Risk of cancer in patients with Guillain-Barré syndrome (GBS)

Abstract. The possible relationship between Guillain-Barré syndrome (GBS) and cancer is still controversial and the existence of a paraneoplastic GBS remains unconfirmed. To better define whether there is a relationship between GBS and malignancy, we compared the observed and the expected number of patients with tumours in a population-based cohort of subjects with GBS. Clinical differences between GBS patients with or without malignancies were analysed. Data were obtained from the Piemonte and Valle dAosta Register for GBS (PARGBS) (years 1990–1998). GBS was diagnosed according to NINCDS criteria. The number of expected cases of malignancy in the PARGBS population was calculated using the incidence rate of all types of cancer (ICD codes 140–208) in Piemonte [1985–1987], and in the most important town of this region, that is Turin (years 1993–1997). In the nine-year period, 435 incident patients with GBS were found. Nine of them developed cancer in the six months preceding or following GBS; in seven of them, the diagnosis of cancer and GBS was concomitant. The expected number of malignant tumours was 3.7 (using the incidence in Piemonte) and 3.8 (using the incidence in Turin); therefore, the odds ratios were 2.43 (95 % CI, 1.11–4.62) and 2.37 (95% CI, 1.09–4.50), respectively (p < 0.01). Although the cases with malignancies were clinically similar to the other cases of GBS observed through the Register, the mortality in GBS patients with cancer was higher and was the final cause of death in two patients affected by severe cancer. These results suggest a possible correlation between some cases of GBS and cancer. However, GBS in cancer patients does not meet all the criteria for paraneoplastic diseases.* Piemonte and Valle dAosta Register for GBS (PARGBS): Coordinating center: 2^nd Division of Neurology, Department of Neuroscience, University of Torino, Italy. Project coordinator: A. Chiò, MD. Study monitors: A. Calvo, MD, N. Di Vito, MD, M. Vercellino, MD. Scientific Committee: A. Bertolotto, MD, E. Bottacchi, MD, A. Chiò, MD, D. Cocito, MD, M. T. Giordana, MD, M. Leone, MD, L. Mazzini, MD, G. Mora, MD. Collaborating centers: A. Chiò, MD, A. A. Terreni, MD, D. Schiffer, MD, R. Mutani, MD, D. Cocito, MD, B. Bergamasco, MD, I. Rainero, MD (Department of Neuroscience, Section of Neurology, University of Torino, and Azienda Ospedaliera San Giovanni Battista, Torino), A. Bertolotto, MD, A. Tribolo, MD, R. Sciolla, MD, F. Mondino, MD, M. T. Giordana, MD (Department of Neuroscience, Section of Neurology, University of Torino, and Azienda Ospedaliera San Luigi Gonzaga, Orbassano), M. Leone, MD, P. Gaviani, MD, F. Monaco, MD (Department of Neurology, Amedeo Avogadro University, Novara), M. De Mattei, MD, E. Morgando, MD (Department of Neurology, Azienda Ospedaliera San Giovanni, Torino), L. Sosso, MD, M. Gionco, MD (Department of Neurology, Ospedale Mauriziano, Torino), U. Morino, MD, M. Nobili, MD (Department of Neurology, Ospedale Martini, Torino), L. Appendino, MD (Department of Neurology, Ospedale Maria Vittoria, Torino), D. Piazza, MD (Department of Neurology, Ospedale S. Giovanni Bosco, Torino), E. Oddenino, MD, W. Liboni, MD (Department of Neurology, Ospedale Gradenigo, Torino), G. Vaula, MD, G. Ferrari, MD (Department of Neurology, Ivrea), M. Favero, MD, C. Doriguzzi Bozzo, MD (Department of Neurology, Pinerolo), P. Santamaria, MD (Department of Neurology, Vercelli), U. Massazza, MD, E. Bollani, MD (Department of Neurology, Biella), A. Villani, MD, R. Conti, MD (Department of Neurology, Domodossola), G. Mora, MD, C. Balzarini, MD (Department of Neurological Rehabilitation, Fondazione S. Maugeri, Clinica del Lavoro e della Riabilitazione, IRCCS, Scientific Institute of Veruno), M. Palermo, MD (Department of Neurology, Alessandria), F. Vergnano, MD (Department of Neurology, Casale Monferrato), S. Cordera, MD, C. Buffa, MD (Department of Neurology, Novi Ligure), M. T. Penza, MD (Department of Neurology, Tortona), F. Fassio, MD (Department of Neurology, Asti), P. Meineri, MD (Department of Neurology, Azienda Ospedaliera Santa Croce e Carle, Cuneo), A. Cognazzo, MD, C. Mocellini, MD, A. Dutto, MD, A. Cucatto, MD (Department of Neurology, Savigliano), C. Cavestro, MD, W. Troni, MD (Department of Neurology, Alba), G. Corso, MD, E. Bottacchi, MD (Department of Neurology, Aosta).     

Length of stay and antipsychotic treatment costs of patients with acute psychosis admitted to hospital in Spain.

