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Biomedical subjects

M Macaluso

Publications and source records attributed to M Macaluso.

At least 55 records · Page 3Linked to original sources
PubMed1997

Clinical, laboratory, radiographic, and histopathologic features of methotrexate-associated lung injury in patients with rheumatoid arthritis: a multicenter study with literature review.

OBJECTIVE: To describe the clinical, laboratory, radiologic, and histopathologic features of methotrexate (MTX)-induced lung injury in a combined cohort of selected patients with rheumatoid arthritis (RA) and all cases reported in the English-language literature. METHODS: Retrospective combined cohort review and abstraction from the medical literature. Case reports were obtained from 6 centers that had 4 or more cases of potential MTX lung injury per site. RA patients who were seen between 1981 and 1993 and who satisfied predetermined criteria for the presence of MTX lung injury were identified. RESULTS: Twenty-seven patients satisfied the criteria for definite MTX lung injury, and 2 for probable MTX lung injury. Predominant clinical features of MTX lung injury included shortness of breath in 27 patients (93.1%), which was present for 23.5 +/- 22.3 days (mean +/- SD), cough in 24 (82.8%), present for 26.9 +/- 28.5 days, and fever in 20 (69.0%), present for 10.4 +/- 12.8 days. Five patients (17.2%) died, compared with 12 of 68 (17.6%) reported in the medical literature. Four of the 6 patients who were re-treated with MTX after an initial pulmonary event developed recurrent lung toxicity, resulting in 2 deaths, compared with a recurrence rate of 3 of 6 in the literature. CONCLUSION: MTX lung injury is most often a subacute process, in which symptoms are commonly present for several weeks before diagnosis. Approximately 50% of the cases are diagnosed within 32 weeks from initiation of MTX treatment. A patient who recovers from MTX lung injury should not be re-treated. Earlier recognition and drug withdrawal may avoid the serious and sometimes fatal outcome that has been observed in this and other studies.

Aged↗
PubMed1997

Comparison of the accuracy of two tests with a confirmatory procedure limited to positive results.

Sensitivity (S) and specificity (F) of a test can be estimated in a study only if the disease status of all subjects is independently confirmed using a gold standard. A confirmatory procedure, however, rarely is administered to all subjects, and studies comparing two tests often restrict confirmation to subjects classified as positive by either test. In this context, the parameters of interest (S1, S2, F1, and F2) cannot be estimated directly. Two useful comparative measures of accuracy that can be estimated in this design are the relative sensitivity (RSN, S1/S2) and the relative false-positive rate [RFP, (1 - F1)/(1 - F2)]. The comparison of the two tests can be regarded as a self-matched study in which each observation consists of a pair of test results. Common statistical techniques for matched data analysis can be used to make inferences about RSN and REP. A variance estimator developed for the log-risk ratio in a matched cohort study can be applied to estimate confidence intervals for RSN and RFP. In addition, conditional logistic regression is useful to test hypotheses about RSN and RFP and to assess the impact of multiple potential modifiers of RSN and RFP.

Adult↗
PubMed1996

A follow-up study of synthetic rubber workers.

Although 1,3-butadiene (BD) has been classified as an animal carcinogen, epidemiologic research has reported inconsistent results on the relationship between BD and lymphopoietic and other cancers in humans. This study evaluated the mortality experience of 15649 men employed for at least 1 year at any of eight North American styrene-butadiene rubber (SBR) plants. About 75% of the subjects were exposed to BD; 83% were exposed to styrene (STY). During 1943-1991, the cohort had a total of 386172 and an average of 25 person-years of follow-up, with 3976 deaths observed compared to 4553 deaths expected based on general population mortality rates (standardized mortality ratio (SMR) = 87, 95% confidence interval (CI) = 85-90). More than expected leukemia deaths occurred in the overall cohort (48 observed/37 expected, SMR = 131, CI = 97-174) and among ever hourly subjects (45/32, SMR = 143, CI = 104-191). The excess was concentrated among ever hourly subjects with 10+ years worked and 20+ years since hire (28/13, SMR = 224, CI = 149-323) and among subjects in polymerization (15/6.0, SMR = 251, CI = 140-414), maintenance labor (13/4.9, SMR = 265, CI = 141-453) and laboratories (10/2.3, SMR = 431, CI = 207-793), three areas with potential for relatively high exposure to BD or STY monomers. Some cohort sub-groups had slight increases in deaths from lymphopoietic cancers other than leukemia, but mortality patterns by race, years worked and process group within the SBR industry did not indicate a causal association with occupational exposures. These results indicate that exposures in the SBR industry cause leukemia.

