RESUMEN
Introduction: Left ventricular ejection fraction [LVEF] is considered to be the single most important prognostic factor in patients with previous myocardial infarction. LVEF is not improved in all patients after coronary artery bypass grafting [CABG]. This study aimed to assess the possibility of prediction of LVEF changes after CABG using myocardial perfusion gated signle photon emission computed tomography [GSPECT]
Materials and Methods: Overall, 48 patients with mean LVEF of 30.2% [ +/- 4.7] underwent Echocardiography and GSPECT after injection of Tc-99m-MIBI at rest. Myocardial uptake was evaluated in 17 myocardial segments and was compared with age and gender matched normal data pool. The risks and benefits of CABG were explained to the patients and 16 cases [15 male and 1 female] with the mean age of 61.1 years [ +/- 10.8] accepted to undergo off-pump CABG. All the patients were followed-up for at least six months and echocardiography and GSPECT were repeated at the end of follow up
Results: The mean LVEF was increased from of 31.1% [ +/- 3.5] to 34.5% [ +/- 3.6] after surgery [P<0.001]. Delta LVEF was defined as ?LVEF=LVEF [before CABG] -LVEF [after CABG]. ?LVEF was within the range of 0-8% with the mean of 3.4% [ +/- 2.5]. The number of non-viable myocardial segments was not significantly different between patients with ?LVEF ? 5% and those with smaller changes. Myocardial perfusion was estimated for all segments, and the mean global uptake was defined by adding the mean uptake in all segments, divided by 17. The mean global uptake was 53.1% in our patients. Regression analysis revealed that ?LVEF after CABG can be predicted reliably using the following formula: ?LVEF= -33.8 + [0.77 × mean global uptake] [P<0.01]
Conclusion: Our study showed that change of LVEF after CABG can be predicted reliably using mean global uptake in preoperative myocardial perfusion SPECT at rest
RESUMEN
Hydatid cyst disease should be considered in differential diagnosis in many doubtful clinical situations as can present with non-specific symptoms especially in the endemic areas. Cardiac involvement should be considered in patients with history of previous hydatid cyst disease.. Cardiac hydatid cysts account for less than 2% of all hydatid diseases. In this report we aimed to present a case of 14-year-old boy with the diagnosis of occlusion of artery of the right lower extremity. Surgical exploration of the femoral artery revealed multiple hydatid cysts. Echocardiography showed a mobile mixed mass lesion. Complete resection of the mass was done from interventricular septum. Histopathological examination of the removed tissue revealed a complicated hydatid cyst and complete mass excision was confirmed. In this case a 7 year clinical and serological tests evaluation follow-up after surgical treatment showed no evidence of recurrence. The finding of this case emphasizes that in endemic countries, primary cardiovascular echinococcosis should be considered in differential diagnosis
RESUMEN
The objective of this study was to determine and compare Cystatin C changes before and after radiotherapy in patients with stomach cancer who were candidate for radiotherapy. This study was conducted as a prospective cohort one. Eighteen patients with definite diagnosis of stomach cancer under treatment by radiotherapy who presented to Radiotherapy-Oncology Center of Imam Hossein Hospital, Tehran-Iran, and the treatment in all cases was simultaneous chemoradiation with Xeloda were included. In all patients before radiotherapy and after radiotherapy serum creatinine [Cr] and Cystatin C were measured simultaneously. Mean cystatin level before treatment [1.2 +/- 0.4] was significantly lower than that of post-treatment [1.6 +/- 0.36], [P=0.001]. Serum Cr level before treatment was 1.15 +/- 0.33 and after radiotherapy was 1.08 +/- 0.24 and did not show significant difference. Glomerular filtration rate [GFR] of the patients before radiotherapy was-46.8 +/- 21.0 and after radiotherapy was 43.8 +/- 15.8 that did not have significant difference [P=0.146] and also blood urea nitrogen [BUN] before radiotherapy was 20.72 +/- 3.7 and 20 +/- 6.38 after radiotherapy that did not have significant difference [P=0.6]. Comparison of the Cystatin C difference with total radiation dose of the kidneys that are put in three dose groups in radiotherapy field had association that in dose of less that 18 gray [Gy] the Cystatin C change showed significant and positive association [P=0.027; r=0.52] and about 18-24 Gy the Cystatin C difference showed significant and negative association [P=0.023, r=-0.53]. It seems that for evaluating the renal function, serum Cystatin C measurement is preferable than serum Cr. level