The prevalence of renal cell carcinoma diagnosed at autopsy

OBJECTIVE: To compare the rate of renal cell carcinoma (RCC) detected only at autopsy, from two periods, to determine if the apparent recent increase in RCC in the USA is a true increase or mainly a result of improved imaging techniques, as a true increase in the clinical incidence of RCC should not affect the number of previously undiscovered RCC found only at autopsy. PATIENTS AND METHODS: We identified all individuals who underwent autopsy in two periods, 1955-60 (3307) and 1991-2001 (2938), and who were identified with renal tumour either before or after death. Information was obtained on age, sex, histological type and size of tumour, and whether the tumour was identified before or only after death. All cases of RCC detected at autopsy were reviewed for this analysis by one pathologist (L.D.). RESULTS: Between 1955-60 and 1991-2001 there was a 55% reduction in the mean annual number of autopsies. The proportion of malignant renal masses (RCC) did not change significantly (35.4% to 32.8%). The rate of previously unsuspected RCC detected only at autopsy did not change significantly (0.91 vs 0.72 per 100 autopsies). CONCLUSION: The number of renal masses, both benign and malignant, discovered only at autopsy is declining, possibly because of better detection before death. However, the rate of occult kidney cancer per 100 autopsies did not change significantly between the two periods, suggesting a true increase in the frequency of clinically detected kidney cancer.     

Meta-analysis of survival models of lung cancer

Lung cancer is a common disease that is difficult to treat successfully. Despite the continuous improvement and development of diagnostic method, the disease is still diagnosed in advanced stages. The present study aimed to calculate the 5-years survival rate of patients with lung cancer, to construct different models of survival rates according to different factors and to perform a meta-analysis involving systematic statistical pooling of eligible studies concerning survival of lung cancer. A longitudinal retrospective study was conducted in the treatment centers of Faculty of Medicine and Gamal Abd-El Nasser Hospital. All available records of patients diagnosed and confirmed pathologically as lung cancer during the years 1992 to 2001,were reviewed, the total number amounted to 1099 patients, these patients were followed up for one year till the end of 2002. Life table revealed that the cumulative probability of survival was 18.7% and 16.7%, respectively at 36 -< 42 month and 42 -< 48 month. No one survived up to 5 years. The median survival time was 7.97 months .Kaplan-Meier survival curves yielded that the lowest probability of survival throughout the studied period was noticed among those aged 70 years or more, with stage IV and patients who were treated with radiotherapy alone. Cox regression delineated three significant predictors for survival within 5 years, which were age of patients, stage of tumor and grade of differentiation. Results of meta-analysis demonstrated that pooling the results of different studies yielded a trend toward a reduced relative risk of death by 22% among patients with stage I compared to stage II, and reduced relative risk of 33% for patients with stage I compared to stage III. It is essential to improve the strategies for prevention of smoking and health education program for cessation of smoking early for smokers. Diagnosis, staging and development of a management plan should be completed as quickly as possible. Focuses on the treatment of patients with lung cancer with chemotherapy and radiotherapy.     

Feeling cold at work increases the risk of symptoms from muscles, skin, and airways in seafood industry workers

BACKGROUND: Norwegian workers in seafood industry plants are exposed to a cold and often wet environment. METHODS: 1,767 seafood industry workers participated in a questionnaire study. Seventeen plants were visited for thermal measurements. RESULTS: 15.9% of industrial workers and 1.7% of administrative workers reported that they often felt cold at work. Mean finger temperatures after 1 hr work varied between 16 and 22 degrees C. Foot temperature dropped from morning measurement until lunch time in 85% of the measurements. Industrial workers who reported that they often felt cold, had significantly increased prevalence of symptoms from muscles, skin, and airways while working, compared to workers who reported that they never felt cold at work. CONCLUSIONS: Moderate cooling, caused by a cold indoor working environment, may increase muscle-, airway-, and skin symptoms. The prevalence of feeling cold may be a useful exposure estimate in moderate cold exposure situations.     

Comparison of Electrocardiographic Changes during Microlaryngoscopy under Halothane Anaesthesia induced by Althesin® or Thiopentone

The incidences of electrocardiographic (ECG) changes during microlaryngoscopy under halothane anaesthesia were compared by using Althesin® and thiopentone as induction agents.
During the procedure the most common ECG change in both groups was junctional rhythm, which occurred in 37% of the patients in the Althesin group and in 29% of the patients in the thiopentone group. The next most common changes in the Althesin group were: ventricular ectopic beats (22%), ischaemic S-T segment depression (14%), and T wave flattening or inversion (14%); those in the thiopentone group were ventricular ectopic beats (18%) and rapidly ascending S-T segment depression (12%). As well as during the procedure, some ECG changes were registered in both groups during intubation. ECG changes disappeared without any special treatment after manipulation of the vocal cords or after intubation.
There was no statistically significant difference in the total incidence of dysrhythmias between the Althesin and thiopentone groups, but the types of dysrhythmias were different in the two groups. There were more lower nodal rhythms, less serious ectopic beats and more ischaemic S-T segment depression in the Althesin group than in the thiopentone group.
The results suggest that Althesin is useful and superior to thiopentone in patients with a tendency to develop serious ventricular ectopic beats, whereas in patients with heart and coronary arterial disease, Althesin is inferior to thiopentone and should be used with care.     

