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Biomedical subjects

A Lusky

Publications and source records attributed to A Lusky.

At least 55 records · Page 3Linked to original sources
PubMed1995

[Coronary artery bypass without extra corporeal circulation].

240 patients underwent coronary artery bypass grafting (CABG) without extracorporeal circulation (ECC). Mean grafts per patient was 1.9 (range 1-5). The internal mammary artery (IMA) was used in 210 cases (87%), but in only 53 (22%) were there grafts to the circumflex marginals. Unfavorable results included an operative mortality of 7 cases (2.9%), nonfatal perioperative myocardial infarction (MI) (2.5%), stroke (0.4%), and sternal infection (1.7%). There were 2 deaths among 17 patients (12%) with calcified aorta, and 4 among 40 (10%) who underwent emergency operation. Multivariate analysis showed these 2 risk factors to be the only predictors of early mortality: emergency operation odds ratio 9.8, and calcified aorta odds ratio 8.0. Perioperative risk factors that were not major predictors of early mortality or unfavorable outcome included left ventricular dysfunction (EF < 35%: 52 patients, 22%), congestive heart failure (53, 22%), cardiogenic shock (8, 3%), acute MI (67, 28%), age > 70 years (64, 27%), renal failure (22, 9%), and stroke or carotid disease (12, 5%). Followup ranged from 1-31 months (mean 12). There were 9 late deaths (4 cardiac), and 18 cases (7.5%) of early return of angina. 1-year actuarial survival was 92%; 192 patients (80%) had uneventful outcomes and are doing well. Calcified aorta, nonuse of the IMA, reoperation, and diabetes mellitus were independent predictors of unfavorable events. We conclude that CABG without ECC can be performed with relatively low operative mortality, but there seems to be increased risk of early return of angina. It should therefore be considered for those patients with appropriate coronary anatomy in whom ECC poses a very high risk. However, it is still a hazardous procedure when used as as an emergency operation, and for cases with calcified aorta.

Aortic Diseases↗
PubMed1994

The association between alpha-fetoprotein and beta hCG levels prior to and following chorionic villus sampling in cases that spontaneously miscarried.

Maternal serum alpha-fetoprotein (AFP) and beta-human chorionic gonadotropin (beta hCG) measurements taken prior to chorionic villus sampling (CVS) in 21 patients who subsequently miscarried were compared with measurements in a control group of 113 patients with uneventful pregnancies. Patients with AFP levels of 10 iu/ml or more prior to the CVS had a 4.3 times greater risk of miscarriage (95 per cent confidence interval 1.3-13.6). AFP levels obtained 1 week after the CVS in the 13 patients with late miscarriages were higher than in the control group (P = 0.06). Patients miscarrying had a greater rise in AFP (P = 0.06) and a greater fall in beta hCG levels (P = 0.04) following the CVS procedure, compared with the control subjects. Each 10-unit change in the difference between AFP or beta hCG levels prior to and 1 week following the CVS was associated with a significantly increased risk for late miscarriage. Elevated maternal serum AFP levels early in pregnancy and changes in AFP and beta hCG levels following CVS may predict an increased risk for subsequent miscarriage.

Abortion, Spontaneous↗
PubMed1994

A prospective comparison of the outcome of triplet pregnancies managed expectantly or by multifetal reduction to twins.

