Search

Background: Causal relationships with the occurrence of cancer have been established for a number of infections and environmental risk factors., Methods: Numbers and proportions (population-attributable fractions, PAF) of cancer cases attributable to these factors in Germany were calculated by sex and age groups for ages 35 to 84 years based on population projections, national cancer incidence, exposure data, and published risk estimates., Results: For 2018, more than 17 600 cancer cases (4.0% of all incident cancers) were estimated to be attributable to infections. The largest contributions come from Helicobacter pylori (n = 8764) and human papillomavirus (n = 7669) infections. Infection with hepatitis B and C, human immunodeficiency virus, and human herpesvirus 8 were estimated to cause 983 cases, 144 cases, and 116 cases, respectively. More than 5400 cancer cases (1.2% of all incident cancers) were estimated to be attributable to selected environmental factors, of which the largest contributor is indoor radon (n = 3185), followed by particulate matter (n = 1049), sunbed use (n = 892), and secondhand smoke (n = 309)., Conclusion: Of all cancers expected in 2018 in Germany, at least 5% are attributable to potentially avoidable infections and environmental factors. Further research should be directed towards more comprehensive identification and quantification of environmental risks as a basis for targeted cancer prevention.

Objective: There is debate whether infection with Helicobacter (H.) pylori, the main inducer of chronic atrophic gastritis (CAG), is a risk factor for cardiovascular disease and premature mortality., Methods: Serological measurements of H. pylori infection and pepsinogen (PG) I and II were obtained in a population-based German cohort of 9953 older adults (50-74 years). Cox regression was employed to estimate hazard ratios (HR) and 95% confidence intervals (CI) for myocardial infarction, stroke, cardiovascular and all-cause mortality during five-year follow-up., Results: According to serology, 4977 participants (51.9%) were infected with H. pylori (2604 with cytotoxin-associated gene A (cagA) strains) and 541 (5.7%) had CAG (PGI<70 ng/mL and PGI/PGII<3). During follow-up, 540 participants died (163 from cardiovascular causes), 170 experienced a primary myocardial infarction and 241 had a stroke. Neither cytotoxin-associated gene A (cagA) negative nor cagA positive H. pylori infections were associated with an increased risk for myocardial infarction, stroke or all-cause mortality. Intriguingly, infection with cagA positive H. pylori strains was inversely associated with cardiovascular mortality (HR, 0.62; CI: 0.41-0.94). No statistically significant associations were observed for the small group of participants with CAG, but point estimates of adjusted HRs for myocardial infarction, stroke and cardiovascular mortality were all below 1 (0.71, 0.59 and 0.65, respectively)., Conclusions: Our results do not support the hypothesis that H. pylori infection or CAG are risk factors for cardiovascular disease or mortality and instead suggest an inverse relationship of cagA positive H. pylori infection with fatal cardiovascular events., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)

Introduction: Complications of gastroduodenal ulcers such as bleeding and perforation have been afflicted with a mortality of up to 40 % in the past. Altered ulcer manifestation by improvement of medical treatment as well as advances in surgical techniques and intensive care medicine might currently have improved the outcome of these severely ill patients., Patients and Methods: A retrospective analysis of 73 patients with emergency operation for bleeding or perforated gastric (n = 50) and duodenal ulcer (n = 23) between 10/1994 and 7/2001 was performed., Results: The median age was 58 years (17-90 years) with 30 % of patients exceeding the age of 70 years. Eighty-one percent of patients had perforation, 19 % had bleeding. Factors predisposing for gastroduodenal ulcers were present in 88 %. Five percent of gastric perforations were due to gastric malignancies. Diagnosis of perforation was made in 88 % by conventional X-rays, in 12 % of perforations no free abdominal gas was detectable. A local surgical procedure (excision of ulcer and sutures/pyloroplasty) was performed in 64/73 patients (88 %), partial gastroduodenal resection was necessary in 9 patients (12 %). Histologic examination for helicobacter pylori was positive in 30/39 specimens (77 %). In-hospital mortality was 14 %, both for patients with bleeding and perforated ulcers. Surgical complications were 12 %., Discussion: Altered ulcer manifestation, minimized surgical therapy and improved intensive care medicine led to a recent reduction in postoperative mortality of patients suffering from perforated or bleeding gastroduodenal ulcer. A further reduction of this still high mortality might be expected by improvement of surgical training and/or restriction of therapy to a limited number of surgeons.