136 results on '"Gilutz, Harel"'
Search Results
102. Extracorporeal Circulation
- Author
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Gilutz, Harel, primary
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- 1998
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103. Unusual Bleeding Complications of Thrombolytic Therapy After Cardiopulmonary Resuscitation
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Cafri, Carlos, primary, Gilutz, Harel, additional, Ilia, Reuben, additional, Abu-ful, Akram, additional, Battler, Alexander, additional, and Cafri, Carlos, additional
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- 1997
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- View/download PDF
104. Deactivation Mechanism of Platelets
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Gilutz, Harel, primary and Reutelingsperger, C. P. M., additional
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- 1997
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105. Jaundice Induced by Streptokinase
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Gilutz, Harel, primary, Cohn, Gisela, additional, and Battler, Alexander, additional
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- 1996
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- View/download PDF
106. Aneurysm of the left main coronary artery: progression of dilatation with concomitant deterioration of coronary stenoses
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Ilia, Reuben, primary, Goldfarb, Benjamin, additional, Gilutz, Harel, additional, and Battler, Alexander, additional
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- 1994
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107. Short- and Long-Term Comparative Study of Anistreplase Versus Streptokinase in Acute Myocardial Infarction
- Author
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Silber, Haim, primary, Hausmann, Michael J., additional, Katz, Amos, additional, Gilutz, Harel, additional, Zucker, Nili, additional, and Ovsyshcher, Ilya, additional
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- 1992
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- View/download PDF
108. Adherence by Primary Care Physicians to Guidelines for the Clinical Management of Dyslipidemia.
- Author
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Vashitz, Geva, Meyer, Joachim, Parmet, Yisrael, Henkin, Yaakov, Peleg, Roni, Liebermann, Nicky, and Gilutz, Harel
- Published
- 2011
109. Clopidogrel and Proton Pump Inhibitors: Is There a Significant Drug-Drug Interaction?
- Author
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Shmulevich, Emilia, Friger, Michael, Gilutz, Harel, and Azab, Abed N.
- Abstract
Copyright of Canadian Journal of Cardiovascular Nursing is the property of Canadian Council of Cardiovascular Nurses (CCCN) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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- 2011
110. Factors Affecting Physicians Compliance with Enrollment Suggestions into a Clinical Reminders Intervention.
- Author
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Safran, C., Reti, S., Marin, H.F., Vashitz, Geva, Meyer, Joachim, Parmet, Yisrael, Liebermann, Niki, and Gilutz, Harel
- Abstract
Clinical reminders can promote adherence with evidence-based clinical guidelines, but they may also have unintended consequences such as alert fatigue, false alarms and increased workload, which cause clinicians to ignore them. The described clinical reminder system identifies patients eligible for primary prevention of cardiovascular diseases and lets the physician to choose which patients will be included in the reminders intervention. We analyzed data of 87,165 visits of 35,699 patients and evaluated factors which may affect clinicians' decision to enroll patients to the intervention. The physicians included most of the patients suggested for inclusion (85.7%). Yet, they skipped the enrollment suggestion in 62.6% of the visits. Patients with a cardiovascular disease, dyslipidemia, diabetes, or hypertension were more likely to be included in the intervention, while older patients were less likely to be included. Insights regarding the usability of clinical reminders are discussed. [ABSTRACT FROM AUTHOR]
- Published
- 2010
111. Mid left anterior descending coronary artery originating from the right coronary artery
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Ilia, Reuben, primary, Gilutz, Harel, additional, and Gueron, Moshe, additional
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- 1991
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112. Psoriasis and the Metabolic Syndrome.
- Author
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Cohen1,2, Arnon D., Gilutz, Harel, Henkin, Yaakov, Zahger, Doron, Shapiro, Jonathan, Bonneh, Dan Y., and Vardy, Daniel A.
- Subjects
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PSORIASIS , *METABOLIC syndrome , *METABOLIC disorders , *HEART diseases , *ISCHEMIA , *DIABETES , *OBESITY - Abstract
Previous reports have shown a possible association between psoriasis and obesity, ischaemic heart disease, hypertension or diabetes mellitus. However, most of these studies were uncontrolled and were based on small sample sizes. We therefore investigated the association between psoriasis and the metabolic syndrome in a case control study. Case patients were defined as patients with a diagnosis of psoriasis vulgaris. Control patients were subjects who underwent hernioplasty or appendectomy. We used data mining techniques utilizing the database of the southern district of Clalit Health Services. The proportions of patients with diseases that belong to the metabolic syndrome were compared between case and control patients by univariate analyses. χ² tests were used to compare categorical parameters between the groups. Logistic regression models were used to measure the association between psoriasis and the metabolic syndrome. A total of 340 patients with psoriasis and 6643 controls were included in the study. The mean age of case patients was 47.7 years (SD 10.7 years). There were 50.3% men and 49.7% women. Ischaemic heart disease was present in 23.5% of the patients with psoriasis, compared with 17.2% of the controls (p=0.003). Diabetes mellitus was present in 27.9% of the patients with psoriasis, compared with 19.5% of the controls (p <0.001). Hypertension was present in 44.4% of the patients with psoriasis, compared with 37.2% of the controls (p=0.007). Obesity was present in 29.4% of the patients with psoriasis, compared with 23.5% of the controls (p=0.012). Dyslipidaemia was present in 50.9% of the patients with psoriasis, compared with 44.2% of the controls (p=0.015). The association between psoriasis and the metabolic syndrome was pronounced after the age of 50 years and in men. Multivariate models adjusting for age and gender demonstrated that psoriasis was associated with an increased risk for ischaemic heart disease (odds ratio (OR) 1.4 95% confidence interval (Cl) 1.0-1.8), diabetes mellitus (OR 1.5 95% CI 1.2-2.0), hypertension (OR 1.3 95% CI 1.0-1.7), obesity (OR 1.3 95% CI 1.0-1.7) and dyslipidaemia (OR 1.2 95% CI 1.0-1.6). Our findings demonstrate a possible association between psoriasis and the metabolic syndrome. Further studies are needed to establish this observation. [ABSTRACT FROM AUTHOR]
