Amir Elami - Academia.edu (original) (raw)
Papers by Amir Elami
PubMed, Jul 1, 1996
Aortopulmonary (AP) window is an uncommon cardiac anomaly which is frequently associated with oth... more Aortopulmonary (AP) window is an uncommon cardiac anomaly which is frequently associated with other cardiac anomalies. Concomitant repair of all intra- and extracardiac anomalies is usually recommended. Between October 1993 and July 1994, 4 patients aged 37 days, 4 weeks, 3.5 and 1.5 years, respectively, underwent repair of AP window and associated malformations. The associated anomalies consisted of interrupted aortic arch (IAA), and atrial and ventricular septal defects in the 1st patient, patent ductus arteriosus in the 2nd, inlet ventricular septal defect in the 3rd and congenital narrowing of the right pulmonary artery and a patent foramen ovale in the 4th. Extreme metabolic acidosis after repair of IAA in the 1st, dictated ligation of the AP window before repair of the intracardiac anomalies at 2 months of age. In the 2nd and 3rd, repair of the window and associated anomalies was performed in a single stage. In the 4th, left pulmonary artery banding preceded complete repair. All patients are doing well at 18, 13, 12 and 11 months, respectively, of follow-up after their last operation. Surgical management of AP window may have to be staged according to the physiological influence of the associated anomalies in each patient, to minimize the cumulative risk of complete repair.
PubMed, Jul 1, 1988
Twenty one patients suffering from rupture of the ventricular septum (RVS) following acute myocar... more Twenty one patients suffering from rupture of the ventricular septum (RVS) following acute myocardial infarction were operated upon between 1982-1985. Eighteen patients were operated upon urgently within 9.3 +/- 2.1 hours following diagnosis of RVS. In all, RVS occurred during the first infarction. None had concomitant myocardial revascularization. There were twelve operative survivors for an operative mortality of 42.5%. Two patients died 6 and 9 months postoperatively. All survivors are in functional class I, during a follow-up period of 14 to 56 months. The need for urgent repair of RVS is stressed and the value of concomitant coronary artery bypass is discussed.
PubMed, Dec 1, 1994
Continuous warm blood cardioplegia is utilized by many surgeons as their method of choice for myo... more Continuous warm blood cardioplegia is utilized by many surgeons as their method of choice for myocardial protection during operations for acquired heart disease. Objective: this study was performed to determine the feasibility and safety of this method for intracardiac procedures through the right atrium and in particular, total cavopulmonary connection. Materials and methods: procedures included closure of an atrial septal defect (23), atrial septectomy (2) and total cavopulmonary connection (4). Antegrade blood cardioplegia was delivered continuously for an average of 27 +/- 21 minutes at an average flow of 130 +/- 60 cc/min to maintain the aortic root pressure between 60 and 80 mmHg (mean 74 +/- 5 mmHg). Perfusion with regular blood commenced in the last 2 to 8 minutes and complete de-airing procedure was performed on the beating heart before removal of the aortic cross-clamp. Results: all patients resumed sinus rhythm and all but one had normal cardiac output postoperatively. In one patient after cavopulmonary connection the inferior vena-cava to pulmonary-artery connection was taken down because of increased pulmonary vascular resistance resulting in low output state. All patients made an uneventful recovery without neurological complications. Conclusions: this initial experience suggests that normothermic aerobic arrest can be used safely in the repair of congenital defects and may provide superior myocardial protection for complex procedures such as the Fontan procedure.
PubMed, 1987
Between February 1978 and October 1982, 40 patients with preoperative ejection fraction (EF) of 0... more Between February 1978 and October 1982, 40 patients with preoperative ejection fraction (EF) of 0.35 or less underwent aortocoronary bypass. An average of 3.1 saphenous vein grafts per patient were inserted and revascularization was considered complete in 33 (82%) of the subjects in the group. Mean follow-up period was 29 months (range 12-65 months). Early mortality was 5% (2 patients) and there were seven late deaths (3 cardiac and 4 non-cardiac). The five-year cardiac actuarial survival rate was 74% +/- 13% (+/- SEM). Angina has improved in 29 (94%) of the 31 long-term survivors with 23 (74%) being totally asymptomatic. Twenty-two of the long-term survivors performed an exercise test at the end of their follow-up period. These tests revealed that bypass surgery in such patients results in significantly enhanced myocardial oxygen consumption with concomitant increase in effort level and duration. The exercise ability is probably directly related to the degree of revascularization.
