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Biomedical subjects

H Gilutz

Publications and source records attributed to H Gilutz.

At least 19 recordsLinked to original sources
PubMed2001

Significance of balloon imprint during coronary angioplasty.

Balloon imprint during angioplasty is often seen, but not at all inflations. We prospectively studied 235 consecutive patients undergoing 282 PTCAs during a 4-month period, who were divided into two groups: those with balloon imprint during inflation (159 patients, 190 lesions; 67%) and those without (76 patients, 92 lesions; 33%). Clinical and lesion characteristics and immediate outcome were compared. Patients undergoing urgent PTCA had less balloon imprint than those undergoing nonurgent PTCA (14.2% vs. 28.3%; P < 0.005). Although not reaching statistical significance, younger patients and diabetic patients tended toward less balloon imprint (P < 0.06). Patients with observed imprint had less visible thrombus at lesion site (31.1% vs. 42.4%; P < 0.05), and a tendency without statistical significance toward more dissections but less acute closure was observed (P < 0.07). In addition, more stents were implanted in the imprint group (79.5% vs. 66.3%; P < 0.02). Patients needing pressure > 6 atm to break the imprint had more eccentric lesions (68% vs. 27.1%; P < 0.000) and more dissections (13.9% vs. 5.1%; P < 0.03) than those needing lower pressure. Patient and lesion characteristics may determine the appearance of balloon imprint at PTCA, which in turn influences the procedure and its immediate outcome. Cathet Cardiovasc Intervent 2001;53:331-333.

Aged↗
PubMed2001

Low-pressure deployment of stents: short- and long-term outcome.

This study investigates a strategy of low-pressure stenting with concomitant anti-platelet treatment designed to prevent short- and long-term events after stenting. Ninety consecutive patients who underwent percutaneous transluminal coronary angioplasty with stenting using low-pressure stent deployment (mean 8.1 atmospheres) with concomitant anti-platelet therapy based on ticlopidine and aspirin were followed. The 30-day outcome revealed a stent thrombosis rate of 6.4%, while the 9-month major clinical event rate was 8.6%. Low-pressure stent deployment appears to confer added risk for acute or sub-acute thrombosis even when aspirin and ticlopidine are used. Conversely, low-pressure inflation is associated with excellent long-term results.

Aged↗
PubMed2000

Comparison of coronary stent expansion by intravascular ultrasonic imaging in younger versus older patients with diabetes mellitus.

The poor long-term outcome in young diabetic patients receiving stents is not well understood. The purpose of this study was to characterize the pastprocedural results of stent placement in diabetic patients using intravascular ultrasound to identify factors that might be associated with poor clinical outcome. The acute dimensions from intravascular ultrasound studies after stent deployment at 5 sites were measured from 39 coronary segments from patients with diabetes mellitus (DM) and 161 segments from nondiabetic patients (non-DM). Within these 2 groups, segments were subgrouped into young (y) and old (o) in reference to the mean study age of 64 years, forming 4 groups: yDM (n = 20), y non-DM (n = 65), oDM (n = 19), and o non-DM (n = 96). Results are reported as mean +/- 1 SD. Diabetic patients had smaller mean lumen area within the treated segment than o non-DM (8.37+/-2.59 vs. 9.11+/-3.35 mm2, p<0.01). These differences were more pronounced at the distal reference vessel lumen of yDM than y non-DM (7.6+/-2.3 vs. 10.3+/-4.5 mm2, p<0.003), and were associated with greater percent plaque area in the distal reference vessel (43.4+/-13% vs. 34.1+/-11.2%, p<0.003). In young diabetic patients undergoing elective stent placement, underexpansion of the stented segment is common, which may contribute to the relatively poor long-term outcome in these patients. We suggest that when stenting is the procedure of choice in this subgroup of high-risk patients, special attention should be given to optimizing lumen dimensions.

Age Factors↗
PubMed2000

Cardiogenic shock: single center experience with and without on-site catheterization facilities.