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- 2007
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113. Anomalous origin of the posterior descending artery from the obtuse marginal
- Author
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Ilia, Reuben, primary, Gilutz, Harel, additional, Gussarsky, Yehoshua, additional, and Gueron, Moshe, additional
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- 1990
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114. Molecular and cellular interface between behavior and acute coronary syndromes
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Gidron, Yori, Gilutz, Harel, Berger, Rivka, and Huleihel, Mahmoud
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CORONARY disease , *CYTOKINES , *THROMBOSIS - Abstract
This review article integrates empirical findings from various scientific disciplines into a proposed psychoneuroimmunological (PNI) model of the acute coronary syndrome (ACS). Our starting point is an existing, mild, atherosclerotic plaque and a dysfunctional endothelium. The ACS is triggered by three stages. (1) Plaque instability: Pro-inflammatory cytokines (IL-1, IL-6, TNF-α) and chemoattractants (MCP-1, IL-8) induce leukocyte chemoattraction to the endothelium, and together with other triggers such as the CD40L–CD40 co-stimulation system activate plaque monocytes (macrophages). The macrophages then produce matrix metalloproteinases that disintegrate extra-cellular plaque matrix, causing coronary plaque instability. Acute stress, hostility, depression and vital exhaustion (VE) have been associated with elevated pro-inflammatory cytokines and leukocyte levels and their recruitment. (2) Extra-plaque factors promoting rupture: Neuro-endocrinological factors (norepinephrine) and cytokines induce vasoconstriction and elevated blood pressure (BP), both provoking a vulnerable plaque to rupture. Hostility/anger and acute stress can lead to vasoconstriction and elevated BP via catecholamines. (3) Superimposed thrombosis at a ruptured site: Increases in coagulation factors and reductions in anticoagulation factors (e.g. protein C) induced by inflammatory factors enhance platelet aggregation, a key stage in thrombosis. Hostility, depression and VE have been positively correlated with platelet aggregation. Thrombosis can lead to severe coronary occlusion, clinically manifested as an ACS. Thus, PNI processes might, at least in part, contribute to the pathogenesis of the ACS. This chain of events may endure due to lack of neuroendocrine-to-immune negative feedback stemming from cortisol resistance. This model has implications for the use of psychological interventions in ACS patients. [Copyright &y& Elsevier]
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- 2002
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115. Changes over Time in Hemoglobin A1C (HbA 1C) Levels Predict Long-Term Survival Following Acute Myocardial Infarction among Patients with Diabetes Mellitus.
- Author
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Plakht, Ygal, Gilutz, Harel, and Shiyovich, Arthur
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MYOCARDIAL infarction , *PEOPLE with diabetes , *DIABETES , *HEMOGLOBINS , *MORTALITY - Abstract
Frequent fluctuations of hemoglobin A1c (HbA1C) values predict patient outcomes. However, data regarding prognoses depending on the long-term changes in HbA1C among patients after acute myocardial infarction (AMI) are scarce. We evaluated the prognostic significance of HbA1C levels and changes among diabetic patients (n = 4066) after non-fatal AMI. All the results of HbA1C tests up to the 10-year follow-up were obtained. The changes (∆) of HbA1C were calculated in each patient. The time intervals of ∆HbA1C values were classified as rapid (
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- 2021
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116. Abstract 10649: Changes Over Time in Hemoglobin A1c (hba1c) Levels Predict Long-Term Survival Following Acute Myocardial Infarction
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Shiyovich, Arthur, Gilutz, Harel, and Plakht, Ygal
- Abstract
Introduction:Frequent fluctuations in hemoglobin A1c (HbA1C) values are independent predictors of diabetic complications and patient outcomes.Objective:To evaluate the prognostic significance of HbA1Clevels and its changes among diabetic patients after non-fatal AMI.Methods:Patients with diabetes mellitus (DM) who were admitted to a tertiary medical center with AMI throughout 2002-2017 and survived >1year thereafter were evaluated. All the results of HbA1Cvalues during the follow-up period (up to 10-years after discharge) were obtained and analyzed. The changes (Δ) of HbA1Cwere calculated for all pairs of tests in each patient. The time interval of ΔHbA1Cvalues was classified as rapid (<1 year) and slow (≥1 year) change. The outcome was all-cause mortality.Results:A total of 4,066 patients were analyzed, mean age 66.4±11.9 years, 36% females. A U-shaped association was observed between HbA1C and mortality: adjOR=1.887 and adjOR=1.302 for HbA1C<5.5% and ≥8.0% respectively, as compared with 5.5-6.5% (p<0.001). A U-shaped independent association between ΔHbA1Cand long-term survival was found: adjOR=2.376 and adjOR=1.340 for the groups of <-2.5% and ≥2.5% HbA1Cchanges respectively (p<0.001 for each), as compared to the group of minimal ΔHbA1C(±0.5%). Rapid increase in HbA1C(but not decrease) following AMI was associated with greater risk for mortality.Conclusions:HbA1Cvalues, its changes and their rate are significant independent prognostic markers for long-term all-cause mortality with a U-shaped association following non-fatal AMI among DM patients. Thus, ΔHbA1Cand its timing, in addition to absolute HbA1Cvalues should be monitored among these patients.