PubMed, Jul 1, 1991
Hemopericardium and tamponade occurred in a 12 year old boy with Marfan's syndrome, two years aft... more Hemopericardium and tamponade occurred in a 12 year old boy with Marfan's syndrome, two years after surgical repair of pectus excavatum. This life-threatening complication resulted from penetration of a fractured metal plate through the pericardium into the right atrium. The clinical details are reported and discussed.
Medical & Biological Engineering & Computing, May 1, 1991
Advances in Cardiology, Apr 16, 2015
We studied 40 patients with preoperative ejection fraction (EF) of 0.35 or less who underwent aor... more We studied 40 patients with preoperative ejection fraction (EF) of 0.35 or less who underwent aortocoronary bypass. An average of 3.1 saphenous vein grafts per patient were inserted and revascularization was considered complete in 33 (82%) of the subjects in the group. Mean follow-up period was 29 months (range 12-65 months). Early mortality was 5% (2 patients) and there were 7 late deaths (3 cardiac and 4 non-cardiac). The 5-year cardiac actuarial survival rate was 74 +/- 13% (+/- SEM). Angina has improved in 29 (94%) of the 31 long-term survivors with 23 (74%) being totally asymptomatic. Twenty-two of the long-term survivors performed an exercise test at the end of their follow-up period. These tests revealed that bypass surgery in such patients results in significantly enhanced myocardial oxygen consumption with concomitant increase in effort level and duration. The exercise ability is probably directly related to the degree of revascularization.
Clinical Infectious Diseases, May 1, 1997
Anesthesiology, Sep 1, 2000
The Journal of Thoracic and Cardiovascular Surgery, Mar 1, 1992
Size, preoperative duplex scan assessment of suitability, and early clinical experience We are cu... more Size, preoperative duplex scan assessment of suitability, and early clinical experience We are currently evaluating the inferior epigastric artery as an alternative arterial conduit for coronary bypass grafting. Fifty-seven inferior epigastric arteries were harvested from 47 adults. There were no differences in size between the right and left inferior epigastric arteries. Diameter was 2.5 to 3.5 mm proximally and 2 to 3 mm distally. Usable length was 6 to 16 em (mean 11.2 ± 0.25 em), Grade IjIV atherosclerosis was found in one patient (2.1 %). Duplex scanning was used for preoperative evaluation of the inferior epigastric arteries in 51 patients. In 21 patients the arteries were not harvested, in part because of duplex scan findings of small caliber or early bifurcation. In 30 patients the duplex findings could be compared with the surgical findings. The average length at operation was twice the length detected on duplex scan (11.2 cm versus 5.8 cm, p < 0.001). There was a good correlation between diameter on duplex scan and that measured at operation (2.56 ± 0.05 versus 2.62 ± 0.07, p = not significant). Between December 1989 and May 1991,38 patients (29 to 74 years, mean 56 years) received 42 inferior epigastric artery grafts. Proximal anastomoses were to the aorta in 17, to the vein graft hood in 20, or onto an internal mammary artery graft in 5. Distal anastomoses were to the left anterior descending artery in 2, the diagonal branch in 27, the marginal branch in 9, or the right coronary artery in 4. There were no early deaths. Complications included perioperative myocardial infarction in 1, deep sternal wound infection in 2, superficial infection at the harvest site of the inferior epigastric artery in 5, and reexploration for bleeding in 2. Because of its size and the low incidence of atherosclerosis, the inferior epigastric artery may evolve as an alternative arterial conduit for coronary bypass. Duplex scanning is a valuable noninvasive tool for preoperative evaluation of the artery's suitability. Long-term studies of patency of the inferior epigastric artery as a coronary bypass conduit are needed.
