Tyrosine kinase-targeting drugs-associated heart failure.

BACKGROUND: The impact of cancer therapies on cardiac disease in the general adult cancer survivor population is largely unknown. Our objective was to evaluate which tyrosine kinase-targeting drugs are associated with greater risk for new-onset heart failure (HF). METHODS: A nested case-control analysis was conducted within a cohort of 27 992 patients of Clalit Health Services, newly treated with a tyrosine kinase-targeting, and/or chemotherapeutic drug, for a malignant disease, between 1 January 2005 and 31 December 2012. Each new case of HF was matched to up to 30 controls from the cohort on calendar year of cohort entry, age, gender, and duration of follow-up. Main outcome measure was odds ratio (OR) with 95% confidence interval (CI) of new-onset HF. RESULTS: There were 936 incident cases of HF during 71 742 person-years of follow-up. Trastuzumab (OR 1.90, 95% CI 1.46-2.49), cetuximab (OR 1.72, 1.10-2.69), panitumumab (OR 3.01, 1.02-8.85), and sunitinib (OR 3.39, 1.78-6.47) were associated with increased HF risk. Comorbidity independently associated with higher risk in a multivariable conditional regression model was diabetes mellitus, hypertension, chronic renal failure, ischaemic heart disease, valvular heart disease, arrhythmia, and smoking. CONCLUSIONS: Trastuzumab, cetuximab, panitumumab, and sunitinib are associated with increased risk for new-onset HF.

A prospective case-control study of non-healing wounds of the lower limbs - the value of biopsies for ulcerating carcinoma.

BACKGROUND: In some leg ulcer patients there is cancer that is responsible for lack of healing of such a wound. AIM: This study was aimed at prospective analysis of histopathology of non-healing wounds (NHWs) in the patient presenting with high and low suspicion for ulcerating carcinoma. MATERIAL AND METHODS: Forty patients with NHWs were enrolled and had been prospectively divided into two groups: 25 patients with high suspicion for ulcerating carcinoma according to their medical history and physical examination, and the second group of 15 patients without suspicion for malignancy (control group). All NHWs were photographed and underwent biopsies. RESULTS: In the control group biopsies did not reveal cancers. On the contrary, in 10 patients (40%) from high suspicion group biopsies revealed cancers: seven basal cell carcinomas (BCCs), one - malignant melanoma, one - Bowen's disease and one - squamous cell carcinomas. Histopathology of six of seven BCCs suggested that non-healing benign wound might have preceded malignancy. We found that leg ulcers which were small (wound area less than 3 cm(2) ), longstanding (duration 24 ≤ weeks), presenting with granulation tissue covering ≥75% of the wound area, with a dull pink appearance of the granulation tissue, or an atypical clinical presentation, can actually be an ulcerating carcinoma. Dull pink granulation tissue or an atypical clinical presentation of ulceration, as a single clinical finding, suggested an underlying malignancy with a statistical significance (71.5% vs. 0%; P = 0.001 and 27.8% vs. 0%; P = 0.0049 respectively). CONCLUSIONS: Prevalence of malignancy, primarily: BCCs in NHWs, may be higher than expected and clinical features suggestive of such a nature of ulcer are an indication for diagnostic biopsy.

Pain evaluation and control during and following the treatment of hypertrophic scars and keloids by contact and intralesional cryosurgery--a preliminary study.

