Hospital Chronicles (E-Journal)
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Διαβητική Δυσλιπιδαιμία: ΠαλαιότεÏα και ΣÏγχÏονα δεδομÎνα
Get PDFΟ σακχαÏώδης διαβήτης Ï„Ïπου 2 (ΣΔ2) αποτελεί Îνα ιδιαίτεÏα συχνό και μείζον Ï€Ïόβλημα υγείας που στις μÎÏες μας Îχει λάβει διαστάσεις επιδημίας στις ανεπτυγμÎνες χώÏες. Η μεγάλη αÏξηση της συχνότητας του διαβήτη συνδυάζεται με την παÏάλληλη εξάπλωση της παχυσαÏκίας. Η τελευταία, ιδίως όταν οφείλεται σε κεντÏική εναπόθεση της πεÏίσσειας λίπους, σε συνδυασμό με τη μείωση της σωματικής δÏαστηÏιότητας αλλά και με γενετικοÏÏ‚ παÏάγοντες, διαδÏαματίζει κεντÏικό Ïόλο στην παθογÎνεια του ΣΔ2 καθώς αποτελεί καθοÏιστικό γενεσιουÏγό παÏάγοντα της αντίστασης στην ινσουλίνη. Η αντίσταση στην ινσουλίνη Ï€Ïοκαλεί αντιδÏαστική υπεÏινσουλιναιμία με αποτÎλεσμα να αντιÏÏοπείται η τάση για αÏξηση των τιμών σακχάÏου στο αίμα. Ωστόσο, όταν τα β-κÏτταÏα αδυνατοÏν πλÎον να αντιÏÏοπήσουν την ινσουλινοαντίσταση εμφανίζεται ο κλινικός διαβήτης... (excerpt
Coronary Sinus Diverticulum and Accessory Pathway
Get PDFA rare case of coronary sinus diverticulum is herein presented in a patient with classical Wolff-Parkinson-White syndrome undergoing catheter ablation of a posteroseptal accessory pathway. Only after a coronary venous angiogram was performed was the location of the accessory pathway identified and successfully ablated
Primary Prevention of Bleeding from Oesophageal Varices
Get PDFVariceal bleeding is the most serious complication of patients with cirrhosis and portal hypertension. Mortality related to variceal bleeding has been falling in recent years but is still considered among the leading causes of death in these patients. Therefore, the issue of primary prophylaxis of variceal bleeding is an important one. In the pre-primary prophylaxis setting (prevention of formation/growth of varices) all cirrhotics should be screened for varices at diagnosis although there is no currently indication for treating patients in order to prevent the formation of varices. Areas requiring further study include the natural history of low-risk varices and treatment possibilities for the decrease or the prevention of the development and/or the progression of varices. Patients with small varices could be treated with beta-blockers, which have been proved effective in reducing the risk of first variceal bleeding in patients with medium and large oesophageal varices. Endoscopic band ligation seems to be more effective in recent trials, but concerns have been raised regarding its safety. Further, studies are required to clarify whether the use of the combination of band ligation and beta-blockers is better than each treatment alone. The future aim is to improve current medical therapy taking into consideration the cost-effectiveness and the quality of life
Percutaneous Closure of a Large Atrial Septal Defect: A Simplified Approach
Get PDFA 44-year-old female patient presented with easy fatigability, dyspnea on exertion and frequent episodes of migraine. Echocardiography revealed a large atrial septal defect (ASD) of the secundum type. This was further visualized with transesophageal echocardiography (TEE) (Figure, Panel A, arrow).The diameter of the ASD at TEE was measured at 1.93 cm. Pulmonary to systematic flow ratio (Qp/Qs) was calculated at 3.3:1, indicating a significant left-to-right shunt across the ASD. Percutaneous closure of the defect was subsequently undertaken. The diameter of the defect was measured intra-procedurally using an intracardiac balloon and it was found to be 2.6 cm (Panel B).An Amplatzer 9-ASD-032 occluder was successfully implanted percutaneously via the right femoral vein (Panel C, arrow). TEE 48 hours after implantation showed that the closure device was in proper place (Panel D, arrows) and the left-to-right shunt was abolished
Thrombocytosis in primary lung cancer
Get PDFBACKGROUND The prevalence of thrombocytosis in lung cancer has been variably reported from 13% to 60%. The vast majority of published data derive from retrospective studies and therefore the estimation of the real prevalence is difficult. PATIENTS AND METHODS We prospectively enumerated platelets in the peripheral blood of 317 consecutive, untreated lung cancer patients. Thrombocytosis was defined as a pletelet count >400.000/mm3. Tumours were histopathologically classified according to the WHO classification and staging was performed according the 2002 version ISS for NSCLC and to the VALSG two stage system for SCLC. RESULTS Thrombocytosis was present in 64 (20.2%) patients and it was unrelated to gender and extent of disease but it was age related: 29/91 (31.8%) in patients ≤50 yrs versus 35/226 (15%) in patients >50yrs old (p=0.001). The distribution of thrombocytosis in the two major histological types was 54/165 (32.7%) for NSCLC and 10/152 (6.6%) for SCLC (
Incidence and Mortality in Breast Cancer: Are We Doing Better?
