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Biomedical subjects

A Kogan

Publications and source records attributed to A Kogan.

At least 37 records · Page 2Linked to original sources
PubMed2003

Nausea and vomiting after fast-track cardiac anaesthesia.

BACKGROUND: The aim of this study was to determine the prevalence of postoperative nausea and vomiting (PONV) after fast-track cardiac anaesthesia, risk factors for PONV and its influence on the length of stay in the intensive care unit (ICU). METHODS: A prospective study was performed in the cardiothoracic ICU (CTICU) of a university hospital; 1221 consecutive patients undergoing fast-track anaesthesia (FTCA) in cardiac surgery were enrolled in the study. Severity of PONV was assessed immediately after extubation and then every hour until discharge from the CTICU. Metoclopramide 10 mg i.v. was used as a first-line rescue medication and ondansetron 4 mg i.v. as second-line rescue medication for PONV. RESULTS: Nausea was reported in 240 (19.7%) patients, and vomiting in 53 (4.3%). A total of 269 (22%) patients were treated with metoclopramide and 38 (3.1%) with metoclopramide and ondansetron. The latter was effective in all cases. Risk factors for PONV were age less than 60 yr, female gender and previous history of PONV. Discharge from the CTICU was delayed for a few hours because of PONV in eight patients, all of whom were discharged the same day. CONCLUSIONS: The incidence of PONV is relatively low after FTCA and does not prolong ICU stay. Prophylactic administration of anti-emetic drugs before FTCA is not necessary.

Adult↗
PubMed2003

Neonatologists are using much less dexamethasone.

Two historical cohorts (1993-1994 and 2001) of preterm infants ventilated for respiratory distress syndrome were compared. Dexamethasone administration fell from 22% to 6%. Chronic lung disease in survivors rose slightly from 13% to 17%, and mortality fell from 21% to 15% (other causes). The effect of restriction of dexamethasone use on chronic lung disease and mortality remains to be seen.

Birth Weight↗
PubMed2001

Common MEFV mutations among Jewish ethnic groups in Israel: high frequency of carrier and phenotype III states and absence of a perceptible biological advantage for the carrier state.

Familial Mediterranean fever (FMF) is an autosomal recessive disease, characterized by recurrent attacks of fever and inflammation of serosal membranes and gradual development of nephropathic amyloidosis. The recent cloning of the FMF gene (MEFV) and identification of disease-associated mutations in most patients made the direct determination of FMF carrier frequency feasible. The aim of the present study was to investigate the carrier rate of the most common MEFV mutations among different Jewish ethnic groups in Israel. Further, an attempt was made to elucidate the possible biological advantage that the heterozygote state may confer. Three hundred Ashkenazi, 101 Iraqi, and 120 Moroccan Jews were screened for the E148Q, V726A, and M694V mutations (at least two most common mutations per group), with a resulting overall carrier frequency in the respective ethnic group of 14%, 29%, and 21%. No difference in morbidity between Ashkenazi carriers and non-carriers of MEFV mutations was discerned, although an excess of febrile episodes in carriers of the V726A and in carriers of either V726A or E148Q was evident (P < 0.02 and P < 0.05, respectively). The frequency of subjects with two MEFV mutations but not expressing FMF (phenotype III) was 1:300 in Ashkenazi Jews and 1:25 in Iraqi Jews, exceeding the reported rate of overt FMF in these ethnic groups by 40-240 fold. These results affirm the high carrier rate among the studied Jewish ethnic groups in Israel and suggest that most subjects with FMF mutations are unaffected.

Alleles↗
PubMed2001

Linear lesion radiofrequency ablation in canine vagal atrial fibrillation: effects of special catheters designed for efficiency, and the critical role of lesions from the crista terminalis to the superior vena cava.

