Primary biliary cirrhosis: an epidemiological study.

A three-year study (1977-9) of primary biliary cirrhosis in the city of Sheffield disclosed 34 cases, a point prevalence of 54 per million population. Closer inspection showed an apparent clustering of cases, and the prevalence in relation to one water reservoir appeared to be more than ten times that of the other reservoirs. Nevertheless, analyses of the water showed no significant relevant differences between the reservoir serving areas with a high prevalence of cirrhosis and other reservoirs. Despite the inconclusive results of the water analyses, these findings do suggest that an environmental agent may be a cause of primary biliary cirrhosis and that further epidemiological studies may help to elucidate the cause.     

Condylomata acuminata and risk of cancer: an epidemiological study.

OBJECTIVE--To determine whether patients with condylomata acuminata have an increased risk of developing cancer. DESIGN--Prospective cohort study on patients diagnosed as having condylomata acuminata. The number of malignant tumours in the cohort was compared with national incidences obtained from the Swedish Cancer Registry. SETTING--Dermatology department of the Karolinska Hospital, Stockholm, Sweden. SUBJECTS--3260 patients (2549 males and 711 females, median (range) age 23 (1-80) years) seen during 1969-84, with a mean follow up of 7.8 years. MAIN OUTCOME MEASURES--Number of malignant tumours observed in the cohort during the study period and expected number from national incidence. RESULTS--There were 27 malignancies in the study group. There was no significant increase genital cancer in females compared with the national incidence. Only one patient had invasive cervical cancer (relative risk = 1.8; 95% confidence interval 0 to 10.1). Seventeen women had cervical carcinoma in situ (1.5; 0.9 to 2.5) compared with an expected number of 11.5; this increase was not significant. For males 22 cancers were observed at all sites (1.6; 1.0 to 2.5). The number of genitourinary cancers observed in males was almost three times higher than expected (2.6; 1.2 to 5.0). CONCLUSION--The results indicate that the risk of developing cervical carcinoma in situ or invasive cervical cancer after a genital human papillomavirus infection is less than previously thought. The implications of increase in the genitourinary malignancies in males are uncertain.     

Deep venous thrombosis and occult malignancy: an epidemiological study.

OBJECTIVE--To determine the risk of subsequent cancer in patients with deep venous thrombosis confirmed by venography. DESIGN--Follow up of all patients who had venography for suspected deep venous thrombosis during 1984-88. Patients were traced through a cancer registry up to 1 January 1991. SUBJECTS--4399 patients who had phlebography in one hospital. SETTING--General hospital in Malmö, Sweden, serving a population of 230,000. MAIN OUTCOME MEASURE--Number of cancers recorded. RESULTS--4399 patients had venography for suspected deep venous thrombosis; 604 were known to have a malignancy at the time of venography and were excluded from further analysis. 1383 had deep venous thrombosis, 150 of whom subsequently developed cancer. 182 of the 2412 patients without thrombosis developed cancer. During the first six months after venography 66 patients with thrombosis developed malignancy compared with 37 patients without thrombosis (P < 0.0001). 38 of the cancers in the deep venous thrombosis group were detected by history, physical examination, and laboratory tests. Three patients had postoperative or post-traumatic deep venous thromboses. Only two of the remaining patients would have benefited from early detection by extensive screening. After six months the incidence of cancer was identical in patients with and without thrombosis. CONCLUSION--Deep venous thrombosis is associated with a significantly higher frequency of malignancy during the first six months after diagnosis. Malignancies can be found with simple clinical and diagnostic methods and extensive screening is not required.     

Immunocytochemical methods in the study of lymphoma and related conditions.

The diagnosis and classification of malignant lymphomas is based upon traditional histological criteria evolved over the years by successive generations of pathologists. Immunoperoxidase methods applied to formalin paraffin sections have permitted a direct correlation of these established morphologic criteria with newer immunological concepts of the form and function of the B lymphocyte and its derivatives. Study of material from 500 cases of Hodgkin's disease, non-Hodgkin lymphomas, and myeloma has revealed that many of these conditions may find a common origin in the lymphocyte, and that some malignant cells, previously identified as malignant histiocytes or reticulum cells are rather related to or derived from the transformed lymphocyte or immunoblast. The corresponding tumors are thus more logically designated immunoblastic sarcoma. The study also reveals a claser developmental relationship between multiple myeloma and immunoblastic sarcoma than previously suspected, and suggests that all of the B cell lymphomas occur as part of a continuous spectrum of disease, rather than as separate entities as implied by current histological classifications. The study of immunoglobulin in formalin paraffin sections is illustrative of the great potential of this method in the diagnosis and study of neoplasia in general.     

