Hospital Chronicles (E-Journal)
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Staged Percutaneous Coronary Intervention (PCI) for Multivessel STEMI Patients?
Get PDFPrimary percutaneous coronary intervention (PCI) is the treatment of choice for patients with ST-elevation myocardial infarction (STEMI) since it results in greater patency of the infarct-related artery (IRA) and lower rates of re-infarction, stroke and death when compared with fibrinolysis alone. Multivessel disease (MVD) occurs in 40% to 65% of patients with STEMI. Is it possible for an aggressive multivessel percutaneous revascularization strategy to afford advantages in greater myocardial salvage and avoidance of staged procedures, with subsequent savings in compounded procedural risks? ...(excerpt
Is There a Place for Endovascular Treatment in Aortic Arch Pathology?
Get PDFBACKGROUND: Aortic arch stenting appears to be a debatable topic among cardiac surgeons, cardiologists and interventional radiologists. During the last decade a variety of products of endovascular treatment has been applied either to open heart surgery or to hybrid management of aortic arch pathology. In general, fenestrated, bare and multilayer stents are separate issues to be investigated, in contrary to covered stents which seem to gain their place in cardiovascular operations. Additionally new sophisticated devices and methods derived from current literature, e.g. Djumbodis, E-xl, BOS, Frozen elephant trunk (EVITA OPEN), & Cardiatis, promote the idea of hybrid treatment of aortic arch pathology. AIM, METHODS & RESULTS: The primary purpose in our presentation is to discuss several aspects of aortic arch stenting and to investigate the possibility of performing less invasive operations by the use of evolutionary facilities in order to define the spectrum of indications and to improve decision making. Currently there is no adequate evidence (level A or B) to develop guidelines for the management of acute aortic syndromes and thoracic aneurysms. According to several articles in the literature, endovascular interventions and hybrid repairs seem to approach or even to decrease the rate of mortality and morbidity in comparison to open surgical procedures and medical treatments. On the other hand, many reports in current literature indicate that conventional aortic arch surgery or conservative treatment are superior to stenting, thus creating a foggy field for a well established decision making. CONCLUSION: Thus, for endovascular or hybrid treatment of aortic arch pathology, these new technological entities in pair to previous applied methods should be studied further in multicenter prospective randomized trials in order to create a safe treatment environment
Comparison of Serum Total Antioxidant Status Between Patients with Community Acquired Pneumonia and Severe Asthma Exacerbation.
Get PDFBackground: Oxidant/antioxidant imbalance has been reported in various respiratory diseases including pneumonia and asthma. However the role of blood antioxidants has not been fully discussed. Objectives: The aim of this exploratory study was the measurement and comparison of serum Total Antioxidant Status (TAS) in patients with community-acquired pneumonia (CAP) or asthma exacerbation during hospitalization. Methods: Forty five patients (41 men – 4 women, with a mean age of 48.95±22.06 years) admitted to hospital for community-acquired pneumonia and thirty patients with severe asthma exacerbation (22 men – 8 women, with a mean age of 41.27±20.73 years) as well as eighteen normal subjects (40.22±9.96 years of age) were included in the study. On admission and on the 7th day serum TAS was measured using a colorimetric method in 600nm. Results: In both groups TAS on admission was decreased compared with normal subjects (0.83±0.13 vs. 1.19±0.09 mmol/L, p<0.001 and 0.98±0.08 vs. 1.19±0.09 mmol/L, p<0.001 respectively). In patients with CAP, but not in asthmatics, TAS on discharge was still decreased compared with normals (1.00 ±0.18 vs. 1.19±0.09 mmol/L, p<0.001). Change of TAS between 1st and 7th day was not different between the two groups of patients. Comparison between TAS on admission and TAS on discharge revealed statistically significant difference in both groups of patients (asthma: 0.98±0.08 vs. 1.13±0.18 mmol/L, p<0.001, pneumonia: 0.83±0.13 vs. 1.00±0.18 mmol/L, p<0.001). Comparison of TAS on admission and TAS on discharge between the two groups of patients showed that both measurements were statistically significantly decreased in patients with pneumonia compared with asthmatics (0.83±0.13 vs. 0.98±0.08 mmol/L, p<0.001 and 1.00±0.18 vs. 1.13±0.18 mmol/L, p=0.003 respectively). Decreased TAS on admission was found in smokers with pneumonia compared with smokers asthmatics but on discharge this difference was obscured. Non smokers with pneumonia had decreased TAS both on admission and discharge compared with non smokers asthmatics. Conclusions: It is concluded that serum TAS is decreased in patients with CAP or asthma exacerbation suggesting the presence of oxidative stress. Although TAS change during the course of the disease is similar, this decrement is more profound in CAP patients on admission as well as on discharge
Coronary Care Unit (CCU) Psychosis Syndrome
Get PDFIntensive (ICU) or cardiac care unit (CCU) syndrome or psychosis or delirium is frequently encountered among ICU or CCU patients constituting a significant barrier in the communication between them and their health care providers. We are herein briefly describing some aspects of this syndrome so that we can make it more easily recognizable by the ICU/CCU personnel who could intervene early and provide substantive help in these vulnerable patients
Post-Infarction Ventricular Rupture
Get PDFWe report the case of a 67-year-old lady who developed apical ventricular septalrupture after suffering acute anterior myocardial infarction. Having experienced symptoms of acute chest pain three days earlier, she visited the health unit of her residence area, an Ionian sea island. Her electrocardiogram and elevated myocardial necrosis enzymes in blood tests, confirmed a presumptive diagnosis of acute anterior myocardial infarction. The patient was urgently transferred by air-ambulance to our hospital due to hemodynamic deterioration... (excerpt
