Hospital Chronicles (E-Journal)
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The Contribution of Cardiac Magnetic Resonance Imaging to the Diagnosis of Cardiac Diseases
Get PDFBackground: Cardiac magnetic resonance imaging (MRI) has been established in clinical practice as a valid imaging modality for the diagnosis of various cardiovascular disorders. Objectives: To underline the importance of cardiac MRI as an alternative non - invasive imaging method for the diagnosis and follow-up of cardiac patients based on findings from our own recent experience. Patients and Methods: The study included all cardiac patients referred for cardiac MRI over a period of one year. Cardiac MRI studies were performed with the use of a 1.5-Tesla scanner using a body phased-array coil, breath and ECG-triggering. Almost all cardiac sequences were gated to the patient’s cardiac cycle. Cine imaging for the evaluation of cardiac volumes and heart motion was performed using a cine breath-hold true short-axis and true four-chamber sequence with whole left ventricular coverage. Black blood imaging for the assessment of morphology was acquired on a true short-axis and true four-chamber view. Depending on the pathology under investigation, special sequences were added to the imaging protocol, such as late-enhancement imaging after gadolinium administration. Results: The study cohort comprised 114 patients who were referred for cardiac MRI with the following indications and clinical diagnoses: myocarditis (n=29), arrhythmogenic right ventricular cardiomyopathy (ARVC; n=27), valvular heart disease (n=23), history of myocardial infarction (n=13; seeking myocardial viability), hypertrophic (n=12), or dilated (n=2), or tako-tsubo (n=1), or non-compaction (n=2) cardiomyopathy, pericardial effusion (n=2) and various intracardiac masses (n=3). Cardiac MRI confirmed the clinical diagnosis and gave further specific information in 52% of myocarditis cases, in 37% of suspected ARVC cases, in 38% of coronary artery disease patients regarding myocardial viability, while it confirmed all other clinical diagnoses (100% match). Conclusions: Cardiac MRI represents a clinically useful imaging method for the diagnosis of various cardiac disorders since it has the capability of providing highly accurate and reproducible measurements of cardiac hemodynamics in addition to the detailed demonstration of cardiac anatomical structures
Telemedicine in Congenital Heart Disease
Get PDFBACKGROUND: The primary rationale for the development of telemedicine has been to serve populations that have limited access to traditional, high quality medical services. These include those living in rural areas or other underserved areas, like islands, or even urban areas when a rare medical subspecialty, such as pediatric cardiology is not available. OBJECTIVE: The aim of the present study was to present our results with use of telemedicine during the European project TELEREMEDY over a period of 26 months when adult cardiologists and pediatricians of our hospital communicated with pediatric cardiologists at the tertiary Children’s Hospital “Agia Sofia” in Athens and at the Royal Brompton Hospital in London, as well as with physicians at the “Venizelio” Hospital in Crete. METHODS AND RESULTS: Over 26 months, 31 teleconference sessions were organized. During this period, 155 children with suspected congenital heart disease (CHD) underwent echocardiographic examination, which confirmed CHD in 83 (54%), acquired heart disease in 13 (8%) and normal anatomy in 59 (38%). Ventricular septal defect was diagnosed in 26/83 (31%), complex CHD in 20 (24%), atrial septal defect in 12 (14%) and patent ductus arteriosus in 8 (10%) children. Our hospital with the adult electrophysiology team was the expertise center for diagnosis and treatment of 30 children with arrhythmia. During 23 sessions with the tertiary Children’s Hospital “Agia Sofia” in Athens, an immediate transfer to the pediatric intensive care unit of the tertiary center was decided for 27 cases (17%). During 3 sessions with one participating hospital we provided consultation for 10 cases with arrhythmias. During 6 sessions with the Royal Brompton Hospital in London, rare cases of CHD, both adult and pediatric, were discussed. Two multilane conferences were organized among all participants and the systems capabilities in each hospital were discussed. CONCLUSION: Telemedicine systems, like the one used herein in the context of the TELEREMEDY program, facilitate a timely diagnosis and management of children with CHD in hospitals lacking pediatric cardiology service. In the present series, use of this program obviated unnecessary and costly transfers in 83% of cases. Thus, immediate access to specialists can guide patient management and may potentially alter the morbidity and mortality in this patient population
