Pre-eclampsia and acute pulmonary embolism-the importance of making a differential diagnosis: a case report.

We describe the case of a 41-year-old pregnant patient who presented at 38 weeks of gestation for an urgent cesarean section, with new onset of pre-eclampsia as the initial diagnosis. The intraoperative course was complicated by seizures and hemodynamic collapse. Initially, the presentation of seizure pointed to pre-eclampsia/eclampsia; however, with careful consideration of each event as it occurred, the correct diagnosis was later determined to be pulmonary embolism and stroke. This case illustrates the importance of considering multiple possible etiologies, even when a particular diagnosis seems obvious.

The effectiveness of an indicator gel in the detection of exposed dentine.

OBJECTIVES: To investigate the effectiveness of an indicator gel in revealing exposed dentine. METHODS: Teeth prepared into dentine and then stained with the indicator gel were sectioned for histological examination. RESULTS: The indicator gel was found to stain dentine and thin layers of enamel. CONCLUSION: The gel is suggested to be an effective indicator as an aid to acid etching and in the preparation of teeth for resin-bonded restorations.

Back pain among workers in the United States: national estimates and workers at high risk.

Back pain accounts for about one fourth of workers' compensation claims in the United States. The Occupational Health Supplement to the 1988 National Health Interview Survey provided an opportunity to assess the scope of this problem. The 30,074 respondents who worked in the 12 months before the interview were defined as "workers", and those with back pain every day for a week or more during that period were defined as "cases." A weighting factor was applied to the answers to derive national estimates. In 1988, about 22.4 million back pain cases (prevalence 17.6%) were responsible for 149.1 million lost workdays; 65% of cases were attributable to occupational activities. For back pain attributed to activities at work, the risk was highest for construction laborers among males (prevalence 22.6%) and nursing aides among females (18.8%). Our analyses show that back pain is a major cause of morbidity and lost production for U.S. workers and identifies previously unrecognized high risk occupations, such as carpenters, automobile mechanics, maids, janitors, and hairdressers, for future research and prevention.

Prevalence and work-relatedness of self-reported carpal tunnel syndrome among U.S. workers: analysis of the Occupational Health Supplement data of 1988 National Health Interview Survey.

To estimate the prevalence and work-relatedness of self-reported carpal tunnel syndrome (CTS) among U.S. workers, data from the Occupational Health Supplement of 1988 National Health Interview Survey (NHIS) were analyzed. Among 127 million "recent" workers" who worked during the 12 months prior to the survey, 1.47% (95% CI: 1.30; 1.65), or 1.87 million self-reported CTS, and 0.53% (95% CI: 0.42; 0.65), or 675,000, stated that their prolonged hand discomfort was called CTS by a medical person. Occupations with the highest prevalence of self-reported CTS were mail service, health care, construction, and assembly and fabrication. Industries with the highest prevalence were food products, repair services, transportation, and construction. The risk factor most strongly associated with medically called CTS was exposure to repetitive bending/twisting of the hands/wrists at work (OR = 5.2), followed by race (OR = 4.2; whites higher than nonwhites), gender (OR = 2.2; females higher than males), use of vibrating hand tools (OR = 1.8), and age (OR = 1.03; risk increasing per year). This result is consistent with previous reports in that repeated bending/twisting of the hands and wrists during manual work is etiologically related to occupational carpal tunnel syndrome.

The prevalence of back pain, hand discomfort, and dermatitis in the US working population.

OBJECTIVES: The purpose of the study was to provide the health care and public health communities with national prevalence estimates of selected conditions in the US working population. METHODS: National prevalence estimates of self-reported conditions among working people were calculated from data collected for the 1988 Occupational Health Supplement to the National Health Interview Survey. RESULTS: The highest prevalence estimates were found among occupational groups. For example, the prevalence of back pain due to an injury at work among truck drivers was 6.7%; back pain due to repeated activities at work among mechanics and repairers of heavy equipment and machinery was 10.5%; hand discomfort among operators of machines that process metal, plastic, stone, and glass was 23.5%; and dermatitis due to contact with substances at work among physicians, dentists, nurses, pharmacists, and dietitians was 5.6%. CONCLUSIONS: A substantial proportion of these conditions among occupational groups with the highest prevalence estimates are occupational in origin. These prevalence estimates identify occupations in which efforts are needed to prevent these conditions.

The US prevalence of self-reported carpal tunnel syndrome: 1988 National Health Interview Survey data.

To estimate the prevalence of carpal tunnel syndrome among US adults, data from the Occupational Health Supplement of the 1988 National Health Interview Survey were analyzed. Based on a sample of 44,233 households (response rate, 91.5%), an estimated 1.55% (2.65 million) of 170 million adults self-reported carpal tunnel syndrome in 1988. Females and Whites had a higher prevalence of self-reporting carpal tunnel syndrome than males and non-Whites, respectively. Among 127 million adults who worked during the 12 months before the survey, 0.53% (0.68 million) reported that their "prolonged" hand discomfort was called carpal tunnel syndrome by a health care provider.

Prevalence of chronic diseases and impairments among US farmers, 1986-1990.

