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Biomedical subjects

M Deeb

Publications and source records attributed to M Deeb.

At least 19 recordsLinked to original sources
PubMed2000

Left ventricular apical puncture: a procedure surviving well into the new millennium.

We report two patients with a history of prior mitral valve and aortic valve replacement with St. Jude prosthetic valves, who were referred for repeat valve replacement after noninvasive assessment was suggestive of prosthetic valve malfunction. Both patients were managed medically after evaluation with direct left ventricular apical puncture revealed normal hemodynamics in the first and mild aortic stenosis in the second patient. These two cases illustrate that, despite the advancements in the noninvasive evaluation of prosthetic heart valves, left ventricular direct puncture continues to have an important value in the evaluation of patients referred for repeat valve replacement, and it can prevent unnecessary surgeries associated with a high risk of morbidity and mortality. Cathet. Cardiovasc. Intervent. 49:68-73, 2000.

Aortic Valve↗
PubMed1997

Danaparoid for cardiopulmonary bypass in patients with previous heparin-induced thrombocytopenia.

Anticoagulation for cardiopulmonary bypass in patients with heparin-induced thrombocytopenia requires the use of other anticoagulants. We report a case in whom this was achieved using the heparinoid danaparoid (Orgaran). Based on our experience and a review of the literature, we provide guidelines for managing these rare patients. A danaparoid dose substantially lower than that recommended by the manufacturer may minimize bleeding complications.

Anticoagulants↗
PubMed1997

Fertility levels and differentials in Beirut during wartime: an indirect estimation based on maternity registers.

In this paper, total fertility estimates for Greater Beirut in the mid-eighties and early nineties are presented, and changes in socio-religious differentials of fertility across time are explored. The baseline information was recorded from registration details for all maternities in Beirut and its inner suburbs in 1984 and 1991: age of mother, number of children ever-born, hospital class, and religion of newborn. An indirect method was used to estimate total fertility from the joint distribution of mothers by age and parity, and, using hospital class as a proxy for social class, differentials in fertility were investigated by Poisson regression. The estimates of total fertility for Beirut shifted from 2.60 in 1984 to 2.52 in 1991, and were higher for Muslims than for Christians in the two periods. The regression analysis showed that: (1) the difference between the two religious groups persisted after control for social class, and in fact applied to the lower social class; (2) fertility dropped between the two dates in the lower social class, and more so for Muslims than for Christians. In comparison with other countries of the region, the decline in Beirut was found to be relatively modest. If the trends assessed in this study were to continue, the religious-based fertility differentials would taper off progressively in the capital city of Lebanon.

Fertility↗
PubMed1997

Child survival in Beirut during wartime: time trends and socio-religious differentials.

BACKGROUND: Child mortality estimates in Beirut are presented for the late 1970s and the mid 1980s, and changes in socio-religious differentials of mortality across time are investigated. METHODS: Baseline information was obtained from maternity registries in Beirut in 1984 and 1991. Age of mother, number of children ever born and number of children alive, hospitalization class (1, 2 or 3 within each hospital, depending on the room rate, the services and the doctor's fees), and religion of newborn was recorded. Brass and Macrae's technique was used to convert the proportion dead among children ever born to mothers in age group 30-34 into 5q0 estimates for the reference periods 1978 (1984 data) and 1985 (1991 data). Using hospitalization class as a proxy for social class, religious differentials in child mortality were explored by logistic regression analysis within each period. RESULTS: Overall, 5q0 is estimated at 46 per 1000 in the late 1970s, and at 36 per 1000 in the mid 1980s. The religious differentials in 5q0 mortality estimates were quite large in the former period, with a risk for Muslims relative to Christians of 1.53, which declined to 1.35 in the latter period. The regression analysis of the proportion dead among children ever born; (1) confirmed the magnitude of the religious differentials in child mortality, and their reduction over time; (2) demonstrated the existence of an interaction between religion and social class, as the religious differentials in child mortality were found to be highly prevalent in the lower social classes, and almost insignificant in the middle and upper ones; (3) highlighted the decisive role of differential fertility in generating differential child mortality, with higher fertility and higher child mortality in Muslims, and with the disappearance of religious differentials in child mortality after adjustment for fertility. CONCLUSION: The findings confirm the hypothesis of a reduction over time of religious-based child mortality differences in the capital city of Lebanon, in agreement with the pattern found for religious-based fertility differences. Comparisons with other countries in the region indicate that the war in Lebanon has slowed down the decline in child mortality, causing the country to loose its priviledged position among Arab countries.

