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E Kassis

Publications and source records attributed to E Kassis.

At least 19 recordsLinked to original sources
PubMed2001

[Coronary artery bypass without use of the heart-lung-machine].

INTRODUCTION: Off pump coronary artery bypass via sternotomy (OPCAB) and via a small left anterior thoracotomy (MIDCAB) on the anterior coronary arteries of the heart was introduced at the present center in 1997. Starting this year we decided to increase OPCAB and MIDCAB to constitute at least 50% of CAB procedures including the posterior aspect of the heart. METHODS: From January 1st through April 16th 1999 we performed 152 CAB procedures: 108 CABG, 6 MIDCAB, 13 OPCAB (on the anterior cornary arteries) and 25 OPCAB-Cx (including the circumflex artery). OP procedures were done using OCTOPUS-II to expose and stabilize the arteriotomies, and control angiography was performed before discharge. RESULTS: Off pump CAB was performed in 2% of the first 50 CAB patients, 36% of the next 50 and 50% of the last 52. The CABG and OPCAB-Cx groups were comparable as regards degree of coronary artery disease and number of distal anastomoses, but differed as regards poor left ventricular function and unstable preoperative status. Early mortality was 1.9% in the CABG group and 0% in the OP groups. Control angiograms in the OP groups showed a patency from 92 to 100%. CONCLUSIONS: In this short preliminary series, it was possible to increase the fraction of OP procedures to nearly 50% with good results.

Adult↗
PubMed2001

[Abciximab (ReoPro) in the treatment of acute coronary syndromes].

Platelet activation plays a major role in the pathophysiology of acute coronary syndromes (ACS). Inhibition of platelet function is the basic pharmacological treatment of ACS. Platelet membrane glycoprotein IIb/IIIa inhibitors, a new class of potent antiplatelet agents, have been used in the treatment of ACS and in the prevention of complications after percutaneous coronary interventions (PCI). Several large clinical trials have demonstrated the effectiveness of this class of agents. The first of these agents to show beneficial effects after coronary interventions was the mouse/human chimeric Fab fragment antibody c7E3 abciximab (ReoPro). The purpose of this article is to describe the pharmacology of abciximab and to review the results of the clinical trials carried out with the drug in patients with ACS, treated either with or without acute/elective PCI.

Angioplasty, Balloon, Coronary↗
PubMed2000

[Contrast echocardiography. Basic principles and clinical applications].

Recent advances in ultrasound technology and intravenous contrast agents have made it possible for contrast echocardiography to move from bench to bedside. Ultrasound contrast agents enhance endocardial border delineation and the Doppler signal, which may improve the diagnostic accuracy of echocardiography in selected patients. The most exciting feature of contrast echocardiography is its capability to achieve a quantitative assessment of myocardial perfusion, and the method may thus provide a range of clinical applications in patients with ischaemic heart disease.

Contrast Media↗
PubMed1998

Community-acquired urinary tract infection in adults: a hospital viewpoint.

The clinical and epidemiologic spectrum of 175 cases of community-acquired urinary tract infection (UTI) were evaluated at a university hospital. Patients were grouped in five different categories of which complicated UTI was the most common (39%). Bacteraemia was detected in eight patients (18%) of this group and in five (12%) with acute uncomplicated pyelonephritis. A single organism was isolated in 166 cases (95%). The rate of Escherichia coli bacteriuria ranged from 60% (asymptomatic bacteriuria) to 94% (uncomplicated cystitis). Of the 184 isolates, 92% were susceptible to ciprofloxacin and significantly high rates of resistance were found for ampicillin, cefazolin, cefuroxime, and co-trimoxazole. Isolates causing uncomplicated UTI had significantly high rates of resistance to ampicillin, amoxycillin-clavulanate and co-trimoxazole and those causing complicated UTI, had significantly high rates of resistance to most oral antibiotics tested, except quinolones and nitrofurantoine. Community-acquired UTI requiring hospital evaluation occurs in a complex group of patients, and current patterns of antibiotic resistance make it difficult to suggest empiric oral treatments in this setting.

Acute Disease↗
PubMed1998

The Barath Cutting Balloon versus conventional angioplasty. A randomized study comparing acute success rate and frequency of late restenosis.

