Occupational trichloroethylene exposure and non-Hodgkin's lymphoma: a meta-analysis and review.

METHODS: Meta-analysis and review of 14 occupational cohort and four case-control studies of workers exposed to trichloroethylene (TCE) to investigate the relation between TCE exposure and the risk of non-Hodgkin's lymphoma (NHL). Studies were selected and categorised based on a priori criteria, and results from random effects meta-analyses are presented. RESULTS: The summary relative risk estimates (SRRE) for the group of cohort studies that had more detailed information on TCE exposure was 1.29 (95% CI 1.00 to 1.66) for the total cohort and 1.59 (95% CI 1.21 to 2.08) for the seven studies that identified a specific TCE exposed sub-cohort. SRREs for three studies with cumulative exposure information were 1.8 (95% CI 0.62 to 5.26) for the lowest exposure category and 1.41 (95% CI 0.61 to 3.23) for the highest category. Comparison of SRREs by levels of TCE exposure did not indicate exposure-response trends. The remaining cohort studies that identified TCE exposure but lacked detailed exposure information had an SRRE of 0.843 (95% CI 0.72 to 0.98). Case-control studies had an SRRE of 1.39 (95% CI 0.62 to 3.10). Statistically significant findings for the Group 1 studies were driven by the results from the subgroup of multiple industry cohort studies (conducted in Europe) (SRRE = 1.86; 95% CI 1.27 to 2.71). The SRRE for single industry cohort studies was not significantly elevated (SRRE = 1.25; 95% CI 0.87 to 1.79). CONCLUSIONS: Interpretation of overall findings is hampered by variability in results across the Group 1 studies, limited exposure assessments, lack of evidence of exposure response trends, lack of supportive information from toxicological and mechanistic data, and absence of consistent findings in epidemiologic studies of exposure and NHL. Although a modest positive association was found in the TCE sub-cohort analysis, a finding attributable to studies that included workers from multiple industries, there is insufficient evidence to suggest a causal link between TCE exposure and NHL.

Clinical benefits and tolerability of increased fill volumes in Japanese peritoneal dialysis patients.

BACKGROUND: Increasing fill volume is an effective means of improving clearances in patients on peritoneal dialysis (PD). Since Japanese PD patients are physically smaller than their Western counterparts, there is some concern that PD patients in Japan may be unable to tolerate larger fill volumes. OBJECTIVE: To determine patient tolerance and changes in solute clearance and net ultrafiltration resulting from increased fill volumes in Japanese patients on PD. DESIGN: Prospective double-blind study, randomizing patients to three different fill volumes (2.5% dextrose solution: 1.5 L, 2.0 L, or 2.5 L) administered in random order on three different occasions separated by 1 week. RESULTS: Twenty-one patients with a mean age of 55.4 +/- 2.1 years and a mean body surface area of 1.66 +/- 0.03 m2 were studied. On a scale of 0 to 10, patients' mean discomfort scores were 2.14 +/- 0.59, 3.48 +/- 0.54, and 3.81 +/- 0.63 (p = 0.047) at the end of the 1.5-L, 2.0-L, and 2.5-L dwells, respectively. There were no reports of cramps or shortness of breath with any fill volume. Patients were able to correctly guess the actual fill volume for only 34 of the 63 total exchanges (54.0%). Increasing fill volume resulted in an incremental improvement in peritoneal creatinine clearance, from 3.74 +/- 0.16 to 4.49 +/- 0.21 (p < 0.001, 2.0 L vs 1.5 L) to 5.12 +/- 0.20 mL/minute (p< 0.001, 2.5 L vs 2.0 L) for 1.5-L, 2.0-L, and 2.5-L dwells, respectively. Peritoneal urea clearance also increased significantly, from 5.65 +/- 0.13 to 7.04 +/- 0.17 (p < 0.001, 2.0 L vs 1.5 L) and 8.16 +/- 0.29 mL/minute (p < 0.001, 2.5 L vs 2.0 L), with incremental increases in fill volume. Similarly, net ultrafiltration in a 4-hour dwell increased significantly with fill volume, from 255.24 +/- 24 mL with 1.5 L, to 356 +/- 24 (p < 0.004, 2.0 L vs 1.5 L) and 392 +/- 29 mL (p < 0.086, 2.5 L vs 2.0 L) in patients receiving 2.0 L and 2.5 L, respectively. CONCLUSION: Increasing the fill volume results in improvement in solute clearance and net ultrafiltration in Japanese PD patients, with minimal increase in patient discomfort. A large percentage of patients were unable to identify the actual fill volume.