BACKGROUND: Intralesional cryosurgery effectively treats hypertrophic scars and keloids (HSK), but pain experienced by the patient during treatment can limit the application of cryosurgery. OBJECTIVES: To characterize the pain response during cryosurgical treatment of HSK, and to evaluate the pain experienced during contact and intralesional cryosurgery that employs a pain-control protocol. METHODS: Twenty-nine patients (17 women, 12 men) aged 17 years and older (mean ages 31.9±12.5 and 38.9±18.6 years, respectively, P=0.24), who were treated for a total of 36 HSKs by intralesional (n=20; 22 cryotreatments) or contact (n=9; 14 cryotreatments) cryosurgery were evaluated. The pain-control protocol involved oral pain-relief tablets (Dipyrone) and translesional local anaesthesia with Bupivacaine hydrochloride 0.5%. Pain evaluation according to the Visual Analogue Scale (VAS) (0-10 cm) was compared between the two groups at three time points: during cryosurgery, immediately after it, and 4 h later. Scores ≤3 cm were considered to define the 'zone of analgesic success'. These results were compared with control data (contact cryosurgery without a pain-control protocol; n=56). RESULTS: Pain in the intralesional group was significantly lower than that in the contact group during and immediately after cryotreatment. During: mean VAS=1.68±2.21 vs. 5.07±4.01 cm; median VAS=0.5 vs. 5.5 cm, respectively; P<0.0001. Immediately after: mean VAS=1.22±1.77 vs. 5.38±3.81 cm; median VAS=0 vs. 6.0 cm, respectively; P=0.001. The control group had more pain during treatment (mean VAS=5.34±2.31, median=6.0) and 4 h later (mean=3.79±2.35, median=4.0) than the intralesional group (P<0.0001 and P=0.988, respectively). The pain level in the control group during the cryotreatment did not differ from that in the contact group (P=0.988). In the intralesional, contact and control groups analgesic success (VAS ≤3 cm) was achieved in 77.3%, 35.7% and 33.9%, respectively, of cases (P=0.002) during cryotreatment, and in 54.5%, 42.9% and 33.9%, respectively, of cases 4 h after treatment (P=0.24). CONCLUSIONS: The pain-control protocol significantly reduced pain severity to tolerable levels (VAS ≤3 cm) during and following intralesional and contact cryosurgery. Intralesional cryosurgery caused the least pain during and immediately after treatment.

Variability in outpatient antimicrobial consumption in Israel.

BACKGROUND: Antibiotic consumption has an important effect on microbial resistance. Nationwide data on the comparative use of antibiotics in outpatient settings in Israel have only been partially collected and published. The aim of our study was to analyze the use of antibiotics in the outpatient setting in Israel and assess a number of influencing factors. MATERIALS AND METHODS: Defined daily doses per 1,000 inhabitants per day (DID) of total antibiotic use, consumption in different age groups, and consumption of different antibiotic groups were calculated for the years 2003-2005 in the districts of Israel. The data was collected from prescription data compiled by the pharmaceutical services of "Clalit Health Services", the largest health maintenance organization (HMO) in Israel, covering 55% of the population.Trends in use and variables associated with antibiotic consumption were analyzed. RESULTS: There was a significant decrease in antibiotic use from 2003 to 2005, ranging from 1.8 to 8.2% in the different districts. The highest consumption was noted in the youngest age groups, with more than half of all antibiotics prescribed to children < or = 18 years of age. Antibiotic consumption was significantly different between the different regions in Israel. A multivariate analysis revealed that a higher prevalence of diabetes mellitus was the only significant variable associated with antibiotic use. Variability in the use of different antibiotics was also found; for example, amoxicillin comprised 19.5-33.4% of total antibiotic consumption in the different districts, while fluoroquinolone consumption ranged from 3.2 to 7.3%. CONCLUSIONS: Outpatient antibiotic use in the population insured by "Clalit Health Services" declined between 2003 and 2005. Children had the highest consumption rates. There were large differences in antibiotic use between geographic regions, and diabetes mellitus was the only variable significantly associated with antibiotic use. We therefore conclude that most of the differences in antibiotic use are likely due to doctor preferences, local routines, and patients' attitudes and expectations.

Cardiovascular risk factors in primary hyperparathyroidism.

