Early stage IgD multiple myeloma in a 50-year-old man.

We present the case of a 50-year-old Hispanic man who presented to the emergency department with an acute right femur fracture after 3 months of intermittent discomfort in the right leg. He was eventually diagnosed with immunoglobulin D (IgD) multiple myeloma, a rare class of myeloma that is often of advanced stage at diagnosis. Fortunately, our patient was stage I at diagnosis and did not have hypercalcemia, anemia, or renal insufficiency, as is common with myeloma. This report describes a rare case of an uncommon condition and highlights the fortunate aspects of this patient's unfortunate diagnosis.

Systematic review and meta-analysis of the evidence for flexible sigmoidoscopy as a screening method for the prevention of colorectal cancer.

BACKGROUND: Colorectal cancer is a significant cause of death. Removal of precancerous adenomas, and early detection and treatment of cancer, has been shown to reduce the risk of death. The aim of this review and meta-analysis was to determine whether flexible sigmoidoscopy (FS) is an effective population screening method for reducing mortality from colorectal cancer. METHODS: MEDLINE (1946 to December 2012) and Embase (1980-2012, week 15) were searched for randomized clinical trials in which FS was used to screen non-symptomatic adults from a general population, and FS was compared with either no screening or any other alternative screening methods. Meta-analysis was carried out using a random-effects Mantel-Haenzsel model. RESULTS: Twenty-four papers met the inclusion criteria, reporting results from 14 trials. Uptake of FS was usually lower than that for stool-based tests, although FS was more effective at detecting advanced adenoma and carcinoma. FS reduced the incidence of colorectal cancer after screening, and long-term mortality from colorectal cancer, compared with no screening in a selected population. Compared with stool-based tests in a general population, FS was associated with fewer interval cancers. CONCLUSION: FS is efficacious at reducing colorectal cancer mortality compared with no screening. It is more effective at detecting advanced adenoma and carcinoma than stool-based tests. FS may be compromised by poorer uptake. Introduction of FS as a screening method should be done on a pilot basis in populations in which it is not currently used, and close attention should be paid to maximizing uptake. The relative risk of adverse events with FS compared with stool-based tests should be quantified, and its real-world effectiveness evaluated against the most effective stool-based tests.

World Congress of Epidemiology 2011: themes and highlights.

Modern-day epidemiologists are confronted with huge changes, such as the rise in the global population due to reduced mortality, migration within and across countries, massive shifts in economic standing and lifestyles, and environmental degradation. With over 1000 posters, more than 100 oral presentations, 16 workshops, four lunchtime symposia, many exhibitions and immeasurable discussions, the task of capturing all highlights of the International Epidemiology Association (IEA) World Congress of Epidemiology 2011 is impossible, but this article has provided a sample. Many presenters showed that the challenges facing global health are complex, changing and in demand of measurement, and they demonstrated the central role of epidemiology. The cutting-edge methodologies theme promised the emergence of a more transparent, better balanced, but also more critical approach to dealing with bias. Preceding the United Nations high-level meeting on non-communicable diseases (New York, 19th-20th September 2011), the Congress's chronic diseases stream was especially timely. The neglected conditions theme illustrated inspiring work battling against apathy, inertia and ignorance; perhaps the special challenge of the 'neglected conditions epidemiologist'. Translating epidemiology's insights into effective policies and programmes to prevent diseases or reduce their impact is not easy. Speakers highlighted the common failure of epidemiologists to contribute actively to improving the health of the populations they serve, especially the poor and disadvantaged, but also provided many examples where they had done so. The 'other' theme ensured that important studies were not lost from the programme just because they did not fit easily into the specific themes. The studies focused on identified risk factors throughout the life course. A variety of methods were used to identify factors that altered the rate of birth, disease and death. Ongoing epidemiology is not only broad but is also deep, and ever more so as collaborative pooling of expertise, data, populations and ideas has emerged, accelerated by modern-day communication technologies. Epidemiology, and epidemiologists, seem poised for tomorrow's world.

Is there an association between preterm birth or low birthweight and chronic widespread pain? Results from the 1958 Birth Cohort Study.

OBJECTIVE: The aim was to examine the relationship between gestational age and birthweight and adult chronic widespread pain (CWP). DESIGN AND PARTICIPANTS: A prospective cohort study of 18,558 participants recorded birthweight and gestation at birth. EXPOSURE: Participants were categorised by gestation (fullterm ≥37 weeks; preterm <37 week) and birthweight (full birthweight (FBW) ≥2.5 kg; low birthweight (LBW) 1.5-2.5 kg; and very low birthweight (VLBW) <1.5 kg). OUTCOME: The presence or absence of CWP was measured by self-completed questionnaire in 8572 participants at age 45 yrs. Risk ratios were calculated using Poisson regression. Adjustment was made for potential confounding factors. RESULTS: Premature birth was associated with a 26% increase in the risk of CWP compared to fullterm birth, although this was not statistically significant (risk ratio 1.26, 95% confidence interval 0.95-1.67). This increased risk was robust to adjustment for sex, social class at birth and age 42 yrs, or birthweight, but was completely attenuated when adjusted for childhood behavioural problems and adult psychiatric disorder. LBW was not associated with an increased risk of CWP (RR 1.01, 95%CI 0.78-1.32). VLBW was associated with a non-significant increased risk (RR 1.48, 0.42-5.22) although there was insufficient study power to examine this relationship in the context of other factors. CONCLUSIONS: Premature birth and VLBW are associated with increased risk of adult CWP although these effects are modest, and not statistically significant. Although not conclusive in itself, this study lends support to the theory that adult chronic pain may have its origins - at least in part - in very early life.

Growth of bacteria in prefilled syringes stored in home refrigerators.

Insulin was examined for the rate of bacterial growth after being stored in prefilled syringes in home refrigerators and in a controlled laboratory refrigerator. Home refrigerators were used to simulate conditions that exist in client homes to establish the safety of storing insulin in prefilled syringes in uncontrolled environments. Insulin from each source was inoculated on three different media and incubated at three temperatures in three oxygen environments. A total of 768 cultures were examined. It was found that temperature had a significant effect on the incidence of bacteria. The difference in incident of bacteria between syringes stored in the controlled versus uncontrolled environments was not statistically significant.

Hazards of occupational transmission and strategies for prevention of infectious disease in dental education.

The emergence of AIDS has alerted the nation's health care community to the dangers of occupational transmission of infectious disease. This article assesses the risk of occupational transmission in the health care setting and examines two prevention strategies: vaccination programs and infection control protocols. The implementation of these strategies by the School of Dentistry, University of California at San Francisco, is recounted to illustrate an institutional response to the issue of infection control in the dental setting.

The utilization of cystic duct cholangiography.

The patient records at two hospitals were reviewed to ascertain the incidence of unsuspected common duct stones and to evaluate the patterns of utilization of routine and selective intraoperative cystic duct cholangiography. The incidence of unsuspected common duct stones discovered only by cystic duct cholangiography was 4.3 per cent. Unnecessary common duct exploration was performed on 5.3 per cent of patients undergoing routine cystic duct cholangiography because of false-positive cholangiograms. The use of routine and preexploratory cystic duct cholangiography was significantly different at the two hospitals studied. Choledochotomy without preexploratory cystic duct cholangiography resulted in unnecessary common bile duct explorations in 44 per cent of patients. Although routine cystic duct cholangiography will identify unsuspected common duct stones, it is associated with an equal incidence of unnecessary common duct exploration. Preexploration cholangiography is an essential procedure which diminishes unnecessary choledochotomy and facilitates accurate demonstration of biliary tract pathology.