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Search Results: 1 - 10 of 3140 matches for " Christina Routsi "
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Postpartum fatal cerebral vein thrombosis: A case report and review  [PDF]
Marina Kontogiorgi, Vasiliki Kalodimou, Spyros Kollias, Demetrios Exarchos, Serafim Nanas, Abraham Ghiatas, Christina Routsi
Open Journal of Clinical Diagnostics (OJCD) , 2012, DOI: 10.4236/ojcd.2012.21001
Abstract: Background: Cerebral vein thrombosis, is an emergent condition presenting with a variety of symptoms ranging from isolated headache to profound coma. Case Presentation: We present the case of a previously healthy young woman on the 18th postpartum day admitted into our hospital with a persistent headache for three days followed by seizures and coma. Magnetic Resonance Angiography revealed superior sagittal sinus and right transverse sinus thrombosis. Despite supportive measures and anticoagulation, the patient died because of uncontrolled increase in intracranial pressure. Conclusion: The possibility of cerebral vein thrombosis should be considered in all women with brain dysfunction during the puerperium.
Causes of admission of young adult 18-30 years old in Intensive Care Unit
Vasilios Tziallas,Christina Routsi,Christina Marvaki,Maria Polikandrioti
To Vima tou Asklipiou , 2010,
Abstract: Admission of young adult in Intensive Care Unit (ICU) consists a complex phenomenon with various dimensions.The aim of the present study was to explore the causes of admission in Intensive Care Unit of young adult 18-30 years old according to their demographic variables.Method and material: The sample of the present study consisted of individuals’ age 18-30 years old that were hospitalized in Intensive Care Unit during 2005-07. Data was collected by the use of a specially designed clinical protocol which besides the demographic data included variables related to the causes of admission, the duration of treatment as well as the outcome of the disease. For the analysis of data the statistical packet SPSS v.13 was used and the method x2.Results: 74,9% of the sample studied was men and the 25,1% women. Regarding nationality, 78,4% were Greek whereas 21,6% were foreigners. The fist reason of admission in ICU was road accidents with percentage 59,4%, pathological problems followed with 14,1%, the post-operative period with 9,8%, work accidents with 5%, criminal actions with 4,2%, suicide attempt with 4% and the use of drugs with 3,5%. The statistical analysis of data showed that : regarding the relation of admission to marital status and occupation, students, private employees and free-lancers who were not married were more likely to be involved in road accident, p<0,001. The foreigners were admitted more frequently because of work accidents and criminal actions with statistical significant difference compared to Greeks, p<0,001, respectively. On the contrary, Greeks admitted less frequently because of suicide and pathological problems with statistical significant difference compared to foreigners, p<0,001, respectively.Conclusions: Social and demographic variables significantly affect admission of young in Intensive Care Unit.
Nitroglycerin can facilitate weaning of difficult-to-wean chronic obstructive pulmonary disease patients: a prospective interventional non-randomized study
Christina Routsi, Ioannis Stanopoulos, Epaminondas Zakynthinos, Panagiotis Politis, Vassilios Papas, Demetrios Zervakis, Spyros Zakynthinos
Critical Care , 2010, DOI: 10.1186/cc9326
Abstract: Twelve difficult-to-wean (failed ≥ 3 consecutive trials) chronic obstructive pulmonary disease patients, who presented systemic arterial hypertension (systolic blood pressure ≥ 140mmHg) during weaning failure and had systemic and pulmonary artery catheters in place, participated in this prospective, interventional, non-randomized clinical trial. Patients were studied in two consecutive days, i.e., the first day without (Control day) and the second day with (Study day) nitroglycerin continuous intravenous infusion starting at the beginning of the spontaneous breathing trial, and titrated to maintain normal systolic blood pressure. Hemodynamic, oxygenation and respiratory measurements were performed on mechanical ventilation, and during a 2-hour T-piece spontaneous breathing trial. Primary endpoint was hemodynamic and respiratory effects of nitroglycerin infusion. Secondary endpoint was spontaneous breathing trial and extubation outcome.Compared to mechanical ventilation, mean