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PubMed2002

Mechanisms of snowboarding-related severe head injury: shear strain induced by the opposite-edge phenomenon.

OBJECT: To date, there has been no published study in which the focus was on the mechanisms of head injuries associated with snowboarding. The purpose of this study was to identify these mechanisms. METHODS: The patient population consisted of 38 consecutive patients with snowboarding-related major head injuries who were treated at two hospitals in Japan, where for years many winter sports injuries have been treated. The skill level of the snowboarder, the cause of the accident, the direction of the fall, the site of impact to the head, and the condition of the ski slope were examined. The injuries were classified as coup, contrecoup, or shear injuries. The predominant features of snowboarding-related major head injuries included: falling backward (68% of cases), occipital impact (66% of cases), a gentle or moderate ski slope (76% of cases), and inertial injury (76% of cases [shear injury in 68% and contrecoup injury in 8% of the patients]). Acute subdural hematoma frequently occurred after a patient fell on the slope (p = 0.025), fell backward (p = 0.0014), or received an occipital impact (p = 0.0064). Subcortical hemorrhagic contusions frequently occurred after the patient fell during a jump (p = 0.0488), received a temporal impact (p = 0.0404), or fell on the jump platform (p = 0.0075). Shear injury frequently occurred after a fall that occurred during a jump or after simple falls on the ski slope, and contact injury was frequently seen after a collision (p = 0.0441). CONCLUSIONS: The majority of severe head injuries associated with snowboarding that occur after a simple fall on the slope are believed to involve the opposite-edge phenomenon, which results from a fall backward on a gentle or moderate slope causing occipital impact. The use of a device to protect the occiput is proposed to reduce head injuries associated with snowboarding.

Adolescent↗
PubMed2005

Use of an embolic protection system during endovascular recanalization of a totally occluded cervical internal carotid artery at the chronic stage. Case report.

A symptomatic internal carotid artery (ICA) occlusion with hemodynamic compromise was treated at its chronic stage by using an endovascular technique. An embolic protection system was used during the recanalization procedure to prevent stroke by reversing the flow from the distal ICA to the common carotid artery. The totally occluded ICA was completely recanalized through percutaneous transluminal angioplasty and stent placement. The patient's symptom (transient ischemic attack) disappeared completely after treatment with no new neurological deficit. Single-photon emission computerized tomography findings confirmed improvement of the hemodynamic compromise, and no new high-intensity spots appeared on diffusion-weighted magnetic resonance imaging after treatment. This case shows that endovascular recanalization by using an embolic protection device can be considered as an alternative treatment for symptomatic ICA occlusion with hemodynamic compromise and refractoriness to antiplatelet therapy, even in the chronic stage of the illness.

Aged↗
PubMed2004

Percutaneous interventional treatment of extracranial vertebral artery stenosis with coronary stents.

Stenosis of extracranial vertebral artery (VA) is not an infrequent lesion, and it can pose a significant clinical problem. However, the standard treatment for a significant VA stenosis has still not been established. Here in this study, we report our experiences of VA stenting in 25 patients (age 56.2 +/- 15.2 years, male 76%). The patients had comorbidities as follows: DM (36%), hypertension (64%), Takayasu's (12%) and Behcet's diseases (4%). There were combined involvement of other vessels such as the coronary artery (72%), carotid artery (36%), subclavian artery (32%) and the contralateral vertebral artery (24%). Indications for stenting were prior stroke or symptoms related to vertebrobasilar ischemia in 11 patients, and an asymptomatic but angiographically significant stenosis (> 70% stenosis) in 14 patients. Twenty-three balloon-expandable stents and two self-expandable stents were deployed. A drug-eluting coronary stent and distal balloon protection device were each used in one case. A technically successful procedure was achieved in all patients. The baseline reference diameter was 4.7 +/- 1.3 mm, minimal luminal diameter (MLD) 1.0 +/- 0.6 mm (diameter stenosis 77.8 +/- 12.5%) and lesion length 6.4 +/- 3.9 mm. After stenting and adjuvant dilation, the MLD was increased to 4.5 +/- 0.9 mm (diameter stenosis 3.1 +/- 17.9%). There were no procedure-related complications. During the further follow-up period of 25 (3-49) months, no stroke or death occurred. Restenosis was observed in 4 (30.8%) of 13 eligible patients. In conclusion, VA stenting is feasible with a high degree of technical success, and this treatment is associated with a relatively low incidence of procedure-related complications. However, a relative high rate of in-stent restenosis remains as a problem to be resolved.

