Home About us Contact
|
Home About us Contact | ||
|
|
||
Etiologic Factors (etiologic + factor)
Selected AbstractsHepatocellular carcinoma occurring in nonfibrotic liver: Epidemiologic and histopathologic analysis of 80 French casesHEPATOLOGY, Issue 2 2000Marie-Pierre Bralet M.D., Ph.D. Hepatocellular carcinoma (HCC) occurring in nonfibrotic liver represents a rare, ill-defined subgroup of HCC without cirrhosis in which mechanisms of hepatocarcinogenesis remain unclear. The aim of our study was to assess epidemiological factors and detailed histopathologic changes in the nontumoral liver of patients developing such tumors. Of 330 HCCs resected in our institution between 1985 and 1998, we retrospectively analyzed 80 cases (53 men, 27 women; mean age, 51 ± 16 years) in which the nontumoral liver showed no (n = 28) or minimal (n = 52) portal fibrosis without any septal fibrosis. In the group with no portal fibrosis there was no male predominance, and patients were significantly younger (44 ± 19 years vs. 54 ± 14 years) than those with minimal portal fibrosis. Sixty-seven tumors were typical HCCs, 8 were of fibrolamellar type, and 5 were hepatocholangiocarcinomas. Mean tumor size was 10 ± 5 cm. Risk factors for HCC development were found in 30 patients: hepatitis B (n = 17) or C (n = 2) virus infections, alcohol consumption (n = 11), and hemochromatosis (n = 1). In the nontumoral liver, periportal and lobular necrosis, mild portal inflammation, steatosis, and iron overload were present in 15%, 57%, 52%, and 54% of cases, respectively. Liver cell changes were noted in 6%. This study emphasizes the need for strict criteria to classify HCC without cirrhosis. HCC in nonfibrotic liver is a distinct subgroup in which nontumoral liver shows nonspecific minimal changes without regeneration or premalignant lesion. Etiologic factors are often unidentified, although presence of HBV infection in 21% suggests a direct oncogenic role of this virus. [source] Laser-Doppler Examination Shows High Flow in Some Common Telangiectasias of the Lower LimbDERMATOLOGIC SURGERY, Issue 4 2005Imre Bihari MD Background. The accepted pathophysiology of telangiectasias is reflux from superficial or deep veins. There are physical signs and scientific findings that do not fit this theory but support the possibility of arteriovenous (AV) shunt origin. Objective. If there is a higher flow in spider veins than in the surrounding skin, it means that AV shunts participate in the circulation of the telangiectasia. On the other hand, slow flow indicates reflux as the etiologic factor. Method. Telangiectasias and the surrounding skin of 22 legs of 19 patients were examined with laser-Doppler equipment. Results. The probe over the spider vein found a higher flow value (average 28.2 perfusion units [PU]) than in the surrounding skin (15.6 PU) in 13 limbs, but it was significantly higher only in 5 cases. In 9 limbs, the flow was slower. Conclusion. We interpret the higher flow values as a consequence of open AV shunts. This means that AV shunt pathophysiology was present in some of our cases. IMRE BIHARI, MD, PHD, ANIKÓ MURÁNYI, MD, AND PéTER BIHARI, MD, HAVE INDICATED NO SIGNIFICANT INTEREST WITH COMMERCIAL SUPPORTERS. [source] Plantar Hyperhidrosis and Pitted Keratolysis Treated with Botulinum Toxin InjectionDERMATOLOGIC SURGERY, Issue 12p2 2004Bhertha M. Tamura Background. Sulcate plantare keratolysis or pitted keratolysis (plantar keratolysis sulcatum) is a disease that is commonly found in tropical countries. Patients have also reported plantar hyperhidrosis. Objective. Two patients with pitted keratolysis resistant to topical and systemic treatments are described. Methods. Both patients were injected with botulinum toxin distributed evenly through the plantar extension. Results. The response to the treatment was excellent despite using a low dose of botulinum toxin with the plantar keratolysis healing completely. Conclusion. Hyperhidrosis may be considered the major etiologic factor for pitted keratolysis that does not respond to treatment. [source] HPV-positive/p16-positive/EBV-negative nasopharyngeal carcinoma in white North Americans,HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 5 2010Jessica H. Maxwell MD Abstract Background Human papillomavirus (HPV) has been detected in keratinizing nasopharyngeal carcinomas (NPCs); however, the relationship between HPV and Epstein,Barr virus (EBV) among whites with nonkeratinizing NPCs remains unclear. The HPV, p16, and EBV status was examined in current University of Michigan patients with NPC. Methods From 2003 to 2007, 89 patients, 84 with oropharyngeal cancer (OPC) and 5 with NPC, were enrolled in an organ-sparing trial. Biopsy tissues from all 89 patients were evaluated for HPV and p16 expression. A separate HPV analysis of the 84 OPC patients is in progress. Among the patients with NPC, tumor tissue was also analyzed for EBV-encoded RNA (EBER). Results Five of 89 patients (5.6%) had NPC, all with nonkeratinizing histology. The 4 white patients with NPC were HPV(+) (subtype-16, subtype-18 [2 patients], and subtype-59)/p16(+)/EBER(-). One Asian patient with NPC had an HPV(-)/p16(-)/EBER(+) NPC tumor that developed distant metastases. Conclusion We postulate that HPV may be the etiologic factor in some EBV-negative, nonkeratinizing NPCs among whites. © 2009 Wiley Periodicals, Inc. Head Neck, 2010 [source] Is season important for the diagnosis of cutaneous melanoma in southern Brazil?INTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 1 2010A 10-year hospital-based study Background, Exposure to sunlight is an important etiologic factor in cutaneous melanoma (CM). In several countries, more cases of CM are diagnosed in summer than in winter. Aim, To analyze whether there is seasonal variation in the diagnosis of CM in southern Brazil. Methods, Data were collected from a hospital-based registry, including all cases of CM diagnosed between 1996 and 2005. Summer to winter and spring to fall ratios were used for the analysis, and a 95% confidence interval (CI) was calculated using Poisson regression. Results, Two hundred and eighty-one patients were diagnosed in this period. Although some months