Asbestos-related chest X-ray changes among Greek merchant marine seamen.

One hundred forty-one retired Greek mariners were examined radiologically for asbestos-related lung disease. Thirty-eight (27%) had small opacities classified as ILO category 1/0 or more; 37 (26%) had radiologic evidence of pleural lesions; 17 (12%) had both parenchymal and pleural lesions; and a total of 58 (41%) had one or more radiologic findings of asbestos-related lung disease. In discriminant analysis, duration of maritime employment was predictive of pleural lesions, but the association was not statistically significant (one-tail, p = .16). The prevalence of pleural lesions was also higher among sailors than among officers, and this association was statistically significant (one-tail, p = .05). In this group, none of the occupational variables studied (age, duration of maritime employment, and rank) was related to lung fibrosis. After controlling by multiple regression for mutual confounding effects, suggestive negative associations for the presence of pleural lesions were found with FVC (one-tail, p = .13) as well as with FEF25% (one-tail, p = .09) and FEF50% (one-tail, p = .07). By contrast, no association was found between pulmonary fibrosis and any of the respiratory volumes. The results of this study suggest that mariners may present evidence of asbestos-related disease after many years from onset of exposure on ships.

Influence of an aggressive early enteral nutrition protocol on nitrogen balance in critically ill children.

The objective was to determine stress related factors and nutritional indices affecting the nitrogen balance (NB) and the creatinine height index (CHI) in critically ill children on early enteral nutrition (EEN). Seventy-one consecutively enrolled critically ill children aged 2 to 204 months, requiring prolonged mechanical ventilation, were studied. All patients were on early intragastric nutrition (Nutrison Pediatric or Standard) from day 1 (energy intake equal to 1/2, 1, 5/4, 6/4 and 6/4 of the predicted basal metabolic rate on days 1-5, respectively). Nitrogen balance and CHI changes determined efficacy. Study patients had severe depletion of somatic protein status on stress day 1 (CHI <60%) but they reached the normal range of somatic protein status at the end of the EEN, on post-stress day 5 (CHI >80%, p <.004). On day 1, none of the patients had positive NB but after 5 days of EEN, 44 (62%) had positive NB and only 27 (38%) had negative NB (p <.0001). Multivariate stepwise regression analysis showed that only the difference of daily given-recommended dietary allowances protein and the total repleted energy were positively correlated (r(2) =.47, p <.001 and r(2) = 34, p =.003, respectively) and multiple organ system failure negatively correlated with the NB (r(2) = -.24, p <.03) on the 5th day of the EEN protocol. Our data suggest that achievement of positive protein and energy balance in relation to the basic metabolic rate using an aggressive EEN protocol improves NB during the acute phase of stress in 2/3 of critically ill children.