Mortality of adults with asthma: a prospective cohort study

BACKGROUND: Few studies have been published on the overall survival of adult patients with asthma. A cohort study was performed to assess the mortality from all causes, from chronic obstructive pulmonary disease, and from lung cancer among adult asthmatic subjects. METHODS: A population of 31,110 Finnish adult women and men, mostly twins, was studied to compare the 16 year mortality rates among asthmatic (n = 471) and non-asthmatic persons. A further 293 twin pairs, discordant for asthma, were also studied to determine whether the mortality of patients with asthma differs from that of their age matched siblings. RESULTS: Mortality from all causes was increased among asthmatic adults (age adjusted hazard ratios 1.49, 95% CI 1.09 to 2.05 for men and 1.53, 95% CI 1.10 to 2.13 for women), and mortality due to chronic obstructive pulmonary diseases was also significantly increased in asthmatic subjects. The risk of death due to lung cancer was increased in men with asthma (hazard ratio adjusted for smoking 3.19, 95% CI 1.39 to 7.31). The risk ratios found among twins discordant for asthma corresponded to those found in the whole cohort. CONCLUSIONS: Survival in adults with asthma is worse than in those without asthma. The excess deaths due to chronic obstructive pulmonary disease may explain some part of the increased mortality rates, but not all of it.


     

Short-Ti inversion-recovery pulse sequence: analysis and initial experience in cancer imaging

Inversion recovery (IR), commonly considered a pulse sequence capable of producing T1-weighted images with excellent display of normal anatomy, is versatile: The null point and peak time provide a useful, succinct summary of the properties of IR and its capacity for producing both T1- and T2-weighted images. Shortening of the inversion time (TI) and creation of a short-TI inversion-recovery (STIR) pulse sequence increases sensitivity to malignancy and other abnormalities by making the effects of prolonged T1 and T2 on signal intensity additive and by nulling the signal from fat. The authors examined over 300 patients with various malignancies and compared STIR images with T1- and T2-weighted images obtained at 0.5 T. In 43 cases, signal-difference-to-noise ratios (SD/Ns) were calculated between tumor, fat, and muscle. In general, STIR images demonstrated tumor as a conspicuously high-intensity area in a background of muted, discernible anatomic detail. The good contrast achieved with STIR sequences between tumor and fat (SD/N = 18.1) and tumor and muscle (SD/N = 12.9) consolidated into a single image the information contained separately on T1- and T2-weighted images, which facilitates efficient detection and localization of malignancy.     

Solitary rectal ulcer syndrome: findings at barium enema study and defecography

Sixteen cases of histopathologically proved solitary rectal ulcer syndrome were encountered. Fifteen patients underwent barium enema study; in nine cases the findings--including rectal stricture, granularity of the mucosa, and thickened rectal folds-were nonspecific. In six cases the study was normal. All patients had a long history of defecation disorders, and defecography was performed in all. In seven cases, intussusception of the rectal wall was seen; in another case the intussusception was accompanied by a rectocele. One case showed rectal prolapse. In four cases, failed relaxation of the puborectalis occurred and prevented the passage of the bolus; in another case there was abnormal perineal descent. In two patients studies were normal. In patients with defecation disorders, the possibility of this syndrome should be considered. Defecography is the method of choice for establishing the diagnosis.