Endoscopic removal of a dental prosthesis in the hepatic flexure of the colon

The diagnosis of impacted foreign body in the colon is usually delayed until the complications such as perforation or abscess formation occur. Here we describe a patient who presented with diffuse abdominal pain due to the impaction of a dental prosthesis in the hepatic flexure of the colon. The dental prosthesis, which was inadvertently swallowed, was successfully removed under colonoscopy. Unexplained abdominal pain should alert the clinician to the possibility of foreign body ingestion and further therapeutic colonoscopy may replace or lessen the need for surgical procedures to extract foreign bodies from the colon.     

Hearing loss among workers at an oil refinery in Taiwan

In this study, the authors determined the characteristics of noise-induced hearing loss (NIHL) and its association with hearing-loss-related symptoms (HLRSs) among workers at an oil refinery in Taiwan. Workers from the refinery (N = 384) who had chronic noise exposure (range = 73 to 89 dBa; mean = 81.2, standard deviation = 5.4 dBa) were enrolled in the study. Workers chronically exposed to noise levels that were less than 85 dBa experienced slight hearing loss at high frequencies [(3k + 4k + 6k)/3]. Workers with > or = 1 HLRSs had increased hearing loss at low frequencies [(0.5k + 1k + 2k)/3] and high frequencies (odds ratios = 7.2 and 3.7, respectively). An increased hearing threshold shift for high frequencies (3k, 4k, and 6k Hz) was found in workers who had chronic noise exposure for more than 15 yr. These findings indicate that self-reported HLRSs provide valuable early warning signs of NIHL.     

Simultaneous determination of urinary cadmium,cobalt, lead,and nickel concentrations in steel production workers by differential pulse stripping voltammetry

Screening for metals in urine is important because toxic levels of these elements are linked to disease. In the current study, the authors used differential pulse stripping voltammetry on a hanging mercury drop electrode for the simultaneous determination of cadmium, cobalt, lead, and nickel in the urine of 63 production and 63 quality control workers in a steel production plant, along with 63 matched normal controls. Urinary sampling is a noninvasive procedure, and in this study participants had good compliance. Metal levels for both the production and quality control workers were significantly higher than for controls. The results reveal the need for immediate improvements in workplace ventilation and industrial hygiene practices for this cohort.     

Genetic variants of the serotonin system and weight change during clozapine treatment

Clozapine-induced weight gain may impair health and affect patient compliance. The aim of this study is to investigate the relationship between the genetic variants of the serotonin system and clozapine-induced body weight change (BWC). Ninety-three treatment-resistant schizophrenic patients were weighed monthly for 4 months during clozapine treatment. At the conclusion of treatment, patients had gained an average of 2.4 kg body weight, with BWC ranging from -17.5 to +12.9 kg. The levels of the serotonin transporter variants, serotonin 2A, serotonin 2C and serotonin 6, demonstrated no statistically significant relationship to BWC. Patients with a lower initial body mass index demonstrated a greater weight gain associated with clozapine treatment. Further exploration of the neurotransmitters implicated in the antipsychotic-induced BWC is important in order to reduce the morbidity and noncompliance associated with weight gain.     

How should doctors approach patients? A Confucian reflection on personhood

The modern doctor-patient relationship displays a patient-centred, mutual-participation characteristic rather than the former active-passive or guidance-cooperation models in terms of medical decision making. Respecting the wishes of patients, amounting to more than mere concern for their welfare, has become the feature central to certain modern bioethics theories. A group of ethical principles such as respect for autonomy, beneficence, non-maleficence, and justice has been proposed by bioethicists and widely adopted by many medical societies as an ethical guide to how doctors, in their daily practice, should treat their patients. However, seeing patients as persons who are rational, self-conscious beings capable of valuing their own lives, and who are consequently entitled to the liberty and rights to choose for themselves, is in general the backbone of Western bioethical principles. Since Confucian philosophy has long been a representative of the East-Asia cultural tradition and Confucian bioethics has recently been developed as a theory of applied ethics, examining Confucius's idea of "persons" may shed some light on the current bioethical debates. Confucius's concept of persons, which is best interpreted via his theories of "chun-tze", (the morally ideal person) encapsulating a two-dimensional approach, (the "autonomous person" and the "relational person"), provides a more comprehensive model regarding what a person is and how he/she should be treated. This two-dimensional approach sees a person not only as a rational, autonomous agent but also as a relational, altruistic identity whose self actualisation involves incessant participating in and promoting of the welfare of his fellow persons. Hence this may balance the current bioethical trend whereby "respect for autonomy" often triumphs.