Increasing incidence of Achilles tendon rupture

During the period 1987-91, 153 cases of total Achilles tendon rupture were diagnosed in the city of Malmo (population 230,000). Almost two thirds were caused by sporting activities, notably badminton. Ruptures caused by nonsports injuries were found in older subjects. Compared to the age-specific incidence in 1950-73, a marked increase in both sports and nonsports injuries was found and patients in the latter group were older than in the former period. Patients with Achilles tendon ruptures can be classified into two subgroups with partly different etiologies: young or middle-aged athletes and older non-athletic persons. The increase in the former group is mostly explained by increased participation in recreational sports; the cause of increase in the latter group is unknown.     

Increasing incidence of childhood class V lupus nephritis

1. Homozygously mdr1a gene disrupted mice (mdr1a(-/-) mice) and wild type mice (mdr1a(+/+) mice) were used to develop a method for P-glycoprotein (P-gp) function imaging non-invasively and to study the effect of a P-gp reversal agent on its function in vivo. 2. [11C]verapamil (0.1 mg/kg) was administered and the changes in tissue concentrations were determined ex vivo by organ extirpation and in vivo with PET. To block P-gp function, cyclosporin A was administered. 3. Biodistribution studies revealed 9.5-fold (P < 0.001) and 3.4-fold (P < 0.001) higher [11C]verapamil in the brain and testes of mdr1a(-/-) mice than in mdr1a(+/+) mice. Cyclosporin A (25 mg/kg) increased [11C]verapamil levels in the brain and testes of mdr1a(+/+) mice in both cases 3.3-fold (P < 0.01 (brain); P < 0.001 (testes)). Fifty mg/kg cyclosporin A increased [11C]verapamil in the brain 10.6-fold (P < 0.01) and in the testes 4.1-fold (P < 0.001). No increases were found in the mdr1a(-/-) mice. This indicates complete inhibition of P-gp mediated [11C]verapamil efflux. 4. Positron camera data showed lower [11C]verapamil levels in the brain of mdr1a(+/+) mice compared to those in mdr1a(-/-) mice. [11C]verapamil accumulation in the brain of mdr1a(+/+) mice was increased by cyclosporin A to levels comparable with those in mdr1a(-/-) mice, indicating that reversal of P-gp mediated efflux can be monitored by PET. 5. We conclude that cyclosporin A can fully block the P-gp function in the blood brain barrier and the testes and that PET enables the in vivo measurement of P-gp function and reversal of its function non-invasively.     

Rising incidence of non-Hodgkin''s lymphoma in Spain: analysis of period of diagnosis and cohort effects

INTRODUCTION: Individual annual cosmic radiation doses for fulltime airline crewmembers were calculated for 12 consecutive months using data from flight profiles and previously reported cosmic radiation intensity measurements at various altitudes. METHODS: Every flight of each crewmember was analyzed using block time and aircraft flight profiles. Actual flight time at various flight levels was first calculated, then cumulative total body radiation doses were calculated for each flight phase and altitude. RESULTS: Cabin crewmembers averaged 673 block hours (range 906-273 h) and pilots 568 block hours (range 833-168 h). Average annual cosmic ray dose for cabin crews was 2.27 mSv x a(-1) (range between 3.1 - 0.72 mSv x a(-1)). Long-distance MD11 flight captains received the highest annual doses of 2.19 mSv x a(-1) (2.83 - 1.08 mSv x a(-1)). M.D.80 pilots who also fly long high-altitude sectors in Europe received 1.94 mSv x a(-1) (2.37 - 1.12) and other aircraft type cockpit crews averaged between 1.49 - 1.26 mSv x a(-1). CONCLUSION: The calculated individual doses reflect the type of aircraft flown and the amount of flight time. The calculated doses are lower than those received by simply assuming constant radiation exposure at all altitudes during flight. Annual individual doses are well below the maximum 5 mSv x a(-1) allowed by the national laws.     

