Circannual variation in relative weight of children 5 to 16 years of age.

BACKGROUND: Summer weight gain in children has been reported; however, this is usually based on two time points. Our objective was to investigate monthly variation in weight status. METHODS: Cross-sectional, de-identified health records including height, weight and demographics, collected between 2007 and 2012 from South Central Wisconsin in 70 531 children age 5-16 years were analysed. The monthly averages in body mass index (BMI) z-score were analysed cross-sectionally followed by a paired analysis for a subset with one visit each during school and summer months. RESULTS: BMI z-scores during the summer months (June-August) were lower than values during the school year (September-May). Of note, there was a rapid decrease in BMI z-scores from May to June, with June BMI z-score values being 0.065 units less (95% CI 0.046-0.085) than those in May, little change from June to August and a rapid increase between the August and September BMI z-scores. CONCLUSION: The monthly pattern does not fully agree with previous two-point school-based studies. Results raise concern that the use of two time point measures of BMIs (early fall and late spring) is suboptimal for evaluation of circannual variation. We suggest that future evaluation of the effect of school-based or summer interventions utilizes additional measures in those periods so that a seasonal analysis can be performed.

Factors associated with profitability in pasture-based systems of milk production.

The global dairy industry needs to reappraise the systems of milk production that are operated at farm level with specific focus on enhancing technical efficiency and competitiveness of the sector. The objective of this study was to quantify the factors associated with costs of production, profitability, and pasture use, and the effects of pasture use on financial performance of dairy farms using an internationally recognized representative database over an 8-yr period (2008 to 2015) on pasture-based systems. To examine the associated effects of several farm system and management variables on specific performance measures, a series of multiple regression models were developed. Factors evaluated included pasture use [kg of dry matter/ha and stocking rate (livestock units/ha)], grazing season length, breeding season length, milk recording, herd size, dairy farm size (ha), farmer age, discussion group membership, proportion of purchased feed, protein %, fat %, kg of milk fat and protein per cow, kg of milk fat and protein per hectare, and capital investment in machinery, livestock, and buildings. Multiple regression analysis demonstrated costs of production per hectare differed by year, geographical location, soil type, level of pasture use, proportion of purchased feed, protein %, kg of fat and protein per cow, dairy farm size, breeding season length, and capital investment in machinery, livestock, and buildings per cow. The results of the analysis revealed that farm net profit per hectare was associated with pasture use per hectare, year, location, soil type, grazing season length, proportion of purchased feed, protein %, kg of fat and protein per cow, dairy farm size, and capital investment in machinery and buildings per cow. Pasture use per hectare was associated with year, location, soil type, stocking rate, dairy farm size, fat %, protein %, kg of fat and protein per cow, farmer age, capital investment in machinery and buildings per cow, breeding season length, and discussion group membership. On average, over the 8-yr period, each additional tonne of pasture dry matter used increased gross profit by €278 and net profit by €173 on dairy farms. Conversely, a 10% increase in the proportion of purchased feed in the diet resulted in a reduction in net profit per hectare by €97 and net profit by €207 per tonne of fat and protein. Results from this study, albeit in a quota limited environment, have demonstrated that the profitability of pasture-based dairy systems is significantly associated with the proportion of pasture used at the farm level, being cognizant of the levels of purchased feed.

Evolution of Carotid Surgical Practice in the last Decade.

Stroke units provide immediate care and appropriate intervention in the evolving stroke. The aims of this study were to review the practice of carotid endarterectomy (CEA) before and after the establishment of a Stroke Unit in St. James's Hospital. Prior to the introduction of the Stroke Unit, 263 CEA's were performed over a five-year period. 139/263 (53%) of these were for symptomatic disease. 229 were performed in the five years since. 179/229 (78%) of these were for symptomatic disease. The 30-day stroke and death rates were < 2% before the introduction of the Stroke Unit, and have remained unchanged. Since the introduction of the Stroke Unit, there has been a slight decrease in the overall number of CEA's performed with a 25% increase in the proportion of endarterectomies performed for symptomatic disease. Despite the reduction in surgery for asymptomatic disease the overall 30-day stroke and death rate remains excellent at 2/229 (2%).

