Dolor precordial en pacientes hospitalizados en el servicio de medicina interna del Hospital General de Medellin, septiembre de 1986 a septiembre de 1987 / Chest pain in patients hospitalized in the internal medicine service of Hospital General de Medellin, september 1986 to september 1987

Se realizo este estudio retrospectivo en el servicio de medicina interna del hospital general de Medellin, con el fin de conocer las causas de dolor precordial y su relacion con ciertas variables clinicas, tomando una muestra de 48 pacientes, entre septiembre 1986 a septiembre de 1987 que consultaron por esta causa

Morbilidad respiratoria en trabajadores de la industria del talco / Respiratory morbidity of workers at a talc industry

Con el fin de conocer su morbilidad respiratoria se estudiaron los 36 trabajadores de la Empres de Talcos de Yarumal (Antioquia-Colombia); a cada trabajador se le realizaron historia clinica y ocupacional; examen fisico; estudios radiologicos de torax; espirometria; pruebas de tuberculina e histoplasmina; baciloscopias y cultivos para micobacterias. Se hicieron igualmente mediciones del grado de contaminacion del ambiente laboral. Se encontro una alta frecuencia de sintomatologia respiratoria previa; la mitad de los trabajadores anomalias al examen fisico; dos terceras partes tenian anormalidades radiologicoas y una tercera parte anormalidades espirometricas

Asbestos body content of the larnyx in asbestos workers. A study of five cases.

Occupational exposure to asbestos has been epidemiologically associated with carcinoma of the larynx; however, no search for or quantitation of laryngeal asbestos bodies has been performed. This report concerns an autopsy study of five patients with occupational asbestos exposure and proven asbestos-associated pulmonary disease in whom histologic sections of the larynx were examined and a digestion-concentration technique was used to isolate and quantitate the asbestos bodies in the remaining laryngeal tissues. No dysplastic epithelial changes were present in the mucosa. Asbestos bodies were recovered from two of the five larynges but from none of ten larynges obtained from autopsy controls.

A new approach for evaluating risk factors in coronary artery disease: a study of lipid concentrations and severity of disease in 1847 males.

Using recently developed statistical techniques, we estimated joint probability density functions for plasma cholesterol and plasma triglyceride concentrations in 12 subgroups of 1847 males with angiographically demonstrated coronary artery disease. The subjects were grouped by patterns of age, history of hypertension, history of smoking and severity of disease. From the estimated joint probability density functions, we determined the way in which the risk of severe vs moderate coronary artery disease varied with the joint variation of plasma lipids for given combinations of the other risk factors. The patterns of risk that we found are evidence of the complicated way in which the relationship between plasma lipids and the severity of coronary artery disease is affected by other risk factors.

The cigarette factor in lung cancer due to chloromethyl ethers.

In a prospective study of 51 men who had moderate to heavy cumulative exposure to chloromethyl ethers, 11 developed lung cancer in a ten-year perod. The risk was higher in men who were not smoking cigarettes at the start of observation than in those who were. This difference was even more impressive when examined in relation to the risks of lung cancer by smoking habit in the general population. The data suggest that continued cigarette smoking entailed a factor which partially inhibited the carcinogenic effect of chloromethyl ethers.

Risk factors and angiographic coronary artery disease: a report from the coronary artery surgery study (CASS).

The findings for 14 risk variables were correlated with the results of coronary arteriography in 8807 patients registered in the interinstitutional Coronary Artery Surgery Study (CASS). Discriminant-function analysis revealed that age, sex, cigarette smoking and the level of blood cholesterol best distinguished between the groups with (6688 patients) and without (2119 patients) coronary artery disease. A family history of coronary artery disease and the presence of hypertension or diabetes were of addition, but less, discriminating value. The relative risk for coronary artery disease in patients with the combination of cigarette smoking and an elevated cholesterol level was high (> 4) in females age 55 years or younger and in males age 35 years or younger. Few females age 45 years or younger (seven of 97) had coronary artery disease when both of these risk factors were absent. In spite of these correlations, only limited gains accrued from the use of discriminant-function analysis in correctly allocating patients into disease and nondisease groups. This indicates that, while certain factors are significantly correlated with coronary arteriographic findings, their value for predicting the presence of coronary artery disease is limited.

Elevated serum levels of pancreatic secretory proteins in cigarette smokers after secretin stimulation.

The secretory pancreatic proteins in serum were analyzed in a group of cigarette smokers and a control group of nonsmokers before and after intravenous secretin stimulation. None of these persons had any signs of pancreatic disease. In the control group, serum total amylase activity, pancreatic isoamylase, cationic trypsinogen, and pancreatic secretory trypsin inhibitor concentrations varied within the normal range before and after secretin injection. In contrast, the concentrations of these pancreatic proteins in all the cigarette smokers elevated from normal to abnormally high serum concentrations after secretin stimulation. The results indicate a probable toxic effect of cigarette smoking on the exocrine pancreas.

Noncontraceptive estrogens and myocardial infarction in young women.

The effect of noncontraceptive estrogens on the risk of myocardial infarction (MI) in women aged 30 to 49 years was investigated in 477 women with first infarctions and in 1,832 hospital control subjects. There was little evidence of an effect: overall, the estimated relative risk of acute MI for women who had used noncontraceptive estrogens in the preceding month, after allowance for potential confounding factors, was 1.0 (95% confidence intervals, 0.6 to 1.7); the corresponding estimate for women who had discontinued use more than one month previously was 1.2 (0.8 to 1.8). There was also no apparent association in various subgroups, including women who smoked heavily and those who had no identified predisposition.

Individuals transplacentally exposed to maternal smoking may be at increased cancer risk in adult life.

