Biomedical subjects

Shemy Carasso

Publications and source records attributed to Shemy Carasso.

11 recordsLinked to original sources

PubMed2006

The added value of real-time 3-dimensional echocardiography in the diagnosis of isolated cleft mitral valve in adults.

We evaluated the potential advantage of real-time 3-dimensional echocardiography on the assessment of mitral valve morphology and function in patients with isolated cleft mitral valve. Five patients, aged 33 +/- 9 years, with isolated cleft mitral valve and no associated cardiac anomalies, were studied. Real-time 3-dimensional echocardiography demonstrated the cleft in each case and allowed the measurement of its width and depth, the extent of cleft edge fibrosis and retraction, and the presence of accessory chordae and their attachment to the septum. Four patients had moderate or severe mitral regurgitation and in one patient the regurgitation was mild. In all patients the mitral regurgitant jet originating from the cleft was detected, and in one patient, a second jet was detected and not seen in the 2-dimensional study. Real-time 3-dimensional echocardiography is a reliable and reproducible technique that provides accurate and detailed echocardiographic characterization of the isolated cleft mitral valve in adults.

Adult↗

PubMed2006

Improvement of congestive heart failure by upgrading of conventional to resynchronization pacemakers.

AIMS: To compare the clinical response of patients with right ventricular apical pacing (RVAP) upgraded to cardiac resynchronization therapy (CRT) to that of previously nonpaced heart failure (HF) patients who had de novo CRT implantation. BACKGROUND: The role of CRT in patients with wide QRS and HF due to RVAP is less well established than in other CRT candidates. METHODS: Ninety-eight consecutive patients with CRT were studied (mean age 70, mean ejection fraction 0.23). Group A: patients having RVAP prior to CRT implantation (n = 25), group B: patients without prior RVAP (n = 73). Clinical and echocardiographic parameters were recorded prior to, and 3 months after, CRT implantation. RESULTS: Group A patients had a wider QRS at baseline compared to group B (203 +/- 32 ms vs 163 +/- 30 ms respectively, P < 0.001), and a shorter 6-minute walking distance (222 +/- 118 m vs 362 +/- 119 m, respectively, P < 0.005). Otherwise, clinical and echocardiographic parameters were not different. At follow up, group A patients had an average 0.7 +/- 0.5 decrease in their NYHA functional class, compared to 0.3 +/- 0.7 in group B patients (P < 0.05). Six-minute walking distance increased by 93 +/- 113 m in group A, versus 36 +/- 120 m in group B (P = 0.22). There was no difference in echocardiographic response to CRT between the groups. CONCLUSIONS: HF patients with prior RVAP demonstrate clinical improvement after upgrading to CRT that is comparable, and in some aspects, even better than that observed in HF patients with native conduction delay who undergo de novo CRT implantation.

Aged↗

PubMed2006

A large saphenous vein graft aneurysm presenting as a right atrial mass: a case report.

An aneurysm of a saphenous vein graft (SVG) is a rare but potentially fatal complication of coronary artery bypass grafting (CABG). We describe a case of a large SVG aneurysm (7 x 6 cm) compressing the right atrium. The patient presented with chest pain, dyspnea and desaturation, and a right intra-atrial mass was revealed on echocardiography. The differential diagnosis of intracardiac masses revealed by echocardiography should include extrinsic lesions. Due to its potential lethal complications, an SVG aneurysm should be considered in a post-CABG patient presenting with acute coronary syndrome or heart failure.

Aged, 80 and over↗

PubMed2005

Plowing the atrium and growing thrombi: two cases of large atrial thrombi following ablative and surgical procedure for atrial fibrillation.

