Reducing methylmercury accumulation in the food webs of San Francisco Bay and its local watersheds.

San Francisco Bay (California, USA) and its local watersheds present an interesting case study in estuarine mercury (Hg) contamination. This review focuses on the most promising avenues for attempting to reduce methylmercury (MeHg) contamination in Bay Area aquatic food webs and identifying the scientific information that is most urgently needed to support these efforts. Concern for human exposure to MeHg in the region has led to advisories for consumption of sport fish. Striped bass from the Bay have the highest average Hg concentration measured for this species in USA estuaries, and this degree of contamination has been constant for the past 40 years. Similarly, largemouth bass in some Bay Area reservoirs have some of the highest Hg concentrations observed in the entire US. Bay Area wildlife, particularly birds, face potential impacts to reproduction based on Hg concentrations in the tissues of several Bay species. Source control of Hg is one of the primary possible approaches for reducing MeHg accumulation in Bay Area aquatic food webs. Recent findings (particularly Hg isotope measurements) indicate that the decades-long residence time of particle-associated Hg in the Bay is sufficient to allow significant conversion of even the insoluble forms of Hg into MeHg. Past inputs have been thoroughly mixed throughout this shallow and dynamic estuary. The large pool of Hg already present in the ecosystem dominates the fraction converted to MeHg and accumulating in the food web. Consequently, decreasing external Hg inputs can be expected to reduce MeHg in the food web, but it will likely take many decades to centuries before those reductions are achieved. Extensive efforts to reduce loads from the largest Hg mining source (the historic New Almaden mining district) are underway. Hg is spread widely across the urban landscape, but there are a number of key sources, source areas, and pathways that provide opportunities to capture larger quantities of Hg and reduce loads from urban runoff. Atmospheric deposition is a lower priority for source control in the Bay Area due to a combination of a lack of major local sources. Internal net production of MeHg is the dominant source of MeHg that enters the food web. Controlling internal net production is the second primary management approach, and has the potential to reduce food web MeHg in some habitats more effectively and within a much shorter time-frame. Controlling net MeHg production and accumulation in the food web of upstream reservoirs and ponds is very promising due to the many features of these ecosystems that can be manipulated. The most feasible control options in tidal marshes relate to the design of flow patterns and subhabitats in restoration projects. Options for controlling MeHg production in open Bay habitat are limited due primarily to the highly dispersed distribution of Hg throughout the ecosystem. Other changes in these habitats may also have a large influence on food web MeHg, including temperature changes due to global warming, sea level rise, food web alterations due to introduced species and other causes, and changes in sediment supply. Other options for reducing or mitigating exposure and risk include controlling bioaccumulation, cleanup of contaminated sites, and reducing other factors (e.g., habitat availability) that limit at-risk wildlife populations.

Spatial trends and impairment assessment of mercury in sport fish in the Sacramento-San Joaquin Delta watershed.

A three-year study was conducted to examine mercury in sport fish from the Sacramento-San Joaquin Delta. More than 4000 fish from 31 species were collected and analyzed for total mercury in individual muscle filets. Largemouth bass and striped bass were the most contaminated, averaging 0.40 microg/g, while redear sunfish, bluegill and rainbow trout exhibited the lowest (<0.15 microg/g) concentrations. Spatial variation in mercury was evaluated with an analysis of covariance model, which accounted for variability due to fish size and regional hydrology. Significant regional differences in mercury were apparent in size-standardized largemouth bass, with concentrations on the Cosumnes and Mokelumne rivers significantly higher than the central and western Delta. Significant prey-predator mercury correlations were also apparent, which may explain a significant proportion of the spatial variation in the watershed.

Multicenter randomized evaluation of a nutritional education software in obese patients.

