Intra-arterial urokinase for acute ischemic stroke: factors associated with complications.

The authors abstracted the records of 43 patients treated with intra-arterial urokinase for acute ischemic stroke to identify predictors of serious complications. Sixteen (37%) had such a complication. Higher urokinase dose (>1.5 x 10(6) U), higher mean arterial blood pressure before treatment (>130 mm Hg), basilar occlusive strokes, and severe strokes were most predictive of these complications. Although urokinase is no longer manufactured, these findings identify patients at risk for complications from other intra-arterial thrombolytics.

Longitudinal changes in bronchial responsiveness associated with swine confinement dust exposure.

STUDY OBJECTIVES: Acute exposure to the air in swine confinement units causes bronchial hyperresponsiveness and inflammation of the airways. This study was performed to assess the longitudinal development of bronchial responsiveness in pig farmers and to establish exposure-response relationships. METHODS: A cohort of 171 pig farmers was followed over a 3-year period. Bronchial responsiveness was assessed by a histamine provocation test. Long-term average exposure to inhalable dust and endotoxin was determined by personal monitoring in summer and winter, using data on farm characteristics and activities. Time-weighted average (TWA) personal exposure to ammonia was measured. Data on farm characteristics were gathered in the same period. RESULTS: Mean increase in responsiveness was 2.52 doubling concentrations of histamine for a 10% decrease in FEV(1) and 1.36 doubling concentrations for a 20% decrease in FEV(1). Long-term average exposure to dust was 2.63 mg/m(3) and to endotoxin was 105 ng/m(3). TWA exposure to ammonia was 1.60 mg/m(3). After adjusting for age and smoking behavior, long-term average exposure to inhalable dust was associated with increases in bronchial responsiveness expressed as steps for provocative concentration causing 10% fall in FEV(1). TWA exposure to ammonia, use of wood shavings as bedding, and automated dry feeding were associated with increases in responsiveness expressed as steps for provocative concentration causing a 20% fall in FEV(1). CONCLUSIONS: Exposure to dust and ammonia in pig farms contributes to chronic inflammation of the airways and should be reduced.

Organic dust toxic syndrome in swine confinement farming.

BACKGROUND: Pig farmers are exposed to organic dust with pro-inflammatory capacities. This makes it likely that they suffer from organic dust toxic syndrome (ODTS). No studies that included unexposed control populations are available so far. METHODS: The prevalence of ODTS was established by the use of questionnaires in a group of 239 pig farmers and 311 rural controls working in nonagricultural occupations. RESULTS: Pig farmers suffered more often from ODTS than controls (6.4% vs. 2.6%, P < 0.05). Organic dust toxic syndrome was associated with symptoms of atopy (prevalence odds ratio (POR) 3.1, 95% confidence interval (CI) 1.2-8.0) and with the use of wood-shavings as bedding (POR 4.3, 95% CI 1.2-15.6). An inverse association with the number of years worked as pig farmer was found (up to 5 years vs. more than 5 years; POR 5.0, 95% CI 0.8-32.9). CONCLUSIONS: The prevalence of ODTS was elevated among pig farmers when compared to nonfarming, rural controls.

Health-based selection for asthma, but not for chronic bronchitis, in pig farmers: an evidence-based hypothesis.

In cross-sectional surveys among pig farmers an elevated prevalence of chronic bronchitis is usually reported, but not of asthma, despite many factors promoting the manifestation of asthma. To investigate this apparent contradiction a postal questionnaire survey was performed among 239 pig farmers and 311 rural controls. Pig farmers reported an elevated prevalence of symptoms of chronic bronchitis (20.2 versus 7.7%, p<0.001), but not of asthma (5.9 versus 5.5% for chest tightness). Among pig farmers the use of disinfectants (prevalence odds ratio (POR) 9.4, 95% confidence interval (CI) 1.6-57.2 for quaternary ammonium compounds) and aspects of the disinfecting procedure were associated with the prevalence of asthma symptoms. Compared with controls, pig farmers reported fewer allergies to common allergens (4.6 versus 14.6%, p<0.001 for pollen) and fewer symptoms of atopy in childhood (9.9 versus 17.2, p<0.05 for one or more of four symptoms). Atopy in childhood was strongly associated with the prevalence of asthma symptoms (POR 4.1, 95% CI 2.2-7.7), but not with chronic bronchitis. Health-based selection of nonasthmatics for pig farming, which tends to mask a work-related hazard for asthma, is offered as an explanation for these results.

