EPIBACDIAL: a multicenter prospective study of risk factors for bacteremia in chronic hemodialysis patients

Bacteremic infections are a major cause of mortality and morbidity in chronic hemodialysis patients. New developments in managing these patients (erythropoietin therapy, nasal mupirocin, long-term implanted catheters, and synthetic membranes) may have altered the epidemiologic patterns of bacteremia in dialysis patients. This multicenter prospective cross-sectional study was carried out to determine the current incidence of and risk factors for bacteremia in chronic hemodialysis patients in France. A total of 988 adults on chronic hemodialysis for 1 mo or longer was followed up prospectively for 6 mo in 19 French dialysis units. The factors associated with the development of at least one bacteremic episode over 6 mo were determined using the multivariate Cox proportional hazards model. Staphylococcus aureus (n=20) and coagulase-negative staphylococci (n=15) were responsible for most of the 51 bacteremic episodes recorded. The incidence of bacteremia was 0.93 episode per 100 patient-months. Four risk factors for bacteremia were identified: (1) vascular access (catheter versus fistula: RR=7.6; 95% CI, 3.7 to 15.6); (2) history of bacteremia (> or =2 versus no previous episode: RR=7.3; 95% CI, 3.2 to 16.4); (3) immunosuppressive therapy (current versus no: RR=3.0; 95% CI, 1.0 to 6.1); and (4) corpuscular hemoglobin (per 1 g/dl increment: RR=0.7; 95% CI, 0.6 to 0.9). Catheters, especially long-term implanted catheters, were found to be the leading risk factor of bacteremia in chronic hemodialysis patients. There was a trend toward recurrence of bacteremia that was not associated with chronic staphylococcal nasal carriage. Synthetic membranes were not associated with a lower risk of bacteremia in this population of well dialyzed patients, but anemia linked to resistance to erythropoietin appeared to be a possible risk factor for bacteremia.     

Primers for the nef gene in the diagnosis of HIV infection using the polymerase chain reaction

The incidence of chronic alcoholism among the non-medical staff of a hospital was evaluated in an occupational health service context. Three criteria were sought routinely: suspicion by history of excessive alcohol intake, typical findings by physical examination, and suggestive behavioural changes reported by work colleagues. Gamma glutamyl transpeptidase levels and mean corpuscular volume were measured when one of these three criteria existed. The diagnosis of chronic alcoholism was made when two criteria were found or when only one criterion existed but accompanied by laboratory abnormalities. The incidence of chronic alcoholism was 6.2 per cent among male staff and 0.6 among female staff. It appeared to be less than in the population as a whole. The selective and non-systematic use of laboratory investigations and the frequent absence of indication to the occupational health physician of behavioural problems were sources of bias which probably contributed to underestimation of the incidence of chronic alcoholism among employees of the Orleans Regional Hospital Group. Provision of information to all staff is essential in order to explain the behavioural changes associated with chronic alcoholism and the usefulness of reporting employees showing evidence of such changes to the occupational physician. This enables medico-social diagnosis and the early care of those with early chronic alcohol abuse.     

The role of prenatal diagnosis in the decreasing incidence of congenital defects in the pediatric population of the Czech Republic from 1989 to 1995

CONCLUSION: A dosage of 300 mg/d of allopurinol was not effective in reducing pain or improving activities of daily living in chronic pancreatitis. BACKGROUND: Allopurinol prevents the generation of oxygen-derived free radicals by inhibiting xanthine oxidase. The purpose of this study was to determine whether allopurinol is effective in reducing pain of chronic pancreatitis. METHODS: Thirteen patients with chronic pancreatitis who were experiencing abdominal pain requiring medication at least three times each week entered a randomized, double-blind, two-period crossover clinical trial. Patients evaluated their pain daily using a categorical pain intensity scale, numeric pain intensity scale, and a visual analog scale, and weekly completed a McGill Pain Questionnaire and activities of daily living (ADL) questionnaire. RESULTS: The mean baseline score of pain was approx 50% of most severe pain in all scoring systems. There was no significant decrease in pain associated with allopurinol compared to the placebo (p = 0.24-0.75). In addition, there was no benefit in terms of ADL score associated with allopurinol compared with placebo (p = 0.32). Mean uric acid level was decreased by 1.15 mg/dL while patients were taking allopurinol, compared to when they were taking placebo (p = 0.007).     

