Hospital Chronicles (E-Journal)
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PET imaging in breast cancer
Get PDFThe application of Positron Emission Tomography (PET) using 2-[F18] fluoro-2-deoxy- D-Glucose (FDG) and the more recently fused technique of Computerized Tomography and PET (PET/CT) in patients with breast cancer is reviewed. Their role in diagnosis of primary tumour, staging, chemotherapy monitoring and radiotherapy planning, follow-up and restaging is introduced. The advantages of combination of anatomical and functional images are emphasized and the comparison with other imaging techniques is highlighted
Non Alcoholic Fatty Liver Disease: Correlation With Clinical Hormonal and Biochemical Parameters
Get PDFBACKGROUND:? PATIENTS AND METHODS: Clinical, biochemical and histological features of 36 patients with NAFLD were analyzed. Insulin and leptin serum levels were measured and Body Mass Index (BMI) and insulin resistance (HOMA index) were calculated. The same parameters were analyzed in 10 healthy controls.RESULTS: Signs of chronic liver disease and histological findings of advanced fibrosis were detected in 2 patients (5,5%), while hepatomegaly was a frequent finding (21 patients, 58,3%).NASH was confirmed in 21 patients (58,3%).Statistically significant difference was found between patients and controls in BMI (32 vs 25, p=0,002), insulin levels (33,3 vs 9,5, p=0,015) and HOMA index (9,4 vs 2,3 p=0,006). In comparing NASH patients with fatty liver (FL) patients, we observed similar levels (31,1 vs 32) of BMI, while insulin levels were higher in NASH patients (42 vs 22 p=0,044), as well as HOMA (11 vs 7,5) and leptin levels (22 vs 16,6) although this differences did not reach a statistical significance.CONCLUSIONS: This study confirms the important role of obesity and insulin resistance in a group of greek NAFLD patients. A positive correlation is also found between severity of liver damage and degree of insulin resistance.Non alcoholic fatty liver disease (NAFLD) refers to a wide spectrum of liver damage, ranging from simple steatosis to steatohepatitis (NASH) and cirrhosis.The aim of this study was to describe the variance of clinical and laboratory parameters that could play a role in the development of NASH in a group of patients with NAFLD
Contact and Non-Contact Electroanatomic Mapping in Electrophysiology
Get PDFThis brief review focuses on the two available electro-anatomical mapping systems, currently employed for guiding catheter ablation of diverse cardiac arrhythmias, representing two distinct non-fluoroscopic, contact and non-contact, approaches which offer 3D re-conctruction of electroanatomic maps by tracking intracardiac catheters. Mapping systems are now being merged with images from computed tomography or magnetic resonance imaging to produce an accurate anatomic and electrical map of the heart to guide catheter ablation procedures
The Relation of Migraine Headaches and Interatrial Shunts
Get PDFForamen ovale plays a very important role in fetal circulation by bypassing the lungs and diverting circulation from the right to the left heart. With birth it is usually sealed; however, probe patent or incompletely sealed foramen ovale remains in approximately 25% of adults. Patent foramen ovale (PFO) acquires significance in various congenital heart diseases or other particular settings leading to a right to left shunt, and thus to paradoxical embolism. PFO has been associated with transient ischemic attacks or cryptogenic strokes and also a host of other problems, including migraine. The recognition of an association between migraine syndrome with aura and PFO appears to have come ???full circle??? over the past two decades. Epidemiologic studies have suggested a notably increased PFO prevalence in persons suffering from migraine.The prevalence of migraine headache is higher in cryptogenic stroke patients with PFO than in the general population. Studies have suggested that closure of the PFO may reduce migrainous symptoms. The relation between this association and the recognition of migraine as a risk factor for ischemic stroke in the young is unclear, though right to left passage of circulating factors has been postulated in both syndromes. Despite case series and uncontrolled studies documenting beneficial effects of PFO closure in patients with migraine, particularly those also afflicted by cryptogenic stroke, the recommendation for PFO closure in patients with migraine alone will need to await the results of ongoing randomized trials
Reducing Barriers for Implementation of Immediate CPR with Chest Compressions Alone
Get PDFIt is well known that out-of-hospital sudden cardiac death is a leading public health problem. In the absence of early defibrillation, survival rates of patients with outof- hospital cardiac arrest are dismal and have remained essentially unchanged. The guidelines advocate the same approach for 2 entirely different pathophysiological conditions: respiratory arrest in which severe arterial hypoxia and hypotension eventually lead to secondary cardiac arrest, and primary cardiac arrest in which the arterial blood is fully saturated with oxygen at the time of the arrest. Cardiopulmonary resuscitation (CPR) is traditionally defined as chest compressions plus ventilations. The need for chest compressions is unquestionable, but the need for mouth-to-mouth ventilations for cardiac arrest has been questioned. Recent observational studies underline the paramount role of chest compressions in an alternative way of CPR, compression only CPR. Public education and training in compression only CPR is much simpler. Compression only CPR may significantly increase bystander-initiated resuscitation efforts and thereby give patients a better chance of survival, given the reluctance of lay people to provide mouth to mouth rescue breaths.In view of the above, the principal question is, what barriers are delaying the guidelines from recommending compression only CPR? Perhaps the major problem is the difficulty to change the paradigm. For decades, the ???ABCs?? (airway, breathing, and circulation) have been advocated for bystander basic life support, making it extremely difficult to transform the so ingrained in the popular understanding ???ABC?? to ???AC?
