The impact of early-diagnosed new-onset post-transplantation diabetes mellitus on survival and major cardiac events.

The impact of early-diagnosed new-onset post-transplantation diabetes mellitus (PTDM) on cardiovascular (CV) disease is not well described. The objectives of the present prospective single-center observational study were to assess the long-term effects of early-diagnosed new-onset PTDM on major cardiac events (MCE; cardiac death or nonfatal acute myocardial infarction) and patient survival. Diabetic status and CV risk factors were assessed in 201 consecutive renal allograft recipients 3 months after transplantation (baseline) during a period of 16 months (1995-96). Follow-up data until January 1, 2004 were obtained from the Norwegian Renal Registry. The 8-year (range 7-9 years) cumulative incidence of MCEs was 7% (nine out of 138) in recipients without diabetes, 20% (seven out of 35) in patients with new-onset PTDM and 21% (six out of 28) in patients with diabetes mellitus before transplantation (DM). Proportional hazards regression analyses (forward stepwise regression) revealed that patients with PTDM had an approximately three-fold increased risk of MCEs as compared with nondiabetic patients (hazard ratio (HR)=3.27, 95% confidence interval (CI)=1.22-8.80, P=0.019). A total of 61 patients (30%) died. Eight-year patient survival was 80% in the nondiabetic group, 63% in the PTDM group and 29% in the DM group, respectively. Pretransplant diabetes (HR=5.09, 95% CI=2.60-9.96, P<0.001), age (HR=1.03, 95% CI=1.01-1.05, P=0.016), cytomegalovirus (CMV) infection (HR=2.66, 95% CI=1.27-5.53, P=0.009), and creatinine clearance (HR=0.98, 95% CI=0.96-1.00, P=0.046), but not PTDM (HR=1.20, 95% CI=0.58-2.49, P=0.621), were independent predictors of death in the multiple Cox regression model. Early-diagnosed PTDM is a predictor of MCEs, but not of all-cause mortality, the first 8 years after renal transplantation.

Dental health in workers previously exposed to mercury vapour at a chloralkali plant.

OBJECTIVES: The dental health of 73 workers previously exposed to mercury vapour at a chloralkali plant was studied and compared with that of 51 non-exposed referents. METHODS: A record of oral, periodontal, gingival and mucosal conditions, including teeth, restorations, prostheses, and oral hygiene, was established during a 30 min examination. The participants' periodontal conditions were assessed according to the community periodontal index of treatment needs (CPITN). The results with the CPITN index were also compared with previously published data for another similar population. RESULTS: There was no significant difference between the exposed workers and the referents with respect to the number of remaining teeth, amount of amalgam restorations, crowns, bridges, or endodontically treated teeth. The oral hygiene among the exposed workers was significantly better than among the referents, but the periodontal health conditions did not significantly differ between the two groups, nor from those of another Norwegian population. DISCUSSION: The present results seem to contradict previous reports claiming tooth loss as a possible result of exposure to mercury vapour.

Mercury and selenium in workers previously exposed to mercury vapour at a chloralkali plant.

The concentrations of total mercury (B-Hg), inorganic mercury (B-IHg), and methyl mercury (B-MeHg) in whole blood, urinary mercury (U-Hg), and selenium in urine (U-Se) and whole blood (B-Se) were determined in 74 chloralkali workers previously exposed to Hg vapour, and compared with 51 age matched referents. Dental amalgam state, fish consumption, and exposure related indices were studied with regard to the determined elements. A significant relation between the surface of dental amalgam and U-Hg (Pearson's r = 0.63, p < 0.001) was found among the referents. Mean U-Se was significantly lower (p < 0.001) among the subjects previously exposed to Hg (34.1 nmol/mmol creatinine) compared with that for the referents (42.6 nmol/mmol creatinine). A significant negative relation between the cumulative Hg dose and U-Se was also found. The mechanisms and the clinical significance of these findings are not clear. No relation between current U-Hg and previous occupational exposure to Hg was found among subjects in whom exposure had ceased more than one year before the study.

Effect of placement of amalgam restorations on urinary mercury concentration.

Dental amalgam emits mercury, especially during setting. In addition, the preparation of the amalgam and its compaction into the cavity involve unbound metallic mercury or create a waste product with free metallic mercury. The present study was performed to explore whether emission of mercury in these situations would measurably influence the individual urinary mercury concentration of dental patients as a result of a single-session treatment with dental amalgam restorations. Informed consent was obtained from the patients of nine children about to be treated with amalgam restorations as part of their regular dental care. The children delivered a total of five morning urine samples before, during, and after the treatment period. No effect on the urine mercury concentration was found during the treatment period. Conclusively, one single session of amalgam treatment did not per se represent a mercury exposure of sufficient quantity to be detectable in a longitudinal, individual study.

Correlation between amalgam restorations and mercury concentrations in urine.

The creatinine-adjusted urinary concentration of mercury in 73 schoolchildren with a mean age of 12 years was determined. In addition, the number of amalgam restorations and their size, prevalence of allergy, and days absent from school due to illness were recorded for each individual. A significant positive correlation (r = 0.55) was found between urine Hg and extent of amalgam restorations, but no correlation existed between urine Hg and allergy or between urine Hg and absence from school due to illness. Neither could any correlation be found between extent of amalgam restorations and either allergy or absence from school.