Determinants of organophosphorus pesticide urinary metabolite levels in pregnant women from the CHAMACOS cohort.

Organophosphosphorus pesticides (OPs) are widely used as insecticides in agriculture. Human exposure to OPs has been linked to adverse effects including poorer child neurodevelopment, reduced birth weight, altered serum hormone levels, and reduced semen quality. We measured six OP dialkyl phosphate (DAP) metabolites [three dimethyl alkylphosphates (DMs) and three diethyl alkylphosphates (DEs)] in urine samples collected two times during pregnancy (~13 and ~26 weeks gestation) from 594 women participating in the CHAMACOS birth cohort study and resided in an agricultural community in the United States (U.S.) between 1999 and 2000. Previous studies have shown these women have higher OP exposures compared with the general U.S. population. We examined bivariate associations between prenatal DAP metabolite levels and exposure determinants such as age, season, years living in the US, housing characteristics, fruit and vegetable consumption, occupation and residential proximity to agricultural fields. Final multivariable models indicated that season of urine collection was significantly associated (p < 0.01) with specific gravity-adjusted DM, DE and total DAP metabolites; samples collected in fall and winter had higher concentrations than those collected in spring-summer. Specific gravity-adjusted levels of DM and total DAP metabolites were significantly higher in women who had resided in the U.S. for 5 years or less (p < 0.05). Levels of DM metabolites also increased with daily fruit and vegetable servings (p < 0.01), and levels of DE metabolites were higher in residences with poorer housekeeping quality (p < 0.01) and in mothers that worked in agriculture (p < 0.05). These findings suggest that there are multiple determinants of OP exposure in pregnant women.

Ultrafine, fine, and black carbon particle concentrations in California child-care facilities.

Although many U.S. children spend time in child care, little information exists on exposures to airborne particulate matter (PM) in this environment, even though PM may be associated with asthma and other respiratory illness, which is a key concern for young children. To address this data gap, we measured ultrafine particles (UFP), PM2.5 , PM10 , and black carbon in 40 California child-care facilities and examined associations with potential determinants. We also tested a low-cost optical particle measuring device (Dylos monitor). Median (interquartile range) concentrations for indoor UFP, gravimetric PM2.5 , real-time PM2.5 , gravimetric PM10 , and black carbon over the course of a child-care day were 14 000 (11 000-29 000) particles/cm3 , 15 (9.6-21) µg/m3 , 15 (11-23) µg/m3 , 48 (33-73) µg/m3 , and 0.43 (0.25-0.65) ng/m3 , respectively. Indoor black carbon concentrations were inversely associated with air exchange rate (Spearman's rho = -.36) and positively associated with the sum of all Gaussian-adjusted traffic volume within a one-kilometer radius (Spearman's rho = .45) (P-values <.05). Finally, the Dylos may be a valid low-cost alternative to monitor PM levels indoors in future studies. Overall, results indicate the need for additional studies examining particle levels, potential health risks, and mitigation strategies in child-care facilities.

Formaldehyde and acetaldehyde exposure and risk characterization in California early childhood education environments.

Little information is available about air quality in early childhood education (ECE) facilities. We collected single-day air samples in 2010-2011 from 40 ECE facilities serving children ≤6 years old in California and applied new methods to evaluate cancer risk in young children. Formaldehyde and acetaldehyde were detected in 100% of samples. The median (max) indoor formaldehyde and acetaldehyde levels (µg/m3 ) were 17.8 (48.8) and 7.5 (23.3), respectively, and were comparable to other California schools and homes. Formaldehyde and acetaldehyde concentrations were inversely associated with air exchange rates (Pearson r = -0.54 and -0.63, respectively; P < 0.001). The buildings and furnishings were generally >5 years old, suggesting other indoor sources. Formaldehyde levels exceeded California 8-h and chronic Reference Exposure Levels (both 9 µg/m3 ) for non-cancer effects in 87.5% of facilities. Acetaldehyde levels exceeded the U.S. EPA Reference Concentration in 30% of facilities. If reflective of long-term averages, estimated exposures would exceed age-adjusted 'safe harbor levels' based on California's Proposition 65 guidelines (10-5 lifetime cancer risk). Additional research is needed to identify sources of formaldehyde and acetaldehyde and strategies to reduce indoor air levels. The impact of recent California and proposed U.S. EPA regulations to reduce formaldehyde levels in future construction should be assessed.

