Evaluation of diabetes mellitus, serum glucose, and thyroid function among United States workers exposed to 2,3,7,8-tetrachlorodibenzo-p- dioxin

OBJECTIVE: Some studies suggest that exposure to 2,3,7,8- tetrachlorodibenzo-p-dioxin (TCDD) may affect glucose metabolism and thyroid function. To further assess the relation between exposure to TCDD and endocrine function, data from the largest morbidity study of industrial workers exposed to TCDD were examined. METHODS: A cross sectional study of workers employed > 15 years earlier in the manufacture of 2,4,5-trichlorophenol or one of its derivatives at two United States chemical plants was conducted. The referent group consisted of people with no occupational exposure to phenoxy herbicides and were recruited from the neighbourhoods where the workers lived. RESULTS: A total of 281 workers and 260 unexposed referents participated. The mean current serum lipid adjusted TCDD concentration among workers was 220 pg/g lipid, and among referents was 7 pg/g lipid (p < 0.05). The half life extrapolated TCDD concentrations (the estimated TCDD concentration when occupational exposure to TCDD stopped) among workers averaged 1900 pg/g lipid (range: not detected-- 30,000 pg/g lipid). Overall, the prevalence of diabetes mellitus was not significantly different between the workers and referents. Also, there was not a significant positive trend between prevalence of diabetes and increasing serum TCDD concentration. However, diabetes was found in six of 10 (60%) workers with current serum TCDD concentrations > 1500 pg/g lipid. After excluding subjects being treated for diabetes, workers in the group with the highest half life extrapolated TCDD concentrations had a significantly increased adjusted mean serum glucose concentration compared with referents (p = 0.03). Workers were also found to have a significantly higher adjusted mean free thyroxine index compared with referents (p = 0.02), especially among workers in the group with the highest half life extrapolated TCDD concentrations. However, no evidence was found that workers exposed to TCDD were at increased risk of thyroid disease. CONCLUSIONS: These findings provide modest evidence that exposure to TCDD may affect thyroid function and glucose metabolism.

 

     

Laparoscopic splenectomy in patients with hematologic malignancies

BACKGROUND: Although laparoscopic splenectomy (LS) for benign hematologic disease is well accepted, its role in hematologic malignancies is not clearly defined. This study examined the efficacy and feasibility of LS for hematologic malignancies. METHODS: Records were reviewed from patients who underwent LS at two university hospitals. Charts from 77 open splenectomies for malignancy (OM) during the same period were also reviewed. RESULTS: Fifty-three patients underwent LS, 22 for hematologic malignancies (LM) and 31 for benign hematologic disorders (LB). Median splenic weight was greater in the LM group (930 g) than in the LB group (164 g, P = 0.001). LM was associated with longer operations and greater blood loss than was LB. LM had a 41% conversion rate. Morbidity, mortality, and transfusion rates were similar. Median hospital stay was shorter for LM (4 days) than for OM (6 days, P = 0.001). CONCLUSIONS: LS is feasible in hematologic malignancies but is associated with increased operative time and blood loss and a high conversion rate. Morbidity and mortality, however, was similar. Shorter hospital stays for LM compared with OM may translate into earlier recovery and initiation of antineoplastic therapy.     

Age-related changes in the kinetics of water transport in normal human lenses

The aim of this work was to study blink frequency changes and levels of ocular discomfort during work at a video display terminal, and the effects on these parameters of augmented or reduced humidification of the ocular surface.Blink rate was measured from recordings of the electrical signal evoked by the contraction of the orbicularis oculi muscle. Blink rate and interblink intervals were analyzed at rest and during performance of a task with a computer (playing a card game) for 10 or 30 min in steady environmental conditions and during application of a continuous stream of air to the face. In two separate sessions, the effect of pretreatment with humidifying ocular solutions of different elastoviscosity (balanced salt solution or elastoviscous 0.1% Hylan A solution) was assayed. At the end of each experimental period, the subjects marked the level of ocular discomfort experienced on a 0-10 cm visual analogue scale.The blink frequency at rest (12.4+/-1.2 blinks min-1) was reduced significantly (to 10.3+/-1.1 blinks min-1) by pretreatment with elastoviscous eyedrops both with and without air applied to the face. This effect was not obtained with balanced salt solution. During performance of the visual task for 10 or 30 min, basal blink rate decreased significantly, to about 40% of the control value. Neither application of an air jet on the face nor application of eye solutions of different viscosity modified this reduced blink rate.A low degree of ocular discomfort developed after performance of the visual task that was enhanced by air application to the face. This discomfort was reduced by pretreatment with ocular solutions, the elastoviscous eye solution being more efficient than the balanced salt solution. Interblink interval duration was also more regular after treatment with the elastoviscous solution.These data suggest that blink rate at rest is maintained in part by activation of sensory receptors of the cornea and conjunctiva, which are stimulated by desiccation of the ocular surface. Reduction of eye blink frequency elicited by the performance of a visual task with a computer appears to depend on central neural mechanisms that are quite independent of peripheral sensory inputs. The reduction of blink frequency consecutive to computer use was associated with a sensation of discomfort that was attenuated more effectively by elastoviscous eyedrops than by regular balanced salt solution.     

Colonization of hydrogel lenses with Streptococcus pneumoniae: risk of development of corneal infiltrates.

