[Advances in percutaneous coronary revascularization].
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Angioplasty, Balloon, Coronary↗
Biomedical subjects
J Rozenman
Publications and source records attributed to J Rozenman.
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↗
Nocardia asteroides infection complicating rheumatoid arthritis.
We describe a case of pulmonary nocardiosis in a patient with rheumatoid arthritis (RA) receiving treatment with combined immunosuppressive agents and prednisone. This infection is still considered rare, hard to diagnose, and difficult to treat. To the best of our knowledge, such a case has not been described in a patient with RA.
Arthritis, Rheumatoid↗
[Pulmonary disease induced by methotrexate].
A 68-year-old man with rheumatoid arthritis developed methotrexate-induced lung disease. He presented with fever, cough, respiratory distress and pulmonary infiltrates, which were initially mistaken for pneumonia. Alertness to this rare and dangerous complication of methotrexate treatment will reduce possible damage and help maintain its place as a leading medication for rheumatoid arthritis.
Aged↗
Isolated ectopic lung uptake of technetium 99m methylene diphosphonate on bone scintigraphy in primary amyloidosis.
Pulmonary deposition of technetium 99m methylene diphosphonate was found on a bone scan of a patient with undiagnosed primary AL amyloidosis. Unusual clinical manifestations during the course of the disease led to a post-mortem diagnosis. The mechanisms for pulmonary and other ectopic soft tissue bone scan tracer depositions, as well as their significance in the diagnosis of amyloidosis, are discussed.
Aged↗
Pneumatic rupture of the esophagus caused by carbonated drinks.
Pneumatic rupture of the esophagus occurs when gas under pressure is accidentally delivered into the oral cavity. To the 4 cases previously described we add 2 pediatric patients and in both the source of the offending gas was a bottle of carbonated drink. The mild initial symptoms were followed in both by physical and radiographic findings suggesting pharyngoesophageal perforation. Early radiologic findings included free subcutaneous and mediastinal air, followed later by hydropneumothorax and mediastinal widening as well as leak of contrast material on gastrografin swallow. CT findings contributed to patient evaluation and management.
Adolescent↗
Computed tomography in children with esophageal and airway trauma.
Computed tomography (CT) was used in five children, four with esophageal and one with airway trauma. The examination contributed valuable information that aided in planning and evaluating therapy: (1) it assessed mediastinal and pleural cavity involvement prior to surgery or drainage; (2) it evaluated the efficacy of drainage; (3) it gave excellent information about the position of chest tubes; and (4) it demonstrated unsuspected pneumothoraces, pleural effusion, pulmonary infiltrates, and lung perforation by a chest tube. In the postoperative assessment of laryngotracheal fracture, neck radiographs were useless since the airways were obliterated by hematomas and edema. In this situation, CT showed the position and state of the laryngeal cartilages. However, CT findings were not pathognomonic for esophageal tears or airway fractures. The primary diagnosis was still made by conventional radiography. Esophageal tears were accurately demonstrated by gastrografin swallow and the tracheolaryngeal fracture was diagnosed by a lateral neck radiograph--the state of the child permitting no lengthy workup. CT and conventional radiography with contrast studies play a complementary role in esophageal and airway trauma in children.
Child↗
Castleman's disease. An uncommon computed tomographic feature.
A case of localized intrathoracic Castleman tumor demonstrated, on CT scan, calcifications in a circumferential distribution. The prevalence of calcifications in Castleman's disease and the differential diagnosis of the above unusual CT findings are discussed.
Adult↗
Prediction of atrial and ventricular fibrillation complicating myocardial infarction from admission data: a prospective study.
This study set out to examine prospectively two logistic formulae based on admission clinical data to predict ventricular or atrial fibrillation complicating acute myocardial infarction. A prospective study of 87 consecutive patients with acute transmural myocardial infarction was conducted. The formula for predicting ventricular fibrillation from the diastolic blood pressure, degree of ST-segment elevation, and QTc had a sensitivity of 93%, specificity of 83%, and a predictive value for an abnormal test of 62% (13 of 14 patients who developed ventricular fibrillation were identified). The formula for predicting atrial fibrillation from the age of the patient, a history of heart failure, systolic blood pressure, and four electrocardiographic parameters had a sensitivity of 78%, specificity of 85%, and a predictive value of 67% (14 of 18 patients identified). Our study shows that patients with myocardial infarction who are liable to develop ventricular or atrial fibrillation can be identified on admission from simple clinical data.
