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Biomedical subjects

Z Rotstein

Publications and source records attributed to Z Rotstein.

At least 55 records · Page 3Linked to original sources
PubMed1996

Antenatal sonographic findings associated with scimitar syndrome.

Scimitar syndrome is a rare congenital anomaly that consists of secondary dextroposition in situs solitus, due to right pulmonary hypoplasia. The prenatal sonographic findings of this abnormality have not been previously described. We describe early sonographic findings in a fetus that included isolated cardiac dextroposition with normal abdominal situs, hydramnios and mild narrowing of the right pulmonary artery. Postnatally, the infant developed heart failure, and a right hypoplastic lung was found. Catheterization revealed collateral supply to the right lung arising from the descending aorta and anomalous drainage of right pulmonary veins to the inferior vena cava. The diagnosis of scimitar syndrome was therefore established. A coil embolization of arterial collaterals to the right lung was performed. Scimitar syndrome should be considered in a fetus with the sonographic findings of a right shift of the mediastinal structures, an intact diaphragm and narrow right pulmonary artery. This may allow early neonatal stabilization and treatment.

Adult↗
PubMed1996

Intravenous immune globulin in multiple sclerosis: clinical and neuroradiological results and implications for possible mechanisms of action.

Extensive evidence exists indicating that immunoregulatory mechanisms are involved in the pathogenesis of Multiple Sclerosis (MS). Several possible mechanisms by which intravenous immune globulin (IVIG) modulates the course of the disease are related to limiting the inflammatory process and repairing the damage by enhancing remyelination. Presently, the evidence for the effect of IVIG in MS is based on the results of small open trials, some of which have been encouraging. In the current study, the positive impact of IVIG treatment on arresting disease progression was evident by decreased brain Magnetic Resonance Imaging (MRI) scores of the lesion area. In an effort to extend these findings, the authors initiated a multicentre, prospective, randomized, double-blind, placebo-controlled study. The trial was designed to compare the efficacy of IVIG treatment with placebo in relapsing-remitting patients (ages 20-55 years) with definite MS, disease duration of 2-10 years and frequency of exacerbations 1-3/year during the 2 years prior to the study. Patients were examined monthly and brain MRI studies scheduled at entry, and after the first and second years of the trial. The primary endpoints included the number of acute exacerbations and neurological disability. The secondary endpoints included change in the MRI lesion burden, evaluated by the number and area of lesions. The trial ended in June 1995.

Adult↗
PubMed1996

Allocation of emergency ward patients to medicine departments: increasing physicians' incentive to shorten length of stay.

BACKGROUND: Duration of hospital stay is one of the major determinants of hospital cost. In addition, high bed occupancy, especially in internal medicine departments, can delay the admission of patients from the emergency ward. OBJECTIVE: To shorten average hospital stay and hasten admission of patients from the emergency room to the medicine department. DESIGN: Patients from the emergency ward were assigned to internal medicine departments according to a quota system that insured that each department received a similar share of these admissions. Outcome measures for the year following this administrative change were compared to the two prior years in the same hospital and to a similar public hospital during the study period. SETTING: A major public hospital. MAIN OUTCOME MEASURES: Length of hospital stay (LOS), occupancy rate, number of admissions, number of readmissions, and mortality. RESULTS: The average length of stay in the internal medicine departments was shortened from 8 +/- 8 days in 1987 and 1988 to 6.3 +/- 6.8 days in 1989 (p = 0.0001). Occupancy rate was also reduced from 94% in 1987 and 1988 to 88% in 1989 (p = 0.002). The number of admissions increased by 19.2%, with a higher rate of readmissions within 30 days of discharge from the index hospitalization (12.5% and 13.4%, respectively in 1987 and 1988, versus 16.4% in 1989, p = 0.0001). In-hospital as well as 6-month mortality were unchanged. Case mix was similar during the study period to that in the previous two years. Length of stay, occupancy rate, and number of admissions were unchanged during the same period at a similar hospital without a corresponding patient allocation system. CONCLUSION: A relatively simple administrative intervention influenced physician incentive and significantly decreased hospital length of stay.