Occupational epidemiological study of workers in an acrylonitrile using factory with particular attention to cancers and birth defects

An occupational epidemiological study was organised among workers in an acrylonitrile using factory in Hungary. Of the 888 workers, 783 were included in the study and three groups were differentiated: Group A (N = 452) with direct and continuous exposure, Group B (N = 171) with direct but occasional exposure and Group C (N = 160) without direct exposure, as referent. There were two main objectives: to determine the occurrence of cancer in workers and congenital abnormalities in their liveborn infants. The study did not indicate a higher occurrence of cancer among workers: only one lung cancer patient was found, prostate cancer did not occur. Among congenital abnormalities, the group of specified multiple congenital abnormalities showed a higher rate than expected but characteristic defect-pattern was not found among seven multimalformed babies, though five had cardiovascular malformations. In conclusion, our study did not indicate the carcinogenic, mutagenic and teratogenic effect of acrylonitrile among workers using this chemical in the factory.     

Teesside coronary survey: an epidemiological study of acute attacks of myocardial infarction.

A 12-month epidemiological survey of attacks of acute myocardial infarction was carried out in a large urban population. The incidence and mortality at all ages and in both sexes were examined. Altogether, 1938 attacks were diagnosed--an overall incidence of 4-89 per 1000 population. The 28-day fatality rate was 50-5%. A third of the patients were treated at home and these patients had a lower fatality rate than those in hospital, a difference that could not be attributed to age, sex, or severity of attack. Half of the deaths that were witnessed occurred suddenly and a further 21% occurred within the next two hours. The median time to patients coming under care was about three hours. As used at present, coronary care units are unlikely to improve fatality rates. Future advances in treatment must take place outside hospital and will require re-education of the public and the general practitioner.     

Birth defects after maternal exposure to corticosteroids: prospective cohort study and meta-analysis of epidemiological studies

BACKGROUND: Corticosteroids are first-line drugs for the treatment of a variety of conditions in women of childbearing age. Information regarding human pregnancy outcome with corticosteroids is limited. METHODS: We collected prospectively and followed up 184 women exposed to prednisone in pregnancy and 188 pregnant women who were counseled by Motherisk for nonteratogenic exposure. The primary outcome was the rate of major birth defects. A meta-analysis of all epidemiological studies was conducted. The Mantel-Haenszel summary odds ratio was calculated for the pooled studies with 95% confidence intervals. A cumulative summary odds ratio was also calculated by combining studies in chronological order. Chi-squared for homogeneity was determined to establish the comparability of the studies. RESULTS: In our prospective study, there was no statistical difference in the rate of major anomalies between the corticosteroid-exposed and control groups. In the meta-analysis, the Mantel-Haenszel summary odds ratio for major malformations with all cohort studies was 1.45 [95% CI 0.80, 2.60] and 3.03 [95% CI 1.08, 8. 54] when Heinonen et al. ('77) was removed. This suggests a marginally increased risk of major malformations after first-trimester exposure to corticosteroids. In addition, summary odds ratio for case-control studies examining oral clefts was significant (3.35 [95% CI 1.97, 5.69]). CONCLUSIONS: Although prednisone does not represent a major teratogenic risk in humans at therapeutic doses, it does increase by an order of 3.4-fold the risk of oral cleft, which is consistent with the existing animal studies.     

Thyroid and other autoantibodies in British and Japanese women: an epidemiological study of breast cancer.

To define the role of asymptomatic autoimmune thyroiditis in the cause of breast cancer, the presence of circulating thyroid autoantibodies was studied in two populations, one with a high risk of breast cancer (British women) and one with a low risk (Japanese women). Ostensibly healthy women and patients with breast cancer from both countries were studied. There was no difference in the incidence of thyroid autoantibodies between women with breast cancer and healthy women in either race. The incidence of thyroid autoantibodies in healthy British women, however, was two to three times that in healthy Japanese women. The incidence of reticulin antibodies, was considerably higher in both groups of Japanese women. No remarkable differences in the incidence of antinuclear, smooth-muscle, antimitochondrial, gastric parietal cell, or liver-kidney microsomal antibodies were found between women with breast cancer and healthy women or between the two races. Only the incidence of antinuclear antibodies was marginally higher in Japanese patients with advanced cancer. These results indicate that asymptomatic autoimmune thyroid disease is more prevalent among British than among Japanese women, but they fail to provide direct evidence that autoimmune thyroid disease is associated with breast cancer. Prospective studies of women with autoimmune thyroiditis and studies of young women from low-risk and high-risk populations are needed.     

