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PubMed1997

Cancer mortality among man-made vitreous fiber production workers.

We have updated the follow-up of cancer mortality for a cohort study of man-made vitreous fiber production workers from Denmark, Finland, Norway, Sweden, United Kingdom, Germany, and Italy, from 1982 to 1990. In the mortality analysis, 22,002 production workers contributed 489,551 person-years, during which there were 4,521 deaths. Workers with less than 1 year of employment had an increased mortality [standardized mortality ratio (SMR) = 1.45; 95% confidence interval (CI) = 1.37-1.53]. Workers with 1 year or more of employment, contributing 65% of person-years, had an SMR of 1.05 (95% CI = 1.02-1.09). The SMR for lung cancer was 1.34 (95% CI = 1.08-1.63, 97 deaths) among rock/slag wool workers and 1.27 (95% CI = 1.07-1.50, 140 deaths) among glass wool workers. In the latter group, no increase was present when local mortality rates were used. Among rock/slag wool workers, the risk of lung cancer increased with time-since-first-employment and duration of employment. The trend in lung cancer mortality according to technologic phase at first employment was less marked than in the previous follow-up. We obtained similar results from a Poisson regression analysis limited to rock/slag wool workers. Five deaths from pleural mesothelioma were reported, which may not represent an excess. There was no apparent excess for other categories of neoplasm. Tobacco smoking and other factors linked to social class, as well as exposures in other industries, appear unlikely to explain the whole increase in lung cancer mortality among rock/slag wool workers. Limited data on other agents do not indicate an important role of asbestos, slag, or bitumen. These results are not sufficient to conclude that the increased lung cancer risk is the result of exposure to rock/slag wool; however, insofar as respirable fibers were an important component of the ambient pollution of the working environment, they may have contributed to the increased risk.

Aged↗
PubMed1997

Cancer mortality among workers with benzene exposure.

We updated a cohort mortality study of 4,172 workers at a chemical plant to examine cancer mortality among workers exposed to low levels of benzene. Overall mortality [standardized mortality ratio (SMR) = 1.0; 95% confidence interval (CI) = 0.9-1.1] and cancer mortality (SMR = 1.0; 95% CI = 0.8-1.3) rates were at expected levels for production workers with benzene exposure. We observed elevated, albeit imprecise, rates of leukemia (SMR = 2.3; 95% CI = 0.7-5.3) and multiple myeloma (SMR = 2.3; 95% CI = 0.7-9.4) in this group of workers. The leukemias and multiple myelomas occurred predominantly among workers 20 or more years after first exposure. The leukemias were not restricted to acute myelogenous subtypes, and they occurred predominantly among workers hired before 1950 at exposure levels lower than previously reported. Leukemia (SMR = 1.3; 95% CI = 0.6-2.4) and multiple myeloma (SMR = 1.2; 95% CI = 0.3-2.9) rates were at expected levels among maintenance workers with intermittent high exposure to benzene. These findings provide evidence on both sides of the debate about whether low benzene exposure increases the risk of multiple myeloma and all types of leukemia.

Benzene↗
PubMed1991

Mortality and cancer incidence in aluminum reduction plant workers.

An historical cohort study was conducted among 4,213 men who worked for 5 or more years at a Soderberg aluminum reduction plant in British Columbia (BC), Canada. Standardized mortality and incidence ratios were used to compare the mortality and cancer incidence of the cohort with that of the BC population and to examine risk by cumulative exposure to coal-tar pitch volatiles (CTPV) and electromagnetic fields. Significantly elevated rates were observed for bladder cancer incidence (standardized incidence ratio [SIR] = 1.69) and brain cancer mortality (standardized mortality ratio = 2.17). The risk of bladder cancer was strongly related to cumulative exposure to CTPV (P less than .01). The risk for non-Hodgkin's lymphoma also increased with increasing exposure (P less than .05), although the overall rate was similar to that of the general population (SIR = 1.06). The lung cancer rate was as expected (SIR = 0.97), but showed a weak association with CTPV exposure that was not statistically significant. No individual cause of death or incident cancer site was related to exposure to electromagnetic fields. Analysis of the joint effect of smoking and CTPV exposure on lung and bladder cancer showed the exposure response relationships to be independent of smoking.

