Confounders contributing to the reported associations of coffee or caffeine with disease

The role of caffeine or coffee in causing or promoting the incidence of serious disease is equivocal. Two design factors may account for the discrepancies in reported findings on the effects of coffee drinking: (a) imprecision of measurement and (b) confounding variables. A study of 2,714 white U.S. adults disclosed that, of 32 risk factors analyzed by linear and logistic regression, only sex and cigarette smoking were found to be important potential confounders of caffeine and coffee intake. Partial R2 values of the other 30 risk factors were relatively small and were inconsistent for each sex. It is unlikely that any of these factors could explain any of the reported associations between caffeine or coffee consumption and certain diseases. However, certain weak associations with caffeine or coffee intake should be included in the study design when they are known to be risk factors of a disease under investigation. These factors for men are dietary fat intake, vitamin C intake, and body mass index; and for women are vitamin use, alcohol intake, stress, and perceived health status.     

The Usefulness of Magnetic Resonance Imaging in the Diagnosis of Anterolateral Impingement of the Ankle

The purpose of this study is to assess the sensitivity and specificity of magnetic resonance imaging (MRI) in the diagnosis of anterolateral impingement of the ankle and to assess the most helpful sequence in making the diagnosis. Twenty-four patients who had undergone ankle arthroscopy were chosen. Twelve patients had arthroscopically documented anterolateral impingement, and 12 patients with no impingement on arthroscopy served as controls. Two musculoskeletal radiologists and an orthopedic surgeon, blinded to the operative diagnosis, retrospectively reviewed selective MRI images in the sagittal, axial, and coronal planes. The sensitivities and specificities were calculated for all 3 reviewers. The Kendall coefficient of concordance was calculated for overall agreement among reviewers. Sensitivities varied from 0.75 to 0.83, whereas specificities varied from 0.75 to 1.00. Using the Fisher exact test of contingency, the sensitivities and specificities showed that all reviewers' interpretations were statistically significant with P = .039, .001, and .012, respectively. The axial images were felt to be most helpful in making the diagnosis. The physicians felt that the sagittal images were helpful in 67%, 83%, and 100%, respectively. MRI is a useful tool that can aid the clinician in the diagnosis of anterolateral impingement of the ankle. T1 sagittal images demonstrating displacement of the normal fat signal anterior to the fibula by scar can be useful and help to confirm the diagnosis.     

142Effects of Low‐Frequency Ultrasound Applied In Vitro to Highly Antibiotic‐Resistant Acinetobacter Isolates Recovered From Soldiers Returning From Iraq

Abstract  Brooke Army Medical Center isolated 25 highly antibiotic‐resistant Acinetobacter ssp . (primarily A. baumannii ) from wounded soldiers returning from Iraq. Concern about effective treatment of these organisms led our institution to begin investigating low‐frequency ultrasound (LFU) as a method of increasing the effectiveness of antibiotics on A.baumannii in wound management. Studies have suggested that LFU applied in conjunction with antibiotics may increase their overall effectiveness. We hypothesize that combining antibiotics with LFU may be an effective method of wound management and that this combination may be synergistic in its overall effect. In this initial work, we wanted to determine if sonocation would have an effect on our organism of interest, A. baumannii . We selected several organisms, both gram positive and gram negative, that have been shown to be killed by sonocation ( E. coli, S. aureus , and S. pyogenes ) and added three highly resistant A. baumannii isolates. Bacterial death was measured by both colony counts after 24 hours of growth and acridine orange staining using a standard protocol.
Colony counts were significantly reduced by sonocation. Furthermore, A.'baumannii colony counts were also greatly reduced by sonocation. Actual cell destruction was also visualized using acridine orange staining. Our data support the assertion that sonocation has an antibacterial effect on some bacteria, including A. baumannii . Our next step is to add antimicrobial agents and determine if their effectiveness can be increased by sonocation.     

Religious orientation, aging, and blood pressure reactivity to interpersonal and cognitive stressors

Background: Research on religion and health suggests general health benefits for those who are more religiously involved. Particular aspects of religiosity that may influence this finding, however, have not been sufficiently investigated.Purpose: This study was designed to explore the relationship between religious orientation (intrinsic, extrinsic) and blood pressure reactivity among older (over 60 years) and younger (18–24 years) adults exposed to two qualitatively different laboratory stressors (cognitive, interpersonal).Methods:Participants were categorized as exhibiting either a predominately intrinsic or extrinsic religious orientation based on scores on the Religious Orientation Scale. They were subsequently exposed (in counterbalanced order) to two laboratory stressors that varied in terms of whether an interpersonal confrontation was involved. Measures of blood pressure were obtained at baseline and during stressor presentation.Results: Analyses indicated that older extrinsically religious individuals demonstrated exaggerated reactivity compared to younger participants and older intrinsically religious individuals. Older intrinsically religious participants did not differ from younger persons. Similar results were found for analysis of baseline data. Extrinsic participants had greater reactivity during the interpersonal confrontation condition than did intrinsic individuals.Conclusions: These findings suggest that religious orientation may be an important variable to study regarding cardiovascular reactivity in, particularly, older adults. This research was supported in part by National Institute on Aging Grant 1 R03 AG 18554-01. A previous version of this article was presented in August 2002 as a Citation Paper at the 110th Annual Convention of the American Psychological Association, Chicago. We thank Timothy W. Smith, James A. Blumenthal, Carl E. Thoresen, and Edward M. Heath for their assistance throughout this project. We also thank Llewellyn Jones and Jodi Hildabrandt for their efforts in collecting data.     

