Cancer risk from diagnostic radiology in a deliberate self-harm patient.

OBJECTIVE: Patients who engage in recurrent deliberate self-harm (DSH) behaviours have increased morbidity and mortality and use emergency services more than others. Unrecognized iatrogenic injury may play a role. Specifically, we call attention to the potential danger of cumulative radiation exposure. METHOD: Case presentation and discussion. RESULTS: A 29-year-old woman with multiple episodes of deliberate foreign body ingestion received over 400 diagnostic radiology examinations during a 12 year period. The patient's calculated total radiation dose reached an average of 20.5 mSv per year, a dose comparable to atomic bomb survivors and nuclear industry workers, populations in which there is a significant excess cancer risk. CONCLUSION: Patients with recurrent self-injurious behaviours, frequent users of healthcare services who often undergo repeated medical assessment and treatment, are likely at higher risk for iatrogenic adverse events. Multiple diagnostic radiology examinations have recently come under scrutiny for causing increased lifetime risk of cancer. Healthcare providers, in particular psychiatrists and emergency department physicians, should consider the cumulative risks of radiological procedures when assessing and treating patients with DSH.

Recent trends in mesothelioma incidence in the United States.

Mesothelioma incidence rates based on data from population-based cancer registries in New York State (exclusive of New York City), Los Angeles County, California, and the SEER Program of the National Cancer Institute were analyzed for trends, using original cancer registry diagnoses. Results indicate a significant increase in incidence during 1973-80 for pleural mesothelioma among white males older than 55 at time of diagnosis but not for other age-race-sex-site subgroups. A histopathologic review of New York State and Los Angeles County cases by two independent pathologists, expert in the diagnosis of mesothelioma, lowered the overall estimates but a significant upward trend remained. The observed trend does not appear to be related to changes in diagnostic practice. The results of a five-member panel of expert pathologists will be published in a separate methodology paper.

Intravascular spill of hyperosmolar urea during induced midtrimester abortion.

Intravascular spill of hypertonic sodium chloride and the resultant serious and occasionally fatal consquences have been reported in association with induced midtrimester abortion. This report details 3 cases of intravascular spill of hyperosmolar urea. Although urea may pose less concern, because of its ability to readily cross cell membranes and its action as an osmotic diuretic, inadvertent intravascular spill can produce symptoms that include nausea, headache, sensations of warmth, and intense uterine cramping. In addition, abnormal blood pigments may occasionally be noted in the urine. Treatment includes intravenous hydration, careful monitoring of fluid/electrolyte balance and renal function, and avoiding the use of oxytocic agents.

PIP: 3 cases of intravascular spill of hyperosmolar urea during induced midtrimester abortion are reported. In each case 80 gm of urea had been infused. Although urea may pose less concern than hypertonic sodium chloride because of its ability to readily cross cell membranes and its action as an osmotic diuretic, inadvertent intravascular spill can produce symptoms that include nausea, headache, sensations of warmth, and intense uterine cramping. Also, abnormal blood pigments may occasionally be noted in the urine. The 3 patients were 23, 20, and 24 years old, all para 0. The symptoms generally subsided after 30 minutes, and serum and urinary abnormalities returned to normal within 24 hours. Treatment included iv hydration, careful monitoring of fluid/electrolyte balance and renal function, and avoiding the use of oxytocic agents for at least 24 hours. The 3 patients eventually underwent successful abortions, 1 with intraamniotic prostaglandin F2 alpha (PGF2a), and 1 with urea-PGF2a abortion, without further complications.