Revascularization treatment in patients with coronary artery disease

G. S. Foussas, Z. G. Tsiaousis

Abstract

The choice of optimal revascularization strategy in patients with coronary artery disease (CAD) is becoming more challenging lately, due to recent advances in percutaneous coronary intervention (PCI) and coronary artery bypass grafting surgery (CABG). On one hand, drug-eluting stents (DES) have emerged as a solution to the problem of restenosis after balloon angioplasty or bare-metal stent implantation, which was responsible for a higher rate of events (mainly repeat revascularization) in relation to CABG. On the other hand, off-pump bypass techniques and minimally invasive grafting of the left anterior descending artery appear to be safe and efficacious alternatives to traditional, on-pump CABG. Available literature includes studies outdated by current technologies, leaving the dilemma of best revascularization strategy unanswered in the general CAD population, but also in high-risk groups, such as diabetics and patients with chronic kidney disease. A number of ongoing trials, especially designed for this purpose, are set to end the debate, providing headto- head comparisons between DES-assisted PCI and contemporary bypass surgery.

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Isolated double gastric rupture caused by blunt abdominal trauma in an eighteen months old child: A case report

S. Roupakias, G. Tsikopoulos, C. Stefanidis, K. Skoumis, I. Zioutis

Abstract

We report a case of an isolated double gastric rupture, resulted from blunt abdominal trauma, that we successfully repaired by primary closure. A 18-month-old girl injured in a motorvehicle accident was admitted to our hospital where the plain X-ray and the CT findings revealed the presence of free abdominal air. An immediate performed exploratory laparotomy disclosed two full-thickness ruptures of the stomach (on the greater curvature and the posterior wall). The ruptures were closed primarily by a two-layer closure. Twenty-four hours post-operatively the patient developed delayed shock as a result of chemical peritonitis. On the 8th postoperative day the girl developed septic shock and gastrorrhagia. She underwent a gastroscopy which revealed stress ulcer, and was treated conservatively in the children intesive care unit of our hospital. She was discharged home on 20th postoperative day. At 3-month follow up, she was doing well with normal growth and eating a regular regimen about her age. Gastric rupture following blunt abdominal trauma is rare, with a reported incidence of 0.02 - 1.7%. The morbidity and mortality are directly related to the number of associated injuries, the delay in diagnosis and the development of intraabdominal sepsis. In this paper we emphasise the need for early diagnosis and the aggressive surgical treatment as a key to decreasing the mortality and morbidity from this relatively rare injury, especially in this age group of children.

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Cardio-renal anemia syndrome

G Efstratiadis, D. Konstantinou, I. Chytas, G. Vergoulas

Abstract

The interaction between cronic heart failure, cronic kidney insufficiency and anemia, form a vicious cycle, termed as the cardio-renal anemia syndrome. The interaction between these three conditions causes deterioration of the cardiac and renal function and increases anemia. Each of the three can cause or be caused by the others. We herein analyze and speculate the mechanisms involved in the pathophysiology of this new syndrome highlighting the main points of interest that seem to expand upon more than one specialty. The cardio-renal anemia syndrome is emerging in the area of clinical investigation with progressively elevated significance.Additionaly we report the data related to anemia treatment as part of therapeutic perspective concerning the management of patients manifesting the profile of this syndrome


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Prevention of malignant melanoma

G. Chaidemenos, A. Stratigos, M. Papakonstantinou, F. Tsatsou

Abstract

those of Secondary prevention which aims at an early diagnosis of malignant melanoma. Australia was the country with the best results obtained in both Prevention strategies, especially in avoiding intense, though intermittent, UV exposure.The success of these programs encouraged health authorities to initiate their application to other disorders. New sunscreens containing substances correcting the UV-damaged DNA may offer a promising result in the decades to come.However, so far no one epidemiological study has proved the prevention of malignant melanoma with the use of sun protecting agents. A meta-analysis verified the connection between melanoma and solarium use. The protective role of vitamin D in the development of prostate, breast and colon cancer was shown in a meta-analysis. The authors, however,suggest that fair-skinned persons should take oral supplementation of vitamin D, instead of exposing themselves to the sun. The Hellenic Society of Dermatology and Venereology published the results of 5-year-prevention programs in Greece. Their favorable results in the early diagnosis of melanoma justify an intense continuation of these efforts.

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Management of hyperglycemia in patients with diabetes mellitus and chronic renal failure

Ch. Sampanis

Abstract

Diabetes mellitus is recognized as a leading cause of chronic kidney disease and end-stage renal failure. Chronic renal failure is associated with insulin resistance and, in advanced renal failure, decreased insulin degradation. Both of these abnormalities are partially reversed with the institution of dialysis. Except for diet with protein restriction, patients with diabetes should be preferably treated with insulin. The management of the patients with hyperglycemia and chronic renal failure calls for close collaboration between the diabetologist and the nephrologists. This collaboration is very important so that the patient will not be confused and will not lose confidence to the doctors. Furthermore good glycemic control in these patients seems to reduce microvascular and macrovascular complications.