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- 2021
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117. Cell free DNA detected by a novel method in acute ST-elevation myocardial infarction patients.
- Author
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Shimony, Avi, Zahger, Doron, Gilutz, Harel, Goldstein, Hagit, Orlov, Gennady, Merkin, Miri, Shalev, Aryeh, Ilia, Reuben, and Douvdevani, Amos
- Subjects
MYOCARDIAL infarction ,PROGNOSIS ,ELECTROPHORESIS ,POLYMERASE chain reaction ,NECROSIS ,CREATINE kinase ,ECHOCARDIOGRAPHY - Abstract
Background: High levels of circulating cell free DNA (CFD) have been associated with poor prognosis in various diseases. Data pertaining to CFD in acute myocardial infarction (MI) are scarce. The available data have been obtained by either electrophoresis or polymerase chain reaction. We evaluated a novel method for the detection of CFD in patients with ST elevation myocardial infarction (STEMI) and examined its correlation with established markers of necrosis and ventricular function. Methods: Serum concentrations of CFD, troponin-T and creatine kinase (CK) were measured simultaneously in 16 randomly selected acute STEMI patients upon admission and at three more time points. 47 healthy subjects served as a control group. CFD was quantified by a novel rapid fluorometric assay. Ejection fraction (EF) was assessed by echocardiography. Results: Peak CFD levels were significantly higher in patients compared with controls ( P = 0.001) and correlated with peak levels of CK and troponin-T (R = 0.79, P <0.001); R = 0.65, P = 0.006, respectively). Peak CFD levels tended to be associated with lower EF ( P = 0.075). Conclusion: With this method, CFD levels correlated with the levels of established markers of myocardial necrosis but not with EF. The kinetic pattern of CFD release after STEMI and its prognostic value require further investigation. [ABSTRACT FROM AUTHOR]
- Published
- 2010
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118. Reply to: Predictors of Early and Late New-Onset Atrial Fibrillation in the Course of Acute Myocardial Infarction.
- Author
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Shiyovich, Arthur, Axelrod, Michal, Gilutz, Harel, and Plakht, Ygal
- Subjects
ATRIAL fibrillation risk factors ,MYOCARDIAL infarction complications ,RISK assessment ,ACUTE diseases - Abstract
In this article, the authors talks about the European Society of Cardiology guidelines which includes new-onset atrial fibrillation (NOAF); and potentially important parameters to be obtained, analyzed as potential predictors and compared between the 2 subgroups of NOAF.
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- 2020
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119. Meta-analysis of clinical correlates of acute mortality in takotsubo cardiomyopathy
- Author
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Harel Gilutz, Balwinder Singh, John D. Horowitz, Ajay K. Parsaik, Zafar A Usmani, Gagandeep Sawhney, Ranjit Shah, Kuljit Singh, Kristin V Carson, Singh, Kuljit, Carson, Kristin, Shah, Ranjit, Sawhney, Gagandeep, Singh, Balwinder, Parsaik, Ajay, Gilutz, Harel, Usmani, Zafar, and Horowitz, John
- Subjects
Pediatrics ,medicine.medical_specialty ,Cardiac & Cardiovascular Systems ,business.industry ,Incidence (epidemiology) ,Mortality rate ,Odds ratio ,takotsubo cardiomyopathy ,Global Health ,Confidence interval ,Survival Rate ,Takotsubo Cardiomyopathy ,cardiovascular mortality ,Meta-analysis ,Cohort ,Humans ,Medicine ,Hospital Mortality ,cardiovascular diseases ,Cardiology and Cardiovascular Medicine ,business ,Survival rate ,Cause of death - Abstract
The incidence and clinical correlates of acute in-hospital mortality of takotsubo cardiomyopathy (TTC) are not clear. We performed a systematic review and meta-analysis to consolidate the current evidence on acute mortality in TTC. We then assessed the impact of "secondary" TTC, male gender, advancing age, and catecholamine use on mortality. A comprehensive search of 4 major databases (EMBASE, Ovid MEDLINE, PubMed, and Google Scholar) was performed from their inception to the first week of July 2013. We included original research studies, recruiting participants, published in English language, and those that reported data on mortality and cause of death in patients with TTC. Of 382 citations, 37 studies (2,120 patients with TTC) from 11 different countries were included in the analyses. The mean age of the cohort was 68 years (95% confidence interval [CI] 67 to 69) with female predominance (87%). The in-hospital mortality rate among patients with TTC was 4.5% (95% CI 3.1 to 6.2, I-2 = 60.8%). Among all deaths, 38% were directly related to TTC complications and rest to underlying noncardiac conditions. Male gender was associated with higher TTC mortality rate (odds ratio 2.6, 95% CI 1.5 to 4.6, p = 0.0008, I-2 = 0%) so was "secondary" TTC (risk difference 0.11, 95% CI -0.18 to -0.04, p = 0.003, I-2 = 84%). The mean age of patients dying tended to be greater than that in the whole cohort (72 7 vs 65 7 years). In conclusion, TTC is not as benign as once thought. To reduce the mortality rate, greater efforts need to be directed to the diagnosis, treatment, and ultimately prevention of "secondary" TTC. Refereed/Peer-reviewed
- Published
- 2014
120. Mortality rate of patients with giant cell arteritis as isolated inflammation or fever of unknown origin, typo or sensational?