Cancer incidence in a cohort of infertile women

Among 2,496 infertile Israeli women treated between 1964 and 1974, 143 cancer cases were observed as compared with 116.1 expected (standardized incidence ratio (SIR) = 1.2, 95% confidence interval (CI) 1.0-1.5) through 1991. Site-specific analysis revealed 12 ovarian cancers versus 7.2 expected (SIR = 1.6, 95% CI 0.8-2.9), 21 endometrial cancers versus 4.3 expected (SIR = 4.85, 95% CI 3.0-7.4), and 59 breast cancers versus 46.6 expected (SIR = 1.3, 95% CI 0.96-1.6). Sensitivity analysis revealed that confounding was unlikely to explain the raised risk of endometrial cancer, but nulliparity might explain the increased risk of ovarian cancer. The excess of endometrial cancer was prominent among patients with normal estrogen production but progesterone deficiency (SIR = 9.4, 95% CI 5.0-16.0). The risk for ovarian cancer was similar among the total groups of treated and untreated patients (SIR = 1.7 vs. 1.6). The standardized incidence ratio for endometrial cancer was higher among the treated group than the untreated group, although not significantly. Treatment with ovulation-inducing drugs does not appear to increase the risk for ovarian cancer, but its role cannot be completely excluded.     

Testicular calcifications: incidence, histology and proposed pathological criteria for testicular microlithiasis

PURPOSE: Testicular microlithiasis is a clinical syndrome in which men present with innumerable testicular calcifications. Indirect evidence suggests that this syndrome may be associated with an increased risk of germ cell neoplasia. The incidence and types of testicular calcification in normal and diseased testes is unknown. MATERIALS AND METHODS: A series of 131 orchiectomy specimens were reviewed, including 79 germ cell tumors, and 100 entirely embedded autopsy testes in men with no known testicular pathology. RESULTS: Two types of calcifications were identified. Hematoxylin bodies, consisting of amorphous calcific debris, were present in 6 cases associated with germ cell tumors. In contrast, laminated calcifications were found not only in association with germ cell tumors (35 cases), but also in 2 of 4 cryptorchid testes and 6 of the remaining 145 testes (4%). Of these calcifications 61% were multiple. When laminated calcifications were associated with germ cell tumors there was an increased incidence of extension beyond the tunica albuginea (43 versus 21%) and lymphatic invasion (52 versus 17%, p = 0.046 and 0.012, respectively). CONCLUSIONS: Testicular calcifications are heterogeneous. Hematoxylin bodies are specific for germ cell tumors but laminated calcifications, while more common in germ cell tumors, also occur in otherwise normal testes. The pathological criteria for testicular microlithiasis should include the identification of multiple laminated calcifications within seminiferous tubules.     

Simulation of HIV incidence dynamics in the Rakai population-based cohort, Uganda

BACKGROUND: Laparoscopic creation of an intestinal stoma may be preferable to open operation when intervention is required solely for faecal diversion. METHODS: Experience with laparoscopic intestinal stoma formation for faecal diversion from a single institution is presented. RESULTS: A total of 55 stomas were studied, 40 laparoscopic and 15 open. The conversion rate from laparoscopic to open operation was 5 per cent. Mean(s.e.m.) operating time was significantly reduced for laparoscopic stomas (54(4.7) versus 72(8.7) min). Time to return of bowel function was significantly reduced (1.6(0.3) versus 2.2(0.2) days). Mean(s.e.m.) hospital stay was significantly reduced in the laparoscopic group (7.4(0.5) versus 12.6(2.5) days). CONCLUSION: Morbidity and mortality appeared to be reduced in patients undergoing laparoscopic stoma formation. The technique was found to be safe, suitable for the majority of patients and to give results superior to those of open surgery.     

