Reproductive outcomes in relation to malathion spraying in the San Francisco Bay Area, 1981-1982.

We studied reproductive outcomes in a cohort of 7,450 pregnancies identified through three Kaiser-Permanente facilities in the San Francisco Bay Area, in relation to exposure to the pesticide malathion, applied aerially to control an infestation by the Mediterranean fruit fly. We included in the cohort all women over age 17 who were registered at these facilities and who were confirmed as pregnant during the spraying period. Residence histories throughout the pregnancy were obtained by mailed questionnaire or telephone interview from 933 women with adverse outcomes and a sample of 1,000 women with normal outcomes, and were converted to geographical coordinates. We linked the coordinates for malathion spraying corridors with the residence coordinates to create individual exposure indices for each week of pregnancy. The statistical analysis compared each of the adverse pregnancy outcome groups against an appropriate control group using logistic regression or survival time regression approaches. After adjustment for various confounders, no important association was found between malathion exposure and spontaneous abortion, intrauterine growth retardation, stillbirth, or most categories of congenital anomalies. Gastrointestinal anomalies were related to second trimester exposure (odds ratio = 2.6), based on 13 cases and not specific to any particular International Classification of Diseases code.     

Growth hormone and IGF-I in diabetic children with and without microalbuminuria

In order to evaluate the relationship between urinary GH, urinary IGF-I and plasma IGF-I levels and presence of incipient diabetic nephropathy in paediatric age, we studied fifty (25 male and 25 female) prepubertal patients with insulin-dependent diabetes mellitus (T1DM). The patients were subdivided into two groups according to the presence of persistent microalbuminuria defined as albumin excretion rate (AER) >20 microg/min in at least 5 urine collections in the 6 months prior to the beginning of the study: Group A: 18 patients with microalbuminuria; Group B: 32 patients without microalbuminuria. A group of 20 healthy subjects, sex-, age- and pubertal stage-matched, served as control. No difference was observed between the urinary output of IGF-I and GH and plasma IGF-I values between normoalbuminuric and control subjects (normoalbuminuric vs controls: urinary GH: mean+/-SD 7.9+/-0.7 ng/day vs 8.1+/-0.6; urinary IGF-I: 178.3+/-19.7 ng/day vs 175.5+/-20.3; plasma IGF-I: 203.9+/-31.2 ng/ml vs 199.4+/-43.2), but a significant difference was observed between the urinary output of IGF-I and GH and plasma IGF-I levels between microalbuminuric patients and normoalbuminuric and controls (microalbuminuric subjects: urinary GH: 13.1+/-1.4 p<0.01; urinary IGF-I: 451.3+/-45.9 p<0.001; plasma IGF-I: 326.5+/-63.2 p<0.01). Moreover, plasma IGF-I, urinary GH and urinary IGF-I were not significantly associated with microalbuminuria, while plasma IGF-I levels were positively related to glomerular filtration rate (GFR) (p<0.05). In conclusion, our study demonstrates that microalbuminuric patients have higher levels of urinary IGF-I, urinary GH, plasma IGF-I than normoalbuminuric diabetic subjects. These data support the hypothesis that IGF-I can have a role in the changes of renal function observed in patients with persistent microalbuminuria.     

Increased frequency and enhanced perception of reflux in non-erosive reflux disease patients non-responders to proton pump inhibitors

BackgroundThe unsatisfactory response to medical treatment in non-erosive patients is becoming a real challenge for gastroenterologists. Non-responder patients, evaluated under treatment, present symptoms which are related to non-acidic, mixed and proximal reflux episodes.MethodsTo elucidate the reflux pattern and mechanisms related to persistence of symptoms despite treatment, oesophageal pH-impedance was performed in 55 non-erosive responder and 24 non-responder patients, studied off therapy. Ten responder and 10 non-responder patients underwent a repeated study during proton pump inhibitor treatment.ResultsNon-responders were characterised by a higher overall number and larger proportion of symptomatic reflux episodes. Non-responders were also characterised by an enhanced sensitivity to acidic, mixed and proximal refluxes. Weakly acidic reflux accounted for 29% of symptomatic refluxes in non-responders and 34% in responders. Proportions of acidic and weakly acidic reflux episodes were comparable both in responders and non-responders when analysed off and on treatment.ConclusionsAn increased overall number of reflux episodes and enhanced sensitivity to reflux are strongly associated with treatment failure. Treatment strategies aimed at decreasing transient lower oesophageal sphincter relaxations, pain modulators or anti-reflux surgery should be considered in non-responders in whom a significant relationship between symptoms and reflux has been confirmed.     

