Risk of lung cancer among patients with head and neck cancer

A cohort of 5180 patients with head and neck cancer, who were part of the tumor registry of the Surveillance, Epidemiology, and End Results area of western Washington State, was followed up for as many as 15 years to determine the risk of lung cancer. A sample of 522 patients from this cohort was interviewed to determine smoking history. Lung cancer developed in 356 (6.9%) of the 5180 patients. The overall annual incidence of lung cancer remained relatively constant between approximately 1.0% and 2.0% during the 15 years of follow-up. Men had an increased risk of lung cancer compared with women (relative risk [RR] = 1.56; 95% confidence interval [CI] = 1.18 to 2.03). Compared with patients with oral cavity cancer (RR = 1.00), the relative risk of lung cancer developing by the site of the index tumor was 0.63 (95% CI = 0.40 to 0.98) for lip, 1.12 (95% CI = 0.81 to 1.56) for intrinsic larynx, 1.73 (95% CI = 1.21 to 2.47) for oropharynx, 1.84 (95% CI = 1.16 to 2.92) for hypopharynx, and 2.28 (95% CI = 1.60 to 3.24) for extrinsic larynx. Among the 522 patients who were interviewed, men smoked more than women ( p < 0.0001), and patients with laryngeal or pharyngeal cancer smoked more than patients with cancer of the lip or the oral cavity ( p < 0.05). Among patients with head and neck cancer, the risk of lung cancer is highest for men and for patients with cancer of the pharynx or extrinsic larynx. These findings may be explained by differences in smoking consumption. (Otolaryngol Head Neck Surg 1997;116:630-6.)     

Navigating growth attenuation in children with profound disabilities. Children's interests, family decision-making, and community concerns

A twenty‐person working group convened to discuss the ethical and policy considerations of the controversial intervention called “growth attenuation,” and if possible to develop practical guidance for health professionals. A consensus proved elusive, but most of the members did reach a compromise.     

Allogeneic related donor hematopoietic stem cell transplantation for treatment of chronic lymphocytic leukemia

Between 1980 and 1999, 25 patients with chronic lymphocytic leukemia (CLL) received related donor hematopoietic stem cell transplants. Median patient age was 46.6 years. Preparative regimens included busulfan (BU) plus cyclophosphamide (CY), CY plus TBI, and etoposide, CY plus TBI. Twenty-one donors were HLA-identical siblings, one was a DR mismatched sibling, and three were identical twins. Bone marrow was the source of hematopoietic stem cells in 22 cases and G-CSF stimulated peripheral blood in three cases. Most patients received methotrexate and cyclosporine for GVHD prophylaxis. Fourteen patients developed grades 2-4 acute GVHD and 10 developed clinical extensive chronic GVHD. Late clearance of CLL cells was associated with the development of chronic GVHD in one patient. Two patients had recurrent CLL. Nonrelapse mortality at day 100 was 57% for the seven patients conditioned with BU/CY and 17% for the 18 patients conditioned with TBI-containing regimens. Actuarial survival at 5 years for the 25 patients is 32%. All patients who received BU/CY died within 3 years of transplant. For the 14 patients transplanted since 1992 and who received TBI, actuarial 5-year survival is 56%. The maximum response of CLL to hematopoietic cell transplantation may be delayed, but long-term disease-free survival can be achieved.     

Viral hepatitis among young men who have sex with men: prevalence of infection,risk behaviors,and vaccination

BACKGROUND: Men who have sex with men (MSM) are at risk for acquiring hepatitis A virus (HAV), hepatitis B virus (HBV), and hepatitis C virus (HCV). GOAL: The goal was to describe the seroprevalence of and risk factors for viral hepatitis, the frequency of vaccination against HAV and HBV, and reasons for lack of vaccination among young MSM. STUDY DESIGN: We performed hepatitis serologies on 833 MSM aged 15 to 29 years who attended public venues in King County, Washington. RESULTS: While 14.6% were HAV-immune due to vaccination, 13.9% had prior HAV infection; 57.9% were susceptible and 13.5% had unclear status. While 24.5% were HBV-immune due to vaccination, 13.3% had prior HBV infection; 44.2% were susceptible and 18.0% had unclear status. Prior HBV infection was associated with prior HAV infection. Men unvaccinated against HAV or HBV were unaware of the vaccines or had never been offered vaccination or perceived themselves at low risk for infection. Among 10 HCV-seropositive men, 70.0% reported injection drug use. CONCLUSION: MSM must be vaccinated at an early age to prevent acquisition of HAV and HBV. Given the frequency of coinfection with HAV and HBV, a combined vaccine would be useful in this population.     

Seroepidemiology of human herpesvirus 8 among young men who have sex with men

BACKGROUND: The modes of transmission of human herpesvirus 8 (HHV-8) remain unclear. GOAL: To study HHV-8 seroprevalence and risk factors among young men. STUDY DESIGN: The Young Men's Survey was a multisite cross-sectional HIV seroprevalence and behavioral risk survey of men aged 15 to 22 years who attended public venues frequented by young men who have sex with men (MSM). Blood specimens were tested for HHV-8 by using an immunofluorescence assay at a 1:40 dilution among 488 participants in Seattle-King County, WA. RESULTS: Total HHV-8 seroprevalence was 6% among MSM and 5% among men who have sex only with women (MSW). In multivariate analysis, unprotected receptive anal sex during the past 6 months, injection drug use, and cytomegalovirus infection were associated with HHV-8 seropositivity in MSM. CONCLUSION: The HHV-8 seroprevalence among these young MSM was similar to the HHV-8 seroprevalence among young MSW, but lower than seroprevalence estimates in earlier studies of older MSM. The association of MSM between HHV-8 infection and unprotected receptive anal sex supports previous findings that HHV-8 is sexually transmitted. Although CMV infection and injection drug use may be markers for unsafe sexual practices, it is also possible that these are independent risk factors for acquiring HHV-8.     

