Hospital Chronicles (E-Journal)
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Infections Associated With the Hemophagocytic Syndrome
Get PDFThe hemophagocytic syndrome (HPS) is an unusual but potentially fatal disease resulting from dysregulated activation and proliferation of natural killer (NK) cells and cytotoxic T cells. The term hemophagocytosis describes the pathological finding of activated macrophages, engulfing erythrocytes, leukocytes, platelets, and their precursor cells. The clinical appearance of the syndrome is heterogeneous, characterized by hemophagocytosis in bone marrow, liver, or lymph nodes, variable cytopenias, hyperferritinenia, hypercytokinemia, high fever, coagulation disorders, hepatosplenomegaly and lymphadenopathy. The syndrome can be either primary or secondary. Until recently, we believed that symptoms of HPS due to genetic causes generally arose during infancy and early childhood. The truth is that the first episode of HPS can occur throughout life, from prenatal to the seventh decade. With the availability of genetic testing, distinctions between primary (genetically determined) and secondary (acquired) forms of HPS have become increasingly blurred. Secondary or reactive HPS is associated with infections, autoimmune diseases, or malignancies. This review summarizes the pathogenesis, clinical and diagnostic features and management of HPS in the context of specific infections. It is important to realize that both primary and secondary syndromes can be precipitated by an infection, particularly Epstein-Barr virus (EBV) and other herpes viruses, human immunodeficiency virus (HIV), influenza, parvovirus, hepatitis viruses, as well as bacterial, fungal, and parasitic infections
Elevated Levels Within the Normal Limits of Liver Enzymes in Patients With Atrial Fibrillation
Get PDFBackground. Emerging evidence suggests that a strong link exists between certain liver enzymes such as γ-glutamyltransferase (γ-GT) and alanine transaminase (ALT) and cardiovascular diseases independently of alcohol intake. Elevated levels of γ-GT and ALT within normal values are considered as markers of inflammation and oxidative stress independent of the metabolic syndrome. Objective. This pilot observational study was conducted to evaluate serum levels of γ-GT and ALT within normal values in different atrial fibrillation (AF) populations. Methods. Consecutive patients with AF and healthy control subjects were screened. Clinical and echocardiographic characteristics were carefully recorded. In each participant, serum levels of γ-GT and ALT along with conventional inflammatory markers were determined. The final study population consisted of 81 patients with paroxysmal AF, 45 patients with persistent AF, and 39 control subjects. Results. Serum γ-GT levels within normal values were significantly elevated in patients with paroxysmal (30.40±12.34 U/L) and persistent AF (38.38±18.11 U/L) in relation