Colonic ischemia: the Achilles heel of ruptured aortic aneurysm repair

Colonic ischemia is an often fatal complication of abdominal aortic aneurysm (AAA) repair. In elective AAA repair, patency of the inferior mesenteric artery (IMA) has been shown to be an important contributing factor. The purpose of this study was to determine which clinical and operative factors are important in the development of colonic ischemia in ruptured AAA repair. A retrospective review of all patients treated for ruptured AAA over a 7-year period was performed. Of 101 patients who were treated for ruptured AAA, 71 (70 per cent) survived for longer than 24 hours postoperatively, and these patients are the basis for this study. Colonic ischemia, primarily left sided, was a common perioperative complication (n = 24; 35 per cent) requiring colectomy in 11 patients (44 per cent). It carried a 44 per cent mortality compared to 20 per cent in patients without this complication (P = 0.07). Colonic ischemia occurred more frequently in patients with preoperative shock (P = 0.01) and a greater intraoperative blood loss (P = 0.003), but showed no correlation with patient age, co-morbid medical conditions, laboratory values, time to operation, or treatment of the IMA. Most patients with postoperative bowel ischemia were found to have chronic IMA occlusion, including 8 of the 11 patients requiring colectomy. Revascularization would not be feasible in this group. Revascularization of patent IMAs had little effect on outcome. Of the 17 patent IMAs, 9 were reimplanted and 5 (55 per cent) developed bowel ischemia, two of which required colectomy. Eight were ligated and 3 (38 per cent) developed bowel ischemia, one requiring colectomy. The presence of preoperative shock is the most important factor predicting the development of colonic ischemia following ruptured AAA. The incidence of ischemia is not altered by the presence of a patent IMA or with attempts at IMA revascularization. Colonic ischemia remains a significant source of morbidity and mortality in these patients.     

Daily life patterns associated with 18-months changes of disability among frail elderly living at home

The purpose of this study was to investigate daily life patterns associated with changes of disability over 18-months among frail elderly living at home. Subjects were 50 frail elderly living at home who were interviewed at baseline, in July-September 1995. By detailed time budgets among them, five life patterns were classified. Lying-rest life pattern, Sitting-rest life pattern, Hobby life pattern, Walking life pattern, and Houseworking life pattern. Activities of daily living (ADL) measured by Extended ADL Index consisted of 8 items of Barthel Index and 4 items of TMIG Index of Competence. Information for follow-up were obtained from home health nurses or mail-questionnaires February-March in 1997. The results were as follows: All samples were able to be followed. Seven people died within the 18 months follow-up. Overall change of score on ADL was not seen between baseline and follow-up study. ADL improvement was seen in 45.0% and 43.7% had declines. Daily life patterns were not correlated with changes in ADL score. However, analysis of decline in ability to perform each activities, relative associations (not statistically significant) were found for changes in function and daily life patterns. Lying-rest life pattern and Sitting-rest life pattern elderly were more likely to decline in ADL than Walking life pattern and HouseworKing life pattern elderly. Hobby life pattern elderly only declined in walking. These findings support previous studies showing that disability of home frail elderly could be improved. Daily life pattern among them would be a helpful predictor of changes in specific physical performance over years.     

Assessment of functional ability with the bed rise difficulty scale in a group of elderly patients

