G. Plotnick - Academia.edu (original) (raw)

Papers by G. Plotnick

Pacing and Clinical Electrophysiology, 1982

WOHL, B., ETAL.; Late unheralded pacemaker pocket infection due to Staphylococcus epidermidis: A ... more WOHL, B., ETAL.; Late unheralded pacemaker pocket infection due to Staphylococcus epidermidis: A new clinical entity. Late pacemaker pocket infections in the absence of predisposing factors such as niuitip]e pacemaker related procedures, skin erosion, chest wall trauma or generalized sepsis have been rarely reported. In the past year, we have seen three late pocket infections (18, 32 and 47 months post-impianlafionj due to Staphylococcus epidermidis [S. epidermidis). AJi three patients with late S. epidermidis infections presented with painJess sweliing over the pulse generator site and had been well until shortly before admission. The patients denied febrile illnesses or chest trauma in the preceding year and no skin erosion was evident. All had been seen reguJarJy in cJinic and bimonthly transteJephonic recordings had shown normaJ pacemaker function. Locai drainage, antibiotics and re-movaJ of the pacing system was successful in all three patients. We conclude that late pacemaker pocket infections due to S. epidermidis may become an imporlanf clinical problem in this era of long-lasting puise generators. In light of the insidious nature of S. epidermidis infections, regular inspection of the pocket area by both patient and physician is mandatory.

The American journal of managed care, Jan 25, 1998

To compare the overall diagnostic costs associated with non-contrast and contrast echocardiograph... more To compare the overall diagnostic costs associated with non-contrast and contrast echocardiography. Phase III clinical trial. In a secondary analysis of data from a phase III clinical trial of the intravenous contrast agent Optison, we compared the costs associated with obtaining a diagnosis in 203 patients who underwent non-contrast and contrast echocardiography. Costs for the initial test and any follow-up tests were derived from adjusted Medicare charges and a transition-1 microcost accounting system. Diagnostic yield from echocardiograms was 87% with the use of Optison (3 mL) and 49% when no contrast agent was used (P < 0.001). Because technically inadequate echocardiograms were more common in the non-contrast group, follow-up testing was recommended for 42% of patients in this group compared with 12% of those who had undergone a contrast-enhanced echocardiogram (P < 0.001). Although use of Optison increased the initial diagnostic cost by $125, overall costs were 17% lower...

Technetium-99m-pyrophosphate (TcPYP) scintigraphy may have great value in patients with suspected... more Technetium-99m-pyrophosphate (TcPYP) scintigraphy may have great value in patients with suspected acute myocardial infarction (AMI), but interobserver variability undoubtedly has adverse impact on predictive value. TcPYP scintigrams for 133 (80%) of 166 consecutive patients admitted for suspected AMI were interpreted independently by three experienced readers. Although there was complete agreement for 87 interpretations (65%), major discrepancies (i.e., at least one

The American Journal of Cardiology

The American journal of physiology, 1986

To evaluate the extent to which the Frank-Starling mechanism is utilized during successive stages... more To evaluate the extent to which the Frank-Starling mechanism is utilized during successive stages of vigorous upright exercise, absolute left ventricular end-diastolic volume and ejection fraction were determined by gated blood pool scintigraphy at rest and during multilevel maximal upright bicycle exercise in 30 normal males aged 26-50 yr, who were able to exercise to 125 W or greater. Left ventricular end-systolic volume, stroke volume, and cardiac output were calculated at rest and during each successive 3-min stage of exercise [25, 50, 75, 100, and 125-225 W (peak)]. During early exercise (25 W), end-diastolic and stroke volumes increased (+17 +/- 1 and +31 +/- 4%, respectively), with no change in end-systolic volume. With further exercise (50-75 W) end-diastolic volume remained unchanged as end-systolic volume decreased (-12 +/- 4 and -24 + 5%, respectively). At peak exercise end-diastolic volume decreased to resting level, stroke volume remained at a plateau, and end-systolic ...

The Canadian journal of cardiology

In this series of 198 patients studied prospectively before major noncardiac surgery, we previous... more In this series of 198 patients studied prospectively before major noncardiac surgery, we previously reported that an abnormal preoperative electrocardiogram was a statistically significant independent predictor of an increased risk of postoperative complications, i.e., death, myocardial infarction, or myocardial ischemia. We therefore carried out a detailed analysis of the preoperative electrocardiographic (ECG) findings using Minnesota code criteria. Both ST-T abnormalities and intraventricular conduction delays showed a statistical trend toward a higher frequency in patients with a complicated vs. an uncomplicated postoperative course (82% vs. 59% and 24% vs. 7%, respectively). Although only a minority of patients with either ECG finding actually developed a complication (22% and 40% respectively), the preoperative ECG appears to be a useful screening method, with ST-T abnormalities and intraventricular conduction delays identifying patients at increased risk for postoperative com...

