[The condition and trends of morbidity of diseases of urogenital system in adult population of Moscow].

The article presents the results of studying state and trends of incidence of adult urban population in the city of Moscow by the classes of diseases of the genitourinary system. The purpose of study was to analyze urogenital morbidity of population of metropolis as compared with similar indices of the Central Federal Okrug and the Russian Federation in 2014-2018. The corresponding official statistical data of the Minzdrav of Russia and research publications were studied. It was established that permanent monitoring of dynamics of urological morbidity can be considered as important methodological and informational and analytical base for planning medical care of population, that makes it possible to develop in practice the basis of development and implementation of integrated system of measures of development of community-based and hospital care, which must be taken into account by the administration of medical organizations and health care management at various levels.

[Escherichia coli productora de betalactamasas de espectro extendido como agente causal de gangrena de Fournier de origen urogenital asociada a mayor mortalidad]. / Escherichia coli producer of extended-spectrum beta-lactamases as causative agent of Fournier gangrene of urogenital origin associated with higher mortality.

ANTECEDENTES: La gangrena de Fournier (GF) es una fascitis necrotizante que pone en peligro la vida del paciente. El objetivo de este trabajo fue determinar la etiología y el impacto del agente aislado en el cultivo de la herida y de orina. MÉTODO: Se llevó a cabo un análisis retrospectivo de una cohorte de 66 pacientes con GF de origen urogenital. Los valores cualitativos medidos se expresaron como frecuencia y porcentaje, y se compararon con la prueba de ji al cuadrado y la prueba de Fisher. La diferencia se consideró estadísticamente significativa con p < 0.05. RESULTADOS: Los pacientes que murieron presentaban con mayor frecuencia cultivos de orina y herida positivos para Escherichia coli productora de betalactamasas de espectro extendido (BLEE): orina, sobrevivientes 14.5% vs. muertes 44.4%; herida, sobrevivientes 20.8% vs. muertes 66.6% (p < 0.001). CONCLUSIONES: Durante la valoración integral del paciente con GF es fundamental realizar cultivos de orina y de herida con el fin de iniciar el manejo antibiótico dirigido de manera temprana. Los pacientes con GF que mueren presentan mayor número de cultivos positivos para E. coli BLEE. BACKGROUND: Fournier gangrene (FG) is a necrotizing fasciitis that endangers the patient's life. The objective of this study was to determine the etiology and impact of the agent isolated on wound and urine culture. METHOD: We performed a retrospective analysis within a cohort of 66 patients with FG of urogenital origin. The measured qualitative values were expressed as frequency and Percentage and compared with the chi square test and Fisher's test. The difference was considered statistically significant at p < 0.05. RESULTS: Patients who died had more frequent cultures of urine and wound positive for extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli: urine, survivors 14.5% vs. deaths 44.4%; wound, 20.8% vs. 66.6% (p < 0.001). CONCLUSIONS: During the integral evaluation of the patient with FG it is essential to perform the urine and surgical wound cultures in order to initiate the antibiotic management directed at an early stage. Patients with GF who die present a greater number of cultures positive for E. coli ESBL.

Combined high dose rate brachytherapy and external beam radiotherapy for clinically localised prostate cancer.

PURPOSE: To report the clinical outcomes and treatment-related toxicities after combined high-dose-rate (HDR) brachytherapy (BRT) with external beam radiotherapy (EBRT) for patients with clinically localised high-risk prostate cancer. MATERIAL AND METHODS: Between 2008 and 2012, three hundred and three consecutive patients with organ-confined high-risk prostate cancer were treated with definitive radiotherapy consisting of HDR-BRT followed by supplemental EBRT. The transrectal 3D-ultrasound-based HDR-BRT boost consisted of two single-fraction implants of 10.5 Gy, prescribed to the 90% of the gland (D90), for a total physical dose of 21.0 Gy delivered to the prostatic gland. EBRT was delivered with conventional fractionation, prescribing 45.0 Gy to the prostatic gland and seminal vesicles. Biochemical failure was defined according to the Phoenix Consensus Criteria, genitourinary (GU)/gastrointestinal (GI) toxicity was evaluated using the Common Toxicity Criteria for Adverse Events (version 3.0). RESULTS: The median follow-up was 71.6 months. The 7-year overall survival, biochemical control and metastasis-free-survival rates for the entire cohort were 85.7%, 88.3% and 93.8%, respectively. Androgen deprivation therapy was initiated prior to treatment for 92.7% of patients with a median duration of 12 months. Toxicity was scored per event with late Grade 2, 3 and 4 GU adverse events and was found to be 15.3%, 2.2% and 0.3%, respectively. Late Grade 2 GI toxicity accounted for 0.3% with no instances of Grade 3 or higher late adverse events. CONCLUSION: HDR-BRT with supplemental EBRT results in low biochemical relapse-free survival rates associated with a very low incidence of higher-grade late adverse events.

