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Biomedical subjects

M Gotsman

Publications and source records attributed to M Gotsman.

At least 19 recordsLinked to original sources
PubMed1994

Very early thrombolysis in acute myocardial infarction--a light at the end of the tunnel.

Myocardial damage in acute myocardial infarction is a time-dependent process. Thrombolytic therapy effectively opens the coronary artery, restores coronary blood flow and prevents ongoing necrosis. We examined the effect of very early thrombolytic therapy (including prehospital administration) in a consecutive group of 510 patients with myocardial infarction on the following factors: mortality, complications and the preservation of left ventricular function. The treatment was given to 89 at home (time delay to treatment 1.2 +/- 0.6 h) and 421 in hospital (2.0 +/- 1.0 h). Twelve patients died in hospital and major hemorrhage occurred in 10. The arterial patency rate in 416 patients who underwent coronary angiography 6 days later was 82%. Infarct size measured by left ventriculography was determined by the area at risk, the delay time until the initiation of thrombolytic therapy, the total duration of ischemic pain and the degree of restoration of arterial blood flow. We conclude that early thrombolytic therapy, particularly prehospital management, is feasible and safe and reduces infarct size and mortality. A further decrease in the delay to initiation of treatment and more effective thrombolytic therapy will further decrease mortality and myocardial damage.

Aged↗
PubMed1992

Angiographic findings in the coronary arteries after thrombolysis in acute myocardial infarction.

The angiographic appearance of the coronary arteries was examined in 308 patients with acute myocardial infarction (AMI) who received high-dose intravenous thrombolytic therapy. Coronary angiography was performed on day 7 after admission to the hospital. Patients had an average of 2.4 discrete arterial narrowings or obstructions. The narrowings were proximal and related to bifurcations. Four fifths of the culprit arteries were patient; 104 (34%) had a ruptured plaque, 22 (7%) had an ulcerated plaque, and in 190 (62%) the lesions were eccentric. Patients differed from a comparable, previously studied, control series of 302 patients with chronic stable angina pectoris who had more extensive disease. They had 5.7 narrowings/patient, also located proximally and at bifurcations, but more widely distributed in the coronary tree. Patients with AMI who are suitable for thrombolysis have a unique coronary angiographic picture. The data confirm that AMI is caused by sudden rupture of a localized atheromatous plaque that initiates an obstructive thrombotic cascade.

Angina Pectoris↗
PubMed1990

Cardiopulmonary assessment in beta-thalassemia major.

Thalassemia patients succumb at a young age to congestive heart failure. Hitherto, attention has been focused on left ventricular function. This report emphasizes right ventricular dysfunction and abnormal pulmonary function. We performed cardiopulmonary evaluation, including echo-Doppler, spirometry, CO diffusion (DCO), and blood gas analyses in 35 patients with homozygous beta-thalassemia maintained by multiple blood transfusions. Six autopsy lung specimens were studied. Thalassemia patients exhibited pulmonary dysfunction, characterized by hypoxemia (85 percent of the patients were outside the 95 percent confidence limits), reduced lung volumes (51 percent), flow rates (63 percent) and DCO (50 percent). Right ventricular dysfunction was more prevalent than left ventricular dysfunction. Furthermore, 75 percent of the patients had evidence of pulmonary hypertension consistent with more frequent right ventricular rather than left ventricular dysfunction. Our findings suggest that in thalassemia patients, complex cardiopulmonary abnormalities precede the final outcome of congestive heart failure.

Adult↗
PubMed1990

Psychosocial adjustment before and after coronary artery bypass surgery.

Twenty-eight consecutive male patients were examined a few days before, and again twelve months after, coronary artery bypass surgery. The evaluation included the patients' psychological distress, psychosocial adjustment, cardiac state, personality and family relations. Before surgery the patients were relatively well adjusted, despite being severely disabled physically. On the follow-up evaluation the cardiac state improved significantly on every index examined. On the other hand no change occurred in the psychological distress, personality and family relations. Significant post-operative improvement was found in some of the domains of the psychosocial adjustment, but not in others.

Adaptation, Psychological↗
PubMed1988

Dissection of the left main coronary artery: a complication of PTCA to the anterior descending artery.

This case report describes a patient with severe discrete left anterior descending coronary artery atheroma who underwent percutaneous transluminal coronary angioplasty. During the procedure, dissection occurred in a superior atheromatous plaque of the left main coronary artery and needed immediate surgery. Special care should be taken in the selection and angioplasty of patients with concomitant left main artery disease.

Angina Pectoris↗
PubMed1986

Pulmonary valve stenosis and hemophilia A. Report of three cases and discussion of a possible genetic linkage.

We treated three unrelated patients with hemophilia A and congenital pulmonary valve stenosis. In two patients, the occurrence of the cardiac malformation was sporadic and in one familial. The coexistence of hemophilia A and pulmonary valve stenosis might suggest a genetic linkage for both disorders. Review of the literature supports the hypothesis that the inheritance of pulmonary valve stenosis is dominant and X-linked.

Adolescent↗
PubMed1986

Further characterisation of the inotropic effect of a bufodienolide glycoside--an endogenous ouabain like compound.

A ouabain like compound obtained from toad skin and plasma and identified to be a steroidal bufodienolide glycoside was found to displace ouabain from its binding site and to inhibit Na+-K+ ATPase, and have positive inotropic effects on cardiac muscle. The ionic and rate dependence of this positive inotropy was studied in the frog atrium. The effect was dependent on extracellular potassium, sodium, and calcium concentrations and on the rate of stimulation, which is similar to the properties of cardiac glycosides. Occasionally, the compound gave transient or even negative inotropic responses, as do the glycosides. The action potential configuration was also affected by the compound in the same complex pattern as is that of cardiac glycosides. It is concluded that the endogenous bufodienolide compound has the same physiological effects as cardiac glycosides. Since the same compound is present in toad plasma it may serve as an intrinsic humoral regulator of cardiac contractility. This study is the first detailed characterisation of the cardioactive properties of this compound.

Action Potentials↗
PubMed1985

Aggregation of plasma lipids and lipoproteins in families with and without coronary heart disease.

Familial aggregation of total plasma cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C) and high density lipoprotein cholesterol (HDL-C) was analyzed in 37 families with incidence cases of first myocardial infarction (MI), in 154 families of coronary heart disease (CHD) prevalence cases and in control families. Fasting plasma lipid levels were adjusted for age, sex, country of origin and season of year. Mean TC, LDL-C and TG levels were higher among cases, their spouses and among 17-year-old children of incidence cases than among control families. HDL-C was lower among cases and among wives of incidence cases than in their controls. No differences in HDL-C were noted among children. Mid parent-child correlations for TC and LDL-C were higher in 32 families of men who had a MI (r = 0.43 and r = 0.49) than for control families (r = 0.32 and r = 0.29, respectively). When the 5 families of mothers who had a first MI were included in the analysis, the case-child correlations for TC and LDL-C were 0.60 and 0.68, respectively. Father-child correlation for HDL-C was significantly lower (r = -0.17) among the MI incidence case families than among the control families (r = 0.22; P less than 0.05). No substantial differences in familial correlations for lipid variables were noted in the CHD prevalence families and their controls. These findings suggest that total cholesterol and LDL-C levels, but not HDL-C levels, may be a risk marker in adolescents. The associations evident in adolescent children of families with MI incidence cases were not apparent in children whose parents had CHD on entering the study. This could be due to the probably greater misclassification of CHD prevalence cases than MI incidence cases, the awareness in patients with CHD and subsequent behavioural changes, to possible differences in patterns of survival in the two categories, or may reflect a chance finding.

Adolescent↗