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OBSTRUCTIVE SLEEP APNEA SYNDROME AS A CAUSE OF SECONDARY ARTERIAL HYPERTENSION IN YOUNG ADULTS
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Abstracts from 10th Congress of the European Federation of Internal Medicine/European Journal of Internal Medicine 22S (2011) S1–S112
and need for adrenaline, atropine and intubation were associated with poor outcomes. Witnessed arrests had favorable immediate outcome (p<0.01). In cases with primary respiratory arrests successful resuscitation was achieved in 90% and 1-year survival was 76%. There was no statistically significant difference in survival with increasing age. Conclusions: The initial, 1-month and 1-year survival following CPR were 37.9%, 24% and 16% respectively. Early recognition of critically ill patients, nursing in monitored areas and effective advanced life support training may be improving outcomes in our hospital.
QUALITY OF LIFE IN PATIENTS WITH PACEMAKER Esra Köroùlu1, Hatice Fesci2. 1Ankara University, Health Science Faculty, Nursing Department, Turkey; 2Gazi Ankara University, Health Science Faculty, Nursing Department, Turkey Pacemaker implantation, affecting the lives of patients with symptoms such as confusion, palpitations, fatigue, chest pain, dizziness, dyspnea gives a positive answer. On the other hand pacemaker leads to fear, limited social activities, depression, anxiety and negative effects in quality of life.This research was conducted to determine the quality of life in patients with pacemakers. The sample of the research was consisted of pacemaker patients admitted to the hospital at a metropol city in Turkey. Cause of number of the universe known, stratified random sampling method was used and 183 patients was selected. As a data collection tool, “Introductory Information Form” and “SF-36 Quality of Life Scale” was used. According to the results obtained from the research, quality of life of patients was affected by gender, age, education, working status, the situation of regularly come to control, patient education attainment about pacemaker (p> 0.05). 48.6% of the sample were women, 54.1% 61 years and older, 45.9% were primary school graduates, 75.4% are married. 35.3% of these individuals live 2-6 years with a pacemaker, 51.9% occasionally feel existence of pacemaker, 68.3% of them feel no restriction in the daily life, 69.9% received education related to pacemaker. As patients’ ages increased, their scores decreased in areas of quality of life. Nurses have a key role among medical staff in pacemaker clinics. Therefore nurses should evaluate the quality of life in patients with pacemaker and their psychosocial status regularly, provide education and counseling.
HEPATOCELLULAR CARCINOMA: CLINICAL CHARACTERISTICS OF THE DISEASE IN CENTRAL GREECE Eriola Koumati, Aggelos Stefos, Kalliopi Zachou, Georgia Papadamou, Eirini I. Rigopoulou, George N. Dalekos. Department of Medicine and Research Laboratory of Internal Medicine, Medical School, University of Thessaly, Larissa, Greece Background: Hepatocellular carcinoma (HCC) is a global health problem. It remains the 6th most common cancer and the 1st cause of death in cirrhotic patients. The aim of the study was the assessment of disease characteristics in Central Greece. Methods: Between 2000 and 2010, 117 patients were diagnosed with HCC in our referral centre. Epidemiological, clinical and laboratory characteristics were available and analysed retrospectively in 94 patients. Results: 82% of the patients were men (median age 66, range 33-87 years). 73.4% of the patients were cirrhotic in the first visit. Underlying liver disease was detected in 94.7%: 70/94 had chronic viral hepatitis, 51/94 alcohol abuse and 2/94 autoimmune hepatitis. At diagnosis, 4.3% of the patients were stage 0 according to BCLC classification, 11.7% stage A, 53.2% stage B, 23.4% stage C and 7.4% stage D. Treatment for HCC received 86/94. A single lesion, with a mean size of 5.1 cm (range 0.9 – 33.5 cm), was detected in 58.5%. The rest had multinodular HCC. Mean a-FP levels at diagnosis was 28.2 IU/ml (range 1.22-148610 IU/ml). Histopathological confirmation was available in 68.1%. 59/94 patients died from liver related disease (mean follow-up time 12 ± 16.8 months), 1/94 died from other reasons, 1/94 underwent liver transplantation and 5/94 were lost in follow-up. 28/94 are still in follow-up (mean follow-up time 24.5 ± 22.9 months). Conclusions: HCC has a high morbidity and mortality. In Central Greece, it is directly related with the high incidence of chronic viral hepatitis and the widespread use of alcohol.