Cause-specific mortality in adults with atopic dermatitis.

BACKGROUND: Adult atopic dermatitis (AD) has been associated with several comorbidities, but cause-specific mortality risk is unknown. OBJECTIVE: To examine cause-specific death rates and risk in adults with AD. METHODS: We performed cross-linkage of nationwide health care and cause of death registers. Adult patients with AD were matched with 10 controls per study subject. We calculated incidence rates per 1000 person-years and hazard ratios (HRs) of cause-specific death with 95% confidence intervals (95% CIs) using Cox proportional hazards models. RESULTS: A total of 8686 patients and 86,860 matched controls were studied. The risk for death due to any cause was significantly increased in patients with AD (HR 1.27, 95%CI 1.11-1.45). Significant causes included cardiovascular (HR 1.45; 95% CI 1.07-1.96), infectious (HR 3.71; 95% CI 1.43-9.60), and urogenital diseases (HR 5.51; 95% CI 1.54-19.80). No increased risk for death due to cancer, endocrine, neurologic, psychiatric, respiratory, or gastroenterologic disease was observed. LIMITATIONS: The results might not be generalizable to patients seen exclusively by primary care physicians. CONCLUSION: Adults with atopic dermatitis had slightly increased risk for death during follow-up. While the risk for death from cardiovascular, urogenital, and infectious diseases was slightly elevated among patients with AD, the absolute risk was very low.

Effects of Air Temperature on Climate-Sensitive Mortality and Morbidity Outcomes in the Elderly; a Systematic Review and Meta-analysis of Epidemiological Evidence.

INTRODUCTION: Climate change and rapid population ageing are significant public health challenges. Understanding which health problems are affected by temperature is important for preventing heat and cold-related deaths and illnesses, particularly in the elderly. Here we present a systematic review and meta-analysis on the effects of ambient hot and cold temperature (excluding heat/cold wave only studies) on elderly (65+ years) mortality and morbidity. METHODS: Time-series or case-crossover studies comprising cause-specific cases of elderly mortality (n=3,933,398) or morbidity (n=12,157,782) were pooled to obtain a percent change (%) in risk for temperature exposure on cause-specific disease outcomes using a random-effects meta-analysis. RESULTS: A 1°C temperature rise increased cardiovascular (3.44%, 95% CI 3.10-3.78), respiratory (3.60%, 3.18-4.02), and cerebrovascular (1.40%, 0.06-2.75) mortality. A 1°C temperature reduction increased respiratory (2.90%, 1.84-3.97) and cardiovascular (1.66%, 1.19-2.14) mortality. The greatest risk was associated with cold-induced pneumonia (6.89%, 20-12.99) and respiratory morbidity (4.93% 1.54-8.44). A 1°C temperature rise increased cardiovascular, respiratory, diabetes mellitus, genitourinary, infectious disease and heat-related morbidity. DISCUSSION: Elevated risks for the elderly were prominent for temperature-induced cerebrovascular, cardiovascular, diabetes, genitourinary, infectious disease, heat-related, and respiratory outcomes. These risks will likely increase with climate change and global ageing.

Low magnesium levels an important new prognostic parameter can be overlooked in patients with Fournier's gangrene: a multicentric study.

