Peritonsillar abscess: epidemiology and relationship with climate variations.

BACKGROUND: Peritonsillar abscess is the most common deep infection of the head and neck in young adults. It is considered a purulent complication of acute tonsillitis, but other mechanisms have been proposed. There is no consensus as to whether seasonality affects peritonsillar abscess incidence. METHODS: This observational, descriptive, retrospective study explored the epidemiology of peritonsillar abscess and its relationship with seasonality. The cases were selected from the emergency otolaryngology service of a tertiary hospital. RESULTS: The sample comprised 528 patients (42.61 per cent males, mean age = 26.63 years). A moderate positive correlation was found between peritonsillar abscess incidence and monthly average temperature. No associations were found with insolation, precipitation or humidity. CONCLUSION: In this sample, peritonsillar abscess was more likely to occur in warmer months. The findings corroborate the theory that peritonsillar abscess is not a direct complication of acute tonsillitis and may improve understanding of peritonsillar abscess aetiology.

Smoking and drinking cessation and risk of esophageal cancer (Spain).

OBJECTIVES: To explore the effectiveness of alcohol drinking and tobacco smoking cessation in reducing esophageal cancer risk, taking into account the key characteristics of each habit and the simultaneous exposure to both habits. METHODS: Data from a series of five hospital-based case-control studies of incident squamous-cell carcinoma of the esophagus conducted by the International Agency for Research on Cancer (IARC, Lyon, France) in high-risk areas in South America were combined and analyzed by multivariate logistic regression procedures. A total of 2063 men (655 case patients and 1408 control subjects) were included in the pooled analysis. RESULTS: For either habit, the risk of esophageal cancer decreased rapidly, strongly and significantly with longer periods of abstention. The risk reduction was statistically significant regardless of the intensity and duration of each habit and the type of tobacco or alcoholic drink consumed. For subjects exposed to both risk factors, the protective effect of quitting both habits appeared to be synergistic, reaching, after only five to nine years of simultaneous cessation of both exposures, a 70% risk reduction, a reduction that clearly overlapped with the risk intervals of both never-smokers and never-drinkers. The risk benefit of merely quitting alcohol drinking was delayed (>10 years of cessation) unless it was also accompanied by a few years of smoking cessation. CONCLUSIONS: Our findings solidly demonstrate for the first time the effectiveness of smoking and drinking cessation in reducing esophageal cancer risk. For the large proportion of subjects in the general population exposed to both risk factors, our results further emphasize the importance of smoking cessation to effectively reduce cancer risk.

Influence of mate drinking, hot beverages and diet on esophageal cancer risk in South America.

To estimate the effects of consuming hot beverages, including mate (an infusion of the herb Ilex paraguayensis), tea, coffee and coffee with milk, and other food items on esophageal cancer risk, we analyzed data from 830 cases and 1,779 controls participating in a series of 5 hospital-based case-control studies of squamous-cell carcinoma of the esophagus conducted in high-risk areas of South America. After adjusting for the strong effects of tobacco and alcohol consumption, both heavy mate drinking (>1 l/day) and self-reported very hot mate drinking were significantly associated with esophageal cancer risk in men and women. The magnitude and strength of the association for mate amount and, to a lesser extent, mate temperature were higher for women than men. The joint effects of mate amount and mate temperature were more than multiplicative, following a statistically significant synergistic interaction (p = 0.02) which was particularly evident among heavy drinkers (>1.50 l/day) of very hot mate (odds ratio = 4.14, 95% confidence interval: 2.24-7.67) compared to light drinkers (<0.50 l/day) of cold/warm/hot mate. Consumption of other very hot beverages, such as tea and coffee with milk but not coffee alone, was also significantly associated with an increased risk, in the 2- to 4-fold range. Statistically significant protective associations were identified for high consumption of vegetables, fruits, cereals and tea. In contrast, frequent consumption of meat, animal fats and salt was associated with a moderately increased risk. This pooled analysis adds evidence for a carcinogenic effect of chronic thermal injury in the esophagus induced by the consumption of very hot drinks, including mate. Our study further confirms the protective effect of a dietary pattern characterized by daily consumption of fruits and vegetables and low consumption of meat and animal fats.

Human papillomavirus infection and invasive cervical cancer in Paraguay.

