Chronic iliofemoral vein obstruction - an under-recognized cause of exercise limitation.

Local symptoms of chronic venous insufficiency after deep vein thrombosis (DVT) are well described, but little is known about the effect of residual venous obstruction on exercise capacity. We tested our hypothesis that chronic residual iliofemoral vein occlusion (IFVO) after DVT may impair exercise capacity. Nine post-DVT patients with residual IFVO and effort intolerance were studied; a comparison cohort consisted of 11 healthy volunteers.

Unexplained cough: it is time to rule out Sjogren's syndrome.

Sjogren's syndrome is associated with chronic cough, but sicca symptoms are missing from cough evaluation guidelines. We evaluated patients with unexplained cough for undiagnosed Sjogren's syndrome. Patients referred to our pulmonary clinic (Sheba Medical Center, 2009 to 2012) with unexplained cough and concomitant dry eyes were selected for evaluation.

Cardio-vascular reserve index (CVRI) during exercise complies with the pattern assumed by the cardiovascular reserve hypothesis.

Objectives: The Cardio-vascular reserve index (CVRI) had been empirically validated in diverse morbidities as a quantitative estimate of the reserve assumed by the cardiovascular reserve hypothesis. This work evaluates whether CVRI during exercise complies with the cardiovascular reserve hypothesis.

Design: Retrospective study based on a database of patients who underwent cardio-pulmonary exercise testing (CPX) for diverse indications.

Exercise haemodynamics may unmask the diagnosis of diastolic dysfunction among patients with pulmonary hypertension.

Aims: Heart failure with preserved ejection fraction can lead to pulmonary hypertension. The aim of the present study was to evaluate the role of exercise during right heart catheterization in the unmasking of diastolic dysfunction.

Methods And Results: Between 2004 and 2012, 200 symptomatic patients with exertional dyspnoea, preserved left ventricular systolic function and suspected pulmonary hypertension, underwent right heart catheterization.

Autoimmune pulmonary alveolar proteinosis: clinical course and diagnostic criteria.

Pulmonary alveolar proteinosis (PAP) is caused by accumulation of surfactant components in the alveoli and terminal airways. All forms of PAP are caused by insufficient surfactant clearance by alveolar macrophages. Autoimmune PAP, a rare, antibody-mediated disease, that compromises 90% of cases of PAP, is causes by IgG autoantibodies that block GM-CSF effect, a crucial step for macrophage maturation.

Methacholine challenge testing: improved patient comfort with a 2-tiered protocol.

Background: The methacholine challenge test (MCT) is a test of bronchial hyperreactivity used as an aid in the diagnosis of asthma. MCT results are reported as the provocation concentration at which the forced expiratory volume in 1 second (FEV1) decreases 20% (PC20). The requirement for a 20% or greater decrease in FEV1 results in precipitous decreases in FEV1 in some patients.

Breath-hold after forced expiration before removal of the biopsy needle decreased the rate of pneumothorax in CT-guided transthoracic lung biopsy.

Purpose: To assess the effect of a breath-hold after forced expiration on the rate of pneumothorax after computed tomography (CT)-guided transthoracic needle biopsy of pulmonary lesions.

Materials And Methods: Between January 2008 and December 2011, percutaneous CT-guided lung biopsy was performed in 440 patients. Two hundred and twenty-one biopsies were performed without (control group) and two hundred and nineteen biopsies were performed with (study group) the study maneuver - a breath-hold after forced expiratory approach.

[Normal or high maximal oxygen uptake: a target in health].

To achieve the predicted maximal oxygen consumption, many organs need to increase their output in a synchronized fashion. Therefore, maximal oxygen consumption is the single most reliable parameter predicting fitness, morbidity and mortality. Peak O2 uptake can be measured from noninvasive ventilatory parameters during short, incremental, cardiopulmonary exercise test (CPET) on a cycle ergometer or on a treadmill.

[Chronic thromboembolic pulmonary hypertension: can successful thrombendarterectomy normalize exercise capacity and gas exchange?].

Introduction: Chronic thromboembolic pulmonary hypertension, a rare complication of pulmonary embolism is amenable to thrombendarterectomy (TEA) and when successful, improves exercise capacity and normalizes resting pulmonary arterial pressure.

Goal: To test if exercise capacity and exercise gas exchange are also normalized after successful TEA.

Methods: Over a period of 4 years, 5 patients underwent TEA at Sheba Medical Center.

[The verge and the abyss: tiotropium (Spiriva) in COPD].

Tiotropium, a Long-acting anticholinergic bronchodilator, has many beneficial effects in chronic obstructive pulmonary disease (COPD). Among them are: a bronchodilator effect which is additive to that of beta-adrenergic agonists, that persists long-term without tolerance; reduction of dyspnea; improved exercise tolerance; enhanced response to rehabilitation; improved quality of life; and reduced frequency of exacerbations and hospital admissions. Therefore, tiotropium is widely used, and has been added to the Health Basket by the Israel Ministry of Health.

Ventilatory response to hypercapnia in C(5-8) chronic tetraplegia: the effect of posture.

Objective: To study the effect of posture on the hypercapnic ventilatory responses (HCVR).

Design: Nonrandomized controlled study.

Setting: Rehabilitation hospital and a pulmonary institute.

Diaphragmatic paralysis: a clinical imitator of cardiorespiratory diseases.

Diaphragmatic paralysis has a predictable effect on lung function. However, the symptoms depend on the preexisting heart-lung diseases and may mimic various cardiorespiratory processes. We describe the presentation in six patients.

Familial Mediterranean fever gene and protection against asthma.

