Reproductive effects of sodium borates on male employees: birth rate assessment.

OBJECTIVES: The purpose of the study was to investigate potential reproductive effects of sodium borates on occupationally exposed male employees at a large mining and production facility in the Mojave Desert of California. METHODS: The standardised birth ratio (SBR) was used to assess fertility of the male employees. Live births were the measured end point, and the rate of female to male offspring was also assessed. Data were collected through a questionnaire after a series of on site introductory and explanatory meetings with the employees. Initial non-responders were followed up by telephone. Medical insurance records were assessed for those who declined to participate. RESULTS: The questionnaire was a good method of ascertainment for live births. There was no evidence of selection bias in the results. There was a highly significant excess of offspring fathered by the male employees. There was no evidence of a relation between exposure and this excess of offspring, nor were there any temporal differences during the period of observation (> 30 years). Also, there was an excess of the percentage of female offspring fathered by these male employees. This excess of female offspring was not significant. There was no evidence of an exposure relation to sodium borates with this excess of female offspring nor were there any temporal differences. CONCLUSION: Under the conditions studied, there were no adverse reproductive effects of high borate doses as reported from oral ingestion studies in animals.

[Posterior depression-separation fracture in bimalleolar fractures]. / La fracture séparation-enfoncement postérieure dans les fractures bimalléolaires.

The authors analyse the anatomic character and the functional consequences of the posterior depression-separation in ankle fractures. The posterior depression fracture was present in 20 per cent of the ankle fractures of the studied series. The major depression was noticed 1 by 3. The lesion justified a specific operation. Its presence had also to be searched in rotation fractures treated conservatively, when the lateral malleolus was uncorrectly reduced. These two situations unnoticed or neglected create an incontinence of the talus leading to a triple desaxation, even if it does not appear on usual x-ray views. Tomographic sagittal x-ray views are on that score an important contribution to the diagnostic. Ankles showing such a residual defect deteriorated to an early articular narrowing during the first 6 months and to arthrosis during the first or second year.

Prolonged paralysis associated with long-term pancuronium use.

We cared for a 4-year-old patient who had undergone orthotopic liver transplantation and was placed on a ventilator for respiratory distress associated with Pneumocystis carinii pneumonia. The neuromuscular blocking agent pancuronium bromide 1.0-1.2 mg every hour as needed was used to facilitate artificial ventilation for 40 days. On discontinuation of pancuronium, the patient experienced severe, generalized neuromuscular dysfunction. Because no improvement was seen for 2 weeks, the acetylcholinesterase inhibitors edrophonium and pyridostigmine were instituted. Shortly thereafter the patient's condition began to improve. Gradual improvement occurred over 3-4 months and the patient has since returned to baseline neurologic function. We suggest that long-term pancuronium use was the cause of the patient's prolonged paralysis. The improvement experienced after the initiation of antidotal therapy strongly supports our proposal.