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Biomedical subjects

M Mosseri

Publications and source records attributed to M Mosseri.

At least 73 records · Page 4Linked to original sources
PubMed1991

Coronary capillaries in patients with congestive cardiomyopathy or angina pectoris with patent main coronary arteries. Ultrastructural morphometry of endomyocardial biopsy samples.

BACKGROUND: The coronary microvasculature may be abnormal even in the presence of angiographically normal epicardial arteries. Abnormalities of small coronary vessels have been invoked as a cause of angina. METHODS AND RESULTS: To quantitatively evaluate the morphology of capillaries in patients with idiopathic dilated cardiomyopathy (DCM) or the syndrome of angina and small vessel disease (SVD), we performed electron microscopic morphometry of capillaries in right ventricular biopsy samples taken from 32 patients. Ten had angina, normal epicardial coronary arteries, and evidence for SVD; 12 had DCM; and 10 had normal hearts. In patients with DCM, the ratio of microvessels to myocytes was not different than that of controls (0.49 +/- 0.06 versus 0.51 +/- 0.05). Mean cross-sectional areas of the capillaries (lumen plus wall) and lumen were significantly greater than those of controls (45.3 +/- 15.1 versus 22.7 +/- 8.3 micron 2, p less than 0.001; 17.6 +/- 6.9 versus 11.6 +/- 6.2 micron 2, p less than 0.05, respectively). Fibrous content of the myocardium, as assessed by quantitative light microscopy, was significantly increased (16.3 +/- 3.3% versus 5.0 +/- 2.4%, p less than 0.001). In contrast, in patients with SVD, the capillary-to-myocyte ratio was reduced (0.33 +/- 0.08, p less than 0.001). Although mean cross-sectional areas of the entire capillary (32.4 +/- 19.7 micron 2) and the lumen (8.9 +/- 7.8 micron 2) were not statistically different than those of controls, there was an absence of capillaries less than 15 micron 2 in cross-sectional area, and the frequency distribution of the lumen area was skewed to the left. Swollen endothelial cells frequently encroached upon the lumen. There was a mild increase in fibrous content (9.5 +/- 3.7%, p less than 0.05). CONCLUSIONS: Enlarged capillaries and a normal ratio of capillaries to myocytes appear to be features of DCM. Of the patients with SVD, there was both a relative lack of capillaries and capillary lumen narrowing from swollen endothelium. These changes may induce ischemia and angina and may result in mild fibrosis.

Adult↗
PubMed1990

Electrocardiographic manifestations of combined hypercalcemia and hypermagnesemia.

Near drowning in the Dead Sea is a potentially lethal accident; the swallowing of the salty water causes acute combined hypercalcemia and hypermagnesemia, and this, rather than aspiration, is considered to be the main pathogenetic fator. The authors reviewed the electrocardiographic data of 37 patients who nearly drowned in the Dead Sea. Common findings in the acute phase included P wave changes, tendency for prolongation of P-R interval, prolongation of QRS complex, infra-His conduction disturbances, tendency for broadening and inversion of T wave, and the appearance of a prominent U wave. Three patients had potentially lethal ventricular tachyarrhythmias. The QaTc interval (beginning of QRS complex to apex of T wave, corrected for heart rate), the expected QaTc calculated from calcium blood level (QaTce), and their difference (DQaTc), were measured or calculated. The QaTc was found within normal limits and did not change during recovery from the Dead Sea water poisoning. The DQaTc correlated significantly with serum magnesium level (p less than 0.001). This correlation signifies that hypermagnesemia normalizes the QaTc interval, which is usually shortened by isolated hypercalcemia. Combined hypercalcemia and hypermagnesemia can be caused by swallowing excessively salty water. The potential cardiac complications require strict monitoring and electrocardiographic follow up study.

Arrhythmias, Cardiac↗
PubMed1990

Thrombolytic therapy of a stenosed coronary vein bypass graft with continuous intragraft streptokinase drip.

A patient with newly onset angina due to recent thrombotic occlusion of a saphenous vein graft to the left anterior descending coronary artery is described. The patient was successfully treated by a direct intragraft infusion of streptokinase (STK) followed by a continuous intragraft infusion of an additional 1.5 million units of STK during the next 20 h through a regular diagnostic catheter. The patient was discharged on oral anticoagulant treatment with remarkable relief of the angina. Repeat angiography showed complete dissolution of the graft thrombus. This patient demonstrates that continuous infusion of STK into a saphenous vein graft is an effective treatment for recently formed thrombi.

