Smokers as a high-risk group: data from a screening population.

GOAL: To determine the number of pack-years exposure associated with a 2-fold increase risk for significant colorectal neoplasia and to examine the risk of smoking in younger patients. BACKGROUND: Cigarette smoking has been shown to be a significant risk factor for colorectal neoplasia and may be used to stratify patients for screening or triaging of screening resources. However, more information is needed regarding the amount of exposure required to significantly increase by 2-fold an individual's risk for colorectal neoplasia. METHODS: Data collected for 2707 patients presenting for screening colonoscopy included tobacco use measured in pack-years and known risk factors for colorectal neoplasia. Our outcome was endoscopically detected significant colorectal neoplasia that included large (>1 cm) tubular adenomas, villous adenomas, multiple (3 or more) adenomas, high-grade dysplasia, and adenocarcinoma. RESULTS: Patients who smoked more than 30 pack-years were more than 2 times more likely to have significant colorectal neoplasia than patients who never smoked (odds ratio: 2.40; 95% confidence interval: 1.65-3.50). For patients aged 40 to 49 years, smokers were more likely than nonsmokers to have significant colorectal neoplasia (odds ratio: 2.71; 95% confidence interval: 1.05-6.97). CONCLUSIONS: Patients who have smoked more than 30 pack-years had a more than 2-fold increase for significant colorectal neoplasia as compared with nonsmokers. The increased risk was also observed in younger patients. Our data have implications for screening guidelines.

Statistical methods for anomalous discrete time series based on minimum cell count.

Temporal incidence patterns of point epidemics often contain periods of unusually low or high frequencies. Identifying variations in incidence frequencies, which may be caused by changes in exposure to infectious or environmental agents, may provide important insights into the pathogenesis or etiology of a disease. We propose and formulate new statistical tests for temporal and space-time anomalies that are based on the minimum frequency in a unit of time and that are meaningful for the characteristic incidence patterns of the cases studied. Among the most widely applied methods are the Ederer-Myers-Mantel test, the Maxima test, and the scan test, which are all sensitive to the maximum frequency within a short period of time. We elucidate the importance and utility of our new tests and the existing tests and suggest a systematic statistical analysis of reported disease anomalies using these tests combined. Data on a temporal series of adolescent suicide from the US National Center for Health Statistics were analyzed using these methods.

Colorectal cancer screening attitudes and practices preferences for decision making.

BACKGROUND: The availability of several effective screening options for colorectal cancer (CRC) screening calls for involving patients in decision making about CRC screening. The current study examined (1) participant characteristics associated with their preferences for participation in CRC screening decision making, (2) correspondence between participant preferences for decision making and their usual participation in decision making, and (3) associations between participant decision-making preferences and CRC screening practices and attitudes. METHODS: Data were obtained using a random, population-based telephone survey, conducted during August 2001 and April 2002, of 2119 community-living adults aged 50 to 75 years (56% female) residing in Long Island, NY. RESULTS: Overall, 77% reported that preferences for CRC screening decision making matched how screening decisions were usually made (simple kappa coefficient=0.67 [0.64-0.69]). Fifteen percent preferred to make screening decisions themselves, while 25% preferred to make decisions after considering their physician's opinion; nearly 50% preferred to share decision making, and 16% preferred that their physician make all screening decisions. Less education was associated with preferring that the physician make all screening decisions. Preferring physician involvement in screening decision making was associated with greater odds of citing no physician recommendation as a barrier to CRC screening, when compared to those who preferred no physician involvement. Preferring no physician involvement in decision making was associated with lower odds of reporting a recent CRC screening exam, as well as lower odds of endorsing positive attitudes and greater odds of endorsing negative attitudes toward CRC screening, when compared to participants who preferred physician involvement in decision making. Their attitudes also reflected intentions not to screen for CRC if they were asymptomatic, as well as the perception that they were not at personal risk for CRC. CONCLUSIONS: Several factors were identified as significantly associated with preferences for decision making and deserve further exploration for their application to clinical practice.