OBJECTIVE: Our aim was to compare the outcome of triplet pregnancies managed expectantly or by multifetal reduction to twins. STUDY DESIGN: From January 1984 through January 1992, 140 triplet gestations were diagnosed before the ninth gestational week. Multifetal pregnancy reduction was performed at the patient's request in 34 women. The remaining 106 triplet pregnancies were managed expectantly. All patients were prospectively followed up and delivered in a single perinatal department. RESULTS: Loss of the entire pregnancy before 25 gestational weeks occurred in 20.7% of the triplet pregnancies managed expectantly as compared with 8.7% in the group with reduction to twins. A successful pregnancy as defined by the discharge home of at least one infant occurred in 88.2% of the group with reduction to twins and 74.5% of the triplets managed expectantly. Fetal reduction to twins was associated with a significantly lower incidence of the following: prematurity (p < 0.001), low-birth-weight infants (p < 0.001), and very-low-birth-weight infants (p < 0.001). Pregnancy complications and neonatal morbidity and mortality were less in the group with reduction to twins. CONCLUSIONS: Multifetal pregnancy reduction of triplet pregnancies to twins resulted in improved pregnancy outcome without an excess loss of the entire pregnancy as compared with the outcome of triplet gestations managed expectantly.

Abortion, Therapeutic↗
PubMed1994

Mononuclear cell magnesium content remains unchanged in various hypertensive disorders of pregnancy.

Serum magnesium levels, as well as magnesium content of red blood cells and peripheral mononuclear cells, were examined in 31 pregnant women in their third trimester. Ten were preeclamptic; chronic hypertension was found in 10, and 11 were normotensive. Magnesium serum levels were 1.2 +/- 0.1, 1.2 +/- 0.1 and 1.3 +/- 0.1 mEq/l in the normotensives, chronic hypertensives and preeclamptics, respectively. Red blood cell magnesium concentration was 3.4 +/- 0.4, 3.7 +/- 0.7 and 3.5 +/- 0.5 mEq/l, and mononuclear magnesium content was 37.9 +/- 30.6, 27.6 +/- 15.9 and 30.2 +/- 25.7 fg/cell in the same groups, respectively. These changes were not statistically significant. The results do not support the hypothesis that magnesium deficiency is involved in the pathophysiology of preeclampsia.

Adult↗
PubMed1994

Fluorescence polarization of serum lipids in pregnancies complicated by hypertensive disorder.

Hypertensive disorders in pregnancy are associated with an increase in serum lipid fractions. Fluorescence Polarization (FP) of lipids in the serum of 80 hypertensive pregnant patients at full term was compared to measurements in a control group of 71 healthy pregnant volunteers. In addition, the FP values were correlated with measurements of serum lipid fraction in 34 hypertensive and 17 control patients. Both chronic hypertension and pregnancy induced hypertensive (PIH) subjects had significantly reduced serum FP values compared to the control group. This difference was however present only in the severely hypertensive patients, independent of the etiology of this disorder. Highly significant correlations were present between the FP values and serum level of Triglycerides r = -0.85, Very Low Density Lipoprotein r = -0.76, and Low Density Lipoprotein r = 0.53. Serum FP values appear to reflect the change in the lipoprotein pattern present in pregnant patients with hypertensive disorders. This change appears to reflect the severity of the condition rather than the etiology of the hypertension.

Cholesterol↗
PubMed1994

Variation in mortality rates in Tel Aviv region municipalities.

Age, sex and cause-specific mortality rates in 1982-86 for eight municipalities in the Tel Aviv region were compared to comparable rates of a reference population--the 1984 Jewish population of Israel. Residents of Or Yehuda, Tel Aviv, Holon and Bat Yam had an elevated risk of dying. Of particular interest is the elevated risk among adult residents of the Tel Aviv municipality. Males and females aged 30-44 had excess mortality from heart disease and external causes of death, and males aged 45-64 from ischemic heart disease and external causes. Tel Aviv females aged 30-44 also had excess mortality from cerebrovascular disease and females aged 45-64 from malignancy. High mortality rates in these age groups contribute considerably to years of life lost, and it is suggested that local health service or governmental action should be taken to investigate and reduce the disparities. Small area analysis, as shown here, may provide considerable information for monitoring community health.

Adolescent↗
PubMed1993

Factors affecting the development of skin cancer after scalp irradiation.

