Economic impact of childhood obesity on health systems: a systematic review.

The primary purpose of this study is to analyse the costs related to childhood obesity (CO) with reference to different models of healthcare systems. A systematic review of the economic impact of CO on healthcare systems was conducted by searching the main electronic scientific databases. Cost-of-illness (COI) analyses of children aged under 18 years who had been diagnosed as overweight or obese published up to July 2010 were considered. Short- and long-term consequences of CO were taken into account. In order to appraise the quality of the included studies, the British Medical Journal referees' checklist was used. About 3,844 COI analyses were initially found and 10 were finally considered in the current review: two studies referred to Beveridge and eight referred to Voluntary health insurance models. No studies have been conducted within a Bismarck model. Six studies considered in-patient costs, four studies estimated outpatient and primary care costs and seven studies considered pharmaceutical costs. The average quality of the included analyses was medium. The analysis confirmed the significance of CO related costs and the heterogeneity among available studies, which made it impossible to compare the different healthcare models.

A rare case of retrocaval ureter associated with persistent left vena cava.

We report a rare case of a retrocaval ureter associated with a left inferior vena cava transposition and with concomitant nephrolithiasis in a young woman already surgically treated during her first years of life for cardiovascular disease. Diagnosis and surgical procedure are described, including the use of a flexible ureterorenoscope to facilitate kidney stone removal.

Peri-engraftment respiratory distress syndrome during autologous hematopoietic stem cell transplantation.

From 1987 to 1998, 19 of 416 patients (4.6%) who underwent autologous hematopoietic stem cell transplantation experienced peri-engraftment (within 5 days of neutrophil recovery) respiratory distress syndrome (PERDS) not attributable to infection, fluid overload, or cardiac dysfunction. The median time from stem cell infusion to onset of PERDS was 11 days (range 4-25). Risk of PERDS or its outcome was not predicted by any pre- or peri-transplant clinical or laboratory feature. The respective median white blood cell and platelet counts at first symptoms were 1.3 x 10(9)/l and 25 x 10(9)/l. No patients had an infectious etiology by bronchoalveolar lavage. Six of the 19 patients had alveolar hemorrhage, which was significantly correlated with high neutrophil count. PERDS was directly implicated in four deaths (21%). Eleven patients received high-dose corticosteroid therapy, including five of the six who required mechanical ventilation. Ten of these patients experienced clinical improvement, which occurred within 24 h in five. The rapid response to corticosteroid treatment and the fact that such therapy was delayed until after intubation in all the mechanically ventilated cases point to a therapeutic benefit.

Surface properties of Ascaris suum eggs: hydrophobic potential and Lewis acid-base interactions.

The cell surface properties of Ascaris suum eggs were investigated to determine the hydrophobic properties of eggs of different origins. Hydrophobic potential measurements were based on adhesion to hydrocarbons. Freshly laid eggs with or without the external coat and eggs that had been stored for 3 months at -20 degrees C were tested. The hydrophobic potential differed according to the hydrocarbon used (hexadecane or octane) and the eggs tested (stored or fresh). The hydrophobic potential with octane was 95% for fresh eggs and 72% for eggs stored at -20 degrees C. Tests with Ascaris eggs with and without an external coat showed similar hydrophobic characteristics; the presence or absence of this external structure did not appear to influence hydrophobic interactions. Acidic interactions also appeared to play no part in the adhesion of eggs to the surface of octane emulsions.

The effect of liming on the microbiological quality of urban sludge.

Treatments applied to sludge in order to stabilise and dehydrate them may give notable inactivation of microorganisms. This is observed when sludge is exposed either to high temperature or drastic pH when residual sludge is limed. The control of virological, parasitological and bacteriological sludge quality by detecting pathogenic microorganisms is slow and too expensive to be commonly practised. Thus, it is possible to replace pathogenic microorganisms detection by that of contamination indicators. The aim of this study was to determine the influence of liming on the behaviour of pathogenic microorganisms detected in urban sludge. The detection of Salmonella and helminth eggs was carried out in liquid sludge (2-3% dryness) and solid sludge (23% dryness) with added lime (0-45% weight/dry weight) and stored for 24 h-46 weeks. The results showed that liming modified some characteristics such as temperature, dryness and pH of the sludge. It appeared that, whatever the percentage of added lime, the temperature of liquid sludge did not change while it increased by about 9 degrees C when 30-45% lime was added to solid sludge. In the same way, the dryness of liquid sludge did not change during the liming, whereas the dryness of 45% limed solid sludge increased from 23% to 31%. Finally, 15%, 30% and 45% liming gave a pH of at least 10, 11.5 and 12, respectively, although the pH increase depended on the sludge type. The efficiency of liming was considered to be related to the pH and not to the percentage of added lime. Three factors determined the efficiency of pathogen elimination: (a) the pH reached by the sludge, (b) the period of liming activity and (c) the dryness of the sludge. Salmonella were eliminated from liquid sludge in 24 h at pH 10.7 and from solid sludge in 24 h at pH 10.0. Viable helminth egg concentration decreased to 3 eggs/10 g DM in liquid sludge in 14 d at pH 11.9 and 60 d at pH 11.6. In solid sludge, egg reduction was achieved in 24 h at pH 12.5, 7 d at pH 12.0 and 14 d at pH 11.5. From this study, it appeared that liming resulted in a much better microbiological quality of liquid sludge if its pH was maintained at 11.6 over 60 d or at pH 11.9 for 14 d. Solid sludge needed to be maintained at pH 11.5 for 14 d, pH 12.0 for 7 d or pH 12.5 for 24 h to achieve similar results.

