Abstract: In this paper, we present an intelligent system for the diagnosis and treatment of urinary incontinence (UI) for males as well as females, called e-URIN. e-URIN is an intelligent system for diagnosis and treatment of urinary incontinence according to symptoms that are realized in one patient and usually recorded through his clinical examination as well as specific test results. The user-friendly proposed intelligent system is accommodated on a hospital server supporting e-health tools, for use through pocket PCs under wireless connection as a decision support system for resident doctors, as well as an educational tool for medical students. It is based on expert system knowledge representation provided from urology experts in combination with rich bibliographic search and study ratified with statistical results from clinical practice. Preliminary experimental results on a real patient hospital database provide acceptable performance that can be improved using more than one computational intelligence approaches in the future.
Abstract: Metal-induced allergic reactions are not rare in every day practice but nickel, cobalt and chromium are the most common offenders. Other metal anions and metal alloys represent also emerging causes for hypersensitivity reaction in humans. The metal struts of endovascular and intracardiac devices are usually alloys containing nickel and constitute causes for allergic reactions with possible intracardiac and intracoronary mast cell activation resulting in the Kounis hypersensitivity coronary syndrome. Newer intracoronary stents avoid nickel thus making them less allergenic. It is advisable that, before any device implantation, careful history of any metal allergy should be taken and efforts should be made for the development of new devices with better biocompatibility.
Abstract: An unusual case of giant hydatic cyst of the left ventricle producing cardiac and systemic symptomatology is described. The patient had suffered presyncopal and syncopal attacks and the final diagnosis was made by combination of echocardiography, magnetic resonance imaging and serological tests. Surgical resection of the cyst supplemented by medical therapy yielded favorable results.
Abstract: AIMS AND OBJECTIVES. The aim of this study was to determine the perceptions of nurses who work in critical care units about positive and negative effects related to the use of technological equipment and identify relationships between these perceptions and demographic characteristics of participants. BACKGROUND. Previous researchers have investigated the perceptions of nursing personnel about the effects of technology on clinical practice. However, most of them focus on specific negative effects. Positive and negative effects have never been studied as a whole. DESIGN. Critical care nurses were surveyed to elicit their perceptions regarding the use of technological equipment. The instrument comprised a 14-item questionnaire and a series of demographic characteristics. A five-point Likert scale was used for each of these 14 questions. METHODS. The questionnaire was administered to 122 nurses working at the four critical care units of a major academic hospital in Patras, Greece, from 1/10/2003 to 31/12/2003. The completion of the questionnaires was achieved by means of a personal interview. RESULTS. A total of 118 questionnaires were completed. The majority of nurses recognized the positive effects of equipment regarding patient care and clinical practice. At the same time, they agreed that use of equipment possibly leads to increased risk due to human errors or mechanical faults, increased stress and restricted autonomy of nursing personnel. CONCLUSIONS. The use of machines does not add to nursing prestige and this may be related to decreased autonomy. Human errors, mechanical faults and increased stress do not seem to come as a result of time constriction but rather of inadequate education. Undergraduate and continuing education should respond efficiently to the needs of contemporary critical care. RELEVANCE TO CLINICAL PRACTICE. Recognition of positive and negative effects of machines through the investigation of perceptions of nurses is the first step before looking for ways of maximizing advantages and facing disadvantages of equipment use.
Abstract: A 60-year-old male was bitten by a venomous snake (Vipera ammodytes) and gradually developed signs of an allergic reaction including generalized itching, generalized rash, and chest discomfort. This was followed by severe retrosternal pain with electrocardiographic evidence of an inferior myocardial ischemia progressing to acute myocardial infarction. Cardiac enzymes and troponin, serum tryptase, and histamine were elevated. Coronary arteriography showed normal coronary arteries. This is a characteristic type I variant of Kounis syndrome, which is the concurrence of acute coronary syndromes with conditions associated with mast cell activation including allergic or hypersensitivity reactions as well as anaphylactic or anaphylactoid reactions. This is the first report to show that viper bites can induce allergic angina and/or allergic myocardial infarction.
