Hospital Chronicles (E-Journal)
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Primary Congenital Coronary Artery Anomalies: An Angiographic Study in Greece
Get PDFAbstract Background: Primary congenital coronary anomalies are anatomical variations of the origin, course and termination of coronary arteries, which are not associated with complex congenital heart disease. In Greece, apart from some case reports, there are no published data. Thus, the aim of this study was to assess the prevalence of the different forms of primary coronary artery anomalies in a Greek adult population. Methods: 5051 coronary arteriographies obtained from January 2008 to December 2010 were retrospectively analyzed. Coronary anomalies were classified according to the criteria proposed by Angelini and coworkers as anomalies of origin and course, anomalies of intrinsic coronary anatomy, and anomalies of termination. Results: 123 variations of coronary artery anatomy (incidence 2.44%) were identified. Of these, 76 (61.8%) patients had anomalous origin and course, 25 (20.3%) patients had ectasias, 14 (11.4%) patients had myocardial bridging, and 8 (6.5%) patients had small coronary fistulas. The most common anomalies observed were the separate origin of the left anterior descending (LAD) and left circumflex (LCx) coronary arteries, the ectopic right coronary artery (RCA) and the anomalous LCx from the opposite sinus. Conclusions: The incidence of primary congenital anomalies in Greece is similar to that reported in other populations. Congenital coronary anomalies do not predispose to accelerated atherosclerosis of the anomalous vessel. Although the majority of coronary anomalies were not associated with symptoms and were detected incedentaly during coronary angiography, awareness of these anatomical variants is clinically important for the appropriate management of cardiac patients
Novel Insights into the Pathogenesis, Diagnosis and Treatment of Glomerular Diseases
Get PDFGlomerular diseases (GD) are characterized by lesions of the glomerular basement, which may be or may not be accompanied by inflammation and cellular hyperplasia. They are mainly classified as primary or secondary to a systemic disease. They are also classified as proliferative or non-proliferative diseases depending on the cellular infiltrate. Minimal change disease, focal segmental glomerulosclerosis and thin membrane disease are non-proliferative, usually primary, glomerular diseases. Nephrotic syndrome is mainly the clinical syndrome that accompanies these GD. Proliferative GDs comprise IgA and IgM nephropathy, and crescentic GDs with or without immunodeposits. Secondary proliferative GDs include systemic lupus erythematosous GD, vasculitides, and post-infection GDs. Non proliferative secondary GDs encompass diabetic nephropathy, amyloidosis, HIV nephropathy. Recent data on many aspects of GDs, i.e. pathogenesis and pathophysiology, diagnosis, therapy and other are briefly discussed in the present review
Ventricular Tachycardia Recognized as Ventricular Fibrillation by an Implantable Cardioverter Defibrillator, Due to Double Counting of the QRS Complex
No full textA case of ventricular tachycardia misdiagnosed as ventricular fibrillation due to double counting of the tachycardia’s wide QRS complex in an implantable cardioverter defibrillator (ICD) recipient is presented. As a result, an inappropriate shock was delivered by the device instead of anti-tachycardia pacing. The reprogramming of the detection criteria in a less sensitive manner solved the problem
Therapeutic Applications of Neuromuscular Electrical Stimulation in Critical Care Patients
Get PDFNeuromuscular Electrical Stimulation (NMES) is commonly used by physiotherapists for pain relief, stimulation of denervated or disused muscles, and the promotion of wound healing. The purpose of this review is to discus the applications of NMES in Intensive Care Unit (ICU) patients according to the current research evidence. The first application is the neuromuscular electrical stimulation (NMES) in ICU acquired weakness with research evidence indicating significant benefits such as preservation of muscle mass, prevention of polyneuromyopathy and improvement of muscle performance. Secondly, NMES has been proved to be effective in preventing pressure ulcers and accelerating wound healing through mechanisms which are clearly demonstrated by many experimental and clinical studies. However, very few studies have examined the effect of E.S. in pressure ulcers of long term hospitalized ICU patients. Lastly, NMES in ICU can be applied in the form of functional electrical stimulation (FES), a well known technique used to mobilize patients with permanent neurological deficits such as stroke and spinal cord injury. Current evidence in this area is reviewed and future research is proposed
Beware of the Ailments of Vitamin B12 Deficiency
