Clustering of inflammatory bowel disease with immune mediated diseases among members of a northern california-managed care organization

BACKGROUND AND AIMS: Previous studies provide evidence that some immune-mediated diseases occur at greater frequency among inflammatory bowel disease (IBD) patients than in the general population. The present study examined the co-occurrence of IBD with common immune-mediated disorders including asthma, psoriasis, type 1 diabetes, rheumatoid arthritis, multiple sclerosis, systemic lupus erythematosus, vitiligo, autoimmune thyroiditis (Grave's and Hashimoto's), and chronic glomerulonephritis. METHODS: We conducted a cross-sectional study among members of the Kaiser Permanente Medical Care Program for the period 1996-2005. A total of 12,601 patients with at least two IBD diagnoses in computerized visit data were ascertained. Four persons without IBD were matched to each IBD patient on age, gender, and length of enrollment. Information on co-occurring diseases was obtained from computerized visit data for 1996-2005. Conditional logistic regression was used to estimate the odds ratio and 95% confidence interval for the association of IBD with immune-mediated disorders after adjusting for smoking. RESULTS: Seventeen percent of the IBD patients and 10% of the persons without IBD had a diagnosis for at least one immune-mediated disease. IBD patients were more likely to have asthma (1.5, 95% CI 1.4-1.6), psoriasis (1.7, 95% CI 1.5-2.0), rheumatoid arthritis (1.9, 95% CI 1.5-2.3), and multiple sclerosis (2.3, 95% CI 1.6-3.3). CONCLUSIONS: Among the immune-mediated diseases we studied, most were more common in IBD patients than in persons without IBD, suggesting that IBD shares common etiologic factors with other immune-mediated diseases.     

Subcapsular hematoma evacuation as a method of evaluating injured kidneys for transplant

BACKGROUND: Approximately one-third of organ donors in the United States are trauma victims. In general, kidneys with large subcapsular hematomas are not used for transplant because of the possibility of significant parenchymal injury. A large subcapsular renal hematoma may cause scarring resulting in renal parenchymal compression and development of the Page syndrome. OBJECTIVE: To elucidate a successful method of evaluating kidneys subject to trauma, while also possibly preventing further damage and improving their function. DESIGN: Data were collected from the donor kidney pool of the New York Organ Donor Network from January 2006 through July 2007. Four kidneys during that period were determined to have significant subcapsular hematomas. Surgical intervention was undertaken and outcomes after transplantation were reviewed. MAIN OUTCOME MEASURES: Four of the kidneys underwent a surgical procedure to drain the subcapsular hematoma allowing assessment of the underlying renal parenchyma. All 4 of these kidneys were deemed transplantable. After transplantation, 3 of the 4 kidneys had immediate function and did not require dialysis. The remaining kidney was removed as a result of primary nonfunction. CONCLUSION: The described surgical intervention allows the transplant surgeon to accurately assess the extent of damage to a traumatized kidney while possibly preventing further damage to the kidney.     

Outpatient Mastectomy and Breast Reconstructive Surgery

Background In the United States, post-mastectomy breast reconstruction is a state (all 51 jurisdictions) and federally mandated benefit. Outpatient mastectomy, which could lower use of breast reconstruction, may raise concerns about whether patients receive adequate post-mastectomy care. Methods Using linked surveillance, epidemiology, and end results (SEER)–Medicare data, we identified Medicare fee-for-service women aged 65–69 years, diagnosed with early-stage breast cancer, and receiving unilateral mastectomy from 1998–2002. The corresponding surgery delivery settings were determined from claims data. The outcome of interest was reconstruction within 4 months of diagnosis. We used multivariable logistic regression models to examine the association of outpatient mastectomy with the likelihood of post-mastectomy reconstruction, controlling for patient’s characteristics. Results Among the 3,419 patients in the sample, 717 (21%) patients received outpatient mastectomy. The proportions of patients receiving reconstruction were 13% for inpatient mastectomy patients and 4% for outpatient mastectomy patients. Outpatient mastectomy patients were younger and had less comorbidities than inpatient mastectomy patients. Multivariable regression analysis suggested that outpatient mastectomy patients were less likely to receive reconstruction (odds ratio = 0.247; 95% confidence interval (CI): 0.166–0.368). Additional analysis suggests that African American patients were less likely than white patients to undergo reconstruction (odds ratio = 0.515; 95% CI: 0.293–0.906) and that this ethnic difference was more manifest among patients undergoing inpatient mastectomies. Conclusions This study shows that outpatient mastectomy was associated with lower use of breast reconstruction. A better understanding of choice of delivery setting of mastectomy with a focus on younger and minority breast cancer patients should be explored in future research.     

