Histopathology of inflammatory skin disease in oncological patients

The spectrum of cutaneous lesions in oncological patients includes entities encountered in the general population, lesions associated with underlying malignant processes (such as paraneoplastic syndromes) and conditions related to the immunosuppressed status of these patients or their antineoplastic treatment. The paraneoplastic syndromes represent a group of skin conditions that may precede or coexist with the diagnosis of malignancy and may also signal tumour recurrences. In general, there is a high prevalence of immunosuppression in oncological patients, related to the alteration of humoral and cellular immunity or their immunosuppressive therapy. Thus, these patients are especially susceptible to certain infections associated with high morbidity and mortality. Correct and early recognition of the cutaneous manifestations in oncological patients provides an important insight into underlying malignant process, possible complications (iatrogenic or not) and prognosis. In this review we offer a practical overview of inflammatory or neoplastic conditions associated with internal malignancies and cutaneous infectious in oncological patients.     

Organization of management of and role of clinical prognosis in the childhood oncological service of Russia]

Cancer control service cannot be managed without having a clear idea of trends and changes in the incidence of malignant neoplasms and associated death rates. These studies become a basis for setting up oncological facilities for both children and adults, having an adequate infrastructure (final fund, the profile of units, a list of staff, the volume of work). Pediatric oncological rooms to collect statistics, to make a primary diagnosis, a follow-up, and outpatient chemotherapy in children with malignant neoplasms, and to do methological work with pediatric and non-oncological specialized children's out- and inpatient units have been opened in most administrative, regional, territorial, and republican centers. Notification is much more complete where specialized pediatric oncological rooms (Moscow) register such children. Unfortunately, such rooms are still few and so such ill children are registered by regional and city oncological dispensaries (and, as shown, 50% of the patients are outside registration).     

Allelic loss at 1p34, 13q12, 17p13.3, and 17q21.1 correlates with poor postoperative prognosis in breast cancer.

Allelic losses of tumor suppressor genes (TSGs), or the chromosomal regions harboring them, in tumor DNA may become useful postoperative prognostic indicators. To examine whether specific allelic losses might correlate with postoperative survival in a 5-year prospective follow-up, we tested tumors from a cohort of 264 breast cancer patients for allelic losses of 18 microsatellite markers representing either a known TSG or a region where genetic alterations are frequent in breast tumors. Patients whose tumors had lost an allele at 1p34, 13q12, 17p13.3, or 17q21.1 had significantly higher risks of postoperative mortality than those whose tumors retained both alleles at those loci (at 1p34, a 5-year mortality rate of 29% among patients with losses vs. 7% with retentions, P = 0. 0008; at 13q12, 31% vs. 10%, P = 0.0062; at 17p13.3, 24% vs. 13%, P = 0.026; and at 17q21.1, 31% vs. 13%, P = 0.0047). Furthermore, combined losses at 13q12 and 17p13.3 increased the predicted postoperative mortality risks by a factor of 9.6 (5-year mortality rate of 42% vs. 5% with retentions, P = 0.0001), and combined losses at 1p34 and 17p13.3 raised the predicted postoperative mortality risks by a factor of 8.6 (27% vs. 3%, P = 0.0064). We conclude that allelic losses at these loci can serve as negative prognostic indicators to guide postoperative management of patients. Genes Chromosomes Cancer 26:134-141, 1999.     

Live births,natural losses,and elective terminations with Down syndrome in Massachusetts

PurposeNo studies to date have reported an estimated number of live births, elective terminations, and natural losses (miscarriages and stillbirths) for Down syndrome (DS) in Massachusetts (MA). These numbers would be helpful to estimate how many expectant parents of children with DS need support and the number of live-born children with DS who require services.MethodsCombining robust data sets, including the Annual Reports of the MA Birth Defects Monitoring Program, we estimated the number of live births, elective terminations, and natural losses with Down syndrome from 1900 to 2010.ResultsThe live birth prevalence for DS in MA for the most recent years for which data are available (2006–2010) was estimated at 12.4 per 10,000 live births, with a total of approximately 94 live births annually. During this period, an estimated 126 DS-related elective pregnancy terminations were performed in MA annually. As of 2008, the estimated rate at which live births with DS was reduced as a consequence of DS-related elective pregnancy terminations was 49%.ConclusionThe reduction of live births with DS is significantly higher in MA than in the rest of the United States as a whole. However, ethnic and racial differences in reduction rates were similar—highest for Asians/Pacific Islanders, followed by non-Hispanic whites, non-Hispanic blacks/Africans, and Hispanics.     