- Author
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Gilutz H
- Subjects
- Humans, Inflammation, Fever of Unknown Origin, Giant Cell Arteritis
- Published
- 2020
121. In-hospital switching from clopidogrel to prasugrel following thrombolysis for ST-elevation myocardial infarction: a 3-year single center experience.
- Author
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Lerman TT, Zahger D, Arad J, Gilutz H, Reitblat O, and Shimony A
- Subjects
- Aged, Clopidogrel, Female, Hospitalization, Humans, Male, Middle Aged, Prasugrel Hydrochloride therapeutic use, Tertiary Healthcare, Thrombosis chemically induced, Ticlopidine administration & dosage, Ticlopidine therapeutic use, Percutaneous Coronary Intervention adverse effects, Prasugrel Hydrochloride administration & dosage, ST Elevation Myocardial Infarction drug therapy, Thrombosis prevention & control, Ticlopidine analogs & derivatives
- Abstract
Background: Prasugrel has proved its superiority over clopidogrel for reducing ischemic events among patients with ST elevation myocardial infarction (STEMI) undergoing urgent percutaneous coronary intervention (PCI). Data on switching of antiplatelet therapy in acute coronary syndrome patients in clinical practice are very limited. Importantly, the safety of in-hospital switching from clopidogrel to prasugrel following thrombolysis has not been addressed., Methods: We reviewed consecutive STEMI patients from February 2011 to April 2014 who were transferred to a tertiary center after receiving thrombolysis and a loading dose of clopidogrel in a non-PCI-capable center. If not contraindicated, these patients were reloaded and treated with prasugrel. A control group, three times larger, was selected from patients who underwent primary PCI and were initially treated with prasugrel. In-hospital outcomes were examined., Results: Cases (n=45, 13% female, mean age 56 years) and controls (n=135, 11% female, mean age 54 years) did not differ significantly with respect to MI location, left ventricular systolic function, and extent of coronary artery disease. Mean time from thrombolysis to prasugrel loading was 32±19 hours. No significant differences were found between cases and controls in TIMI major or minor bleeding (0% vs. 3%), overall mortality (0% vs. 1.5%), and hospitalization length (4.8 vs. 5.5 days)., Conclusions: In-hospital reloading and subsequent maintenance therapy with prasugrel in patients who received thrombolysis and a loading dose of clopidogrel appears to be as safe as in STEMI patients managed by primary PCI; however, larger studies are needed to verify these results., (© The European Society of Cardiology 2015.)
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- 2016
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122. Factors affecting physicians compliance with enrollment suggestions into a clinical reminders intervention.
- Author
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Vashitz G, Meyer J, Parmet Y, Liebermann N, and Gilutz H
- Subjects
- Aged, Cardiovascular Diseases therapy, Decision Support Systems, Clinical, Diabetes Mellitus drug therapy, Dyslipidemias therapy, Female, Humans, Hypertension drug therapy, Male, Middle Aged, Practice Guidelines as Topic, Guideline Adherence, Physicians, Reminder Systems
- Abstract
Clinical reminders can promote adherence with evidence-based clinical guidelines, but they may also have unintended consequences such as alert fatigue, false alarms and increased workload, which cause clinicians to ignore them. The described clinical reminder system identifies patients eligible for primary prevention of cardiovascular diseases and lets the physician to choose which patients will be included in the reminders intervention. We analyzed data of 87,165 visits of 35,699 patients and evaluated factors which may affect clinicians' decision to enroll patients to the intervention. The physicians included most of the patients suggested for inclusion (85.7%). Yet, they skipped the enrollment suggestion in 62.6% of the visits. Patients with a cardiovascular disease, dyslipidemia, diabetes, or hypertension were more likely to be included in the intervention, while older patients were less likely to be included. Insights regarding the usability of clinical reminders are discussed.
- Published
- 2010
123. Ventricular fibrillation as the presenting manifestation of adrenocortical carcinoma.
- Author
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Shimony A, Bereza S, Shalev A, Gilutz H, Ilia R, and Zahger D
- Subjects
- Adult, Death, Sudden, Cardiac, Fatal Outcome, Humans, Male, Adrenal Cortex Neoplasms complications, Adrenocortical Carcinoma complications, Ventricular Fibrillation etiology
- Abstract
We describe a case of a young adult in whom sudden cardiac death due to ventricular fibrillation was the presenting manifestation of an adrenocortical carcinoma. The arrhythmia was precipitated by severe hypokalemia induced by the aldosterone-secreting tumor. Sudden death has not been previously described as a manifestation of this adrenal neoplasm. Unexplained persistent hypokalemia after resuscitated sudden death (especially when combined with hypertension( should prompt investigation for an underlying secondary hypertension, particularly adrenal pathology. Adrenocortical carcinoma should be considered in the differential diagnosis of unexplained sudden death associated with unexplained hypokalemia.
- Published
- 2009
- Full Text
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124. Computerized community cholesterol control (4C): meeting the challenge of secondary prevention.
