George Ilonidis

Arrhythmogenesis in patients with stable chronic obstructive pulmonary disease.

Objective Fatal arrhythmias are a common cause of death in chronic obstructive pulmonary disease (COPD). Two major hypotheses for arrhythmogenesis in COPD have been proposed: arrhythmias are a consequence of hypoxaemia, hypercapnia or (tissue localised) acid–base disturbances, or arrhythmias are the result of the autonomic neuropathy that characterises COPD. Our objective was to verify these two hypotheses. Methods A total of 29 consecutive COPD patients (seven men and 22 women, mean age 63.75 ± 10.50 years) were included in the study. Pulmonary function tests were performed and arterial blood gases were obtained simultaneously. Twelve-lead electrocardiograms were recorded from all patients. QT dispersion, which is a measure of myocardial repolarisation heterogeneity, and the coefficient of variation of the RR interval, which is a measure of heart rate variability, were calculated. Results Of the parameters measured, only the coefficient of variation of the RR interval appeared to be related to arrhythmias, since it correlated positively with arterial oxygen pressure (r = 0.418, statistical significance set at P < 0.05). Conclusions Our results rule out the electropathy hypothesis and underline the role of autonomic neuropathy as the most probable arrhythmogenic mechanism in hypoxaemic COPD patients. Our interpretation is based on the fact that hypoxaemia decreases heart rate variability and on the strong association between the reduction in heart rate variability and arrhythmogenesis.

A training network for introducing telemedicine, telecare and hospital informatics in the Adriatic-Danube-Black Sea region

DIMNET is a training mechanism for a region of central Europe. The aim is to upgrade the information technology skills of local hospital personnel and preserve their employability following the introduction of medical informatics. DIMNET uses Internet-based virtual classrooms to provide a 200-hour training course in medical informatics. Training takes place in the cities of Drama, Kavala, Xanthi and Varna. So far, more than 600 people have benefited from the programme. Initial results are encouraging. DIMNET promotes a new vocational training culture in the Balkans and is supported by local governments that perceive health-care as a fulcrum for economic development.

A simple telemedicine system to provide second-opinion advice to the patients of an Albanian diagnostic centre

Since August 2003, the IKEDA Klinika diagnostic centre in Tirana, Albania, has offered patients telemedical help from Greece. The teleconsultation service is based on Internet technologies adapted to telemedical use, including the use of forms (e.g. for the patient history), multimedia file exchanges (e.g. for radiographs and electroencephalograms) and videoconferencing. The teleconsultants assist in treatment planning and, when necessary, in organizing the transfer of patients to Greece. The four cornerstones of the service are: the provision of second opinions by telemedicine; assistance in treatment planning; assistance to patients during transfer; and the continuity of medical care on their repatriation. Based on the first six months of operation, we estimate that, if bureaucratic visa restrictions to patient movement between Albania and Greece are removed, more than 2000 patients per year will benefit from the service and more than 400 patients will be transferred to Greek hospitals for treatment.

Evaluation of Treatment with Bosentan in Patients with Carcinoid Heart Disease: Single Center Study

Background: The primary aim of this study was to evaluate a combined therapeutic intervention, including the dual endothelin receptor antagonist bosentan, in patients with carcinoid heart disease (CaHD). The efficacy of the treatment protocol was investigated using serological, echocardiographic, and clinical markers. Patients and Methods: Since 2003, 40 patients with neuroendocrine tumours were identified; 14 had echocardiographic findings consistent with CaHD. Six of the 14 patients with CaHD and a New York Heart Association (NYHA) functional class ≥ III received bosentan and were eligible for inclusion in this study. Results: N-terminal pro-brain natriuretic peptide (NT-pro-BNP) had decreased 6 months after treatment with bosentan (median: 646 pg/ml vs. 400.5 pg/ml; p = 0.02); the right ventricular systolic pressure had decreased after 3 and 6 months (median: 69 mmHg vs. 61 mmHg, p = 0.02; median: 69 mmHg vs. 48.5 mmHg, p = 0.02); the 6-minute walk distance (6MWD) had significantly improved after 3 and 6 months of treatment (median: 293.5 vs. 406.5 m; p = 0.02; median: 293.5 vs. 578.5 m; p = 0.02). The NYHA functional class improved in 5/6 patients receiving bosentan. Conclusions: Combined treatment with bosentan is effective in patients with CaHD, based on functional class, 6MWD, and NT-pro-BNP. Further clarification of the CaHD fibrosis pathogenesis is needed to facilitate development of targeted antifibrotic therapeutic agents.

