Significant Etiologic Factors Research Articles

Occupational Noise Exposure in Relation to Hypertension: A Cross-sectional Study in the Steel Factory

Background: Noise has been acknowledged as one of the most prevailing physical hazard in occupational health and safety. Noise can possess both permanent and temporary health outcomes. The hazardous exposure to occupational noise is generally identified to have aural effects. However in past few years, researches have been carried out to perceive the association between noise exposure and cardiovascular diseases. Yet, the topic has been under controversies regarding its actual relationship or association since there is an existence of other confounders, variables or lifestyle with the exposure which might affect the subsequent disease condition. The results have not been consistent in the studies. Hypertension is one of the most significant etiological factors for cardiovascular diseases. Noise can cause high blood pressure mostly by two ways: either by releasing stress hormones like steroids or by stimulating sympathetic nervous system. China being one of the most rapidly developing countries in the world is having most prominent effect of noise in the daily life since it is a point for most of the goods manufacturing. Various national and international organizations like CDC, OSHA, and NIOSH etc. has recommended various ways to control the noise hazard and its deleterious impact on human health. This research was also done to assess the relationship or association between noise exposure level and prevalence of hypertension in the workers from steel factory in Guangzhou. Aim: The goal of the study was to find out the relationship between occupational noise exposure and prevalence of hypertension regarding its confounders. Methods: A cross-sectional study was carried out to find out the association between noise exposure level (<85, 85-90, >90) dBs and hypertension. The data was collected in Guangzhou No.12 Peoples hospital. A sample of 274 workers was taken from the steel factories in Guangzhou. The data was collected through physical examination and questionnaires. For statistical analysis, Chi square test was used in order to compare the variables. Logistic regression analysis was used to test the association between hypertension and the selected variables. Results: As a result, we found out that cumulative noise exposure is associated with hypertension (P=0.004). The total prevalence of 9.8% of hypertension cases were under the noise exposure group of >90 db. The independent association of hypertension was seen after the linear regression analysis as BMI group over weight (odd ratio = -0.090, CI 95%= (-0.005)–(-4.280) with P=0.039 when compared to the reference category of BMI underweight. The correlation of hypertension was also seen with age group (P=0.009), working years and sleeping hours with P=0.030 and P=0.047 respectively. Conclusion: The study showed that the prevalence of hypertension is associated with the occupational noise exposure and highly influenced by BMI group overweight after our final regression analysis. Age group, working years and sleeping hours also showed having some association with the prevalence of hypertension.

Occupational Noise Exposure in Relation to Hypertension: A Cross-sectional Study in the Steel Factory

Background: Noise has been acknowledged as one of the most prevailing physical hazard in occupational health and safety. Noise can possess both permanent and temporary health outcomes. The hazardous exposure to occupational noise is generally identified to have aural effects. However in past few years, researches have been carried out to perceive the association between noise exposure and cardiovascular diseases. Yet, the topic has been under controversies regarding its actual relationship or association since there is an existence of other confounders, variables or lifestyle with the exposure which might affect the subsequent disease condition. The results have not been consistent in the studies. Hypertension is one of the most significant etiological factors for cardiovascular diseases. Noise can cause high blood pressure mostly by two ways: either by releasing stress hormones like steroids or by stimulating sympathetic nervous system. China being one of the most rapidly developing countries in the world is having most prominent effect of noise in the daily life since it is a point for most of the goods manufacturing. Various national and international organizations like CDC, OSHA, and NIOSH etc. has recommended various ways to control the noise hazard and its deleterious impact on human health. This research was also done to assess the relationship or association between noise exposure level and prevalence of hypertension in the workers from steel factory in Guangzhou. Aim: The goal of the study was to find out the relationship between occupational noise exposure and prevalence of hypertension regarding its confounders. Methods: A cross-sectional study was carried out to find out the association between noise exposure level (<85, 85-90, >90) dBs and hypertension. The data was collected in Guangzhou No.12 Peoples hospital. A sample of 274 workers was taken from the steel factories in Guangzhou. The data was collected through physical examination and questionnaires. For statistical analysis, Chi square test was used in order to compare the variables. Logistic regression analysis was used to test the association between hypertension and the selected variables. Results: As a result, we found out that cumulative noise exposure is associated with hypertension (P=0.004). The total prevalence of 9.8% of hypertension cases were under the noise exposure group of >90 db. The independent association of hypertension was seen after the linear regression analysis as BMI group over weight (odd ratio = -0.090, CI 95%= (-0.005)–(-4.280) with P=0.039 when compared to the reference category of BMI underweight. The correlation of hypertension was also seen with age group (P=0.009), working years and sleeping hours with P=0.030 and P=0.047 respectively. Conclusion: The study showed that the prevalence of hypertension is associated with the occupational noise exposure and highly influenced by BMI group overweight after our final regression analysis. Age group, working years and sleeping hours also showed having some association with the prevalence of hypertension.

