Eileen K. Steinberger

Long-term use of narcotic/antidepressant medication in the management of phantom limb pain

&NA; The successful management of 5 consecutive patients with intractable phantom limb pain is described. The main therapy is a combination of a narcotic and antidepressant. Medication remained effective during the average observation time of 22 months. There were no signs of habituation or addiction. We conclude that narcotics can be safely and successfully utilized for long‐term management of phantom limb pain.

Specificity of Intertubular Capillary Changes: Comparative Ultrastructural Studies in Renal Allografts and Native Kidneys

The pathophysiology of chronic rejection of renal allografts is poorly understood and specific morphologic markers are being sought for its diagnosis. Ultrastructural splitting and reduplication of the basal lamina of the intertubular capillaries (ITCs) have been shown to be consistently associated with transplant glomerulopathy (TG) in renal allografts and have been used as a marker of chronic allograft rejection. Although the presence of ITC abnormalities is extremely helpful diagnostically and has been considered a surrogate for the diagnosis of TG when glomeruli are not available for examination, their specificity has not been tested. This study examined 135 biopsy specimens from renal allografts and native kidneys and categorized the ITC basal lamina alterations into 5 patterns. The results showed that although marked ITC basal lamina abnormalities are characteristically seen in association with TG, lesser degrees of these changes may also be found in native kidneys and in transplants with other types of glomerulopathies. In native kidneys, splitting and reduplication of the ITC basal lamina were observed in cases of active lupus nephritis, membranoproliferative glomerulonephritis type I, crescentic glomerulonephritis, cryoglobulinemia, and hypertension. In allografts, ITC changes were seen in postinfectious proliferative glomerulonephritis, acute cyclosporin toxicity, and hemolytic uremic syndrome, in addition to cases with TG. The histopathologic diagnosis in renal diseases relies heavily on clinical, immunofluorescence, and ultrastructural findings. Therefore, in the transplantation setting, with other less common pathological processes ruled out, the presence of abnormalities of the ITC basal lamina is highly indicative of TG. This association is particularly true for cases with severe ITC abnormalities.

Association of age at diagnosis and Crohn's disease phenotype

BACKGROUND fifteen percent of patients with Crohns disease (CD) are elderly; they are less likely to have complications and more likely to have colonic disease. OBJECTIVE to compare disease behaviour in patients with CD based on age at diagnosis. DESIGN cross-sectional study. SETTING tertiary referral centre. SUBJECTS patients with confirmed CD. METHODS behaviour was characterised according to the Montreal classification. Patients with either stricturing or penetrating disease were classified as having complicated disease. Age at diagnosis was categorised as <17, 17-40, 41-59 and ≥ 60 years. Logistic regression analysis was performed to examine the association between advanced age ≥ 60 and complicated disease. RESULTS a total of 467 patients were evaluated between 2004 and 2010. Increasing age of diagnosis was negatively associated with complicated disease and positively associated with colonic disease. As age of diagnosis increased, disease duration (P < 0.001), family history of Inflammatory bowel disease (IBD) (P = 0.015) and perianal disease decreased (P < 0.0015). After adjustment for confounding variables, the association between age at diagnosis and complicated disease was no longer significant (OR: 0.60, 95% CI: 0.21-1.65). CONCLUSIONS patients diagnosed with CD ≥ 60 were more likely to have colonic disease and non-complicated disease. However, the association between age at diagnosis and complicated disease did not persist after adjustment for confounding variables.

Quality Assessment of Colonoscopy Reporting: Results from a Statewide Cancer Screening Program

This paper aimed to assess quality of colonoscopy reports and determine if physicians in practice were already documenting recommended quality indicators, prior to the publication of a standardized Colonoscopy Reporting and Data System (CO-RADS) in 2007. We examined 110 colonoscopy reports from 2005-2006 through Maryland Colorectal Cancer Screening Program. We evaluated 25 key data elements recommended by CO-RADS, including procedure indications, risk/comorbidity assessments, procedure technical descriptions, colonoscopy findings, specimen retrieval/pathology. Among 110 reports, 73% documented the bowel preparation quality and 82% documented specific cecal landmarks. For the 177 individual polyps identified, information on size and morphology was documented for 87% and 53%, respectively. Colonoscopy reporting varied considerately in the pre-CO-RADS period. The absence of key data elements may impact the ability to make recommendations for recall intervals. This paper provides baseline data to assess if CO-RADS has an impact on reporting and how best to improve the quality of reporting.