BACKGROUND: The beneficial effect of on-site catheterization facilities on the survival of all patients with myocardial infarction complicated by cardiogenic shock has been questioned. Our objective was to evaluate the impact of the availability of on-site catheterization facilities on the outcome of unselected patients with cardiogenic shock. METHODS AND RESULTS: We studied the hospital records of 70 consecutive patients with cardiogenic shock admitted to our intensive coronary care unit during 1990-1996, and compared two groups of patients: those admitted before (n = 34) and after (n = 36) the opening of our catheterization laboratory. Patients admitted when the catheterization laboratory was available were of similar age, but included fewer males and fewer patients with prior myocardial infarction. Following the activation of the catheterization laboratory, utilization rates of coronary angiography, percutaneous transluminal coronary angioplasty and intra-aortic balloon pump increased, compared with the previous period. However, there was no improvement in in-hospital (88 vs. 83%; p = 0.7) and 30-day mortality (91 vs. 86%; p = 0.7) before versus after the activation of our catheterization laboratory. Twelve patients selected to cardiac catheterization (9 underwent percutaneous transluminal coronary angioplasty) experienced lower in-hospital and 30-day mortality compared with patients who were not selected (58 vs. 96, and 67 vs. 96%, respectively; p < 0.02). CONCLUSIONS: Following the activation of the catheterization laboratory, the mortality of the entire population of cardiogenic shock patients remained relatively unchanged. Still, a small subgroup of these patients selected for urgent cardiac catheterization had a lower mortality compared with patients who were not selected.

Aged↗
PubMed1999

[Accidental severance of a venous catheter: diagnostic and therapeutic approach].

The most common invasive procedure performed in hospitals is the insertion of a vascular access device. This procedure has the rare complication of catheter emboli. Accidental cutting of a peripheral catheter, the use of duplex ultrasound to locate the cut and the extraction of the catheter through a venesection is described. If peripheral extraction fails, percutaneous extraction or thoracotomy should be tried, in that order. The immediate precautions have an impact on the final results.

Aged↗
PubMed1999

Is it safe to administer thrombolytic therapy to myocardial infarction patients soon after laparoscopic cholecystectomy?

Thrombolytic therapy is usually contraindicated after abdominal surgery because of the risk of bleeding. We report a case of a 73-year-old woman who was admitted because of anterior wall acute myocardial infarction (AMI) two weeks after laparoscopic cholecystectomy. She was treated with streptokinase, aspirin and heparin and subsequently developed a hematoma at the site of the removed gallbladder. Our observation suggests that thrombolytic therapy for anterior AMI, two weeks after laparoscopic cholecystectomy, should be considered as a relative contraindication and an optional treatment in this life-threatening situation.

Aged↗
PubMed1998

The "door-to-needle blitz" in acute myocardial infarction: the impact of a CQI project.

BACKGROUND: A continuous quality improvement (CQI) project was conducted at Soroka Medical Center in Beer-Sheva, Israel, in an effort to identify and address causes of delays in thrombolytic therapy in patients arriving at a high-volume (160,000 patients per year) emergency department with acute myocardial infarction and thereby reduce the "door-to-needle time" (DTNT). The study had four phases: preintervention survey, peri-intervention process redesign, postintervention evaluation, and follow-up evaluation. CQI TEAM: The CQI team followed a seven-step protocol: problem definition, present-state screening, factors analysis, solution development, outcome evaluation, standardization, and conclusions. RESULTS: A DTNT of 45 minutes was considered acceptable for this data set, and accordingly, patients were divided into an "early" group (n = 50, DTNT < 45 minutes), and a "late" group (n = 50, DTNT > or = 45 minutes). After the CQI intervention, the mean DTNT decreased from 61.8 +/- 32.5 (mean +/- standard deviation) to 47.6 +/- 18.5 minutes (p < 0.029). The prolonged DTNT time intervals of the late versus the early groups was primarily due to extended decision-making time (36.0 +/- 22.7 versus 13.6 +/- 6.7 minutes, p < 0.003), followed by time until therapy was initiated (26.2 +/- 14.2 versus 11.1 +/- 5.8 minutes, p < 0.002). CONCLUSIONS: Results suggest that the 30-minute DTNT suggested by the American College of Cardiology/American Heart Association is appropriate for patients with a clear diagnosis and no contraindications for thrombolysis, but when the risk-benefit ratio of thrombolytic therapy raises concerns, a 45- to 60-minute DTNT may still be acceptable. Further CQI projects should address technical triage of simple cases and clinical estimation of risk-benefit ratio in complicated patients.