The most significant etiological factors of the acute and chronic urticaria

Background. Urticaria is а common disease characterized by the formation on the skin itchy blisters. It is easy to diagnose an urticaria, but it isn’t always simple to treat because of various severity, frequent resistance to antihistamine drugs, a substantial reduction in quality of life. Objective. The purpose of the study is to carry out the retrospective analysis of medical case history of patients with acute and chronic urticaria for identification of the most significant etiological factors of the disease for the optimization of diagnostics and treatment of such patients. Materials and methods. There were analysed 307 medical cards of the patients with various forms of urticaria who were on treatment in the allergology department from 2008 till 2014. The diagnosis was established on the basis on the results of the clinical methods conforming to the standards of diagnosis of this disease, and also specific allergological research. Results. Though patients with acute and chronic urticaria pass examination and treatment in the hospital according to the one medical economic standard, patients with a chronic urticaria demand wider range of diagnostic actions. Respectively, their medical examination is more expensive. Conclusion. Despite on a wide range of the possible reasons of an urticaria, there are patients at whom the provocative factor isn»t taped. Thus, the urticaria is a multicausal disease at which complex examination of the patient is required.

Cytopathologic Herpes Simplex Virus Features In Laryngeal Squamous Cell Carcinoma

Cytopathologic Herpes Simplex Virus Features In Laryngeal Squamous Cell Carcinoma

Motor and somatosensory abnormalities are significant etiological factors for adolescent idiopathic scoliosis

ObjectiveIn adolescent idiopathic scoliosis (AIS), we explore the role of lateralized motor and somatosensory abnormalities as a possible etiological factor. MethodsIntraoperative transcranial electrical stimulation was performed in 15 AIS and 14 adult degenerative scoliosis (ADS) patients. Inter-side motor output balance (MOB) by comparing the ratios of right to left motor evoked potentials (MEP) amplitudes, and inter-side motor output excitability (MOE) computed with MEP amplitude, was determined separately for both patients groups.For somatosensory evoked potentials (SSEP), peak to peak P37 amplitudes from right and left lower limb SSEP and inter-side P37 amplitude ratios were obtained. ResultsInter-side MOB was significantly asymmetric in AIS patients, contributed mainly by inter-side MOB changes in the upper than the lower limbs. Inter-side MOE comparisons of ipsilateral and contralateral MEP amplitudes were significantly different between AIS and ADS patients. Mean upper limb MEP amplitudes were significantly reduced in AIS patients. Amplitude of the right upper limb MEPs were positively correlated with inter-side MEP ratio. AIS patients show larger mean MEP amplitudes on the same side as the scoliotic curve. Overall, no correlation of Cobb's angle or total levels of scoliosis involvement with inter-side MOB and MOE parameters was found. Inter-side SSEP ratios were significantly higher in AIS patients. ConclusionsPrimary dysfunctional and distributed motor output contributing to abnormalities of inter-side MOB and MOE changes involving the upper limbs is evident in AIS. Simultaneous but independent somatosensory and motor observations seen these patients suggest a central mechanism as an etiological factor.

Poisson Spatial Regression Model to Study Gastric Cancer in Boyacá Department, Colombia in 2005

Gastric cancer is the most prevalent and the leading cause of cancer death in Colombia. It has been identified as possible risk factors associated the altitude in the Andean region and the acquisition of the bacterium Helicobacter (H.) pylori in childhood. The aim was to explain the behavior of this pathology in the department of Boyacá, Colombia for 2005, to assess the effect of incorporating a structure of spatial dependence in the model, and identify the most significant etiological factors that may explain the occurrence of cases. In this study, two models were estimated, the first one, a generalized linear model with Poisson response without spatial structure (GLMp), and the second one, a generalized linear mixed model Poisson with spatial structure using Moran eigenvectors (GLMMp_ME) to remove the spatial autocorrelation of the residuals. Additionally, spatial aggregation tests for model residuals were made. The work was developed in R 3.1.1. The results showed aggregations of local type in some municipalities of the department and very few of the explanatory variables were significant in the model. The importance of considering spatial effects in these models was evident and some etiological hypotheses referenced in related studies were refuted.