PURPOSE: To report the association between colonization of contact lenses with Streptococcus pneumoniae and the observation of corneal infiltrative events in a group of patients wearing disposable hydrogel lenses on an extended-wear schedule. METHODS: In a prospective clinical trial, 330 patients wore disposable hydrogels on a 6-night extended-wear and replacement schedule. The contact lens, lid, and conjunctival microbiota of these subjects was analyzed at frequent intervals and at the time of an adverse event. RESULTS: Streptococcus pneumoniae was an uncommon isolate and was recovered from only one of the 3,763 conjunctival samples, five (0.1%) of the 3,764 lid samples, and 33 (0.8%) of the 4,315 contact lens samples. Of the 33 lens samples, 10 (30%) were associated with corneal infiltrative events. Many of the events were mild inflammatory responses and resolved rapidly on discontinuation of lens wear. The presence of S. pneumoniae on the contact lens was associated with a significant risk of development of corneal infiltrates (odds ratio, 3.0; p = 0.0227, logistic-regression analysis). CONCLUSIONS: Presence of S. pneumoniae on hydrogel lenses is a significant risk factor for the development of corneal infiltrates.     

Effect of filter vent blocking on carbon monoxide exposure from selected lower tar cigarette brands.

Two studies were conducted to determine the effect of blocking filter vents on carbon monoxide (CO) exposure under ad lib smoking conditions. In Study 1, 12 daily cigarette smokers smoked cigarettes from the brands Now (1 mg tar by the FTC Method) and Marlboro Lights (10 mg tar) under each of two vent-blocking conditions (unblocked and finger blocked). Blocking filter vents with fingers led to an 85% increase in CO for the brand Now, but had no added effect on CO exposure from the Marlboro Lights. In Study 2, another 12 daily cigarette smokers smoked cigarettes from each of four additional brands: Carlton (1 mg tar), Now (2 mg tar), Virginia Slims Ultra-lights (5 mg tar), and Virginia Slims Lights (8 mg tar). Blocking filter vents with the lips caused all four brands to produce equal CO exposures. Blocking vents increased smokers' exposure to CO by 239% when smoking Carltons and by 44% when smoking Nows. No significant increases in CO with blocking were found for either of the Virginia Slims brands. These results suggest that the degree to which a brand is ventilated determines whether that brand is susceptible to increased CO yields as a result of vent blocking.     

Laparoscopic versus open appendectomy: a prospective randomized trial of 81 patients

Objective

To compare the efficacy of laparoscopic appendectomy (LA) and open appendectomy (OA) in the treatment of acute appendicitis.

Design

A prospective randomized trial.

Setting

A university teaching hospital.

Patients

Eighty-one patients with a diagnosis of acute appendicitis were prospectively randomized to undergo either LA or OA. The two groups were matched for age and sex.

Interventions

LA or OA.

Main Outcome Measures

Number of days in hospital and time to full recovery.

Results

The mean hospital stay for LA was 3.23 days compared with 3.03 days for OA (p < 0.001). The mean number of narcotic injections required for patients in the LA group was 4.05 compared with 5.58 for patients in the OA group (p < 0.001). The mean time to complete recovery for patients in the LA group was 9.0 days compared with 16.2 days for patients in the OA group (p < 0.001). The mean operative time for LA was 73.8 minutes compared with 45.0 minutes for OA (p < 0.001). Three patients in the LA group had intra-abdominal abscesses (p > 0.25). No significant difference in wound infection rates was demonstrated (p > 0.05). Similarly, pain scores at 7 and 28 days showed no significant difference (p > 0.05).

Conclusions

With LA significantly fewer narcotic injections are required and there is a more rapid return to normal activities. LA takes longer to perform and was associated with three intra-abdominal abscesses. In cases of simple acute appendicitis the hospital stay for LA is significantly shorter.     

Electronic data collection by trainee anaesthetists using palm top computers

The Royal College of Anaesthetist requires that trainees wishing to specialise in Anaesthesia register with the College and keep a logbook documenting their experience and training in clinical anaesthesia. There are a number of advantages if such logbooks are kept in an electronic format. For the first time in the United Kingdom, we have evaluated the usefulness in a district general hospital of introducing a computerized system of record keeping based on a portable palm top computer. This has enabled the careful analysis of the individual work load of each trainee in the department by means of a specific program designed to generate a comprehensive report after the information from each individual has been downloaded on to a standard desk top computer. We have found a number of interesting and unexpected results and have highlighted ways in which the system may be improved.     

Methadone versus morphine as a first-line strong opioid for cancer pain: a randomized, double-blind study.

PURPOSE: To compare the effectiveness and side effects of methadone and morphine as first-line treatment with opioids for cancer pain. PATIENTS AND METHODS: Patients in international palliative care clinics with pain requiring initiation of strong opioids were randomly assigned to receive methadone (7.5 mg orally every 12 hours and 5 mg every 4 hours as needed) or morphine (15 mg sustained release every 12 hours and 5 mg every 4 hours as needed). The study duration was 4 weeks. RESULTS: A total of 103 patients were randomly assigned to treatment (49 in the methadone group and 54 in the morphine group). The groups had similar baseline scores for pain, sedation, nausea, confusion, and constipation. Patients receiving methadone had more opioid-related drop-outs (11 of 49; 22%) than those receiving morphine (three of 54; 6%; P =.019). The opioid escalation index at days 14 and 28 was similar between the two groups. More than three fourths of patients in each group reported a 20% or more reduction in pain intensity by day 8. The proportion of patients with a 20% or more improvement in pain at 4 weeks in the methadone group was 0.49 (95% CI, 0.34 to 0.64) and was similar in the morphine group (0.56; 95% CI, 0.41 to 0.70). The rates of patient-reported global benefit were nearly identical to the pain response rates and did not differ between the treatment groups. CONCLUSION: Methadone did not produce superior analgesic efficiency or overall tolerability at 4 weeks compared with morphine as a first-line strong opioid for the treatment of cancer pain.