Hellenic Journal Research Articles

A new era for the Hellenic Journal of Surgery

A new era for the Hellenic Journal of Surgery

The Hellenic Journal of Cardiology: a 64-year voyage of discovery from the cradle of European civilization to the world.

The Hellenic Journal of Cardiology: a 64-year voyage of discovery from the cradle of European civilization to the world.

Editorial: STEM Education: “What’s in a Name?”

In this editorial, I am explaining my background in STEM education course design, delivery, and research experiences and discussing the current state of STEM journals internationally. I am also including a short overview of the three articles of this inaugural issue of Hellenic Journal of STEM Education.

In-hospital management of elderly patients undergoing myocardial perfusion scintigraphy.

To investigate the impact of myocardial perfusion scintigraphy results on the decision for invasive coronary angiography in elderly patients (≥75 years) with suspected coronary artery disease hospitalized in a single tertiary medical center. In the retrospective study, data of 276 (136 elderly) consecutive hospitalized patients referred to myocardial perfusion imaging were analyzed. The clinical characteristics, myocardial perfusion scintigraphy results, invasive coronary angiography and revascularization rates and in-hospital adverse events were identified by manually reviewing the patients' records. Ischemia was found in 40.2% of patients. There was no significant difference in the proportion of ischemia between elderly and younger patients (38.2% vs. 42.1%, P=0.508). Invasive coronary angiography was performed in 64.0% of patients with ischemia and in 6.8% of patients with normal myocardial perfusion imaging (P<0.001). The referral rate for invasive coronary angiography was not different between elderly and younger patients with ischemia (63.5% vs. 64.4%, P=0.848). Ischemia on myocardial perfusion imaging was the most predictive variable for a referral to invasive coronary angiography (odds ratio 31.8, 95% confidence interval 14.6-69.5, P<0.001). There was no significant difference between the younger and elderly patients in revascularization rate and adverse events until discharge (39% vs. 40%, P=0.99 and 7.1% vs. 8.8%, P=0.6, respectively). Ischemia on myocardial perfusion scintigraphy is a powerful predictor for in-hospital invasive coronary angiography independent of the patient's age. Elderly patients with ischemia received invasive coronary angiography equally as their younger counterparts and have similar rates of adverse events until discharge.