were shown to have higher absolute numbers of diagnosed melanomas (April, July, and January), there was no statistically significant seasonal variation in most of the melanomas in terms of either the summer to winter ratio [odds ratio (OR) = 1.09; 95% CI, 0.77,1.44] or spring to autumn ratio (OR = 1.01; 95% CI, 0.71,1.43). Only the number of lentigo maligna melanomas (LMMs) diagnosed in summer was higher than that in winter (OR = 2.83; 95% CI, 1.07,8.78). Conclusions, In southern Brazil, CMs do not seem to be more frequently diagnosed in summer than in winter. Darkening of melanocytic lesions and increased awareness of skin lesions during the summer could be possible explanations for LMMs being more frequently diagnosed in summer than in winter in this sample. [source] Anterior urethral valve as a cause of end-stage renal diseaseINTERNATIONAL JOURNAL OF UROLOGY, Issue 3 2001Cem Aygün Abstract Although posterior urethral valves are predominant as a cause of obstructive uropathy in children, anterior urethral valves may also appear as the underlying etiologic factor in end-stage renal disease that results from obstruction. Two cases are presented of anterior urethral valve patients that were admitted with end-stage renal disease. The first case was successfully treated with diverticulectomy and urethral reconstruction in preparation for renal transplantation. The second case, however, had been on cystostomy drainage for 6 years and also had a contracted bladder. A more extensive lower urinary tract reconstruction was delayed. Children with poor stream and recurrent infections should be evaluated carefully and anterior urethral valve or diverticula should be considered in differential diagnosis of obstructive lesions. [source] LPS-Induced Inhibition of Osteogenesis Is TNF-, Dependent in a Murine Tooth Extraction Model,,JOURNAL OF BONE AND MINERAL RESEARCH, Issue 10 2009Nobuyoshi Tomomatsu Abstract TNF-, is a major etiologic factor of inflammatory bone diseases such as periodontitis and rheumatoid arthritis. In addition, patients with metabolic diseases such as chronic heart disease and diabetes have significantly increased plasma levels of TNF-,. Several lines of evidence show inhibition of osteoblastogenesis by TNF-, in vitro. Therefore, bone formation and osteogenesis in these patients might be inhibited because of TNF-,. However, little is known about the inhibitory role of TNF-, in bone formation/osteogenesis in vivo. The purpose of this study was to investigate the role of TNF-, in osteogenesis using a murine tooth extraction model. Lipopolysaccharide (LPS) was injected subcutaneously into the calvariae of either wildtype (WT) or TNF-,,deficient (KO) mice. The left incisor was extracted 4 days after LPS injection. The measuring area was established as the tooth socket under the mesial root of the first molar. A significant increase in serum TNF-, levels after LPS injection was observed in WT mice. The BMD of the tooth socket was significantly decreased by LPS injection 21 days after extraction in WT but not in KO mice. Histomorphometric analysis showed a significant decrease in the mineral apposition rate after LPS injection, which appeared at an early stage in WT but not in KO mice. Injection of a peptide that blocked the TNF-, signaling pathway by preventing transmission of the NF-,B signal recovered the inhibition of osteogenesis observed after LPS injection. In conclusion, TNF-, might play a major role in LPS-induced inhibition of osteogenesis under inflammatory conditions. [source] Infection frequently triggers thrombotic microangiopathy in patients with preexisting risk factors: A single-institution experienceJOURNAL OF CLINICAL APHERESIS, Issue 2 2010Kenneth W. Douglas Abstract Thrombotic microangiopathies are rare conditions characterized by microangiopathic hemolytic anemia, microthrombi, and multiorgan insult. The disorders, which include hemolytic uremic syndrome and thrombotic thrombocytopenic purpura, are often acute and life threatening. We report a retrospective analysis of 65 patients presenting to our institution from 1997 to 2008 with all forms of thrombotic microangiopathy. Therapeutic plasma exchange was a requirement for analysis and 65 patients were referred to our institution; 66% of patients were female and median age at presentation was 52 years. Bacterial infection was the most commonly identified etiologic factor and in the multivariate model was the only significant variable associated with survival outcome (odds ratio 5.1, 95% confidence interval, 1.2,21.7). As infection can be considered a common trigger event for thrombotic microangiopathy, patients with hepatobiliary sepsis may benefit from elective cholecystectomy. We conclude that bacterial infection frequently triggers TTP and other thrombotic microangiopathies in patients with preexisting risk factors and propose a model for the development of these syndromes. © J. Clin. Apheresis 2010. © 2010 Wiley-Liss, Inc. [source] Synergistic effects of nicotine on arecoline-induced cytotoxicity in human buccal mucosal fibroblastsJOURNAL OF ORAL PATHOLOGY & MEDICINE, Issue 8 2001Yu-Chao Chang Abstract: Areca quid chewing has been linked to oral submucous fibrosis and oral cancer. Arecoline, a major areca nut alkaloid, is considered to be the most important etiologic factor in the areca nut. In order to elucidate the pathobiological effects of arecoline, cytotoxicity assays, cellular glutathione S-transferase (GST) activity and lipid peroxidation assay were employed to investigate cultured human buccal mucosal fibroblasts. To date, there is a large proportion of areca quid chewers who are also smokers. Furthermore, nicotine, the major product of cigarette smoking, was added to test how it modulated the cytotoxicity of arecoline. At a concentration higher than 50 ,g/ml, arecoline was shown to be cytotoxic to human buccal fibroblasts in a dose-dependent manner by the alamar blue dye colorimetric assay (P<0.05). In addition, arecoline significantly decreased GST activity in a dose-dependent manner (P<0.05). At concentrations of 100 ,g/ml and 400 ,g/ml, arecoline reduced GST activity about 21% and 46%, respectively, during a 24 h incubation