Wire coding in the EMF and Breast Cancer on Long Island Study: relationship to magnetic fields.

The Electromagnetic Fields and Breast Cancer on Long Island Study (EBCLIS) is a large population-based case-control study investigating possible associations between magnetic fields and breast cancer, and includes a comprehensive set of in-home measurements. We investigated the reproducibility of wire codes, their relation to 24-h measurements of residential magnetic fields, and potential influences, such as housing characteristics, in homes of the 1161 EBCLIS participants. Replicate wire coding was performed in homes originally categorized as having very high current configurations (VHCC) in the Wertheimer-Leeper (W-L) wire coding scheme, and a random sample of other homes (235 residences). Reproducibility was very high, with a kappa statistic of 0.83 (95% confidence interval (CI)=0.77-0.89) for the five-category W-L wire codes and 0.91 (95% CI=0.86-0.95) for the three-category Kaune-Savitz (K-S) codes. As levels of W-L and K-S wire codes increased, the mean and median 24-h levels of broadband and harmonic fields in the residences also increased, indicating an association between wire codes and magnetic fields measurements. Regions of Long Island with the highest percentage of homes built before 1950 had the highest percentage of higher current configuration homes, as well as the highest average 24-h broadband and harmonic measurements. Adjustment for age of the home and region did not affect the relation between wire codes and measured magnetic fields. Our results indicate that: (a). a high reproducibility in wire coding was achieved, (b). wire codes were correlated with magnetic fields, and (c). wire code levels were related to the age of the home. The high level of reproducibility suggests that, in our case-control analyses, there will be minimal bias due to misclassification of wire code categories. Results also suggest that wire codes are a proxy measure, to some degree, for current in-home magnetic field measurements in this study.

Exact Statistical Tests for Heterogeneity of Frequencies Based on Extreme Values.

Sophisticated statistical analyses of incidence frequencies are often required for various epidemiologic and biomedical applications. Among the most commonly applied methods is Pearson's χ2 test, which is structured to detect non-specific anomalous patterns of frequencies and is useful for testing the significance for incidence heterogeneity. However, the Pearson's χ2 test is not efficient for assessing the significance of frequency in a particular cell (or class) to be attributed to chance alone. We recently developed statistical tests for detecting temporal anomalies of disease cases based on maximum and minimum frequencies; these tests are actually designed to test of significance for a particular high or low frequency. We show that our proposed methods are more sensitive and powerful for testing extreme cell counts than is the Pearson's χ2 test. We elucidated and illustrated the differences in sensitivity among our tests and the Pearson's χ2 test by analyzing a data set of Langerhans cell histiocytosis cases and its hypothetical sets. We also computed and compared the statistical power of these methods using various sets of cell numbers and alternative frequencies. Our study will provide investigators with useful guidelines for selecting the appropriate tests for their studies.

Blood transfusion is associated with increased resource utilisation, morbidity and mortality in cardiac surgery.

The purpose of the present investigation was to examine the impact of blood transfusion on resource utilisation, morbidity and mortality in patients undergoing coronary artery bypass graft (CABG) surgery at a major university hospital. The resources we examined are time to extubation, intensive care unit length of stay (ICULOS) and postoperative length of stay (PLOS). We further examined the impact of number of units of packed red blood cells (PRBCs) transfused during PLOS. This is a retrospective observational study and includes 1746 consecutive male and female patients undergoing primary CABG (on- and off-pump) at our institution. Of these, 1067 patients received blood transfusions, while 677 did not. The data regarding the demography, blood transfusion, resource utilisation, morbidity and mortality were collected from the records of patients undergoing CABG over a period of three years. The mean time to extubation following surgery was 8.0 h for the transfused group and 4.3 h for the nontransfused group ( P

A hydroquinone formulation with increased stability and decreased potential for irritation.

