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Biomedical subjects

U Goldbourt

Publications and source records attributed to U Goldbourt.

At least 19 recordsLinked to original sources
PubMed1992

The importance of biopsychosocial factors in the development of duodenal ulcer in a cohort of middle-aged men.

This study prospectively evaluated psychosocial as well as biologic, behavioral, and demographic factors in the development of duodenal ulcer. Baseline data were collected in 1963 on 8,458 Israeli men over age 40 years who had no history of duodenal ulcer. The subjects were followed for 5 years, and 254 reported the development of radiographically proven duodenal ulcer. The average annual incidence was six per 1,000 subjects. Multivariable logistic regression analysis confirmed several previously reported risk factors: smoking (odds ratio (OR) = 1.64, 95% confidence interval (Cl) 1.25-2.16), greater age (60 years and over) (OR = 1.85, 95% Cl 1.25-2.74), lower salary (OR = 1.50, 95% Cl 1.14-1.96), and lower systolic blood pressure (less than 140 mmHg) (OR = 1.58, 95% Cl 1.16-2.15). In addition, logistic regression analysis revealed a significant association of duodenal ulcer incidence with preceding measures of family stress, emotional support, and coping style. These were: increased family problems (OR = 1.60, 95% Cl 1.19-2.16), low level of perceived love and support from subject's wife (OR = 2.06, 95% Cl 1.05-4.05), and restraining retaliation when hurt by coworkers (OR = 1.89, 95% Cl 1.19-3.00). This study confirms several previously reported risk factors and underlines the importance of stress, lack of social support, and coping style in the development of duodenal ulcer.

Adaptation, Psychological↗
PubMed1992

Primary ventricular tachycardia in acute myocardial infarction: clinical characteristics and mortality. The SPRINT Study Group.

OBJECTIVE: To examine the immediate and long-term clinical and prognostic significance of primary ventricular tachycardia, defined as tachycardia of ventricular origin occurring within 48 hours of acute myocardial infarction in patients without hemodynamic compromise (Killip class I). DESIGN: Prospective cohort study. SETTING: Intensive coronary care units in eight regional, referral, and university hospitals. PATIENTS: A total of 162 patients with primary ventricular tachycardia, both sustained and nonsustained (study group), and 2578 counterparts without ventricular tachycardia (reference group). MEASUREMENTS: In-hospital rates of atrial fibrillation, atrioventricular block, congestive heart failure, cardiogenic shock, and cardiac arrest. In-hospital and 1-year follow-up rates of sudden death, nonsudden cardiac death, and noncardiac death. RESULTS: The study and reference groups had similar mortality (in-hospital, 6.8% and 9.6%, P greater than 0.2 and at 1 year after discharge, 3.7% and 5.4%, P greater than 0.2, respectively) and in-hospital complication rates (atrioventricular block, 13.0% and 9.7%, P greater than 0.2; cardiogenic shock, 3.7% and 3.0%, P greater than 0.2; cardiac arrest, 1.8% and 4.4%, P greater than 0.2, respectively). Patients with sustained ventricular tachycardia (28 patients) compared with those with nonsustained ventricular tachycardia (134 patients) had higher rates of polymorphic tachycardia (50% compared with 6%, P = 0.001), in-hospital total cardiac mortality (21% compared with 4%, P = 0.003) and sudden-death mortality (14% compared with 2%, P = 0.001); they also showed a trend toward a higher in-hospital mortality than the reference group (21.4% compared with 9.6%, P = 0.15) but had no increased mortality 1 year after discharge (4.6% compared with 5.4%, P greater than 0.2). CONCLUSIONS: As a group, patients with primary ventricular tachycardia do not differ from counterparts without primary ventricular tachycardia in their in-hospital clinical course and 1-year prognosis. Primary sustained ventricular tachycardia is often polymorphic and carries worse in-hospital prognosis than nonsustained tachycardia. However, it does not predict recurrent ventricular tachycardia or increased sudden-death rates during the next year.

Coronary Care Units↗
PubMed1992

Prevalence and prognosis of chronic obstructive pulmonary disease among 5,839 consecutive patients with acute myocardial infarction. SPRINT Study Group.

