Building-related symptoms and molds: a two-step intervention study.

AIMS: To evaluate the relation between mold growth and symptoms in an intervention study design. METHODS: The building was examined by a walk-through and microbiological testing from surfaces and ventilation canals before and after each of two steps of the renovation. The examination program for the 25 employees comprised questionnaire, clinical examination, 2-week peak-flow monitoring, and blood samples, and in six persons also a bronchial challenge. RESULTS: Initially the building had severe moisture problems with growth of Trichoderma and Phoma as dominating microfungi. The total number of symptoms from a nine-item building-related symptom score was 66%, peak-flow variability was 20%. After the first renovation, no visible mold growth was seen, but samples showed that the building was still contaminated. Symptoms decreased to 33%. After further cleaning the mold levels decreased on surfaces, and the number of symptoms decreased to 4%. Mean peak-flow variability fell to 15%. DISCUSSION: In a poorly maintained building with moisture problems and mold growth, the staff had a number of irritative and general symptoms. The first renovation eradicated most visible signs of molds and gave a decreased number of symptoms. The second renovation sufficiently cleaned the building, and the rate of symptoms and peak-flow variability fell to normal levels. A thorough cleaning after renovation seems necessary for the eradication of symptoms.

Function of the upper extremities in hereditary multiple exostoses.

The radiographic anatomy, functional status, and impairment ratings of twenty-eight patients (fifty-six extremities) who had hereditary multiple exostoses were evaluated. The patient (or the parent) also subjectively graded the function of each extremity with use of a standard rating-assessment tool. Degenerative joint disease was evident in three (5 per cent) of the fifty-six extremities at the time of follow-up, when the patients were an average of twenty-one years old. With use of the hand test of Jebsen et al., the average score was in the forty-seventh percentile for the dominant extremity and in the twenty-eighth percentile for the non-dominant extremity. Loss of pronation and supination increased with increasing age. Dislocation of the radial head was significantly associated with negative ulnar variance (p=0.008) and with the impairment rating (p=0.001), but not with the subjective score or with the performance on the hand test of Jebsen et al. So-called whole-person impairment ratings ranged from 0 to 17 per cent (average, 5 per cent). It has been our experience that deformities of the upper extremity in patients who have hereditary multiple exostoses are well tolerated and lead to little loss of function as measured both subjectively and objectively.

Evaluation of noise in hearing instruments caused by GSM and DECT mobile telephones.

The annoyance of noise in hearing instruments caused by electromagnetic interference from Global Systems for Mobile Communication (GSM) and Digital European Cordless Telecommunication (DECT) mobile telephones has been subjectively evaluated by test subjects. The influence on speech recognition from the GSM and DECT noises was also determined. The measurements involved 17 hearing-impaired subjects. The annoyance was tested with GSM and DECT noise, each one mixed with continuous speech, a mall environment noise, or an office environment noise. Speech recognition was tested with the DANTALE word material mixed with GSM and DECT noise. The listening test showed that if noise level is acceptable so also is speech recognition. The results agree well with an investigation carried out on normal-hearing subjects. If a hearing instrument user is to be able to use a telephone without annoyance, the input-related noise level must not exceed 47 dB SPL for GSM and 46 dB SPL for DECT.

A prospective evaluation of orthopedic patients evacuated from Operations Desert Shield and Desert Storm: the Walter Reed experience.

A prospective review of all orthopedic casualties received from the southwest Asia theater of operations during Operations Desert Shield and Desert Storm was carried out at Walter Reed Army Medical Center. An injury analysis of the 181 orthopedic patients revealed 143 total fractures in 69 patients, with the remaining patients sustaining soft tissue injuries from trauma, overuse, or pre-existing conditions. Seventy percent of the fractures were open, of which 23% were treated with external fixators and 41% eventually underwent an operative stabilization procedure. An analysis of the distribution of injuries is given as well as the incidence of amputations, nerve injuries, and arterial injuries. Early multidisciplinary involvement in the care of these casualties proved to be greatly beneficial.