BACKGROUND: Long-term treatment with a high-strength hydroquinone (HQ) cream (usually 4% HQ) is the mainstay therapy for hyperpigmentation disorders. Instability and high potential for irritancy hinders patient compliance. A new 4% HQ preparation has been designed with an innovative antioxidant for stability and a biomimetic of an herbal extract for skin calming. AIMS: To investigate the activity, stability, and irritancy of a new HQ cream. METHODS: To evaluate the new HQ cream in comparison with commercial 4% HQ creams for stability by temperature stress test, for irritancy by repeated-insult patch test on human subjects, and for lightening effect using the MelanoDerm B skin equivalent model. RESULTS: The new HQ is more resistant to browning and shows less irritancy than three commercially available 4% HQ products. It has comparable bleaching effect with faster onset than a 4% HQ product containing 0.05% tretinoin and 0.01% fluocinolone acetonide. CONCLUSION: Based on its improved stability, lower irritancy, and activity in skin lightening, the new approach to the formulation of 4% HQ may improve therapeutic outcomes by improving patient compliance to dosing.

Mitral annular remodeling with varying degrees and mechanisms of chronic mitral regurgitation.

HYPOTHESES: Degree of mitral annular remodeling is directly associated with severity of chronic mitral regurgitation (MR). Mitral annular remodeling occurs in a symmetric fashion, regardless of MR severity. In addition to MR severity, MR mechanism plays a significant role in mitral annular remodeling. BACKGROUND: Limited data exists on mitral annular remodeling in patients with MR. Identification of annular changes may be important in aiding surgical repair. METHODS: Mitral annular dimensions (anteroposterior, intercommissural, surface area, and circumference) were measured in end systole and diastole using 3-dimensional reconstructive software in 83 patients: trace to no MR (23), mild MR (15), moderate MR (26), and severe MR (19). Annular sphericity indices were determined by dividing intercommissural by anteroposterior dimensions. Patients were further subgrouped by mechanism of MR. RESULTS: With increasing MR severity, there was a corresponding increase in all annular measurements, most pronounced in the anteroposterior dimension, circumference, and area. Larger increases were seen in patients with prolapse/flail and dilated mechanisms. Furthermore, the mitral annulus became more circular (sphericity index approached 1.0) with increasing MR severity. Patients with prolapse/flail mechanisms exhibited normal left ventricular volumes despite significant annular enlargement. CONCLUSIONS: Mitral annular remodeling is directly associated with MR severity and occurs in an asymmetric fashion, yet is not limited to one region of the annulus. Mechanism of MR plays a significant role in annular remodeling. Annular remodeling can occur independently of left ventricular remodeling.

Body mass index: a marker for significant colorectal neoplasia in a screening population.

BACKGROUND AND AIMS: Although some studies suggest a positive association between increasing body mass index (BMI) and risk for colorectal neoplasia, the impact on screening has not been examined. We performed a cross-sectional study to examine the association of BMI and colorectal neoplasia in a screening population. METHODS: Data collected for 2493 patients presenting for screening colonoscopy included known risk factors for colorectal neoplasia, demographic information, and lifestyle factors. Our outcome was the endoscopic detection of significant colorectal neoplasia which included adenocarcinoma, high-grade dysplasia, villous tissue, adenomas 1 cm or greater and multiple (>2) adenomas of any size. RESULTS: Overall, we observed an increased risk and prevalence for significant colorectal neoplasia in women as BMI increased (P value for trend <0.002). This relationship was the strongest for the women with a BMI > or =40 (odds ratios=4.26; 95% confidence intervals=2.00-9.11). There was no such relationship in our male population. CONCLUSIONS: Increasing BMI, in our population, was associated with an increase risk for colorectal neoplasia in female patients. This study reinforces the importance of screening colonoscopy especially in obese women.

Relationship of mitral annular remodeling to severity of chronic mitral regurgitation.