Finger Necrosis Due to Cryoglobulinemic Vasculitis in Association with Membranous Nephropathy

Cryoglobulinemic vasculitis is a small vessel vasculitis that has been associated with chronic infections and autoimmune, lymphoproliferative, and neoplastic disorders. When no significant etiological factors are identified, it is called essential mixed cryoglobulinemia. A detailed and thorough laboratory investigation is required to exclude all possible causes of cryoglobulin formation. Although cryoglobulin testing is simple, careful temperature regulation is needed to avoid false-negative results. Consensus diagnosis should be developed and implemented for appropriate cryoglobulin detection and accurate clinical diagnosis for cryoglobulinemic vasculitis. Here we present an interesting, first-ever case report of a 54-year-old Hispanic-American woman with essential mixed cryoglobulinemia presenting with significant digital necrosis in association with membranous nephropathy.

Pre Eclampsia and Iron Status: A Review

Preeclampsia is an idiopathic multisystem disorder specific to pregnancy and development of hypertension and proteinuria, increased vascular resistance and endothelial dysfunction in the mother , altered placental perfusion and restricted fetal growth. The vasospasm leads to destruction of RBCs release iron thus, there is elevated serum iron levels in preeclamptic women. The excess iron released from destruction of RBCs can react with free radicals produced from cell membrane (as it is rich in polyunsaturated fatty acids) and circulating lipoproteins initiates lipid peroxidation both in placenta and vasculature. This is one of the significant etiologic factors in the endothelial cell damage of preeclampsia. the raised serum iron levels in turn alters the iron related parameters like total iron binding capacity(TIBC), serum ferritin, transferrin, percent saturation.

Presence of aerobic micro-organisms and their influence on basic semen parameters in infertile men.

Urogenital tract infections in males are one of the significant etiological factors in infertility. In this prospective study, 72 patients with abnormal semen parameters or any other symptoms of urogenital tract infection were examined. Semen analysis according to the WHO 2010 manual was performed together with microbial assessment: aerobic bacteria culture, Chlamydia antigen test, Candida culture, Ureaplasma and Mycoplasma-specific culture. In total, 69.4% of semen samples were positive for at least one micro-organism. Ureaplasma sp. was the most common micro-organism found in 33% of semen samples of infertile patients with suspected male genital tract infection. The 2nd most common micro-organisms were Enterococcus faecalis (12.5%) and Escherichia coli (12.5%), followed by Staphylococcus aureus (7%), Chlamydia trachomatis (7%) and Candida sp. (5.6%). Generally, bacteria were sensitive to at least one of the antibiotics tested. No statistically significant relationship was observed between the presence of aerobic micro-organisms in semen and basic semen parameters: volume, pH, concentration, total count, motility, vitality and morphology.

Carcinoma of the Tongue: A Case-control Study on Etiologic Factors and Dental Trauma

Carcinoma of the tongue is the most common intra-oral malignancy in Western countries. Incidence and mortality rates have increased in recent years, and survival has not improved. This study aimed to determine etiologic factors for tongue cancer with age-sex matched case-control data. 47 patients with carcinoma of the tongue referred to our oral medicine clinic between years 2005-2006 were analyzed and compared with control group data. The medical records , including family history of cancer, dental trauma, and history of abuse of alcohol and tobacco products was recorded for all subjects. Chi square comparison tests and linear regression analysis were performed using the SPSS program for statistics. Patient and randomly selected control groups each consisted of 30 male and 17 female subjects with mean ages 53.2 (± 12.6) and 52.6 (± 11.5) years respectively. Smoking and alcohol abuse proportions were significantly higher in the patient group (p=0.0001, p<0.0001 respectively). Chronic mechanical trauma was observed in 44.7% of the patients and 17.0% of the control group (p=0.004). Similarly, family history of cancer of any type (for the first degree relatives) was found to be more common in the patient group (p=0.009). On regression analysis, alcohol abuse, family history of cancer, smoking, chronic mechanical traumas appeared as significant etiologic factors (p=0.0001). We believe that field cancerization may become evident in oral and oropharyngeal mucosa with multiple steps of molecular changes starting from the first sign of dysplasia with chronic exposure to etiological factors. Chronic trauma cases need particular attention to search for very early signs of cancer.

