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S Nessim

Publications and source records attributed to S Nessim.

28 records · Page 2Linked to original sources
PubMed1992

Interaction of age and preoperative risk factors in predicting operative mortality for coronary bypass surgery.

BACKGROUND: Models for predicting operative mortality for coronary bypass surgery assume that preoperative risk factors affect mortality to the same extent in all patients groups. METHODS AND RESULTS: To determine whether certain preoperative risk factors disproportionately increase operative mortality in the elderly, 663 consecutive elderly patients (age 75 years or older) and 1,464 younger patients (age 65 or younger) undergoing isolated coronary bypass surgery between 1982 and 1990 were studied. Hospital mortality was significantly greater in the elderly patients than in younger patients (7.5% versus 1.8%; relative risk, 4.5). Univariate analysis identified age, prior coronary artery bypass grafting, congestive heart failure, left main disease, New York Heart Association functional class, hypertension, prior myocardial infarction (MI), and preoperative atrial fibrillation as associated with mortality. Multivariate analysis was then used to construct a model to describe the risk of operative mortality in terms of selected risk factors. However, comparison of observed mortality rates with those predicted by the model revealed problems with the model's goodness of fit. Further testing revealed that young patients without prior MI had a mortality rate lower by an order of magnitude than either younger patients with prior MI or elderly patient groups with and without MI. Two separate models were therefore constructed stratifying by the presence of prior MI. This resulted in a significant improvement in the fit of the models to the observed data. CONCLUSIONS: These results suggest that the impact of risk factors on the elderly may be significantly different from the effect of these risk factors on younger patients. Models for predicting outcome after bypass surgery should be tested for potential interactions between age and risk factors.

Adult↗
PubMed1992

Comparative efficacy of ring and suture annuloplasty for ischemic mitral regurgitation.

BACKGROUND: Patients with ischemic mitral regurgitation (MR) represent a therapeutic challenge, and results after combined valve replacement and revascularization have been poor. Valve repair is a promising approach, but the optimal method of repair is not known. METHODS AND RESULTS: In 60 patients with coronary artery disease and 3+ or 4+ MR, we used intraoperative Doppler echocardiography to study the efficacy of Carpentier-Edwards ring (n = 27) and commissural suture (n = 33) annuloplasty. Patients with ruptured papillary muscles, torn chordae, and ballooning or scalloping of the leaflets were excluded. Ring and suture groups were similar in preoperative ejection fraction (35 +/- 14% and 34 +/- 17%), MR grade (3.5 +/- 0.5 and 3.4 +/- 0.6), and acuity of MR (41% and 33% acute) (p = NS). Postoperatively, the ring group achieved a lower residual MR grade than the suture group (0.5 +/- 0.5 versus 1.5 +/- 1.1; p < 0.001), and the mitral annular diameter was reduced to a greater extent in the ring group (by 1.5 +/- 0.5 cm versus 0.5 +/- 0.4 cm; p < 0.001). Success (> or = 2 grade MR reduction) was more frequent in the ring than in the suture group (96% versus 67%, p < 0.01). One-year survival was similar (74 +/- 9% ring, 71 +/- 8% suture). Follow-up Doppler studies showed a higher mean gradient (4.0 +/- 1.2 mm Hg) and smaller valve area (2.1 +/- 0.5 cm2) in the ring group, but the postoperative New York Heart Association class was similar in both groups (83% versus 74% class I-II). CONCLUSIONS: Ring annuloplasty provides a more effective reduction of ischemic MR and a higher success rate than the suture technique. This may be related to uniform rather than localized shortening of the annulus and a greater reduction in annulus diameter.

Aged↗
PubMed1991

Morbidity and mortality after coronary artery bypass in octogenarians.

One hundred fifty seven consecutive octogenarians (mean age +/- standard deviation, 82.4 +/- 1.9 years) underwent coronary artery bypass grafting with hypothermia (mean temperature, 21.8 degrees +/- 1.8 degrees C), hyperkalemic cardioplegia, and cardiopulmonary bypass in a 9-year period. Sixty-six percent were male. Preoperatively, 115 patients (73%) were in New York Heart Association functional class IV, with the remainder being in either class III (23%) or class II (4%). Twenty percent of the patients had major complications including postoperative hemorrhage (15), sepsis (9), cerebrovascular accident (6), third-degree heart block (5), renal failure requiring dialysis (1), and pulmonary embolism (1). The 30-day or in-hospital mortality rate was 7.0%. Mean total hospital stay was 26.1 +/- 17.9 days. One-year and 5-year actuarial survival rates were 85% and 62%, respectively. Higher mortality was seen to be associated with New York Heart Association class IV, left ventricular ejection fraction less than 0.40, and lesser values for cardiac output and cardiac index. At the 6-month postoperative follow-up, 73% of the survivors reported that their general health had improved as compared with before operation. This experience demonstrates that for select octogenarians with unmanageable angina pectoris, coronary artery bypass grafting is an effective therapeutic option.

Aged↗
PubMed1991

Lupus erythematosus in the 1980s: a survey of 570 patients.

