Urinary tract infection in children: etiology and epidemiology

The urinary tract is a relatively common site of infection in infants and young children.Urinary tract infection (UTI) may result in significant acute morbidity, as well as longterm medical complications. Recent advances elucidating the pathogen-host interaction have broadened the understanding of the pathogenesis and clinical progression of pediatric UTI. This article focuses on the epidemiology and pathogenesis of pediatric UTI, and briefly discusses UTI-related complications.     

Oral lichen planus part I: epidemiology, clinics, etiology, immunopathogeny, and diagnosis

This article presents a review of the literature on oral lichen planus, focusing on important aspects of its epidemiology, etiopathogeny, and clinical manifestations. The oral form is an important clinical presentation of lichen planus. It may precede or accompany the skin lesions, or it may be the only manifestation of the disease. Dermatologists, dentists, otorhinolaryngologists, and other specialists who deal with the oral cavity must be aware of this disease so they can diagnose, treat, and keep these patients under observation.     

The nephropathies of HIV infection: pathogenesis and treatment

Several different renal syndromes have been reported in patients with HIV infection. Patient characteristics and a syndrome approach may help the clinician formulate a tentative diagnosis, but a renal biopsy is necessary to make a firm diagnosis in patients with chronic renal disease in the setting of HIV infection. The pathogenesis of the HIV nephropathies can teach us much about the pathophysiology of common renal problems such as IgA nephropathy, immune complex glomerulonephritis, focal segmental glomerulosclerosis, and diabetic renal disease. HIV-associated renal disease may be the result of the interaction of the expression of specific HIV genes in patients with distinct genetic susceptibilities to disease in particular environments. New treatment approaches have provided hope for patients with classic HIV-associated nephropathy.     

New onset of diabetes after transplantation — An overview of epidemiology,mechanism of development and diagnosis

New onset of diabetes after transplantation (NODAT) is a serious and common complication following solid organ transplantation. NODAT has been reported to occur in 2% to 53% of renal transplant recipients. Several risk factors are associated with NODAT, however the mechanisms underlying were unclear. Renal transplant recipients who develop NODAT are reported to be at increased risk of infections, cardiovascular events, graft loss and patient loss. It has been reported that the incidence of NODAT is high in the early transplant period due to the exposure to the high doses of corticosteroids, calcineurin inhibitors and the physical inactivity during that period. In addition to these risk factors the traditional risk factors also play a major role in developing NODAT. Early detection is crucial in the management and control of NODAT which can be achieved through pretransplant screening there by identifying high risk patients and implementing the measures to reduce the development of NODAT. In the present article we reviewed the literature on the epidemiology, risk factors, mechanisms involved and the diagnostic criteria in the development of NODAT. Development of diagnostic tools for the assessment of β-cell function and determination of the role of glycemic control would include future area of research.     

Spine-area pain in military personnel: a review of epidemiology, etiology, diagnosis, and treatment

Background contextNonbattle illnesses and injuries are the major causes of unit attrition in modern warfare. Spine-area pain is a common disabling injury in service members associated with a very low return-to-duty (RTD) rate.PurposeTo provide an overview of the current understanding of epidemiology, possible causes, and relative prognosis of spine-area pain syndromes in military personnel, including a discussion of various treatment options available in theaters of operation.Study designLiterature review.MethodsSearch focusing on epidemiology, etiology and associative factors, and treatment of spinal pain using electronic databases, textbooks, bibliographic references, and personal accounts.ResultsSpine-area pain is the most common injury or complaint “in garrison” and appears to increase during training and combat deployments. Approximately three-quarters involve low back pain, followed by cervical and midback pain syndromes. Some predictive factors associated with spine-area pain are similar to those observed in civilian cohorts, such as psychosocial distress, heavy physical activity, and more sedentary lifestyle. Risk factors specific to military personnel include concomitant psychological trauma, g-force exposure in pilots and airmen, extreme shock and vibration exposure, heavy combat load requirements, and falls incurred during airborne, air assault, and urban dismounted ground operations. Effective forward-deployed treatment has been difficult to implement, but newer strategies may improve RTD rates.ConclusionsSpine-area pain syndromes comprise a major source of unit attrition and are often the result of duty-related burdens incurred during combat operations. Current strategies in theaters of operation that may improve the low RTD rates include individual and unit level psychological support, early resumption of at least some forward-area duties, multimodal treatments, and ergonomic modifications.     