Pneumonia caused by Mycoplasma pneumoniae and Chlamydophila pneumoniae in children – comparative analysis of clinical picture

The aim of the study was comparative analysis of clinical picture and prevalence of pneumonia caused by Mycoplasma pneumoniae and Chlamydophila pneumoniae in children. The study involved 332 children hospitalized in the 3rd Department of Paediatric, Polish Mother's Memorial Hospital - Research Institute, due to pneumonia caused by Mycoplasma pneumoniae - group I or Chlamydophila pneumonia - group II. Over 2003-2009 period there were 1870 children hospitalized due to pneumonia, of which in 332 (17.8%) the Mycoplasma pneumoniae and/or Chlamydophila pneumoniae etiology was confirmed. Mycoplasma pneumoniae, Chlamydophila pneumoniae, and mixed infection was diagnosed in 198 (10.6%), 102 (5.5%), and 32 (1.7%) children, respectively. The dominant clinical feature in both groups was cough, observed in 186 (93.9%) and 88 (86.3%) children, respectively. Further, reddening of the throat, rhinitis, shortness of breath, fever, enlarged lymph nodes, skin lesions and dyspepsia were also observed. The frequency of specific clinical features in both groups was similar. Statistical relationship (p≤0.05) was observed only in case of skin lesions. In chest x-ray there was no statistical link as for analyzed changes. Interstitial inflammatory changes were most frequently observed. Mycoplasma pneumoniae and Chlamydophila pneumoniae are significant etiological factors in pneumonia in children, and as such they should be taken into consideration in differential diagnosis of pneumonia in children. The clinical picture of pneumonia caused by Mycoplasma pneumoniae and Chlamydophila pneumoniae is hardly specific, with basic labs and chest x-ray of little help in differentiation of infection etiology.

Çok Nadir Rastlanan Bir Olgu: Krukenberg Tümör Rüptürü

Krukenberg tumors are metastases of gastrointestinal and bladder tumors to the ovaries. Krukenberg tumors are frequently diagnosed as huge ovarian tumors. In some cases, they were identified in early stage and curative operation could be performed. We report a case of a 43-year-old woman investigated for acute abdominal pain and found to have a ruptured Krukenberg tumor from colon cancer. In physical examination severe abdominal pain, constipation and signs of peritonitis were seen. Laparotomy and abdominal exploration was performed. Ruptured Krukenberg tumor, left colonic tumor and liver metastasis were found at the time of operation. Left hemicolectomy, right salphingo-oophorectomy and liver biopsy were performed. Postoperative course was uneventful, appropriate chemotherapy regimen was added to treatment. Ruptures of ovarian cysts are one of the significant etiological factors for women with acute abdominal pain. However, Krukenberg tumor rupture related to colon cancer metastases is very rare.

