Major burn injuries among restaurant workers in New York City: an underappreciated public health hazard.

Major burns among food service workers appears to be an underappreciated source of morbidity and public expense in New York City. A retrospective study was conducted to identify workers requiring hospital admission over the past 3 years. Seventy-six restaurant workers (3.8% of all adult admissions) were identified. They averaged 33 years of age, and sustained burns with a mean %TBSA of 12.5, resulting in a mean length of stay of 12.8 days. Scalds predominated, with water/coffee burns most common (n = 29), followed by oil (n = 27), and soup/sauce burns (n = 12). Burns to the extremities occurred in 97% of patients. Surgery was required in 32 of 76 patients (42.1%). Oil burns were more likely to require surgery than aqueous scalds (59 vs 34%; P < 0.01). Hospitalization expenses averaged $1.13 million dollars per year. There were no mortalities. Restaurant-related major burns are a frequent occurrence, particularly scald injuries. Hospital care and further disability result in enormous publicly funded expenses. The morbidity and lost wages are a severe detriment to workers and their families. Greater public health awareness measures are warranted.

Accurate localization and surgical management of active lower gastrointestinal hemorrhage with technetium-labeled erythrocyte scintigraphy.

OBJECTIVE: There is disagreement over the reliability of technetium Tc 99m (99mTc)-labeled erythrocyte scintigraphy in the localization of active lower gastrointestinal hemorrhage. A previous study at The New York Hospital-Cornell Medical Center that showed a superior sensitivity for localization of scintigraphy versus angiography in surgical patients led the authors to emphasize scintigraphy as the diagnostic test of first choice in the clinical diagnostic algorithm. The authors hypothesized that tagged erythrocyte scintigraphy can be used accurately as the primary diagnostic modality in localizing acute bleeding and guiding surgical intervention. METHODS: The authors conducted a 5-year, retrospective analysis of 224 inpatients who underwent scintigraphic imaging for diagnosis and localization of active lower gastrointestinal bleeding. Using scintigraphy as the primary diagnostic test, with colonoscopy, upper endoscopy, and angiography as adjunctive studies, 99mTc-labeled erythrocyte scans were performed at the clinician's discretion and were reviewed again for study purposes by two nuclear radiologists who were blinded to clinical outcome. Adjunctive diagnostic tests also were ordered for clinical indications. RESULTS: Using delayed periodic scintigraphic imaging, results of 115 scans (51.3%) demonstrated bleeding, with 96 scans (42.9%) localizing to a specific anatomic site. Patients with positive scans were five times more likely to require surgery (p < 0.005) than patients with negative scans, and surgical patients were twice as likely to localize by scintigraphy (p < 0.0001). Fifty patients (22.3%) required surgical intervention to control hemorrhage and had a bleeding site confirmed by both clinical and pathologic examinations. Forty-eight of those patients (96%) had a bleeding site determined preoperatively. For 37 patients with bleeding sites localized preoperatively by scintigraphy, 36 (97.3%) had correct localization based on surgical pathology. Only one patient required a subtotal colectomy solely because of nonlocalized bleeding. No patient bled postoperatively, and there was no mortality in either operated or nonoperated patients. The mean volume of transfused erythrocytes was similar in both scan-localized and nonlocalized surgical patients. CONCLUSION: When performed correctly and interpreted conservatively, scintigraphy is a useful and safe means of guiding segmental resection, and should be the primary tool used in the diagnosis of patients with active lower gastrointestinal bleeding.

Nitric oxide and cardiovascular dysfunction.

Prior to the mid-1980s, nitric oxide (NO) was viewed as an environmental pollutant but not as a compound of physiological significance. Thus, it was a skeptical audience that first heard the pronouncement at a scientific meeting in 1986, that NO was the identity of the elusive endothelium-derived relaxing factor, a mediator of vasorelaxation in response to numerous endogenous stimuli. Since then, the simple gas NO has gone from obscurity to center stage, being identified as a key player in physiologic processes as diverse as blood pressure maintenance, neural transmission, and immunologic defense. In addition to its physiological roles, NO has been implicated in the pathogenesis of a multitude of disease states, many of which are of primary interest to the cardiovascular surgeon: circulatory shock, atherosclerosis, diabetes mellitus, and ischemia-reperfusion injury. Recent years has seen NO biology emerge as an exciting and extremely fertile area of biomedical investigation. To fully understand the molecular basis of many clinical problems facing the cardiovascular surgeon, appreciation of NO's involvement is essential.

Stimulation cycles suppressed with gonadotropin-releasing hormone analog yield accelerated embryos.

A retrospective study was performed to assess embryonic development and morphology in 71 patients whose follicular stimulation was regulated after down regulation with a gonadotropin-releasing hormone analog, leuprolide acetate. The embryos were compared with those from 66 patients who did not receive agonists and who were treated during the same period. A separate group of thawed embryos cryopreserved after down regulation in 21 patients was compared with embryos frozen after conventional stimulation during the same period from 21 other patients. Eleven morphological criteria were assessed in the fresh embryos, and analyses did not reveal any differences between the groups studied. However, the rate of development of embryos obtained during down-regulated cycles was significantly higher than that of embryos developing in conventional stimulation cycles. Although no significant morphological differences could be shown between the groups of cryopreserved embryos, there was a decreased incidence of implantation of embryos from patients who were exposed to analogs. It is suggested that embryos from down-regulated cycles should be cryopreserved earlier to correct for their accelerated development.

Videocinematography of fresh and cryopreserved embryos: a retrospective analysis of embryonic morphology and implantation.

Eleven morphologic criteria were studied from videotapes of 323 fresh and 103 thawed embryos. The proportion of thawed embryos (30/39; 77%) with more than one abnormality was (P = 0.03) higher than that of fresh embryos (5/13; 38%), despite similar implantation rates (18% and 15%, respectively). The best predictor of thawed embryo implantation was cell-cell adherence: when scored "positive," 11 of 17 women (65%) became pregnant, whereas none became pregnant (0/15; P = 0.0002) when blastomeres did not adhere. The total number of abnormalities for thawed embryos was an important prognostic. An increased percentage variation of zona pellucida thickness was the most important prognostic for fresh embryos. When the "best" embryo had a zona pellucida that varied more than 25%, 24 of 60 (40%) resulted in pregnancy; pregnancies were not induced (0/21) when the "best" embryo had less than 10% variation (P = 0.0003).

Propranolol in the treatment of anxiety.

Since 1964, of 725 patients presenting with anxiety syndromes, 513 were treated with propranolol for periods of several days to over 10 years, some intermittently, others virtually without interruption. Of these, 237 had previously received or were receiving psychotropic drugs, mostly benzodiazepines and/or phenothiazines, which had proved ineffective or deleterious. Dosage was adjusted to achieve an optimum clinical response and a relatively high degree of beta-blockade, as judged by the virtual abolition of orthostatic and hyperventilatory tachycardia. As a rule, 80-320 mg daily sufficed, but increments up to 1200 mg were temporarily required to control bizarre or unusually intense symptoms. With few exceptions, the somatic and psychic symptoms were relieved or moderated and overall functional capacity was restored. Depression, evident in 50% of the patients, usually lifted, but persisted in one-third as a lone symptom responsive to antidepressants. Propranolol requirements usually diminished and lasting remissions were not infrequent. The effects of propranolol contrasted sharply with those experienced by the patients receiving tranquillizers. Single-blind placebo trials involving 76 cases endorsed the specificity of the response to beta-blockade. This long term study reveals that effective control of the somatic and psychic symptoms of anxiety can be achieved with propranolol in appropriate dosage.