A market basket survey of inorganic arsenic in food.

Dietary arsenic intake estimates based on surveys of total arsenic concentrations appear to be dominated by intake of the relatively non-toxic, organic arsenic forms found in seafood. Concentrations of inorganic arsenic in food have not been not well characterized. Accurate dietary intake estimates for inorganic arsenic are needed to support studies of arsenic's status as an essential nutrient, and to establish background levels of exposure to inorganic arsenic. In the market basket survey reported here, 40 commodities anticipated to provide at least 90% of dietary inorganic arsenic intake were identified. Four samples of each commodity were collected. Total arsenic was analysed using an NaOH digestion and inductively coupled plasma-mass spectrometry. Separate aliquots were analysed for arsenic species using an HCl digestion and hydride atomic absorption spectroscopy. Consistent with earlier studies, total arsenic concentrations (all concentrations reported as elemental arsenic per tissue wet weight) were highest in the seafoods sampled (ranging from 160 ng/g in freshwater fish to 2360 ng/g in saltwater fish). In contrast, average inorganic arsenic in seafood ranged from less than 1 ng/g to 2 ng/g. The highest inorganic arsenic values were found in raw rice (74 ng/g), followed by flour (11 ng/g), grape juice (9 ng/g) and cooked spinach (6 ng/g). Thus, grains and produce are expected to be significant contributors to dietary inorganic arsenic intake.

Cancer patients and home care: extent to which required services are not received.

This study examined the frequency with which cancer patients who needed home nursing after hospital discharge did not receive required services. In addition, the types of healthcare problems these patients experienced were explored. This study represents a secondary analysis of a data set originally gathered to identify home care needs of patients with cancer. Additional data were gathered from patients' medical records. Results indicate that 41% (n = 15) of the 37 patients who did not receive home care in the present study had complex problems indicative of a need for ongoing nursing services in the home. Forty-one complex problems were identified for the 15 patients for whom home nursing services appeared to be required. Study results indicate that healthcare professionals need to continue efforts to identify and eliminate barriers to the receipt of required home nursing services for patients with cancer and their families.

Determinants of subsequent home health care nursing service use by hospitalized patients with cancer.

BACKGROUND: The authors examined the extent to which specific patient characteristics and length of hospital stay were capable of independently explaining the use of home health care nursing services by hospitalized patients with cancer after discharge. METHODS: The current study represents a secondary analysis of a data set originally gathered to identify the home health care needs of patients with cancer. The sample involved 87 patients with cancer who received home health care after hospitalization and 43 patients who did not receive such services. RESULTS: A logistic regression analysis indicated that home health care use was related to patient age, length of hospital stay, and level of symptom distress. Specifically, the likelihood of home health care use was found to increase among subjects older than 50 years of age, subjects with hospital stays of more than 7 days (apparently related to surgery), and those who experienced moderate to high levels of symptom distress. CONCLUSIONS: The results indicate a need for home health care nurses to be skilled in the management of cancer symptoms and in the complex problems commonly experienced by the postsurgical patient with cancer.

Needs of family caregivers of persons with cancer: a review.

The focus of cancer patient care has moved from the hospital to the home as a result of shortened acute-care stays and subsequent early discharges. Thus, family members and friends frequently must assume the caregiving role. Research has provided information regarding who in the family assumes the responsibility for care of the cancer patient, the needs of these family caregivers, community resources available, and service gaps within the present health care system.

Intracuff pressures in endotracheal and tracheostomy tubes. Related cuff physical characteristics.