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Gilutz H, Novack L, Shvartzman P, Zelingher J, Bonneh DY, Henkin Y, Maislos M, Peleg R, Liss Z, Rabinowitz G, Vardy D, Zahger D, Ilia R, Leibermann N, and Porath A
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- Aged, Analysis of Variance, Coronary Artery Disease drug therapy, Coronary Artery Disease mortality, Disease Progression, Female, Humans, Hydroxymethylglutaryl-CoA Reductase Inhibitors therapeutic use, Israel, Male, Community Health Services organization & administration, Coronary Artery Disease prevention & control, Decision Support Systems, Clinical statistics & numerical data, Drug Therapy, Computer-Assisted statistics & numerical data, Medication Adherence statistics & numerical data, Secondary Prevention methods, Secondary Prevention statistics & numerical data
- Abstract
Background: Dyslipidemia remains underdiagnosed and undertreated in patients with coronary artery disease. The Computer-based Clinical Decision Support System provides an opportunity t close these gaps., Objectives: To study the impact of computerized intervention on secondary prevention of CAD., Methods: The CDSS was programmed to automatically detect patients with CAD and to evaluate the availability of an updated lipoprotein profile and treatment with lipid-lowering drugs. The program produced automatic computer-generated monitoring and treatment recommendations. Adjusted primary clinics were randomly assigned to intervention (n=56) or standard care arms (n=56). Reminders were mailed to the primary medical teams in the intervention arm every 4 months updating them with current lipid levels and recommendations for further treatment. Compliance and lipid levels were monitored. The study group comprised all patients with CAD who were alive at least 3 months after hospitalization., Results: Follow-up was available for 7448 patients (median 19.8 months, range 6-36 months). Overall, 51.7% of patients were adequately screened, and 55.7% of patients were compliant with treatment to lower lipid level. In patients with initial low density lipoprotein >120 mg/dl, a significant decrease in LDL levels was observed in both arms, but was more pronounced in the intervention arm: 121.9 +/- 34.2 vs. 124.3 +/- 34.6 mg/dl (P < 0.02). A significantly lower rate of cardiac rehospitalizations was documented in patients who were adequately treated with lipid-lowering drugs, 37% vs. 40.9% (P < 0.001)., Conclusions: This initial assessment of our data represent a real-world snapshot where physicians and CAD patients often do not adhere to clinical guidelines, presenting a major obstacle to implementing effective secondary prevention. Our automatic computerized reminders system substantially facilitates adherence to guidelines and supports wide-range implementation.
- Published
- 2009
125. Symptomatic Brugada unmasked by fever.
- Author
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Shalev A, Zeller L, Galante O, Shimony A, Gilutz H, and Illia R
- Subjects
- Adult, Analgesics, Non-Narcotic therapeutic use, Anti-Bacterial Agents therapeutic use, Brugada Syndrome complications, Brugada Syndrome physiopathology, Brugada Syndrome therapy, Bundle-Branch Block physiopathology, Defibrillators, Implantable, Fever drug therapy, Humans, Male, Risk Factors, Tonsillitis complications, Tonsillitis drug therapy, Brugada Syndrome diagnosis, Fever etiology, Syncope etiology, Tachycardia, Ventricular etiology
- Published
- 2008
126. General practitioners' adherence with clinical reminders for secondary prevention of dyslipidemia.
- Author
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Vashitz G, Meyer J, and Gilutz H
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- Attitude of Health Personnel, Female, Humans, Lipoproteins blood, Logistic Models, Male, Physicians, Family, Practice Guidelines as Topic, Practice Patterns, Physicians', Workload, Decision Support Systems, Clinical, Dyslipidemias therapy, Family Practice, Guideline Adherence, Reminder Systems
- Abstract
A variety of computer-based applications, including computerized clinical reminders, are intended to increase adherence to evidence-based clinical guidelines. The value of these systems in clinical practice is still unclear. One reason for the limited success of clinical reminders may be physicians' low tendency to adhere to their advice. We studied the determinants of physicians' adherence to clinical advice regarding the management of dyslipidemia. Overall, the clinical reminders increased physicians' adherence to the clinical guidelines. Physicians were more compliant with the reminders when they experienced a greater patients' load, when they were less acquainted with the patient, and when more time has passed since the last major cardiac event. These findings can help to predict physicians' adherence and to improve the usage of clinical reminders for the benefit of patients, physicians and HMOs.
- Published
- 2007
127. Predicting survival with reperfusion arrhythmias during primary percutaneous coronary intervention for acute myocardial infarction.
- Author
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Ilia R, Zahger D, Cafri C, Abu-Ful A, Weinstein JM, Yaroslavtsev S, Gilutz H, and Amit G
- Subjects
- Aged, Angioplasty, Balloon, Coronary adverse effects, Angioplasty, Balloon, Coronary mortality, Arrhythmias, Cardiac etiology, Coronary Angiography, Electrocardiography, Female, Hospital Mortality, Humans, Male, Middle Aged, Myocardial Infarction complications, Myocardial Infarction therapy, Myocardial Reperfusion adverse effects, Prospective Studies, Risk Factors, Survival Rate, Treatment Outcome, Arrhythmias, Cardiac mortality, Myocardial Infarction mortality, Myocardial Reperfusion mortality
- Abstract
Background: The significance of arrhythmia occurring after successful recanalization of an occluded artery during treatment following primary percutaneous coronary intervention for ST-segment elevation myocardial infarction is controversial., Objectives: To study the association of reperfusion arrhythmia with short and long-term survival., Methods: We used a prospective registry of consecutive STEMI patients undergoing PPCI. Patients with an impaired epicardial flow (TIMI flow grade < 3) at the end of the procedure were excluded., Results: Of the 688 patients in the study group, 22% were women. Mean (+/- SD) age of the cohort was 61 (+/- 14) years and frequent co-morbidities included diabetes mellitus (25%), dyslipidemia (55%), hypertension (43%) and smoking (41%). RA was recorded in 200 patients (29%). Patients with RA had lower rates of diabetes (16% vs. 30%, P < 0.01) and hypertension (48% vs. 62%, P < 0.01), and a shorter median pain-to-balloon time (201 vs. 234 minutes, P < 0.01) than patients without RA. Thirty day mortality was 3.7% and 8.3% for patients with and without RA, respectively (P = 0.04). After controlling for age, gender and pain-to-balloon time the hazard ratio for mortality for patients with RA during a median follow-up period of 466 days was 0.46 (95% confidence interval 0.23-0.92)., Conclusions: The occurrence of RA immediately following PPCI for acute STEMI is associated with better clinical characteristics and identifies a subgroup with a particularly favorable prognosis.