BACKGROUND AND AIMS: Severe primary hyperparathyroidism (PHP) has been associated with increased cardiovascular morbidity. Such an association in mild PHP is not known. We conducted a cross-sectional study to assess the correlation between mild and traditional PHP and emergent cardiovascular risk factors. SUBJECTS AND METHODS: A total of 139 patients with PHP (72 with severe PHP and indications for parathyroidectomy, 67 with mild PHP and no indications for surgery) and 111 control subjects, of similar age and body weight, were enrolled in this study. Participants had measurement of fasting blood levels of calcium, PTH, insulin, glucose, total cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides, interleukin-6, and C-reactive protein. Body mass index (BMI), waist and hip circumferences, blood pressure, homeostasis model assessment 2-insulin resistance index (IR) and the presence of metabolic syndrome (MS) were evaluated. RESULTS: Severe PHP patients had significantly higher rates of MS (37.5%), IR (38.9 %) vs mild PHP (34.3 and 23.9%, respectively) and controls (14.4 and 14.4%, respectively). Multivariate logistic-regression model, adjusted for age and BMI, and for age and waist size, revealed that severe PHP had significantly higher likelihood of cardiovascular risks [odds ratio (OR) 3.5, 95% confidence interval (CI) 1.5-8.125, p=0.004 for MS, and OR 3.7, 95% CI 1.64-8.29, p=0.002 for IR]. Serum calcium significantly predicted the presence of MS (OR 1.875, 95% CI 1.259-2.793, p=0.002) and IR (OR 2.043, 95% CI 1.365-3.057, p=0.002). CONCLUSIONS: Greater probability of MS and insulin resistance was observed in patients with severe PHP. Serum calcium is a predictor of these cardiovascular risk factors.

Diabetes mellitus and hypertension as risk factors for early diffuse idiopathic skeletal hyperostosis (DISH).

OBJECTIVES: To describe and identify factors, in clinical practice, that might be useful increasing the index of suspicion for diffuse idiopathic skeletal hyperostosis (DISH), at a relatively young age. DESIGN: A group of 18 patients with DISH (12.8) who were diagnosed before the age of 50 years (group A) was compare with a group of 20 patients of similar age with osteoarthritis (group B), and 24 patients with DISH diagnosed after the age of 60 years (group C). Data collection included demographic characteristics, body region of main complaint evidence for enthesopathies or tendonitis, length of follow-up, body mass index (BMI), serum lipid profile, family history of diabetes mellitus (DM), and hypertension (HTS). The presence of concomitant diseases and use of medications was recorded at presentation and during the follow-up period. RESULTS: Patients in group A compared with group B, had statistically significant more pain in the lumbar and thoracic spine (P=0.001 and 0.016, respectively), tendonitis/enthesopathies (P=0.004), obesity (BMI> or =30, P=0.014), and first degree relative with HTS and DM (P=0.015 and 0.05, respectively). By the end of the follow-up, significantly more patients in group A were affected by DM compared with group B (P=0.007). CONCLUSIONS: Individuals in the fifth decade of life are likely to be affected by DISH if they are obese, have a first degree relative with either HTS or DM, complain of lumbar or thoracic spinal pain, and are affected by enthesopathies or tendonitis. The likelihood of relatively young patients with > or =3 clinical parameters to be affected with DISH, was six times higher than age and sex matched controls (P=0.004).

Adherence to guidelines on empiric use of antibiotics in the emergency room.

BACKGROUND: In October 2002, guidelines for empiric antibiotics in emergency room (ER) were introduced. AIMS: To evaluate physician's compliance with guidelines and their utility in improving patient care. METHODS: Reviewing charts of patients admitted to ER during October 4, 2004 to February 14, 2005 with suspected infection, subsequently hospitalized to internal medicine ward. Along with demographic data, the following parameters were recorded: Initiating antibiotics in ER, according-to-guidelines treatment (ATGT), lag-time between admittance and first antibiotic dose, diagnosis, proper coverage of pathogens by treatment (PCPT), and outcome. RESULTS: A total of 534 patients were admitted to ER with a suspected infection, 481 (90.1%) of them were managed according to guidelines, and from the 431 patients (80.7%) who received antibiotics, 381 (88.4%) were given ATGT. In 105 cases (19.7%), positive cultures (urine or blood) were obtained: 23.6% and 30.0% of the patients who received ATGT and not-ATGT, and the given antibiotic ensured proper coverage of the pathogen which grew in 73.3% and 46.7% of the cases, respectively. Percentages of good outcome (staying alive) for ATGT, non-ATGT, PCPT, and not-PCPT were 92.1%, 76.0%, 89.0%, and 69.0%, respectively. By multivariate analysis, early ATGT proved to be related to good outcome. CONCLUSIONS: Physicians' compliance with hospital guidelines to empiric antibiotics in ER was high. Adherence to guidelines was associated with a better outcome. Local susceptibility patterns to antibiotics need to be actively monitored. Prompt administration of antibiotics in the ER is likely to have a favorable outcome on survival, yet larger studies are required to establish this conclusively.