AIM: We present two patients with a large left atrial (LA) thrombus following invasive treatment for atrial fibrillation and inadequate anticoagulation. METHODS AND RESULTS: Case 1: A 30-year-old woman, with a one-year history of symptomatic paroxysmal atrial fibrillation resistant to medical therapy, underwent catheter ablation for atrial fibrillation. Three days after the procedure the patient presented with dizziness, fatigue, rapid atrial fibrillation with a sub-therapeutic INR. Transesophageal echocardiography (TEE) revealed a large LA thrombus. Case 2: A 59-year-old male, with severe mitral regurgitation and chronic atrial fibrillation, underwent mitral valve repair and Cox-Maze procedure. Three months later, while asymptomatic, a follow-up transthoracic echocardiography a large posterior LA thrombus was imaged. His INR was also sub-therapeutic. Both patients were treated by enhancing anticoagulation and close echocardiographic follow-up. So far both patients have remained asymptomatic two months following discharge. CONCLUSION: Large LA thrombi detected by transthoracic echocardiography are a rare complication of the Cox-Maze procedure and radio-frequency ablation for atrial fibrillation, which may occur even in patients with restored normal sinus rhythm receiving inadequate anticoagulation therapy.

Adult↗

PubMed2005

Atrial fibrillation in dobutamine stress echocardiography.

OBJECTIVES: To describe the incidence of atrial fibrillation induced by dobutamine stress echocardiography and characterize patients at risk of developing atrial fibrillation, by constructing a simple validated risk score index. DESIGN: An observational study using prospectively collected data. METHODS: 3800 consecutive patients in sinus rhythm undergoing dobutamine stress echocardiography were randomly divided to a case (2/3) and test group (1/3). Associations of predetermined demographic, clinical, electrocardiographic and echocardiographic variables were calculated in patients with and without atrial fibrillation induced by dobutamine stress echocardiography in the case group. Logistic regression analysis determined significant independent risk predictors, a scoring index was constructed and validated on the test group. RESULTS: There was a 2% incidence of dobutamine stress echocardiography-induced atrial fibrillation in the study population. Risk predictors of atrial fibrillation included: a history of atrial fibrillation (2 points), increased left atrial diameter, right bundle branch block, decreased rest heart rate and hypertension (1 point each). The case subgroup low-risk patients (score 0-2) had a 1% risk, moderate-risk patients (score 3) a 2.7% and high-risk patients (score 4-6) a 14.5% risk of developing atrial fibrillation during dobutamine stress echocardiography. The rates in the test subgroup were 1%, 3.8% and 15.3%, respectively. CONCLUSION: Atrial fibrillation during dobutamine stress echocardiography is not common, the risk of developing atrial fibrillation during dobutamine stress echocardiography can be predicted by using a simple risk score system comprised of clinical, electrocardiographic and rest echocardiographic variables, which may be of help when planning a dobutamine stress echocardiography test in selected cases.

Aged↗

PubMed2005

Usefulness of four echocardiographic risk assessments in predicting 30-day outcome in acute myocardial infarction.

One thousand fifty-one consecutive patients who had acute myocardial infarction were classified into 3 risk groups by 4 echocardiographic risk assessments: left ventricular ejection fraction, left ventricular filling pattern, estimated systolic pulmonary artery pressure, and mitral regurgitation, with 30-day mortality rates of 13.7%, 3.8%, and 1%, respectively (p <0.001). Independent echocardiographic and clinical predictors of 30-day mortality included age (10 years, hazard ratio [HR] 1.30, 95% confidence interval [CI] 0.91 to 1.89), female gender (HR 2.12, 95% CI 0.94 to 4.74), Killip's class > or =II on admission (HR 3.09, 95% CI 1.38 to 7.11), group 2 (moderate) risk (HR 2.89, 95% CI 1.07 to 8.56), and group 1 (high) risk (HR 8.16, 95% CI 2.95 to 25.23).

Age Factors↗

PubMed2005

Programmable multiple pacing configurations help to overcome high left ventricular pacing thresholds and avoid phrenic nerve stimulation.