HYPOTHESES: (1) Mitral regurgitation (MR) severity is directly associated with mitral annular remodeling as evidenced by mitral annular enlargement. (2) Increasing severity of chronic MR will result in symmetric enlargement of the mitral annulus as measured by annular shape indices. BACKGROUND: Limited data exist on mitral annular remodeling for patients with MR. Identification of annular changes may be important in aiding surgical repair. METHODS: The mitral annulus was measured in several planes using transthoracic echocardiography in 173 patients: trace to no MR (34), mild MR (48), moderate MR (45), and severe MR (46). Patients were subgrouped by mechanism of MR and annular shape indices were determined. RESULTS: With increasing MR severity, there was a corresponding symmetric increase in all systolic and diastolic measurements, but no significant differences in annular shape indices between subgroups by MR severity or by MR mechanism. CONCLUSIONS: Mitral annular remodeling is symmetric, regardless of degree or mechanism of MR.

Shift work, light at night, and breast cancer on Long Island, New York.

The hypothesized association between breast cancer and circadian disruption was evaluated in the Electromagnetic Fields and Breast Cancer on Long Island Study. Participants included 576 women with breast cancer diagnosed from August 1996 to June 1997 and 585 population-based controls (87% and 83% participation rates, respectively) aged < 75 years and living in the same Long Island, New York, home for > or = 15 years. An in-person interview ascertained light-at-night exposure histories through shift work (previous 15 years) and at home (previous 5 years). Odds ratios and 95% confidence intervals were estimated by unconditional multivariate logistic regression. Breast cancer was not associated with overall shift work (odds ratio (OR) = 1.04, 95% confidence interval (CI): 0.79, 1.38) or evening shift work (OR = 1.08, 95% CI: 0.81, 1.44). However, overnight shift workers were at lower risk than women never working shifts (OR = 0.55, 95% CI: 0.32, 0.94). Women who frequently turned on lights at home during sleep hours (> or = twice/week and > or = twice/night) had increased risks (OR = 1.65, 95% CI: 1.02, 2.69). The latter results suggest positive associations with residential light-at-night exposure, or they could reflect response biases. Furthermore, overall and evening shift work were not significant factors, and analyses of overnight shift workers yielded reduced risk estimates. The study thus provides mixed evidence for the light-at-night hypothesis.

Intraoperative assessment of mitral regurgitation: role of phenylephrine challenge.

OBJECTIVES: We defined the effects of the operative (OP) state and phenylephrine challenge on the assessment of mitral regurgitation (MR) severity. METHODS: In all, 57 patients underwent transesophageal echocardiographic assessment of MR severity pre-OP (PREOP) and intra-OP. MR severity was assessed PREOP under conscious sedation and intra-OP with general anesthesia, before and after hemodynamic manipulation with vasoactive agents, to match intra-OP and PREOP transesophageal echocardiographic mean arterial blood pressures. RESULTS: Intra-OP MR and mean arterial pressure were less than PREOP in 27 patients (both P < .001). When PREOP and OP blood pressures were matched using phenylephrine, there was no significant difference in MR severity between the two states (P = 1.0). Nonetheless, MR severity was still underestimated in 6 patients and overestimated in 7 patients intra-OP. CONCLUSIONS: Intra-OP transesophageal echocardiography underestimates MR severity. Phenylephrine reduces, yet does not eliminate, intra-OP underestimation of MR severity.

Resource utilization in on- and off-pump coronary artery surgery: factors influencing postoperative length of stay--an experience of 1,746 consecutive patients undergoing fast-track cardiac anesthesia.