The aim of the study (part of the Progetto Longitudinale Gussago) was to evaluate the variables related to the difficulty in rising from a bed in 2 groups of elderly patients: nursing home residents, and patients admitted to a geriatric evaluation and management unit. Functional ability was tested through the bed rise difficulty scale (BRD). The version used in this study considered only those 7 items (out of 12) found to be of value. Only those patients who were able to rise from bed without help were selected in order to achieve the aim of the study (33 males, 113 females; mean age 79.6 +/- 7.3 years). Although the 146 patients assessed were considered as having a good functional level (Tinetti score 18.8 +/- 6.9, ADL Katz score 1.6 +/- 1.4), most of them had high scores on the BRD scale, indicating the ability of this scale to detect early, mild disability. The total score of the BRD scale was significantly related to the ADL Katz (r = 0.29, p = 0.000), Tinetti scale (r = -0.39, p = 0.000) and physical performance test (PTT; r = -0.47, p = 0.000). Similar results were obtained for the correlation between BRD time and ADL Katz (r = 0.033, p = 0.000), Tinetti scale (r = -0.30, p = 0.000) and PPT-(r = -0.46, p = 0.000). In a logistic regression analysis the items of the PPT scale considering upper extremity function and Tinetti balance score were significantly associated with the total bed rise time and score.     

Isolation and characterization of bacteriophage BCJA1, a novel temperate bacteriophage active against the alkaliphilic bacterium, Bacillus clarkii

A previous epidemiological study on myasthenia gravis (MG) in Sardinia indicated a prevalence rate of 4.5 per 100,000 population and an incidence of 0.25 per 100,000 population in the period 1958-1986. This study, however, investigated the entire Sardinian population (about 1,500,000) and the reported rates are likely to be underestimated. Because the use of a very large population has been found to cause major bias in case finding, the present study was designed to overcome this bias by determining the prevalence and incidence of MG in a well-defined area of Northwestern Sardinia, with a population of about 270,000 (1991 census). Potential MG cases were ascertained using all possible medical sources. The diagnosis of MG was based on the clinical, neurophysiological and conventional pharmacological findings (Tensilon test, response to anticholinesterases). On prevalence day (December 31, 1994) 29 MG patients were living in the study area (17 women and 12 men). Since the total population on prevalence day was 268,926 (137,284 women and 131,642 men), the calculated prevalence was 11.1 per 100,000 population (12.4 women and 9.9 men). The present study shows that the risk of MG in Sardinia is higher than previously suggested. The risk, however, is not significantly different from that found in other comparable Italian and European areas. It contrasts with what has been found for other autoimmune diseases such as multiple sclerosis and insulin-dependent diabetes mellitus in Sardinians, both showing frequencies up to 3-5 times higher than in the rest of Italy.     

Renal function and requirement for dialysis in chronic nephropathy patients on long-term ramipril: REIN follow-up trial. Gruppo Italiano di Studi Epidemiologici in Nefrologia (GISEN). Ramipril Efficacy in Nephropathy

BACKGROUND: The Ramipril Efficacy In Nephropathy (REIN) study found that in patients with chronic nephropathies and proteinuria of 3 g or more per 24 h, ramipril safely reduced the rate of decline of the glomerular filtration rate (GFR) and halved the combined risk of doubling of serum creatinine or end-stage renal failure (ESRF), as compared with placebo plus conventional antihypertensive drugs at the same level of blood pressure control. At the end of the core study patients continued on or shifted to ramipril and were formally enrolled into the REIN follow-up study. METHODS: 97 patients entered the follow-up study. Patients originally randomised to ramipril continued with the same daily dose (n=51), whereas those originally on placebo plus conventional antihypertensive drugs switched to ramipril after the first visit of the follow-up study (n=46). Ramipril (1.25 to 5.00 mg/day) and conventional antihypertensive therapy were targeted at achieving diastolic blood pressure under 90 mm Hg. The main efficacy variables were GFR decline and ESRF (need for dialysis). Analysis was by intention to treat. FINDINGS: During the follow-up study the mean rate of GFR decline per month decreased from 0.44 (SD 0.54) mL/min per 1.73 m2 in the core study to 0.10 (0.50) mL/min per 1.73 m2 in patients originally randomised to ramipril (p=0.017), and from 0.81 (1.12) to 0.14 (0.87) mL/min per 1.73 m2 in those originally randomised to placebo plus conventional antihypertensive therapy (p=0.017). At the final visit, mean absolute GFR values were 12 mL/min per 1.73 m2 higher (33% better) in patients randomised to ramipril than in those assigned placebo (n=26 and 17, respectively: 35.5 [19.0] vs 23.8 [9.4] mL/min per 1.73 m2, p=0.01). 19 of the patients originally on ramipril versus 35 switched from placebo to ramipril progressed to ESRF (p=0.027) during the whole observation period; of these, six (8%) versus 14 (16%) reached that endpoint during the follow-up study; and the risk ratios were 1.86 (95% CI 1.07-3.26) over the whole observation period and 2.95 (1.13-7.68) during follow-up. Beyond follow-up at month 36, the incidence of ESRF was zero in patients originally randomised to ramipril but 30% in patients on placebo plus conventional antihypertensive therapy. INTERPRETATION: In patients with chronic nephropathy and high risk of rapid progression to ESRF, ramipril reversed the tendency of GFR to decline with time. Moreover, a treatment period of sufficient duration (> or =36 months) eliminated the need for dialysis. Even patients previously treated with antihypertensive drugs other than angiotensin-converting-enzyme inhibitors benefited from shifting to ramipril.     