Pro-Brain Natriuretic Peptide is a Sensitive Marker for Detecting Cardiac Metastases in Patients with Non-Small Cell Lung Cancer

Background: B-type natriuretic peptide (BNP) and N-terminal-pro-BNP (NT-pro-BNP) are important diagnostic tools for patients with suspected cardiac disorders. The aim of this study was to evaluate the predictive value of plasma NT-pro-BNP in identifying cardiac metastases in patients with non-small cell lung cancer (NSCLC) and dyspnoea. Patients and Methods: A total of 120 patients, median age 62 years (range 46–83), with NSCLC and dyspnoea were studied. Patients with heart failure or documented coronary artery disease were excluded. Echocardiographic imaging was used to detect cardiac metastases and estimate global left ventricular function. Ejection fraction and E/A ratio from transmitral inflow pattern were calculated. Plasma NT-pro-BNP was also measured. 72 patients (72/120, 60%) with cardiac metastases were identified. Results: NT-pro-BNP was significantly higher in patients with metastases (1347.5 ± 1004.30 pg/ml vs. 159.02 ± 93.29 pg/ml; p = 0.001). No differences between groups, regarding s-creatinine (p = 0.45), haemoglobin (p = 0.71), left ventricular hypertrophy (p = 0.91), and diastolic dysfunction (p = 0.79), were observed. Conclusion: Plasma NT-pro-BNP is remarkably elevated in patients with NSCLC and myocardial/pericardial infiltrations and may be used as a sensitive marker for detecting cardiac metastases in these patients.

The Varna–Thessaloniki telemedical collaboration in setting up a regional transborder transplantation network

In most Balkan countries, with the exception of Greece, transplantation is very rare and equality of access does not exist. In 2003, a Balkan partnership was established called SETNET (South-Eastern European Transplantation Network) for the promotion of transplantation. The objectives are to bring about the diffusion of transplantation techniques and practices in the Balkans, to increase public support for and participation in transplantation, and to eliminate the disparities in access to good health-care. SETNET is already beginning to generate data for an analysis of transplantation-related needs in the Balkans and to accelerate cross-border data exchange in transplantation-related emergencies. In the next few years, a regional training programme will be introduced for all health-care staff involved in transplantation. A regional organ procurement and transplantation network will be set up to utilize the existing telemedicine infrastructure. If successful, it will also prove that telemedicine infrastructures, however modest, can be the backbone for other, far-reaching human networks.

Deutsche Osteoonkologische Gesellschaft gegründet

zudem Dr. Holger Uhthoff, Speyer (Schatzmeister) und Prof. Dr. M. Heinrich Seegenschmiedt, Hamburg (Schriftführer) an. Zu Beisitzern wurden PD Dr. Christian Eberhardt, Hanau, Prof. Dr. Tanja Fehm, Tübingen, Prof. Dr. Franz Jakob, Würzburg, und PD Dr. Florian Schütz, Heidelberg berufen. Die Gesellschaft umfasst derzeit 45 Gründungsmitglieder. Mitglied werden kann jeder, der sich wissenschaftlich mit dem Gebiet der Osteoonkologie beschäftigt. Die Gesellschaft wird als Verein eingetragen und die Gemeinnützigkeit wird beantragt.