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Biomedical subjects

G Mintz

Publications and source records attributed to G Mintz.

At least 19 recordsLinked to original sources
PubMed2001

Carotid artery stenting in patients with high-risk anatomy for carotid endarterectomy.

PURPOSE: To report the results of carotid artery stenting (CAS) in patients considered to have high-risk anatomical characteristics for carotid endarterectomy. METHODS: CAS was performed in 39 carotid arteries of 37 consecutive patients (26 men; mean age 72 +/- 8 years, range 56-88) who met the criteria for high-risk surgical anatomy: previous ipsilateral carotid endarterectomy (20/39, 51.3%), common carotid bifurcation above the mandibular angle (5/39, 12.8%), contralateral carotid artery occlusion (15/39, 38.5%), or previous radiation therapy to the neck (1/39, 2.6%). Palmaz, Integra, or Wallstents were deployed via a percutaneous femoral artery access. Independent neurological evaluation was performed at specified time points, and a dedicated committee adjudicated all clinical events. RESULTS: Procedural success was 100%, with no major in-hospital complications. Neurological events were rare. Only 1 (2.6%) transient ischemic attack occurred prior to discharge; at 30 days, 1 (2.6%) additional minor stroke had been observed, giving a 2.6% cumulative 30-day "death plus any stroke" rate. Over a mean 11 +/- 6-month follow-up, 2 (5.4%) patients died of nonneurological causes, but there were no strokes. CONCLUSIONS: CAS is a viable endovascular revascularization technique that can be performed safely and effectively in patients with high-risk anatomy for carotid endarterectomy.

Aged↗
PubMed2000

Mechanical properties and imaging characteristics of remanufactured intravascular ultrasound catheters.

Intravascular ultrasound (IVUS) as a routine device in interventional cardiology is handicapped by its high price. 19 factory-made, 'remanufactured' IVUS catheters which consist of sterilized, used phased-array IVUS transducers inserted into a new catheter shaft were compared with 23 new IVUS catheters. 3 mechanical and 4 imaging characteristics were assessed on a 5 point scale (1 = unacceptable, 5 = excellent). Mechanical as well as imaging properties of 'remanufactured' IVUS catheter were comparable to new catheters with excellent ratings for each of the evaluated characteristics in 38 to 94% of 'remanufactured' catheters and 50 to 96% of new catheters. The initial failure rate for 'remanufactured' IVUS catheters was 31.6% vs. 4.3% for new catheters (P < 0.05). Overall failure rate was 47.3% for "remanufactured" catheters vs. 8.7% for new catheters (P < 0.05). The failure was due to an electronic connecting problem occurring during mechanical stress to the IVUS catheter. In conclusion, 'remanufactured' IVUS catheters offer mechanical and imaging characteristics which are comparable to new catheters. Improvements in the 'remanufacturing' process to resolve the high rate of electronic connecting problems may make this a promising approach to substantially lower the price of IVUS catheters.

Catheterization↗
PubMed1995

Measurement of clinical activity of systemic lupus erythematosus and laboratory abnormalities: a 12-month prospective study.

OBJECTIVE: To assess flares in outpatients with systemic lupus erythematosus (SLE) using SLAM (systemic lupus activity measure) and to determine laboratory abnormalities as predictors of disease activity. METHODS: Fifty-three Mexican patients were assessed using SLAM scale. They were evaluated monthly for a total of at least 572 months. The SLAM scale was applied at each visit. Samples were drawn for complete blood cell count, erythrocyte sedimentation rate, urinalysis, 24-h protein and creatinine clearance, anti-DNA, C3 and C4. An SLE flare was defined as the occurrence of new clinical manifestations or worsening compared to the previous month that usually required restarting or increasing prednisone or immunosuppressive drugs. RESULTS: Thirty-three patients had flares, mainly in minor organs. The incidence of flares was 0.69/patient/year of followup. Active nephritis and extrarenal manifestations correlated with high levels of dsDNA and low complement levels. We found an odds ratio (OR) = 3 (CI = 1.7-5.7) for flare in asymptomatic patients with high dsDNA and OR = 2 (CI = 1.3-4.5) for low C3 levels. CONCLUSION: Flares are frequent in patients with SLE and they occur independent of disease duration and the time the disease has been under control. Flares are apparently predictable and are related to serologic abnormalities.

Adult↗
PubMed1994

Intravenous cyclophosphamide pulses in the treatment of pyoderma gangrenosum associated with rheumatoid arthritis: report of 2 cases and review of the literature.

