Diagnosed skin diseases among migrant farmworkers in North Carolina: prevalence and risk factors.

Skin diseases are common among farmworkers, yet little research documents their prevalence and risk factors. This analysis documents the prevalence of skin diseases among farmworkers in North Carolina, examines variation in the prevalence across the agricultural season, and delineates factors associated with skin disease. Data are from a longitudinal surveillance study with assessments at approximately three-week intervals from May through October 2005. The sample included 304 farmworkers from 45 camps with 1048 data points. Data collection included a structured interview and a standard set often digital photographs. A board-certified dermatologist reviewed the photographs and made specific diagnoses in five categories: inflammatory disease, infection, pigmentary disorder, tumor, and trauma. The prevalences of the five skin disease categories and specific diagnoses are described with counts and frequencies for the entire season and for six time periods. The inflammatory disease and infectious disease categories are modeled with an extension of logistic regression that accounts for repeated measures and clustering of farmworkers within camps. Farmworkers experience high levels of inflammatory skin disease (57.2%) including acne, folliculitis, and contact dermatitis; infectious skin disease (73.8%) including tinea pedis, onychomycosis, and warts; pigmentary disorders (19.1%); and trauma (34.5%). The odds of inflammatory skin disease decreased with age, while those for infectious skin disease increased with age. The odds of inflammatory skin disease increased with pesticide exposure and decreasing housing quality. Skin diseases are highly prevalent among farmworkers. Research is needed to delineate specific factors causing high levels of infection and inflammation in this population.

Skin disease among Latino farmworkers in North Carolina.

An estimated 4.2 million seasonal and migrant farmworkers and their dependents live in the U.S. Most of these farmworkers are Latino. These workers are exposed to numerous occupational and environmental risk factors that can result in skin disease. Few data exist on the prevalence of skin disease in this population. The purpose of this study was to estimate the prevalence and predictors of skin disease in a sample of Latino farmworkers in North Carolina. A sample of 59 farmworkers was recruited and interviewed at two camps during the 2004 agricultural season. A dermatologist completed a skin exam of each worker and recorded any skin disease present. Forty-two (77.7%) of the 54 men, and all five of the women examined had a diagnosed skin disease. For the men, onychomycosis (nail fungus, 31.5%), tinea pedis (foot fungus, 27.8%), and acne (24.1 %) were the most commonly diagnosed skin diseases, with contact dermatitis diagnosed in 5.6% of the sample. Other diagnoses included scars, sunburn, and atopic dermatitis. Among the women, diagnoses included melasma (dark patches on the face, 2 cases), xerosis (excessively dry skin, 1 case), tinea pedis (2 cases), onychomycosis (1 case), acne (1 case), and insect bites (1 case). There were no statistically significant differences between workers in the two camps despite different growing seasons and different crops harvested. Skin disease is prevalent among the North Carolina Latino farmworkers who participated in this study, with fungal disease being the most prevalent.

[Usefulness of stress echocardiography for early diagnosis of anthracycline-induced cardiomyopathy]. / Durchführbarkeit der Stressechokardiographie zur Früherkennung der Anthracyclin-induzierten Kardiomyopathie.

BACKGROUND: Early evidence of drug induced cardiomyopathy is of great importance in oncological treatment, especially for application of Anthrazyklines. Stress echocar-diography (SE) has been proven to be of value in determining left ventricular function at rest and under stress. This study was performed to investigate the cardiac function under Anthrazykline-chemotherapy (aCT). PATIENTS AND METHODS: Patients with malignant thoracic tumors and indication for aCT underwent pharmacological SE (infusion of increasing dobutamin-doses, 5 microgram/kg/bw in 3 minute-steps) before starting aCT. Left ventricular ejection fraction (LVEF) and wall motion were measured. If the tumor decreased and the patients underwent 4 or more cycles of CT, at the end of the last CT another SE investigation was performed. RESULTS: 30 patients (20 men, 15 women; mean age 52, range 28 - 71) were included and the data were compared. Before aCT the mean LVEF was 59 % at rest and 71 % at maximum load, no disturbances of wall motion could be observed. After the end of aCT (mean dose 408 mg, range 256 - 549; mean 4.4 cycles, range 4 - 7) the LVEF was 58 at rest and 68 at maximum load (not significant) and there were also no disturbances of motion. CONCLUSION: SE is an alternative to echocardiography at rest in assessment of left ventricular function in patients receiving Anthrazykline-CT. With the doses applied no patient developed cardiomyopathy. So we consider SE a cost-effective method and safe for patients.

Reconciling animal and human data in a cancer risk assessment of acrylonitrile.

