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| EDITOR PAGE |
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| Year : 2003 | Volume
: 4
| Issue : 2 | Page : 1 |
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At a Glance
Rachel Hajar
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| Date of Web Publication | 22-Jun-2010 |
Correspondence Address:
Rachel Hajar
,
 Source of Support: None, Conflict of Interest: None  | Check |
How to cite this article:
Hajar R. At a Glance. Heart Views 2003;4:1 |
In the last two decades the interventional cardiologists have invaded the domain of the cardiac surgeon. PTCA, stents, percutaneous valvuloplasty and closure of PDAs, ASDs, and fistulae with devices have become routine in clinical cardiology practice.
For several years, pediatric cardiologists have been dreaming of closing VSDs since it is the most common congenital heart anomaly. Modifications in the design of the Amplatzer device have made their dream possible. At present, only a few centers in the world are performing VSD device closures. This year, 2003, the pediatric cardiologists at Hamad Medical Corporation in Doha began transcatheter closure of VSDs. In this issue of the Journal, Al-Hroob et al present their experience in Qatar with transcatheter closure of perimembranous and muscular ventricular septal defects with the Amplatzer septal occluder (p.42-46). They report excellent results, achieving immediate and complete closure in 92% (11/13). They conclude that non-surgical closure of VSD is feasible and safe.
The size of the VSD becomes a key concern when devise closure is attempted. It is well-known that the positions, sizes, and shapes of ventricular septal defect can be difficult to assess by two-dimensional echocardiography. In the accompanying editorial, Dr. Roxane Mckay, from Hamad Medical Corporation, Doha, Qatar, (p.47-49), raises the important issue of accurate measurement of VSD size. Precise delineation of the size, shape, and position of the VSD will help in appropriate preselection of patients. The editorial addresses pertinent issues such as the continuing use of nomenclature and classification of VSDs that were devised with right-sided morphology in mind because the surgeon approached the VSD through the right ventricle. She suggests a re-evaluation of terminology that will address the defect and its morphological relation to the left side of the septum and the suboartic area. Knowledge of the precise relationship to other anatomic landmarks will help to avoid complications from device closure such as damage to the aortic or tricuspid valves. Another relevant concern that she raises are the long-term results, which are not known at this point in time.
In the field of cardiac surgery, new technology and surgical techniques continue to evolve and be refined. Off-pump procedures are well established and robotic surgery is revolutionary. The article by Dr. Pasquale Mastroroberto from the University of Magna Graecia, Catanzaro, Italy, (p.50-52) describes the techniques of preserving the aortic valve in Type A aortic dissection and presents the experience at his institution.
The case report, "Erythromycin-Induced Torsade de Pointes" by Dr. A. Salam and Dr. Ali Ashraf from Hamad Medical Corporation, Doha, Qatar, (p.53-56) raises a clinically relevant warning about precipitating proarrythmia. An interesting case report, "Sport and Atrial Fibrillation" by Dr. M. Al Nozha and Dr. Y. Sharif from King Fahad Cardiac Center, King Khalid University. Hospital, Riyadh, Saudi Arabia, (p.57-59) links atrial fibrillation to chronic sports practice.
"Laughter is the best medicine", so it has been said, but ironically, we physicians use it the least. However, the general public knows instinctively the power of laughter and has used it to good effect, sometimes as a weapon, throughout the ages. Jokes, according to Freud, are the acceptable face of aggression. Humor is a way for people to fight back against the powerful and those professions with high-minded aspirations. The learned professions are particularly open to ridicule. Satire is a form of revenge, designed to deflate, exposing pretension and humbug. Bitter mockery and derision and caricature targeting doctors were extremely popular during the 18th and 19th centuries due to the lack of effective treatments against many diseases. "Satire was the language of the age . . ."
The Art and Medicine Section (p.61-68) highlights this epoch of skepticism about physicians in graphic and literary satire. Of interest however, is that the benefits of humor and laughter have been studied extensively. By raising beta-endorphins and enkephalins, laughter helps one fight severe pain. By stimulating IGA concentration, T lymphocyte production and natural killer cell activity, humor and laughter combat the immune suppressing effects of medical stress. It is time that we use humor and laughter in our interaction with our patients. As Voltaire, the French writer and philosopher so wisely put it: "The art of medicine consists in amusing the patient while Nature cures the disease."
The History of Medicine section features a comprehensive and well-illustrated article, "Arab Roots of European Medicine" (p.69-80) by David Tschantz, who is a historian and epidemiologist. He underlines the important role of the coming and rise of Arab and Islamic civilization in preserving and disseminating lost knowledge at a time when Europe was plunged in the Dark Ages. He reminds us of the important and original contributions of Arab and Islamic physicians to Western medicine. Al Razi (AD 841-926) or Rhazes as he is known in the West, stated: "Positive comments from doctors encourage patients, make them feel better and speed their recovery." He also said that "Changing from one doctor to another wastes patients' health, wealth and time." The above statements are still true today. Because human nature is unchanging, interaction between patient and physician are similar throughout time. Technology changes but human nature remains the same.
Dr. Hajar Albinali continues his Special Section: Chairman's Reflections (p.81-84). He narrates the story of one of his friends, an Iraqi whom he met while a student at the University of Colorado in 1965. That friend became his patient in Doha just before the 2003 war on Iraq. The story has a sad ending.
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