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Biomedical subjects

M Mosseri

Publications and source records attributed to M Mosseri.

90 records · Page 5Linked to original sources
PubMed1986

Intraaortic balloon entrapment: a complication of balloon perforation.

A patient in whom perforation of a percutaneously inserted intraaortic balloon resulted in a clot formation inside the balloon is described. The balloon could not be withdrawn percutaneously and was lodged in the femoral artery. It was removed surgically, and the artery was repaired.

Aged↗
PubMed1986

Histologic evidence for small-vessel coronary artery disease in patients with angina pectoris and patent large coronary arteries.

We studied six patients who suffered from angina pectoris but had angiographically patent major coronary arteries. Two of the patients suffered also from congestive heart failure. Three patients had supraventricular tachyarrhythmias. Three patients had conduction disturbances. During coronary angiography the patients had significantly reduced flow velocity of angiographic contrast medium compared with that in a control group. Echocardiographic and Doppler flow studies showed a tendency for symmetrical thickening of the left ventricular wall, enlargement of the right ventricle, and reduced compliance of both ventricles. Right ventricular endomyocardial biopsy revealed pathologic small coronary arteries with fibromuscular hyperplasia, hypertrophy of the media, myointimal proliferation, and endothelial degeneration. Capillaries had swollen endothelial cells encroaching on the lumen. Myocardial hypertrophy, lipofuscin deposition, and patchy fibrosis were also observed. These cases show that small-vessel coronary artery disease can cause classic angina pectoris. The diagnosis can be suspected when the coronary angiogram shows large patent arteries with slow flow of the angiographic contrast medium and it can be confirmed by endomyocardial biopsy.

Adult↗
PubMed1986

Emergency coronary artery bypass for acute myocardial ischemia following percutaneous transluminal coronary angioplasty.

Acute myocardial ischemia is a serious complication of percutaneous transluminal coronary angioplasty (PTCA). Between September 1981 and September 1985, 240 patients underwent 260 PTCAs at the Hadassah University Hospital. Thirteen patients (5%) developed signs of acute ischemia during or immediately after the procedure. In 10 patients (4.2%) emergency coronary artery bypass grafting was performed. The left anterior descending artery in nine cases and the right coronary artery in one case were occluded. In eight patients intraaortic balloon counterpulsation (IAB) was begun prior to surgery. On the average 1.8 grafts per patient were performed. Two patients who were transferred to surgery while being resuscitated died from myocardial rupture, one during surgery and the other 4 days postoperatively. Perioperative infarction rate was 50% (5/10). Six patients are angina-free 3 to 46 months postoperatively. Better patient selection, performance by an experienced team, early use of IAB, and immediate surgery might reduce the current periprocedure morbidity and mortality rate of PTCA.

Adult↗
PubMed1986

Perforation of the esophagus electrocardiographically mimicking myocardial infarction.

A 76-year-old woman developed a perforation of the median esophagus. A concomitant electrocardiographic follow-up was compatible with an acute anterior wall myocardial infarction, but was not accompanied by typical chest pain or elevated serum myocardial enzymes. Perforation of the esophagus is added to the list of diseases electrocardiographically imitating acute myocardial infarction.

Aged↗
PubMed1985

Prevention of myocardial damage in acute myocardial ischemia by early treatment with intravenous streptokinase.