Seminars in thoracic and cardiovascular surgery, 1992

$Research paper thumbnail of Case 33: a burst fracture of the first lumbar vetebral body$

Clinical cardiology, 2000

The ultrasound assessment of brachial artery flow-mediated vasodilation provides a noninvasive me... more The ultrasound assessment of brachial artery flow-mediated vasodilation provides a noninvasive means for measuring endothelial function. The test is performed using either upper or lower arm blood pressure cuff arterial occlusion to induce hyperemia. Upper arm occlusion produces a greater hyperemic stimulus. Brachial artery flow-mediated vasodilation is abnormal in the presence of coronary risk factors. The study sought to compare the ability of the upper and lower arm occlusion techniques to differentiate endothelial function in subjects with and without risk factors. We measured brachial artery flow-mediated vasodilation in 20 subjects, 10 without and 10 with a single risk factor (hypertension, hypercholesterolemia, or cigarette smoking) using both the upper and lower arm occlusion techniques (5 min blood pressure cuff occlusion). Using 11 MHz ultrasound, Doppler blood flow velocities were measured before and immediately after cuff deflation. Brachial artery vasodilation was measu...

International journal of cardiac imaging, 1998

Impaired endothelial function is observed as altered vasomotion in both the peripheral and corona... more Impaired endothelial function is observed as altered vasomotion in both the peripheral and coronary circulation in the presence of cardiovascular risk factors and early atherogenesis. An improvement in endothelium-dependent vasoactivity has been reported with both cholesterol reduction and smoking cessation. This study was performed to determine whether smoking status in coronary artery disease (CAD) effects both flow-mediated and cold pressor vasoactivity. We studied 25 men (ages 30-59), 12 smokers and 13 nonsmokers with angiographically documented coronary artery disease and cardiac risk factors who were grouped as smokers and nonsmokers. Using 7.5 MHz ultrasound, we measured brachial artery diameter and Doppler flow velocity at baseline, following 5 mins of ipsilateral blood pressure cuff occlusion and release (flow-mediated), during contralateral ice water hand immersion (cold pressor test) and after sublinqual nitroglycerin administration (an endothelium-independent vasodilator...

The American journal of physiology, 1995

Flow-mediated brachial artery vasoactivity has been recently proposed as a noninvasive means for ... more Flow-mediated brachial artery vasoactivity has been recently proposed as a noninvasive means for assessing endothelial function. To better characterize this technique, we measured brachial artery diameter and flow using 7.5-MHz ultrasound following 1, 3, and 5 min of upper arm blood pressure cuff occlusion in 19 normal volunteers and 13 patients with coronary artery disease (CAD). Although similar flow increases were observed with each protocol, statistically significant vasodilatation (12.6 +/- 5.7%) was observed in the normals only after 5 min of occlusion. With the use of this protocol, postocclusion blood flow increased 528 +/- 271 and 481 +/- 247% in the normals and CAD patients, respectively (P = NS). More vasodilatation was observed in the normals compared with the CAD patients (11.3 +/- 5.4 vs. 1.6 +/- 5.2%, P < 0.001). Interestingly, vasodilatation persisted for 20 min despite return of blood flow to baseline in 2 min. With the use of lower arm occlusion, arterial diamet...

Comprehensive therapy, 1995

Pericardial effusions may be present in a variety of clinical situations, often presenting challe... more Pericardial effusions may be present in a variety of clinical situations, often presenting challenging clinical diagnostic and therapeutic problems. Although several imaging modalities are available, ECHO has become the diagnostic method of choice due to its portability and wide availability. CT and MRI may also be employed and may be more accurate. A pericardial effusion under pressure may result in hemodynamic compromise and tamponade. Although there are several echocardiographic clues to tamponade (including diastolic chamber collapse, Doppler flow velocity paradoxus, and inferior vena cava phlethora), the diagnosis remains a clinical and hemodynamic one. The clinical signs include elevated jugular venous pressure, hypotension, tachycardia, and pulsus paradoxus. Hemodynamic measurements include equalization of diastolic pressures and decreased cardiac output Treatment of tamponade involves drainage of the effusion and prevention of reaccumulation. Needle pericardiocentesis via th...