Butadienes↗
PubMed1996

Leukemia and cumulative exposure to butadiene, styrene and benzene among workers in the synthetic rubber industry.

Retrospective, quantitative estimates of exposure to 1,3-butadiene, styrene and benzene were developed for a follow-up study of leukemia mortality among 16610 subjects employed at six North American styrene-butadiene rubber manufacturing plants (418846 person-years, 58 leukemia deaths). The estimation procedure entailed identifying work areas within each manufacturing process, historical changes in exposure potential and specific tasks involving exposure, and using mathematical models to calculate job- and time-period-specific average exposures. The resulting estimates were linked with the subjects' work histories to obtain cumulative exposure estimates, which were employed in stratified and Poisson regression analyses of mortality rates. Mantel-Haenszel rate ratios adjusted by race, age, and cumulative styrene exposure increase with cumulative butadiene exposure from 1 in the nonexposed category to 4.5 in the category of 80 ppm-years or more (P = 0.01). The risk pattern is less clear and statistically nonsignificant for styrene exposure. A trend of increasing risk with butadiene exposure is still present after exclusion of the nonexposed category (P = 0.03). A parsimonious interpretation of the findings presented here, in light of previous epidemiologic studies, is that exposure to butadiene in the synthetic rubber industry produces a dose-related increase in the occurrence of leukemia.

Benzene↗
PubMed1995

Mortality patterns among women in the motor vehicle manufacturing industry.

This retrospective follow-up study evaluated the mortality experience of 11,271 women employed in a large motor vehicle manufacturing company in 1973. Company computerized personnel records were used to identify subjects and to obtain their employment histories. Follow-up through December 31, 1985, was conducted using company, state, and national data sources. The mortality rates of the cohort were compared with the rates of the U.S. general population of white or black women, adjusting for age and calendar time and using the standardized mortality ratio (SMR) as the measure of association. The overall mortality rate of the cohort was lower than the U.S. rate by 15% among whites (SMR = 85, 95% confidence interval (CI) = 78-93) and by 40% among blacks (SMR = 59, CI = 49-70). Among whites, the low mortality rate was due primarily to deficits of noncancer deaths, although a 32% deficit also was observed for breast cancer (SMR = 68, CI = 48-92). Black female workers had 40% fewer deaths than expected overall, and their all cancer SMR also was below expectation (SMR = 82, CI = 60-109). Despite evidence of a strong healthy worker effect among women in the motor vehicle manufacturing industry, the study found excesses of lung cancer among white women in assembly jobs (SMR = 158, CI = 107-226) and of pancreatic cancer among white assembly workers in upholstery and trim operations (SMR = 302, CI = 97-704).

Adult↗
PubMed1995

Survival and drug discontinuation analyses in a large cohort of methotrexate treated rheumatoid arthritis patients.

OBJECTIVES: To determine the probability of drug continuation in a large cohort of methotrexate treated rheumatoid arthritis (RA) patients, the reasons for discontinuation of methotrexate, the overall survival of the members of this cohort, and the causes of death in these patients. METHODS: Yearly follow up was conducted in methotrexate treated RA patients who formed a cohort between 1981 and 1986 at a tertiary care centre. The probability of drug continuation and the patients' survival were calculated using standard statistical procedures; standardised mortality ratios were calculated using death certificate data and USA general population and mortality tables. RESULTS: The probability of methotrexate continuation at 10 years from the time the first members entered the cohort was 30%. Toxicity (and its severity) was the most frequent cause of discontinuing methotrexate. The cumulative probability of survival was 85% for women and 45% for men. A greater than expected number of deaths from infections was observed, but the number of deaths from cancer and cardiovascular diseases were within the range expected. CONCLUSIONS: Toxicity remains the most common cause for methotrexate discontinuation. Survival was comparable to that of other RA cohorts. Methotrexate may be implicated as an associated factor in the deaths from infections.

