Severe perioperative anaphylaxis: Incidence in a tertiary hospital in Spain over a 20-year period. A historical cohort study.

OBJECTIVE: To assess the incidence of severe perioperative anaphylaxis, the mechanisms involved, the value of laboratory/skin tests, and the most effective treatments. METHODS: A historical cohort study conducted in a tertiary public hospital in Spain. Patients that had undergone anaesthesia during the 20-year period were included. In these patients, 66 cases of severe anaphylaxis were found. In patients with suspicion of severe anaphylaxis, levels of blood histamine at less than 15min and serum tryptase at 2, 6, and 24h following the reaction were determined. Skin and specific IgE tests were performed between 4 and 8 weeks later. RESULTS: Over the 20-year period, 288 594 anaesthetic procedures were performed. We observed cases of 66 severe anaphylaxis reaction (59% men; age, 60.8±17.3 years. Symptoms observed were cardiovascular (86%), respiratory (73%), and mucocutaneous (56%). Elevated serum tryptase levels were associated with degree of severity at 2 (P<.0001) and 6h (P=.026) and were highest in IgE-mediated reactions (P=.020). All patients required treatment, and 3 events were fatal. In 84.8% of patients, skin and/or specific IgE tests were positive for antibiotics (35.8%), non-steroidal anti-inflammatory drugs (23.1%), neuromuscular blocking agents (15.4%) and latex (15.4%). CONCLUSIONS: The incidence of severe anaphylaxis in our hospital was 1 in 4.373 anaesthetic procedures, with a death rate of 4.5%. All cases required treatment. Serum tryptase was a good predictor of reaction severity. The most frequent causative agents were antibiotics, non-steroidal anti-inflammatory drugs, neuromuscular blocking agents and latex.

Particulate matter and manganese exposures in Indianapolis, Indiana.

The distribution of PM(2.5) and manganese (Mn) personal exposures was determined over a 4-month period in Indianapolis, IN, at a time when the gasoline additive, methylcyclopentadienyl manganese tricarbonyl (MMT), was not being used. The data collection period coincided with the data collection period in the Toronto, ON, study, where MMT had been used as a gasoline additive for over 20 years. The inferential or target population consisted of noninstitutionalized residents of the Indianapolis area during the monitoring period (from May 1996 through August 1996) who were at least 16 years old. The survey instruments used in this study (and also in Toronto) included a household screener form (HSF), a study questionnaire (SQ), and a time and activity questionnaire (TAQ). The SQ was administered to elicit information about the participant and his/her activities, occupation, and surroundings that might be relevant to his/her exposure to particles and Mn. In addition to the personal particulate matter (PM) and elemental 3-day monitoring, 240 participants completed a TAQ on a daily basis during the actual monitoring period. Also, a subset of participants had 3-day outdoor and indoor stationary monitoring at their home (approximately 58 observations), and sampling was conducted at a fixed site (approximately thirty-three 3-day observations). The quality of data was assessed and compared to the Toronto study in terms of linearity of measurement, instrument and method sensitivity, measurement biases, and measurement reproducibility. Twenty-six of the sample filters were subjected to two analyses to characterize the within-laboratory component of precision in terms of relative standard deviations (RSDs). The median RSD for Mn was 8.7%, as compared to 2.2% for Toronto. The quality assurance (QA) laboratory exhibited a clear positive bias relative to the primary laboratory for Al and Ca, but no systematic difference was evident for Mn. A high interlaboratory correlation (>0.99) was also attained for Mn. Mean field blank results for PM and Mn were 0.87 microg/m(3) and 0.71 ng/m(3), respectively, which were comparable to the Toronto study. The median RSDs for colocated fixed site and residential samples ranged from 2.2% to 9.0% for PM and from 8.8% to 15.3% for Mn, which were close to those observed in Toronto. For the PM(10), the 90th percentile indoors was 124 microg/m(3) compared with 54 microg/m(3) outdoors. This pattern was even more pronounced for the PM(2.5) data (90th percentiles of 92 microg/m(3) indoors vs 30 microg/m(3) outdoors). Personal PM(2.5) was somewhat higher than the indoor levels, but the percentiles seemed to follow the more highly skewed pattern of the indoor distribution. This difference was largely due to the presence of some smokers in the sample; e.g., exclusion of smokers led to a personal exposure distribution that was more similar to the outdoor distribution. The estimated 90th percentile for the nonsmokers' personal exposures to PM was 43 microg/m(3) compared with 84 microg/m(3) for the overall population. In general, the Indianapolis PM levels of a given type and cut size were somewhat higher than the levels observed in Toronto, e.g., the median and 90th percentile for the personal PM(2.5) exposures were 23 and 85 microg/m(3), respectively, in Indianapolis, while in Toronto, the corresponding percentiles were 19 and 63 microg/m(3). The cities' distributions of the proportion of the PM(10) mass in the 2.5-microm fraction appeared similar for the residential outdoor data (medians of 0.67 and 0.65 for Indianapolis and Toronto, respectively, and 90th percentiles of 0.83 for both cities). For the indoor data, Indianapolis tended to have a larger portion of the mass in the fine fraction (median of 0.80 compared to 0.70 for Toronto). Unlike the PM, the Indianapolis indoor Mn concentration levels were substantially lower than the outdoor levels for both PM sizes, and the median personal levels for Mn in PM(2.5) appeared to fall between the median indoor and outdoor levels. The personal Mn exposure distributions exhibited more skewness than the indoor or outdoor distributions (e.g., the means for the personal, indoor, and outdoor distributions were 7.5, 2.6, and 3.5 ng/m(3), respectively, while the medians were 2.8, 2.2, and 3.2 ng/m(3), respectively). At least a substantial portion of the high end of the personal exposure distribution appeared to be associated with occupational exposures to Mn. In general, the Mn levels in both cut sizes in Indianapolis were approximately 5 ng/m(3) smaller than those in Toronto (e.g., the estimated median and mean levels for personal Mn exposures in PM(2.5) were 2.8 and 7.5 ng/m(3), respectively, in Indianapolis, but were 8.0 and 13.1 ng/m(3) in Toronto). For the nonoccupational subgroups with no exposure to smoking and no subway riders in the two cities, the medians (2.6 ng/m(3) in Indianapolis and 7.8 ng/m(3) in Toronto) were similar to those for the overall populations, but the means were substantially smaller (3.1 ng/m(3) in Indianapolis and 9.2 ng/m(3) in Toronto). The median proportion of Mn in the fine fraction (relative to the PM(10) Mn) for Indianapolis was 0.39 for outdoors and 0.55 for indoors; these ratios were somewhat smaller than the corresponding Toronto medians (0.52 and 0.73). The study found high correlations for particulates and Mn between personal exposures and indoor concentrations, and between outdoor and fixed site concentrations, and low correlations of personal and indoor levels with outdoor and fixed site levels. The pattern was similar to that observed for Toronto, but slightly more pronounced. The PM(10) Mn concentrations (log scale) generally exhibited stronger associations among these various measures than the PM(2.5) Mn concentrations. Comparisons of the particulate distributions between PTEAM (Riverside, CA) and the Indianapolis and Toronto studies were also made.