This study compared intracuff pressure (ICP) during mechanical ventilation in a variety of currently used endotracheal (ET) and tracheostomy (trach) tube cuffs and related cuff physical characteristics. Tracheostomy tube physical characteristics were also measured. Variation was observed to exist between "just-seal" inspiratory and end-expiratory intracuff pressure during mechanical ventilation. Cuff diameter, thickness, compliance, geometry (shape), resting volume, and just-seal volume also varied. ICP varied with cuff diameter, thickness, compliance, geometry (shape), and trachea size, as well as tube curve and cuff position in the trachea. Thin, large-diameter, compliant cuffs generally "just seal" with relatively low ICPs. We recommend use of tracheal airways (endotracheal and tracheostomy) fitted with cuffs that seal in patients with low intracuff pressures. We also recommend nonrigid (soft) thermolabile tracheostomy tubes.

Cuffed tracheal tubes--physical and behavioral characteristics.

This study compares physical and behavioral characteristics of currently used cuffed tracheal tubes. Variability in physical and behavioral characteristics between size 8 tracheal tubes and cuffs exists: radius of tube curvature varies from 12.1 to 15.8 cm, bevel angle 39 to 56 degrees, bevel direction 73 to 107 degrees, distance from proximal end of bevel to cuff 15.4 to 24.4 mm, internal tube diameter 7.5 to 8.8 mm, wall thickness 1.14 to 2.37 mm, force to collapse 1020 to 3103 g, angle to kink 52 to 96 degrees, and indentation hardness 65.4 to 83.1. Cuff lengths vary from 29.7 to 45.3 mm, thickness 0.03 to 0.54 mm, diameter 14.5 to 32 mm, and cuff resting volume 0.15 to 19.9 ml. We recommend use of a soft, thermolabile, kink- and collapse-resistant tracheal tube fitted with a soft, thin-walled, tough, compliant, moderately long cuff, with a moderately large resting volume and diameter larger than tracheal diameter. Argyle, National Catheter, Ohio, Portex, Rusch "safety," and Shiley tracheal tubes resist collapse and kinking. Argyle, Lanz, National Catheter "hi-lo," National Catheter "intermediate hi-lo," Ohio, and Portex "profile" cuffs are thin and have diameters larger than the average male tracheal diameter.

Pulmonary diffusing capacity and physical working capacity in swimmers and non-swimmers during growth.

We measured physical working capacity at a heart rate of 170 bpm (PWC170) and diffusing capacity for carbon monoxide (DLCO) in two groups of children ranging in age from 9 to 17 years. One group was formed of highly trained competitive swimmers and the other of age, sex and size matched untrained counterparts. Bicycle ergometry was used to establish PWC170. The DLCO was measured at rest (DLCO rest) and while pedalling at 170 bpm (DLCO ex). The PWC 170, DLCO rest and DLCO ex were significantly higher in swimmers than in non-swimmers. Repeated measurements in the same subjects show that individual increases in DLCO rest and DLCO ex were result of both growth and training.

Physical characteristics of and rates of nitrous oxide diffusion into tracheal tube cuffs.

Physical characteristics and time-related volume changes in air-inflated tracheal tube cuffs exposed to nitrous oxide were measured in an environmental chamber. Cuff wall diameter, thickness, residual volume, and length were also measured. Gas volumes in most air-inflated tracheal tube cuffs increased 1.7 to 7 ml within 30 min of exposure to pure nitrous oxide. Diffusion rates into most cuffs varied inversely with cuff thickness and directly with the partial pressure of nitrous oxide. There were significant differences in diffusion rates among cuffs of the same composition with different densities or porosities as well as among cuffs of different compositions. Cuff diameters ranged from 13.8 to 32 mm; thicknesses from .033 to .55 mm; residual volumes from .22 to 19.4 ml; lengths from 23.1 to 49.1 mm. Intracuff volume and pressure increase related to gas diffusion into air-inflated cuffs should be periodically adjusted or pressure automatically controlled during nitrous oxide anesthesia. Large-diameter, thin-walled cuffs are recommended.