Proarrhythmic Effect of Implantable Defibrillator Function
Get PDFProarrhythmia usually refers to the worsening of an arrhythmia from an antiarrhythmic medication. However, implantable cardioverter defibrillator (ICD) devices can also be proarrhythmic as is shown in the case herein presented
Non-invasive Ventilation in Cancer Patients: a historically matched controlled study
Get PDFPrognosis of cancer patients requiring Invasive Mechanical Ventilation (IMV) is poor. Various studies conducted mainly in patients with haematological malignancies have shown that Non-Invasive Ventilation (NIV) is associated with improved results OBJECTIVE: To compare NIV with IMV in patients with various malignancies. An assessment was also made of the possible bias in our results due to recent improvements in IMV. MATERIAL AND METHODS: A historically matched controlled study of NIV versus IMV. Forty seven patients treated by NIV were matched with 47 historical controls treated by IMV. Matching was performed according to 5 variables: type of cancer, leucopenia, allogeneic bone marrow transplantation, SAPS II score and reason for ventilation. RESULTS: Duration of ventilation and of hospitalisation were significantly (p=0.001) shorter in the NIV group; 48% of patients treated with NIV were discharged from the hospital versus 23% of those treated by IMV (p=0.08). NIV was statistically more effective than IMV in solid tumours, non transplanted and non leucopenic patients. Contrary to the period before 1996, when the analysis was restricted to the IMV matched cases, in the period since 1996, no difference in terms of mortality between IMV and NIV was found. CONCLUSIONS: In comparison with IMV, NIV in cancer patients: is associated with two significant advantages: reduction in ventilation duration and reduction in hospitalisation stay
The Expression of Heat Shock Proteins 27 and 70 in Lupus Nephritis
Get PDFBackground: Heat shock protein (HSP ) up-regulation is a cytoprotective response following stress insults (toxic, ischemic, inflammatory and oxidative). Ob ject ive: To study the localization of HSP 27 and HSP 70 in the renal tissue of patients with lupus nephritis (LN) and correlate our findings with the severity of histological involvement (activity and chronicity indices) and the degree of renal function impairment. Pat ients and Methods: Seventy patients with LN (diffuse proliferative n=31, focal proliferative n=20, and membranous n=19) were included in the study. The distribution of HSP 27/HSP 70 was studied by immuno-histochemistry in renal biopsy sections. A double staining method for vimentin, a-smooth muscle actin, CD 34 and CD 68 (+) cells were performed to identify the type of glomerular cells expressing HSP s. The severity of immunostaining for HSP 27/70 was evaluated semiquantitively. Results : HSP 27 and HSP 70 were identified within the cytoplasm of tubular epithelial cells of all patients. Increased HSP 27 expression was noted within intrinsic glomerular cells in diffuse lupus nephritis whereas no glomerular expression was observed in focal proliferative and membranous LN. A significant positive correlation was found between HSP 27 expression in diffuse proliferative nephritis and the activity and total (activity + chronicity) indices. The severity of histological involvement was also related to the degree of renal function impairment. Conclusions: Up-regulation of heat shock protein expression was identified in patients with various types of LN, especially those with diffuse proliferative nephritis. The severity of HSP 27 expression was related to the activity and total indices. These results suggest a possible defensive role for HSP 27 in severe lupus nephritis
Percutaneous Catheter Dilatation of Benign Ureteroenteric Anastomotic Strictures Followed or not by Retrograde Transconduit Placement of a Catheter: Long Term Results