INTRODUCTION: We evaluated low magnesium levels and three different scoring systems including the Fournier's Gangrene Severity Index (FGSI), the Uludag Fournier's Gangrene Severity Index (UFGSI), and the Charlson Comorbidity Index (CCI) for predicting mortality in a multicentric, large patient population with FG. METHODS: The medical records of 99 FG patients who were treated and followed up in different clinics were reviewed. The biochemical, hematological, and bacteriological results from the admission evaluation were recorded. The CCI, FGSI, and UFGSI were evaluated and stratified by survival. RESULTS: The results were evaluated for the following patients: the survivors (n = 82) and the nonsurvivors (n = 17). The magnesium level for the survivors and nonsurvivors was 2.09 ± 0.28 and 1.68 ± 0.23, respectively (p 0.004). The admission FGSI, UFGSI, and CCI scores were significantly higher in nonsurvivors (p 0.001, p 0.001, p < 0.001, respectively). The receiver operating characteristics analysis revealed that the UFGSI was more powerful than the FGSI. The hypomagnesemia, low hemoglobin and hematocrit, low albumin and HCO3 levels; high alkaline phosphatase; and the high heart and respiratory rates, an FGSI >9, rectal involvement, and a high CCI were associated with a worse prognosis. CONCLUSION: Low magnesium levels might be an important parameter for a worse FG prognosis. Monitoring the serum magnesium levels might have prognostic and therapeutic implications in patients with FG. High CCI, FGSI, and UFGSI scores might be associated with a worse prognosis in patients with FG. The UFGSI might be more powerful scoring system than the FGSI.

Hypofractionated versus conventionally fractionated radiotherapy for patients with prostate cancer (HYPRO): acute toxicity results from a randomised non-inferiority phase 3 trial.

BACKGROUND: In 2007, we began the randomised phase 3 multicentre HYPRO trial to investigate the effect of hypofractionated radiotherapy compared with conventionally fractionated radiotherapy on relapse-free survival in patients with prostate cancer. Here, we examine whether patients experience differences in acute gastrointestinal and genitourinary adverse effects. METHODS: In this randomised non-inferiority phase 3 trial, done in seven radiotherapy centres in the Netherlands, we enrolled intermediate-risk or high-risk patients aged between 44 and 85 years with histologically confirmed stage T1b-T4 NX-0MX-0 prostate cancer, a PSA concentration of 60 ng/mL or lower, and WHO performance status of 0-2. A web-based application was used to randomly assign (1:1) patients to receive either standard fractionation with 39 fractions of 2 Gy in 8 weeks (five fractions per week) or hypofractionation with 19 fractions of 3·4 Gy in 6·5 weeks (three fractions per week). Randomisation was done with minimisation procedure, stratified by treatment centre and risk group. The primary endpoint is 5-year relapse-free survival. Here we report data for the acute toxicity outcomes: the cumulative incidence of grade 2 or worse acute and late genitourinary and gastrointestinal toxicity. Non-inferiority of hypofractionation was tested separately for genitourinary and gastrointestinal acute toxic effects, with a null hypothesis that cumulative incidences of each type of adverse event were not more than 8% higher in the hypofractionation group than in the standard fractionation group. We scored acute genitourinary and gastrointestinal toxic effects according to RTOG-EORTC criteria from both case report forms and patients' self-assessment questionnaires, at baseline, twice during radiotherapy, and 3 months after completion of radiotherapy. Analyses were done in the intention-to-treat population. Patient recruitment has been completed. This study is registered with www.controlled-trials.com, number ISRCTN85138529. FINDINGS: Between March 19, 2007, and Dec 3, 2010, 820 patients were randomly assigned to treatment with standard fractionation (n=410) or hypofractionation (n=410). 3 months after radiotherapy, 73 (22%) patients in the standard fractionation group and 75 (23%) patients in the hypofractionation group reported grade 2 or worse genitourinary toxicity; grade 2 or worse gastrointestinal toxicity was noted in 43 (13%) patients in the standard fractionation group and in 42 (13%) in the hypofractionation group. Grade 4 acute genitourinary toxicity was reported for two patients, one (<1%) in each group. No grade 4 acute gastrointestinal toxicities were observed. We noted no significant difference in cumulative incidence by 120 days after radiotherapy of grade 2 or worse acute genitourinary toxicity (57·8% [95% CI 52·9-62·7] in the standard fractionation group vs 60·5% (55·8-65·3) in the hypofractionation group; difference 2·7%, 90% CI -2·99 to 8·48; odds ratio [OR] 1·12, 95% CI 0·84-1·49; p=0·43). The cumulative incidence of grade 2 or worse acute gastrointestinal toxicity by 120 days after radiotherapy was higher in patients given hypofractionation (31·2% [95% CI 26·6-35·8] in the standard fractionation group vs 42·0% [37·2-46·9] in the hypofractionation group; difference 10·8%, 90% CI 5·25-16·43; OR 1·6; p=0·0015; non-inferiority not confirmed). INTERPRETATION: Hypofractionated radiotherapy was not non-inferior to standard fractionated radiotherapy in terms of acute genitourinary and gastrointestinal toxicity for men with intermediate-risk and high-risk prostate cancer. In fact, the cumulative incidence of grade 2 or worse acute gastrointestinal toxicity was significantly higher in patients given hypofractionation than in those given standard fractionated radiotherapy. Patients remain in follow-up for efficacy endpoints. FUNDING: The Dutch Cancer Society.