Background: Asthma is an inflammatory airway disease caused by interaction between susceptibility genes and diverse environmental factors. In Israel, asthma seems to be familial and more severe in patients of Iraqi Jewish descent. On the other hand, asthma is less frequent in individuals with familial Mediterranean fever, an autoinflammatory disease prevalent in the Iraqi Jewish community and linked to mutations in the familial Mediterranean fever gene, designated MEFV.

Breath sound distribution images of patients with pneumonia and pleural effusion.

Objective: To determine whether breath sound distribution maps can differentiate between patients with pneumonia or pleural effusion versus healthy controls.

Methods: We recorded breath sounds from 20 patients conventionally diagnosed as having pleural effusion, 20 patients conventionally diagnosed as having pneumonia, and 60 healthy controls, of whom 20 served as a learning sample. All subjects were examined with a computer-based multi-sensor breath sound mapping device that records, analyzes, and displays a dynamic map of breath sound distribution.

Exercise training in advanced heart failure patients: discordance between improved exercise tolerance and unchanged NT-proBNP levels.

Background: Exercise training can improve aerobic capacity and symptoms in congestive heart failure (CHF) patients.

Aims: To test the feasibility of exercise training in advanced CHF patients, and examine the potential benefit from peripheral vascular and muscular conditioning as well as improved central hemodynamic and neurohumoral status.

Methods And Results: Thirty NYHA functional class III, CHF patients (mean age 61+/-13 yr, ejection fraction 27+/-4%, VO2max 11.

Effects of exercise training on quadriceps muscle gene expression in chronic obstructive pulmonary disease.

Exercise capacity and training response are limited in chronic obstructive pulmonary disease (COPD), but the extent to which this is related to altered skeletal muscle function is not fully understood. To test the hypothesis that muscle gene expression is altered in COPD, we performed needle biopsies from the vastus lateralis of six COPD patients and five sedentary age-matched healthy men, before and after 3 mo of exercise training. RNA was hybridized to Affymetrix U133A Genechip arrays.

Detection of non-diploid cells in premalignant and malignant oral lesions using combined morphological and FISH analysis - a new method for early detection of suspicious oral lesions.

Alteration in DNA content is an early event in oral carcinogenesis. We have examined oral brush samples to detect non-diploid cells (NDC) using simultaneous morphological and cytogenetic analysis. The study included 8 oral squamous cell carcinomas (OSCC), 22 premalignant lesions (OPLs), and 25 control individuals.

Do angiotensin-converting enzyme (ACE) inhibitors enhance the effect of exercise rehabilitation in patients with hypertension and ACE DD and DI genotypes?

Objective: To test whether pharmacologic angiotensin-converting enzyme (ACE) inhibition in carriers of the ACE DD or DI (D, deletion; I, insertion of 287 base pairs) genotypes can simulate the genetic advantage of the II genotype and thereby enhance the conditioning effects of aerobic exercise.

Design: Nonrandomized controlled trial.

Setting: Pulmonary institute.

Central versus peripheral cardiovascular limitation to exercise: the role of two-modality testing.

Background: Uncertainty arises when physiological findings indicate a cardiovascular limitation but the limiting constituents within the cardiovascular system cannot be identified.

Objectives: It was the aim of this study to investigate the value of two-modality exercise testing to assess effort intolerance when the cause remains obscure despite standard exercise testing.

Methods: A second modality maximal exercise test to fatigue, using either upper extremity or supine exercise, was performed following a nonconclusive standard sitting ergometry.

Necrotizing granulomata in the lung preceding colonic involvement in 2 patients with Crohn's disease.

Extraintestinal involvement, including the chest, is common in the late course of Crohn's disease. We describe 2 female patients in whom the course of the disease was unique in two aspects: (1) each had a pulmonary mass with granulomatous inflammation and necrosis, and (2) these findings had preceded the colonic involvement by 5 years. This sequence supports some of the theories on the pathogenesis of Crohn's disease and on its possible relation with sarcoidosis, another idiopathic granulomatous disease.

Effects of aerobic training on gene expression in skeletal muscle of elderly men.

Purpose: To analyze the effect of 3 months of training on global gene expression in skeletal muscle of healthy elderly men in order to better characterize the pathways that differentiate the trained from the sedentary state.

Methods: Needle biopsies were obtained from the vastus lateralis of six healthy, sedentary, 68.0 +/- 2.

Ventilatory support during training improves training benefit in severe chronic airway obstruction.

Background: One mechanism that may limit training effect in chronic obstructive pulmonary disease is the ventilatory limitation and associated dyspnea.

Objectives: To minimize ventilatory limitation during training of patients with severe COPD by applying bi-level positive pressure ventilation during training in order to augment training intensity (and effect).

Methods: The study group comprised 19 patients (18 males, 1 female) with a mean age of 64 +/- 9 years.

[By the sweat of your brow shall you eat bread: a blessing or a curse?].

Physical activity is crucial for maintaining normal structure and function of metabolic processes and body organs, such as the heart and muscles. Lack of regular activity leads to the deterioration of these organs, thereby increasing levels of morbidity and mortality. Physical activity is associated with lower incidence of total mortality and mortality from heart diseases.

Reduced exercise capacity in untreated adults with primary growth hormone resistance (Laron syndrome).

Objective: Primary IGF-I deficiency (Laron syndrome, LS) may decrease exercise capacity as a result of a lack of an IGF-I effect on heart, peripheral muscle or lung structure and/or function.

Methods: Eight patients (six females) who had never received treatment with IGF-I, with mean age of 36 +/- 10 (SD) years (range 21-48), weight 47 +/- 9 kg (31-61), height 126 +/- 12 cm (112-140) and body mass index of 29 +/- 4 kg/m2 (24-34), and 12 age-matched controls, underwent lung function tests and incremental cycling to the limit of tolerance (CPX, MedGraphics). Predicted values for the patients were derived from adult equations based on height.