Linking electronic health records with community-level data to understand childhood obesity risk.

BACKGROUND: Environmental and socioeconomic factors should be considered along with individual characteristics when determining risk for childhood obesity. OBJECTIVES: To assess relationships and interactions among the economic hardship index (EHI) and race/ethnicity, age and sex in regard to childhood obesity rates in Wisconsin children using an electronic health record dataset. METHODS: Data were collected using the University of Wisconsin (UW) Public Health Information Exchange database, which links electronic health records with census-derived community-level data. Records from 53,775 children seen at UW clinics from 2007 to 2012 were included. Mixed-effects modelling was used to determine obesity rates and the interaction of EHI with covariates (race/ethnicity, age, sex). When significant interactions were determined, linear regression analyses were performed for each subgroup (e.g. by age groups). RESULTS: The overall obesity rate was 11.7% and significant racial/ethnic disparities were detected. Childhood obesity was significantly associated with EHI at the community level (r = 0.62, P < 0.0001). A significant interaction was determined between EHI and both race/ethnicity and age on obesity rates. CONCLUSIONS: Reducing economic disparities and improving environmental conditions may influence childhood obesity risk in some, but not all, races and ethnicities. Furthermore, the impact of EHI on obesity may be compounded over time. Our findings demonstrate the utility of linking electronic health information with census data to rapidly identify community-specific risk factors in a cost-effective manner.

International consensus for a definition of disease flare in lupus.

The Lupus Foundation of America (LFA) convened an international working group to obtain a consensus definition of disease flare in lupus. With help from the Paediatric Rheumatology International Trials Organization (PRINTO), two web-based Delphi surveys of physicians were conducted. Subsequently, the LFA held a second consensus conference followed by a third Delphi survey to reach a community-wide agreement for flare definition. Sixty-nine of the 120 (57.5%) polled physicians responded to the first survey. Fifty-nine of the responses were available to draft 12 preliminary statements, which were circulated in the second survey. Eighty-seven of 118 (74%) physicians completed the second survey, with an agreement of 70% for 9/12 (75%) statements. During the second conference, three alternative flare definitions were consolidated and sent back to the international community. One hundred and sixteen of 146 (79.5%) responded, with agreement by 71/116 (61%) for the following definition: "A flare is a measurable increase in disease activity in one or more organ systems involving new or worse clinical signs and symptoms and/or laboratory measurements. It must be considered clinically significant by the assessor and usually there would be at least consideration of a change or an increase in treatment." The LFA proposes this definition for lupus flare on the basis of its high face validity.

The role of sport-fish consumption advisories in mercury risk communication: a 1998-1999 12-state survey of women age 18-45.