Adult↗
PubMed1995

Successful treatment of amoxapine-induced refractory status epilepticus with propofol (diprivan)

Tonic-clonic seizure activity is a recognized complication of amoxapine overdose. Refractory drug-induced status epilepticus is associated with significant morbidity and mortality. Standard regimens for controlling status epilepticus may be ineffective for aborting drug-induced seizures. The authors report the case of a 30-year-old woman who presented with an amoxapine overdose that deteriorated into status epilepticus refractory to conventional therapy. Propofol given by intravenous bolus and maintenance infusion successfully halted the patient's seizure activity. This case suggests that propofol may be effective as an anticonvulsant in refractory drug-induced status epilepticus.

Adult↗
PubMed1969

Rapid diagnosis of bacteremia.

Early appropriate treatment of bacteremia is important in minimizing morbidity and mortality. Standard blood culture methods are not optimal since several days are often required for recovery and identification of organisms which may be present in the blood. The use of a membrane filter technique allows one to grow any organisms present in blood much more rapidly than by broth or pour plate culture. Furthermore, growth is in the form of typical colonies on the surface of solid media, and a series of rapid diagnostic tests may be used to provide speedy identification. Use of membrane filters also facilitates removal by washing of normal antibacterial factors and antimicrobial drugs which may be present in blood. Although the filter technique yielded the most rapid growth, broth culture and whole blood pour plates yielded more positive cultures and use of all three systems was necessary for maximal recovery of organisms in blood cultures. Data on quantitative aspects of bacteremia in the antimicrobial era are also presented. The number of low level bacteremias (10 colonies/ml or less) is surprisingly high. This is particularly true for gram-negative bacilli; antimicrobial therapy at the time of culture undoubtedly influenced these results greatly. Finally, suggestions are given for a much simpler and more efficient membrance filter blood culture technique.

Bacteriological Techniques↗
PubMed1996

Filgrastim. A reappraisal of pharmacoeconomic considerations in the prophylaxis and treatment of chemotherapy-induced neutropenia.

Neutropenia is a frequent and often dose-limiting complication of chemotherapy and is associated with considerable patient morbidity and mortality. Standard treatment in patients who become febrile includes hospitalisation and empirical antibiotic therapy. Filgrastim is a recombinant human granulocyte colony-stimulating factor (rHuG-CSF). It significantly decreases the incidence of febrile neutropenia in patients receiving standard-dose chemotherapy, and shortens the duration of febrile neutropenia in patients undergoing autologous bone marrow transplantation (BMT) or peripheral blood progenitor cell (PBPC) infusion after myeloablative chemotherapy regimens. These effects are usually associated with a decrease in hospitalisation and antibiotic requirements. The contribution of filgrastim therapy to beneficial effects on other clinically important end-points (e.g. quality of life, tumour relapse rate, and short and long term survival) remains to be accurately determined. Pharmacoeconomic data concerning the use of filgrastim as an adjunct to standard-dose chemotherapy are derived largely from the results of phase III trials. Cost analyses based on hospital charges suggest that the cost of providing filgrastim therapy can be fully recouped if the drug is used as primary prophylaxis in previously untreated patients, for whom the risk of developing febrile neutropenia is at least 40%. Reserving filgrastim for use in patients who have developed febrile neutropenia in a previous chemotherapy cycle may result in further cost savings. However, careful patient selection is required, since potential cost savings will vary depending upon the risk of hospitalisation in the absence of filgrastim treatment. Infusion of filgrastim-mobilised PBPCs is emerging as a preferred strategy in patients receiving myeloablative chemotherapy, and promising results have been obtained from cost analyses. From a pharmacoeconomic viewpoint, future research should be directed towards defining optimum dosage regimens and hence improving the cost-effective use of filgrastim. Data evaluating patient quality of life and treatment preferences would help define the cost utility of filgrastim therapy. In the meantime, available pharmacoeconomic data support the use of filgrastim as an adjunct to chemotherapy in selected clinical situations.