Farmers in the United States suffer disproportionately from certain chronic diseases and impairments. This analysis estimated the prevalence of selected diseases among farmers and compared these rates with those for other US workers. Five years (1986-1990) of National Health Interview Survey data on white male workers were combined to provide a basis for estimating the prevalence of selected conditions and impairments among this subgroup. Crude prevalence rates were significantly elevated for farmers compared with other workers for cardiovascular diseases, arthritis, skin cancer, hearing loss, and amputations. These elevations persisted when farmers were compared with blue-collar workers. The crude prevalence of orthopedic impairments and chronic respiratory diseases was not elevated among farmers, but the age-adjusted prevalence ratios for cardiovascular diseases, arthritis, and amputations were significantly elevated for farmers as compared with other workers. The prevalence of hearing loss was significantly higher only for farmers older than 65 years. This method of pooling data holds promise for studying disease rates in other small segments of the US population.

Worker awareness of exposure: industries and occupations with low awareness.

A goal of occupational health is to inform workers of hazards on their jobs. This analysis addresses this goal by identifying industries and occupations with low worker awareness of potential exposures. Industries and occupations were ranked by the greatest positive difference between the proportion of workers exposed and proportion perceiving exposure to chemical and physical hazards. Those with low awareness had the greatest difference, i.e., high exposure and low perception. This analysis was performed by adding exposure data from a national exposure survey to a national health survey with perceived exposure data. The hospital and construction industries and occupations in these industries ranked among the top five for all hazards. For example, for hospital workers the difference between proportion exposed and proportion perceiving exposure to chemicals was 62% and to radiation was 42%, and for workers in construction the difference was 54% for exposure to noise and 63% for exposure to vibration.

[Instrumentation of root canal walls with Nd-YAG laser]. / Die Bearbeitung der Wurzelkanalwände mit dem Nd-YAG Laser.

An in vitro study showed that it is possible to alter the surface morphology of root canals with a Nd-YAG Laser. S.E.M. and dye penetration photographs showed these changes in the canal surface morphology. In our opinion when an energy level of 15 IPS/1,5 W is used, the resulting changes are useful and of benefit in root canal treatment.

[Effectivity of ultrasonics by the root canal instrumentation]. / Die Effektivität von Ultraschall bei der Wurzelaufbereitung.

The investigative results showed that preparation of root canals is more effective with ultrasonic as compared to hand instrumentation. Areas like diverticula, canal enlargements or side canals were seen to be extremely clean. This is probably due to the effect of cavitation, implosion of small bubbles, the acceleration of minute particles and the formation of ultra sonic waves. The REM investigation showed no residual bacteria. The hand instrumented canals showed pulp remainders in the canal.

[Ultrasonic root planing. An alternative method versus hand instruments? An in vitro comparison and SEM study]. / Ultraschall-Wurzelglättung. Eine alternative Methode gegenüber Handinstrumenten? Ein in vitro-Vergleich und REM-Untersuchung.

This study showed no difference between the use of the "Piezon Master 400", using four different attachments as compared to the "Hu Friedy" Curettes as far the formation of grooves and scratch marks is concerned. Both root planing methods gave rise to a scalloped surface of the root cement. The ultrasonic root planing however showed a more discrete scalloped surface with very small tears and having a hammered appearance. Hand instrumentation showed much wider tears on the root surface structure.

Effect of the air hammer on the hands of stonecutters. The limestone quarries of Bedford, Indiana, revisited.

In the limestone quarries of Indiana, USA, pneumatic percussive hammers replaced the mallet and hammer around 1900. By 1917 the air hammer was being used exclusively for periods of eight to ten hours a shift. In 1918 Alice Hamilton investigated an unusual "disease" in these stonecutters of Bedford, Indiana, who complained of "attacks of numbness and blanching of the fingers coming on suddenly under the influence of cold and then disappearing." The prevalence of vibration induced white finger (VWF) found in this population of 38 stonecutters was 89%, with decreased light touch, pain, and temperature appreciation in advanced cases. In 1978 a VWF research team revisited these limestone quarries. During the 60 year interval the stonecutting industry had contracted from 4000 workers in 40 quarries in 1918 to 3-400 in 10 quarries in 1978, with only 50 employees remaining in the Bedford area. In a population of 30 stonecutters the prevalence of VWF in 1978 was 80%, with similar sensory loss in light touch, pain, and temperature appreciation. Between 1918 and 1978 no change had taken place in the design of the air hammers used for stonecutting. Vibration levels of 4859 metres/s2 on the chisel, and 2010 metres/s2 on the barrel were measured over a frequency range 6.3 to 1000 Hz. The fundamental frequency was 75 Hz. These measured vibration levels are outside the ISO/DIS/5349 (1979) recommended limits for human exposure to vibration transmitted to the hand. The VWF data presented in this paper, and those originally reported by Hamilton in 1918, call for an immediate redesign of stonecutting pneumatic hammers in order to remove one cause of Raynaud's phenomenon of occupational origin.

A peripheral vascular insufficiency test using photocell plethysmography.

A preliminary laboratory study seeking an objective test for vascular insufficiency of the fingertips (Raynaud's syndrome) is described. In a limited number of subjects, circulatory changes in the vascular bed of one hand were examined by photocell plethysmography while the opposite had was immersed in ice water. The time to complete recovery after cessation of the cold stimulus was significantly longer with primary Raynaud's patients than with the control subjects (p = 0.0045). The analysis of another parameter, the relative change in pulse amplitude during cold immersion, was confounded by age and sex differences between the Raynaud's and the control group. A follow-up investigation of the application of this technique to a population of vibration-exposed chipper and grinder and control workers is in progress.