HPV types 16 and 18 have been categorized as human carcinogens based on their strong associations with cervical cancer in previous case-control studies. Recent IARC studies in the Philippines, Thailand and Morocco show strong associations between invasive cervical cancer and less common HPV types, including HPV 31, 33, 45, 51, 52 and 58. We present results of a further IARC case-control study conducted in Asunción, Paraguay, to examine the association between specific HPV types and invasive cervical cancer as well as risk factors other than HPV. One-hundred thirteen incident histologically confirmed invasive cervical cancer cases and 91 age-matched hospital controls were recruited. A standardized questionnaire was administered to investigate known and suspected risk factors for cervical cancer. For HPV status determination, cervical biopsy specimens from case subjects and exfoliated cervical cells from control subjects were obtained. HPV DNA was ascertained using a GP5+/6+ PCR-based assay capable of detecting more than 33 HPV types. Overall HPV prevalence was 97% in the cervical cancer cases and 20% in the control subjects. As a single infection, HPV 16 was the predominant type with a prevalence of 48% among case subjects and 5.5% among control subjects. Significant associations with the risk of cervical cancer were detected as follows: any HPV type (OR = 114; 95% CI: 36-361); HPV 16 (OR = 910); HPV 18 (infinite OR); HPV 31 (OR = 110); HPV 33 (OR = 261); HPV 45 (OR = 129); and HPV 58 (OR = 36). In the multivariate model, risk factors other than HPV significantly associated with cervical cancer risk were a higher number of lifetime sexual partners, lower educational status and never having had a Pap smear. Strong associations were found between invasive cervical cancer and specific HPV types 16, 18, 31, 33, 45 and 58.

Independent and joint effects of tobacco smoking and alcohol drinking on the risk of esophageal cancer in men and women.

To estimate the independent and joint effects of tobacco smoking and alcohol drinking, we analyzed data from a series of 5 hospital-based case-control studies of squamous-cell carcinoma of the esophagus conducted in high-risk areas in South America. A total of 830 case subjects and 1779 control subjects were included in the pooled analysis. All exposure characteristics of amount, duration, cessation and type of alcohol and tobacco consumed were strongly related to esophageal-cancer risk in both sexes. Women had the same exposure profile as men, but the magnitudes of the associations were lower than were those among men. Black-tobacco smoking was associated with a 2-fold increased risk as compared with the smoking of blond or mixed tobacco. Quitting either of the 2 habits significantly reduced esophageal-cancer risk. Alcohol and tobacco alone were strongly related to the risk of esophageal cancer, even in the absence of the other exposure. A history of simultaneous exposure to cigarette smoking and alcohol drinking had a strong multiplicative effect on risk. Concomitant exposure to heavy alcohol drinking and black-tobacco smoking identified the group with the highest risk for developing esophageal cancer (odds ratio = 107). A synergistic interaction was found between the 2 habits, particularly in women and in moderately exposed men. Moderate cigarette smoking without drinking and moderate alcohol drinking without smoking had a negligible effect on esophageal-cancer risk. However, simultaneous exposure to the same moderate amounts increased the risk 12- to 19-fold in men and in women respectively. The overall public-health implications of these findings are obvious for a tumor that depends on preventive strategies for its control.

Plantar melanoma: a case-control study in Paraguay.

In Paraguay, the plantar surface of the foot is the most common site for malignant melanoma, as it is in several other populations worldwide, most notably in those of African descent. Here, we report the results of the first case-control study of plantar melanoma, carried out in Paraguay. Sixty incident, histologically confirmed cases of plantar melanoma and 256 hospital controls were recruited in 11 hospitals throughout the country during 1988-93. Information was collected on general demographic, social, and lifestyle variables, on external exposures of feet (shoewear, work activities, injuries), and on some constitutional factors (skin, eye and hair color, and pigmented lesions of the feet). Few of the factors examined appeared to be associated with the risk of plantar melanoma. Adjusted for possible confounders, the strongest association was found for reported injuries (odds ratio [OR] = 40.9, 95 percent confidence interval [CI] = 14.8-112.7) and for occurrence of naevi on the soles (OR = 5.9, CI = 2.5-14.3). Walking barefoot did not seem to contribute to the risk although an outdoor workplace was associated with an increased melanoma occurrence (OR = 2.3, CI = 1.1-4.8). Future studies should be aware of problems of recall bias with respect to previous injuries, and ensure that evaluation of pigmentation of the sole is carried out blind to case/control status.

Hot and cold mate drinking and esophageal cancer in Paraguay.

