Effects of an awareness symposium on perception of Libyan physicians regarding telemedicine.

The awareness of health care providers, particularly physicians, towards telemedicine is pivotal to its development. In this study we distributed questionnaires among Libyan physicians attending a medical symposium on telemedicine, held in the period 28 February-1 March, 2005. The sample comprised 28 males and 13 females from different specialties and from different parts of the country. Most reported being confused (53.7%) or unaware (14.6%) regarding telemedicine before the symposium. Afterwards, 12.2% were confused, 39.0% showed excellent understanding and 48.8% reported fair understanding; 97.6% supported the implementation of telemedicine in the country and appreciated the importance of establishing remote health services.

Reversible cortical blindness following successful surgical repair of two stab wounds in the heart.

This report describes a case of cortical blindness that followed successful surgical repair of two stab wounds in the heart in a 29-year old Libyan man. The patient presented in a state of pre cardiac arrest (shock and low cardiac output status), following multiple chest stab wounds. Chest tube was immediately inserted. Surgery was urgently performed suturing the two wounds; in the root of the aorta and in the left ventricle, and haemostasis was secured. Cardiac arrest was successfully prevented. The patient recovered smoothly, but 24 hours later he declared total blindness. Ophtalmic and neurological examinations and investigations that included fundoscopy, Electroencephalograms (EEGs) and Computed Tomography Scans revealed no abnormalities, apart from absence of alpha waves in the EEGs. We diagnosed the case as cortical blindness and continued caring for the patient conservatively. Three days later, the patient regained his vision gradually and was discharged on the 7(th) postoperative day without any remarks.

Effects of an awareness symposium on perception of Libyan physicians regarding telemedicine

The awareness of health care providers, particularly physicians, towards telemedicine is pivotal to its development. In this study we distributed questionnaires among Libyan physicians attending a medical symposium on telemedicine, held in the period 28 February-1 March, 2005. The sample comprised 28 males and 13 females from different specialties and from different parts of the country. Most reported being confused [53.7%] or unaware [14.6%] regarding telemedicine before the symposium. Afterwards, 12.2% were confused, 39.0% showed excellent understanding and 48.8% reported fair understanding; 97.6% supported the implementation of telemedicine in the country and appreciated the importance of establishing remote health services

Reversible Cortical Blindness Following Successful Surgical Repair of Two Wounds in the Heart

This report describes a case of cortical blindness that followed successful surgical repair of two stab wounds in the heart in a 29-year old Libyan man. The patient presented in a state of pre cardiac arrest (shock and low cardiac output status); following multiple chest stab wounds. Chest tube was immediately inserted. Surgery was urgently performed suturing the two wounds; in the root of the aorta and in the left ventricle; and haemostasis was secured. Cardiac arrest was successfully prevented. The patient recovered smoothly; but 24 hours later he declared total blindness. Ophtalmic and neurological examinations and investigations that included fundoscopy; Electroencephalograms (EEGs) and Computed Tomography Scans revealed no abnormalities; apart from absence of alpha waves in the EEGs. We diagnosed the case as cortical blindness and continued caring for the patient conservatively. Three days later; the patient regained his vision gradually and was discharged on the 7th postoperative day without any remarks

Ultrasound wall-sign in pulmonary echinococcosis (new application).

PURPOSE: We report our experience in diagnosing pulmonary cystic echinococcosis using an ultrasound sign related to the cystic wall. MATERIALS AND METHODS: 40 patients with 46 cysts, suspected of pulmonary echinococcosis, based on plain chest radiographs and clinical findings, were examined by ultrasound over a 9-year period (1996 - 2004), and followed up until discharge. We applied our long experience with echinococcal cysts utilising the wall sign (WS) to diagnose pulmonary hydatid disease. All cysts were subject to surgical removal, and postoperative histopathology was the gold standard. RESULTS: There were 34 (74 %) unilocular and 12 (26 %) multivesicular echinococcal cysts. In the univesicular cysts, the WS was found in 20 cases (66.7 %) while it was present in all multivesicular cysts (100 %). Following surgical removal, echinococcosis was confirmed by histopathology in all cases. CONCLUSION: We conclude that a double layered border in univesicular and double layered internal septum in multivesicular pulmonary echinococcal cysts is a reliable indicator of pulmonary echinococcosis, with a specificity of 66 % and 100 %, respectively.

[Patient archiving and communication systems: an example of the clinical application of information technology].

The applications of patient archiving and communication systems have increased lately, particularly since the medical imaging companies began to distribute the software along with machines. These systems are very important in developing clinical work, particularly in critical care, for example following cardiac surgery. This paper describes these systems and explores how they work, as an example of the application of information technology in developing clinical work, and critical care in particular.

Tetra-layered sign of adult intussusception (new ultrasound approach).

