Clinical and epidemiologic considerations in the role of newborn diseases causing asthma in children

The authors present results of a multidisciplinary study in 712 children with asthma concerning the role of certain newborns events and the role of feeding in the onset of disease: resuscitation during the delivery--82.68%, respiratory distress--75.5%, Apgar score = 7 - 58.56%, bottle-feeding 50.50%, multi-pregnancy--44.23%, abnormal pregnancy--20.11%, premature infant and small for gestational age infant 10.60%, mother age less then 20 years 8.6%.     

Ethical considerations regarding the implementation of new technologies and techniques in surgery

Ethical considerations relevant to the implementation of new surgical technologies and techniques are explored and discussed in practical terms in this statement, including (1) How is the safety of a new technology or technique ensured?; (2) What are the timing and process by which a new technology or technique is implemented at a hospital?; (3) How are patients informed before undergoing a new technology or technique?; (4) How are surgeons trained and credentialed in a new technology or technique?; (5) How are the outcomes of a new technology or technique tracked and evaluated?; and (6) How are the responsibilities to individual patients and society at large balanced? The following discussion is presented with the intent to encourage thought and dialogue about ethical considerations relevant to the implementation of new technologies and new techniques in surgery.     

Aspects regarding the incidence and prevalence of vascular dementia forms

Vascular dementia is the form of dementia associated with cerebrovascular disease. It involves complex interrelationships between vascular etiologies, pathological changes in the brain, and clinical symptoms. Vascular dementia is associated with vascular and other risk factors, including cognitive ability, age, and education. Vascular dementia is the second most common cause of dementia, having a high rate of causes by itself, or in combination with Alzheimer's disease. Further complicating the diagnosis and treatment of vascular dementia is that it often coexists with Alzheimer's disease in elderly patients. It can be difficult to determine whether vascular abnormality has caused dementia, has contributed to its development, or is simply coincidental. When both vascular and degenerative changes may be contributing to the cognitive decline, term "Mixed" dementia is used. There are many questions still to be answered as to the incidence and prevalence of vascular dementia. Once there is a consensus on what diagnostic criteria should be used and how they should be implemented, or witch are the prevalence and incidence rates for vascular dementia by age, sex, region etc.     

Clinical outcome and technical considerations of late removal of abdominal aortic endografts: 8-year single-center experience

During an 8-year period, 355 patients underwent endovascular repair of mainly true (97%) infrarenal aneurysms. After a mean follow-up of 48 months, 11 (3.1%) patients required conversion to open repair and 10 were eligible for open surgical intervention. Via a midline incision, explantation of the endograft was performed by using an infrarenal aortotomy. Explantation was done for rupture in four patients (40%), with a marked difference in mortality rates between acute (50%) and elective (0%) explantations. The main reason for explantation was proximal type I endoleak caused by (1) malposition of the device, (2) proximal migration of the endograft, and (3) dislodgment of a tube endograft that followed former central reconstruction. Proximal migration is most worrisome and demands preventive endovascular reintervention. The mortality and morbidity rates of elective explantation are acceptable. When delayed conversion is indicated, priority has to be given to operate on these patients.     

Collaborative action of M-CSF and CTGF/CCN2 in articular chondrocytes: possible regenerative roles in articular cartilage metabolism

It is known that expression of the macrophage colony-stimulating factor (M-CSF) gene is induced in articular chondrocytes upon inflammation. However, the functional role of M-CSF in cartilage has been unclear. In this study, we describe possible roles of M-CSF in the protection and maintenance of the articular cartilage based on the results of experiments using human chondrocytic cells and rat primary chondrocytes. Connective tissue growth factor (CTGF/CCN2) is known to be a potent molecule to regenerate damaged cartilage by promoting the growth and differentiation of articular chondrocytes. Here, we uncovered the fact that M-CSF induced the mRNA expression of the ctgf/ccn2 gene in those cells. Enhanced production of CTGF/CCN2 protein by M-CSF was also confirmed. Furthermore, M-CSF could autoactivate the m-csf gene, forming a positive feed-back network to amplify and prolong the observed effects. Finally, promotion of proteoglycan synthesis was observed by the addition of M-CSF. These findings taken together indicate novel roles of M-CSF in articular cartilage metabolism in collaboration with CTGF/CCN2, particularly during an inflammatory response. Such roles of M-CSF were further supported by the distribution of M-CSF producing chondrocytes in experimentally induced rat osteoarthritis cartilage in vivo.     

Epidemiology of poststreptococcal, non-suppurative, late complications, in a Moldavian area (Romania) during the last decade

The ubiquity of the acute infections caused by the group A beta-haemolytic streptococcus (ABHS) requires the continuation of the screening strategies of the risk to develop nonsuppurative late complications. The aim of this study was to assess the poststreptococcal pathologic evolution in an area where, during the last 10 years, there were recorded high values of the morbidity due to acute infections determined by ABHS. Using methods of retrospective data collecting, in Gala?i district, during 1990-2003, they monitored the dynamics of the case incidence and general and hospitalized morbidity, according to various age and home environment categories, for acute rheumatic fever (RF), carditis (CR), and acute poststreptococcal glomerulonephritis (APSG). The results emphasized the need to re-launch some targeted prevention programs, in order to lower the still high morbidity, due to these complications and, implicitly, to limit the deriving invalidity or social economical loss.     

