The management of lymphangioma in children is challenging because complete resection is difficult to achieve in some cases, and recurrences are common. The authors reviewed their experience to assess the risk factors for recurrence and the role of nonoperative treatment.
A retrospective study over a period of 25 years was carried out. One hundred eighty-six patients with 191 lesions (five patients with de novo lesions in different sites) were treated. There were 98 boys and 88 girls. The average age at diagnosis was 3.3 years (range, fetal life to 17 years) and the average size 8 cm in diameter. Histocytological confirmation was obtained in all patients. The involved sites were head and neck, 89 patients (48%); trunk and extremities, 78 patients (42%); internal or visceral locations (eg, abdominal and thorax), 19 patients (10%). The treatment consisted of macroscopically complete excision in 145 patients (150 lesions, of which five were recurrences in different sites), partial excision in 10 patients, aspiration in five patients, laser excision in 10 patients, biopsy only in four patients, drainage and biopsy in two patients, and injection of sclerosing agents in 10 patients.
There were 54 recurrences; 44 underwent excision (five of them more than once), and five regressed spontaneously on follow-up. Five other recurrences were stable and not progressing. Recurrences, (defined as clinically obvious disease), were found to be 100% after aspiration, 100% after injection, 40% after incomplete excision, 40% after laser excision, and 17% after macroscopically complete excision. The recurrence rate in the last group was the highest in the head (33%), the least in the internal locations (0%), and intermediate for the cervical location (13%). There were no significant differences, in terms of outcome, between those who had their surgery immediately at the time of diagnosis (n = 101) and those who had delayed surgery (n = 85).
There were fewer recurrences after macroscopically complete excision. Aspiration and injection had the highest recurrence rate. Risk factors for recurrence included location, size, and complexity of lesions. A period of observation may be useful for infants to facilitate complete excision. In the present series, spontaneous regression was infrequent and was seen more often with recurrent lesions.
Guidelines recommend treatment of latent tuberculosis in patients at increased risk for active tuberculosis. Studies investigating the association of therapy with serious adverse events have not included the entire treated population nor accounted for comorbidities or occurrence of similar events in the untreated general population. Our objective was to estimate the risk of adverse events requiring hospital admission that were associated with therapy for latent tuberculosis infection in the general population.
Using administrative health data from the province of Quebec, we created a historical cohort of all residents dispensed therapy for latent tuberculosis between 1998 and 2003. Each patient was matched on age, sex and postal region with two untreated residents. The observation period was 18 months (from 6 months before to 12 months after initiation of therapy). The primary outcome was hospital admission for therapy-associated adverse events.
During the period of observation, therapy for latent tuberculosis was dispensed to 9145 residents, of whom 95% started isoniazid and 5% started rifampin. Pretreatment comorbid illness was significantly more common among patients receiving such therapy compared with the matched untreated cohort. Of all patients dispensed therapy, 45 (0.5%) were admitted to hospital for a hepatic event compared with 15 (0.1%) of the untreated patients. For people over age 65 years, the odds of hospital admission for a hepatic event among patients treated for latent tuberculosis infection was significantly greater than among matched untreated people after adjustment for comorbidities (odds ratio [OR] 6.4, 95% CI 2.2-18.3). Excluding patients with comorbid illness, there were two excess admissions to hospital for hepatic events per 100 patients initiating therapy compared with the rate among untreated people over 65 years (95% CI 0.1-3.87).
The risk of adverse events requiring hospital admission increased significantly among patients over 65 years receiving treatment for latent tuberculosis infection. The decision to treat latent tuberculosis infection in elderly patients should be made after careful consideration of risks and benefits.
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Plasma C-reactive protein (CRP) levels recently have been identified as an emerging risk factor for ischemic heart disease (IHD). However, whether plasma CRP levels predict an increased risk for future IHD beyond traditional risk factors has yet to be evaluated in a large prospective, population-based study.
The association between elevated plasma CRP levels and the risk for future IHD was investigated in the prospective, population-based cohort of 2037 IHD-free middle-aged men from the Quebec Cardiovascular Study. During a 5-year follow-up, 105 first IHD events were recorded. Baseline plasma CRP levels were measured using a highly sensitive assay.