Understanding nursing students'' stress: a proposed framework

This study examined the direct and indirect costs due to acute form of lymphatic filariasis caused by Wuchereria bancrofti to the households in rural communities in Tamil Nadu state in south India. For nearly one-third of the acute adenolymphangitis (ADL) episodes the affected did not seek treatment and for 27% of the episodes they consulted health personnel, underwent treatment and paid for it. On average, the ADL patients spent Rupees (Rs.) 2.35 (US $ 0.07) per episode on treatment, but expenditure was as high as Rs. 32.11 (US $ 0.92) among those who paid. Doctor's fees and medicines constituted 83% of the total treatment costs. Patients with multiple and longer duration episodes and with better living conditions spent relatively more on treatment. The proportion of patients who spent money on treatment was smaller in poorer households, but their treatment costs formed a relatively higher proportion of their income than those of middle and high-income households. The ADL episodes curtailed economic and domestic activities. In 87% of the episodes, the affected were not able to attend any economic activity compared to 37% of the episodes in the case of controls. Patients spent only 0.68 +/- 1.91 hours on economic activity compared to 4.40 +/- 3.74 hours by the control individuals during the ADL episodes. The sign rank test showed that the mean difference of 3.73 +/- 3.81 and 2.14 +/- 1.83 hours in the time spent on economic and domestic activity respectively between cases and controls was highly significant (P < 0.01). Regression analysis demonstrated that the difference in the time spent on activities is only due to ADL and no socio-economic variable had any effect on it. The cost of treatment and loss in economic activities combined with high incidence in the study communities indicate the extent of the economic burden imposed by the hitherto neglected acute form of lymphatic filariasis and the necessity to control it.     

Incidence and prevalence of juvenile chronic arthritis in East Berlin 1980-88

OBJECTIVE: To estimate the incidence and prevalence rates of juvenile chronic arthritis (JCA). METHODS: The study population was children under 16 years of age living in the East Berlin area (part of the former German Democratic Republic). By admission order that was effective up to 1990, all children with symptoms of a rheumatic disease living in the East Berlin area had to be referred to the 2nd Children's Hospital at Berlin-Buch. This specific condition allowed us to ascertain cases from the clinical records and to calculate population rates. Based upon this data, the results of surveys with different methods of case ascertainment are compared. RESULTS: An incidence rate of 3.5 per 100,000 and a prevalence rate of 2.0 per 10,000 children were calculated. The frequency of JCA is higher for girls, with an incidence of 4.3 per 100,000 and a prevalence of 2.3 per 10,000. The figures for boys are 2.7 per 100,000 and 1.7 per 10,000, respectively. CONCLUSION: Because of the specific prerequisites, the population rates of prevalence and incidence that were based on clinical records can be regarded as valid in this study. Deviant results of other surveys can be explained by differences in the study design or in the diagnostic procedures used.     

Topical nitroglycerin in the management of anal fissure: an explosive outcome!

