Aviva Fattal-Valevski, MD, Jacques Bernheim, MD, Yael Leitner, MD, Bela Redianu, RN, Haim Bassan, MD and Shaul Harel, MD
Background: Low birth weight has been shown to be strongly related to hypertension in adult life.
Objective: To determine whether blood pressure is higher in children with intruterine growth retardation than in control subjects.
Methods: Blood pressure was measured in 58 children aged 4-6 years with IUGR and in 58 age-matched controls. The control children, whose birth weight was appropriate for gestational age, were also matched for gestational age.
Results: The children with IUGR had significantly higher mean values of systolic (p<0.05) and diastolic blood pressures (p<0.05) and mean arterial pressure (p<0.05). Significant differences in blood pressure values were found between preterm IUGR (n=21) and preterm controls (p<0.05).
Conclusion: These data indicate that children with IUGR may be at higher risk of hypertension already in childhood.
Haim Ashkenazi, MD, Bernard Rudensky, PhD, Esther Paz, MA, David Raveh, MD, Jonathan A. Balkin, MBBCh, Dan Tzivoni, MD and Amos M. Yinnon, MD
Background: Recent studies have suggested a possible association between Chlamydia pneumoniae infection and coronary heart disease.
Objectives: To determine titers of antibodies to Chlamydia pneumoniae in patients with acute myocardial infraction compared with titers in several control groups.
Methods: This prospective case-control study investigated 209 individuals. We assessed the serum IgG antibody titers to Chlamydia pneumoniae in 57 consecutive patients admitted with AMI to our intensive coronary care unit during a 4 month period. A serum sample was drawn upon admission after 6 weeks. Results were compared with those of four control groups: a) patients admitted with community-acquired pneumonia (n=18), b) patients with community-acquired urinary tract infection (n=42), c) patients with angiographically normal coronary artery disease (n=44), and d) patients with stable coronary artery disease (n=48). Serum immunoglobin G antibody titers to C. pneumoniae were determined using standard micro-immunofluorescene technology.
Results: Of 57 patients with AMI, 32 (56%) had a high lgG titer to C. pneumoniae (>=1:256) on the initial test, which remained unchanged (62%) after 6 weeks. The percentage of patients with high titers was significantly lower in the control groups: 5 of 18 patients (28%) in the pneumonia group (P<0.01), 11 of 42 (26%) in the urinary tract infection group (P<0.01), 11 of 44 (25%) with normal coronary arteries (P<0.01), and 17 of 48 (35%) with stable chronic ischemic heart disease (P<0.05).
Conclusion: The detection of high titers of lgG antibodies to C. pneumoniae in many patients with AMI, compared to control groups, suggest that chronic Chlamydia pneumoniae infection plays a role in the pathogenesis of atherosclerosis and acute ischemic events.
Avital Hershkovitz, MD, Bruce M. Rothschild, MD, Julia H. Rose, PhD, Thomas Hornick, MD and Elizabeth E. O'Toole, MD
Background: Musculoskeletal complaints represent the second most common reason for visits to a physician, second only to the common cold. The limited capability of medical treatment for musculoskeletal disease requires modification of communication with patients by attending to their perception of the disease.
Objectives: To assess patients’ satisfaction with care provided by their primary physicians, and the relationship of patients' satisfaction to their expectations of that care, perceptions of physician performance, and perceived severity of musculoskeletal disease.
Methods: Questionnaires were administered to 90 community-dwelling elderly patients (mean age 76+-8 years) presenting for follow-up appointments with their primary care physicians. Patients were asked to report on their satisfaction with the medical care provided by the primary physicians for musculoskeletal symptoms, their expectations of that care, their perceptions of their primary physicians' interaction (regarding competence, performance, and communication), and their perceptions of disease severity (based on the number of areas involved, pain frequency and intensity, and impact on daily activity). The effects on the degree of satisfaction were assessed with regard to demographic variables, co-morbidity, site involved, and response to recommended treatment.
Results: Most patients (> 85%) expressed overall satisfaction with their doctor's interpersonal skills. Fewer (76.9%) were satisfied with the amount of effort their doctors spend evaluating their musculoskeletal symptoms, the information received regarding their musculoskeletal symptoms (75%), the degree of pain relief (75%), and the degree of functional improvement (61.8%). Level of education and response to recommended treatment for musculoskeletal disease were the only parameters associated with degree of satisfaction (higher education P = 0.005, lower education P = 0.059, medication P = 0.008, rehabilitation P = 0.076). A high level of expectations (regarding physician's care and musculoskeletal disease treatment) was noted.
Conclusions: The high level of patient satisfaction with their primary physicians' care for musculoskeletal symptoms may reflect the overall tendency of the elderly population to be satisfied with its primary care physicians. However, their high level of expectations (related to perceived efficacy of medical treatment) and their unrealistic perceptions of disease may lead to disappointment and non-compliance with their doctor's recommendations. Management of musculoskeletal disease in the elderly should address the patients’ disease perceptions, as well as their therapeutic and functional needs.
Baruch Klin, MD, Lev Zlotkevich, MD, Tifha Horne, MD, Yigal Efrati, MD, Francis Serour, MD and Gad Lotan, MD
Background: Acute scrotal pain in children presents a major diagnostic and therapeutic challenge. Epididymitis has been considered uncommon in childhood. The clinical spectrum and therapeutic policy of the acute scrotum in children is continually being reassessed.
Objectives: To determine whether there has been an increase in the incidence of epididymitis in children and to advocate a more selective surgical approach to the acute scrotum.
Methods: We conducted a retrospective review of 65 children admitted to our department of pediatric surgery with the diagnosis of acute scrotum during a 5 year period.
Results: Of the 65 children admitted with the diagnosis of acute scrotum, epididymitis was diagnosed in 42 (64.6%). The remaining cases included torsion of the testis in 12 patients (18.5%), torsion of the appendix testis in 5 (7.7%), scrotal pain and minimal physical findings in 4 (6.1%), and scrotal hematoma and idiopathic scrotal edema in one patient each. Doppler ultrasound of the groin, color Doppler ultrasound of the testis and testicular nuclide scintigraphy (Tc-99m scan) examinations were performed on 49, 30 and 57 occasions, respectively; the Tc-99m scan was the most effective tool. All the patients with epididymitis were diagnosed before surgical intervention and were treated conservatively.
Conclusions: We observed an increasing frequency of epididymitis in children admitted with the diagnosis of acute scrotum.
Rahamim Avisar, MD, Aharon Arnon, MD, Erez Avisar, BSc and Dov Weinberger, MD
Background: The time to recurrence after surgical removal of primary pterygium (pterygium) and the association between the rate of recurrence and the postoperative interval remain unclear.
Objective: To determine the amount of follow-up time needed to identify recurrence in patients after surgical removal of pterygium.
Methods: We rviewed the files of 143 patients (143 eyes) with recurrent pterygium to determine the interval from surgery to recurrence.
Results: Almost all (91.6%) of the recurrences appeared by 360 days after surgery.
Conclusions: One year is the optimal follow-up time to identify recurrence of pterygium.