Increasing incidence of carcinoma of the gastric cardia in Sweden from 1970 to 1985

Several American, Japanese and European centres have reported an increase in carcinoma of the gastric cardia, contrary to the general trend in the incidence of gastric cancer. The aim of this nationwide population-based study was to describe trends in the incidence of tumours of the gastric cardia in Sweden over the 16-year period from 1970 to 1985. The Swedish cancer register, which is more than 95 per cent complete, was used to identify cases. There were 1514 men and 481 women with cancer of the gastric cardia. The age-standardized rates increased in men from 1.9 per 10(5) population in 1970-1973 to 3.0 per 10(5) in 1982-1985, corresponding to a mean annual increase of 2.5 per cent (95 per cent confidence interval (c.i.) 1.6-3.4 per cent). In women, the age-standardized rates increased from 0.5 per 10(5) in 1970-1973 to 0.8 per 10(5) in 1982-1985, the mean annual increase being 0.9 per cent (95 per cent c.i. 0.0-1.8 per cent). The highest incidences were found in southern Sweden, contrary to the geographical distribution of gastric cancer in general, which shows a south-to-north gradient. The disparate epidemiological features of cancer of the cardia and gastric cancer at other sites suggest that the aetiologies may also be different. Since little is known about the aetiology of cancer of the cardia, and the incidence seems to be rising rapidly, analytical studies are urgently needed.     

Mortality and incidence of cancer among sewage workers: a retrospective cohort study

To study the incidence of and mortality from cancer among sewage workers a retrospective analysis was performed on a cohort of 656 men employed for at least one year at any one of 17 Swedish sewage plants during the years 1965-86. Assessment of exposure was done by classification of work tasks. Lower than expected total mortality (standardised mortality ratio (SMR) = 0.75, 95% confidence interval (95% CI) 0.58-0.97) and cardiovascular mortality (SMR = 0.61, 95% CI 0.39-0.91) was found. This was interpreted as a result of the healthy worker effect. For all cancers combined the mortality (SMR = 1.08, 95% CI 0.68-1.67) and morbidity (SMR = 1.02, 95% CI 0.72-1.38) were comparable with those of the general population. There were increased incidences for brain tumours (SMR = 2.19, 95% CI 0.45-6.39), gastric cancers (SMR = 2.73, 95% CI, 1.00-5.94), and renal cancers (SMR = 1.68, 95% CI = 0.35-4.90). For lung cancer the risk was reduced (SMR = 0.70, 95% CI 0.15-2.05). Allowance for a latency period of 10 years from the start of exposure did not change the pattern. Logistic modelling was used to search for exposure-response relations. In a logistic model with the confounder age forced in, renal cancer had a significant positive relation with a weighted sum of employment times, where the weights describe the classification of exposure. No exposure-response relations were found for brain tumors or gastric cancers. The increased risks are based on small numbers of cases. A future follow up will add more conclusive power to the study. Specific exposures need to be identified to allow for a better dose-response analysis.     

An enigma: contralateral effects of experimental unilateral testicular torsion

To investigate the effects of unilateral testicular torsion on both testes, we studied 4 groups of adult male New Zealand rabbits using sham operation, torsion and detorsion after one or eight hours and permanent torsion. Bilateral orchiectomy was performed 9 weeks after the operation, and testicular weights, Johnsen scores, quantitative analyses, tubular diameters were calculated and histopathologic diagnosis was determined. Testicular weights, Johnsen scores, spermatid counts and tubular diameters were all decreased in torsioned testes depending on the duration of torsion. The contralateral testes showed no significant change in any of the study groups when compared with the control group.     

Increasing capacity: Practice effects in absolute identification.

In most of the long history of the study of absolute identification—since Miller's (1956) seminal article—a severe limit on performance has been observed, and this limit has resisted improvement even by extensive practice. In a startling result, Rouder, Morey, Cowan, and Pfaltz (2004) found substantially improved performance with practice in the absolute identification of line lengths, albeit for only 3 participants and in a somewhat atypical paradigm. We investigated the limits of this effect and found that it also occurs in more typical paradigms, is not limited to a few virtuoso participants or due to relative judgment strategies, and generalizes to some (e.g., line inclination and tone frequency) but not other (e.g., tone loudness) dimensions. We also observed, apart from differences between dimensions, 2 unusual aspects of improvement with practice: (a) a positive correlation between initial performance and the effect of practice and (b) a large reduction in a characteristic trial-to-trial decision bias with practice. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