Comparison of different scoring systems for outcome prediction in patients with Fournier's gangrene: experience with 50 patients.

OBJECTIVE: The aim of this study was to evaluate effective factors in the survival of patients with Fournier's gangrene (FG) and compare three different validated scoring systems for outcome prediction: Fournier's Gangrene Severity Index (FGSI), Uludag Fournier's Gangrene Severity Index (UFGSI) and age-adjusted Charlson Comorbidity Index (ACCI). MATERIAL AND METHODS: Fifty men who underwent surgery for FG between July 2005 and August 2012 were included in the study. Data were collected on medical history, symptoms, physical examination findings, vital signs, admission and final laboratory tests, timing and extent of surgical debridement, and antibiotic treatment used. The FGSI, UFGSI and ACCI were evaluated stratified by survival. Admission and final parameters were measured using the Mann-Whitney test. RESULTS: The results were evaluated for two groups: survivors (n = 43) and non-survivors (n = 7). Survivors were younger than non-survivors (median age 58 vs 68.5 years, p = 0.017). The median extent of body surface area involved in the necrotizing process in patients who survived and did not survive was 2.3% and 4.8%, respectively (p = 0.04). No significant differences in laboratory parameters were found between survivors and non-survivors at the time of admission, except for haemoglobin, haematocrit, serum urea and albumin levels. Only UFGSI, but not FGSI or ACCI, had any meaning or predictive value in disease severity or patients' survival. CONCLUSION: Only the UFGSI score could predict the disease severity and the patients' survival. The findings did not support previous findings that an UFGSI threshold of 9 is a predictor of mortality during initial evaluation.

125Iodine monotherapy for Japanese men with low- and intermediate-risk prostate cancer: outcomes after 5 years of follow-up.

Data from 305 Japanese men with low-risk (n = 175) or intermediate-risk (n = 130) prostate cancer who underwent (125)I monotherapy were retrospectively analyzed. Of the 305 patients, 93 received hormonal therapy for a median of 6 months (range, 1-33 months) before implantation. The prescribed dose to the prostate plus 3- to 5-mm margin was set at 145 Gy. The mean dose to 90% of the prostate volume at 1 month (D90) and the prostate volume receiving at least 100% dose at 1 month (V100) were 173.4 Gy and 95.8%, respectively. The median follow-up was 66 months (range, 12-94 months). The 5-year biochemical non-evidence of disease rate was 95.5% (low-risk, 94.2%; intermediate-risk, 97.3%). The 5-year freedom from clinical failure rate was 98.9% (low-risk, 98.9%; intermediate-risk, 99.2%).The initial prostate-specific antigen level was identified as a significant predictive factor for biochemical recurrence (P = 0.029). The late Grade 3 genitourinary toxicity rate was 2.0%. No patients displayed late gastrointestinal toxicity of Grade 3 or worse. Monotherapy with (125)I showed excellent outcomes with limited morbidity for Japanese men with low- and intermediate-risk prostate cancer after 5 years of follow-up.

Toxicity and efficacy of three dose-fractionation regimens of intensity-modulated radiation therapy for localized prostate cancer.

Outcomes of three protocols of intensity-modulated radiation therapy (IMRT) for localized prostate cancer were evaluated. A total of 259 patients treated with 5-field IMRT between 2005 and 2011 were analyzed. First, 74 patients were treated with a daily fraction of 2.0 Gy to a total of 74 Gy (low risk) or 78 Gy (intermediate or high risk). Then, 101 patients were treated with a 2.1-Gy daily fraction to 73.5 or 77.7 Gy. More recently, 84 patients were treated with a 2.2-Gy fraction to 72.6 or 74.8 Gy. The median patient age was 70 years (range, 54-82) and the follow-up period for living patients was 47 months (range, 18-97). Androgen deprivation therapy was given according to patient risk. The overall and biochemical failure-free survival rates were, respectively, 96 and 82% at 6 years in the 2.0-Gy group, 99 and 96% at 4 years in the 2.1-Gy group, and 99 and 96% at 2 years in the 2.2-Gy group. The biochemical failure-free rate for high-risk patients in all groups was 89% at 4 years. Incidences of Grade ≥ 2 acute genitourinary toxicities were 9.5% in the 2.0-Gy group, 18% in the 2.1-Gy group, and 15% in the 2.2-Gy group (P = 0.29). Cumulative incidences of Grade ≥ 2 late gastrointestinal toxicity were 13% in the 2.0-Gy group at 6 years, 12% in the 2.1-Gy group at 4 years, and 3.7% in the 2.2-Gy group at 2 years (P = 0.23). So far, this stepwise shortening of treatment periods seems to be successful.