Periodontal disease and coronary heart disease: an epidemiological and microbiological study

AIMS: This is an investigation on the association between periodontal disease and an increased risk of coronary heart disease; the main hypothesis is that periodontal infections may increase the systemic inflammatory burden of the host above a threshold that may favour the atherogenic processes. MATERIALS AND METHODS: Case-control study with 27 cases, cardiologically affected, and 15 healthy controls. Patients underwent a complete periodontal probing. Periodontal conditions were compared between cases and controls to assess the mentioned association and to search for periodontal conditions related to the increased coronary risk. The presence and prevalence of periodontal pathogens was assessed in crevicular fluid samples. RESULTS: The overall periodontal conditions resulted worse in the test group. In particular periodontal conditions such as the presence of deep pockets (probing depth >6 mm) and the loss of more than 12 teeth might represent indicators of a strongly increased risk of cardiological disease and microbiological investigations confirmed these findings; Prevotella gingivalis was the most common bacteria. CONCLUSION: This study supports the existence of an epidemiologic association between periodontal disease and coronary heart disease and confirms previous data present in the literature. Two periodontal parameters, deep pockets and number of missing teeth, seem to be important risk factors for cardiovascular diseases.     

A comparative study of body wall structures of a pogonophore and an annelid from a phylogenetic viewpoint

Pogonophores are tube worms that live in reducing deep-sea waters where sunlight does not penetrate. They are highly adapted for their special habitat in lacking guts and possessing endosymbiotic chemosynthetic bacteria. Because of these peculiar characteristics, it is not yet clear whether they should be classified as annelids or not. Electron-microscopic observations of sections of a Japanese pogonophore (Oligobrachia mashikoi) show that the body wall has circular and longitudinal muscular systems. These muscular systems, however, differ from the annelid (Branchiura sowerbyi) in these ways: (1) The outer circular muscle of the pogonophore was constructed of smooth muscle cells. In contrast, that of the annelid was composed of obliquely-striated muscle cells, even though the cells were small and bore undeveloped characteristics. (2) The inner longitudinal muscle of the pogonophore was constructed of undeveloped obliquely-striated muscle cells, whereas that of the annelid was composed of well-developed ones. These observations suggest that this pogonophore can not be classified as an annelid, although many previous studies have placed pogonophores in that phylum.     

Consciousness and body image: lessons from phantom limbs,Capgras syndrome and pain asymbolia.

Words such as ''consciousness'' and ''self'' actually encompass a number of distinct phenomena that are loosely lumped together. The study of neurological syndromes allows us to explore the neural mechanisms that might underlie different aspects of self, such as body image and emotional responses to sensory stimuli, and perhaps even laughter and humour. Mapping the ''functional logic'' of the many different attributes of human nature on to specific neural circuits in the brain offers the best hope of understanding how the activity of neurons gives rise to conscious experience. We consider three neurological syndromes (phantom limbs, Capgras delusion and pain asymbolia) to illustrate this idea.     

Cryptorchism and related defects in dogs: epidemiologic comparisons with man.

In a study of 1266 dogs with cryptorchism from a large clinic/hospital series 8 breeds were found to be at excess risk of the defect and 3 breeds at significantly low risk. Review of the medical histories revealed that hip dysplasia, patellar dislocation, defects of the penis and prepuce, and umbilical hernia were excessively associated with cryptorchism. Testicular tumors were diagnosed 10.9 times more commonly among cryptorchid dogs. The epidemiologic features of canine cryptorchism were compared with those in man. Cryptorchid dogs could be used as models for etiologic research.     

Pregnancy and the syndrome of herniated lumbar intervertebral disc; an epidemiological study.

In a study of the epidemiology of acute herniated lumbar intervertebral discs in the New Haven, Connecticut, area, it was found that the female cases had had more pregnancies resulting in live births than women of similar age without known herniated discs. However, cases had not had more pregnancies resulting in miscarriages than other women of their age. Among women who underwent surgery for their herniated discs, the association between number of live births and herniated discs was found for women with herniations at the L5 level but not for women with herniations at the L3 level.     

Clinical anophthalmia: an epidemiological study in northeast Italy based on 368,256 consecutive births.

We describe an epidemiological and clinical study of Clinical Anophthalmia in a population of consecutive live and stillborns enrolled in a hospital based registry of congenital malformations in Northeast Italy during the period from 1981 to 1989; 22 cases were detected among 368,256 births yielding a birth prevalence of 0.60 per 10,000 (95% CI 0.34-0.84); 20 cases were associated with at least one other major malformation. Malformation syndrome, association, or sequence was diagnosed in 13, while a non-recognizable multiple defect pattern was observed in 7/20 (35%). A chromosomal anomaly was present in eight syndromic cases. No significant trend over time, nor space or time clusters, were detected. As most CAn cases are associated with other anomalies recognizable by ultrasound, a decreasing trend in its prevalence at birth is expected in the future.