Acute Disease↗
PubMed1990

Percutaneous angioplasty of totally occluded coronary vein bypass grafts: case histories.

Seven patients with totally occluded coronary artery bypass vein grafts underwent percutaneous transluminal angioplasty. All patients had either acute or recent occlusion of the graft itself. In 2 patients the proximal and in 3 the distal anastomosis were also narrowed. The vein graft was successfully dilated in all the patients. Six patients also received direct intragraft thrombolytic therapy during the procedure. Five uncomplicated patients improved clinically. One patient was studied routinely as part of a myocardial infarction-streptokinase protocol and had no symptoms. This patient had a no-reflow phenomenon. One patient did not receive intragraft thrombolytic therapy and the procedure was complicated by embolization with myocardial infarction and a cerebral embolus. In 2 patients, a routine angiogram was performed two to six months after graft dilatation and in both the grafts were patent. Another patient, initially successfully dilated, had recurrent angina and restenosis of the proximal anastomosis ten months after angioplasty; this was successfully redilated. Angioplasty of acutely or recently totally occluded coronary vein grafts is feasible and improves angina when present. Additional thrombolytic therapy prevents embolization.

Aged↗
PubMed1990

Cardiopulmonary assessment in beta-thalassemia major.

Thalassemia patients succumb at a young age to congestive heart failure. Hitherto, attention has been focused on left ventricular function. This report emphasizes right ventricular dysfunction and abnormal pulmonary function. We performed cardiopulmonary evaluation, including echo-Doppler, spirometry, CO diffusion (DCO), and blood gas analyses in 35 patients with homozygous beta-thalassemia maintained by multiple blood transfusions. Six autopsy lung specimens were studied. Thalassemia patients exhibited pulmonary dysfunction, characterized by hypoxemia (85 percent of the patients were outside the 95 percent confidence limits), reduced lung volumes (51 percent), flow rates (63 percent) and DCO (50 percent). Right ventricular dysfunction was more prevalent than left ventricular dysfunction. Furthermore, 75 percent of the patients had evidence of pulmonary hypertension consistent with more frequent right ventricular rather than left ventricular dysfunction. Our findings suggest that in thalassemia patients, complex cardiopulmonary abnormalities precede the final outcome of congestive heart failure.

Adult↗
PubMed1989

[Follow-up of heart transplants].

6 patients, 37-55 years old, who underwent heart transplantation in Belgium, have been followed in our clinic for the past 2 years. All had suffered for 6-12 months from congestive heart failure which had not responded to intensive medical treatment and were considered terminal. 5 had had ischemic heart disease and 1 idiopathic dilated cardiomyopathy. After transplantation all patients were again in good physical condition and 5 of them had resumed a productive lifestyle. In 3, follow-up endomyocardial biopsies revealed episodes of "moderate rejection" of the transplant, all of which were successfully treated with pulse courses of corticosteroids and increased cyclosporine dosage. Mild renal failure developed in 3, and in 3 systemic hypertension, controlled by antihypertensive drugs. 4 patients examined in our department and found suitable for transplantation died before a compatible donor was found. In 2 other patients heart transplantation was not possible due to severe pulmonary hypertension. Heart transplantation is recommended for patients with terminal congestive heart failure unresponsive to medical treatment. Early transplantation prevents irreversible changes in the pulmonary vessels which would make operation impossible, and lowers operative risk.

Adrenal Cortex Hormones↗
PubMed1989

[Long-term follow-up of acute myocardial infarction after early intravenous streptokinase].

In a series of 30 patients with acute myocardial infarction (AMI) intravenous streptokinase was given within 4 hours of the onset of chest pain. Cardiac catheterization and angiography were performed on the 6th day, and again 4 months after the acute episode. Residual coronary artery stenosis increased significantly (from 84 +/- 3% to 95 +/- 7%, p less than 0.05) in those who had stenosis of more than 80% in infarct-related arteries. In this subgroup, a higher incidence of complete occlusion was found at the second investigation than in the other patients (p less than 0.002). Those who had received early treatment with streptokinase or had residual stenosis of less than 75% showed improvement in regional function of the infarct area, confirmed at the second angiography. End-systolic volume, regarded as a sensitive prognostic marker after myocardial infarction, correlated at the second investigation with residual coronary artery stenosis determined on day 6 (p less than 0.0016). Significant improvement in global ventricular function and return of regional function to normal was found in those who had received streptokinase within 2 hours of onset of pain, and in whom residual coronary artery stenosis was less than 75%. Early fibrinolytic treatment at the time of infarction is crucial for preservation of ventricular function and its later restoration. Coronary angiography 1 week after infarction detects high-risk patients who need early revascularization.