Adult↗
PubMed1996

Noise levels of orthopedic instruments and their potential health risks.

Exposure to intense levels of noise has been identified as a potential workplace risk for the development of hearing impairment for health care workers. With this knowledge a noise level survey was performed on selected orthopedic equipment. Several instruments produced threshold levels of 95 dBA to 106 dBA. Often these levels remained as high as 90 dBA at 4 ft from the source. Based on the results of this survey, audiometric tests were conducted on five cast technicians to determine the prevalence of noise-induced hearing loss (NIHL). Audiometric measurements of the cast technicians indicated that, in the absence of other risk factors for hearing loss, there was an association between the presence of NIHL and the years of exposure. NIHL was most evident on the side of the dominant hand used for holding the cast cutter. These findings suggest there may be a risk of NIHL from the occupational exposure to various orthopedic instruments. Further, this level of risk may warrant the use of an individual hearing protection device or the development of quieter instruments.

Adult↗
PubMed2003

Treatment of previously undiagnosed psychiatric disorders in persons with developmental disabilities decreased or eliminated self-injurious behavior.

BACKGROUND: Self-injurious behavior (SIB) is one of the most common challenging behaviors in persons with autistic disorder or severe/profound mental retardation. Many psychotropic drugs have been evaluated for their effectiveness in SIB. Results have varied, and no one psychotropic drug has been indicated for SIB. In this prospective, open clinical study, psychotropic drugs were used to treat the previously undiagnosed psychiatric disorder in persons exhibiting SIB. METHOD: Data were collected from 26 individuals with mental retardation (14 males, 12 females), 7 to 45 years of age (mean = 30.3 years), who exhibited SIB. Psychiatric diagnosis was made according to DSM-III-R and DSM-IV criteria. The Behavior Problem Inventory, Yudofsky's Overt Aggression Scale, repeated direct observation, and information on use of protective devices and Likert scales from log books were used to evaluate degree of SIB. Most of the patients were treated with different psychotropic drugs and behavior modification before they were evaluated for this study, but only 7 of them carried a psychiatric diagnosis. Data were collected between 1987 and 1997. RESULTS: Depressive disorders, impulse-control disorder, and anxiety disorder were the most common final diagnoses. Neuroleptics were discontinued in 5 patients and tapered by 50% to 75% in 14 patients. Antidepressants were added in 12 patients. Treatment of psychiatric disorders produced significant (p < .001) decrease in the severity of SIB in the 26 patients, and SIB was eliminated in 12 patients. The severity of SIB decreased to mild from a moderate, severe, or extreme degree in 11 patients and from an extreme to a severe degree in 3 patients. CONCLUSION: The most effective treatment for SIB that is resistant to environment changes and behavior modification in persons with developmental disabilities is the treatment of their psychiatric disorders with the appropriate psychotropics.

Adolescent↗
PubMed2001

Pulmonary functions in ARC-welders in Ile-Ife, Nigeria.

OBJECTIVE: To investigate the occupational effects of Arc-welding on small scale welders in Modakeke, Ile-Ife, Nigeria. DESIGN: A community-based, cross-sectional study. SETTING: A semi-urban area Modakeke, Ile-Ife, Nigeria. POPULATION: A semi-urban area with a population of about 300,000 (three hundred thousand). STUDY POPULATION: Forty four Arc-welders in Modakeke, Ile-Ife and fifty age and sex-matched controls working in the Maintenance Department of Obafemi Awolowo University, Ile-Ife, Nigeria. INTERVENTION: Structured questionnaires adapted from the Medical Research Council, UK respiratory questionnaire with some modifications were administered to all subjects and controls. Physical examination and lung function tests were also carried out on all subjects and controls. MAIN OUTCOME MEASURES: Occupational-related symptoms of welders and controls were compared. Ventilatory function of welders and controls were also compared using the Student's 't'-test. Chi-square was adopted to test the strength of relationship between smoking and lung function abnormalities. RESULTS: The most frequent symptoms found among the subjects were eye irritation (95.43%), rhinitis (50.09%) and skin irritation (43.19%). The arc-welders were found to have characteristically lower lung function parameters than controls (p < 0.05). Ten (22.7%) of the subjects had obstructive lung disease compared to four (8%) of the controls; while 18 (40.9%) of the subjects had restrictive lung disease. Their lung abnormalities had no relationship to their smoking history. CONCLUSION: Workers exposed to arc-welding are at risk of occupational-related symptoms and chronic lung disease. Adoption of protective devices and monitoring of welders' breathing zones for toxic levels of gases and fumes are necessary to reduce the risk associated with arc-welding.