In a randomized multicenter study initial success rate and 6 months' follow-up were compared between coronary angioplasty performed with the Barath Cutting Balloon (group A, n = 32) and conventional balloons (group B, n = 32) in patients with type A or B lesions in native coronary arteries. The culprit lesion was not reached in one patient in group A. Initial success rates were similar with and without additional stenting (8 in group A and 10 in group B). Angiographic follow-up data (in 95%) revealed a non-significant improvement in minimal lumen diameter, diameter stenosis in group A. Restenosis developed in 16.7% of group A vs 25.8% of group B, (p = 0.57). A separate analysis of stented patients showed no restenosis in group A and restenosis in 4 out of 10 patients in group B (p = 0.10). A possible beneficial effect of the Cutting Balloon with respect to in-stent restenosis requires further studies.

Aged↗
PubMed1998

Future directions in esophageal cancer.

The incidence of esophageal cancer in the United States has been increasing in recent years. Since multimodality therapy for esophageal cancer has produced discouraging results, recent approaches have focused on molecular biological techniques, positron emission tomography, and minimally invasive surgery to improve pretreatment staging which will facilitate a more accurate assessment of new treatment. This article summarizes the results of studies investigating these approaches and outlines the strategy currently used at the University of Pittsburgh Medical Center.

DNA, Neoplasm↗
PubMed1997

Danish multicenter randomized study of invasive versus conservative treatment in patients with inducible ischemia after thrombolysis in acute myocardial infarction (DANAMI). DANish trial in Acute Myocardial Infarction.

BACKGROUND: The aim of the DANish trial in Acute Myocardial Infarction (DANAMI) study was to compare an invasive strategy of percutaneous transluminal coronary angioplasty (PTCA) or coronary artery bypass grafting (CABG) with a conservative strategy in patients with inducible myocardial ischemia who received thrombolytic treatment for a first acute myocardial infarction (AMI). METHODS AND RESULTS: Of the 503 patients randomized to an invasive strategy, PTCA was performed in 266 (52.9%) and CABG in 147 (29.2%) from 2 to 10 weeks after the AMI. Of the 505 patients in the conservative treatment group, only 8 (1.6%) had been revascularized 2 months after the AMI. The patients were followed up from 1 to 4.5 years. The primary end points were mortality, reinfarction, and admission with unstable angina. At 2.4 years' follow-up (median), mortality was 3.6% in the invasive treatment group and 4.4% in the conservative treatment group (not significant). Invasive treatment was associated with a lower incidence of AMI (5.6% versus 10.5%; P=.0038) and a lower incidence of admission for unstable angina (17.9% versus 29.5%; P<.00001). The percentages of patients with a primary end point were 15.4% and 29.5% at 1 year, 23.5% and 36.6% at 2 years, and 31.7% versus 44.0% at 4 years (P=<.00001) in the invasive and conservative treatment groups, respectively. At 12 months, stable angina pectoris was present in 21% of patients in the invasive treatment group and 43% in the conservative treatment group. CONCLUSIONS: Invasive treatment in post-AMI patients with inducible ischemia results in a reduction in the incidence of reinfarction, fewer admissions due to unstable angina, and lower prevalence of stable angina. We conclude that patients with inducible ischemia before discharge who have received treatment with thrombolytic drugs for their first AMI should be referred to coronary arteriography and revascularized accordingly.

Adult↗
PubMed1994

Skeletal muscle vascular responses in human limbs to isometric handgrip.

Studies of whole limb blood flow have shown that static handgrip elicits a vasodilatation in the resting forearm and vasoconstriction in the resting leg. We asked if these responses occur in the skeletal muscle vascular bed, and if so, what is the relative contribution of local metabolic versus other mechanisms to these vascular responses. Blood flow recordings were made simultaneously in the skeletal muscle of the resting arm and leg using the Xenon-washout method in ten subjects during 3 min of isometric handgrip at 30% of maximal voluntary contraction. In the arm, skeletal muscle vascular resistance (SMVR) decreased transiently at the onset of exercise followed by a return to baseline levels at the end of exercise. In the leg SMVR remained unchanged during the 1st min of handgrip, but had increased to exceed baseline levels by the end of exercise. During exercise electromyography (EMG) recordings from nonexercising limbs demonstrated a progressive 20-fold increase in activity in the arm, but remained at baseline in the leg. During EMG-signal modelled exercise performed to mimic the inadvertent muscle activity, decreases in forearm SMVR amounted to 57% of the decrease seen with controlateral handgrip. The present study would seem to indicate that vascular tone in nonexercising skeletal muscle in the arm and leg are controlled differently during the early stages of static handgrip. Metabolic vasodilation due to involuntary contraction could significantly modulate forearm skeletal muscle vascular responses, but other factors, most likely neural vasodilator mechanisms, must make major contributions. During the later stages of contralateral sustained handgrip, vascular adjustments in resting forearm skeletal muscle would seem to be the final result of reflex sympathetic vasoconstrictor drive, local metabolic vasodilator forces and possibly neurogenic vasodilator mechanisms.

