Airway foreign bodies (FB): a 10-year review

A retrospective chart review of children who had airway foreign body removed via direct laryngoscopy and bronchoscopy (DLB) from 1987-1997 was conducted in Children's Hospital, Boston. Patient characteristics noted included age, sex, and clinical presentation. Pre-operative radiographic findings, reason for delay in evaluation, DLB findings, length of procedure, reason for repeat DLB, and types of foreign body etc. were recorded. Serious complications from aspirated foreign bodies such as severe airway obstruction and death tend to occur in infants and younger children because of their small airway size. A history compatible with foreign body aspiration dictates diagnostic endoscopy with or without radiologic confirmation. Chest and airway radiographs supplemented by fluoroscopy can increase the ratio of correct and early diagnosis. Fluoroscopy should be universally accepted as an initial diagnostic technique in airway foreign body evaluation. Fluoroscopy is not a worthwhile investigation if a preceeding chest radiograph suggests the presence of a foreign body. Long-standing airway foreign bodies are associated with considerable morbidity, and early diagnosis remains the key to successful and uncomplicated management of foreign body aspiration. Education aimed at increasing diagnostic acumen of the physicians and heightening of public awareness are the most important steps needed to reduce the morbidity and mortality. Parents should be instructed to abstain from feeding nuts and seeds to young children and to keep small, potentially ingestible objects out of their reach.     

Detection of fungi in sinus fluid of patients with allergic fungal rhinosinusitis

We aim to develop a rapid, accurate and sensitive diagnostic assay with which to detect the surface antigens of fungi thought to be involved in allergic fungal rhinosinusitis (AFRS), by assessing the usefulness of immunofluorescence microscopy (IMF) and enzyme linked immuno-absorbent assays (ELISA). The age, sex, clinical symptoms and signs, imaging (CT and/or MRI), microbiological subculture data, sinus contents, blood eosinophilia, aspergillosis precipitins, radioallergoabsorbent technology (RAST) for fungal allergens and histopathology were performed on individuals undergoing endoscopic sinus surgery for suspected AFRS. Thirteen patients were examined, and five monoclonal antibodies raised to the surface washings of various fungi were found to recognize and differentiate between fungal species implicated in sinus disease, i.e. Aspergillus niger, Alternaria alternata, Cochliobolus lunata, Penicillium expansum and Cladosporium species. The IMF microscopy proved to be a useful assay to distinguish visually between the cultured fungi, but was less useful for visualization of fungi in the patient samples. However, ELISA assays with 5 monoclonal antibodies gave clear and unambiguous data as to the presence of certain fungi within the patient samples. There is good correlation between the ELISA data and the pathology findings. This preliminary study suggests that both IMF and ELISA techniques may offer an important advance in this area.     

Early postnatal alcohol exposure reduced the size of vibrissal barrel field in rat somatosensory cortex (SI) but did not disrupt barrel field organization.

Prenatal alcohol exposure (PAE) has been shown to alter the somatosensory cortex in both human and animal studies. In rodents, PAE reduced the size, but not the pattern of the posteromedial barrel subfield (PMBSF) associated with the representation of the whiskers, in newborn, juvenile, and adult rats. However, the PMBSF is not present at birth, but rather first appears in the middle of the first postnatal week during the brain-growth spurt period. These findings raise questions whether early postnatal alcohol exposure might disrupt both barrel field pattern and size, questions that were investigated in the present study. Newborn Sprague-Dawley rats were assigned into alcohol (Alc), nutritional gastric control (GC), and suckle control (SC) groups on postnatal day 4 (P4). Rat pups in Alc and GC were artificially fed with alcohol and maltose-dextrin dissolved in milk, respectively, via an implant gastrostomy tube, from P4 to P9. Pups in the Alc group received alcohol (6.0 g/kg) in milk, while the GC controls received isocaloric equivalent maltose-dextrin dissolved in milk. Pups in the SC group remained with their mothers and breast fed throughout the experimental period. On P10, pups in each group were weighed, sacrificed, and their brains removed and weighed. Cortical hemispheres were separated, weighed, flattened, sectioned tangentially, stained with cytochrome oxidase, and PMBSF measured. The sizes of barrels and the interbarrel septal region within PMBSF, as well as body and brain weights were compared between the three groups. The sizes of PMSBF barrel and septal areas were significantly smaller (P<.01) in Alc group compared to controls, while the PMBSF barrel pattern remained unaltered. Body, whole-brain, forebrain, and hemisphere weights were significantly reduced (P<.01) in Alc pups compared to control groups. GC and SC groups did not differ significantly in all dependent variables, except body weight at P9 and P10 (P<.01). These results suggest that postnatal alcohol exposure, like prenatal exposure, significantly influenced the size of the barrel field, but not barrel field pattern formation, indicating that barrel field pattern formation consolidated prior to P4. These results are important for understanding sensorimotor deficits reported in children suffering from fetal alcohol spectrum disorder (FASD).     