BACKGROUND: In 2002, in the United States, 48 states issued advisories for sport-fish consumers that included 39 chemical contaminants. The most commonly identified chemical was methyl mercury, which is linked to reproductive and developmental effects. Advisories to reduce consumption of contaminated fish have been issued by states since the early 1970s. Advisories are being integrated to include both sport and commercial fish. METHODS: As part of a comprehensive risk-communication project, from December 1998 through August 1999 the Wisconsin Division of Public Health and the State of Maine Bureau of Health conducted a 12-state random-digit-dial telephone survey of 3015 women of childbearing age (ages 18-45). The goal was to assess the prevalence of fish consumption, understanding of mercury toxicity, and awareness of state sport-fish consumption advisories for mercury. We gathered information concerning respondents' demographic characteristics, understanding of mercury toxicity, fish consumption during the preceding 12 months, and sport-fish consumption advisory awareness. RESULTS: The overall survey completion rate was 57% with a Council of American Survey Research Organizations (CASRO)-calculated response rate of 50%. Completion rates varied from 37% in New Jersey to 73% in Minnesota. Fish consumption during the previous 12 months was reported by 87% of respondents (range by state of 82-90%). Nearly 10% of women reported consuming two or more fish-meals per week over the prior 12 months. Twenty-nine percent reported sport-fish consumption during the same time period, with a greater state-to-state variability (14-43%). Most women (71%) were aware of mercury's toxicity to a developing child (87% among those aware of an advisory and 67% among those unaware of an advisory). However, awareness of state advisories was only 20%, ranging by state from 8% to 32%. Women who were older, had more than a high school education, and had a household member with a fishing license were the most informed about mercury and fish-consumption advisories. CONCLUSIONS: Most women of childbearing age consume commercial fish and a substantial number also consume sport-caught fish. Despite this potential exposure to dietary mercury, most are unfamiliar with their state's mercury fish-consumption advisory. Most women were aware of the most toxic effects of mercury but less informed about mercury and its relationship to types of fish and fish characteristics. Minorities, women over age 30, family incomes above 25,000 US dollars, and those with some collage education were more likely to be consuming two or more fish-meals per week. Until source control and environmental remediation efforts can reduce the environmental burden of mercury below levels of concern, combined sport and commercial fish consumption advisories will remain the primary means of reducing human exposure to methylmercury. Assuring and assessing the effectiveness of such advisories is paramount. Our survey documents that current efforts to inform vulnerable populations are far from optimal.

Aeroallergens, allergic rhinitis, and sedating antihistamines: risk factors for traumatic occupational injury and economic impact.

BACKGROUND: The U.S. workplace injury burden is significant. Our objective was to assess the particular impact of aeroallergen, allergic rhinitis, and antihistamine exposures and side effects on the risk of traumatic work-related injuries, and the associated economic impact. METHODS: This is an observational case-control study with 1,223 acute traumatic injury cases that are compared to 1,202 chronic back injury controls. Structured telephone interviews were conducted in 1998 and 1999 on Workers' Compensation applicants injured in 1997. Antihistamine use and pollen levels were measured 2 weeks prior to the injury date. RESULTS: Sedating antihistamine exposures elevated acute injury risk (main effect OR: 2.93). A significant increase in traumatic injury risk was observed for combined sedating antihistamine and high pollen exposures among subjects with physician and self-diagnosed allergic rhinitis (OR: 2.41). Direct medical costs associated with this increased risk were estimated at $143 million in 2001. CONCLUSIONS: Workers with physician-diagnosed allergic rhinitis have as high a reliance on sedating antihistamines as do self-diagnosed and self-medicating nasal allergy sufferers. High pollen exposures along with sedating antihistamine use may confer significant additional injury risks among allergic rhinitis sufferers. Medical management "best practices" of diagnosed allergic rhinitis should include avoidance of sedating antihistamines to minimize acute, traumatic injury risks.

The effects of PCB exposure and fish consumption on endogenous hormones.

Previous studies have suggested that exposure to polychlorinated biphenyls (PCBs) may alter thyroid function, but data on effects of PCB exposure on other endogenous hormones has been lacking. The current study is ancillary to a larger investigation of the effects of Great Lakes fish consumption on PCBs and reproductive function. In the current study we examine associations of PCBs, 1,1-bis (4-chlorophenyl)-2,2-dichloroethene (DDE), and fish consumption with thyroid and steroid hormones in 178 men and PCBs, DDE, and fish consumption with thyroid hormones in 51 women from the original study. Serum PCB level and consumption of Great Lakes fish are associated with significantly lower levels of thyroxine (T(4)) and free thyroxine index (FTI) in women and with significantly lower levels of T(4) in men. Fish consumption, but not PCB level, is significantly and inversely associated with triiodothyronine (T(3)) in men. Results for thyroid-stimulating hormone (TSH) are inconsistent. Among men, there are significant inverse associations of both PCB and fish consumption with sex hormone-binding globulin (SHBG)-bound testosterone, but no association with SHBG or free testosterone. There are no significant overall associations of PCB, DDE, or fish consumption with estrone sulfate, follicle-stimulating hormone, luteinizing hormone, or dehydroepiandrosterone sulfate. The results of this study are consistent with previous studies showing effects of fish consumption and PCB exposure on thyroid hormones and suggest that PCBs may also decrease steroid binding to SHBG. Elucidation of specific mechanisms must await future investigations.