systemic arterial pressure, rate-pressure product, mean pulmonary arterial pressure, and pulmonary artery occlusion pressure increased [from (mean ± SD) 94 ± 14, 13708 ± 3166, 29.9 ± 4.8, and 14.8 ± 3.8 to 109 ± 20mmHg, 19856 ± 4877mmHg b/min, 41.6 ± 5.8mmHg, and 23.4 ± 7.4 mmHg, respectively], and mixed venous oxygen saturation decreased (from 75.7 ± 3.5 to 69.3 ± 7.5%) during failing trials on Control day, whereas they did not change on Study day. Venous admixture increased throughout the trial on both Control day and Study day, but this increase was lower on Study day. Whereas weaning failed in all patients on Control day, nitroglycerin administration on Study day enabled a successful spontaneous breathing trial and extubation in 92% and 88% of patients, respectively.In this clinical setting, nitroglycerin infusion can expedite the weaning by restoring weaning-induced cardiovascular compromise.In patients with chronic obstructive pulmonary disease (COPD), the rate of weaning failure is high (
Primary right atrium angiosarcoma mimicking pericarditis
Marina Kontogiorgi, Demetrios Exarchos, Christos Charitos, Ioannis Floros, Demetra Rontogianni, Charis Roussos, Christina Routsi
World Journal of Surgical Oncology , 2007, DOI: 10.1186/1477-7819-5-120
Abstract: We present a case of a young male who was transferred to our hospital because of shock and multiple organ failure after a complicated pericardial biopsy. During the previous seven months he presented with recurrent episodes of pericardial effusions and tamponade. Chest computed tomography revealed a mass in the right atrium, infiltrating the myocardium and pericardium. During emergency surgery that followed, the patient died because of uncontrolled hemorrhage. Autopsy revealed the mass of the right atrium, which was identified on histological examination as primary cardiac angiosarcoma.This case highlights the difficulties both in early diagnosis and in the management of patients with cardiac angiosarcoma.Primary tumors of the heart are extremely rare and the majority of them are benign [1-7]. Angiosarcoma is the most common primary malignant tumor in adults. It is a highly aggressive tumor characterized by a predilection in the right side of the heart, a short clinical course and a fatal outcome. Because of nonspecific clinical presentation early diagnosis is difficult. We report a case of right atrial angiosarcoma that presented with recurrent pericardial effusions and cardiac tamponade.A 29-year-old male patient was transferred to our Intensive Care Unit (ICU) from another hospital, because of shock and multiple organ failure after a complicated pericardial biopsy. Seven months before, after a syncopal episode, he had been diagnosed with cardiac tamponade diagnosed by a transthoracic echocardiogram (TEE). Subxiphoidal drainage of 700 ml hemorrhagic fluid was performed resulting in hemodynamic stabilization. Cytologic examination of the fluid was negative for malignancy. Pericarditis was diagnosed caused by chlamydia; azithromycin and anti-inflammatory drugs were administered. For the next four months the patient was relatively well except for complain of easy fatigue. From that point on, he gradually presented dyspnea on exertion, along with pain in the back and
Electrical muscle stimulation prevents critical illness polyneuromyopathy: a randomized parallel intervention trial
Christina Routsi, Vasiliki Gerovasili, Ioannis Vasileiadis, Eleftherios Karatzanos, Theodore Pitsolis, Elli Tripodaki, Vasiliki Markaki, Dimitrios Zervakis, Serafim Nanas
Critical Care , 2010, DOI: 10.1186/cc8987
Abstract: One hundred and forty consecutive critically ill patients with an APACHE II score ≥ 13 were randomly assigned after stratification to the EMS group (n = 68) (age:61 ± 19 years) (APACHE II:18 ± 4, SOFA:9 ± 3) or to the control group (n = 72) (age:58 ± 18 years) (APACHE II:18 ± 5, SOFA:9 ± 3). Patients of the EMS group received daily EMS sessions. CIPNM was diagnosed clinically with the medical research council (MRC) scale for muscle strength (maximum score 60, <48/60 cut off for diagnosis) by two unblinded independent investigators. Duration of weaning from mechanical ventilation and intensive care unit (ICU) stay were recorded.Fifty two patients could be finally evaluated with MRC; 24 in the EMS group and 28 in the control group. CIPNM was diagnosed in 3 patients in the EMS group as compared to 11 patients in the control group (OR = 0.22; CI: 0.05 to 0.92, P = 0.04). The MRC score was significantly higher in patients of the EMS group