Abstract: BACKGROUND: Snake venom poisoning is a medical emergency requiring immediate attention. Bites from poisonous European snakes can lead to local tissue damage and systemic symptoms. Vipera ammodytes accounts for the most envenomation in Greece. METHODS: The demographic and epidemiological characteristics, clinical symptoms and signs, laboratory findings, treatment, and outcome of 147 consecutive victims of V. ammodytes admitted to our hospital from 1988 to 2003 were reviewed and analyzed. RESULTS: The most common symptoms and signs included fang marks (100%), pain (100%), swelling (98.64%), ecchymosis (60.54%), tachycardia (32.65%), fainting or dizziness (29.93%), fever (23.13%), enlargement of regional lymph nodes (17.69%), nausea (16.33%), hypotension (13.61%), and vomiting (12.93%). The main complications were reduced range of motion, thrombophlebitis, local hemorrhagic blister formation, skin bleeding, rhabdomyolysis, reduced sensation, acute renal failure, necrosis with tissue loss, carpal tunnel syndrome, compartment syndrome, Kounis syndrome, and digit amputation. CONCLUSIONS: A V. ammodytes bite is a potentially serious event that requires immediate hospital care. Yet, the majority of victims can be treated successfully with conservative methods. No deaths occurred in our series.
Abstract: OBJECTIVES: This study examined the use of auditory brainstem response (ABR) by classic clicks and verbal stimuli in young dyslexic adults to identify latency abnormalities. METHODS: Subjects included 10 dyslexic adults and 10 age-, sex-, IQ-, education-, and hearing sensitivity-matched normal subjects. Both groups had normal auditory status. Measurements included the absolute latencies of waves I through V; the interpeak latencies I-III, III-V, and I-V elicited by acoustic click; and the negative peak latencies of A and B waves, as well as the interpeak latencies of A-B elicited by the verbal stimulus "ma," created on a digital speech synthesizer. RESULTS: The measured latencies and interpeak latencies in response to both clicks and verbal stimuli were found delayed in eight dyslexic subjects, although they did not reach the level of significant difference. However, two dyslexic subjects had significantly delayed peak and interpeak latencies elicited by verbal stimuli. CONCLUSIONS: There are dyslexic subjects who may have abnormalities in acoustic representation of a speech sound as low as the auditory brainstem, as elicited by the verbal stimulus "ma."
Abstract: Allergic angina and allergic myocardial infarction (Kounis syndrome) occurring during the course of a drug-induced allergic reaction in the absence of angiographically stenosed coronary arteries, is rare in clinical practice. This paper reports the case of a 70-year-old woman with no significant risk factors for coronary artery disease who developed coronary artery spasm after intravenous injection of cefuroxime. A subsequent coronary angiogram revealed normal coronary arteries (type I variant of the syndrome). The allergic reaction following cefuroxime administration seems to have triggered the development of coronary artery spasm. Susceptible individuals expressing an amplified mast cell degranulation effect may be more vulnerable to coronary artery spasm. The clinical implications of this syndrome are also discussed.
Abstract: Two cases of allergic angina and allergic myocardial infarction (Kounis syndrome) following penicillin administration are described. The patients suffered from lung and mandible neoplasms and had previously received several courses of antineoplastic therapy without any sequelae. One patient had normal coronary arteries (type I variant of the syndrome) and the other had coronary artery disease with previous myocardial infarction (type II variant of the syndrome). The allergic reaction following penicillin administration seemed to have triggered the development of an acute coronary artery spasm in the first patient and an acute myocardial infarction in the second. This report shows that susceptible individuals expressing a magnified mast cell degranulation effect may be more vulnerable to coronary artery spasm and plaque erosion or rupture.
Abstract: INTRODUCTION: In this study, we initiated a prospective, randomised, clinical trial comparing the AMBI, TGN and PFN operations used for treatment of unstable fractures, for differences in intra-operative use, consolidation, complications and functional outcome. MATERIALS AND METHODS: We have compared the pre-, intra- and post-operating variables of AMBI, TGN and PFN operations that were used for treatment of unstable trochanteric fractures, of 120 patients all above 60 years old diagnosed with extracapsular hip fractures classified as AO Type 31-A2 or Type 31-A3. RESULTS: According to our results the three methods are comparable in the treatment of unstable trochanteric fractures of patients above 60 years old. CONCLUSION: The AMBI remains the gold standard for the fractures of trochanteric region. TGN has an easier and faster procedure, facilitates early weight bearing and had minor late complications. An improper use of the PFN system was the reason for the most complications and the longer operation time of the device. PFN is also an accepted minimally invasive implant for unstable proximal femoral fractures but future modification of the implant to avoid Z-effect phenomenon, careful surgical technique and selection of the patients should reduce its high complication rate.
