Inhibition of endothelial Progenitor Cells Inhibition in the first 24 hours of an Acute Ischemic Cerebrovascular Event.

BACKGROUND: Endothelial progenitor cells may have a role in ongoing endothelial repair. Impaired mobilization or depletion of these cells may contribute to progression of vascular disease. Our hypothesis was that endothelial progenitor cells would be suppressed in patients with acute cerebrovascular event based on our previous study that found severe endothelial dysfunction in those patients. OBJECTIVES: To study the ability of patients with acute stroke to build colonies of endothelial progenitor cells. METHODS: We studied the number of colony-forming units of endothelial progenitor cells (CFU-EPCs) from the peripheral blood of 22 male patients with a first-time acute stroke (age 58.09 ± 9.8 years) and 13 healthy men (34 ± 6.7 years), 8 female patients with a first-time acute stroke (54.6 ± 10.3 years) and 6 healthy women (38.3 ± 11.6 years). Endothelium-dependent function was assessed by high-resolution ultrasonography of the brachial artery that measured the change in diameter of the artery by flow-mediated diameter percent change (FMD%). All patients had strokes demonstrated by a brain computed tomography (CT) scan done on admission. Peripheral blood was drawn soon after admission and was processed for endothelial progenitor cells in culture. RESULTS: Thirty patients without known cardiovascular risk factors and who did not take any medications were admitted with a first-time acute stroke. All demonstrated a strong correlation between CFU-EPCs grown in culture and endothelial dysfunction (r = 0.827, P < 0.01). Endothelial dysfunction with an FMD% of -2.2 ± 9.7% was noted in male patients vs. 17.5 ± 6.8% in healthy males (P = 0.0001), and -7.2 ± 10.1% in female patients vs. 25.1 ± 7.1% in healthy females (P = 0.0001). CFU-EPCs were 5.5 ± 6.3 in men with stroke vs. 23.75 ± 5.3 in healthy males (P = 0.0001), and 7.6 ± 4.9 in women with stroke vs. 22.25 ± 6.7 in healthy females (P = 0.0004).

Erectile Dysfunction, Sleep Disorders, and Endothelial Function.

BACKGROUND: Erectile dysfunction (ED) is a syndrome associated with endothelial dysfunction, which may predict cardiovascular events in men presenting with this syndrome. It has been shown to be associated with a higher rate of acute myocardial infarction and cardiovascular mortality, vascular inflammation, and impaired endothelial function. In this review we present the literature findings and describe the mechanistic pathways that are known to be involved in this syndrome and its related clinical consequences.

[Multidisciplinary rehabilitation for lymphedema].

Lymphatic edema could appear in the extremities, in the breasts or anywhere else in the body and restrict function by decreased flexibility and motility, limited extremities' range of motion, feelings of fatigue and heavy swollen limbs, edematous skin changes, sensations of uneasiness and impaired mobility accompanied by psychological stress (due to the chronic nature of the illness and dependency on medical care). We present four case studies that demonstrate integrated management and a combined approach of treatment for patients with lymphatic edema, including aspects of physiotherapy, as part of an integrated rehabilitation service.

Homocysteine (Hcy) follow-up study.

BACKGROUND: Hyperhomocysteinemia confers an increased risk of coronary artery disease, stroke, and deep vein thrombosis, and is a strong predictor of mortality among patients with ischemic heart disease. PURPOSE: To determine the long term clinical outcome of patients with risk factors to atherosclerosis with high concentrations of homocysteine (Hcy). METHODS: 89 patients with one or more risk factors for atherosclerosis, whose plasma total Hcy concentrations were measured, were followed for 5 years. Patients were interviewed and underwent a clinical examination in the outpatient clinic. Their medical records were reviewed in the last 5 years including smoking habits, medications, other diseases (hypertension, diabetes mellitus, hyperlipidemia) and their management. SPSS was used to describe and explore possible relationships between Hcy concentration, other diseases, medications and the clinical long term outcome. RESULTS: All men with normal Hcy concentrations (10.76+/-1.71 micromol/L) survived during the 5 years' follow up, while 5 of the men with high Hcy concentrations (21.27+/-5.37 micromol/L), died (17%) (P< 0.05). In women Hcy concentration did not affect survival. No association was found between diabetes mellitus, hypercholesterolemia, hypertension and Hcy. Long term treatment with Beta Blockers, ACE inhibitors, Calcium Channel blockers, and especially with Aspirin prevented death and changed the natural history of patients with high Hcy concentrations (P < 0.05). CONCLUSIONS: Hyperhomocysteinemia may have an effect on survival in men. Long term treatment with Beta Blockers, ACE inhibitors, Calcium Channel Blockers, and especially with Aspirin--prevented death and changed the natural history of patients with high Hcy concentrations.

