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Biomedical subjects

Y Rozenman

Publications and source records attributed to Y Rozenman.

At least 73 records · Page 4Linked to original sources
PubMed1995

Early intravenous thrombolysis in acute myocardial infarction: the Jerusalem experience.

Myocardial damage in acute myocardial infarction is a time-dependent process. We examined the influence of very early thrombolytic therapy, comparing prehospital to hospital administration, in a consecutive group of patients with myocardial infarction on mortality, complications and the preservation of left ventricular function. Seven hundred sixty patients received early thrombolytic therapy: 114 at home (time delay to treatment 1.4 +/- 0.8 h) and 646 in hospital (2.1 +/- 1.0 h). Sixteen patients died in hospital and significant hemorrhage occurred in 15 (including three patients with hemorrhagic stroke). There was no difference between groups in hospital mortality or rate of complications. The duration of ischemia was shorter in patients with prehospital therapy (pain duration: 3.3 +/- 2.1 vs. 4.0 +/- 2.2; P < 0.05, and time to recovery of the ST segment in the electrocardiogram: 4.3 +/- 3.3 vs. 6.6 +/- 6.3; P < 0.002). Peak plasma creatine kinase was earlier in patients with prehospital therapy (11.2 +/- 5.0 vs. 13.0 +/- 5.8; P < 0.002), although there was no difference between groups in the absolute peak plasma level. Left ventricular function was assessed by contrast ventriculography 1 week after admission (616 patients). Ventricular function was better in patients with prehospital therapy: (ejection fraction of 58 +/- 13% vs. 54 +/- 15%; P < 0.05 and a left ventricular dysfunction index of 534 +/- 515 vs. 691 +/- 519 units; P < 0.05). We conclude that prehospital thrombolytic therapy is feasible and safe. Reperfusion is achieved earlier and more myocardium can be salvaged using this strategy without increasing the rate of complications.

Coronary Angiography↗
PubMed1995

Combined mechanical and thrombolytic treatment for totally occluded bypass grafts.

Totally occluded venous grafts are usually less amenable to mechanical reperfusion alone (for example percutaneous transluminal coronary angioplasty, PTCA) because of the large mass of thrombotic material within the graft. A combined approach using mechanical and thrombolytic treatment might therefore be more successful. Twenty one patients (20 males, one female) with a mean age of 64.5 (SD 5.6) years underwent angiography because of crescendo or unstable angina (n = 19) or myocardial infarction (n = 2) at a mean of 21.7 (18.6) days after onset of symptoms (range 1-60). All patients had had coronary artery bypass grafting (CABG) at a mean of 8.02 (4.02) years (range 0.3-13 years) before the current admission. At catheterisation, totally occluded venous bypass grafts to the left anterior descending coronary artery or diagonal (n = 10), marginal (n = 6), or right coronary artery (n = 5) were found. A combination of PTCA and thrombolytic treatment (in eight patients extended thrombolysis for 24 hours) was successful in reopening the venous graft in 16/21 patients (76.2%). Immediate complications included femoral haematoma (4), distal embolisation (3), and infection in one patient. Out of 13 patients catheterised within three months, two had reoccluded, seven had restenosis, while four had patent grafts. Recurrent PTCA (at least once more) was done in eight patients. At long term follow up of a mean of 26.7 (21.6) months (range 4-75 months), four patients were asymptomatic, eight still suffered from mild stable angina, while three had recurrent hospital admissions and needed a second coronary artery bypass. A combination of thrombolytic treatment and PTCA is a feasible and practised approach to recanalise recently occluded venous bypass grafts.

Aged↗
PubMed1995

Charles Bonnet syndrome in temporal arteritis.

An 87-year-old woman presented with Charles Bonnet syndrome--the occurrence of formed visual hallucinations in sane aged individuals. This was followed by headaches and unilateral visual loss, and the diagnosis of temporal arteritis (TA) was confirmed by biopsy. Steroid therapy resulted in disappearance of hallucinations, which recurred 7 mo later, responding to an increase in steroid dosage. Charles Bonnet syndrome may be an early sign of decreasing visual acuity in aged individuals; thus, diagnosis of TA or exacerbation of established TA should be considered in such patients.

