Incidence of glioblastoma multiforme in Aragon and La Rioja. An epidemiological survey

The aim of this work has been to evaluate the epidemiologic data in a series of 157 patients operated for glioblastoma multiforme in Aragón and La Rioja, during a period of 15 years. We haven't analyzed the cases that weren't operated on, because of the localization of the tumor or the bad situation of the patient. All the patients have an anatomopathologic confirmation. We have studied a total of 795 patients operated for a cerebral or cerebellar tumor. The glioblastoma multiforme was the third type of tumor in frequency, after the meningioma and the astrocytoma. In the different groups of age the peak incidence was between the 50 and 59 years old, followed the group between 60 to 69. 153 cases appeared in adults and only 4 cases were found below the age of 20. The right hemisphere was the most frequently affected. Males were more often affected than females, with 96 cases (61.14%) in males and 61 cases (38.85%) in females. We couldn't find a significative relation between the presence of the tumor and the profession or another personal antecedent of the patients.     

The utilization of anti-infective agents in primary care in La Rioja

The relationship between the rhythm in tissue nonprotein sulphydryl groups (NPSH) and that in 1,2-diamine (trans-I)-cyclohexane oxalatoplatinum (1-OHP) toxicity was investigated in a total of 266 male B6D2F1 mice, using buthionine sulphoximine (BSO), an inhibitor of gamma-glutamylcysteine synthetase. Mice were synchronized with an alternation of 12 h light (L) and 12 h darkness (D; LD 12:12), and circadian time was expressed in hours after light onset (HALO). NPSH was measured in liver, jejunum and bone marrow at 0, 8 and 16 HALO. Dosing 1-OHP at these times achieved intermediate. high or low toxicity respectively. The physiological circadian rhythm in NPSH content was statistically significant in all tissues studied, with a maximum at the transition from D to L (0 HALO). BSO administration (450 mg/kg i.p., 4 h before sampling) induced a large depletion in liver and jejunum NPSH at their physiological peak (0 HALO), but exerted no significant effect at their trough (8 HALO). As a result, 24 h rhythm was suppressed in liver and jejunum, but remained similar to the physiological one in bone marrow. BSO enhanced 1-OHP-induced mortality and jejunal toxicity, but exerted no significant effect upon bone marrow toxicity. Despite these differences, 1-OHP remained least toxic at 16 HALO, near the middle of the dark span, which corresponds to maximum activity in the circadian rest/activity cycle. Our results show that mean NPSH levels in liver seem to account for the mean level of 1-OHP toxicity, while jejunal NPSH rhythm plays an important role in the intestinal toxicity rhythm of this drug.     

Surgical pathology of submandibular gland. Experience in La Rioja community

The AA. had work through medical histories of 44 patients operated for inflammatory and tumoral pathology of submandibular gland. Between inflammatory diseases they emphasize sialolithiasis (45%), acute submaxillaritis (18%) and Kuttner's tumor (11%). Pleomorphic adenoma accounted for the 50% of tumors. Diagnosis was based on each peculiar history sheet, on imaging procedures (simple X-ray plate, echography, sialography, TC) and extemporaneous biopsy. In all cases a complete exeresis of the gland was performed. In malignoma cases the procedure was completed with a prophylactic neck dissection. Incidence of lasting paralysis of the ramus marginalis mandibulae accounted for 6.8%.     

Epidemiological aspects of ageing

A major societal challenge is to improve quality of life and prevent or reduce disability and dependency in an ageing population. Increasing age is associated with increasing risk of disability and loss of independence, due to functional impairments such as loss of mobility, hearing and vision; a major issue must be how far disability can be prevented. Ageing is associated with loss of bone tissue, reduction in muscle mass, reduced respiratory function, decline in cognitive function, rise in blood pressure and macular degeneration which predispose to disabling conditions such as osteoporosis, heart disease, dementia and blindness. However, there are considerable variations in different communities in terms of the rate of age-related decline. Large geographic and secular variations in the age-adjusted incidence of major chronic diseases such as stroke, hip fracture, coronary heart disease, cancer, visual loss from cataract, glaucoma and macular degeneration suggest strong environmental determinants in diet, physical activity and smoking habit. The evidence suggests that a substantial proportion of chronic disabling conditions associated with ageing are preventable, or at least postponable and not an inevitable accompaniment of growing old. Postponement or prevention of these conditions may not only increase longevity, but, more importantly, reduce the period of illnesses such that the majority of older persons may live high-quality lives, free of disability, until very shortly before death. We need to understand better the factors influencing the onset of age-related disability in the population, so that we have appropriate strategies to maintain optimal health in an ageing population.     

