Obesity and Breast Cancer Risk in Men: A National Case-Control Study in England and Wales.

Background: Breast cancer is rare in men, and information on its causes is very limited from studies that have generally been small. Adult obesity has been shown as a risk factor, but more detailed anthropometric relations have not been investigated. Methods: We conducted an interview population-based case-control study of breast cancer in men in England and Wales including 1998 cases incident during 2005-2017 at ages younger than 80 years and 1597 male controls, with questions asked about a range of anthropometric variables at several ages. All tests of statistical significance were 2-sided. Results: Risk of breast cancer statistically significantly increased with increasing body mass index (BMI) at ages 20 (odds ratio [OR] = 1.07, 95% confidence interval [CI] = 1.02 to 1.12 per 2-unit change in BMI), 40 (OR = 1.11, 95% CI = 1.07 to 1.16), and 60 (OR = 1.14, 95% CI = 1.09 to 1.19) years, but there was also an indication of raised risk for the lowest BMIs. Large waist circumference 5 years before interview was more strongly associated than was BMI with risk, and each showed independent associations. Associations were similar for invasive and in situ tumors separately and stronger for HER2-positive than HER2-negative tumors. Of the tumors, 99% were estrogen receptor positive. Conclusions: Obesity at all adult ages, particularly recent abdominal obesity, is associated with raised risk of breast cancer in men, probably because of the conversion of testosterone to estrogen by aromatase in adipose tissue. The association is particularly strong for HER2-expressing tumors.

Comparing phase and electrographic flow mapping for persistent atrial fibrillation.

BACKGROUND: An increasing number of methods are being used to map atrial fibrillation (AF), yet the sensitivity of identifying potential localized AF sources of these novel methods are unclear. Here, we report a comparison of two approaches to map AF based upon (1) electrographic flow mapping and (2) phase mapping in a multicenter registry of patients in whom ablation terminated persistent AF. METHODS: Fifty-three consecutive patients with persistent AF in whom ablation terminated AF in an international multicenter registry were enrolled. Electrographic flow mapping (EGF) and phase mapping were applied to the multipolar simultaneous electrograms recorded from a 64-pole basket catheter in the chamber (left vs right atrium) where AF termination occurred. We analyzed if the mapping methods were able to detect localized sources at the AF termination site. We also analyzed global results of mapping AF for each method, patterns of activation of localized sources. RESULTS: Patients were 64.3 ± 9.4 years old and 69.8% were male. EGF and phase mapping identified localized sources at AF termination sites in 81% and 83% of the patients, respectively. Methods were complementary and in only n = 2 (3.7%) neither method identified a source. Globally, EGF identified more localized sources than phase mapping (5.3 ± 2.8 vs 1.8 ± 0.5, P < 0.001), with a higher prevalence of focal (compared to rotational) activation pattern (49% vs 2%, P < 0.01). CONCLUSIONS: EGF is a novel vectorial-based AF mapping method, which can detect sites of AF termination, agreeing with, and complementary to, an alternative AF mapping method using phase analysis.

"Chronicity," "nervios" and community care: a case study of Puerto Rican psychiatric patients in New York City.

The role of ethnicity, community structure, and folk concepts of mental illness in facilitating the adaptation of long term psychiatric patients to community living has received little attention. This article examines the cultural concepts of mental illness and the community involvement of 30 Puerto Rican psychiatric patients participating in a New York City treatment program. It is shown that many of the attributes usually associated with chronic mental illness do not apply to this population. It is argued that the folk concept of nervios helps to foster the integration of these patients in a wide range of community networks. The impact of gentrification on these patients' community integration is also discussed.

Subacute osteoporotic compression fracture: misleading magnetic resonance appearance.

Three patients with benign subacute osteoporotic vertebral compression fractures are presented. T1 weighted magnetic resonance (MR) images (SE 500/30) showed decreased vertebral signal. Because the results of the MR examination were thought to indicate malignant disease, extensive medical workups, including one biopsy, were pursued in all three patients. Routine (SE 500/30) spin-echo pulse sequences cannot definitively distinguish between benign and malignant vertebral compression fractures.

Crystalline inclusions associated with lung adenomas in C57BLxC3H F1 mice.