Application of molecular techniques to the study of hospital infection

Nosocomial infections are an important source of morbidity and mortality in hospital settings, afflicting an estimated 2 million patients in United States each year. This number represents up to 5% of hospitalized patients and results in an estimated 88,000 deaths and 4.5 billion dollars in excess health care costs. Increasingly, hospital-acquired infections with multidrug-resistant pathogens represent a major problem in patients. Understanding pathogen relatedness is essential for determining the epidemiology of nosocomial infections and aiding in the design of rational pathogen control methods. The role of pathogen typing is to determine whether epidemiologically related isolates are also genetically related. To determine molecular relatedness of isolates for epidemiologic investigation, new technologies based on DNA, or molecular analysis, are methods of choice. These DNA-based molecular methodologies include pulsed-field gel electrophoresis (PFGE), PCR-based typing methods, and multilocus sequence analysis. Establishing clonality of pathogens can aid in the identification of the source (environmental or personnel) of organisms, distinguish infectious from noninfectious strains, and distinguish relapse from reinfection. The integration of molecular typing with conventional hospital epidemiologic surveillance has been proven to be cost-effective due to the associated reduction in the number of nosocomial infections. Cost-effectiveness is maximized through the collaboration of the laboratory, through epidemiologic typing, and the infection control department during epidemiologic investigations.     

Economical impact of tropical theileriosis in the Cappadocia region of Turkey

This study was initiated to investigate the economical impact of vaccination against tropical theileriosis in cattle in Cappadocia in Turkey. A total of 554 vaccinated and non-vaccinated animals were monitored for Theileria annulata infection using microscopic examination serology by measuring the antibody response of the animals by the indirect immunofluorescence antibody test (IFAT). The prevalence of T. annulata infection, morbidity and mortality were significantly higher in unvaccinated than in vaccinated cattle, whereas the seropositivity was significantly lower in the unvaccinated group. Acute tropical theileriosis cases were diagnosed in 156 of 554 (27.61%) cattle, and 86 of 156 (56.21%) died from the disease. The total economic losses because of tropical theileriosis were estimated at US $598,133 for 2 years.     

Weight loss and survival in HIV-positive patients in the era of highly active antiretroviral therapy

Weight loss and wasting have long been established as strong predictors of mortality in HIV-infected patients. Today, despite the effectiveness of highly active antiretroviral therapy (HAART), there is evidence that HIV-related wasting is still an important comorbidity in many patients. We conducted a study to determine if wasting is still associated with decreased survival in patients receiving HAART and which parameter (weight, fat-free mass [FFM], body cell mass [BCM], or fat mass [FM]) is most strongly associated with mortality. The study population consisted of 678 HIV-positive participants enrolled in the Nutrition for Healthy Living study. Weight, FFM, BCM, and FM were assessed for all participants at 6-month intervals. At each follow-up visit, percent losses of each parameter were calculated from values at baseline and the previous visit. Cox proportional hazards models were used to estimate and compare the relative risks of death for each parameter, adjusting for potential confounders such as HAART use, body mass index, and CD4 cell counts. In analyses examining the parameters separately and together in the same model, weight loss emerged as the strongest independent predictor of mortality. Weight loss of >or=10% from baseline or the previous visit was significantly associated with a four- to sixfold increase in mortality compared with maintenance or gaining of weight. Even one episode of weight loss of >or=3% from baseline or >or=5% from the previous visit was predictive of mortality. In summary, despite the apparent benefits of HAART use on HIV-related survival, weight loss remains an independent predictor of mortality. In addition, FFM or BCM estimated using bioelectrical impedance analysis does not add further prognostic value over weight loss.     

Relation between breast cancer mortality and screening effectiveness: systematic review of the mammography trials

The mammography screening trials have shown varying results. This could be because screening was better in some trials than in others at advancing the time of diagnosis. If so, more cancers would be identified in such trials relative to the control group, and fewer of the cancers would have reached an advanced stage. I performed a systematic review of the mammography screening trials using metaregression. Finding many cancers was not related to the size of the reduction in breast cancer mortality (p = 0.19 after seven and p = 0.73 after 13 years of follow-up). In contrast, finding few cancers in stage II and above predicted a larger reduction in breast cancer mortality (p = 0.04 and p = 0.006). This expected association was also found for node-positive cancers (p = 0.008 and p = 0.04). However, a screening effectiveness of zero (same proportion of node-positive cancers in the screened group as in the control group) predicted a significant 16% reduction in breast cancer mortality after 13 years (95% confidence interval, 9% to 23% reduction). This can only occur if there is bias. Further analyses uncovered bias in both assessment of the cause of death and of the number of cancers in advanced stages. Consequently, the differences in the reported reductions in breast cancer mortality cannot be explained by differences in screening effectiveness. Given that the size of the bias was similar to the estimated screening effect, screening appeared ineffective.     

