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Dear colleagues,

In this first issue of the Greek e-journal of Perioperative Medicine for 2018 we are very honored to present -throughout our Editorial- an invitation from the organizing and scientific committee of the ANAESTHESIA 2018 for ANAESTHESIA 201815th Congress of Anesthesiology and Ιntensive Medicine which is to be held in Thessaloniki, on the 20th to the 23rd of September, 2018.

The present issue, also, covers a wide area of interests. The review article of Schizodimos et al summarizes the classification, epidemiology and management of Bloodstream infections (BSIs). They refer to the therapeutic strategy of Bloodstream infections that should be based on international guidelines in combination with local microbiology and local antibiotic resistance data.

Next, Grosomanidis V et al present an experimental study in order to record the effect of increased intra-abdominal pressure on the cardiovascular system of pigs, with or without additional sepsis. Their results showed that the increase in intra-abdominal pressure was well tolerated by the laboratory animals without septic condition,… Continue reading

Adequate adrenocortical function is essential to survive critical illness. The goal of this study was to determine whether eosinophilia could serve as a useful and early marker of adrenal insufficiency in critically ill patients with severe septic shock. During a 1-year period, we prospectively studied 294 ICU patients.16 patients (5.4% of ICU admissions) with eosinophilia more than 3% of the white blood cell count and septic shock unresponsive to adequate fluid and vasopressor therapy, were included. A high dose (250 mcg i.v) corticotropin stimulation test was performed. Eosinophilia (>3%) was diagnosed in 16 patients with vasopressor-unresponsive septic shock. Eosinophilia was present 1.9±0.9d (range 8-96h) before the onset of septic shock. 11/16 patients failed to respond to corticotropin stimulation test above the critical level of 9 mcg/dL rise and 2/16 had baseline cortisol concentration <10 mcg/dL. Baseline cortisol level, maximal cortisol increase post-corticotropin administration and Eosinophils count (%) were higher in survivors (p≤0.05). A hydrocortisone infusion (300mg/d) treatment resulted in haemodynamic improvement in 12 of 16 patients (75%). The 28-day mortality (following the onset of septic shock) was 43.7%. Relative eosinophilia may be considered as a useful and early bioassay for adrenocortical function assessment in critically ill patients with septic shock and assumed adrenocortical depression.

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The vast advance in medical knowledge forces us to super specializations. Yet, as we get to know better the tree, we might lose the perspective of the forest. Team work and more specifically, diversity teams, keep us in touch with the different aspects of knowledge. And although diversity has potential to disrupt group functioning, in reality, in both in behavioral and psychological science and in business arena, diverse teams are proven smarter1-2.

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Dear colleagues,

From 2004, the presence of the Greek e-Journal of Perioperative Medicine among the National Scientific Journals has been gradually increased. On behalf of the editorial board of the Greek e-journal of the Perioperative Medicine, we would like to thank you for your support in order to reform and modernize our journal.

We would like to inform you that the Greek e-journal of the Perioperative Medicine is accepted in several indexing databases like DRJI – Directory of Research Journal  Indexing, Research Bible, GIF.org, Journal Index.net, INNOSPACE, Unifactor.org, MJL-Medical journals Links, ICMJE- International Committee of Medical Journal Editors, CiteFactor.org, ISI-International Scientific Indexing, EZB – Universitätbibliothek Regensburg, OAJI – Open Access Journal Indexing, PBN-Polska Bibliografia Naukowa, ESJI- Eurasian Scientific Journal Index, ISRUS (EyeSource) – International society of Universal Research in Sciences, JIF – Global Society for Scientific Research and DOAJ – Directory of Open Access Journals.

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We report a rare case of a young woman with anti-N-Methyl-D-Aspartate receptor (NMDAR) encephalitis, who developed psychiatric symptoms, dyskinesias, hypoventilation, hypersalivation and seizures. Serial analysis of antibodies to NR1/NR2B heteromers of the NMDAR was positive on the patient's serum and cerebrospinal fluid (CSF). Removal of an ovarian teratoma after intravenous immunoglobulin and corticosteroid therapy resulted in a prompt neurological response.

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Dear colleagues,

Traditional publishing is an ex cathedra affair, top down, hierarchical. Electronic publishing is essentially egalitarian1. That’s why the present journal had never adopted printed form.

Here, we would like to underline some of the changes that occurred in the journal. These changes were designed to maintain excellence while improving the efficiency of the review process and taking advantage of new technology. Thus, new features have been added in the article section and feedback surveys are planned to be performed in regular basis. New sections for bibliographic information and editorial board / reviewers’ panel have been added. Organizational changes for a better workflow are also en route. The journal is already accepted in several electronic databases (see “indexing” section), while application for inclusion in several others is also under way. For all the changes, every website visitor is invited to explore these new features.

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Neurologic complications after liver transplantation are quite common, with central pontine myelinolysis (CPM) being a rare but fatal complication. In this report, we describe the case of female liver transplant recipient who developed CPM after orthotopic liver transplantation (OLT).A 62-year old woman was admitted to the ICU for postoperative recovery after OLT. The procedure was described as uneventful. The patient had a history of decompensated cirrhosis, tension ascites, class I hepatic encephalopathy and chronic hyponatremia which necessitated repeated hospitalizations in the year prior to transplantation.The patient was unable to be weaned from ventilator support and did not show an improvement in mental status (GCS=5) despite the cessation of sedation. After neurologic consultation, a brain MRI was performed which showed evidence of CPM in the pons. Despite supportive therapy, the patient did not show an improvement of mental status and after a 55-day hospitalization in the ICU she died from septic complications.The etiology of CPM is multifactorial, with liver transplant recipients being at an increased risk. Supportive treatment is the standard of care, and there are not enough evidence supporting other types of treatment.

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This study was undertaken to evaluate the immediate postoperative complications in renal transplant recipients requiring Intensive Care Unit (ICU) admission. All renal transplant recipients with immediate post-transplantation complications (<1 week) admitted to our ICU from 1992 to 2012 were studied. Patients’ characteristics, transplant variables and prognosis were evaluated and data were analyzed to identify factors of outcome. Over the study period 13 men and 3 women, (26.2 % of renal transplant recipients requiring ICU admission) aged 45.4±10 years, were included in the study. APACHE II and SOFA scores on ICU admission were 17.8±4.6 and 8.4±3.6 respectively.

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The incidence of preeclampsia in the western countries is estimated to range from 2% to 6% in healthy, nulliparous women. In developing nations, the incidence of the disease is reported to be 4- 18%,with hypertensive disorders being the second most common obstetric cause of stillbirths and early neonatal deaths in these countries Etiology of the disease is multifactorial, with risk factors like ma-ternal age, oxidative stress, angiotensin T-235 homozygote having a different role in every case. Moreover, the disease its self is a multisystem expression of a complicated pathophysiology. Many attempts to explain the latter have been made with often controversial results. In the present article we explore the hypothesis of intra-abdominal pressure as possible causative factor of preeclampsia and the role ofthe maternal venous compartment and rennin-angiotensin-anldosterin system in this hypothesis. Continue reading
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