Prevalence and risk factors for asymptomatic bacteriuria in women with Type 2 diabetes mellitus.

AIMS: Asymptomatic bacteriuria (ASB) has been considered as a complication in diabetic women. The reported data on the prevalence and various risk factors for ASB appear to be conflicting. Consequently, we investigated the prevalence and major risk factors of ASB in women with Type 2 diabetes mellitus. METHODS: A total of 411 non-pregnant women (aged 59.6 +/- 10.8 years) with Type 2 diabetes, and 160 women without diabetes (aged 53.3 +/- 15.1 years) assigned as controls, attending an outpatient endocrine clinic in a university-affiliated teaching hospital, were included. All participating women were interviewed and screened for the presence of ASB. In all participants, fasting blood glucose, HbA(1c) and renal function were measured. Complications of diabetes were also assessed. RESULTS: Of the 411 diabetic women, 25 (6.1%) had ASB, compared with four of 160 (2.5%) in control women (P = 0.07). Independent risk factors for the presence of ASB were albuminuria > 150 mg/24 h [odds ratio (OR) 4.96 (95% CI 1.64-15.0, P = 0.005)] and serum creatinine [OR 3.5 (95% CI 1.4-8.8, P = 0.008)]. No significant association was evident with age, BMI, duration of disease, glycaemic control assessed by HbA(1c) or chronic complications of diabetes, namely macrovascular disease, neuropathy and retinopathy. CONCLUSIONS: Women with Type 2 diabetes are not at higher risk of developing ASB than non-diabetic women. Independent and significant risk factors for ASB are macroalbuminuria and serum creatinine. The low prevalence of ASB found in this study may be as a result of the ethnic origin of these women and the circumcised state of their partners.

Complementary medicine and psoriasis: linking the patient's outlook with evidence-based medicine.

BACKGROUND: There is increasing evidence for the extensive use of complementary and alternative medicine (CAM) by patients with psoriasis. Clinical research in the arena of CAM and psoriasis treatment is evolving and includes some randomized controlled trials. OBJECTIVE: To study CAM use among patients with psoriasis attending a dermatology clinic in a major university hospital in northern Israel. Prevalence, reasons for CAM use and its relevance to doctor-patient communication were emphasized. METHODS: Semistructured interviews were conducted with psoriasis patients in a dermatology clinic. Consent was obtained for 78 patients. Post-visit questionnaires were given to 5 physicians. RESULTS: Seventy-eight patients with psoriasis were interviewed and 77 were studied. Sixty-two percent used CAM. Fifty-eight percent of users had seen a CAM practitioner. The study found a trend of CAM use among patients with psoriasis from Arab compared to Jewish descent (p=0.087). CAM users reported on average 2 different CAM modalities. Herbal medicine and nutritional treatments ranked first, followed by homeopathy, traditional Chinese medicine and nutritional supplements. The main reason for CAM use was stated to be to do everything to heal the disease, followed by a quest for improved quality of life. Others mentioned an interest in a less toxic treatment, disappointment with conventional treatment and stress reduction. Well over half of the study participants and their dermatologists did not initiate a discussion about CAM use. The dermatologists' ability to predict CAM use in their patients was relatively low. CONCLUSION: There is growing evidence of extensive CAM use among patients with psoriasis. Most patients use CAM as a complementary treatment, rather than an alternative to conventional treatment. Teaching CAM should be integrated into the dermatology residency curriculum. Dermatologists need to increase their awareness of CAM use by their patients in order to improve therapeutic communication.

Empiric use of trimethoprim-sulfamethoxazole (TMP-SMX) in the treatment of women with uncomplicated urinary tract infections, in a geographical area with a high prevalence of TMP-SMX-resistant uropathogens.

