OBJECTIVE: Our goal was a prospective follow-up of Barrett's esophagus to determine what clinical, endoscopic, and histological features at the time of initial diagnosis are predictive of the development of Barrett's adenocarcinoma or multifocal high-grade dysplasia (HGD). METHODS: Newly diagnosed Barrett's esophagus patients were prospectively followed with a standardized endoscopic and bioptic surveillance protocol. Features examined by χ2 and stepwise logistic regression analyses as potential predictors the development of multifocal HGD or adenocarcinoma included age, length of Barrett's segment, hiatal hernia size, severity of dysplasia at diagnosis, severity of dysplasia during surveillance, and type of long-term medical treatment. RESULTS: One hundred-eight Barrett's patients have had follow-up ranging from 12 months to 101 months (mean ± SD, 39.9 ± 20.8 months), for a total of 361.8 patient-years. Overall, five patients developed multifocal HGD and five developed adenocarcinoma. The incidence of adenocarcinoma as well as multifocal HGD was 1 per 71.9 patient-years. χ2 analysis showed progression to Barrett's multifocal HGD/adenocarcinoma was associated with hiatal hernia (p= 0.02), the length of Barrett's (p= 0.001), the presence of dysplasia at diagnoses (p < 0.001) or anytime during surveillance (p < 0.001). Stepwise logistic regression analysis revealed progression to multifocal HGD or adenocarcinoma was significantly and independently associated with presence of dysplasia at diagnosis (p < 0.0001) or anytime during follow-up (p < 0.03), hiatal hernia size (p < 0.02, for hernia ≥3 cm), and length of Barrett's (p= 0.009, >2 cm). CONCLUSIONS: Endoscopic and histological features of Barrett's esophagus patients at initial diagnosis are predictive of risk of progression to cancer.
SYNOPSIS To clarify the actual components of headache syndromes and their possible association with other types of pain and psychological traits, 177 patients subject to severe intermittent headaches were studied. Data used were derived from (a) a de tailed headache questionnaire, (b) a second questionnaire concerning the occurrence of other pain and of feelings of good or ill health, (c) the Cornell Medical Index. A stepwise regression analysis was run for each headache characteristic using data from the pain questionnaire and the Cornell Medical Index as independent variables. Interesting associations of variables were (1) increased frequency of headache with male sex and increased duration of headache with female, (2) inability to carry on work load during headache, headache preceded by spots before the eyes, weakness of arm or leg preceding headache were all positively associated with history of fainting. Neither vomiting with headache, nor unilaterality of pain was associated with any other pain variables. Also of note was the fact that there was no evidence by testing of increased psychological disturbance in patients with back pain. The results suggest that the “tension headache‐neurosis” concept is dubious, that autonomic instability as evidenced by fainting is indeed important in some headache syndromes, and that new headache syndromes need to be defined.
During 1956–65, 57 per cent of the 2090 physicians practicing in Kansas participated in courses of continuing education offered by the State University. Approximately 7 per cent of all physicians took half of all hours of continuing education recorded. Participation was influenced by the type of practice and was related to graduation from the State Medical School, access to circuit centers, status of recent graduate and practice of a specialty. Participation was unrelated to class standing in medical school and was lowest in metropolitan areas. Maternal and perinatal death rates in various areas were unrelated to hours of continuing education in obstetrics and pediatrics taken by local physicians. Similarly, high regional rates for certain operative procedures were not associated with increased use of appropriate postgraduate education.