Adult↗
PubMed1994

Short- and long-term survival after aortic balloon valvuloplasty for calcified aortic stenosis in 137 elderly patients.

UNLABELLED: Percutaneous transluminal balloon aortic valvuloplasty was performed in 137 patients with symptomatic severe calcified aortic stenosis (50 men and 87 women, mean age 77 years) between December 1986 and September 1990. The purpose of the study was to evaluate short- and long-term survival after balloon aortic valvuloplasty, mean follow-up was 19 months. At the time of balloon aortic valvuloplasty congestive heart failure (NYHA III-IV) was present in 89%, angina pectoris in 47%, and syncope in 31% of the patients. Aortic balloon dilatation produced significant decreases in peak pressure gradient from 91 +/- 34 mmHg to 40 +/- 26 mmHg (p < 0.001). The procedure related mortality was 8% (11 pts) and the 30-days mortality 17% (23 pts). Severe complications occurred in 25% of the patients during the procedure and within the first 24 hours. Immediate clinical improvement was noted in 68% of the patients surviving the treatment. The overall survival rate was at one, two, three and four years follow-up 63%, 40%, 28%, and 21%, respectively. These survival rates were all statistically different from the survival rates in an age- and sex-matched background population (p < 0.001). A multivariate Cox analysis revealed that only female sex and angina before treatment seemed to improve survival. CONCLUSION: The long-term outcome after aortic balloon valvuloplasty for severe aortic stenosis is so poor that we recommend aortic valve replacement as the initial treatment in these patients, if at all possible.

Adult↗
PubMed1993

Effects of orthostatic stress on peripheral capillary filtration in mild congestive heart failure after healing of myocardial infarction.

Patients with heart failure have impaired baroreflex control of the peripheral circulation with attenuated vasoconstrictor response during orthostatic stress. The aim of this study was to test if this impaired baroreflex control not only affects the arterial, but also the capillary bed. Blood flow and capillary filtration were measured in the forearm (plethysmography) in 7 normal subjects and 7 patients with mild congestive heart failure (New York Heart Association functional class II). Measurements were done with the subjects supine and during head-up tilt at 45 degrees. While supine, forearm vascular resistance and capillary filtration coefficient did not differ significantly between the groups. In the control subjects, tilt decreased capillary filtration coefficient by 14 +/- 3% (p < 0.02), and increased forearm vascular resistance by 88 +/- 37% (p < 0.02); in contrast, patients with heart failure had an increase in capillary filtration coefficient of 26 +/- 5% (p < 0.02) and only increased the forearm vascular resistance by 10 +/- 1%, (p = NS, p = 0.26). Our data provide evidence that patients with mild heart failure, in contrast to normal subjects, increase the peripheral capillary filtration during orthostatic stress. The data indicate that impaired baroreflex mechanisms might influence the capillary filtration and it is suggested that impaired baroreflex control of the peripheral circulation can contribute to formation of edema in patients with heart failure.

Adult↗
PubMed1993

Valve area and cardiac output in aortic stenosis: quantification by magnetic resonance velocity mapping.