OBJECTIVE: To study the efficacy of the nutritional education software, Nutri-Expert, in the management of obese adult patients. MATERIAL AND METHODS: Two groups of obese patients were followed up over one year in a randomized study: the first group received close traditional management (seven nutritional visits over the year, with physicians and dietitians conjointly) and the second one also used at home by Minitel the Nutri-Expert system. 557 patients were enrolled in the study by 16 French centers of diabetology and nutrition. Body mass index (BMI), tests of dietetic knowledge, dietary records and centralized biological measurements were assessed at inclusion, 6 and 12 months. 341 patients were evaluable at the end of the year. RESULTS: The group using Nutri-Expert scored significantly better in the tests of dietetic knowledge than the control group. For all patients, nutritional education led to a significant improvement in BMI, dietary records and biological measurements, without significant difference between the two groups. Five years after the end of the study, the weight of 148 patients was recorded; mean BMI was significantly lower than the initial value but there was no significant difference between the two groups. CONCLUSION: In the management of obese patients, Nutri-Expert system has a role to play in reinforcing nutritional knowledge; if regular follow-up is not possible, or if a large series of obese patients is to be treated, Nutri-Expert could partly replace traditional management, for example between visits.

Effect on compliance, acceptability of blood glucose self-monitoring and HbA(1c) of a self-monitoring system developed according to patient's wishes. The ACCORD study.

OBJECTIVES: To test a blood glucose monitor developed upon diabetic's recommendations (Glucotrend Premium). Self-monitoring of blood glucose (SMBG) generates hope when introduced, however several studies questioned its efficacy and many diabetics judge it too constraining. MATERIAL AND METHODS: Thirty diabetes centres in France, for 6 months in 179 insulin-treated diabetics, using SMBG but non optimally and with HbA(1c) (>=130% of the upper limit). Randomisation to 3 groups: either their previous system (Group A), or to the Glucotrend Premium monitor with a memory to assess compliance (Group B), or to another monitor, new for the patient, and with a memory too, the One Touch Profile (Group C). At entry, and then at 3 and 6 months, patients had an acceptability and compliance questionnaire, HbA(1c), count of weekly hypoglycaemia, record of insulin doses and an assessment of the key compliance factors. RESULTS: HbA(1c) improved significantly in the 3 groups, more markedly in groups B (Glucotrend) and C (One Touch), e.g. - 0.6 +/- 1.1% (group A), - 0.9 +/- 1.2% (group B) and - 1.0 +/- 0.9% (group C) at M6. Acceptability was judged better for groups B and C, an additional benefit for Glucotrend: better accuracy vs laboratory blood glucose (C/L) determinations and a lower utilisation cost. Intermediate (lente) and regular insulin doses only significantly decreased (26% and 10% respectively) in group B (Glucotrend) despite a decrease in HbA(1c). Compliance (defined as 75-150% of recommended self-monitoring) improved within the 3 groups (from 34% to 65%), this improvement was maintained after month 3 (M6: 76%) only in group B (Glucotrend), vs a worsening in groups A and C (M6: 62 and 57% respectively). A better accuracy of C/L was observed with Glucotrend at M0, M3 and M6. CONCLUSION: SMBG has limits due to various causes, and to specific difficulties of this invasive and repetitive technique. The development of a system based on advices formulated by patients themselves, Glucotrend Premium, has resulted in a marked improvement on acceptability, compliance and glucose control.

Psychosocial aspects of coronary artery disease related to military patients.

OBJECTIVE: Coronary artery disease (CAD) is a major cause of nontraumatic morbidity and mortality in military personnel. Most studies of the psychosocial impact of CAD have dealt with civilian populations. The purpose of this paper is to highlight differences between military and civilian populations with CAD in 4 areas: depression and anxiety, social support, return to work, and stress. METHOD: A computerized literature search from 1985 to 1995 using the search terms "stress," "cardiovascular," "cardiac," "depression," "military," "anxiety" and "psychosocial" was undertaken. Controlled and prospective studies of civilian patients were selected along with relevant studies involving military populations. RESULTS: Unique characteristics of the military may be important factors in affecting the psychosocial outcome of military patients with CAD. These characteristics include a high level of denial of illness, strong social supports, a powerful military work ethic, and stressful situations unique to the military. CONCLUSIONS: Most studies of the psychosocial impact of CAD are based on civilian populations. A review of available studies suggests that little is known about how military patients adapt to CAD, particularly with regard to symptoms of depression and anxiety, social impairment, and rates of return to work. Studies in this area are needed regarding the psychosocial aspects of CAD in military populations.

[Tuberculous dacryocystitis]. / Dacryocystite tuberculeuse.