OBJECTIVES: Bioassays of rats exposed to acrylonitrile have consistently detected an elevated incidence of central nervous system (CNS) cancer. In contrast, epidemiologic studies have not found a statistically stable increase in CNS cancer mortality. The purpose of this paper is to examine whether or not CNS cancers predicted from the most appropriate inhalation bioassay in rats are consistent with CNS cancers observed in 3 recent, large epidemiologic studies. METHODS: A linearized multistage model was fit to dose-response data from a rat inhalation bioassay to estimate carcinogenic potency. This potency was applied to epidemiologic studies of acrylonitrile-exposed workers. After adjustment for less than complete lifetime follow-up in the epidemiologic studies, consistency was examined between CNS cancers predicted by the model fit to the animal data for the exposure levels and sample sizes of the epidemiologicy studies and the CNS cancers observed in the epidemiologic studies. RESULTS: The model predicted totals of 17.7, 3.6, and 7.6 CNS cancer deaths for the studies. These predictions were not far from the observed CNS cancer deaths (12, 6, and 6) and were well within their 95% confidence intervals of 6.9-22.3, 2.2-13.1, and 2.2-13.1, respectively. CONCLUSIONS: The CNS cancer potency estimated from the best available inhalation bioassay was consistent with the observed deaths in the epidemiologic studies as long as continuous lifetime exposure was chosen as the exposure metric. The lack of observed excess in CNS cancer among the studied workers may have been due to low exposures, insufficient follow-up times, or both.

Occupational bladder cancer mortality among racial and ethnic minorities in 21 states.

BACKGROUND: Occupational bladder cancer mortality among minority racial/ethnic groups is not well described compared to occupational bladder cancer mortality among non-minority males in the United States. METHODS: Race/ethnicity- and sex-specific bladder cancer mortality (1985-1992) of workers employed in 21 states was examined using a proportionate mortality study design. Mortality of specific racial/ethnic/occupational groups was compared separately with workers in the specific occupation and with members of the specific racial/ethnic group. RESULTS: This study identified elevated bladder cancer mortality among African American males and females and Latino males in several occupational groups with exposure to suspected bladder carcinogens as well as among Asian males in sales (PMR = 2. 13) and Asian females in the personal services industry (PMR = 5.25; CI: 1.64-16.75). CONCLUSIONS: Surveillance of occupational cancer risks among racial/ethnic minorities using regularly available death certificate data is facilitated when states code both usual occupation/industry and race/ethnicity.

The contribution of benzene to smoking-induced leukemia.

Cigarette smoking is associated with an increased risk of leukemia; benzene, an established leukemogen, is present in cigarette smoke. By combining epidemiologic data on the health effects of smoking with risk assessment techniques for low-dose extrapolation, we assessed the proportion of smoking-induced total leukemia and acute myeloid leukemia (AML) attributable to the benzene in cigarette smoke. We fit both linear and quadratic models to data from two benzene-exposed occupational cohorts to estimate the leukemogenic potency of benzene. Using multiple-decrement life tables, we calculated lifetime risks of total leukemia and AML deaths for never, light, and heavy smokers. We repeated these calculations, removing the effect of benzene in cigarettes based on the estimated potencies. From these life tables we determined smoking-attributable risks and benzene-attributable risks. The ratio of the latter to the former constitutes the proportion of smoking-induced cases attributable to benzene. Based on linear potency models, the benzene in cigarette smoke contributed from 8 to 48% of smoking-induced total leukemia deaths [95% upper confidence limit (UCL), 20-66%], and from 12 to 58% of smoking-induced AML deaths (95% UCL, 19-121%). The inclusion of a quadratic term yielded results that were comparable; however, potency models with only quadratic terms resulted in much lower attributable fractions--all < 1%. Thus, benzene is estimated to be responsible for approximately one-tenth to one-half of smoking-induced total leukemia mortality and up to three-fifths of smoking-related AML mortality. In contrast to theoretical arguments that linear models substantially overestimate low-dose risk, linear extrapolations from empirical data over a dose range of 10- to 100-fold resulted in plausible predictions.

[Intermittent positive pressure ventilation in post tuberculosis syndrome]. / Intermittierende Selbstbeatmung (ISB) beim Post-Tuberkulose-Syndrom.

Pulmonary tuberculosis sequelae with chronic respiratory failure is a clinical picture that is often mentioned, but seldom separately described, in connection with noninvasive ventilation in the case of acute or chronic respiratory failure. We report on the functional data and the ventilation of 26 patients. The patient group is characterized by great chronological latency between the start of pulmonary tuberculosis and the development of respiratory illness. Acute or chronic respiratory failure with this clinical entity should be treated in the form of noninvasive positive pressure ventilation.

[Course of pulmonary hemodynamics in intermittent ventilation]. / Verlauf der pulmonalen Hämodynamik unter intermittierender Selbstbeatmung (nISB).

Patients with chronic respiratory failure often show an elevated pulmonary vascular resistance. We examined in a prospective study with the follow-up of patients with intermittent non-invasive ventilation (nISB) and pulmonary hypertension using dobutamine stress echocardiography. The data show that ISB lowers the pressure in all patients, more in patients with restrictive diseases, due to thoracic deformities, than in patients with COPD.

