Effect of magnitude and timing of maternal pregnancy blood lead (Pb) levels on birth outcomes.

OBJECTIVE: Associations between magnitude and timing of maternal pregnancy blood lead (Pb) levels (BLLs), birth weight, and total days of gestation were examined, as well as associations with related clinical diagnoses of low birth weight (LBW), preterm, and small-for-gestational-age (SGA) birth. STUDY DESIGN: Among a sample of 262 mother-infant pairs studied retrospectively, one-way analysis of variance and regression statistics were used to measure the relationship between level of maternal pregnancy BLLs and birth outcomes while controlling for key maternal and newborn factors. RESULTS: Women with maximum pregnancy BLLs (max-PBLLs) > or =10 microg/dl tended to give birth earlier and their babies were at substantially increased risk for preterm and SGA birth. By holding other explanatory factors constant, each unit increase in max-PBLL above 10 mug/dl was found to be associated with a decrease of -0.3 in total days of gestation. Compared to women with lower levels, women with max-PBLLs > or =10 microg/dl were at a threefold increased risk for preterm birth (adjusted OR=3.2, 95% CI 1.2-7.4) and more than a fourfold increased risk for having an SGA infant (adjusted OR=4.2, 1.3-13.9). Second trimester maximum BLLs > or =10 microg/dl were associated with a steep decrease in total days of gestation (a decrease of -1.0 days per each unit increase above 10 microg/dl). CONCLUSIONS: These data provide evidence of the adverse effects of maternal pregnancy BLLs, particularly when levels are > or =10 microg/dl. Prenatal Pb exposure at these levels was associated with significant decreases in total days of gestation and an increased risk of preterm and SGA birth.

Medical surveillance of the lead exposed worker. Current guidelines.

1. The "lead standards" established by OSHA for general industry in 1978 and the construction industry in 1993 require employers and clinicians to follow very specific guidelines for protecting lead exposed workers. Depending on the level of exposure, medical surveillance may be legally required. 2. Lead affects multiple body systems and can cause permanent damage. Low level exposures that in the past were thought safe are now considered hazardous as new information emerges about the toxicity of lead. 3. Lead poisoning, if undetected, often results in misdiagnosis and costly care. Adults are exposed to lead in many different workplace settings. All clinicians caring for lead exposed workers need to be informed about the health effects of lead, employer and physician responsibilities, and worker rights. 4. Occupational and environmental health nurses can help identify workers at risk and prevent lead poisoning by education and early intervention through collaboration with the workers, the employer, the company physician, and other health and safety professionals.

[Secondary hyperparathyroidism as a cause of delayed functioning of renal graft. Reports of two cases]. / Wtórna nadczynnosc przytarczyc jako przyczyna opóznionego podjecia czynnosci przez przeszczepiona nerke.

Parathormone (PTH) exerts vasomodulatory effect. In patients with severe hyperparathyroidism (HPTx) post transplant (Tx) PTH level decreases slowly and this could be a reason of delayed graft function. Case 1: 19 years old female; 2 years of CAPD-renal Tx lost after 8 years--6 years on hemodialysis (HD), clinical symptoms of severe HPTx (iPTH > 1300 pg/ml). Elective parathyroidectomy was cancelled as patient received the second graft. Then she was oliguric and required regular HD from the 4th day after Tx. We observed increasing resistance index (RI) and finally no diastolic blood flow in graft USG-Doppler scan. Ten days after Tx, the patient was revised surgically and renal biopsy was performed. No pathology but slight ATN was found. At the same time iPTH level was 1225 pg/ml. Plasmapheresis (PF) was introduced, decreasing iPTH level to 850 pg/ml, 995 pg/ml, and 345 pg/ml respectively. After the second PF urine output increased (to 600 ml). Serum creatinine level decreased from 7.3 to 1.3 mg/dL within the next 10 days. Actually (5 months post Tx) graft function remains stable (creatinine 1.2 mg/dl). The level of iPTH at the second month after Tx was 756 pg/ml, at 4th month--439 pg/ml. Case 2: M.P. 20 years old female initially on HD, then Tx, lost after 5 months because of FSGS recurrence--again HD therapy. She developed severe secondary HPTx (iPTH level > 1300 pg/ml). Planned parathyroidectomy was cancelled as she received a second transplant. After Tx she was anuric for 5 weeks and was treated with HD. She had high RI index in repeated USG-Doppler scans, blood flow in renal cortex was deceleration. Repeated renal biopsy showed no pathology and PF therapy was introduced. After the first PF the patient started to urinate, after the 5th--the urine output was 1000 ml. Overall 10 PFs were done. Now, 13 months after Tx, graft function is satisfactory (creatinine level 2.1 mg/dL). The level of iPTH in 4th month after Tx was 772 pg/ml, in 10th month--631 pg/ml. We suggest that disturbances in graft blood flow were influenced by high level of iPTH, decreased successfuly by PF therapy.