Get PDFBACKGROUND: We report our experience on multiple balloon dilatations for benign ureteroenteric anastomotic strictures after total cystectomy and urinal deviation by ileal conduit, followed or not by retrograde placement of a permanent catheter through the stoma of the ileal conduit. PATIENTS AND METHODS: Patients were classified in two groups: Group A included patients treated only by multiple balloon dilatations and Group B patients in whom multiple dilatations were followed by retrograde insertion of a permanent catheter through the stoma of the ileal conduit, which then had to be replaced regularly. Records of survival and patency rates were recorded. RESULTS: Twenty patients with 24 benign ureteroenteric anastomotic strictures referred to radiology department. Long-term results were available in only 15 patients, who finally included in the study. In Group A long term follow-up was achieved in five patients. Mean primary patency time of stenoses (interval between initial dilatation and recurrence) was 33.2 months. This time-period proved to be the same as the survival time of Group A patients, since all five patients eventually succumbed to the underlying disease or other reasons. In Group B, 6 patients are still alive and 4 patients eventually succumbed to the underlying disease or other reasons. Mean primary patency time of stenoses was 38.1 months. CONCLUSIONS: Balloon dilatations of benign ureteroenteric anastomotic strictures, due to radical cystectomy and urinal deviation by ileal conduit, were technically successful in all cases. Patency rate was comparable in the two study groups. However, regular catheter replacement through the ileal conduit is well tolerated and gives a sense of security to both patient and physician
Paulus Aegineta: The Pioneer of Plastic Surgery Evolution and Comparisons
Get PDFPaulus Aegineta was one of the major representatives of surgery in the Byzantine period. His works had a great influence on Islamic and Western medicine, conveying significant practices, including ???plastic?? surgery, to the subsequent ages. In the present paper we compared Paulus???s Aegineta???s surgical techniques with their respective operations described in Surgical Manuals of the 19th century or thereafter. His methods in surgery remained virtually fadeless for a very long period of time. From the comparisons made we traced many similarities, which lead to the conclusion that for over 1200 years the evolution of this field of surgery, today called ???plastic surgery??, was rather minor. The great evolution of plastic surgery emerged in the second half of the 20th century and particularly the last 20 years, concurrently with the amazing technological progress. We conclude that plastic and reconstructive surgery remained unchanged for many centuries in a neonatal stage. It is probably the technological evolution of the 20th century that changed the rate of development of plastic surgery in our era, converting it to a completely discrete, high-tech specialty, as is today
Stem Cells and Cardiac Repair
Get PDFContrary to the initial belief that the heart is a terminally differentiated organ that cannot replace its own cell damage, there is now proof that the circulating blood provides the injured tissue with adult stem and progenitor cells, which have the potential to differentiate into cardiomyocytes and ultimately improve cardiac function. Thus, transplantation of stem cells into the myocardium in patients with severe myocardial dysfunction post-myocardial infarction is being currently investigated for experimental as well as for clinical purposes. Many issues regarding the mode of action remain to be elucidated. The BOOST trial was the first completed, randomized study that showed safety, feasibility and efficacy of the method. However, a more recent doubleblind, placebo-controlled study failed to reveal an increase in global left ventricular ejection fraction and cast doubt on the efficacy of the method. Thus, further randomized studies are needed to evaluate this novel approach in the treatment of ischemic heart failure and determine its role, safety and efficacy
QT and QU Interval Prolongation, Bidirectional Ventricular Tachycardia and Aborted Sudden Death. An Andersen-Tawil Syndrome
Get PDFA 42-year-old lady survived an episode of near-drowning and she was subsequently diagnosed with a rare genetic disease, recently classified as long QT 7 syndrome, for which she received an implantable cardioverter defibrillator. The features of this syndrome are herein described
Sustained Ventricular Tachycardia During Dobutamine Stress Echocardiography
Get PDFDobutamine stress echocardiography (DSE) has been frequently performed safely and renders important diagnostic information of underlying myocardial ischemia in patients with coronary artery disease. During DSE, death or other major events, such as myocardial infarction and sustained ventricular tachycardia (VT), have been extremely rare. We herein present three patients who developed three different types of sustained VT during DSE. These clinical observations indicate that various mechanisms may be involved in the development of this malignant arrhythmia during DES