Two-dimensional ultrasound is the principle method for the detection of intussusception. The aim of this study was to establish a pathognominic ultrasound criterion for diagnosing intestinal intussusception to facilitate a proper clinical decision. We have developed a new approach to diagnosing colonic intussuception based on the hypothesis that ultrasound image of the invaginated segment should reveal four border layers. We called this sign tetra-layered sign (TLS). In a prospective manner, all adult patients diagnosed with intussusception using the TLS approach in the period from July 1990 and July 2005 were included in this study. All patients underwent explorative laparotomy, and our preoperative diagnoses were compared with the surgical outcome. Thirty patients were diagnosed with intestinal intussusception using the TLS ultrasound sign. Surgery confirmed the preoperative diagnosis in all cases. Conventional ultrasound is very reliable in diagnosing intestinal intussusception in adult patients when utilizing the simple ultrasound applicable TLS. This facilitates the decision-making, improves the clinical outcome and reduces the associated costs.

[Patient archiving and communication systems: an example of the clinical application of information technology]

The applications of patient archiving and communication systems have increased lately, particularly since the medical imaging companies began to distribute the software along with machines. These systems are very important in developing clinical work, particularly in critical care, for example following cardiac surgery. This paper describes these systems and explores how they work, as an example of the application of information technology in developing clinical work, and critical care in particular

Relationship between depression and non-adherence to anticoagulant therapy after valve replacement.

Management of anticoagulant therapy after mechanical valve replacement is difficult in developing countries because of patient non-adherence. The effect of depression on adherence to drug therapy and to a clinic visit schedule was evaluated for 62 patients who received prostheses. All were prescribed a once-per-day regimen of warfarin and were scheduled for three appointments at the anticoagulant clinic for dose adjustment at 3-week intervals. According to the Center for Epidemiological Studies Depression Scale, 22 were depressed. Non-depressed patients were more compliant than depressed patients; adherence was inversely correlated with depression scores. While depression had no relationship with age, sex and cardiac symptoms, there was a relationship with anxiety and poor social support.

Relationship between depression and non-adherence to anticoagulant therapy after valve replacement

Management of anticoagulant therapy after mechanical valve replacement is difficult in developing countries because of patient non-adherence. The effect of depression on adherence to drug therapy and to a clinic visit schedule was evaluated for 62 patients who received prostheses. All were prescribed a once-per-day regimen of warfarin and were scheduled for three appointments at the anticoagulant clinic for dose adjustment at 3-week intervals. According to the Center for Epidemiological Studies Depression Scale, 22 were depressed. Non-depressed patients were more compliant than depressed patients; adherence was inversely correlated with depression scores. While depression had no relationship with age, sex and cardiac symptoms, there was a relationship with anxiety and poor social support

Atypical bronchial carcinoid tumour with amyloid deposition.

The rare association of carcinoid tumors and amyloid deposition has previously been reported. A case of amyloid deposition associated with bronchial carcinoid tumor is presented. The clinical and histopathological findings are discussed.

Assessment of myocardial damage by circulating cardiac myosin light chain I after heart transplantation.

The purpose of this study was to evaluate the cardiac damage by cardiac myosin light chain I after transplantation. This study included 30 patients who underwent cardiac operations and who were divided into three groups. These groups consisted of (1) control group, 15 valvular patients without coronary disease (no electrocardiography changes and creatine kinase MB isoenzyme of 100 micrograms/L or less); (2) infarction group, eight patients (six coronary bypass and two valvular patients with perioperative infarction pattern in the electrocardiography and creatine kinase MB isoenzyme of 100 micrograms/L or more; and (3) transplantation group, seven transplant patients (six heart and one heart-lung). The peak cardiac myosin light chain I value in the transplantation group (32.9 +/- 3.4 micrograms/L) was comparable to the infarction group (27.6 +/- 2.6 micrograms/L), and both of them were significantly higher than the control group (9.2 +/- 0.9 micrograms/L) (p < 0.01). Peak cardiac myosin light chain I levels in the control and transplantation groups correlated with the ischemic time (r = 0.48, p < 0.05 and r = 0.67, p < 0.05, respectively). The total dose of dopamine in the transplantation group correlated with the peak cardiac myosin light chain I (r = 0.67, p < 0.05), and with the cardiac myosin light chain I value on day 7 (r = 0.88, p < 0.01). This study suggests that circulating cardiac myosin light chain I estimations are useful to evaluate myocardial damage after transplantation during postoperative week 1.

Detection of perioperative myocardial structural damage by the estimation of cardiac myosin light chain I.