Analysis of late toxicity associated with external beam radiation therapy for prostate cancer with uniform setting of classical 4-field 70 Gy in 35 fractions: a survey study by the Osaka Urological Tumor Radiotherapy Study Group.

We aimed to analyse late toxicity associated with external beam radiation therapy (EBRT) for prostate cancer using uniform dose-fractionation and beam arrangement, with the focus on the effect of 3D (CT) simulation and portal field size. We collected data concerning patients with localized prostate adenocarcinoma who had been treated with EBRT at five institutions in Osaka, Japan, between 1998 and 2006. All had been treated with 70 Gy in 35 fractions, using the classical 4-field technique with gantry angles of 0°, 90°, 180° and 270°. Late toxicity was evaluated strictly in terms of the Common Terminology Criteria for Adverse Events Version 4.0. In total, 362 patients were analysed, with a median follow-up of 4.5 years (range 1.0-11.6). The 5-year overall and cause-specific survival rates were 93% and 96%, respectively. The mean ± SD portal field size in the right-left, superior-inferior, and anterior-posterior directions was, respectively, 10.8 ± 1.1, 10.2 ± 1.0 and 8.8 ± 0.9 cm for 2D simulation, and 8.4 ± 1.2, 8.2 ± 1.0 and 7.7 ± 1.0 cm for 3D simulation (P < 0.001). No Grade 4 or 5 late toxicity was observed. The actuarial 5-year Grade 2-3 genitourinary and gastrointestinal (GI) late toxicity rates were 6% and 14%, respectively, while the corresponding late rectal bleeding rate was 23% for 2D simulation and 7% for 3D simulation (P < 0.001). With a uniform setting of classical 4-field 70 Gy/35 fractions, the use of CT simulation and the resultant reduction in portal field size were significantly associated with reduced late GI toxicity, especially with less rectal bleeding.

[Global burden of mortality in Italian polluted sites]. / Valutazioni globali del carico di mortalità nei siti di interesse nazionale per le bonifiche.

SENTIERI Project has assessed the overall mortality profile in all the IPSs combined, and performed IPS-specific analyses. The epidemiological evidence of the causal association between cause of death and exposure was classified into one of these three categories: Sufficient (S), Limited (L) and Inadequate (I). The procedures and results of the evidence evaluation have been presented in a 2010 Supplement of Epidemiology & Prevention devoted to SENTIERI. Mortality for causes of death with a priori Sufficient or Limited evidence of association with the environmental exposure exceeds the expected figures, with a SMR of 115.8 for men (90%CI 114.4-117.2; 2 439 extra deaths) and 114.4 for women (90% CI 112.4-116.5; 1 069 extra deaths). These excesses are also observed when analysis is extended to all the causes of death (i.e. with no restriction to the ones with a priori Sufficient or Limited evidence): for a total of 403 692 deaths (men and women combined), an excess of 9 969 deaths is observed, with an average of around 1 200 extra deaths per year. Most of these excesses are observed in IPSs located in Southern and Central Italy. The distribution of the causes of deaths shows that the excesses are not evenly distributed: cancer mortality accounts for 30%of all deaths, but is 43.2%of the excess deaths (4 309 cases of 9 969). Conversely, the percentage of excesses in non cancer causes, 19%, is lower than their share of total mortality (42%). Consistently with previous studies, the results suggest that the health status of populations living in the IPSs is worse than what regional averages show. Compared to previous studies, the analysis of the causes selected in SENTIERI, on the basis of a priori Sufficient or Limited evidence of association with the environmental exposures, provides additional information on their role, though some limitations, due to methodology and data used, should be considered.

[Mortality results in SENTIERI Project]. / Risultati dell'analisi della mortalità nel Progetto SENTIERI.