Antineoplastic Agents↗
PubMed1996

Relative mortality in lower limb amputees with diabetes mellitus.

A nationwide epidemiological study included 3516 primary major lower limb amputations in diabetic patients, during the period 1982 to 1992. On this well defined diabetic amputee population the relative mortality (Standard Mortality Ratio, SMR) has been analysed. The mortality rate was found to be 8 times the expected during the first year following amputation. The relative mortality is higher for females than males. An inverse relation between age and SMR was found, and the SMR was significantly related to the level of amputation. No significant difference could be detected when analysing SMR in relation to subdiagnosis (NIDDM vs IDDM) or SMR in relation to the period of treatment 1982-87 versus 1988-92.

Adult↗
PubMed1993

Variations in mortality and length of stay in intensive care units.

OBJECTIVE: To evaluate the amount of variation in in-hospital mortality and length of intensive care unit (ICU) stay that can be accounted for by clinical data available at ICU admission. DESIGN: Inception cohort study. SETTING: Forty-two ICUs in 40 hospitals, including 26 hospitals that were randomly selected and 14 large tertiary care hospitals that volunteered for the study. PARTICIPANTS: A consecutive sample of 16,622 patients and 17,440 ICU admissions. MEASUREMENTS AND MAIN OUTCOMES: Data on selected demographic characteristics, comorbidity, and specific physiologic variables were recorded during the first ICU day for an average of 415 admissions at each ICU; hospital discharge status (dead or alive) and length of ICU stay were recorded for individual patients; and the ratio of actual to predicted in-hospital mortality, standardized mortality ratios, and the ratio of actual to predicted length of ICU stay were recorded for individual ICUs. RESULTS: Unadjusted in-hospital mortality rates for the 42 units varied from 6.4% to 40%, and 90% (R2 = 0.90) of this variation was attributable to patient characteristics at admission. The standard mortality ratio varied from 0.67 to 1.25. The mean unadjusted length of ICU stay varied from 3.3 to 7.3 days, and 78% of the variation (R2 = 0.78) was attributed to patient and selected institutional characteristics. The best performing unit had a length of stay ratio of 0.88, whereas the poorest performing unit had a ratio of 1.21. CONCLUSIONS: Clinicians can use readily available admission data to adjust for considerable variations in patient severity and type in different ICUs. Such data should permit precise evaluation and comparison of ICU effectiveness and efficiency, which varied substantially in this study, and result in improved methods of risk prediction and evaluation of new medical practices.

Aged↗
PubMed1992

[The evolution of mortality from ischemic heart disease in Basque Country 1975-1990].

BACKGROUND: Given the importance of ischemic cardiopathy (IC) as a cause of death in industrialized countries, the trend of mortality by IC in people from 30 to 69 years of age residing in the Basque Country between 1975-1990 were studied. Furthermore, the evolution of the mortality by cardiac diseases and by other causes which may compete with IC in the certification or coding of the cause of death was studied. METHODS: The rate of mortality standardized by age by the direct methods were estimated from data from the Natural Movement of Population. The trend was graphically studied and quantified by means of the percentage difference between the rates. RESULTS: Mortality by IC decreased between 1975-1990 by 37% in men and 46% in women with a mean annual percentage decrease of 2.8% and 2.9%, respectively. Mortality by cardiac disease decreased 34% in men and 52% in women. CONCLUSIONS: Mortality by ischemic cardiopathy in the Basque Country has significantly decreased in both sexes. This decrease is not explicable by possible changes over the years in the practises of certification or coding of the cause of death.

Adult↗
PubMed1990

[Selected elements of health status of the Polish population in relation to other European countries in the light of the program "Health for all up to 2000"].