PURPOSE: The purpose of this study was to report the prevalence and the clinical significance of clinically recognized chronic obstructive pulmonary disease (COPD) during acute myocardial infarction. PATIENTS AND METHODS: During 1981 to 1983, a secondary prevention study with nifedipine (SPRINT) was conducted in Israel among 2,276 survivors of acute myocardial infarction. During the study, demographic, historical, and medical data were collected on special forms for all patients with diagnosed acute myocardial infarction in 13 hospitals (the SPRINT Registry, n = 5,839). Mortality follow-up was completed for 99% of hospital survivors for a mean follow-up of 5.5 years (range: 4.5 to 7 years). RESULTS: The prevalence of COPD was 7% (406 of 5,839). The latter rate increased significantly in men (7.6%), smokers (9.7%), and older patients (70 years or older, 10.0%). Patients with COPD exhibited a complicated hospital course with an in-hospital mortality rate of 23.9%. Subsequent mortality rates in survivors at 1 and 5 years were 12.3% and 35.9%, respectively. Rates at the same time periods in patients without COPD were 17.2%, 9.2%, and 26.9% (p < 0.005 for in-hospital and 5 years). In a multivariate analysis that included age, gender, and history of myocardial infarction and congestive heart failure, COPD was not independently associated with either in-hospital or postdischarge excess fatality rates. CONCLUSION: In this large cohort of consecutive patients with myocardial infarction, the prevalence of COPD was 7% and higher among smokers, men, and elderly patients. Although in-hospital and postdischarge mortality rates were higher among patients with COPD, this condition did not independently increase either the risk of early death or the risk of long-term mortality among survivors of acute myocardial infarction.

Actuarial Analysis↗
PubMed1992

Correlation between myocardial ischemia and changes in arterial resistance during coronary artery bypass surgery.

The arterial resistometer provides continuous on-line monitoring of changes in arterial resistance. Resistance index (Ri), which bears a direct relationship to systemic vascular resistance (SVR), is defined by the equation Ri = P'/(dP'/dt), where dP'/dt is the peak dP/dt of the arterial waveform, and P' is the pressure at dP'/dt. In 42 patients with unstable angina, changes in Ri were studied at six periods during aortocoronary bypass surgery before tracheal intubation, during tracheal intubation, leg elevation, presternotomy, sternotomy, and dissection of the internal mammary artery. Thirty-four episodes of ischemia (0.1 mV ST segment changes) were observed in 26 patients. All ischemic episodes were associated with increased Ri (mean increase, 102 +/- 52%). Elevation of the pulmonary capillary wedge pressure correlated with ischemia during the preintubation, intubation, and sternotomy periods, but not in the remaining periods. Changes in arterial pressure and heart rate were not good predictors of ischemia. The prevalence of ST segment changes increased markedly during all periods of anesthesia with increase in Ri (P less than 0.05). Ninety-one percent of ST segment changes were associated with a 25% increase from the baseline Ri. Raising the cutoff point to a greater than or equal to 75% increase in Ri improved the specificity of Ri in ischemia detection from 61% to 92%. An increase of greater than or equal to 75% in Ri occurred in only 8% of cases without ST segment changes. It was found that an increase in Ri as depicted by the arterial resistometer was the best hemodynamic correlate of myocardial ischemia.

Adult↗
PubMed1992

Long-term prognosis of patients with paroxysmal atrial fibrillation complicating acute myocardial infarction. SPRINT Study Group.

The aim of the study was to assess the relationship between paroxysmal atrial fibrillation during acute myocardial infarction and the long-term prognosis of patients after acute myocardial infarction. The incidence of paroxysmal atrial fibrillation among 5803 consecutive hospitalized patients was 9.9% (557/5803). Incidence rose with increasing age (less than or equal to 59 years, 4.2%), (60-69 years, 10.5%), (greater than or equal to 70 years, 16.0%) and was slightly (but not significantly) higher in women (11.0%) than in men (9.6%). The presence of congestive heart failure and mean age represented two major discriminants between patients with paroxysmal atrial fibrillation (70% and 68.6 years) in comparison with their counterparts (35% and 62.3% years). Hospital mortality was significantly higher (25.5%) in patients with paroxysmal atrial fibrillation than in those without (16.2%). However, the effect of paroxysmal atrial fibrillation disappeared when other factors influencing the short term prognosis (i.e. heart failure) were taken into account by a multivariate logistic regression analysis. The covariate adjusted relative odds of in-hospital mortality then fell to 0.82. The 1- and 5-year mortality rates were 18.6% and 43.3% in patients with paroxysmal atrial fibrillation as compared to 8.2% and 25.4% (P less than 0.001), respectively, in patients free of paroxysmal atrial fibrillation. Using a proportional hazards analysis of mortality through the first quarter of 1988 (average follow-up time, 5.5 years) the net risk of dying among patients with paroxysmal atrial fibrillation complicating the acute myocardial infarction is estimated at 1.28 (90% confidence interval, 1.12-1.46) relative to counterparts free of the complication.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMed1991