Child↗
PubMed1996

Early experience in lung transplantation.

Lung transplantation is becoming an acceptable mode of therapy worldwide for the end-stage lung disease. We present our initial experience with the first 10 consecutive lung transplant patients at Hadassah University Hospital. There were 5 males and 5 females with an age range 27 to 59 years. Eight patients underwent single lung transplantation, one patient had double lung transplantation and one had heart-lung transplantation. Indications were: pulmonary fibrosis in 4, emphysema in 4, cystic fibrosis in 1, and cystic bronchiectasis in 1. Two patients had primary graft failure (1 death). Nine patients had a serious infection after transplantation (1 death). Four patients developed airway complications including dehiscence of bronchial anastomosis (1 death), bronchial stenosis requiring placement of a stent in 2 patients, and pneumothorax in 1 patient. One patient required tracheostomy. One patient died of massive brain infarction secondary to pulmonary venous thrombosis and embolization. Six patients are intermediate-term survivors, with a follow-up period of 4-24 months. Four of them had at least one episode of rejection each. In all survivors pulmonary functions and quality of life improved and they do not need supplemental oxygen. We conclude that lung transplantation is a viable option for end-stage lung disease. Better selection of patients and perhaps improved immunosuppression agents will further improve outcome in lung transplantation. Shortage of donor supply is currently the limiting factor in successful lung transplantation in Israel.

Adult↗
PubMed1995

Luke warm blood cardioplegia for CAB surgery in patients with severely impaired LV function. Improved results.

Ward blood cardioplegia (WBC) has recently been reported to improve myocardial protection in adult open heart surgery, especially in high risk cases. However, WBC has been reported to have some disadvantages including narrow safety margins concerning brain and kidney perfusion. We therefore modified our technique to utilize luke-warm blood cardioplegia (LWBC). We carried out 470 open heart procedures using luke-warm cardioplegia (anterograde + retrograde perfusion) from 1/2/1991 - 30/9/1992; 94 had LVEF < 30% and form the basis of this study. Other major risk factors in this group included: > 70 yrs - 26 patients, L main > 50% - 14 patients, emergencies - 11 patients, redo's - 3 patients. Eightyone patients underwent CAB only; 3 had additional MVR, 3 additional closure acute VSD of whom one underwent additional LV aneurysmectomy, one additional AVR; 4 patients underwent AVR only, and 2 MVR. Average number of grafts/patient for the 81 isolated CAB's was 4.5. IABP was necessary postbypass in 4 patients (9 emergencies were on IABP support at time of operation). Thirty day mortality was 3 patients (3.2%). Late mortality was 5 cases. These results are superior to those achieved using cold protection and warm blood cardioplegia. LWBC is a safe method for myocardial protection in patients undergoing CAB, particularly when LV function is severely compromised.

Adult↗
PubMed1994

Recurrence of sarcoidosis following bilateral allogeneic lung transplantation.

We report the first case of recurrent sarcoidosis manifested by clinical symptoms, radiographic abnormalities, and pathologic changes in a patient following sequential double allogeneic lung transplantation. A 40-year-old male patient underwent bilateral allogeneic lung transplantation for end-stage pulmonary sarcoidosis. Thirteen months posttransplantation, he developed fatigue, shortness of breath, and bilateral upper lobe pulmonary infiltrates. Transbronchial biopsy specimens revealed noncaseating granulomata. The patient's symptoms and radiographic abnormalities resolved with an increased dose of oral prednisone.