A RARE CAUSE OF BRONCHOBILIARY FISTULA

SESSION TITLE: Medical Student/Resident Pulmonary Manifestations of Systemic Disease 3 SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: Bronchobiliary fistula (BBF) is a rare medical condition that presents a diagnostic dilemma. It may be congenital or acquired, with the former having a prevalence of less than 1 million. Once diagnosed its etiology is often evident, however with its incidence due to echinococcal origin being < 2 percent, patients often have multiple hospitalizations prior to diagnosis. We present a rare case of a BBF, treated successfully with a minimally invasive approach. CASE PRESENTATION: 74 year old Syrian female with prior of history of a liver cyst drained of 200 millimeters 3 years prior at another institution comes with right upper quadrant abdominal pain, nausea and vomiting. She has an abdominal magnetic resonance imaging, subsequent CT-guided fine-needle aspiration and is diagnosed with hydatid cyst, treated conservatively with albendazole. She is discharged and presents 3 days later, with productive cough of yellow/green mucus, malaise and fever. She is treated as a healthcare associated pneumonia. Sputum culture shows gram positive cocci and antibiotics are tailored from cefepime and vancomycin to cephalexin in view of MSSA. The patient improves clinically and is discharged on albendazole plus cephalexin and scheduled for elective hepatic cyst resection. She returns 8 days later for fever and productive cough. She is found to have persistent pneumonia with elevated right hemidiaphragm on chest x-ray, treated with piperacillin-tazobactam and vancomycin empirically along with albendazole for hydatid cyst. She has a laparoscopic echinococcal cyst resection with some hepatic resection to facilitate cyst removal. While on the medical floor, she develops bilioptysis and leukocytosis. A BBF is suspected and confirmed with DISIDA scan. An endoscopic retrograde cholangiopancreatography (ERCP) is done with sphincterotomy and stent placement. She continues to clinically improve and is subsequently discharged with no cough for outpatient follow-up. DISCUSSION: Acquired BBF is a rare complication of echinococcal origin. While bilioptysis is the hallmark sign of BBF it may not always be present. This poses a diagnostic dilemma for physicians and potential life threatening complications for patients. The diagnosis is made with a DISIDA. Historically treatment has been surgical, but conservative options such as embolization and stent placement have been proposed. In this case, an ERCP sphincterotomy and stent placement is successfully used. This intervention results in a decrease in the transpapillary pressure gradient, thereby facilitating biliary flow to the intestine and healing of the BBF. CONCLUSIONS: BBF of echinococcal origin has an incidence of < 2%. Bilioptysis, a clinical hallmark, maybe absent posing a clinical dilemma resulting in multiple hospitalizations. This case highlights a rare diagnosis of BBF secondary to hydatid cyst and a successful conservative option, to a once surgical problem. Reference #1: Mohammadreza Seyyedmajidi MD, Mojtaba Kiani MD, Hamid Javadi MD, Alireza Raeisi MD, Majid Assadi MD. Hepatobiliary scintigraphy with SPET in the diagnosis of bronchobiliary fistula due to a hydatid cyst. Hellenic Journal of Nuclear Medicine. 2015 May - August; 18(2):160-162. Reference #2: Guan-Qun Liao, Hao Wang, Guang-Yong Zhu, Kai-Bin Zhu, Fu-Xin Lv, Sheng Tai. Management of acquired bronchobiliary fistula: A systematic literature review of 68 cases published in 30 years. World Journal of Gastroenterology. 2011 September; 17(33): 3842-3849. Reference #3: Anton Crnjac, Vid Pivec, Arpad Ivanecz. Thoracobiliary fistulas: literature review and a case report of fistula closure with omentum majus. 2013 Radiol Oncol; 47(1): 77-85. DISCLOSURES: No relevant relationships by Sahai Donaldson, source=Web Response No relevant relationships by Killol Patel, source=Web Response No relevant relationships by Shanta Shrestha, source=Web Response

Asia Oceania Journal of Nuclear Medicine & Biology; A big step forward to advance scientific publication & cooperation in the region.

Asia Oceania Journal of Nuclear Medicine & Biology; A big step forward to advance scientific publication & cooperation in the region.

The 2010 impact factor: the position of the Netherlands Heart Journal within Europe