to control population (24.03±11.73 U/L) (p<0.001). Of note, γ-GT concentration was significantly higher in patients with persistent AF compared to those with paroxysmal AF (p: 0.010). Serum ALT levels were significantly higher in patients with paroxysmal (27.51±10.23 U/L) and persistent AF (28.73±9.34 U/L) compared to controls (20.26±9.34 U/L) (p<0.001). In multinomial logistic regression analysis, the relative risk ratio of developing paroxysmal AF per 1 U/L increase in ALT was 1.08 (CI: 1.02-1.14, p: 0.011). The relative risk ratio of having persistent AF per 1 U/L increase in γ-GT was 1.06 (CI: 1.01-1.12, p: 0.013). Conclusions. This study shows an association between increased levels within normal reference intervals of liver enzymes such as γ-GT and ALT and AF. Serum γ-GT levels may be related to AF burden. Larger studies are needed to examine this potential association
ΣυσκευÎÏ‚ ΚαÏÎ´Î¹Î±ÎºÎ¿Ï Î•Ï€Î±Î½Î±ÏƒÏ…Î³Ï‡ÏÎ¿Î½Î¹ÏƒÎ¼Î¿Ï ÏƒÎµ Ασθενείς με ΚαÏδιακή ΑνεπάÏκεια. Ψυχολογική ΕπιβάÏυνση και Î ÏοσαÏμογή
Get PDFΗ αμφικοιλιακή βηματοδότηση Îχει πλÎον καθιεÏωθεί ως αποτελεσματική θεÏαπεία στην ανθεκτική καÏδιακή ανεπάÏκεια κατηγοÏίας ΙΙΙ και IV και τελευταία ίσως και σε πιό Ï€Ïώϊμα στάδια (II), καθ’όσον με τον καÏδιακό επανασυγχÏονισμό που επιτυγχάνει βελτιώνει τα συμπτώματα των ασθενών και την ποιότητα ζωής των, αλλά επίσης παÏατείνει και το Ï€Ïοσδόκιμο επιβίωσης αυτών των ασθενών. Οι εμφυτεÏσιμες συσκευÎÏ‚ μποÏεί να είναι αμφικοιλιακοί βηματοδότες ή αμφικοιλιακοί απινιδωτÎÏ‚. Ωστόσο, ÎÏευνες Îχουν δείξει ότι υπάÏχει μεγάλος ψυχολογικός αντίκτυπος στους ασθενείς με εμφυτευμÎνες συσκευÎÏ‚. Οι ασθενείς αυτοί μποÏεί να παÏουσιάζουν Îνα σημαντικό αÏιθμό ψυχοκοινωνικών διαταÏαχών, όπως άγχος, κατάθλιψη, φόβο μιας ενδεχόμενης απινίδωσης σε όσους φÎÏουν Ï„Îτοιες συσκευÎÏ‚, εξάÏτηση του ατόμου από τη συσκευή, αλλαγή ÏƒÏ‰Î¼Î±Ï„Î¹ÎºÎ¿Ï ÎµÎ¹Î´ÏŽÎ»Î¿Ï…, σημαντικÎÏ‚ αλλαγÎÏ‚ στον Ï„Ïόπο ζωής και απομόνωση από το κοινωνικό πεÏιβάλλον. Η Ï€Ïώτη Ï€ÏοσÎγγιση των νοσηλευτών σε αυτοÏÏ‚ τους ασθενείς που Ï€Ïοτείνεται απο τους Sears και Conti πεÏιλαμβάνει τα 4 Α: Ask –θÎτουμε εÏωτήσεις, Advice- δίνουμε συμβουλÎÏ‚, Assist- βοηθοÏμε, Arrange- οÏγανώνουμε- Ï€ÏογÏαμματίζουμε. Η δεÏτεÏη Ï€ÏοσÎγγιση που Ï€Ïοτείνεται από τον Eads πεÏιλαμβάνει 7 αÏχÎÏ‚: καθοÏισμό του Ï€Ïοβλήματος, παÏοχή πληÏοφοÏιών, δημιουÏγία ομάδας υποστήÏιξης, καθησÏχαση για το φόβο που αισθάνονται, ενθάÏÏυνση της ψυχικής αποφόÏτισης, δήλωση ότι είναι δυνατό να επιστÏÎψει ο ασθενής στις κανονικÎÏ‚ του δÏαστηÏιότητες, ενθάÏÏυνση του ασθενοÏÏ‚ να αναλάβει δÏάση. ΑυτÎÏ‚ και διάφοÏες άλλες εναλλακτικÎÏ‚ Ï€Ïοσεγγίσεις των νοσηλευτών μποÏοÏν να παίξουν καθοÏιστικό Ïόλο στην υποστήÏιξη αυτών των ασθενών και να βελτιώσουν την ψυχική τους υγεία με σημαντικό αντίκτυπο και στη φυσική τους κατάσταση και ανταπόκÏιση στη θεÏαπεία του καÏÎ´Î¹Î±ÎºÎ¿Ï ÎµÏ€Î±Î½Î±ÏƒÏ…Î³Ï‡ÏονισμοÏ
The Role of High Sensitivity Troponin: More Acute Coronary Syndromes or More False Positive Results?