SENTIERI Project (Mortality study of residents in Italian polluted sites) studies mortality of residents in 44 sites of national interest for environmental remediation (Italian polluted sites, IPS). The epidemiological evidence of the causal association between causes of death and exposures was a priori classified into one of these three categories: Sufficient (S), Limited (L) and Inadequate (I). In these sites various environmental exposures are present. Asbestos (or asbestiform fibres as in Biancavilla) has been the motivation for defining six sites as IPSs (Balangero, Emarese, Casale Monferrato, Broni, Bari-Fibronit, Biancavilla). In five of these, increases in malignant neoplasm or pleura mortality are detected; in four of them, results are consistent in both genders. In six other sites (Pitelli, Massa Carrara, Aree del Litorale Vesuviano, Tito, "Aree industriali della Val Basento", Priolo), where other sources of environmental pollution in addition to asbestos are reported, mortality from malignant neoplasm of pleura is increased in both genders in Pitelli, Massa Carrara, Priolo, "Litorale vesuviano". In the time span 1995-2002, a total of 416 extra cases of malignant neoplasm of pleura are detected in the twelve asbestos-polluted sites. Asbestos and pleural neoplasm represent an unique case. Unlike mesothelioma, most causes of death analyzed in SENTIERI have multifactorial etiology; furthermore, in most IPSs multiple sources of different pollutants are present, sometimes concurrently with air pollution from urban areas: in these cases, drawing conclusions on the association between environmental exposures and specific health outcomes might be complicated. Notwithstanding these difficulties, in a number of cases an etiological role could be attributed to some environmental exposures. The attribution could be possible on the basis of increases observed in both genders and in different age classes, and the exclusion of a major role of occupational exposures was thus allowed. For example, a role of emissions from refineries and petrochemical plants was hypothesized for the observed increases in mortality from lung cancer and respiratory diseases in Gela and Porto Torres; a role of emissions from metal industries was suggested to explain increased mortality from respiratory diseases in Taranto and in Sulcis-Iglesiente-Guspinese. An etiological role of air pollution in the raise in congenital anomalies and perinatal disorders was suggested in Falconara Marittima, Massa-Carrara, Milazzo and Porto Torres. A causal role of heavy metals, PAH's and halogenated compounds was suspected for mortality from renal failure in Massa Carrara, Piombino, Orbetello, "Basso bacino del fiume Chienti" and Sulcis-Iglesiente-Guspinese. In Trento-Nord, Grado and Marano, and "Basso bacino del fiume Chienti" increases in neurological diseases, for which an etiological role of lead, mercury and organohalogenated solvents is possible, were reported. The increase for non-Hodgkin lymphomas in Brescia was associated with the widespread PCB pollution. Mortality for causes of death with a priori Sufficient or Limited evidence of association with the environmental exposure exceeds the expected figures, with a SMR of 115.8% for men (90% IC 114.4-117.2; 2 439 extra deaths) and 114.4% for women (90% CI 112.4-116.5; 1 069 extra deaths). These excesses are also observed when analysis is extended to all the causes of death (i.e. with no restriction to the ones with a priori Sufficient or Limited evidence): for a total of 403 692 deaths (both men and women), an excess of 9 969 deaths is observed, with an average of about 1 200 extra deaths per year. Most of these excesses are observed in IPSs located in Southern and Central Italy. The procedures and results of the evidence evaluation are presented in a 2010 Supplement of Epidemiology & Prevention devoted to SENTIERI.

[Official statistics on urological morbidity in the Russian Federation].

Official medical statistics have been analysed corcerning overall urological morbidity in the Russian Federation (RF) and in some particular regions of the RF. The analysis covered morbidity and mortality from urogenital diseases including glomerular, tubulointersticial and other diseases of the kidneys and ureter, prostatic diseases, male infertility, cancer of the urinary bladder and prostatic gland. It was found that information on urological and oncourological morbidity in the literature is available but its amount is not satisfactory. It is necessary to introduce innovations in organization of medical statistical service, in registration of urological diseases, in particular. Active screening for urological cancer in the RF does not meet requirements and potentialities of modern health care. Special screening programs must be designed to reduce mortality and improve follow-up of urological patients.

Hospital costs of older people in New South Wales in the last year of life.

