Hospital Chronicles (E-Journal)
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Ablation Techniques in a Patient with a Right Accessory Pulmonary Vein. Is it Always Feasible?
Full text linkA 32-year-old woman with lone paroxysmal atrial fibrillation had two pulmomary vein isolation procedures over 1 year, by means of the circular multipolar duty-cycled radiofrequency PVAC in the first and the Thermocool® SmartTouchTM catheter in the second procedure. Following both procedures, the patient remained highly symptomatic on a weekly to monthly basis and a third procedure by using the second generation of cryoballoon Arctic Front AdvanceTM. Right inferior pulmonary vein was completely reconnected and an extreme hockey stick configuration was necessary in order to achieve complete occlusion and isolation. Thirty months later the patient remains symptom free in the absence of any therapy
Rapidly Progressive Dementia: Is it Alzheimer’s or not?
Full text linkAlzheimer’s disease (AD) is a chronic progressive disease, which accounts for 60% of all dementias. Sometimes 10-30% of AD cases have a more fulminant course, but this AD subtype is not the only cause of rapidly progressive dementia (RPD). There exists a variety of entities presenting as RPDs, a number  of which are reversible or treatable. It is imperative that accurate and prompt diagnosis be made, since it is crucial for neuronal survival. Some of these rapidly progressive manifestations concern vascular, infectious, toxic-metabolic, autoimmune, metastatic-neoplastic, iatrogenic, neurodegenerative or systemic diseases, which can be arranged in a list using the mnemonic "VITAMINS". This review summarizes the major etiologies of RPDs. Differential diagnostic algorithms are also presented
Cardiology News / Recent Literature Review / Third Quarter 2016
Full text linkHCS Panhellenic Congress: Athens, 20-22/10/2016TCT Conference: Washington, DC, 29/10-2/11/2016AHA Scientific Sessions: New Orleans, 12-16/11/2016AF Symposium: Orlando, 12-14/1/2017ACC.17: Washington, DC, 17-19/3/2017HRS Scientific sessions: Chicago, 10-13/5/2017EHRA Europace-Cardiostim: Vienna, 18-21/6/2017ESC Congress: Barcelona, 26-30/8/2017POST 2 Study: Patients with Vasovagal Syncope Improved Modestly with Fludrocortisone 0.2 mg daily with Insignificant 31% Reduction in the Hazard of Fainting in the Intent-to-Treat AnalysisAmong 210 patients (71% female, median age 30 years) with recurrent vasovagal syncope randomized to fludrocortisone or placebo at highest tolerated doses from 0.05 mg to 0.2 mg daily, there was a marginally nonsignificant reduction in syncope in the fludrocortisone group (hazard ratio - HR: 0.69; p = 0.069). In a multivariable model, fludrocortisone significantly reduced the likelihood of syncope (HR: 0.63; p = 0.024). When the analysis was restricted to outcomes after 2 weeks of dose stabilization, there was a significant benefit due to fludrocortisone (HR: 0.51; p = 0.019) (Sheldon R et al, J Am Coll Cardiol 2016;68:1-9).Patients With Variant Angina Presenting With Aborted Sudden Arrhythmic Death (SCD) Face a Worse Prognosis Than Those Without SCD, While Therapy With Vasodilator Drugs is not Sufficiently Protective/ Additional ICD Implantation Might be Necessary as a Secondary Prevention Treatment Among 188 patients with variant angina with atherosclerosis (ASCD) and 1,844 patients with variant angina without ASCD (predictors of ASCD: age, hypertension, hyperlipidemia, family history of sudden cardiac death, multivessel spasm, and left anterior descending artery spasm), over a median of 7.5 years, the incidence of cardiac death was higher in ASCD patients (24.1 vs 2.7 per 1,000 patient-years; hazard ratio - HR: 7.26; p< 0.001). Death from any cause also occurred more frequently in ASCD patients (27.5 vs 9.6 per 1,000 patient-years; HR: 3; p< 0.001). The incidence rate of recurrent ventricular tachyarrhythmia in ASCD patients was 32.4 per 1,000 patient-years, and the composite of cardiac death and ventricular tachyarrhythmia was 44.9 per 1,000 patient-years. A total of 24 ASCD patients received ICDs (Ahn JM et al, J Am Coll Cardiol 2016; 68:137-145.)... (excerpt)Â
Discrimination Power Assessment of STR Genotyping in Parentage Investigation
Full text linkOBJECTIVE Nowadays, the application of DNA-typing in laboratory medicine is increasing rapidly for paternity/maternity disputes. The goal of this study was to evaluate the use of polymorphic microsatellite marker DNA analysis and to establish this analysis as the method of choice for parentage investigations.SUBJECTS AND METHODS Among 708 civil parentage tests addressed to our Laboratory previously examined for HLA class I (-A*,-B*,-Cw*), and class II (-DRB1*,-DQB1*,-DPB1*) alleles using PCR-SSOP and/or PCR-SSP methodologies, a cohort of 50 cases (137 individuals) of disputed parentage was selected. In these cases DNA-typing was generated from co-amplification of 15 autosomal STR DNA markers (D3S1358, HUMTH01, D21S11, D18S51, Penta E, D5S818, D13S317, D7S820, D16S539, HUMCSF1PO, Penta D, HUMvWA, D8S1179, HUMTPOX, HUMFGA and the sex determining Amelogenin marker HUMAMEL), using fragment analysis methodology.RESULTS The evaluation of the results showed that 15 out of 50 cases, were sufficient for exclusion of fatherhood by both approaches (HLA and STRs). In all remaining 35 non-excluded cases, the PI value using HLA genotyping ranged from 76 to 6,452,794, whereas using aSTR genotyping ranged from 15,173 to 9.2 x 1010. In one non-excluded motherless case the alleged father showed one genetic discrepancy with the child at D21S11 locus, due to a mutation event.CONCLUSION The use of DNA-typing with 15 aSTR loci for parentage testing provides an accurate and high-sensitivity method which is simpler to perform and more rapid than an accepted standard technology, such as HLA genotyping. The analysis of aSTR loci offers a highly discriminating test suitable for trio paternity testing, increasing the W rate in comparison to HLA genotyping. Nevertheless, when a mutation event occurs in motherless cases, combination of HLA and STR polymorphisms offers high level of information, and also diminishes the possibility of false exclusion due to aSTRs mutations