Tracheobronchial amyloidosis.

OBJECTIVE: To evaluate the presentation and clinical course of patients with tracheobronchial amyloidosis. PATIENTS AND METHODS: We retrospectively reviewed the records of all patients with biopsy-proven tracheobronchial amyloidosis who were evaluated at the Mayo Clinic in Rochester, Minn, between 1973 and 1999. All relevant information, such as clinical, historical, demographic, laboratory, and histological data, was examined. RESULTS: Tracheobronchial amyloidosis was diagnosed in 17 patients (9 women and 8 men), with a mean age of 56.6 years. The most common symptoms at presentation were dyspnea, cough, hemoptysis, and hoarseness. None of the 14 patients who underwent investigation for systemic amyloidosis had any evidence of disease outside the tracheobronchial system except for a man in whom multiple myeloma had been diagnosed 3 years before the development of respiratory disease. Treatment of tracheobronchial amyloidosis consisted of laser or forceps resection, external radiation, systemic therapy, or observation. Two patients died of complications directly related to their disease. CONCLUSIONS: Patients presenting with tracheobronchial amyloidosis have symptoms similar to those caused by various airway disorders. Tracheobronchial amyloidosis is not typically associated with systemic amyloidosis or pulmonary parenchymal involvement. It often recurs and despite repeated attempts with bronchoscopic techniques, airway compromise remains a major problem.

Chest roentgenography after outpatient thoracentesis.

OBJECTIVE: To evaluate the clinical utility of posteroanterior chest roentgenograms after thoracentesis in the outpatient setting. DESIGN: We undertook a retrospective study of clinical records of outpatient thoracentesis performed between January and December 1996 by the Division of Pulmonary and Critical Care Medicine at Mayo Clinical Rochester. MATERIAL AND METHODS: The medical records of 54 men and 39 women who underwent 123 outpatient thoracentesis were reviewed. Exclusion criteria were the need for pleural biopsy at time of thoracentesis or the need for ultrasound-guided assistance for completion of the procedure. Indications for thoracentesis and postthoracentesis chest roentgenography were analyzed. RESULTS: Of 123 thoracentesis performed in the outpatient setting during the specified study period, 104 met the inclusion criteria. Of these 104 thoracentesis, 54 (52%) were followed by chest roentgenography. Pneumothorax occurred in only 5 of these 104 procedures (5%), in 5 separate patients. Three of these patients were asymptomatic and did not require therapeutic intervention; the two symptomatic patients required hospitalization and chest tube drainage. Of the two pneumothoraces in patients with symptoms, one was detected on the same day as the thoracentesis, and the other was diagnosed 2 days later. The patients who did not undergo postthoracentesis chest roentgenography had no reported complications. Of the 54 chest roentgenograms, 52 were obtained in asymptomatic patients, with no suspicion of pneumothorax. These x-ray studies led to a total cost of $4,862 and detection of three pneumothoraces that did not require therapy. CONCLUSION: Routine performance of chest roentgenography after outpatient thoracentesis can incur substantial cost. A more selective approach to this practice is needed, both to optimize patient care and to manage limited medical resources efficiently. Postthoracentesis chest roentgenograms should be limited to patients with symptoms indicative of thoracentesis-induced pneumothorax.

Rheumatic fever revisited. Keep this diagnosis on your list of suspects.

The symptoms of recurrent rheumatic fever in adults can be very different from those in children, and the diagnosis is easy to overlook. Nonetheless, rheumatic fever is still a problem in many parts of the world, as illustrated by this case. Dr Capizzi and associates remind us to keep our options open.