period. However, arecoline at any test dose did not increase lipid peroxidation in the present human buccal fibroblast test system. The addition of extracellular nicotine acted synergistically on the arecoline-induced cytotoxicity. Arecoline at a concentration of 50 ,g/ml caused about 30% of cell death over the 24 h incubation period. However, 2.5 mM nicotine enhanced the cytotoxic response and caused about 50% of cell death on 50 ,g/ml arecoline-induced cytotoxicity. Taken together, arecoline may render human buccal mucosal fibroblasts more vulnerable to other reactive agents in cigarettes via GST reduction. The compounds of tobacco products may act synergistically in the pathogenesis of oral mucosal lesions in areca quid chewers. The data presented here may partly explain why patients who combined the habits of areca quid chewing and cigarette smoking are at greater risk of contracting oral cancer. [source] Favorable Impact of a Vegan Diet with Exercise on Hemorheology: Implications for Control of Diabetic NeuropathyJOURNAL OF THE PERIPHERAL NERVOUS SYSTEM, Issue 2 2003MF McCarty A little-noticed clinical report indicates that a low-fat, whole-food vegan diet, coupled with daily walking exercise, leads to rapid remission of neuropathic pain in the majority of type 2 diabetics expressing this complication. Concurrent marked improvements in glycemic control presumably contribute to this benefit, but are unlikely to be solely responsible. Consideration should be given to the possibility that improved blood rheology , decreased blood viscosity and increased blood filterability , plays a prominent role in mediating this effect. There is considerable evidence that neural hypoxia, secondary to impaired endoneurial microcirculatory perfusion, is a crucial etiologic factor in diabetic neuropathy; the unfavorable impact of diabetes on hemorheology would be expected to exacerbate endoneurial ischemia. Conversely, measures which improve blood fluidity would likely have a beneficial impact on diabetic neuropathy. There is indeed evidence that vegan diets, as well as exercise training, tend to decrease the viscosity of both whole blood and plasma; reductions in hematocrit and in fibrinogen may contribute to this effect. The fact that vegan diets decrease the white cell count is suggestive of an improvement in blood filterability as well; filterability improves with exercise training owing to an increase in erythrocyte deformability. Whether these measures influence the activation of leukocytes in diabetics , an important determinant of blood filterability , remains to be determined. There are various reasons for suspecting that a vegan diet can reduce risk for other major complications of diabetes , retinopathy, nephropathy, and macrovascular disease , independent of its tendency to improve glycemic control in type 2 patients. The vegan diet/exercise strategy represents a safe, ,low-tech' approach to managing diabetes that deserves far greater attention from medical researchers and practitioners. [source] Cryptogenic fulminant hepatic failure in infancy: Report of 2 cases with unique vascular obstructive changes in native liversLIVER TRANSPLANTATION, Issue 9 2006Naoki Shimojima Although the causes of fulminant hepatic failure (FHF) remain cryptogenic in many cases, a few reports have reviewed the pathological findings of native livers to evaluate the etiology. We report 2 cases of infantile cryptogenic FHF with unique vascular obstructive changes in the native livers. Clinically, it was notable that these 2 patients developed FHF very early in life, at 2 months and 5 months of age, respectively. One patient died from chronic rejection associated with hepatic veno-occlusive disease 4 months after transplantation. Histologically, hepatocytes in the native livers were completely destroyed in both patients, and vascular findings revealed obstruction of central veins in 1 patient and obstruction of portal veins in the other patient. Although the pathogenesis of vascular obstructions is not yet understood, this study suggests that an obstructive vascular event may be a contributing etiologic factor of FHF in infancy. Liver Transpl 12:1418,1422, 2006. © 2006 AASLD. [source] Helicobacter pylori Colonization in the Larynges of Patients With Hoarseness,,THE LARYNGOSCOPE, Issue 3 2008Tuan-Jen Fang MD Abstract Objectives: Vocal nodules and polyps are two common noninfectious causes of hoarseness. Patients with persistent hoarseness often require microscopic laryngeal surgery to excise mass lesions of the larynx despite extensive voice resting and modification of voice use behavior. Helicobacter pylorihas recently been reported to present in the upper aerodigestive tract. This study applies the rapid urease test to determine the colonization of Helicobacter pylori in surgical specimens of patients with vocal nodules and polyps. Methods: In this prospective study, 53 consecutive patients with vocal nodules (n = 20) or vocal polyps (n = 33) were investigated from November 2004 to July 2005. Microscopic laryngeal surgery was performed in all cases. Tissue specimens harvested from the larynx were analyzed using the rapid urease test. Results: The study population consisted of 33 females and 20 males with a mean age of 43.1 ± 9.9 years. Thirteen (24.5%) of the 53 patients revealed Helicobacter pylori colonization, and all were histopathologically diagnosed with vocal polyps. The difference in incidence of Helicobacter pylori colonization between vocal nodules and vocal polyps was statistically significant (0% [0/20] vs. 39.4% [13/33], P = .001). Conclusions:Helicobacter pylori often colonizes in the larynxes of patients with vocal polyps. These results indicate the involvement of Helicobacter pylori in vocal polyps. However, the presence of Helicobacter pylori as an etiologic factor in vocal polyps remains inconclusive. [source] Measurement of Angle and Length of the Eustachian Tube on Computed Tomography Using the Multiplanar Reconstruction TechniqueTHE LARYNGOSCOPE, Issue 7 2007Kenji Takasaki MD Abstract Objective: To compare the anatomic features of the eustachian tube (ET) between children with and without otitis media with effusion (OME) and with adults. Methods: The angle and length of the ET in children with OME (54 ears, OME children) and without OME (50 ears, normal children), as well as those of normal adults (90 ears), were measured on computed tomography using the multiplanar reconstruction technique. Results: The angles of ET in the OME children group, the normal children group, and the normal adult group were 20.4 ± 3.5° and 21.2 ± 4.8°, 19.9 ± 3.4° and 20.0 ± 3.6°, and 27.3 ± 2.7° and 27.3 ± 2.8° on the right and the left sides, respectively. There was no significant difference between the right and the left side in any group (P = .541, P = .952, P = .978). The lengths of ET in the OME children group, the normal children group, and the normal adult group were 37.2 ± 3.0 mm (mean ± SD) and 37.6 ± 3.2 mm, 37.5 ± 3.3 mm and 38.0 ± 3.2 mm, and 42.5 ± 2.8 mm and 42.9 ± 2.9 mm on the right and the left sides, respectively. There was no significant difference between the right and left sides in any group (P = .670, P = .597, and P = .545). Both the angles and lengths were significantly greater in the normal adult group than in either the OME children group or the normal children group (one-way analysis of variance and Fisher's protected least significant difference tests, P < .05), but there was no significant difference in either the angle or length of the ET between the OME and normal children groups (P > .05). In the OME and normal children groups, the angle was observed to constantly increase with age, and the values were found to be within the range of the adult size in all the patients older than 7.5 years and 7.7 years in the OME children group and the normal children group, respectively. As well as the angle, the lengths were observed to constantly increase with age, but the increase appeared to be greater at a younger age (until approximately 3 to 4 years) than at an older age, and the values were found to be within the range of the adult size in all the patients older than 6.8 years and 7.7 years in the OME children group and the normal children group, respectively. Conclusion: The angle and length of the ET are more horizontal and shorter in infants than in adults. However, there is no statistical difference between the angle and length of the ET in infants with and without OME. These results lead us to believe that a short and horizontal ET may not be a main etiologic factor related to high susceptibility to OME in infants and children. [source] Evaluation of Membrane Oxygenators and Reservoirs in Terms of Capturing Gaseous Microemboli and Pressure DropsARTIFICIAL ORGANS, Issue 11 2009Yulong Guan Abstract An increasing amount of evidence points to cerebral embolization during cardiopulmonary bypass (CPB) as the principal etiologic factor of neurologic complications. In this study, the capability of capturing and classification of gaseous emboli and pressure drop of three different membrane oxygenators (Sorin Apex, Terumo Capiox SX25, Maquet QUADROX) were measured in a simulated adult model of CPB using a novel ultrasound detection and classification quantifier system. The circuit was primed with 1000 mL heparinized human packed red blood cells and 1000 mL lactated Ringer's solution (total volume 2000 mL, corrected hematocrit 26,28%). After the injection of 5 mL air into the venous line, an Emboli Detection and Classification Quantifier was used to simultaneously record microemboli counts at post-pump, post-oxygenator, and post-arterial filter sites. Trials were conducted at normothermic (35°C) and hypothermic (25°C) conditions. Pre-oxygenator and post-oxygenator pressure were recorded in real time and pressure drop was calculated. Maquet QUADROX membrane oxygenator has the lowest pressure drops compared to the other two oxygenators (P < 0.001). The comparison among the three oxygenators indicated better capability of capturing gaseous emboli with the Maquet QUADROX and Terumo Capiox SX25 membrane oxygenator and more emboli may pass through the Sorin Apex membrane oxygenator. Microemboli counts uniformly increased with hypothermic perfusion (25°C). Different types of oxygenators and reservoirs have different capability of capturing gaseous emboli and transmembrane pressure drop. Based on this investigation, Maquet QUADROX membrane oxygenator has the lowest pressure drop and better capability for capturing gaseous microemboli. [source] Anterior coracoscapular ligament and suprascapular nerve entrapmentCLINICAL ANATOMY, Issue 6 2002B.W. Avery Abstract A reduction in the height of the suprascapular foramen may predispose to entrapment of the suprascapular nerve. In this study, 16 of 27 cadavers (60%) demonstrated a heretofore unreported ligament located on the anterior aspect of the suprascapular foramen. In 11 of the 27 cadavers (41%), the ligament was observed bilaterally. The ligament decreased the foraminal height from the normative value of 5.6 ± 0.4 to 2.3 ± 0.4 mm (mean ± SEM). Because this ligament, for which we propose the term anterior coracoscapular ligament (ACSL), substantially narrows the suprascapular foramen, it should be considered as a possible etiologic factor in suprascapular nerve entrapment. Clin. Anat. 15:383,386, 2002. © 2002 Wiley-Liss, Inc. [source] Pigmentary Changes After Alexandrite Laser Hair RemovalDERMATOLOGIC SURGERY, Issue 4 2003Noah Kawika Weisberg MD Background Postinflammatory pigmentary changes are a frequently encountered problem with numerous dermatologic procedures. Limited literature is available that documents this complication with laser hair removal. Objective It is important for all physicians performing laser hair removal to be aware of this potential complication. We present our experience with postinflammatory pigmentary change and discuss some potential etiologic factors. Methods Seven patients who experienced postinflammatory complications after alexandrite laser hair removal are presented. These are all the patients who developed this complication in our office over the past 2.5 years. Results The patients who we describe in this article all developed a similar pattern of initial hyperpigmented rings, later developing into a thin wafer-like crust followed by hypopigmentation