OBJECTIVE: The purpose of the present investigation was to examine factors influencing resource utilization in patients undergoing on-pump coronary artery bypass graft and off-pump coronary artery bypass (OPCAB) graft surgery at a major university hospital. The resources examined were time to extubation, packed red blood cell (PRBC) transfusion, intensive care length of stay (ICULOS), preoperative and postoperative length of stay (PLOS), and total length of stay (LOS). DESIGN: Observational study of consecutive patients undergoing on- and off-pump coronary artery bypass surgery. SETTING: Tertiary care cardiac referral center. PARTICIPANTS: One thousand seven hundred forty-six consecutive male and female patients undergoing primary coronary artery bypass graft (CABG) surgery over a period of 3 years (1999-2001). Eight hundred eighty-one patients underwent CABG with pump, and 865 patients underwent off-pump coronary artery bypass (OPCAB) surgery. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The mean time to extubation after surgery was 7.4 hours for on-pump patients and 5.8 hours for the OPCAB group (p72 hours to postoperative tracheal extubation compared with 1.5% in the OPCAB group (p=0.041). Hospital mortality was 2.7% for the on-pump group and 1.0% for the OPCAB group (p=0.010). CONCLUSION: The authors found that patients undergoing on-pump CABG have significantly longer time to tracheal extubation, increased blood use, longer ICULOS, PLOS, and total LOS and higher in-hospital mortality, which would translate into significant differences in the expenses associated with these 2 surgical approaches to coronary surgery.

Octogenarians undergoing coronary artery bypass graft surgery: resource utilization, postoperative mortality, and morbidity.

OBJECTIVE: The purpose of the present study was to examine resource utilization in octogenarians undergoing coronary artery bypass grafting (CABG) and compare it with usage in their younger cohorts at a tertiary care heart center. The resources examined were time to extubation, packed red blood cell transfusions, intensive care unit (ICU) length of stay (LOS), and preoperative and postoperative LOS. The study also examined differences in postoperative morbidity and mortality. DESIGN: Retrospective hospital follow-up study of consecutive patients undergoing CABG using a prospectively designed database. SETTING: University teaching tertiary care referral center for cardiac surgery. PARTICIPANTS: Seventeen hundred forty-six male and female patients undergoing CABG surgery, including 155 octogenarians and 1591 patients younger than 80 years. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Demographic, mortality, morbidity, and resource utilization data were collected from the records of patients undergoing CABG at the authors' institution over 3 years. There were 1746 patients: 155 octogenarians and 1591 nonoctogenarians. Octogenarians had a significantly higher incidence of preoperative stroke, peripheral vascular disease, chronic obstructive lung disease, congestive heart failure, and left main disease. They weighed significantly less, and had lower preoperative and postoperative hematocrit. There was a significantly higher percentage of women in the octogenarian group. Mean time from the end of surgery to endotracheal extubation was 9.3 hours for octogenarians and 6.3 hours for their younger cohorts (p < 0.001). Blood transfusion was required in 88.4% of octogenarians compared with 58.6% of nonoctogenarians (p < 0.001). Mean ICU LOS was 1.9 days for octogenarians and 1.4 days for nonoctogenarians (p < 0.001). Mean postoperative LOS was 8.7 days for octogenarians and 5.8 days for nonoctogenarians (p < 0.001). Clinical and demographic variables were correlated with age 80 years or older. Multivariate linear and logistic regression models were constructed to show the combined effects of age and comorbid conditions on outcomes. Octogenarians had a significantly higher incidence of postoperative renal failure and neurologic complications. The 30-day mortality rate was 9.0% for the octogenarian group v 1.2% for the younger group (p < 0.001). Age 80 years or older was significantly associated with outcome, and was an independent predictor of increased resource utilization and postoperative mortality and morbidity. CONCLUSIONS: The results demonstrated that octogenarians undergoing CABG required increased resource utilization and had significantly higher morbidity, with increased incidence of postoperative renal failure, neurologic complications, and 30- day mortality. Age 80 years or older was an independent predictor of increased resource utilization, postoperative morbidity, and mortality.

Prevalence and risk of colorectal neoplasia in consumers of alcohol in a screening population.