Emergency Service, Hospital↗
PubMed1996

Jaundice induced by streptokinase.

Streptokinase is the mainstream therapy for acute myocardial infarction. A fifty-seven-year-old man with acute MI was admitted to the intensive cardiac care unit and received streptokinase and heparin. At the time of admission, he was not receiving any drugs and denied any previous exposure to a hepatotoxic agent. Five hours later he developed a dramatic hypersensitivity reaction including high fever, pulmonary edema, cyanosis, and convulsions. Within twelve hours, his clinical state was stabilized. After forty-eight hours, he developed jaundice and transaminasemia, which subsided by the eighth day. Only a few reports of overt jaundice are associated with streptokinase.

Anticoagulants↗
PubMed1994

[Primary quality control in Israel Air Force clinics].

The practice of primary medicine within a military framework differs from that in the civilian environment in: accessibility, its consumers, obligations of the providers, involvement of the funder (the commanders), and ability to define and enforce professional guide lines. These differences influence the scope of medical service, as well as affect the methods and results of quality control. A system of quality control evaluation and feedback of military primary care in 16 Israel Air Force clinics was carried out by a team of experienced physicians using peer group review and according to a specially prepared protocol. Emphasis was placed on medical record assessment using obligatory markers of adequate medical evaluation and treatment. Identification of the population at risk, further medical training, and medical administration with a direct effect on the quality of medical treatment were also evaluated. 2 quality control surveys with feedback were carried out 6 months apart. The overall mean score was 81.66 +/- 7.16% at the first evaluation, increasing to 88.60 +/- 7.46% at the second (p < 0.01). The greatest improvements were in follow-up of population at risk (increasing from 68.4% to 86.4%, p < 0.025), training of medical teams, (from 75.7% to 87.5%, p < 0.05) and patient case management (from 79.4% to 85.1%, N.S.). Categories in which there was no improvement were medical records, recovery of old medical files and patient education. The categories in which there was improvement had a common denominator: "recognition of importance" and "provision of patterns" by headquarters. The quality control system was designed for routine use, and not as a research project.(ABSTRACT TRUNCATED AT 250 WORDS)

Aerospace Medicine↗
PubMed1994

Long-term prognosis of low-risk, post-MI patients: the importance of subjective perception of disease.

In 1980, 87 male patients (age range 34-60 years), hospitalized after their first myocardial infarction (MI), were asked why they believed they got the infarct and what would help them cope with it. In a multiple regression analysis, their causal attributions accounted for 15% of the explained variance in their physical, sexual, social and work functioning after 6 and 18 months, their level of education accounted for 25% and the severity of their infarct for 10%. This result was replicated in a cross-cultural study. A follow-up study shows that 12 years after the MI, the patients' initial causal attributions still accounted for part of their rehabilitation and life expectancy. Of the original 87, 23 had died between 1980-1992 from cardiac causes and 50 male patients were located and re-interviewed at the Soroka ICCU, in 1992. This suggests a very low-risk post-MI sample. The only risk-factor, accounting for the difference between the surviving and the deceased patients, was the initial obesity of the latter. The functional capacity outcome of the survivors was accounted for by their age (24%) and initial causal attributions (26%). Also the initial causal attributions (5%) still accounted for the subjective perception of functioning among the survivors. These results suggest that the initial causal attributions may have created positive or negative self-fulfilling prophecies which had long-term consequences, especially in a low-risk, post-MI population, in which risk factors hardly effected long-term prognosis.

Adult↗