Journal of Laparoendoscopic & Advanced Surgical Techniques, 2018
BACKGROUND Endoscopic vacuum-assisted closure (EVAC) therapy is increasingly being used as a new ... more BACKGROUND Endoscopic vacuum-assisted closure (EVAC) therapy is increasingly being used as a new promising method for repairing upper gastrointestinal defects of different etiologies with high success rates. EVAC therapy consists of placing a sponge either within the lumen or within an abscess cavity connected with a nasogastric (NG) tube to a negative pressure system, thus decreasing bacterial contamination and edema and promoting granulation tissue proliferation, thereby gradually decreasing the cavity size until complete closure. Herein, we describe a modified technique for EVAC therapy in which the NG tube is passed into the esophagus through an existing intrapleural drain tract using a rendezvous technique. The small residual fistula was amendable to fibrin glue embolization. This allows easier sponge placement and exchange compared to traditional EVAC technique, and allows oral intake during treatment. We also review the literature regarding other endoscopic treatment options for esophageal anastomotic leaks and perforations. METHODS The PubMed database was searched using the terms "esophagus," "esophageal," "leak," "fistula," "endoluminal vacuum-assisted closure (VAC)," "endoscopic VAC," "stent," "sealant," "glue," and "over-the-scope clip (OTSC)." Reference lists of identified articles were searched for further articles, and the "similar articles" function was used on all included articles. RESULTS Complete closure of the nonhealing fistula was achieved after 8 days of EVAC treatment and fibrin glue embolization. CONCLUSIONS Modified EVAC technique as described is feasible and safe. To the best of our knowledge, this is the first description of this technique. The technique allows easier sponge placement and exchange compared to traditional EVAC technique, and allows oral intake during treatment.
Cardiovascular Surgery
The effect of using the internal mammary artery (IMA) as a conduit for revascularization on the o... more The effect of using the internal mammary artery (IMA) as a conduit for revascularization on the outcome of early (< 30 days) coronary artery bypass graft surgery after acute myocardial infarction was determined. Forty patients were studied: 27 underwent urgent operation for ongoing ischaemia and/or haemodynamic instability early after acute myocardial infarction and 13 had emergency surgery for failed percutaneous transluminal coronary angioplasty associated with clinical and enzymatic evidence of myocardial infarction. Nine patients experienced low cardiac output before operation, in six of whom intra-aortic balloon counterpulsation was used to treat cardiogenic shock. In 26 patients (group 1) the left IMA was utilized with or without additional vein grafts. In the remainder (group 2, n = 14), only vein grafts were used. Group 1 patients were younger than those in group 2 (mean(s.d.) age 55(9) versus 67(8) years, P = 0.0001). Other preoperative and perioperative variables were similar in the two groups. There was one death in hospital (2%, group 2). Eight (31%) group 1 patients sustained postoperative low cardiac output compared with ten (71%) in group 2 (P < 0.04). Preoperative low cardiac output (P < 0.025) and non-use of the IMA (P < 0.05) were identified by univariate and multivariate analysis as the most significant independent predictors of low cardiac output after operation. Although age was excluded as a predictor of low cardiac output, it is concluded that the IMA is an adequate conduit that can safely be used in patients younger than 70 years of age undergoing myocardial revascularization during or early after acute myocardial infarction.
Advances in Cardiology
We studied 40 patients with preoperative ejection fraction (EF) of 0.35 or less who underwent aor... more We studied 40 patients with preoperative ejection fraction (EF) of 0.35 or less who underwent aortocoronary bypass. An average of 3.1 saphenous vein grafts per patient were inserted and revascularization was considered complete in 33 (82%) of the subjects in the group. Mean follow-up period was 29 months (range 12-65 months). Early mortality was 5% (2 patients) and there were 7 late deaths (3 cardiac and 4 non-cardiac). The 5-year cardiac actuarial survival rate was 74 +/- 13% (+/- SEM). Angina has improved in 29 (94%) of the 31 long-term survivors with 23 (74%) being totally asymptomatic. Twenty-two of the long-term survivors performed an exercise test at the end of their follow-up period. These tests revealed that bypass surgery in such patients results in significantly enhanced myocardial oxygen consumption with concomitant increase in effort level and duration. The exercise ability is probably directly related to the degree of revascularization.