OBSTRUCTIVE SLEEP APNEA SYNDROME AS A CAUSE OF SECONDARY ARTERIAL HYPERTENSION IN YOUNG ADULTS Dafni Koumoutsea1, Vasilios German1, Marios Dilanas1, Stavros Chrisanthopoulos2, Spyridon Kourouklis2, Konstantinos Psathakis3, Panagiotis Panagou3, Antonios Liolios1, Anastasios Galinas4, † Konstantinos Karamitsos4, Kyriakos Lazaridis2. 1First and Second Department of Internal Medicine, 401 General Military Hospital of Athens, Athens, Greece; 1 Department of Cardiology, 401 General Military Hospital of Athens, Athens, Greece; 3Department of Pulmonary Medicine, 401 General Military Hospital of Athens, Athens, Greece; 4Department of Nephrology (Renal Medicine), 401 General Military Hospital of Athens, Athens, Greece Background/Aim: The diagnosis of Sleep Apnea Syndrome as a cause of Secondary Arterial Hypertension in young adult recruits, which is related to the obstruction of upper airway in this particular age-related group, raised the following significant issue: whether we should potentially examine and assess the upper respiratory tract in all young adults with arterial hypertension (in the entirety of hypertensive young adults), because of some certain particularities of our demographic sample. Materials - Methods: During a long-lasting period of almost eight years, 298 recruits/soldiers with a mean age of 22,3±3,4 years (18-26) were admitted to the internal medicine, cardiology and renal medicine departments of our hospital with clinical suspicion of secondary hypertension for further investigation. These soldiers underwent detailed physical examination as well as detailed diagnostic evaluation which included complete and specific laboratory tests as well as other additional specialized laboratory investigation. The clinical suspicion of secondary hypertension was finally confirmed in 49 military recruits/soldiers. In the above group, eleven (11) cases of Sleep Apnea Syndrome were diagnosed. The diagnosis of Sleep Apnea Syndrome was established by Polysomnographic Study of Sleep (Polysomnography) which was held in the certified and accredited Laboratory of Sleep in the Department of Pulmonary Medicine of our hospital. Among the eleven (11) patients with Sleep Apnea Syndrome, eight (8) patients had Obstructive Sleep Apnea due to certain anatomical abnormalities of upper respiratory tract and obstruction of upper airway [abnormally large or massive tonsils, massive uvula, massive tongue, tied tongue (ankyloglossia), high narrow nose, massive tori, elongated soft palate, high palate – upper dental narrow arch etc.]. The remaining three (3) cases of patients had Central Type Sleep Apnea. All of them were obese (BMI: 33,7 kgr/m2, 36,3 kgr/m2 and 37,8 kgr/m2) with abdominal (visceral) type of obesity. All of them were judged unsuitable for military commitment and they did not join the army. The eight (8) hypertensive patients with anatomical abnormalities of upper respiratory tract and Obstructive Sleep Apnea Syndrome underwent specific surgical interventions (operations) of correction and restoration of their anatomical abnormalities with permanent surgical removal of upper airway obstruction. Results: After permanent surgical removal of upper airway obstruction had been achieved, during a long-lasting postoperative period of 9-months follow up, we realized that the arterial blood pressure levels were within normal range in all of our patients. Postoperatively, all patients were absolutely normotensive. The causes of Secondary Hypertension in 49 military recruits/ soldiers are shown below: 1) Chronic Glomerulonephritis (renal parenchymal hypertension): 25 patients (51,02%), 2) Sleep Apnea Syndrome: 11 (22,44%), 3) Aortic Isthmus Stenosis: 4 (8,16%), 4) Polycystic Kidney Disease (renal parenchymal hypertension): 4 (8,16%), 5) Primary Hyperaldosteronism: 2 (4,08%), 6) Lupus Nephritis: 1 patient (2,04%), 7) Systemic Vasculitis (Polyarteritis Nodosa): 1, 8) Liddle Syndrome: 1. Conclusions: After we had carefully reviewed the relevant current international literature, we realized that the correlation of Obstructive Sleep Apnea Syndrome with Secondary Arterial Hypertension has not been fully investigated and is not sufficiently focused on this particular age-related group as well as on this particular demographic sample (young adult recruits) with its entirely special clinical characteristics. Sleep Apnea Syndrome remains a potentially life-threatening condition and very significant public health burden. It is of the utmost vital importance to consider the diagnosis of Obstructive Sleep Apnea Syndrome in all hypertensive young adults with anatomical abnormalities of the upper respiratory tract, when there is a strong clinical suspicion of Secondary Arterial Hypertension.