Get PDFBreast cancer in women is a major health problem: each year, more than 1 million new cases are diagnosed worldwide. One in 8 women will be confronted with breast cancer during her lifetime. The objective of this review is to present an overview of the epidemiology of breast cancer i.e. the incidence and mortality rate of breast cancer. In other words, how often does breast cancer occur and how often it is lethal? The geographical variation and the evolution over time are discussed - are we now doing better than 10 or 20 years ago? Possible ways of preventing breast cancer are also presented
Ventricular Tachycardia Ablation:Current Status
Get PDFVentricular tachycardia (VT) occurs in the diseased heart as well as in the normal heart but it is not always easy to distinguish. Ventricular tachycardias in the morphologically normal ventricle include idiopahic (fascicular) left ventricular tachycardia and out-flow-tract tachycardia from the right ventricular outflow tract (RVOT) or left ventricular outflow tract (LVOT), whereas VT in diseased heart comprises stable and unstable VT in post-infarction ventricle, VT in dilated cardiomyopathy, VT in arrhythmogenic right ventricular cardiomyopathy, and bundle branch re-entry
Off-Pump Coronary Artery Bypass Surgery: Current Status
Get PDFCoronary revascularization was first performed on the beating heart. Later on the heart-lung machine facilitated the wide-spread application and allowed accurate anastomoses to be performed on a fibrillating or arrested heart. The contemporary beating heart surgery goes back to the original approach, thereby using appropriate technology and techniques that have allowed surgeons to perform high quality reproducible anastomoses. Beating heart surgery has once again established its place as an acceptable method for multi-vessel coronary revascularization. Worldwide, approximately 30% of all surgical coronary revascularization procedures are performed on a beating heart (off-pump coronary artery bypass-OPCAB); in some countries they exceed 50%, while in some centers they even approach 99% of unselected cases. Several end-points have been analyzed from recent publications of the world literature, and are presented herein
How Harmful is Conventional Right Ventricular Apical Pacing? Iatrogenic Left Bundle Branch Block: Need for Alternate Site Pacing
Get PDFThe right ventricular (RV) apex has been used as the traditional pacing site since the development of transvenous pacing in 1959. Some studies suggest that pacing the RV apex may cause an ???iatrogenic?? left bundle branch block and remodeling of the left ventricle and is therefore harmful. In the past decade, the need for alternate site pacing became imperative and there have been a multitude of studies of the hemodynamic, electrophysiological, electrocardiographic, and clinical effects of ventricular pacing at other sites.Pacing of the left ventricle singly or with biventricular pacing has emerged as an effective and safe therapy for moderate to severe congestive heart failure in patients with prolonged QRS complexes. Studies of alternate RV sites, like the RV outflow tract, have given mixed results, and further clarification of the specificsites of the RV outflow tract is needed. Direct His-bundle pacing is an attractive alternate pacing site because of the possible hemodynamic benefits that could be obtained by a normal activation sequence, but the small size and anatomic position of the His bundle have made this approach difficult. Bifocal RV resynchronization therapies have been used as an alternative to biventricular pacing
The Nurse's Role in Patients Supported with an Intra-Aortic Balloon Pump
Get PDFAim: The purpose of this investigation was to collect data on the appropriate nursing care to patients supported with an intra-aortic balloon pump (IABP).Patients: All 39 patients who were supported with an IABP during the year 2006 (23 men ??? 16 women) took part in this investigation. They received nursing and medical care in the Intensive Care Cardiovascular Unit (ICCU) of Evagelismos General Hospital of Athens