The Israel Medical Association journal : IMAJ, 2001
Harefuah, Jan 15, 2000
Coronary artery disease amenable to percutaneous interventions or coronary artery bypass grafting... more Coronary artery disease amenable to percutaneous interventions or coronary artery bypass grafting, and resectable lung cancer are major causes of morbidity and mortality. We present our experience in the treatment of 3 patients (men aged 64 and 66 and a woman of 77) who each had significant coronary artery disease and a resectable lung tumor. They underwent combined coronary artery bypass grafting and pulmonary lobectomy. We conclude from our experience and review of the literature that concomitant surgery in such cases is safe and effective, decreases suffering, and decreases the cost of 2 separate invasive procedures.
Harefuah, 1996
The optimal surgical treatment for concomitant carotid and coronary artery disease is controversi... more The optimal surgical treatment for concomitant carotid and coronary artery disease is controversial. Between 1991 and 1995 we performed 34 procedures for combined disease of the carotid and coronary arteries. The first 8 operations were carotid endarterectomies followed by coronary artery bypass grafting (staged procedure). The next 26 operations were performed during a single anesthesia (combined procedure). The patients were 28 men and 6 women, aged 58-81 years (mean 68). 80% were in functional class III or IV. In 40% ventricular function was moderately or severely reduced. There was an average of 3.6 grafts per patient, and in all except 3 patients the left internal thoracic artery was used as a conduit for coronary artery bypass grafting. 30% had symptomatic carotid stenosis; there was no perioperative mortality. In the staged procedure group, 2 patients had postoperative cardiac complications: in 1 acute coronary insufficiency and acute myocardial infarction in the other. 1 had...
Israel journal of medical sciences, 1996
Lung transplantation is becoming an acceptable mode of therapy worldwide for the end-stage lung d... more Lung transplantation is becoming an acceptable mode of therapy worldwide for the end-stage lung disease. We present our initial experience with the first 10 consecutive lung transplant patients at Hadassah University Hospital. There were 5 males and 5 females with an age range 27 to 59 years. Eight patients underwent single lung transplantation, one patient had double lung transplantation and one had heart-lung transplantation. Indications were: pulmonary fibrosis in 4, emphysema in 4, cystic fibrosis in 1, and cystic bronchiectasis in 1. Two patients had primary graft failure (1 death). Nine patients had a serious infection after transplantation (1 death). Four patients developed airway complications including dehiscence of bronchial anastomosis (1 death), bronchial stenosis requiring placement of a stent in 2 patients, and pneumothorax in 1 patient. One patient required tracheostomy. One patient died of massive brain infarction secondary to pulmonary venous thrombosis and emboliza...
Respiratory Medicine CME, 2009
Pneumonia complicates as many as 2.7 in every 1000 pregnancies putting both mother and fetus at i... more Pneumonia complicates as many as 2.7 in every 1000 pregnancies putting both mother and fetus at increased risk. Parapneumonic pleural effusion is generally managed by thoracocentesis and, if ''complicated'', by tube thoracostomy. If conservative management is unsuccessful, surgical decortication may be necessary. We report the case of a 24 year old gravida, who at 33 weeks of gestation presented to the emergency department with right sided pneumonia complicated by empyema. Blood and pleural fluid cultures were positive for Streptococcus pneumonia. Treatment with antibiotics, tube thoracsotomy and interpleural streptokinase led to resolution of the pneumonia and empyema without the need for surgical intervention. The patient carried her pregnancy to term and delivered a healthy baby after 39 weeks and 5 days of gestation. To our knowledge this is the first report of empyema treated with streptokinase in advanced pregnancy.