Disseminated intravascular coagulation in solid tumors: clinical and pathologic study.

Disseminated intravascular coagulation (DIC) is a well known hemostatic complication of solid tumors. We evaluated the occurrence of DIC in 1117 patients with solid tumors. Of these patients, 76 (6.8%) were diagnosed with DIC. There were a total of 145 bleeding and clotting episodes reported in the 76 patients. Thrombocytopenia, hypofibrinogemia, elevated D-dimer and fibrinogen degradation products were the most common coagulation abnormalities encountered in patients with DIC. In multivariate analysis, older age (p = .0001), male gender (p = .009), advanced malignancies (p = .027), breast cancer (p = .038) and the presence of necrosis in the tumor specimen (p = .004), emerged as independent factors significantly related to the occurrence of DIC in patients with solid tumors. Of the 76 patients, 25 (33%) achieved response to treatment of DIC as defined in the study. Patients with early stage and advanced malignancies who developed DIC had inferior survival when compared with their counterparts without DIC (p = .039 and p = .005, respectively). Taken together, this study indicates that certain clinical and laboratory features are more common in patients with solid tumors who developed DIC. The occurrence of DIC appears to have an independent effect on survival of patients with cancer. Cooperative studies are encouraged to better address the usefulness and optimal prophylactic heparin regimen in patients at risk for DIC.

Future development of lymphoproliferative disorders in patients with autoimmune hemolytic anemia.

The association between autoimmune hemolytic anemia (AIHA) and subsequent appearance of lymphoproliferative disorders (LPDs) has not been properly addressed in large-scale studies. We evaluated 107 patients with idiopathic (67 patients) or underlying (40 patients) immune disorders diagnosed with AIHA between 1992 and 1999. The following variables were examined in univariate and multivariate analysis: age; sex; type of AIHA (warm- or cold-active antibodies); presence of underlying immune disorders; and serum monoclonal protein. Of the 107 patients, 19 (18%) developed malignant LPDS: The median time to develop malignancy was 26.5 months (range, 9-76 months). At multivariate analysis, advanced age (P = 0.005), underlying autoimmune diseases (P = 0.002), and the presence of serum gammopathy (P = 0.045) were risk factors for future development of LPDs in these patients. Also, serum monoclonal IgM protein was a significant predictor (P = 0.0001) for the appearance of LPDs in patients with AIHA. The present study provides evidence that AIHA in some patients should be considered as a precursor of malignant LPDS: Knowledge of certain characteristics may help identify patients at risk for this transformation; periodic clinical and laboratory assessment of these patients is warranted.

Acquired hemophilia in patients with hematologic malignancies.

OBJECTIVES: To evaluate the occurrence of acquired hemophilia in patients with hematologic malignancies and to assess their response to treatment. DESIGN: Data on 8 patients with hematologic neoplastic disorders and inhibitor against factor VIII were analyzed retrospectively. SETTING: Three large tertiary-care centers. RESULTS: All 8 patients presented with spontaneous or posttraumatic hemorrhages. The mean inhibitor titer at the time of diagnosis was 79 Bethesda units (BU), and residual factor VIII activity was detectable in 3 patients. The inhibitor disappeared in 5 patients after a mean of 92 days, but persisted in the 3 other patients. The patients who achieved complete resolution of their circulating anticoagulant had lower mean inhibitor titers at the time of diagnosis than those who had persistent inhibitor (27 BU vs. 167 BU, respectively). Two patients died as a result of major hemorrhages that did not respond to treatment. CONCLUSIONS: Antibodies against factor VIII may be responsible for some bleeding episodes in patients with lymphoid or myeloid malignancies. Acquired hemophilia in this setting should be differentiated from other causes of bleeding because the approach to treatment is different. No conclusion can be drawn regarding the association between the activity of the underlying illness and the inhibitor titer, although it appears that at least in some patients such a relationship may exist. The underlying pathogenetic mechanisms responsible for the production of autoantibodies against factor VIII remain unclear, but we provide a few explanations in this article.

