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Biomedical subjects

Z Rotstein

Publications and source records attributed to Z Rotstein.

At least 37 records · Page 2Linked to original sources
PubMed1998

Preadmission psychosocial screening of older orthopedic surgery patients: evaluation of a Social Work Service.

A preadmission social work intervention was evaluated for impact on length of hospital stay (LOS) and patient satisfaction. Psychosocial issues related to function and post-discharge needs were assessed at an exploratory level. A modified post-test only control group design was used. Study group patients were screened before hospitalization and offered services on admission. Control group patients received standard care. Study group patients were significantly more satisfied with services but impact on length of stay was not demonstrated with one possible exception. Post-operative complications were significantly related to longer LOS; however, unlike control group patients, study group patients with complications did not have significantly longer LOS. Women and those limited in preadmission physical function were most likely to report insufficient help after discharge. A more intensive preadmission intervention is recommended to improve impact on LOS and informal support system involvement, while future outcome studies would clarify the nature of service gaps and high risk groups.

Aged↗
PubMed1998

Peripheral right pulmonary artery blood flow velocimetry: Doppler sonographic study of normal and abnormal fetuses.

The knowledge of fetal lung circulation in normal and abnormal human fetuses is limited. Our objectives were to assess normal values for flow velocity waveforms in the fetal pulmonic circulation and to test the hypothesis that Doppler velocimetry can predict lung hypoplasia. In a cross-sectional study, peripheral right pulmonary artery flow velocimetry was investigated prospectively in 96 healthy fetuses between 14 and 37 weeks' gestation and four fetuses with abnormalities known to induce lung hypoplasia. The pulsatility index was used to quantify the velocity waveforms. In normal fetuses the mean pulsatility index in the peripheral right pulmonary artery was low, being equivalent to that corresponding to 14 to 17 weeks' gestation (2.89; confidence interval = 2.35 to 3.42), increasing at midgestation to 3.44, with a confidence interval of 3.04 to 3.83; P < 0.01. Thereafter, during the late second and third trimesters the mean pulsatility index did not change significantly with GA, being 3.66 (confidence interval = 3.04 to 4.04) at term. In fetuses with proven lung hypoplasia, the pulsatility index measurements were within the 95% confidence limits of those for normal fetuses. In a normal pregnancy, except for the early stages, a relatively stable high vascular resistance of the fetal pulmonary circulation was found. Our preliminary data suggest that the pulsatility index of the lung circulation cannot be used as an indicator of lung hypoplasia.

Adult↗
PubMed1998

Superior mesenteric artery blood flow velocimetry: cross-sectional Doppler sonographic study in normal fetuses.

Our objectives were to describe the flow velocity waveform of the fetal superior mesenteric artery and to establish a nomogram for its pulsatility index. In a cross-sectional study using color Doppler ultrasonography, superior mesenteric artery flow velocimetry was investigated prospectively in 96 healthy fetuses of between 14 and 37 weeks of gestation. In normal fetuses the pulsatility index measurements showed a slight but insignificant increase over the course of gestation (r = 0.26; P > 0.5). The lowest mean +/- standard deviation for pulsatility index in the superior mesenteric artery was 1.86 +/- 0.45 (95% confidence interval 1.67-2.06), recorded between 18 and 21 weeks' gestation. Thereafter the pulsatility index increased to 1.94 +/- 6.4 (95% confidence interval 1.74-2.8) at 22 to 25 weeks, and from weeks 26 to 29 it increased to 2.18 +/- 0.52 (95% confidence interval 1.91-2.46). During the third trimester and at term, the mean pulsatility index of 2.23 +/- 0.32 (95% confidence interval 1.43-3.03) did not change significantly with gestational age. In normal fetuses, except for the early stages, a relatively stable vascular resistance of the intestinal circulation was found. The application of this nomogram in clinical practice may facilitate evaluation of intestinal perfusion in compromised fetuses with blood flow centralization.