A nested case control study of persons who developed skin cancer after scalp irradiation in childhood revealed two risk factors for the appearance of radiation-induced skin cancer: (a) an apparently higher radiation dose delivered inadvertently, manifested by a higher prevalence of alopecia and radiation dermatitis (RR = 3.4; CI 1.3-8.8); (b) a more frequent exposure to the sun, manifested by summer sunbathing (RR = 2.6; CI 1.1-6.1). These findings may have certain implications with regard to the understanding of radiation-induced cancer, after low-dose radiation exposure, in general.

Adolescent↗
PubMed1992

[Mortality among Moslem, Christian and Druze infants].

Infant mortality in 3 heterogeneous non-Jewish religious groups in Israel was examined (1977-80). Risk factors contributing to infant mortality were identified and their effects assessed by logistic regression analysis. Mortality among Moslems and Druze was 26.0/1000, compared to 17.2/1000 among Christians and 12.7/1000 among Jews. These differences between the populations were mostly evident after the first month of life. Unexpected excess mortality rates were observed among female infants, compared to males, in the postneonatal period in all 3 groups. This excess was present mainly in Christian and Druze infants born to fathers with few years of education. The trend persisted after accounting for birth weight, maternal age, birth order and place of birth. The female mortality in the postneonatal period was twice that of males in Christians and 1.5 times higher than that of males in Druze. Congenital malformations and immaturity-related conditions were the main causes of neonatal deaths, while infections were the major cause of postneonatal deaths. Among the Druze the postneonatal death rate due to infections reached 8/1000. In the non-Jewish groups 42% of postneonatal deaths occurred out of hospital, compared to 15% among Jews.

Christianity↗
PubMed1992

Surgical closed pulmonary valvotomy for critical pulmonary stenosis: implications for the balloon valvuloplasty era.

BACKGROUND: Closed pulmonary valvotomy for critical pulmonary stenosis has no apparent advantage over the percutaneous balloon technique, though it is used when balloon valvuloplasty fails. Experience of this technique at the Heart Institute, Tel Hashomer, since it was first used in 1973 has been reviewed. METHODS: Thirty eight infants up to 1 year old (25 of them neonates--that is, nil to 1 month old) with critical pulmonary stenosis were operated on from 1973 to 1989. All had a transventricular valvotomy, by a modification of the Brock method, and all underwent cardiac catheterisation before surgery. RESULTS: Five of the 25 neonates (20%) died, but none of the other infants, so that the total mortality (five out of 38) was 13%. Three of the 38 required an aortopulmonary shunt. All 38 survivors were followed up--from one month to 14 years (mean 7.5 years). All were symptom free at the last check up. Fifteen of the survivors had required further surgery; this was successful in all cases. CONCLUSIONS: For the balloon valvuloplasty era surgical pulmonary valvotomy provides a good back up for failed attempts at percutaneous valvuloplasty. Review of outcome provides data for comparison with balloon valvuloplasty in the future.

Catheterization↗
PubMed1992

The effect of thyroxine and corticosteroids upon amniotic fluid fluorescence polarization: a randomized controlled study.

The efficacy of glucocorticoid and intra amniotic thyroxine therapy on fetal lung maturity were compared in a randomized prospective clinical trial. Eighty two patients received either intra amniotic thyroxine (n = 36), or intra muscular Dexamethasone (n = 46). The Fluorescence Polarization (FP) of amniotic fluid measured prior to and one week following treatment were similar in the two groups. The rate of decrease in FP value per unit of time (dFP/dt) was identical in the T4 and corticosteroid treated patients and the proportion of immature FP values obtained was similar in the two groups. The effect of thyroxine therapy was more pronounced in pregnancies above 33 weeks gestation. Intra amniotic thyroxine therapy appeared to be as effective as glucocorticoids for the enhancement of fetal lung maturity. This therapeutic modality may be of particular use on pregnant subjects in whom a relative contra indication for the administration of steroids exists.