Hazardous ammonia releases in Wisconsin: trends and risk factors for evacuation and injury.

OBJECTIVE: To assess trends in hazardous ammonia releases and risk factors for subsequent evacuation and injury. METHODS: Analysis of the Wisconsin Hazardous Substances Emergency Events Surveillance system data during 1993 through 1998. RESULTS: Ammonia releases (291) accounted for 13% of all reported chemical releases, but 26% of all releases that led to evacuations. The majority of non-transportation-related ammonia releases are the result of equipment failure or operator error (85.5%). Few ammonia releases are transportation-related (6.5%) or occur during extreme weather (14.4%). Extreme weather is not a risk factor for evacuation or injury following ammonia releases. CONCLUSIONS: Ammonia releases are frequently the result of equipment failure or operator error and thus preventable. The majority of ammonia releases that lead to evacuation and injury are not the result of transportation accidents or weather factors beyond human control. Prevention efforts that focus on preventive maintenance, and worker training and awareness could reduce the burden of hazardous ammonia releases.

Fish consumption habits and advisory awareness among Fox River anglers.

Eating PCB-contaminated fish caught from the Lower Fox River, northeast Wisconsin, has raised concern about the health risk to consumers, especially to children and unborn babies. The fish advisory published by the state of Wisconsin recommends which fish are safe to eat. However, there is reason to believe that many anglers, especially non-English speaking anglers, are not aware of the advisory and the possible health risks of eating contaminated fish. A face-to-face survey administered to 104 anglers fishing along the Fox River indicates that 17% of anglers eat some or all of the fish they catch and that 83% practice "catch and release." Almost all the anglers were not familiar with Wisconsin's fish advisory but had heard of the health risks from their local newspaper and TV. As a follow-up, a fish health advisory brochure specific to the Fox River was developed.

Asthma hospitalizations in Wisconsin: a missed opportunity for prevention.

Asthma is the most common chronic disease of children and the third leading cause of preventable hospitalizations in the United States. To assess the impact of this disease on Wisconsin, we examined 1996-1998 state-wide and county-specific asthma hospitalization rates and compared these rates to Wisconsin 1990-1992 rates, national rates, and United States Healthy People 2010 asthma target objectives. Wisconsin's average asthma hospitalization rate has decreased from 13.4/10,000 during 1990-1992 to 12.1/10,000 during 1996-1998. Wisconsin children 0-4 years of age had the highest asthma-related hospitalization rate (38.0/10,000) of all age groups, during 1996-1998. Wisconsin African American residents had an average asthma hospitalization rate 6.6 times higher than whites (58.5 vs. 8.8 per 10,000, respectively) during 1996-1998. Milwaukee County had the highest county-specific asthma hospitalization rate in the state (26.4/10,000). Unless significant reductions are achieved, Wisconsin will not reach the Healthy People 2010 target objectives. Interventions should be directed to preventing asthma hospitalizations, especially among Wisconsin's youth and African American population.

Intrathecal methotrexate-induced megaloblastic anemia in patients with acute leukemia.

OBJECTIVE: To evaluate the occurrence of megaloblastic anemia induced by the infusion of therapeutic or prophylactic methotrexate in patients with acute leukemia. DESIGN: Data on 3 patients with acute leukemia receiving intrathecal methotrexate were prospectively analyzed. SETTING: Large tertiary-care center. RESULTS: All 3 patients with acute leukemia developed megaloblastic anemia confirmed by examination of the bone marrow aspirate and biopsy. Two of the 3 patients had low folic acid levels, while all patients had normal serum B(12) levels. All patients responded favorably to a therapeutic trial of folic acid. The median time for recovery of the hematologic parameters in these patients was 7 days. CONCLUSIONS: Intrathecally administered methotrexate may result in megaloblastic changes in the bone marrow of leukemic patients. The morphologic clues suggestive of folate deficiency in patients with acute leukemia may be masked by coexisting factors, such as the effects of cytotoxic treatment, prior transfusions, or persistent changes from the leukemic clone itself. Caution should be exercised to avoid attributing these changes to the neoplastic process, since the prognosis and treatment for the conditions involved are totally different. Repeat examination of the bone marrow, obtaining folic acid and vitamin B(12) levels, and a therapeutic trial of folic acid may help identify and reverse these changes.