This study evaluated whether trimethoprim-sulfamethoxazole (TMP-SMX) is effective for treatment of uncomplicated urinary tract infections (UTIs) due to TMP-SMX-resistant (TMP-SMX-R) pathogens. Healthy nonpregnant premenopausal women with symptomatic lower UTI were assessed for the presence of pyuria and bacteriuria; if either was present, a urine sample was cultured and TMP-SMX was prescribed. Clinical and microbiologic cure was assessed at days 5-9 and 28-42 after cessation of therapy. For 71%, of patients, cultures grew TMP-SMX-susceptible (TMP-SMX-S) microorganisms, and for 29%, cultures grew TMP-SMX-R organisms. Escherichia coli remained the predominant bacteria in both groups of cultures. At visit 2, microbiological cure had been achieved in 86% of the patients in the TMP-SMX-S group and 42% of those in the TMP-SMX-R group. Similar differences were found at visit 3 by clinical evaluation. Treatment with TMP-SMX of uncomplicated UTI caused by TMP-SMX-R microorganisms results in microbiologic and clinical failure. In high-resistance areas, TMP-SMX should not be the empiric drug of choice for uncomplicated UTI.

Can exaggerated response to a GH provocative test identify patients with partial GH insensitivity syndrome?

OBJECTIVES: In the majority of children with short stature, the etiology is unknown. Mutations of the GH receptor (GHR) have been reported in a few children with apparent idiopathic short stature (ISS). These patients had low IGF-I, IGF-binding protein-3 (IGFBP-3) and GH-binding protein (GHBP), but a normal or exaggerated GH response to provocative stimuli, suggestive of partial GH insensitivity (GHI). We attempted to identify children with partial GHI syndrome, based on their response to GH provocative stimuli and other parameters of the GH-IGF-I axis. SUBJECTS AND METHODS: One hundred and sixty-four pre-pubertal children (97 boys, 67 girls) aged 7.2 (0.5-16.75) years were studied. All had short stature with height <3rd centile. The weight, bone age (BA) and body mass index (BMI) of the subjects, as well as the parents' heights and mid parental height (MPH) were assessed. Basal blood samples were taken for IGF-I, IGFBP-3 and GHBP. All subjects underwent a GH provocative test with either clonidine, arginine or insulin. The subjects were divided into three groups: (A) patients with peak GH concentration <18 mIU/l in two different provocative tests (GH deficiency - GHD, n=33); (B) patients with peak GH between 18.2 and 39.8 mIU/l (normal response, n=78); (C) patients with peak GH >40 mIU/l (exaggerated GH response, n=53). RESULTS: No significant differences were found in age, height (standard deviation score (SDS)), parental height (SDS) and the difference between chronological age and bone age (DeltaBA) between the groups. Patients with GHD were heavier (P=0.039) and had significantly higher BMI (SDS) (P=0.001) than the other groups. MPH (SDS) was lower in the group of exaggerated responders (P=0.04) compared with the other groups. No significant differences were found between the groups for the biochemical parameters when expressed nominally or in SDS, except for IGFBP-3 (SDS), which was lower in the GHD group (P=0.005). The GHBP levels were not lower in the group of exaggerated GH response to provocative stimuli. Height (SDS) correlated negatively with basal GH values in pooled data of all the subjects (r=-0.358, P<0.0001), in normal responders (r=-0.45, P<0.0001) and in the exaggerated responders (r=-0.341, P<0.0001), but not in the GHD group. CONCLUSION: Exaggerated GH response to provocative tests alone does not appear to be useful in identifying children with GHI.

The classic approach to diagnosis of vulvovaginitis: a critical analysis.

OBJECTIVE: To correlate the symptoms, signs and clinical diagnosis in women with vaginal discharge, based on the combined weight of the character of the vaginal discharge and bedside tests, with the laboratory diagnosis. METHODS: Women presenting consecutively to the women's health center with vaginal discharge were interviewed and examined for assessment of the quantity and color of the discharge. One drop of the material was then examined for pH and the whiff test was done; a wet mount in saline and in 10% KOH was examined microscopically. The clinical diagnosis was based on the results of these assessments. Gram stain and cultures of the discharge were sent to the microbiology laboratory. RESULTS: One hundred and fifty-three women with vaginal discharge with a clinical diagnosis of vulvovaginitis participated in the study. Fifty-five (35.9%) had normal flora and the other 98 (64.1%) had true infectious vulvovaginitis (kappa agreement = 18%). According to the laboratory, the principal infectious micro-organism causing the vulvovaginitis was Candida species. Candida infection was associated with pH levels of less than 4.5 (p < 0.0001, odds ratio = 4.74, 95% confidence interval: 2.35-9.5, positive predictive value 68.4%). The whiff test was positive in only a small percentage of bacterial vaginosis (BV) (p = not significant (NS)). Clue cells were documented in 53.3% of patients with a laboratory diagnosis of BV (p < 0.02, positive predictive value 26.7%). CONCLUSIONS: The current approach to the diagnosis of vulvovaginitis should be further studied. The classical and time-consuming assessments were shown not to be reliable diagnostic measures.