Aged↗
PubMed1995

[Angioplasty for vein grafts and native coronary arteries after previous coronary artery bypass grafting].

219 patients after previous coronary artery bypass grafting (CABG) underwent coronary artery or vein graft angioplasty in 1984-1991. 452 stenotic lesions out of 498 were successfully dilated in 337 procedures (90.7%). For arterial lesions the initial success rate had been 89.2% (321/360) and for vein graft lesions 94.9% (131/138). For repeated angioplasty the success rate was the same. Major complications included 3 deaths (0.9%). 15 myocardial infarctions (5.3%) and 1 emergency CABG. Factors that had reduced the success rate were lesions at the proximal anastomosis, total occlusions, and complex (type C) lesions. Time since grafting did not affect success rate of the second procedure. Restenosis after successful angioplasty was 37.3% (34/91) for arterial lesions and 56.8% (25/44) for graft lesions, after a mean time of 11.2 +/- 2.7 months. Restenosis was more common in type C lesions and old vein grafts. There was considerable improvement in treadmill exercise time of patients after the angioplasty (5.92 vs 7.31 minutes) and in double product. During a follow up of about 3 years, 7.6% (15/196) died of cardiac events, 5.2% (10/189) had myocardial infarctions, 10.5% (20/189) were reoperated and 31.0% (68/219) needed at least 1 repeat angioplasty. Long term followup was better after angioplasty of native arteries than of grafts. After angioplasty of vein grafts, there were more cardiac related deaths, more MIs and more reoperations than after angioplasty of native arteries: 11.5% vs 3.5%, 9.6% vs 2.8%, 21% vs 4.9%, respectively, than in the arterial group. Considering the high mortality and morbidity of reoperation, balloon angioplasty in selected patients may be the preferred strategy. Clinical and angiographic results are better after re-angioplasty of native arteries than vein grafts.

Angioplasty, Balloon, Coronary↗
PubMed1994

[The vascular stent in percutaneous coronary revascularization].

Balloon angioplasty is commonly used for coronary revascularization. Coronary stents were introduced to overcome its 2 main limitations: acute coronary occlusion and restenosis. We describe our experience with the use of 27 coronary stents in 26 patients. The indications for stenting were acute or threatened coronary occlusion in 16 patients, in 7 recurrent restenosis, and vein graft narrowing in the rest. Stent deployment was successful in all cases and there was no mortality. The hospital course was complicated by subacute thrombotic occlusion of the stent (2 patients) initially treated by balloon angioplasty, retroperitoneal bleeding (3), and surgical closure of femoral pseudoaneurysm (2); 22 were discharged without complications; 1 patient required coronary bypass. Coronary stenting has a high rate of success and is very effective in cases of abrupt coronary occlusion which would otherwise require emergency surgery. It is probably associated with a lower restenosis rate than standard balloon angioplasty. Accurately monitored anticoagulant therapy is essential to prevent complications.

Angioplasty, Balloon, Coronary↗
PubMed1994

Mitomycin C therapy for corneal intraepithelial neoplasia.

We treated three patients who had intraepithelial neoplasia involving the visual axis and a subsequent decrease of visual acuity with topical mitomycin C 0.02% four times daily for ten to 22 days. In two of the three cases, the intraepithelial neoplasia was histologically confirmed. The intraepithelial neoplastic lesion was replaced by biomicroscopically normal epithelium within nine weeks of the beginning of drug administration and did not recur during the four to 12 months of follow-up. Adverse reactions to topical mitomycin in two patients ranged from minimal conjunctival hyperemia after 14 days to marked hyperemia, ocular pain, and blepharospasm after 22 days. These signs and the symptoms, however, disappeared after the drug was discontinued. Administration of topical mitomycin C 0.02% for two weeks may be an effective treatment for corneal intraepithelial neoplasia that affects the visual axis.

