Dov Gavish, MD, Eyal Leibovitz, MD, Itzhak Elly, MD, Marina Shargorodsky, MD and Reuven Zimlichman, MD
Background: The implementation of treatment guidelines is lacking worldwide.
Objectives: To examine whether follow-up in a specialized lipid clinic improves the achievement rate of the treatment guidelines, as formulated by the National Cholesterol Education Program and the Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure.
Methods: The study group included patients who were referred to the lipid clinic because of hyperlipidemia. At each of five visits over a 12 month period, lipid levels, liver and creatine kinase levels, body mass index, and adherence to diet and medications were measured, and achievement of the NCEP target level was assessed.
Results: A total of 1,133 patients (mean age 61.3 years, 60% males) were studied. Additional risk factors for atherosclerosis included hypertension (41%), type II diabetes mellitus (21%), smoking (17%), and a positive family history of coronary artery disease (32%). All patients had evidence of atherosclerotic vascular disease (coronary, cerebrovascular or peripheral vascular diseases). The low density lipoprotein target of <100 mg was present in only 22% of patients before enrollment, with improvement of up to 57% after the follow-up period. During follow-up, blood pressure control was improved (from 38% at the time of referral to 88% after 12 months, P < 0.001), as was glycemic control in diabetic patients (HgA1C improved from 8.2% to 7.1% after 12 months, P < 0.001). Improved risk factor control was due to increased compliance to medication treatment (from 66% at enrollment to more than 90% after 12 months), as well as careful attention to risk factor management that translated into a change in the treatment profile during the follow-up. There was an increase in the use of the following medications: aspirin from 68% to 96%, statins from 42% to 88%, beta blockers from 20% to 40%, and angiotensin-converting enzyme inhibitors from 28% to 42%; while calcium channel blocker use decreased from 40% to 30% in patients during follow-up.
Conclusion: Follow-up of patients in a specialized clinic enhances the achievement of LDL-cholesterol treatment goals as well as other risk factor treatment goals, due to increased patient compliance and increased use of medications.
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Yaacov Ori, MD, Haim Neuman, MD, Avry Chagnac, MD, Annette Siegal, MD, Ana Tobar, MD, Maxim Itkin, MD, Uzi Gafter, MD, PhD and Asher Korzets, MB, BS
Background: The use of an automated biopsy system for renal biopsy has recently gained popularity, but its safety in single functioning kidneys is unclear.
Objective: To report our experience with the automated system for closed renal biopsy during a 5 year period.
Methods: Eighty-five patients underwent percutaneous native renal biopsy with the automated biopsy gun (16G needle) under real-time ultrasound. They were chronologically divided into two groups: 41 patients (group A), using an older ultrasound machine; and 44 patients (group B), using a newer ultrasound machine. Nine patients biopsied with a manual 14G Tru-cut needle served as the control (group C).
Results: The number of "attempted" passes at the kidney was 4.0 ± 0.1 in group B, 4.7 ± 0.3 in group A (P < 0.05 vs. group B), and 5.8 ± 0.5 in group C (P < 0.01 vs. group B). The number of successful passes did not differ (3.3 ± 0.1, 3.3 ± 0.1, 3.1 ± 0.2). The ratio of "attempted/successful" was 1.28 ± 0.07 in group B, 1.95 ± 0.38 in A, and 1.90 ± 0.21 in C (P < 0.01 vs. B). The number of glomeruli obtained was similar in the three groups. Adequate tissue was obtained in 95%, 98%, and 100%, respectively. Hemoglobin decreased by 4.3 ± 1.1% in group B, 6.9 ± 1.3% in group A, and 11.3 ± 1.8% in group C (P < 0.05 vs. B). Perinephric/subcapsular hematoma occurred in 5 patients (11.4%) in group A (2 taking aspirin), in 2 patients (4.9%) in group B, and in none in group C. The necessity for blood transfusion post-biopsy was similar in all groups. Four of five patients with single functioning kidneys (one in group A and four in group B) had uneventful biopsies, and adequate tissue was obtained in three.
Conclusions: The use of the automated biopsy gun is effective, safe and has a low rate of major complications. It may be used safely in single functioning kidneys.
Aliza Amiel, PhD, Orit Reish, MD, Elena Gaber, PhD, Ronit Masterman, MD, Tally Tohami, MSc and Moshe D. Fejgin, MD
Background: While most allelic pairs of DNA replicate synchronously during the S phase of the cell cycle, some genes normally replicate asynchronously, i.e., genes on the X chromosome and imprinted genes. The replication control mechanism is unknown but was shown to be impaired in malignancies and chromosomal trisomies where replication pattern becomes asynchronous.
Objectives: To determine the level of asynchronization in replication timing of cells from patients with microdeleted genomes.
Methods: We applied monocolor fluorescent in situ hybridization with different probes on leukocytes from microdeleted genomes.
Results: All samples derived from the microdeleted genomes showed significantly higher levels of an asynchronized pattern compared to normal individuals.
Conclusions: Even a “small” genetic imbalance (microdeletion) can interfere with gene replication and cell cycle progression, as previously shown in full trisomies.
Pierre Singer, MD
Pressure sores are a well-recognized problem, with an etiology that is multifactorial and not solely a consequence of pressure itself. Malnutrition is one of the factors involved, namely low calorie and protein intake. Mainly elderly patients, patients after hip fracture, but also patients after trauma, burns or extended surgery require additional nutritional support to reduce the possibility of pressure ulcers developing. Evidence has shown the efficacy of percutaneous endoscopic gastrostomy in elderly patients with malnutrition and dementia. Nutritional support should include sufficient calories, protein, fat, carbohydrates, vitamins and minerals. Arginine is the main amino acid required and is essential for collagen deposition and wound healing. Vitamin A and zinc should be added to nutritional support.
Zvi Fireman, MD, Arkady Glukhovsky, PhD, Harold Jacob, MD, FACG, Alexandra Lavy, MD, Shlomo Lewkowicz, DSc and Eitan Scapa, MD
Mogher Khamaisi, PhD and Itamar Raz, MD
Gisele Zandman-Goddard, MD and Miri Blank, PhD
Simon Bar-Meir, MD and Eytan Bardan, MD
Imad R. Makhoul, MD, DSc, Monica Epelman, MD, Imad Kassis, MD, Marcelo Daitzchman, MD and Polo Sujov, MD
Yoram Moses, MD and Boris Yoffe, MD, FACS
Alla Shnaider, MD, Anna Basok, MD, Boris Rogachev, MD and Marcus Mostoslavsky, MD
Matitiahu Lifshitz, MD and Vladimir Gavrilov, MD
Dan Miron, MD, Yoseph Merzel, MD, Amiram Lev, MD, Jean-Jack Meir, MD and Yoseph Horowitz, MD
Ido Solt, MD, Ron Beloosesky, MD and Michael Deutsch, MD
Arie Roth, MD and Michal Golovner, MD