Blood pressure changes at the Dead Sea (a low altitude area).

The Dead Sea (barometric pressure: 800 mm Hg) is an important balneotherapeutic centre for chronic dermatologic and arthritic diseases. In the past, hypertensive patients have complained sporadically of weakness and dizziness during a stay in the Dead Sea. It was therefore recommended that hypertensives do not stay at these health centres. The aim of our study was to investigate the changes in blood pressure (BP) parameters of 72 hypertensive and normotensive osteoarthritic and rheumatoid arthritic elderly patients during a 2-week stay in the Dead Sea, and to further evaluate the effect of different balneotherapeutic means on these BP changes. Following a primary BP assessment at the out-patient clinic (Beer Sheva barometric pressure: 745 mm Hg), the patients were divided into four groups: (1)thermomineral pool; (2)Dead Sea water baths; (3) combination of the aforementioned treatments; and (4) controls (no balneotherapy). We demonstrated that the systolic BP (SBP) of hypertensives and normotensives decreased by an average of 17 mm Hg and that diastolic BP (DBP) decreased by an average of 8 mm Hg from their basic clinic-measured values. These favourable results were sustained during the first 10 days duration, and by the end of their stay they had diminished slightly. Thermomineral water had an additional lowering effect on the BP of the normotensives, but the SBP of hypertensives increased. Immediately following Dead Sea bath immersion, we noted a temporary increase of SBP in normotensives only. No patient, hypertensive or normotensive, complained of dizziness, malaise, or any other complaint. In our experience, patients feel well at low altitudes, and there is no justification in upholding hypertension as a contraindication to balneotherapy in the Dead Sea.

INFLUENCE OF EGF ON THE RELATIVE VOLUMES OF COLLOID, EPITHELIUM AND STROMA AND ON THYROCYTE NUCLEI SIZE IN RAT THYROID LOBES IN VITRO.

The epidermal growth factor (EGF) is believed to be a potent growth factor for the thyroid gland. In the present study, we have examined the relative volumes of the main histological compartments (colloid, epithelium and stroma) and the size of thyrocyte nuclei (the mean volume, the mean intersection area and the mean perimeter) in the rat thyroid lobes incubated in vitro for 18 hrs with EGF, applied in 5 different concentrations: 0.1, 1.0, 10, 100 and 1000 ng/ml. Morphometric evaluation was performed, using a computer image analysis system, developed by us. We found that EGF - in concentration of 100 ng/ml - increased the relative volume of stroma when compared to controls, as well as to all the other groups incubated in exposure to that growth factor (used in different concentrations); at the same time, EGF decreased the relative volume of epithelium in the thyroid gland (statistical significance has been recorded only vs. EGF concentrations of 10 ng/ml and 1000 ng/ml). On the other hand, we observed that EGF - in concentration of 100 ng/ml - significantly increased the mean nuclear volume and the mean intersection area of thyrocyte nuclei when compared to the controls, as well as to EGF in concentrations of 1 ng/ml and 1000 ng/ml. With regards to the mean perimeter, a significant increase of its length was noted in the EGF(100 ng/ml)-exposed group vs. the group incubated with an addition of EGF (1 ng/ml).

Three teams improving thrombolytic therapy.

BACKGROUND: The American Heart Association (AHA) standard for delivering thrombolytic therapy to chest pain patients is 30 to 60 minutes after patient presentation to the emergency department. Three acute care hospitals in an integrated health system in northern California shortened the time of administration of thrombolytic agents to appropriate patients presenting with chest pain in the emergency department. FINDING THE SOLUTIONS: Physician-led multidisciplinary teams developed algorithms to reduce variation and decrease the thrombolytic administration process to 30 minutes. Changes were made to prehospital and hospital thrombolytic policies and staff practices. REALIZING RESULTS: Each of the three acute care hospitals reduced their thrombolytic administration time by 48% to 59% to levels within the AHA standard. LEARNING FROM THE PROCESS: Internal benchmarking for clinical processes promotes a synergy between hospitals and medical staffs for the improvement of patient care. Multidisciplinary teams, which include community representatives, achieve a thorough understanding of a process, which in turn reduces variation in practice and improves quality.