OBJECTIVE: To estimate hospital inpatient costs by age, time to death and cause of death among older people in the last year of life. DESIGN AND SETTING: Cross-sectional analytical study of deaths and hospitalisations in New South Wales from linked population databases. PARTICIPANTS: 70,384 people aged 65 years and over who died in 2002 and 2003. MAIN OUTCOME MEASURES: Hospital costs in the year before death. RESULTS: Care of people aged 65 years and over in their last year of life accounted for 8.9% of all hospital inpatient costs. Hospital costs fell with age, with people aged 95 years or over incurring less than half the average costs per person of those who died aged 65-74 years ($7028 versus $17,927). Average inpatient costs increased greatly in the 6 months before death, from $646 per person in the sixth month to $5545 in the last month before death. Cardiovascular diseases (43.1% of deaths) were associated with an average of $11,069 in inpatient costs, while cancer (25.0% of deaths) accounted for $16,853. The highest average costs in the last year of life were for people who died of genitourinary system diseases ($18,948), and the highest average costs in the last month of life were for people who died of injuries ($8913). CONCLUSION: Population ageing is likely to result in a shift of the economic burden of end-of-life care from the hospital sector to the long-term care sector, with consequences for the supply, organisation and funding of both sectors.

Increased long-term mortality in patients less than 55 years old who have undergone knee replacement for osteoarthritis: results from the Swedish Knee Arthroplasty Register.

Patients with osteoarthritis undergoing knee replacement have been reported to have an overall reduced mortality compared with that of the general population. This has been attributed to the selection of healthier patients for surgery. However, previous studies have had a maximum follow-up time of ten years. We have used information from the Swedish Knee Arthroplasty Register to study the mortality of a large national series of patients with total knee replacement for up to 28 years after surgery and compared their mortality with that of the normal population. In addition, for a subgroup of patients operated on between 1980 and 2002 we analysed their registered causes of death to determine if they differed from those expected. We found a reduced overall mortality during the first 12 post-operative years after which it increased and became significantly higher than that of the general population. Age-specific analysis indicated an inverse correlation between age and mortality, where the younger the patients were, the higher their mortality. The shift at 12 years was caused by a relative over-representation of younger patients with a longer follow-up. Analysis of specific causes of death showed a higher mortality for cardiovascular, gastrointestinal and urogenital diseases. The observation that early onset of osteoarthritis of the knee which has been treated by total knee replacement is linked to an increased mortality should be a reason for increased general awareness of health problems in these patients.

Mortality and cancer incidence in males with Y polysomy in Britain: a cohort study.

The mortality and cancer incidence risks among males with Y polysomy are unknown because there have been no large long-term cohort studies carried out of such men. We conducted a cohort study of 667 men diagnosed with the abnormality in Britain since 1959 to compare their mortality and cancer incidence rates with those of the general population. Sixty deaths occurred during follow-up to December 2005, twice the number expected from general population rates (standardised mortality ratio (SMR) = 2.0 (95% confidence interval (CI) 1.5-2.6)). Significantly raised mortality was observed for diseases of the nervous system (SMR = 7.0, 95% CI: 2.3-16.4), circulatory system (SMR = 2.1, 95% CI: 1.3-3.2), respiratory system (SMR = 4.0, 95% CI: 1.8-7.5), genitourinary system (SMR = 10.2, 95% CI: 1.2-36.9), and congenital anomalies (SMR = 11.9, 95% CI: 3.2-30.5). Four of the five nervous system deaths were from epilepsy, the risk of death from this condition being more than 20-fold raised. The rates of cancer incidence and mortality among these men was not significantly different from those in the general population. This study provides evidence that mortality rates from several specific causes are raised among men with Y polysomy. The use of these data in genetic counselling should be cautious particularly for cases of Y polysomy that are detected prenatally. Further investigations are required to confirm these findings and to elucidate the possible role of genes on the Y chromosome in the aetiology of these causes of death.

[Genitourinary diseases mortality in mercury miners]. / Mortalidad por enfermedades genitourinarias en los mineros de mercurio.