OBJECTIVE: To determine whether specially devised catheters could be used to place radiofrequency (RF) linear lesions quickly and efficiently for termination and/or prevention of atrial fibrillation (AF). METHODS: Two versions of 2 different types of ablating catheters were used in 12 canines with AF induced by rapid pacing during vagal stimulation. 1) Modified basket catheters in two versions, one designed to produce caudo-cranial linear lesions through extended bare electrode-splines in contact with the atrial wall; and the other designed to produce horizontal linear lesions by revolving within the atrium. Together these would form "longitude and latitude" grids in the atrium. 2) The second catheter type was 2 versions of coil electrodes with thermocouples centered under each of the large-area coil electrodes. One version of these deflectable coil electrodes was intended to produce lesions in the tricuspid valve annulus-inferior vena cava (IVC) isthmus; and along the crista terminalis from the superior vena cava (SVC) to the IVC. A different type of deflection angulation on the second version was intended to produce more horizontal lesions from the crista to the tricuspid annulus. Guidance was fluoroscopic, and by electrograms and transesophageal echo. Gross pathologic examinations followed each experiment. Prior to use in canines, all electrode configurations were tested in vitro on fresh bovine preparations suspended in saline at 37 degrees C. RESULTS: The bare spline and coil electrode catheter configurations produced discrete non-perforating non-charring lesions in the in vitro preparations. One dog died of exsanginating hemorrhage. Post mortem examination revealed the lesions to be extremely variable, ranging from no evidence of effective RF delivery to deep lesions with perforation. Seven clinical successes were achieved (6 complete), with the coil electrode catheters accounting for 5 of the 7, although the procedure times were shorter with the baskets. Critical lesions were those from the crista to the SVC. Planned trans-isthmus lesions were not done, but may be needed to prevent atrial flutter not seen prior to effective AF ablation. CONCLUSIONS: Special basket and coil-electrode catheters may be useful but require refinement. The finding that lesions between the crista terminalis and the SVC were critical to success may be applicable to some cases of AF in humans.

Animals↗
PubMed2000

Detection of artifacts in monitored trends in intensive care.

In intensive care, decision-making is often based on trend analysis of physiological parameters. Artifact detection is a pre-requisite for interpretation of trends both for clinical and research purposes. In this study, we developed and tested three methods of artifact detection in physiological data (systolic, mean and diastolic artery and pulmonary artery pressures, central venous pressure, and peripheral temperature) using pre-filtered physiological signals (2-min median filtering) from 41 patients after cardiac surgery. These methods were: (1) the Rosner statistic; (2) slope detection with rules; and (3) comparison with a running median (median detection). After tuning the methods using data from 20 randomly chosen patients, the methods were tested using the data from the remaining patients. The results were compared with those obtained by manual identification of artifacts by three senior intensive care unit physicians. Out of an average of 22,480 data points for each variable, the three observers labelled 0.98% (220 data points) as artifacts. The inter-observer agreement was good. The average (range) sensitivity for artifact detection in all variables in the test database was 66% (33-92%) for the Rosner statistic, 64% (24-98%) for slope detection and 72% (41-98%) for median detection. All methods had a high specificity (> or = 94%). Slope detection had the highest mean positive prediction rate (53%; 21-85%). When the performance was measured by the cost function, slope detection and running median performed equally well and were superior to Rosner statistics for systemic arterial and central venous pressure and peripheral temperature. None of the methods produced acceptable results for pulmonary artery pressures. We conclude that median filtering of physiological variables is effective in removing artifacts. In post-operative cardiac surgery patients, the remaining artifacts are difficult to detect among physiological and pathophysiological changes. This makes large databases for tuning artifact algorithms mandatory. Despite these limitations, the performance of running median and slope detection were good in selected physiological variables.

Algorithms↗
PubMed2000

Early postnatal dexamethasone treatment and increased incidence of cerebral palsy.