Anal sphincter spasm is a common finding in patients with anal fissure disease. It is postulated that spasm impedes mucosal blood flow and impairs healing. Topical nitroglycerin (NTG), a nitric oxide donor compound, has been shown to cause relaxation of the anal sphincter and may have treatment efficacy in the management of anal fissure. The purpose of this study was to assess the usefulness of NTG for anal fissure. We performed a retrospective review of patients with anal fissure treated with various concentrations of topical NTG ointments over an 18-month period ending July 1997. Of the 81 patients studied, 44 (54%) were male. There were 42 acute and 39 chronic fissures. NTG preparations included 1 per cent isosorbide (n = 37), 0.2 per cent NTG (n = 38), and 0.5 per cent NTG (n = 6). Healing with NTG therapy occurred in 29 acute (69%) and 21 chronic fissure (54%) patients. There was no difference in the incidence of healing of acute or chronic fissure between the various NTG treatment preparation groups. When acute and chronic fissure therapy was subdivided by time of NTG treatment (immediate versus post-conservative therapy failure (PCF)), 14 (74%) of acute PCF and 5 (42%) of chronic PCF patients healed. We conclude that no single formula was superior. When patients were subdivided into a PCF group, NTG therapy demonstrated a significant salvage rate, thus avoiding surgery.     

Pancreatic cancer screening. Analysis of the problem and the role of radionuclide imaging

The clinical, surgical, and pathologic findings in a five year prospective study of 192 patients referred with a high probability of pancreatic cancer are reported. We have defined the requirements of any pancreatic imaging procedure as its ability to distinguish a normal pancreas from pancreatic cancer or chronic pancreatitis and the capability of detecting tumors less than 5 cm in diameter. There was a 47 percent incidence of pancreatic disease (27 percent pancreatic cancer and 20 percent chronic pancreatitis). Prospective radionuclide imaging as routinely performed was found to be of little clinical value in this patient population; it was neither specific nor sensitive to pancreatic cancer or chronic pancreatitis. Preliminary data with longitudinal multiplane emission tomography show an improved diagnostic accuracy and the ability to detect resectable tumors, but its efficacy needs to be prospectively compared with other screening tests on a carefully defined patient population.     

Sociomedical study of centenarians in Nagoya City

The purpose of this study was to assess the background to the longevity of 36 centenarians in Nagoya city and to compare 14 institutionalized centenarians out of those 36 with 202 individuals in the 70-99 age group in our special nursing home, particularly with regard to blood chemistry and immunity tests. The reasons for their social longevity in terms of profile appeared to be attention to eating habits, abstention from smoking and drinking, occupations with adequate exercise. The incidence of dementia was 65.6% among them. We evaluated centenarians from the viewpoint of Hasegawa's Dementia Scale (HDS) and comprehensive functional assessment of the elderly consisted of the revised version of Hasegawa's Dementia Scale (HDSR), and examination of activity of daily living (ADL), physical perception, and social life. All were positively associated. Thus centenarians independent of physical assistance demonstrated significantly higher systolic blood pressure, and respective scores for HDS, HDSR, ADL, physical perception and social life than their dependent counterparts, were less likely to be institutionalized and suffered from fewer disorders. In particular none were diagnosed as positive for cerebral hemorrhage, infarction and dementia. Age demonstrated significant positive or negative correlation with the following values in blood chemistry and immunity tests: blood cell counts, hemoglobin concentration, hematocrit value, albumin, total protein, total cholesterol, low density lipoprotein cholesterol, creatinine, blood cell nitrogen, uric acid, helper T cell, and IgA immunoglobulin.     

Caring for the caregivers

The relationship between disabled elderly veteran care receivers' functional status and their in-home family caregivers' strain was examined in this study. The convenience sample was composed of 93 dyads. Data were obtained from care receivers' health care records and included the Folstein Mini-Mental State Examination (MMS), Activities of Daily Living (ADL), Instrumental Activities of Daily Living (ADL), and Robinson's Caregiver Strain Index (CSI). Major findings were: 52% of caregivers experienced significant strain; 59% of care receivers were cognitively impaired to some extent and were severely impaired in IADL and ADL; and the relationships between care receivers' functional status (cognitive, ADL and IADL) and caregiver strain were statistically significant.     