Arthritis, Rheumatoid↗
PubMed1994

Plasma homocyst(e)ine, folate, and vitamin B-12 concentrations and risk for early-onset coronary artery disease.

High plasma homocyst(e)ine (Hcy) concentrations may be a determinant of coronary artery disease (CAD). Folate and vitamin B-12 are required for the primary metabolic pathway to reduce Hcy concentrations. The interrelationships of Hcy and these two vitamin cofactors were investigated in a case-control study of 101 white males aged 30-50 y with angiographically demonstrated CAD, and 108 white male, similarly aged, control subjects living in the same community as the patients. The odds ratio (OR) of CAD per quartile increase of plasma Hcy concentration based on control values was 1.6 (95% CI: 1.3, 2.1). After age, HDL and LDL cholesterol, body mass index, smoking, hypertension, and diabetes were controlled for, Hcy remained an independent risk factor (OR: 1.4; 95% CI: 1.0, 2.0). The OR change per quartile increase of folate concentration was 0.8 (95% CI: 0.6, 1.0). This difference was reduced (OR: 0.9; 95% CI: 0.7, 1.2) after Hcy adjustment. No difference in the geometric mean of vitamin B-12 concentration was found between patients and control subjects, both 5.8 nmol/L. However, after Hcy and the other CAD risk factors were controlled for, the OR per quartile increase in vitamin B-12 concentration was 1.5 (95% CI: 1.0, 1.8). Reduction in plasma Hcy by interventions to increase plasma folate concentration may decrease CAD risk.

Adult↗
PubMed1994

Local and systemic effects of cigarette smoking on folate and vitamin B-12.

A cross-sectional study was carried out among 39 current smokers (CS) and 60 noncurrent smokers (NCS) to evaluate the effects of cigarette smoking on folate and vitamin B-12 concentrations in the circulation and in tissues directly exposed to cigarette smoke. Univariate analysis showed significantly lower plasma, red blood cell (RBC), and buccal mucosa (BM) folate and BM vitamin B-12 concentrations in CS compared with NCS. The association between smoking and folate and vitamin B-12 concentrations in plasma, RBCs, and BM cells was reduced after other variables were controlled for. Total folate intake and plasma vitamin C concentrations were significant predictors of plasma and RBC folate concentrations. The plasma and RBC concentrations of folate were significantly lower in subjects who had last smoked < 1 h before the blood sample was drawn than in subjects who had smoked earlier. At the current recommended dietary allowance (RDA) for folate, CS had 42% lower plasma folate concentrations than NCS, whereas at an intake three times the RDA, the plasma folate concentration was the same for CS and NCS. The results also suggested that CS have BM folate and vitamin B-12 concentrations that are lower than those of NCS.

Black People↗
PubMed1994

Cancer mortality among women employed in motor vehicle manufacturing.