VOC exposures in California early childhood education environments.

Little information exists about exposures to volatile organic compounds (VOCs) in early childhood education (ECE) environments. We measured 38 VOCs in single-day air samples collected in 2010-2011 from 34 ECE facilities serving California children and evaluated potential health risks. We also examined unknown peaks in the GC/MS chromatographs for indoor samples and identified 119 of these compounds using mass spectral libraries. VOCs found in cleaning and personal care products had the highest indoor concentrations (d-limonene and decamethylcyclopentasiloxane [D5] medians: 33.1 and 51.4 µg/m³, respectively). If reflective of long-term averages, child exposures to benzene, chloroform, ethylbenzene, and naphthalene exceeded age-adjusted "safe harbor levels" based on California's Proposition 65 guidelines (10-5 lifetime cancer risk) in 71%, 38%, 56%, and 97% of facilities, respectively. For VOCs without health benchmarks, we used information from toxicological databases and quantitative structure-activity relationship models to assess potential health concerns and identified 12 VOCs that warrant additional evaluation, including a number of terpenes and fragrance compounds. While VOC levels in ECE facilities resemble those in school and home environments, mitigation strategies are warranted to reduce exposures. More research is needed to identify sources and health risks of many VOCs and to support outreach to improve air quality in ECE facilities.

Association of prenatal maternal or postnatal child environmental tobacco smoke exposure and neurodevelopmental and behavioral problems in children.

We review the potential neurodevelopmental and behavioral effects of children's prenatal and/or postnatal exposure to environmental tobacco smoke (ETS). Children's exposure to ETS has been assessed in epidemiologic studies as a risk factor for a variety of behavioral and neurodevelopmental problems including reduced general intellectual ability, skills in language and auditory tasks, and academic achievement, and behavioral problems such as hyperactivity and decreased attention spans. We review 17 epidemiologic studies that have attempted to separate the effects of maternal active smoking during pregnancy from passive ETS smoke exposure by the pregnant mother or the child. Based on the available data, we found that ETS exposure could cause subtle changes in children's neurodevelopment and behavior. However, studies to date are difficult to interpret because of the unknown influence of uncontrolled confounding factors, imprecision in measurements of smoking exposure, and collinearity of pre- and postnatal maternal smoking. Although some evidence suggests that maternal smoking during pregnancy may be associated with deficits in intellectual ability and behavioral problems in children, the impact of prenatal or postnatal ETS exposure remains less clear.

[Laparoscopic surgery of perforated duodenal ulcer]. / Trattamento laparoscopico dell'ulcera duodenale perforata.

BACKGROUND AND AIM: Endoscopic diagnostic and therapeutic possibilities have been increased by videolaparoscopy. The method enables an immediate reliable diagnosis to be made, associated with possible surgical treatment. METHODS: The authors report their laparoscopic experience relating to the treatment of perforated duodenal ulcer from 1972 to 1995 in 8 patients divided into two groups. Jacob Palmer's laparoscopic operator was used in the first group together with Menghini's needle for the aspiration of peritoneal effusion; the operation was performed under local anesthesia with nitrogen monoxide insufflation using Taylor's technique number I. The second group underwent ulcorrhaphy with omentopexy, again using a laparoscopic route, together with abundant lavage and accurate aspiration of fibrin. RESULTS: The patients in the first group made a prompt recovery in terms of their general conditions following the remission of fever, pain, diminished leukocytes and an early renewal of canalisation; cicatrisation of the ulcer was confirmed by the endoscopic control on day 15. Patients in the second group showed early deambulation approximately 4 hours after surgery; canalisation occurred after about 6 hours and all patients were discharged on day 3. The eradication of Helicobacter pylori led to complete resolution, as was confirmed by subsequent follow-ups. CONCLUSIONS: Laparoscopy was found to be extremely useful both in the immediate diagnosis of acute abdomen following perforated ulcer and in its surgical treatment as a result of the introduction of operating laparoscopes and in particular videolaparoscopes, together with surgical instruments that allow careful abdominal cleansing and ulcorrhaphy. In the authors' opinion, the latter procedure is the most suitable for managing this pathology.