with gradual return to their normal skin color. Conclusion In general, the alexandrite laser is both safe and effective for hair removal in patients of varying skin types. Complication rates will increase as skin pigment increases and as the power used increases. However, even in light-skinned individuals without recent pretreatment or posttreatment sun exposure, with proper treatment parameters, complications, and side effects can arise. We have found this to be especially true when treating areas other than the face. [source] Characteristics of adult dentally fearful individuals.EUROPEAN JOURNAL OF ORAL SCIENCES, Issue 4 2000A cross-cultural study This cross-cultural study investigated adult dental fear patients in three countries. A joint intake interview questionnaire and a dental anxiety scale explored the level, background and concomitant factors of dental anxiety among patients at the Universities of Tel Aviv (Israel), Göteborg (Sweden), and Pittsburgh (USA). It was shown that patients at all three sites were quite similar with regard to age, sex, level of dental anxiety (DAS) and avoidance time. Negative emotions were common, with more negative everyday life effects among Swedish patients. Regardless of country, most patients stated that they had always been fearful, but environmental etiologic factors were frequently reported. Swedish patients more often reported both direct and indirect learning patterns than Israeli patients. Patients' motivation for treatment was high, while the belief in getting fear reduction was clearly lower. The most common reason for Israeli patients to seek treatment was a personal decision to try to cope with the situation, while for Swedish patients it was pain. Israeli and US patients preferred more ,active' modes of treatment such as behavioral management therapies, while Swedish patients equally preferred active and more ,passive' treatment approaches such as general anesthesia. Preference for dentist attributes were similar among groups and underlined the strong emphasis that fearful individuals place upon dentists' behaviors and their performance of dentistry. [source] Squamous cell carcinoma of the head and neck in never smoker,never drinkers: A descriptive epidemiologic studyHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 1 2008Kristina R. Dahlstrom BS Abstract Background. While the attributed risk factors for the vast majority of patients with squamous cell carcinoma of the head and neck (SCCHN) are smoking and alcohol abuse, there appears to be a rising proportion of SCCHN patients who report no significant smoking or drinking history. This study reports the demographic and potential risk factors of a large series of never smoker,never drinker (NSND) patients. Methods. All subjects were participants in a prospective epidemiologic study of incident SCCHN. We obtained demographic data, clinical characteristics, and potential etiologic factors for 172 NSND patients and 1131 ever smoker,ever drinker (ESED) patients. Results. NSND patients were more likely to be female and to present at extremes of age, but overall were significantly younger than ESED patients. NSND patients had a higher proportion of oral cavity and oropharyngeal cancers than ESED patients had. Eleven percent of NSND patients (17% of NSND men) reported regular use of noncigarette tobacco products or marijuana, 41% (45% of NSND women) reported regular environmental exposure to tobacco smoke, 24% (36% of NSND men) reported regular occupational exposures to carcinogens/toxins, and 30% had a history of gastroesophageal reflux disease. More than half the NSND patients with an oropharyngeal primary were serologically positive for human papillomavirus type 16. Conclusion. NSND patients with SCCHN are commonly young women with oral tongue cancer, elderly women with gingival/buccal cancer, or young to middle-aged men with oropharyngeal cancer. While several exposures studied may be important to the etiology of a subset of these cancers in NSND patients, it is likely that no single known factor is responsible for a majority of SCCHN in NSNDs. © 2007 Wiley Periodicals, Inc. Head Neck, 2008 [source] Preliminary study of ciprofloxacin in active Crohn's diseaseINFLAMMATORY BOWEL DISEASES, Issue 1 2002Dr. George L. Arnold Abstract Based on limited reports of the successful use of antibiotics in the treatment of Crohn's disease (CD) and on the possibility that intestinal bacteria may be one of the etiologic factors playing a role in the pathogenesis of this condition, we undertook a study to evaluate the use of a broad-spectrum antibiotic in CD. Our team studied the efficacy of adding the antibiotic ciprofloxacin to the treatment of moderately active, but resistant cases of CD. Forty-seven adults with moderately active CD were randomly assigned treatment with ciprofloxacin 500 mg twice daily versus placebo twice daily for 6 months. The primary endpoint was the change in scores on the Crohn's Disease Activity Index (CDAI) from baseline to month 6. Although 47 patients were randomized, at 1 month of follow-up 28 patients received ciprofloxacin and 19 received placebo. The mean entry CDAI scores were not significantly different: 187 for the ciprofloxacin group versus 230 for the placebo group (p = 0.638). Mean CDAI scores at the completion of study were 112 for the ciprofloxacin group (n = 25) and 205 for the placebo group (n = 12), (p < 0.001). Disease remission is defined as a decrease in the CDAI score to less than 150 points. Our preliminary study suggests that ciprofloxacin may be an effective agent when added to the treatment of moderately active, resistant CD. [source] Progressive macular hypomelanosis in Singapore: a clinico-pathological studyINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 6 2006Sujith Prasad W. Kumarasinghe MBBS Introduction, Progressive macular hypomelanosis (PMH), a condition of uncertain etiology, is characterized by asymptomatic hypopigmented macules predominantly located on the trunk. To date, there are no reports from South-East Asia concerning this condition. We sought to record the clinical features of PMH in Asian patients, identify etiologic factors, and study the