The Landau‐Kleffner syndrome

The genesis of the Landau-Kleffner syndrome gave no clue to the notoriety that would later emerge. In the 1950s, developmental disorders in children were a topic of increasing attention in both medical and educational professions. Kleffner’s institution, Central Institute for the Deaf, had a reputation for its work in teaching speech and language to children who were born deaf. Via Landau, his institution, Washington University School of Medicine, adjacent neighbor of Central Institute, expressed interest in studying the neurologic status of the children enrolled there, most of whom lived in its residential facility. Both institutions quickly found ways to collaborate by setting up a project for obtaining neurologic evaluations and electroencephalography (EEG) studies of all Central Institute children. Among the referrals to Central Institute for the Deaf were several who had developed speech and language normally, only to begin having marked difficulty both in speaking and in comprehending what was said to them. These children were diagnostically puzzling, because although they appeared to be deaf, they had good auditory capacity and had developed normal or near-normal verbal abilities. Kleffner arranged for Landau to pay special attention to these cases. As a result, we were both surprised, Landau because he had never seen such children, and Kleffner because he had no idea that such cases would be unknown to Landau. Recognizing their unique pattern, Landau took the lead in submitting to the journal Neurology the 1957 paper that led to the designation of Landau-Kleffner syndrome (LKS). As part of our introductory presentation at this Symposium, we provided serial films of an early case, Jill, demonstrating her initial symptoms in 1960, her progress a year later after some therapy, and her performance in 2006 as a normally functioning 52-year-old mother of two normal children. Her waking and sleep EEG studies were normal, as was her magnetic resonance imaging (MRI), including state-of-the-art measurement of her temporal lobe cortical thickness. The surprise and honor of the Belgian conclave expanded our hopes for new substantive understanding of our casual observations. Although we deeply appreciate the two dozen contributions documented herein, we must assume the chutzpah of setting forth our wish list of what still needs to be known. Although aphasia is the major disability of this condition, attention has yet to be given to the types, forms, and severity of the speech/language impairments, or to the efficacies of any modes of therapy or retraining for recovery of speech/language functions. To be sure, the use of different forms of communication appropriate for deaf subjects was described, but differences among various approaches for the deaf appeared to be as much influenced by psychosocial philosophies and beliefs regarding the deaf, as by the nature of the language impairment or educational techniques. Evidence regarding the how of education for this disability remains nil. Regarding the epilepsy component of LKS, a major constituent of the syndrome of which we had been unaware is the tremendous exaggeration of paroxysmal brain activity during sleep. We know now that such highly abnormal nocturnal EEGs are also associated with other clinical syndromes, suggestive of predominant paroxysmal activity in other than auditory cerebral territory. But that’s where the descriptive data seem to end. There is no evidence regarding any etiologic relationship between LKS and electroencephalographically similar conditions. We still hope for multiinstitutional efforts to ascertain any significant etiologic factors. Still to be ascertained are cellular histopathology, histochemistry, and channelopathy or other synaptic disturbance. Pathogenesis may possibly be metabolic, genetic, toxic, infectious, or autoimmune. During the era when many new anticonvulsant medications came upon the scene, there have been no systematic efforts even to compare the efficacy of different anticonvulsant medications upon the aphasia symptom. Nor has any ethical or scientific rationale been developed for the non–evidence-based fad of steroid medication. Ill-conceived surgical adventures have failed even to exploit the opportunities for study of LKS brain tissue by any mode. The single report of thin cerebral cortex in the first temporal gyrus of patients with LKS has yet to be confirmed. Our hopeful prayer is that attention to this Symposium and the Epilepsia supplement may mark the graduation of our baby LKS from dictionary curiosity to more productive scientific enterprise. Disclosure: Neither of the authors has any conflict of interest to disclose.

Dietary Habits, Demographical, and Socio-economical Risk Factors of the Newly Diagnosed Gastric Cancers in the Eastern Anatolia Region of Turkey: An Endemic Upper Gastrointestinal Cancer Region

The Eastern Anatolia Region of Turkey is an endemic upper gastrointestinal (esophageal and gastric) cancer region, and the incidence of these cancers are still increasing in the region. We investigated demographic features, dietary habits, and some possible etiologic factors for this high prevalence. Special attention was given to the relationship between consumption of boiled yellow butter and the occurrence of gastric cancer. Age, sex, residential area, socio-economical status, educational status, vegetable and fruit consumption, alcohol and tobacco use, tea consumption, boiled butter usage, cooking and storage methods of the patients with gastric cancer and controls were investigated in East Anatolian Regional Erzurum State Hospital. Helicobacter pylori infection for gastric cancer risk was not studied. Fruit, yellow-green vegetables, boiled butter, and breads baked by animal manure consumptions and no refrigeration are found to be statistically significant etiologic factors for gastric carcinogenesis. Dietary habits might be risk factors for gastric carcinogenesis among East Anatolian population. Some regional differences in food processing and preparation also seem to play a role in gastric carcinogenesis.

Copper- and iron-induced differential fibril formation in α-synuclein: TEM study

alpha-Synuclein filaments are the central component of intracytoplasmic inclusion bodies characteristic of Parkinson's disease (PD) and related disorders. Metals are the significant etiological factors in PD, and their interaction with alpha-synuclein affect dramatically the kinetics of fibrillation. Currently, we have investigated the influence of Cu(II) and Fe(III) on alpha-synuclein fibril formation. Cu(II) and Fe(III) selectively and differentially induced the formation of discrete alpha-synuclein fibrillar species. Transmission electron microscopy was used to monitor the aggregation state of alpha-synuclein (wild-type, A30P, A53T, and E46K) after 60h with stirring at 37 degrees C in the presence and absence of metal ions. Cu(II) has induced thin long network-like fibrils with the wild-type of alpha-synuclein, while the mutant, showed amorphous aggregates with no fibrillar forms. Fe(III) induced short and thick fibrils with both wild and mutant forms and were similar to alpha-synuclein fibrils incubated without metal ion. The present study illustrates the metal-specific fibril morphology, and has relevance in understanding the role of metals in neurodegeneration.