- Published
- 2007
128. [Diabetics with normal coronary arteries: clinical features and prognosis].
- Author
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Wolak A, Amit G, Cafri C, Zahger D, Gilutz H, and Ilia R
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- Aged, Coronary Disease epidemiology, Diabetic Angiopathies epidemiology, Female, Humans, Male, Middle Aged, Prognosis, Risk Factors, Coronary Angiography, Coronary Vessels physiopathology, Diabetes Mellitus diagnostic imaging
- Abstract
Background: Diabetic patients comprise a large proportion of patients referred for coronary angiography. Only a minority of these patients will be found to have normal coronary arteries., Aim: To characterize diabetic patients who have angiographically normal coronary arteries., Methods: Case-control study based on a computerized database., Results: Using our computerized database, 13,342 consecutive patients referred for coronary angiography were identified. Diabetes mellitus was diagnosed in 24% of cases. Angiographically normal coronary arteries were found in 151 (5%) and 1228 (12%) of diabetic and non-diabetic patients, respectively (p<0.01). Diabetic patients with angiographically normal coronary arteries were matched with 155 diabetic patients who were catheterized on the same day but were found to have coronary artery disease. The median follow-up period was 1,774 days. The age of the diabetic patients with normal coronary arteries and diabetic patients with coronary artery disease was 5710 and 6410 years old respectively (p<0.01). A total of 39% and 60% of diabetic patients with normal coronary arteries and with coronary artery disease respectively were males, (p<0.01). Dyslipidemia was diagnosed in 66 (43%) of the diabetic patients with normal coronary arteries and 87 (57%) of the diabetic patients with coronary artery disease (P<0.01). After controlling for age and sex, the finding of normal coronary arteries was associated with decreased mortality (OR: 0.47, 95% CI 0.23 to 0.95)., Conclusions: In diabetic patients referred for angiography it is unusual to find angiogrtaphically normal arteries. These patients have a relatively benign prognosis, as opposed to diabetic patients with evident coronary disease.
- Published
- 2006
129. No gender difference in the clinical management and outcome of unstable angina.
- Author
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Ben-Ami T, Gilutz H, Porath A, Sosna G, and Liel-Cohen N
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- Aged, Aged, 80 and over, Angina, Unstable complications, Female, Follow-Up Studies, Hospitalization, Humans, Israel, Male, Middle Aged, Prejudice, Prognosis, Prospective Studies, Angina, Unstable diagnosis, Angina, Unstable therapy, Outcome and Process Assessment, Health Care, Sex Factors
- Abstract
Background: Women with myocardial infarction have a less favorable prognosis than men. Many studies have indicated gender bias in the evaluation and treatment of myocardial infarction, but few data exist concerning these aspects in the management of unstable angina., Objective: To investigate gender differences in the baseline characteristics, clinical presentation, treatment and prognosis of women with unstable angina., Method: Data were collected prospectively as part of the Acute Coronary Syndromes Israeli Survey in 2000 at Soroka University Medical Center. In-hospital management and 2 year follow-up were monitored for 226 consecutive patients with unstable angina admitted to our medical center during February and March 2000., Results: Women were older (71 +/- 12 vs. 66 +/- 12, P = 0.006), more diabetic (41.3% vs. 34.5%, not significant) and hypertensive (76.3% vs. 64.6%, P = 0.07). Women presented more often with atypical chest pain (18.8% vs. 7.5%, P = 0.038). Heparin, aspirin and angiotensin-converting enzyme inhibitor were delivered equally, but more beta-blockers were administered to women (88.5% vs. 75.7%, P = 0.02) and more statins to men (48.1% vs. 35.4%, P = 0.07). Angiography rates were similar (17.7% vs. 19.6%). Similar management was documented during the 2 year follow-up. Re-hospitalization rates were similar (53.3% of women and 63.7% of men, NS). Men had a tendency to develop acute myocardial infarction more often (9.6% vs. 2.7%, P = 0.06) and to develop peripheral vascular disease (3.7% vs. 0%, P = 0.09), and they had a non-significant higher rate of coronary artery bypass graft (6.7% vs. 1.3%, P = 0.08). No gender difference was found in angiography (14.7% of women vs. 16.3% of men) or percutaneous intervention (13% vs. 16.7%). At 2 years there was no gender-related difference in mortality (13.3% of women vs. 16.3% of , NS). Kaplan-Meier analysis for event-free survival after 2 years showed no gender difference in survival. Multi-regression analysis showed that gender was not a prognostic factor for survival., Conclusions: We found no major difference in the management of men and women with unstable angina. Although men showed a tendency to suffer more major cardiac events, their 2 year prognosis was the same as for women.
