RESUMEN
Recent natural and human-caused disasters have awakened public health officials to the importance of emergency preparedness. Guided by health behavior and media effects theories, the analysis of a statewide survey in Georgia reveals that self-efficacy, subjective norm, and emergency news exposure are positively associated with the respondents' possession of emergency items and their stages of emergency preparedness. Practical implications suggest less focus on demographics as the sole predictor of emergency preparedness and more comprehensive measures of preparedness, including both a person's cognitive stage of preparedness and checklists of emergency items on hand. We highlight the utility of theory-based approaches for understanding and predicting public emergency preparedness as a way to enable more effective health and risk communication.
Asunto(s)
Planificación en Desastres/organización & administración , Individualidad , Teoría Psicológica , Administración en Salud Pública , Adulto , Comunicación , Recolección de Datos , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Masculino , Medios de Comunicación de Masas , Persona de Mediana Edad , Factores de Riesgo , Autoeficacia , Percepción SocialRESUMEN
This article describes the design, implementation, and evaluation of a simulation of risk communication in the first hours of a pandemic. The simulation design was based on Crisis and Emergency Risk Communication principles espoused by the Centers for Disease Control and Prevention, as well as the collective experience of the authors. Over 4 hours, 17 local health district risk communicators in Georgia responded to a scenario in which every community in the state had teenagers infected with avian flu after returning from an international conference. The evaluation revealed that local risk communicators had much greater difficulty following risk communication principles under the time pressures of a realistic and stressful event than they did in a tabletop exercise. Strengths and weaknesses of the performance of the local risk communicators are identified in addition to lessons learned about the design and implementation of a risk communication simulation.
Asunto(s)
Control de Enfermedades Transmisibles/métodos , Brotes de Enfermedades/prevención & control , Gripe Humana/prevención & control , Difusión de la Información , Simulación de Paciente , Georgia , Humanos , Gripe Humana/epidemiología , Regionalización , Riesgo , Estados Unidos/epidemiologíaRESUMEN
To better inform public health officials during a flu pandemic, this study analyzes a representative statewide telephone survey among 1,602 adults to examine knowledge and perceptions about a flu pandemic, trust in government, and support for government actions in a flu pandemic. The findings show citizens do not understand what avian/bird flu is and how it evolves into a pandemic. They also seem to have divergent perceptions regarding the susceptibility and severity of a flu pandemic. More than half of the respondents trust the government to handle a flu pandemic and show strong support for many proposed government actions in a pandemic, except for offering non-fully approved drugs. The findings suggest public health and risk communicators should reinforce support for controversial actions through trust building and personalization of risks rather than mere education or publicity. Public education and engagement should also begin pre-pandemic and continue throughout all phases of the event.
Asunto(s)
Control de Enfermedades Transmisibles/métodos , Brotes de Enfermedades/prevención & control , Conocimientos, Actitudes y Práctica en Salud , Subtipo H5N1 del Virus de la Influenza A , Gripe Aviar/transmisión , Gripe Humana/prevención & control , Adulto , Animales , Aves , Femenino , Georgia/epidemiología , Humanos , Gripe Aviar/epidemiología , Gripe Humana/epidemiología , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Práctica de Salud Pública , Opinión Pública , ConfianzaRESUMEN
Sacroiliac joint (SIJ) involvement has been reported in up to 9.7 percent of patients with skeletal tuberculosis. Lack of awareness of this now uncommon form of infection often leads to diagnostic delay and increased morbidity. Eleven consecutive cases of SIJ tuberculosis are reported; clinical and radiologic features, diagnosis, treatment, and outcome are discussed. Buttock pain was the presenting complaint in all patients. However, radicular pain in the lower back (seven patients) or lower limb (10 patients) was common and in one patient precipitated an unnecessary surgical intervention. SIJ tuberculosis is frequently an isolated phenomenon. Therefore, direct sampling of the SIJ is necessary to establish the diagnosis. The recently described technique of closed needle biopsy of the SIJ was employed in all 11 patients and established the diagnosis in nine of the 11.