Get PDFVitamin B12 or cobalamin deficiency is a common problem in adult patients, which is however frequently missed. The most common cause of cobalamin deficiency is the food cobalamin malabsorption syndrome (> 60% of all cases). Neuropsychiatric manifestations can be the presenting and only early sign of cobalamin deficiency even in the absence of hematologic abnormalities. The deficiency can occur despite serum cobalamin levels at low normal values; thus, normal vitamin B12 levels have been revised upward to >350 pg/ml. Early detection and treatment are important to prevent structural and irreversible damage. The causes and ailments of vitamin B12 deficiency are herein overviewed and a diagnostic and therapeutic strategy is outlined
Spot Stenting is Preferable in Long Diffuse Coronary Lesions: Possible Incremental Value of Physiologic and Intracoronary Imaging Modalities
Get PDFThe treatment of long and diffuse coronary lesions with percutaneous coronary intervention (PCI) has been problematic since the era of plain balloon angioplasty. With the advent of bare-metal stents (BMS), long and multiple stents were used to completely cover the diseased segments in order to improve outcomes.  Lesion length has been proven to be a factor related to higher rates of restenosis and target lesion revascularization (TLR) and the risk was further increased by the multiplicity of implanted stents. Covering the lesion with the least number of non-overlapping stents might reduce the risk of restenosis. This strategy, called spot stenting, was initially tested in the BMS era to treat discrete high-grade disease within moderately diseased vessel segments and has been shown to significantly reduce restenosis rates. Drug-eluting stents (DES) have been consistently shown to reduce restenosis and the need for TLR and thus provide improved clinical efficacy compared with BMS. However, even with DES, diffuse disease and long lesions are still associated with an increased risk of restenosis, need for TLR and major adverse cardiac events (MACE). A major long-term concern regarding DES is the potential for stent thrombosis which is increased after complex procedures with implantation of longer, multiple and overlapping stents. Data are limited but recent reports suggest that even when DES are used, selective stenting of only the severely narrowed areas of long lesions reduces the risk of MACE compared to full lesion coverage. The data supporting the spot stenting approach along with some considerations regarding the technique are presented herein
Persistent Left Superior Vena Cava With Absent Right Superior Vena Cava
Get PDFWe report the case of a 52-year-old patient who referred to our hospital with the indication for a pacemaker implantation. The attempt to implant the pacemaker lead through the right subclavian vein revealed an unusual course of the lead. The phlebography through the right subclavian vein revealed the presence of a persistent left superior vena cava and the absence of right superior vena cava
Small Bowel Capsule Endoscopy: Indications, Limitations and Diagnostic Yield
Get PDFSmall bowel capsule endoscopy (CE) is a simple, safe, non-invasive, reliable technique, well accepted and tolerated by the patients, which allows complete exploration of the small intestine. The advent of CE in 2000 has dramatically changed the diagnosis and management of many diseases of the small intestine, such as obscure gastrointestinal bleeding, Crohn’s disease, small bowel tumors, polyposis syndromes, etc. CE has become the gold standard for the diagnosis of most diseases of the small bowel. Lately this technique has also been used for esophageal and colonic diseases. The review focuses on the indications, limitations and diagnostic yield of capsule endoscopy in the investigation of small bowel diseases
Percutaneous Extraction of Chronically Implanted Left Ventricular Lead Aided by Telescopic Sheaths Spares Patient Major Cardiac Surgery
Get PDFA 70-year-old patient sustained a severe pocket infection of a biventricular pacemaker system implanted 4 years ago. Patient opted for a percutaneous approach to lead extraction over open heart surgery. However, use of special locking stylets to facilitate lead traction was hampered by inability to insert the stylets due to mechanical lumen blockage and/or uncoiling and fracture of lead conductors. Hence, the procedure was finally carried out successfully only with use of telescoping sheaths, which facilitated extraction by freeing leads from multiple adhesions along their intravascular and intracardiac course, sparing patient major open cardiac surgery which would have been the only alternative should the percutaneous technique have failed
Catheter Ablation of Ventricular Extrasystoles Originating from the Left Coronary Cusp
Get PDFWe describe the case of a 55-year-old man with frequent premature ventricular extrasystoles displaying inferior axis and positive QRS concordance in precordial leads. The arrhythmia was successfully ablated from the left coronary cusp. The electrocardiographic and electrophysiological characteristics of this arrhythmia are discussed