as compared to the control group [58 (33 to 60) vs. 52 (2 to 60) respectively, median (range), P = 0.04). The weaning period was statistically significantly shorter in patients of the EMS group vs. the control group [1 (0 to 10) days vs. 3 (0 to 44) days, respectively, median (range), P = 0.003].This study suggests that daily EMS sessions prevent the development of CIPNM in critically ill patients and also result in shorter duration of weaning. Further studies should evaluate which patients benefit more from EMS and explore the EMS characteristics most appropriate for preventing CIPNM.ClinicalTrials.gov NCT00882830Critical illness polyneuromyopathy (CIPNM) is an acquired neuromuscular disorder observed in survivors of acute critical illness. It is characterized by profound muscle weakness and diminished or absent deep tendon reflexes [1] and is associated with delayed weaning from mechanical ventilation [2] suggesting a possible relation between limb and respiratory neuromuscular involvement. In addition, the syndrome is associated with
Maximum inspiratory pressure, a surrogate parameter for the assessment of ICU-acquired weakness
Georgios Tzanis, Ioannis Vasileiadis, Dimitrios Zervakis, Eleftherios Karatzanos, Stavros Dimopoulos, Theodore Pitsolis, Elli Tripodaki, Vasiliki Gerovasili, Christina Routsi, Serafim Nanas
BMC Anesthesiology , 2011, DOI: 10.1186/1471-2253-11-14
Abstract: Seventy-four patients were recruited in the study and prospectively evaluated in a multidisciplinary university ICU towards the appearance of ICU-AW. APACHE II admission score was 16 ± 6 and ICU stay 26 ± 18 days. ICU-AW was diagnosed with the Medical Research Council (MRC) scale for the clinical evaluation of muscle strength. MIP was measured using the unidirectional valve method, independently of the patients' ability to cooperate.A significant correlation was found between MIP and MRC (r = 0.68, p < 0.001). Patients that developed ICU-AW (MRC<48) had a longer weaning period compared to non ICU-AW patients (12 ± 14 versus 2 ± 3 days, p < 0.01). A cut-off point of 36 cmH2O for MIP was defined by ROC curve analysis for ICU-AW diagnosis (88% sensitivity,76% specificity). Patients with MIP below the cut-off point of 36 cmH2O had a significant greater weaning period (10 ± 14 versus 3 ± 3 days, p = 0.004) also shown by Kaplan-Meier analysis (log-rank:8.2;p = 0.004).MIP estimated using the unidirectional valve method may be a potential surrogate parameter for the assessment of muscle strength compromise, useful for the early detection of ICU-AW.ICU-acquired weakness (ICU-AW) is a well recognised complication, with an incidence of 10-25%, among long-term mechanically-ventilated patients [1-5]. ICU-AW presents with profound muscle weakness and difficulty to wean from mechanical ventilation (MV); it results in prolonged Intensive Care Unit (ICU) and hospital stay and even in increased mortality [6,7]. Clinical, electrophysiological and histological approaches have been used for the diagnosis [2,8,9]. Clinical detection is based on the assessment of skeletal muscle weakness. A standardized and reliable method to evaluate limb muscle groups is the Medical Research Council (MRC) muscle strength score [10-12] which has been used for the diagnosis of ICU-AW [2,9,13-15].Although ICU-AW was firstly described in patients with prolonged time to successful weaning from the ventilator
Electrical muscle stimulation preserves the muscle mass of critically ill patients: a randomized study
Vasiliki Gerovasili, Konstantinos Stefanidis, Konstantinos Vitzilaios, Eleftherios Karatzanos, Panagiotis Politis, Apostolos Koroneos, Aikaterini Chatzimichail, Christina Routsi, Charis Roussos, Serafim Nanas
Critical Care , 2009, DOI: 10.1186/cc8123
Abstract: Forty-nine critically ill patients (age: 59 ± 21 years) with an APACHE II admission score ≥13 were randomly assigned after stratification upon admission to receive daily EMS sessions of both lower extremities (EMS-group) or to the control group (control group). Muscle mass was evaluated with US, by measuring the cross sectional diameter (CSD) of the vastus intermedius and the rectus femoris of the quadriceps muscle.Twenty-six patients were finally evaluated. Right rectus femoris and right vastus intermedius CSD decreased in both groups (EMS group: from 1.42 ± 0.48 to 1.31 ± 0.45 cm, P = 0.001 control group: from 1.59 ± 0.53 to 1.37 ± 0.5 cm, P = 0.002; EMS group: from 0.91 ± 0.39 to 0.81 ± 0.38 cm, P = 0.001 control group: from 1.40 ± 0.64 to 1.11 ± 0.56 cm, P = 