Hormone replacement therapy and the risk of myocardial infarction in women with coronary risk factors

To assess the risk of myocardial infarction in users of post-menopausal hormone replacement therapy who are at high risk of coronary disease because of hypertension, diabetes mellitus, or smoking, we used data from a previously published case-control study of women 45-74 years. After adjustment for age, ethnicity, and education, the odds ratio for myocardial infarction in current users of hormone replacement therapy was 0.9 (95% confidence interval (CI) = 0.5-1.6) in women with no major coronary risk factors, 0.8 (95% CI = 0.5-1.8) in women with one risk factor, and 1.1 (95% CI = 0.5-2.2) in women with two risk factors.     

Effects of In Utero Ultrasound Exposure In Humans

ABSTRACT: A review and analysis of studies of the effects of ultrasound exposure on human fetuses leads to a conclusion that there is no association of exposure with birthweight, hearing loss, or major congenital anomalies. Conflicting data from studies on birthweight is probably due to methodologic problems with the studies that have found positive associations. There have been few sound studies of the effects of in utero ultrasound exposure in humans. Limited studies to date are mostly reassuring, but it is premature to say that ultrasound has been proven safe for the human fetus. Further research on the question of biological effects of ultrasound in humans is needed, particularly the question of a possible association of ultrasound with dyslexia.     

A serious complication in colorectal surgery: anastomotic leakage. Our experience

Anastomotic leakage is a severe complication in colorectal surgery with a lot of generic and specific risk factors. There are still controversies about the possibility to prevent it or to limit its severity with the use of faecal diversions. We report our experience on 189 patients operated in five years on colon-rectum, in election and emergency, with manual or mechanical anastomoses in the last 20 cm from the anal verge. We have had 21 anastomotic leakages (11%), symptomatic in 10 cases (5.5%), and 5 deaths (2.6%), 3 directly correlated to the leakage. In the patients (n 98) with loop-ileostomy there wasn't anastomotic leakages reduction, but only of clinical impact. We prefer loop-ileostomy in cases of extraperitoneal anastomoses, always in emergency and in anastomoses at risk.     

Psychological questionnaire score, cigarette smoking, and myocardial infarction: a continuing enigma

The ability of a group of 94 psychological questions to discriminate between men in whom cigarette smoking was associated with increased risk of myocardial infarction and men in whom smoking was not so associated remains puzzling. Further analyses, controlling for reported alcohol consumption and for a questionnaire item that might reflect physical activity, failed to alter this finding. This interaction of the questionnaire responses with smoking was not found with two other major coronary risk factors, serum cholesterol and systolic blood pressure. Believing that these observations may provide (a) a clue to how cigarette smoking affects risk of myocardial infarction, or (b) some means of identifying greater or lesser susceptibility to the effects of smoking, we invite other investigators to join in the pursuit of this matter. A list of ten selected yes-or-no questions with strong interaction with smoking is provided to assist others in studying this phenomenon; these are similar to ten items on the Minnesota Multiphasic Personality Inventory.     

Inhaled corticosteroids and allergy specialty care reduce emergency hospital use for asthma

BACKGROUND: The interrelationships between optimal inhaled corticosteroid (IC) therapy, allergy specialist care, and reduced emergency hospital care for asthma have not been well defined. OBJECTIVE: We sought to evaluate the independent effectiveness of various levels of IC dispensing and allergy specialist care in reducing subsequent emergency asthma hospital use. METHODS: Asthmatic patients (n = 9608) aged 3 to 64 years were identified from an electronic database of a large health maintenance organization. The outcome was any year 2000 asthma hospitalization or emergency department visit. The main predictors were at least one allergy department visit and the number of IC canisters dispensed in 1999. Analyses were adjusted for age, sex, insurance type, and asthma severity (1999 emergency asthma hospital use, beta-agonist use, and oral corticosteroid use). RESULTS: Dispensing of 7 or more canisters of ICs (odds ratio [OR], 0.64; 95% CI, 0.43-0.94) and allergy care (OR, 0.73; 95% CI, 0.55-0.97) were associated with reduced subsequent emergency asthma hospital use. More patients with allergy specialist care than those without such care received 7 or more dispensations of ICs (24.7% vs 8.3%, P <.001). When 7 or more dispensations of ICs and allergy specialist care were simultaneously included in an adjusted model, both ICs (OR, 0.68; 95% CI, 0.46-1.00) and allergy care (OR, 0.77; 95% CI, 0.58-1.02) were independently associated with a lower risk of year 2000 emergency asthma hospital care, although significance was borderline. CONCLUSION: Allergy care reduces emergency hospital use for asthma by increasing use of ICs but probably also has an independent effect.