A hospital-based case-control study, including 131 cases of esophageal cancer and 381 controls, was carried out in Paraguay to investigate the role of hot and cold mate drinking in esophageal cancer risk. Detailed information on mate drinking and on tobacco smoking, alcohol consumption, and dietary habits was obtained by interview. Amount and duration of cold or hot mate drinking were not associated with esophageal cancer risk. However, temperature at which mate was drunk was significantly associated with risk. As compared to drinkers of warm or hot mate, drinkers of very hot mate had an increased risk for esophageal cancer even after adjusting for the strong effects of alcohol and tobacco consumption (adjusted odds ratio = 2.4; 95% confidence interval = 1.3-4.3). This effect seemed to be mainly due to the temperature at which mate cocido (one of the two ways in which hot mate is prepared) was drunk (odds ratio = 6.5; 95% confidence interval = 3.2-12.2). As expected, very strong dose-response associations were found for alcohol consumption and cigarette smoking. After correcting for these and the consumption of other food groups, diets rich in fats and red meats, especially beef, were associated with esophageal cancer risk. In conclusion, the findings from this study suggest that cold mate drinking does not increase the risk of esophageal cancer. This study identifies the very hot temperature at which mate is drunk, and not the amount or the duration, as an important risk factor for esophageal cancer in this population. Alcohol drinking and tobacco smoking remain, nevertheless, the main risk factors for esophageal cancer in Paraguay.

Epidemiology of complete hydatidiform mole in Paraguay.

The incidence of complete hydatidiform mole in Paraguay is 0.23-0.25 cases per 1,000 pregnancies. The incidence is as high at the extremes of reproductive age as at other ages. That finding is at variance with long-accepted concepts. The incidence in the 15- to 19-year age group is lower than earlier, with a greater use of contraceptives in the older group. Complete mole is a rare condition with a high incidence in certain geographical areas.

Multicentric angiofollicular lymph node hyperplasia associated with a solitary osteolytic costal IgG lambda myeloma. POEMS syndrome in a South American (Paraguayan) patient.

We report the case of a 46-year-old woman presenting with a disorder characterized by the association of multicentric Castleman's disease, organomegaly, a solitary IgA lambda myeloma with lytic bone lesions but no serum monoclonal peak, peripheral neuropathy and skin changes. This unusual association resulted in an incomplete form of that peculiar multisystem syndrome described under a variety of names: Crow-Fukase syndrome, Shimpo's syndrome, Takatsuki's syndrome, PEP syndrome or POEMS syndrome. The possible relationship between localized and multicentric Castleman's disease with myeloma or extramedullary plasmacytoma on one hand and on the other hand with polyneuropathy and the other symptoms of the POEMS syndrome is discussed.

[Cancer of the thyroid in an area of endemic goiter. "Papillarization" with prophylactic iodization]. / Cancer de la thyroïde en zone de goitre endémique. "Papillarisation" avec l'iodisation prophylactique.

Thyroid cancer is characterized by endemic goiter, usually where the insufficiency of iodine has lasted a long time. Prophylactic iodization produces a change in the histological distribution of the thyroid carcinomas, with a significant increase in the quantity of papillary carcinomas and a reduction in that of follicular carcinomas. In autopsies, occult carcinomas of minimal size are, with few exceptions, papillary. The change which is produced by iodization allows us to say that papillary carcinoma is the original carcinoma in the thyroid gland and that the follicular carcinoma, differentiated or less differentiated, may be evolutionary stages derived from the insufficiency of iodine. The insufficiency of iodine would be an active factor in the evolution of papillary thyroid cancer. This reasoning is maintained by the inversion of frequency of thyroid cancer in iodized areas and the remarkable regularity of findings of papillary cancer in autopsies.

Malignant trophoblastic disease in paraguay.

The incidence of malignant trophoblastic diseases from 1960 to 1969 and 1970 to 1974 in the population of Parguay was low, as shown by the analysis of unselected hospital admissions as compared to the total population. Paraguay showed disease characteristics comparable to those of developing countries where malignant diseases of the trophoblast have elevated frequencies. The apparently high frequencies in lower socioeconomic groups appear to be due to the fact that these groups make up a large proportion of the hospital population. The hardship of poverty predisposes to the hospital concentration of pathologic pregnancies from around the country and to the home delivery of grossly normal gestations. Thus, a biased incidence of diseases results.

