Porcelain heart

A 65-year-old hypertensive man with shortness of breath andatypical thoracic pain underwent coronary angiography for     

Failed Amplatzer Septal Occluder device implantation due to an embryonic septal remnant

Embryonic remnants of incomplete septation may complicate occlusiondevice implantation in secundum atrial septal defects (sASD)even if stiff devices such as the Amplatzer Occluder are used. A 35-year-old woman was referred to our center for evaluationof a sASD.     

Teaching and training in the psychiatric-psychosomatic consultation-liaison setting

BACKGROUND: The consultation-liaison (C-L) psychiatrist is in an opportune position to undertake the tasks of education, training and assessment of performance as regards future physicians, psychiatrists, specialists in other branches and nurses. This paper describes the education and training programme in the Psychiatric-Psychosomatic C-L Service of Modena University Hospital. DESCRIPTION OF THE PROGRAMME: This programme consists of the following main activities: (1) daily group-case supervision, performed by the full-time psychiatrist together with the psychiatry residents of the C-L staff; (2) a bimonthly quality management meeting, which is part of a European project of measurement and improvement of quality of service; (3) weekly lectures on selected topics; (4) monthly tutorials in research techniques; (5) bimonthly presentations of literature reviews; (6) weekly clinical case conferences, which are the nucleus of the curriculum and which focus on the following main topics: 'the patients', 'the intervention' and 'the group', and (7) liaison meetings requested by non-psychiatric departments. CONCLUSIONS: A common denominator seen throughout the teaching and training activities of such a programme is the attitude of openness and effort toward integration which should be the C-L psychiatrist's distinguishing mark, in the context of the general hospital.     

COMPRI--an instrument to detect patients with complex care needs: results from a European study

The authors developed a screening instrument to detect patients in need of complex care coordination at admission to a general hospital. On the basis of a series of risk factors for care complexity, the authors constructed a short, care complexity prediction instrument (COMPRI) and assessed its qualities. The COMPRI is an easily administered screening instrument that detects patients at risk for complex care needs for whom care coordination is indicated. COMPRI's predictive power exceeds all currently available case-mix instruments.     

Patent foramen ovale with paradoxical embolism: mid-term results of transcatheter closure in 256 patients

The purpose of this study was to assess the safety and feasibility of percutaneous interventional closure of patent foramen ovale (PFO) with or without atrial septal aneurysm (ASA) in symptomatic patients. Between June 1999 and June 2002, we performed transcatheter closure of PFO in 256 consecutive symptomatic patients (female/male = 1.45; mean age 48 +/- 16 years; range 14-75): ischemic stroke (n = 101), transient ischemic attack (n = 144), peripheral and coronary arterial embolism (n = 17); multiple events (n = 23); platypnea-orthodeoxia syndrome (n = 2); refractory hypoxemia (n = 1); and migraine aura (n = 27). The implanted devices were an Amplatzer PFO Occluder (n = 248), a Gore-HELEX Septal Occluder (n = 4), and PFO STAR (n = 4). Most procedures (n = 176.69%) were done under two-dimensional intracardiac echocardiography (ICE) guidance alone; in the last 30 patients, 3D/4D ICE reconstruction (TomTec Imaging Systems) 6mbH was obtained. In 30 cases, ICE and contrast enhanced-TCD have been used simultaneously in the catheterization laboratory. The devices were placed correctly in all patients. Mean fluoroscopy time was 9.45 +/- 5 minutes (range = 2.5-35 minutes); mean procedural time was 57 +/- 21 minutes (range = 15-135 minutes). Total occlusion rate at follow-up (mean 19 months, range 1-33) was 98.1%. No significant recurrent neurological events were observed. Transcatheter closure of PFO with or without ASA is a safe and effective, minimally invasive procedure that ensures high closure rate and avoids life-long anticoagulation. Mid-term follow-up results appear favorable with respect to recurrent thromboembolic events.     

Calcified plaque: the Achilles‘ Heel of present computed tomography coronary angiography for the elderly?

Nine percent to 27% of cardiac catheterizations today showed either angiographic normal coronary arteries or minimal atherosclerosis. Given the expense of cardiac catheterization and the desire to use this valuable resource for therapeutic rather than diagnostic purpose, there is a strong impetus to develop non-invasive means of accurately detecting significant coronary artery stenosis. Although echocardiography is the most common non-invasive cardiac procedure, nuclear