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A prospective two years study of first trimester screening for Down Syndrome

V. Zournatzi, A. Daniilidis, C. Karidas, T. Tantanasis, A. Loufopoulos, J Tzafettas

Abstract

Introduction: Nowadays maternal age of pregnant women has increased in most developed countries. The rate of women above 35 years old constitutes about 15% of pregnancies. Aim: The aim of our study is to prove that by first trimester screening, the number of women who have indication for invasive prenatal diagnostic procedure is significantly reduced. Materials and methods: This prospective study lasted two years from 02/2005 to 02/2007. The participants to our study were 531 pregnant women with a mean maternal age of 30 years (19-42). We used the first trimester screening test for Down's syndrome. The biochemical blood test of free b-hCG (beta human chorionic gonadotropin) and PAPP-A (pregnancy associated plasma protein A) and the measurement of nuchal translucency were performed between 11-13 weeks+6 days (mean gestational age 12 weeks +2days).Results: In our study group, 69 women (12%) were 35 years old or more. The risk estimate for Down syndrome was 1 in 300 or more in 14 (2%) cases. In all these 14 cases we offered CVS (chorionic villus sampling) or amniocentesis.Conclusion: It is a fact that although the risk of any individual 36 years old is higher, most abnormalities (approximately 70%) occur in the low risk population. With the first trimester screening the sensitivity of detecting DOWN syndrome reaches 90%.Our study confirms that by first trimester screening, the number of women who have indication for invasive prenatal diagnostic procedure is significantly reduced. As a result the cost for prenatal diagnosis of the population and also the risk of iatrogenic missed miscarriages is also reduced. Finally, this screening method gives the advantage of early diagnosis.

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Injection injuries: seemingly minor injuries with major consequences

Z. H. Dailiana, D. Kotsaki, S Varitimidis, S. Moka, M. Bakarozi, K. Oikonomou, K. N. Malizos

Abstract

Background: High-pressure injection injuries are rare injuries, characterized by a small puncture wound that is often underestimated by physicians and patients. The injected substance leads to extensive tissue damage and sometimes to loss of the limb. Aim: To underline the severity of these injuries and to alert physicians to recognize them and treat them appropriately.Methods: Eight patients with injection injuries from lubricants (6) or solvents (2) were treated in a University Orthopaedic Department in a 5-year period. In all patients the mild initial symptoms were aggravated over the next 4-6 hours leading to a severe compartment syndrome of the hand. Five patients were referred with a mean delay of 3.8 days and 3 were treated immediately; all with debridement and compartment release.Results: The total number of procedures per patient was 2 to 5. In 3 patients a heterodigital flap was necessary whereas in one the second ray was amputated. Results were excellent in 5 cases and good in 3.Conclusions: In injection injuries, prompt diagnosis and immediate aggressive surgical intervention are necessary to save the patients digit/limb. Patients should be informed about the severity of their injury, its potential complications and the multiple surgical procedures that may be required for a satisfactory functional result.


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CT guided percutaneous adrenal biopsy for lesions with equivocal findings in chemical shift MR imaging

I. Tsitouridis, M. Michaelides, S. Stratilati, D. Sidiropoulos, A. Bintoudi, G. Rodokalakis

Abstract

Purpose: The aim of this study was to evaluate the usefulness of CT guided adrenal biopsy in patients with equivocal MR chemical shift imaging findings.Material and Methods: Fifty seven patients, 32 with history of malignancy and 25 without history of malignancy, 30 men and 27 women (33-82 years, mean age:58.8 years), with equivocal findings in chemical shift MR imaging, were subjected to CT guided percutaneous adrenal biopsy. Results: From the 57 lesions that were sent for histopathological evaluation, 31 proved to be metastases (54.4%), 20 adenomas (35.1%), 3 cortical carcinomas (5.3%), 1 benign pheochromocytoma (1.8%) and 2 samples were non diagnostic(3.5%). In oncology patients metastases were found in 28/32 of the patients (87.5%) and adenomas in 3/32 (9.4%), while in patients without history of malignancy, metastases were found in 3/25 of the patients (12%) and adenomas in 17/25 (68%). Conclusion: CT guided percutaneous adrenal biopsy is a safe and accurate method for a definite diagnosis of adrenal lesions.Since most adrenal lesions are benign, dedicated adrenal imaging is necessary for choosing which of them have to be further evaluated by biopsy. Chemical shift adrenal imaging alone seems to be a reliable method and can be used alternatively to CT enhancement washout technique for selecting which lesions are suspicious of malignancy and have to be investigated with biopsy, especially in cases where iodine contrast media is contraindicated.