This article summarizes published data on employment and cancer patterns in the motor vehicle manufacturing (MVM) industry and presents results from a new study of female MVM workers. Historically, female MVM employees worked primarily in aerospace; electric and electronic equipment manufacturing; and paint, plastic, and trim operations. Women are now moving into vehicle assembly and metal parts production. Investigations of cancer have focused on men and reported excesses of lung cancer in foundry operations, of gastrointestinal cancer in metal processing operations involving exposure to machining fluids, and of colorectal cancer in wood pattern making. Numbers of women were insufficient for a meaningful evaluation of their cancer patterns. A recent study found that white women employed at a MVM company, compared to the female general US population, had small excesses of lung cancer (standardized mortality ratio (SMR) = 1.26; 95% confidence interval (CI) = 0.96-1.63) and of colorectal cancer (SMR = 1.27, 95% CI = 0.87-1.78) and a deficit of breast cancer (SMR = 0.68, 95% CI = 0.48-0.92). The lung cancer increase was concentrated among women in assembly jobs (SMR = 1.58, 95% CI = 1.07-2.26); the colorectal cancer increase, among women in nonproduction jobs (SMR = 1.78, 95% CI = 0.97-2.98); and the breast cancer deficit, among women in production-related jobs (SMR = 0.60, 95% CI = 0.37-0.91). Further investigation is needed to determine if these patterns are due to the occupational environment and to clarify causes of cancer among women in the MVM industry.

Automobiles↗
PubMed1994

Correction of hypokalemia with antialdosterone therapy in Gitelman's syndrome.

Six adult patients (4 females and 2 males, age range 26-57 years) with Gitelman's syndrome (GS) were treated with spironolactone 200-300 mg/day (n = 5) and/or amiloride 10-30 mg/day (n = 3) for 1-18 months. The patients had hypokalemia, hyperreninemia, chloride-resistant metabolic alkalosis, renal hypomagnesemia (n = 5), and hypocalciuria (n = 5). Free water clearance studies during maximal water diuresis and furosemide administration were suggestive of a solute reabsorptive defect beyond the loop of Henle. Antialdosterone therapy induced a significant increase of PK (from 2.6 +/- 0.4 to 3.4 +/- 0.4 mM; p < 0.0001) and a decrease of CK (from 21.4 +/- 13.2 to 10.6 +/- 4.8 ml/min, p < 0.02) and FEK (from 21.0 +/- 13.6 to 13.4 +/- 5.7%; p < 0.03); PMg increased from 1.38 +/- 0.38 to 1.64 +/- 0.21 mg/dl (p < 0.03) with a parallel fall of CMg (from 5.5 +/- 2.3 to 2.9 +/- 1.5 ml/min; p < 0.02) and FEMg (from 5.7 +/- 2.6 to 2.9 +/- 0.6%; p < 0.05); arterial blood pH and HCO3- did not change (P = plasma, C = clearance, FE = fractional excretion). The creatinine clearance fell (from 90.5 +/- 16.8 to 65.8 +/- 20.9 ml/min; p < 0.05), and Prenin rose (from 16.6 +/- 8.9 to 35.3 +/- 25.3 ng/ml/h; p < 0.02, as did Paldo (from 26.1 +/- 12.3 to 109 +/- 82.6 ng/dl; p < 0.01), indicating extracellular fluid volume contraction; however no significant clinical symptoms of hypovolemia ensued.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Calcium metabolism and calciotropic hormone levels in Gitelman's syndrome.

In 10 adult patients (5 females and 5 males, aged 13-57 years) with Gitelman's syndrome (GS, or hypocalciuric variant of Bartter's syndrome, characterized by chronic renal hypokalemia, metabolic alkalosis, hypomagnesemia and hypocalciuria), parameters of Ca metabolism and calciotropic hormone levels were evaluated. Hypocalciuria was associated with a marked reduction of fractional excretion of ionized Ca (as compared with 16 sex- and age-matched controls) and normal filtered Ca load, as indicated by serum ionized Ca; hypocalciuria was thus the result of increased tubular reapsorption of filtered Ca. Plasma levels of total Ca were increased in GS (p < 0.02) but ionized Ca was not different from controls; percent fraction of ionized to total Ca was reduced, indicating increased Ca complexation and/or protein binding, possibly related to a metabolic alkalosis-induced increase of plasma albumin affinity for Ca. Levels of plasma total protein and albumin were similar in GS and controls. Despite similar ionized Ca levels, PTH1-84 was lower in GS than in controls, indicating abnormal ionized Ca-PTH relationship, possibly related to hypomagnesemia. Plasma 1,25(OH)2D levels were not different in GS and in controls, and intestinal fractional Ca absorption (evaluated with a simplified method using stable Sr as a tracer) was not reduced in 4 patients. However, in 5 patients bone mineral density in the forearm (3 patients) or lumbar spine (2 patient) was normal. Thus, despite chronic hypocalciuria and normal 1,25(OH)2D levels, Ca 'thesaurosis' does not occur in bones of GS patients; a likely explanation is that, despite normal 'fractional' intestinal Ca absorption, 'net' intestinal absorption is reduced, due to increased intestinal Ca secretion.