High plasma CRP concentrations (equal to or above vs below the median level of 1.77 mg/L) were associated with a significant 1.8-fold increase in IHD risk (95% confidence interval [CI], 1.2-2.7). This association remained significant after adjustment for lipid risk factors but not when the simultaneous contribution of nonlipid traditional risk factors was taken into account. Multivariate analyses indicated that CRP level predicted short-term risk for IHD (events that occurred 2 years). Moreover, high plasma CRP levels predicted an increased risk for IHD, independent of any other confounder, in younger (55 years) individuals.
Plasma CRP levels may provide independent information on IHD risk only in younger middle-aged men and in the case of IHD events that may occur relatively soon after the baseline evaluation.
Recent guidelines have acknowledged that thrombolysis decreases mortality from acute myocardial infarction (AMI) independently of age. The purpose of this study was to determine the age-related rates of thrombolytic administration and in-hospital mortality and the variables related to the use of thrombolytic therapy for patients with AMI.
A prospective cohort analysis involved a registry of 44 acute care Quebec hospitals that enrolled 3741 patients with AMI between January 1995 and May 1996. The main outcomes of interest were crude and adjusted age-related in-hospital mortality rates and rates of use of thrombolytic therapy.
In-hospital mortality rates increased dramatically with age from 2.1% in patients with AMI who were less than 55 years of age to 26.3% in those who were 85 years of age or older. Overall, 35.8% of the patients received thrombolysis. There was a pronounced inverse gradient in the use of thrombolysis with age, ranging from 46.2% in the youngest age group ( or = 85 years). After adjustment for potential confounders, the older patients remained significantly less likely to receive thrombolytic therapy. Compared with patients who were less than 55 years of age, the odds ratio of receiving thrombolytic therapy was 0.68 (95% confidence interval [CI] 0.52-0.89) for patients aged 65-74 years, 0.48 (95% CI 0.35-0.65) for patients aged 75-84 years and 0.13 (95% CI 0.06-0.26) for patients aged 85 years or more. Other variables related to thrombolytic therapy were diabetes (odds ratio [OR] 0.77, 95% CI 0.59-1.00), cerebrovascular disease (OR 0.46, 95% CI 0.30-0.72), angina (OR 0.73, 95% CI 0.56-0.95), typical chest pain (OR 2.56, 95% CI 1.88-3.47); ST elevation (OR 8.93, 95% CI 7.24-11.00), Q wave MI (OR 5.26, 95% CI 4.20-6.60) and increased length of time between onset of symptoms and arrival at hospital.
Age is an important independent predictor of in-hospital mortality and lower thrombolytic use following AMI. Other studies are required to further evaluate the appropriateness of thrombolytic therapy for elderly patients.
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We examined the associations between emergency department (ED) visits for ischemic heart disease (IHD) and short-term elevations in ambient air pollutants (CO and NO(2)).
A hierarchical clusters design was used to study ED visits (n = 4979) for ischemic heart disease (ICD-9: 410-414) that occurred at a Montreal hospital between 1997 and 2002. The generalized linear mixed models technique was applied to create Poisson models for the clustered counts of ED visits for IHD. The analysis was done by gender for two age categories, all patients and patients aged over 64 years.
The results are presented as an excess risk increase associated with the interquartile range (IQR) of daily average of the pollutant concentration. The results for NO(2) (IQR = 9.5 ppb) were 5.9% (95% CI: 2.1-9.9) for all patients and 6.2% (95% CI: 1.2-11.4) for males; for patients aged over 64: 7.1% (95% CI: 2.5-11.9) for all patients, 9.1% (95% CI: 2.8-15.7) for males, and 6.5% (95% CI: 0.7-12.7) for females (for exposure lagged by 1-day). The results for CO (IQR = 0.2 ppm): 5.4% (95% CI: 2.3-8.5) for all patients, and 7.5% (95% CI: 3.6-11.6) for males. For patients aged over 64 years, 4.9% (95% CI: 1.3-8.7) for all patients, and 7.5% (95% CI: 2.6-12.6) for males. The results show the associations for the same day exposures.
The short-term effects of nitrogen dioxide and carbon monoxide are associated significantly with daily ED visits for ischemic heart disease. For NO(2) the associations are stronger for patients aged over 64 years. As indicated by our results, it is likely that vehicular traffic, a producer of NO(2) and CO, contributes to an increased number of ED visits for IHD.
Aboriginal populations worldwide face increasing rates of suicide. Despite this recurring observation, little research has emerged from Aboriginal settings.
This paper describes the psychosocial and behavioral characteristics of 30 consecutive adult suicides from four First-Nations communities in Quebec, Canada.