The lithium ratio and the incidence of side effects

1. During a prospective and outpatient study the correlation between the lithium ratio and the incidence of lithium side effects and type of comedications was studied in 51 Iranian bipolar patients by using new direct method of measuring erythrocyte lithium concentration. 2. Results revealed that patients who received lithium alone the incidence of lithium side effects was extremely lower than those with lithium and neuroleptics in combination. Both neurological and renal side effects of lithium were higher in patients who received lithium in combination with neuroleptics. 3. In patients on lithium alone the lithium ratio among patients with side effects were significantly lower than those without side effects, and the plasma lithium concentrations were significantly higher in those with side effects. In patients who received neuroleptics in combination with lithium, the lithium ratios were also significantly lower in those with serious side effects than those with slight side effects, but there were no significant correlation in plasma lithium concentrations between them. 4. Previous studies about the correlation of the lithium ratio and incidence of side effects have yielded inconsistent results, and methodological problems may be a reason for these discrepancies. By using the new direct method of measuring erythrocyte lithium concentration, repetition of previous studies on lithium ratio may elucidate its value as a tool in daily practice.     

Increasing incidence and comparison of nalidixic acid-resistant Salmonella enterica subsp. enterica serotype typhimurium isolates from humans and animals

We determined the resistance to quinolone of 309 Salmonella enterica subsp. enterica serotype Typhimurium strains isolated from humans and animals (cattle, pigs, or poultry) in 1995 or 1996. Nalidixic acid resistance increased from 8.5% in 1995 to 18.6% in 1996. The highest resistance levels correlated with a mutation at Ser-83 (or Asp-82). All strains remained ciprofloxacin susceptible. Human and animal isolates were compared by pulsed-field gel electrophoresis, and the banding patterns of the human isolates most closely matched those of the bovine isolates.     

Comparison of breast cancer incidence in the Massachusetts tuberculosis fluoroscopy cohort and in the Japanese atomic bomb survivors

Breast cancer has occurred in excess among women exposed briefly to atomic bomb radiation and among those exposed repeatedly over many years to medical radiation for tuberculosis (TB). The excess relative risk of breast cancer incidence in the Japanese atomic bomb survivors, however, is significantly higher (two-sided P = 0.04) than that in the Massachusetts TB fluoroscopy patients. The best estimate of the ratio between the excess relative risk coefficients for the Japanese and Massachusetts cohorts is 2.11 (95% CI 1.05, 4.95). However, this higher relative excess risk is attributable to the lower baseline risk of breast cancer among Japanese women compared with the Massachusetts women, and the excess absolute breast cancer risks in the two data sets are statistically indistinguishable (two-sided P = 0.32). The best estimate of the ratio between the excess absolute risk coefficients among Japanese and Massachusetts women is 0.73 (95% CI 0.41, 1.44). After childhood exposures, an early onset of radiation-induced breast cancer was seen among Japanese atomic bomb survivors but not among the Massachusetts women. There are some indications (two-sided P = 0.04) of differences in the patterns of risk over time since exposure between these groups exposed in childhood. However, in general there are no marked differences between the Massachusetts and Japanese data sets in the age and time distribution of risk of radiation-induced breast cancer. These data provide little evidence for a reduction of breast cancer risk after fractionated irradiation.     

Analysis of incidence of infection with enterotoxigenic Escherichia coli in a prospective cohort study of infant diarrhea in Nicaragua

Nalidixic acid-resistant Salmonella typhi (NARST) was first isolated in Viet Nam in 1993. Analysis of the quinolone resistance-determining region of gyrA in 20 NARST isolates by polymerase chain reaction and single-stranded conformational polymorphism yielded two novel patterns: pattern II corresponding to a point mutation at nucleotide 87 Asp-->Gly (n = 17), and pattern III corresponding to a point mutation at nucleotide 83 Ser-->Phe (n = 3). In trials of short-course ofloxacin therapy for uncomplicated typhoid, 117 (78%) of 150 patients were infected with multidrug-resistant S. typhi, 18 (15%) of which were NARST. The median time to fever clearance was 156 hours (range, 30-366 hours) for patients infected with NARST and 84 hours (range, 12-378 hours) for those infected with nalidixic acid-susceptible strains (P < .001). Six (33.3%) of 18 NARST infections required retreatment, whereas 1 (0.8%) of 132 infections due to susceptible strains required retreatment (relative risk = 44; 95% confidence interval = 5.6-345; P < .0001). We recommend that short courses of quinolones not be used in patients infected with NARST.     

