The effect of music during warm-up on consecutive anaerobic performance in elite adolescent volleyball players.

Music is believed to improve athletic performance. The aim of the present study was to determine the effect of arousing music during warm-up on anaerobic performance in elite national level adolescent volleyball players. Twenty-four players (12 males and 12 females) performed the Wingate Anaerobic Test following a 10-minute warm-up with and without music (two separate occasions, random order). During warm-up with music, mean heart rate was significantly higher. Following the warm-up with music, peak anaerobic power was significantly higher in all volleyball players (10.7 +/- 0.3 vs. 11.1 +/- 0.3 Watts/kg, p < 0.05, without and with music, respectively). Gender did not influence the effect of music on peak anaerobic power. Music had no significant effect on mean anaerobic output or fatigue index in both genders. Music affects warm-up and may have a transient beneficial effect on anaerobic performance.

Correlation between serum lipids and stroke in an Israeli population.

The role of blood lipids as a risk factor for cerebrovascular disease remains uncertain. In the present prospective study, 202 patients admitted with stroke to a community hospital in Jerusalem were evaluated. All patients had a full clinical and neurological evaluation, and a risk factor analysis. The study protocol included routine blood evaluation, fasting blood lipid analysis, brain imaging, 2D echocardiography and carotid Doppler ultrasonography. Stroke risk factors were correlated to stroke types as defined by the modified NINCDS Stroke Data Bank Criteria. Lacunar and atherosclerotic ischaemic infarctions were the most frequent type of stroke in both sexes. Lipid values were in general lower in males than in females. Comparison of stroke patients to age and sex matched controls disclosed lower LDL-C values in male and female patients (p less than 0.001), and lower cholesterol levels in women with strokes than in control subjects (p less than 0.001). Our study corroborates previously reported risk factors for stroke: hypertension (major risk factor in both sexes), smoking (more prevalent in males) and diabetes (more frequent in females).

Clinical, psychological and thallium stress studies in patients with chest pain and normal coronary arteries.

The clinical and psychological profiles of 36 consecutive patients with chest pain and normal coronary arteries (study group) were compared to those of 34 patients with chest pain and significant coronary arterial disease (control group). All 70 patients were hospitalized for chest pain at least once prior to coronary angiography. The features of a typical episode of chest pain were similar in the normal coronary arteries and coronary arterial disease groups, but the female patients with normal coronary arteries had a shorter duration of a typical episode of chest pain, and the male patients with normal coronary arteries had a lower frequency of positive effort tests. Psychological testing showed the women with normal coronary arteries to have a tendency to increased somatization, anxiety, and a lower ability to identify origin of difficulties. The patients in the normal coronary and coronary arterial disease groups had psychological profiles typical of patients with chronic somatic disease. A psychiatric interview demonstrated an increased frequency of depressive trait (score 0-2) in the normal women (0.6 +/- 0.8 vs 0, P less than 0.05), and a tendency to increased somatization, anxiety, and sleeping disorders. Increased somatization was found in the normal coronary men (1.1 +/- 0.7 vs 0.5 +/- 0.7, P less than 0.05). Twenty-five patients of the normal coronary group underwent quantitative thallium stress studies, and 13 patients (52%) had evidence of stress-induced myocardial perfusion defect. There were no differences in the clinical and psychological profiles of the patients with normal and those with pathological thallium stress tests.(ABSTRACT TRUNCATED AT 250 WORDS)

Failure of long-term digitalization to prevent rapid ventricular response in patients with paroxysmal atrial fibrillation.

Digitalis is frequently prescribed to patients with paroxysmal atrial fibrillation to reduce the ventricular rate during subsequent paroxysms. To verify the validity of this assumption, we determined the ventricular rate during paroxysmal atrial fibrillation in 13 patients receiving long-term digoxin therapy (mean plasma digoxin level + 1.28 +/- 0.4 ng/ml) and compared it with that of a group of 14 patients who had not taken digoxin or beta-adrenergic and calcium-blocking agents before the attack. The treated and the untreated groups were similar statistically. The mean ventricular rate of the digitalized patients was 121 +/- 15 beats per minute, while that of the patients in the control group was 118 +/- 16 beats per minute. It is concluded that long-term digoxin therapy is not effective in reducing the ventricular response in patients with paroxysmal atrial fibrillation despite adequate therapeutic levels.