structural and ultrastructural features of melanocytes in this disorder. Methods, Patients who presented to the National Skin Center with acquired, hypopigmented macules on the trunk, without a history of inflammation or infection, were recruited. Erythrocyte sedimentation rate (ESR), complete blood count, fasting blood glucose, liver function tests, skin scrapings for fungi, and skin biopsy specimens (from lesional and normal skin) were obtained. Biopsies were stained with hematoxylin and eosin (H&E), Fontana Masson, an immunohistochemical panel for identification of melanocyte differentiation antibodies (HMB 45, Melan A, and S100) and CD 68. Electron microscopy (EM) was also performed. The patients were evaluated every 3 months. Results, During a 9 month period, eight patients (all Chinese) presented with hypopigmented, ill-defined, confluent macules involving the lower aspect of the trunk. There were four men and four women, and the mean age was 25.9 years (range 19,45 years). Skin scrapings were negative for fungi and laboratory tests were normal. Microscopic evaluation of skin biopsy speciments showed reduced pigmentation of lesional as compared with normal appearing skin, but H&E-stained sections revealed only minimal histologic differences between lesional and normal skin. EM demonstrated a statistically significant (P = 0.047, Wilcoxon Signed Rank Test, Wilcoxon 95% CI 0.02,0.62) higher ratio of stage IV and late stage III (dark) melanosomes in normal vs. lesional skin. Conclusions, PMH may occur among young adults in Singapore. Its etiology is uncertain. The melanin content of lesional skin appears to be less than that in normal sites. EM shows a higher ratio of immature melanosomes in lesional vs. normal skin. [source] Localized lymphedema (elephantiasis): a case series and review of the literatureJOURNAL OF CUTANEOUS PATHOLOGY, Issue 1 2009Song Lu Background:, Lymphedema typically affects a whole limb. Rarely, lymphedema can present as a circumscribed plaque or an isolated skin tumor. Objective:, To describe the clinical and pathologic characteristics and etiologic factors of localized lymphedema. Methods:, Case,control study of skin biopsy and excision specimens histologically diagnosed with lymphedema and presenting as a localized skin tumor identified during a 4-year period. Results:, We identified 24 cases of localized lymphedema presenting as solitary large polyps (11), solid or papillomatous plaques (7), pendulous swellings (4), or tumors mimicking sarcoma (2). Patients were 18 females and 6 males with a mean age of 41 years (range 16,74). Anogenital involvement was most frequent (75%) , mostly vulva (58%), followed by eyelid (13%), thigh (8%) and breast (4%). Causative factors included injury due to trauma, surgery or childbirth (54%), chronic inflammatory disease (rosacea, Crohn's disease) (8%), and bacterial cellulitis (12%). Eighty-five percent of these patients were either overweight (50%) or obese (35%). Compared with a series of 80 patients with diffuse lymphedema, localized lymphedema patients were significantly younger (41 vs. 62 years old, p = 0.0001), had no history of cancer treatment (0% vs. 18%, p = 0.03), and had an injury to the affected site (54% vs. 6%, p = 0.0001). Histologically, all cases exhibited dermal edema, fibroplasia, dilated lymphatic vessels, uniformly distributed stromal cells and varying degrees of papillated epidermal hyperplasia, inflammatory infiltrates and hyperkeratosis. Tumor size significantly and positively correlated with history of cellulitis, obesity, dense inflammatory infiltrates containing abundant plasma cells, and lymphoid follicles (p < 0.05). A history of cellulitis, morbid obesity, lymphoid follicles and follicular cysts predicted recurrent or progressive swelling despite excision (p < 0.05). Conclusions:, Localized lymphedema should be considered in the etiology of skin tumors when assessing a polyp, plaque, swelling or mass showing dermal edema, fibrosis and dilated lymphatics on biopsy. A combination of lymph stasis promoting factors (trauma, obesity, infection and/or inflammatory disorders) produces localized elephantiasis. [source] Association of viral factors with non-familial breast cancer in Taiwan by comparison with non-cancerous, fibroadenoma, and thyroid tumor tissues,JOURNAL OF MEDICAL VIROLOGY, Issue 2 2005Ju-Hsin Tsai Abstract To study the etiologic factors of non-familial breast cancer, the polymerase chain reaction (PCR) and Southern hybridization were used to detect six viruses including human papillomavirus (HPV), cytomegalovirus (CMV), Epstein,Barr virus (EBV), herpes simplex virus (HSV)-1, HSV-2, and human herpesvirus (HHV)-8 DNA in 69 patients with breast cancer and 60 specimens from non-cancerous or other individuals with thyroid tumors or fibroadenoma (non-breast cancer controls). Two specimens from patients with a familial history of breast cancer and five breast cancer specimens with negative results for ,-globin, which was used as internal control, were excluded from this study. Eight (12.9%) HSV-1, 28 (45.2%) EBV, 47 (75.8%) CMV, 8 (12.9%) HPV, and 28 (45.2%) HHV-8 positive samples out of the 62 breast cancer specimens were detected; no HSV-2 DNA was detected in any group. Among the viral gene-positive breast cancer samples, 12 (23.1%) were positive for 1 virus, 16 (30.8%) were positive for 2 viruses, 21 (40.4%) were positive for 3 viruses, and 3 (5.8%) were positive for 4 viruses. Among the viral gene-positive specimens of the control groups, only one virus, CMV, was found in the non-cancerous and thyroid tumor specimens, while multiple viruses were found in the fibroadenoma specimens. The viruses associated with breast cancer were HHV-8,>,EBV (P,<,0.01). The viruses associated with fibroadenoma were HSV-1 and HHV-8,>,EBV (P,<,0.01). The presence of more than one virus was found predominantly in breast cancer and exclusively found in fibroadenoma. CMV was the only virus associated with thyroid tumors. J. Med. Virol. 