In June 2011, the impact factors of the main journals were announced for the year 2010. These data can be found at http://isiknowledge.com/jcr (access limited to subscribers only). As previously indicated in this journal [1–3], the impact factor in a specific year consists of the average number of citations of publications in the previous two years divided by the number of publications (citable items) in these two years. Consequently, the impact factor of NHJ 2010 is the number of citations to NHJ articles published in 2008 and 2009, divided by the number of citable NHJ articles published in 2008 and 2009. The total number of citations over 2008 and 2009 was 191 (2008: 118 citations, 2009: 72 citations), whereas the total number of citable articles in this period was 132 (2008: 64, 2009: 68). As a result, the 2010 NHJ impact factor was calculated as 191/132 = 1.447 (almost 1.5). Although this is just a small step forward compared with the 2009 impact factor (1.392), it is still a significant achievement for a national journal that has only been listed by PubMed since January 2007 [4, 5]. It is encouraging to observe that the number of citations is steadily increasing over time (1 citation in 2007, 58 in 2008, 200 in 2009, 288 in 2010, and halfway through 2011 already 238 citations). At the same time, the number of citable items per year has remained fairly constant over the years, varying from 61 to 68, at least suggesting improvement in impact factor in the forthcoming years. What about the position of NHJ within Europe with particular emphasis on the role of NHJ as a Journal of a National Society (i.e. the Netherlands Society of Cardiology)? Several years ago the European Society of Cardiology (ESC) launched an Editors Network comprising all European National Society Cardiovascular Journals [6]. The main goals of the Editors Network were defined as 1) to increase collaboration among the Chief Editors of the National Society Journals, 2) to enhance editorial standards, 3) to improve quality requirements, 4) to preserve publication ethics, 5) to guarantee scientific credibility, and 6) to expand dissemination of scientific knowledge. At present, the Editors Network consists of 46 National Society Journals belonging to 40 ESC National Societies (some countries have more than one National Society Journal: Germany has 4 national journals, Russia 3). Of those 46 European journals, only 10 (22%) have an impact factor at this moment. When we list these journals according to impact factor, we get the following picture (journal, country, impact factor 2010, respectively): Basic Research in Cardiology, Germany, 6.128 Heart, United Kingdom, 4.706 Clinical Research in Cardiology, Germany, 3.466 Revista Espanola de Cardiologia, Spain, 2.157 Netherlands Heart Journal, Netherlands, 1.447 Archives des Maladies du Coeur et des Vaisseux, France, 1.207 Hellenic Journal of Cardiology, Greece, 1.172 Journal of Cardiovascular Medicine, Italy, 0.786 Acta Cardiologica, Belgium, 0.650 Kardiologia Polska – Polish Heart Journal, Poland, 0.523 What do we learn from these facts? First, it is an achievement in itself for a national society journal to have an impact factor, and second, the NHJ takes a very acceptable position among those national society journals that do have an impact factor. To conclude, we again thank all authors for their excellent contributions to the NHJ. Apparently, the quality of the papers was of such a level that they were read and -more importantly-cited by other authors. To improve our 2011 impact factor we hope to receive many more fine articles that deserve to be cited. In summary, the NHJ has again taken an important step on the way to international recognition.

The Angiotensin Converting Enzyme 2/Ang-(1-7) Axis in the Heart

For decades, the literature has been inundated with evidence of the important role of the renin–angiotensin system (RAS) in cardiac remodeling and function with most in the field familiar with this classic, dogmatic story. The protease renin is synthesized and released from the kidney and acts on a circulating inactive peptide, angiotensinogen, produced by the liver, giving rise to angiotensin (Ang) I. Ang I is then transformed into the biologically active octapeptide, Ang II, through enzymatic cleavage by angiotensin-converting enzyme (ACE).1 Ang II is the main effector molecule of the RAS, acting in an endocrine, autocrine/paracrine, and intracrine hormone pathway on cardiac cells. Ang II binds and activates G protein–coupled receptors, the angiotensin type 1 (AT1R) and angiotensin type 2 (AT2R) receptors, to mediate its actions. Activation of AT1R mediates most of the cardiovascular responses attributed to Ang II (ie, vasoconstriction, mitogenic and hypertrophic effects, fibrosis, inflammation, and fluid retention). In contrast, AT2R activation may cause opposing physiological responses that are increased in several disease processes.2 Nearly 50 years after the discovery of ACE, a genomic based screening resulted in a characterization of ACE2, thus adding an unexpected twist into the well-known tale of the RAS.3,4 ACE2 is a carboxypeptidase that cleaves a single residue from Ang I to form Ang-(1-9), which is then converted to Ang-(1-7) by either ACE or neutral endopeptidases.3 This process is less efficient because of the requirement of 2 enzymatic processes. ACE2 …

Retroperitoneal Pararenal Castleman's Tumor in an Adolescent Managed Laparoscopically