Polyarteritis nodosa and familial Mediterranean fever: a report of 2 cases and review of the literature.

Two cases of polyarteritis nodosa (PAN) in patients with familial Mediterranean fever (FMF) are reported. These and another 11 cases found in the literature suggest that PAN occurs more commonly in patients with FMF than would be expected in the general population. Perirenal hematoma, which is surprisingly high in patients with FMF, is a life threatening complication of PAN. The diagnosis of PAN in patients with FMF may be delayed due to the similarity of the clinical manifestations of both diseases.

Pathophysiological changes associated with increasing grade of hepatic encephalopathy.

The pathophysiological changes occurring with increasing grade of encephalopathy were examined in 93 consecutive episodes in 44 patients with liver cirrhosis (37 posthepatic). The incidence of gastrointestinal bleeding and leukocytosis increased significantly when the grade advanced from 1 to 5. The following variables showed a trend for change that did not reach statistical significance: rising serum bilirubin, SGOT, and BUN levels; decreasing serum sodium and chloride levels; and increased incidence of infection. The mean values of the following variables were significantly different in 25 fatal episodes and 68 survivors, implicating a bad prognosis: high serum bilirubin, alkaline phosphatase, and BUN levels; low serum albumin, sodium, and chloride levels; and a higher incidence of severe infections (sepsis, infected ascitic fluid). Because increasing grade of encephalopathy is the most important factor in determining the prognosis of hepatic encephalopathy (mortality 0, 10, 5, 19, and 85 percent in grades 1 to 5, respectively), more efforts should be made to understand and prevent the pathophysiological changes associated with advancing grades of encephalopathy.

Variable efficacy of interferon-alpha treatment on growth of human hepatoma cell lines in vitro.

Three human hepatoma cell lines, PLC/PRF/5, Mahlavu and Sk-Hep 1, two of which contain integrated HBV DNA, were grown in culture and treated with human alpha-IFN for up to 14 days. IFN treatment caused a varying suppression of cell growth of the three hepatoma cell lines. While doubling time and cloning efficiency were significantly reduced for all three hepatoma cell lines tested, 3[H]thymidine incorporation was markedly suppressed, in a dose-dependent fashion, only in treated PLC/PRF/5 cells but not in Sk-Hep 1 and Mahlavu cells. The inhibiting effect of interferon treatment on growth of PLC/PRF/5 cells in vitro was neutralized by antibodies to human IFN. IFN treatment caused a significant suppression of HBsAg and alpha FP secretion by PLC/PRF/5 hepatoma cells. This effect, while constant throughout the observation period for HBsAg, was cumulative for alpha FP secretion. Following discontinuation of treatment, suppression of PLC/PRF/5 hepatoma cell growth was rapidly reversed, and HBsAg and alpha FP secretion returned to their pretreatment levels. These experiments suggest that human alpha-IFN suppresses the growth of some human hepatoma cells in culture but that this effect is dependent on the continuous presence of IFN in the growth medium. Finally, the inhibitory effects of IFN on cell growth differed for the various hepatoma cell lines tested.

Fertility and obstetric history in patients with familial Mediterranean fever on long-term colchicine therapy.

The obstetric histories were examined for 36 women with familial Mediterranean fever (FMF) on long-term colchicine treatment followed for periods ranging between 3 and 12 years. Seven of 28 pregnancies (25%) associated with colchicine therapy ended in miscarriage. Thirteen women (36%) had periods of infertility; these were due to ovulatory dysfunction in six women, to peritoneal adhesions in four and remained unexplained in three women. The rates for miscarriage and infertility are high but are similar to those reported for women with FMF before colchicine therapy was introduced. All 16 infants born to mothers who had taken colchicine during pregnancy were healthy. Currently, we do not advise discontinuation of colchicine before planned pregnancy but recommend amniocentesis for karyotyping and reassurance.

