In a 2-yr prospective follow-up study of patients presenting clinically with possible reactive arthritis (ReA), 17 (9%) of the patients turned out to have acute sarcoid arthritis (SA). The number of new cases of SA per year was 2.9/100,000 persons in the city of Oslo between 18 and 60 yr of age. The onset of SA clustered in the spring. All the SA patients presented with bilateral ankle joint involvement and bilateral hilar lymphadenopathy, and ten (59%) presented with the triad of erythema nodosum, arthritis and lung involvement. A prospective follow-up after 104 weeks showed complete remission of arthritis in all 17 cases of SA. The total duration of arthritis [median (range)] was 11 (2-107) weeks. Erythema nodosum was mild and transient in all cases. At week 104, the lung and hilar manifestations had resolved. We conclude that the outcome of SA appeared favourable. Bilateral ankle joint involvement, erythema nodosum and bilateral hilar lymphadenopathy found at the routine chest X-ray examination are important clues for the diagnosis of SA.
Time series of daily administrative cardio-respiratory health and environmental information have been extensively used to assess the potential public health impact of ambient air pollution. Both series are subject to strong but unrelated temporal cycles. These cycles must be removed from the time series prior to examining the role air pollution plays in exacerbating cardio-respiratory disease. In this paper, we examine a number of methods of temporal filtering that have been proposed to eliminate such temporal effects. The techniques are illustrated by linking the number of daily admissions to hospital for respiratory diseases in Toronto, Canada for the 11 year period 1981 to 1991 with daily concentrations of ambient ozone. The ozone-hospitalization relationship was found to be highly sensitive to the length of temporal cycle removed from the admission time series, and to day of the week effects, ranging from a relative risk of 0.874 if long wave cycles were not removed at all to 1.020 for models which removed at least cycles greater than or equal to one month based on the interquartile pollutant range. The specific statistical method of adjustment was not a critical factor. The association was not as sensitive to removal of cycles less than one month, except that negative autocorrelation increased for series in which cycles of one week or less were removed. We recommend three criteria in selecting the degree of smoothing in the outcome: removal of temporal cycles, minimizing autocorrelation and optimizing goodness of fit. The association between ambient ozone levels and hospital admissions for respiratory diseases was also sensitive to the season of examination, with weaker associations observed outside the summer months.
Aluminum potroom exposure is associated with increased mortality of COPD but the association between potroom exposure and annual decline in lung function is unknown. We have measured lung volumes annually using spirometry from 1986 to 1996. The objective was to compare annual decline in forced expiratory volume in 1?s (dFEV1) and forced vital capacity (dFVC).
The number of aluminum potroom workers was 4,546 (81% males) and the number of workers in the reference group was 651 (76% males). The number of spirometries in the index group and the references were 24,060 and 2,243, respectively.
After adjustment for confounders, the difference in dFEV1 and dFVC between the index and reference groups were 13.5 (P?
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A less traumatic and safe way was sought for the superlobular bronchus and artery occlusion that permits the hemostatic effect to be quickly achieved, the risk and duration of the operation to be minimized. The approach consists in the use of transsternal approach instead of a conventional intercostal approach in 5 patients with superlobular fibrotic cavernous pulmonary tuberculosis, its positive effects being lessening of traumatic harm, improving of safety of operation, together with reduction of intraoperative time.
OBJECTIVE: To compare complication rates after rectal resection using a conventional surgical technique (1983-1992) and mesorectal excision (1993-2000), and to find out whether the rate of complications changed with time after the introduction of mesorectal excision. DESIGN: Prospective, observational study. SETTING: University hospital, Norway. PATIENTS: All patients who had rectal resections for cancer in the period 1983-2000. INTERVENTIONS: In the conventional surgery period 217, and in the mesorectal excision period 176, patients had rectal resections. The mesorectal excision period was split in two, the early and the late mesorectal excision period, 88 rectal resections being performed in each period. Total mesorectal excision was done in 118 patients, and partial mesorectal excision in 58. MAIN OUTCOME MEASURES: Major surgical complications in both periods; intraoperative bleeding, transfusions during the hospital stay, and cardiovascular complications in the mesorectal excision period. RESULTS: 23/217 (11%) developed major surgical complications in the conventional surgery period, compared with 17/88 (19%) in the early mesorectal excision period (p = 0.04). This was caused by an increased incidence of anastomotic leaks after low anterior resection, being 11/122 (9%) in the conventional surgery period and 12/52 (23%) in the early mesorectal excision period (p = 0.01). The incidence of anastomotic leaks declined to 5/61 (8%) in the late mesorectal excision period (p = 0.03). Multiple regression analysis identified a low anastomosis, major bleeding, and age over 75 years as significant risk factors for the development of anastomotic leaks. Major intraoperative bleeding occurred in 36/84 (43%) of the patients in the early and 22/82 (27%) in the late mesorectal period (p = 0.04). Blood transfusions were given to 61/84 (74%) in the early mesorectal period and 41/82 (50%) in the late period (p
Bone mass density, fracture history, self-reported osteoporosis as proxy variables for estrogen and the risk of non-small-cell lung cancer--a population based cohort study, the HUNT study: are proxy variables friends or faults?