MORPHOLOGIC CHANGES IN THE BRONCHIOLAR EPITHELIA OF RATS EXPOSED TO VOLCANIC ASHES

This study reports the quantitative,and qualitative changesin the small airways after exposure to volcanic ash and quartz,and fol-lowed by an additional nine months of clean air.Three matched groupsof 75 rats were exposed to volcanic ash,quartz,and clean air in a Ro-chester exposure chamber 6 hours daily for 14 days.Animals were sac-rificed and studied,at pariodic intervals.Morphologic and morphometricevaluations were made using light microscope,transmissional electron mi-croscope and scanning electron microscope.The results showed:a.volcanicash produced the same damage in the small ailway as quartz did but lesssevere,b.Clara cells were the most severely damaged cell type occuringmost often at the end of exposure,and c.the damaged epithelial cellsmight be repaired by means of proliferation and differentiation of re-maining Clara cells,and perhaps type Ⅱ cells and Clara cells couldtransform mutually,and d.peribronchiolar fibrosis was greater after3 month exposure which may be persistent.These evidences indicate the exposure to either quartz or volcanic ashhas a persistent fibrogenic effect on the small airways in rats,butbronchiolar epithelium can be repaired as the stimulus is terminated.     

Marrow transplantation for aplastic anemia and acute leukemia

Patients with severe aplastic anemia or refractory acute leukemia with HLA identical sibling donors were considered for marrow transplantation in Seattle. Patients with aplastic anemia were generally conditioned for grafting by high-dose cyclophosphamide (CY); those with acute leukemia by CY and total body irradiation. All patients received methotrexate post-grafting to ameliorate anticipated graft-versus-host disease (GVHD) and were supported with blood products, antibiotics, and intensive care as necessary.Of 73 patients with aplastic anemia, 31 are alive 1 to 5 1/2 years following transplantation; 25 are well, 6 have chronic GVHD. Major causes of death were GVHD (16 patients), graft rejection (17 patients), and infection (6 patients). Of 110 patients with acute leukemia, 17 are alive 1 to 6 years after transplantation. There has been no evidence of recurrent leukemia in 14, although leukemia has relapsed and a subsequent remission has been induced in 3 patients. Respiratory failure secondary to interstitial pneumonia led to the death of 34 patients, other infections led to the death of 16 patients, and 27 patients died as a result of recurrent leukemia. These studies in man, and laboratory studies in the dog, contribute information about many aspects of transplantation biology. Discussed in this report are graft rejection, GVHD, graft-versus-leukemia, the nature of stable graft-host tolerance, and the genetics of transplantation. Despite the many problems that remain, the results described in man establish marrow transplantation as an important form of therapy for selected patients with an otherwise fatal illness.

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Résumé Cet article rapporte l'expérience du groupe de Seattle avec les transplantations de moËlle osseuse. On y décrit l'expérience accumulée chez les patients souffrant d'anémie aplastique sévère ou de leucémie aigüe chez qui des donneurs de la mÊme famille porteur d'antigènes HLA identiques étaient disponibles. En préparation à la greffe, les patients porteurs d'anémie aplastique furent traités au cyclophosphamide, tandis que ceux atteints de leucémie aigüe, en plus du traitement au cyclophosphamide, furent soumis à l'irradiation corporelle totale. Après la greffe, tous les patients reÇurent du méthotrexate pour minimiser la réaction greffe-versus-hÔte et on leur administra au besoin des antibiotiques et des transfusions sanguines. Des 73 patients porteurs d'anémie aplastique, 31 sont vivants de un à 5 1/2 ans après la transplantation; 25 se portent bien et 6 sont atteints de la maladie de la greffe-versus-l'hÔte (GVH) de faÇon chronique. Les principales causes de décès furent la maladie GVH (16 patients), le rejet du greffon (17 patients), et l'infection (6 patients). Des 110 patients atteints de leucémie aigüe, 17 sont vivants de 1 à 6 ans après la transplantation. Quatorze d'entre eux sont en bonne santé, tandis que chez 3 autres, la leucémie est réapparue mais a pu Être contrÔlée par le traitement habituel. Les principales causes de décès furent la défaillance respiratoire secondaire à la pneumonie interstitielle (34 patients), autres infections (16 patients), et la récidive de la leucémie (27 patients). Ces résultats obtenus chez l'homme et des études similaires faites en laboratoire chez le chien, améliorent notre compréhension des phénomènes biologiques reliés à la transplantation. Les auteurs joignent à ce rapport une discussion couvrant les phénomènes de rejet du greffon, de la maladie GVD et de la greffe-versus-leucémie, la tolérance hÔte-greffon et la génétique des transplantations. En dépit des multiples problèmes encore à résoudre, ces résultats obtenus chez l'homme assurent à la greffe de moËlle une place de choix dans le traitement de ces maladies autrement fatales.

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Supported by Grants CA 18579, CA 18029, CA 15704, CA 17117, and CA 18047, awarded by the National Cancer Institute, DHEW, and Contract AI 52515 from the National Institute of Allergy and Infectious Diseases. Dr. Thomas is a recipient of Research Career Award AI 02425 from the National Institute of Allergy and Infectious Diseases. Dr. Weiden is supported in part by a Fellowship from the American Cancer Society.     

乳腺MR检出病灶中恶性可能性:基于BI-RADS图像特征和临床指标的多变量预测模型

目的探讨基于病人与病灶特征的多变量模型在预判MRI检出的乳腺病灶中恶性病灶可能性的应用价值。方法回顾性分析2003年1月—2006年11月期间行乳腺