As part of a program for evaluation of environmental contaminants in drinking water, risk assessments are being conducted to develop Public Health Goals (PHGs) for chemicals in drinking water, based solely on public health considerations. California's Safe Drinking Water Act of 1996 mandated the development of PHGs for over 80 chemicals by 31 December 1999. The law allowed these levels to be set higher or lower than federal maximum contaminant levels (MCLs), including a level of zero if data are insufficient to determine a specific level. The estimated safe levels and toxicological rationale for the first 26 of these chemicals are described here. The chemicals include alachlor, antimony, benzo[a]pyrene, chlordane, copper, cyanide, dalapon, 1,2-dichlorobenzene, 1,4-dichlorobenzene, 2,4-D, diethylhexylphthalate, dinoseb, endothall, ethylbenzene, fluoride, glyphosate, lead, nitrate, nitrite, oxamyl, pentachlorophenol, picloram, trichlorofluoromethane, trichlorotrifluoroethane, uranium and xylene(s). These risk assessments are to be considered by the State of California in revising and developing state MCLs for chemicals in drinking water (which must not exceed federal MCLs). The estimates are also notable for incorporation or consideration of newer guidelines and principles for risk assessment extrapolations.

Algorithms↗

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Value of screening for markers of hepatitis in dialysis units.

The value of monitoring the serum activity of SGOT, as well as markers of hepatitis B virus and hepatitis A virus infections, in the patients and staff of two dialysis units has been assessed retrospectively. Sera were checked each month for SGOT and HBsAg on 406 patients and 170 staff members over a 4-year period. Anti-HBc, anti-HBs, and anti-hepatitis A antibodies were assayed on the stored sera. Only 30% of the patients had normal SGOT values (less than 65 units per ml) on all occasions. Most of the abnormal values were less than 100 units per ml and could not be explained. Viral hepatitis was a reasonable explanation for only half of those instances where the SGOT value was greater than 100 units per ml. Hepatitis A virus contributed nothing to the problem of dialysis-associated liver disease. Testing for HBsAg alone missed approximately 40% of the hepatitis B events acquired in the unit. Only two of these episodes were of epidemiologic importance, however, because the rest were recognized only after there was serologic resolution of the infection. There was a high frequency of potentially "false positive" reactions with all the antibodies tested. It is not cost-effective to monitor dialysis patients and staff regularly with anti-HBc, anti-HBs, or antibodies against hepatitis A. Initial screening with anti-HBc and anti-HBs on entry to the unit is of value but weak positive results must be interpreted with caution since approximately half of such results will prove to be nonspecific.

Antibodies, Viral↗

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Safety and efficacy of a new flexible video laparoscope in diagnostic laparoscopy.

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Humans↗

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Laparoscopic and histologic findings in patients with the human immunodeficiency virus.

Hepatic dysfunction frequently develops in patients infected with the human immunodeficiency virus (HIV). This retrospective study was undertaken to determine the laparoscopic and histologic findings in a group of HIV-seropositive patients with or without the acquired immune deficiency syndrome (AIDS). Fifty-four patients, 44 with AIDS and 10 HIV-positive, underwent laparoscopic examination and visually guided biopsies for the assessment of clinical or biochemical evidence of liver injury. Significant abnormalities were detected in 31/44 (70%) AIDS patients and 3/10 (30%) HIV-positive patients. Overall, specific laparoscopic findings were described in 25/54 (46%). The most common findings were peritoneal involvement, massive intra-abdominal adhesions, focal lesions of the liver or spleen, and diffuse nodularity of the liver; these were usually related to opportunistic infections or neoplasms such as non-Hodgkin's lymphomas and Kaposi's sarcoma. No procedure-related deaths occurred. Laparoscopy is a safe and accurate method to detect underlying disease in a selected population of HIV-seropositive patients.

AIDS-Related Opportunistic Infections↗

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The role of the pediatric nurse practitioner in educating teens with mental retardation about sex.

Adolescents with mental retardation have sexual needs that are often overlooked, underestimated, or considered problematic by parents, teachers, or other caregivers. This article describes ways in which the pediatric nurse practitioner can help these special teens develop responsible social and sexual relationships through assessment, education, coordination of services, appropriate referrals, and regular follow-up.

Adolescent↗

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