RESUMEN
Although the risk of progression from monoclonal B-cell lymphocytosis (MBL) to chronic lymphocytic leukemia (CLL) has been well characterized, it is unknown whether other common complications associated with CLL, such as increased risk of infection, occurs in individuals with MBL. We used the Mayo CLL database to identify cohorts of individuals with newly diagnosed MBL (n=154) or newly diagnosed CLL (n=174) who resided within 50 miles of Mayo Clinic. A cohort of 689 adult patients seen for a general medical examination who resided within 50 miles of Mayo clinic and who enrolled in a case-control study of non-Hodgkin lymphoma (NHL) was used as a comparison cohort. Hospitalization with infection was more common among individuals with MBL (25/154; 16.2%), and CLL (32/174; 18.4%) than controls (18/689; 2.6%). On pooled multivariable Cox proportional hazards analysis of all 1017 patients (controls, MBL and CLL), male sex (hazards ratio (HR)=2.3; P=0.002), major co-morbid health problems (HR=1.7, P=0.04), the presence of CLL (HR=3.2, P<0.001), treatment for progressive CLL (HR=2.4, P=0.001) and the presence of MBL (HR=3.0, P=0.001) were independently associated with risk of hospitalization for infection. These results suggest the risk of serious infection in clinical MBL is substantially greater than the risk of progression requiring treatment.
Asunto(s)
Infecciones/etiología , Leucemia Linfocítica Crónica de Células B/complicaciones , Linfocitosis/complicaciones , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Comorbilidad , Femenino , Estudios de Seguimiento , Hospitalización , Humanos , Infecciones/mortalidad , Leucemia Linfocítica Crónica de Células B/diagnóstico , Leucemia Linfocítica Crónica de Células B/mortalidad , Linfocitosis/diagnóstico , Linfocitosis/mortalidad , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Prospectivos , Factores de Riesgo , Tasa de Supervivencia , Adulto JovenRESUMEN
OBJECTIVE: To describe a medical student-run smoking intervention clinic, report initial outcomes, and assess medical student competence in smoking intervention counseling. PATIENTS AND METHODS: Volunteer medical students of Mayo Medical School in Rochester, Minn, staffed a free smoking intervention clinic in conjunction with the Salvation Army Free Acute Care Clinic between December 1997 and January 1999. Patients received a comprehensive intervention for smoking that comprised counseling, frequent follow-up contact, and pharmacologic therapy, including bupropion and nicotine replacement. Eighty-eight patients seen during the first 13 months of the clinic's operation and 30 medical student volunteer counselors were included in the study. Patients were contacted via telephone to assess 6-month self-reported smoking abstinence. Medical student counselors completed a self-assessment questionnaire surveying competence before and after working in the clinic. RESULTS: The 6-month self-reported smoking abstinence rate was 18% (95% confidence interval, 11%-28%). Twelve of 14 medical students completing the survey reported improved competence in smoking intervention counseling. CONCLUSIONS: A comprehensive smoking intervention program provided by medical students yielded smoking abstinence rates comparable to other treatment programs. Medical students believed they improved their smoking cessation counseling skills.
Asunto(s)
Cese del Hábito de Fumar , Estudiantes de Medicina , Adulto , Consejo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Minnesota , Servicios de Salud para Estudiantes/organización & administraciónRESUMEN
Two cases of death associated with amyl nitrite are discussed. An attempt is made to highlight its noxious properties and the difficulty in attributing death to it when inhaled.
Asunto(s)
Nitrito de Amila/envenenamiento , Muerte Súbita/patología , Homicidio/legislación & jurisprudencia , Administración por Inhalación , Administración Oral , Adulto , Autopsia , Causas de Muerte , Humanos , Masculino , Persona de Mediana EdadRESUMEN
This paper illustrates the remarkable fall of carbon monoxide poisoning due to the abolition of coal gas in the 1970 era and a corresponding decrease in suicide deaths. It enfolds the varying forms of suicide and accident according to age, sex and circumstance.