PIP: The obstetric histories of 36 women with familial Mediterranean fever (FMF) on longterm colchicine treatment were followed for periods ranging from 3-12 years and examined. 7 of 28 pregnancies (25%) associated with colchicine therapy ended in miscarriage. 13 women (36%) had periods of infertility; these were due to ovulatory dysfunction in 6 women, to peritoneal adhesions in 4, and were unexplained in 3 women. The rates for miscarriage and infertility are high but are similar to those reported for women with familial Mediterranean fever before colchicine therapy was introduced. All 16 infants born to mothers who had taken colchicine during pregnancy were healthy. Currently, it is not advised that colchicine be discontinued before a planned pregnancy but rather, amniocentesis is recommended for karyotyping and reassurance.

Immunogenetics of rheumatoid arthritis in Israel.

In an attempt to study the variation of associations between HLA and rheumatoid disease a population of 44 Ashkenazi and 29 non-Ashkenazi patients with Rheumatoid Arthritis were tested for HLA-A, B, C and DR antigens and compared with the relevant control groups. In contrast to the results obtained in Middle European or North American Caucasians, Rheumatoid Arthritis in Israel is not associated with B15 and Cw3, indicating that it is very unlikely that B- and C-locus antigens are involved in coding for disease susceptibility for RA. The allele DR4 which is found associated with RA in almost all populations tested so far was in the total patient group (47.9%) slightly but not significantly more frequent than in the control group (38.3%). This difference was entirely due to a nonsignificant increase in the frequency of DR4 in the Ashkenazi patients (54.5%) compared to controls (40%), while the frequency of DR4 in non-Ashkenazi patients and controls was virtually identical (38.0% vs 36.7%). Another surprising finding was that the frequency of HLA-DR1, which has been reported to be increased in different populations of patients with RA was found to be completely normal in the present study on Israeli patients. The alleles of the Bf and the GLO system did not show any significant difference between patients and controls.(ABSTRACT TRUNCATED AT 250 WORDS)

Total lymphoid irradiation in refractory systemic lupus erythematosus.

In two patients with systemic lupus erythematosus, conventional therapy was considered to have failed because of persistent disease activity and unacceptable side effects. Both were treated with total lymphoid irradiation without clinical benefit, despite adequate immunosuppression as documented by markedly reduced numbers of circulating T lymphocytes and T-lymphocyte-dependent proliferative responses in vitro. The first patient developed herpes zoster, gram-negative septicemia, neurologic symptoms, and deterioration of lupus nephritis. The second patient developed massive bronchopneumonia, necrotic cutaneous lesions, and progressive nephritis and died 2 weeks after completion of radiotherapy. These observations, although limited to two patients, indicate that total lymphoid irradiation in patients with severe systemic lupus erythematosus should be regarded as strictly experimental.

The effects of long-term colchicine therapy on male fertility in patients with familial Mediterranean fever.

Four out of 19 male patients suffering from familial Mediterranean fever (FMF) had fertility problems while on colchicine therapy (0.5-2.0 mg daily for as long as 11 years). Three of the patients had had children while off therapy but their wives could not conceive while they were on therapy. In one patient primary sterility remained one year after cessation of colchicine. In this and two other patients the spermiogram was normal but the sperm penetration test was pathological. The fourth patient had azoospermia. Patients should be informed about this possible risk of colchicine therapy. The need for continued follow-up and the value of the sperm penetration test in the detection of fertility problems in male patients on long-term colchicine therapy are stressed. It is concluded however, that overall the benefits outweigh the danger of long-term colchicine treatment in male patients with FMF.

Yellow nail syndrome: case report and review of the literature.

A patient with yellow nail syndrome is described. The presenting features were right pleural effusion resistant to therapy, leg edema and slow-growing yellow nails. T-lymphopenia in the peripheral blood and T cell predominance in the pleural fluid were demonstrated. In addition, the capillaries in the conjunctival and nail beds showed increased vasomotion and decreased diameter. It is suggested that the disease is not confined to the lymphatic system, but also involves the capillaries.

