Hospital Chronicles (E-Journal)
Not a member yet
657 research outputs found
Sort by
Insights into Catheter Ablation of Ventricular Tachycardias in Arrhythmogenic Right Ventricular Cardiomyopathy / Dysplasia
Full text linkArrhythmogenic right ventricular cardiomyopathy/ dysplasia (ARVC/D), mostly affecting young/middle-aged individuals, poses a significant risk of malignant ventricular arrhythmias (VAs) and subsequent sudden cardiac death (SCD). Antiarrhythmic agents (AAA) provide insufficient arrhythmia suppression and prevention and can be proarrhythmic. Thus, the implantable cardioverters-defibrillator (ICD) is considered the first-line treatment, especially in patients with secondary prevention indication. Nevertheless, catheter ablation is an additional therapy to the ICD which has proved its efficacy in primary and secondary prevention of fatal arrhythmias and sudden cardiac death. The superiority of the combined endo- and epicardial VT ablation in this population is clear since the ARVC/D substrate has been shown to be mostly epicardial. Due to progressive nature of ARVC/D, ablation seems to be a useful tool for the patients who experience recurrent VT episodes or electrical storms
Pulmonary Hypertension Due to Chronic Thromboembolic Disease Complicated with Hemoptysis and Infection
Full text linkA 45 year old woman developed exertional dyspnea after surgical removal of uterine fibroids. Heart ultrasound suggested the presence of right heart enlargement and stress due to pulmonary arterial hypertension, whereas the subsequent CT angiography revealed pulmonary embolism. Anticoagulants were initiated. Perfusion defects were noticeable in lung perfusion scan 6 months after the initiation of anticoagulant therapy, while CT angiography was negative for pulmonary embolism. The diagnosis of chronic thromboembolic pulmonary hypertension was initially set and subsequently confirmed by right heart catheterization. Deterioration of dyspnea and right heart dysfunction led to administration of intravenous epoprostenol through a tunneled central venous catheter. After 6 months the patient was admitted to the intensive care unit with fever, hemoptysis, lung infiltrates, and acute-on-chronic hypoxemic respiratory failure. Bronchial artery embolization, oxygen therapy, and antibiotics led to clinical improvement
Cardiology News / Recent Literature Review / Second Quarter 2015
Full text linkESC Congress: London, 29/8-2/9/2015TCT Meeting 2015: San Francisco, 11-15/10/2015HCS Congress: Thessaloniki, 29-31/10/2015AHA Scientific Sessions: Orlando, 7-11/11/2015DAPT Study: Continuation of Dual Antiplatelet Therapy After PCI in Patients With and Without Acute Myocardial Infarction Beyond 1 Year Reduced Ischemic Events, but Increased Bleeding Compared With Treatment With Aspirin Alone Among 11,648 randomized patients (9,961 treated with drug-eluting stents, 1,687 with bare-metal stents), 30.7% presenting with MI, between 12 and 30 months, continued thienopyridine reduced stent thrombosis compared with placebo in patients with and without MI at presentation (MI group, 0.5% vs 1.9%, p< 0.001; no MI group, 0.4% vs. 1.1%, p< 0.001). The reduction in major adverse cardiovascular and cerebrovascular events (MACCE) for continued thienopyridine was greater for patients with MI (3.9% vs 6.8%; p< 0.001 for MI; 4.4% vs 5.3%; p= 0.08 for no MI). In both groups, continued thienopyridine reduced MI (2.2% vs 5.2%, p< 0.001 for MI; 2.1% vs 3.5%, p< 0.001 for no MI) but increased bleeding (1.9% vs 0.8%, p= 0.005 for MI; 2.6% vs 1.7%, p= 0.007 for no MI). The authors concluded that extended dual antiplatelet therapy reduced the risk of stent thrombosis and MI in patients with and without MI, but increased bleeding (Yeh RW et al, J Am Coll Cardiol 2015;65:2211-2221).Metaanalysis: Dual Antiplatelet Therapy (DAPT) is Associated With Protection Against Stent Thrombosis but Increases Risk of Bleeding in Patients With Drug Eluting Stents (DES) / Benefit of Extended DAPT for Patients With First-Generation DES, but not for Second-Generation DES Metaanalysis of 10 randomized controlled trials (N = 32,135) indicated that compared to longer duration DAPT (L-DAPT; mean exposure time 20.3 months for second-generation DES and 28 months for first-generation DES), shorter duration DAPT (S-DAPT; mean exposure time 7.8 months for second-generation DES and 10.9 months for first-generation DES) had an overall higher rate of stent thrombosis (odds ratio - OR: 1.71; p = 0.001). The effect of S-DAPT on stent thrombosis was attenuated with the use of second-generation DES (OR: 1.54) compared with first-generation DES (OR: 3.94; p for interaction = 0.008). S-DAPT had an overall significantly lower risk of bleeding (OR: 0.63; p < 0.001). Finally, a numerically lower all-cause mortality rate was observed with S-DAPT (OR: 0.87; p = 0.073). The authors concluded that S-DAPT had overall lower rates of bleeding yet higher rates of stent thrombosis compared with L-DAPT; the latter effect was significantly attenuated with the use of second-generation DES. All-cause mortality was higher (not statistically) with L-DAPT (Giustino G et al, J Am Coll Cardiol 2015;65:1298-1310)... (excerpt
Computed Tomography Coronary Angiography: is There Any Progress?
