Hospital Chronicles (E-Journal)
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Utility of Positron Emission Tomography Imaging in Lymphoma: A Clinician's Point of View
Get PDFPositron emission tomography (PET) using fluorine-18 (FDG) is increasingly used in the staging of lymphoma. Results of the use of PET during and after completion of therapy for staging of Hodgkin’s lymphoma and aggressive non-Hodgkin’s lymphoma demonstrate a highly predictive value for outcome. Based on recommendations of the International Harmonization Project, FDG-PET has been incorporated into the revised response criteria of lymphoma. There is currently no evidence to support the use of FDG-PET in indolent lymphoma, nor for its routine use during follow-up. Evidence also lacks on the impact of FDG-PET on treatment outcome. Clearly, well designed clinical trials are warranted to determine the subsets of patients that will benefit from this modality
Long Term Beneficial Effects of Good Glycemic Control on Macrovascular Disease: Results from UKPDS 10-Year Post Trial Monitoring
Get PDFCardiovascular disease is a significant cause of morbidity and mortality in patients with diabetes mellitus. The impact of tight glycemic control in the mortality has been investigated in large randomized clinical trials. The data are controversial, as some trials (ACCORD, ADVANCE and VADT) have found that intensive glycemic control either has no impact on cardiovascular outcomes or even worsens them. On the other hand, results of the 10-year follow-up of the UKPDS study suggest that tight glycemic control of younger, newly diagnosed patients with type 2 diabetes may have long term beneficial cardiovascular effects. All these data have led to the adoption of clinical guidelines suggesting a different strategy according to the patient’s age and duration of diabetes
Hypertrophic Obstructive Cardiomyopathy and Severe Mitral Regurgitation due to Chordae Tendinae Rupture
Get PDFA 60-year-old gentleman came to the cardiac emergency room of our hospital complaining of a 3-day long shortness of breath and orthopnea. The patient gave a history of prior diagnosis of hypertrophic obstructive cardiomyopathy (HOCM). Due to the existence of two jets of mitral regurgitation and the lack of full clarification of the mitral valve anatomy by transthoracic echo, the patient underwent transesophageal echocardiography study. The latter was able to detect the origin of the jets, therefore,the jet towards the posterior wall of the left atrium was caused by the SAM of the mitral valve leaflet, while the one towards the atrial septum was created by the flail posterior leaflet – medial segment (P2) – because of the chordae tendineae rupture. The patient underwent surgical operation namely myectomy according to the Morrow procedure and mitral valve replacement. He had an uneventful postoperative course
Bidirectional Ventricular Tachycardia
Get PDFBidirectional ventricular tachycardia (VT) is a form of tachycardia with alteration of the QRS axis in the same electrocardiographic lead. We present a case of bidirectional VT recorded in a female patient under chronic digitalis treatment and respiratory acidosis
Acute Aortic Syndromes: Surgical, Endovascular or Medical Treatment?
Get PDFThe term acute aortic syndrome (AAS) embraces a heterogeneous group of patients with a similar clinical profile of acute presentation and characteristic “aortic pain”. Acute aortic syndrome encompasses classic aortic dissection, less common variants such as intramural hematoma, penetrating aortic ulcer, and iatrogenic or traumatic transsection of the aorta. In some patients, AAS may also be caused by symptomatic degenerative aortic aneurysm. Eventually, any one of AAS may progress to frank aortic rupture that will be contained or not. These acute aortic pathologies appear separately, may precede one another and/or just coexist. AAS is the most frequently fatal condition in the spectrum of patients with chest pain. These patients are characterised by ‘‘aortic pain’’ and a long-lasting history of severe hypertension... (excerpt
Left Ventricular Lead Implanted in the Right Ventricle Through a Thrombotic Subclavian Vein
Get PDFAn 86-year-old patient was referred to our hospital because of pacemaker extrusion. The attempt to advance a right ventricular lead through the left subclavian vein failed due to vein thrombosis. Finally, an over-the-wire left ventricular lead was stabilized at the apex of the right ventricle successfully, through the thrombosed subclavian vein
Angiotensin II-Receptor Blockers: their Relevance in Clinical Practice
No full textThe implication of the renin angiotensin system (RAS) and specifically angiotensin II in the pathogenesis of essential hypertension, cardiac, cerebrovascular and renal disease is well established. Among the different categories of drugs that manage hypertension, angiotensin receptor blockers (ARBs) and angiotensin-converting enzyme inhibitors (ACEIs) are notably effective in the downregulation of RAS. Whereas ACEIs achieve RAS inhibition by constraining the conversion of angiotensin I to angiotensin II, they can display adverse effects, such as cough and angioedema that result from the increased production of bradykinin and prostaglandin. The direct antagonistic action of ARBs on angiotensin II receptors has proved to be very well tolerated. Achieving rapid blood pressure reduction and twenty-four hour hypertension control, they are superior to other antihypertensive agents in the regression of left ventricular hypertrophy, new onset diabetes and stroke and in the delay of renal dysfunction. The combination of ARBs with other drug categories, such as diuretics or calcium channel blockers, can provide additive effects, favouring their recommendation and use for the clinical management of hypertension and cardiovascular diseases. Meta-analyses of clinical trials have provided evidence that ARBs are comparable with other drugs against cardiovascular and all-cause mortality
Radial Approach to Percutaneous Coronary Intervention
Get PDFThe radial approach is considered alternative to the traditional femoral approach to perform coronary angiography and percutaneous coronary intervention (PCI). Transradial compared to transfemoral PCI has been consistently shown to be equally effective but safer, since it significantly reduces access site related and bleeding complications. Additionally, it increases patient comfort and reduces hospitalization cost. Modern interventional strategies and aggressive antithrombotic regimens have limited ischemic adverse events following PCI. At the downside, bleeding complications remain a serious problem and adversely affect outcomes. They can be reduced with novel pharmacologic agents but still have unacceptably high rates and are mostly related to femoral access. In this context the radial approach seems a reasonable choice to further reduce access related bleeding. A concise overview of recent data supporting a more widespread dissemination of transradial PCI and a brief presentation of the most important pertinent technical issues are attempted herein
Dyslipidemia: The Role of Non-HDL Cholesterol, Apolipoprotein B, and Small, Dense LDL
Get PDFElevated low-density lipoprotein cholesterol (LDL-C) has traditionally been considered an independent risk factor for coronary artery disease (CAD). A level of LDL-C< 70 mg/dl is recommended for very high risk individuals. However, it has recently been suggested that the threshold for atherosclerosis may be much lower and it is widely accepted that even with the intense use of statins, not all cardiovascular adverse events are prevented. Consequently, new indexes have emerged that could outperform LDL-C especially in the highest risk populations, such as patients with diabetes type II or the metabolic syndrome. Non- high density lipoprotein (HDL) cholesterol is defined as all of the cholesterol that is not HDL (total cholesterol- HDL cholesterol). It has been shown that for each LDL-C category, an increase in non-HDL cholesterol increased the risk for cardiovascular disease. Prospective trials have also shown that total apo-B level reflects the total number of apo- B lipoproteins and measures the total atherogenic particle number. It seems that apo-B levels are much more closely related to the risk of vascular events than LDL-C or non-HDL cholesterol. Finally, there are at least 7 distinct subclasses of LDL of different particle sizes and several recent studies have suggested that LDL subfraction distribution, especially the presence of increased levels of small, dense LDL particles, aid in the prediction of cardiac heart disease risk. Further studies will clarify the clinical circumstances that justify lipoprotein analysis and how to best use the information taken from these new indices in the management of our patients