Emergency Service, Hospital↗
PubMed1994

Absence of tachycardia during tilt test predicts failure of beta-blocker therapy in patients with neurocardiogenic syncope.

Not all patients with neurocardiogenic syncope respond to beta-blockers. To determine whether differences in heart rate response to head-up tilt test with and without isoproterenol may predict drug efficacy, we evaluated 32 consecutive patients with a history of syncope, who were treated with beta-blockers after a positive tilt test. During the tilt test 21 patients (group A) with a baseline heart rate of 72 +/- 15 beats/min had tachycardia (mean 131 +/- 15) during tilt, before syncope, whereas 11 patients (group B) with a baseline heart rate of 68 +/- 13 beats/min did not (mean 86 +/- 13; p < 0.001). There were no significant differences between groups with regard to demographic and clinical characteristics or mean heart rate and mean arterial pressure in the supine position and during syncope. However, the proportion of patients requiring isoproterenol for provocation of syncope was significantly higher in group A compared with group B (15 of 21 vs 1 of 11; p < 0.001). All patients were treated with beta-blockers (propranolol or metoprolol). During a follow-up period of 18 +/- 6 months only one patient in group A had syncope and a positive tilt test compared with six patients in group B (9% vs 54%; p < 0.01). Development of tachycardia was a better predictor of drug efficacy than an isoproterenol-induced positive tilt test. The six nonresponders from group B were subsequently treated with disopyramide. During a mean follow-up period of 9 +/- 3 months, only one patient had syncope and another had a positive response to tilt test.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenergic beta-Antagonists↗
PubMed1994

Transvaginal echocardiographic examination of the fetal heart between 13 and 15 weeks' gestation in a low-risk population.

The object of our investigation was to evaluate the potential of transvaginal echocardiography for a complete anatomic study of the fetal heart, and for detection of congenital heart diseases in low-risk pregnant patients between 13 and 15 weeks' gestation. High-frequency (6.5 MHz and 7.5 MHz) transvaginal probes were employed for fetal echocardiographic assessment. Six hundred and sixty patients considered at low risk for congenital heart disease underwent in utero ultrasonographic studies, neonatal records, postnatal imaging studies, and pathologic examination. The four-chamber view was obtained in 100% of the fetuses, while the extended fetal heart examination was completed in 98%. Six fetuses with cardiac defects were diagnosed during the study: three had major heart defects (aortic atresia, tetralogy of Fallot, and persistent truncus arteriosus), all detected at the early transvaginal scan; three cardiac anomalies escaped our early diagnosis; two fetuses had a minor ventricular septal defect diagnosed only postnatally; and one had multiple cardiac rhabdomyoma diagnosed in the third trimester. Our results demonstrate that between 13 and 15 weeks' gestation transvaginal echocardiographic assessment of the fetal heart in the low-risk population is feasible. Moreover, some severe anomalies may be detected at such an early gestational age.

Echocardiography↗
PubMed1994

First-trimester diagnosis of fetal congenital heart disease by transvaginal ultrasonography.

OBJECTIVE: To describe the feasibility of diagnosing fetal congenital heart defects by transvaginal ultrasonography during the first trimester of pregnancy. METHODS: Pregnant women presenting to the Ultrasonographic Unit at the Chaim Sheba Medical Center who had a diagnosis of fetal heart defects were reviewed retrospectively. Attention was paid to prenatal ultrasound studies, karyotype, and pathologic examinations. RESULTS: Using high-resolution transvaginal ultrasonography, we were able to detect fetal tachycardia (one case), ectopia cordis with ventricular septal defect (one case), atrioventricular septal defect (two cases), ventricular septal defect with persistent truncus arteriosus (one case), tetralogy of Fallot (two cases), and large right atrium with unguarded tricuspid valve (Uhl disease) (one case). Seven of these fetuses had normal karyotypes and all showed additional sonographic abnormalities, including septated cystic hygroma (three cases), hydrops (ascites and pericardial effusions) (two cases), omphalocele (one case), and bilateral agenesis of kidneys (one case). Only one fetus with an abnormal karyotype (45,XO) showed a combination of septated cystic hygroma with hydrops. CONCLUSIONS: High-resolution duplex Doppler transvaginal ultrasonography during the first trimester of pregnancy seems to be a useful diagnostic method for detecting some congenital heart diseases.