Acute and chronic diarrhoea and abdominal colic associated with enteroaggregative Escherichia coli in young children living in western Europe

BACKGROUND: Enteroaggregative Escherichia coli (EAggEC or EAEC) can spread and cause disease in developing countries, but it is not presently known whether it spreads disease in industrialised countries. Therefore, we did a prospective study to assess the incidence and the clinical manifestations of infections due to EAEC in children in Germany. METHODS: 798 children with diarrhoea, admitted to hospital within a defined geographical area during a 24-month period, were included in the trial. EAEC were cultured from stool specimens, screened by PCR, and identified by colony hybridisation from DNA sequences found on the virulence plasmid. The findings were confirmed by aggregative adherence to HEp-2 cells. Stool samples from 580 children admitted to hospital without diarrhoea were also studied as controls. FINDINGS: EAEC were found in the stools of 16 (2%) of 798 children with diarrhoea, but in none of 580 children without diarrhoea. Only four of the EAEC-infected children had travelled to developing countries. Most EAEC infections were acquired in the summer months. Infection with EAEC was associated with acute, watery diarrhoea in 12 children, and with chronic diarrhoea of up to 5 months' duration in four. Five children had abdominal colic that lasted for 2-4 weeks as their main symptom. The incidence of EAEC infection was 7.7 patients admitted to hospital per 100,000 children in the general population aged younger than 16 years. INTERPRETATION: EAEC infection is associated with acute, watery diarrhoea and may be acquired in industrialised countries. Chronic diarrhoea or abdominal colic of unknown aetiology in young children may also be caused by EAEC infection.     

Changes in cigarette smoking not observed following repeated cocaine self-administration.

Acute administration of some psychoactive drugs (e.g., cocaine, heroin, methadone, d-amphetamine) has been found to increase spontaneous cigarette smoking for 1-3 hr, but the effects of chronic drug administration have not been systematically studied. Computerized cigarette dispensers were used to study the effects of multiple daily cocaine administrations on cigarette smoking. Participants were 8 (5 male) cocaine-dependent cigarette smokers who resided on a closed clinical research ward and smoked an average of 16.7 cigarettes per day during the week prior to starting the study. During test sessions on Monday, Wednesday, and Friday of each week, participants could obtain either cocaine (25 mg iv) on 2 days or saline (1 ml iv) on the other day, 3 times per day at 2-hr intervals under double-blind conditions. The number of cigarettes dispensed during study days was analyzed in 2-hr increments. No significant cocaine effect was found. These findings fail to show a change in the number of cigarettes smoked after chronic cocaine self-administration over time intervals longer than 1-3 hr. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Central serous chorioretinopathy. Clinical, fluorescein angiography and demographic aspects

The purpose of this retrospective study was to analyze the demographic characteristics of central serous chorioretinopathy (CSC). METHODS: Findings of 100 consecutive subjects with CSC were evaluated. Clinical and fluorescein angiographic findings, demographic characteristics, and visual acuity were analyzed. RESULTS: The age of the patients ranged from 28 to 68 years with a mean of 43 years. No significant sex differences were found concerning age and other parameters. The highest age peak was in the group of women. The male to female ratio was 5:1. Patients with chronic CSC were significantly older (P = 0.015) than patients with the other angiographic findings. Median visual acuity was 0.5. In 40% bilateral characteristics of CSC were found. Clinical and fluorescein angiographic findings showed no significant correlation with visual acuity. CONCLUSION: The range of age distribution in CSC is wide. In older patients distinguishing CSC from age-related macular degeneration can be difficult.     