Malignant arrhythmias in relation to values of serum potassium in patients with acute myocardial infarction.

The relationship between levels of potassium in the serum and the development of malignant arrhythmias was examined in a retrospective study involving 1011 patients presenting with acute myocardial infarction. Thirteen percent of the overall patients studied had significant hypokalemia (k less than 3.5 mmol/liter). The average initial level of potassium in patients who developed malignant arrhythmias was (4.10 mmol/liter) significantly lower (P less than 0.01) than those patients who did not develop such arrhythmias (4.19 mmol/liter). To determine whether the level of potassium was, in itself, the primary cause of malignant arrhythmias following myocardial infarction, a subgroup analysis of factors influencing these levels was performed. It was determined that diabetics have a higher level of potassium than nondiabetics (4.2 mmol/liter versus 4.11 mmol/liter - P = 0.01) and a lower incidence of malignant arrhythmias (50.5% versus 63.5% - P = 0.002). No correlation was found between treatment with either digitalis or diuretics and malignant arrhythmias. Size and location of infarcted areas was found to have a direct relationship with development of arrhythmias. Size and location of infarctions, however, were not found to be related to levels of potassium in the serum. Our findings support and clarify earlier suggestions establishing the levels of potassium in the serum as an important causative factor, together with size and location of infarctions, in the development of malignant arrhythmias.

Adrenergic beta-Antagonists↗
PubMed1991

In-hospital and 1-year mortality in 1,524 women after myocardial infarction. Comparison with 4,315 men.

We determined in-hospital and 1-year prognoses after acute myocardial infarction (MI) in 5,839 consecutive patients derived from 14 of 21 coronary care units in Israel during 1981-1983. Age-adjusted in-hospital mortality was 23.1% in 1,524 women and 15.7% in 4,315 men (p less than 0.0005). One-year age-adjusted mortality rates in patients surviving hospitalization were 11.8% in women and 9.3% in men (p = 0.03). Cumulative age-adjusted 1-year mortality rates were 31.8% in women and 23.1% in men (p less than 0.0005). Relative odds of mortality, covariate-adjusted for major prognostic factors that included age, prior MI, congestive heart failure, and infarct location by electrocardiogram, indicated that female gender was independently and significantly associated with increased mortality both during hospitalization (relative odds, 1.72; 95% confidence interval, 1.45-2.04) and at 1 year after discharge (relative odds, 1.32; 95% confidence interval, 1.05-1.66). In separate multivariate analyses for each gender, a major factor that emerged as a predictor of outcome in women, but not in men, was a reported history of diabetes mellitus, both for in-hospital mortality and for 1-year mortality. However, even in the nondiabetics in this population, female gender was a significant, independent predictor of in-hospital mortality. The findings of the present study substantiate that women fare worse than men after suffering an acute MI, that increased age does not fully account for the increased mortality in women, and that diabetic women are at particularly high risk once MI has occurred.

Aged↗
PubMed1991

Prevalence of diabetes mellitus in Ethiopian immigrants.

The prevalence of diabetes mellitus among 445 new immigrant Ethiopian Jews was studied immediately after their arrival to Israel, and found to be 0.4%. This low prevalence could be attributed to their long trek accompanied by severe malnutrition which caused death to the old, weak and sick, leaving a selectively young and healthy population group.

Adolescent↗
PubMed1991

Fatty acid composition of adipose tissue in Ethiopian immigrants: a prospective study during their first year in Israel.