Adolescent↗
PubMed1993

Use of organic solvents and potential worker exposure in the motor vehicle manufacturing industry.

This survey was designed to assist with planning epidemiologic studies of the effects of solvent exposure among motor vehicle manufacturing workers. The objectives were to identify subgroups of workers with solvent exposure, and to evaluate the availability of data for a job-exposure matrix (JEM). Of 65 plants selected, 31 (48%) participated. Participant plants represent all production activities initially included in the survey, and employ 97,655 hourly workers. About 14% of these workers use organic solvents (direct exposure), and 19% work in the proximity of solvent-using operations (indirect exposure). However, only 3% have direct exposure, and 6% have indirect exposure to large-volume (> or = 100 gallons/month)/high-frequency (hourly)-use solvents. The highest solvent exposure prevalence occurs in plants manufacturing engines and power train components and in metal degreasing/cleaning and painting tasks, and entails exposure to petroleum fractions, aromatic hydrocarbons, alcohols, and ketones. A JEM can be developed using plant records on job titles, work histories, production scheduling, and plant engineering, and using the corporate computerized personnel and industrial hygiene databases. However, information on solvent use and on exposure is adequate only for recent time periods.

Automobiles↗
PubMed1993

Mortality patterns among men in the motor vehicle manufacturing industry.

This retrospective follow-up study evaluates the mortality experience of 123,232 male hourly workers employed at a motor vehicle manufacturing company in 1973. Company computerized personnel records were used to identify subjects and to obtain their employment history. Follow-up through December 31, 1985 was conducted using company, state, and national data sources. The mortality rates of the cohort were compared with the rates of the United States (U.S.) general population of white or black men, adjusting for age and calendar time, and using the standardized mortality ratio (SMR) as the measure of association. The overall mortality rate of cohort members is lower than the U.S. rate by 11% among whites (11,060 observed/12,427 expected deaths; SMR = 89) and by 24% among blacks (3,744/4,926 deaths; SMR = 76). These low mortality rates reflect deficits of diseases other than cancer. Cancer SMRs are 99 for whites and 90 for blacks. There are slight excesses of stomach cancer (SMR = 113) and of lung cancer (SMR = 108) among whites and of cancer of the large intestine and rectum (SMR = 114) and of the lymphopoietic tissue (SMR = 111) among blacks. Both whites and blacks have a large deficit of buccal cancer and pharynx cancer, and blacks also have a deficit of esophagus cancer. The cohort's overall deficit of deaths is due largely to the favorable mortality experience of active workers. In contrast, white subjects who have left active employment have an 11% mortality excess, and inactive black subjects have a mortality rate that is similar to the general population rate. The increased mortality among inactive whites is not limited to any one particular disease category. This pattern may reflect illness-related employment termination and generalized confounding by socioeconomic status, although the study does not rule out a relationship between workplace exposures and specific diseases.

Adult↗
PubMed1993

Retrospective follow-up study of foundry and engine plant workers.

A retrospective follow-up study of 21,013 workers employed at a foundry and two engine manufacturing plants was conducted to determine if these workers had an unusual mortality experience. A total of 2,235 deaths occurred during the follow-up period of 1970-1987. Mortality from all causes was lower than expected. Men experienced a 6-13% excess of lung cancer deaths, depending on the choice of the comparison group. The data displayed evidence of a positive trend between lung cancer mortality and increasing duration of employment (p = 0.008). White men experienced a statistically significant excess of deaths from stomach cancer (standardized mortality ratio [SMR] = 158; 95% confidence interval [CI] = 101-234). Black men had increased mortality from pancreatic cancer, especially among engine plant workers (SMR = 303; CI = 121-624), and an excess of prostate cancer, concentrated among foundry workers (SMR = 234; CI = 112-430).