Trends in Avoidable Death over 20 Years in Korea

To evaluate the achievement of health care services in Korea independent of other socioeconomic factors, we observed the time trend of avoidable death between 1983 and 2004. A list of avoidable causes of death was constructed based on the European Community Atlas of "Avoidable Death". We calculated sex- and age-standardized mortality rates of Korean aged 1-64 yr using data of the Korea National Statistical Office. The avoidable mortality rate (per 100,000 persons) decreased from 225 to 84 in men and from 122 to 41 in women. Accordingly, the proportion of avoidable deaths among all classifiable deaths was reduced by 8.1% in men and 6.4% in women. However, mortality rates from some preventable causes such as ischemic heart disease and malignant neoplasms of lung, breast, cervix, and colorectum have been on the rise. Mortality preventable by appropriate medical care showed the greatest reduction (by 77.8%), while the mortality preventable by primary prevention showed the least reduction (by 50.0%). These findings suggest that health care service has significantly contributed to the improvement of health in Korea. However, more effective intervention programs would be needed given the less reduction in mortality avoidable by primary or secondary prevention than expected and unexpectedly increasing mortality from several preventable causes.     

The incidence and economic impact of the Escherichia coli peritonitis syndrome in Dutch poultry farming

The incidence and economic impact of the Escherichia coli peritonitis syndrome (EPS), characterized by acute mortality, were estimated in chicken egg-producing farms in the Netherlands in 2013. The incidence was significantly higher (P?相似文献   

Neuroleptic malignant syndrome.

Neuroleptic malignant syndrome is a life-threatening reaction of neuroleptic medication. The estimated incidence rate of neuroleptic malignant syndrome is between 1% and 1.5% of patients treated with neuroleptics. The reported mortality rate varies from 11% to 38%. Risk factors include younger males (80% less than 40 years) and physical disability. Although 80% of neuroleptic malignant syndrome cases develop within the first 2 weeks of treatment, the syndrome can develop anytime during the therapy period. The clinical picture and laboratory findings are not always unique. Less than 50% of cases manifest with classical symptoms. Deaths usually result from cardiovascular collapse. Renal failure, pulmonary emboli, aspiration pneumonia, and respiratory failure are also reported. Familiarity with the syndrome, baseline laboratory values including creatine phosphokinase, lactate dehydrogenase, serum glutamicoxaloacetic transaminase, and complete blood cell count with a differential count, and a high index of suspicion are of the utmost importance in making the diagnosis of neuroleptic malignant syndrome. A judicial choice of neuroleptic medication and careful observation of patients may reduce the incidence, morbidity, and mortality of neuroleptic malignant syndrome.     

Site-independent prognostic value of chromosome 9q loss in primary gastrointestinal stromal tumours

Although the significance of tumour site for estimating malignant potential in gastrointestinal stromal tumours (GISTs) has recently been recognized, site-specific genetic patterns have not to date been defined. This study examined 52 c-kit-positive primary GISTs (with a mean follow-up of 42.3 months in 51 cases) from three different locations (35 gastric, 12 small intestinal, and five colorectal) using comparative genomic hybridization (CGH). In general, tumour site correlated with key prognostic factors, including tumour size, mitotic rate, proliferative activity, and probable malignant potential. Furthermore, several DNA copy number changes showed a site-dependent pattern. These included losses at 14q (gastric 83%, intestinal 35%; p = 0.001), losses at 22q (gastric 46%, intestinal 82%; p = 0.02), losses at 1p (gastric 23%, intestinal 88%; p = 1 x 10(-5)), losses at 15q (gastric 14%, intestinal 59%; p = 0.002), losses at 9q (gastric 14%, intestinal 53%; p = 0.006), and gains at 5p (gastric 11%, intestinal 53%; p = 0.002). These data demonstrate strong site-dependent genetic heterogeneity in GISTs that may form a basis for subclassification. Prognostic evaluation of DNA copy number changes identified losses at 9q as a site-independent prognostic marker associated with shorter disease-free survival (p = 0.03) and overall survival (p = 0.002). Furthermore, 9q loss also appeared to carry prognostic value in predicting overall survival for patients with advanced or progressive GISTs (p = 0.003).     

