A field study conducted at Kidston Gold Mine, to evaluate the impact of arsenic and zinc from mine tailing to grazing cattle.

The grazing trial at Kidston Gold Mine, North Queensland, was aimed specifically to assess the uptake of metals from the tailing and the potential for unacceptable contamination of saleable meat. Further aims included estimating metal dose rates and identifying potential exposure pathways including plant uptake of heavy metals, mine tailings adhered to plants and direct ingestion of mine tailing. It was found that of the 11 metals analysed (As, Zn, Co, Cd, Cr, Sn, Pb, Sb, Hg, Se and Ni) in the animal's liver, muscle and blood during the 8-month trial period, only accumulation of arsenic and zinc occurred. A risk assessment including these two metals was conducted to determine the potential for chronic metal toxicity and long-term contamination, using the estimates of metal dose rate. It was concluded that no toxicity or long-term contamination in cattle was likely at this site. Management procedures were therefore not required at this site; however, the results highlight percent ground cover and standing dry matter (DM) as important factors in decreasing metal exposure from direct ingestion of tailings and dust adhered to plants.

Cubital tunnel syndrome in a collegiate wrestler: a case report.

OBJECTIVE: The authors present a case study involving a 21-year-old male collegiate wrestler diagnosed with cubital tunnel syndrome. BACKGROUND: Cubital tunnel syndrome is a condition brought on by an increase in the pressure exerted upon the ulnar nerve at the elbow within the cubital tunnel. The wrestler was diagnosed with cubital tunnel syndrome after 6 weeks of increasing disability and dysfunction. DIFFERENTIAL DIAGNOSIS: Ulnar nerve contusion, ulnar nerve neuritis, cubital tunnel syndrome, thoracic outlet syndrome, C8 nerve root entrapment, double-crush syndrome, tumor. TREATMENT: The subject was treated conservatively for 3 months without resolution of the symptoms. Surgical treatment then involved a subcutaneous ulnar nerve transposition performed to decompress the cubital tunnel. Following surgery, the athlete participated in an aggressive rehabilitation program to restore function and strength to the elbow and adjacent joints. He was cleared for full unrestricted activity 15 days following surgery and returned to varsity athletic competition in 1 month. UNIQUENESS: Our literature review found no reported cases of cubital tunnel syndrome in wrestlers. Cubital tunnel syndrome is usually seen in throwing athletes and results from either acute trauma or repetitive activities. CONCLUSION: The athletic trainer should consider cubital tunnel syndrome as a possible pathology for nonthrowing athletes when presented with associated signs and symptoms.

The effect of a coronary artery risk evaluation program on serum lipid values and cardiovascular risk levels.

In this study, serum lipid and cardiovascular risk levels of 195 military men and women were measured immediately before and 6 months after participation in a coronary artery risk evaluation (C.A.R.E.) program. Mean total cholesterol levels decreased from 257 mg/dl to 223 mg/dl (t(194) = -16.76, p = 0.00), low-density lipoprotein levels decreased from 170 mg/dl to 141 mg/dl (t(194) = -15.22, p = 0.00), and high-density lipoprotein levels increased from 45 mg/dl to 48 mg/dl (t(194) = 3.27, p = 0.01). Cardiovascular risk categories (based on serum lipid levels) were lowered from high to moderate risk in 54 subjects, high to low risk in 19 subjects, and moderate to low risk in 31 subjects (chi 2 = 98.28, p = 0.00). This study demonstrates that health education programs such as the C.A.R.E. Program can have a significant impact on serum lipid levels and cardiovascular risk levels and can potentially improve the health of high-risk populations.

Aspects of FHR tracings as warning signals.

We have reviewed several different groups of common clinical problems with an eye toward their effects on FHR tracings. Although argument exists in the literature concerning the universal applicability of continuous EFM, most authors agree that continuous EFM is desirable, if not imperative, within these subgroups. Schifrin said, "It appears that potential benefits accrue when EFM and scalp sampling are employed with understanding and adequate training." With appropriate training, EFM and pH analysis can help the clinician to quickly and accurately assess fetal condition and to make necessary decisions regarding labor and delivery. The interpretation of fetal monitoring patterns necessitates consideration of gestational age and maternal condition as a starting point in analysis. The many other components of fetal-maternal interactions that occur with labor and delivery can be assessed satisfactorily only in this light.

Control of postpartum uterine atony by intramyometrial prostaglandin.

Five patients with severe postpartum hemorrhage due to uterine atony and unresponsive to oxytocin, ergonovine, and massage were treated with intramyometrial injection of 250 micrograms of prostaglandin (15S)-15-methyl PGF2 alpha-Tham. Four patients received 2 injections (500 micrograms), and 1 patient required 1 injection (250 micrograms). Three (60%) of 5 patients responded successfully with an increase in uterine tone and cessation of uterine hemorrhage, thus obviating the need for hysterectomy. Two patients had no uterine response, possibly because of delayed use of the drug, excessive blood loss, and accompanying shock; they required hysterectomy. Intramyometrial injection of prostaglandin is an effective and safe method of managing severe postpartum hemorrhage unresponsive to oxytocin and ergonovine, but it must be used early during the management of atony to obtain maximum effect. This method should precede surgical management of uterine atony.