Adolescent↗
PubMed2005

Pesticide use on agricultural fields and health problems in various activities.

OBJECTIVES: To assess the health status, attitude and level of awareness of safe pesticide handling practices of farm workers engaged in the application of pesticides on agricultural farms. DESIGN: Cross sectional study. SETTING: Two farms in northwest Ethiopia, 2004. SUBJECTS: Farm workers of job categories; sprayers, pest assessors, supervisors, spraymachine mechanics and tractor operators. RESULTS: The farm workers had respiratory symptoms of cough, phlegm and wheezing. Systolic and diastolic blood pressures did not show abnormalities. Liver function tests showed elevated values. Respiratory symptoms in the farm workers revealed that cough phlegm and wheezing at Ayehu farm were significantly (p < 0.05) higher than the controls. Alkaline phosphatase (ALP) at Birr Farm in the sprayers and mechanics were significantly higher than the controls (p < 0.05). The ALP value in the sprayers, glutamate pyruvate transaminase (GPT) in the assessors and glutamate oxaloacetate transaminase (GOT) in the sprayers and mechanics at Ayehu were significantly higher than the controls (p < 0.05). From a total of 82 farm workers 35.7% at Birr and 75% at Ayehu Farm described that they were not formally instructed about safe pesticide handling methods. CONCLUSION: The farm workers health is affected by the unwise use of pesticides. The level of awareness and attitude on safe pesticide handling practices is low. It is recommended that appropriate type of personal protective device (PPD), in service training about the proper use of chemical pesticides and periodic medical check-up should be fulfilled to minimise the adverse health effects of chemical pesticides.

Adult↗
PubMed1990

Sodium hydroxide-induced subclinical irritation. A test for evaluating stratum corneum barrier function.

This report concerns the development of a short, simple, non-invasive test for assessing sensitivity to irritant dermatitis. Application of NaOH (0.005-2.0 mol/l) to human skin resulted in significantly greater skin surface water loss directly after exposure (1-15 min) than of control (water). The increase in skin surface water loss after NaOH application was dose-dependent (0.005-0.1 mol/l) and application time-dependent (1-10 min). Application times exceeding 10 min did not further increase skin surface water loss and doses higher than 0.1 mol/l reversed the effect on skin surface water loss. 15 min after removal of the alkali, skin surface water loss baseline values were almost regained. This procedure did not cause visible reactions or discomfort for the volunteers. In a subsequent experiment, volunteers were exposed to 0.2 mol/l NaOH for 5 min on one forearm and to 1% sodium lauryl sulfate for 24 h contralaterally. Skin surface water loss after 5 min of NaOH application was significantly correlated with transepidermal water loss measurements after 24 h of sodium lauryl sulfate patch application. This is, to our knowledge, the first description of a procedure for quantifying interindividual differences in stratum corneum barrier function without inducing visible changes or causing volunteers discomfort. Use of this model should help to further investigate skin barrier function as well as to test protective devices and barrier creams.

Adult↗
PubMedDate not supplied

[Ground-isolated input circuits of the electronic diagnostic apparatus as means of increasing electric safety of the patient].

Introduction into the medical practice of new diagnostic and therapeutic methods, such as electric stimulation, measurement of intracardiac blood pressure, of pH and others, entails possible hazards for the patient to suffer an electric current injury. To ensure the patient's safety during various disturbances in the operation of the devices certain protective measures have to be devised. On an example of the electrocardiograph possible methods of accomplishing complete isolation of the patient from the ground through separating the signal and supply circuits is shown.

Burns, Electric↗
PubMed1999

Prevention of youth injuries.