We evaluated the effectiveness of early intravenous administration of 750,000 units of streptokinase in 53 patients with acute myocardial ischemia treated by a mobile-care unit at home (9 patients) or in the hospital (44 patients). Treatment was begun an average (+/- S.D.) of 1.7 +/- 0.8 hours from the onset of pain. Non-Q-wave infarctions developed subsequently in eight patients, whereas all the others had typical Q-wave infarct patterns. In 81 per cent of the patients the infarct-related artery was patent at angiography performed four to nine days after admission. Vessel patency was independent of the time of treatment, but residual left ventricular function was time dependent. Patients treated less than 1.5 hours after the onset of pain had a significantly higher ejection fraction (56 +/- 15 vs. 47 +/- 14 per cent; P less than 0.05) and infarct-related regional ejection fraction (51 +/- 19 vs. 34 +/- 20 per cent; P less than 0.01) and a lower QRS score (5.6 +/- 4.9 vs. 8.6 +/- 5.5; P less than 0.01) than patients receiving treatment between 1.5 and 4 hours after the onset of pain. Patients treated earlier by the mobile-care unit also had better-preserved left ventricular function than patients treated in the hospital. We conclude that thrombolytic therapy with streptokinase is most effective if given within the first 1.5 hours after the onset of symptoms of acute myocardial infarction.

Adult↗
PubMed1983

Methyldopa-induced immune hemolytic anemia and chronic active hepatitis.

Immune hemolytic anemia and chronic active hepatitis developed concurrently in a 76-year-old man after prolonged therapy with methyldopa. Both complications disappeared following cessation of treatment with the offending drug and a short course of a high-dose corticosteroid (prednisone). Inhibition of T-suppressor lymphocyte function by methyldopa may be instrumental in the emergence of autoimmune complications following usage of the drug.

Aged↗
PubMedDate not supplied

Three-dimensional echocardiographic reconstruction: qualitative and quantitative evaluation of ventricular function.

Three-dimensional (3-D) images of the human left ventricle were reconstructed from 2-dimensional echocardiographic pictures. All images were recorded at held end-expiration from an optimal point where a high-quality parasternal long-axis view maximally visualizing the left ventricle could be obtained. Multiple short-axis views were obtained from the same reference point. Interactive computer techniques were used to reconstruct 3-D shells of endocardium and epicardium. End-diastolic and end-systolic outlines were superimposed after correcting for motion during the cardiac cycle to demonstrate wall motion. Images were displayed from different perspectives and regional wall thickness, thickening, and motion were then demonstrated using surface map displays. Volumes and derived indices of left ventricular function were calculated. The ejection fraction of normal patients was 69 +/- 9%, compared to 57 +/- 7% in infarct patients; the latter results correlated well with contrast angiography. 3-D echocardiographic reconstruction provides the observer with a spatial appreciation of left ventricular wall motion and thickness, as well as useful quantitative information. The system requires only a standard echocardiographic recorder and simple computer hardware.

Echocardiography↗
PubMedDate not supplied

The effect of ionizing irradiation on vasomotor reactivity in the rat thoracic aorta in vitro.

PURPOSE: Ionizing irradiation inhibits restenosis in animal models and human. Vasomotor tone preservation during and after radiation therapy is of clinical importance. We therefore investigated vascular reactivity following radiation therapy. METHODS AND MATERIALS: Wistar Sabra rats were treated with a single dose of 1000 cGy external X-ray irradiation. Vascular reactivity of 192 segments of rat thoracic aorta was studied in vitro in four groups (12 rats in each group, four segments from each aorta). Immediately after in vivo irradiation, immediately after ex vivo irradiation, 1 month after irradiation, and no irradiation (control). RESULTS: Vasoconstriction to phenylephrine (PE) 10(-9)-10(-5) M or KCl 118.0 mM in all the irradiated groups was similar to controls. Endothelium-dependent vasorelaxation to acetylcholine (ACh) 10(-9)-10(-5) M in segments studied immediately after in vivo irradiation was increased compared to controls at all concentrations (109.7+/-35. and 90.0+/-40.0%, respectively, at 10(-5) M, P=.006). Endothelium-independent relaxation to nitroglycerin 10(-9)-10(-5) M in all irradiated groups was similar to controls. CONCLUSIONS: External-ionizing irradiation with 1000 cGy in the rat aortic model induces acute and transient increase in endothelium-dependent relaxation to ACh, and does not alter vasoconstriction and endothelium-independent relaxation.

