Yesterday I saw a 28 y/o male patient with no history of chronic illnesses, who referred a penile rash/growth that first started 5 years ago, but that 5 months ago started to get way out of proportion. He denies sexual contact with a person with genital warts (that he knows of). When I examined the patient his glans is 3-4 times bigger than the one in the picture, had multiple cauliflower-like growths and was secreting yellow/green liquid from various places, with incredible mal odor. He denies pain or pruritus.
He was already seen by one urologist who performed a biopsy and the results were mixed: condyloma (warts) vs. cancer. The recommendation was a partial penectomy (removing part of his penis). Obviously the patient refused and wanted a second opinion. He was sent to another urologist who recommended a circumsicion and laser removal of as much tissue as possible to avoid the penectomy. I explained the procedure, as well as the possible outcomes of treatment, to the patient.
He is scheduled to have surgery next week.
I immediately thought it was cancer, because I had no idea warts could get that bad. That was until I did research and found several pictures of similar people.
The following picture is from a patient with the same disease before surgery.
This picture is after the circumsicion and debridement.
I hope the surgery goes well, though my patient has it much worse.
Children given acetaminophen with vaccinations have lower rates of fever in response, but the vaccinations produce a lower immunogenicity, reports a Lancet study.
Researchers, including some from the sponsoring vaccine manufacturer, followed over 400 infants receiving primary and booster immunizations. Half received acetaminophen via suppository in three doses over the first 24 hours after vaccination, and half received no prophylaxis.
The percentage of children with a temperature of 38 degrees C or higher was significantly lower in the acetaminophen group by some 40% to 50% both at primary and booster immunizations. However, vaccine immunogenicity was lower in the acetaminophen group — significantly so for some antigens, e.g., all 10 pneumococcal serotypes after the primary immunization. The authors hypothesize that the effect could result from acetaminophen's preventing inflammation.
Over 95% of all children had seroprotective antibody levels, but researchers argue that antipyretics "should ... no longer be routinely recommended" with vaccination. Editorialists agree, calling the case "compelling."
By Charles Bankhead, Staff Writer, MedPage Today Published: October 07, 2009
Reviewed by Zalman S. Agus, MD; Emeritus Professor
University of Pennsylvania School of Medicine and
Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner
A falling CD4 count predicted increased susceptibility to seven types of cancer in people infected with human immunodeficiency virus (HIV), according to a study of more than 50,000 patients.
The cancers include both AIDS-defining and non-AIDS-defining malignancies, investigators reported online in The Lancet Oncology. They speculated that early diagnosis and treatment of HIV could delay the onset of at least some of the cancers.
The authors also recommended cancer-specific screening for HIV-infected individuals.
"Our results suggest that combination antiretroviral therapy would be most beneficial if it restores or maintains the CD4 count above 500 cells per microliter, thereby indicating an earlier diagnosis of HIV infection and an earlier treatment initiation," Marguerite Guiget, PhD, of the University of Pierre and Marie Curie and the French national health institute (INSERM), and colleagues concluded.
"Access to cervical-cancer screening programs should be regularly offered to all HIV-positive women, and cancer-specific screening programs, such as for lung cancer and for anal cancer, need to be assessed in HIV-infected patients," they wrote.
Improved treatment for HIV and AIDS has led to longer patient survival. However, that increased life expectancy has also brought an increased susceptibility to cancer.
Antiretroviral therapy's effect on cancer risk had not been carefully studied, the authors said.
So they studied it using records from the national French hospital database. They analyzed cancer risk in 52,278 HIV-infected patients from 1998 to 2006. The analysis included three AIDS defining cancers (Kaposi's sarcoma, non-Hodgkin's lymphoma, and cervical cancer) and four non-AIDS-defining cancers (Hodgkin's lymphoma, lung cancer, liver cancer, and anal cancer).
For each type of cancer, the authors evaluated 78 models derived from immunodeficiency status (defined by current CD4 count), viral load, and combination antiretroviral therapy.
Immunodeficiency predicted increased risk for all of the cancers, and CD4 count was the most predictive factor for all except anal cancer.
In general, cancer risk correlated inversely with CD4 count. For Kaposi's sarcoma, for example, a CD4 count of 350 to 499 cells/µL almost doubled the risk of a CD4 count of 500 or greater (RR 1.9, 95% CI 1.3 to 2.7).
If the patient had a CD4 count <50 cells/µL, the risk for Kaposi's sarcoma was 25 times greater than it was for patients with CD4 levels of 500 or greater (RR 25.2, 95% CI 17.1 to 37.0, P<0.0001).
Similar associations between CD4 count and cancer risk were observed for non-Hodgkin's lymphoma, Hodgkin's lymphoma, liver cancer, and lung cancer (P<0.0001 for each). A higher CD4 count lowered the risk of cervical cancer (RR 0.7 per log2, 95% CI 0.6 to 0.8, P=0.0002).
HIV RNA load exceeding 100,000 copies/mL tripled the risk of Kaposi's sarcoma (RR 3.1, P<0.0001) and non-Hodgkin lymphoma (RR 2.9, P<0.0001).
Combination antiretroviral therapy predicted a lower risk of Kaposi's sarcoma (RR 0.3, P<0.0001) and cervical cancer (RR 0.5, P=0.03) and a trend toward a lower risk of non-Hodgkin lymphoma (RR 0.8, P=0.07).
The risk of anal cancer increased with duration of time with a CD4 count <200 cells/µL (1.3 per year, P=0.0001) and with a viral load >100,000 copies/mL (1.2 per year, P=0.005).
Adherence to a Mediterranean-style diet is associated with lower risk for developing depression, reports Archives of General Psychiatry.
Some 10,000 young adults in Spain completed food-frequency questionnaires to assess how well they followed a Mediterranean dietary pattern (i.e., high in fruits, vegetables, fish, nuts, cereal, and legumes; low in meat and whole-fat dairy; moderate alcohol intake; and high ratio of monounsaturated-to-saturated fatty acids).
After a median 4 years' follow-up, people in the top three quintiles of diet adherence had lower hazard ratios for incident self-reported depression than those in the lowest quintile. High consumption of fruits and nuts, legumes, and fish were each separately associated with lower depression risk.
The authors speculate that the observed effect may be explained by the diet's beneficial impact on endothelial function, which may, in turn, improve production of brain-derived neurotrophic factor — reported to be reduced in depression.
Posts