Amniotic Fluid↗
PubMed1992

Aprotinin prevents cardiopulmonary bypass-induced platelet dysfunction. A scanning electron microscope study.

BACKGROUND: Administration of aprotinin during extracorporeal circulation reduces blood loss and improves platelet function. METHODS AND RESULTS: To evaluate the protective effect of aprotinin on platelets, 50 patients undergoing cardiopulmonary bypass were randomized before surgery to one of three groups. Seventeen patients (group A) received continuous high-dose aprotinin (7 x 10(6) KIU) during cardiopulmonary bypass, 17 (group B) received a single bolus of aprotinin in the pump prime (2 x 10(6) KIU), and 16 (group C) received placebo. Scanning electron microscopy was used to evaluate platelet aggregation on extracellular matrix. The platelet function was graded from 1 to 4, with grade 4 being normal aggregation. Immediately after cardiopulmonary bypass, 16 patients in group A (94%) reached preoperative aggregation grade (mean grade, 3.4 +/- 0.7) compared with nine of 17 in group B (52%) (mean grade, 2.9 +/- 1.2), and none in group C (0%) (mean grade, 1.4 +/- 0.5; p < 0.001). Postoperative platelet count did not differ significantly among the three groups. After surgery, group A bled less than groups B and C (395 +/- 120 versus 488 +/- 135 and 780 +/- 408 ml, respectively; p < 0.01). Patients in the aprotinin groups received fewer red blood cell units (0.9 +/- 1.2 and 1.9 +/- 1.2 versus 3.4 +/- 1.9, respectively; p < 0.01) and were exposed to less homologous blood products (1.3 +/- 1.7 and 2.1 +/- 1.1 versus 6.1 +/- 5, respectively; p < 0.001). CONCLUSIONS: By preserving platelet function, aprotinin improves postoperative hemostasis in all patients who receive high dose and in most who receive low dose.

Aprotinin↗
PubMed1992

Synergism between infarct-borne left ventricular dysfunction and cardiomegaly in increasing the risk of coronary bypass surgery.

The effect of cardiomegaly on operative and late mortality in patients with left ventricular dysfunction undergoing coronary bypass operation was investigated. The study group consisted of 178 patients whose left ventricular ejection fraction was below 45% and who were operated on from 1978 through 1985. Forty-five patients (group A) had severe left ventricular dysfunction (ejection fraction < 30%) and 133 (group B) had moderate dysfunction (30% > ejection fraction > 45%). Twenty-four of group A (53%) and 54 of group B (41%) patients had cardiomegaly (cardiothoracic ratio on chest x-ray films > 0.5). There were 10 (6%) hospital deaths, four in group A (9%) and six in group B (4.5%). All four deaths in group A and the six deaths in group B were patients who had cardiomegaly. Regardless of the severity of the left ventricular dysfunction, there was no operative death among patients with normal heart size (p < 0.001). Age over 65, bypass time longer than 2 hours, and incomplete revascularization emerged as risk factors. Follow-up ranged from 5 to 13 years (mean 7.8 years). Overall 5-year actuarial survival, including hospital mortality, was 80% +/- 3%. Reduced 5-year survival was observed in patients with cardiomegaly (67% +/- 5% versus 91% +/- 3%, p < 0.05). Five- and 10-year survival of patients from group A with cardiomegaly was 53% +/- 7% and 18% +/- 13%, respectively.

Cardiomegaly↗
PubMed1991

A criterion for a standardized definition of low birthweight.

A criterion for the definition of low birthweight (LBW) which is tailored to each population group is presented. The suggested criterion is based on an assumption according to which the distribution of birthweight is actually a mixture of the following two components: the predominant (including about 95% of the newborns and is normally distributed) and the residual (assumed to be mainly composed of newborns under extreme risk for perinatal mortality). The LBW category is defined to include a small but equal (for all groups) percentage of the predominant component. Thus, population groups which differ with respect to their specific predominant birthweight distribution are comparable with respect to the perinatal mortality risk. Application of the suggested definition is demonstrated using data from two ethnic groups in Israel. Results show a smaller percentage of female LBW than males in both population groups when using the suggested criterion. The reverse is observed (i.e. more male than female LBW), using the standard criterion (less than 2500 gm). The suggested criterion is shown to reduce the sex and ethnic differences in perinatal mortality among the respective LBW categories.