Postoperative aortic fistulas into the airways: etiology,pathogenesis, presentation,diagnosis, and management

Postoperative aortobronchial and aortopulmonary fistulas are rare and late complications of cardiac surgery. They mostly complicate descending thoracic aortic procedures. Hemoptysis is the main symptom, and may be massive or intermittent. The reported interval between the time of operation and the onset of hemoptysis ranges from 3 weeks to 25 years. Diagnostic examinations are often unable to directly visualize a fistula. Indication for surgical or endovascular repair mostly relies on clinical suspicion and nonspecific diagnostic features. Urgent treatment is based on the association of the following elements: (1) hemoptysis, (2) history of previous cardiac or aortic operation, (3) presence of lung infiltrates on the chest roentgenogram, (4) lung hemorrage on the computed tomographic scan, and (5) and visualization of a pseudoaneurysm. Aortobronchopulmonary fistulas are uniformly fatal if untreated. The overall surgical mortality rate is 15.3%. There is no procedure-related mortality after endovascular stent grafting. A review of the English-language literature from 1947 to October 2002 is presented.     

Septic arthritis of the hand: Current issues of etiology,pathogenesis, diagnosis,treatment

Septic arthritis of the hand is a serious disease that often results in dysfunction of the joint or even the need to perform amputation of the finger. They rank second in the frequency of occurrence after lesions of the knee joint. Many points concerning the etiology, the timing of the development of cartilage destruction and the development of osteomyelitis, approaches to surgical treatment, the duration of antibiotic therapy, and the start of rehabilitation measures remain the subject of numerous discussions. Based on a search in the PubMed, Web of Science and Google Scholar databases down to 1990-2021, publications on septic arthritis of the hand were found and analyzed. The following inclusion criteria were used in our review: (1) Septic arthritis of the hand; (2) Published in a peer review journal; (3) Written in English; and (4) Full text version available. Studies were excluded if they met any of the following criteria: (1) Letters; (2) Articles published in abstract form only; and (3) Cadaveric studies. Septic arthritis of the hand was characterized by the most frequent damage to the joints of the index and middle fingers (> 50% of cases). Up to 90% of cases, the infection enters the joint as a result of penetrating trauma, animal bites, etc. Staphylococcus aureus became the most frequently isolated microorganism (30%-55%), and its polyantibiotic-resistant form Methicillin-resistant Staphylococcus aureus was found, according to various sources, from 0% to 73% among all isolated Staphylococcus aureus. In arthritis, Pasteurella multocida (6%-11%) is often isolated as a result of animal bites. Articular cartilage destruction in the experiment developed within 24-48 h after infection. In clinical studies, the development of osteomyelitis was noted when treatment was delayed by more than 10 d. X-ray data during the first two weeks were uninformative. Priority of surgical treatment of septic arthritis. Drainage and surgical treatment, and with the development of osteomyelitis, the implementation of arthrodesis. Antibacterial therapy for 2-4 wk and early start of rehabilitation measures. Timely surgical treatment in combination with antibiotic therapy and rehabilitation makes it possible to obtain a positive result in the treatment of septic arthritis of the hand.     

Peyronie's disease: etiology, epidemiology and medical treatment

The investigation of medical options for the treatment of Peyronie's disease is lacking controlled clinical trials with uniform standardized assessments and objective measures of deformity, including curvature and circumference. A key to defining the beneficial effects of various medical therapies lies in standardizing the evaluation of the Peyronie's patient across various studies so that the proposed benefits can be confirmed and applied to all populations. Furthermore, basic science research into the pathophysiology of this disorder is likely to yield new insights into potential treatment options and direct future therapies.     

Renal cell carcinoma: etiology, incidence and epidemiology

PURPOSE OF REVIEW: The incidence of renal cell carcinoma has been increasing worldwide. Although the etiology of renal cell carcinoma is largely unknown, recent epidemiological investigations have shed some light on the issue. This article reviews the literature related to etiology, incidence and epidemiology of renal cell carcinoma published between May 1, 2003 and April 30, 2004. RECENT FINDINGS: Accumulating evidence has confirmed the increasing incidence of renal cell carcinoma. A racial disparity has been reported for the first time. Being overweight and obesity were confirmed to be risk factors for renal cell carcinoma. Recreational exercise was shown to reduce the risk, whereas a Western-style diet and smoking increased the risk. Occupational exposure may relate to the development of renal cell carcinoma; however, no definite carcinogens have so far been identified. A susceptibility to develop renal cell carcinoma may also exist in relation to the gene polymorphisms of detoxifying enzymes including glutathione S-transferase and cytochrome P450. SUMMARY: Although high-risk groups for renal cell carcinoma have been identified, a large portion of renal cell carcinoma still has an unknown etiology. Life-style modifications might reduce renal cell carcinoma risks. Further studies are thus needed to explore the etiology of renal cell carcinoma in terms of gene-environment interactions.     