[Intermittent self-ventilation in neuromuscular diseases. Comparison of lung function parameters in ventilated and non-ventilated patients]. / Intermittierende Selbstbeatmung bei neuromuskulären Erkrankungen. Vergleich der Lungenfunktionsparameter bei beatmeten und nichtbeatmeten Patienten.

BACKGROUND: Based on neuromuscular-disease patients in our case, we investigate the possibility of elaborating criteria by which to judge when home intermittent mechanical ventilation should be commenced and to access its consequences over an extended period. PATIENTS AND METHODS: Out of 24 patients with neuromuscular diseases (6 female, 18 male, mean age 32 years), 14 were treated with IPPV. They were suffering from hypercapnic respiratory failure with heavy sleep disruption and corresponding daily symptoms. RESULTS: The aim was to calculate significant examination parameters to facilitate indication for IPPV. The clinical situation of patients dependent on respiratory support improved under IPPV. We witnessed a "ventilation-saving effect" and--despite progression of the basic disease within the monitoring period--no deterioration of the blood-gas situation. CONCLUSIONS: It is possible to elaborate criteria for the indication of IPPV based on our group of neuromuscular-disease patients.

[Conservative or surgical treatment for foreign body injuries of the brain]. / Konservative oder operative Behandlung von Fremdkörperverletzungen des Gehirns.

Presenting our patients with cerebral foreign body injuries since 1954 we find that surgical management is not absolutely indispensable. Criteria for conservative management are presented with illustrative cases.

[Diagnosis and therapy of ventral sacral meningoceles]. / Zur Diagnostik und Therapie ventraler sakraler Meningozelen.

On the basis of the example of two observations symptomatology and therapy of the ventral sacral meningocele are discussed. Besides the clinical diagnosis, the combination of myelography and computer tomography show the greatest informative value. The therapy should be a surgical one with the aim of the extirpation or elimination of the cellular bag.

[A plastic substitute for the superior sagittal sinus in pigs]. / Plastischer Ersatz des Sinus sagittalis superior beim Schwein.

The substitute of the superior sagittal sinus by a new method namely a vessel prosthesis (Gore-Tex) and special connecting pieces in relationship with drug treatment is represented. The method is very simple and can also be carried out by microsurgically untrained operators. Moreover, this method allows a clear faster operation without using a bypass. The sinus was ligated, partially resected or incised and replaced by the described prosthesis in 15 pigs. 3 experiments were without any assertion at all. The sufficiency of the prosthesis was provable in 10 of the 12 remaining pigs. With that a high sufficiency quota was obtained in comparison with the literature. An open prosthesis for a longer time makes possible the formation of a collateral circulation. Furthermore, the prosthesis enables the microsurgical implantation of bigger pontine veins.

[Postoperative complications in space occupying processes of the base of the skull]. / Postoperative Komplikationen bei raumfordernden Prozessen der Schädelbasis.

Tumours of the skull base become manifest by the nervous structures surrounding them. After the removal of the tumour, the complications are produced by the same disturbed structures. Proceeding under microsurgical conditions will reduce both the risk of subsequent haemorrhages in patients with olfactory--groove meningiomas and central disturbances of the respiratory and circulatory--functions.

[Meningiomas of the spinal canal. Clinical aspects and long-term results]. / Meningiome des Spinalkanals. Klinik und Langzeitergebnisse.

Within a period of 27 years a total of 102 patients (93 women, 9 men) were operated on because of a spinal meningioma. With a mean duration of the disease of 25 months, about two thirds of the meningioma carriers were operated on in an advanced stage of the disease. In the period of follow-up examinations of at least three years an improvement occurred in 68.8 per cent of the patients. Of these 53.9 per cent were able to walk by themselves and 14.7 per cent needed help, 18.6 per cent became fit for work in their professions or trades. Fourteen patients (13.7%) were in a condition requiring special care. The total mortality rate related to three years post operationem was 17.6 per cent. The prognosis for the benign meningiomas in the spinal canal is clearly diminished by a retarded recognition.

[Acute intracerebral contralateral massive hemorrhage following removal of a brain tumor]. / Akute intrazerebrale kontralaterale Massenblutung nach Hirntumorentfernung.

This article is to draw the attention to a possible, though rare complication occurring after interventions to the brain, that is, a contralateral, intracerebral haemorrhage. The clinical and computer-tomographic supervision determines the subsequent therapy and also records the course.

[Substitution of the superior sagittal sinus by the Gore-Tex artificial prosthesis in experimental animals]. / Sinus sagittalis superior-Ersatz mittels Gore-Tex-Prothese im Tierversuch (2. Mitteilung).

The first animal experiments for substituting the superior sagittal sinus by Gore-Tex prosthesis were carried out. The sufficiency of the prosthesis was documented in two pigs after overcoming technical and anesthesiological problems.