Health risk assessment of dioxin emissions from municipal waste incinerators: the Neerlandquarter (Wilrijk, Belgium).

Two municipal waste incinerators in the vicinity of a residential area close to the city of Antwerp caused concern to local habitants. Risk assessment was performed combining chemical, toxicological measurements and model calculations. As the first step in risk assessment an inventory was made of historic emissions from both incinerators with emphasis on dioxins. The operational atmospheric transport and deposition model for priority substances (OPS) was used to calculate the deposition of dioxins in the vicinity of incinerators. The observed soil contamination pattern did not correspond to the calculated deposition pattern, indicating that other sources may contribute at least partly to the local PCDD/PCDF contamination of the area. Dioxin exposure of people in the Neerlandquarter as a function of the food consumption behavior was calculated using a mathematical model (VLIER-HUMAAN) combined with transfer factors. According to the results of these calculations, just residing in the impact area does not result in a meaningful risk. Only if locally produced food was consumed (milk, meat and vegetables), exposure in the Neerlandquarter was enhanced compared to the average dioxin exposure estimated for the Flemish population. Exposure in 1997 was below the exposure in 1980. As a consequence of different eating habits and lower bodyweight, children are subjected to significantly higher exposure than adults. Adverse health outcomes from dioxin exposure in the past cannot be excluded. There was no evidence for enhanced exposure to genotoxicants based on a comparison of chromosomal damage to blood cells of children from the study area to those from a control group.

Amenorrhea, galactorrhea, hyperprolactinemia syndrome and breast carcinoma in a young woman.

A young female patient with amenorrhea, galactorrhea and hyperprolactinemia developed a carcinoma of the breast a few years later. Examination of the amenorrhea--galactorrhea syndrome did not reveal any prolactinoma so that hyperprolactinemia remains unexplained. Treatment with bromoergocryptine 5 mg daily was successful. The carcinoma was treated in the classic way by amputation of the breast, axillary curettage and adjuvant chemotherapy. However, the association of amenorrhea, galactorrhea and breast carcinoma via hyperprolactinemia raises the question of whether there is any etiologic--pathogenetic relationship. Convincing evidence of such a relationship has not been found in the literature.

Laparoscopic sterilization with electrocautery, silastic bands and spring-loaded clips: report of our experience with 790 patients.

A comparative study was carried out in 790 women undergoing one of the 3 most frequently used laparoscopic sterlization techniques: high-frequency unipolar electrocoagulation of the tubes, application of silastic rings or spring-loaded clips to the tubes. The technical problems and per- and postoperative (early) complications are assessed. The use of high-frequency unipolar current has been superseded by today's mechanical and non-electrical sterilization methods. The spring-loaded clip method appears to be a sterilization technique with a minimum of severe complications, and theoretically the greatest chances for possible refertilization.

PIP: In a 7-year comparative study, 790 women were sterilized using either high-frequency unipolar electrocoagulation with tubal transection (133 women) and double coagulation technique without cutting (350 women), silastic rings (142 women), or spring-loaded clips (165 women). Complications using the electrocoagulation technique include electrical shock, intra-abdominal burns, bleeding due to inadequate electrocoagulation, and coagulation necrosis of the skin. Bleeding occurred in the placement of silastic rings due to blood vessel damage with the sharp prongs of the ring applicator. Excessive traction with the clip applicator may cause bleeding during clip application. The clips and silastic rings also may drop in the Douglas' cul-de-sac but may be removed from the abdomen. 2 tubal pregnancies and 1 intrauterine pregnancy occurred using the electrocoagulation technique, 1 intrauterine pregnancy with the silastic ring technique, and 1 intrauterine pregnancy with the clip technique. Spring-loaded clips have few disadvantages but a hydrosalpinx or edomatously thickened tube are contraindications. In addition, the clip technique may be a method of possible refertilization.

Laparoscopic tubal sterilization: postoperative follow-up and late gynecological complaints.

PIP: In a 7 year study, 322 women between 31-45 years old who submitted for laparoscopic tubal sterilization were questioned on specific gynecological complaints. 4 techniques including coagulation with tubal resection, double coagulation without resection, silastic rings, and spring-loaded clips were the surgical procedures used. After accounting for combination-pill use and abdominal complaints previous to sterilization, 7.1% of the women complained of menorrhagia, 6.2% complained of dysmenorrhea, and 8.7% complained of vague abdominal pain. The incidence of menorrhagia and dysmenorrhea occurred equally for each sterilization technique. Postoperative complaints may be due to hyperplasia of stroma with endometrial biopsies indicative of a persisting proliferation phase.^ieng