BACKGROUND: High left ventricular pacing (LVP) thresholds and phrenic nerve stimulation (PNS) are common problems with cardiac resynchronization (CRT). Newer systems capable of multiple LVP configurations may help overcome these problems without the need for reoperation. METHODS: CRT systems capable of multiple LVP configurations (Guidant models H155 and H145) were implanted in 43 patients (study group). An additional 49 patients (control group) received CRT systems (Guidant, Medtronic, Biotronik, St. Jude Medical, various models) lacking this feature. RESULTS: Overall, acute high (> or =2.5 V/0.5 ms) LVP thresholds were encountered in 13 (30%) of the study group, and 25 (50%) of control group patients (P = 0.03). PNS was encountered in 5 (12%) of the study group and 12 (24%) of control group patients (P = 0.13). All cases of high LVP thresholds and PNS in the study group were managed by switching to a different LVP configuration, while high thresholds remained in control group patients, and PNS was managed by replacing the lead. The CS lead was successfully placed in a lateral branch in 95% of study group, compared to only 77% of control group patients (P = 0.004). CONCLUSIONS: Multiple LVP configurations were clinically useful in a significant number of patients undergoing CRT system implantation by helping to overcome high LVP thresholds and PNS, and by providing more flexibility in placing the LV lead.

Aged↗

PubMed2005

[Knowledge management in health organizations].

BACKGROUND: In 2002 the head of the Israel Defense Forces (IDF) Technology and Logistics Command took a strategic decision to manage knowledge across the organization. The IDF Medical Corps was one of the initiation sites selected. Insights from the process of establishment of a knowledge management (KM) system in the IDF Medical Corps as a health organization (HO) are described. METHODS: IDF's medical services were identified, mapped and their participants interviewed, as were KM personnel in Israeli HOs. Information analysis pointed to the medical rendezvous (MR) as the central process for initiation of KM. The knowledge challenges were identified, and knowledge services and administrative interventions were planned. RESULTS INCLUDING KM CHALLENGES AND RESPONSE: The MR was found to be the process in which most of the clinically and administratively significant decisions in HO's were taken. Practitioners had large clinical and administrative knowledge gaps. Medical and administrative knowledge originated from various sources, in many formats. It could not be retrieved either easily or completely, was usually presented in an inconvenient form for assimilation, and was not always updated. Therefore, the MR was selected as the initial intervention point. Optimally, a comprehensive solution providing access to high quality knowledge can be a knowledge portal, including diagnostic indexing as a key for retrieval of information. Furthermore, indexed clinical, administrative, services list, quality assurance, risk management, and continuing medical education knowledge services, as well as a collegial and administrative feedback, link all entities involved into a knowledge community. This may increase the opportunity for optimal and efficient managed care.

Health Knowledge, Attitudes, Practice↗

PubMed2004

[Characteristics of emergency room admissions of IDF soldiers in northern Israeli hospitals between May 2002 and April 2003].

BACKGROUND: The hospitalization rate of patients visiting the emergency room depends on various parameters including demography, clinical data and other variables. Long term follow-up of hospitalized IDF soldiers reflected variability in hospital admission rate among hospitals and raises the possibility of vastly inappropriate hospitalizations. AIM: The aim of this study was to characterize the admission policy for IDF soldiers in various hospitals, to assess the rate of inappropriate hospitalizations, and to evaluate these costs to the Medical Corps. METHODS: Three hospitals in northern Israel were screened between May 2002 and April 2003, one urban tertiary care hospital (A) and two rural hospitals of different sizes (B and C). One fifth of the discharge forms were randomly screened. Every admission was given a risk evaluation based only on clinical data found upon presentation in the emergency room. One abnormal finding rendered the admission to be considered as appropriate. The rate of admission, lengths of stay, as well as clinical data and utilization of diagnostic tests were recorded and compared. RESULTS: During the study period 65 +/- 1105, 39 +/- 536, and 54 +/- 485 Emergency Room visits were made monthly in hospitals A, B and C, respectively. A total of 1.0% +/- 6.5. 1.4% +/- 12.6 and 2.7% +/- 11.8 of these visits resulted in hospitalization in hospitals A, B and C, respectively. Approximately one quarter of the patients admitted to hospital A were low risk, compared to more than half in the rural hospitals. Low risk admissions were one day shorter in the urban hospital, whereas high risk admissions had the same length of stay. The cost of low risk admissions in the urban hospital was about half of its cost in any of the rural hospitals. The estimated annual cost of low risk admission in all three hospitals screened was about $US 1 million. CONCLUSIONS: The admission rate in the urban hospital was half of its rate in the rural hospitals. Overall, 27% less low risk admissions were made in the urban hospital. The rural hospitals tendency to admit more low risk patients was compounded with their tendency to lengthen these admissions. The reason for this behaviour is not clear, although it may be related to differences in experience and clinical knowledge, consideration of the distance between the hospital and the soldier's home or unit, and financial admission policies.