PubMed, Jul 1, 1996
Aortopulmonary (AP) window is an uncommon cardiac anomaly which is frequently associated with oth... more Aortopulmonary (AP) window is an uncommon cardiac anomaly which is frequently associated with other cardiac anomalies. Concomitant repair of all intra- and extracardiac anomalies is usually recommended. Between October 1993 and July 1994, 4 patients aged 37 days, 4 weeks, 3.5 and 1.5 years, respectively, underwent repair of AP window and associated malformations. The associated anomalies consisted of interrupted aortic arch (IAA), and atrial and ventricular septal defects in the 1st patient, patent ductus arteriosus in the 2nd, inlet ventricular septal defect in the 3rd and congenital narrowing of the right pulmonary artery and a patent foramen ovale in the 4th. Extreme metabolic acidosis after repair of IAA in the 1st, dictated ligation of the AP window before repair of the intracardiac anomalies at 2 months of age. In the 2nd and 3rd, repair of the window and associated anomalies was performed in a single stage. In the 4th, left pulmonary artery banding preceded complete repair. All patients are doing well at 18, 13, 12 and 11 months, respectively, of follow-up after their last operation. Surgical management of AP window may have to be staged according to the physiological influence of the associated anomalies in each patient, to minimize the cumulative risk of complete repair.
PubMed, Jul 1, 1988
Twenty one patients suffering from rupture of the ventricular septum (RVS) following acute myocar... more Twenty one patients suffering from rupture of the ventricular septum (RVS) following acute myocardial infarction were operated upon between 1982-1985. Eighteen patients were operated upon urgently within 9.3 +/- 2.1 hours following diagnosis of RVS. In all, RVS occurred during the first infarction. None had concomitant myocardial revascularization. There were twelve operative survivors for an operative mortality of 42.5%. Two patients died 6 and 9 months postoperatively. All survivors are in functional class I, during a follow-up period of 14 to 56 months. The need for urgent repair of RVS is stressed and the value of concomitant coronary artery bypass is discussed.
PubMed, Dec 1, 1994
Continuous warm blood cardioplegia is utilized by many surgeons as their method of choice for myo... more Continuous warm blood cardioplegia is utilized by many surgeons as their method of choice for myocardial protection during operations for acquired heart disease. Objective: this study was performed to determine the feasibility and safety of this method for intracardiac procedures through the right atrium and in particular, total cavopulmonary connection. Materials and methods: procedures included closure of an atrial septal defect (23), atrial septectomy (2) and total cavopulmonary connection (4). Antegrade blood cardioplegia was delivered continuously for an average of 27 +/- 21 minutes at an average flow of 130 +/- 60 cc/min to maintain the aortic root pressure between 60 and 80 mmHg (mean 74 +/- 5 mmHg). Perfusion with regular blood commenced in the last 2 to 8 minutes and complete de-airing procedure was performed on the beating heart before removal of the aortic cross-clamp. Results: all patients resumed sinus rhythm and all but one had normal cardiac output postoperatively. In one patient after cavopulmonary connection the inferior vena-cava to pulmonary-artery connection was taken down because of increased pulmonary vascular resistance resulting in low output state. All patients made an uneventful recovery without neurological complications. Conclusions: this initial experience suggests that normothermic aerobic arrest can be used safely in the repair of congenital defects and may provide superior myocardial protection for complex procedures such as the Fontan procedure.
PubMed, 1987
Between February 1978 and October 1982, 40 patients with preoperative ejection fraction (EF) of 0... more Between February 1978 and October 1982, 40 patients with preoperative ejection fraction (EF) of 0.35 or less underwent aortocoronary bypass. An average of 3.1 saphenous vein grafts per patient were inserted and revascularization was considered complete in 33 (82%) of the subjects in the group. Mean follow-up period was 29 months (range 12-65 months). Early mortality was 5% (2 patients) and there were seven late deaths (3 cardiac and 4 non-cardiac). The five-year cardiac actuarial survival rate was 74% +/- 13% (+/- SEM). Angina has improved in 29 (94%) of the 31 long-term survivors with 23 (74%) being totally asymptomatic. Twenty-two of the long-term survivors performed an exercise test at the end of their follow-up period. These tests revealed that bypass surgery in such patients results in significantly enhanced myocardial oxygen consumption with concomitant increase in effort level and duration. The exercise ability is probably directly related to the degree of revascularization.