Pyoderma gangrenosum is a chronic ulceronecrotic inflammatory cutaneous disorder that can be associated with diseases such as rheumatoid arthritis (RA). No definitive treatment exists for this condition; steroids have been the mainstay of therapy, and the addition of immunosuppressives has been advocated. We describe 2 patients with pyoderma gangrenosum occurring in the setting of RA who, in addition to steroids, received pulse intravenous cyclophosphamide and had a remarkably good and lasting response. This is the first report of such a therapeutic approach. The pertinent literature is discussed. We conclude that pulse cyclophosphamide is another possible therapy for pyoderma gangrenosum.

Adult↗
PubMed1993

Ankylosing spondylitis: clinical course in women and men.

OBJECTIVE: To compare the clinical course; laboratory and radiological features of women and men with ankylosing spondylitis (AS). METHODS: Retrospective review of charts of 41 women and 41 men with AS (25 B27+ and 16 B27- in each group) individually matched for age at onset and disease duration. RESULTS: No differences were observed in the clinical picture in either sex, but the disease was less severe in women than in men with lesser duration of uveitis attacks, lower leukocyte counts (p < 0.05), lower levels of gamma-globulins (p < 0.05), and longer asymptomatic periods. At the end of the study, women had less restriction of spinal extension (p = NS), less sequelae of uveitis without significant visual loss (p = NS), required fewer hip replacements, had less frequency of bamboo spine (p < 0.02), and better functional class (p < 0.0027) than men. CONCLUSION: There are no significant clinical or radiographic differences between women and men with AS. However, the disease was more severe in men and these features may be due to sexual dimorphism.

Adolescent↗
PubMed1991

Enhanced left ventricular diastolic function in hyperthyroidism: noninvasive assessment and response to treatment.

Hyperthyroidism is associated with a marked effect on the cardiovascular system. Despite enhanced resting ventricular systolic performance, thyrotoxicosis has been implicated as a primary cause of cardiomegaly, congestive heart failure, and decreased exercise tolerance. To further assess potential alterations in ventricular function we have noninvasively studied diastolic performance in nine newly diagnosed and untreated hyperthyroid patients. Parameters including diastolic flow velocities, isovolumic relaxation time (IVRT), and the rate of diastolic flow deceleration were compared to those of an age- and sex-matched control population, and then repeat determinations were made after beta-adrenergic blockade and again when the patients were chemically and clinically euthyroid. Before treatment the IVRT was 33.0 ms, which was significantly (P less than 0.005) shorter than the control value (57.9 ms) and in combination with other measures of diastolic function indicated enhanced left ventricular relaxation. beta-Adrenergic blockade slowed the resting heart rate from 97 to 80 beats/min (P less than 0.005) and partially normalized the rate of diastolic deceleration, but had no effect on the IVRT (33.8 ms). When patients were euthyroid, the IVRT was 51.7 ms, and other measures of diastolic performance were the same as those in controls. The current data assessing resting diastolic function in hyperthyroidism are similar to those previously reported for systolic function. Our findings of enhanced cardiac diastolic performance do not support the hypothesis that thyrotoxicosis is associated with compromised left ventricular function and suggest the possibility that the cardiac symptoms that accompany hyperthyroidism may be due to noncardiac mechanisms.

Adult↗
PubMed1991

Testicular function in active ankylosing spondylitis. Therapeutic response to human chorionic gonadotrophin.

Testicular function was studied in 22 patients with ankylosing spondylitis (AS) with serum measurements of hormone levels, seminal fluid analysis and testicular reserve test. Results were correlated with disease activity. The abnormal findings were elevated luteinizing hormone (LH), inversion of estradiol/testosterone ratio (E2:T) and diminished testicular reserve for testosterone (T) and slightly increased for estradiol (E2). Nine patients with severe active AS received biweekly 2,500 IU of human chorionic gonadotrophin injections with a resulting increase in E2 serum levels. When the values of E2 reached 40 pg/ml or higher, there was a decrease of the sedimentation rate (p less than 0.05) and a reversal to normal of the E2:T ratio. This was accompanied by an improvement in AS at the 10th week that lasted up to 9 weeks after discontinuation of treatment. Our findings suggest a possible role of sex hormones in the physiopathogenesis of AS and offers a possible therapeutic alternative.

20-alpha-Dihydroprogesterone↗
PubMed1990

Ovarian function studies in active ankylosing spondylitis in women. Clinical response to estrogen therapy.

Ovarian function was studied in 17 women with active ankylosing spondylitis (AS). Levels of FSH, LH, prolactin and androstenedione were normal in menstruating patients and FSH and LH were elevated in menopausal patients. In menstruating patients with active AS the estradiol levels were lower than in patients with inactive AS and significantly (p less than 0.05) lower than controls. Progesterone levels in menstruating patients were lower (P = NS) than controls. In menopausal patients estrogen levels were lower than their controls (P = NS). There was a significant (p less than 0.05) inverse correlation between the sedimentation rate and the estrogen level. Seven patients accepted oral estrogen therapy (average duration 4 months) and peripheral arthritis subsided within one month, all variables of clinical activity of AS improved and at the end of the study all patients were in functional class I.