There are four categories of causes responsible for the majority of injuries in youth 10-19 years of age: 1) motor vehicle traffic; 2) violence (intra-familial, extra-familial, self, pregnancy-related); 3) recreational; and 4) occupational. This article presents data from the National Center for Health Statistics mortality data and the National Pediatric Trauma Registry morbidity data. Nationwide, the pediatric injury death rate is highest among adolescents 15-19 years of age. Motor vehicle-related deaths account for 41% and firearm-related deaths account for 36% of injury deaths in this age group. For youths aged 10-14 years, motor vehicle-related deaths account for 38% and; firearm-related deaths account for 26% of injury deaths. For both age groups, occupant motor vehicle-related deaths account for the majority of deaths and underscore the need for seat belt use. Using theoretical principles based on the Haddon matrix and a knowledge of adolescent development, proposed interventions to decrease injuries and deaths related to motor vehicles and firearms include graduated licensing, occupant restraint, speed limits, conflict resolution, and gun control. Occupational injuries, particularly injury associated with agricultural production, account for an estimated 100,000 injuries per year. Preventive strategies include OSHA regulations imposing standards for protective devices and further study for guidelines for adolescent work in agriculture. Injuries related to recreation include drowning and sports injuries. Preventive strategies may include proper supervision and risk reduction with respect to use of alcohol/drugs. The data presented support the use of primary prevention to achieve the most effective, safe community interventions targeting adolescents.

Accidents, Occupational↗
PubMed1999

[Acute carbamate poisoning: apropos of 7 cases occurring in a Senegalese industrial unit].

The authors describe an onset of acute pesticide intoxication which occurred in an industrial site in Dakar. The substance responsible belongs to the class of carbamates which leads to variety of symptoms in relation with acetylcholin accumulation. All seven employees involved were young, males, unqualified temporary workers. Many factors appear to facilitate the intoxication: heat stress, inappropriate protective devices, and lack of information on pesticides' hazards. Routes of entry were cutaneous and respiratory. Symptoms were related to muscarinic and nicotinic syndromes. The course of this episode was favourable because of adequate treatment.

Acute Disease↗
PubMed2000

Techniques of carotid artery stenting: the state of the art.

The technique of carotid stenting has undergone significant refinement since its introduction and continues to improve as experience with the procedure matures and more suitable equipment becomes available. Improved stent designs and the utilization of cerebral protection devices are expected to significantly impact on the technique, its ultimate outcomes, and widespread application. In using the currently available technology for carotid stenting, patient selection and meticulous attention to procedural details are very important in minimizing embolic events. In this article, we provide a comprehensive practical discussion of the state-of-the-art carotid stenting techniques that have allowed us to maintain low event rates.

Carotid Arteries↗
PubMed2000

[Chronic perchloroethylene poisoning].

The authors describe the clinical features of the chronic perchloroethylene poisoning discussing their own 7 cases (2 women and 5 men). The 2 women worked as dry-cleaner, the 5 men performed degreasing of metal objects. The mean age of the patients was 46 (36-55), the exposure time 9.1 (0.5-30) years. In 3 cases the level of the exposure exceeded the maximum allowable concentration verified by the measurement of the perchloroethylene in the air of the workplace. One patient suffering from a serious cranial nerve lesion was not informed on the toxic exposure, so worked without any protective devices. 3 patients had an isolated lesion of the nervous system, 4 one an isolated hepatic damage. The authors draw attention to importance of the prevention.

Adult↗
PubMed2000

Do health care workers need to wear masks when caring for patients with pulmonary tuberculosis?

Outbreaks of hospital acquired tuberculosis (TB) in the 1990s, some of which affected staff, highlight the fact that TB still poses a risk to health care workers (HCWs). This risk is best minimised by the primary controls of early identification and treatment, good infection control practice such as early isolation, patients covering mouths when coughing, and engineering controls such as negative pressure isolation. There is no direct evidence to prove that the use of respiratory protective devices has prevented HCWs from acquiring TB, but modelling has shown that environmental controls are not enough to prevent exposure. Masks that filter aerosols (including TB) and have at least 95% efficiency of filtering particles 0.3 micron in diameter can reduce exposure. Environmental controls in the United Kingdom (UK) do not (always) include a specified minimum number of air-changes per hour or negative pressure. Therefore it seems reasonable to advise that HCWs should use masks as advocated by national guidelines for high risk procedures. Masks are also of value when entering any body cavity or dissecting any viscus/organ in which TB is suspected, as in the necropsy room or operating theatre. This is recommended in current guidelines from the United States but not those from the UK.

Guidelines as Topic↗
PubMed2001

Occupational noise exposure and hearing loss of workers in two plants in eastern Saudi Arabia.