Analysis of Variance↗
PubMedDate not supplied

Perioperative hemodynamic changes in ischemic heart disease patients undergoing dental treatment.

Twenty patients with stable ischemic heart disease in functional capacity Class II-IV underwent dental treatment. Scaling was performed in seven patients without local anesthesia. In the remaining 13 patients, pain control for restoration placement was obtained by local anesthesia: in seven patients, the anesthetics contained epinephrine, while in six this drug was omitted. Heart rate, blood pressure, and electrocardiograph were continuously monitored during the dental session. All patients had elevated systolic blood pressure and rate pressure product during treatment. In the patients who received plain local anesthetics only, the elevation in systolic blood and rate pressures was, however, significantly lower than the ischemic threshold. Arrhythmia or ST segment depression of > or = 1 millimeter were not recorded in any of the subjects. In severely compromised ischemic heart disease patients undergoing routine dental procedures of limited chair time, plain local anesthesia seems to be the preferred analgesic modality.

Adult↗
PubMedDate not supplied

Age- and gender-related differences in success, major and minor complication rates and the duration of hospitalization after percutaneous transluminal coronary angioplasty.

This report describes the effect of age and gender on the results of balloon angioplasty using current technique and indications. A consecutive group of 2,067 patients who underwent angioplasty at a single institution after 1990 is described. Angioplastic success was 92.2% and similar among men and women and the various age groups. Sixteen patients (0.8%) died, and mortality among women was significantly higher (1.4 vs. 0.6%, p < 0.001). There were no age or gender differences in the rate of Q-wave myocardial infarction and the need for coronary artery bypass. Minor complications such as groin complications (10.5% women, 5.0% men; p < 0.001) and infections (6.4% women, 3.7% men; p < 0.05) were more common in women, and as a result the duration of hospitalization after angioplasty was longer. The length of hospitalization after angioplasty was longer with advanced age, mainly as a result of higher groin complications (p < 0.001), infections (p < 0.01) and renal failure (p < 0.05). We conclude that using current indications and technique, angioplasty can be performed safely with a high success rate. Mortality is higher among women. The length of hospitalization after angioplasty is longer in women and, at advanced age, due to higher rate of minor complications.

Age Factors↗
PubMedDate not supplied

Acute septal myocardial infarction diagnosed by endomyocardial biopsy in a heart transplant recipient.

We describe an unusual case of acute septal myocardial infarction in a heart transplant recipient. The clinical presentation was most suggestive of acute rejection; the correct diagnosis was first made by endomyocardial biopsy and was then verified by coronary angiography. Acute myocardial infarction should be included in the differential diagnosis of acute rejection after heart transplantation and included among the possible diagnoses made by endomyocardial biopsy in these patients.

Biopsy↗
PubMedDate not supplied

Capillary and myofiber ultrastructure in endomyocardial biopsies from cyclosporine-treated heart transplant patients.

This study focuses on the ultrastructure of microvessels and myofibers in 54 endomyocardial biopsy specimens from 16 patients treated with cyclosporine after heart transplantation. Although the capillary and myofiber pathologic condition was significantly correlated with the degree of rejection, ultrastructural changes sometimes occurred in biopsy specimens with little or no histologic cellular infiltration. Immunocytochemical studies of some biopsy specimens showed that all microvessels were positive for IgM, whereas concentrations of IgG, complement, and fibrin varied. The microvascular and myofiber changes appeared to be reversible and correlated (Pearson's coefficient of correlation of myofiber vacuoles and microangiopathy, R = 0.67, p less than 0.00001). The vacuoles in myofibers resembled those in subendocardial regions of ischemic myocardium. They could, however, be related to cyclosporine toxicity because similar vacuoles have been described in kidneys of transplant patients receiving cyclosporine. We conclude that in cases of unclear graft failure in the absence of classic signs of rejection, electron microscopy could be helpful in detecting microvascular and myofiber pathologic situations that may influence myocardial function.

Adult↗