Atrial Fibrillation↗
Pleuro-pulmonary manifestations of systemic lupus erythematosus: clinical features of its subgroups. Prognostic and therapeutic implications.
Correct identification of the subsets of pulmonary lupus has an unquestioned importance in planning the proper therapeutic regimen in this extremely variegated disease. Asymptomatic pulmonary lupus needs no treatment; however, pulmonary involvement in lupus may be life threatening, in which case prompt and aggressive treatment is mandatory. The different aspects of pulmonary lupus are demonstrated through the clinical histories of patients who suffered from pleuro-pulmonary lupus. The following entities are presented: lupus pneumonitis, lymphocytic interstitial pneumonia, pulmonary hypertension, pulmonary hemorrhage, pulmonary embolism associated with circulating lupus anticoagulant, lupus pleuritis and weakness of the diaphragm.
Adult↗
Pyloric channel duplication in a newborn infant.
This is the first reported case of pyloric channel duplication demonstrated preoperatively by endoscopy and contrast radiography. Endoscopically, the lesion resembled a mucosal flap overlying the pyloric orifice. On radiography the lesion presented as a polypoidal filling defect in the duodenal bulb. The infant had, in addition, postduplication stress ulcer.
Adult↗
Hypospadias before and after repair: a radiological evaluation.
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Humans↗
Radiological findings of the urinary tract in hypospadias: a report of 110 cases.
One hundred and ten patients with hypospadias underwent excretory urography and micturating cysto-urethrography before surgical correction. Urographic studies revealed abnormalities in 50 patients (45%), mainly anomalies of ascent and rotation of the kidneys. None of these patients required corrective surgery. Voiding cysto-urethrography disclosed disease of the urinary tract in 65 of 110 patients (59%). Meatal stenosis was found in 38 patients and a rudimentary vagina or a prostatic utricle was revealed in 11 others. Vesico-ureteral reflux was present in 14 patients, seven of whom had meatal stenosis as well. Cystitis was found in eight and a stricture of the membraneous urethra in one patient. The voiding cysto-urethrogram is able to demonstrate functionally significant meatal stenosis, genital abnormalities and vesico-ureteral reflux. It can also serve as a useful baseline for comparison with postoperative studies. We therefore consider that it should be included in the preoperative work-up of every patient with hypospadias. Excretory urography, however, is perhaps indicated only in those with urinary tract infection, or in patients otherwise symptomatic.
Adolescent↗
Spiral CT and 3D image reconstruction of vascular rings and associated tracheobronchial anomalies.
OBJECTIVE: Spiral CT (SCT) angiography and three-dimensional (3D) reconstruction methods represent noninvasive tools in diagnosis of vascular rings and associated tracheobronchial anomalies in the pediatric age group. MATERIALS AND METHODS: Three patients suspected on clinical and conventional radiological grounds of having vascular and tracheobronchial anomalies were examined using SCT. Three-dimensional images were reconstructed using a surface rendering technique. RESULTS: In one case the diagnosis of complete double aortic arch was confirmed by angiography. In the other two patients the SCT and 3D reconstruction established the diagnosis of pulmonary sling and right aortic arch associated with left aberrant subclavian artery and angiography could be avoided. CONCLUSION: Spiral CT and color-coded 3D reconstruction represent important additional tools and perhaps alternatives to angiography or other noninvasive techniques used in evaluation of vascular anomalies of the thoracic aorta and pulmonary arteries in infants and children.
Aorta, Thoracic↗
Corneal transplant allograft reactions in unilateral, double corneal transplants.
In support of the idea that the HLA system plays a major role in corneal graft rejection, we report these two unique cases. Both had two penetrating grafts in the same eye. One was a regular graft and the second a patch graft to repair a perforation in the initial one. In the first case, the original graft had an allograft reaction and the patch graft remained unaffected. In the second case, an allograft reaction to the patch graft developed while the regular graft remained completely clear. Both grafts in the two cases cleared following medical therapy. The fact that in these two cases rejection reactions involved one transplant only, even though the other graft was subject to the same conditions, implies that the difference in the antigenicity of the two grafts is an important factor in the chain of events leading to rejection.
Adult↗