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Q Fever myocarditis

I. Vogiatzis, G. Dimoglou, V. Sachpekidis

Abstract

Clinical manifestations of Q fever infection are fever, productive cough, decrease in exercise tolerance and chills. Cardiovascular involvement is well recognized and usually presents as endocarditis and infection of an aneurysm or vascular graft. Myocarditis has only rarely been described as a manifestation of acute Q fever infection. In this report we describe a case of a young adult who presented with angina-like symptoms and ECG and biochemical markers indicative of acute coronary syndrome. The diagnosis of myocarditis was ultimately made based on the results of a normal coronary angiography and increased anti-Coxiella burnetii antibody titer. The patient has not developed dilated cardiomyopathy after two years of follow up.

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Pulmonary Zygomycosis caused by Cunninghamella bertholletiae in a child with acute lymphoblastic leukemia

E. Bibashi, V. Sidi, M. Kotsiou, E. Makrigiannaki, D. Koliouskas

Abstract

Zygomycosis is an invasive mycotic disease caused by fungi of the class Zygomycetes. Infections caused by zygomycetes, are known for their difficulty of diagnosis and treatment. Cunninghamella bertholletiae (Cb), is a saprobic fungus commonly found in the soil of temperate climates. Pulmonary infections caused by Cb are being identified with increasing frequency among patients on immunosuppressive therapy, and these infections usually have a fatal outcome. We present a rare case of pulmonary zygomycosis caused by Cb in a 10 year old male child with acute lymphoblastic leukemia. In spite of intensive antifungal chemotherapy (iv liposomal amphotericin B 7 mg/Kg once daily) following clinical diagnosis, he died of pulmonary failure.

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Intracranial arachnoid cyst associated with traumatic intracystic hemorrhage and subdural haematoma

P. P. Tsitsopoulos, C. G. Pantazis, C. E. Syrmou, D. P. Tsitsopoulos

Abstract

Background: Brain arachnoid cysts are fluid collections of developmental origin. They are commonly detected incidentally in patients imaged for unrelated symptoms. Case Description: A 15-year-old healthy boy with a recent history of head trauma experienced headache that gradually worsened over the course of 10 days. He underwent CT and MRI brain scans which revealed the presence of subdural haematoma caused by the rupture of a middle cranial fossa arachnoid cyst. This was accompanied by intracystic haemorrhage.The subdural haematoma was removed, while communication of the cyst with the basal cisterns was also performed. The postoperative course of the patient was uneventful. Conclusions: The annual haemorrhage risk for the patients with middle cranial fossa cysts remains very low. However, when haemorrhage occurs, in most occasions it can be effectively managed only with haematoma evacuation.

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Küttner’s tumour: an unusual cause of salivary gland enlargement

E. Kiverniti, A. Singh, P. Clarke

Abstract

Enlargement of the submandibular gland is a condition that raises the alarm for further investigation as the risk of an underlying malignancy is higher in comparison to parotid gland enlargement. Chronic sclerosing sialadenitis or Kuttner's tumour is usually mis-recognised as it is only after excision of the gland that the correct diagnosis is made. We present a case of a 47-year-old male patient who presented with one year history of firm non-tender enlarged right submandibular gland which was removed surgically and histology showed to be sclerosing sialadenitis. Küttner’s tumour is a rare disease, which mimics malignancy. There is not enough evidence to support any diagnostic means that could help in the differential diagnosis of this benign condition. Given the high rate of malignancy in firm, painless lesions of the submandibular gland, surgical excision is often advocated and Kuttner's tumour is usually diagnosed by the histopathologist.

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Testing the effect of specific socioeconomic factors on the ischemic mortality rate. The case of Greece

M. A. Mouza

Abstract

In this paper we present a model to evaluate the effect of certain majors socioeconomic factors (such as alcohol and fat consumption, cigarettes smoking, unemployment rate as a proxy for uncertainty which results frustration, number of passenger cars as a proxy for physical exercise and per capita GDP as a proxy for nutrition quality), to the ischemic mortality rate. Since the existing research works on this field, suffer from the proper model testing, we analytically present all the tests necessary to justify the reliability of the result obtained. For this purpose, after specifying and estimating the model, we applied the specification error test, the linearity, multicollinearity and heteroscedasticity tests, the autocorrelation and stability tests and the ARCH effect test. Finally, we present the aggregate efect of the above socioeconomic factors. In brief, we found that an increase of cigarettes smoked, of fat and alcohol consumption and the number of passenger cars will result to a relevant increase regarding mortality. The latter one is also affected by the changes in unemployment rate. On the other hand, an increase of personal disposable income may negatively affect mortality, by almost the same portion.

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