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Biomedical subjects

I Shapira

Publications and source records attributed to I Shapira.

At least 19 recordsLinked to original sources
PubMed1995

Long-term results of coronary artery bypass surgery in patients with severely depressed left ventricular function.

STUDY OBJECTIVE: The objective of the present study was to evaluate medium- and long-term results of coronary artery bypass grafting (CABG) in patients with severe left ventricular dysfunction (LVD). DESIGN: Prospective evaluation (clinical follow-up and equilibrium radionuclide angiography scan) of all the patients with severe LVD who underwent CABG from November 1986 to November 1991 at the Tel Aviv Medical Center and were referred to the Post Cardiac Surgery Follow-up Clinic at this institution. PATIENTS: Seventy-four consecutive patients (65 men, 9 women, aged 43 to 82 years; mean age, 68.2 years) with left ventricular ejection fraction (LVEF) of 30% or less who underwent isolated CABG (without automatic implantable cardioverter-defibrillator implantation, aneurysmectomy, valve replacement, or other open heart procedures) during a 5-year period and were discharged from hospitalization were prospectively evaluated. Preoperatively, 62% of patients had angina, 65% had congestive heart failure (CHF), and the LVEF ranged from 10 to 30%. The mean number of grafts was 2.98 per patient; the internal mammary artery (IMA) was used in 54 patients. The patients were followed up 4 to 96 months (mean, 64.9 months) post-surgery for survival, clinical status, and left ventricular function. RESULTS: Survival was 96%, 93.2%, 91.9%, 87.8%, 86.5%, 83.8%, and 83.8%, at 1, 2, 3, 4, 5, 6, and 7 years, respectively. Postoperatively, mean angina class improved from 2.9 to 1.4 (p < 0.0001) and mean CHF class improved from 2.7 to 1.8 (p < 0.0001). Mean LVEF improved from 23.5% preoperatively to 35.7% postoperatively (p < 0.0001). CONCLUSIONS: The following occur in patients with coronary artery disease and severe LVD undergoing CABG: (1) good medium- and long-term survival is attained; (2) angina class improves; (3) CHF class improves; (4) LVEF objectively improves; and (5). IMA can be used safely as a conduit.

Adult↗
PubMed1992

Hereditary microphthalmia with colobomatous cyst.

We examined five members of a highly inbred kinship who had isolated microphthalmia associated with colobomatous cysts and various other ocular lesions. They were all offspring of consanguineous (first cousins) and unaffected parents. Microphthalmia in this kindred was transmitted as an autosomal recessive trait. Ultrasonography was effective for prenatal diagnosis in two pregnancies at risk.

Child↗
PubMed1990

Programmed ventricular stimulation using up to two extrastimuli and repetition of double extrastimulation for induction of ventricular tachycardia: a new highly sensitive and specific protocol.

The sensitivity and specificity of a new protocol of programmed ventricular stimulation were evaluated in 71 consecutive patients who were divided into 2 groups: group 1 included 41 patients, of whom 25 had sustained ventricular tachycardia (VT) not associated with cardiac arrest and 16 had ventricular fibrillation (VF) not precipitated by any obvious factor; group 2 included 30 patients without demonstrable heart disease and no suspected or documented sustained ventricular tachyarrhythmias. The study consisted of a standard protocol (up to 2 extrastimuli given only once for each extrastimulus prematurity, 2 right ventricular sites and 3 basic pacing cycle lengths, as well as rapid ventricular pacing) in which double extrastimulation at the shortest coupling intervals that allowed ventricular capture was repeated 10 times. A stimulus current of 3 mA was used. Sustained ventricular tachyarrhythmias were induced in 23 of 25 (92%) patients who presented with sustained VT, 14 of 16 (88%) patients who presented with VF and 2 of 30 (7%) group 2 patients. Eighteen of 25 (72%) patients with sustained VT but only 4 of 16 (25%) with VF had arrhythmias inducible at "immediate" trials of single or double extrastimulation (p less than 0.01). Repetition of double extrastimulation increased the yield of inducible sustained ventricular tachyarrhythmia to 92% in patients with sustained VT (+20%, p = 0.14) and 75% (+50%, p = 0.013) in patients with VF. Rapid right ventricular pacing added a 13% increase in the overall yield in patients with VF. This new protocol of programmed ventricular stimulation has both high sensitivity (90%) and specificity (93%) for induction of sustained VT.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiac Pacing, Artificial↗
PubMed1989

[Interventional electrophysiology: transcatheter electrical shock ablation for arrhythmias].

Patients with supraventricular or ventricular tachyarrhythmias resistant to antiarrhythmic drugs are candidates for surgical ablation of the bundle of His, and of accessory pathways or ventricular or atrial foci responsible for the arrhythmia. During the past 6 years closed-chest catheter techniques have been devised that allow electrical shock ablation of the atrioventricular junction, accessory pathways, or foci responsible for arrhythmias. The promising results of these ablative procedures (especially of the atrioventricular junction and posteroseptal accessory pathways) justify their trial in suitable patients before cardiac electrosurgery.

Arrhythmias, Cardiac↗
PubMed1989

Biochemical and cardiovascular measures in subjects with noise-induced hearing loss.