Thermodynamics imprinting reveals differential binding of metals to α-synuclein: Relevance to parkinson’s disease

The aggregation of α-synuclein is a hallmark feature of Parkinson’s disease (PD) and other synucleinopathies. Metals are the significant etiological factors in PD, and their interaction with α-synuclein affect dramatically the kinetics of fibrillation in vitro and are proposed to play an important and potential neurodegenerative role in vivo. In the present study, we investigated the stoichiometry of binding of copper [Cu (II)] and iron [Fe (III)] with α-synuclein (wild recombinant type and A30P, A53T, E46K mutant forms) using isothermal titration calorimetry (ITC). α-Synuclein monomer (wild and mutant forms) titrated by Cu (II), showed two binding sites, with an apparent K B of 10 5 M and 10 4 M, respectively. But, α-synuclein (wild type and mutant forms) titrated with Fe (III) revealed a K B of 10 5 M with single binding site. The present investigation uncovers the detailed binding propensities between metals and α-synuclein and has biological implications in PD.

Calprotectin Expression in Human Monocytes: Induction by Porphyromonas gingivalis Lipopolysaccharide, Tumor Necrosis Factor‐α, and Interleukin‐1β

Background: Calprotectin is a major cytosolic protein of monocytes and granulocytes. It is increased in inflammatory tissues and is detected at high levels in the gingival crevicular fluid (GCF) of periodontitis patients. We previously reported that lipopolysaccharide of Porphyromonas gingivalis (P‐LPS) and cytokines induced the release of calprotectin from monocytes isolated from human peripheral blood. The mechanisms of calprotectin expression and presence of its regulation factors in periodontal disease are unknown. On the other hand, P‐LPS and cytokines are significant etiologic factors in the initiation and progression of periodontal diseases. In this study, we investigated the expression and production of calprotectin from human monocytes by examining the effects of lipopolysaccharide of P‐LPS, tumor necrosis factor‐α (TNF‐α) and interleukin‐1β (IL‐1β).Methods: Monocytes were isolated from the peripheral blood of healthy donors and cultured in the presence or absence of P‐LPS, TNF‐α, or IL‐1β. The expressions of calprotectin mRNAs (MRP8 and MRP14) were detected by Northern blotting. The contents of calprotectin in the cells and medium fractions were determined by enzyme‐linked immunosorbent assay (ELISA). The DNA binding activity of C/EBPα, a transcription factor of MRP14, was assessed by electrophoretic mobility shift DNA‐binding assay (EMSA).Results: P‐LPS, TNF‐α, and IL‐1β induced MRP8/14 mRNAs and calprotectin production in monocytes. These factors also induced DNA CEBPα binding activity in monocytes. P‐LPS increased MRP14 mRNA expression in monocytes to the maximum level, about two times the control level after 24 hours treatment, but did not enhance the basal level of MRP8. When the effects of TNF‐α and IL‐1β on those mRNAs were investigated, both MRP8 and MRP14 significantly increased to about 2‐ and 2.5‐fold the control level, respectively. Increases of MRP8/14 mRNA expression were followed by their protein production at about 2‐fold the basal amount. DNA binding activity of C/EBPα was increased in P‐LPS, TNF‐α, and IL‐1β‐treated monocytes.Conclusions: These results demonstrate that P‐LPS, TNF‐α, and IL‐1β induce calprotectin production from human monocytes and that this production is associated with the activation of DNA C/EBPα binding complex. J Periodontol 2005;76:437‐442.