Studies which provide evidence suggesting that cancer could result from transplacental exposure to maternal smoking include animal experiments showing that: (1) compounds present in tobacco smoke and cigarette smoke condensate itself are active transplacental carcinogens; (2) the fetus has greater sensitivity to some carcinogens than the adult, so that estimates of doses necessary for transplacental carcinogenesis cannot be accurately predicted from effects in adults; (3) carcinogens administered transplacentally can increase sensitivity to later carcinogenic exposures; and (4) many (at lower doses probably most) tumours resulting from transplacental exposure are not evident until adulthood and their morphology and sites do not differ from those of spontaneously occurring tumours. Studies in man have shown that components of tobacco smoke can reach the fetus and that human fetal tissues are capable of activating carcinogens similar to those in tobacco smoke. These findings suggest that conditions causing transplacental carcinogenesis in animals may be duplicated in man by prenatal exposure to maternal smoking, and that resulting tumours could occur in adulthood. In view of the widespread prevalence of smoking during pregnancy, epidemiological studies of cancer in adults should investigate the possible role played by maternal smoking in increasing cancer risk.

Alcohol, smoking, and incidence of spontaneous abortions in the first and second trimester.

32,019 women completed a questionnaire on alcohol use at their first antenatal visit; thereafter they were followed to assess the incidence of spontaneous abortions. 51.7% reported drinking no alcohol in early pregnancy; 44.7% had less than 1 drink daily; and 2.4, 0.4, and 0.1% had an average of 1-2, 3-5, or more than 6 drinks respectively. Life-table analysis showed that the age-adjusted relative risks of second-trimester losses (15-27 weeks) were 1.03 (not significant: ns), 1.98 (p < .01), and 3.53 (p < .01) for women taking less than 1, 1-2, and more than 3 drinks daily, compared with non-drinkers. The corresponding relative risks for first-trimester losses (5-14 weeks) were 1.12 (ns), 1.15(ns), and 1.15(ns). Smokers had relative risks of 1.01(ns) and 1.21(ns) in the first and second trimesters, compared with non-smokers. The increased risk of second-trimester miscarriage in drinkers was not explained by age, parity, race, marital status, smoking, or the number of previous spontaneous or induced abortions. Thus alcohol may harm human fetuses not only when it is abused but also when taken in moderation.

PIP: 32,019 women completed a questionnaire on alcohol use at their 1st antenatal visit; thereafter they were followed to assess the incidence of spontaneous abortions. 51.7% reported drinking no alcohol in early pregnancy; 44.7% had less than 1 drink daily; and 2.4, 0.4, and 0.1% had an average of 1-2, 3-5, or more than 6 drinks respectively. Life-table analysis showed that the age-adjusted relative risks of second trimester losses (15-27 weeks) were 1.03 (ns; not significant), 1.98 (P.01), and 3.53 (P.01) for women taking less than 1, 1-2, and more than 3 drinks daily, compared with nondrinkers. The corresponding relative risks for first trimester losses (5-14 weeks) were 1.12 (ns), 1.15 (ns), and 1.15 (ns). Smokers had relative risks of 1.01 (ns) and 1.21 (ns) in the first and second trimesters, compared with nonsmokers. The increased risk of second trimester miscarriage in drinkers was not explained by age, parity, race, marital status, smoking, or the number of previous spontaneous or induced abortions. Thus alcohol may harm human fetuses not only when it is abused but also when taken in moderation.

Drinking during pregnancy and spontaneous abortion.

PIP: The frequency of drinking alcohol among 616 women who aborted spontaneously (cases) was compared with that among 632 women who delivered after at least 28 weeks gestation (controls). 17.0% of cases reported drinking twice a week or more during pregnancy whereas among controls, only 8.1% of women reported drinking twice a week or more. The hypothesis that drinking during pregnancy is associated with spontaneous abortion was tested by maximum-likelihood logistic regression analysis. The adjusted-odds ratio for this association was 2.62. We estimate that more than 1/4 of pregnant women drinking twice a week or more are likely to abort, compared with about 14% among women who drink less often. Consideration of wine, beer, and spirits suggested that the minimum harmful dosage was 1 ounce of absolute alcohol. Several potentially confounding variables, including maternal age, gestation, prior spontaneous abortions, smoking, and nausea/vomiting, were controlled in the analysis. The association between drinking during pregnancy and spontaneous abortion did not vary with these factors. Even moderate alcohol consumption during pregnancy is a risk factor for, and may be a cause of, spontaneous abortion. Among the possible mechanisms, acute fetal poisoning seems the most likely, although chronic poisoning is also possible.^ieng

Occupational disease in dentistry and chronic exposure to trace anesthetic gases.

A mail survey of 30,650 dentists and 30,547 chairside assistants grouped according to occupational exposure to inhalation anesthetic and sedatives in the dental operatory indicated increased general health problems and reproductive difficulties among respondents exposed to anesthetics. For male dentists who were heavily exposed to anesthetics, the increase in liver disease was 1.7-fold, kidney disease was 1.2-fold, and neurological disease was 1.9-fold. For wives of male dentists who were heavily exposed to anesthetics, the increase in spontaneous abortion rate was 1.5-fold. Among female chairside assistants who were heavily exposed to anesthetics, the increase in liver disease was 1.6-fold, kidney disease was 1.7-fold, and neurological disease was 2.8-fold. The increase in spontaneous abortion rate among assistants who were heavily exposed was 2.3-fold. Cancer rates in women heavily exposed to inhalation anesthetics were increased 1.5-fold but this finding was not statistically significant (P = .06). Separate analysis of the data for disease rates and birth difficulties by type of inhalation anesthetic indicates that in both dentists and chairside assistants chronic exposure to nitrous oxide alone is associated with an increase rate of adverse response.