BackgroundThe prevalence and role of human papillomavirus (HPV) in the aetiology of oesophageal squamous cell carcinoma is uncertain. Based on the presence of HPV in the oral cavity and its causal association with squamous cell carcinoma of the oropharynx, we hypothesised that HPV is more strongly associated with proximal than distal oesophageal squamous cell carcinoma.MethodsA population-based study comparing HPV infection in relation to tumour site in patients diagnosed with oesophageal squamous cell carcinomas in the Stockholm County in 1999–2006. Multiplex polymerase chain reaction genotyping (PCR) with Luminex was conducted on pre-treatment endoscopic biopsies to identify type specify HPV. Carcinogenic activity of HPV was assessed by p16INK4a expression. Multivariable logistic regression was used to calculate odds ratios and 95% confidence intervals.ResultsAmong 204 patients, 20 (10%) had tumours harbouring HPV DNA, almost all (90%) of HPV high-risk type, mainly HPV16. Tumours containing HPV were not overrepresented in the upper compared to the middle or lower third of the oesophagus (odds ratio 0.6, 95% confidence interval 0.2–1.9). P16INK4a expression was similarly common (24% and 16%) in the HPV-positive and HPV-negative groups.ConclusionThis study found a limited presence of HPV in oesophageal squamous cell carcinoma of uncertain oncogenic relevance and did not demonstrate that HPV was more strongly associated with proximal than distal tumours.

A nationwide Swedish case -control study of 388 men and 63 women with adenocarcinoma of the oesophagus and gastrooesophageal function and 676 men controls and 140 women investigated whether sex differences in aetiology contribute to male predominance. Compared with men, women seemed more vulnerable to reflux (odds ratio (OR) ¼ 4.6, 95% confidence interval (CI) ¼ 2.0 -10.5 vs OR ¼ 3.4, 95% CI ¼ 2.5 -4.6), obesity (OR ¼ 10.3, 95% CI ¼ 2.6 -42.3 vs OR ¼ 5.4, 95% CI ¼ 2.6 -10.8) and smoking (OR ¼ 5.3, 95% CI ¼ 2.0 -14.1 vs OR ¼ 2.8, 95% CI ¼ 1.9 -4.2), less harmed by low intake of fruit and vegetables (OR ¼ 0.9, 95% CI 0.3 -2.4 vs OR ¼ 1.6, 95% CI ¼ 1.1 -2.2) and less protected by Helicobacter pylori infection (OR ¼ 0.5, 95% CI ¼ 0.3 -0.8 vs OR ¼ 1.6, 95% CI ¼ 0.5 -5.4).

Patients with abdominal aortic aneurysms (AAA) are more prone to develop popliteal artery aneurysms (PAA), but the prevalence is not well known. Our aim was to investigate the prevalence of PAA in patients with AAA, and to determine whether a certain risk factor profile is more commonly found in patients with concurrent aneurysms. All AAA patients (ICD code I71.3, I71.4) attending the outpatient clinic at the Karolinska University Hospital between 2011 and 2013 were included in the study cohort (n=465); 48% (225) had been subjected to an ultrasound or computed tomography scan of their popliteal arteries. In these patients, three definitions of PAA were considered (⩾ 10.5, ⩾ 12, ⩾ 15 mm), although the overall analysis is based on PAA ⩾ 12 mm. The mean age was 70.7 years (SD 7.5), 89% were men, and the mean AAA diameter was 47 mm (SD 14). The prevalence of PAA was 19% (n=43) by definition ⩾ 12 mm, and 11% (n=25) with 15 mm. Claudication was more frequently found in AAA patients with PAA than patients without PAA. Sensitivity between clinical examination and radiology was 26%, and the specificity for clinical examination was 90%. In conclusion, owing to the high prevalence of PAA in AAA patients, described by us and others, the low cost and risks associated with ultrasound and the poor sensitivity at clinical examination, all women and men with AAA should undergo one radiological examination of their popliteal arteries.

Recurrence of reflux might explain the lack of protective effect of antireflux surgery regarding risk of developing esophageal adenocarcinoma.