We measured the subcutaneous adipose tissue fatty acid composition in 22 male Ethiopian Jews, aged 17-65, shortly after their immigration to Israel. These subjects showed a concentration of linoleic acid (17.8%), which was relatively low compared with Israeli levels, and a high concentration of palmitic acid (28.5%). The linoleic/saturated (P/S) ratio was 0.52. After 5 months, a repeat measurement indicated increases of the linoleic acid content and of the P/S ratio to 20.1% and 0.62, respectively (P less than 0.05). In another sample from the same immigrant group, levels after 1 year in Israel were 20.9% and 25.1% for linoleic and palmitic acid, respectively, and the P/S ratio was 0.67. These results differed significantly (P less than 0.02) from those obtained in the first sample after immigration. Apart from decreasing plasma triglyceride levels, no pattern of lipid changes was discernible in our limited samples. Changes in subcutaneous fatty acid composition reflect changes in diet over months, suggesting a decreased carbohydrate intake and in increased fat intake. It remains to be seen whether changing fatty acid composition in conjunction with changes in blood lipids or other factors, over a prolonged period of time, will affect the cardiovascular risk in the immigrants.

Adipose Tissue↗
PubMed1991

Blood pressure in Ethiopian immigrants: relationship to age and anthropometric factors, and changes during their first year in Israel.

Blood pressure was measured in 483 Ethiopian immigrants during the first week following their arrival in Israel. Mean levels of diastolic (DBP) and systolic blood pressures (SBP) were very low compared with known levels in the Israeli population. BPs were elevated in men greater than 20 years old and in women greater than 40 years old. Quetelet index averaged below 2.00 g/cm2. Considerable weight gains were observed in 265 individuals examined after 1 year. Simultaneously, DBP increased by 4 mm Hg on average, whereas the changes in SBP were small. At the end of 1 year, the mean SBP ranged from 107 (age 5-9 and 10-14) to 124 mm Hg (age greater than or equal to 60) and mean DBP from 69 (age 10-14 and 15-19) to 78 mm Hg (age greater than or equal to 60), remaining nevertheless considerably lower than levels observed in diverse Israeli population groups. Covariance analysis revealed that initial BPs, gender, age, and weight gain significantly affected SBP and DBP at the end of the year.

Adaptation, Physiological↗
PubMed1990

Prognosis of acute myocardial infarction complicated by primary ventricular fibrillation. Principal Investigators of the SPRINT Study.

In 5,839 consecutive patients with acute myocardial infarction (AMI), hospitalized between July 1981 and July 1983 in 14 coronary care units in Israel, the incidence of primary ventricular fibrillation (VF) was 2.1%. Patients with primary VF resembled counterparts without VF in terms of age, gender, frequency of previous AMI and past cigarette smoking habits. The hospital course of patients with primary VF revealed increased incidence of primary atrial fibrillation and atrioventricular block. Increased serum levels of glutamic oxaloacetic transaminase and lactic dehydrogenase were noted among the patients with primary VF. In-hospital mortality rate was 18.8% in 122 patients with primary VF compared with 8.5% in 3,707 patients forming the reference group (p less than 0.01). Adjustment by age using logistic function yielded an estimate of 2.86 for relative mortality odds associated with primary VF, and further adjustment by gender, history of AMI, systemic hypertension, and by enzymatically estimated infarct size slightly reduced the estimated odds, at 2.52 (95% confidence interval, 1.42 to 4.46). Prognosis after discharge from the hospital was independent of primary VF. In conclusion, primary VF exerts an independent, significant effect on in-hospital mortality.

Aged↗
PubMed1990

Effects of thrombolysis on the 12-lead signal-averaged ECG in the early postinfarction period.