Acute Disease↗
PubMed1989

Dead Sea water poisoning.

A unique chemical intoxication by Dead Sea water and its resultant physiological effects of combined severe hypercalcemia and hypermagnesemia are described. Of 48 adult patients, 16 had at least one severe clinical manifestation of either disturbed sensorium or a syndrome similar to adult respiratory distress syndrome. The patients had tachyarrhythmias (11 of 38, 29%), conduction disturbance (nine of 37, 24%), and a normal QTc interval in the presence of severe hypercalcemia. Combined respiratory and metabolic acidosis and concomitant extreme hypercalcemia and hypermagnesemia, reaching serum levels up to 28.8 and 33 mg/dL, respectively, were responsible for most of the clinical findings. The adult mortality was 19%. Four pediatric patients with variable degrees of intoxication survived. Discriminant function analysis determined that admission serum calcium concentration of more than 15.5 mg/dL was the best predictor of mortality. In patients with severe intoxication, supportive medical treatment, including forced diuresis, was disappointing. Early dialysis for severe cases merits further study.

Adult↗
PubMed1988

Changes in ventricular function and coronary stenosis after successful intravenous thrombolysis in acute myocardial infarction.

Temporal changes in residual stenosis in the infarct-related coronary artery and ventricular function were studied in 30 consecutive patients with an acute myocardial infarction who received rapid, high dose intravenous infusions of streptokinase within 4 h of pain onset. Patients were studied 6 days and 3.9 +/- 1.3 months after the acute episode. Inferior infarction, early thrombolysis (less than 1.5 h after pain onset) and adequate reperfusion (less than 75% residual stenosis in the infarct-related coronary artery) were associated with smaller left ventricular infarcts, smaller ventricular volumes and better ventricular function. Residual stenosis tended to increase with time and in 6 patients the artery closed completely (1 with an overt clinical episode). Ventricular function and volumes improved progressively in patients with good initial function and less residual stenosis in the infarct-related coronary artery.

Aged↗
PubMed1987

Right ventricular infarction: unusual electrocardiographic and electrophysiological manifestations.

Right ventricular infarction occurs in 19-43% of patients with acute inferior wall infarction (Lorell et al., 1979). Its clinical, hemodynamic, and anatomic features are well known and include associated inferior wall infarction, distended neck veins, clear lung fields, hypotension, and heart block (Cintron et al., 1981; Coma-Canella et al., 1979; Lloyd et al., 1981; Lopez-Sendon et al., 1981; Raabe and Chester, 1978; Rotman et al., 1974). Isolated right ventricular infarction is less frequent and occurs in 2.5-4.6% of autopsy studies of myocardial infarction (Cohn et al., 1974; Erhardt et al., 1976; Wartman and Hellerstein, 1948). This report describes a patient with isolated right ventricular infarction with unusual electrophysiological findings. Her initial electrocardiogram showed atrial escape rhythm with incomplete right bundle-branch block and left posterior hemiblock. Later, she developed atrioventricular (AV) block with supra- and infra-Hisian, "phase 4," conduction defects. The sinus malfunction and high degree AV block persisted over 2 weeks and an atrioventricular sequential pacemaker was implanted. Hymodynamic study showed that her cardiac output was highly dependent on the heart rate and properly timed AV interval, and the pacemaker was programmed accordingly.

Aged↗
PubMed1987

Quantitation of variations in regional left ventricular function in isolated disease of the left anterior descending coronary artery.