Abstract: BACKGROUND: Cardiorespiratory complications may occur during gastrointestinal endoscopy, and elderly people seem to be more vulnerable to these complications during endoscopic procedures involving the manipulation of abdominal viscera. OBJECTIVES: To determine the incidence of cardiac arrhythmias, changes in oxygen saturation, heart rate and blood pressure during endoscopic retrograde cholangiopancreatography (ERCP) via Holter monitoring in elderly patients older than 70 years of age. METHODS: Holter monitoring and 12-lead electrocardiograms were performed in 30 elderly patients undergoing ERCP and in 30 control subjects undergoing routine chest, abdomen, bone and upper gastrointestinal small bowel follow-through studies. A computerized nontriggered template system was used to analyze the electrocardiograms qualitatively and quantitatively. Arrhythmias, cardiac axis, conduction defects, pauses, ST segment changes, ectopic beats, oxygen desaturation and changes in blood pressure and rate-pressure product were evaluated. RESULTS: Increased heart rate, ST segment changes resulting from myocardial ischemia, oxygen desaturation and transient atrial and ventricular ectopic beats were frequent during ERCP compared with the control group. In one patient, transient left bundle branch block developed and this was attributed to pre-existing hypertension with cardiomegaly. One patient developed ventricular tachycardia and one other sinus bradycardia, but this was attributed to sick sinus syndrome. CONCLUSIONS: Transient myocardial ischemia and various cardiac arrhythmias are frequent in elderly patients undergoing ERCP. Appropriate noninvasive monitoring seems to be justified during this procedure.
Abstract: A case in which inspissated barium was retained and produced sigmoid obstruction after one year is described. The patient was elderly and myxoedematous. Prolonged retention of barium producing a bowel obstruction requiring surgery is a rare complication and, to our knowledge, is only the second case described in which the symptoms of obstruction appeared so late after the examination.
Abstract: This is the first case reported of combined cervical emphysema and pneumomediastinum associated with unusual electrocardiographic and local neurologic findings. These may be the result of an increase in intracervical and intrathoracic pressure induced by the dissecting air.
Abstract: Two cases of allergic angina and allergic myocardial infarction (Kounis syndrome) secondary to shellfish ingestion are described. The patients had pre-existing quiescent coronary artery disease (type II variant of the syndrome) and the allergic reaction following eating shellfish seemed to have triggered the development of an acute myocardial infarction. The clinical implications are also discussed.
Abstract: To assess the exact cause and extent of transdermal glyceryl trinitrate (GTN)-induced allergic reactions, a study of continuous and intermittent use of GTN patches was conducted in 320 patients with New York Heart Association (NYHA) class II and III angina pectoris. Three commercially available GTN patch systems were used. Twenty-one patients (6.5%) developed cutaneous reactions. In 17 patients (5.3%), the reactions were confined to the area of application and were characterised as irritant reactions. Four patients (1.2%) developed both localised and remote from the area of application lesions and one patient developed a generalised anaphylactic reaction. The rate of discontinuation of therapy was 3.4%. The irritant skin reactions were mainly due to contaminants and additives. Changing to a different transdermal system reduced the incidence of local reactions--a particularly desirable effect in patients who respond well to GTN therapy.
Abstract: The authors of this study used the method of increased stimulus rate on brainstem auditory evoked potentials (BAEPs) in 30 patients with ischemic heart disease (IHD) and in an equal number of healthy age-matched control subjects. The BAEPs were recorded using 100- to 3000-Hz alternating polarity clicks at a rate of 22.6 per second. Measurements included the absolute latencies of waves I through V, the interpeak latencies I-III, III-V, and I-V, and the peak amplitudes of peaks I, III, and V. The measured absolute latencies and interpeak latencies were found to be significantly increased, and the peak amplitudes were found to be diminished. The audiometric tests revealed no significant hearing loss in IHD patients. This study is the first to demonstrate prolongation of BAEPs in IHD patients. BAEP recording may become an additional noninvasive tool for detecting IHD patients with impaired microcirculation.
Abstract: RATIONALE AND OBJECTIVES. Enteroclysis (small-bowel enema) involves the introduction of a large amount of fluid into the small bowel, through a tube, producing small bowel distention. A study was done to determine the incidence of any electrocardiographic changes during enteroclysis with Holter monitoring. METHODS. Continuous electrocardiographic monitoring and 12-lead electrocardiograms were performed in 30 elderly patients undergoing enteroclysis and in 30 control subjects undergoing routine chest, bone, and upper gastrointestinal small bowel follow-up studies. Two channel qualitative and quantitative electrocardiographic analysis was performed by a computerized nontriggered template system. Arrhythmias, change in cardiac axis, conduction defects, pauses, ST segment changes, and ectopics were sought. RESULTS. Increased sympathetic tone resulting in increased heart rate and transient atrial and ventricular ectopics was frequent during enteroclysis compared with the control group. In one patient ventricular tachycardia developed, and two patients had diminished heart rate, but this was attributed to preexisting heart disease and concurrent medication. CONCLUSION. Transient, nonhazardous cardiac arrhythmias are encountered during enteroclysis in elderly patients. These arrhythmias may be attributed to the preexisting heart disease, fear, and anxiety during intubation, or increased sympathetic tone from the enteric loop distention.