Adult↗
PubMed1997

Transcutaneous multielectrode basket catheter for endocardial mapping and ablation of ventricular tachycardia in the pig.

BACKGROUND: Endocardial mapping using standard electrode catheters is often technically limited in ventricular tachycardia and constitutes a major obstacle to successful ablation. We wished to examine the utility of a basket-shaped multielectrode mapping catheter (MMC) in the mapping and ablation of ventricular tachycardia. METHODS AND RESULTS: This study of sustained monomorphic ventricular tachycardia (SMVT) was conducted in two phases in the postinfarction pig model. In the first phase, the utility of the MMC in providing adequate localization of potential ablation site(s) of SMVT by different techniques (presystolic potentials, pace mapping, and concealed entrainment) was assessed in 21 pigs. In the second phase, ablation of induced SMVT was attempted in 10 pigs. Mapping of SMVT was performed after percutaneous introduction of the MMC to the LV. Comprehensive mapping was performed in 90 episodes of SMVT and required 2.0 to 25 seconds. Diastolic potentials were recorded during 86 episodes; good or identical pace maps (> or = 9 of 12 paced surface ECG leads identical to ventricular tachycardia surface ECG leads) were obtained in 25 of 31 maps, and entrainment was achieved during 28 of 42 SMVTs. In 10 pigs, 10 SMVTs were recorded at least twice and were considered for radiofrequency ablation. An 8-mm tip ablation catheter was advanced to potential ablation sites with a specially designed "homing" device, requiring a median time of 120 seconds. In these 10 pigs, either identical pace map (> or = 11 of 12, 6 SMVTs) or concealed entrainment (4 SMVTs) guided the ablation procedure. After ablation, 8 of 10 SMVTs were rendered noninducible, while 2 pigs died during energy application of degeneration of SMVT to ventricular fibrillation. CONCLUSIONS: The MMC allows rapid, comprehensive, and reliable endocardial mapping during SMVTs, which facilitates successful ablation in the porcine post-myocardial infarction model.

Animals↗
PubMed1997

Congenital heart defects: natural course and in utero development.

BACKGROUND: Most congenital heart defects (CHDs) are diagnosed on targeted prenatal transvaginal (TVS) or transabdominal (TAS) ultrasonography during the early second trimester or at midgestation. Nevertheless, delayed diagnosis in some cardiac malformations still remains despite detailed echocardiographic examination. The present study was conducted to evaluate the evolution of fetal cardiac anomalies and assess their development in utero. METHODS AND RESULTS: We retrospectively reviewed 22,050 pregnant women who were divided into two groups: 6924 who had initial TVSs at 13 to 16 weeks' gestation, followed by TASs at 20 to 22 weeks, and 15,126 who had initial TASs at 20 to 22 weeks. Both groups were subsequently examined in their third trimester. All newborns were examined by certified pediatricians. CHD was diagnosed in 168 babies: 66 in group A and 102 in group B. In group A, 42 malformations (64%) were detected at the first TVS examination, and 11 (17%) were found during the subsequent TAS. Three additional anomalies (4%) were found during the third trimester, and 10 malformations (15%) were detected postnatally. In group B, 80 malformations (78%) were detected in the initial examination at midtrimester, and an additional 7 (7%) were found in the third trimester, whereas 15 (15%) were diagnosed postnatally. The 10 anomalies (group A, n=3; group B, n=7) that were detected only during the third trimester comprised aortic stenosis (n=2), cardiac rhabdomyoma (n=2), subaortic stenosis (n=1), tetralogy of Fallot (n= 1), aortic coarctation (n=1), sealed foramen ovale (n=1), ventricular septal defects (n=1), and hypertrophic cardiomyopathy (n=1). CONCLUSIONS: Although most fetal cardiac anomalies are detectable early in gestation, some may evolve in utero at different stages of pregnancy.

Adolescent↗
PubMed1997

Massive bone allografts in the treatment of pathologic fractures due to bone metastases.