Get PDFCardiac troponins (cTn) are the most sensitive and specific biomarkers of myocardial damage. Troponin has both diagnostic and prognostic significance for acute coronary syndrome (ACS). The joint European Society of Cardiology/American College of Cardiology Foundation/American Heart Association/World Heart Federation task force recommendations for a universal definition of acute myocardial infarction (AMI) in 2007 are based on detection of cTn and associated clinical evidence. Although the clinical introduction of new generation high sensitivity cTnT and cTnI assays is certainly valuable in the appropriate setting, its widespread use in a variety of clinical situations may lead to the detection of cTn elevation in absence of thrombotic ACS. Until now there is no clarity between “sensitive†and “high sensitive†cTn assays something that raises concerns regarding the interpretation of the latest clinical studies. The increased analytical sensitivity against compromised specifity may increase ‘‘false positive’’ results in patients with cardiovascular disease or apparently healthy subjects with previously undetected cTn levels. A cTn rise in the absence of ACS should prompt for an assessment for a different, non-ischemic mechanism of troponin elevation and direct management at the primary cause. The role of the clinician is to apply clinical doubts where abnormal cTn levels are not due to myocardial injury. The current strategy of management of such patients is based on established algorithms and clinical knowledge
Angiosarcoma of the Heart: from Primary Location to Rapid Extension
Get PDFA 68-year-old man was admitted to our department with severe dyspnea and hemodynamic instability. The initial echocardiogram revealed a massive pericardial effusion with signs of tamponade. Urgent pericardiocentesis was performed. The cytological examination of the pericardial fluid was negative for malignant cells but the pre-discharge transthoracic echocardiogram depicted a heterogeneous tissue (mass) in the right atrium. The subsequent transesophageal echocardiogram revealed a large sessile heterogeneous mass adherent to the right atrial free wall, extending into the inferior vena cava... (excerpt
Idiopathic Effusive-Constrictive Pericarditis
Get PDFWe herein describe the case of a 71-year-old man, who presented with clinical manifestations of congestive heart failure, in whom non-invasive imaging techniques played a decisive role in arriving at the correct diagnosis of effusive-constrictive pericarditis
ΕπιπλεγμÎνη Αγγειοπλαστική Διάσωσης (Rescue PCI) σε 38χÏονο Ασθενή
Get PDFΠεÏιγÏάφεται η πεÏίπτωση 38χÏονου ασθενοÏÏ‚ με θÏομβολυμÎνο Î¿Î¾Ï Ï€Ïόσθιο ÎμφÏαγμα που επεπλάκη από μετεφÏαγματική στηθάγχη, καÏδιακή ανεπάÏκεια και καÏδιογενÎÏ‚ shock και οδηγήθηκε σε επείγουσα στεφανιογÏαφία που κατÎδειξε νόσο στελÎχους και 3 αγγείων. Ο ασθενής αντιμετωπίστηκε με αγγειοπλασική διασώσεως (rescue) και stenting με λίαν επιπλεγμÎνη ποÏεία, οι φάσεις της οποίας αναλÏονται λεπτομεÏÏŽÏ‚ με τελική ωστόσο ικανοποιητική Îκβαση
Interventional Therapies for Resistant Hypertension
Get PDFResistant hypertension represents a major health problem despite the plethora of antihypertensive drugs. Activation of the sympathetic nervous system is considered to be the basis of its pathogenesis. Two novel invasive therapeutic strategies for the treatment of resistant hypertension have recently emerged, namely catheter based renal sympathetic denervation and carotid baroreceptor stimulation. Both are effective in reducing elevated blood pressure values and display a good tolerability profile without the occurrence of any major untoward effect
Î’rugada Syndrome
Get PDFThe Brugada syndrome (BS) is a relative new clinical entity characterized by complete or incomplete right bundle branch block (RBBB) and ST-segment elevation in leads V1 through V3 on surface electrocardiogram (ECG), the absence of structural heart disease, and a high risk of atrial fibrillation, ventricular tachycardia/ventricular fibrillation (VT/VF) and sudden cardiac death (SCD). The syndrome is considered responsible for 4-12% of all sudden deaths and at least 20% of deaths in patients with structurally normal hearts. BS typically manifests with syncope and cardiac arrest, occurring in the third and fourth decade of life, and usually at rest or during sleep. Although the average age at time of first diagnosis or SCD is 40 years, the BS has been described in a wide range of ages. The clinical phenotype is 8 to 10 times more prevalent in males than in females. Since its initial recognition, an exceptional progress regarding the pathophysiology and management of the disease has been performed... (excerpt
Atrioventricular Nodal Reentrant Tachycardia in a Patient With Superior-Inferior Ventricles and Dextrocardia Treated With Cryoablation
Get PDFA 19-year-old female underwent repair of complex congenital heart disease (atrial and ventricular septal defect with a criss-cross atrioventricular relationship) in infancy. Because or recurrent palpitations she underwent an electrophysiology study. Atypical atrioventricular nodal reentrant tachycardia was diagnosed. Catheter ablation was performed successfully using cryothermal energy. The diagnostic and therapeutic approach is discussed