Valve area and cardiac output were determined with magnetic resonance (MR) velocity mapping in 12 patients with aortic stenosis. Heart catheterization, Doppler echocardiography, and indicator dilution were performed for comparison. Left ventricle could be catheterized in only nine patients; in these cases, MR measured a mean valve area of 1.2 cm2 compared with 0.9 cm2 derived from catheterization data, with a mean difference of 0.2 cm2 between the 2 methods. The limits of agreement were [0.0, +0.5] cm2, less in patients with an important degree of concomitant regurgitation. In the whole material, MR measured a mean area of 1.1 cm2 compared with 1.2 cm2 derived from Doppler echocardiography data, with a mean difference of 0.1 cm2 and [-0.5, +0.6] cm2 as limits of agreement. In 11 patients the cardiac output was quantified by MR to a mean of 4.9 L/min and by indicator dilution to 5.0 L/min, with a mean difference of 0.2 L/min, and [-0.6, +0.8] L/min as limits of agreement. In addition, MR offers the major advance of simultaneous quantification of regurgitant volume in cases of concomitant regurgitation. In conclusion, because the two important prognostic determinants in aortic stenosis--the valvular area and the cardiac output--may be quantified, MR has potential to become a clinical tool in assessment of severity in aortic stenosis.

Aged↗
PubMed1993

Coronary artery bypass surgery in patients with severe left-ventricular dysfunction.

In the period 1988-91 31 patients with depressed function of the left ventricle but without valvular disease or congestive heart failure underwent coronary arterial bypass surgery. The median number of previous infarctions was 1.7 (0-4). Four patients had no history of previous myocardial infarction. All patients had ischemic heart disease and significant stenoses of the circumflex artery, the left anterior descendent artery, or the right coronary artery. Preoperatively the mean left-ventricular ejection fraction (LVEF) was 20% (9-26) judged by echocardiography. The median number of peripheral anastomoses was 4.9 (2-7). The perioperative mortality was 9.7%. One year survival was 90%. Postoperatively the median LVEF increased to 35% (11-50). After surgery the working capacity increased in 71% of the patients. This study has demonstrated that coronary arterial bypass surgery in patients with ischemic heart disease and poor left-ventricular function caused mainly by perfusion defects may result in symptomatic and functional benefit.

Adult↗
PubMed1992

Subcutaneous and skeletal muscle vascular responses in human limbs to lower body negative pressure.

Cardiopulmonary baroreceptor unloading in humans comparably increases sympathetic discharge to skeletal muscle in the forearm and calf, but blood flow studies have disclosed differential rather than uniform vasomotor responses in the extremities. The aim of the present study was to address the issue of differential effects of orthostatic stress on forearm and calf vascular adjustment and to extend previous studies by determining changes in vascular responses separately in various vascular beds of the limbs. The local [133Xenon] washout method was used for recording blood flow rates in subcutaneous tissue and skeletal muscle. Simultaneous recordings from the forearm and calf were performed in 11 healthy young males during lower body negative pressure at -10 mmHg. Heart rate, arterial mean and pulse pressures did not change during lower body negative pressure. In the forearm blood flow rates decreased significantly, in subcutaneous tissue by 16 +/- 2% (mean +/- SEM) and in skeletal muscle by 16 +/- 1%. In the calf lower body negative pressure induced a significant decrease in blood flow rates of 17 +/- 3% in subcutaneous tissue and of 30 +/- 2% in skeletal muscle. This vasoconstriction in calf skeletal muscle was consistently disclosed in both legs and was about the same magnitude in each calf when studied with the one leg exposed to lower body negative pressure and the other outside the lower body negative pressure chamber. These findings suggest that during unloading of cardiopulmonary afferents, reflex sympathetic activation as an important autonomic adjustment to orthostatic stress is accompanied by uniform vasoconstriction in subcutaneous and skeletal muscle vascular beds of human limbs.

Adult↗
PubMed1991

[Coronary bypass surgery in patients with decreased function of the left ventricle].

During 1988-1990, 21 patients with poor left ventricular function underwent coronary artery bypass surgery. The median number of previous infarctions was 1.6 (0-4). Three patients had no previous history of myocardial infarction. All patients had ischemic heart disease and significant stenoses or occlusion of the circumflex artery, the left anterior descendent artery and the right coronary artery. Preoperatively the left ventricular ejection fraction (LVEF) was 23% (10-28) judged by echocardiography. The median number of peripheral anastomoses was 4.8 (2-7). The perioperative mortality was 9.5%. One year survival was 90%. Postoperatively the median LVEF increased to 35% (25-50). The working capacity increased in 70% of the patients. This study has shown that coronary arterial bypass surgery in patients with ischemic heart disease and poor left ventricular function may result in symptomatic and functional benefit.

Adult↗