Case studies of power and control related to tobacco use during pregnancy.

OBJECTIVE: The objective was to identify and describe elements of power and control evident in couple tobacco-related interaction patterns during pregnancy. METHODS: Using a case study approach, elements of the Duluth Abuse Intervention Project Power and Control Wheel were used to examine women's experiences of tobacco reduction during pregnancy and post partum. Three cases were selected from a larger qualitative sample, using a maximum variation sampling approach. RESULTS: Although no direct evidence of partner abuse or violence accompanying partner efforts to influence women's smoking was described, most of the elements of power and control were present in the case study, and appeared to cause an emotional toll and a negative impact on women's ability to freely express their views about their own tobacco use. CONCLUSIONS: Elements of power and control, however subtle, are potentially important and unrecognized dimensions of women's tobacco reduction experiences. Additional care and attention should be taken in designing tobacco reduction interventions and policies directed at pregnant and post partum women and their partners to reduce the possibility that these interventions may contribute to the use of power and control.     

Work environment and self-rated health as predictors of remaining in work 5 years later among Danish employees 35-59 years of age.

In 1990, a random sample of employees (1674 males and 1646 females) in Denmark between 35 and 59 years of age were interviewed about their psychosocial work environment, health, and job satisfaction. In 1995, the cohort was interviewed again regarding present employment status. Predictors from the 1990 interview for remaining in work in 1995 were identified by gender. After controlling for age, very good self-rated health and high development possibilities were found to be independent predictors for remaining in work among males. Among females the predictors were very good self-rated health, high development possibilities, high decision authority, medium level social support and absence of musculoskeletal problems in the knees. In the two extreme 10% risk groups, the "risk" of remaining in work was 58% and 81%, respectively, for males, and 46% and 82% for females.     

Use of oral contraceptives and endometrial cancer risk (Sweden)

Objectives: To estimate the magnitude and persistence of the protective effect of use of combined oral contraceptives (COCs) and endometrial cancer risk.Methods: We performed a nation-wide, population-based case–control study among postmenopausal women aged 50–74 years in Sweden, which included 709 subjects with incident, histopathologically verified endometrial cancer, and 3,368 controls with an intact uterus. We used unconditional logistic regression to calculate odds ratios as estimates of relative risks.Results: Use of any sort of oral contraceptive decreased risk for endometrial cancer by 30%, while progestin-only pills reduced risk more markedly. For COCs the reduction in risk was noticeable following 3 or more years of use (OR 0.5, 95% CI 0.3–0.7), and increased with duration of intake, reaching 80% lower risk after 10 years of use. The protective effect of COC use was similar for all degrees of tumor differentiation and invasiveness, and remained for at least 20 years after cessation of use. Subsequent use of hormone replacement did not modify these protective effects.Conclusions: We conclude that COC use confers a long-lasting protection against endometrial cancer risk which is particularly marked for long-term users.(institution where the work has been performed)     

The sensitivity of grass shrimp, Palaemonetes pugio, embryos to organophosphate pesticide induced acetylcholinesterase inhibition