BACKGROUND AND OBJECTIVES: Pathologic fractures due to disseminated metastases are common and often involve major long bones, where the metastasis is responsible for wide bone erosion that is equivalent to major bone loss. Stabilization of these fractures necessitates tumor excision and reconstruction of the destructive metastatic process. METHODS: Massive allografts were used either as intercalary or "composite" grafts (allografts and regular prostheses) in 17 patients. RESULTS: Fourteen patients could ambulate independently after surgery, and nursing of the remaining three became feasible and less painful. CONCLUSION: In the event of pathologic fractures due to metastatic bone diseases associated with major bone involvement, massive bone allografts offer an inexpensive, adjustable, simple, solution.

Adult↗
PubMed1997

Percutaneous multielectrode endocardial mapping and ablation of ventricular tachycardia in the swine model.

A basket shaped catheter carrying 64 electrodes was developed in the left ventricle (LV) of 53 pigs which had undergone induction of myocardial infarction. Pacing during sinus rhythm, or echocardiographic and hemodynamic measurements as well as pathological studies revealed no significant damage due to the basket catheter. Eighty one episodes of ventricular tachycardia (VT) were mapped and analyzed, requiring only several beats and less than 10 seconds to complete. We were able to successfully ablate ventricular tachycardias in four pigs.

Animals↗
PubMed1997

Cerebral lateral ventricular asymmetry: is this a normal ultrasonographic finding in the fetal brain?

OBJECTIVE: To evaluate the clinical significance of in utero detection of fetal cerebral lateral ventricular asymmetry. METHODS: We used high resolution ultrasonography to study asymmetries of the fetal lateral ventricles in the human brain. A retrospective survey was conducted on 7200 pregnant women who presented at two large district hospitals in Israel. Only fetuses with a difference of greater than 2.4 mm (two standard deviations) in the width of the lateral ventricles, with no known brain pathology, were included in the study. Index cases were evaluated regarding maternal complications, prenatal ultrasound examinations, postnatal imaging studies, and neonatal outcome up to 6 months of age. RESULTS: Lateral ventricular asymmetry was found in 21 subjects, all with available clinical data. In 15 fetuses (71%), the body or the occipital horn of the left lateral ventricle was larger than the right, whereas in six fetuses (29%), the right was larger than the left. In four cases (20%), serial scans noted resolution of asymmetry; in 15 (75%), it was persistent; and in one (5%), asymmetry increased. In one case, termination of pregnancy was performed; however, pathologic examination of the fetal brain failed to detect any structural abnormality. Underlying cerebral pathology was later found only in three fetuses (14%); one had subclinical cytomegalovirus ventriculitis, one had insidious periventricular hemorrhage, and in one fetus with increased asymmetry, trisomy 21 was verified. All the remaining 17 cases had normal neurologic development. CONCLUSIONS: Some degree of asymmetry of the lateral ventricles exists in the human fetal brain and is detectable in utero. Lateral ventricular asymmetry alone is probably not clinically significant, and it may be considered as a normal variant, rather than a pathologic finding.

Adult↗
PubMed1997

Fetomaternal haemorrhage discovered after trauma and treated by fetal intravascular transfusion.

Fetomaternal haemorrhage can occur spontaneously, or after abdominal trauma. We describe a case of fetomaternal haemorrhage diagnosed at 27 weeks gestation after blunt trauma. The Kleihauer-Betke smear on admission and during the first week was positive, ranging between 3% and 5%. Cordocentesis revealed a fetal haemoglobin of 8.8 gm/dl. An intravascular fetal transfusion was performed. The weeks until delivery and the neonatal period were unremarkable. Fetal anaemia can be a serious complication of fetomaternal haemorrhage, however, intravascular fetal transfusion is an effective treatment when this occurs. The Kleihauer-Betke test should be performed in every patient with a history of abdominal trauma during pregnancy.