[Cholecystic-choledochal calculi. Endolaparoscopic treatment]. / Calcolosi colecisto-coledocica. Trattamento endolaparoscopico.

BACKGROUND AND AIM: Common bile duct calculosis is a pathology which has always been treated using traditional laparotomic surgery. The introduction of endoscopic papillosphincterotomy and mini-invasive and videolaparoscopic methods has drawn attention to the fact that these methods may be able to replace conventional surgery. METHODS: The authors examine the epidemiological and clinical aspects of common bile duct calculosis, reporting their experience in ten female patients treated during the period from 1992 to 1997, all of whom presented jaundice, pain and fever. Of these, eight underwent papillosphincterotomy using an endoscopic approach, followed by laparoscopic removal of common bile duct calculi within 24 hours. In two cases it was necessary to resort to conventional methods owing to difficulty in cannulating the papilla caused by a diverticulum in one patient and stenosis in the other, and the tenacious synechiae between the common bile duct and the gallbladder. RESULTS: The postoperative period was free of complications. CONCLUSIONS: The associated treatment, namely endoscopic papillosphincterotomy and endoscopic cholecystectomy proved a valid alternative to traditional laparotomic treatment, demonstrating a good level of reliability and safety for patients and reductions in terms of resources and hospitalisation time.

[Use of surgical staplers in emergency surgery]. / L'utilizzo delle suturatrici meccaniche in chirurgia d'urgenza.

BACKGROUND AND AIM: Over the past decade the use of surgical staplers has resulted in a substantial change in both elective and emergency surgery for gastrointestinal pathologies. A large number of studies have now affirmed the safety, reliability, simplicity, rapidity and usefulness of these instruments. They offer many advantages, above all the possibility of shortening operating times and thus reducing morbidity and mortality, especially in emergency surgery. METHODS: The authors describe their experience in treating 68 cases of emergency intestinal resection from 1980 to 1997 which were treated with the help of automatic staplers. Twenty-three cases of hemicolectomy (right and left) were performed; 17 sigmoid resections for diverticulitis; 15 gastric sections using Billroth II; 7 Meckel's diverticuli; 6 total gastrectomies. GEA 50 and 75 staplers were used for the intestine, TA 50, 90, 90 Plus and Roticulator, Circular staplers for esophagus, stomach and rectum. Patients were predominantly male: 40 males and 25 females with a ratio of 2:1. RESULTS: Complications included a fistula caused by dehiscence of the esophagojejunal anastomosis which lead to death in 30 days; 3 cases of hemorrhage of the gastroenteric anastomosis which regressed with medical therapy. CONCLUSIONS: In conclusion, mechanical staplers have led to considerable savings in time and a reduced number of postoperative complications.

[Update on the treatment of choledocholithiasis]. / Attualità nel trattamento della calcolosi coledocica.

Primitive or residual common bile duct calculi following common bile duct surgery can now be treated with minimum surgery using an endoscopic or X-ray guided approach. Having examined the etiopathogenetic theories, the authors analyse the treatment, in particular the possibility of endoscopic papillosphincterotomy and X-ray guided dilatation of the papilla, affirming that the latter can be extremely valuable in cases where it is difficult to canalize the latter.

[The hemorrhagic complication of peptic ulcer]. / Complicanza emorragica dell'ulcera peptica.

The hemorrhagic complication of peptic ulcer is a pathology which is still responsible for a high mortality. After reviewing the etiopathogenesis and physiopathology of hemorrhagic complications in the light of the recent discoveries regarding H. pylori, the authors report their experience and confirm the important role of surgery in the treatment of this pathology. Resolution is improved by the use of surgical staplers which are regarded as particularly valuable in emergency surgery where the need to cut operating times has undoubted advantages in terms of patient survival.

[An update in the treatment of intra-abdominal abscesses]. / Attualità nel trattamento degli ascessi intraddominali.