Penile cancer: epidemiology,pathogenesis and prevention

Objectives  Penile cancer is a disease with a high morbidity and mortality. Its prevalence is relatively rare, but the highest in some developing countries. Insight into its precursor lesions, pathogenesis and risk factors offers options to prevent this potentially mutilating disease. This review presents an overview of the different histologically and clinically identified precursor lesions of penile cancer and discusses the molecular pathogenesis, including the role of HPV in penile cancer development. Methods  A systematic review of the literature evaluating penile carcinogenesis, risk factors and molecular mechanisms involved. Results  Careful monitoring of men with lichen sclerosis, genital Bowen’s disease, erythroplasia of Queyrat and bowenoid papulosis seems useful, thereby offering early recognition of penile cancer and, subsequently, conservative therapeutic options. Special attention is given to flat penile lesions, which contain high numbers of HPV. Their role in HPV transmission to sexual partners is highlighted, but their potential to transform as a precursor lesion into penile cancer has been unsatisfactorily explored. Conclusions  Further research should not only focus on HPV mediated pathogenic pathways but also on the non-HPV related molecular and genetic factors that play a role in penile cancer development. Options for prevention of penile cancer include (neonatal) circumcision, limitation of penile HPV infections (either by prophylactic vaccination or condom use), prevention of phimosis, treatment of chronic inflammatory conditions, limiting PUVA treatment, smoking cessation and hygienic measures. M.C.G Bleeker and D.A.M Heideman have contributed equally to this paper.     

An overview of the epidemiology of cutaneous melanoma

Incidence of cutaneous melanoma has increased over the last several decades. Screening for melanocytic lesions is an effective approach to reducing incidence. This article presents information useful in melanoma screening, including histologic types of tumors, measurements, and anatomic sites. Causes of tumors, including ultraviolet radiation and the role of steroid hormones, are discussed. In addition, the presence of atypical and benign nevi is addressed.     

Postoperative pulmonary complications: An analysis of etiology,diagnosis, prophylaxis and treatment

Because of prevalent misconceptions regarding postoperative pulmonary complications, an effort has been made to stress those salient factors in their etiology and diagnosis which will lead to more effective prophylaxis and treatment. It is the author's opinion that atelectasis is the primary pathologic process, and that pneumonia and lung abscess represent advanced stages of the initial atelectasis. Therefore, the time of onset is of major importance in diagnosis. Bronchial obstruction is the sole determining cause of postoperative atelectasis. The quantity and character of the tracheobronchial secretions, and the forces available for expulsion of these secretions, are the factors concerned in the formation of bronchial plugs. Any agent causing an unfavorable change in either factor may precipitate bronchial occlusion. Most often it is the result of an increased amount of thickened secretions with lessened ability to expel them. If infection is superimposed upon the atelectasis, pneumonitis results. Abscess formation follows if the organism is sufficiently virulent and proper treatment is delayed.The following factors, involving the trachoebronchial secretions, powers of expulsion of the secretions, and pulmonary infection, have been discussed and evaluated: operative site, operative sepsis, acute and chronic preëxisting respiratory infection, dental sepsis, anesthesia, incisional trauma with resultant muscle-splinting, constricting dressings, with diaphragmatic limitation, immobility, use of morphia, atropine, and cough sedatives, and the predisposing factors of age, sex, and season.The time of onset has been stressed in diagnosis. Complications appearing in the first five postoperative days are usually atelectasis. Pneumonia seldom occurs prior to the fifth day and most often makes its appearance between the fifth and eighth days. Embolic complications and lung abscesses are usually met after the eighth day. This differentiation is important in the diagnosis of atelectasis from bronchopneumonia, as the clinical picture and even the roentgenogram are often deceptive.Prophylaxis must be directed towards the prevention of bronchial obstruction and pulmonary infection. Each of the several etiologic factors must be given serious consideration as to its potentiality. The following prophylactic measures have been recommended: preoperative care of the respiratory tract, including the prevention of “colds” after admission; incision and operation as atraumatic as possible; avoidance of tight upper abdominal dressings; an individualized anesthetic; judicious use of opiates with preservation of the cough reflex and elimination of pre- and postoperative atropine; semi-Fowler position, supervised deep breathing exercises, and frequent turning after consciousness is regained; encouragement to remove bronchial secretions by cough; carbon dioxide inhalations routinely after abdominal operations; and thyroid extract where the basal metabolic rate is definitely below normal, to prevent embolism.Only the treatment of atelectasis is presented, for if this condition is treated promptly and efficiently pneumonia and lung abscess will not occur. Mention is made of therapy of embolism. Treatment of atelectasis means removal of the obstruction. Measures used in prophylaxis are also utilized in treatment. In addition, postural drainage, with the aid of cough while in the most favorable position for drainage, is recommended. Bronchoscopic aspiration is strongly recommended when the more conservative methods of drainage fail. Two illustrative cases are presented.     

Incidence, epidemiology, and etiology of esophageal cancer

The precise causes of esophageal cancer have not been identified. A number of carcinogens and predisposing conditions have been implicated. There are pronounced differences between the demographic groups affected by squamous cell carcinoma and adenocarcinoma of the esophagus. Whereas the incidence of squamous cell carcinoma has remained constant, the incidence of adenocarcinoma of the esophagus has been rising steadily in recent years. The reasons for this trend remain unclear. Further studies of the molecular biology and epidemiology of this disease are needed.