Alcoholic Liver Disease from the Clinical Point of View
Full text linkLiver disease is responsible for more than 55% of deaths resulting from alcohol abuse, while the prevalence of alcoholic liver disease (ALD) is closely correlated with per capita alcohol consumption. ALD represents a wide range of histological changes ranging from simple steatosis to heavier forms of liver injury including alcoholic hepatitis, cirrhosis and/or concurrent development of hepatocellular carcinoma. These alterations of the hepatic parenchyma do not necessarily reflect distinct stages of liver disease progression, but rather a continuum relating to histological changes that may be observed simultaneously in the same patient. The fact that only 35% of patients with heavy alcohol abuse develop advanced stages of liver disease, suggests that in the pathogenesis of ALD a number of other factors are involved that include gender, obesity, drinking patterns, dietary factors, non-sex-linked genetic factors and smoking. Also, long-term drinking can affect synergistically with hepatitis B or C and/or the human immunodeficiency virus, the non-alcoholic fatty liver disease and hepatic disorders such as hemochromatosis. The diagnosis of ALD is based on a combination of findings, including the history of significant alcohol consumption, the clinical evidence of the concomitant liver injury supported by the resultant histological, imaging and laboratory findings. A beneficial effect of alcoholic hepatitis treatment with corticosteroids is observed in patients with encephalopathy or with poor prognosis based on the various grading and prognostic systems of gravity, while the harmful effect is prominent in patients with milder disease, as they manifest an increased risk of infections compared with those not receiving corticosteroids. In patients with alcoholic hepatitis that cannot take corticosteroids for various reasons and in those with the onset of functional renal failure (“hepatorenal syndromeâ€), use of pentoxifylline is recommended
Need for a Permanent Pacemaker after Transcatheter Aortic Valve Implantation
Full text linkA permanent pacemaker is commonly required in patients undergoing transcatheter aortic valve implantation (TAVI) at ranges up to 30-50%. In general, the incidence is higher with the self- vs balloon-expandable valves. Several risk factors have been identified. Importantly, pacemaker implantation does not seem to improve prognosis and this needs to be further explored. Finally, new generation valves appear to increase the complication of AV block and need for permanent pacing. These issues are herein briefly reviewed
Adverse Cardiovascular Effects and Drug Interactions with Herbs
Full text linkThe herbs are plants or products of plants and despite their widespread promotion, their purity, efficacy and safety are often unknown. The healthcare professionals may be asked to give advice on the use of these products, in conjunction with other medications .Thus, they can potentially interact with the cardiovascular drugs with subsequent dramatic effects on the coagulation pathways and the platelets adhesion. The administration of the herbs in patients suffering from cardiovascular diseases should be done sparingly, with caution and with thorough knowledge of their possible interactions with the already prescribed drugs
Is left ventricular dysfunction reversed after complete alcohol abstinence in asymptomatic alcoholics? A tissue Doppler-derived strain and 2D strain imaging stress echocardiography study
No full textABSTRACTBACKGROUND: Long-term alcohol abuse exerts a deleterious effect on the myocardium, although clinical manifestations of alcoholic cardiomyopathy are not always present. In the present study we evaluate left ventricular (LV) dysfunction by means of tissue Doppler (TD) derived strain and 2D strain imaging stress echocardiography techniques in asymptomatic alcoholics and examine the reversibility ofLV dysfunction after complete abstinence from alcohol.METHODS AND RESULTS: In 13 chronic alcoholics (9 men, mean age 45±6 years) with mean alcohol consumption 207.7±98.3 g/day over 16.5±6.9 years, dobutamine stress echocardiography (DSE) was performed.LV deformation in 12 segments was assessed using TD velocity and strain and speckle tracking with 2D strain imaging, at baseline as well as at 5, 10, and 20 μg/kg/min stages of dobutamine infusion. The examinations were repeated one month after alcohol discontinuation. LV dimensions, wall thickness and ejection fraction were within normal limits. Grade I diastolic dysfunction was observed in 9 patients. During DSE peak TD systolic velocity was increased significantly in allLV myocardial segments, whereas TD strain and 2D strain did not change significantly in the majority of the myocardial segments. One month’s complete abstinence from alcohol did not lead to any noticeable improvement, since baseline and peak DSE, TD and 2D strain did not progress significantly.CONCLUSIONS: The lack of myocardial strain improvement during DSE may indicate early effects on the myocardium due to chronic alcohol abuse, before clinical manifestations are even present. No reversibility ofLV dysfunction was observed after complete abstinence from alcohol for one month.Â
Improved Cardiac Output with Right Ventricular Septal Pacing in a Patient with Right Bundle Branch Block and Left Ventricular Dysfunction
Full text linkAlternate site pacing improved the left ventricular outflow tract velocity time integral compared to native rhythm in a patient with ischemic cardiomyopathy and severe left ventricular dysfunction with underlying right bundle branch block