Adult↗
PubMed1993

Warm blood cardioplegia for patients undergoing revascularization for left main coronary artery disease.

Between February 1991 and June 1992, 62 patients (50 males) underwent coronary artery bypass (CAB) operation for significant left main coronary artery disease. Age varied between 47 and 81 years. 53 patients had unstable angina, 16 had recent myocardial infarction, and 16 had heart failure. 22 patients were in functional capacity class IV (Canadian Heart Association) and 2 patients were in unstable hemodynamical condition before the operation. Intraaortic balloon pump was inserted before the operation in 3 patients. Six patients had previous CAB surgery. All the patients were operated using myocardial protection with warm blood cardioplegia, given antegradely and retrogradely in 58 and only antegradely in 4 patients. Body temperature was maintained at 30 +/- 1.8 degrees C. Number of distal anastomoses averaged 4.3 +/- 0.9. One patient underwent additional resection of a left atrial myxoma and another aortic valve replacement. LIMA (left internal mammary artery) was used to bypass the LAD in 58 (94%) patients. Early mortality was 3 cases (4.8%). Major and minor postoperative complications occurred in 17 patients. These data suggest that warm blood cardioplegia provides superior myocardial protection in patients with left main coronary artery disease.

Aged↗
PubMed1990

Noninvasive evaluation of sympathetic nervous system in human heart by positron emission tomography.

The noninvasive functional characterization of the cardiac sympathetic nervous system by imaging techniques may provide important pathophysiological information in various cardiac disease states. Hydroxyephedrine labeled with carbon 11 has been developed as a new catecholamine analogue to be used in the in vivo evaluation of presynaptic adrenergic nerve terminals by positron emission tomography (PET). To determine the feasibility of this imaging approach in the human heart, six normal volunteers and five patients with recent cardiac transplants underwent dynamic PET imaging after intravenous injection of 20 mCi [11C]hydroxyephedrine. Blood and myocardial tracer kinetics were assessed using a regions-of-interest approach. In normal volunteers, blood 11C activity cleared rapidly, whereas myocardium retained 11C activity with a long tissue half-life. Relative tracer retention in the myocardium averaged 79 +/- 31% of peak activity at 60 minutes after tracer injection. The heart-to-blood 11C activity ratio exceeded 6:1 as soon as 30 minutes after tracer injection, yielding excellent image quality. Little regional variation of tracer retention was observed, indicating homogeneous sympathetic innervation throughout the left ventricle. In the transplant recipients, myocardial [11C]hydroxyephedrine retention at 60 minutes was significantly less (-82%) than that of normal volunteers, indicating only little non-neuronal binding of the tracer in the denervated human heart. Thus, [11C]hydroxyephedrine, in combination with dynamic PET imaging, allows the noninvasive delineation of myocardial adrenergic nerve terminals. Tracer kinetic modeling may permit quantitative assessment of myocardial catecholamine uptake, which will in turn provide insights into the effects of various disease processes on the neuronal integrity of the heart.

Adult↗
PubMed1987

Measures of social class based on education for use in health studies in developing countries.

In this paper we consider the appropriateness of education, compared to occupation and income, as a measure of social class for use in health-related studies in developing societies in transition. Three evaluation criteria were used, namely, the feasibility of constructing the measure, its sensitivity in reflecting relevant social class life conditions, and its ability to produce a family-level measure of social class. We used two data sets from community health surveys in areas of Amman city, Jordan, and in Beirut city, Lebanon, to define a family-based average educational score. We then proceeded, using the Beirut data, to test the score's ability to discriminate social class effects on family health, compared to a more standard representation based on the educational level of the head of the family. It was found that the performance of the average educational score was often better than, but not consistently superior to, the educational level of the head of the family.

Developing Countries↗