PIP: The incidence of malignant trophoblastic diseases in the population of Paraguay was low in the 1960-1969 and 1970-1974 periods, as shown by the analysis of unselected hospital admissions as compared to the total population. The Institute of Pathologic Anatomy and the National Tumor Registry in Asuncion, Paraguay, receive material from the entire republic. Cases are reported from all the affiliated centers. During the 10 years from 1960-1970, 227 cases of hydatidiform mole, 21 of choriocarcinoma, and 13 of chorioadenoma destruens were registered. In the 1970-1974 period, 121 hydatiform moles, 10 choriocarcinomas, and 3 chorioadenomas destruens were registered. To determine the incidence of choriocarcinoma and chorioadenoma destruens for Paraguay, the number of cases was divided by the number of total pregnancies, calculated from an analysis of 1965 estimates and related to the fertility rate in each age group. Using the estimated number of total pregnancies per year in Paraguay, there is 1 choriocarcinoma per 43,489 pregnancies and 1 chorioadenoma destruens per 70,252 pregnancies if all the probable pregnancies in the period of fertility are considered. Thus, the incidence of choriocarcinoma and chorioadenoma destruens is 0.229 and 0.142/1000 pregnancies, respectively. This means that 25.22 hydatidiform moles occur for 1 carcinoma or 17.46 hydatidiform moles for 1 chorioadenoma destruens. There were no differences in the calculations for the 1970-1974 period. Vaginal metastases were found in 28.57% of the patients with choriocarcinoma.

Gastrointestinal pathology in South America.

Non-neoplastic gastrointestinal disease in South America is largely related to environmental conditions. Parasitic disorders, including Chagas' disease with megacolon, predominate in endemic regions. Common enteritides of various etiologie are frequent, whereas appendicits, diverticulosis of the colon, ulcerative colitis and Crohn's disease are extremely rare. There was no appendicitis in native Indians of Paraguay.

Epidemiological aspects of hydatidiform mole in the Republic of Paraguay (South America).

A total of 227 hydatidiform moles was recorded in Paraguay over a 10-year period (1960 to 1969). Using demographic studies, the annual incidence of hydatidiform moles was calculated as 0.229 per 1000 pregnancies or 1 per 4369 pregnancies, with the highest incidence occurring at the extremes of reproductive life.

[Paracoccidioidomycosis: an epidemic in the Republic of Paraguay, the center of South America]. / Paracoccidioidomicosis - epidemiología en la República del Paraguay, Centro de Sud América

The investigation done on the frequency or incidence of Paracoccidioidomycosis in the Republic of Paraguay, with the cases appeared and registered in the Institute of Pathology of Asuncion, presents an incidence rate of 0.46 per 100,000 in the total population; 0.52 per 100,000 in the population at risk. Considering the exposed masculine population the rate is 1.03 per 100,000 and for the feminine 0.02 per 100,000. The age group most affected is within the 50-54 year range with 3.54 per 100,000, the highest rate of all the groups studied. These are the incidence in a strongly exposed population which is controlled and well known. The period of 10 years (1960/69) which has been chosen for this investigation, shows a frequency of the mixed type (lymphatic-visceral or lymphoma-type) which reaches 25% of the total, and a low frequency for the pulmonary form which reaches a mere 12.5%. The mucocutaneous lesion with the involvement of the regional lymph nodes is the dominating form. Considering three consecutive 5 year periods between 1960 to 1974, no cases with proved pulmonary involvement were found until 1964; from 1965 to 1969 the percentage of pulmonary lesions in all the cases considered was 23.0% and from 1970 to 1974 reached to 38.4%. However, mucocutaneous and the lymphatic-visceral or mixed forms do not show significant variations. The rats are small and represent the incidence of this mycosis. It is suggested that a failure of the immunologic system would be found in those affected by the disease and there would be a strong resistence in the majority of the population exposed or within the endemic area of the infection.

[Human sparganosis. Report of a probable 7th case in South America and review of the subject]. / Sparganose humaine. Présentation du probable septième cas en Amérique du Sud et révision du sujet

A case of human Sparganosis was found in a resident of Northern Argentina, Pozo del Tigre, Province of Formosa, a zone bordering with the Republic of Paraguay, with a histopathologic diagnosis realized in the Pathologic Anatomy Institute of Asunción. In the Republic of Paraguay Dyphyllobrotium has been observed in cats, which reveals the existence of intermediaries (rats, water snakes, birds, etc.) as sources of human infection. Northern Argentina, where the patient always lived, is a geographic zone similar to the Republic of Paraguay. This case is the first described in the inland zone of the continent (and probably the seventh case in the Southamerican continent). The patient's profession, called "tropero" (cowherd), required that he had close contact with the land or a habitual exposure to nature, which does not exclude the probability of infection related to the patient's professional habitat.