Hospital Chronicles (E-Journal)
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Indications of Cardiac CT and Coronary CT angiography: A Review
No full textAbstract The non-invasive imaging modality of multi-detector computed tomography has dramatically evolved the last ten years and that is due to hardware and software developments. The newer generation of scanners allows increased spatial and temporal resolution that improves the clinical reliability giving further insights into the evaluation of coronary artery disease. Heart morphology imaging followed by studies of myocardial function and assessment of cardiac valves can be performed from the information derived from the data of the coronary artery examination. Also, the venous anatomy of the heart, coronary artery bypass grafts, stents, and cardiac tumors can be imaged and evaluated when necessary. For the beneficial use of this method, entrance criteria for different patient groups need to be set in order to allow improved outcome of multi-detector CT
A Tribute to Aristotle Katsas
Get PDFOn the 10th of December 2009, Aristotle Katsas, a revered and well-loved colleague and mentor, reached the end of his life's journey. Born in Athens in 1932, son of Gregory Katsas, a Professor of Forensic Medicine, he developed a well-rounded and multifaceted character that would serve to enrich Hellenic Surgery. He graduated in 1950 from Varvakeio Model School and came first among 1300 successful entrants for the University of Athens Medical School; the first indication of a brilliant carrer that was to follow. After his graduation in 1957, he set off for the USA to specialize in General Surgery... (excerpt
Concealed Myocardial Infarction Revealed by High Lateral and Posterior Electrocardiographic Leads
Get PDFWe report the case of a 50-year-old man with history of hypertension who presented with chest pain and subtle electrocardiographic (ECG) abnormalities. Only with the aid of additional high lateral and posterior ECG leads (V7-9) was a posterolateral acute myocardial infarction identified and subsequently confirmed with positive cardiac enzyme serology. Coronary angiography showed total occlusion of the left circumflex coronary artery, which was successfully recanalized via coronary angioplasty and stenting. This case highlights the use of high lateral and posterior ECG leads (15-lead ECG) in enhancing the diagnostic yield of a conventional ECG in patients presenting with symptoms suspicious for an acute coronary syndrome by disclosing a posterior myocardial infarction and guiding reperfusion therapy
High Sensitivity Cardiac Troponins: a Curse or a Blessing?
Get PDFThe use of cardiac troponins (cTn) in lieu of creatine kinase to diagnose myocardial infarction (MI) has allowed us to detect even the smallest myocardial damage. Recently the use of high-sensitivity assays to measure even the tiniest myocardial injuries has led to a substantial increase in the diagnosis of MI. However, the specificity of such tests has been compromised and false positive results are rising. Clinicians should be aware that elevated cTn may be encountered in a variety of conditions of non-thrombotic cardiac damage, but also in a plethora of non-coronary diseases and laboratory interferences. These caveats are herein overviewed and an algorithm is proposed of a step-wise approach to using cTn measurement to triage and manage patients with suspected acute coronary syndromes
Non-Compaction Cardiomyopathy: Echo and Angiographic Imaging
Get PDFA 35-year-old gentleman was referred to our clinic after two syncopal episodes, and ensuing work-up disclosed a trabeculated left ventricle with blood-filled myocardial recessions on color Doppler echocardiography and myocardial filling defects on left ventriculography, all leading to the diagnosis of noncompaction cardiomyopathy. Ventricular tachyarrhythmias were induced at an electrophysiology study and the patient received an implantable defibrillator
Late Tricuspid Regurgitation as a Result of Rheumatic Tricuspid Disease in a Patient With Prosthetic Mitral Valve. Combined Two-Dimensional and Real-Time Three-Dimensional Transthoracic Echocardiographic Assessment
Get PDFWe herein present the case of a 65-year-old lady with late tricuspid regurgitation 15 years after successful mitral valve replacement due to severe mitral stenosis of rheumatic origin. She presented to our department complaining of fatigue which worsened over the last 6 months. Transthoracic echocardiographic examination including both 2D and real time 3D modalities revealed severe tricuspid regurgitation and the patient was scheduled for tricuspid annuloplasty. A propos with this case, a brief review of the literature is provided highlighting the key points of this topic
Cochlear Implant Innovations
Get PDFExtensive research has improved cochlear implant technology in a number of aspects. New coding strategies are important for better speech understanding and music appreciation. Obstructed cochleas can be implanted due to specially designed electrodes. Hybrid devices permit hearing preservation at the low frequencies which can be amplified with the use a hearing aid. Criteria for cochlear implant candidacy have been expanded from profound to severe sensorineural hearing loss. It is important for the Otolaryngologists to be informed about these advances in cochlear implant technology , in order to provide patients with the best options for hearing loss rehabilitation
Atrial Flutter With 1:1 Atrioventricular Conduction and Profound Nonischemic ST Segment Depression
Get PDFA 60-year-old lady presented to the emergency room with breathlessness, palpitations, dizziness and hypotension. The ECG showed narrow QRS complex tachycardia at a rate of 300 beats/min and downsloping ST segment depression. Following intravenous administration of adenosine, atrial flutter was confirmed and due to hemodynamic instability a direct current shock was delivered which restored sinus rhythm. The causes of such rapid ventricular rates in atrial flutter are discussed a propos with this case report
Superficial Granulomatous Pyoderma of the Face
Get PDFA 37 year-old male presented with a 5-year history of recurrent erythematosus, demarcated plaques of the right malar region that underwent progressive suppuration. The lesions evolved into a superficial ulcer with atrophic scarring. Despite treatment with numerous antibiotics, the lesions did not improve. Skin biopsy revealed a non-specific granulomatous folliculocentric reaction. Specific stains and tissue cultures were negative for infectious agents. An exclusion diagnosis of superficial granulomatous pyoderma was made and the patient was treated with use of cyclosporine combined with prednisolone with good response; the lesion healed within 3 months
The Examination of Accreditation for Foreign Medical Graduates in Greece: an Evaluation of the Multiple Choice Questions Format Using the Difficulty and Discrimination Indices
Get PDFBackground: The multiple choice questions (MCQ) format is the most commonly used written assessment technique for the accreditation of foreign medical graduates in Greece.Objective: To evaluate the appropriateness of the range of the MCQ tests and to compare the performance among foreign medical graduates, Greek medical students and interns (medical doctors during their residency). Methods: Twenty-six items from the internal medicine question paper and 24 from the surgery question paper were randomly selected from an MCQ format used in one assessment. For these items discrimination and difficulty indices were calculated for separate groups of candidates and volunteer participants (medical students and interns). Comparisons were made between group scores, first considering the whole questionnaire as a single entity and then using scores for each discipline calculated separately. Results: A significant number of “inappropriate” questions were included in the examination. Surgery questions were more candidate-oriented, given the best range of acceptable Difficulty Index values for that group of participants while internal medicine questions proved to be more appropriate for medical students. Furthermore, comparisons of groups performed using a total score over the whole range of the two disciplines revealed a significantly better performance of interns over students (p<0.001), whereas comparisons performed separately for each discipline revealed no significant difference between interns and students in surgery scores but a significant difference in internal medicine scores (p<0.001). Conclusion: These findings suggest the importance of the evaluation of the MCQs before using them in examinations, aiming at revising inappropriate questions. In order to evaluate the participants’ performance, calculation of scores across separate disciplines is proposed, since it is less likely to be biased towards good performance in the questions of one discipline