Adult↗
PubMed1997

The dynamics of patient visits to a public hospital ED: a statistical model.

Using a public hospital's computerized database, we formulated a statistical model to explain emergency department (ED) patient volume for better staffing and resource allocation. All patients visiting the ED over a 3-year period were included in this retrospective study. Each observation described the total daily number of referrals and was defined by the following variables: day of the week, month of the year, holiday/ weekday, relative order in a 3-year sequence, and number of visits to the ED on that day. The statistical method used to build the model was analysis of covariance. Periodicity in average number of daily visits existed for each of the seasonal factors that were examined, repeating every year during the study period. Based on a graphic analysis, the model was defined and explained 65% of the variance during the 3-year study, with a relatively low standard deviation of error. A statistically significant correlation existed between time-related factors and the number of visits to the ED. This statistical model may prove to be of value for planning emergency services, which operate under stressful, unpredictable situations.

Analysis of Variance↗
PubMed1997

Development of the fetal tongue between 14 and 26 weeks of gestation: in utero ultrasonographic measurements.

Our objective was to establish nomograms for fetal tongue measurements from 14 weeks until mid-gestation by using transvaginal and transabdominal high-resolution ultrasound techniques. A prospective, cross-sectional study was performed on 120 normal singleton pregnancies between 14 and 26 weeks of gestation. Tongue circumference was measured by transvaginal ultrasonography between 14 and 17 weeks, and by abdominal ultrasound between 18 and 26 weeks of gestation. Fetal tongue circumference, as a function of gestational age, was expressed by the regression equation: tongue circumference (mm) = -23.9 + 3.75 x gestational age (weeks). The correlation, r2 = 0.95, was found to be highly statistically significant (p < 0.0001). The normal mean of tongue circumference per week and the 95% prediction limits were defined. During the study period we evaluated two cases with tongue circumference outside these 95% confidence limits: one had microglossia, the other macroglossia, and both were found to be associated with abnormal fetal karyotype. The presented normative data may be helpful in the prenatal diagnosis of suspected congenital syndromes that include, among their manifestations, tongue growth disturbances.

Female↗
PubMed1997

Intraamniotic prostaglandin F2 alpha for pregnancy termination in the second and early third trimesters of pregnancy.

OBJECTIVE: To examine the effectiveness and safety of intraamniotic prostaglandin F2 alpha (PGF2 alpha) instillation during second- and early third-trimester termination of pregnancy. STUDY DESIGN: The study group consisted of 173 women between 18 and 32 weeks of gestation admitted for termination of pregnancy with a live, singleton fetus. The procedure included intraamniotic instillation of 40 mg PGF2 alpha. In cases of failed induction; after 24 hours an additional procedure (repeated PGF2 alpha injection, oxytocin augmentation or extraovular balloon installation) was performed. RESULTS: The mean induction-to-abortion interval was 27 +/- 17 hours, 26 minutes. The induction-to-abortion interval was not significantly influenced by parity, maternal age, indication for pregnancy termination or gestational age at the time of the procedure. Complications were related to a longer induction-to-abortion interval (35 hours, 41 minutes +/- 26 hours, 15 minutes in complicated cases as compared to 25 hours, 43 minutes +/- 15 hours, 28 minutes, P = .012). However, complications were uncommon. CONCLUSION: Intraamniotic PGF2 alpha instillation was safely used for termination of pregnancy, even at advanced gestational ages. The induction-to-abortion interval is the main factor influencing complications and is important as a catalyst for cases that fail to abort within 24 hours.

Abortion, Therapeutic↗
PubMed1997

Prenatal diagnosis of vein of Galen aneurysmal malformation: report of two cases with proposal for prognostic indices.