Endotoxin exposure as a major determinant of lung function decline in pig farmers.

Exposure-response relationships for endotoxin as measured in dust and longitudinal decline in lung function were studied. A cohort of 171 pig farmers was followed over a 3-yr period. Long-term average exposure to dust and endotoxin was determined by personal monitoring in summer and winter, using data on farm characteristics and activities. Mean decline in FEV1 was 73 ml/yr and in FVC 55 ml/ yr. Long-term average exposure to dust was 2.63 mg/m3 (geometric SD [GSD] 1.30), and to endotoxin, 105 ng/m3 (GSD 1.5). Annual decline in FEV1 was significantly associated with endotoxin exposure. An increase in exposure with a factor 2 was associated with an extra decline of FEV1 of 19 ml/yr.

Longitudinal changes in lung function associated with aspects of swine-confinement exposure.

Several aspects of swine-confinement farming appear to be leading to adverse respiratory effects. This study was set up in a longitudinal design to study the association between certain characteristics of farms or the way they are run and a decline in lung function. A cohort of 171 pig farmers was observed for 3 years. Lung function was measured. Exposure to farm characteristics was determined at the start of the observation period, using data from standardized farm surveys and from diaries kept by the participants. Mean decline in lung function was 73 mL/year for forced expiratory volume in 1 second (FEV1) and 55 mL/year for forced vital capacity (FVC). A longitudinal decline in FEV1 was significantly associated with the use of quaternary ammonium compounds as disinfectants (an additional 43 mL/year) and also with the use of an automated dry feeding system (an additional 28 mL/year). The association with the use of wood shavings as bedding material was not statistically significant. The impact of these characteristics in a longitudinal study provides stronger evidence for causal inference than that shown in previous cross-sectional designs. This may be useful in promoting preventive measures.

Bronchial hyperresponsiveness and exposure in pig farmers.

OBJECTIVE: To study the effect of exposure on bronchial responsiveness in pig farmers. METHOD: A group of 196 pig farmers were tested for lung function and bronchial responsiveness to histamine in the summer of 1992. To achieve sufficient contrast in respiratory morbidity and exposure, 96 of the farmers were selected because they had chronic respiratory symptoms and the remaining 100 because they were free from any respiratory symptoms. Personal exposure to dust, endotoxins and ammonia was measured during 1 working day in the summer of 1991 and 1 day in the winter of 1992. Data on farm characteristics were gathered in the same period. RESULTS: After adjusting for age and smoking behaviour, mild bronchial responsiveness, defined as PC10 < or = 16 mg/ml, was associated with the use of quaternary ammonium compounds as disinfectant [prevalence odds ratio (POR) 6.7, 95% confidence interval (CI) 1.4-32.8], use of wood-shavings as bedding (POR 13.3, CI 1.3-136.7), use of automated dry feeding (POR 2.8, CI 1.0-7.8), use of pellets as feeding material (POR 4.8, CI 1.1-21.1) and location of air exhaust via pit or roof in the confinement units (POR 2.7, CI 1.2-6.3). The association with the use of disinfectants other than quaternary ammonium compounds was not significant (POR 2.4, CI 0.7-8.4). No associations between bronchial responsiveness and measured exposure to dust, endotoxins or ammonia were discernible. CONCLUSION: Protective measures, designed to prevent airway disease in confinement farming, should be based on information about the operational and other characteristics of farms that are related to high exposure and health effects. Specifically, the use of quaternary ammonium compounds as disinfectant, the use of wood-shavings as bedding and the use of automated dry feeding should be discouraged.

Respiratory morbidity in relationship to farm characteristics in swine confinement work: possible preventive measures.