Coronary Care Unit (CCU) Psychosis Syndrome
Get PDFIntensive Care Unit (ICU) syndrome or psychosis is frequently encountered among ICU patients constituting a significant barrier in the communication between them and their health care providers and posing a risk to their entire treatment plan. It has been reported that the effort required from the nursing staff to deal with patients having this problem is overwhelming more mentally than physically. We are herein briefly describing some aspects of this issue so that we can make it more easily recognizable by the ICU personnel since an early intervention before it reaches its peak is mostly beneficial for our critically ill patients. We use the term organic psychosyndrome reported in the classification of mental illnesses and disease DSM-IV. Of note, the same clinical entity is found in the literature under various terms, such as delirium, syndrome of units, acute situation, and delirium owed to medical general situation
Is Detection of Hibernation Critical in Deciding Surgical Revascularization in Patients with Very Low Ejection Fraction?
Get PDFMyocardial hibernation is a condition of chronic ventricular dysfunction, regional and/or global, due to myocardial ischemia usually due to ischemic heart disease. The term ???hibernation?? referring to this condition was first coined by Diamond et al. in 1978? but was not widely recognized until Rahimtoola documented the importance of this condition, particularly in relation to potential improvement of ventricular function following myocardial reperfusion therap
Transradial Percutaneous Coronary Intervention in Acute Coronary Syndromes: a Case Report and Review of the Literature
Get PDFThe radial approach to perform coronary angiography and percutaneous coronary interventions (PCI) is currently supported by voluminous literature and has been repetitively shown to minimize access site related complications, reduce hospitalization time and costs and increase patient comfort compared to the femoral approach. Most importantly, in acute coronary syndromes the radial access has the potential to significantly decrease serious bleeding complications, which are related to increased morbidity and mortality rates. Despite gradually gaining popularity the radial approach is still used in only a small fraction of the total number of coronary procedures. We present herein the case of a woman suffering from acute inferior myocardial infarction referred to our hospital for emergency catheterization after failed fibrinolysis and treated successfully with transradial rescue PCI. The case presentation is followed by a concise overview of data supporting the wider use of the radial approach, especially focusing on acute coronary syndromes
Rosacea-Like Demodicosis Induced by Topical Pimecrolimus: Immunohistochemical Evaluation of Inflammatory Infiltrate
Get PDFWe present a 48-year-old female patient who developed rosacea-like demodicosis after seven days of? topical application of? 1% pimecrolimus cream. The inflammatory infiltrate in the lesions was mainly composed of T-cells with a CD4+/CD8+ ratio = 0.33; B-cells (CD20+) and NK-cells (CD56+) were not detected. Large numbers of (CD68+) histiocytes were demonstrated, whereas the number of Langerhans cells (CD1a+) revealed no significant alteration. The reduced CD4+:CD8+ ratio may have led to a modification of follicular microenvironment favouring the excessive proliferation of Demodex mites, who triggered a presently unknown sequence of events leading to the development of pimecrolimus-induced rosacea-like demodicosis. ? ?