Asunto(s)
Articulación Sacroiliaca/patología , Tuberculosis Osteoarticular , Antituberculosos/uso terapéutico , Biopsia con Aguja , Quimioterapia Combinada , Femenino , Estudios de Seguimiento , Humanos , Masculino , Factores de Tiempo , Tuberculosis Osteoarticular/diagnóstico , Tuberculosis Osteoarticular/tratamiento farmacológico , Tuberculosis Osteoarticular/patologíaRESUMEN
A 61-year-old man presented with ascites in the course of agnogenic myeloid metaplasia (AMM). Ascitic fluid was exudative and contained mature and immature leukocytes, erythroid cells, and megakaryocytes as observed on a bone marrow smear. Peritoneal biopsy showed myeloid metaplasia, and liver biopsy revealed intrasinusoidal myeloid metaplasia and peliosis. Ascites cleared after abdominal radiotherapy but treatment resulted in transient aplasia. Subsequently, portal hypertension was demonstrated by hepatic transjugular catheterization. Complications of splenomegaly led to splenectomy and splenorenal shunt followed by fatal acute hepatitis and septic shock. A review of the literature and an analysis of mechanisms of ascites occurring in AMM, especially peritoneal implants of myeloid tissue and occurrence of peliosis in myeloproliferative disorders, are presented.
Asunto(s)
Ascitis/etiología , Hematopoyesis Extramedular , Peliosis Hepática/complicaciones , Mielofibrosis Primaria/complicaciones , Adulto , Humanos , Hígado/fisiopatología , Masculino , Persona de Mediana Edad , Peritoneo/fisiopatología , Mielofibrosis Primaria/fisiopatologíaRESUMEN
Six unusual cases of primary gastric stump carcinoma associated with gastritis cystica polyposa and arising in old gastrojejunostomy stomas are presented. The clinical data, the gross and microscopic pathological features, and the histochemical mucin profile of these two lesions are described in detail. A review is undertaken of the most relevant and previously published reports concerning, separately, either primary gastric stump carcinoma or gastritis cystica polyposa. The findings available in these reports are compared with those observed in our six cases. Some aspects of gastritis cystica polyposa are not unlike those seen in the solitary ulcer syndrome of the rectum and Ménétrier's disease. The histological type and mucin profile of primary gastric stump carcinoma parallel those recorded in gastric cancer arising in the unoperated stomach. However, the role of intestinal metaplasia and its histochemical typing appear somewhat different in primary gastric stump carcinoma.
Asunto(s)
Adenocarcinoma/patología , Gastritis/complicaciones , Mucinas/análisis , Síndromes Posgastrectomía/patología , Neoplasias Gástricas/patología , Adenocarcinoma/análisis , Adenocarcinoma/complicaciones , Anciano , Humanos , Intestinos/patología , Masculino , Metaplasia , Persona de Mediana Edad , Úlcera Péptica/cirugía , Neoplasias Gástricas/análisis , Neoplasias Gástricas/complicaciones , Factores de TiempoRESUMEN
The lymphoid stromal reaction, particularly the T lymphoid reaction, was studied immunohistochemically on cryostat sections in 14 cases of primary gastrointestinal B lymphomas, and compared with the type and distribution of lymphoid cells in three cases of gastric lymphoid hyperplasia. A pronounced T lymphoid reaction, mainly of the T helper phenotype, occurred in both lesions. Most of these T cells bore HLA-DR antigens, but only a few of them had the receptor for interleukin 2. The T lymphoid reaction was observed inside the lymphomas in seven of a total of 14 cases, and around the lymphomas in four of the six cases clinically classified as stage I. Perivascular mucosal and submucosal nodules, entirely composed of T cells, seemed characteristic of gastric lymphoid hyperplasias. A T lymphoid reaction in lymphoid hyperplasias suggests an amplification of the cell mediated immune response; in lymphomas it could represent a host reaction against the lymphomatous infiltrate, therefore favouring a better prognosis.
Asunto(s)
Neoplasias Gastrointestinales/patología , Linfoma no Hodgkin/patología , Linfocitos B/inmunología , Neoplasias Gastrointestinales/inmunología , Antígenos HLA-DR/análisis , Histiocitos/inmunología , Humanos , Hiperplasia , Técnicas para Inmunoenzimas , Inmunoglobulinas/análisis , Recuento de Leucocitos , Linfoma no Hodgkin/inmunología , Estómago/patología , Linfocitos T/patologíaRESUMEN
Small bowel biopsy specimens were taken from 21 patients undergoing gastrointestinal endoscopy to detect a possible adhesion of bacteria to the mucous layer of the upper gastrointestinal tract. In 30 control biopsy specimens taken from 10 patients free from gastrointestinal pathology, no associated bacteria were found, whereas in 23 biopsy specimens taken from eight gastrectomized patients an associated bacterial flora including E. coli or Pseudomonas was grown. Bacterial adhesion was confirmed by means of transmission electron microscopy of the eight patients yielding positive cultures. Bacterial adhesion induced local alterations of the brush border membrane. These results suggest that adherent bacteria may be present in hypochlorhydric patients. Pathophysiologic consequences require further studies.