0.004, respectively). However, the CSD of the right rectus femoris decreased significantly less in the EMS group (-0.11 ± 0.06 cm, -8 ± 3.9%) as compared to the control group (-0.21 ± 0.10 cm, -13.9 ± 6.4%; P < 0.05) and the CSD of the right vastus intermedius decreased significantly less in the EMS group (-0.10 ± 0.05 cm, -12.5 ± 7.4%) as compared to the control group (-0.29 ± 0.28 cm, -21.5 ± 15.3%; P < 0.05).EMS is well tolerated and seems to preserve the muscle mass of critically ill patients. The potential use of EMS as a preventive and rehabilitation tool in ICU patients with polyneuromyopathy needs to be further investigated.clinicaltrials.gov: NCT00882830Critical illness polyneuromyopathy (CIPNM) is a common complication of critical illness presenting with muscle weakness, diminished tendon reflexes, difficult weaning from mechanical ventilation [1,2], and prolonged intensive care unit (ICU) and hospital stay [2,3], and is associated with increased mortality [4]. CIPNM is reported to have an incidence ranging from 25 to 50% [5,6] or higher [7] depending on the criteria used for diagnosis and the patient population evaluated. In afflicted patients muscle weakness may persist for months and a percentag
Electrical Muscle Stimulation: An Effective Form of Exercise and Early Mobilization to Preserve Muscle Strength in Critically Ill Patients
Eleftherios Karatzanos,Vasiliki Gerovasili,Dimitrios Zervakis,Elli-Sophia Tripodaki,Kleovoulos Apostolou,Ioannis Vasileiadis,Emmanouil Papadopoulos,Georgios Mitsiou,Dimitra Tsimpouki,Christina Routsi,Serafim Nanas
Critical Care Research and Practice , 2012, DOI: 10.1155/2012/432752
Abstract: Purpose. This is a secondary analysis of previously published data to investigate the effects of electrical muscle stimulation (EMS) on strength of various muscle groups in critically ill patients. Methods. One hundred forty-two consecutive patients, with APACHE II , were randomly assigned to the EMS or the control group. EMS sessions were applied daily on vastus lateralis, vastus medialis, and peroneus longus of both lower extremities. Various muscle groups were evaluated with the Medical Research Council (MRC) scale for muscle strength. Handgrip strength assessment was also employed. Results. Twenty four patients in the EMS group and 28 patients in the control group were finally evaluated. EMS patients achieved higher MRC scores than controls ( ) in wrist flexion, hip flexion, knee extension, and ankle dorsiflexion. Collectively, the EMS group performed higher ( ) in the legs and overall. Handgrip strength correlated ( ) with the upper and lower extremities’ muscle strength and the overall MRC scores. Conclusions. EMS has beneficial effects on the strength of critically ill patients mainly affecting muscle groups stimulated, while it may also affect muscle groups not involved presenting itself as a potential effective means of muscle strength preservation and early mobilization in this patient population. 1. Introduction Intensive Care Unit acquired weakness (ICU-AW) is a neuromuscular complication frequently observed in survivors of acute critical illness. It is characterized by profound muscle weakness [1] and is associated with delayed weaning from mechanical ventilation [2]. Risk factors include systemic inflammatory response and sepsis [3, 4], several medications [5], prolonged immobility and bed rest [5], and severity of organ dysfunction [6]. Apart from controlling for potentially reversible risk factors and subsequent adjustment of therapy, no other effective means have been suggested so far for the prevention of ICU-AW. Prevention of ICU-AW is also related to early mobilization and rehabilitation in the ICU. Recent studies have demonstrated that early mobilization can be safe and feasible, with a potential reduction in short-term physical impairment [7, 8]. However, patient’s cooperation is necessary for an essential intervention to be applied. Electrical muscle stimulation (EMS) is a form of exercise and mobilization that does not require active participation and can be applied to immobilized subjects. EMS has been shown to be beneficial in patients with chronic heart failure (CHF) [9] and chronic obstructive pulmonary disease (COPD) [10,
Recombinant human erythropoietin therapy in critically ill patients: a dose-response study [ISRCTN48523317]
Dimitris Georgopoulos, Dimitris Matamis, Christina Routsi, Argiris Michalopoulos, Nina Maggina, George Dimopoulos, Epaminondas Zakynthinos, George Nakos, George Thomopoulos, Kostas Mandragos, Alice Maniatis, the Critical Care Clinical Trials Greek Group