In a study on lung adenomas induced by the administration of a single intragastric dose of sodium thiocyanate, diethylnitrosamine, or its precursors to 15-day-old C57BLxC3H F1 mice the occurrence of crystalline inclusions in pulmonary parenchyma was noted. A correlation between crystalline deposits and number and type of adenomas seen between 46 and 110 weeks was observed. In 45/61 adenomas, eosinophilic cells containing inclusions were seen scattered in the pulmonary tissue, adjacent to tumor areas, in desquamated cells in the bronchioles, in the lumens of the submucosal bronchial glands, and within the alveoli. By contrast 7/85 mice without adenomas showed inclusions (4/7 mice had pneumonitis). The inclusions stained with bromophenol blue, were PAS positive diastase resistant and showed varying amounts of alpha-1-antitrypsin, IgG, and IgA by immunoperoxidase technique. Ultrastructure revealed membrane bound rods with a lattice pattern.

Neonatal lupus with congenital atrioventricular block and myocarditis.

This is a case of a child with neonatal lupus and congenital atrioventricular (AV) block, born to a mother with asymptomatic, systemic lupus erythematosus (SLE). The child, despite pacemaker insertion, died of septicemia and myocarditis at the age of three months. Although the association of neonatal lupus with congenital AV block is well-recognized, there are only few pathologic studies of the conduction system reported in the literature. This is such a study in which we emphasize that, due to an altered immune system in the child, septicemia may be the cause of death in some cases.

Induction of neoplastic lesions in the livers of C57BL x C3HF1 mice by chloral hydrate.

Chloral hydrate is a compound of environmental significance. The current investigation was undertaken to evaluate the carcinogenic effect of chloral hydrate, because it is present in drinking water and it is also used as a sedative. Fifteen-day-old C57BL x C3HF1 male mice were given a single dose of chloral hydrate in distilled water at two dose levels: group 1, 5 micrograms/g BW; group 2, 10 mu/g BW (20-25 mice per group). Thirty-five mice given distilled water only served as controls. Animals were sacrificed at 24 hr and thereafter at various intervals up to 92 weeks. The entire liver was fixed and examined histologically. Mice sacrificed between 48 and 92 weeks showed hepatic lesions ranging from hyperplastic to trabecular carcinomas. The tumor incidence in mice given 10 micrograms/g chloral hydrate (six of eight) was significantly higher (P less than 0.05) than the incidence in the controls (two of 19). These findings indicate that chloral hydrate should be more thoroughly studied for potential carcinogenicity.

Progressive multifocal leukoencephalopathy: clinical and radiographic features.

Between April 1982 and March 1984 7 pathologically confirmed cases of progressive multifocal leukoencephalopathy (PML) were diagnosed at our institution. Only 1 case had been seen in the preceding twenty years. Four patients had acquired immunodeficiency syndrome (AIDS). The others had chronic lymphocytic leukemia, Hodgkin's lymphoma, and systemic lupus erythematosus. All patients presented with progressive neurological deficits. In most, the initial computed tomographic (CT) scan was disproportionately less abnormal than the clinical findings. In 5 patients the first CT scan revealed hypodensities of the cerebral white matter which lacked mass effect and did not enhance with contrast agent. The lesions were observed to enlarge progressively on CT scans but often lagged behind the rate of clinical evolution. Although 3 patients were treated with cytosine arabinoside, none improved. PML had similar clinical, radiographic, and pathological features in the AIDS and non-AIDs patients. Of 79 AIDS patients cared for at our institution between December 1979 and December 1983, 3.8% had PML. PML should be suspected in AIDS patients in the presence of the characteristic CT features, especially when CT-clinical dissociation occurs.

IgA deposition in liver in alcoholic liver disease. An index of progressive injury.

A retrospective study was done to evaluate the prognostic importance of the patterns of IgA deposition in the liver in alcoholic liver disease. The patterns of IgA deposition in the liver were determined by direct immunofluorescence with fluorescein conjugated rabbit antihuman IgA. Twenty of 40 patients showed a characteristic continuous pattern, and 20 patients showed the nonspecific discontinuous pattern of IgA deposition in the liver. Alcoholic liver disease progressed considerably in 14 (70%) of the 20 patients with an initial continuous pattern and in three (15%) of the 20 patients with an initial discontinuous pattern. Alcoholic liver disease did not progress in six (30%) of 20 patients with an initial continuous pattern and in 17 (85%) of the 20 patients with an initial discontinuous pattern of IgA deposition in the liver.