BACKGROUND: Acute infection and inflammation of the nasolacrimal sac may complicate congenital obstruction of the nasolacrimal duct. Acute dacryocystitis is uncommon later and tuberculosis is exceptionally responsible for it. CASE REPORT: A 4 1/2 year-old boy was admitted because he suffered from acute left dacryocystitis with fever and cervical adenitis. Involvement of both lacrymal gland and lymph node persisted despite antibiotic and corticosteroid therapy. Needle biopsy of the lymph node showed presence of Mycobacterium tuberculosis and excision revealed caseating granulomas. The tuberculin skin test was positive while pulmonary tuberculosis was discovered in the patient's father. The patient was successfully given izoniazid, rifampin for 9 months and pyrazinamide for 2. Drainage of the sac area was necessary after 1 month of treatment followed by dacryocystorhinostomy. CONCLUSION: This rare case of tuberculous dacryocystitis permits to delineate the difficulties of ophthalmologic therapy.

[Multicenter evaluation of the Nutri-Expert Telematic System in diabetic patients]. / Evaluation multicentrique du Système Télématique Nutri-Expert aupres de patients diabétiques.

Nutri-Expert is a system for self-monitoring and dietetic education, accessible through Minitel. A preliminary randomised evaluation of one hundred diabetic patients in the Midi-Pyrénées region showed that Nutri-Expert improved dietetic knowledge, dietary habits and metabolic balance. The aim of the present study was to show that the system can be successfully prescribed to patients by physicians outside the center which originated it, indicating the benefit of a wider use of Nutri-Expert, among the diabetic population. One hundred and fifty-five patients, recruited by six French centres of diabetology, used Nutri-Expert from their homes for six months. Clinical examination, tests of dietetic knowledge and biological tests, including lipid fractions, were carried out before and after six months of use. After six months, there was a significant improvement in the patients' dietetic knowledge and in some biological parameters. Nutri-Expert is thus useful even when prescribed by a centre other than the hospital which devised the system. It is an additional beneficial tool in the ambulatory management of diabetic patients.

[Violence and consumption of illicit drugs in Quebec adolescents. An analysis of their perceptions]. / Violence et consommation de drogues illicites chez les adolescents du Québec. Une analyse de leur perception.

OBJECTIVE: To study adolescents' perception of the connection between violence and the consumption of illegal drugs. DESIGN: A self-administered questionnaire. SETTING: A town with 30,000 inhabitants north of Montreal. PARTICIPANTS: Almost 3300 students between the ages of 12 and 19. RESULTS: About 25% reported that they had been victims of violence by other adolescents who were, in their estimation, under the influence of an illicit drug. This rate increased significantly among adolescents who used drugs themselves, and was highest among female adolescents between the ages of 12 and 15. CONCLUSION: Students, especially young women, who consume illegal drugs are more likely to be victims of violence than those who do not. Family physicians should advise young patients of this risk.

[Balance sheet of CETRADIM after 10 years of functioning as an alternative to hospitalization]. / Bilan du CETRADIM après 10 ans de fonctionnement en alternative a l'hospitalisation.

CETRADIM (Educational Centre for the Treatment of Diabetes and Nutritional Diseases) is a hospital department of the Roubaix (France) general hospital functioning uniquely as an alternative to conventional hospital care (outpatient clinics, day hospital, weekday hospital). Its catchment area is essentially local, covering a population of about 200,000. Its vocation is triple: care (including education), training and the supply of information to the treating team and general public. The aim of this study was to evaluate the effect of the existence of a unit of this kind on the frequency of admission of patients for conventional hospital care to the various medical departments of the Roubaix hospital. The indicator used was the percentage of conventional hospitalisation (PCH) in the Endocrinology/Diabetology/Nutrition department, calculated by dividing the number of conventional hospital stay in this specialty by the total number of hospital stay days. Data were obtained for the Roubaix hospital and for 3 hospitals in the Northern region serving comparable types of population but lacking any institution functioning totally as an alternative to hospital care. The PCH was 4.3% for the Roubaix Hospital Centre and 8.2, 8.46 and 10.6% respectively for the other three hospitals. These findings suggest that the existence of an institution such as CETRADIM reduces the number of conventional hospital stay days of patients with Endocrine/Diabetes/Nutrition diseases. Its effects on the constitution of new local care units is discussed, and arguments in favour of its role in the improvement of health care and education costs developed.