Asunto(s)
Adhesión Bacteriana , Duodeno/microbiología , Enterobacteriaceae/metabolismo , Mucosa Intestinal/microbiología , Pseudomonas/metabolismo , Biopsia , Duodeno/ultraestructura , Enterobacteriaceae/ultraestructura , Escherichia coli/metabolismo , Escherichia coli/ultraestructura , Femenino , Gastrectomía , Humanos , Masculino , Microscopía Electrónica , Microvellosidades/microbiología , Persona de Mediana Edad , Estudios Prospectivos , Pseudomonas/ultraestructuraRESUMEN
This report documents an uncommon case of osteoclastoma-like giant cell tumor of the renal pelvis associated with papillary transitional cell carcinoma, which resulted in the patient's death. A low-grade transitional papillary carcinoma associated with a prominent osteoclastoma-like giant cell tumor was found in the pelvicalyceal system of the right kidney in a 69-year-old man. The spindle component of the tumor stained for epithelial membrane antigen, indicating an epithelial origin. Positive staining with antibody against p53 protein was observed in both tumoral components. Our results suggest that this osteoclastoma-like giant cell tumor was truly neoplastic and that the two components could have arisen from an initial monoclonal neoplastic proliferation.
Asunto(s)
Carcinoma de Células Transicionales/patología , Tumor Óseo de Células Gigantes/patología , Neoplasias Renales/patología , Anciano , Carcinoma Papilar/patología , Carcinoma de Células Transicionales/química , Tumor Óseo de Células Gigantes/química , Humanos , Inmunohistoquímica , Neoplasias Renales/química , Pelvis Renal/patología , Masculino , Hibridación de Ácido NucleicoRESUMEN
Primary non-Hodgkin's lymphomas of the pleural cavity have been described mostly in Japan. We report a case of high-grade non-Hodgkin's lymphoma (immunoblastic type) of the pleural cavity occurring in a nonimmunocompromised patient 55 years after an artificial pneumothorax was performed for the treatment of pulmonary tuberculosis. Immunohistochemical study revealed a B phenotype (CD20), and an in situ hybridization detected small nuclear RNAs encoded by Epstein-Barr virus in most lymphomatous cells. A link between primary pleural lymphoma and the local long-standing chronic inflammation, inducing a clonal transformation of Epstein-Barr virus-infected immortalized B lymphocytes, is suspected.
Asunto(s)
Empiema Tuberculoso/etiología , Herpesvirus Humano 4/aislamiento & purificación , Linfoma Inmunoblástico de Células Grandes/etiología , Neoplasias Pleurales/etiología , Neumotórax Artificial/efectos adversos , Tuberculosis Pulmonar/cirugía , Anciano , Empiema Tuberculoso/patología , Humanos , Linfoma Inmunoblástico de Células Grandes/patología , Linfoma Inmunoblástico de Células Grandes/virología , Masculino , Neoplasias Pleurales/patología , Neoplasias Pleurales/virología , ARN Viral/aislamiento & purificación , Factores de TiempoRESUMEN
Increased prevalence of gallbladder cancer has been related to specific occupations and suggests a possible professional exposure to carcinogens. The authors report the case of a 64-year-old woman who had a squamous cell carcinoma of the gallbladder with hepatic metastases, and professional exposure to trichloroethylene in a degreasing metal laboratory. Although trichlorothylene could not be assumed to be a true carcinogen for gallbladder cancer, this case underscores that epidemiologic studies taking into account professional exposure, in addition to the usual risk factors of gallbladder cancer, are requested, in order to detect a new patient group at risk for gallbladder cancer.
Asunto(s)
Carcinoma de Células Escamosas/inducido químicamente , Neoplasias de la Vesícula Biliar/inducido químicamente , Tricloroetileno/efectos adversos , Carcinoma de Células Escamosas/epidemiología , Exposición a Riesgos Ambientales , Femenino , Neoplasias de la Vesícula Biliar/epidemiología , Humanos , Persona de Mediana Edad , Prevalencia , Factores de RiesgoRESUMEN
We report the case of a 49 year old male patient who had Recklinghausen's disease associated with hyperchlorhydria. The principal features of Recklinghausen's disease were cutaneous localizations and countless digestive tumors, found mainly on the small bowel. The ultrastructural aspect of these tumors was neurinoma or schwannoma. Basal acid gastric hypersecretion and a positive secretin test were highly suggestive of a Zollinger-Ellison syndrome. Gastrinoma was not found at laparotomy even though a gastrin gradient had been demonstrated by pancreatic venous sampling. In a patient with Recklinghausen's disease, neuroendocrine tumors (APUDomas) should be looked for systematically.