Psychological autopsies guided by the LEDS with family members of the deceased.
Suicide among this group is overrepresented by young single men. Alcohol intoxication at the time of death was reported for 22 cases in association with rapid acting out after the precipitating event for 20. All but two cases had a history of alcohol abuse, and drug use was also present in 23 cases. In 16 cases there had been a previous suicide attempt, 14 of which occurred during the previous year. The main socio-demographic characteristics of the communities were overcrowded living arrangements and no job status (90%). Seven cases were incarcerated or locked up at the time of death. Clustering of suicide was observed within seven nuclear families including 16 suicides.
This study shows that Aboriginal suicide is the result of a complex interweaving of individual, familial, and socio-historical variables. The impact of contemporary social stressors on individual well-being must be addressed to prevent suicide in this community.
Apolipoprotein E phenotypes and plasma lipid and lipoprotein levels were determined in 435 individuals (233 men, 202 women) of French Canadian descent living in northeastern Quebec. This region is known for its high frequency of mutant genes responsible for rare genetic disorders. Total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, and triglyceride levels were adjusted for age, height, weight, body mass index (BMI), and waist circumference using regressions performed separately in men and in premenopausal and postmenopausal women. The APOE allele frequencies in this population-based sample were 0.137, 0.749, and 0.114 for the *2, *3, and *4 alleles, respectively. APOE2 (APOE 2,2 and APOE 3,2) subjects had lower total and LDL cholesterol levels than APOE3 (APOE 3,3) subjects. In APOE4 (APOE 4,3 and APOE 4,4) men and postmenopausal women levels of total and LDL cholesterol and triglycerides were significantly higher than in the corresponding APOE3 subjects. The *2 allele was also found to be associated with higher triglyceride levels in men and postmenopausal women. Men of the APOE4 group also presented lower HDL cholesterol levels. Although the impact of APOE polymorphism on blood lipid and lipoprotein levels in this French Canadian population is similar to what has been reported in other white populations, the frequency of the *2 allele is among the highest ever reported. This finding is discussed in terms of the founder effect characterizing the Quebec population.
To examine whether male drivers aged 45 to 70 years suffering from cardiovascular disease (CVD) are more likely to be involved in motor vehicle crashes (MVC) that are reported to the police.
Population-based case-control study.
Data on drivers' ages and medical conditions were compiled from the Societé de l'assurance automobile du Québec's (SAAQ) computerized files. A questionnaire was mailed to all subjects to collect additional information on annual distances driven and various driving behaviours.
Age-stratified population-based random sample. Subjects were 2504 drivers involved in MVCs during a 6-month period; controls were 2520 drivers not involved in crashes.
Proportion of drivers with CVD involved in MVCs.
Response rate to the questionnaire was 35.5%. Analysis of the SAAQ files' entire sample of 5024 drivers showed that drivers suffering from CVD were less likely to be involved in MVCs (odds ratio [OR] 0.82, 95% confidence interval [CI] 0.67 to 0.99) than drivers without CVD. Although the estimate of risk remains unchanged when adjusted for age, it becomes statistically insignificant. It also remains unchanged and statistically insignificant when adjusted for yearly distance driven and driver behaviour, as shown by responses to the questionnaire. Drivers suffering from CVD drove significantly less each year (8900 km) than drivers without medical conditions (13,000 km).
This study shows no increased risk of motor vehicle crashes for drivers suffering from CVD.
To determine the age and sex variations in the associations between obesity and depression.
This analysis was based on data from 59,652 adults >or=18 years of age in the provinces of Nova Scotia, Quebec, Saskatchewan, Alberta, and British Columbia, who participated in the Canadian Community Health Survey conducted in 2005. The survey included a set of 27 questions about symptoms of depression, which were taken from the Composite International Diagnostic Interview. Based on these questions, depression scores were calculated and used to define depression, which corresponds to a 90% likelihood of a positive diagnosis of major depressive episode. Body weight and height were based on self-report.
The prevalence of depression was 5.3% in adults living in the five provinces and was higher in women than in men. People with abnormal body weight tended to have an increased risk of depression. On average, obesity and being underweight were associated with approximately 30% and 40% increases in depression, respectively. Particularly in women, depression was more markedly associated with obesity in the 18-39 year age group (OR 1.67, 95% CI 1.29-2.15) and with being underweight in the 40-59 year age group (OR 2.23, 95% CI 1.45-3.42) than other age groups.
Obesity is associated with an increased risk of depression in younger women.