Five hundred seventy lupus erythematosus patients observed in a private practice between 1980 and 1989 were surveyed. Fifty-five percent were diagnosed after 1980. Five hundred three fulfilled criteria for systemic lupus erythematosus ( [SLE]; 464 idiopathic, 23 overlap, 16 drug-induced) and 67 had biopsy-documented cutaneous (discoid) lupus. In the idiopathic SLE group, symptoms began at a mean age of 31 years and patients were observed for a mean of 6 years. Findings in idiopathic SLE patients were (1) 27% have a family history of autoimmune disease; (2) nephritis patients without nephrotic syndrome rarely develop renal failure (4%); (3) nephrotic syndrome patients are relatively cyclophosphamide-resistant; (4) organ-threatening disease is present in 54%; and (5) 13% of women who become pregnant are recurrent aborters and 26% never conceive. In an analysis of cohort data, 5- and 10-year survivals were 97% +/- 2% and 93% +/- 3%, respectively. Additionally, men and patients with renal disease or thrombocytopenia had a poorer prognosis. Blacks had similar clinical findings and survival to whites. Approximately 50% of deaths were from active disease and 50% from complications of therapy. Prolonged survival has resulted from new diagnostic procedures and serologic tests, and improved antibiotics and antihypertensive agents, as well as more efficacious treatment modalities.

Adolescent↗
PubMed1990

Increased mortality of women in coronary artery bypass surgery: evidence for referral bias.

STUDY OBJECTIVE: To determine whether differences in referral reasons explain the higher operative mortality of women in coronary artery bypass surgery. DESIGN: Case series. SETTING: A tertiary care, private teaching hospital. PATIENTS: Consecutive patients who had isolated coronary artery bypass surgery between 1982 and 1987 (total, 2297; 79% male and 21% female). MEASUREMENTS AND MAIN RESULTS: The inhospital mortality rate was significantly higher for women than for men (4.6% compared with 2.6%; P = 0.036; 95% CI for difference in mortality, 0% to 4.0%). Women were older than men (mean, 68.2 and 64.0 years, respectively; P less than 0.001), and a higher percentage of women were referred with unstable angina (P = 0.007), postmyocardial infarction angina (P = 0.029), congestive heart failure (P less than 0.001), and New York Heart Association class IV symptoms (66% compared with 45%, P less than 0.001). More men were referred with a history of an abnormal exercise test (P less than 0.001), and patients referred because of a positive exercise test had a lower mortality (P less than 0.001). Using multivariate analysis, adjustment for the higher preoperative functional class of women and for age accounted for all of the difference in mortality between men and women (odds ratio, 1.04; CI, 0.60 to 1.79; P = 0.89). After correction for functional class alone, there continued to be no significant difference in mortality between men and women (P = 0.40). CONCLUSIONS: Differences in functional class and age account for the higher operative mortality of women in coronary bypass surgery. Women are referred for coronary bypass surgery later in the course of their disease than men, and later referral may increase their changes of operative death.

Adult↗
PubMed1989

A study of colonic adenocarcinoma, with comparison of histopathology, DNA flow cytometric data, and number of nucleolar organizer regions (NORs).

Nucleolar organizer regions (NORs) are loops of DNA encoded for ribosomal RNA production. NORs can be demonstrated in tissue sections with the use of a silver nitrate solution since they are argyrophilic (Ag-NORs). AgNORs have been shown to be increased in a variety of malignant tumors, including colonic adenocarcinoma, when compared to their benign counterparts or corresponding normal tissue. We studied 44 cases of colonic adenocarcinoma to determine whether or not correlations could be found between AgNORs and various histopathologic observations, as well as tumor cell DNA content as determined by flow cytometric analysis. We were unable to demonstrate significant correlations that would justify the use of the AgNOR technique in the daily study of colonic adenocarcinoma.

Adenocarcinoma↗
PubMed1985

Autopsy calibration of carotid artery B-mode ultrasound imaging: effects of pressure on residual lumen size.

The accuracy of B-mode ultrasound (9 MHz) vascular imaging was studied on seven carotid arteries obtained at autopsy. Parallel cross-sectional images on five serial planes of each artery were compared with readings on corresponding sections of silicone rubber replicas of the vessel lumens and with histologic sections. A close correlation between ultrasound and cast measurements was observed (r = 0.88, p less than 0.01), and both corresponded well with histologic measurements. Longitudinal ultrasound views of the arteries were employed to determine changes of normal vessel diameter (maximum lumen diameter) and residual lumen diameter with increasing arterial pressure. In the specimens studied, compression of lesions occurred in addition to circumferential vessel enlargement, and the rate of compression of lesions exceeded that of circumferential vessel diameter enlargement.

Arteriosclerosis↗
PubMed1983

Nutrient Analysis System--a computerized seven-day food record system.

A self-recording, directly computer-readable, seven-day food record system (the Nutrient Analysis System [NAS]) was developed using the National Heart, Lung, and Blood Institute Food Table as a data bank for the nutrient analysis. This article describes the system and reports the results of a study which evaluates the system in an experimental setting. It is concluded that the Nutrient Analysis System is no less accurate or biased than the traditional written food record method under the conditions of this test. Additionally, NAS is a system which allows for efficient use of professional time and immediate availability of nutrient analysis for use in counseling.

Adult↗
PubMed1978

Efficiency and cost of primary care by nurses and physician assistants.

We conducted a prospective study in a prepaid primary-care practice (health-maintenance organization) of a system in which nurses and physician assistants used protocols, and compared the efficiency and costs of this "new-health-practitioner" protocol system to a physician-only nonprotocol system. In five months, we studied 472 patients with any of four common acute complaints--respiratory infections, urinary and vaginal infections, headache, and abdominal pain; a subset of 203 patients was randomly allocated between the two systems. In the new-health-practitioner system physician time per patient was reduced by 92 per cent, from 11.8 to 0.9 minutes, and average visit costs--including practitioner time and charges for laboratory tests and medications--were 20 per cent less (P = 0.01). We conclude that this protocol system saves physician time and reduces costs.

Abdomen↗