Recommendations for image prefetch or film digitization strategy based on an analysis of an historic radiology image database

BACKGROUND: The effect of interferon therapy on the incidence of hepatocellular carcinoma in chronic hepatitis C is poorly defined. OBJECTIVE: To compare the incidence of hepatocellular carcinoma in interferon-treated patients with chronic hepatitis C to that of historical controls and to examine whether response to therapy is related to incidence of hepatocellular carcinoma in patients with chronic hepatitis C. DESIGN: Retrospective cohort study. SETTING: One university hospital and seven university-affiliated hospitals. PATIENTS: 419 consecutive patients with chronic hepatitis C who started interferon therapy between January 1992 and December 1993 (interferon group) and 144 patients with chronic hepatitis C who had liver biopsy between January 1986 and December 1989 and did not receive interferon (controls). INTERVENTION: Patients in the interferon group received human lymphoblastoid interferon, recombinant interferon-alpha2a, or recombinant interferon-alpha2b for 6 months. MEASUREMENTS: The end point was development of hepatocellular carcinoma on abdominal ultrasonography or computed tomography. Sustained response was defined as persistent normalization of alanine aminotransferase (ALT) levels during interferon therapy and follow-up. Relapse was defined as a normal serum ALT level at the end of treatment with an increase to an abnormal level after cessation of treatment. Nonresponse included all other ALT patterns. RESULTS: Median follow-up in the interferon and control groups was 47.6 and 46.8 months, respectively. During follow-up, hepatocellular carcinoma was found in 28 interferon-treated patients and 19 controls. Cox proportional hazards regression analysis that included all patients revealed that interferon therapy (P=0.041), older age (P=0.003), greater histologic activity (P=0.029), and higher histologic stage (P=0.049) were independent factors associated with the development of hepatocellular carcinoma. The risk ratios for development of hepatocellular carcinoma in patients with sustained response, relapse, and nonresponse were 0.06 (95% CI, 0.01 to 0.46), 0.51 (CI, 0.20 to 1.27), and 0.95 (CI, 0.48 to 1.84), respectively, compared with controls. CONCLUSIONS: The incidence of hepatocellular carcinoma was lower in patients with sustained response to interferon therapy than historical controls and nonresponders. Interferon therapy may decrease the risk for hepatocellular carcinoma in patients with chronic hepatitis C.     

Intraoperative pacemaker dysfunction caused by the use of electrocautery during a total hip arthroplasty

PURPOSE: To evaluate if there is a seasonal pattern to the incidence of endogenous uveitis in south-western Finland with special reference to acute anterior uveitis. METHODS: The incidence rates per month of the 414 new uveitis cases from years 1980-82 and 1988 in the district of Turku University Hospital were calculated. The months of the year were grouped into warm (June to September), transitional (April, May, October, November), and cold (December to March) seasons based on the mean air temperature of the months in Turku. RESULTS: We observed a statistically significant increase in the incidence of all uveitis cases in the warm and transitional seasons compared with the cold season (p=0.030 and p=0.008 respectively). A similar seasonal trend was found among anterior uveitis cases, but not among the intermediate, posterior or panuveitis cases. The incidence of acute anterior uveitis cases was higher in the transitional than in the cold season (p=0.025). No seasonal variation of the incidence was found in the subgroup of acute anterior uveitis where ankylosing spondylitis had been confirmed (p=0.70). CONCLUSION: The present data suggests that there is seasonal variation of the incidence of uveitis in south-western Finland.     

Where''s the cash?

This study was done to analyze the epidemiology of invasive Haemophilus influenzae disease in Bochum city area. Forty-eight children with invasive Haemophilus influenzae infections were treated at the University Children's Hospital in Bochum during the study period from January 1971 to June 1992. Clinical manifestations included meningitis (n = 34), epiglottitis (n = 8), pneumonia (n = 2), bacteremia (n = 2), cellulitis (n = 1) and osteomyelitis (n = 1). The overall yearly incidence rate for all invasive Haemophilus influenzae infections was 13 per 100,000 children younger than five years of age, with a marked increase in the last six years. Haemophilus influenzae meningitis showed no significant change during the study period with an overall yearly incidence of 9 per 100,000 children younger than five years. Twenty-eight cases (58%) of all invasive Haemophilus influenzae infections occurred in patients under two years of age and five cases (10%) were younger than six months. Invasive Haemophilus influenzae disease showed no seasonal prevalence. All isolates were susceptible to ampicillin. No deaths occurred, but severe bilateral deafness resulted in one patient with meningitis. Prospective epidemiologic studies are needed to estimate clinical efficacy of the Haemophilus influenzae type b immunization program in Germany.