Administration, Topical↗
PubMed1994

Creation and healing of severe coronary dissection by the use of oversized balloon for the treatment of restenosis after an initially successful angioplasty.

We describe two patients who underwent successful coronary angioplasty with a balloon that matched the normal size of the artery. Both patients returned for a second angioplasty because of restenosis. The morphology of the restenotic lesion was very similar to that of the original lesion. In the second angioplasty a larger balloon was used, and in both cases severe dissection occurred. Repeat angiography 3 months later demonstrated an open artery with clinically insignificant residual stenosis. We believe that in these two cases the initial angioplasty stretched the artery and it recoiled slowly to its original dimensions. A larger balloon size was necessary to crack atherosclerotic plaque and cause a successful long-term outcome.

Aged↗
PubMed1994

The earliest diagnosis of acute myocardial infarction.

Acute myocardial infarction results from the cessation of myocardial blood flow caused by thrombotic occlusion of a coronary artery. Rapid restoration of blood flow to the ischemic myocardium minimizes cardiac damage and improves early and long-term morbidity and mortality. Chest pain is the first symptom of myocardial infarction, but in some patients with silent ischemia, the disease can be diagnosed only in retrospect. In symptomatic patients, myocardial infarction should be accurately and promptly diagnosed so that reperfusion therapy can begin immediately. Electrocardiography is the simplest diagnostic modality. Although regional ST-segment elevation is specific, it is not sensitive. In contrast, new computerized algorithms for electrocardiographic analysis and serial monitoring increase sensitivity without decreasing specificity. In the emergency room, echocardiography is used to diagnose patients with no prior history of coronary artery disease whose electrocardiograms proved nondiagnostic. Time-consuming perfusion nuclear studies are inferior to echocardiography but may nevertheless enable physicians to diagnose myocardial infarction in the emergency room. Although the presence of excess creatine kinase is a sign of myocardial necrosis, its increase is delayed for a few hours after coronary occlusion. Doctors can diagnose myocardial infarction as early as two hours after coronary occlusion with the help of simpler automatic assays of MB-creatine kinase mass that use monoclonal antibodies. Other investigational markers of myocardial necrosis include myoglobin and troponin. Elevation of a circulating protein marker also signifies established necrosis, but physicians hope to achieve reperfusion through therapy before irreversible damage occurs.

Creatine Kinase↗
PubMed1994

Total coronary artery occlusion late after successful coronary angioplasty of moderately severe lesions: incidence and clinical manifestations.

Coronary restenosis after balloon angioplasty is a slow process that develops over a few months. In some patients, with an initially successful angioplasty, an artery that originally had only moderate stenosis becomes totally occluded as a result of restenosis. This report describes 16 such patients out of 415 dilated lesions with late angiographic follow-up. Ten patients presented with stable angina pectoris, 5 had unstable angina and only one was admitted with a small myocardial infarction. Visible collaterals were present in 15 patients. Except for the patient who sustained myocardial infarction, none of the late angiograms showed the typical morphological features of acute lesion. We conclude that total coronary occlusion late after successful angioplasty of an artery that was moderately narrowed is rare. The 'restenotic' occlusion is a slow process that stimulates collateral formation and thus the risk of myocardial infarction is small.

Adult↗
PubMed1994

Value of dobutamine/nitrate radionuclide angiography in predicting revascularization effects on ventricular function.

OBJECTIVE: Dobutamine and Nitrate Radionuclide Angiography (RNA) may help to distinguish viable from nonviable myocardium and to predict revascularization effects on LV function. SETTING: Ambulatory. EXPERIMENTAL DESIGN: Prospective. PATIENTS AND METHODS: We studied 12 patients (11 male, 1 female; mean age 56 +/- 10 years) with three-vessel disease, severe LV dysfunction, and prior MI for a mean follow-up time of 10 +/- 3.4 months. Thallium-201 scintigraphy favored potential viability in all patients: inducible ischemia with satisfactory perfusion in more than one coronary arterial territory. Global and regional LVEF's were calculated from preoperative RNA (baseline rest study and with continuous dobutamine infusion with gradual rate increase plus oral nitrates) and postoperative RNA at 1 and 6 months. RESULTS: There was no operative mortality, but two late deaths occurred. Symptomatically, most patients showed improvement. Global LVEF increased during dobutamine and nitrates preoperatively (p < 0.01), but not at 1 and 6 months postoperatively (without pharmacological intervention). Mean LVED volume was not significantly changed postoperatively. Regional EF improvement was found in 4 out of 9 LV wall segments under dobutamine and nitrates, and this increase persisted postoperatively at 1 and 6 months. CONCLUSIONS: Mild but significant increase in global LVEF during dobutamine and nitrates administration is not predictive of postoperative LVEF improvement. However, regional EF improvement appears to be predictive of post-revascularization LV functional improvement.

