Mercury exposure in chloralkali plants

The employees of two chloralkali plants were studied to correlate the signs and symptoms of mercury toxicity with levels of exposure. For purposes of comparison, the workers were divided into three groups. These groups were selected on the basis of hours worked in the mercury cell room or in other areas of mercury exposure. The population of the first plant was studied from 1957-1978, and preliminary findings were published in 1964. The second plant's population was studied for 3.5 years beginning in 1976. Time-weighted average exposure levels to mercury vapor in the high exposure group generally ranged between 0.05 to 0.10 mg/m3. No significant differences in the frequency of objective or subjective findings were noted among the three groups except for a lower post exposure systolic and post exposure diastolic blood pressure in the high exposure group in the second plant's population. There was no correlation of mercury vapor exposure with subjective or objective weight loss.     

Role of insulin in management of surgical patients with diabetes mellitus

Because surgery is a likely event during the lifetime of patients with diabetes, health-care team members need to be aware of the metabolic problems that may occur during the perioperative period. Surgery, especially in the presence of general anesthesia, will produce a diabetogenic response. This is generally due to an elevation of counterregulatory hormones, although endogenous insulin is also suppressed. The excessive lipolysis and ketogenesis that can occur during surgery can have particularly deleterious effects for patients with diabetes. Thus, sufficient insulin must be provided during this period to suppress these catabolic processes. The major controversy regarding surgery and diabetes concerns the route of insulin administration. This article reviews the various treatment options for patients with insulin-dependent and non-insulin-dependent diabetes mellitus, with particular emphasis on the role of insulin. Special situations, e.g., outpatient surgery, coronary artery bypass, and emergency surgery, are also discussed.     

Evaluation of a New Microporous Filtration Membrane System for Therapeutic Plasma Exchange

A new therapeutic plasma exchange device developed by Sarns Inc./3M was evaluated in plasmapheresis of 20 healthy volunteers and in a multicenter clinical study of therapeutic plasma exchange that included 49 patients. Safety and efficacy of plasma separation from whole blood were assessed for a module that contains Durapore microporous surfactant-free polyvinylidene fluoride membrane (Millipore Corp., Bedford, Mass., USA). The extra-corporeal volume was 80 ml. Citrate and heparin anticoagulants were utilized. Mean plasma separation efficiency was 62% with unhindered passage of plasma proteins through the membrane pores and no hemolysis or activation of complement as measured by total hemolytic complement (CH50) and C3 conversion. Mean decrease in platelet count after procedures was 10%. No severe reactions occurred, and citrate effects (13%) were comparable to values reported with centrifugal instruments. The Sarns Inc./3M Therapore device is a rapid, safe and efficient system for plasma exchange and potentially for source plasma collection. The principal benefits are small extracorporeal volume and cell-free filtrate.     

Caution on the use of saliva measurements to monitor absorption of progesterone from transdermal creams in postmenopausal women.

OBJECTIVES: To determine the levels of progesterone in plasma, red cells and saliva as well as pregnanediol-3-glucuronide excretion in postmenopausal women using transdermal progesterone creams. METHODS: A double-blind placebo controlled study was carried out using 24 postmenopausal women. Creams (placebo, 20 or 40 mg progesterone/g) were applied twice daily for 3 weeks followed by 1 week without before a further 3-week treatment. Morning samples were collected at 0, 1, 3, 4, 7 and 8 weeks for analysis. RESULTS: There were small increases in plasma progesterone levels and pregnanediol-3-glucuronide excretion compared to the placebo group and red cell progesterone levels never exceeded plasma levels during progesterone cream use. Saliva progesterone levels were very high and variable in the progesterone cream groups compared to the placebo group and presented a paradox to the usual relationship observed between plasma and saliva progesterone in premenopausal women. CONCLUSION: The absorption of progesterone from transdermal creams is low and we caution against the use of saliva measurements to monitor progesterone absorption. The low systemic absorption of progesterone may not be due to peripheral conversion by 5 alpha-reductase(s). We also conclude that the low level of progesterone associated with red cells suggests they are not important in the delivery of progesterone to target tissues.     

Treatment of basal-cell carcinoma: comparison of radiotherapy and cryotherapy

A prospective randomised trial to compare radiotherapy and cryotherapy in the treatment of basal-cell carcinomas was carried out in 93 patients. Two years after treatment, 4% of tumours treated with radiotherapy and 39% of those treated with cryotherapy had recurred. It is concluded that cryotherapy does not offer a satisfactory alternative to radiotherapy in the treatment of basal-cell carcinomas.     

Tear and serum antibody levels in ocular herpetic infection: diagnostic precision of secretory IgA.

A sensitive enzyme linked immunosorbent assay (ELISA) was developed to evaluate the potential of herpes simplex virus (HSV) specific antibodies in the diagnosis of herpetic eye infection. The presence of HSV specific secretory IgA (sIgA) in tears was found to be diagnostic of infection. However, serum and tear HSV specific IgG and IgA were not considered reliable indicators of active infection.