Swine confinement farming is associated with an increased risk of respiratory morbidity. Adverse health effects have been shown in association with levels of dust, endotoxins, and ammonia. This study was conducted to evaluate characteristics of confinement farms associated with respiratory morbidity in order to establish priorities for preventive measures. A questionnaire on symptoms and farm characteristics was completed by 1,432 male swine confinement farmers. Of these, 200 with and 200 without chronic respiratory symptoms were randomly selected for lung function testing. A significantly increased risk for chronic respiratory symptoms was shown if farmers used wood-shavings as bedding (prevalent odds ratio [POR]2.2), used disinfectants (POR 1.7), used natural ventilation (POR 2.6), had floor types other than slatted or half-slatted (POR 2.1), or used a mechanical feeding system (POR 1.4). Lung function (FEV1) was significantly lower with increasing numbers of years worked (51 ml/10 years), with smaller numbers of pigs (8.5 ml/100 pigs), and when the air outlet of the ventilation system was via the pit (248 ml). To decrease the risk of respiratory morbidity the following preventive measures are proposed: discouragement of the use of disinfectants and of wood-shavings as bedding, and promotion of the use of mechanical ventilation systems.

Disinfectant use as a risk factor for atopic sensitization and symptoms consistent with asthma: an epidemiological study.

Exposure to some nonallergenic compounds has been shown to increase the risk of atopic sensitization and asthmatic symptoms. In order to gain more insight into the largely unknown aetiology of respiratory symptoms in pig farmers, we studied the role of nonallergic exposure. We evaluated associations between chronic respiratory symptoms, specific and total serum immunoglobulin E (IgE) levels, use of disinfectants, and endotoxin exposure levels in a population of 194 Dutch pig farmers. Atopic sensitization (defined as increased production of IgE to common allergens) was found to occur more frequently in farmers who used disinfectants containing quaternary ammonium compounds (QACs) (odds ratio (OR) 7.4; 95% confidence interval (95% CI) 1.3-43.1). ORs for other disinfectants ranged 2.3-4.1 (NS). Atopic sensitization was not found to occur more frequently in farmers with a high endotoxin exposure. The use of disinfectants was only related to respiratory symptoms consistent with asthma in atopics. This is illustrated by the significantly elevated ORs for farmers with IgE to common allergens (house dust mite, grass pollen, birch pollen), and who used disinfectants containing QACs, in the total population and in a subgroup of the total population restricted according to bronchial hyperresponsiveness to histamine (symptomatics with a provocation dose of histamine producing a > or = 10% decrease in forced expiratory volume in one second (PC10) < or = 16 mg.mL-1, compared with asymptomatics with a PC10 > 16 mg.mL-1) (OR 4.4, 95% CI 1.3-14.6; and OR 8.2, 95% CI 1.6-42.6, respectively). Atopy and use of QACs and endotoxin exposure level taken individually were not associated with respiratory symptoms. A combination of atopic sensitization and high endotoxin exposure (> 101 ng.m-3) was strongly associated with respiratory symptoms in the restricted population (OR 6.1; 95% CI 1.0-36.2). Our results suggest that occupational exposure to nonallergenic agents (disinfectants) may induce immunoglobulin E sensitization to common aeroallergens, and that the combination of atopy and exposure to nonallergenic agents (disinfectants and endotoxin) is an important risk factor for development of symptoms consistent with asthma.

Farmers at risk for prostate cancer.

OBJECTIVE: To summarize the literature on the risk of prostate cancer among farmers and farm workers, to evaluate the magnitude of the risk and to determine the presence of risk factors peculiar to agricultural work. METHODS: Recent literature was searched and reviewed, selecting only case-control studies in which both positive and negative odds ratios were presented for several occupations, while only cohort studies and death-certificate studies were selected which presented risk estimates for several cancer sites, elevated as well as decreased. RESULTS: In most of the studies reviewed, a slight excess risk of prostate cancer incidence or mortality was observed among farmers. It is as yet unclear whether this excess risk is caused by particular occupational exposures or by risk factors in their personal lifestyle (e.g. dietary habits). Evidence was found for a relationship between the use of pesticides and of other agricultural chemicals and the risk of prostate cancer. CONCLUSION: Farmers probably have a slightly elevated risk of contracting prostate cancer. However, the actual risk factors are still a matter of conjecture.

Lung function and chronic respiratory symptoms of pig farmers: focus on exposure to endotoxins and ammonia and use of disinfectants.