- Published
- 2005
130. Extensive fibrosis surrounding myocardial bridging: an intravascular ultrasound study.
- Author
-
Gilutz H, Cafri C, and Ilia R
- Subjects
- Coronary Angiography, Echocardiography, Fibrosis diagnostic imaging, Fibrosis pathology, Humans, Male, Middle Aged, Stents, Coronary Vessel Anomalies diagnostic imaging, Coronary Vessel Anomalies pathology, Myocardium pathology, Ultrasonography, Interventional methods
- Published
- 2004
131. Improved procedural results in coronary thrombosis are obtained with delayed percutaneous coronary interventions.
- Author
-
Cafri C, Svirsky R, Zelingher J, Slutky O, Kobal S, Weinstein JM, Ilia R, and Gilutz H
- Subjects
- Abciximab, Aged, Antibodies, Monoclonal therapeutic use, Anticoagulants therapeutic use, Coronary Angiography, Coronary Thrombosis diagnostic imaging, Female, Heparin therapeutic use, Humans, Immunoglobulin Fab Fragments therapeutic use, Israel, Male, Middle Aged, Prospective Studies, Time Factors, Treatment Outcome, Angioplasty, Balloon, Coronary, Coronary Thrombosis therapy
- Abstract
We investigated the efficacy of percutaneous coronary intervention (PCI) in coronary thrombotic lesions according to the timing of the procedure. Eighty-two patients who underwent immediate PCI (IPCI) were compared to 24 patients who underwent PCI 4.9 3 days after the diagnostic catheterization [delayed PCI (DPCI)]. DPCI was associated with a lower rate of thrombus-related angiographic events (4% versus 27%; p < 0.03), including coronary embolism (0% versus 7%; p = NS), no-reflow phenomenon (0% versus 8%; p = NS), acute closure (0% versus 10%; p = NS), stent thrombosis (4% versus 1%; p = NS) and residual thrombus (0% versus 17%; p = 0.03). No differences were seen in the hospital clinical outcome, including non-fatal myocardial infarction (4% versus 9%; p = NS), death (4% versus 0%; p = NS) or major bleeding (4% versus 3%). Delayed PCI after pharmacological treatment is a safe and efficient strategy of treatment for coronary thrombus.
- Published
- 2004
132. Door to balloon and door to needle: temporal trends in delays to reperfusion.
- Author
-
Wolak A, Gilutz H, Amit G, Cafri C, Ilia R, and Zahger D
- Subjects
- Analysis of Variance, Female, Humans, Israel, Male, Middle Aged, Myocardial Infarction drug therapy, Myocardial Reperfusion methods, Retrospective Studies, Time Factors, Angioplasty, Balloon, Coronary, Myocardial Infarction therapy, Thrombolytic Therapy
- Abstract
Background: Reperfusion practices have changed markedly over the last few years with the introduction of primary percutaneous coronary intervention. This technique has gained growing popularity in Israel, but little published data are available regarding the delays to primary PCI in real life in this country., Objectives: To examine temporal trends in time to reperfusion achieved in a large tertiary center over 6 years., Results: Between 1997 and 2002, 1,031 patients were admitted to our hospital with ST elevation myocardial infarction. Of these, 62% underwent thrombolysis and 38% primary PCI. The proportion of patients referred for primary PCI increased steadily, from 14% in 1997 to 68% in 2002. Door to treatment time among patients referred for thrombolysis or primary PCI was 54 +/- 42 and 117 +/- 77 minutes, respectively (P < 0.00001). The door to needle time in patients given thrombolysis remained virtually unchanged during the study period at around 54 minutes. In contrast, the door to balloon time progressively and substantially decreased, from 175 +/- 164 minutes in 1997 to 96 +/- 52 minutes in 2002., Conclusions: There is a steady increase in the proportion of patients referred for primary PCI than for thrombolysis. The door to needle delay in patients given thrombolysis substantially exceeds the recommended time. The door to balloon time has declined considerably but still slightly exceeds the recommended time. Given the inherent delay between initiation of lysis and arterial recanalization, it appears from our experience that PCI does not substantially delay arterial reperfusion as compared to thrombolysis. Efforts should continue to minimize delays to reperfusion therapy.
