Diagnostische videoassistierte Thorakoskopie

Modern radiologic diagnostics show a variety of pathological changes in the mediastinum, pleura, and lung but no evidence on their histogenesis. Transbronchial and transthoracal fine-needle aspiration biopsy usually cannot yield detailed diagnostic results because of its small size. Sufficient and representative material can be obtained by thoracoscopy. Video-assisted thoracoscopy allows safe and fast diagnosis of diffuse lung diseases, pleural diseases including malignant mesothelioma, indeterminate peripheral lung nodule, and mediastinal masses. This gentle diagnostic method can give invaluable information guiding further management of the thoracic injury. Video-assisted thoracoscopy is a safe and effective guiding tool if performed by experienced thoracic surgeons able to convert to thoracotomy. It is to be noted that interpretation of intraoperative findings plays a decisive role in interdisciplinary diagnostics of intrathoracal diseases.     

Giant left atrial myxoma in an elderly patient: natural history over a 7-year period

We present the case of a 71-year-old woman with a 7-year history of a giant left atrial myxoma. The myxoma was attached to the atrial septum and occupied almost the entire left atrial cavity. The patient was hospitalized 4 times because of dyspnea on exertion, palpitations, fatigue, general asthenia, and weight loss. During prior hospitalizations, the patient had refused cardiac surgery. She developed several complications, including atrial fibrillation, mitral and tricuspid regurgitation, mesenteric embolism, pulmonary edema, and thrombotic stroke. We herein describe the natural history of left atrial myxoma in an elderly patient over a 7-year period.     

Left and right ventricular diastolic functions in patients with rheumatoid arthritis without clinically evident cardiovascular disease

The aim of this study was to assess the prevalence of diastolic dysfunction of the left ventricle (LV) and of the right ventricle in patients with rheumatoid arthritis (RA) without clinically evident cardiovascular manifestations and to estimate whether there is a correlation between the duration of RA and the degree of LV diastolic dysfunction. The study included 81 patients (61 females and 20 males) with RA without clinically evident heart disease (group 1) and 40 healthy subjects (29 females and 11 males) who served as a control group (group 2). Both groups were matched for age and sex. Echocardiographic and Doppler studies were conducted in all patients with RA and control subjects. There were significant differences between patients with RA vs. control group with regard to early diastolic flow velocity (E), atrial flow velocity (A) and the E/A ratio (0.68 +/- 0.19 m/s vs. 0.84 +/- 0.14 m/s, p < 0.001; 0.73 +/- 0.15 m/s vs. 0.66 +/- 0.13 cm/s, p = 0.01; and 0.97 +/- 0.3 vs. 1.32 +/- 0.37, p < 0.001, respectively). There was significant difference between groups regarding the right ventricular early diastolic (Er)/atrial (Ar) flow velocities (Er/Ar ratio) (1.07 +/- 0.3 vs. 1.26 +/- 0.3, p = 0.002). There was a weak correlation between transmitral E/A ratio and the duration of RA (r = - 0.22, p = 0.001). Myocardial performance index (MPI) appeared to differ little in patients with RA as compared with control group (0.51 +/- 0.1 vs. 0.52 +/- 0.2, p = NS). In patients with RA without clinically evident cardiovascular disease, the left ventricular diastolic function and the right ventricular diastolic function are reduced. Left ventricular wall thickness, dimensions, systolic function and MPI were found to be normal. LV diastolic function had a weak correlation with the duration of RA.     

Breaking Bad News in a Southeast European Population: A Survey among Cancer Patients in Albania

Abstract Objective: The purpose of this study was to explore the attitudes of cancer patients, their family, and community members in Albania, a post-communist country in Southeast Europe, regarding breaking bad news. Methods: One hundred and fifty consecutive cancer patients, 150 respective relatives, and an age-sex-residence matched sample of 150 individuals in Tirana district were interviewed from September 2009-January 2010 about attitudes related to diagnosis disclosure. Logistic regression was used to assess the association of diagnosis disclosure with demographic characteristics. Results: Community members were the most in favor, whereas the patients' relatives were the least in favor of diagnosis disclosure. Most of the patients, who were aware of their diagnosis, were not satisfied with the disclosure approach employed by the medical staff. The odds of favoring diagnosis disclosure were significantly higher among younger, male, urban, and more educated patients. Conclusion: This survey identified important characteristics of cancer patients, their relatives, and a community-based sample in Albania that could predict the willingness to disclose a fatal diagnosis. Establishment of a formal training of health professionals regarding breaking bad news should be considered in order to ensure a proper approach of communicating diagnosis to cancer patients in transitional Albania.