The pattern of contraction of the endocardial wall of the left ventricle in the right anterior oblique cineangiogram was studied by using a frame by frame radial technique and a fixed centroid without correction for rotation and translation motion during the cardiac cycle. Spatial defects of contraction were quantitated by measuring the shortening fraction of each radius and temporospatial defects by using a time-contraction integral. Twelve normal subjects were used as a basis for comparison. Thirty-two patients with isolated disease of the left anterior descending (LAD) coronary artery were divided into seven arbitrary clinicopathological subsets. Five subsets showed significant quantitative differences in contraction from the normal subjects but there was no significant difference between the subsets. They had a typical defect of contraction in the distal two thirds of the anterior wall, the apex and distal quarter of the inferior wall of the left ventricle. The subsets included: (1) patients who had undergone an anterior myocardial infarction and who had total occlusion of the LAD artery and a large anterior infarction on ECG; (2) patients with a previous classical myocardial infarction but with only 95% residual narrowing of the LAD; (3) patients with an anterior infarction and total occlusion of the LAD with return of the R waves in the anterior precordial leads; (4) patients with anterior infarction, LAD obstruction and left bundle branch block and (5) patients with anterior infarction but with early successful reperfusion with intracoronary streptokinase. Two other subsets, (1) patients with total obstruction of the LAD without a clinical myocardial infarction or (2) subtotal occlusion of the LAD without infarction, had mild left ventricular dysfunction at rest and did not differ significantly from normal.

Adult↗
PubMed1987

Prehospital coronary thrombolysis. A new strategy in acute myocardial infarction.

Thirty-four patients with acute myocardial infarction were treated prospectively using a new strategy of prehospital intravenous streptokinase given by a physician-operated mobile intensive care unit. The 29 prehospital-treated patients who had experienced no previous myocardial infarction were compared to a similar group treated with streptokinase inhospital. Patients receiving streptokinase in the prehospital phase of acute myocardial infarction had smaller infarcts and better residual myocardial function than the group given streptokinase inhospital in terms of peak creatinine phosphokinase, ejection fraction, computer-derived dysfunction index, and electrocardiographic QRS score. The only difference between these groups at baseline was the duration of pain prior to initiation of streptokinase therapy. There were no major complications related to prehospital administration of streptokinase.

Aged↗
PubMed1987

Influence of vessel involvement and early streptokinase therapy on regional and global left ventricular function in acute myocardial infarction.

150 consecutive patients with acute myocardial infarction received 750,000 units of intravenous streptokinase within four hours of pain onset. Angiography was performed on day 6, from which ejection fraction (EF), infarct-related ejection fraction (IREF), and non-infarct related ejection fraction (NREF) were calculated. 50% stenosis was considered to be significant. The streptokinase patients with patent infarct-related arteries who had no evidence of previous myocardial infarction were compared with 82 conventionally treated (without streptokinase) patients who had no evidence of previous myocardial infarction. Sub-group analysis based on vessel involvement, usage and timing of streptokinase was done. Streptokinase was associated with better left ventricular function in all sub-groups if given less than 2 hours after pain onset. In inferior myocardial infarction, streptokinase patients with single-vessel disease had normal EF (67 +/- 8), compared to significantly depressed EF in multi-vessel disease (56 +/- 12, p less than 0.05). This difference is accounted for more by the NREF than the IREF. In anterior infarction, patients with single-vessel disease did only slightly better than multi-vessel disease. In multi- and single-vessel anterior infarction, preservation of function by streptokinase appears to be due to the compensatory ability of the non-infarcted region as well as the residual function of the infarct-related region. region.

Cardiac Output↗
PubMed1987

Early treatment of acute myocardial infarction with intravenous streptokinase. A high-risk syndrome.

Fifty-one successive patients treated with intravenous streptokinase 1.7 +/- 0.8 (mean +/- SD) hours after onset of symptoms of acute myocardial infarction were evaluated during a three-month posthospital follow-up period. Coronary angiography was performed four to nine days after the initial hospital admission. Twenty-eight patients had a second late angiogram. Forty-one patients had successful reperfusion but only 25% of all patients were without significant clinical cardiovascular manifestations during this period. Postmyocardial infarction angina pectoris occurred in 21 patients, an abnormal stress test result was present in 28 patients, eight patients developed congestive heart failure, and five patients had reinfarction. An intervention with percutaneous transluminal coronary angioplasty or coronary artery bypass graft was performed in 15 (37%) of 41 reperfused patients. A significantly higher intervention rate was present in patients treated with streptokinase within one hour following the onset of symptoms. Early reocclusion (within three months of the infarct) was noted in patients with 60% or more residual stenosis in their infarct-related coronary artery. These patients also had a significantly greater incidence of angina pectoris. Our findings indicate that early thrombolytic therapy of acute myocardial infarction preserves myocardium, and since the infarct-related artery is patent, but narrowed, the jeopardized area is responsible for a high-risk syndrome with an increased likelihood of ischemic symptoms. An early aggressive approach may be indicated, especially for patients with greater than 60% residual stenosis in their infarct-related coronary artery.

Adult↗