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Preliminary results of skin cancer screening in West Virginia.

Although skin cancer screening is theoretically of value, its effectiveness has not been firmly established because few studies have systematically followed persons with a positive screen to obtain pathologically confirmed diagnoses. From the 799 persons screened at Charleston Area Medical Center in 1988 and 1989, 153 screenees with suspected skin cancer, dysplastic nevi, and congenital nevi were followed to determine their final diagnosis. Follow-up was done by letter and telephone calls to both the individuals who screened positive and their treating physicians. Eighty-four (54 percent) then sought medical attention as a result of letters and calls. Thirty-one basal cell carcinomas, three squamous cell carcinomas, three dysplastic nevi, two melanomas, and one congenital nevus were pathologically confirmed. The predictive value positive of the screenings was 32 percent to 60 percent for non-melanoma skin cancer, 9 percent to 25 percent for dysplastic nevi, and 15 percent for melanoma. This study suggests that post-screening follow-up of those with suspected premalignant and malignant skin lesions is feasible and should be encouraged so that more definitive evaluation and treatment can potentially be performed and skin cancer screenings more accurately assessed.

Adolescent↗

[Results of an in-depth examination of men 20 to 59 with possible ischemic heart disease detected during mass epidemiological screening].

ECG assessment after the Minnesota code with defining "definite" CHD and "expected" CHD was used as one of the criteria of establishing diagnosis in mass screening of the population to find out CHD prevalence. A profound clinico-instrumental study of 100 men aged 20 to 59 with "expected" CHD showed that in 16% ECG-changes reflected true CHD, in 42% they were determined by noncoronarogenic causes. In 42% of the cases cardiovascular pathology was undetectable among the persons with "expected" CHD. Significant incidence of the noncoronarogenic pathology in the population is of interest to research.

Adult↗

[Evaluation of the colonic endoscopic polypectomy in patients of the National Carlos Alberto Seguín Escobedo Hospital ESSALUD of Arequipa (1999-2004)].

The investigation was performed in the Carlos Alberto Seguín Escobedo National Hospital of Essalud-Arequipa, in 194 patients that were submitted to Colonic Endoscopic Polypectomy from January of 1999 to December of 2004. This study is observational, retrospective and transverse. The clinical histories, endoscopies reports and pathological anatomy reports were reviewed, taking the personal data, clinical symptoms, endoscopic and pathologic characteristics of the polyps; colonoscopies associate findings; surgical technique of polypectomies, complications and complementary treatment of post-polypectomy. The colonic endoscopic polypectomy was performed in 194 patients from 1380 colonoscopies (14.05 %), with more frequency in the sixth decade of life, and corresponding most to the masculine sex. Most of the patients did not have previous symptoms, and of those who had clinical manifestations the more frequent were the bleeding lost and changes in the intestinal rhythm. The polyps endoscopic characteristics found that the sessile were the more frequent and were located in rectum--sigmoid zone. The preponderant size was from 5 to 10mm, and mostly unique. The histopathology type of the polyps was adenoma, frequently with some grade of dysplasia. The surgical techniques for the colonic endoscopy polypectomy were with cold pincer and electric cut. The complications were rare. The complementary treatment after polypectomy was injectotherapy and surgery. Finally, our results were discussed and compared with other similar studies, and then we elaborated the conclusions and recommendations, with whom we expect to contribute to a better knowledge of the Colonic Endoscopy Polypectomy in our country.

Adolescent↗

Lies and liars: psychiatric aspects of prevarication.

The authors discuss the phenomenon of lying, a common psychic process that has received remarkably little scrutiny. The ubiquity of lying and others forms of deception suggests that they have "normal" aspects, but lying which is persistent or destructive to the quality of a person's life becomes pathological. Lying has many determinants, including developmental, biological, social, and psychodynamic. Antisocial, histrionic, narcissistic, borderline, and compulsive personalities have been associated with lying. The treatment of lying needs to be individualized according to the overall symptom complex in which it is embedded.

Adolescent↗

Replicating helminth parasites of man.

Most helminth parasites of man are unable to replicate within the human host. Thus, the worm burden of an infected person (on which the pathology largely depends - see Box 1) is a function of the number of infective forms to which the person is exposed. But for some species of helminths, the ability to replicate in man has a marked effect on the course and duration of infection, and for the pathogenesis of disease. In this review, David Grove discusses the mechanisms by which such replication may occur, and considers how this ability affects our approach to therapy and control.