Asunto(s)
Intoxicación por Monóxido de Carbono/epidemiología , Accidentes Domésticos/estadística & datos numéricos , Adolescente , Adulto , Anciano , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Suicidio/epidemiología , Reino UnidoAsunto(s)
Asma/patología , Muerte Súbita/patología , Bronquios/patología , Humanos , Pulmón/patologíaRESUMEN
A 19-year-old man, mentally handicapped but physically well, died within 2 days of onset of an acute episode of gastrointestinal upset and "haematuria." Autopsy and microscopy suggested a haemolytic episode and family studies showed haemolytic anemia due to glucose-6-phosphate dehydrogenase deficiency, which was almost certainly present in the deceased.
Asunto(s)
Anemia Hemolítica/genética , Adulto , Anemia Hemolítica/etiología , Anemia Hemolítica/mortalidad , Anemia Hemolítica/patología , Deficiencia de Glucosafosfato Deshidrogenasa/complicaciones , Deficiencia de Glucosafosfato Deshidrogenasa/genética , Heterocigoto , Humanos , Discapacidad Intelectual/complicaciones , MasculinoAsunto(s)
Adenocarcinoma/etiología , Polvo/efectos adversos , Senos Etmoidales , Enfermedades Profesionales/etiología , Neoplasias de los Senos Paranasales/etiología , Madera , Adenocarcinoma/patología , Anciano , Senos Etmoidales/patología , Humanos , Masculino , Persona de Mediana Edad , Enfermedades Profesionales/patología , Neoplasias de los Senos Paranasales/patologíaRESUMEN
A retrospective autopsy survey of 583 cases of ruptured berry aneurysm over a period of 25 years with reference to incidence, circumstances and predisposing factors. Over half of the deaths occurred in the 50-80 year age group, the overall male/female ratio being 2:3, the aneurysms being predominately on the middle and anterior cerebral arteries. Most deaths occurred in the home environment without precipitating factors, one fifth being sudden and unexpected in nature. There was no connection between physical trauma and ruptured aneurysm and no instance of a criminal or civil charge. Autopsy and dissection of the cerebral vessels is vital to diagnosis, particularly when deaths are unexpected in nature.
Asunto(s)
Aneurisma Intracraneal/patología , Adolescente , Adulto , Factores de Edad , Anciano , Arteriosclerosis/complicaciones , Cardiomegalia/complicaciones , Circulación Cerebrovascular , Niño , Femenino , Medicina Legal , Humanos , Aneurisma Intracraneal/complicaciones , Aneurisma Intracraneal/fisiopatología , Masculino , Persona de Mediana Edad , Rotura EspontáneaRESUMEN
A study of 201 cases of death due to hanging, 95% being suicidal in nature and 5% being accidental; in addition there was one judicial hanging. The majority of deaths were in persons over 50 years of age, males predominating particularly in the 50- 60 age group. In contrast to the Registrar General's annual returns for suicide which show a steady decrease over the past 20 years, deaths due to hanging have increased considerably, particularly in the last decade. This trend could be related to the dramatic fall in carbon monoxide poisoning and more circumspect prescribing of barbiturate drugs.
Asunto(s)
Medicina Legal , Accidentes , Adolescente , Adulto , Anciano , Autopsia , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Suicidio/epidemiología , Reino UnidoRESUMEN
This is a review of the current status of legal and illicit abortions in England as related to the changes brought on by the United Kingdom Abortion Act or 1968. The controversy surrounding the Act is discussed, and a review of mortality statistics is also included.
Asunto(s)
Aborto Criminal , Aborto Legal/mortalidad , Aborto Terapéutico/mortalidad , Adolescente , Femenino , Humanos , Embarazo , Primer Trimestre del Embarazo , Segundo Trimestre del Embarazo , Reino UnidoAsunto(s)
Atención Primaria de Salud , Refugiados , Adulto , Niño , Femenino , Humanos , Masculino , Zambia/etnología , ZimbabweAsunto(s)
Suicidio/epidemiología , Adulto , Factores de Edad , Anciano , Autopsia , Femenino , Humanos , Londres , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
A four-man pediatric group in private practice instituted a rotation system whereby one of the four worked entirely in the hospital for a week at a time. That physician also took all emergency nighttime calls. The program was evaluated for patient acceptance and for income production.