Solitary necrotic nodule of the liver: diagnostic and therapeutic considerations regarding a case

Solitary necrotic nodule is a rare benign lesion of the liver of unknown aetiology, which as a result of its radiological features can be misdiagnosed as a necrotic tumour. We believe that surgical exploration with a limited liver resection and an extemporary examination of the specimen is the best strategy for this rare type of lesion.     

Report of a case of Gardner's syndrome: clinical and epidemiologic considerations and review of the literature

Familial adenomatous polyposis is a hereditary clinical syndrome characterised by the presence of numerous adenomatous polyps of the colon and rectum and by lesions in other organs. The disease affects various different tissues and characteristically presents a variable biological and clinical behaviour. Colon polyps are precancerous lesions and the certainty of their malignant evolution within the 3rd-4th decades of life is now practically an established, extensively documented fact. Recently, new methods of genetic screening, prevention and early diagnosis and, as a result, more advanced treatment protocols have been introduced in clinical practice, thus offering young patients diagnosed as suffering from familial adenomatous polyposis better prospects and a better quality of life. The patient in our case came in for medical observation for abdominal pain experienced close to the scar of a previous appendectomy and for the presence of an abdominal tumefaction on the same side. Initially the patient underwent surgical resection of the growth that proved to be a desmoid tumour of the abdominal wall. The results of the pathology examination and the patients' long-term disease and family history led to a presumptive diagnosis of familial adenomatous polyposis, which was then confirmed by the appropriate instrumental examinations. Genetic tests on the patient's relatives yielded the same diagnosis in some of them. On the basis of our personal experience and a thorough review of the literature we can safely state that no medical treatment currently available is capable of reducing, let alone definitively eliminating colon polyps. To date, then, the therapeutic options most commonly adopted are colectomy with ileo-rectal anastomosis and total conservative proctocolectomy with an ano-ileal pouch anastomosis. These two types of surgical procedures yield different results in terms of functional capability and oncological radicality with their respective repercussions on the patient's quality of life. The choice of the most appropriate surgical procedure is made on the basis of a series of parameters such as age, site of the polyps, number of polyps, degree of cell atypia of the polyps, and patient willingness to undergo regular check-ups. The current tendency advocated by the various authors is to perform a total colectomy as soon as possible.     

High incidence of initial and late steroid resistance in childhood nephrotic syndrome

BACKGROUND: Conventional wisdom states that greater than 80% of children with nephrotic syndrome (NS) respond to steroid treatment, remain steroid-sensitive during subsequent relapses, and consequently have a favorable long-term prognosis. In contrast, steroid resistance is believed to be associated with a high risk of developing chronic renal failure. Recent reports suggest that the histologic pattern of NS in children may be changing, but whether the change is accompanied by a parallel change in steroid sensitivity is unknown. METHODS: Initial and subsequent steroid responsiveness was evaluated in all children aged 1 to 18 years who presented with newly diagnosed NS to the 2 pediatric nephrology referral centers in southeastern Louisiana between 1994 and 2003. NS was defined as presence of edema, heavy proteinuria, and serum albumin concentration below 2.5 g/dL. Steroid sensitivity (SS) was defined as total resolution of proteinuria and edema, and partial response to steroids (PR) was defined as loss of edema with continuing proteinuria. RESULTS: There were 210 new cases of NS. Forty-one patients (20%) had immune complex glomerulonephritis. Six patients were excluded because of incomplete data availability. Of the remaining 163 patients, 115 (71%) were SS and 23 (14%) achieved PR during the initial 4 weeks of treatment; 25 (15%) were steroid-resistant (SR). Follow-up data were available for 91 of the 115 initially SS patients; 19 subsequently became steroid-resistant. Thus, at least 45% of the patients with new-onset NS did not have typical childhood steroid-responsive NS. Initial steroid resistance was more likely in African American children and in children with older age at onset (11.5 vs. 4.6 years). Development of steroid resistance after initial SS was associated with shorter interval to the first relapse (2.2 vs. 5.4 months) and having the first relapse during the initial steroid treatment. CONCLUSION: Compared to previous reports, our results show a higher incidence of initial and subsequent steroid resistance, characteristics not consistent with typical minimal change NS with a benign prognosis. The results suggest that in the current era, NS in children may not be as benign as indicated by earlier studies.     

Melanoma incidence rises for children and adolescents: An epidemiologic review of pediatric melanoma in the United States

Background/Purpose

This study was conducted to determine the influence of age on disease presentation and evaluate the change in pediatric melanoma incidence between 1998 and 2007.

Methods

We performed a retrospective review of all children ≤ 18 years with cutaneous melanoma who were included in the 2007 National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) database between 1988 and 2007.

Results

We identified a total of 1447 patients with cutaneous melanoma. The overall average annual melanoma incidence was 5.4 per 1 million children and adolescents in the U.S., which increased throughout the study period. Most patients (89%) were at least 10 years of age (average age 15 years). Melanoma in situ (21%), thin (< 1 mm) lesions (37%), stage I disease (46%), and superficial spreading histology (25%) were common at presentation. Only 1% of patients presented with distant metastases. Preadolescents younger than age 10 were ethnically more diverse and more likely to present with non-truncal primaries and advanced disease (P < .01) compared to adolescents.

Conclusions

The incidence of pediatric melanoma in the U.S. is increasing. There are significant differences between children and adolescents which suggest age-based inherent differences in the biology of the disease may exist.