PubMed, Jul 1, 1991
Hemopericardium and tamponade occurred in a 12 year old boy with Marfan's syndrome, two years aft... more Hemopericardium and tamponade occurred in a 12 year old boy with Marfan's syndrome, two years after surgical repair of pectus excavatum. This life-threatening complication resulted from penetration of a fractured metal plate through the pericardium into the right atrium. The clinical details are reported and discussed.
Medical & Biological Engineering & Computing, May 1, 1991
Advances in Cardiology, Apr 16, 2015
We studied 40 patients with preoperative ejection fraction (EF) of 0.35 or less who underwent aor... more We studied 40 patients with preoperative ejection fraction (EF) of 0.35 or less who underwent aortocoronary bypass. An average of 3.1 saphenous vein grafts per patient were inserted and revascularization was considered complete in 33 (82%) of the subjects in the group. Mean follow-up period was 29 months (range 12-65 months). Early mortality was 5% (2 patients) and there were 7 late deaths (3 cardiac and 4 non-cardiac). The 5-year cardiac actuarial survival rate was 74 +/- 13% (+/- SEM). Angina has improved in 29 (94%) of the 31 long-term survivors with 23 (74%) being totally asymptomatic. Twenty-two of the long-term survivors performed an exercise test at the end of their follow-up period. These tests revealed that bypass surgery in such patients results in significantly enhanced myocardial oxygen consumption with concomitant increase in effort level and duration. The exercise ability is probably directly related to the degree of revascularization.
Clinical Infectious Diseases, May 1, 1997
Anesthesiology, Sep 1, 2000
The Journal of Thoracic and Cardiovascular Surgery, Mar 1, 1992
Size, preoperative duplex scan assessment of suitability, and early clinical experience We are cu... more Size, preoperative duplex scan assessment of suitability, and early clinical experience We are currently evaluating the inferior epigastric artery as an alternative arterial conduit for coronary bypass grafting. Fifty-seven inferior epigastric arteries were harvested from 47 adults. There were no differences in size between the right and left inferior epigastric arteries. Diameter was 2.5 to 3.5 mm proximally and 2 to 3 mm distally. Usable length was 6 to 16 em (mean 11.2 ± 0.25 em), Grade IjIV atherosclerosis was found in one patient (2.1 %). Duplex scanning was used for preoperative evaluation of the inferior epigastric arteries in 51 patients. In 21 patients the arteries were not harvested, in part because of duplex scan findings of small caliber or early bifurcation. In 30 patients the duplex findings could be compared with the surgical findings. The average length at operation was twice the length detected on duplex scan (11.2 cm versus 5.8 cm, p < 0.001). There was a good correlation between diameter on duplex scan and that measured at operation (2.56 ± 0.05 versus 2.62 ± 0.07, p = not significant). Between December 1989 and May 1991,38 patients (29 to 74 years, mean 56 years) received 42 inferior epigastric artery grafts. Proximal anastomoses were to the aorta in 17, to the vein graft hood in 20, or onto an internal mammary artery graft in 5. Distal anastomoses were to the left anterior descending artery in 2, the diagonal branch in 27, the marginal branch in 9, or the right coronary artery in 4. There were no early deaths. Complications included perioperative myocardial infarction in 1, deep sternal wound infection in 2, superficial infection at the harvest site of the inferior epigastric artery in 5, and reexploration for bleeding in 2. Because of its size and the low incidence of atherosclerosis, the inferior epigastric artery may evolve as an alternative arterial conduit for coronary bypass. Duplex scanning is a valuable noninvasive tool for preoperative evaluation of the artery's suitability. Long-term studies of patency of the inferior epigastric artery as a coronary bypass conduit are needed.