Total mortality from main causes of death (diseases of circulatory system, malignant neoplasms, injuries and poisoning) life expectancy at birth, infant and maternal mortality in Poland in the years 1970-1988 were analyzed on the basis of targets of the regional strategy for "Health for all by the year 2000" (HFA 2000). It seems that it isn't possible to achieve targets concerning mortality by the year 2000. However it is possible to decrease infant and maternal mortality. Standardization of health indicators to european population allows to compare health status of the polish population to other european countries. This comparison shows that situation in Poland is not optimistic.

Adolescent↗
PubMedDate not supplied

Trends in malignant skin melanoma and other skin cancers in Spain, 1975-1983, and their relation to solar radiation intensity.

Epidemiological studies have shown solar exposure to play an important role in the appearance of skin cancer. We investigated the association between mortality standardized by the indirect method for malignant skin melanoma and other skin cancers and the mean intensity of solar radiation during July and August for the different provinces in Spain. A statistically significant relation was observed (p less than .05) for these two months but not upon considering mean annual solar radiation. We thus suggest that intermittent, intense exposure to sunlight constitutes an important risk factor for skin cancer. We observed an 8.5% and 15.72% increase in mortality due to malignant skin melanoma and other skin cancers, respectively, during the period 1975-1983. Mortality was slightly higher among males than females.

Dose-Response Relationship, Radiation↗
PubMed1979

Report to the Veterans' Administration Department of Medicine and Surgery on service-connected traumatic limb amputations and subsequent mortality from cardiovascular disease and other causes of death.

Men drafted into the Army, hospitalized during 1944 to 1945 for service-connected trauma to the extremities, and consequently separated for disability were followed for mortality from January 1946 to April 1977. Three groups were established consisting of those whose injury resulted in (a) limb amputation, (b) disfiguration without loss of body part, (c) loss of part of hand or part of foot. Group (a) had a mortality, standardized for age and calendar time, 1.4 times that of Group (b), matched on age and length of service at admission, and 1.3 times that of Group (c), similar on age and length of service to Group (a). The excess mortality of limb amputees was statistically significant (P less than .05) for ischemic heart disease, other diseases of the cardiovascular system, suicide by poisoning, alcholic cirrhosis, and cute pancreatitis. Possibly (P less than .1) there was also an increased risk of diabetes and cancer of the buccal cavity and pharynx.

Adult↗
PubMed1986

[Retrospective cohort study of the cancer incidence in pesticide-exposed male pest control workers].

A cohort of 1,214 pest control workers employed during 1945-1980 for at least 5 yr was investigated with regard to cancer mortality. Standardized Mortality Ratio (SMR) was significantly elevated for all malignant neoplasms (SMR = 133; 65 observed vs. 48.5 expected). Significantly elevated SMRs were also found for the following tumor sites: esophagus, SMR = 430 (4 observed vs. 0.9 expected); stomach, SMR = 180 (14 observed vs. 7.8 expected) and melanoma, SMR = 588 (2 observed vs. 0.3 expected). Mortality from stomach cancer showed a rising trend by number of years licensed (less than 10 years, SMR = 118; 10-19 years, SMR = 160; greater than 19 years, SMR = 260). The findings help clarify the role of occupational pesticide exposure as a risk factor for cancer.

Adenocarcinoma↗
PubMed1994

Clostridium septicum abscess in hepatic metastases: successful medical management.

Clostridium septicum bacteremia is frequently associated with hematologic and colonic malignancies and neutropenia. It frequently produces 'metastatic' gangrene with excessive mortality. Standard therapy usually includes surgical debridement and antibiotics. We present a patient with metastatic breast cancer treated with high-dose chemotherapy and bone marrow transplantation. She was treated successfully with antibiotics alone despite developing Cl. septicum bacteremia and gas in hepatic metastases. The pathophysiology of this infection is reviewed.

Adult↗
PubMed1993

[Mortality from pleural mesothelioma in the province of Barcelona].

