National & Kapodistrian University of Athens

The early diagnosis of acute coronary syndrome remains problematic, despite recent improvements. Traditionally, the diagnosis of acute cardiac ischaemia relies on the combination of chest pain, electrocardiographic changes and elevation... more

Introduction: Ischaemia-modified albumin (IMA) has recently been shown to be an early and sensitive marker of ischaemia. It is generally accepted that cardiac arrest causes the most severe form of global ischaemia. The aim of the present... more

Introduction: Ischaemia-modified albumin (IMA) has recently been shown to be an early and sensitive marker of ischaemia. It is generally accepted that cardiac arrest causes the most severe form of global ischaemia. The aim of the present study was to identify whether IMA is an independent predictor of return of spontaneous circulation (ROSC) in a swine model of cardiac arrest. Methods: Ventricular fibrillation (VF) was induced in 30 piglets, which were left untreated for 8 min before attempting resuscitation with precordial compression, mechanical ventilation and electrical defibrillation. Electrical defibrillation was attempted after 10 min of VF. Blood samples for IMA determination were drawn at baseline, after 8 min of VF and before delivery of each shock. A binary logistic regression model was implemented for the prediction of animals achieving ROSC from data available before the first defibrillation attempt. Backward stepwise selection was used to extract the final model. Inclusion and exclusion significance levels were 0.1 and 0.05, respectively. Receiver operating characteristic curves were used to determine the diagnostic accuracy, sensitivity and specificity of the parameters and to obtain the appropriate cut-off points. Results: IMA exhibited 100% sensitivity and 93.8% specificity in defining the subgroup of animals that will achieve ROSC. This high-accuracy prediction had a very early onset (from eighth VF minute) and remained at the same level until the end of the experiment. When combining IMA and coronary perfusion pressure (CPP) measurements from the first CPR cycle in the form of the simple ratio IMA/CPP, a cut-off point of 7 could provide 100% sensitivity and specificity in distinguishing the animals that will achieve ROSC in the upcoming defibrillation attempts. Conclusions: Until today, CPP has been found to be the only key determinant of successful resuscitation. Our study suggests that IMA can be a predictive index of ROSC even before the initiation of CPR.

Hypertrophic cardiomyopathy (HCM) is a common genetic cardiovascular disease that affects the left ventricle. HCM can appear at any age, with the majority of the patients remaining clinically stable. When patients complain of symptoms,... more

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- by Pantazopoulos Ioannis
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- Bioinformatics

The objective of this study was to evaluate and compare the complications of cardiopulmonary resuscitation after manual or mechanical chest compressions in a swine model of ventricular fibrillation. In this retrospective study, 106 swine... more

Lack of resuscitation skills of nurses and doctors in basic life support (BLS) and advanced life support (ALS) has been identified as a contributing factor to poor outcomes of cardiac arrest victims. Our hypothesis was that nurses' and... more

Aim: The aim of this study was to assess the performance of the Glidescope ® in a manikin cardiopulmonary resuscitation (CPR) scenario. Methods: Following a brief didactic session, 45 volunteer doctors inexperienced with airway... more

Objective: The study objective was to determine cardiologists' theoretic knowledge of the 2005 American Heart Association (AHA) resuscitation guidelines.

Objective: Nurses are usually the first-responders in cases of in-hospital cardiac arrest. Their competence in Basic Life Support (BLS) is important in improving patient outcome. The purpose of this study was to evaluate the nurses' BLS... more

Epinephrine is a nonselective α-adrenoreceptor (α 1 and α 2 ) and β-adrenoreceptor (β 1 and β 2 ) agonist. Its beneficial effects are mediated by α-adrenergic receptors causing arterial and arteriolar vasoconstriction in the skin, mucosa,... more

Although approximately one million sudden cardiac deaths occur yearly in the US and Europe, cardiac arrest (CA) remains a clinical condition still characterized by a poor prognosis. In an effort to improve the cardio pulmonary... more

The aim of the present study is to review the literature and discuss nifekalant's potential use as a first aid drug in an emergency care setting. The PubMed database was used to identify papers, using keywords nifekalant, MS-551,... more

Background and Goal of Study: Ex tensive liver resections can cause an excess of portal flow, an increase in portal pressure, a reduction of arterial flow and an inflammatory reaction, that leads to hepatic failure in the first... more

Background and Goal of Study: Ex tensive liver resections can cause an excess of portal flow, an increase in portal pressure, a reduction of arterial flow and an inflammatory reaction, that leads to hepatic failure in the first postoperative days (i.e. small-for-size syndrome, SFSS). Anesthetic drugs alter the hepatic circulation and can modulate the inflammatory response to injury, which could modif y the response af ter liver surgery. The study aimed to compare the ef fect of two anesthetic drugs (sevoflurane and propofol) on portal pressure and hepatic blood flow one day af ter hepatectomy. Secondary outcomes included changes in liver function. Materials and Methods: The study was approved by the Ethics Commit tee. Ten Mini-pigs were randomized into two groups: anesthetized with propofol (P) vs sevoflurane (S). All animals were subjected to a hepatectomy (85% of the liver), reoperation and sacrifice af ter 24 hours. Monitoring: PiCCO catheter; femoral-artery, porta-and suprahepatic-vein, and central-venous pressures; hepatic-artery and portal-vein flows. Liver function data: chemical pathology, clot ting and indocyanine green clearance. Data were collected: at baseline (B) half an hour af ter resection (R); and af ter 24 hours (24h). Data were expressed as mean ± DS. Statistical analysis: Kolmogorov-Smirnov, and student's T tests. Results and Discussion: At B, group P showed lower portal pressure (S 15±3, P 11±3 mm Hg, p=0.053) and increased arterial blood flow (p=0,2). At R, data showed no significant dif ferences. At 24h, there was an overall increase in portal pressure, but it remained lower for P (S 22±1, P 17±2, p=0.005) and the B-24h portal flow increased significantly for S (average increase 238 ml/min, p=0.002) but not for P (64 ml/min p=0.7). At 24h, all 5 cases in group P showed a portal pressure ≤ 20 (considered the limit to develop SFSS (1)), while all 5 cases in group S exceeded that limit. There was no difference in liver function data, but with lactate level trending upward in S group. Conclusion(s): Propofol reduces the increase of portal pressure and flow after a great liver resection compared with sevoflurane, suggesting a protective ef fect that may reduce the incidence of SFSS. If this ef fect is confirmed in humans, the use of propofol could reduce postoperative risk af ter liver resection.

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- by I. Floros and +2
  Theodoros Xanthos
  Pantazopoulos Ioannis
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- by Dimitrios Barouxis and +2
  Theodoros Xanthos
  Pantazopoulos Ioannis
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- 4
  Nursing, Advanced Nursing Practice, Community health nursing, Time Factors

The main goal of this article is to update etiology, epidemiology, diagnosis, treatment and outcome of the various causes of mesenteric ischemia in order to elucidate its labyrinthine clinical riddle, by reviewing the current English... more

Medicine

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