Treatment of a field case of avian intestinal spirochaetosis caused by Brachyspira pilosicoli with tiamulin.

There has been much confusion over the significance of spirochaetes found in the caeca of laying hens and the impact they may have on egg production. In recent years, the situation has been made clearer and the presence of such species as Brachyspira pilosicoli have been shown to cause a mild, chronic disease in both layers and breeders and to reduce egg production by reportedly 5%. In the United Kingdom, a multi-age caged laying site with three separate flocks of approximately 12 000 birds each was chronically infected with B. pilosicoli but displayed few clinical signs except for a noticeable reduction in egg production and an increased mortality. The flocks were treated for 3 days in the drinking water with tiamulin at 12.5 mg/kg bodyweight, and a steady improvement in performance was recorded. The production results were compared with a flock that had been untreated with tiamulin previously, as a control, and one that had been treated at 25 and 45 weeks of age. A 9.8% improvement in egg production/hen housed up to 72 weeks of age and 9.7% in total egg weight was recorded, as well as an 8.6% reduction in actual hen mortality, in the tiamulin-treated flock in comparison with the untreated control. After taking into account the difference in breeds used, there was only a 6% reduction in egg production but an 8.84% increase in mortality in the untreated flock compared with the individual breed's standard production data. The cost of the disease was estimated at 14 million pound in the United Kingdom, based on a national laying flock of 30 million or 1.5% of production. Faecal examination for potentially pathogenic spirochaetes should be part of the differential diagnosis of under-performing laying flocks.     

Adoptive immunotherapy of malignancies

The results of the studies show that mononuclear leukocytes isolated from human peripheral blood, malignant effusions, and surgically removed spleen can be generated into lymphokine-activated killers (LAK) characterized by high anti-tumor activity. LAKs may be used foradoptive immunotherapy of malignant effusions and the prevention of tumor recurrence in oncological patients after radical surgery.     

Mortality in malignant hemopathies in Yugoslavia

The authors have analysed the mortality of malignant haemopathies in Yugoslavia from 1978 to 1987. The standardized rate of mortality among all malignant haemopathies was from 6.5 to 7.2%000. These rates were higher in males (7.8-8.8%000), than in the females (4.8-5.9%000). The mortality of this group of malignant tumors shows a decreasing tendency, which is more evident in females than in males. Since Hodgkin's disease and lymphoid leukemia participate with about 50% in the structure of mortality from all malignant hemopathies, and for that reason, mortality from these two diseases is especially analysed. The standardized rate of mortality from Hodgkin's disease was between 1.7-2.5%000 (males 2.1-3.2%000; females 1.3-2.0%000). Mortality from this malignant haemopathy has a tendency of decreasing, which is approximately of the same intensity in both sexes. Mortality from lymphoid leukemia in the period between 1978 and 1987 was from 0.7 to 1.2%000 (males 0.9-1.7%000; females 0.5-1.0%000). The mortality trend from lymphoid leukemia shows a similar slight decrease in males and females.     

The economic burden of HIV in the United States in the era of highly active antiretroviral therapy: evidence of continuing racial and ethnic differences

BACKGROUND: Assessing the economic burden of HIV/AIDS can help to quantify the effect of the epidemic on a population and assist policy makers in allocating public health resources. OBJECTIVE: To estimate the economic burden of HIV/AIDS in the United States and provide race/ethnicity-specific estimates. METHODS: We conducted an incidence-based cost-of-illness analysis to estimate the lifetime cost of HIV/AIDS resulting from new infections diagnosed in 2002. Data from the HIV/AIDS Reporting System of the Centers for Disease Control and Prevention were used to determine stage of disease at diagnosis and proportion of cases by race/ethnicity. Lifetime direct medical costs and mortality-related productivity losses were estimated using data on cost, life expectancy, and antiretroviral therapy (ART) use from the literature. RESULTS: The cost of new HIV infections in the United States in 2002 is estimated at $36.4 billion, including $6.7 billion in direct medical costs and $29.7 billion in productivity losses. Direct medical costs per case were highest for whites ($180,900) and lowest for blacks ($160,400). Productivity losses per case were lowest for whites ($661,100) and highest for Hispanics ($838,000). In a sensitivity analysis, universal use of ART and more effective ART regimens decreased the overall cost of illness. CONCLUSION: Direct medical costs and productivity losses of HIV/AIDS resulting from infections diagnosed in 2002 are substantial. Productivity losses far surpass direct medical costs and are disproportionately borne by minority races/ethnicities. Our analysis underscores economic benefits of more effective ART regimens and universal access to ART.     