Fibromyalgia in familial Mediterranean fever.

OBJECTIVE: To determine whether chronic lower body pain in a subpopulation of patients with familial Mediterranean fever (FMF) is due directly to the musculoskeletal manifestations of FMF or whether they are connected to mechanical problems in the low back and leg/foot or to other factors operative in fibromyalgia (FM). METHODS: In 93 consecutive patients with FMF a point count of 14 tender points (TP) was conducted by thumb palpation. Tenderness thresholds were assessed in some of the TP and of control point sites by Chatillon dolorimeter. RESULTS: In female patients with FMF dolorimeter thresholds of fibrositic and control point sites were significantly lower than in male patients with FMF (p < 0.004). Also patients with FMF with back pain and foot/leg pain are more tender than patients with FMF without this characteristic (p < 0.001). CONCLUSION: The detection of FM and definition of tenderness thresholds is relevant to this disease, since musculoskeletal complaints are common in this group of patients but not always explained by objective findings.

Environmental and genetic factors of hypertension in a biracial Beduin population.

This study attempts to understand the various factors involved in the pathophysiology of hypertension in black Beduins. Parameters known to differentiate US black from white hypertensives were examined. Sixty Beduin families (thirty families each of black and white, total of 205 subjects) were evaluated for environmental risk factors: a traditional nomad shepherd life-style compared with working in a city, living in tents or in western style housing and dietary habits related to cardiovascular risk factors. Blood pressure, body mass index (BMI), sodium-lithium counter transport rate and 24 hour urinary sodium excretion (UNa) were measured and the data obtained were compared between normotensives and hypertensives, within each racial group. The mean value of the BMI of the white population was greater than that of the black population while the BMI of hypertensives was greater than that of the normotensives in each of the racial groups. The mean systolic BP of black hypertensives was greater than that of the corresponding whites. There were no significant differences in UNa between the four groups. Sodium-lithium countertransport was significantly higher in the hypertensive whites compared with the normotensive population (0.46 versus 0.22 mmol Li efflux/IRBC/hr). The countertransport rate for black hypertensives was lower than that of white hypertensives (0.20 versus 0.46). Black families had lower socio-economic scores than did white families and families with a hypertensive member scored lower than did families with a normotensive history. These results demonstrate some similarities between the American and Beduin black hypertensive populations, in spite of entirely different life-styles, indicating that in these populations genetic factors, rather than environmental influences, appear to be dominant in the pathophysiology of hypertension.

Serum and synovial fluid levels of serum amyloid A protein and C-reactive protein in inflammatory and noninflammatory arthritis.

Serum and synovial fluid (SF) levels of serum amyloid A (SAA) and C-reactive protein (CRP) were measured in 46 cases of various inflammatory arthritis (Group 1), and in 40 cases of noninflammatory arthritis: 18 cases of osteoarthritis (Group 2) and 22 cases of traumatic arthritis (Group 3). Serum and SF SAA levels were markedly elevated in Group 1: 126.4 micrograms/ml +/- 19.2 SEM and 46.4 micrograms/ml +/- 10.5 SEM, respectively; moderately elevated in Group 2: 10.1 micrograms/ml +/- 2.9 SEM, 4.0 micrograms/ml +/- 1.1 SEM and moderately elevated in Group 3: 10.4 micrograms/ml +/- 1.2 SEM, 4.0 micrograms/ml +/- 1.2 SEM, respectively. Serum/SF SAA ratios were similar in all 3 groups and ranged between 2.52-2.72. In comparison to SAA, the increment of serum and SF CRP above normal levels was moderate. A positive strong correlation was found between serum SAA and serum CRP: r = 0.64 (p less than 0.001) and between SF SAA and SF CRP: r = 0.59 (p less than 0.0001). SF SAA did not correlate with the number of SF white blood cells but did correlate with the percent of SF polymorphonuclear cells: r = 0.23 (p less than 0.05).