Journal of Laparoendoscopic & Advanced Surgical Techniques, 2018
BACKGROUND Endoscopic vacuum-assisted closure (EVAC) therapy is increasingly being used as a new ... more BACKGROUND Endoscopic vacuum-assisted closure (EVAC) therapy is increasingly being used as a new promising method for repairing upper gastrointestinal defects of different etiologies with high success rates. EVAC therapy consists of placing a sponge either within the lumen or within an abscess cavity connected with a nasogastric (NG) tube to a negative pressure system, thus decreasing bacterial contamination and edema and promoting granulation tissue proliferation, thereby gradually decreasing the cavity size until complete closure. Herein, we describe a modified technique for EVAC therapy in which the NG tube is passed into the esophagus through an existing intrapleural drain tract using a rendezvous technique. The small residual fistula was amendable to fibrin glue embolization. This allows easier sponge placement and exchange compared to traditional EVAC technique, and allows oral intake during treatment. We also review the literature regarding other endoscopic treatment options for esophageal anastomotic leaks and perforations. METHODS The PubMed database was searched using the terms "esophagus," "esophageal," "leak," "fistula," "endoluminal vacuum-assisted closure (VAC)," "endoscopic VAC," "stent," "sealant," "glue," and "over-the-scope clip (OTSC)." Reference lists of identified articles were searched for further articles, and the "similar articles" function was used on all included articles. RESULTS Complete closure of the nonhealing fistula was achieved after 8 days of EVAC treatment and fibrin glue embolization. CONCLUSIONS Modified EVAC technique as described is feasible and safe. To the best of our knowledge, this is the first description of this technique. The technique allows easier sponge placement and exchange compared to traditional EVAC technique, and allows oral intake during treatment.
Cardiovascular Surgery
The effect of using the internal mammary artery (IMA) as a conduit for revascularization on the o... more The effect of using the internal mammary artery (IMA) as a conduit for revascularization on the outcome of early (< 30 days) coronary artery bypass graft surgery after acute myocardial infarction was determined. Forty patients were studied: 27 underwent urgent operation for ongoing ischaemia and/or haemodynamic instability early after acute myocardial infarction and 13 had emergency surgery for failed percutaneous transluminal coronary angioplasty associated with clinical and enzymatic evidence of myocardial infarction. Nine patients experienced low cardiac output before operation, in six of whom intra-aortic balloon counterpulsation was used to treat cardiogenic shock. In 26 patients (group 1) the left IMA was utilized with or without additional vein grafts. In the remainder (group 2, n = 14), only vein grafts were used. Group 1 patients were younger than those in group 2 (mean(s.d.) age 55(9) versus 67(8) years, P = 0.0001). Other preoperative and perioperative variables were similar in the two groups. There was one death in hospital (2%, group 2). Eight (31%) group 1 patients sustained postoperative low cardiac output compared with ten (71%) in group 2 (P < 0.04). Preoperative low cardiac output (P < 0.025) and non-use of the IMA (P < 0.05) were identified by univariate and multivariate analysis as the most significant independent predictors of low cardiac output after operation. Although age was excluded as a predictor of low cardiac output, it is concluded that the IMA is an adequate conduit that can safely be used in patients younger than 70 years of age undergoing myocardial revascularization during or early after acute myocardial infarction.
Advances in Cardiology
We studied 40 patients with preoperative ejection fraction (EF) of 0.35 or less who underwent aor... more We studied 40 patients with preoperative ejection fraction (EF) of 0.35 or less who underwent aortocoronary bypass. An average of 3.1 saphenous vein grafts per patient were inserted and revascularization was considered complete in 33 (82%) of the subjects in the group. Mean follow-up period was 29 months (range 12-65 months). Early mortality was 5% (2 patients) and there were 7 late deaths (3 cardiac and 4 non-cardiac). The 5-year cardiac actuarial survival rate was 74 +/- 13% (+/- SEM). Angina has improved in 29 (94%) of the 31 long-term survivors with 23 (74%) being totally asymptomatic. Twenty-two of the long-term survivors performed an exercise test at the end of their follow-up period. These tests revealed that bypass surgery in such patients results in significantly enhanced myocardial oxygen consumption with concomitant increase in effort level and duration. The exercise ability is probably directly related to the degree of revascularization.