Asunto(s)
Neoplasias del Sistema Digestivo/metabolismo , Ácido Gástrico/metabolismo , Neurofibromatosis 1/metabolismo , Síndrome de Zollinger-Ellison/diagnóstico , Diagnóstico Diferencial , Neoplasias del Sistema Digestivo/patología , Neoplasias del Sistema Digestivo/ultraestructura , Humanos , Masculino , Persona de Mediana Edad , Neurofibromatosis 1/diagnósticoRESUMEN
A case of tropical sprue in a 73-year old parisian male returning from endemic areas is reported. Clinical manifestations were megaloblastic anemia, malabsorption and protein-losing enteropathy. Biopsy of the jejunal mucosa showed partial villous atrophy with thickening of the basement membrane region; fat droplets were observed inside and close to the epithelial cells on electron microscopy study. Fat intestinal absorption after a test meal was delayed. Clinical, biological and histological improvement was obtained with tetracycline and folic acid therapy. The particular clinical and anatomical features of this case, as well as the difficulties for establishing the diagnosis of tropical sprue in non-endemic areas are analyzed.
Asunto(s)
Esprue Tropical/diagnóstico , Anciano , Anemia Megaloblástica/etiología , Humanos , Yeyuno/patología , Yeyuno/ultraestructura , Masculino , Paris , Enteropatías Perdedoras de Proteínas/etiología , ViajeRESUMEN
We report a case of a clinically and biologically typical hypergastrinemia syndrome due to ovarian mucinous cystadenoma. When examined under histoimmunofluorescence, this "border-line" tumor was shown to contain a polymorphous endocrine cell proliferation, composed primarily of G cells and, to some degree, of D cells. Electron microscopic study further evidenced a small amount of prolactin containing cells, which coincided with elevated prolactin-levels in blood. Ovariectomy combined with vagotomy and pyloroplasty resulted in a prompt disappearance of both clinical and biological abnormalities. Ovarian mucinous cystadenomas have been known for a long time to contain endocrine cells, but only five cases, including the present one, have been described with fully developed endocrine expression. We suggest that this particular condition could be more frequent than generally admitted, and could justify systematic screening for mucinous cystadenoma in the case of peptide hormone dysfunction.
Asunto(s)
Cistoadenoma/complicaciones , Gastrinas/sangre , Hiperprolactinemia/etiología , Neoplasias Ováricas/complicaciones , Adulto , Cistoadenoma/sangre , Cistoadenoma/patología , Femenino , Humanos , Neoplasias Ováricas/sangre , Neoplasias Ováricas/patología , SíndromeRESUMEN
Campylobacter jejuni is an enteropathogen with invasive ability which may be responsible for acute colitis. We report the case of a 38-year-old woman who was hospitalized for severe acute colitis. Stool specimen examination revealed Campylobacter jejuni. A laparotomy was performed due to clinical deterioration and toxic megacolon. Colic perforations were observed. The examination of the colectomy specimen revealed ulcerative pancolitis. This is the first published case of Campylobacter jejuni infection complicated by toxic megacolon and perforation.
Asunto(s)
Infecciones por Campylobacter/complicaciones , Campylobacter jejuni/aislamiento & purificación , Colitis/microbiología , Ileítis/microbiología , Megacolon Tóxico/complicaciones , Adulto , Infecciones por Campylobacter/microbiología , Infecciones por Campylobacter/patología , Infecciones por Campylobacter/cirugía , Colectomía , Colitis/complicaciones , Colitis/patología , Colitis/cirugía , Enfermedades del Colon/etiología , Enfermedades del Colon/cirugía , Femenino , Humanos , Ileítis/complicaciones , Ileítis/cirugía , Perforación Intestinal/etiología , Perforación Intestinal/cirugía , Megacolon Tóxico/patología , Megacolon Tóxico/cirugíaRESUMEN
We report the case of a 72 year-old woman with late-onset common variable immunoglobulin deficiency who was hospitalized for diarrhoea and fever. Colonoscopy showed aphtoïd and deep ulcerations in the rectum, the sigmoid and transverse colon, suggestive of Crohn's disease. Histologic and immunohistochemical study revealed a low grade B cell mucosa-associated lymphoid tissue (MALT) lymphoma. This is an unusual presentation for colonic lymphoma, and the second case of colonic lymphoma associated with late-onset common variable immunoglobulin deficiency.