OBJECTIVE: To study the long term neurodevelopmental outcome of children who participated in a randomised, double blind, placebo controlled study of early postnatal dexamethasone treatment for prevention of chronic lung disease. METHODS: The original study compared a three day course of dexamethasone (n = 132) with a saline placebo (n = 116) administered from before 12 hours of age in preterm infants, who were ventilated for respiratory distress syndrome and had received surfactant treatment. Dexamethasone treatment was associated with an increased incidence of hypertension, hyperglycaemia, and gastrointestinal haemorrhage and no reduction in either the incidence or severity of chronic lung disease or mortality. A total of 195 infants survived to discharge and five died later. Follow up data were obtained on 159 of 190 survivors at a mean (SD) age of 53 (18) months. RESULTS: No differences were found between the groups in terms of perinatal or neonatal course, antenatal steroid administration, severity of initial disease, or major neonatal morbidity. Dexamethasone treated children had a significantly higher incidence of cerebral palsy than those receiving placebo (39/80 (49%) v. 12/79 (15%) respectively; odds ratio (OR) 4.62, 95% confidence interval (95% CI) 2.38 to 8.98). The most common form of cerebral palsy was spastic diplegia (incidence 22/80 (28%) v. 5/79 (6%) in dexamethasone and placebo treated infants respectively; OR 4.45, 95% CI 1.95 to 10.15). Developmental delay was significantly more common in the dexamethasone treated group (44/80 (55%)) than in the placebo treated group (23/79 (29%); OR 2. 87, 95% CI 1.53 to 5.38). Dexamethasone treated infants had more periventricular leucomalacia and less intraventricular haemorrhage in the neonatal period than those in the placebo group, although these differences were not statistically significant. Eleven children with cerebral palsy had normal ultrasound scans in the neonatal period; all 11 had received dexamethasone. Logistic regression analysis showed both periventricular leucomalacia and drug assignment to dexamethasone to be highly significant predictors of abnormal neurological outcome. CONCLUSIONS: A three day course of dexamethasone administered shortly after birth in preterm infants with respiratory distress syndrome is associated with a significantly increased incidence of cerebral palsy and developmental delay.

Anti-Inflammatory Agents↗
PubMed2000

Course and outcome of obstetric patients in a general intensive care unit.

BACKGROUND: To characterize the course, interventions required to achieve predetermined end-points and outcome of obstetric patients admitted to a general intensive care unit. METHODS: A retrospective case series study was performed including all pregnant patients admitted to an 8-bed general intensive care unit at a tertiary care university-affiliated hospital over a 4-year period. All patients referred by the obstetricians were admitted. Patients were divided into two groups: group 1, (n = 19) those requiring mechanical ventilatory support and group 2, (n = 27) those requiring intensive monitoring. Data collected included demographics, reason for admission, admission diagnosis, Acute Physiology and Chronic Health Evaluation (APACHE II) and Therapeutic Intervention Scoring System (TISS) scores, intensive care unit course, types of interventions used and outcome. End-points of therapy included systolic blood pressure 110-150 mmHg, urine output > or = 1 cc/kg/h and oxygen saturation > 95%. RESULTS: Over the study period, 46 obstetric patients were admitted to the intensive care unit, representing 0.2% of all deliveries and an intensive care unit utilization rate of 2.3%. Commonest admission diagnoses were pregnancy-induced hypertension and hemorrhage. Reason for admission was mechanical ventilation in 41% while 59% were admitted for monitoring. Median length of stay was 25 +/- 80.9 (mean 48.8) hours. The median APACHE II score was 6 +/- 3.9 (mean 7.24) and the TISS score was > 20 in both groups. Only one patient died (mortality rate 2.3%). CONCLUSION: Despite a short length of stay and low APACHE score, the high TISS score in obstetric patients admitted for both ventilation and monitoring suggests that these patients require a level of intervention and care typically provided by a general intensive care unit.

Adult↗
PubMed1999

Longitudinal measurements of 17alpha-hydroxyprogesterone in premature infants during the first three months of life.

AIMS: To determine normal concentrations of 17alpha-hydroxyprogesterone (17OHP) for premature infants. METHODS: 17OHP was measured in 66 consecutive premature infants once a week during the first month, and once every two weeks thereafter, until the age of 3 months. The 17OHP values in 100 full term healthy neonates on the third day of life served as controls. Blood was sampled on filter paper using a neonatal radioimmunoassay kit. Findings were correlated with gestational age, birthweight, mode of delivery, Apgar scores, presence of respiratory distress syndrome and intake of maternal steroids. RESULTS: Mean 17OHP was raised at 7 days of age (138.9, 46.3, 53.3, 29.9 nmol/l, respectively, for infants whose gestational age was under 29 weeks, 29 to 30 weeks, 31 to 32 weeks, and 33 weeks and above). It fell sharply in the first two weeks after which it gradually decreased further, reaching 32.7, 23.6, 16.9, and 13.0 nmol/l, respectively, by the age of 90 days. The mean (SEM) 17OHP concentration in full term infants on day 3 of life was 17.8 (8.9) nmol/l. These values were independent of the presence and severity of respiratory distress syndrome and of prenatal maternal steroids. CONCLUSIONS: The increased 17OHP concentrations found at birth fell to those found in term infants during the first three months of life in infants over 31 weeks of gestation. Postconceptional age is the most important factor determining 17OHP concentration.

