肥胖与吸烟对银屑病临床表现和治疗的影响

Objective: To study the impact of obesity and smoking on psoriasis. Design: Cross-sectional study. Setting: University of Utah Department of Dermatology clinics. Patients: A case series of patients with psoriasis enrolled in the prospective Utah Psoriasis Initiative (UPI) (which carefully performs phenotyping of patients with psoriasis) was compared with 3population databases: the Behavioral Risk Factor Surveillance System of theUtah population, the 1998 patient-member survey from the National Psoriasis Foundation, and 500 adult patients who attend our clinics and do not have psoriasis (nonpsoriatic population). Results: The prevalence of obesity in patients within the UPI population was higher than that in the general Utah population (34% vs 18% ; P < .001) and higher than that in the nonpsoriatic population attending our clinics. Assessment of body image perception with a standardized diagram in the UPI group resulted in the median body image score of normal weight at 18 years of age and the onset of psoriasis, but it transitioned to overweight at the time of enrollment in the UPI.Thus, obesity appears to be the consequence of psoriasis and not a risk factor for onset of disease. We did not observe an increased risk for psoriatic arthritis in patients with obesity; furthermore, obesity did not positively or negatively affect the response or the adverse effects of topical corticosteroids, lightbased treatments, and systemic medications. The prevalence of smoking in the UPI population was higher than in the general Utah population (37% vs 13% ; P< .001) and higher than in the nonpsoriatic population (37% vs 25% ; P< .001). We found a higher prevalence of smokers in the obese population within the UPI than in the obese population within the Utah population (25% vs 9% ; P< .001). Conclusions: Patients with psoriasis attending the University of Utah Dermatology Clinics were more likely to be obese and to smoke compared with nonpsoriatic patients and more likely to be obese comparedwith other large cohorts with psoriasis. Smoking appears to have a role in the onset of psoriasis, but obesity does not. The high prevalence of obesity and smoking in a psoriasis cohort has not been previously noted; if confirmed, it supports the prediction that a significant portion of patients with psoriasis will have the comorbid conditions and public health issues of those with obesity and smoke.

卵巢癌和原发性腹膜癌患者直结肠切除术

Objective:This study examines the operative details and complications of colorectal resection in patients with ovarian and primary peritoneal carcinoma. Study design:Patients who underwent colorectal resection for ovarian and primary peritoneal cancer were identified in our surgical database for the period 1988 through 2002. Results:Of the 125 patients who were identified,73%were undergoing primary cytoreduction; 18%were undergoing secondary cytoreduction,and 7%were undergoing interval cytoreduction. The mean length of colon that was removed was 15.7 cm. The method of anastomosis was stapler in 63%and hand sewn in 22%; 15%patients had no anastomosis performed. A protective ostomy was used in 13%of patients. Optimal cytoreduction ( < 1 cm) was achieved in 74%. Operative complications occurred in 37%of patients,with the most common being hemorrhage (25%). Anastomotic leaks occurred in 2.5%of the patients,and the most common postoperative complication was ileus (28%). Postoperative bowel function returned to normal in 71%of patients. Conclusion:To obtain optimal cytoreduction in patients with ovarian cancer,colorectal resection often is necessary. Colorectal resection can be performed with a low risk of anastomotic complications,and patients frequently have the return of normal bowel function.

家庭暴力延误宫颈癌的治疗

Background. Intimate partner violence (IPV) is underreported and creates a complex psychosocial medium that adversely affects the health of its victims. We present the first case report in the literature, though likely not the first time, in which a patient delayed her cancer treatment due to domestic abuse and her disease progressed. Case. A 41-year-old female with vaginal bleeding was diagnosed with cervical cancer. After several years of declining recommendations for treatment, she was questioned separate from her partner and she revealed a long-standing history of abuse. Conclusions. Physicians must be aware of the signs of spousal abuse to lessen negative impact on the treatment of their patients. Once domestic violence is discovered, there are many resources available to help patients with their needs.