Intrapartum monitoring and management of the postdate fetus.

Postdate pregnancy presents a difficult problem in both the antepartum and intrapartum periods. Because of the various complications associated with prolonged gestation, the following precautions should be taken during intrapartum monitoring and delivery: 1. Strict criteria must be established for elective induction should it be needed. Elective induction should be limited to those postdate patients with inducible cervices. 2. Extensive intrapartum fetal heart rate and uterine activity monitoring should be done on all patients. Physicians should be alert and ready for intervention and for any possible abnormal finding. Fetal biochemical assessment should be done liberally, especially when meconium is passed. 3. For patients with thick meconium passage, close intrapartum surveillance should be done by both biophysical and biochemical means. During delivery, attention should be given to minimizing the possibility of meconium aspiration. Good neonatal resuscitation is essential. 4. When the estimated fetal weight is 4500 gm or greater, the possibility of shoulder dystocia should be considered. Unless the patient's previous obstetric history or the progress of labor suggests a possible successful vaginal delivery, cesarean section should be considered.

Response of ovine uterine blood flow to angiotensin II: effect on the fetus.

The effect of intravenous infusion of angiotensin II (2 to 200 ng/kg/min) on uterine blood flow and cardiovascular performance was studied in the normotensive, unanesthetized pregnant ewe. With low rates of infusion (2 to 4 ng/kg/min), only a transient increase in uterine blood flow, lasting 1 to 3 minutes, was observed. Higher rates (110 to 200 ng/kg/min) of infusion caused a decrease in uterine blood flow; this decrease was significantly correlated to the dose. Angiotensin II also caused a significant decrease in the maternal heart rate and an increase in mean maternal arterial blood pressure as the rate of infusion was increased. A high rate of infusion resulted in decreased fetal heart rate and PaO2, probably due to a marked reduction in uteroplacental blood flow.

Toxicity of lidocaine in adult, newborn, and fetal sheep.

The relative central nervous system and cardiovascular toxicity of lidocaine was compared in adult, newborn, and fetal sheep during continuous infusion of lidocaine into the jugular vein at the rate of 2 mg x kg-1 x min-1. An identical sequence of toxic manifestations occurred in the adult, newborn, and fetus: convulsions, hypotension, respiratory arrest, and circulatory collapse. Doses necessary to produce these manifestations were highest in fetuses and lowest in adults. For example, in order to elicit convulsions, 5.8 +/- 1.8 mg/kg of lidocaine was required in the adults, 18.4 +/- 2.2 in the newborns, and 41.9 +/- 6.0 in the fetuses. Measurements of lidocaine concentrations in blood demonstrated that these toxic symptoms occurred at levels which were not significantly different among the three groups. The results indicate that fetal and newborn lambs are no more sensitive to lidocaine toxicity than are adult sheep. The fact that the highest doses were required in the fetuses is probably related to the placental clearance of the drug into mothers and better fetal maintenance of arterial Po2 despite convulsions and respiratory arrest (cessation of breathing-like movements).

Prediction of abnormal umbilical cord position and intrapartum cord problems from the nonstress test.

A prospective analysis of the nonstress test revealed a group of patients who demonstrate typical variable decelerations associated with fetal movement. Such variable decelerations were observed only in patients who had the test performed for suspected intrauterine growth retardation or for postdatism. Almost half of the suspected small-for-gestational-age fetuses and fetuses of a postdate gestation who demonstrated variable deceleration at nonstress testing also demonstrated an umbilical cord in an abnormal position at delivery. The position of the cord in utero of the remaining patients with variable deceleration at nonstress testing was not determined; however, 88% of this group demonstrated significant variable deceleration during labor. An abnormally positioned cord was noted in half of the patients undergoing cesarean section. It appears that patients with small-for-gestational-age fetuses and those with postdate gestation are at higher risk of intrapartum cord compression problems when variable decelerations are noted with fetal movements during a nonstress test.

The suspicious contraction stress test.

From a clinical service using the contraction stress test as an evaluator of fetal well-being, a 37-month review of the significance of the suspicious contraction stress test was performed. There were no antepartum losses in a group of 107 patients whose initial test was suspicious. Following each testing a number of patients delivered spontaneously or were delivered for other reasons. Results in 5 of 67 patients at the second testing changed from a suspicious to a positive test, 36 became negative, and 26 remained suspicious. There were no further conversions to a positive test after the second testing. There is a strong correlation between the loss of fetal heart reactivity and the repeated suspicious contraction stress test. The chief value of the suspicious test is as a marker in the high-risk pregnancy appraisal for consideration of additional fetal and maternal evaluation and possible clinical management alteration.