[Risk factors of adynamic bone disease in children with end-stage renal failure: personal experience]. / Czynniki ryzyka adynamicznej choroby kosci u dzieci ze schylkowa niewydolnoscia nerek--doswiadczenia wlasne.

The aim of the study was to estimate predisposing factors which can cause adynamic bone disease (ABD) and biochemical markers, bone densitometry results, bone histomorphometry in 17 children with this from of the renal osteodystrophy. Half of these of patients were treated with alphacalcidol pulses. In 47% of patients hypercalcemic episodes were noted, 76% had PTH level < 50 pg/ml. Four patients with osteoporosis (low bone volume at histological analysis) were distinguished. Two of them were treated with corticosteroids, 1 was immobilized for a long time.

[Tubulointerstitial nephritis related to immunotherapy and immunostimulation: a report of two cases]. / Sródmiazszowe zapalenie nerek zwiazane ze stosowaniem immunoterapii i leków immunostymulujacych--opis 2 przypadków.

Two cases of tubulointerstitial nephritis (TIN) with renal failure related to immunotherapy (case 1) and immunostimulation (case 2) have been described. Case 1: 18 years old male patient with hay fever was admitted because of rapid increase of serum creatinine from 1.1 mg/dl to 5.5 mg/dl, fever, weight loss and anemia which developed during 6 months after second course of immunotherapy. Case 2: 12 years old boy was admitted because of fever, weight loss and rapid progression to renal failure after treatment of pharyngitis with antibiotics and immunostimulant drug. In both patients renal biopsy was performed and TIN with huge lymphocytes T infiltrates was diagnosed. After 6 months treatment with corticosteroids renal function turned back to previous levels in both patients. Pathogenesis and treatment of TIN is discussed.

Occupational exposure to perchloroethylene in the dry cleaning industry.

Field surveys were conducted of 67 dry cleaning establishments to assess working conditions and potential for exposure to perchloroethylene, a solvent of choice in this industry. Evaluation of ventilation controls showed that 28% of cleaning machines (transfer type) did not have functioning local exhaust systems, and an additional 32% had inadequately maintained systems providing less than the recommended face velocity at the door opening. Personal sampling was performed in 20 firms to relate operator exposure levels to the process used and degree of local exhaust ventilation. Utilization of the dry-to-dry (closed system) process resulted in a lower mean TWA exposure, 28.3 ppm, as compared to 86.6 ppm for transfer operations. Five-minute peak samples taken during clothing transfer demonstrated significant exposure levels ranging from 11.3 to 533.8 ppm. A lower mean peak exposure (25.3 ppm) was found for firms with local exhaust ventilation at the recommended rate than for facilities with poorly or unventilated cleaning machines (159.7 ppm). The study points out the manner in which available control measures can be used optimally to reduce employee exposure. Increased involvement of trade associations and local health authorities is also recommended to promote the safe use of perchloroethylene in the dry cleaning industry.

Respiratory health hazards and lung function in wildland firefighters.

The authors discuss the multitude of contaminants to which wildland firefighters are exposed, including carbon monoxide, sulfur dioxide, particulate and silica, polyaromatic hydrocarbons, aldehydes, and benzene. They examine the respiratory effects of these contaminants and then present their recommendations for an occupational health program for wildland firefighters.

Occupational exposures in California wildland fire fighting.

Industrial hygiene measurement of exposures to wildland fire fighters was conducted in northern California during three consecutive fire seasons (1986-1989) in conjunction with three separate health effects studies. Chemicals that were monitored included carbon monoxide, total and respirable particulates, polyaromatic hydrocarbons (PAHs), crystalline silica, aldehydes, and benzene. Measurements were taken at both wildland fires and prescribed (planned) burns. A variety of collection methods were employed--colorimetric detector tubes and a CO monitor were used for direct-reading area measurements; colorimetric diffusion tubes, filter cassettes, sorbent tubes, and passive vapor monitors were used for determining personal time-weighted average exposures. A new screening method (National Institute for Occupational Safety and Health Method 2539) was used to identify the presence of specific aldehydes. Results show that wildland fire fighters may at times be exposed to concentrations of carbon monoxide, total or respirable particulates, or silica at levels near or higher than recommended occupational exposure limits, although group means were generally well below the limits. Time-weighted average formaldehyde levels, measured in a few instances above 0.37 mg/m3 (0.3 ppm), indicate a potential for formaldehyde-induced eye or respiratory irritation under these conditions. Certain characteristics of the work such as high altitude, temperature, and breathing rate; extended work shifts; and additional off-shift exposures suggest that adjustment of 8-hr exposure limits may be necessary to provide adequate protection. In part, because of the rigors of performing industrial hygiene measurements under fire fighting conditions, data are limited and could not be considered representative of the full range of exposures fire fighters may encounter.(ABSTRACT TRUNCATED AT 250 WORDS)