Hospital Chronicles (E-Journal)
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Automatic External Defibrillator: Training and Practical Issues
Get PDFSudden cardiac death is the single most important cause of death in the industrialized countries. In general, traditional Emergency Medical Systems (EMS) have been only minimally effective in treating out-of-hospital cardiac arrest, and this occurred mainly due to unacceptably long times from patient collapse to defibrillation. The use of automated external defibrillators (AED) by non-medical personnel, offers an appealing solution of this problem. It can be used safely and effectively by a variety of crews of social security services and public responders who have the potential of approaching the victims of cardiac arrest earlier than the ambulance crews. Therefore time to defibrillation may be shortened. For public access defibrillation (PAD) programs to be effective, they should be integrated into an emergency medical system strategy for treating patients with cardiac arrest. All aspects of implementation should be planned very carefully. Recommended elements for PAD programs include a planned and practiced approach, training of anticipated rescuers in cardiopulmonary resuscitation (CPR) / AED, link with the local EMS, continuous program review and quality improvement.  Emphasis should be placed not only on making potential rescuers familiar with CPR/AED practice, but also in giving detailed directives for successful resuscitation of cardiac arrest victims in the specific location where the PAD program has been implemented
Acute Coronary Syndromes in the Young
Get PDFThe leading cause of death in developed countries is cardiovascular disease. Acute coronary syndrome (ACS) is considered as a disease of the middle and old age. The knowledge for ACS is gained from research made in older aged patient groups. However, heart disease exists also in younger ages. In recent decades, ACS appears more often in young people and increased clinical interest has emerged in this topic since it can lead to premature death
Totally Implantable Artificial Heart: Still a Major Challenge
Get PDFThe first mechanical heart was placed by Liotta and Cooley in 1969 in a dying patient at the Texas Heart Institute in Houston as a 2 ½-day bridge for a transplant, albeit the patient died 32 hours after transplantation. Years later (1982) a totally implantable artificial heart (model Jarvik-7) was permanently implanted in a patient by DeVries et al at the University of Utah Medical Center in Salt Lake City, Utah, USA and the patient lived for 112 days. Subsequent attempts of implantation of a total artificial heart (e.g. CardioWest/SynCardia models) have limited its use as a bridge to transplantation, like the left- or bi-ventricular assist devices (VADs). The SynCardia model (SynCardia Systems Inc., Tuscon, AZ) has been approved for compassionate use by the Food and Drug Administration (FDA) for patients with end-stage biventricular heart failure as a bridge to transplantation since 1985 and has had FDA approval since 2004
Lack of Association Between Estrogen Receptor-Alpha Single-Nucleotide Polymorphism (Codon 594 G-->A) and Postmenopausal Osteoporosis: A Pilot Study
Get PDFBackground: Recent studies have suggested that the estrogen receptor alpha (ERα) gene is implicated in reduced bone mineral density (BMD). Objective: In the present study, we investigated the relationship between genetic polymorphism in ΕRα 2014G-->A (T594T) (codon 594 G-->A) and osteoporosis in postmenopausal women. Methods: A total of 59 postmenopausal women were included in the study (21 normal, 24 osteoporotic, 14 osteopenic). The polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method was used to identify the ΕRα 2014G->A polymorphism. Results: The three groups were found to be in genetic equilibrium. Also, there were no allele (p=0.578) and/or genotype frequencies (p=0.59) among the groups, i.e. the three groups could be treated as a genetically uniform population. As expected, normal women exhibited the highest BMD values (1.11 g/cm2) followed by the osteopenic (0.91 g/cm2) and the osteoporotic women (0.73 g/cm2). There was significant difference (p<0.05) in age only between the osteoporotic group (mean age 48.7 years) and either the normal (mean age 46 years) or the osteopenic group (mean age 45 years). No allele and/or genotype effect on BMD or age was detected. Conclusion: Our results support the lack of association between ERα codon 594 and BMD in postmenopausal women, since we found no allele and/or genotype effect on BMD or age. Further studies in a larger sample of postmenopausal women are needed to confirm our results
2013 European Guidelines for Hypertension Management
