Faculty Bibliography

With the increased use of anti-TNF therapy for both ulcerative colitis and Crohn's disease, there is serious concern about long term adverse events, especially malignancy. Recent data suggests that anti-TNF agents increase the risk of non-Hodgkin's lymphoma; however, there is limited evidence on the risk of solid tumors. Many patients have been exposed to other immunosuppressive therapies in the past making it difficult to discern the true risk of malignancy with TNF-alpha inhibitors alone. The purpose of this review is to discuss the risk of extra-intestinal solid cancer, excluding skin cancer, in adult inflammatory bowel disease patients exposed to anti-TNF agents.

BACKGROUND AND AIMS: The development of esophageal varices in cirrhotic patients carries a significant risk of hemorrhage and associated morbidity/mortality. Universal endoscopic screening, however, is invasive and expensive. Conversely, cirrhotic patients often have imaging findings which suggest portal hypertension. The aim of this study was to evaluate the ability of CT and/or MRI to detect esophageal varices compared to EGD. METHODS: Medical records from 2000 to 2007 were retrospectively reviewed. CT and/or MRI images were included if performed within 90 days of EGD. Two blinded, experienced radiologists were asked to review images for the presence of esophageal varices, as well as other findings associated with portal hypertension. Sensitivity, specificity, PPV and NPV were calculated using EGD findings as the gold standard. RESULTS: A total of 195 patients and 142 patients met criteria for CT and MRI, respectively. The sensitivity of CT to detect EGD varices was 58-89%, but increased to 65-100% when specifically looking at large endoscopic varices. Overall specificity was 68-82%, but increased to 97-100% when applying >/=4 mm varices criteria. CT was superior to MRI in the detection of endoscopic varices; the addition of other portal hypertension stigmata did not improve results. CONCLUSIONS: The exclusion of large endoscopic varices by CT, using standardized criteria, may obviate the need or frequency of EGD screening in select patient populations. Alternatively, CT findings highly suggestive of esophageal varices in cirrhotic patients may warrant further investigation and/or treatment. Further studies are needed to validate these findings.

PURPOSE: To evaluate myopia prevalence, myopia progression, and various potential myopia risk factors in third-year law students. DESIGN: Cross-sectional study and survey. PARTICIPANTS: One hundred seventy-nine third-year law students at the University of Pennsylvania. METHODS: We administered a questionnaire to assess the prevalence of myopia, myopia progression, and risk factors, including near work, family history, and daily light/dark exposure. We conducted a screening eye examination to ascertain myopia status. Myopia was defined as the mean spherical equivalent of the two eyes of 5.6 hours of darkness per day (95% vs. 80%, P = 0.07). To account for possible confounding effects of risk factors with myopia progression, logistic regression with categorization of the continuous exposure variables (hours of near work, sleep, and darkness) above or below median values weakened the near work association (odds ratio 1.8, 95% confidence interval 0.5-6.7, P = 0.35) but continued to identify darkness association with daily hours of darkness (odds ratio 4.8, 95% confidence interval 1.0 >/= 23.3, P < 0.05). Among the 77 students with myopia onset before college, those with