Trends in self-reported health care provider recommendations for colorectal cancer screening by race

OBJECTIVE To examine whether a racial difference exists in self-reported recommendations for colorectal cancer screening from a health care provider, and whether this difference has changed over time. METHOD Secondary analysis of the 2002, 2004, 2006, and 2008 Maryland Cancer Surveys, cross-sectional population-based random-digit-dial surveys on cancer screening. Participants were 11,368 White and 2495 Black Maryland residents age ≥ 50 years. RESULTS For each race, recommendations for colonoscopy/sigmoidoscopy increased over time (67%-83% for Whites, 57%-74% for Blacks; p<0.001 for both), but the race difference remained approximately 10% at each survey. Among respondents without a colonoscopy in the last 10 years (n=5081), recommendations for fecal occult blood test (FOBT) in the past year decreased over time for Whites (37%-24%, p<0.001) and for Blacks (36-28%, p=0.05), with no difference by race in any year. In multivariable analysis, the effect of race on the odds of reporting a provider recommendation did not vary significantly across time for either test (p=0.80 for colonoscopy/sigmoidoscopy, p=0.24 for FOBT for effect modification by year). CONCLUSION Whites were more likely than Blacks to report ever receiving a provider recommendation for colonoscopy/sigmoidoscopy. Although the proportion of patients receiving recommendations for colonoscopy/sigmoidoscopy increased over time, the gap between races remained unchanged.

Measuring Health Behaviors and Landline Telephones: Potential Coverage Bias in a Low-Income, Rural Population

Objectives. Population-based landline telephone surveys are potentially biased due to inclusion of only people with landline telephones. This article examined the degree of telephone coverage bias in a low-income population. Methods. The Charles County Cancer Survey (CCCS) was conducted to evaluate cancer screening practices and risk behaviors among low-income, rural residents of Charles County, Maryland. We conducted face-to-face interviews with 502 residents aged 18 years and older. We compared the prevalence of health behaviors and cancer screening tests for those with and without landline telephones. We calculated the difference between whole sample estimates and estimates for only those respondents with landline telephones to quantify the magnitude of telephone coverage bias. Results. Of 499 respondents who gave information on telephone use, 80 (16%) did not have landline telephones. We found differences between those with and without landline telephones for race/ethnicity, health-care access, insurance coverage, and several types of cancer screening. The absolute coverage bias ranged up to 6.5 percentage points. Simulation scenarios showed the magnitude of telephone coverage bias decreases as the percent of the population with landline telephone coverage increases, and as landline telephone coverage increases, the estimates from a landline telephone survey would approximate the estimates from a face-to-face survey. Conclusions. Our findings highlighted the need for targeted face-to-face surveys to supplement telephone surveys to more fully characterize hard-to-reach subpopulations. Our findings also indicated that landline telephone-based surveys continue to offer a cost-effective method for conducting large-scale population studies in support of policy and public health decision-making.

Self‐reported oral cancer screening by smoking status in Maryland: trends over time

OBJECTIVES The study aims to examine whether a higher proportion of current and former smokers reported having an oral cancer screening (OCS) exam in the past year compared with never smokers in Maryland between 2002 and 2008. METHODS Secondary analysis of the Maryland Cancer Surveys (conducted in 2002, 2004, 2006, and 2008), population-based, random-digit-dial surveys on cancer screening among adults age 40 years and older. Of 20,197 individuals who responded to the surveys, 19,054 answered questions on OCS and smoking. Results are weighted to the Maryland population. RESULTS Self-reported OCS in the past year increased from 33 percent in 2002 to 40 percent in 2008. Screening among never and former smokers increased from about 35 percent to 42 percent and from 35 percent to 43 percent, respectively; screening among current smokers remained between 23 percent and 25 percent. In the adjusted analysis, current smokers had decreased odds of screening compared with never smokers; no significant difference was observed between former and never smokers. When the variable dental visit in the last year was included in the adjusted analysis, it became the strongest predictor of OCS. CONCLUSIONS Between 2002 and 2008, self-reported OCS in the last year increased among former and never smokers, but remained unchanged for current smokers. A visit to a dental professional attenuated the difference in OCS between current and never smokers. Dental visit in the last year was the strongest predictor of OCS.