75:276,281, 2005. © 2004 Wiley-Liss, Inc. [source] Root surface debridement and endotoxin removalJOURNAL OF PERIODONTAL RESEARCH, Issue 3 2003J. Cadosch Objective:, This study assessed associations between the number of standardized scaling strokes and the reduction of endotoxin on the root surface. Background:, Therapy of periodontally involved teeth attempts removal of accretions by scaling and root planing. The amount of mechanical therapy required to free the root surface from etiologic factors remains unknown. Methods:, Twenty-four extracted human caries-free single rooted teeth with at least 5 mm attachment loss were used. A region of interest (ROI) which contained subgingival calculus was defined on the root surface of each tooth. Standardized force instrumentation was applied using a force-measuring curet. Fifty working strokes were applied to every ROI. Forces applied were recorded. The force recordings were converted from Millivolts into Newtons (N). After every unit of 5 strokes, presence of calculus was evaluated and scaling debris was collected. Endotoxin concentration was determined in the debris samples. Results:, The endotoxin values for strokes 1,5 were statistically significantly greater than the values from all other stroke intervals. Complete calculus removal occured after a mean of 9.3 strokes. The endotoxin concentration reached a minimal level with concentrations of 0.03,0.306 EU/ml after calculus removal was complete. Conclusion:, These findings suggest that completion of calculus removal coincides with endotoxin levels associated with clinically healthy teeth. [source] Resolution of alcoholic neuropathy following liver transplantationLIVER TRANSPLANTATION, Issue 12 2004Edward Gane Between 10 and 20% of adult liver transplants are performed for end-stage alcoholic liver disease. Severe extrahepatic end-organ damage from alcoholism (cardiomyopathy, pancreatitis, central nervous system injury, and neuropathy) is widely regarded as an absolute contraindication to liver transplantation, despite a lack of data on the effect of transplantation on these complications. We describe such a patient who presented with decompensated alcoholic liver disease and moderately severe peripheral neuropathy. Both his liver failure and neuropathy progressed despite 9 months abstinence and intensive nutritional support. By 12 months post-transplant, however, this patient had regained almost normal muscle strength, with associated recovery in sensory and motor conduction velocities. Direct alcohol toxicity, nutritional and vitamin deficiencies, and liver failure were all likely etiologic factors in this patient's neuropathy. In conclusion, this case suggests that peripheral neuropathy in a patient with alcoholic cirrhosis may resolve following liver transplantation and should not constitute a contraindication to transplantation, even when it is disabling. (Liver Transpl 2004;10:1545,1548.) [source] Taxonomy of pain. (Lehigh Valley Hospital, Center for Pain Management, Allentown, PA) Clin J Pain 2000;16:S114,S117.PAIN PRACTICE, Issue 2 2001Bruce Nicholson: This article discussed the way that research on the pathophysiology of chronic pain has started to challenge the traditional diagnostic and treatment paradigms for the patient with neuropathic pain. It stated that the heterogeneous nature of neuropathic pain indicated that more than one anatomic lesion is most likely responsible for the clinical presentation of a particular syndrome. Conclude that the current taxonomy often falls short of identifying the multifactorial nature of neuropathic pain syndromes and, therefore, may lead to imprecise management of those conditions. It is suggested that an integrated approach to the diagnosis and treatment of neuropathic pain that considers both etiologic factors and possible mechanisms will lead to more effective taxonomy, treatment paradigms, and outcomes. [source] Definitions of the phenotypic manifestations of sickle cell disease,AMERICAN JOURNAL OF HEMATOLOGY, Issue 1 2010Samir K. Ballas Sickle cell disease (SCD) is a pleiotropic genetic disorder of hemoglobin that has profound multiorgan effects. The low prevalence of SCD (,100,000/US) has limited progress in clinical, basic, and translational research. Lack of a large, readily accessible population for clinical studies has contributed to the absence of standard definitions and diagnostic criteria for the numerous complications of SCD and inadequate understanding of SCD pathophysiology. In 2005, the Comprehensive Sickle Cell Centers initiated a project to establish consensus definitions of the most frequently occurring complications. A group of clinicians and scientists with extensive expertise in research and treatment of SCD gathered to identify and categorize the most common complications. From this group, a formal writing team was formed that further reviewed the literature, sought specialist input, and produced definitions in a standard format. This article provides an overview of the process and describes 12 body system categories and the most prevalent or severe complications within these categories. A detailed Appendix provides standardized definitions for all complications identified within each system. This report proposes use of these definitions for studies of SCD complications, so future studies can be comparably robust and treatment efficacy measured. Use of these definitions will support greater accuracy in genotype,phenotype studies, thereby achieving a better understanding of SCD pathophysiology. This should nevertheless be viewed as a dynamic rather than final document; phenotype descriptions should be reevaluated and revised periodically to provide the most current standard definitions as etiologic factors are better understood, and new diagnostic options are developed. Am. J. Hematol. 