The Israel Medical Association journal : IMAJ, 2001
Harefuah, Jan 15, 2000
Coronary artery disease amenable to percutaneous interventions or coronary artery bypass grafting... more Coronary artery disease amenable to percutaneous interventions or coronary artery bypass grafting, and resectable lung cancer are major causes of morbidity and mortality. We present our experience in the treatment of 3 patients (men aged 64 and 66 and a woman of 77) who each had significant coronary artery disease and a resectable lung tumor. They underwent combined coronary artery bypass grafting and pulmonary lobectomy. We conclude from our experience and review of the literature that concomitant surgery in such cases is safe and effective, decreases suffering, and decreases the cost of 2 separate invasive procedures.
Harefuah, 1996
The optimal surgical treatment for concomitant carotid and coronary artery disease is controversi... more The optimal surgical treatment for concomitant carotid and coronary artery disease is controversial. Between 1991 and 1995 we performed 34 procedures for combined disease of the carotid and coronary arteries. The first 8 operations were carotid endarterectomies followed by coronary artery bypass grafting (staged procedure). The next 26 operations were performed during a single anesthesia (combined procedure). The patients were 28 men and 6 women, aged 58-81 years (mean 68). 80% were in functional class III or IV. In 40% ventricular function was moderately or severely reduced. There was an average of 3.6 grafts per patient, and in all except 3 patients the left internal thoracic artery was used as a conduit for coronary artery bypass grafting. 30% had symptomatic carotid stenosis; there was no perioperative mortality. In the staged procedure group, 2 patients had postoperative cardiac complications: in 1 acute coronary insufficiency and acute myocardial infarction in the other. 1 had...
Israel journal of medical sciences, 1996
Lung transplantation is becoming an acceptable mode of therapy worldwide for the end-stage lung d... more Lung transplantation is becoming an acceptable mode of therapy worldwide for the end-stage lung disease. We present our initial experience with the first 10 consecutive lung transplant patients at Hadassah University Hospital. There were 5 males and 5 females with an age range 27 to 59 years. Eight patients underwent single lung transplantation, one patient had double lung transplantation and one had heart-lung transplantation. Indications were: pulmonary fibrosis in 4, emphysema in 4, cystic fibrosis in 1, and cystic bronchiectasis in 1. Two patients had primary graft failure (1 death). Nine patients had a serious infection after transplantation (1 death). Four patients developed airway complications including dehiscence of bronchial anastomosis (1 death), bronchial stenosis requiring placement of a stent in 2 patients, and pneumothorax in 1 patient. One patient required tracheostomy. One patient died of massive brain infarction secondary to pulmonary venous thrombosis and emboliza...
Respiratory Medicine CME, 2009
Pneumonia complicates as many as 2.7 in every 1000 pregnancies putting both mother and fetus at i... more Pneumonia complicates as many as 2.7 in every 1000 pregnancies putting both mother and fetus at increased risk. Parapneumonic pleural effusion is generally managed by thoracocentesis and, if ''complicated'', by tube thoracostomy. If conservative management is unsuccessful, surgical decortication may be necessary. We report the case of a 24 year old gravida, who at 33 weeks of gestation presented to the emergency department with right sided pneumonia complicated by empyema. Blood and pleural fluid cultures were positive for Streptococcus pneumonia. Treatment with antibiotics, tube thoracsotomy and interpleural streptokinase led to resolution of the pneumonia and empyema without the need for surgical intervention. The patient carried her pregnancy to term and delivered a healthy baby after 39 weeks and 5 days of gestation. To our knowledge this is the first report of empyema treated with streptokinase in advanced pregnancy.