Prothrombotic conditions in an unselected cohort of children with venous thromboembolic disease

Venous thromboembolic events (VTEs) in children are usually associated with underlying clinical conditions. The added contribution of prothrombotic conditions to the occurrence of VTEs in children is not clear. This study reports the prevalence of prothrombotic conditions in 171 consecutive children with VTE followed in the Hospital for Sick Children Thrombosis Outpatient Clinic. The median age of the children at the time of VTE was 2.3 months (range 1 day to 16.5 years). An underlying medical condition and a central venous line (CVL) were present in 156 (91%) and 132 (77%) of 171 children, respectively. A positive family history was present in 8% of children. The prevalence of factor V Leiden was 4.7%, prothrombin G20210A polymorphism was 2.3%, protein S deficiency was 1.2%, protein C deficiency was 0.6% and increased plasma lipoprotein (a) concentration (>30 mg dL-1) was 7.5% (tested in 107 children). The overall frequency of inherited prothrombotic coagulation proteins was 13% (95% confidence interval 7 to 19%) and the frequency was not significantly different between neonates and older children with VTE. Inherited prothrombotic coagulation proteins were not associated with gender, CVL-related VTE, a positive family history of thrombosis or spontaneous VTE in neonates. Increased frequency of inherited prothrombotic coagulation proteins was, however, found in older children with spontaneous VTE (60%) compared with older children with VTEs secondary to an underlying medical condition (10%) (P = 0.02). In conclusion, this study indicates that inherited prothrombotic coagulation proteins do not contribute significantly to the pathogenesis of VTEs in neonates and children, in whom the most significant etiological factors are the presence of a CVL and/or other medical conditions.

Factors Predicting Outcome of Surgery for Intractable Epilepsy with Pathologically Verified Mesial Temporal Sclerosis

To examine the subgroup of patients with medically intractable epilepsy receiving temporal lobectomies who have pathologically verified mesial temporal sclerosis (MTS) and to determine the relation of demographic and clinical factors, results of diagnostic testing, and details of the surgical procedure with prognosis for achieving control of seizures. All patients receiving surgical treatment for intractable epilepsy between 1991 and 1998 at the University of Washington were reviewed. There were 118 patients who met inclusion criteria of adequate pathological analysis showing MTS without a progressive process and a minimum of 1-year follow-up. Only personal history of status epilepticus demonstrated significant (p = 0.0276) prediction of outcome, increasing the risk of surgical failure. No other factors were significant predictors of outcome, including history of febrile seizures, possible etiologic factors, EEG, magnetic resonance imaging (MRI) or neuropsychological testing results, or extent of resection. Many factors that have been previously described to predict favorable outcome in the overall group of patients receiving temporal lobe resections for intractable epilepsy are, in fact, predictors of MTS and lose their predictive value when the subgroup of patients with confirmed MTS is examined. Neurosurgical treatment of MTS can be very effective even in the presence of significant etiologic factors, or of bilateral or extratemporal abnormalities on EEG or MRI.

Carcinogen-DNA adducts in human breast epithelial cells.

Diet and environmental exposures are often regarded as significant etiologic factors in human breast cancer. Chemicals that may be involved in these exposures include heterocyclic amines, aromatic amines, and polycyclic aromatic hydrocarbons, which also serve as strong mammary carcinogens in different animal models. In this study, we chose to quantify the major DNA adducts derived from one member of each of these classes of carcinogens, that is, 2-amino-1-methyl-6-phenylimidazo[4,5-b]pyridine (PhIP), 4-aminobiphenyl (ABP), and benzo[a]pyrene (B[a]P), respectively, in DNA isolated from exfoliated ductal epithelial cells in human breast milk. Milk was collected from healthy, nonsmoking mothers. The isolated DNA was digested to 3' nucleotides and subjected to (32)P-postlabeling. Adduct enrichment was achieved using Oasis Sep-Paks and the analyses were conducted by HPLC using radiometric detection. Critical to the analyses were the syntheses of bis(phosphate) standards for the C8-dG adducts of PhIP and ABP, and the N(2)-dG adduct of B[a]P, which were added to each reaction as UV markers. Of the 64 samples analyzed, adducts were found in 31 samples. Thirty samples contained detectable levels of PhIP adducts, with a mean value of 4.7 adducts/10(7) nucleotides; 18 were positive for ABP adducts with a mean value of 4.7 adducts/10(7) nucleotides; and 13 were found to contain B[a]P adducts with a mean level of 1.9 adducts/10(7) nucleotides. These data indicate that women are exposed to several classes of dietary and environmental carcinogens and that these carcinogens react with DNA in breast ductal epithelial cells, the cells from which most breast cancers arise.