BACKGROUND AND AIMS: Although studies suggest a positive association between alcohol consumption and risk for colorectal neoplasia, the impact on screening has not been fully examined. It is also unclear whether all types of alcohol are associated with an increased risk. We performed a cross-sectional study to examine the impact of regular alcohol consumption on the detection of significant colorectal neoplasia in a screening population. METHODS: Data collected for 2,291 patients presenting for screening colonoscopy: known risk factors for colorectal neoplasia and alcohol drinking pattern. Our outcome was the endoscopic detection of significant colorectal neoplasia, which included adenocarcinoma, high-grade dysplasia, villous tissue, adenomas 1 cm or greater and multiple (>2) adenomas of any size. RESULTS: When compared to abstainers, we found an increased risk for significant neoplasia in those patients who consumed more than eight drinks of spirits alcohol (26.3%; OR = 2.53; 95% CI = 1.10-4.28; p < 0.01) and those who drank more than eight servings of beer per week (21.7%; OR = 2.43; 95% CI = 1.11-5.32; p= 0.02). Consuming one to eight glasses of wine per week was associated with a decreased risk for significant neoplasia (OR = 0.55; 95% CI = 0.34-0.87; p < 0.01). CONCLUSIONS: While there was a more than twofold increased risk of significant colorectal neoplasia in people who drink spirits and beer, people who drank wine had a lower risk. In our sample, people who drank more than eight servings of beer or spirits per week had at least a one in five chance of having significant colorectal neoplasia detected by screening colonoscopy.

Effectiveness of women's telephone counseling and physician education to improve mammography screening among women who underuse mammography.

The effect on women's breast cancer screening utilization of a barrier-specific telephone counseling (BSTC) intervention, with and without a concurrent continuing medical education (CME) activity for their physicians, was evaluated. All participants (50-80 years of age) were not regular mammography users at baseline. A 4-arm quasi-experimental design was employed. Women were randomized to the BSTC or no BSTC group and assigned (with their physicians) to the CME or no CME group based on place of residence. Pre- and postintervention data were obtained for 1,601 women using telephone interviews conducted during 1995 and 1998, respectively. Among women who had ever used mammography at baseline, those who received BSTC were more likely than the control group to become regular mammography users at follow-up (OR = 1.4, p = .033). Greater reductions in perceived barriers to mammography, from baseline to follow-up, were significantly associated with receiving BSTC compared with the control group (p = .001), among women with previous mammography experience. Findings suggest that CME may have potential for initiating mammography use among women who never had a previous mammogram. However, because of the small sample available for analyses of the CME intervention and differential attrition among women who never had a previous mammogram, further study is needed to confirm this hypothesis.

Blood use in patients undergoing coronary artery bypass surgery: impact of cardiopulmonary bypass pump, hematocrit, gender, age, and body weight.

UNLABELLED: We investigated the impact of cardiopulmonary bypass pump (CPB), hematocrit, gender, age, and body weight on blood use in patients undergoing coronary artery bypass graft surgery at a major university hospital. Participants were 1235 consecutive patients undergoing primary coronary artery surgery over a period of 2 yr (1999 and 2000); 681 patients underwent coronary surgery with use of CPB, and 554 patients underwent off-pump coronary artery bypass surgery using a median sternotomy incision. There were 881 males and 354 females. Average packed red blood cells (PRBC) transfusion for patients on CPB was 3.4 U compared with 1.6 U for the off-pump group (P = <0.001). Patients on CPB received more frequent PRBC transfusion (72.5%) compared with 45.7% of off-pump patients (P = <0.001). Average PRBC transfusion for males was 2.2 U compared with 3.6 U for females (P = <0.001). A lower percentage of males (52.6%) than females (79.4%) received transfusion (P = <0.001). The impact of CPB, off-pump status, preoperative hematocrit <35%, gender, age >or=65 yr, and weight

Postischemic stunning after adenosine vasodilator stress.