Lung cancer has the highest mortality of all cancers. Patients with early stage disease have the best cure rates and that emphasizes the importance of early detection. About half of all non-small cell lung cancers (NSCLC) are estrogen receptor positive. The impact of estrogen and its receptors for NSCLC carcinogenesis has been studied but is still unclear. Low estrogen levels are associated with osteoporosis. We hypothesize that low bone mineral density (BMD), a positive history of fracture or self-reported osteoporosis, used as a proxy variable for life time estrogen exposure, are associated with a low incidence of NSCLC. We analyzed data from a cohort study, the Nord-Trøndelag Health Study 2 (1995-1997) linked to the Norwegian Cancer Registry. Using the logistic regression model we calculated the odds ratio (OR) with a 95% confidence interval (CI) for the risk of NSCLC for the three proxy variables, stratified by sex. Participants older than 50 years of age, having measured bone density (N = 18,156), having answered the questions on self-reported fracture (N = 37,883) and osteoporosis (N = 25,701) and known body mass index (BMI) (N = 29,291), were evaluated for inclusion. In 6996 participants all these information was available in addition to tobacco use, and in women also hormonal replacement therapy (HRT). Lung function (FEV1 percent of predicted) was included in a sensitivity analysis. We identified 132 (1.9%) cases of NSCLC, 59 (1.2%) and 73 (3.3%) cases in women and men, respectively. Low BMD was associated with a higher risk of NSCLC, OR: 2.38, 95% CI: 1.09-5.18 and OR: 2.67, 95% CI: 1.39-5.16 in women and men, respectively. No association was found between the two other proxy variables and the risk of NSCLC. Inclusion of lung function in the model did not change the results. Contrary to our hypothesis, women and men with low BMD had a higher risk for NSCLC. In addition the study demonstrates that the risk depends on which proxy variable was chosen, and we may ask: are proxy variables reliable?
BACKGROUND: The function of CD8+ T-cell subsets in mediating late allergic responses is incompletely understood. OBJECTIVE: We sought to test the hypothesis that CD8+ alphabeta T cells are proinflammatory in the airways in vivo by using a well-characterized animal model and the technique of adoptive transfer. METHODS: Brown Norway rats were administered CD8 + alphabeta T cells (10 6 ) intraperitoneally purified from lymph node cells of either naive or ovalbumin (OVA)-sensitized rats and were challenged with aerosolized OVA 2 days later. Control rats were sensitized to 100 mug of OVA in Al(OH) 3 subcutaneously or sham sensitized to saline and were OVA challenged 2 weeks later. RESULTS: The OVA-sensitized and OVA-challenged group and the recipients of OVA-primed CD8+ alphabeta T cells had significant late airway responses calculated from lung resistance measured for an 8-hour period after challenge compared with the naive CD8 + alphabeta T cell-transferred group and the sham-sensitized control group. The number of eosinophils in bronchoalveolar lavage fluid increased in the OVA-sensitized group and the OVA-primed CD8+ alphabeta T-cell recipients compared with numbers in the naive CD8+ alphabeta T-cell recipients and the sham-sensitized control group. IL-4 and IL-5 cytokine mRNA expression in bronchoalveolar lavage fluid increased in the OVA-sensitized group and the OVA-primed CD8+ alphabeta T-cell recipients compared with that in the sham-sensitized group. CONCLUSION: We conclude that antigen-primed CD8 + alphabeta T cells might have a proinflammatory role in allergen-driven airway responses in the rat.
The objective of the present study is to determine the feasibility of chest computed tomography (CT) in screening for lung cancer among asbestos-exposed workers. In total, 633 workers were included in the present study and were examined with chest radiography and high-resolution CT (HRCT). A total of 180 current and ex-smokers (cessation within the previous 10 yrs) were also screened with spiral CT. Noncalcified lung nodules were considered positive findings. The incidental CT findings not related to asbestos exposure were registered and further examined when needed. Noncalcified lung nodules were detected in 86 workers. Five histologically confirmed lung cancers were found. Only one of the five cancers was also detected by plain chest radiography and three were from the group of patients with a pre-estimated lower cancer probability. Two lung cancers were stage Ia and were radically operated. In total, 277 individuals presented 343 incidental findings of which 46 required further examination. Four of these were regarded as clinically important. In conclusion, computed tomography and high-resolution computed tomography proved to be superior to plain radiography in detecting lung cancer in asbestos-exposed workers with many confounding chest findings. The numerous incidental findings are a major concern for future screenings, which should be considered for asbestos-exposed ex-smokers and current smokers.
Comment In: Eur Respir J. 2007 Jan;29(1):6-717197479