Adult↗
PubMed1989

Dermatomyositis.

Pregnancy in DM/PM is infrequent probably because of the late age of onset of the disease. When pregnancy occurs in patients with long-standing remissions of childhood onset DM/PM the risk of exacerbation is 40 per cent and the prognosis for the fetus is reasonably good. If pregnancy starts in patients already diagnosed and under steroid treatment of DM/PM, the frequency of exacerbations is low (16 per cent) and the outcome of pregnancy is not as good, with only 50 per cent at-term babies and 37.5 per cent fetal loss. When DM/PM has its onset during pregnancy the fetal mortality reaches 62 per cent. No maternal deaths have been reported. The response to steroid therapy for active DM/PM during pregnancy seems to be good with two patients recovering their muscle strength very rapidly after delivery. There are no placental abnormalities that could explain the increased fetal loss. The newborns have no stigmata of the maternal disease. Pregnancy in DM/PM should be considered a high-risk pregnancy and managed accordingly; adequate prednisone therapy for the maternal disease, frequent monitoring of the growth and development of the fetus, careful search for signs of fetal distress and interruption of pregnancy as needed with the care of a neonatologist at the time of delivery. The mechanisms of the reciprocal interaction between DM/PM and pregnancy are unknown.

Abortion, Spontaneous↗
PubMed1989

Systemic lupus erythematosus.

Pregnancy occurring in patients with diagnosed and controlled SLE will be associated with a flare of disease in 60 per cent of cases, which is not significantly different from flares in nonpregnant patients. Signs and symptoms of active SLE should be carefully evaluated and treated with steroids according to severity and organ systems involved. When pregnancy occurs with inactive kidney disease there is a 10 per cent rate of reactivation and SLE kidney disease may appear for the first time during pregnancy in 6.8 per cent of patients. These rates are similar in the control group. There will be a significantly increased abortion rate which cannot be improved with maternal treatment. There will also be a high prematurity rate and an increased number of newborns with intrauterine malnutrition that are associated with active maternal disease. The following points are important when caring for a pregnant SLE patient: 1. Maintain maternal disease inactive throughout gestation. 2. Monitor growth and development of fetus. 3. Monitor for fetal distress. 4. Interrupt pregnancy when fetal distress is diagnosed. 5. A neonatal intensive care unit should be available at the time of delivery. The short-term prognosis is good with no maternal mortality and there is no long-term deleterious influence of pregnancy on the evolution of SLE.

Abortion, Spontaneous↗
PubMed1988

The radiology of cardiac valve prostheses.

The radiographic findings associated with the complications of valve implantation are presented. Complementary roles of echocardiography and cine fluoroscopy in the recognition of complications associated with this procedure are emphasized. Identification of prosthetic valves and the knowledge of the modes of action of the various types of valves are stressed.

Bioprosthesis↗
PubMed1986

Prospective study of pregnancy in systemic lupus erythematosus. Results of a multidisciplinary approach.

Our prospective study attempted to better define the reciprocal relation between pregnancy and systemic lupus erythematosus (SLE), to reduce maternal morbidity/mortality, and fetal loss. Our protocol included all the pregnancies in our total of patients with SLE between the years 1974-1983. There were 102 pregnancies in 75 patients during this period; SLE was exacerbated in 59.7% that started with inactive disease, most with mild episodes. Hematologic manifestations and renal disease, however, required moderate or high doses of steroids. There were no maternal deaths. There were 49% premature newborns in the entire group and this increased to 59% in mothers with active SLE; 23% of newborns were small for gestational age in the entire group and the rate increased to 65% in mothers with active SLE. There was a 16% spontaneous abortion rate with no difference between mothers with active or inactive disease, 5 stillbirths and one neonatal death, with a total fetal loss of 22% (compared with 6.7% in the control group p less than 0.001). There were 32 cesarean sections with live outcomes and 14 newborn infants with a weight below 1.5 kg survived. Our study shows that in patients with SLE planned rheumatologic care of the mother, with special obstetrical and perinatal attention, may reduce the high maternal and fetal morbidity/mortality.

Abortion, Spontaneous↗
PubMed1985

Diagnosis and primary management of laryngeal trauma.

Four cases of laryngeal trauma are presented and the literature is reviewed. Diagnostic techniques and controversial primary treatment of airway obstruction are discussed. Recommendations include the use of indirect laryngoscopy on initial examination and the performance of a tracheostomy in cases of airway obstruction, in lieu of endotracheal intubation. The cases illustrate these points and demonstrate the variability in time intervals between injury and onset of symptoms.

Adult↗