Environmental effects and exposures to manganese from use of methylcyclopentadienyl manganese tricarbonyl (MMT) in gasoline.

Methylcyclopentadienyl Manganese Tricarbonyl (MMT) has been used since the 1970s in the U.S. as a gasoline octane enhancer Extensive testing of the effects of MMT on regulated gaseous emissions carried out on a wide variety of automobiles showed that use of MMT resulted in significantly lower NOx emissions Tests showed that less than 15% of the manganese from MMT combustion was emitted from the tailpipe, mostly in the PM2.5 fraction as manganese phosphate, with some manganese sulfate and a very small amount of manganese oxide. MMT has been used in Canada in virtually all unleaded gasoline for about 20 years. A probability-based study involving over 900 personal exposure samples in Toronto confirmed exposures to airborne PM2.5 Mn in the general population are quite low (.008 microgram/m3-median). Ambient levels of airborne manganese in Toronto are about the same as those in areas where MMT is not used. Exposures to manganese among the general population in Toronto are well within safe limits determined by the U.S. EPA and other standard setting bodies around the world.

Environmental assessment of MMT fuel additive.

Methylcyclopentadienyl Manganese Tricarbonyl (MMT) has been shown to be an effective octane enhancer in gasoline. It is presently used in the U.S. in leaded gasoline and in Canada in both leaded and unleaded gasoline. Because MMT has a low vapor pressure and a short half-life in sunlight, it is unlikely that significant concentrations of MMT could occur in the environment as a result of its use as a gasoline additive. Greater than 99.9% of the manganese from MMT is converted into inorganic oxides of manganese during the combustion of MMT-containing gasoline. Authors of several health assessments on MMT concluded the increase in environmental levels of manganese oxides would be slight compared to the natural background levels of manganese and would present no health hazards. Studies showed that MMT usage had no effect on CO emissions, caused a slight decrease in NOx emissions, and a slight increase in HC emissions. MMT usage caused a decrease in NOx + HC emissions in one test and had no effect in another.

Studies of coronal lines with electronic cameras during the eclipse of 7 march 1970.

The experimental design described here allows us to study with 2-A. bandpass filters the brightness distribution of the green coronal line, the two infrared lines of Fe XIII, and the neighboring coronal continuum. For the first time, in an eclipse expedition, electrostatic cameras derived from the Lallemand type are used; full advantage was taken of their speed, especially in the near infrared spectral range, and their good photometric qualities. They permit the measurement of intensity and polarization of the lines in the corona to a height of 1.25 solar radii above the limb of the sun, with a spatial resolution >/= (10")(2).