Asia↗
PubMed1991

Hyperinsulinemia, sex, and risk of atherosclerotic cardiovascular disease.

BACKGROUND: The possibility that hyperinsulinemia may be involved in the etiology of atherosclerotic cardiovascular disease (CVD) was first suggested 20 years ago. During the last decade, this possibility has received support from three large prospective studies. METHODS AND RESULTS: In the present study, the association between CVD, glucose intolerance, obesity, and hypertension (the GOH conditions) and hyperinsulinemia was examined cross-sectionally in a representative sample (n = 1,263) of the adult Jewish population aged 40-70 years in Israel. Previously known diabetics were excluded. CVD comprising clinical or ECG evidence of ischemic heart disease, as well as clinical evidence of cerebrovascular or peripheral vascular disease, was identified in 97 men and 39 women. A significant (p less than 0.01) hyperinsulinemia-sex interaction was found for CVD rate, with the adjusted risk ratios (followed by 95% confidence limits), relative to the rate in 298 normoinsulinemic women, being 1.15 (0.68-1.95) in 328 normoinsulinemic men, 0.85 (0.48-1.49) in 277 hyperinsulinemic women, and 2.27 (1.33-3.08) in 360 hyperinsulinemic men. Age-adjusted CVD rates in men versus women were: a) similar and low among all normoinsulinemic normotensives and hyperinsulinemics free of any of the GOH conditions (all rates less than or equal to 6.5%); b) similar and high among normoinsulinemic hypertensives (13.4% versus 10.4%); c) significantly higher in men among hyperinsulinemic normotensives with glucose intolerance and/or obesity (15.2% versus 3.3%; p = 0.02) and all hyperinsulinemic hypertensives (21.5% versus 12.8%; p = 0.04). These trends remained significant after adjusting for age, ethnic group, and blood lipids. CONCLUSIONS: Therefore, hyperinsulinemia was associated with excess CVD risk in men but not in women, and all excess CVD risk in men was confined to hyperinsulinemic individuals in the presence of glucose intolerance, obesity, or hypertension.

Arteriosclerosis↗
PubMed1991

Obesity, glucose intolerance, hyperinsulinemia, and response to antihypertensive drugs.

Responsiveness to antihypertensive medications was investigated cross-sectionally in 559 individuals comprising all treated hypertensive patients identified within a representative sample (n = 3,532, aged 40-70 years) of the Jewish population in Israel. A rate of dosage score (a summed ranking of dosages of all drugs taken) of two or more increased significantly with increasing levels of body mass index (BMI) from 37.5% in levels less than 23, 54.9% in levels 23.0-29.9, and 76.4% in levels of 30 or greater (p less than 0.0001). Multivariate analyses, adjusting for age, gender, arm circumference, and ethnic group, confirmed the independent effect of BMI on dosage score (p less than 0.001). At each level of dosage score, mean blood pressure levels were equivalent at all levels of BMI after adjusting for potential confounders. This indicates that achieved blood pressure level and not BMI itself was the main determinant of the higher dosing regimens prescribed at higher levels of BMI. In representative subgroups, glucose tolerance (n = 372) and hyperinsulinemia (n = 190) were determined and were found to be positively associated with a dosage score of two or more (p less than 0.05) independently of BMI. These effects could not be accounted for by poor compliance or by altered drug absorption or disposition since overnight urinary drug excretion and plasma drug concentrations 2 hours after ingestion, measured in 80 randomly selected patients from the study group, were not different across BMI categories at similar dosages.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