Biomedical subjects
Publications and source records attributed to W Hadden.
Minocycline-induced dark pigmentation has been described affecting the oral cavity (teeth, mucosa, alveolar bone), skin, nails, eyes and thyroid. To date, there is no report of other bones being affected. We report a case of black pigmentation of the acromian in a patient who had used minocycline on a long-term basis for acne rosecea. Biopsy of the iliac crest revealed that the pelvis was also affected.
OBJECTIVES: This study assessed whether aggregate-level measures of socioeconomic status (SES) are less biased as proxies for individual-level measures if the unit of geographic aggregation is small in size and population. METHODS: National Health Interview Survey and census data were used to replicate analyses that identified the degree to which aggregate proxies of individual SES bias interpretations of the effects of SES on health. RESULTS: Ordinary least squares regressions on self-perceived health showed that the coefficients for income and education measured at the tract and block group levels were larger than those at the individual level but smaller than those estimated by Geronimus et al. at the zip code level. CONCLUSIONS: Researchers should be cautious about use of proxy measurement of individual SES even if proxies are calculated from small geographic units.
In order to determine if infants with clinical micrognathia identified in the newborn period have smaller upper airways than do normal infants, and if their airway size is related to risk of later apnoea, respiration-timed upper airway radiographic measurements were performed in 21 asymptomatic neonates with clinical micrognathia. Their radiographic measurements were compared with those of a previously reported cohort of 35 normal infants. The micrognathic infants and a control group of 27 infants referred for parental anxiety were followed for 6 mo on home apnoea monitors. Sleep apnoea at home requiring stimulation by the parents occurred in 6 of 7 infants with micrognathia associated with craniofacial anomalies, 9 of 14 (64%) infants with isolated micrognathia, but only 1 of the 27 control infants (p < 0.001). Upper airway measurements at term of the infants with isolated micrognathia who later experienced apnoea were significantly smaller than either those of normal infants (p < 0.01) or of micrognathic infants who did not have apnoea requiring stimulation (p < 0.05). In conclusion, upper airway measurements on timed lateral radiographs in asymptomatic micrognathic infants at term (corrected age) revealed them to be smaller than those of normal infants. Narrower upper airways were associated with increased risk of subsequent apnoea requiring stimulation.
We present the case of a patient with Noonan's syndrome and massive nonimmune hydrops fetalis in whom lymphangiography was performed in the neonatal period. This demonstrated generalised lymphatic dysplasia, and we suggest a mechanism by which the lymphatic abnormalities in Noonan's syndrome may arise.
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BACKGROUND: There is an inverse relation between socioeconomic status and mortality. Over the past several decades death rates in the United States have declined, but it is unclear whether all socioeconomic groups have benefited equally. METHODS: Using records from the 1986 National Mortality Followback Survey (n = 13,491) and the 1986 National Health Interview Survey (n = 30,725), we replicated the analysis by Kitagawa and Hauser of differential mortality in 1960. We calculated direct standardized mortality rates and indirect standardized mortality ratios for persons 25 to 64 years of age according to race, sex, income, and family status. RESULTS: The inverse relation between mortality and socioeconomic status persisted in 1986 and was stronger than in 1960. The disparity in mortality rates according to income and education increased for men and women, whites and blacks, and family members and unrelated persons. Over the 26-year period, the inequalities according to educational level increased for whites and blacks by over 20 percent in women and by over 100 percent in men. In whites, absolute death rates declined in persons of all educational levels, but the reduction was greater for men and women with more education than for those with less. CONCLUSIONS: Despite an overall decline in death rates in the United States since 1960, poor and poorly educated people still die at higher rates than those with higher incomes or better educations, and this disparity increased between 1960 and 1986.