Body burden levels of dioxin, furans, and PCBs among frequent consumers of Great Lakes sport fish. The Great Lakes Consortium.

Dioxins, furans, and polychlorinated biphenyls (PCBs) are toxic, persist in the environment, and bioaccumulate to concentrations that can be harmful to humans. Sport anglers may be exposed to these residues via consumption of contaminated Great Lakes (GL) fish. The Health Departments of five GL states, Wisconsin, Michigan, Ohio, Illinois, and Indiana, formed a consortium to study body burden levels of chemical residues in fish consumers of Lakes Michigan, Huron, and Erie. In Fall 1993, a telephone survey was administered to sport angler households to obtain fish consumption habits and demographics. A blood sample was obtained from a portion of the study subjects. One hundred serum samples were analyzed for 8 dioxin, 10 furan, and 4 coplanar PCB congeners. Multiple linear regression was conducted to assess the predictability of the following covariates: GL sport fish species, age, BMI, gender, years sport fish consumed, and lake. Of the 100 subjects, there were 58 men; 35 consumed sport fish from Lake Michigan, 29 from Lake Huron, and 36 from Lake Erie. The overall average number of GL sport fish meals consumed in the previous 12 months was 43. Lake Erie male and female consumers, on average, ate more GL sport fish, a mean of 57 and 42 meals, respectively, than men and women from the other two lake subgroups. Median total dioxin toxic equivalents (TEq), total furan TEq, and total coplanar PCB TEq were higher among all men than all women (P=0.0001). Lake trout, salmon, age, BMI, and gender were significant regression predictors of log(total coplanar PCBs). Lake trout, age, gender, and lake were significant regression predictors of log(total furans). Age was the only significant predictor of total dioxin levels.

Serum PCB and DDE levels of frequent Great Lakes sport fish consumers-a first look. The Great Lakes Consortium.

Great Lakes (GL) sport fish consumption is a potential human exposure route for polychlorinated biphenyls (PCBs) and dichlorodiphenyl dichloroethene (DDE). Because of fish tissue contamination, frequent consumers of Great Lakes sport caught fish (GLSCF) may be at risk for PCB and DDE accumulation. To examine this problem, the Health Departments of Wisconsin, Illinois, Indiana, Ohio, and Michigan formed a health assessment consortium. Participants were contacted by telephone to complete a detailed demographic and fish consumption survey. Frequent and infrequent GLSCF consumers were identified, and a participant subset was then asked to donate blood for PCB and DDE analysis. Analysis of variance (ANOVA) was done to study exposure group mean differences, while correlation and regression analyses were performed to examine relationships between demographic characteristics, GLSCF consumption, PCB, and DDE body burdens. A total of 4206 individuals participated in the study. Of these, 2542 were habitual GLSCF consumers (mean greater than 35 meals/year males; greater than 27 meals/year females), while 1664 did not eat GLSCF. A subset of 538 participants donated blood and included 439 frequent and 99 infrequent GLSCF consumers. PCB levels were significantly higher in the group of GLSCF consumers (geometric mean: 4.8 ppb males, 2.1 ppb females) when compared to their referents (geometric mean: 1.5 ppb males, 0.9 ppb females), while DDE levels were also higher for GLSCF consumers. PCB and DDE body burdens varied by exposure group, gender, and great lake (Michigan, Huron, Erie). PCB and DDE levels were significantly correlated to age, body mass index, and sport fish and Great Lakes sport fish consumption histories. Regression analysis identified years of consuming sport caught fish as the most robust predictor of PCBs (r2=25%), while age was the best predictor of DDE levels (r2=21%). This study corroborated previous findings relating frequent GLSCF consumption to a higher body burden for PCBs and DDE.