Central venous catheter-related bloodstream infections: an analysis of incidence and risk factors in a cohort of 400 patients

OBJECTIVE: To determine the incidence of central catheter-related bloodstream infection (CR-BSI) and to compare patient and catheter characteristics of those with and without CR-BSI from a clinically suspected subgroup. Secondly, to assess the efficacy of the acridine orange leucocyte cytospin test (AOLC) as a rapid in situ method of detecting central venous catheter (CVC) infection. DESIGN: One-year prospective audit. SETTING: Intensive care unit/high dependency unit (ICU/HDU) and general wards of a tertiary referral hospital. PATIENTS AND PARTICIPANTS: 400 patients with non-tunnelled CVCs. Interventions: Daily surveillance, blood culture from peripheral venepuncture, blood sample from the CVC for assessment of the AOLC test and removal of suspected CVCs were carried out on patients clinically suspected of having CR-BSI. MEASUREMENTS AND RESULTS: CR-BSI was diagnosed using well defined criteria. Infection rate was calculated by dividing the number of definitive catheter associated infections by the total number of appropriate catheter in situ days. The AOLC test was performed on all those with suspected CR-BSI. A total of 499 CVCs in 400 patients were assessed, representing 3014 catheter in situ days. Over 80 % of patients were from our ICU/HDU, representing 404 CVCs and 1901 catheter in situ days. A total of 49/499 (9.8%) CVCs in the same number of patients were suspected of being infected subsequently 12/499 (2.4 %) CVCs [95% confidence interval (CI) 1.25 to 4.16] in 12 separate patients were demonstrated to be the direct cause of the patient's BSI. Rates of CR-BSI per 1000 catheter days were 3.98 (95 % CI 2.06 to 6.96) for the whole cohort and 4.20 (95 % CI 1.81 to 8.29) for the ICU/HDU subgroup. In the group suspected of having CR-BSI, CVCs were removed unnecessarily in 55 %, and no patient or catheter variables measured were predictive of the development of CR-BSI. The AOLC test was negative in all 12 catheters subsequently shown to be the definitive cause of BSI. CONCLUSIONS: We have defined the incidence of CR-BSI in a cohort of patients from a tertiary referral hospital, the rates comparing favourably with those reported for similar populations. We were unable to demonstrate significant differences in any patient or catheter variables between those with and without CR-BSI. The AOLC test used alone was unhelpful as a method to diagnose in situ CVC infection in this patient population.     

The effects of occupation-based social position on mortality in a large American cohort

OBJECTIVES: Four occupation-based measures were used to derive estimates of social position's effect on all-cause mortality among men and women in a large national cohort. METHODS: The National Longitudinal Mortality Study provided information on principal occupation and 9-year follow-up for 229,851 persons aged 25 through 64 years. Cox's proportional hazards model was used to estimate the age-adjusted risk of death relative to six ordinal categories of social position. The Slope Index of Inequality described average change in death rates across categories. RESULTS: Risk of death was consistently elevated among persons at lower positions in the social hierarchy. Estimates comparing lowest with highest categories varied within a narrow range (1.47-1.92 for men and 1.23-1.55 for women). However, several discrepancies among analyses were noted. The analysis by US census groups revealed nonlinear associations, whereas those using other scales found incremental increases in risk. Effect modification by sex was observed for analyses by two of the four measures. Race/ ethnicity did not modify the underlying association between variables. CONCLUSIONS: Our analysis complements previous findings and supports, with few qualifications, the interchangeability of occupation-based measures of social position in mortality studies. Explanations for why relative risk estimates were modified by sex are offered.