A simple prognostic index for hospitalized geriatric patients. A prospective study of 70 patients.

A simple prognostic index for hospitalized geriatric patients is reported herein. Seven parameters including: mobility, sphincter control, mental competence, feeding ability, presence of pressure sores, medical condition and family state were recorded in 70 patients. The sum of the scores of all parameters constituted the prognostic index. At the end of 3 months the patients were divided into two groups: 18 patients who were discharged (group 1) and 52 patients who were still hospitalized (35 cases) or had died (17 cases) (group 2). The mean index for group 1 was 14.9 +/- 3.2 (mean +/- SD), while that for group 2 was 23.5 +/- 4.3 (p less than 0.00001). Eighty-three percent of the patients in group 1 and only 8% of those in group 2 had scored lower than 17. Thus, the score of 17 or more had a prognostic sensitivity of 92% and a specificity of 83%. The predictive value of indices of 17 or more was 94%. The index described offers therefore a simple and relatively accurate tool for the assessment of the prognosis of elderly patients.

Syncope: a retrospective study of 101 hospitalized patients.

A retrospective study was conducted of 101 hospitalized patients who had one or more episodes of syncope. The etiology of syncope was established with relative ease in 61% of these patients. History and physical examination revealed the cause in 34%, resting ECG in 11% and 24-h ECG monitoring in 16%. Additional tests (electroencephalograms, Doppler studies of the cervical arteries, computerized tomography of the brain, ultrasonography of the heart and cardiac catheterization) either were noncontributory or did not contribute to confirmed diagnoses already established by other means. Cardiac causes were responsible for the syncope in 34% and noncardiac causes in 27%. Comparison between diagnosed and undiagnosed patients revealed no significant differences with respect to age, number of syncopal episodes or presence of hypertension or diabetes. There were, however, significantly more women, and a lower frequency of ischemic heart disease and other associated diseases in the undiagnosed group. It is concluded that all patients with syncope should undergo ambulatory ECG and 24-h ECG monitoring, and that hospitalization should be reserved for patients whose clinical condition requires admission or when further investigation is necessary.

Quinidine-induced vasculitis.

Four patients developed nonthrombocytopenic purpura two to three weeks after initiation of quinidine therapy. The skin lesions disappeared and did not recur after cessation of quinidine therapy. Histologic examination revealed leukocytoclastic vasculitis with deposition of C3, IgA, and/or IgM in the small dermal vessels. Since quinidine purpura is usually associated with thrombocytopenia, the possibility of leukocytoclastic vasculitis as an additional cause of purpura is stressed.

Short course of synacthen therapy as an adjunct in the management of rheumatoid arthritis.

The effect of synthetic adrenocorticotrophic hormone (Synacthen), in conjunction with hydroxychloroquine, aurothioglucose, or penicillamine, was evaluated retrospectively in 21 patients with rheumatoid arthritis (RA). One mg of depo Synacthen was administered at increasing intervals of 4 to 14 days for a total period of 3 to 7 months. Fourteen patients with RA on either hydroxychloroquine or aurothioglucose and not on Synacthen, served as controls. Patients in the Synacthen group were, on the whole, sicker, as indicated by a lower functional capacity, higher mean erythrocyte sedimentation rate, and systemic and articular indices. Physicians' estimate of the patients condition after 1 - 2 months of therapy showed no improvement or deterioration in 10 out of 13 cases in the control group. Likewise, the erythrocyte sedimentation rate decreased significantly more and seronegativity was achieved in more of the Synacthen-treated cases. Six to 8 months after the beginning of therapy (1 to 4 months after cessation of Synacthen) clinical improvement was comparable in both groups, although seroconversion was more common in patients who had received Synacthen (7 out of 10 as compared to 1 out of 7 respectively). It is suggested that Synacthen may be used safely in the early phase of selected RA patients, until the effect of second-line drugs is achieved.