Endoscopic transthoracic sympathectomy for idiopathic upper limb hyperhidrosis

A 5-Year experience of 51 endoscopic transthoracic dorsal sympathectomies for idiopathic palmar hyperhidrosis in 26 patients is presented. Fifty-two percent complained of excessive sweating over their hands, 28% of axillary sweating and 20% over both areas, with a mean duration of 10 years. The second, third and fourth thoracic ganglia and their interconnecting fibres on the affected side were ablated using diathermy cautery. Over a mean follow up time of 26 months, this procedure was successful in curing or improving intractable sweating in 92%. However, axillary sweating was less well controlled than in the palms with 20% of patients describing residual wetness in the axilla. Compensatory sweating (75%) and gustatory sweating (48%) were the commonest side effects; despite this, most patients were satisfied with the functional and cosmetic outcome. Other complications included a temporary Horner's syndrome in one patient, a pneumothorax in the immediate post-operative period in another and a unilateral non-infective reactionary pleural effusion in a third. Two patients developed recurrence of palmar hyperhidrosis within 6 months of surgery. One has been successfully treated by re-operation on the affected side. All patients complained of mild to moderate interscapular chest pain which was easily controlled by non-steroidal anti-inflammatory agents, and resolved within 7–10 days post-operatively. The technique of endoscope transthoracic sympathectomy is effective, relatively simple to perform and usually requires only an overnight stay. It is recommended as the surgical treatment of choice for upper limb hyperhidrosis unresponsive to conservative measures.     

Helping families of homicide victims: A multidimensional approach

Homicide inflicts massive injury upon the intrapsychic and interpersonal realities of the surviving kin of murder victims. A New York City pilot program of outreach and counselling to 1182 families of Brooklyn homicide victims suggests that surviving kin undergo the symptoms of traumatic stress disorder. Recovery is prolonged by knowledge that the perpetrator is usually alive and in some cases unpunished, by repetitive confrontations with the criminal justice system and by the multiple losses endured: loss of a family member, loss of illusions of safety and invulnerability, loss of a sense of trust in the surrounding community, and loss of a belief system. Effective help to survivors requires interventions that respond to all aspects of the survivors' losses.     

Obesity and litigation predict workers' compensation costs associated with interbody cage lumbar fusion.

BACKGROUND CONTEXT: Results of lumbar fusion surgery have been mixed and procedures are costly. Interbody cage lumbar fusion (ICLF) has been advanced to improve arthrodesis and clinical outcomes; however, little attention has been given to ICLF costs or potential predictors of these expenses. PURPOSE: To depict medical and compensation costs associated with ICLF in a Utah cohort of patients receiving workers' compensation as well as to investigate predictors of costs. STUDY DESIGN/SETTING: A retrospective-cohort research design was used involving completion of presurgical and postsurgical medical record reviews and accrual of medical and compensation costs. Presurgical variables included in a regression model were presurgical spinal pathophysiology rating, obesity, and litigation status. PATIENT SAMPLE: Forty-three consecutive patients who were compensated by the Workers' Compensation Fund of Utah and underwent ICLF. OUTCOME MEASURES: Total accrued compensation and medical costs. METHODS: A retrospective review of presurgical variables and total accrued compensation and medical costs was conducted. RESULTS: Multiple regression analysis indicated that nonpathophysiological factors predicted compensation costs (lawyer involvement [beta=0.40]; obesity [beta=0.34]). Specifically, compensation for those with versus without lawyers was $41,657 versus $24,837, and for those who were obese versus nonobese was $46,152 versus $28,168. Arthrodesis was correlated with medical costs (r=-0.47, p=.002), with incurred costs for patients achieving solid fusion versus pseudarthrosis equaling $38,881 versus $71,655, respectively. CONCLUSIONS: Considerable costs were associated with ICLF, particularly for those who were obese, involved in litigation, or failed to achieve solid fusion. With regard to compensation costs, the findings support the importance of assessing nonpathophysiological factors in spinal fusion patients.     

Association between inflammation and epithelial damage-restitution processes in allergic airways in vivo

Background Associations between allergen challenge-induced sites of epithelial damage and the distribution of leucocytes and extravasated plasma remain unexplored. Objective To study neutrophils, eosinophils, and fibrinogen at allergen challenge-induced patchy epithelial damage-restitution sites in guinea-pig trachea. Methods After local challenge tracheal tissue (cryo sections and whole-mounts) and lumen (selective tracheal lavage) were examined at 1, 5, and 24 h. Eosinophils, neutrophils and fibrinogen were identified by histochemistry. Results Neutrophils increased markedly in tracheal lavage fluids and in tissue and were strongly associated with the challenge-induced epithelial craters of damage-restitution. At 1 and 24 h eosinophils were increased in the tracheal lumen whereas the surrounding tissue displayed a reversed pattern. Gels rich in fibrinogen, neutrophils, and eosinophils were present in epithelial crater areas, protruding into the lumen. Clusters of free eosinophil granules, Cfegs, released through lysis of eosinophils, and neutrophils with long cytoplasmatic protrusions abounded in these crater areas. Conclusions The present findings provide important new insights into allergic airways where sites of epithelial damage-restitution processes emerge as the major loci for eosinophil, neutrophil, and plasma protein activities, the latter likely causing leukocyte adhesion and activation in vivo. The disttibution of eosinophils in this study suggests roles of these cells both in airway mucosa and in regional lymph nodes. Based on the present study we also propose that lysis of eosinophils and Cfegs generation are a major paradigm for activation of these cells in vivo.