Abstracts from 10th Congress of the European Federation of Internal Medicine/European Journal of Internal Medicine 22S (2011) S1–S112
and need for adrenaline, atropine and intubation were associated with poor outcomes. Witnessed arrests had favorable immediate outcome (p<0.01). In cases with primary respiratory arrests successful resuscitation was achieved in 90% and 1-year survival was 76%. There was no statistically significant difference in survival with increasing age. Conclusions: The initial, 1-month and 1-year survival following CPR were 37.9%, 24% and 16% respectively. Early recognition of critically ill patients, nursing in monitored areas and effective advanced life support training may be improving outcomes in our hospital.
QUALITY OF LIFE IN PATIENTS WITH PACEMAKER Esra Köroùlu1, Hatice Fesci2. 1Ankara University, Health Science Faculty, Nursing Department, Turkey; 2Gazi Ankara University, Health Science Faculty, Nursing Department, Turkey Pacemaker implantation, affecting the lives of patients with symptoms such as confusion, palpitations, fatigue, chest pain, dizziness, dyspnea gives a positive answer. On the other hand pacemaker leads to fear, limited social activities, depression, anxiety and negative effects in quality of life.This research was conducted to determine the quality of life in patients with pacemakers. The sample of the research was consisted of pacemaker patients admitted to the hospital at a metropol city in Turkey. Cause of number of the universe known, stratified random sampling method was used and 183 patients was selected. As a data collection tool, “Introductory Information Form” and “SF-36 Quality of Life Scale” was used. According to the results obtained from the research, quality of life of patients was affected by gender, age, education, working status, the situation of regularly come to control, patient education attainment about pacemaker (p> 0.05). 48.6% of the sample were women, 54.1% 61 years and older, 45.9% were primary school graduates, 75.4% are married. 35.3% of these individuals live 2-6 years with a pacemaker, 51.9% occasionally feel existence of pacemaker, 68.3% of them feel no restriction in the daily life, 69.9% received education related to pacemaker. As patients’ ages increased, their scores decreased in areas of quality of life. Nurses have a key role among medical staff in pacemaker clinics. Therefore nurses should evaluate the quality of life in patients with pacemaker and their psychosocial status regularly, provide education and counseling.
HEPATOCELLULAR CARCINOMA: CLINICAL CHARACTERISTICS OF THE DISEASE IN CENTRAL GREECE Eriola Koumati, Aggelos Stefos, Kalliopi Zachou, Georgia Papadamou, Eirini I. Rigopoulou, George N. Dalekos. Department of Medicine and Research Laboratory of Internal Medicine, Medical School, University of Thessaly, Larissa, Greece Background: Hepatocellular carcinoma (HCC) is a global health problem. It remains the 6th most common cancer and the 1st cause of death in cirrhotic patients. The aim of the study was the assessment of disease characteristics in Central Greece. Methods: Between 2000 and 2010, 117 patients were diagnosed with HCC in our referral centre. Epidemiological, clinical and laboratory characteristics were available and analysed retrospectively in 94 patients. Results: 82% of the patients were men (median age 66, range 33-87 years). 73.4% of the patients were cirrhotic in the first visit. Underlying liver disease was detected in 94.7%: 70/94 had chronic viral hepatitis, 51/94 alcohol abuse and 2/94 autoimmune hepatitis. At diagnosis, 4.3% of the patients were stage 0 according to BCLC classification, 11.7% stage A, 53.2% stage B, 23.4% stage C and 7.4% stage D. Treatment for HCC received 86/94. A single lesion, with a mean size of 5.1 cm (range 0.9 – 33.5 cm), was detected in 58.5%. The rest had multinodular HCC. Mean a-FP levels at diagnosis was 28.2 IU/ml (range 1.22-148610 IU/ml). Histopathological confirmation was available in 68.1%. 59/94 patients died from liver related disease (mean follow-up time 12 ± 16.8 months), 1/94 died from other reasons, 1/94 underwent liver transplantation and 5/94 were lost in follow-up. 28/94 are still in follow-up (mean follow-up time 24.5 ± 22.9 months). Conclusions: HCC has a high morbidity and mortality. In Central Greece, it is directly related with the high incidence of chronic viral hepatitis and the widespread use of alcohol.