Oral contraception and risk of cancer. Epidemiological aspects of breast and gynecological cancers

Oral contraceptives are now widely used by healthy women. Their safety for long-term use is an important issue that has been addressed by numerous epidemiological studies. The single main question about the safety of oral contraceptives use is its potential effect on the development of breast cancer. Several meta-analysis have reviewed all published studies. They provide a reassuring picture: oral contraceptive use does not appear associated with breast cancer. However, increased risks have been identified in specific population for long-term users by young women or before the first full term pregnancy. The use of combined oral contraceptives is associated with lower risks both of endometrial cancer and ovarian cancer. Because of methodologic problems, the results on the risk of cervical cancer and its precursors remain unclear.     

Incidence and risk factors of the association of AIDS and tuberculosis in Spain

BACKGROUND: Incidence of tuberculosis in persons coinfected with HIV is very high. The aim of this study was to determine the risk factors for tuberculosis in AIDS patients in Spain. PATIENTS AND METHODS: A study was carried into AIDS cases (1993 European AIDS case definition) over 12 years old, diagnosed in Spain in 1994. A comparison was run between cases with tuberculosis and the remaining reported AIDS cases on the register, by sex, age, transmission category and prison record. Multiple logistic regression was used to assess the independent effect of each variable, with the adjusted odds ratio (ORa) and their 95% confidence intervals. RESULTS: Annual incidence of AIDS and tuberculosis comorbidity was 8.9 per 100,000 inhabitants. Multivariate analysis revealed that tuberculosis in AIDS patients appeared with higher frequency in: males (ORa = 1.4; CI 95%, 1.3-1.6); the 13-29 age group (ORa = 1.3; CI 95%, 1.1-1.5) and the 30-39 year old group (ORa = 1.1; CI 95%, 1.0-1.3), injecting drug users (IDU) (ORa = 1.4; CI 95%, 1.2-1.6), and those patients with a prison record (ORa = 2.1; CI 95%, 1.9-2.4). CONCLUSIONS: In Spain, male AIDS patients, under age 40 years with a prison record and IDU have a higher risk of tuberculosis. Control measures for tuberculosis should therefore be intensified among these patients.     

Incidence of transient ischemic attacks and minor ischemic strokes in Segovia, Spain

BACKGROUND AND PURPOSE: The aim of this study was to determine the incidence of transient ischemic attacks (TIAs) and minor ischemic strokes (MISs) in Segovia, Spain. METHODS: A 2-year prospective community-based register of TIAs and MISs established in Segovia from February 16, 1992, to February 15, 1994. Every patient underwent underwent a complete clinical evaluation and cranial CT scan. Sex- and age-specific incidence rates with 95% confidence intervals (CIs) were calculated for all ages. RESULTS: The total series included 235 patients; 103 suffered TIAs and 132 suffered MISs. Mean age was 70.8 years (range, 29 to 96 years); 92 were women and 143 were men. The crude annual incidence was 0.80/1000 (95% CI, 0.70 to 0.90): 0.35/1000 (95% CI, 0.28 to 0.42) for TIAs and 0.45/1000 (95% CI, 0.37 to 0.53) for MISs. The incidence of TIAs and MISs increased with age. Approximately 78 of TIAs and MISs were in the carotid distribution, 19% were vertebrobasilar, and 3% were considered of uncertain vascular distribution. Cranial CT scan was performed in all patients. CT showed cerebral infarcts in 30.1% (31/103; 95% CI, 21% to 39%) of TIAs and 70% (92/132; 95% CI, 62% to 78%) of MISs (P<.00001). CONCLUSIONS: Our study is the first community-based register that provides sex-and age-specific rates for MISs and in which a CT scan was obtained in all patients. The incidence of TIAs in Segovia is comparable to that in other previous similar studies.     

Obsessive-compulsive disorder in children and adolescents. Epidemiological and clinical aspects

Obsessive-compulsive disorder (OCD) in children and adolescents is apparently a much more common disorder than previously believed. The literature on OCD in children and adolescents is reviewed, and OCD is described as a severe disorder with a poor prognosis for about half of the patients. The clinical picture seems to be the same across different cultures. The most common symptoms are obsessions about dirt and contamination and washing rituals.     