- Published
- 2003
133. Triage disposition of patients with acute myocardial infarction--ACSIS 2000.
- Author
-
Arbelle JE, Porath A, Cohen E, Gilutz H, and Garty M
- Subjects
- Age Distribution, Aged, Comorbidity, Electrocardiography, Female, Health Care Surveys, Humans, Israel epidemiology, Male, Middle Aged, Multivariate Analysis, Myocardial Infarction diagnosis, Myocardial Infarction therapy, Myocardial Ischemia diagnosis, Myocardial Ischemia epidemiology, Myocardial Ischemia therapy, Outcome and Process Assessment, Health Care, Retrospective Studies, Sex Distribution, Survival Rate, Critical Care statistics & numerical data, Hospitalization statistics & numerical data, Internal Medicine statistics & numerical data, Myocardial Infarction classification, Myocardial Infarction epidemiology, Triage statistics & numerical data
- Abstract
Background: In the emergency department the physician is often confronted with the decision of where to hospitalize a patient presenting with chest pain and a possible acute myocardial infarction--in the cardiac care unit or in the internal medicine ward., Objective: To characterize the clinical factors involved in the triage disposition of patients hospitalized with AMI in Israel to either CCUs or IMWs and to determine to what extent the perceived probability of ischemia influenced the disposition decision., Methods: During a 2 month nationwide prospective survey in the 26 CCUs and 82 of the 94 IMWs in Israel, we reviewed the charts of 1,648 patients with a discharge diagnosis of AMI. The probability of ischemia at admission was determined retrospectively by the Acute Coronary Ischemia Time-Insensitive Predictive Instrument. Co-morbidity was coded using the Index of Coexistent Diseases., Results: The ACI-TIPI score for patients admitted to CCUs or to IMWs was 76.2% and 57.7% respectively (P < 0.001). Multivariate analysis showed that young patients with a high probability of ischemia and low co-morbidity or functional impairment were more likely to be hospitalized in CCUs than in IMWs., Conclusion: In Israel, the factors that strongly influence the initial triage disposition of AMI patients to CCUs or IMWs are age, perceived probability of ischemia, status of co-morbid conditions and functional impairment.
- Published
- 2003
134. Acute myocardial infarction: patient selection for reperfusion with coronary angioplasty.
- Author
-
Cafri C, Crystal E, Kobal S, Weinstein JM, Gilutz H, and Ilia R
- Subjects
- Aged, Contraindications, Female, Humans, Male, Middle Aged, Myocardial Infarction complications, Myocardial Infarction mortality, Myocardial Infarction physiopathology, Recurrence, Retrospective Studies, Shock, Cardiogenic etiology, Thrombolytic Therapy, Angioplasty, Balloon, Coronary, Myocardial Infarction therapy, Patient Selection
- Abstract
Background: Despite the clinical advantages of mechanical reperfusion in the treatment of acute myocardial infarction, widespread use of percutaneous transluminal coronary angioplasty has been limited by a lack of human and institutional resources., Objective: To evaluate the feasibility of a PTCA-based reperfusion strategy for AMI patients selected according to high risk clinical criteria., Methods: The study group included 110 patients selected for mechanical reperfusion out of 1,080 AMI patients according to the following criteria: hemodynamic disturbance (40%), large anterior wall MI (54%), contraindication to thrombolysis (15%), previous MI (13%), re-infarction (4.5%), non-diagnostic electrocardiogram (0.9%), and unsuccessful thrombolysis (30%)., Results: Cardiogenic shock was present in 23% of the cases and cardiac arrest with prolonged resuscitation in 8%. The cohort 30 day mortality rate was 15%. The 30 day mortality rate for patients without cardiogenic shock was 6.3%., Conclusions: Selection of high risk patients who would benefit most from mechanical reperfusion appears feasible, resulting in low mortality rates when compared with those in the literature. Widespread implementation of well-defined selection criteria should promote better utilization of the limited resources available for primary PTCA.
- Published
- 2003
135. [The use of cardiac troponins in acute coronary syndromes].
- Author
-
Amit G, Gilutz H, and Zahger D
- Subjects
- Anticoagulants therapeutic use, Chest Pain blood, Coronary Disease blood, Coronary Disease drug therapy, Electrocardiography, Heparin, Low-Molecular-Weight therapeutic use, Humans, Myocardium chemistry, Predictive Value of Tests, Prognosis, Syndrome, Troponin C blood, Troponin I blood, Troponin T blood, Coronary Disease diagnosis
- Abstract
In patients with acute coronary syndromes cardiac troponins are sensitive markers of myocardial damage. The troponin complex comprises subunits C, T and I and is a major component in the process of myocyte contraction and relaxation. The T and I subunits have cardiac isoforms with distinct specific immunologic properties which distinguish them from similar subunits of non-cardiac muscle tissue. The high sensitivity and specificity of cardiac troponins make them the preferred biochemical markers for diagnosing acute myocardial infarction and for the triage of patients admitted with chest pain without ST segment elevation on the E.K.G. There is a correlation between cardiac troponin levels and prognosis in patients with acute coronary syndromes. In addition to their prognostic role, cardiac troponins play a role in selecting patients for contemporary treatments. Thus, their level can identify the patients most likely to benefit from treatments such as low molecular-weight heparin, IIb/IIIa receptor blockers and early angiography and coronary intervention. Recently, the American heart Association, the European Heart Society and the Israel Cardiology Society have published guidelines for the use of cardiac troponins. This review summarizes the current data regarding the use of cardiac troponins in the acute coronary syndromes.
- Published
- 2003
136. Rapid evolution from coronary dissection to pseudoaneurysm after stent implantation: a glimpse at the pathogenesis using intravascular ultrasound.
- Author
-
Cafri C, Gilutz H, Kobal S, Esanu G, Weinstein JM, Abu-Ful A, and Ilia R
- Subjects
- Aortic Dissection diagnosis, Aneurysm, False diagnosis, Coronary Aneurysm diagnosis, Coronary Angiography, Female, Humans, Middle Aged, Ultrasonography, Interventional, Aortic Dissection etiology, Aneurysm, False etiology, Angioplasty, Balloon, Coronary adverse effects, Coronary Aneurysm etiology, Stents adverse effects
- Abstract
Coronary dissection during angioplasty can evolve into pseudoaneurysm. Stenting should prevent this complication. We present a case of coronary pseudoaneurysm after dissection that developed despite stent implantation. Intravascular ultrasound demonstrated no sealing of the false lumen due to undersizing and non-apposition to the wall by the stent.
- Published
- 2002
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