Journal of EndourologyVol. 22, No. 11 Laparoscopy and Robotic SurgeryRetroperitoneal Pararenal Castleman's Tumor in an Adolescent Managed LaparoscopicallyPranjal Modi, Amit Trivedi, Rahul Gupta, and S.J. RizviPranjal ModiSearch for more papers by this author, Amit TrivediSearch for more papers by this author, Rahul GuptaSearch for more papers by this author, and S.J. RizviSearch for more papers by this authorPublished Online:2 Dec 2008https://doi.org/10.1089/end.2008.0313AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail FiguresReferencesRelatedDetailsCited byCastleman's disease in the left paravertebral regionAsian Journal of Surgery, Vol. 9Castleman’s Disease: A Unicentric Case of Abdominal Origin and Literature Review10 May 2019 | Hellenic Journal of Surgery, Vol. 91, No. 1Detection of a unicentric type of Castleman-like mass at the site of adrenal grand: A case report and review of literatureWorld Journal of Clinical Cases, Vol. 6, No. 13Left Para-Renal Castleman Disease: Case Report19 December 2018 | Journal of Interdisciplinary Medicine, Vol. 3, No. 2Laparoscopic treatment of Castleman's disease in a patient with a history of malignant Brenner tumorTaiwanese Journal of Obstetrics and Gynecology, Vol. 55, No. 5Castleman's disease of the kidney: Sonographic findings20 June 2014 | Journal of Clinical Ultrasound, Vol. 43, No. 7 Volume 22Issue 11Nov 2008 InformationMary Ann Liebert, Inc.To cite this article:Pranjal Modi, Amit Trivedi, Rahul Gupta, and S.J. Rizvi.Retroperitoneal Pararenal Castleman's Tumor in an Adolescent Managed Laparoscopically.Journal of Endourology.Nov 2008.2451-2454.http://doi.org/10.1089/end.2008.0313Published in Volume: 22 Issue 11: December 2, 2008PDF download

Implantable Cardioverter-Defibrillator Lead Performance

Implantable cardioverter-defibrillators (ICDs) have revolutionized the treatment of patients at risk for sudden cardiac death. In the nearly 3 decades since the first human ICD implant,1 millions of devices have been implanted worldwide and innumerable lives have been saved. Successful resuscitation of a potentially lethal ventricular arrhythmia by an ICD system depends on successful arrhythmia detection and timely delivery of therapy. Both the ICD generator and the ICD lead are critical components of this system. The lead, in particular, is literally a lifeline whose purpose is to convey critical information about the heart’s rhythm to the ICD generator and, in turn, to deliver life-sustaining therapy when needed. Failure of an ICD lead may result in significant clinical events, including failure to pace, failure to defibrillate, inappropriate shocks, and even death. Article p 2727 ICD leads, like many medical technologies, have undergone a remarkable transformation. Epicardial leads, which necessitated a thoracotomy for lead placement, have given way to transvenous leads, which are easier to implant, less costly, and associated with decreased morbidity and mortality.2 Important advances in transvenous lead technology, such as the development of steroid elution, smaller diameter leads, novel insulations, and multipolar leads, have translated into meaningful clinical benefits for patients. Although modern ICD leads consist primarily of electrodes, conductors, insulation, and a fixation mechanism to attach the lead to the myocardium, lead design and performance vary from model to model. Indeed, monitoring of performance is critical not only to identify products with increased failure rates but also to provide physicians and patients with realistic expectations of device performance. In the current issue of Circulation , Eckstein et al add to our understanding of ICD lead performance.3 The investigators conducted a retrospective analysis of 1317 consecutive patients who received ICD systems (including 38 different ICD lead …

Weblogs, social software, and new interactivity on the web.

Weblogs, social software, and new interactivity on the web.

Cigarette smoking, cardiovascular disease, and stroke: a statement for healthcare professionals from the American Heart Association. American Heart Association Task Force on Risk Reduction.