Abnormalities, Multiple↗
PubMed1991

[Pitfalls in international comparisons of health data and indices].

Comparison of published data and health indices from different countries with different health systems is subject to many pitfalls. Comparison of national expenditure for health care based on purchasing power of the currency may be misleading if the purchasing power of the health services is ignored. Comparisons may also be misleading if they ignore national geographic and demographic structures. Government and health authorities often quote different sets of data and use different terminology and definitions. This article stresses the disparity in the definition of medical manpower and points out differences relating to ratios of manpower to population and to per capita spending. Also addressed is the importance of the qualitative and value aspects of health systems not usually involved in comparison of international health indices. In conclusion, safety measures and precautions such as choosing the right index for the right purpose, adjustment of indices to the purchasing power parity of health, demographics, etc., should be used when conducting health care analyses.

Data Collection↗
PubMed1990

[Changing economic environment of hospitals: management challenges of the 1990s].

The modern hospital is an organization which is influenced by the external environment in which it functions. A major relevant area is the economic environment. In recent years the western world has been facing the challenge of rising costs of health care and an increase in their proportion to the gross national product of most countries. Consequently, hospitals as major providers of health care are under pressure from governments and health insurance companies to cut costs and to "produce" more efficiently. Since hospitals worldwide are finding it hard and painful to function in the new environment in which attitudes to hospitals are changing, a potential managerial-economic crisis may be the next phase. How can the hospital adapt to these changes? First, by adopting managerial attitudes and the tools of the business sector. These include: the strategic planning process, hospital operative autonomy, creating medical-economic responsibility centers as departments, cost-accounting for medical procedures, and case-mix budgeting. Management information systems are necessary during the transition. The hospital information system should include functions at the operative level, such as outpatient visits, and admissions and discharges of patients; and also clinical, diagnostic and laboratory procedures related to the patient case-mix. The second level is a management information system which includes salaries of personnel, case-mix budgeting with variance analysis, prices of procedures and epidemiological data. The authors believe that only the managerial approach combining medical and economic disciplines can meet the challenges of the changing modern economic environment.

Economics↗
PubMed1990

Acute hemodynamic and arrhythmogenic effects of high-dose intravenous salbutamol in patients with chronic left ventricular dysfunction.

The short-term hemodynamic and possible arrhythmogenic effects of intravenous salbutamol at a dose of 30 or 60 micrograms/min were evaluated in 14 patients with severe chronic left ventricular dysfunction using equilibrium radionuclide angiocardiography and electrocardiographic monitoring. Salbutamol infusions at a dose of 30 micrograms/min did not cause significant hemodynamic changes; however, at a dose of 60 micrograms/min there was a significant increase in stroke volume, cardiac output, and left ventricular ejection fraction. Heart rate increased significantly while systemic peripheral resistance decreased significantly. Two patients developed ventricular premature beats and another two supraventricular tachycardia, but none were associated with adverse consequences. Thus, high-dose intravenous salbutamol is effective and safe, and may be used in the acute management of patients with poor left ventricular function.

Adult↗
PubMed1990

Effects of thrombolysis on the 12-lead signal-averaged ECG in the early postinfarction period.