Attentional bias for emotional faces in children with generalized anxiety disorder

ObjectiveTo examine attentional bias for angry and happy faces in 7- to 12-year-old children with generalized anxiety disorder (GAD; n = 23) and nonanxious controls (n = 25).MethodChildren completed a visual probe task in which pairs of face stimuli were displayed for 500 milliseconds and were replaced by a visual probe in the spatial location of one of the faces.ResultsSeverely anxious children with GAD showed an attentional bias toward both angry and happy faces. Children with GAD with a milder level of anxiety and nonanxious controls did not show an attentional bias toward emotional faces. Moreover, within the GAD group, attentional bias for angry faces was associated with increased anxiety severity and the presence of social phobia.ConclusionsBiased attention toward threat as a function of increased severity in pediatric GAD may reflect differing threat appraisal processes or emotion regulation strategies.     

Neural encoding of auditory temporal context in a songbird basal ganglia nucleus, and its independence of birds' song experience

Some of the most complex auditory neurons known are found in the songbird forebrain, throughout the 'song system', including its basal ganglia nucleus Area X. These cells are selective for the temporal order of the bird's own song (BOS): they typically respond strongly to BOS, but more weakly when the syllable sequence of BOS is played in reverse order (roBOS), indicating that they integrate auditory information over more than single syllables. Here, studying the zebra finch Area X, we found that order selectivity strongly depends on the mean syllable duration of individual songs, decreasing markedly as this duration approaches 150–200 ms. Simply segmenting the same songs differently, creating an increase in average syllable length towards 150 ms, caused a similar decrease in order selectivity. This suggests that song neurons integrate acoustic information over a relatively limited time window, predominantly less than 150 ms. We provided further support for this by showing that a significant fraction of Area X order selectivity was accounted for by the acoustic similarity between each BOS and roBOS, measured using cross-correlation with fixed window sizes, but only when the correlation windows were at least 50 ms and no more than 200 ms long. All the same findings were evident in birds raised without tutor exposure, indicating that tutor learning has little effect on neural mechanisms underlying song temporal selectivity. Our results suggest that song-selective neurons encode much of the temporal context of song using a short, constant time window that is conserved across differences in songs, birds and learning.     

Choledochojejunostomy revision performed by using the laparoscopic linear cutter

Choledochojejunostomy is commonly performed for biliary bypass for benign and malignant disease. Anastomotic stricture is a known complication of enteric surgery. We report the use of the laparoscopic linear cutter at laparotomy to revise a choledochojejunostomy created 12 years previously for benign disease.     

Transverse mesocolonic hernia of the jejunum mimicking pancreatic neoplasm

A patient admitted repetitively for vomiting was found to have a radiologic abnormality in the lesser sac, initially interpreted as a pancreatic mass. At exploration, intestinal obstruction due to transmesocolonic herniation of the jejunum explained both the symptoms and the radiologic finding.     

<Emphasis Type="Italic">Staphylococcus aureus</Emphasis> Nasal Colonization in Preoperative Orthopaedic Outpatients

Nasal colonization with Staphylococcus aureus (SA) increases the risk of surgical site infection (SSI). We first (1) determined the prevalence of asymptomatic nasal colonization with SA, (2) assessed trends in methicillin resistance with time, (3) ascertained risk factors for nasal colonization; and (4) correlated SSI to nasal colonization status and procedure. We performed a cross-sectional analysis of SA nasal colonization among healthy preoperative orthopaedic outpatients between 2003–2005 who were within 2 weeks of surgery. Of 284 patients, 86 (30%) carried SA; of these, 81 (94%) were colonized with methicillin-sensitive and five (6%) with methicillin-resistant SA (MRSA). Total SA colonization increased from 25/78 (32%) in 2003 to 37/97 (38%) in 2005, and colonization with MRSA increased from 0/78 (0%) to four of 97 (4%), respectively. We found no associations between nasal carriage and demographics or procedures. Surgical site infection occurred in nine of 282 (3%), four of which were attributable to SA; these included 0/43 (0%) carriers who received decolonization with 2% mupirocin, two of 43 (4.7%) who declined decolonization, and two of 196 (1.0%) who were noncarriers. Nasal colonization with SA, including MRSA, among preoperative orthopaedic outpatients is increasing and their rates reflect community rates. Knowledge of colonization status may be important in decolonization, choosing perioperative or any subsequent empiric antibiotics. One of the authors (CSP) has received funding from GlaxoSmithKline Pharmaceuticals.