Full text linkSignificant improvements in technical capabilities of multislice computed tomography (MSCT) scanners over the recent years have resulted in better temporal and spatial resolution of computed tomography coronary angiography (CTCA) and a decrease of the acquisition time and reduction of the radiation dose. CTCA has been validated as having an excellent negative predictive value for ruling-out coronary artery disease (CAD) in populations with low-to-intermediate pretest probability and a high accuracy for detecting CAD in patients with atypical chest pain. It can, also, aid in decision-making for the clinical management of patients found to have significant coronary artery stenoses and in the follow-up these patients. The recent improvements of this technology are herein briefly overviewed
Recommended Vaccination in Solid Organ Transplantation
Full text linkPatients with end stage organ disease, such as end stage renal and liver disease have reduced immune responses to many vaccines. Vaccination should be performed as early as possible during the natural course of these diseases. Verifying immunization status and updating vaccinations are important steps in the evaluation of patients who are solid organ transplant candidates on the waiting list, because the potential benefits of vaccination outweigh the risk of the vaccine related adverse events. Current information on vaccination for adult solid organ transplant candidates is herein reviewed
Atrial Fibrillation and Cognitive Impairment
Full text linkGrowing evidence suggests that atrial fibrillation (AF), in addition to known thromboembolic risk, is a risk factor for significant cognitive impairment via several pathways, further contributing to morbidity and mortality. Whether anticoagulation, rhythm control strategies and other interventions aiming at preventing thromboembolic events and ameliorating the clinical outcome of AF patients, may also have a beneficial effect on long-term cognitive function remains to be seen in future studies
Referral Center for Primary Immune Deficiencies in Adults: Its Stepwise Development at the Department of Immunology- Histocompatibility, Evagelismos General Hospital
Full text linkThe Department of Immunology-Histocompatibility of “Evagelismos†Hospital since its beginning in 1978 showed an interest for the study of patients with primary immunodeficiencies. The cases referred and diagnosed in the Department were mainly adult patients with primary antibody deficiencies. As the number of these cases increased, the development of a Referral Center was begun. In 1999 The Central Health Council of Greece approved the establishment of a “Specialized Center for adult cases with primary immunodeficiencies†as part of the Department of Immunology-Histocompatibility. However, it was only in 2007 that the Center was officially recognized by the Ministry of Health. The services provided by the Center included among others complete laboratory investigation for the diagnosis and classification of primary immunodeficiency, an outpatient clinic, collaboration with other departments of the hospital for the replacement therapy of patients with intravenous infusions of immunoglobulin and their hospitalization for various complications of their disease. During 42 years of follow up, 208 cases with primary antibody deficiency were diagnosed which included 92 cases with common variable immunodeficiency, 78 with selective IgA-deficiency, 24 with IgG subclass deficiency, and 14 with IgA and IgG subclass deficiency. The building of a Registry of these patients according to the procedures outlined by the European Society for Immunodeficiencies had been started but it has not yet been completed. For its optimal function, this Center should be supported by the State in order to have the necessary specialized staff for the management of patients and a better organization for their hospitalization according to their needs
Is it Time to Curtail Triple Antithrombotic Therapy by Omitting Aspirin?
No full textAntithrombotic therapy is a continuously evolving field. However, as the number of available oral antiplatelet and anticoagulant agents continues to grow, so does the uncertainty regarding optimal combination therapy, as clinicians are increasingly faced with coadministration of therapies whose combined effects have not been fully evaluated. Perhaps, the most common and difficult of these scenarios is the use of dual antiplatelet therapy in patients who require chronic oral anticoagulation. Although each of these treatments has clear benefits, there is concern about bleeding risk when they are used together, in the so called “triple therapyâ€. The obvious conflict raised by the prospect of triple therapy, is a more complete ischemic/ thromboembolic protection in the face of significantly increased bleeding risk and perhaps bleeding-related mortality. Accumulating data provide evidence to curtail triple therapy by omitting aspirin, when oral anticoagulation is needed for atrial fibrillation, while dual therapy with oral anticoagulation plus clopidogrel seems a safer and perhaps equally effective strategy compared with triple therapy
Brain Natriuretic Peptide: Structure, Action and Role in the Diagnosis and Prognosis of Heart Failure
Full text linkBrain natriuretic peptide (BNP) is a peptide hormone secreted by cardiomyocytes in response to atrial or ventricular wall stretch. It promotes a number of systemic effects, including vasodilatation, increase in urinary output and sodium excretion as well as inhibition of the sympathetic nervous system and the renin–angiotensin–aldosterone system. Plasma BNP levels have been reported to be elevated in patients with left ventricular hypertrophy, congestive heart failure, acute coronary syndromes, atrial fibrillation and impaired renal function. Moreover, elevated BNP levels have been shown to be a strong predictor of morbidity and mortality in patients with heart failure. Interestingly, it has also been found that the N-terminal peptide of BNP is slightly superior to BNP for predicting death or re-hospitalization for heart failure. Presumably, it is the longer half-life of NT-pro-BNP that may promote it as a more accurate index of ventricular stress and therefore a better predictor of prognosis
The Accuracy of Computed Tomography in the Pretreatment T and N Staging of Colorectal Cancer
Full text linkColorectal cancer is one of the most frequent cancers around the world. Multimodality therapies are used for colorectal cancer including surgery, chemotherapy, radiotherapy and targeted therapy. Correct treatment plan depends greatly on the accurate pretreatment staging. Computed tomography (CT) is a widely used detection and staging modality for colorectal cancer patients in clinical practice. The role of CT in assessing the patients with colorectal cancer has been well established, but the accuracy of evaluating and staging colorectal cancer by CT varies in different reports. With the development of CT techniques, some reformations such as multi-detector CT, CT with water enema or air insufflations, multiple planner reconstruction help to give us higher resolution images in shorter time. CT is playing an increasingly important role in pretreatment staging of colorectal cancer, though magnetic resonance imaging and endorectal ultrasound may provide more precise images and evaluation of local T and N staging of rectal cancer. Finally, positron emission tomography (PET) or PET/CT have not shown significant improvement over CT after completion of standard pretreatment evaluation