High-level handwashing compliance in a community teaching hospital: a challenge that can be met!

Handwashing is the most important and least expensive measure for preventing the transmission of hospital-acquired infection. Compliance, however, rarely exceeds 40%, even in intensive care units. The present study evaluated the effectiveness of the authors' infection control programme in relation to handwashing compliance of healthcare workers. Ten nursing students observed 300 uninformed staff members and recorded their handwashing practices throughout the working day. The observations were categorized by profession, gender, age, hospital unit and type of delivered care. In 1035 opportunities that required handwashing, the overall compliance was 76%. Healthcare workers washed hands before (68%) and after patient care (80%). Females complied more than males (69 vs. 80%, P<0.0001) and nurses more than physicians (81 vs. 69%, P<0.001). In intensive care units, overall compliance exceeded 97%, while in other wards and in the emergency departments, it approximated 61%. More handwashing was observed during the evening shift compared with the morning shift (P=0.02). Despite the high compliance, only 30% washed their hands for the required 10-20s. In conclusion, compliance with handwashing in the authors' institution is the highest reported to date, and reflects the intensive and incessant educational infection control programme.

Screening with faecal occult blood test (FOBT) for colorectal cancer: assessment of two methods that attempt to improve compliance.

Screening with the faecal occult blood test (FOBT) has been shown in randomized control trials to be effective in reducing mortality from colorectal cancer. Compliance to this test recommendation, however, by the general population is usually low. To evaluate different methods of increasing compliance with FOBT, using mailed test kits or order cards, with or without information leaflets, subjects were randomly assigned to receive a test kit or a kit request card. An information leaflet was included in half of the mailings. All participants were contacted for interview. Compliance was evaluated through the central computer system of the study's FOBT laboratory. Self-initiated compliance with FOBT in the year preceding the study was 0.6% of the study participants. The overall compliance rate with the programme invitation was 17.9%, with a somewhat higher, though non-significant response to the mailed kit (19.9%) over the kit request card (15.9%). Women complied with the test significantly more than men, older participants more than younger. Compliance to FOBT is low among the Israeli population aged 50-74 who receive a formal invitation to carry out this screening. Mailing a kit request card within the framework of a screening programme can achieve a substantial increase (to 17.9%) in the level of compliance for the relatively low cost of postage. More effort is needed to study additional means of convincing the non-responders to take part in this potentially life saving activity.

Risk of infection and death among post-splenectomy patients.

OBJECTIVES: The true incidence of post-splenectomy sepsis remains undetermined. METHODS: An English literature review on post-splenectomy sepsis was undertaken by means of databases of MEDLINE for the period 1966-96. The data registered included age at splenectomy, indication for splenectomy, incidence of infection and death, interval between splenectomy and infection, and microbial aetiology. RESULTS: The reports include 19 680 patients having undergone splenectomy with a median follow up of 6.9 years. The incidence of infection after splenectomy was 3.2% and the mortality rate was 1.4%. Only 6942 reports were sufficiently detailed to allow useful analysis. The incidence of infection among children and adults was similar, 3.3% and 3.2%, respectively. However, the death rates among children were higher than adults (1.7% vs. 1.3%). The incidence of infection was highest among patients with thalassemia major (8.2%), and sickle-cell anaemia (7.3%). The highest mortality rates were observed among patients with thalassaemia major (5.1%), and sickle-cell anaemia (4.8%). CONCLUSION: The incidence of sepsis among post-splenectomy patients is low, however, it carries a high mortality rate especially among children with hematological disorders.

Comparison between four immunoassays for growth hormone (GH) measurement as guides to clinical decisions following GH provocative tests.

