Healthy life expectancy by area deprivation: magnitude and trends in England, 1994-1999

This article examines the magnitude of inequalities in health by area deprivation using two composite indices of health expectancy, one based on a subjective assessment of general health status (healthy life expectancy) and the second on reported limiting longstanding illness (disability-free life expectancy). Trends in healthy life expectancy by deprivation for the period 1994-1999 were also examined. Results show that males and females living in the most deprived wards spend twice as many years in poor health, both in absolute (years of life) and relative (proportion of life) terms, than those living in the least deprived wards. There was no change in the healthy life expectancy gap between the most and least deprived areas over the study period.     

Whole body positron emission tomography/computed tomography staging of metastatic choroidal melanoma

PURPOSE: To evaluate whole-body positron emission tomography (PET)/computed tomography in staging of patients with metastatic choroidal melanoma. DESIGN: Interventional non-randomized clinical study. METHODS: Twenty patients were referred for whole-body 18-fluoro-2-deoxy-D-glucose (FDG) PET/computed tomography imaging because of suspected metastatic choroidal melanoma. PET/computed tomography images were studied for the presence and distribution of metastatic melanoma. Subsequent biopsies were performed to confirm the presence of metastatic disease. RESULTS: Twenty patients underwent PET/computed tomography. Eighteen were imaged because of abnormal clinical, hematologic, or radiographic screening studies during the course of their follow-up after plaque brachytherapy or enucleation. Two were imaged before treatment of their primary tumor. PET/computed tomography revealed or confirmed metastatic melanoma in eight (40%) of these 20 patients. The mean time from initial diagnosis to metastasis was 47 months (range 0 to 154). The most common sites for metastases were the liver (100%), bone (50%), lung (25%), lymph nodes (25%), and subcutaneous tissue (25%). Cardiac, brain, thyroid, and posterior abdominal wall lesions (12.5%) were also noted. Six patients (75%) had multiple organ involvement. No false positives were noted. PET/computed tomography imaging also detected benign lesions of the bone and lymph nodes in three patients (15%). All patients had hepatic metastases and liver enzyme assays were abnormal in only one (12.5%) of eight patients. CONCLUSIONS: PET/computed tomography imaging is a sensitive tool for the detection and localization of hepatic and extra-hepatic (particularly osseous) metastatic choroidal melanoma.     

The kidney, cancer, and the eye: current concepts

Herein, we review the associations between the kidney, renal cancers, and the eye. Renal cancers have been reported to metastasize to the eye and the orbit. As these tumors can be confused with other amelanotic or vascular tumors, a high index of suspicion is required for early detection and management of the primary tumor. We discuss the physiology of metastases, clinical features and management of metastatic disease. A variety of ocular anomalies have been associated with renal disease. Wilms tumor, a renal tumor of childhood, can present with aniridia, which may be the first clue leading to the diagnosis of the primary tumor. Paraneoplastic syndromes are common manifestations of renal cancers and can present as retinopathies and neuro-ophthalmic disorders. Multiple cancer syndromes involve both the eye and the kidney. For example, the diagnosis of von Hippel retinal tumors can lead to a systemic evaluation and discovery of associated visceral tumors. The prognosis, screening, and counseling of such patients is discussed. Newer systemic treatments available for renal tumors, such as interferon alfa, may lead to ocular side effects including retinopathy. These patients require periodic ophthalmic examinations. This review demonstrates the essential role of the ophthalmologist, for early diagnosis and treatment that can help reduce the morbidity and mortality associated with kidney tumors and renal-associated disease.     

Hypoglycemia in inpatients after gatifloxacin or levofloxacin therapy: nested case-control study

STUDY OBJECTIVES: To compare the incidence of hypoglycemic events in patients exposed to gatifloxacin or levofloxacin, and to measure the odds of experiencing a hypoglycemic event after receiving gatifloxacin versus levofloxacin while adjusting for confounders. DESIGN: Nested case-control study within a historical cohort. SETTING: A tertiary care, 730-bed, teaching hospital in central Illinois. PATIENTS: Seven thousand two hundred eighty-seven hospitalized patients who received gatifloxacin or levofloxacin therapy. MEASUREMENTS AND MAIN RESULTS: A total of 113 patients (case patients) had blood glucose levels below 51 mg/dl; 113 control patients, matched for age and sex, had no hypoglycemia. Matched conditional logistic regression models adjusted the odds of having hypoglycemia for significant covariates. The 12-month incidence of hypoglycemia was 11/1000 patients after levofloxacin administration and 21/1000 patients after gatifloxacin (absolute risk increase 10/1000 patients, 95% confidence interval [CI] 4-16/1000). Renal failure, sepsis syndrome, and concomitant hypoglycemic drug therapy significantly predicted hypoglycemia. After adjustment for significant predictors, the odds of having hypoglycemia were 2.81 (95% CI 1.02-7.70) times higher after gatifloxacin than levofloxacin therapy. CONCLUSION: Among inpatients, the incidence of hypoglycemic events is greater after treatment with gatifloxacin than levofloxacin. The odds of experiencing hypoglycemic events are greater with gatifloxacin even after adjusting for other hypoglycemia risk factors, such as concomitant hypoglycemic drugs, renal failure, and sepsis syndrome.     