BACKGROUND AND AIMS: Intra-abdominal abscesses represent a relatively severe complication in gastroenterological surgery owing to their association with high levels of morbidity and mortality. METHODS: The authors report their experience between January 1990 and January 1996 in 11 patients with intra-abdominal abscesses secondary to emergency surgery for gastroenterology in 10 cases and gynecology in 1 case. After the lesion had been identified using ultrasonography and CT, it was emptied, washed with antibiotic and drained using Seldinger's ultrasonographic and CT-guided technique. Small abscesses (less than 5 mm) were completed removed. RESULTS: The following results were obtained: the immediate disappearance of pain and fever, accompanied by improved general conditions, restoration of canalisation and closure of the abscess cavity (on average between 10 and 15 days). CONCLUSIONS: In conclusion, ultrasonographic-CT guided drainage of postoperative intra-abdominal abscesses, which were previously managed using surgical methods, appears to be the best treatment, relying on the use of imaging techniques and thereby allowing both morbidity and mortality to be reduced.

[Splenic metastases]. / Le metastasi spleniche.

Splenic metastases are found with a frequency varying from 2.4 to 7.1%. The primary tumours most often followed by metastases are breast, lung, pancreas and melanoma. They may also be the direct extension of retroperitoneal tumours and carcinoma of the pancreas. The authors report a case which came to their attention; by examining the literature, they discover the rarity of this pathology which confirms the possibility of this localisation for both intra-abdominal and extra-abdominal tumours.

Exposures of children to organophosphate pesticides and their potential adverse health effects.

Recent studies show that young children can be exposed to pesticides during normal oral exploration of their environment and their level of dermal contact with floors and other surfaces. Children living in agricultural areas may be exposed to higher pesticide levels than other children because of pesticides tracked into their homes by household members, by pesticide drift, by breast milk from their farmworker mother, or by playing in nearby fields. Nevertheless, few studies have assessed the extent of children's pesticide exposure, and no studies have examined whether there are adverse health effects of chronic exposure. There is substantial toxicologic evidence that repeated low-level exposure to organophosphate (OP) pesticides may affect neurodevelopment and growth in developing animals. For example, animal studies have reported neurobehavorial effects such as impairment on maze performance, locomotion, and balance in neonates exposed (italic)in utero(/italic) and during early postnatal life. Possible mechanisms for these effects include inhibition of brain acetylcholinesterase, downregulation of muscarinic receptors, decreased brain DNA synthesis, and reduced brain weight in offspring. Research findings also suggest that it is biologically plausible that OP exposure may be related to respiratory disease in children through dysregulation of the autonomic nervous system. The University of California Berkeley Center for Children's Environmental Health Research is working to build a community-university partnership to study the environmental health of rural children. This Center for the Health Assessment of Mothers and Children of Salinas, or CHAMACOS in Monterey County, California, will assess (italic)in utero(/italic) and postnatal OP pesticide exposure and the relationship of exposure to neurodevelopment, growth, and symptoms of respiratory illness in children. The ultimate goal of the center is to translate research findings into a reduction of children's exposure to pesticides and other environmental agents, and thereby reduce the incidence of environmentally related disease.

[An update in the diagnosis and treatment of tumors of the hepatic portal]. / Attualità nella diagnosi e nel trattamento dei tumori della placca ilare.

BACKGROUND: Cholangiocarcinoma affecting the cross of the bile ducts is a tumour which has, although treatments, a high rate of mortality. METHODS: Between January 1986 and January 1996 six patients affected by Klatskin's tumor were studied; three of them underwent operation and were treated with insertion of a T tube (Kerr), whereas the other three were managed endoscopically with trans-tumoral stenting. RESULTS: The survival rate was about seven months for patients who underwent operation and fifteen months for patients managed with endoscopic stenting. CONCLUSIONS: After a review of the literature and according to personal experience, it is underlined that only an early diagnosis can achieve best results, since the latest knowledge about hepatic anatomy derived from transplants allows more extensive resections.

[Ogilvie's syndrome]. / La sindrome di Ogilvie.

"Ogilvie's syndrome" or the idiopathic dilatation of the colon is an infrequent pathology whose underlying physiopathology is not yet well known. On the basis of their experience and having reviewed the literature, the authors affirm that this syndrome is caused by the inhibition of gastrointestinal hormones which, under the control of the neurohypophysis, contribute to colon motility. This supposition is backed up by the fact that medical treatment with somatostatin or octreotide leads to the resolution of the disorder.