Tumoral calcinosis: radiologic-pathologic correlation.

OBJECTIVE: Tumoral calcinosis is a frequently misdiagnosed disorder. This study details the radiologic and pathologic characteristics of tumoral calcinosis that distinguish it from most other entities. DESIGN: Radiologic and pathologic findings, and medical records of 12 patients with tumoral calcinosis were reviewed and compared with equivalent information about 5 patients with other calcified lesions. PATIENTS: The 12 patients ranged in age from 15 months to 62 years. Six had idiopathic tumoral calcinosis and 6 had secondary tumoral calcinosis. RESULTS AND CONCLUSIONS: A consistent radiologic finding for tumoral calcinosis was a dense calcified mass that was homogeneous except for a "chicken wire" pattern of lucencies, which correlated histologically with thin fibrous septae. Other characteristics of tumoral calcinosis included fluid-calcium levels, demonstrated in four patients, and smooth osseous erosions adjacent to the mass, demonstrated in three patients. Five cases of tumoral calcinosis were originally confused with other calcified lesions; however, the radiologic findings were characteristic of tumoral calcinosis in retrospect.

Vasectomy, cigarette smoking, and age at first sexual intercourse as risk factors for prostate cancer in middle-aged men.

A population-based case-control study was conducted in men aged 60 or less to assess the risk of prostate cancer associated with vasectomy and other factors. Data were obtained from 216 case-control pairs by telephone interviews; this number represented 55% of all eligible cases. The matched pairs relative risk (RR) for vasectomy in ever married men was 1.4 with a 95% confidence interval (CI) of 0.9-2.3. There was a positive association between the number of years since vasectomy and prostate cancer risk (1-sided P = 0.01). Early age at first sexual intercourse was associated with increased prostate cancer risk (age less than 17 vs. 21+, RR = 2.3, 95% CI = 1.3, 4.0) but there were no consistent associations with number of sexual partners or frequency of sexual intercourse. Cigarette smoking was also associated with increased risk of prostate cancer (RR = 1.9, 95% CI = 1.2, 3.0) and there was a positive dose-response relationship with years of smoking (1-sided P = 0.001). We discuss the possible implication of the low response rate on each of these findings. To determine whether the association with vasectomy might have a hormonal basis, we compared levels of testosterone (T) and testosterone binding globulin-binding capacity (TeBG-bc) in 33 of the vasectomized control men with levels in 33 non-vasectomized controls of the same age, weight and height. T levels were higher in vasectomized than in non-vasectomized controls (1-sided P = 0.06). The ratio of T to TeBG-bc (an index of bioavailable T) was 13.5% higher in vasectomized men (1-sided P = 0.03).

The incidence of duodenal and gastric ulcers in a large health maintenance organization.

We report the incidence of peptic ulcers (duodenal, pyloric canal, gastric, and combined) verified by radiologic, endoscopic, or surgical evidence in a large Health Maintenance Organization (HMO) in Los Angeles, California. For members age 15 and above, the peptic ulcer incidence rate was 0.86 per 1,000 person-years (p-y) (males 1.10, females 0.63). The male to female sex ratio was 1.7. Two hundred twenty-two duodenal, 17 pyloric canal, 89 gastric, and 21 combined first-time diagnosed ulcer cases were located. For duodenal and pyloric canal ulcer, the incidence rate for members age 15 and above was 0.58 per 1,000 p-y (males 0.76, females 0.40). For gastric ulcer, the incidence rate for members age 15 and above was 0.21 per 1,000 p-y (males 0.23, females 0.18). The combined ulcer rate was 0.05 per 1,000 p-y (males 0.07, females 0.02). Gastric ulcer rates were two times higher in 1980 than in 1977. Peptic ulcer age-specific incidence rates increased with age. Incidence rates were much lower than those reported in previous studies, but the gastric to duodenal ulcer ratio and the age and sex relation to ulcer incidence were similar to those previously reported.

A reappraisal of time trends in ulcer disease: factors related to changes in ulcer hospitalization and mortality rates.

There has been a dramatic decline in reported hospitalization and mortality rates for peptic ulcer disease in the past two decades. Data from the National Center for Health Statistics and from the Commission on Professional and Hospital Activities were examined to determine the cause(s) for this decline. Gastric and duodenal ulcer mortality rates decreased by 58 per cent and 68 per cent, respectively, from 1962 to 1978; changes in criteria for selecting the underlying cause of death might account for some of this apparent decrease. Hospitalization rates for duodenal ulcers decreased nearly 50 per cent from 1970 to 1978, but hospitalizations for gastric ulcers did not decrease. During this same time period, hospitalizations for peptic ulcers as one of the "all listed" causes remained stable, and hospitalizations for a closely related diagnosis, gastritis/duodenitis, increased. Changes in coding practices, hospitalization criteria, and diagnostic procedures appear to have contributed to the decline in reported hospitalization and mortality rates for peptic ulcer disease.

The effects of marijuana use during pregnancy. II. A study in a low-risk home-delivery population.

Results from a previous epidemiologic study indicate that marijuana use near term may elevate risk of abnormal progress of labor and meconium staining. We conducted a study of the association of self-reported marijuana use and perinatal problems in a series of 313 women enrolled in a home-birth center. The 41 marijuana users were similar to non-users with respect to most potentially confounding factors, but users had lower mean income and exhibited more tobacco and alcohol use during pregnancy than non-users. Users experienced slightly elevated rates of dysfunctional labor (43% vs. 35% in non-users), precipitate labor (13% vs. 8%) and meconium staining (17% vs. 13%); differences with respect to most other outcomes were smaller or nonexistent. The observed differences were smaller in both relative and absolute terms than those reported by the earlier study, and were little changed upon adjustment for potentially confounding factors (including alcohol use, cigarette use, parity and income). After accounting for statistical variation, the results appear consistent with the earlier findings but further research is recommended.

Hospitalization and mortality rates for peptic ulcers: a comparison of a large health maintenance organization and United States data.

Hospital discharge and mortality rates for peptic ulcer disease from 1970-1980 for a large Health Maintenance Organization, the Kaiser-Permanente Medical Care Program of Southern California, are compared with the corresponding rates for the United States. The Kaiser-Permanente Medical Care Program hospitalization and mortality age-adjusted rates for ulcers are well below the national rates. In comparison with the 25%-31% decline in the national ulcer hospitalization rate, the Kaiser-Permanente Medical Care Program rate has been relatively stable. Most of the decline in national ulcer hospitalizations is due to a decrease in hospitalizations for uncomplicated cases. The Kaiser-Permanente Medical Care Program uncomplicated hospitalization rates are less than 25% of the national rate after age-adjustment and have been relatively stable over time. The age-adjusted Kaiser-Permanente Medical Care Program rates for ulcers with hemorrhages and perforations are 77% of the national data. These data suggest that part of the decline in national hospitalization rates for peptic ulcer disease may be due to changes in medical management and hospitalization criteria. In addition, this study supports the results of other studies which show that hospitalization rates are lower in Health Maintenance Organizations than in non-Health Maintenance Organizations with no apparent adverse impact on outcome.