Get PDFIn June 2013 the European Society of Hypertension (ESH) / European Society of Cardiology (ESC) published new guidelines for the management of hypertension. These are the first European Guidelines for hypertension developed by applying a strict “evidence-based†approach using a grading system for the level of evidence and the strength of recommendations. Several recommendations in the new guidelines deserve careful consideration because they change the way that hypertension is managed is routine clinical practice.Â
Pericardial Fluid Drainage in the Thoracic Cavity During Pericardiocentesis
Get PDFAn 86-year-old male with dizziness and dyspnea due to cardiac tamponade, underwent pericardiocentesis under ultrasound guidance. The procedure was done through the 5th intercostal space at the left sternal border. A 6-F sheath was placed in the pericardial sac. Although only a minimal quantity of pericardial fluid could be removed through the sheath, complete evacuation of the pericardial fluid could be detected with echocardiography, a few minutes after the puncture of the sac. Clinical improvement with hemodynamic stability were present after the procedure. We discuss the mechanism of this strange phenomenon
CryoAblation of Atrial Fibrillation: New Technique/ New expectations
Get PDFA 53-year-old gentleman with frequent episodes of idiopathic paroxysmal atrial fibrillation (AF) who had failed rhythm control with two antiarrhythmic drugs was initially submitted to an ablation procedure during which pulmonary vein (PV) isolation was performed with use of a cryothermic balloon in September 2012. After a 3-month blanking period, he remained free of symptoms for over a year. However, over the last one month he has had frequent arrhythmia recurrences with almost weekly episodes. He returned for a repeat ablation procedure... (excerpt
Uncommon Cardiomyopathies
Get PDFAnderson-Fabry Disease (AFD) is an X-linked recessive lysosomal disorder, leading to multisystemic disease because of abnormal glycosphyngolipids widespread accumulation, the result of α-galactosidaseA deficient activity. Cardiac involvement is common; includes left ventricular hypertrophy and gradually impairing cardiac function. Although the disease is unveiled in childhood and culminates in cardiac, cerebrovascular and end-stage renal disease, diagnosis is often delayed or missed. Recently established enzyme replacement therapy (ERT) may improve most of the disease’s manifestations. Early diagnosis is thus crucial for AFD patient management. Isolated non-compaction of the ventricular myocardium (IVNC) is a rare congenital form of cardiomyopathy. It is characterized by the postnatal persistence of the embryonic pattern of myoarchitecture, consistent of prominent trabeculations and deep intertrabecular recesses, and assumed to occur as a consequence of intrauterine arrest of myocardial compaction. Contemporary diagnosis has been facilitated by the introduction of specific morphologic criteria by echocardiography and magnetic resonance imaging. Management issues revolve around the management of heart failure, arrhythmias and thromboembolic events in order to prevent the significant morbidity and even mortality that has been associated with this entity. Significant overlapping with many other forms of cardiomyopathies suggest that non-compaction may be a morphologic trait rather than a distinct cardiomyopathy
Left Atrial Appendage Closure: Initial Experience with the Watchman Device
Get PDFWe herein present the first left atrial appendage (LAA) percutaneous closure procedure performed in our Institution with use of the Watchman device in an 82-year old woman with atrial fibrillation, unable to continue receiving anticoagulation therapy due to bleeding complications. A propos with this case, we discuss the data related to this therapeutic approach geared to prevent thromboembolism in patients with atrial fibrillation and contraindications to treatment with anticoagulants
49,XXXXY Syndrome Dental Treatment: a Case Report
No full textThis paper presents a 12-year-old male patient with XXXXY syndrome, who was treated under general anesthesia twice due to mental retardation and uncooperative behavior. The general and dentofacial manifestations of XXXXY syndrome where present.The child had to be treated as as an emergency case both times due to severe pain and abcesses. Several teeth were severely decayed and had to be extracted that led to severe anodontia as there were no secondary dentition to follow. This case emphasises the importance of regular dental care, good nutricion and monitoring of dental development in children with XXXXY syndrome. Key-words: XXXXY syndrome,dentofacial manifestations,dental car