OBJECTIVES: To study the mortality due to genitourinary diseases in mercury miners. POPULATION AND METHODS: 3.998 workers exposed to mercury in Minas de Almadén y Arrayanes S.A. were studied. The follow-up period was a century, since 1,895 to 1,994. It was completed assessing the vital status and the basic cause of death, in case of fatalities. Standardized Mortality Ratios by age, sex and calendar period were calculated. Expected deaths were obtained from age, sex and calendar period specific rates for the Spanish and Castilla-La Mancha populations. RESULTS: A significant increase in mortality due to genitourinary diseases was found (CIE-9 codes 580 to 629), being significant with respect to the total population for nephritis, nephrotic syndrome and nephrosis, with SMR of 1.69 an 95% CI 1.18 to 2.34. Mortality excesses due to nephritis, nephrotic syndrome and nephrosis were higher in the metallurgy workers than in miners. A Poisson multivariate regression detected a positive trend in the mortality due to nephritis and nephrosis associated to the exposure length, with the risk increasing fivefold after 30 years of exposure to mercury. CONCLUSIONS: This paper shows an excess in the mortality due to genitourinary diseases, specially in nephritis, nephrotic syndrome and nephrosis, whose estimation and significance increases when compared to the population of Castilla-La Mancha.

[Newborn emergencies in the Pediatric Surgery Service of CHU Donka]. / Les urgences chirurgicales neonatales dans le Service de Chirurgie Pediatrique du CHU Donka.

UNLABELLED: DRANK: The goal of this work is to determine the factors of surgical mortality in period neonatal and to emphasize the difficulties of the assumption of responsibility. MATERIALS AND METHODS: Retrospective study of 222 cases over 10 years from January 1992 to December 00 realized in the service of Paediatric surgery of the National Hospital Donka. We studied the age of the patients to the first consultation according to whether it is received before or after the 6th day of birth, the socio-economic level was appreciated according to the mode of dwelling, accessibility with drinking water and electricity, the diet, associated malformations, the postoperative results. RESULTS: In 10 years (January 1992 at December 2001), we recorded 222 surgical cases of newborn emergency interesting the digestive tract (27.48%), the abdominal wall (37.39%), the parts urogenital (2.25%) and neurological (32.88%). We noted a male prevalence of 64.41% and surgical newborn mortality was 29.28%. The delay with the consultation, poverty on the one hand and the lack of the means of reanimation, the insufficiency of qualified personnel, were the principal factors of risk in our series. CONCLUSION: The surgical newborn urgencies gather affections which require an immediate and adequate assumption of responsibility. The early diagnosis is a requirement; it must be done in the room of childbirth. The childbirth in residence, the ignorance of these affections by much of experts involves the delay with the consultation. The insufficiency of personnel qualified in paediatric surgery and infantile anaesthesia-reanimation, the poverty of the parents who must deal with the medical expenses of the new-born babies are as many factors which delay the time of intervention. The training of the specialists in paediatric anaesthesia-reanimation, the formation continues agents of health on all the levels on the tracking of the newborn urgencies, the creation of the centers of reanimation, the motivation of the personnel looking after in these structures and the intervention of the medical O.N.G. will be major assets to improve the assumption of responsibility and to decrease the death rate.

[Occupation and mortality in the Brazilian Navy]. / Ocupação e mortalidade na Marinha do Brasil.

OBJECTIVE: To describe the distribution of mortality due to digestive tract, genitourinary and nervous system diseases according to occupation among Brazilian Navy servicemen. METHODS: This was an exploratory study of proportional mortality among male servicemen in the Brazilian Navy who died between 1991 and 1995. The study population comprises the entire contingent of servicemen during this same time period. Data were obtained from death certificates submitted in order to obtain dependents' pensions, and from the corresponding occupational histories of these individuals. Basic causes of death were coded in accordance with the International Classification of Diseases (9th Revision). RESULTS: Servicemen presented increased proportional mortality for liver diseases related to alcohol consumption (age-adjusted proportional mortality ratio, PMRadj=2.03; 95% confidence interval, CI: 1.26-3.00), pancreatitis (PMRadj=2.03; 95% CI: 1.06-3.38), digestive hemorrhage (PMRadj=1.61; 95% CI: 1.10-2.23), chronic kidney diseases (PMRadj=2.82; 95% CI: 1.98-3.84), Parkinson's disease (PMRadj=3.00; 95% CI: 1.27-5.72) and degenerative brain diseases (PMRadj=2.88; 95% CI: 1.14-5.70), in relation to the reference population. A statistically non-significant association was observed between radar operators (PMR=6.50; 95% CI: 1.43-29.56) and nervous system diseases was observed. CONCLUSIONS: The results indicate the existence of possible occupational risk factors in the working environment of the Brazilian Navy, and the need for studies using quantitative measurement of such exposure.