Southern medical journal, 1982

This prospective evaluation of 55 consecutive patients, aged 60 years or older, admitted in 1977-... more This prospective evaluation of 55 consecutive patients, aged 60 years or older, admitted in 1977-1978 to a community hospital coronary care unit for treatment of cardiogenic pulmonary edema, examines morality during hospitalization and during the subsequent one-year follow-up. Their treatment was based on clinical criteria, without the "advantage" of Swan-Ganz catheters and before widespread use of vasodilators for severe congestive heart failure. Multiple clinical and laboratory features were reviewed to determine possible prognostic clues. The nine patients who died during the initial hospitalization provided several clues to immediate mortality, including admission systolic blood pressure of less than 150 mm Hg, dyspnea for more than four hours, and peak creatine kinase values greater than 1,000 IU/L. The study identified high-risk patients who may benefit from more aggressive in-hospital therapy. The one-year mortality among the 46 patients discharged from the hospital...

Hospital practice (Office ed.), 1984

The Johns Hopkins medical journal, 1978

Three months after receiving a Bjork--Shiley mitral valve prosthesis, a patient experienced acute... more Three months after receiving a Bjork--Shiley mitral valve prosthesis, a patient experienced acute gastronintestinal bleeding associated with heavy alcohol intake and poor compliance with oral anticoagulation therapy. As a result of the gastrointestinal bleeding, treatment with warfarin was discontinued. Ten months later, the patient presented with symptoms of transient cerebral ischemia. Despite demonstrated loss by phonocardiography of the previously well-recorded opening click and echocardiographic suggestion of a thrombosed prosthetic mitral valve, no thrombosis or dysfunction of the prosthetic mitral valve was revealed at reoperation.

Neurology, 1990

To gain insight into the historical features relevant to the diagnosis of cardiac embolic strokes... more To gain insight into the historical features relevant to the diagnosis of cardiac embolic strokes, we studied the 1,290 patients with cerebral infarcts in the NINCDS Stroke Data Bank. Based solely on the presence of cardiac sources of embolism, we divided the patients into groups of high (n = 250), medium (n = 166), and low (n = 874) risk of a cardiogenic mechanism for their stroke. There was a highly significant graded relationship between increasing risk of a cardiac source and a history, or presence of, systemic embolism, abrupt onset, and diminished level of consciousness at onset. These clinical features may be useful for assessing the likelihood of a cardiac embolic mechanism in patients with cerebral infarcts.

Journal of the American College of Cardiology, 2000

This study investigated the postprandial effect of components of the Mediterranean diet on endoth... more This study investigated the postprandial effect of components of the Mediterranean diet on endothelial function, which may be an atherogenic factor. BACKGROUND The Mediterranean diet, containing olive oil, pasta, fruits, vegetables, fish, and wine, is associated with an unexpectedly low rate of cardiovascular events. The Lyon Diet Heart Study found that a Mediterranean diet, which substituted omega-3-fatty-acid-enriched canola oil for the traditionally consumed omega-9 fatty-acid-rich olive oil, reduced cardiovascular events. METHODS We fed 10 healthy, normolipidemic subjects five meals containing 900 kcal and 50 g fat. Three meals contained different fat sources: olive oil, canola oil, and salmon. Two olive oil meals also contained antioxidant vitamins (C and E) or foods (balsamic vinegar and salad). We measured serum lipoproteins and glucose and brachial artery flow-mediated vasodilation (FMD), an index of endothelial function, before and 3 h after each meal. RESULTS All five meals significantly raised serum triglycerides, but did not change other lipoproteins or glucose 3 h postprandially. The olive oil meal reduced FMD 31% (14.3 Ϯ 4.2% to 9.9 Ϯ 4.5%, p ϭ 0.008). An inverse correlation was observed between postprandial changes in serum triglycerides and FMD (r ϭ Ϫ0.47, p Ͻ 0.05). The remaining four meals did not significantly reduce FMD. CONCLUSIONS In terms of their postprandial effect on endothelial function, the beneficial components of the Mediterranean and Lyon Diet Heart Study diets appear to be antioxidant-rich foods, including vegetables, fruits, and their derivatives such as vinegar, and omega-3-rich fish and canola oils.