Evaluation of autonomic imbalance in patients with heart failure: A preliminary study of pupillomotor function

Background: Purpose of this study was to examine pupil size changes and mobility in normal subjects and in heart failure (HF) patients. Methods: Sixteen stable patients with New York Heart Association (NYHA) class II or III heart failure and sixteen control subjects were studied. Pupillary reaction to light was recorded and nine parameters from this data were measured, reported and then compared in both groups of subjects. Results: Patients with HF had abnormal pupillary function compared with normal subjects. Pupillary light reflex variables differed significantly between two groups (p < 0.05) except baseline radius (R1), minimum radius (R2) and time for maximum constriction (T3). A significant decrease in maximum constriction velocity (VCmax; p < 0.001) and maximum constriction acceleration (ACmax; p < 0.001) was observed in HF subjects. Furthermore, significantly higher values in percentage recovery-redilatation (%R; p < 0.001), percentage R2/R1 (%R2/R1; p < 0.05), latency (T1; p < 0.05) and time for maximum velocity (T2; p < 0.05) were found in the same group. Conclusions: Of the parameters studied, R1 and %R are governed mainly by the action of the sympathetic nervous system, through norepinephrine. The rest are governed mainly by parasympathetic nervous system, through acetylcholine. The results of our study demonstrate generalized adrenergic activation and parasympathetic withdrawal, which are present in HF. (Cardiol J 2010; 17, 1: 65-72

Pregabalin effect on acute and chronic pain after cardiac surgery

Introduction. Pain after cardiac surgery affects long-term patient wellness. This study investigated the effect of preoperative pregabalin on acute and chronic pain after elective cardiac surgery with median sternotomy. Methods. Prospective double blind study. 93 cardiac surgery patients were randomly assigned into three groups: Group 1 received placebo, Group 2 received oral pregabalin 75 mg, and Group 3 received oral pregabalin 150 mg. Data were collected 8 hours, 24 hours, and 3 months postoperatively. Results. Patients receiving pregabalin required fewer morphine boluses (10 in controls versus 6 in Group 1 versus 4 in Group 2, p=0.000) and had lower pain scores at 8 hours (4 versus 3 versus 3, p=0.001) and 3 months (3 versus 2 versus 2, p=0.000) and lower morphine consumption at 8 hours (14 versus 13 versus 12 mg, p=0.000) and 24 hours (19.5 versus 16 versus 15 mg, p=0.000). Percentage of patients with sleep disturbances or requiring analgesics was lower in the pregabalin group and even lower with higher pregabalin dose (16/31 versus 5/31 versus 3/31, p=0.000, and 26/31 versus 16/31 versus 10/31, p=0.000, resp.) 3 months after surgery. Conclusion. Preoperative oral pregabalin 75 or 150 mg reduces postoperative morphine requirements and acute and chronic pain after cardiac surgery

Forms and Legal Aspects of Religious Associations in Ancient Athens

Religious associations have been the subject of exhaustive treatment during the late 19th and the early 20th centuries. The present thesis does not aim to challenge their detailed examination, but rather to reassess the validity of their arguments and conclusions concerning Athenian cult associations, in the light of new pieces of evidence. The Introduction sets the chronological and methodological limits of the thesis. Chapters 1 to 4 discuss the available literary and epigraphical evidence concerning associations of orhogammaepsilononuepsilons, of heroes and goddesses, thetaiotaalphasigmaotaualphaiota and epsilonrhoalphanuiotasigmataualphaiota respectively as well as concommitant matters such as impiety and the relation between enktesis and approval of a cult. Chapter 5 is an attempt to criticise the view that the concept of juristic personality is a proper methodological tool for the comprehension of the associative life and to test a new approach based on the Aristotelian paradigm. In Chapter 6 the social functions of the cult associations are examined, through the application of hermeneutic models like "euergetism", "rituals of conviviality", patronage etc. In the Conclusions I summarise the principal results of the examination and an attempt is made to distinguish between the different religious associations. Finally, three different catalogues are provided, which compile and classify the epigraphical material on Athenian cult associations

