LVEF between two groups [p=0.559, p=0.413, and p=0.408, respectively] ICU stay in repair group was less than replacement group [p=0.009]. Hospital stay difference however was not statistically significant [p=0.928]. The cost of valve repair under 10-TEE monitoring was significantly less than valve replacement [p=0.00l]. 10-TEE not only would assist surgeons by increasing their interest toward valve repair operation instead of replacing impaired cardiac valves but also consequently decrease hospital costs. It is also advised for the cardiac anesthesiologists to use 10-TEE routinely in the valve repair operations provided that there are no contraindications

New aspects of family history of heart disease as a risk factor for coronary artery disease in patients with acute myocardial infarction

This an in-depth investigation of the relationship between some new aspects of positive family history [FH] of coronary artery disease [CAD] and other risk factors related to CAD in patients with acute myocardial infarction [AMI]. The data of 200 patients with AMI and positive FH of CAD [FH Pos.]- as case group- and 200 AMI patients without FH of CAD -as control group- [FH Neg.] were collected. Information about first and second-degree relatives was obtained, including age, occurrence of Ml, and other risk factors related to CAD. We also covered procedures such as coronary angiography [CAG], percutaneous intervention [PCI], and coronary artery bypass grafting [CABG] surgery. AMI with ST-segment elevation in ECG [69.61% vs. 26.76%], heart block [19.47%. vs. 6.34%], and low EF [mean 43 +/- 3.4% vs. 47 +/- 35%] were higher in the FH Pos. group than the FH Neg. group. As well as diabetes [42.71% vs. 11.27%], dyslipidemia [42.19% vs. 14%], and hypertension [73.74% vs. 64.79%] in the FH Pos. group were higher than those in the FH Neg. group. CAG [79.9% vs. 39.9%] and CABG [34.8% vs 14.79%] were higher in the FH Pos. group [all p values<0.05]. More patients in the FH Pos. group were male and younger, in the FH Pos. group, there was 65% positive finding in the second-degree relatives; most of these second-degree relatives came from the father's side [56%]. Also, there were 1.35 times more events in brothers than in sisters. Subjects with a positive family history of CAD were younger and more susceptible to CAD and needed frequent interventional procedures. Also, there was a difference in the power of various kinds of positive FH. In the FH Pos. arm, there was a stronger relationship between the patient and his/her brothers than with sisters and 56% incidence in the second-degree relatives [especially from the father's side]

Serum levels of copper and zinc in patients with acute coronary syndrome

Previous studies suggest a protective role of the essential trace elements against cardiovascular disease, whereas wistful epidemiological data remains controversial. We aimed to investigate the serum concentration of zinc [Zn] and copper [Cu] in patients presented with acute coronary syndrome [ACS] considering status of cigarette smoking. Baseline Zn and Cu concentrations were measured in 100 individuals [50 with unstable angina [UA] and 50 with acute myocardial infarction [AMI]; then these parameters were compared with normal reference values. Current smoking status of patients in each group was analyzed considering values of serum trace elements concentration. In those patients who were admitted with ACS, mean serum Zn [62.1 +/- 13.4 [micro]g/dL] and Cu [66.5 +/- 14.1 [micro]g/dL] levels were lower compared to normal reference values [p < 0.001]. No significant differences were observed between AMI and UA patients in serum Zn [59.6 +/- 2.9 vs. 65.7 +/- 14.2 [micro]g/dL; p=0.28] and Cu [64.9 +/- 13.3 vs. 68.1 +/- 15.0 [micro]g/dL; p=0.79] levels. Also there were not any statistically significant differences in Cu and Zn levels between smoker and non-smoker patients in each study group [p values> 0.05]. Lower Zn and Cu serum concentration was found in patients with ACS but these relatively low levels are not significantly different between AM1 and UA patients. Also, it seems that cigarette smoking dose not considerably affect serum levels of Zn or Cu in ACS patients

Cardiovascular responses to orotracheal intubation in patients undergoing coronary artery bypass grafting surgery. Comparing fiberoptic bronchoscopy with direct laryngoscopy