The accurate estimation of myocardial damage is desirable for the assessment of myocardial protection and surgical treatments. The purpose of the study was to estimate myocardial damage by measuring cardiac myosin light chain I (CMLCI). Forty-nine patients undergoing cardiac surgery (for angina or valvular disease) were arbitrarily divided into four groups according to the maximum CMLCI level. Group 1: max CMLCI < 10 micrograms/L (37%); Group 2: max CMLCI 10-20 micrograms/L (39%); Group 3: max CMLCI 20-30 micrograms/L (16%); Group 4: max CMLCI > 30 micrograms/L (8%). Electrocardiogram (ECG) and serum creatine kinase MB isoenzyme (CK-MB) were conventionally used as standards of myocardial damage, and compared with CMLCI. Perioperative myocardial infarction, injury and minimum damage were determined by combinations of ECG pattern changes and CK-MB levels. The max CMLCI level was usually seen on the third postoperative day. None of the patients in group 1 had any ECG changes. The number of patients with ECG changes was much higher as the max CMLCI level increased, and evidently increased when the max CMLCI was over 20 micrograms/L. The number of patients with high CK-MB > 100 micrograms/L followed the same pattern. Furthermore, perioperative infarction was only seen when the max CMLCI was > 30 micrograms/L. The peak CMLCI level was significantly higher in the infarction group than injury and minimum damage groups. This study showed that CMLCI was able to estimate the actual extent and severity of the myocardial damage and enhanced the diagnosis of perioperative infarction.

The influence of heparin-coated and uncoated extracorporeal circuits on blood rheology during cardiac surgery.

The effect of heparin-coated perfusion circuits on blood trauma during clinical cardiopulmonary bypass (CPB) was studied in order to find out if traumatic changes in the blood could be minimized. Twenty-four patients undergoing coronary artery bypass surgery were randomized prospectively to CPB with heparin-coated circuits (HCC) or non-coated circuits (NCC). The trauma to blood was assessed by measuring damage to blood cells by estimating red and white cell rheology changes. These were measured as red cell filtration rate (RFR) and white cell filtration rate (WFR) using standard microfiltration methods. Furthermore, changes in plasma hemoglobin (P-Hb), whole blood and plasma viscosity were simultaneously assessed. The RFR was significantly reduced in both groups during CPB by 10% in the HCC and 32% in the NCC groups (p less than 0.01). When comparing the HCC and NCC groups, a significant difference was first seen after 30 minutes of bypass (p less than 0.05) and increased at the end of CPB (p less than 0.01). Similar results were seen regarding WFR (15% and 36%, p less than 0.01). After 30 minutes of bypass, a significant difference was seen between HCC and NCC groups (p less than 0.05). Furthermore, a significant increase in P-Hb levels were seen during CPB in both patient groups. At the end of CPB, there was a significant difference in P-Hb levels (HCC 305+/-90 mg/L; NCC 455+/-78 mg/L, p less than 0.01) when comparing the two groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Influence of alprostadil on pulmonary dysfunction after a cardiac operation.

To test the effects of alprostadil on pulmonary dysfunction after cardiac operations, we studied 24 male patients undergoing aortocoronary bypass. Twelve were given an intravenous infusion of alprostadil (synthetic prostaglandin E1), 20 ng.kg-1.min-1, in a double-blind manner during operation; the other 12 were controls. Duration of artificial respirator use and frequent blood gas analyses were used to assess postoperative pulmonary function. Use of the artificial respirator postoperatively was significantly lower in the prostaglandin group (mean time. 5.25 +/- 1.81 hours) compared with the controls (mean time, 8.34 +/- 4.35 hours) (p = 0.047). The proportion of patients with hypercapnia and with hypoxia determined every 4 hours for the first 24 hours after extubation was significantly lower in the prostaglandin group compared with the controls (p less than 0.0001). These results indicate that synthetic prostaglandin E1 may play a role in protecting lung tissue during extracorporeal circulation.

The influence of age on the durability of Carpentier-Edwards biological valves. Thirteen years follow-up.

Two hundred and ninety-nine patients received 325 Carpentier-Edwards biological valves from April 1976 to April 1982. Valves were placed in the following positions: 150 aortic (AVR), 120 mitral (MVR), 26 multiple (MR), 2 pulmonary (PR) and 1 tricuspid (TR). The mean age was 54.7 years. The total follow-up time was 2545 patient-years. Patients were divided into different age groups: less than 40, 40-49, 50-59, 60-69 and greater than 70 years and were followed-up for reoperations and tissue failure. Ninety-three operations were performed in 91 patients (30.5%) for valve related dysfunctions. The main cause of reoperation was primary tissue failure (85%). The respective incidence and risk of reoperation in the different age groups were 51.5% and 5%, 41.5% and 4%, 32% and 3%, 18% and 2.5%, and 0% for greater than 70 years of age. The risk of reoperation decreased significantly with increasing age (P less than 0.05). The respective incidence and risk of tissue failure in the age groups were 43.8% and 4.1%, 35% and 4%, 27.3% and 3.2%, and 17.2%, 2.4% and 0%. The freedom from reoperation and tissue failure was significantly higher in the older patient (greater than 60 years) compared to the younger patients (less than 60 years). The commonest cause of failure in young patients was calcification, while in older patients it was cusp rupture. Comparing aortic and mitral bioprostheses in the different age groups showed no difference between these valves in patients less than 50 years of age.(ABSTRACT TRUNCATED AT 250 WORDS)