Administration, Sublingual↗
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↗
PubMed1993

Clinical and angiographic predictors of immediate recoil after successful coronary angioplasty and relation to late restenosis.

The effect of immediate recoil on the results of balloon angioplasty was examined in a group of 416 patients (596 lesions) who underwent successful coronary angioplasty. Immediate recoil was responsible for loss of 0.42 +/- 0.64 mm from the potentially achievable lesion diameter, and represented 23% of the actual gain in diameter. The immediate recoil was determined mainly by the degree of arterial stretch, which is best represented by the balloon to normal artery size ratio (correlation coefficient 0.49, p < 0.0001). Classic risk factors for coronary artery disease did not affect immediate recoil, except for a trend toward lower values in patients with history of hypercholesterolemia. There was a tendency for lower recoil in patients with residual coronary thrombus and in those who underwent angioplasty within 1 week of acute myocardial infarction. Recoil was larger in the left anterior descending artery than in the circumflex or the right coronary artery. Patients with more immediate recoil developed more restenosis (> 50% stenosis at follow-up). However the late loss of luminal diameter due to the restenotic process was smaller in those who had larger initial recoil. It is concluded that immediate recoil after balloon angioplasty is an elastic phenomenon that is related mainly to the degree of arterial stretch. The relative importance of immediate recoil in determining the late outcome of coronary angioplasty is at least as important as the late restenotic process.

Angioplasty, Balloon, Coronary↗
PubMed1993

Identification of digitalis-like compounds in human cataractous lenses.

Human cataractous lens nuclei extract inhibited, in a dose-dependent fashion, [3H]ouabain binding to rat brain synaptosomes and microsomal Na(+)- and K(+)-dependent adenosine triphosphate (Na+, K(+)-ATPase) activity and interacted with anti-digoxin antibodies. The compounds responsible for these activities, termed digitalis-like compounds (DLC), were also detected in bovine, rat, cat and rabbit, normal, transparent lenses, but the levels were only 0.7-5.4% of the average levels in the cataractous human lenses. DLC from the human cataractous lenses were purified by a procedure consisting of organic extractions and batch chromatography followed by filtration through a 3000 Da cut-off filter and subsequent separations using reverse-phase high-performance liquid chromatography. The presence of DLC in the different fractions obtained in the chromatograms was monitored by their ability to inhibit [3H]ouabain binding and Na+, K(+)-ATPase activity. Based on chemical ionization mass spectrometry together with ultraviolet spectrometry and biological characterization, it is suggested that new bufodienolides, 19-norbufalin and 19-norbufalin peptide derivatives are responsible for the endogenous DLC activity. It is proposed that these compounds may regulate Na+, K(+)-ATPase activity in the lens under some physiological and pathological conditions.

Animals↗
PubMed1993

Anomalous origin of the circumflex coronary artery from the right sinus of Valsalva as a cause of ischemia at old age.

The case of a patient with an anomalous origin of the circumflex coronary artery causing myocardial ischemia and infarction is presented. Even though the anomalous artery was not located between aorta and pulmonary artery, this anomaly, which is usually considered benign, was responsible for the ischemic symptoms. Transesophageal echocardiographic study demonstrated an acute angulation at the proximal portion of this abnormal vessel, very close to its origin from the right coronary sinus, which we believe caused the abnormality in coronary flow in this patient.

Aged↗