Fani Tsolaki

Ondasetron versus haloperidol for the treatment of postcardiotomy delirium: a prospective, randomized, double-blinded study

BackgroundTo investigate the controlling efficacy of ondasetron and haloperidol in regard to the postcardiotomy delirium.MethodsWe included in this prospective, randomized, double-blinded study 80 patients who developed delirium after heart surgery with the application of heart lung-machine. The patients were divided into two, equally-sized groups, which on detection of delirium received ondasetron 8 mg iv or haloperidol 5 mg iv respectively. The statistical analysis compared the baseline and demographic characteristics of the two groups (age, gender, comorbidities, years of education, type of surgery etc.).ResultsBoth ondasetron and haloperidol had very good delirium controlling effects, without statistically significant differences.Discussion-ConclusionsOndasetron and haloperidol are efficient agents as far as the treatment of postcardiotomy delirium is concerned. As, in addition, ondasetron bares milder side-effects, we believe this could be the agent of choice in patients developing postcardiotomy delirium in the future.

Iridoschisis: case report and review of the literature

Iridoschisis is a rare condition that consists of the separation of the anterior mesodermic layer of the iris. In more than two-thirds of cases it is associated with glaucoma. We report the case of an 80-year-old patient who had bilateral iridoschisis and presented with acute angle-closure glaucoma. The patient was free from a history of ocular trauma or of heritable ocular disease. Chronic open-angle glaucoma, as well as intermittent angle-closure glaucoma, should be excluded in all patients with iridoschisis, and regular follow-up should be established upon diagnosis of the entity.

Helicobacter pylori infection and primary open-angle glaucoma: is there a connection?

Glaucoma, the most common form of which is primary open-angle glaucoma (POAG), is a neurodegenerative disease which is the second most common cause of blindness worldwide. Among the factors that have been implicated in the pathophysiology of this disease is infection with Helicobacter pylori. This alleged association has caused a great deal of scientific discussion during the past decade, as the establishment of such a correlation might lead to therapeutic applications for all glaucoma patients. In this review, we assess all relevant major studies and trials in an effort to elucidate the issue.

Alzheimer's disease and primary open-angle glaucoma: is there a connection?

Aim: To present, through a thorough literature research, current and older scientific efforts to investigate the putative association between Alzheimer’s disease (AD) and glaucoma, especially primary open-angle glaucoma (POAG). Methods: We included in our review article epidemiological, experimental and clinical laboratory studies. Results: While many authors support the existence of a strong correlation between the AD and POAG, based on epidemiological, genetic and immunohistochemical data, others present contradictory results, leaving the issue unresolved. Conclusion: Further research, probably targeted towards genetic parameters and based on large, multicenter studies has yet to be conducted. It is the authors’ opinion however, that the existing data already justify the need for at least some degree of elevated clinical alertness for the occurrence of AD in patients with glaucoma and of glaucoma in patients with AD.

Classic and non-classic forms of mitral valve prolapse.

OBJECTIVE To investigate the significance of the established distinction between classic and non-classic forms of mitral valve prolapsed (MVP). METHODS We included in this prospective study all patients examined in our preventive cardiology outpatient clinics during the biannual period October 2004-October 2006. We examined in total 10.818 patients, 238 of whom (2.2%) were diagnosed for MVP. We noted relevant demographic and clinical data (gender, age of diagnosis, symptoms, need for hospitalization) and performed statistical comparisons between patients with the classic and those with the non-classic form. Follow-up controls were performed three years afterwards. RESULTS Patients with the classic form had an earlier age of first diagnosis, more prominent symptoms, and more frequently diagnosis for other disorders (atrial septal defect, ventricular septal defect, Marfan syndrome, Ehlers-Danlos syndrome) than the rest of the patients; however, there were no significant differences as far as certain major complications (stroke, death, submission to surgery) were concerned. CONCLUSION The classic form of mitral valve prolapse is more tightly associated with morbid complications, and a more frequent follow-up control in this group of patients may be useful.

Uthoff phenomenon - a rare manifestation of a rare disease.

An old legacy among experienced physicians has it: think first of the rarest manifestations of common diseases and then of the most common manifestations of rare diseases. Here we present an interesting case report in which clinical suspicion based on a rare manifestation of a rare disease led to a timely diagnosis and early treatment. A 16-year-old female patient presented to the emergency unit of the ophthalmology department complaining of a 2 month history of occasional bilateral blurring of vision in the form of black spots. The patient, whose personal and family history were otherwise unremarkable, correlated the symptoms with exercise and with exposure to hot baths. Fundoscopic examination was normal. The admitting doctor considered multiple sclerosis in the differential diagnosis, based on knowledge of the Uthoff phenomenon. This phenomenon, which consists of visual disturbances during or after the elevation of body temperature, is an early but rare symptom of multiple sclerosis. It reflects areas of impaired inflamed myelin that function inadequately regarding the transmission of electrical impulses, and so become sensitive to even subtle elevations of body temperature. The patient was referred to the neurology department, where the consulting physicians established a diagnosis of multiple sclerosis, based on magnetic resonance imaging (demyelinating spot; Fig. 1) and on cerebrospinal fluid findings. Specifically, the CSF protein was mildly elevated to 60 mg/dL (normal range 15–45 mg/dL), CSF glucose was normal (40 mg/ dL), normal CSF white blood cell level was 120/mL, with a prominently augmented concentration of mononucleocytes (25/mL). There were no other clinical or laboratory pathologies, with the exception of a minor left-sided pleural effusion visible on chest X-ray. The neurologists observed the patient without treatment, until a second Episode. When this occurred, they started the patient on interferon beta 1a at an initial dosage of 8.8 mg and then a dosage of 22 mg three times per week subcutaneously. After 2 months, she has had no further symptoms. The patient has been discharged remaining under ambulatory medical supervision. Three important conclusions can be drawn from this case report. Firstly, clinical physicians of related sub-specialties must keep this rare manifestation in mind, should they encounter such a case in their practice; secondly, the role of the ophthalmologist is one of major importance in the general emergency department, because of the profound correlation of ophthalmology to practically all sectors of clinical medicine. Last but not the least, our case report emphasises the need for close cooperation of physicians of various subspecialties for the benefit of their patients, especially the youngest and most impaired.

Poland's syndrome and recurrent pneumothorax: is there a connection?

Aim. To investigate the possible connection of Polands syndrome with the presence of lung bullae and, thus, with an increased risk for recurrent pneumothorax. Patients-methods. Two male patients, aged 19 and 21 years respectively were submitted to our department after their second incident of pneumothorax. Both had Polands syndrome (unilaterally hypoplastic chest wall with pectoralis major muscle atrophy) and both had multiple bullae to the ipsilateral lung based on CT findings. The patients were treated operatively (bullectomy, lung apicectomy, partial parietal pleurectomy and chemical pleurodesis) due to the recurrent state of their pneumothorax. Results. The patients had good results with total expansion of the affected lung. Conclusions. Polands syndrome can be combined with ipsilateral presence of lung bullae, a common cause of pneumothorax. Whether this finding is part or a variation of the syndrome needs to be confirmed by a larger number of similar cases.