Tomato-rich (Mediterranean) diet does not modify inflammatory markers.

BACKGROUND: The Mediterranean diet is rich in lycopene and has been reported to reduce cardiovascular events. The mechanism of prevention of cardiovascular events has not been clearly established. Our aim was to study the effects of a tomatoes-rich diet on markers of vascular inflammation. METHODS: Plasma concentrations of E-selectin, intercellular adhesion molecule 1 (ICAM-1), and high sensitivity C-reactive protein (hs-CRP) were determined by ELISA in 103 apparently healthy volunteers. Volunteers were randomly assigned to two groups: 50 participants ate 300 g tomatoes daily for 1 month, and 53 participants ate their usual diet with tomatoes prohibited during that period. Markers of inflammation were measured before enrollment and 1 month after their assigned diet. RESULTS: The two diet groups had similar baseline clinical characteristics and similar baseline levels of inflammatory markers. After 30 days of assigned diet concentrations of hs-CRP, E-selectin and ICAM-1 were unchanged compared with baseline in the tomato-rich diet. However, ICAM-1 concentration was increased in the regular diet group from 247.55+/-55 ng/ml to 264.71+/-60.42 ng/ml (P=0.01). CONCLUSIONS: The mechanisms of benefit of the tomato-rich diet are not directly related to inhibition of markers of vascular inflammation.

Beneficial effects of sauna bathing for heart failure patients.

Generally, the sauna bathing has been contraindicated for patients with chronic heart failure. However, it has been well tolerated and improved hemodynamics has been shown in patients with chronic heart failure after a single exposure and after a four-week period of sauna bathing (five days per week). Left ventricular ejection fraction increased from 24+/-7% to 31+/-9% and left ventricular end-diastolic dimension decreased from 66+/-6 mm to 62+/-5 mm after four weeks. In the present review, the mechanisms of action, the clinical data available to date and the possible beneficial effects of sauna bathing for patients with heart failure are discussed, as well as the precautions and the contraindications in this specific group of patients with chronic heart failure.

The stroke trial - can we predict clinical outcome of patients with ischemic stroke by measuring soluble cell adhesion molecules (CAM)?

BACKGROUND: Several studies have found that an increased concentration of haemostatic or inflammation markers was associated with worse prognosis in vascular disease. The inflammatory components in ischemic stroke are of current interest, and there is some experimental evidence that they may be linked. HYPOTHESIS: The study was performed to determine the association between the neurological clinical outcome and levels of cell adhesion molecules in the first four days of hospitalization in patients with acute ischemic event. METHODS: This prospective, pilot, case-controlled study examined the association between the clinical outcome and inflammatory markers within the first few days of hospitalization. The neurological evaluation was performed using the NIH score on admission and four days later, and levels of cell adhesion molecules were measured by ELISA methods on admission and four days later. RESULTS: Twenty three patients with an acute cerebral event (mean age 71 +/- 15 y, 12 women and 11 men) were examined neurologically on admission and four days later. Among 19 patients who improved, there was a significant decrease in the NIH neurological scale, from 3.8 +/- 3.2 to 1.3 +/- 1.8 (p = 0.01), which was accompanied by a significant decrease in the cell adhesion molecules that were measured (E-selectin, ICAM-1 and VCAM-1). Of the four patients who did not improve, their mean clinical NIH score was 10 +/- 4.6 and worsened or remained unchanged after four days of follow-up. In this group, we could not demonstrate a significant change in levels of cell adhesion molecules between days one and four. CONCLUSIONS: Patients who improved clinically within the first four days of hospitalization demonstrated a remarkable inhibition of all three cell adhesion molecules that were measured (E-selectin, ICAM-1, and VCAM-1). Patients who did not improve had more severe cerebral infarcts, a higher NIH score on admission (10 +/- 4.6), and no change was observed in levels of cell adhesion molecules during the follow-up period. Measuring cell adhesion molecule levels may predict objectively the clinical outcome in hospitalized patients with acute ischemic stroke.