Reports on a potential relationship between noise-induced hearing loss (NIHL) and cardiovascular as well as biochemical measures are controversial. This study compares the means of certain cardiovascular and biochemical measures in subjects with NIHL with those in subjects exposed to similar occupational noise, but demonstrating normal hearing. This might indicate certain predisposing factors for NIHL. Eight hundred noise-exposed subjects were divided into two age-matched hearing groups (NIHL and normal hearing). The results showed that the mean values of all the variables examined in both hearing groups were within the normal range. No significant differences were found between the two groups in terms of the distribution of subjects for the indices measured.

Adult↗
PubMed1989

Plasmacytoma of the stomach.

A case of plasmacytoma of the stomach is described. The clinical presentation, diagnostic pitfalls and the treatment of this rare entity are discussed.

Adult↗
PubMed1988

Transcatheter electrical shock ablation of a concealed accessory pathway.

Transcatheter electrical shock ablation of a concealed posteroseptal accessory pathway was performed on a 57-year-old man with drug-refractory paroxysmal supraventricular tachycardia. A single 300-joules shock delivered at the ostium of the coronary sinus abolished conduction in the accessory pathway and resulted in long-term cure of the arrhythmia. No complications were observed during the procedure.

Electrocoagulation↗
PubMed1988

Serum myoglobin levels in patients with ischemic myocardial insult.

Serum myoglobin levels were studied in 178 consecutive patients admitted for chest pain due to ischemic cardiac injury. Serum myoglobin level was compared with the clinical condition, electrocardiographic changes, and serum creatine kinase levels. Elevated serum myoglobin concentration was present in all patients with acute myocardial infarction, as defined by World Health Organization, Geneva, criteria, and, in addition, in about 50% of patients with so-called acute coronary insufficiency. On this basis we could define two different groups of patients with acute coronary insufficiency: cases exhibiting elevated serum myoglobin levels (group 1) and those with normal levels (group 2). In group 1 although creatine kinase levels were in the normal range, they were significantly higher than in group 2. Four patients from group 1 developed heart failure and another a typical acute myocardial infarction during hospitalization, whereas no patients of group 2 had such complications. In patients with acute myocardial infarction, the elevation of serum myoglobin preceded that of creatine kinase in most cases. Myoglobin release appears to be related to infarct size, the highest levels were found in extensive myocardial infarction and less marked elevations in cases of subendocardial infarction and in half of the cases with acute coronary insufficiency. It is proposed that serum myoglobin is a reliable measure of myocardial necrosis and serves to detect a hitherto undefined population of small-size acute myocardial infarction, with its attendant clinical and prognostic implications.

Coronary Disease↗
PubMed1987

Serum myoglobin in detection of myocardial necrosis in patients with "coronary insufficiency".

Myoglobin, an oxygen-binding protein, is synthesized exclusively in striated and cardiac muscle, and is normally found in blood. Serum myoglobin determination has been used in the diagnosis of acute myocardial infarction. Experimental work has shown that myoglobin is released only after muscular necrosis. This prospective study included 101 patients: 62 with acute coronary insufficiency, 16 with acute myocardial infarction, and 23 controls. In all the patients with infarction the serum myoglobin levels were elevated. None of the controls showed serum myoglobin above normal. In patients with coronary insufficiency the peak serum myoglobin ranged from normal to 280 ng/ml. Half of all the patients with coronary insufficiency had a significant elevation of serum myoglobin (p less than 0.001). The obvious explanation of this finding is that myocardial necrosis to some extent develops in cases of so-called coronary insufficiency. Furthermore, this study confirms previous findings that serum myoglobin assessment constitutes a very early marker of myocardial damage.

Acute Disease↗
PubMed1987

Early intervention in acute myocardial infarction: significance for myocardial salvage of immediate intravenous streptokinase therapy followed by coronary angioplasty.

Sixteen patients with acute myocardial infarction underwent treatment with streptokinase up to 3 hours after the onset of chest pain. Nine patients (group I) received streptokinase within 1 hour of the onset of pain, and seven patients (group II) received it within 2 to 3 hours. All underwent multigated radionuclide ventriculography after streptokinase therapy and 1 week later. Percutaneous transluminal coronary angioplasty of the infarct artery was performed within 24 hours in all patients. An effort-limited treadmill stress test was performed before discharge. There was no mortality or serious complication. Mean peak total creatine kinase was 521 +/- 289 mU/ml in group I, and 1,614 +/- 709 mU/ml in group II (p less than 0.05). The mean initial left ventricular ejection fraction was 47 +/- 11% in group I and 37 +/- 10% in group II. After early angioplasty (within 24 hours) and at 1 week recovery, left ventricular ejection fraction increased to 53 +/- 9% in group I (p less than 0.05) and to 40 +/- 7% in group II (p = NS). Seven of the nine patients in group I had normal radionuclide ventriculograms at discharge compared with none of the seven patients in group II. Thrombolytic therapy administered less than 1 hour after the onset of symptoms of acute myocardial infarction followed by angioplasty of the infarct artery results in preservation of left ventricular function, whereas therapy given after 2 hours has only a limited effect.

Adult↗