OBJECTIVE: This study was undertaken to prospectively determine the prevalence of gastric H. pylori infection in Barrett's esophagus and Barrett's complicated by dysplasia or adenocarcinoma. METHODS: The prevalence of H. pylori was determined in Barrett's esophagus patients compared to a control population of patients with gastroesophageal reflux disease (GERD) only. All patients had a minimum of 10 gastric surveillance biopsies obtained. H. pylori colonization was determined upon the basis of hematoxylin and eosin and use of a modified Giemsa and or Steiner's silver stain of all gastric biopsy specimens. RESULTS: Two hundred and eighty-nine Barrett's patients and 217 GERD control patients were included in the study. H. pylori was found in 95/289 (32.9%) of the Barrett's patients, compared with 96/217 (44.2%) of the GERD controls (NS). Forty-seven of the Barrett's patients had low-grade dysplasia/indefinite dysplasia, 14 high-grade dysplasia, and 20 Barrett's adenocarcinoma. When Barrett's was subgrouped according to absence of dysplasia, and presence of low-grade dysplasia, high-grade dysplasia, or adenocarcinoma, H. pylori prevalence was found to be significantly less for patients with Barrett's high-grade dyslpasia (14.3%) and adenocarcinoma (15.0%) versus patients with GERD alone (44.2%), Barrett's alone (35.1%), or Barrett's with low-grade dysplasia (36.2%) (p = 0.016). This difference could not be explained by differences between Barrett's esophagus patients infected with H. pylori and those who were not with respect to gender, smoking history, alcohol consumption, use of proton pump inhibitor, or length of Barrett's mucosa. CONCLUSIONS: Barrett's high-grade dysplasia and adenocarcinoma are significantly more prevalent in patients who are not infected with H. pylori. H. pylori appears to have a protective effect against the development of Barrett's adenocarcinoma.
As part of a large collaborative study, the authors administered a pretested questionnaire to 62 childhood and adolescent cancer survivors and 62 same-sex sibling controls. The authors requested information regarding attained adult height on the questionnaire. Mean adult height of survivors (172.2 cm) was less than that of controls (174.1 cm), at a borderline significant difference of p = 0.0757. Multivariate analysis examined four potential, independent variables as possible predictors of this difference. The presence of brain tumor (vs. nonbrain tumor) (p < .0001) and diagnosis at an early age (≤ 8 years vs. 9-15 years) (p = .05) were factors significantly related to the differential; sex of patient and type of therapy were not. Our findings thus identify malignancy site and age at diagnosis as important predictors of adult height in childhood and adolescent cancer survivors.
SYNOPSIS The frequency of vestibular symptoms in 104 headache patients during the headache‐free phase was studied. The group was comprised of 84 patients with migraine (24 classical and 60 common) 12 with tension and 8 with cluster headache. Fifty‐four headache‐free subjects served as controls. All the participants filled out a vestibular symptom questionnaire. Patients with classical migraine reported significantly more vestibular symptoms than the controls. Specifically they had more dizzy spells (r = 0.002) and vertigo episodes (r = 0.01) not associated with the headache. They also had more frequent motion sickness spells. Of the classical migraine patients reporting motion sickness 87% experienced it at least once in 6 weeks compared to only 11% of the controls. Classical migraine patients also probably have an especially “sensitive” vestibular system, as evidenced by increased tendency to visual vertigo (r = 0.005) and significantly increased dizziness when they themselves were spinning. The common migraine patients showed a tendency to vestibular impairment that was not statistically significant. Recent findings of vestibular function abnormalities in this group may suggest an evolving dysfunction that is not yet symptomatic. Patients with tension and cluster headache did not differ from the controls in all the vestibular symptoms studied. In summary, our findings indicate clearly a vestibular impairment in classical migraine. The relation to “benign recurrent vertigo,” problems in the relationship of the occurrence of motion sickness to migraine and the possible mechanism causing the vestibular dysfunction are discussed.
The semantic differential, a means of measuring attitudes, was administered to 178 fourth grade students to compare attitudes toward health. One school was composed almost entirely of black children from the inner city, the other contained white children from upper middle class homes. When the children were divided into the two groups by sex, differences between the groups were not statistically significant but there were highly significant differences between the races. Generally, white children held more positive attitudes toward health personnel and health institutions than black children, while on the average black children were less concerned about sickness than white children. Whether these differences in attitude are in some way ethnically determined or based rather on a "culture of poverty" could not be determined from this study.
Diurnal rhythm of plasma cortisol, of psychological state, and of pain was measured for two days in 25 migraine patients and eight control subjects. Fourteen of the migraine patients and none of the controls displayed either consistently high plasma cortisol or an occasional aberrant peak. Abnormal psychological findings, particularly depression, were found in the Minnesota Multiphasic Personality Inventory only in migraine patients with abnormal plasma cortisol levels. Neither psychological abnormality nor pain seemed the single cause of elevation of plasma cortisol.