As many as 30% of all coronary heart disease (CHD) deaths in the United States each year are attributable to cigarette smoking, with the risk being strongly dose-related.1 2 Smoking also nearly doubles the risk of ischemic stroke.3 Smoking acts synergistically with other risk factors, substantially increasing the risk of CHD.4 Smokers are also at increased risk for peripheral vascular disease, cancer, chronic lung disease, and many other chronic diseases. Cigarette smoking is the single most alterable risk factor contributing to premature morbidity and mortality in the United States, accounting for approximately 430 000 deaths annually.5 Numerous prospective investigations have demonstrated a substantial decrease in CHD mortality for former smokers compared with continuing smokers.6 This diminution in risk occurs relatively soon after cessation of smoking, and increasing intervals since the last cigarette smoked are associated with progressively lower mortality rates from CHD.7 Similar rapid decreases in risk with smoking cessation are also seen for ischemic stroke.8 9 Benefits from quitting are seen in former smokers even after many years of heavy smoking.2 Investigations also have demonstrated benefits from cessation for smokers who have already developed smoking-related diseases or symptoms. Persons with diagnosed CHD experience as much as a 50% reduction in risk of reinfarction, sudden cardiac death, and total mortality if they quit smoking after the initial infarction.10 11 Furthermore, the patient who has recently developed a clinical illness is very motivated to change, and several studies have shown that intervention in this “teachable moment” can be very effective. Thus, the provision of smoking cessation advice is associated with a 50% long-term (more than 1 year) smoking cessation rate in patients who have been hospitalized with a coronary event, and even modest telephone-based counseling can increase this percentage to ≥70% in …

The Society for the Promotion of Roman Studies, 1910–60

The events which led up to the formation of the Society are recorded in the history of the Hellenic Society written by Mr. George Macmillan and published with the Jubilee issue of the Hellenic Journal in 1929. We read that Dr. Ashby, Director of the British School at Rome, in the Session 1908–9, sent a memorandum to the Council of the Hellenic Society requesting it to approve the making of a grant comparable with that made to the British School at Athens. The Hellenic Society, unable to meet this request, recommended, on the advice of a special committee, that members of the Hellenic Society, the Classical Association and other bodies should be asked to approve the inclusion of Latin studies in the purview of the Hellenic Society with a corresponding increase in its annual subscription, or alternately, to support some other scheme which could command adequate financial support. The great majority replied that they were in favour of the creation of a new Society on the lines of the Hellenic Society, but for the promotion of Roman studies, and this solution was endorsed at a joint conference of the Hellenic Society, the British School at Rome and the Classical Association. The Hellenic Society most generously undertook to work in harmony and collaboration with the new Society and to offer it access to the Library, with the same facilities for borrowing books and slides as those enjoyed by its own members.

Thucydides and Sphacteria

Professor V. Wilamowitz-Moellendorf has recently published a paper in which he argues, firstly, that the very remarkable topographical errors in Thucydides' account of the Pylos and Sphacteria campaign, shown so clearly in Grundy's and Burrows' articles in the Hellenic Journal, can only be accounted for on the supposition that he had none but Athenian sources of information, and secondly, that as later— after 421—; he had access to Peloponnesian sources, his account of this campaign was written before 421; we have, therefore, an early example of Attic prose comparable with the oligarchic Constitution of Athens. Now seeing that the incident of the campaign which interested the contemporary Greeks most was the surrender of the Spartans, and that Thucydides goes out of his way, more Herodoteo rather, to give an anecdote (with explanation) to illustrate this interest, it would be sufficiently remarkable if he had not been to the trouble of getting the Spartan version of the affair; the more especially as Spartan sources were easily available in the prisoners themselves, who seem to have received at Athens the common treatment of that time, compounded of cruelty and freedom, which is so foreign to our own method, and to whom Thucydides could have had ready access. It is therefore worth while seeing if there is any reason for supposing Wilamowitz' view to be true.

Three Red-Figured Cups

The vase-painting published after a photograph in Pl. II. 1, and after a drawing in Fig. 1, has already been reproduced on p. 86 of my Vases in America; but it lost so much in reproduction that I considered it my duty to republish it as soon as possible in order to correct the unsatisfactory impression which the previous publication must have made: the editors of the Hellenic Journal have kindly offered me these pages for the purpose.The painting forms the internal decoration of a fragmentary red-figured cup found at Cervetri and now in the possession of Mr. Edward Warren at Lewes. The stem and foot of the cup are lost, but the stem at any rate was of the normal type. The exterior was undecorated.