Adult↗
PubMed1993

Inter-rater agreement in the assessment of solvent exposure at a car assembly plant.

This study investigated the feasibility and the reproducibility of a retrospective assessment of solvent exposure in the painting operations of a car assembly plant. Five industrial hygienists (the raters) reviewed summary documents on plant operations and solvent exposure levels, developed from plant records and interviews. The raters independently reviewed 695 department-job-year combinations compiled from 29 work histories and used semi-quantitative scores to rate solvent exposure. Inter-rater agreement was evaluated by computing the percent concordance index and the intraclass correlation coefficient (rI). There was discordance among raters, a large proportion of which pertained to low exposure levels (1-5 ppm). The computation of the rI is sensitive to the distribution of exposure levels. A low rI can be observed for a rare exposure even if the percent concordance is high. Inter-rater agreement was good for cumulative exposure scores computed for frequent exposures: coatings (rI = 0.67), aromatic hydrocarbons (rI = 0.66), and petroleum distillates (rI = 0.62).

Automobiles↗
PubMed1992

Trichomonas vaginalis (TV) and human papillomavirus (HPV) infection and the incidence of cervical intraepithelial neoplasia (CIN) grade III.

The temporal relationship between cervical infection with Trichomonas vaginalis (TV) or human papillomavirus (HPV) and the incidence rate of cervical intraepithelial neoplasia grade three (CIN III) was examined in a cohort of 43,016 Norwegian women. From 1980 to 1989, a cervico-vaginal infection from TV and HPV was diagnosed cytologically in 988 and 678 women, respectively. During the 181,240 person-years of observation, 440 cases of CIN III/cervical cancer developed. The age-adjusted incidence rates (IR) of CIN III were 225 per 100,000 person-years among women with no cytologic evidence of infection, 459 among women with TV infection, and 729 among women with HPV infection. A multiple regression model yielded a relative rate (RR) of CIN III of 2.1 (95 percent confidence interval [CI] = 1.3-3.4) among women with TV infection and 3.5 (CI = 1.9-6.6) among women with HPV infection, compared with women with neither infection. As CIN can be misclassified as HPV infection, the entry Pap-smears of 10 women with HPV infection who later developed CIN III were re-examined. Excluding the four discordant cases with the corresponding person-years decreased the RR of CIN III to 2.1 (CI = 0.9-4.8). Our report demonstrates the limitations of studies that rely only on cytologic detection of HPV infection. Nevertheless, the results support the hypothesis that HPV is a causal factor for CIN III lesions, and also display an association between TV infection and cervical neoplasia.

Adult↗
PubMed1992

Oral folic acid supplementation for cervical dysplasia: a clinical intervention trial.

OBJECTIVE: We attempted to evaluate the effect of oral folic acid supplementation on the course of cervical dysplasia. STUDY DESIGN: A total of 235 subjects with grade 1 or 2 cervical intraepithelial neoplasia were randomly assigned to receive either 10 mg of folic acid or a placebo daily for 6 months. Clinical status, human papillomavirus type 16 infection, and blood folate levels were monitored at 2-month intervals. Outcome data were subjected to chi 2 analysis. RESULTS: The prevalence of human papillomavirus type 16 infection initially was 16% among subjects in the upper tertile of red blood cell folate versus 37% in the lower tertile (trend p = 0.035). After 6 months no significant differences were observed between supplemented and unsupplemented subjects regarding dysplasia status, biopsy results, or prevalence of human papillomavirus type 16 infection. CONCLUSION: Folate deficiency may be involved as a cocarcinogen during the initiation of cervical dysplasia, but folic acid supplements do not alter the course of established disease.

Administration, Oral↗