OBJECTIVES: The prevalence of chronic respiratory symptoms among pig farmers is known to be high, but the aetiology of these symptoms is not yet unravelled. Long term average exposure to dust was evaluated, endotoxins and ammonia and use of disinfectants were compared with chronic respiratory symptoms and depressed base line lung function. METHODS: A cross sectional study was performed among 194 Dutch pig farmers, of whom 100 had not and 94 had chronic respiratory symptoms. Exposure-response relations were evaluated with multiple logistic and linear regression analysis. Estimates of long term average exposure were based on two personal exposure measurements, taken on one day in summer and one day in winter. Information on use of disinfectants and disinfection procedures was assessed by a walk through survey and interview by telephone. RESULTS: Exposure to dust, endotoxins, and ammonia were not related to chronic respiratory symptoms. Duration of the disinfection procedure and pressure used at disinfection were strongly and positively related to chronic respiratory symptoms. A significant inverse association between base line lung function and endotoxin exposure was found only among asymptomatic farmers. Ammonia exposure and duration of the disinfection procedure were significantly associated with base line lung function in the entire population. CONCLUSION: Results suggest that use of disinfectants is an important aetiological factor in chronic respiratory health effects of pig farmers. This factor has not been studied before. Results also suggest an aetiological role for exposure to endotoxins and ammonia in development of chronic respiratory health effects, but longitudinal studies with detailed exposure assessment strategies are required to assess their roles.

Chest roentgenographic abnormalities in IL-2 recipients. Incidence and correlation with clinical parameters.

The chest roentgenograms of 54 patients receiving high dose interleukin-2 with or without lymphokine-activated killer cell therapy for advanced cancer were retrospectively reviewed. Thirty-nine patients (72 percent) developed chest roentgenographic abnormalities consisting of pleural effusions, 28 (52 percent); diffuse infiltrates (pulmonary edema), 22 (41 percent); and focal infiltrates, 12 (22 percent). These abnormalities resolved in 30 of 39 (77 percent) patients by four weeks after therapy. Simple pleural effusions were the only residual roentgenographic abnormalities seen and were present primarily in patients receiving IL-2 by bolus intravenous injection (8 of 28) (29 percent) as compared to continuous intravenous infusion (1 of 24) (4 percent) (p = 0.03). Only roentgenographic evidence of pulmonary edema appeared to correlate with the degree of clinical pulmonary toxicity (p = 0.001). The development of chest roentgenographic abnormalities correlated with the administration of IL-2 solely by bolus intravenous injection (p = 0.04), a pretreatment FEV1 of less than 3 L (p = 0.04), and treatment associated bacteremia (p = 0.09), but not with prior therapy, the presence of pulmonary metastases or the degree of systemic capillary leak as measured by percentage of weight gain during therapy. Although the roentgenographic abnormalities did not relate to the number of LAK cells received, two patients developed sudden onset of dyspnea and chest roentgenographic evidence of pulmonary edema shortly after the first LAK cell administration, implying that a direct cause-and-effect relationship exists in some patients. Possible mechanisms for these IL-2 related chest roentgenographic abnormalities and pulmonary toxicity in general are discussed.

The nose and nasal vault.

In this article we have reviewed the anatomy of the nose and nasal vault, with emphasis on specific features that are imaged with the SSCT. Important areas of the lateral wall anatomy include the OMU and SER, areas that are key to understanding the obstructive patterns of inflammatory sinonasal disease. Lesions that result in these specific obstructive patterns include anatomic variants and other focal pathological lesions, such as polyps. Other types of sinonasal inflammatory disease include sinonasal polyposis and granulomatous and fungal disease. Congenital lesions of the nose may be understood through a knowledge of the relevant developmental anatomy. These lesions include nasal dermoids and epidermoids, cephaloceles, gliomas, and choanal atresia. Important benign masses include antrochoanal polyps, inverting papillomas, angiomatous polyps, JNAs, and osteomas. Benign nasal masses have characteristic features that distinguish them from malignant lesions. Malignant nasal tumors, such as SSCa, esthesioneuroblastoma, and others, are characterized by their more aggressive and destructive behavior.

Parathyroid adenoma associated with neurofibromatosis: correlative scintigraphic and magnetic resonance imaging.

Correlative imaging by dual-isotope thallium/technetium subtraction scintigraphy, computed tomography, and magnetic resonance imaging demonstrated a pathologically proven parathyroid adenoma in a 62-year-old man with known neurofibromatosis, who presented with hypercalcemia and an elevated parathormone level. The association between neurofibromatosis and primary hyperparathyroidism is discussed.