BACKGROUND: Pleural mesothelioma is a tumor of low incidence whose relation with the exposure to asbestos has been widely demonstrated. This exposure is generally occupational, but may also be domestic and there is the possibility of environmental exposure. METHODS: By death certifications all the cases of death by pleural mesothelioma residing in the province of Barcelona from 1983-1990 have been identified. The rates of direct or indirect mortality (standardized by age and sex) (cause of standard mortality) for all the municipalities of the province with some case of mesothelioma over the period studied were calculated. The geographic localization of the companies using asbestos in the province of Barcelona has been obtained, being classified into 6 groups according to the productive subsector to which they belong. RESULTS: The rate of mortality per 100,000 inhabitants from 1983-1990 was 0.83 for males and 0.47 for females. The calculation of the cause of standard mortality for the municipalities of the province has shown an statistically significant increase in the risk of pleural mesothelioma for El Prat de Llobregat (ratio of standard mortality: 355.1) and Cerdanyola (ratio of standard mortality 313.9) where the companies producing fibrocement are located. CONCLUSIONS: Part of the cases of pleural mesothelioma in the province of Barcelona may not be due to direct occupational exposure; thus there may be important domestic and/or environmental exposure.

Adolescent↗
PubMed1997

[Relationship between heart rate and general mortality and that caused by cardiovascular diseases].

The sample of 1309 men and 1337 women, aged 35-64, randomly selected for the first Warsaw Pol-Monica screening performed in 1984, was followed up in 1992. All deaths were registered according to the cause of death based on death certificate diagnosis. The proportional hazard Cox model was used for univariate heart rate (HR) analysis and for multivariate analysis after adjustment for covariates (HR divided into 4 subgroups). Out of screened subjects 263 persons died (139 due to cardiovascular disease CVD). Mean baseline HR of persons who died was 76.8 (+/- 11.5) versus 73.9 (+/- 10.2) for subjects who survived (p = 0.0001). In the univariate analysis the heart rate was significantly positively related both to all cause mortality (relative risk RR = 1.29, p = 0.0001) as well as to cardiovascular mortality (RR = 1.31, p = 0.0025). In the multivariate analysis HR was significantly positively related to all cause mortality (standardized RR = 1.24, p = 0.0012), but almost significantly related to cardiovascular mortality (SRR = 1.20, p = 0.052).

Adult↗
PubMed1999

Mortality of patients with clinically localized prostate cancer treated with observation for 10 years or longer: a population based registry study.

PURPOSE: We studied the outcome in patients with early and probably organ confined prostate cancer who were considered candidates for curative therapy and treated expectantly. MATERIALS AND METHODS: The study included 2,570 patients with newly diagnosed prostate cancer reported to the Danish Cancer Registry from 1943 to 1986 and surviving for 10 years or longer. Mortality and causes of death were analyzed and stratified by stage, age and time of diagnosis. Excess mortality was calculated from life expectancy tables for the general population. RESULTS: An overall excess mortality (standard mortality ratio 1.58, 95% confidence interval [95% CI] 1.51 to 1.65) was found. Young age and advanced clinical stage at diagnosis entailed a higher risk of death from prostate cancer. Overall 42.7 and 19.1% of the patients who died had prostate cancer as the direct or contributing cause of death, respectively. Of the annual deaths 13% were attributable to prostate cancer. In 1,326 patients 55 to 64 and 65 to 74 years old with clinically localized prostate cancer at diagnosis the excess mortality was still significant (standard mortality ratio 1.72, 95% CI 1.54 to 1.93 and 1.50, 95% CI 1.39 to 1.62, respectively). Prostate cancer was the primary or contributing cause of death in 42.9% of the younger group and 21.5% of the older group. In these patients 15% of the annual deaths were related to prostate cancer. CONCLUSIONS: Patients with clinically localized prostate cancer for 10 years or longer, who were likely candidates for curative therapy when diagnosed, had significant excess mortality when treated expectantly.

Adult↗