Anomalies of tooth formation in hypohidrotic ectodermal dysplasia

OBJECTIVE: The X-linked hypohidrotic ectodermal dysplasia (HED) is the most common type of ectodermal dysplasia. The clinical identification of possible heterozygous females can be difficult because of the varying degrees of clinical signs caused by X-chromosome inactivation. This study is the first to elaborate on anomalies of tooth formation found in a group of hemizygous males and heterozygous females with known ED1 mutations. These tooth anomalies may be used as dental biomarkers for heterozygous females, enabling an earlier diagnosis, and therefore, better treatment and genetic counselling. METHODS: Anomalies of tooth formation were examined using panoramic radiographs, dental casts and oral photographs in hemizygous males and heterozygous females who were identified by molecular genetic analysis. The results were compared to existing controls and normative data. RESULTS: All affected males had multiple missing permanent teeth and tooth malformations. The heterozygous females had a significantly higher frequency of agenesis of permanent teeth compared to normative data. The heterozygous females had an increased prevalence of tooth malformations and reduced tooth size, especially in the mesiodistal dimension. CONCLUSIONS: We conclude that observed anomalies of tooth formation may be used as dental biomarkers in the clinical identification of potentially heterozygous females.     

CT findings of intussusception in adults

Intussusception is rare in adults, in contrast to its frequent occurrence in infants. The clinical presentation is variable, consisting mainly of abdominal pain that may be chronic, intermittent, or acute. The classic triad of nausea and vomiting, bloody diarrhea, and an abdominal mass typically present in children with intussusception does not usually appear in adults. This diagnosis is, therefore, rarely included in the differential diagnosis of adult patients with vague abdominal complaints. However, with increasing use of CT scanning in the evaluation of patients with abdominal pain, the diagnosis of intussusception can be readily suggested by the radiologist because of its virtually pathognomonic appearance on CT.     

Management of relocation in cognitively intact older adults

As the older adult population grows, the rate of relocation from one home to another will also increase. To promote planning for relocation to a new home and adjustment to this stressful life event, pre-relocation and post-relocation risks need to be assessed and interventions designed to facilitate relocation decision making and adjustment. The evidence-based guideline by Hertz et al. (2005) provides detailed tools and recommendations for management of pre-relocation and post-relocation processes with cognitively intact older adults by nurses and other health care providers in community-based care, long term care, and acute care settings.     

Ureteral injuries: CT diagnosis.

Ureteral injury is a rare, yet very serious, complication of various abdominal, pelvic, and even spinal procedures. It is often clinically unsuspected as symptoms are nonspecific and the patient may present weeks and even months after the injury. Therefore the diagnosis of ureteral injury is often delayed, leading to more serious morbidity. A ureteral injury may be first diagnosed on CT in a patient evaluated after surgery. A high index of suspicion is essential and a CT study should then include a delayed scan in order to establish the diagnosis of ureteral injury resulting in a urinoma. This may obviate the need for additional invasive imaging studies or unnecessary exploration.     

Early identification of relocation risk in older adults with critical illness

One aspect of an evidence-based practice (EBP) guideline on managing relocation in cognitively intact older adults is elaborated upon in this article. The older population is at particular risk for needing to relocate to a new permanent home following hospitalization for a critical illness, but planning for these moves is often done in crisis mode. The purpose of this article is to sensitize nurses to risks for relocation in critically ill older persons and to encourage application of the EBP guideline in practice. Recommendations for risk assessment are made including using existing and supplementary assessment methods and data. Implementing EBP guidelines such as this is one key element in providing quality care to critically ill older adults.     

IVC anomalies and right renal aplasia detected on CT: a possible link?

Background: We report the occurrence of congenital anomalies of the inferior vena cava (IVC) and right renal aplasia in three patients as detected on computed tomography (CT). Methods: The medical records and imaging studies of three patients with congenital anomalies of the IVC and right renal aplasia were studied. We also reviewed eight reported cases with such an association. Results: Eleven patients, nine adults and two girls, were included in the series. Indications for imaging included deep vein thrombosis (n = 5), hypertension (n = 2), failure to advance a femoral vein catheter cranially (n = 1), dilated veins along the abdominal wall (n = 1), endstage renal failure (n = 1), and jaundice (n = 1). CT was performed in seven patients, and venography, aortography, and other imaging modalities were performed in four. IVC anomalies included partial or complete absence of the IVC in nine patients and a double vena cava in two. The azygos vein was very prominent in all patients in whom the IVC was absent. The right kidney was absent or very small in all patients. Conclusion: The association between IVC anomalies and absence of the right kidney as detected on CT probably was not incidental. Although most patients had symptoms deriving from the anomalies, these might have been clinically silent. The radiologist should be aware of the possible association between these anomalies, which can be detected on CT.     

Associations of Mortality with Long-Term Exposures to Fine and Ultrafine Particles,Species and Sources: Results from the California Teachers Study Cohort

Background

Although several cohort studies report associations between chronic exposure to fine particles (PM_2.5) and mortality, few have studied the effects of chronic exposure to ultrafine (UF) particles. In addition, few studies have estimated the effects of the constituents of either PM_2.5 or UF particles.

Methods

We used a statewide cohort of > 100,000 women from the California Teachers Study who were followed from 2001 through 2007. Exposure data at the residential level were provided by a chemical transport model that computed pollutant concentrations from > 900 sources in California. Besides particle mass, monthly concentrations of 11 species and 8 sources or primary particles were generated at 4-km grids. We used a Cox proportional hazards model to estimate the association between the pollutants and all-cause, cardiovascular, ischemic heart disease (IHD), and respiratory mortality.

Results

We observed statistically significant (p < 0.05) associations of IHD with PM_2.5 mass, nitrate, elemental carbon (EC), copper (Cu), and secondary organics and the sources gas- and diesel-fueled vehicles, meat cooking, and high-sulfur fuel combustion. The hazard ratio estimate of 1.19 (95% CI: 1.08, 1.31) for IHD in association with a 10-μg/m³ increase in PM_2.5 is consistent with findings from the American Cancer Society cohort. We also observed significant positive associations between IHD and several UF components including EC, Cu, metals, and mobile sources.

Conclusions

Using an emissions-based model with a 4-km spatial scale, we observed significant positive associations between IHD mortality and both fine and ultrafine particle species and sources. Our results suggest that the exposure model effectively measured local exposures and facilitated the examination of the relative toxicity of particle species.

Citation

Ostro B, Hu J, Goldberg D, Reynolds P, Hertz A, Bernstein L, Kleeman MJ. 2015. Associations of mortality with long-term exposures to fine and ultrafine particles, species and sources: results from the California Teachers Study cohort. Environ Health Perspect 123:549–556; http://dx.doi.org/10.1289/ehp.1408565