Melanocytic conjunctival tumors

Melanocytic conjunctival tumors include a wide range of lesions that vary in their clinical and histopathologic features. Their management depends on numerous factors, including their location, focality, tumor dimensions (including depth), histopathologic characteristics, recurrences, growth, and the presence of metastasis.     

Psychiatric diagnoses, comorbidity, and functioning in National Guard troops deployed to Iraq

Objective

Over 1.8 million troops have been deployed to Iraq (OIF) and Afghanistan. Estimates of mental health problems postdeployment have been based on screening instruments; no studies have examined the postdeployment mental health of troops returning from OIF using structured diagnostic interviews. The goal of the current study is to (a) report on rates of mental health diagnoses and comorbidity in soldiers after deployment to OIF using clinical interviews, and (b) examine the relationship between mental health diagnoses and overall functioning and quality of life.

Method

Participants were 348 National Guard soldiers drawn from the Readiness and Resilience in National Guard Soldiers (RINGS) study, a longitudinal study of mental health after deployment to OIF from March 2006 to July 2007. Participants completed clinical interviews, including the Clinician Administered PTSD Scale and the Structured Clinical Interview for the DSM-IV, and self-report measures of social adjustment and quality of life 6-12 months following deployment.

Results

Most participants did not meet criteria for a mental health diagnosis. Non-PTSD anxiety disorders and depressive disorders were the most common. Mental health diagnoses were associated with poorer functioning and quality of life. PTSD had the strongest relationship with social functioning and quality of life. For those with PTSD, comorbid diagnoses were not associated with an incremental decrease in functioning or quality of life.

Conclusions

The findings highlight the significant rate and burden of mental health disorders among this population and suggest that while PTSD is relatively uncommon, it is a particularly deleterious disorder.     

Effect of angiotensin-converting enzyme inhibitors on arterial stiffness in hypertension: systematic review and meta-analysis

Arterial stiffness is an independent cardiovascular prognostic factor and is modulated by angiotensin-converting enzyme inhibitors (ACEIs). The authors performed a meta-analysis of clinical trials investigating the effects of ACEIs on pulse wave velocity (PWV) or augmentation index. The search included randomized clinical trials as well as uncontrolled studies that measured in-treatment changes in arterial stiffness. The authors performed separate analyses for carotid-femoral PWV, brachioradial PWV, and augmentation index. Average absolute and relative reduction in mean arterial pressure and PWV were -15.4 mm Hg and -13.04% and -1.15 m/s and -9.74% for carotid-femoral PWV studies; and -11.2 mm Hg and -9.3% and -1.9 m/s and -16.7% for brachioradial PWV studies. There was a greater reduction in augmentation index by ACEIs when compared with controls (-1.0% to -5.3%). The authors conclude that ACEIs have modest beneficial effects on arterial stiffness measured as PWV and augmentation index, and this effect is at least partly independent of changes in blood pressure.     

Changing outcomes and treatment strategies for wire induced coronary perforations in the era of bivalirudin use

Objectives : The objective of this study is to analyze the clinical outcomes and treatment strategies of coronary wire perforations (WPs) in the era of heparin use compared to the era of bivalirudin use. Background : Percutaneous coronary intervention (PCI) advances have led to progressive decrease in complications. Therefore, complex coronary lesions such as chronic total occlusions and calcified lesions are being attempted with stiff/hydrophilic wires with resultant higher incidence of coronary WP. Methods : A single‐center retrospective data analysis of coronary perforation (CP) for the last 4 years with review of coronary angiograms was done and WPs were identified. A simple classification scheme based on angiographic appearance of CP was made: Type I (“myocardial stain,” with no frank dye extravasation) and type II (“myocardial fan,” with dye extravasation to pericardial cavity or cardiac chambers). Results : Overall incidence of CP was 0.49% (82/16,859). Of these 50 (61%) were caused by WP; 30 occurred with heparin use (Group A) and 20 with bivalirudin use (Group B). WPs always occurred in type B₂/C lesions (100%) and commonly with use of hydrophilic guidewires (70%). Major adverse cardiac events and cardiac tamponade were frequent in group A (50%) and none in group B (0%); P < 0.01. All WP in group B responded to stopping anticoagulation and prolonged balloon inflation, while group A type II perforations frequently required additional interventions (pericardiocentesis, coil embolization). Conclusions : Cardiac tamponade and major adverse cardiac events from WPs were less frequent with bivalirudin use compared to heparin use. This beneficial effect of bivalirudin may be explained on the basis of its short half‐life and reversible thrombin inhibition property. Therefore, bivalirudin may offer a safer alternative for anticoagulation in complex PCI. © 2009 Wiley‐Liss, Inc.