Emergencies↗

PubMed2003

Intensive care in a field hospital in an urban disaster area: lessons from the August 1999 earthquake in Turkey.

OBJECTIVE: To describe our experience with the implementation of intensive care in the setting of a field hospital, deployed to the site of a major urban disaster. DESIGN: Description of our experience during mission to Turkey; conclusions regarding implementation of intensive care at disaster sites. SETTING: Military Field Hospital at Adapazari in Turkey. PATIENTS: Civilian patients admitted for care at the field hospital. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: On August 17, 1999 a major earthquake occurred in western Turkey, causing approximately 16,000 fatalities and leaving >44,000 injured. Approximately 66,000 buildings were severely damaged or destroyed. A medical unit of the Israeli Defense Forces Medical Corps, consisting of 23 physicians, 13 nurses, nine paramedics, 13 medics, laboratory and roentgen technicians, pharmacists, and associated support personnel, were sent to Adapazari in Turkey. The field hospital treated approximately 1,200 patients over a period of 2 wks, 70 surgical operations were performed, 20 babies were delivered, and a variety of medical, surgical, orthopedic, and pediatric/neonatal care was provided. The 12-bed intensive care unit operated by the unit, was staffed by three physicians and eight nursing/paramedic personnel. Patient mix was: a total of 63 patients, among them five with major trauma, 20 with acute cardiac disease, 15 patients with various acute medical conditions, and 11 surgical and postoperative patients. Three patients were intubated and mechanically ventilated (one cardiogenic pulmonary edema and two major trauma). The intensive care unit provided the following functions to the field hospital: care of the critically ill and injured, preparation for and implementation of transportation of such patients, pre- and postoperative care for major surgical procedures, expertise, and equipment for the care of very ill patients throughout the field hospital. CONCLUSIONS: In suitable circumstances, an intensive care capability should be an integral part of medical expeditions to major disasters.

Disaster Planning↗

PubMed2002

Medical treatment of patients with stable angina pectoris referred for coronary angiography: failure of treatment or failure to treat.

BACKGROUND: Patients referred for elective coronary arteriography because of stable angina pectoris frequently do not receive appropriate medical therapy prior to arteriography. Persistence of symptoms due to lack of appropriate therapy may influence the decision to catheterize and the treatment chosen following catheterization. HYPOTHESIS: The present study evaluates whether patients with stable angina pectoris referred for cardiac catheterization received optimal therapy prior to the procedure. We also evaluated whether medical therapy was optimized as a result of the hospitalization for catheterization. METHODS: We evaluated prospectively the adequacy of medical therapy in 333 consecutive patients undergoing elective coronary arteriography. Of these, 160 had stable angina pectoris as their main problem and constituted the study group. RESULTS: Mean duration of angina was 7.5 +/- 6.3 months. Canadian Cardiovascular Society angina grade 1 was present in 20, grade 2 in 77, grade 3 or 4 in 63 patients. Arteriography showed a > or = 50% coronary stenosis in 141 of 160 patients. Aspirin was used by 96%, and 86% received at least one drug aimed at relieving anginal symptoms: beta blockers in 69%, calcium blockers in 30%, and long-acting nitrates in 29%. Antianginal drugs and drugs aimed at treating risk factors were usually taken at a low, subtherapeutic dosage. Only 35 of 110 patients taking beta blockers had a resting heart rate of <60/min. Following catheterization, 88 of 141 patients with coronary stenosis of > or = 50% underwent percutanous intervention and 5 had urgent surgery. Optimization of treatment was advised in only 7 of 48 patients for whom medical therapy or elective surgery was recommended. CONCLUSION: Patients with stable angina pectoris are frequently referred for cardiac catheterization without making a serious attempt to control their symptoms by medical therapy. Risk factors are undertreated. With proper pharmacotherapy, many patients might have become asymptomatic and have chosen not to undergo catheterization and subsequent percutaneous interventions.

Aged↗