Journal Article↗

Descriptive epidemiology of acute liver enzyme abnormalities in the general population of central Massachusetts.

OBJECTIVES: This study quantifies the incidence of liver enzyme abnormalities in the general population of central Massachusetts. METHODS: Computerized data files from a health maintenance organization were used to ascertain potential subjects during the study period of 1 July 1992-30 June 1993. Medical records and laboratory tests results were reviewed to confirm the diagnoses. RESULTS: The incidence rates were 40.6 cases per 100,000 persons per year for drug-associated liver enzyme abnormalities, 39.0 per 100,000 persons per year for liver enzyme abnormalities secondary to biliary pathologies, 25.2 per 100,000 persons per year for liver enzyme abnormalities secondary to mononucleosis, 25.2 per 100,000 persons per year for liver enzyme abnormalities of unknown aetiology, 15.4 per 100,000 persons per year for alcoholic liver enzyme abnormalities, 12.2 per 100,000 persons per year for liver malignancy, and 7.3 per 100,000 persons per year for viral hepatitis (HAV, HBV and HCV). Men were more commonly affected by alcoholic liver enzyme abnormalities and viral hepatitis, with respective incidence rates approximately 5 and 2 times higher than women. Liver enzyme abnormalities secondary to mononucleosis occurred predominantly between the ages of 15-24 years. In contrast, liver diseases secondary to biliary pathologies, liver malignancies and drug-associated liver enzyme abnormalities were found most frequently among the elderly. CONCLUSION: Liver enzyme abnormalities occurred with a higher incidence in this general population than reported previously in selected patients. Drug-associated liver enzyme abnormality was the most common type. The magnitude of drug-associated liver enzyme abnormality could be much higher as an appreciable proportion of the liver cases of unknown aetiology are potentially drug-attributable.

Journal Article↗

Medical symptoms without identified pathology: relationship to psychiatric disorders, childhood and adult trauma, and personality traits.

Community studies have shown that stressful life events, psychological distress, and depressive and anxiety disorders are associated with 1) a range of medical symptoms without identified pathology, 2) increased health care utilization, and 3) increased costs. In both primary care and medical specialty samples, patients who have syndromes with ill-defined pathologic mechanisms (such as the irritable bowel syndrome and fibromyalgia) have been shown to have significantly higher rates of anxiety and depressive disorders than do patients with comparable, well-defined medical diseases and similar symptoms. Other studies show that after adjustment for severity of medical illness, patients with depression or anxiety and comorbid medical disease have significantly more medical symptoms without identified pathology than do patients with a similar medical disease alone. Both childhood maltreatment and psychological trauma in adulthood have been associated with increased vulnerability to psychiatric illness and more medical symptoms. The substantial functional impairment, distress, and costs associated with medical symptoms without identified pathology suggest that research studies promoting a better understanding of the biopsychosocial cause of these symptoms may yield pragmatic, cost-effective approaches to treatment in medical settings.

Adult↗

A psychoanalytic study of eating disorders: I. A developmental profile of 67 index cases.

Much has been written in both the professional literature and lay press regarding the sociocultural basis for the current increase in eating disorders. The typical victims of these afflictions appear to be intelligent adolescent girls from middle and upper class families (Garfinkel and Garner, 1982). Although the general pressure for thinness, mastery, and achievement among women in our culture undoubtedly help shape the course of illness, these social mores do not appear to be its root causes. The data presented here suggest strongly that the truly eating-disordered individual has a history of disturbances in early relationships, leading to a lack of security and pronounced difficulties in trusting others, and in simply being an authentic individual in the presence of others. As such these individuals share many characteristics of others with severe personality disorders such as inner emptiness, problems with identity, fear of abandonment, and peer relationships (Clarkin et al., in press), but differ in the expression of these basic defects or in solutions found to compensate pathologically for these core deficiencies. Therefore, although contemporary cultural ideals and values may supply the shape of the disorder, these individuals would have fared badly in any social climate although their presentation of illness may have differed (Bemporad et al., 1988). It is this profound underlying personality pathology that necessitates prolonged treatment for any hope of amelioration. Later reports will address this indication with a description of the results of therapy.

Adult↗