OBSTRUCTIVE SLEEP APNEA SYNDROME AS A CAUSE OF SECONDARY ARTERIAL HYPERTENSION IN YOUNG ADULTS Dafni Koumoutsea1, Vasilios German1, Marios Dilanas1, Stavros Chrisanthopoulos2, Spyridon Kourouklis2, Konstantinos Psathakis3, Panagiotis Panagou3, Antonios Liolios1, Anastasios Galinas4, † Konstantinos Karamitsos4, Kyriakos Lazaridis2. 1First and Second Department of Internal Medicine, 401 General Military Hospital of Athens, Athens, Greece; 1 Department of Cardiology, 401 General Military Hospital of Athens, Athens, Greece; 3Department of Pulmonary Medicine, 401 General Military Hospital of Athens, Athens, Greece; 4Department of Nephrology (Renal Medicine), 401 General Military Hospital of Athens, Athens, Greece Background/Aim: The diagnosis of Sleep Apnea Syndrome as a cause of Secondary Arterial Hypertension in young adult recruits, which is related to the obstruction of upper airway in this particular age-related group, raised the following significant issue: whether we should potentially examine and assess the upper respiratory tract in all young adults with arterial hypertension (in the entirety of hypertensive young adults), because of some certain particularities of our demographic sample. Materials - Methods: During a long-lasting period of almost eight years, 298 recruits/soldiers with a mean age of 22,3±3,4 years (18-26) were admitted to the internal medicine, cardiology and renal medicine departments of our hospital with clinical suspicion of secondary hypertension for further investigation. These soldiers underwent detailed physical examination as well as detailed diagnostic evaluation which included complete and specific laboratory tests as well as other additional specialized laboratory investigation. The clinical suspicion of secondary hypertension was finally confirmed in 49 military recruits/soldiers. In the above group, eleven (11) cases of Sleep Apnea Syndrome were diagnosed. The diagnosis of Sleep Apnea Syndrome was established by Polysomnographic Study of Sleep (Polysomnography) which was held in the certified and accredited Laboratory of Sleep in the Department of Pulmonary Medicine of our hospital. Among the eleven (11) patients with Sleep Apnea Syndrome, eight (8) patients had Obstructive Sleep Apnea due to certain anatomical abnormalities of upper respiratory tract and obstruction of upper airway [abnormally large or massive tonsils, massive uvula, massive tongue, tied tongue (ankyloglossia), high narrow nose, massive tori, elongated soft palate, high palate – upper dental narrow arch etc.]. The remaining three (3) cases of patients had Central Type Sleep Apnea. All of them were obese (BMI: 33,7 kgr/m2, 36,3 kgr/m2 and 37,8 kgr/m2) with abdominal (visceral) type of obesity. All of them were judged unsuitable for military commitment and they did not join the army. The eight (8) hypertensive patients with anatomical abnormalities of upper respiratory tract and Obstructive Sleep Apnea Syndrome underwent specific surgical interventions (operations) of correction and restoration of their anatomical abnormalities with permanent surgical removal of upper airway obstruction. Results: After permanent surgical removal of upper airway obstruction had been achieved, during a long-lasting postoperative period of 9-months follow up, we realized that the arterial blood pressure levels were within normal range in all of our patients. Postoperatively, all patients were absolutely normotensive. The causes of Secondary Hypertension in 49 military recruits/ soldiers are shown below: 1) Chronic Glomerulonephritis (renal parenchymal hypertension): 25 patients (51,02%), 2) Sleep Apnea Syndrome: 11 (22,44%), 3) Aortic Isthmus Stenosis: 4 (8,16%), 4) Polycystic Kidney Disease (renal parenchymal hypertension): 4 (8,16%), 5) Primary Hyperaldosteronism: 2 (4,08%), 6) Lupus Nephritis: 1 patient (2,04%), 7) Systemic Vasculitis (Polyarteritis Nodosa): 1, 8) Liddle Syndrome: 1. Conclusions: After we had carefully reviewed the relevant current international literature, we realized that the correlation of Obstructive Sleep Apnea Syndrome with Secondary Arterial Hypertension has not been fully investigated and is not sufficiently focused on this particular age-related group as well as on this particular demographic sample (young adult recruits) with its entirely special clinical characteristics. Sleep Apnea Syndrome remains a potentially life-threatening condition and very significant public health burden. It is of the utmost vital importance to consider the diagnosis of Obstructive Sleep Apnea Syndrome in all hypertensive young adults with anatomical abnormalities of the upper respiratory tract, when there is a strong clinical suspicion of Secondary Arterial Hypertension.