The prognostic value of a left ventricular (LV) mass index (g/m2) estimated from an electrocardiographic model and radiographic estimates of the relative heart volume (ml/m2) and cardiothoracic ratio for predicting the risk of cardiovascular disease mortality were investigated using Cox regression analysis to adjust for age, systolic blood pressure and history of heart attack in 1,807 men (1,609 white, 198 black) and 2,143 women (1,884 white, 259 black). The study population (ages 35 to 74 years at baseline) was followed from 5 to 12 years (average 9.5 years) for cardiovascular disease mortality. LV mass index and relative heart volume were independent predictors of cardiovascular disease mortality among white men. All 3 cardiac size estimates were independent predictors for cardiovascular disease mortality among white and black women. When LV mass index was used as a dichotomized variable to indicate the presence or absence of LV hypertrophy, the age-adjusted relative risk of cardiovascular disease mortality was 2.48 (95% confidence interval 1.77 to 3.46) for white men, 3.03 (1.49 to 6.16) for black men, 1.86 (1.21 to 2.87) for white women and 2.05 (0.83 to 5.05) for black women. The corresponding prevalence of LV hypertrophy was 15.4% for white men, 36.6% for black men, 20.1% for white women and 17.4% for black women. It is concluded that the electrocardiographic estimate of LV mass index can identify a substantially larger fraction of persons at increased risk for cardiovascular mortality than conventional electrocardiographic criteria for LV hypertrophy and that LV mass index estimated by electrocardiogram is a valuable supplement to radiographic cardiac size estimates in epidemiologic applications.
Small bowel atresia may present with congenital ascites. A neonate with ascites was found to have jejunal atresia complicated by volvulus and perforation.
A case of angiolymphoid hyperplasia with eosinophilia arising from the radial artery is presented. Histologically, there was proliferation of atypical endothelial cells forming vascular spaces and solid cords, with a background infiltrate of inflammatory cells and prominent tissue eosinophilia. Immunohistochemical studies demonstrated vimentin and factor VIII related antigen in the endothelial cells. The lymphoid infiltrate was polyclonal. These lesions, which typically occur in the dermis and subcutaneous tissue of the head and neck, are known by a variety of different names reflecting disagreement regarding their pathogenesis. The probable nature of the process is discussed.
We describe the technique of wedge resection for revision of an amputation stump, and report the results of this at below-knee level in 57 patients with peripheral vascular disease; healing occurred in 42 of these (74%).
The year 1987 marks the centennial of electrocardiography. As Beamish reminds us, it was the first and foremost technical aid to the cardiologist. During the history of cardiovascular epidemiology, which dates back roughly forty years, electrocardiography has played a central role as a relatively specific marker for coronary and hypertensive heart disease. The lack of sensitivity of electrocardiography and the advent of new technologies such as ultrasonography for assessment of such heart disease in cardiology and cardiovascular epidemiology has raised questions as to whether electrocardiography might be replaced in the next century. Recent developments in computer electrocardiography have rendered suggestions of the decreased importance of electrocardiography premature. Use of computer analysis of electrocardiograms in epidemiologic studies, which dates back less than three decades, has renewed interest in and expanded the role of electrocardiography in cardiology in general and cardiovascular epidemiology in particular. The computer analysis of electrocardiograms has allowed the processing and analysis of large numbers of electrocardiograms in a rapid, efficient, systematic and consistent manner. This has led to new, more sensitive criteria for detection of left ventricular hypertrophy as a discrete variable. In addition, the numerous waveform amplitude and duration measurements by computer have allowed the development of mathematical models to express the likelihood of coronary heart disease (myocardial infarction) and degree of left ventricular hypertrophy (estimates of left ventricular mass) on continuous scales. These developments have contributed substantially to the potential of electrocardiography (and particularly computer electrocardiography) in future studies and clinical applications.(ABSTRACT TRUNCATED AT 250 WORDS)
Despite important declines in U.S. death rates since 1960, poor and less-educated people have not shared equally in this decline. Data from the 1986 National Mortality Followback Survey and the 1986 National Health Interview Survey were compared to data from the 1960 Matched Record Study. The data clearly show an inverse relationship between mortality and socioeconomic status. Results further indicate a widening of differences in mortality by education among both men and women aged 25 to 64. That is, the mortality differential has increased between those with higher levels of education and those with lower educational attainment. The disparity in mortality rates increased between 1960 and 1986 for both sexes. These findings focus attention on the disparity in death rates for subgroups of the population and point to the increasing need to address socioeconomic differentials to close the gap.