Grass shrimp, Palaemonetes pugio, are common inhabitants of salt marshes along the Atlantic and Gulf coasts of North America. Grass shrimp embryos are brooded externally on the abdomen of adult females for about 2 weeks prior to hatching. In South Carolina, the spring spawning period for grass shrimp coincides with the period of peak pesticide application on crops grown along the South Carolina coast. Thus, grass shrimp of all developmental stages are at risk of exposure to pesticides present in nonpoint source agricultural runoff. Organophosphate (OP) insecticides are commonly applied agricultural chemicals which produce toxicity by inhibiting the nervous system enzyme, acetylcholinesterase (AChE). The purpose of this study was to examine the development of AChE activity in grass shrimp embryos and to assess their sensitivity to OP-induced AChE inhibition. Embryos were exposed for 24 h to either chlorpyrifos or malathion. All exposure concentrations were nominal and ranged from 0 to 2.00 μg l(-1) for chlorpyrifos and from 0 to 120.00 μg l(-1) for malathion. Quantifiable levels of AChE activity first appeared at Stage V of development and increased as embryonic development progressed. AChE inhibition by the OPs was assessed in Stage VI and Stage VII embryos. Both stages of embryos were more sensitive to chlorpyrifos than malathion. The 24-h Effective Concentration (EC(50)) values for chlorpyrifos were 0.49 μg l(-1) (95% C.I.=0.33-0.77 μg l(-1)) and 0.36 μg l(-1) (95% C.I.=0.33-0.38 μg l(-1)) for Stage VI and Stage VII embryos, respectively. In comparison, malathion 24-h EC(50) values were 55.53 μg l(-1) (95% C.I.=22.08-80.73 μg l(-1)) for Stage VI embryos and 29.93 μg l(-1) (95% C.I.=25.22-44.22 μg l(-1)) for Stage VII embryos. For both OPs, there were no significant differences in the EC(50) values calculated for Stage VI and Stage VII embryos; however, AChE inhibition was significantly (P相似文献   

Thalamic afferents from the dorsal column nuclei. An experimental anatomical study in the rat

The distribution of axons originating in the dorsal column nuclei has been studied using the Nauta technique on brains witth lesions restricted to small parts of the gracile and cuneate nuclei. The caudal area of each nucleus projects contralaterally to the ventrobasal complex in a topographical manner and in small amount to the pars medialis of the medial geniculate body. In addition, the rostral part of each nucleus sends axons to the contralateral zona incerta, anterior pretectal nucleus and posterolateral complex within the diencephalon as well as to the collicular plate and pontine protuberance of the brain stem. There is no clear evidence of a projection to the area comparable to the posterior thalamic complex of the cat. This work establishes the identity of some of the cytoarchitectonic divisions of the rat diencephalon, and indicates that the rostro-caudal differences shown for the dorsal column nuclei are reflected in their ascending projections.     

Coffee consumption and the risk of cancer in the Norwegian Women and Cancer (NOWAC) Study

An association between coffee consumption and cancer has long been investigated. Coffee consumption among Norwegian women is high, thus this is a favorable population in which to study the impact of coffee on cancer incidence. Information on coffee consumption was collected from 91,767 women at baseline in the Norwegian Women and Cancer Study. These information were applied until follow-up information on coffee consumption, collected 6–8 years after baseline, became available. Multiple imputation was performed as a method for dealing with missing data. Multivariable Cox regression models were used to calculate hazard ratios (HR) for breast, colorectal, lung, and ovarian cancer, as well as cancer at any site. We observed a 17 % reduced risk of colorectal cancer (HR = 0.83, 95 % CI 0.70–0.98, p _{trend across categories of consumption} = 0.10) and a 9 % reduced risk of cancer at any site (HR = 0.91, 95 % CI 0.86–0.97, p _trend = 0.03) in women who drank more than 3 and up to 7 cups/day, compared to women who drank ≤1 cup/day. A significantly increased risk of lung cancer was observed with a heavy coffee consumption (>7 vs. ≤1 cup/day HR = 2.01, 95 % CI 1.47–2.75, p _trend < 0.001). This was most likely caused by residual confounding due to smoking, as no statistically significant association was observed in never smokers (>5 vs. ≤1 cup/day HR = 1.42, 95 % CI 0.44–4.57, p _trend = 0.30). No significant association was found between coffee consumption and the risk of breast or ovarian cancer. In this study, coffee consumption was associated with a modest reduced risk of cancer at any site. Residual confounding due to smoking may have contributed to the positive association between high coffee consumption and the risk of lung cancer.     

NoiseChem: an European Commission research project on the effects of exposure to noise and industrial chemicals on hearing and balance

Exposure to multiple physical and chemical agents is common in occupational environments but workplace hazards and occupational safety criteria for combined exposures are lacking. NoiseChem is an European Commission research project examining the effects of exposure to noise and chemicals on hearing and balance. Partners in Sweden, Finland, France, Denmark, UK and Poland with expert guidance from partners in the USA will examine workers and study the mechanisms of action in animals to determine the levels of risk associated with joint exposure to noise and solvents. This paper briefly outlines the project details.