The Pottery called Minyan Ware

The name ‘Minyan’ has recently been given to a kind of pottery which was first noticed at Orchomenos by Schliemann in 1881. In the report of his excavation which Schliemann contributed to the second volume of the Hellenic Journal, he carefully described the nature and position of this ware. ‘It is very remarkable that at Orchomenos painted pottery, with spirals and other Mycenean ornamentation, also cows with two long horns and the same variegated colours as at Mycenae, as well as goblets of the very same form and colour as at Mycenae, are generally only found down to a depth of about six feet below the surface of the ground, and that at a greater depth, monochrome, black, red, or yellow, hand-made or wheelmade pottery is found almost exclusively, analogous to some of that collected by me in the royal sepulchres at Mycenae. Very frequent here are the large hand-made black goblets or bowls, with a hollow foot and horizontal flutings in the middle, which I also found at Mycenae. . .

The Apoxyomenos of Lysippus

In the Hellenic Journal for 1903, while publishing some heads of Apollo, I took occasion to express my doubts as to the expediency of hereafter taking the Apoxyomenos as the norm of the works of Lysippus. These views, however, were not expressed in any detail, and occurring at the end of a paper devoted to other matters, have not attracted much attention from archaeologists. The subject is of great importance, since if my contention be justified, much of the history of Greek sculpture in the fourth century will have to be reconsidered. Being still convinced of the justice of the view which I took two years ago, I feel bound to bring it forward in more detail and with a fuller statement of reasons.Our knowledge of many of the sculptors of the fourth century, Praxiteles, Scopas, Bryaxis, Timotheus, and others, has been enormously enlarged during the last thirty years through our discovery of works proved by documentary evidence to have been either actually executed by them, or at least made under their direction. But in the case of Lysippus no such discovery was made until the very important identification of the Agias at Delphi as a copy of a statue by this master.

Note on the Mystica Vannus Iacchi

By the kindness of the Editor of the Annual I am allowed to append to Dr. Schäfer's paper a brief note on two monuments representing likna which came to my knowledge too late for publication in my last article in the Hellenic Journal on the Mystica Vannus lacchi.Dr. Schäfer's paper is naturally to me of great interestand importance. Egypt has yielded what would have been vainly sought for in Greece, namely an actual ancient liknon of precisely the shape so far evidenced only by representations in ancient art and by modern specimens. Mr. Bosanquet wrote to me last year from Berlin to tell me of the existence of such a liknon; and its publication by Dr. Schäfer in Fig. 15 of his paper makes further comment unnecessary.

Mystica Vannus Iacchi (continued)

I must ask the readers of the Hellenic Journal to take the somewhat disjointed notes that follow strictly for what they are, namely, addenda to my paper in last year's Journal (vol. xxiii. 1903) on the ‘Mystica Vannus Iacchi.’My object in writing that paper was to elucidate the mysticism of the ‘fan’ and thereby, I hoped, to throw some light on an obscure chapter in the history of Greek religion, namely the shift from the worship of Demeter to that of Dionysos. Incidentally it became necessary to examine the various forms of winnowing ‘fans.’ My personal interest in this necessary step in my argument was slight and my statement of evidence, I fear, inadequate and superficial. Since the appearance of the article many friendly critics have supplied me with material to fill the gaps left by my ignorance, and the examination of this material has not been without its use to me in clearing up some obscurities as to the mysticism of the fan.

Battles, Ancient and Modern

In the last number of the Hellenic Journal Professor Burrows has once more attacked Pylos and Sphakteria, this time with the aid of certain allies from the Peloponnese and a whole battery of photographs. I am, I confess, loth to dye this ink-stained field a deeper hue, and I have certainly no intention of sending friends of mine to Pylos with a view to reviving a controversy which has gone far enough. At the same time I do not wish to appear to undervalue the evidence of Messrs. Carr Bosanquet, Crowfoot, and Lindsay, though it is not of a very decisive character. I should therefore like to point out, as briefly as possible, its true bearing, and in doing so I have the satisfaction of not having to treat it as hostile, though brought into court by the other side.