Georgios I Tagarakis

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.

Effect of ranolazine in preventing postoperative atrial fibrillation in patients undergoing coronary revascularization surgery.

BACKGROUND/OBJECTIVEnRanolazine is a new anti-ischemic agent approved for chronic angina with additional electrophysiologic properties. The purpose of the present trial was to investigate its effect in preventing postoperative atrial fibrillation (POAF) after on-pump coronary artery bypass graft (CABG) surgery.nnnMETHODSnIn the current prospective, randomized, (1 active: 2 control), single-blind (outcome assessors), single-centre clinical trial we recruited consecutive eligible patients scheduled for elective on-pump CABG. Participants were assigned to receive either oral ranolazine 375 mg twice daily for 3 days prior to surgery and until discharge, or to receive usual care. Patients were monitored for the development of POAF.nnnRESULTSnWe enrolled 102 patients. Significantly lower incidence of POAF was noted in the ranolazine group compared with the control group (3 out of 34 patients, 8.8%, vs 21 out of 68 patients, 30.8%; p< 0.001). Mean values of left atrial diameter and left ventricular ejection fraction between the control and the ranolazine group were not significantly different.nnnCONCLUSIONnOur findings suggest a protective role of oral ranolazine when administered in a moderate dose preoperatively in patients undergoing on-pump CABG surgery. Future studies based on a wider sample of patients will eventually support our conclusions.

Coronary artery surgery in a man with achondroplasia: a case report.

IntroductionAchondroplasia is a musculoskeletal disorder associated with short stature. Despite an estimated prevalence of 1:25,000 in the general population, there is little literature concerning the diagnostic and treatment challenges faced by doctors dealing with a heart operation on a patient with this condition.Case presentationWe present the case of a 41-year-old Caucasian man of Greek ethnicity with achondroplasia, who underwent bypass heart surgery.ConclusionsThe surgery was successful and did not present particular difficulties, showing that heart surgery can be safely performed on people with achondroplasia.

Intrapleural instillation of autologous blood for persistent air leak in spontaneous pneumothorax- is it as effective as it is safe?

ObjectiveThe aim of the present study was to evaluate the efficacy of autologous blood pleurodesis in the management of persistent air leak in spontaneous pneumothorax.Patients and methodsA number of 15 patients (10 male and 5 female) were included in this prospective study between March 2005 and December 2009. The duration of the air leak exceeded 7 days in all patients. The application of blood pleurodesis was used as the last preoperative conservative method of treatment in 12 patients. One patient refused surgery and two were ineligible for operation due to their comorbidities. A blood sample of 50 ml was obtained from the patients femoral vein and immediately introduced into the chest tube.ResultsA success rate of 27% was observed having the air leak sealed in 4 patients in less than 24 hours.ConclusionDespite our disappointingly poor outcome, the authors believe that the procedures safety, convenience and low cost establish it as a worth trying method of conservative treatment for patients with the aforementioned pathology for whom no other alternative than surgery would be a choice.

Classic and non-classic forms of mitral valve prolapse.

OBJECTIVEnTo investigate the significance of the established distinction between classic and non-classic forms of mitral valve prolapsed (MVP).nnnMETHODSnWe 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.nnnRESULTSnPatients 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.nnnCONCLUSIONnThe 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.

Thoracic injuries resulting from intimate partner violence

Intimate partner violence affects individuals in every part of the world regardless of financial status, age, race, religion, nationality and educational background. Women are often the victims of assault by their partners and their presence in emergency departments is well documented. This report highlights the relatively infrequent occurrence of a traumatic pneumothorax as a result of intimate partner physical abuse and aims to emphasize the crucial role all health care professionals need to play if domestic violence is to be recognized early.

Synchronous perforation of a duodenal and gastric ulcer: a case report

IntroductionPeritonitis due to peptic ulcer perforation is a surgical emergency with a high risk of mortality and morbidity.Case presentationWe present a rare case of a 54-year-old Caucasian man who underwent an emergency laparotomy for peritonitis caused by perforation of two peptic ulcers. The first was located on the anterior wall of the duodenum and the second was posterior, pre-pyloric, close to the lesser curvature.ConclusionTo the best of our knowledge, this is only the second report in the medical literature of a simultaneous perforation of two peptic ulcers; though rare, every surgeon performing open or laparoscopic repair of a perforated peptic ulcer should be aware of the possibility of simultaneous perforation.

Can pulmonary artery hypertension be attributed to levosimendan? A problematic based on a patient's case.

I read the recent publication by Fernández-Golfı́n et al. [1] with a great interest. Fernández-Golfı́n et al. studied left ventricle trabeculae (LVT) that are frequently seen in different cardiac diseases [1]. Fernández-Golfı́n reached the conclusion that there might be some usefulness of the new parameters, LVT mass (LVTM) and LVTM percentage (LVTM%) [1]. Differential diagnosis between left ventricular noncompaction and other cardiac diseases might be based on these new parameters [1]. However, there are some issues concerning the use of the new approach. First, the reproducibility of the test must be rechecked. According to a recent study, differences in interobserver end diastolic LV volume and LV mass and interexamination LV mass were statistically significant [2]. In addition, different processes of cardiac magnetic resonance also presented different results [3]. To set reference parameters, the problem of reproducibility has to be completely managed. Second, the costutility and cost-effectiveness of this new approach should also be assessed.

Double auricles of the right atrium: a unique anatomic deformity

BackgroundAnatomic deviations, especially those detected during the course of an operation, are medically intriguing, as they raise concerns about their clinical significance and putative complications.Case presentationWe present, to our knowledge, for the first time a case of an anatomic deviation in the form of a second right atrial auricle in a 70 year-old, coronary bypass-operated male Caucasian patient of Greek origin. No complications were noted intra-or postoperatively.ConclusionsA second right atrial auricle was found intraoperatively, without causing any clinical complications, or obstructing the normal course of a surgical procedure.

Invited Commentary. The Royalty of Evidence: The Randomized Control Trials

In the last issue of the journal we came across a propensity matched analysis of stage I non-small cell lung cancer (NSCLC) patients treated either by means of surgery or by stereotactic body radiotherapy (SBRT)[1]. The authors report equal local control survival, regional control survival, loco-regional control survival, distant control survival (DC), diseasefree survival and progression-free survival, however SBRT patients had worse overall survival rate compared to surgical patients. This paper is interesting and also thought-provoking. Despite the in depth analysis of this paper, all the included studies were based on retrospective data. Most of the referenced papers quote survival times at 2–3 years, not the standard 5-year survival. The authors report favorable overall survival for the surgical group, irrespective of matching and support the imperative need that their conclusions should be strengthened by randomized control trials (RCTs). This report reflects the ongoing debate between SBRT and surgery. Stage I non-small cell lung cancer (NSCLC) is potentially curable, and surgery is considered the standard of care for patients with minimal comorbidities and good performance status. Notably, the 5-year overall survival (OS) has been reported to be around 60% in some studies [2]. Nevertheless, a significant portion of these patients are poor candidates for surgery due comorbidities such as chronic obstructive pulmonary disease (COPD), cardiovascular disease or poor physical status. Stereotactic ablative radiotherapy (SABR) or stereotactic body radiotherapy (SBRT) was employed as an alternative treatment strategy for cancer patients. This method, which is a noninvasive treatment alternative to surgery, adopts modern radiotherapeutic