Abstract. Objective: The aim of this study was to describe the length of stay, cost of drug treatment, diagnostic tests and other therapeutic measures in acute psychotic patients admitted to acute in-patient psychiatric units and to analyse the factors associated with these. Methods: A retrospective review was made of medical records of 200 patients admitted for acute psychosis in eight Spanish hospitals. Information was collected concerning the length of stay, cost of drug treatment and diagnostic tests; bivariate and multivariate analysis was made of factors associated with length of stay and cost of antipsychotic drug treatment. Results: The average admission cost ranged between 2,830.29 and 3,624.95 euros, with a wide variability among hospitals. Of this cost, 94.3% corresponded to fixed costs, 3.4% to diagnostic tests and 2.4% to drug treatment (84.2% of this latter cost corresponded to antipsychotic drugs). Age younger than 25 years and a diagnosis of schizophrenia were associated with longer hospital stays; longer length of stay, the presence of aggressiveness/agitation, a diagnosis of schizophrenia, age younger than 25 years and the use of atypical antipsychotics were associated with higher costs in antipsychotic drug treatment. Conclusions: The hospital admission cost of an acute psychotic episode is mostly dependent on the structural costs derived from in-patient treatment. The differences in costs seem to be related to the different length of stay schemes used by the various hospitals rather than to the clinical characteristics of patients or the drugs used.* The Psychosp Group includes: Ana Alvarez Díaz, Sonia Cruz Pardo (Hospital General de Guadalajara), Milagros Anaya Turrientes, Leonor Sanz Vila, Marta Soler (Hospital Ramón y Cajal de Madrid), Alicia Díez del Pino, Sonia González Ponsjoan, Antonia M^a Mejías Corbacho (Hospital Insular de Las Palmas), María Forés Mayán, Juan Rojo, Mónica Suárez (Hospital Conxo de Santiago),Gregorio Gómez, Salvador Peiró (Fundación Instituto de Investigación en Servicios de Salud, Valencia), Iris Guadarrama, Javier Rejas (Pfizer Spain, Madrid), Isabel Martín Herranz, Juan C. Yañez Rubal (Hospital Juan Canalejo de La Coruña), Montserrat Navarro (Hospital de Santa María, Lleida), Amaya Navarte, José Luis Vila Jato (Hospital General de Santiago), Ramón Pla Poblador, Susana Redondo Capafons (Hospital Mutua de Tarrasa), Josep Rivas, Francesc Sorio (Hospital Clinic i Provincial, Barcelona).     

Acute hemorrhagic leukoencephalitis mimicking herpes simplex encephalitis: case report

Acute hemorrhagic leukoencephalitis (AHLE) is a more severe form of acute disseminated encephalomyelitis (ADEM) characterized by a fulminant clinical course and the presence of hemorrhagic necrosis of the white matter. We report the case of a 57-year-old woman who developed delirium following a respiratory infection. Magnetic resonance imaging of the brain disclosed signal abnormalities in the frontal and temporal lobes, usually found in herpes simplex encephalitis (HSE). Gram stain, India ink and acid-fast bacilli staining were all negative in CSF as was a polymerase chain reaction (PCR) for herpes simplex virus. A diagnosis of AHLE was made and the patient was treated with i.v. methylprednisolone 1g/day for 5 days. Despite treatment, the patient developed several neurological sequelae compatible with the severity of her illness.     

Nonfatal and fatal drownings in recreational water settings--United States, 2001-2002

Drowning is the seventh leading cause of unintentional injury deaths for all ages and the second leading cause of all injury deaths in children aged 1-14 years. Many of these injuries occur in recreational water settings, including pools, spas/hot tubs, and natural water settings (e.g., lakes, rivers, or oceans). To examine the incidence and characteristics of nonfatal and fatal unintentional drownings in recreational water settings, CDC analyzed 2001-2002 data from the National Electronic Injury Surveillance System All Injury Program (NEISS-AIP) and National Vital Statistics System (NVSS) death certificate data from 2001. This report summarizes that analysis, which indicated that, during 2001-2002, an estimated 4,174 persons on average per year were treated in U.S. hospital emergency departments (EDs) for nonfatal unintentional drowning injuries in recreational water settings. Approximately 53% of persons required hospitalization or transfer for more specialized care. During 2001, a total of 3,372 persons suffered fatal unintentional drownings in recreational settings. Nonfatal and fatal injury rates were highest for children aged < or =4 years and for males of all ages. To reduce the number of drownings, environmental protections (e.g., isolation pool-fences and lifeguards) should be adopted; alcohol use should be avoided while swimming, boating, or water skiing or while supervising children; and all participants, caregivers, and supervisors should be knowledgeable regarding water-safety skills and be trained in cardiopulmonary resuscitation (CPR).     

West Nile virus activity--United States, June 23-29, 2004

As of June 29, eight states had reported a total of 57 human cases of West Nile virus (WNV) illness to CDC through ArboNET in 2004. A total of 38 cases had been reported from Arizona, 10 from California, three from New Mexico, two from Florida, and one each from Michigan, Nebraska, South Dakota, and Wyoming. Thirty-six (64%) of the cases occurred in males; the median age of patients was 53 years (range: 9-84 years), and dates of illness onset ranged from April 23 to June 15. Of the 57 cases, one fatal case was reported from Arizona.     

Injuries associated with homemade fireworks-- selected states, 1993-2004

Around the July 4 Independence Day holiday each year in the United States, injuries associated with homemade fireworks are increasingly common. During June-July 2002, approximately 5,700 persons were treated for fireworks-related injuries at U.S. emergency departments; approximately 300 (5.3%) were injured in incidents involving illegal and homemade fireworks. CDC and the Consumer Product Safety Commission (CPSC) recommend that fireworks be handled only by professionals. To describe injuries and emergency responses resulting from homemade fireworks explosions, the Agency for Toxic Substances and Disease Registry (ATSDR) researched data from its Hazardous Substances Emergency Events Surveillance (HSEES) system. This report summarizes four incidents involving homemade fireworks explosions that were identified by the surveillance system. To prevent injuries and deaths, no one should attempt to make their own fireworks.