Pregnancy in women diagnosed with antineutrophil cytoplasmic antibody-associated vasculitis: outcome for the mother and the child.

OBJECTIVE: Antineutrophil cytoplasmic antibody-associated vasculitis (AAV) is infrequently seen in women of childbearing age. Only a limited number of pregnancies in women with AAV have been reported, and often they were associated with complications. METHODS: This was a single-center retrospective observational study. All pregnancies in women with granulomatosis with polyangiitis (Wegener's) (n = 13) and microscopic polyangiitis (n = 1) were included. Women of childbearing age were counseled to abstain from pregnancy during or shortly after disease activity or <1 year after cyclophosphamide treatment. RESULTS: We described 22 pregnancies in 14 women with AAV (median age at diagnosis was 25 years [range 19-36 years]) diagnosed between 1982-2008. The ear, nose, and throat region (71%) and kidneys (50%) were predominantly involved. All women were in remission at conception and cyclophosphamide had been administered to 9 women (15 pregnancies). The median gestational age was 39+4 weeks, including 2 preterm deliveries. The median birth weight was 3,400 gm (1,860-3,890 gm). Hypothyroidism occurred in 1 newborn and a cleft palate in 1 newborn of a twin pregnancy. Otherwise, the fetal outcome was excellent. Preeclampsia was diagnosed in 2 pregnancies. A caesarean section was performed in 2 patients. The median followup after the last conception was 98 months (range 11-307 months). Eight women experienced a relapse 21 months (range 7-62 months) after conception, 1 during pregnancy, and 7 after delivery. CONCLUSION: In this study, the pregnancy outcome in patients with AAV in remission was excellent. Pregnancy in women with AAV in remission does not seem to be associated with increased risk of relapse. Counseling, careful management, and close followup are essential in pregnant women with AAV.

[Misleading advertising claims about the indication of doxazosin (Cardura) for type 2 diabetes mellitus and hypertension]. / Misleidende reclame-uitingen over de indicatiestelling van doxazosine (Cardura) bij diabetes mellitus type 2 én hypertensie.

A number of Dutch medical journals have carried an advertisement promoting doxazosin in the treatment of hypertension in patients with type 2 diabetes mellitus. No long-term randomised clinical trials have examined the cardiovascular outcomes of the alpha-adrenergic blockers to which doxazosin belongs. The drug was removed from the largest study into blood pressure and cholesterol reduction ever performed until now (the antihypertensive and lipid-lowering treatment to prevent heart attack trial), due to an increased incidence of cardiovascular events and in particular congestive heart failure. The clinical significance of its insulin-sensitivity improving and lipid-neutralising effects in small-scale, short-term, small patient-group studies are ambiguous. Accordingly, national and international guidelines omitted the drug in their treatment recommendations. The advertisement claims are therefore misleading.

Exposure to styrene and health complaints in the Dutch glass-reinforced plastics industry.

A study of the health hazards for workers exposed to styrene in the Dutch glass-reinforced plastics industry was undertaken. The open mould techniques of filament winding, spraying and hand laminating were chosen for study because exposure of workers using them was expected to be high. Occupational hygiene surveys were conducted in four plants. In addition to measurements of exposure, data on health complaints were collected. In 12 smaller plants exposure was estimated in walk-through surveys. The results show that although most of the plants had implemented control measures such as ventilation and extraction, the levels of exposure constituted a health risk. Time-weighted average concentrations for workers involved in filament winding ranged from 134 to 716 mg m-3, for those who were spraying from 48 to 602 mg m-3 and for those laminating manually from 18 to 538 mg m-3. The 'no-adverse-effect level' based on effects observed in man is considered to be 105 mg m-3, and the acute subjective health effects experienced by the population studied supported this value. To reduce exposure to below 105 mg m-3, control measures should combine engineering with codes of practice adapted to the particular process or processes employed.