Risk factors for falls among older adults: A review of the literature

Falls are one of the major causes of mortality and morbidity in older adults. Every year, an estimated 30–40% of patients over the age of 65 will fall at least once. Falls lead to moderate to severe injuries, fear of falling, loss of independence and death in a third of those patients. The direct costs alone from fall related injuries are a staggering 0.1% of all healthcare expenditures in the United States and up to 1.5% of healthcare costs in European countries. This figure does not include the indirect costs of loss of income both to the patient and caregiver, the intangible losses of mobility, confidence, and functional independence. Numerous studies have attempted to define the risk factors for falls in older adults. The present review provides a brief summary and update of the relevant literature, summarizing demographic and modifiable risk factors. The major risk factors identified are impaired balance and gait, polypharmacy, and history of previous falls. Other risk factors include advancing age, female gender, visual impairments, cognitive decline especially attention and executive dysfunction, and environmental factors. Recommendations for the clinician to manage falls in older patients are also summarized.     

Malignant hypercalcemia--a hospital survey

A hypercalcemia frequency of 1.5% was found in patients with malignant disease attending a large oncological center. Eighty per cent of hypercalcemias were of obvious malignant etiology. Hypercalcemia was most frequent in multiple myeloma, renal carcinoma, squamocellular carcinomas of different sites and breast cancer. Most patients had advanced metastasized disease. In 80% of those with solid tumors malignant hypercalcemia was associated with bone metastases. Serum calcium could almost invariably be reduced by treatment, and active treatment was associated with a more favorable prognosis. One year actuarial survival of patients with malignant hypercalcemia was 31%.     

The effect of high environmental temperature on the water distribution in the body

Summary Water distribution among various liquid media was studied in rabbits under high external temperatures (+43°, +45°C) by the concurrent determination of the volume of blood and cellular fluid, with the aid of radioactive isotopes. The total water loss and the changes of certain hematological indices were also investigated. The loss of water during a 3-hour exposition of the rabbit to heating with no water to drink amounted to from 2 to 2.5% of the body weight. Diuresis decreases or is completely absent. All the water losses occur at the expence of the extrarenal losses. The volume of the extracellular water increases, while that of the blood plasma slightly rises. Intracellular water serves as a source of the water loss and its increase in the extracellular spaces.Presented by Active Member AMN SSSR S.E. Severin     

PAPNET computer-aided rescreening for detection of benign and malignant glandular elements in cervicovaginal smears: A review of 61 cases

An increasing proportion of the recent cytodiagnostic literature has focused on automation of the Pap smear screening process in hopes of finding a feasible system to aid in the reduction of the number of reported false-negative cases. In a sense, these systems can be thought of as computer-driven sensitivity enhancers for better detection of abnormalities in smeared cervicovaginal specimens. The PAPNET system (Neuromedical Systems, Inc., Suffern, NY) relies on a neural network of artificial-intelligence technology to recognize the complex cellular arrays present in Pap smears, and was originally intended to aid in the identification of morphologically abnormal cells of squamous origin. Herein, we present the results of 61 smears containing a mixture of known diagnostically important benign, dysplastic, and malignant glandular cellular abnormalities which were reviewed by the PAPNET technology. The PAPNET system detected the diagnostic glandular material in 44 of the 45 benign cases reviewed (98% detection rate). In addition, the PAPNET technology identified abnormal cellular material in 15 of the 16 studied smears from patients with malignant/dysplastic morphology (94% detection rate). These data indicate that the PAPNET neural networks are capable of detecting cells with aberrant glandular cytomorphology. In both cases missed by the PAPNET system, the number of abnormal cells per slide was very low, indicating that as with human screeners, the capabilities of this semiautomated method may be exceeded when an extreme paucity of diagnostic cellular material is present in a given slide. Further and larger reviews of glandular abnormalities by automated technologies are needed to assess these systems for their true efficacy at diminishing false-negative cases. Diagn. Cytopathol. 1998;18:307–311. © 1998 Wiley-Liss, Inc.