Abstract: The value of the Somatosensory Evoked Potentials (SEP) in the assessment and detection of neurological disorders could be considerably enhanced if the normative standards of (SEP) characteristic parameters were normalized taking into account all other systematic sources of variance. The present study examines the influence of body height on the peak and interpeak latencies of the pudendal somatosensory evoked potentials. We examined the peak latency (L1) of the evoked potential recorded at the L1 vertebra and the onset latency (ONc) of the cortical evoked potentials, after stimulation of the pudendal nerve, as a function of body height in 40 normal male subjects (age 20-40 years). Significant positive correlation was found between both (ONc) latency and ONc-L1 interpeak latency and body height (H). Assuming that the latter is proportional to the length of the neural pathways, the experimental data were fitted using a theoretical model representing the conduction in the sensory neuraxis as a function of body height. Using the estimated fitting functions, we normalized our data with regard to a typical value of body height. The normalized values of the aforementioned latencies reveal a significantly reduced variance, as compared to the original ones, and consequently their diagnostic importance is significantly increased. Similar procedures applied to the L1 (spinal) latencies and the latencies of the bulbocavernosus reflex (BCR) reveal no correlation with body height and this is discussed on the basis of neuroanatomical considerations.
Abstract: BACKGROUND: Accumulating evidence suggests that synthetic retinoids may be capable of affecting the differentiation and growth of nervous tissue in vivo and in vitro. On the other hand, adverse reactions concomitant with brainstem involvement definitely or probably related to oral retinoid therapy have been reported in a small number of patients. OBJECTIVE: The purpose of the present study was to substantiate the possible effects of oral isotretinoin on the synaptic activity and propagation of action potentials along the nerve fibers. METHODS: The auditory brainstem response of 33 patients with severe nodulocystic acne before and 3 weeks after the onset of oral isotretinoin administration was investigated using auditory evoked potentials. RESULTS: The paired analysis of the response variables before and after treatment failed to reveal any statistically significant differences. However, a marked increase in latencies and interpeak latencies and a decrease in amplitudes for both ears were found in 3 patients after therapy. CONCLUSIONS: It seems reasonable to suggest that these subclinical changes may be due to an isotretinoin-induced synaptic malfunction or to a conduction defect in the auditory nerve fibers.
Abstract: The value of the Auditory Brain Stem Response (ABR) in the assessment and detection of neurological disorders could be considerably enhanced if the normative standards of ABR characteristic parameters take into account all other systematic sources of variance. The present study attempts to take into account the influence of head size on latency and amplitude of the ABR components. We examined amplitude and latency as a function of head size in 40 normal male subjects (age 20-40 years). Significant negative correlation was found between amplitude and head radius. The experimental data were fitted using a theoretical curve of the potential on the surface of a three-concentric sphere model representing the human head. The fitted curve of amplitude versus radius can be applied to normative data in order to substantially reduce dispersion and consequently increase the diagnostic value of this parameter. Moreover, a substantial effect of radius on wave V latency was detected. Normalization of the latencies with reference to the head radius, assuming that the latter is proportional to the length of brain stem, resulted in a significant reduction in the standard deviation of these data as compared to the original.
Abstract: Accumulating evidence suggests that vitiligo is a systemic disease affecting the entire pigmentary system and possibly the melanin-containing cellular elements of the nervous system. In the present paper we comparatively study the auditory brainstem response (ABR) of 30 patients with active vitiligo and 50 healthy human subjects in order to detect possible subclinical abnormalities of the auditory system in this disorder. Our findings reveal a statistically significant (p < 0.01) decrease of the I peak latency and a statistically significant (p < 0.01) increase of the I-III interpeak latency in the patients as compared to the controls. The decrease of the first peak latency may be due to a numerical decrease of active melanocytes in the inner ear which results in an impairment of the ion exchange between the endolymph and perilymph. The increase of the I-III interpeak latency may be explained in terms of an abnormal synaptic activity and transmission of the action potential from the auditory nerve to the superior olive.