Metal working fluid-associated hypersensitivity pneumonitis: an outbreak investigation and case-control study.

Occupational exposure to bacterial or fungal antigens has been associated with hypersensivity pneumonitis (HP), an immunologically-mediated pulmonary disease. Between August 1995 and April 1996, 34 employees working in machining and assembly areas of an engine manufacturing plant were clinically diagnosed with HP. Of these, 20 employees met an epidemiologic case definition. In a case-control study, no exposure variables, including duration and intensity of metal working fluid (MWF) exposure, were statistically associated with an increased risk of disease. Neither cases nor controls demonstrated precipitin reactivity against unused samples of the seven MWF and two biocides used in the plant. HP cases had a significantly higher prevalence of positive precipitin reactions to used oil soluble and synthetic MWFs. Reactivity to used but not unused MWF suggests a biocontaminant, probably bacteria or fungi, is the causative antigen in the development of HP in this setting.

Profiles of Great Lakes critical pollutants: a sentinel analysis of human blood and urine. The Great Lakes Consortium.

To determine the contaminants that should be studied further in the subsequent population-based study, a profile of Great Lakes (GL) sport fish contaminant residues were studied in human blood and urine specimens from 32 sport fish consumers from three Great Lakes: Lake Michigan (n = 10), Lake Huron (n = 11), and Lake Erie (n = 11). Serum was analyzed for 8 polychlorinated dioxin congeners, 10 polychlorinated furan congeners, 4 coplanar and 32 other polychlorinated biphenyl (PCB) congeners, and 11 persistent chlorinated pesticides. Whole blood was analyzed for mercury and lead. Urine samples were analyzed for 10 nonpersistent pesticides (or their metabolites) and 5 metals. One individual was excluded from statistical analysis because of an unusual exposure to selected analytes. Overall, the sample (n = 31) consumed, on average, 49 GL sport fish meals per year for a mean of 33 years. On average, the general population in the GL basin consume 6 meals of GL sport fish per year. The mean tissue levels of most persistent, bioaccumulative compounds also found in GL sport fish ranged from less than a twofold increase to that of PCB 126, which was eight times the selected background levels found in the general population. The overall mean total toxic equivalent for dioxins, furans, and coplanar PCBs were greater than selected background levels in the general population (dioxins, 1.8 times; furans, 2.4 times; and coplanar PCBs, 9.6 times). The nonpersistent pesticides and most metals were not identified in unusual concentrations. A contaminant pattern among lake subgroups was evident. Lake Erie sport fish consumers had consistently lower contaminant concentrations than consumers of sport fish from Lake Michigan and Huron. These interlake differences are consistent with contaminant patterns seen in sport fish tissue from the respective lakes; GL sport fish consumption was the most likely explanation for observed contaminant levels among this sample. Frequent consumers of sport fish proved to be effective sentinels for identifying sport fish contaminants of concern. In the larger study to follow, serum samples will be tested for PCBs (congener specific and coplanar), DDE, dioxin, and furans.

Antibodies against factor VIII in patients with solid tumors: successful treatment of cancer may suppress inhibitor formation.

Between 1995 and 1998, we treated 5 patients with anti-factor VIII antibodies and spontaneous bleeding. All patients had underlying malignant conditions. Initial control of the bleeding episodes and reduction in inhibitor titer was achieved in all patients. Disappearance of factor VIII inhibitor occurred in 3 patients after either resection of the tumor or chemotherapy. Immunosuppression therapy failed to eradicate the antibody in 2 patients with metastatic disease. Antibodies against factor VIII appearing in certain patients may be directly associated with the underlying malignancy, rather than a coincidental finding. Attempts to reduce the titer or eradicate the inhibitor may fail if recognition of the underlying condition is not sought, or an appropriate treatment of cancer is not offered.