Persistent Bradycardia in a Patient With Coronary Artery Disease and Concomitant Carotid Artery Disease
Get PDFWe report a case of a 75-year-old male admitted to our hospital via the emergency room because of wide-QRS complex tachycardia. Non-ST elevation acute coronary syndrome (NSTE-ACS) was observed after termination of tachycardia. Coronary angiogram showed subtotal occlusion at the mid segment of the left anterior descending (LAD) coronary artery, which was treated by percutaneous transluminal coronary angioplasty (PTCA) and stenting. Because of persistent bradycardia (40-45 bpm) in the absence of β-blocker therapy, not responding to intravenous atropine, a temporary pacemaker was inserted. As the patient had bruits on auscultation of both carotid arteries, at the end of the coronary angioplasty procedure, carotid angiography was performed. This revealed severe bilateral disease which was treated with left internal carotid artery (LICA) angioplasty and stenting (CAS) performed at the same session, and right internal carotid artery (RICA) endarterectomy performed the day after. Interestingly, the bradycardia resolved a few hours post CAS. Before discharge, an electrophysiology study, undertaken to evaluate for the wide-QRS complex tachycardia and the persistent sinus bradycardia, yielded negative results. In conclusion, persistent bradycardia, in the absence of bradycardic agents, may be a clue to underlying carotid artery disease
Obstructive Thrombosis of a Mitral Valve Prosthesis and Live Three-Dimensional Transesophageal Echocardiography
Get PDFA 67-year-old woman with a bileaflet mitral valve prosthesis since 2007 due to mitral stenosis and chronic atrial fibrillation was admitted because of severe shortness of breath and diarrhea. She had been discharged from the hospital one week earlier on clarithromycin due to lower respiratory tract infection. She gave a history of increasing shortness of breath on exertion ever since, with the recent addition of diarrhea over the last 24 hours. Her past medical history includes previous ischemic stroke in 2004... (excerpt
Intermediate Coronary Artery Disease Risk Patients: Reclassification With Coronary Calcium Scoring or Statin Therapy?
Get PDFCardiovascular diseases continue to be the leading cause of death in the developed world. A better risk prediction is definitely needed to lower morbidity and mortality by primary prevention measures. The effects of Framingham risk score calculation can be improved by both hsCRP measurement and coronary artery calcium scoring. More trials are needed in order to further estimate and compare their relative efficacy in improving risk estimation especially in the intermediate risk patients who need it more
Endovascular Treatment of Aneurysm With Side Branches - A Simple Method. Myth or Reality?
No full textPURPOSE: The aim of this study is to present performance data on the use of the multilayer stent which is a 3-dimensional (3D) braided mesh made of interconnected layers, particularly in patients with side branches within the aneurysm. METHODS: A study protocol was designed to examine the safety and efficacy of the multilayer stent in patients with aneurysms in different target vessels. Between December 2006 and November 2009, 19 patients were enrolled in the study. Four patients had a renal aneurysm (1 male / 3 females) (mean diameter: 18 mm), while the other 15 patients (all males) had iliac artery (n=12, mean diameter: 25 mm), popliteal artery (n=1, diameter: 55 mm), thoracic aorta (n=1, diameter: 57mm) and abdominal aorta (n=1, diameter: 97.3 mm) aneurysms. RESULTS: The multilayer stent was successfully deployed in all patients (100% technical success); Mean follow-up for the peripheral aneurysms was 28 months (range 12 to 36) and for the aortic aneurysms was 3 months. The occlusion rate of the aneurysm at the peripheral arteries was 100% and all the side branches remained patent. For the thoracic and the abdominal aneurysms, the 3 months computed tomography angiography (CTA) showed patent artery side branches and reduced blood flow inside the sac. CONCLUSION: The multilayer stent seems to be efficient with regard to the side branches which remain patent and the aneurysm is excluded. The question remains about the time needed to achieve the exclusion of the aneurysm in large arteries such as the thoracic and abdominal aorta; we believe this is related to the number and size of the branches within the aneurysm as well as the size of the target vessel itself. A larger multi center study is needed to confirm the suitability of the multilayer stent for the large thoracic, abdominal and thoracoabdominal aneurysms
Evolution of Outcomes in Cardiothoracic Surgery
Get PDFThe measurement of outcomes is a fundamental component of modern surgery to provide the foundations of surgical improvement. The conventional emphasis of clinical outcomes such as morbidity and mortality has been augmented with a growing focus on quality of life, quality of care and patient satisfaction. Outcome measures can provide cardiothoracic surgeons the opportunity to assess their results in increased precision and transparency. An initiative to increase patient awareness and education regarding their hospitals and their surgeons has meant a necessary move towards greater clarity and accountability of all surgical centres. This has seen an adaptation towards a more patient-centered approach. Comprehensive quality measures and a framework for analyzing and interpreting these results is pivotal as is knowing what to measure and how to measure it. Innovative approaches whereby the patient measures and reports their own ‘outcome’ and experience are being piloted in all surgical specialties, including cardiothoracic surgery. Adopting the Donabedian model for quality measurement in three domains structure, process, and outcomes is a valid and reliable instrument for assessing patient’s satisfaction and quality of care as are the wide range of validated surveys of health related quality of life, which should be routinely implemented