The intubation by using fiberoptic brochoscop [FOB] can avoid the mechanical stimulus to oropharyngolaryngeal structures thereby it is likely to attenuate hemodynamic response during orotracheal intubation. Based on this hypothesis, we compared the hemodynamic responses to orotracheal intubation using an FOB and direct laryngoscope [DLS] in patients undergoing general anesthesia for coronary artery bypass grafting [CABG] surgery. Fifty patients with ASA physical status II and Mallampati score I and II were scheduled for elective CABG surgery under general anesthesia requiring orotracheal intubation were randomly allocated to either DLS group [n = 25] or FOB group [n = 25]. The same protocol of anesthetic medications was used. Invasive systolic and diastolic blood pressure [SBP and DBP] and heart rate [HR] were recorded before and after anesthesia induction, during intubation and in the first and second minutes after intubation. The differences among the hemodynamic variables recorded over time and differences in the circulatory variables between the two study groups were compared. Duration of intubation was shorter in DLS group [19.3 +/- 4.7 sec] compared with FOB group [34.9 +/- 9.8 sec; p = 0.0001]. In both study groups basic SBP and DBP and HR were not significantly different [P >0.05]. During the observation, there were no significant differences between the two groups in BP or HR at any time points or in their maximal values [all p values >0.05]. We conclude that the FOB had no advantage in attenuating the hemodynamic responses to orotracheal intubation in patients undergoing CABG surgery

Comparison of oxidative stress content during on-pump and off-pump coronary artery bypass surgery

In contrast to conventional on-pump coronary artery bypass grafting [CABG] surgery only mild increase of parameters of oxidative stress is reported during and after off-pump coronary artery bypass grafting. In this study, we attempted to determine the role of off-pump CABG in the myocardial and systemic inflammatory responses. One hundred patients who underwent elective CABG were divided to three groups: I] patients underwent off- pump CABG or 2] on-pump CABG surgery with controlled reperfusion and 3] on-pump CABG with noncontrolled reperfusion. We took patients systemic venous blood samples for the measurement of serum level malondialde hyde [MDA], Troponin [cTnI] and total antioxidant [TAC] and blood level superoxiddismotas [SOD], before and after Ischemia and reperfusion. Mean values of decrease left ventricular ejection fraction [LVEF] after surgery in patients group 3 were higher than patients group2 and also [LVEF] in patients group2 were higher than patients group l [P

effect of acute normovlumic hemodilution in reducing allogenic red blood cell transfusion during and after cardiac surgery

In this study, effect of acute normovlumic hemodilution [ANH] to reduce consumption rate of allogenic blood transfusion was compared with the traditional protocol during and after cardiac surgery. One thousand patients who underwent elective cardiac surgery [CABG, valve surgery were entered into study. In ANH group [n=500/ blood obtained from patients by using a new formula and re-transfused the collected blood at the end of operation. Total amount of a2logenzc packed red blood cell [PRBC] and fresh frozen plasma PFP] transfusion in ANH group was compared with 500patients that had been operated one year ago in our hospital [Historical Control]. Considering the patients baseline hematocrit values A M technique was used in 59% of patients in ANH group, and 12% in control group. In ANH group fewer patients during operation transfused with PRBC and FFP than control group [23.2% vs. 71.4%; p = 0.001 and 3 1.2% vs 77.4%; p = 0.008, respectively. Significantly lower mean PRBCs units transfused in ANH group comparing with control group [1.1 +/- 0.5 vs. 2.4 +/- 1.3 units; p = 0.006]. After surgery PRBCs and FFP transfusion were lower in ANH group than control group. Mean postoperative bleeding was not significantly different in the two groups [884 +/- 304 ml vs 790 +/- 291 ml; p = 0.312]. The incidence of postoperative complications, ICU stay and in-hospital mortality between the two groups were not significantly different [p > 0.05]. In this stu4, using the A M significantly reduce consumption of allogeneic red blood cell and FFP in cardiac surgery patients

Chronobiological rhythms in onset of massive pulmonary embolism in iranian population

To investigate whether there is any chronobiological rhythms in onset of massive pulmonary embolism in Iranian population and to study any time variation in occurrence of this disease in patients' subgroups. This study was conducted in an emergency department of a referral teaching hospital from March 2003 to March 2007. All medical records of patients with definite diagnosis of massive pulmonary embolism were reviewed for chronobiological rhythms in hourly, daily, monthly and season periods. One hundred and twenty patients [49 women and 71 men] included in the study. The mean age of patients was 63.63 +/- 17.21 years. Massive pulmonary embolism showed a statistical increase in onset in the morning period [p=0.004] with peak of occurrence between 9:00 to 10:00, in the first three day of the week [p<0.001], and during winter [p=0.003]. In addition, hourly and weekly rhythms in onset of massive pulmonary embolism in diabetic patients is different from non-diabetic patients and occur most frequent in evening hours and in the end of week. Our findings revealed that massive pulmonary embolism has a peak of onset during morning hours and in the winter. We also found that massive pulmonary embolism also has a weekly rhythm. Circadian and weekly rhythms of massive pulmonary embolism were different in diabetic patients and this is a novel finding of this study