[Congenital mega-urethra. A case]. / Le méga-urètre congénital. Une observation.

Congenital megalo-urethra is a malformation of the male urethra with a major dilatation of its penile part without obstruction downwards. It is either due to hypoplasia or agenesia of spongy tissue. Two types are described, scaphoid and fusiform types, according to the presence or the absence of erectile tissue. Megalo-urethra is a rare condition, and 56 cases were previously reported until 1987. A new case of this severe anomaly is reported and management discussed.

[Congenital mega-urethra. Comments apropos of a case report]. / Le méga-urètre congénital. Commentaires à propos d'une observation.

Congenital megalourethra is a malformation of the male urethra with a major dilatation of its penile part without obstruction downwards. It is either due to hypoplasia ore agenesia of spongy tissue. Two types are described, scaphoide and fusiform types, according to the presence or the absence of erectile tissue. Megalourethra is a rare condition, and 55 cases were previously reported until 1987. A new case of this severe anomaly is reported and management discussed.

["Traumatic" urethrorragias in young boys: can they be of an unusual etiology?]. / Urétrorragies "traumatiques" du jeune garçon: une étiologie peut-être non exceptionnelle?

The etiology of urethrorragias in the boy is usually unknown. The authors report one case related to a foreign body introduced into the urethra. Considering the urethroscopic findings, several publications about that type of urethral bleeding in the boy show that such a traumatic lesion is often found.

[Porphyria cutanea tarda in a 4-year-old child with uroporphyrinogen decarboxylase deficiency]. / Porphyrie cutanée "tardive" chez une enfant de 4 ans avec déficit en uroporphyrinogène décarboxylase.

A 4 years old girl presents a typical case of patent form of cutaneous late porphyria with a reduced activity of the erythrocyte, uroporphyrinogen decarboxylase (UROD) genetically transmitted over 3 generations; a multifactor inheritance (HLA A3, a normal phenotype of alpha 1 antitrypsin, exogenous toxins, or viral infections) is discussed.

[Epstein-Barr virus cerebellitis in an 11-year-old girl]. / Cérébellite à virus Epstein Barr chez une fillette de 11 ans.

The authors report an eleven year old girl who manifested predominantly an acute cerebellar syndrome secondary to infection by Epstein Barr Virus. This complication is unusual and males are predominantly affected. The diagnostic and common physiopathological hypothesis are discussed.

Chemical disinfection of human rotaviruses: efficacy of commercially-available products in suspension tests.

Suspension tests were conducted on 69 commercial and 7 non-commercial disinfectant formulations to determine which classes of chemicals were most active against human rotavirus (HRV). Virus samples, in the presence of varying levels of organic matter, were exposed to the disinfectants for 1 min. The levels of remaining infectious virus were determined by plaque assay. Products were rated by their ability to reduce the levels of infectious virus by more than 3 log10 in the presence or absence of tryptose phosphate broth (peptides and inorganic salts) or fecal matter. Of the commercially-available products tested, only 25% were rated as highly and 7% as moderately effective. The remaining 68% were either effective only in the absence of any additional organic matter (48%) or were completely ineffective (20%). The majority (64%) of the moderately and highly effective products were further examined for their ability to inactivate greater than 6 log10 of infectious HRV in the presence of fecal matter or tryptose phosphate broth. With one exception, all these products were still effective. Products potentially suitable as topical antiseptics, hard surface disinfectants and instrument soaks were identified. The results emphasize the care that should be exercised in the selection of disinfectants for the control and prevention of rotaviral infections.

[Bromocriptine treatment of prolactinomas and primary hyperprolactinemia (author's transl)]. / Traitement par la bromocriptine des prolactionomes et des hyperprolactinémies primaires.

The therapeutic efficacy of bromocriptine was evaluated in 48 patients; 27 with macroadenomas (16 cases before and 10 cases after surgery, and 1 isolated case); 16 with suspected microadenomas; 5 cases with primary hyperprolactinaemia and a normal sella turcica, for which the product had been prescribed alone for 1 to 4 years. Pretreatment with bromocriptine may provide for postoperative recovery this never occurring after surgery alone, whether or not it is followed by radiotherapy. Though the therapeutic effect is usually constant in other cases, recovery is rarely obtained even after prolonged treatment; it was observed in only 2 of the 21 cases treated.