BACKGROUND: Ischemic left ventricular (LV) dysfunction may occur after exercise but is regarded as uncommon after vasodilator stress. We evaluated the prevalence of LV dysfunction after adenosine stress in relation to reversible perfusion defects and angiographic coronary artery disease (CAD). METHODS AND RESULTS: We studied 86 patients referred for clinically indicated adenosine dual-isotope gated single photon emission computed tomography: 43 with 1 or more reversible perfusion defects (reversible defect group) and 43 age- and sex-matched patients with no known CAD and normal LV perfusion and function (control group). Coronary angiography was performed in 36 of 43 patients (84%) in the reversible defect group. Perfusion was interpreted based on 20-segment/5-point summed rest and stress scores. The extent of reversibility was defined by the summed difference score. LV ejection fraction and volumes at rest and 60 minutes after adenosine and segmental wall thickening were quantified by QGS (Cedars-Sinai Medical Center, Los Angeles, Calif). In patients with extensive reversible perfusion defects (summed difference score > or =8), 8 of 25 (32%) demonstrated depressed post-adenosine LV ejection fraction, abnormal segmental wall thickening, end-systolic dilation, and extensive CAD. CONCLUSION: Adenosine is believed to be less likely than exercise to induce ischemia. However, myocardial stunning occurred in one third of the patients with severe reversible defects, consistent with ischemia.

Predictors of proximal neoplasia in patients without distal adenomatous pathology.

BACKGROUND: Previous colorectal cancer screening studies have observed that some patients may have advanced proximal neoplasia without distal findings. Since these studies have included only gender, age, and family history as risk factors, they are limited in their ability to identify predictors of isolated proximal neoplasia. METHODS: Data were collected from the charts of 1,988 patients who presented for colonoscopy. Information gathered included endoscopic findings, histology, known risk factors for colorectal neoplasia, and smoking pattern. Our main outcome was the presence of proximal adenomatous neoplasia in patients who had no distal adenomas. We defined significant neoplasia as adenocarcinoma, high-grade dysplasia, villous polyps, adenomas 1 cm or greater or more than two adenomas of any size. RESULTS: Fifty-five patients had isolated significant proximal neoplasia that would have been missed on a flexible sigmoidoscopy. While patients older than 60 yr had a greater risk for this neoplasia (odds ratio = 3.01: 95% CI = 1.66-4.23; p < 0.001), those who took a daily aspirin had a reduced risk (OR = 0.60; 95% CI = 0.30-0.88; p < 0.05). A family history of colorectal cancer increased the patient's risk of having any adenomas (OR = 2.01; 95% CI = 1.33-3.40; p < 0.01) or villous tissue (OR = 2.03; 95% CI = 1.27-3.51; p < 0.05) in the proximal colon without distal findings. Smoking was associated with an increased risk of large (> 1 cm) isolated proximal tubular polyps (OR = 2.71; 95% CI = 1.64-4.46; p < 0.01) as well as isolated significant proximal neoplasia (OR = 2.30; 95% CI = 1.59-3.31; p < 0.01). CONCLUSIONS: Age greater than 60 yr, a history of at least 10 pack-years of smoking, and a family history of colorectal cancer increased the risk of finding significant proximal polyps in patients without distal pathology.

Human T lymphocyte response to Borrelia burgdorferi infection: no correlation between human leukocyte function antigen type 1 peptide response and clinical status.

We tested the hypothesis that cross-reactivity between the outer surface protein A (OspA) of Borellia burgdorferi and human leukocyte function antigen (LFA) type 1 mediates chronic autoimmune sequelae of Lyme disease. T cell response was studied in subjects with Lyme disease presenting with erythema migrans alone (n=36), erythema migrans with neurological disease (n=12), and chronic Lyme disease syndrome (n=20), as well as healthy control subjects from Lyme-endemic (n=50) and -nonendemic (n=18) regions. Antigens included recombinant OspA and OspC (all strain B31) and human LFA-1 peptide (IYVIEGTSKQDLTSF). Proliferation to OspA was detected in 11 (28%) of 39 of subjects presenting with erythema migrans, which increased to 50% at 4 weeks of follow-up. Reactivity to OspA and LFA-1 was significantly correlated (P<.001) and was observed in 18 (78%) of 23 of OspA-responsive subjects. However, there was no correlation between T cell response to human LFA-1 peptide and clinical status.