Critical Care , 2005, DOI: 10.1186/cc3786
Abstract: This was a prospective, randomized, multicentre trial. A total of 13 intensive care units participated, and a total of 148 patients who met eligibility criteria were enrolled. Patients were randomly assigned to receive intravenous iron saccharate alone (control group), intravenous iron saccharate and subcutaneous rHuEPO 40,000 units once per week (group A), or intravenous iron saccharate and subcutaneous rHuEPO 40,000 units three times per week (group B). rHuEPO was given for a minimum of 2 weeks or until discharge from the intensive care unit or death. The maximum duration of therapy was 3 weeks.The cumulative number of RBC units transfused, the average numbers of RBC units transfused per patient and per transfused patient, the average volume of RBCs transfused per day, and the percentage of transfused patients were significantly higher in the control group than in groups A and B. No significant difference was observed between group A and B. The mean increases in Hct and Hb from baseline to final measurement were significantly greater in group B than in the control group. The mean increase in Hct was significantly greater in group B than in group A. The mean increase in Hct in group A was significantly greater than that in control individuals, whereas the mean increase in Hb did not differ significantly between the control group and group A.Administration of rHuEPO to critically ill patients significantly reduced the need for RBC transfusion. The magnitude of the reduction did not differ between the two dosing schedules, although there was a dose response for Hct and Hb to rHuEPO in these patients.Anaemia is a common problem in critically ill patients [1,2]. Indeed, it has been shown that, at intensive care unit (ICU) admission, mean haemoglobin (Hb) concentration in critically ill patients is about 11 g/dl, and in 60% and 30% of them the mean Hb is less than 12 and 10 g/dl, respectively. Thus, the majority of critically ill patients exhibit anaemia upon ICU admiss
Compartmentalization of lipid peroxidation in sepsis by multidrug-resistant gram-negative bacteria: experimental and clinical evidence
Chryssoula Toufekoula, Vassileios Papadakis, Thomas Tsaganos, Christina Routsi, Stylianos E Orfanos, Anastasia Kotanidou, Dionyssia-Pinelopi Carrer, Maria Raftogiannis, Fotini Baziaka, Evangelos J Giamarellos-Bourboulis
Critical Care , 2013, DOI: 10.1186/cc11930
Abstract: Lethal sepsis was induced in rats by the intraperitoneal injection of one MDR isolate of Pseudomonas aeruginosa. Produced malondialdehyde (MDA) was measured in tissues 5 hours after bacterial challenge with the thiobarbiturate assay followed by high-performance liquid chromatography (HPLC) analysis. Results were compared with those from a cohort of patients with ventilator-associated pneumonia (VAP) and sepsis by MDR Gram-negative bacteria. More precisely, serum MDA was measured on 7 consecutive days, and it was correlated with clinical characteristics.MDA of septic rats was greater in the liver, spleen, and aortic wall, and it was lower in the right kidney compared with sham operated-on animals. Findings were confirmed by the studied cohort. Circulating MDA was greater in patients with hepatic dysfunction and acute respiratory distress syndrome (ARDS) compared with patients without any organ failures. The opposite was found for patients with acute renal dysfunction. No differences were found between patients with ARDS without or with cardiovascular (CV) failure and patients without any organ failure. Serial measurements of MDA in serum of patients indicated that levels of MDA were greater in survivors of hepatic dysfunction and ARDS and lower in survivors of acute renal dysfunction.Animal findings and results of human sepsis are complementary, and they suggest a compartmentalization of lipid peroxidation in systemic infections by MDR gram-negative bacteria.Oxidative stress results from an imbalance between production of reactive oxygen and nitrogen species (ROS and RNS) and endogenous antioxidant defense mechanisms [1]. A growing body of evidence suggests that many of the effects of cellular dysfunction under oxidative stress are mediated by products of nonenzymatic reactions, such as the peroxidative degradation of polyunsaturated fatty acids. Aldehyde molecules generated during lipid peroxidation are considered ultimate mediators of toxic effects elicited by oxid
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