Signal-averaged ECG has been used to identify patients at risk for ventricular tachycardia and sudden death after myocardial infarction. The goals of this prospective study were to examine the effects of reperfusion achieved with thrombolytic therapy on the 12-lead signal-averaged ECG and on ventricular arrhythmias in the early period after acute myocardial infarction (AMI). A total of 190 consecutive patients with AMI who fulfilled the inclusion criteria were enrolled. Thrombolysis was attempted in 80 patients and was considered successful in 57 (group I) and unsuccessful in 23 (group II); 110 patients were not treated with thrombolytic agents (group III). Signal averaging of 12 ECG leads was performed within 2 days in all patients and between 7 and 10 days after admission in 163 patients. The filtered QRS complex duration (QRSD) was significantly shorter in group I compared to group III in 7 of 12 ECG leads at 2 days and in 10 of 12 leads at 7 to 10 days. The root mean square voltage of the terminal 40 msec of the QRS complex (RMS40) did not change between the two signal-averaged ECG recordings in group I, whereas it became lower in three ECG leads in group II and in seven ECG leads in group III. There was no correlation between infarct site and significant changes in infarct-related signal-averaged ECG leads. The occurrence of complex ventricular arrhythmias was not significantly different among the three groups. We conclude that successful reperfusion, compared with failed and nonattempted reperfusion, is associated with fewer abnormalities in the 12-lead signal-averaged ECG in the early period after AMI.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1990

Effect of thrombolysis on the evolution of late potentials within 10 days of infarction.

Patients with late potentials in the signal averaged electrocardiogram are more at risk of lethal arrhythmias in the period after acute myocardial infarction. To test the effects of thrombolysis on the incidence and evolution of late potentials, 158 consecutive patients were prospectively studied during the first 10 days after acute myocardial infarction. The study population consisted of two groups: 93 control patients treated conservatively and 65 patients treated with intravenous thrombolysis. Recordings of signal averaged electrocardiogram were obtained within two days and 7-10 days after infarction. The incidence of late potentials in the first two days after infarction was not significantly different in the thrombolytic and control groups (14% v 11.8%). By 7-10 days the incidence of late potentials among patients who underwent thrombolysis remained unchanged (14%); however, it increased significantly in the control group (11.8% to 22.5%). Thus thrombolysis seems to reduce the evolution of late potentials within 10 days of infarction. Because the risk of fatal arrhythmias is higher in patients with late potentials this study may partly explain the reduced mortality after thrombolysis.

Arrhythmias, Cardiac↗
PubMed1990

[Strategic planning in the hospital today--a mandatory process].

Since the beginning of this decade strategic planning has become a common analytical method in nonprofit organizations, as well as in the business sector. In the nonprofit sector it has been implemented mainly in hospitals and universities. From experience, it is clear that strategic planning has contributed to the hospital's survival, improved performance, implementation and control. However, such good results have only followed correct planning and implementation, with emphasis on the business elements of an economic firm, such as marketing and budgetary planning, a control system and funding with increasing integration of "mathematical business" models. Recent studies have proved that strategic planning is a necessary condition for the survival of nonprofit organizations in a competitive environment. Experience demonstrates that modification of the business model of strategic planning in the nonprofit sector has significant advantages for both public and private sectors. We describe the way strategic planning is performed in hospitals, as well as relevant modification and limitation of the process. Our message to Israeli hospitals is that those which do not prepare themselves systematically for change, may find survival impossible.

Hospital Administration↗
PubMed1986

The effects of varying lengths and powers of CO2 laser pulses transmitted through an optical fiber on atherosclerotic plaques.

We have studied the changes induced in atherosclerotic arteries by a CO2 laser beam delivered through a silver halide optical fiber. We found that the crater depth and diameter correlate with the total energy delivered and with the mode of delivery. Short-duration high-power pulses caused shallower and narrower craters and less damage to the arterial wall compared to the same energy delivered as low-power pulses of long duration. Thus, high-power pulses for short periods may be an effective and safe procedure for evaporization of atherosclerotic plaques.

Arteriosclerosis↗