Epidemiological aspects of the use of live anticoccidial vaccines for chickens

This review address the epidemiology (epizootiology) of coccidiosis in commercial chickens with emphasis on the effects on the use of live vaccines. Surveys suggest that all seven valid species of chicken coccidia (Eimeria acervulina, Eimeria brunetti, Eimeria maxima, Eimeria mitis, Eimeria necatrix, Eimeria praecox and Eimeria tenella) are ubiquitous. All species are pathogenic to various extents. New results are presented on the pathogeneicities of E. acervulina, E. mitis and E. Praecox. Unless ingested by chickens, oocysts in poultry-house litter may die after about 3 weeks. Oocyst sporulation may be better in drier, rather than wetter, litter. Whether sporulated or not, up to 20% of ingested oocysts may pass undamaged through a chicken's intestine. The excreted, sporulated oocysts can be immediately reingested to initiate an infection; the unsporulated oocysts can still sporulate after passing through the intestine. The seven species differ in their times of appearance in commercial flock; hence particular vaccines may be designed for rearing standard broilers for up to about 6 weeks or for breeding stock. Attenuated, precocious lines of Eimeria in vaccines have low reproductive potentials, thus avoiding crowding, developing optimally, and stimulating immune response with minimal tissue damage. Cross-immunity between Eimeria species is probably minimal. There is reciprocity between the immune status of chicken and their excretion of oocysts for each species, ensuring continual stimulation of immune responses in birds on litter. Paracox vaccine, comprising all seven Eimeria species, is shown here to stimulate immunity to each of them independently. Total oocyst accumulation in litter following Paracox vaccination at 1 week comprises a small peak of vaccinal oocysts at 2-4 weeks, then a higher peak of the local virulent population at 4-7 weeks, which rapidly wanes. The attenuated drug-sensitive vaccinal oocysts probably interbreed with the corresponding wild species, reducing both virulence and drug-resistance in the local population. Anticoccidial vaccines may not induce complete immunity in chickens with lowered immunocompetence due to stressors, including certain viral disease. Future development of live vaccines for standard broilers may be expected in the relatively short term. The useful lives of anticoccidial drugs might be extended by rotating them with live vaccines.     

Epidemiological and clinical aspects relating to the variability of rheumatoid arthritis

OBJECTIVE: To review epidemiological studies dealing with the temporal and geographic variability in the occurrence of rheumatoid arthritis (RA) and clinical studies that address the variability of severity and manifestations among populations. METHODS: An extensive search of the literature, including a Medline search, was completed. Studies addressing the origin, history, and trends in the occurrence of RA were reviewed first. Next, studies of the prevalence and incidence of RA in different populations were reviewed, and occurrence rates compared. Standardization was attempted by tabulating adult prevalence rates of studies using equivalent sets of criteria. Studies comparing RA patients from two populations were sought next. Finally, studies dealing with explanations of the presumed variability were reviewed. RESULTS: Temporal variability is indicated by paleopathological evidence that RA has existed in the New World since 4000 BC, whereas there is no evidence that it occurred in Europe before the 17th century, or in Africa before the 20th century. Epidemiological studies show a possible trend of decreasing incidence of RA in the United States and Western Europe, whereas reports from Africa note a rising incidence. In white populations of Europe and America, prevalence is approximately 1%, and incidence is 0.03%. Significantly higher rates are found in some North American Indians, and significantly lower rates in some Asian and African populations, even when the different population structures are taken into account. In the latter populations, different patterns of occurrence from those observed in whites emerge, such as greater female preponderance and a much younger peak age at onset. Direct standardized comparisons of two diverse populations of RA patients showed some differences in expression, severity, or manifestations of RA between populations. CONCLUSION: The occurrence and manifestations of RA are temporally and geographically variable.     

Incidence and treatment of cancer in transplant recipients

Solid organ transplantation has been an accepted mode of therapy for the treatment of end-stage organ diseases for many years. Recipients' survival, however, has been hindered by organ rejection and the comorbid diseases that develop as a result of immunosuppresive therapy. In particular, organ transplant recipients have an increased risk of developing cancer de novo after transplantation. Prevalence ranges from 4 to 18% with an average incidence of 6%. Data submitted to the Cincinnati transplant tumor registry have revealed that cancers prevalent in the general population exhibited no increase in rate and may even show a slight decline in the transplant population. Length of survival after transplantation is associated with the likelihood of having cancer; the longer the recipient survives, the greater the chance. The actuarial risk among 124 cardiac transplant recipients was 2.7 +/- 1.9% at 1 year and 25.6 +/- 11% at 5 years. This article will review the current literature on the incidence and treatment of cancer in solid organ transplant recipients.     

Incidence and prevalence of eye cancer

A three and one half-year-old female with Melnick-Needles osteodysplasia is presented. In addition to the characteristic bone roengenograms and obstructive uropathy, the patient had inadequate formation of bone marrow elements and pulmonary arter hypertension.