OBJECTIVE: To compare four assays for the measurement of GH following provocative tests and to assess the projected clinical decisions, which would have been based on their respective results. DESIGN: Multiple assays of serum samples obtained during provocative tests for GH response. SUBJECTS: Forty-seven children with short stature, who underwent clinical evaluation and GH provocative tests. METHODS: All samples were measured by the immunoassay Sorin-RIA (A), which is routinely used in our laboratory. Basal and peak samples were analyzed by three other immunoassays: Sorin-IRMA (B), DPC-RIA (C) and Wallac-DELFIA (D). Results were classified as low, partial and normal GH response, corresponding to <10, 10-17.9 and >18 microIU/ml peak serum GH levels. RESULTS: High correlation was found between individual results by the four kits (r=0.92-0.94). However, the mean peak GH values were significantly different (p<0.0001). Further analysis using paired t-test has shown highly significant differences between the assays (p<0.0001) apart from assays A and B that were not significantly different. Clinical grouping by the four tests was profoundly different: by assay A, 14.9% were judged low response and 57.4% normal; by assay D, 36.2% were low and only 21.3% normal. Kappa statistics measurement demonstrated poor agreement between assays A and D and between B and D. CONCLUSION: As the criteria for the diagnosis of GH deficiency and the indications for GH therapy are based on laboratory GH results, more must be done to ensure uniformity and comparability of the GH assays.

Demographic characteristics of patients with community-acquired bacteriuria and susceptibility of urinary pathogens to antimicrobials in northern Israel.

BACKGROUND: Urinary tract infection is one of the most common bacterial infections. Since antibiotics are given empirically, it is necessary to assess the distribution and susceptibility of the microorganisms in each case. OBJECTIVES: To evaluate the demographic characteristics of ambulatory patients with UTI, the distribution and susceptibility of uropathogens, and the risk factors associated with trimethoprim-sulfamethoxazole resistant bacteria in women. METHODS: During 12 days in August 1997 all the urine cultures sent to the Tel-Hanan Laboratory (Haifa) were evaluated. Demographic characteristics of the patients, their underlying diseases and the previous use of antibiotics were obtained. RESULTS: During the 12 day survey 6,495 cultures were sent for evaluation. Of the 1,075 (17%) that were positive 950 were included in the study; 83.7% were from females, of whom 57% were > or = 50 years old. Escherichia coli was the most common pathogen, with 74.7% in the female and 55% in the male population; 86.2% of the E. coli were resistant to amoxicillin, 38.8% to cephalexin and 46.8% to TMP-SMX. Cefuroxime (4.2%), ofloxacin (4.8%), ciprofloxacin (4.8%) and nitrofurantoin (0.4%) showed the lowest rates of resistance. By a multivariant analysis, post-menopause and recurrent UTI were found to be independent factors related to TMP-SMX resistance in women. CONCLUSION: In northern Israel, ampicillin, cephalexin and TMP-SMX cannot be used empirically in the treatment of community-acquired UTI. Post-menopause and recurrent UTI are independent factors associated with TMP-SMX resistant pathogens in women.

Thrombophilic factors and their relation to thromboembolic and other clinical manifestations in Behçet's disease.

OBJECTIVE: To evaluate the prevalence of thrombophilic factors known to induce intravascular clotting and to assess their relationship with thromboembolic complications and the other clinical manifestations in Behçet's disease (BD). METHODS: Twenty-five patients with established BD were studied. Twenty patients with rheumatic conditions not known to be associated with venous or arterial thromboembolic phenomena served as controls. Eight of the patients with BD (32%) had either deep vein thrombosis (6 patients), arterial thromboembolic phenomena (2), or both (2). All participants were tested for IgG and IgM anticardiolipin antibody (aCL) levels, the presence of circulating lupus anticoagulant (LAC), protein C, protein S, and antithrombin III activity, activated protein C resistance, and where appropriate factor V Leiden mutation. RESULTS: Elevated levels of IgG aCL were detected in 10 (40%) patients with BD compared to one (5%) in the control group (p = 0.012). No significant differences were noted in the other variables studied between the 2 groups. No statistically significant correlation was found between any variable and the clinical manifestations. CONCLUSION: Patients with BD do not have decreased protein C, protein S, or antithrombin III activity, activated protein C resistance, circulating LAC, or elevated levels of IgM aCL. A significant number of patients have elevated levels of IgG aCL but they are not associated with venous or arterial thrombosis. No correlation was found between any variable and other clinical manifestations of the disease.