Signal-averaged ECG has been used to identify patients at risk for ventricular tachycardia and sudden death after myocardial infarction. The goals of this prospective study were to examine the effects of reperfusion achieved with thrombolytic therapy on the 12-lead signal-averaged ECG and on ventricular arrhythmias in the early period after acute myocardial infarction (AMI). A total of 190 consecutive patients with AMI who fulfilled the inclusion criteria were enrolled. Thrombolysis was attempted in 80 patients and was considered successful in 57 (group I) and unsuccessful in 23 (group II); 110 patients were not treated with thrombolytic agents (group III). Signal averaging of 12 ECG leads was performed within 2 days in all patients and between 7 and 10 days after admission in 163 patients. The filtered QRS complex duration (QRSD) was significantly shorter in group I compared to group III in 7 of 12 ECG leads at 2 days and in 10 of 12 leads at 7 to 10 days. The root mean square voltage of the terminal 40 msec of the QRS complex (RMS40) did not change between the two signal-averaged ECG recordings in group I, whereas it became lower in three ECG leads in group II and in seven ECG leads in group III. There was no correlation between infarct site and significant changes in infarct-related signal-averaged ECG leads. The occurrence of complex ventricular arrhythmias was not significantly different among the three groups. We conclude that successful reperfusion, compared with failed and nonattempted reperfusion, is associated with fewer abnormalities in the 12-lead signal-averaged ECG in the early period after AMI.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1990

Preferential uptake of a water-soluble phthalocyanine by atherosclerotic plaques in rabbits.

This study is the first demonstration of preferential accumulation of a water soluble phthalocyanine dye in atheromatous plaques in the rabbit. Two groups of rabbits with diet-induced atheromatous plaques were killed 4 and 24 h following intravenous administration of copper phthalocyanine tetrasulfonate. Uptake of the dye by plaque-containing and normal appearing aortae was evaluated macroscopically and quantitatively by extraction of the dye from the tissues. The concentration of the dye in the atheromatous plaques was 2.6 and 1.7 times higher than in the normal vessel wall at 4 and 24 h, respectively. The concentration of the dye in normal appearing aortae in the 2 study groups was similar to that of aortae of control rabbits which were fed a normal diet and exposed to the dye for the same time periods. We conclude that copper phthalocyanine accumulates preferentially in atheromatous plaques in rabbits. These findings provide a basis for the utilization of phthalocyanines for plaque identification and for photodynamic therapy of atherosclerosis.

Animals↗
PubMed1990

Use of pulmonary artery catheters in patients with acute myocardial infarction. Analysis of experience in 5,841 patients in the SPRINT Registry. SPRINT Study Group.

This study analyzes the use of PAC in a registry comprising 5,841 hospitalized patients with AMI. A total of 371 patients received PAC. In-hospital mortality was higher in patients with CHF who received PAC, while there was no difference in patients with cardiogenic shock or persistent hypotension. Mortality in patients receiving PAC was higher irrespective of the presence or absence of "pump failure." A separate analysis of discharge summaries of 364 patients with CHF showed that PAC was used more frequently in sicker patients and that when severity of CHF was assessed, no difference in mortality was found in patients with mild or moderate CHF. We conclude that while a higher in-hospital mortality is found in patients receiving PAC, this excess is likely related to difference in severity of CHF, which had not been assessed in every individual. It is unlikely that PAC increases mortality.

Adult↗
PubMed1990

Levels and correlates of blood pressure in recent and earlier Ethiopian immigrants to Israel.

Blood pressure (BP) and anthropometric data were collected on 483 recent immigrants from Ethiopia to Israel, and on 171 adults and 100 adolescent boarding school students who had immigrated two to three years earlier. Comparison of samples within the Ethiopian groups, and between new and early Ethiopian immigrants with Israel and resident Israelis revealed the following: Systolic and diastolic BP were considerably lower in recent immigrants of both sexes than among counterparts residing in Israel for two to three years. The latter group significantly approached, but did not reach, the BP levels of veteran Israelis. A similar comparison of 100 immigrant Ethiopian boarding school children with an Israeli high school population revealed apparently larger differences among the boys than the girls, whose BP was 'adapted' to a greater degree. Differences in relative weight paralleled those identified for BP, with the Quetelet index (QI) progressively higher when comparing new immigrants with earlier ones, and with persons who have lived in Israel for a longer period. Whether the weight differences provide a complete explanation for BP changes cannot be definitely stated, pending prospective data on weight and BP changes. Correlations of BP with anthropometric parameters and pulse rate indicated that weight rather than QI was the stronger correlate of BP in adults, whereas weight and height, but not QI, correlated with BP in adolescent boys. QI correlated with BP in adolescent, apparently sexually mature girls, but not in boys.

Adolescent↗