2010. © 2009 Wiley-Liss, Inc. [source] The Etiology of Different Forms of Urticaria in ChildhoodPEDIATRIC DERMATOLOGY, Issue 2 2004Cansin Sackesen M.D. In contrast to the ease of its diagnosis, etiologic factors are often difficult to determine. In order to study whether differences exist among various forms of urticaria in childhood and whether the patterns of different types of urticaria differ between adults and children, we extensively studied the possible causes of urticaria in children. Fifty-four children (23 girls and 31 boys; ages 1,19 years) with various forms of urticaria were included in the study. In all cases, questions about food allergies, food additive intolerance, drug intake, signs of infection, causes of physical urticaria, insect bites, and personal and family history of atopy were asked. Clinical characteristics of the disease, such as duration, recurrence, and associated angioedema and symptoms of anaphylaxis were also investigated. Detailed laboratory tests, including serologic, autoimmune, and allergic analyses, were conducted to reveal the probable etiologies of urticaria. Of the study patients, 68.5% and 31.5% were diagnosed as having acute and chronic urticaria, respectively. The patient group with chronic urticaria was older and included more boys than the acute group. In the acute urticaria group, infection was the most frequently documented cause (48.6%), followed by drugs (5.4%), and food allergies (2.7%), whereas in chronic urticaria, physical factors were the leading cause (52.94%). The most frequently documented infection was urinary tract infection, followed by serologically determined infections of Chlamydia pneumoniae and Helicobacter pylori. In this study we found indications that infections were frequently associated with urticaria, which suggests that urticaria management should include a survey of certain infectious agents in addition to a detailed history. [source] Possible etiologic factors in 151 Turkish patients with aplastic anemiaAMERICAN JOURNAL OF HEMATOLOGY, Issue 1 2001M. Nergis Aln No abstract is available for this article. [source] Intervertebral disc degeneration: New insights based on "skipped" level disc pathologyARTHRITIS & RHEUMATISM, Issue 8 2010Kenneth M. C. Cheung Objective Typically, age and abnormal physical loading ("wear and tear") have been associated with the development of intervertebral disc degeneration. In the past decade, various additional etiologic factors for disc degeneration have been sporadically reported in the literature; however, many investigators continue to place tremendous emphasis on the effects of age and biomechanics associated with disc degeneration. The aim of this study was to provide additional insight into the notion that age and biomechanics are key factors in the development of disc degeneration. To this end, we addressed the prevalence of and risk factors associated with a unique pattern of disc degeneration of the lumbar spine, "skipped" level (nonconsecutive) disc degeneration (SLDD). Methods As part of a large genetics-based study in southern Chinese individuals (n = 1,989), a cross-sectional analysis was performed in subjects exhibiting disc degeneration in ,2 levels (n = 838) who were then categorized as having SLDD (n = 174) or non-SLDD (contiguous, multilevel; n = 664). Various radiographic parameters were assessed based on T2-weighted magnetic resonance imaging (MRI). Subject demographics were assessed, and univariate and multivariate logistic regression analyses were performed. Results Overall, 8.7% of the whole population (n = 1,989) had SLDD, while it was present in 20.8% of subjects with multilevel disc degeneration (n = 838). SLDD was more prevalent in male subjects (adjusted odds ratio [OR] 1.48, 95% confidence interval [95% CI] 1.04,2.10, P = 0.028). SLDD was significantly associated with the presence of Schmorl's nodes (adjusted OR 2.72, 95% CI 1.78,4.15, P < 0.001), which also presented in levels with no disc degeneration. A history of disc bulge/extrusion (P = 0.004) and/or a history of back injury (P = 0.010) was significantly associated with non-SLDD, and a greater degree of overall severity of disc degeneration was also associated with non-SLDD. Other demographic and MRI findings did not significantly differ between groups. Conclusion To our knowledge, this report is the first to describe the prevalence and risk factors associated with SLDD. Our study challenges the paradigm that age and biomechanics are the key factors associated with the development of disc degeneration. Although age and biomechanical factors may play a role in the manifestation of disc degeneration, our novel findings of SLDD patterns provide further awareness of and support for the notion that additional etiologic factors may play a role in the development of disc degeneration. Such factors warrant further investigation to shed light on the cause of disc degeneration. [source] Tongue and tonsil carcinomaCANCER, Issue 9 200544 years, Increasing trends in the U.S. population ages 20 Abstract BACKGROUND An increasing incidence of oral carcinoma among young adults has been reported in the U.S. and Europe. Although the association between human papillomavirus infection and tonsillar carcinoma is now well established, to the authors' knowledge little is known about incidence trends in tonsillar carcinoma among younger adults. The objective of the current study was to explore the trends in both oral cavity and pharyngeal squamous cell carcinoma (SCC) in younger U.S. populations, in particular tongue and tonsillar SCC. METHODS Using the 1973,2001 Surveillance, Epidemiology and End Results (SEER) database, we computed age, race, and site-specific trends of oral and pharyngeal (excluding nasopharynx) carcinoma incidence rates. The percent change (PC) and annual percent change (APC) were computed to explore trends in incidence rates over time. RESULTS There were 2262 SCC of the oral cavity and 1251 SCC of the pharynx reported to the SEER program from 1973 to 2001 in adults aged 20,44 years. There was a statistically significant increase in the incidence of oral tongue SCC (APC = +2.1; P < 0.001), base of tongue SCC (APC = +1.7; P = 0.04), and palatine tonsil SCC (APC = +3.9; P < 0.001) among younger white individuals, whereas the incidence of SCC in all other oral and pharyngeal sites decreased or remained constant. CONCLUSIONS The increase in tonsil SCC incidence from 1973 to 2001 paralleled the increase in tongue SCC, whereas SCC in all other oral and pharyngeal sites remained constant or decreased. This may suggest similar etiologic factors for SCC affecting the palatine tonsils and tongue in younger populations. Cancer 2005. © 2005 American Cancer Society. [source] | |||||||||||||