Asunto(s)
Neoplasias del Colon/complicaciones , Inmunodeficiencia Variable Común/complicaciones , Linfoma de Células B/complicaciones , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias del Colon/tratamiento farmacológico , Neoplasias del Colon/patología , Femenino , Humanos , Linfoma de Células B/tratamiento farmacológico , Linfoma de Células B/patologíaRESUMEN
From 1985 through 1988, 52 patients aged 16 to 85 years and referred for acute diarrhea underwent routine clinical, microbiological, endoscopic and histopathological examinations. Enteropathogens were isolated in 50 percent of patients, mostly from stool samples rather than from biopsy samples, though results were sometimes dissociated. Significantly lower digestive endoscopic abnormalities were seen in 60 percent of patients. Upper gastrointestinal endoscopy was not contributive. Rectal and colonic biopsies showed histological abnormalities in nearly all cases half of which were polymorphonuclear infiltrates and crypt abscesses. Glandular distortion was not found. An analysis of clinical, endoscopic and histological data showed that major abnormalities were mostly, but not constantly, related to infections due to enteroinvasive bacteria. As in other studies, a high rate of negative stool cultures was observed. Based on these results, we suggest to perform either further and more sophisticated microbiological investigations, or to conduct a routine search for viral infections whose incidence, among adult patients with acute diarrhea, is actually unknown.
Asunto(s)
Diarrea/etiología , Enfermedad Aguda , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Infecciones Bacterianas/diagnóstico , Infecciones Bacterianas/microbiología , Colon/patología , Diarrea/complicaciones , Diarrea/microbiología , Endoscopía , Humanos , Persona de Mediana Edad , Paris , Estudios ProspectivosRESUMEN
Ectopic subdiaphragmatic development of a bronchogenic cyst is rare. We report the case of a 28-year-old woman with a symptomatic bronchogenic cyst of the right hemidiaphragm simulating a hydatic cyst of the liver on ultrasonography and CT scan. Diagnosis of a diaphragmatic lesion was made during laparotomy, and complete resection was successful. Final diagnosis was done on pathology.
Asunto(s)
Quiste Broncogénico/diagnóstico , Calcinosis/diagnóstico , Diafragma , Equinococosis Hepática/diagnóstico , Dolor Abdominal/etiología , Adulto , Biopsia , Quiste Broncogénico/complicaciones , Quiste Broncogénico/cirugía , Calcinosis/complicaciones , Calcinosis/cirugía , Diagnóstico Diferencial , Errores Diagnósticos , Femenino , Humanos , Tomografía Computarizada por Rayos X , UltrasonografíaRESUMEN
Bone and joint tuberculosis have recently gained a renewal of interest, especially with the spread of HIV infection which may increase its frequency. Bone and joint locations of tuberculosis are pauci-bacillary often requiring local sampling in order to confirm the diagnosis and to initiate early therapy. From 1983 to 1992 we have studied 19 patients with bone and joint tuberculosis. Seventeen local sampling were performed: 12 biopsies and five abscess punctures. Pathological examination of samples disclosed diagnosis of tuberculosis in eight cases out of 12. Among the remaining four patients, direct smear was positive once, and cultures grew Mycobacterium tuberculosis in two, yielding the diagnosis in 11 out of the 12 patients. Bacteriological and pathological examinations were non contributive in only one patient. Microbiological examination of pus disclosed two positive direct smear and three positive cultures. Treatment lasted 9 to 18 months. The outcome was favourable in all patients.
Asunto(s)
Biopsia con Aguja , Tuberculosis Osteoarticular/diagnóstico , Absceso/patología , Adulto , Anciano , Técnicas Bacteriológicas , Huesos/patología , Femenino , Humanos , Articulaciones/patología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Tuberculosis Osteoarticular/patologíaRESUMEN
A woman of 40 years of age without any past history of urinary affections was discovered to have malacoplakia of one kidney, demonstrated by a mass in the right flank, fever, and a coliform urinary infection. No secretion from the affected side was observed on intravenous urography. Renal arteriography showed an inflammatory mass affecting mainly the lower half of the kidney. Histological examination of a nephrectomy specimen led to a diagnosis of a malacoplakia. The authors review the clinical, radiological, and pathological features of renal malacoplakia, which is an inflammatory condition of the renal parenchyma very similar to xantogranulomatous pyelonephritis. The pathogenesis is completely unknown, but the lesion probably arises from a disorder of macrophage function, and renal malacoplakia should be a differential diagnosis of inflammatory renal masses.