[The foundation of the first civil rehabilitation center by the Hadassah organization during the War of Independence].

Following the War of Independence and the establishment of the State of Israel (November 1947 July 1949), there were large numbers of wounded and disabled soldiers and civilians. This situation forced the State of Israel to develop temporary rehabilitation centers. Rehabilitation centers for disabled patients to attend following hospital release were non-existent at the time in civilian hospitals. In August 29, 1948 the first civilian rehabilitation center was founded by the Hadassah Medical Organization in Jerusalem. By the end of the war, the center was closed due to lack of financial support and political reasons. This article describes the establishment of this center by the Hadassah Medical Organization during the War of Independence.

"No Good Deed Goes Unpunished": Ignaz Semmelweis and the Story of Puerperal Fever.

Ignác Fülöp Semmelweis was born almost 200 years ago, in 1818, to a well-to-do middle class Hungarian family. He started law school in 1837, switched to medicine a year later, and graduated in 1844.

High serum lactate level may predict death within 24 hours.

BACKGROUND: Unexpected death within 24 hours of admission is a real challenge for the clinician in the emergency room. How to diagnose these patients and the right approach to prevent sudden death with 24 hours is still an enigma. The aims of our study were to find the independent factors that may affect the clinical outcome in the first 24 hours of admission to the hospital. METHODS: We performed a retrospective study defining unexpected death within 24 hours of admission in our Department of Medicine in the last 6 years. We found 43 patients who died within 24 hours of admission, and compared their clinical and biochemical characteristics to 6055 consecutive patients who were admitted in that period of time and did not die within the first 24 hours of admission. The parameters that were used include gender, age, temperature, clinical and laboratory criteria for SIRS, arterial blood lactate, and arterial blood pH. RESULTS: Most of the patients who died within 24 hours had sepsis with SIRS. These patients were older (78.6±14.7 vs. 65.2±20.2 years [p<.0001]), had higher lactate levels (8.0±4.8 vs. 2.1±1.8mmol/L [p<.0001]), and lower pH (7.2±0.2 vs. 7.4±0.1 [p<.0001]). Logistic regression analysis found that lactate was the strongest independent parameter to predict death within 24 hours of admission (OR 1.366 [95% CI 1.235-1.512]), followed by old age (OR 1.048 [95% CI 1.048-1.075] and low arterial blood pH (OR 0.007 [CI <0.001-0.147]). When gender was analyzed, pH was not an independent variable in females (only in males). CONCLUSIONS: The significant independent variable that predicted death within 24 hours of admission was arterial blood lactate level on admission. Older age was also an independent variable; low pH affected only males, but was a less dominant variable. We suggest use of arterial blood lactate level on admission as a bio-marker in patients with suspected sepsis admitted to the hospital for risk assessment and prediction of death within 24 hours of admission.

Ambulatory and Hospital-based Quality Improvement Methods in Israel.

This review article compares ambulatory and hospital-based quality improvement methods in Israel. Data were collected from: reports of the National Program for Quality Indicators in community, the National Program for Quality Indicators in Hospitals, and from the Organization for Economic Cooperation and Development (OECD) Reviews of Health Care Quality.