Vein of Galen aneurysmal malformation (VGAM) is a rare, intracranial vascular anomaly that, until recently, has usually been diagnosed postnatally. Today, however, with the advances in high-resolution ultrasonography and colour Doppler, prenatal diagnosis is relatively easy. Due to novel intravascular embolization techniques, the prognosis of neonates with VGAM has markedly improved. A healthy infant with normal neurodevelopmental and cardiovascular status is now a reality. For the best outcome, however, careful planning of the appropriate time, mode, and place of delivery should be undertaken. To achieve this goal, in utero prognostic factors should be determined. This report illustrates, for the first time, prenatal ultrasonographic indices that may predict the outcome in two cases with a prenatal diagnosis of VGAM. The indices included mapping of intracranial feeding arteries, assessment of the width of the straight sinus, assessment and measurement of flow in the straight sinus, existence of 'steal' retrograde aortic flow, and the appearance of high-output cardiac state. By using these prenatal ultrasonographic parameters, fetal outcome may be predicted and appropriate management decided upon.

Adult↗
PubMed1996

Percutaneous multielectrode endocardial mapping during ventricular tachycardia in the swine model.

BACKGROUND: Identification of critical areas within the ventricular tachycardia circuit is a prerequisite for catheter ablation. Currently, mapping during ventricular tachycardia, usually performed with standard catheters, is difficult and time-consuming and can be used only in patients with hemodynamically stable tachycardia. METHODS AND RESULTS: A total of 43 pigs underwent closed-chest induction of myocardial infarction. A basket-shaped catheter carrying 64 electrodes was deployed in the left ventricle during normal sinus rhythm. Unipolar pacing at 3 mA was successful in 78% of the basket catheter electrodes, demonstrating good electrode-tissue contact. Hemodynamic and echocardiographic measurements did not reveal any significant interference with myocardial or valvular function during or after catheter deployment. One hundred eighteen episodes of monomorphic ventricular tachycardia were induced in 28 pigs through right ventricular stimulation, 81 of which were mapped and analyzed. Ventricular tachycardia mapping was rapid, requiring only several beats and < 10 seconds to complete. Presystolic potentials, a possible target for ablation, were identified in 58% of the tachycardia episodes mapped. Pathological examination revealed only minor valvular and endocardial catheter-induced lesions immediately after mapping and none a month later. CONCLUSIONS: The multielectrode catheter enables rapid and safe percutaneous endocardial mapping of ventricular tachycardia in the swine model. Exploration of the clinical potential of the multielectrode catheter seems warranted.

Animals↗
PubMed1996

In utero congestive heart failure due to maternal indomethacin treatment for polyhydramnios and premature labour in a fetus with antenatal closure of the foramen ovale.

A case of severe fetal congestive heart failure due to occlusion of the ductus arteriosus in a mother treated with indomethacin for polyhydramnios and premature contractions is described. Closure of the fetal foramen ovale that escaped detection by prenatal echocardiography was later demonstrated at neonatal autopsy. This case suggests that indomethacin treatment in a ductus-dependent fetus may be hazardous. Therefore, careful surveillance of the fetus exposed to indomethacin in utero is warranted.

Adult↗
PubMed1996

Intravenous immunoglobulin treatment in the prevention of childbirth-associated acute exacerbations in multiple sclerosis: a pilot study.

Acute exacerbations frequently occur after childbirth in patients with relapsing-remitting multiple sclerosis (MS). The present pilot study was initiated in an attempt to reduce the number of childbirth-associated acute exacerbations in the postpartum period. We treated nine MS patients with a history of 12 childbirth-associated acute exacerbations that had occurred 2-9 weeks after previous deliveries. The patients were administered intravenous immunoglobulin (IVIg) at a dose of 0.4 g/kg per day for 5 consecutive days during the 1st week after childbirth and at 6 and 12 weeks thereafter. None of the treated patients relapsed during the 6-month period after delivery. However, three patients had a remote relapse, two at 8 months and one at 10 months after childbirth, but these probably represented the natural course of disease and were not associated with childbirth. We conclude that IVIg treatment may prevent acute childbirth-associated exacerbations in relapsing-remitting MS patients.

Adult↗