Comparative Study and Application of the EFA-4 Diagnostic Tool to Alzheimer’s Disease and Mild Cognitive Impairment

Speech is a cortical function that includes virtual, mobile and sensory part for the understanding and the expression of spoken and written word. This study shows the Greek adaptation of the diagnostic tool «Examining for aphasia» or EFA -4. In dementia and especially in Alzheimer’s disease–AD, the speech disorders are among the main diagnostic feature, along with the impairment of memory. How, however, will we recognize Dementia and separate it from the early stage of Mild Cognitive Impairment- MCI according to speech disorders?The diagnostic tool EFA-4 is a regulatory, reliable and valid measure of the speech disorders. The test was administered to 50 normal elders, 50 patients with AD and 31 patients with MCI. The sample selection, although it had a uniform age, was regardless of origin, marital status and socioeconomic status. According to the results of the research, the EFA-4 is perceived to be particularly useful in the setting of language deficits of the patients with AD, who participated in the survey.Specifically, the cut offs showed that the average of the EFA-4 for the normal range ranged from 74,5 – 74,8. Moreover the cut offs showed that the average of EFA-4 for patients with AD ranges from 36.8-46.1 and for patients with MCI ranges from 62.2 - 66.7

Perioperative antithrombotic (antiplatelet and anticoagulant) therapy in urological practice : A critical assessment and summary of the Clinical Practice Guidelines

Peer reviewedPostprin

Ciprofloxacin induced acquired long QT syndrome in a patient under class III antiarrhythmic therapy

We report one case of cardiac arrest related to ciprofloxacin administration. One female patient (aged 70 years old) developed a marked QTc prolongation (QTc = 0.62 s) within 24 hours of ciprofloxacin administration, with documented torsades de pointes and recurrent syncope that required defibrillation. The patient was under amiodarone and sotalol therapy for atrial fibrillation, with no obvious QT prolongation prior to ciprofloxacin therapy. QT prolongation and subsequent torsades de pointes appeared only after initiation of ciprofloxacin and normalized after drug discontinuation. Even though ciprofloxacin is thought to be safer than other agents in its class, it may cause QT prolongation and torsades de pointes, particularly in high risk patients with predisposing factors. Prolongation of the QT interval related to the effect of fluoroquinolones on rapid potassium channels (IKr) may result on potentially serious proarrhythmic effect, leading to torsades de pointes

Low grade fibromyxoid sarcoma: a case report and review of the literature

Low grade fibromyxoid sarcoma (LGFMS) is a distinctive variant of fibrosarcoma with a high metastasizing potential and sometimes long interval between tumour presentation and metastasis. We present the case of a 50-year-old male who developed a large mass in the posterior aspect of his lower left thigh. The tumor was excised with preservation of the neurovascular structures surrounded by the mass. The tumour measured 11 × 10 × 9 cm and on pathology evaluation was diagnosed as LGFMS. Due to the relative rarity of LGFMS, there is no dedicated protocol regarding follow-up recommendations. In order to early diagnose possible metastasis it is important to inform the patients about the longstanding metastatic potential of the disease

Simultaneous occurrence of cerebellar medulloblastoma and pituitary adenoma: A case report

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Prevalence of C9orf72 hexanucleotide repeat expansion in Greek patients with sporadic ALS

A total of 178 consecutive patients with definite sALS without frontotemporal dementia (FTD) were enrolled in this study, after complete clinical evaluation. A Repeat-Primed Polymerase Chain Reaction (RP-PCR) protocol was applied to detect the G4C2 repeats expansions. In the studied sALS patients, 5.06% (n = 9) carried the C9orf72 mutation. Among carriers, 2/3 of them were females and spinal onset accounted for 78% and bulbar for 22%, while the mean age of onset was about 60 years. Our study showed that the prevalence of C9orf72 repeat expansion in Greek sALS patients is similar to the overall frequency of the mutation in European populations. The pathogenic mutation remains a promising biomarker for genetic testing and targeted treatment