Journal of

---

Introduction: Coronary endarterectomy is not a perfect procedure. However, it is sometimes the only available alternative for cardiac surgeons in patients suffering from diffuse coronary artery disease. According to a large volume of studies, coronary endarterectomy results (such as survival, recurrence of the symptoms of myocardial ischemia, and graft patency) are not as satisfactory as standard coronary artery bypass grafting (CABG). While the left anterior descending artery (LAD) is the artery most commonly involved in coronary endarterectomy, RCA can be treated with coronary endarterectomy. This study aimed to evaluate clinical evidence and early results of right coronary artery endarterectomy.

Methods: A total of 20 cases of coronary endarterectomy of the RCA was studied from January 2015 to January 2016 in this retrospective study. Endarterectomy procedure was performed in Imam Reza Hospital affiliated to Mashhad University of Medical Sciences.

Results: The mean age of the subjects was 60±5.2 years (range: 48-75 years).  From among them, 14 were male (70%), and the mean ejection fraction index was 36±5.7 (range: 15-60). Further, in 8 cases, a prior history of myocardial infarction was documented (40%). The mortality rate among patients was 10% (n=2). In total, 7 (35%) and 12 (60%) patients required intra-aortic balloon pump support and high-dose inotropic support, respectively. Perioperative myocardial infarction was observed in 5 (25%) cases, and 3 (15%) patients required re-exploration due to significant hemorrhage. Severe RV failure at the end of procedure was noticed in 4 patients (20%) with resultant mortality in half of them. Some type of heart block w occurred in 1 patient (5%).

Conclusions: In case coronary endarterectomy of the RCA is performed by an experienced cardiac surgeon, favorable outcomes can be expected.

---

Introduction: Abdominal radiography is an important method for acute abdomen cases and it is usually used to determine surgical approaches. This study was performed to determine the effect of abdominal radiography in the surgical approach among patients with acute abdomen attending the emergency ward of Rasool-Akram Hospital.
Methods: In this comparative cross-sectional study, 147 consecutive patients with acute abdomen attending the emergency ward of Rasool-Akram Hospital were enrolled. The effect of abdominal radiography on surgical approach was assessed in them.The collected data were analyzed in SPSS software (version 13) using independent t-test and Fisher’sexact test. The significance level for all tests was considered less than 0.05.
Results: In this study, radiography was effective on surgical approach in 63.3% of cases and it proposed peritonitis in 68% of cases. The impact was associated with lower age (P=0.0001), shorter surgery duration (P=0.003), and male sex (P=0.0001).
Conclusions: According to the results, it may be concluded that clinical assessment has a pivotal role for diagnosis of peritonitis, and if it is positive, no additional procedure is required whereby the operation should be carried out. Abdominal radiography should be used for cases with equivocal results in clinical assessment.

---

• The case in this study was a 33-year-old woman suffering from acute pericardial tamponade with severe left ventricular systolic dysfunction (LVEF=10%) after myocarditis as a result of possible viral respiratory infection.
• The diagnosis was confirmed with two transthoracic echocardiography (TTE) evaluation showing moderate pericardial effusion with diastolic right atrium and ventricle collapse. The hemodynamic and respiratory condition of the patient was unstable and emergent. The drainage of pericardial space was life-saving with good results.

---

• Introduction: Injuries are the causes of irreparable damages and costs in urban and rural settings. Preventive procedures are effective if correct related information is gathered and provided. Therefore, this study aimed to investigate the injury patterns and related factors in a large teaching hospital.
• Methods: The current cross-sectional study was conducted at Edalatian Emergency Center, Mashhad, Iran, in 2016. All study subjects were extracted from the Hospital Information System (HIS).The demographic characteristics and injuries-related factors of 6,350 patients were extracted from the HIS. The extracted variables were emergency severity index (ESI), type of referral, referral reason, insurance organizations, age, anatomic site of injuries, and month of referral. The data were analyzed in SPSS software (version 21) using the descriptive statistics method (frequency and percentage).
• Results: The majority of the study population was composed of males (%76.4). In total, 98.3% of the patients were classified into the semi-urgent and non-urgent levels, and 75.6% of the cases were affected in the right upper extremity. The most common age group was between 10-20 (69.4%) years, and the majority of the cases were admitted in June, July, and August.
• Conclusion: The current study determined the pattern and most important reasons for injuries' referral to an emergency department. Accordingly, the injuries were more frequent in the young people and active human force in our community. Furthermore, there was a significant difference among the frequencies of injury incidence in the summer holidays. It seems necessary to develop preventive procedures for injuries.

---

• Introduction: Peripheral arterial disease in coronary artery disease (CAD) is associated with poor cardiovascular outcomes. This issue is more highlighted in patients undergoing coronary artery bypass graft surgery after catheterization procedures.
• Methods: This study was observational on participants who recourse to the heart clinics and candidates for coronary angiography, based on inclusion and exclusion criteria. In the first, coronary angiography was performed, and so, if the patients had significant involvement of coronary arteries and had at least one inclusion criteria, for assessment of peripheral arterial disease (PAD), peripheral angiography through the femoral artery was performed. The statistical analysis was done by SPSS software (Version 16) and the data were analyzed using the descriptive statistics method, variance analysis, and Fisher's Exact Test. The level of significance was considered to be (0.05).
• Results: Among all patients, there was no significant difference in the demographic variables such as gender (P= 0.497) and age (P= 0.069). The commonest peripheral artery involved in patients was the right femoral artery. A statistically significant relationship between gender and PAD was seen (P=0.001). There was no significant relationship between the type of involved coronary artery and gender (p=0.043; Fisher's Exact Test = 10.719).
• Conclusion: More than one-third of participants with CAD had peripheral arterial involvement in iliofemoral arteries in this study. This situation increased the risk of complications in vascular blind catheterization. So, Improving PAD detection is crucial for more effective cardiovascular prevention and treatment.

---

• Pulmonary Embolism (PE) causes more than 300,000 deaths per year in the United States. Early diagnosis and treatment can significantly reduce mortality. Hiccups are involuntary spasmodic contractions in the respiratory muscles (inspiratory muscles), especially the diaphragm. Due to the importance of early diagnosis and quick treatment of PE, knowing its uncommon symptoms can help to diagnose and treat it before death. A 67-year-old man with no history of previous diseases and a history of knee joint surgery (5 years ago) came to the emergency room (ER) with continuous hiccups since 10 days ago. There were no cardiovascular risk factors such as family history, history of stroke and thromboembolism, smoking, alcohol, diabetes mellitus and hypertension. Respiratory rate (RR) was 18 breaths/minute, pulse rate (PR) was 120 beats/minute, blood pressure (BP) was 122/84 mmHg, oxygen saturation (SPO2) in the room was 96%, and body temperature (T) was 36 °C. He was a candidate for computed tomography angiography (CTA). The filling defect was observed in the distal peripheral of the left main pulmonary artery (LMPA), with extension to the left upper lobe (LUL), left lower lobe (LLL), and segmental branches. After 6 days of hospitalization, with the improvement of symptoms and stability of vital signs, he was discharged with medications. Due to the association of hiccups with dangerous diseases, it is important to investigate continuous and long hiccups.