17-alpha-Hydroxyprogesterone↗
PubMed1998

Pancardiac tuberculosis--a case report.

The authors report a very unusual and unique case of pancardiac tuberculosis in a 25-year-old man who presented initially with atrial flutter with 1:1 conduction. Echocardiographic findings, computerized tomography images, and pathology specimens are presented. After initiation of antituberculous therapy, the patient converted to normal sinus rhythm.

Adult↗
PubMed1998

Referral pattern and outcome in men and women undergoing coronary artery bypass surgery--a critical review.

Women with coronary artery disease are less likely to undergo coronary artery bypass surgery, and this may represent a potential referral bias in favor of men. A higher in-hospital mortality rate in women compared with men has been reported earlier. Accumulating evidence currently suggests, however, that variables other than gender, such as advanced age, late referral, angina classification, diabetes mellitus, concurrent medical conditions, the number of diseased vessels, the caliber of coronary arteries, and the decreased body surface area in women may have accounted for this difference. In fact, when these variables are taken into account, female gender is no longer a statistically significant predictor of operative mortality. Women appear to have comparable immediate and late survival rates. Recurrent angina, perioperative myocardial infarction, congestive heart failure, incomplete revascularization, and early and late graft reocclusion following surgery are, however, more prevalent in women. Men and women show differences in recovery experiences after discharge following bypass surgery. When coronary bypass surgery is offered to women, the decision should be individualized, based on the patients' perioperative baseline clinical risk factors and coronary anatomy. Coronary artery bypass surgery should not be withheld in women who are considered to be appropriate candidates for fear of a reduced success rate.

Adult↗
PubMed1998

Massive bilateral pulmonary embolism in a patient with subsequent occurrence of severe mitral regurgitation due to ruptured chordae tendineae--a case report.

This report concerns an apparently healthy woman who presented simultaneously with acute massive bilateral pulmonary embolism and mitral regurgitation, subsequently, a month later, resulting in pulmonary edema secondary to chordae rupture of the mitral valve. The authors believe that massive pulmonary embolism predisposed to chordal rupture in this case. It is suggested that increased awareness of ruptured chordae tendineae as a cause of mitral regurgitation and the prompt use of transesophageal echocardiography will facilitate the early recognition of this potentially fatal, but treatable, cause of mitral regurgitation in patients with pulmonary embolism.

Acute Disease↗
PubMed1997

Trends in success rate after percutaneous transluminal coronary angioplasty in men and women with coronary artery disease.

Women with coronary artery disease are less likely to undergo percutaneous transluminal coronary angioplasty (PTCA) because of the potential referral bias in favor of men with coronary artery disease in the use of invasive diagnostic procedures and interventions. This difference may represent a sex bias in the delivery of medical care. The apparent sex difference in short-term success of PTCA seen in the early 1980s has not persisted in subsequent studies. The higher in-hospital mortality rate, if any, in women compared with men after PTCA is related more to the severity of their underlying disease rather than sex alone. In addition, women have a better long-term PTCA success rate. PTCA should not be withheld in women who are considered appropriate anatomic candidates for fear of reduced success or increased major complications.

Angioplasty, Balloon, Coronary↗
PubMed1995

Optical recording from cerebellar Purkinje cells using intracellularly injected voltage-sensitive dyes.

We evaluated several techniques for their ability to record membrane potential changes with voltage-sensitive dyes introduced into CNS neurons in the brain slice preparation. Using a probe designed for intracellular application, JPW1114, we found that iontophoresis or pressure pulses could not push the lipophilic dye through electrodes whose resistance was sufficiently high to produce good electrical recordings in cerebellar Purkinje neurons. However, properly selected patch electrodes could introduce the dye into the cell and still give good electrical records. Using this technique we recorded depolarizing and hyperpolarizing transients and climbing fiber responses using either a single photodiode or a fast, cooled CCD camera. While these results are promising, there are still problems due to the slow diffusion of the dye in the dendrites and a low sensitivity which requires signal averaging to acquire traces with a good signal to noise ratio.

Action Potentials↗