Clopidogrel use in children

OBJECTIVES: To review a pediatric experience with the antiplatelet agent clopidogrel and suggest a dosage regimen. STUDY DESIGN: A retrospective chart review of all infants and children treated with clopidogrel at The Hospital for Sick Children, Toronto between January 2001 and April 2004. Clopidogrel dosages, duration of therapy, complications, and adverse effects in a pediatric population were explored. RESULTS: Fifteen infants and children with congenital and acquired heart disease were treated with clopidogrel (median age, 3.5 years; range, 6 weeks to 16 years). Dosages ranged from 1 to 6 mg/kg/day for periods between 1 month and 6 months. Although no thrombotic events were reported, 1 child had a bleeding complication (gastrointestinal) while on triple antithrombotic therapy. Other complications reported in adults, including rash and clinical thrombocytopenia, were not noted in this pediatric series. CONCLUSIONS: Clopidogrel was well tolerated. We suggest a starting dose of 1 mg/kg/day for children.     

Genetic linkage of autosomal dominant progressive supranuclear palsy to 1q31.1

Progressive supranuclear palsy (PSP) is a disorder of unknown pathogenesis. Familial clusters of PSP have been reported related to mutations of protein tau. We report the linkage of a large Spanish family with typical autosomal dominant PSP to a new locus in chromosome 1. Four members of this family had typical PSP, confirmed by neuropathology in one case. At least five ancestors had similar disease. Other members of the family have incomplete phenotypes. The power of the linkage analysis was increased by detecting presymptomatic individuals with 18F-fluoro-dopa and 18F-deoxyglucose positron emission tomography. We screened the human genome with 340 polymorphic markers and we enriched the areas of interest with additional markers. The disease status was defined according to the clinical and positron emission tomography data. We excluded linkage to the tau gene in chromosome 17. PSP was linked, in this family, to one area of 3.4 cM in chromosome 1q31.1, with a maximal multipoint < OD score of +3.53. This area contains at least three genes, whose relevance in PSP is unknown. We expect to further define the gene responsible for PSP, which could help to understand the pathogenesis of this disease and to design effective treatment.     

Migraine and recurrent epistaxis in children

Recurrent epistaxis is a common pediatric problem with uncertain etiology in most cases. We observed frequent complaints, or history of epistaxis in children with migraine. The aim of this study was to determine whether there is an association between epistaxis and migraine in children. A detailed questionnaire was used to conduct a study of 45 consecutive patients, ages 6-11 years, with migraine, diagnosed according to the 1997 proposed pediatric revisions to the International Headache Society criteria; the patients were evaluated in our Pediatric Neurology Clinic. Control subjects consisted of 64 children without recurrent headaches, matched as a group for age and sex, and drawn as a convenient sample from two general pediatric practices and an elementary school. Sixteen (36%) of 45 patients with migraine had epistaxis as compared with 7 (11%) of 64 control subjects (odds ratio = 4.5; 95% confidence interval 1.6-12.1; P = 0.002). Epistaxis began an average of 3 years before migraine with similar characteristics to idiopathic epistaxis in habitual nose-bleeders, such as onset in early childhood, high incidence in sleep, and family history of epistaxis. This study demonstrates a significant association between migraine and recurrent epistaxis in children. Recurrent epistaxis increased the odds of migraine more than fourfold. Moreover, these data raise the question of whether epistaxis may represent a precursor to childhood migraine. The two disorders may share a common pathogenesis, and a prospective, longitudinal study is required to define further the relationship between them.     

Exploring the psychopathology of anorexia nervosa: a Mahlerian standpoint

TOPIC: Anorexia nervosa is an eating disorder that extends beyond the well-known phenomenon of self-starvation to include dynamic psychological themes of autonomy and ego disturbances as well as self-regulation through eating disordered behaviors. PURPOSE AND SOURCE: Exploration of these themes within Mahler's (1975) object relational framework provides the opportunity to examine the genesis of these themes during early psychological ego development and how they may characterize the development of the anorectic experience. CONCLUSION: The Mahlerian perspective can provide psychiatric nursing with a psychoanalytical perspective outside of standard practice, thus promoting critical analysis and integration among the varying professions of psychiatry.