Air pollution and doctors' house calls: results from the ERPURS system for monitoring the effects of air pollution on public health in Greater Paris, France, 1991-1995. Evaluation des Risques de la Pollution Urbaine pour la Santé.

This study examines short-term relationships between doctors' house calls and urban air pollution in Greater Paris for the period 1991-1995. Poisson regressions using nonparametric smoothing functions controlled for time trend, seasonal patterns, pollen counts, influenza epidemics, and weather. The relationship between asthma visits and air pollution was stronger for children. A relative risk (RRP95/P5) of 1.32 [95% confidence interval (CI) = 1.17-1.47)] was observed for an increase from the 5th to the 95th percentile (7-51 micrograms/m3) in daily concentrations of black smoke (BS). The risks for 24-hr sulfur dioxide and nitrogen dioxide levels were in the same range. Cardiovascular conditions, considered globally, showed weaker associations than angina pectoris/myocardial infarction, for which RRP95/P5 was 1.63 (95% CI = 1.10-2.41) in relation to ozone ambient levels. Eye conditions were exclusively related to ozone (RRP95/P5 = 1.17, 95% CI 1.02-1.33). Asthma visits and ozone showed an interaction with minimum temperature: an effect was observed only at 10 degrees C or higher. In two-pollutant models including BS with, successively, SO2, NO2, and O3, only BS and O3 effects remained stable. Along with mortality and hospital admissions, house call activity data, available on a regular basis, may be a sensitive indicator for monitoring health effects related to air pollution.

Frasier syndrome.

OBJECTIVE: To present the case of a 17-year-old girl with primary amenorrhea and a history of hypertension since age 13 years. METHODS: The patient's clinical, laboratory, and radiologic data were summarized, and features of Frasier syndrome and Drash syndrome were compared. RESULTS: The patient's weight was 126 kg, height was 185 cm, and blood pressure was 150/100 mm Hg. She had minimal breast budding and scant pubic hair. Laboratory data were compatible with hypergonadotropic hypogonadism. An ultrasound study of the pelvis revealed an infantile uterus and a questionable right gonad. The patient also had nephrotic-range proteinuria in conjunction with decreased creatinine clearance and normal findings on ultrasonography of the kidneys. A karyotype photomicrograph showed a male 46,XY chromosomal pattern. Although the patient's chronologic age was 17 years, her bone age was 12 1/2 years. CONCLUSION: The patient was diagnosed as having Frasier syndrome. She underwent removal of a left-sided ovary and a right adnexal mass, and her condition is well controlled with lisinopril (10 mg daily) and estrogen therapy.