OBJECTIVE: To determine the prevalence of hearing loss associated with occupational noise exposure and other risk factors. DESIGN: A cross-sectional study involving 269 exposed and 99 non-exposed subjects (non-industrial noise exposed subjects) randomly selected. Current noise exposure was estimated using both sound level meter and noise-dosimeter. Past noise exposure was estimated by interview questionnaire. Otoscopic examination and conventional frequency (0.25-8 kHz) audiometry were used to assess the hearing loss in each subject. RESULTS: 75% (202 subjects) from the exposed group were exposed to a daily Leq above the permissible level of 85 dB(A) and most (61%) of these did not and had never used any form of hearing protection. Hearing loss was found to be bilateral and symmetrical in both groups. Bivariate analysis showed a significant hearing loss in the exposed vs non-exposed subjects with a characteristic dip at 4 kHz. Thirty eight percent of exposed subjects had hearing impairment, which was an 8-fold higher rate than that found for non-exposed subjects. Multivariate analysis indicated exposure to noise was the primary, and age the secondary predictor of hearing loss. Odds of hearing impairment were lower for a small sub-group of exposed workers using hearing protection (N=19) in which logistic regression analysis showed the probability of workers adopting hearing protective devices increased with noise exposure, education, and awareness of noise control. Hearing loss was also greater amongst those who used headphones to listen to recorded cassettes. CONCLUSION: Gross occupational exposure to noise has been demonstrated to cause hearing loss and the authors believe that occupational hearing loss in Saudi Arabia is a widespread problem. Strategies of noise assessment and control are introduced which may help improve the work environment.

Adult↗
PubMed2001

Diffusion-weighted MR imaging after angioplasty or angioplasty plus stenting of arteries supplying the brain.

BACKGROUND AND PURPOSE: There has been concern regarding the safety of revascularization procedures of vessels supplying the brain vessels because of the risk of cerebral embolization during the procedure. We have observed a high incidence of hyperintense lesions on diffusion-weighted MR images of the brain after stenting at the carotid bifurcation. The hypothesis of this study is that diffusion-weighted MR imaging of the brain can reveal new diffusion abnormalities after angioplasty or angioplasty plus stenting of arteries supplying the brain, other than at the carotid bifurcation. Therefore, we prospectively obtained diffusion-weighted MR images of the brain before and after such revascularization procedures. METHODS: Thirty-seven revascularization procedures were performed in 32 patients. Eleven interventions were performed at the distal internal carotid artery, two at the external carotid artery, two at the common carotid artery, five at the innominate artery, five at the vertebral artery, and 12 at the proximal subclavian artery. Diffusion-weighted MR imaging of the brain was performed before and 24 hours after the procedures. RESULTS: After eight (22%) of 37 procedures, new hyperintensities were visible on the diffusion-weighted MR images. With six of these eight procedures, the hyperintensities occurred in the vascular territory supplied by the treated vessel. In total, 35 new cerebral lesions could be seen, 33 (94%) of which occurred in the vascular territory supplied by the treated vessel. None of the patients in whom new diffusion abnormalities were found had new neurologic symptoms or deficits. No new lesions could be seen after procedures at the subclavian artery. CONCLUSION: Revascularization procedures of arteries supplying the brain were associated with new lesions on the diffusion-weighted MR images of the brain after 22% of the procedures, provided that MR imaging could be performed, indicating the occurrence of cerebral microemboli during such procedures. Diffusion-weighted MR imaging of the brain can be used as a tool to assess the impact of modifications of procedural technique and/or the use of cerebral protection devices on the occurrence of such lesions.

Adult↗
PubMed2001

[Occupational toxic exposure in the pregnant woman. 1: principles fo individual risk assessment ].

CONTEXT: Many women of childbearing age are occupationally exposed to chemicals and concerned with the ensuing risk when pregnant. OBJECTIVES: To describe the principles of individual risk assessment to be applied in pregnant women or women wishing to become pregnant that are exposed to chemicals at the workplace. METHOD: Each request for risk assessment is based on a comprehensive review of the hazards of the handled products together with a thorough evaluation of the actual exposure at the workplace. A toxicological advice is then written to the gynecologist or the general practitioner in charge of the patient. When the exposure is estimated to be hazardous for the pregnancy, either total withdrawal, avoidance of certain activities or improvements of individual protective devices are recommended. The outcome of the pregnancy is systematically followed-up. CONCLUSION: An objective assessment of toxic risks in pregnant women exposed to chemicals at the workplace can be done. Thus, patients who must be withdrawn or benefit from improvements of their workstation can be selected.

Female↗
PubMed2002

[Allergic contact eczema because of diethylthiourea in neoprene rubber].

Three cases are reported of acute allergic contact dermatitis caused by diethylthiourea in the neoprene rubber used in a diving suit and orthopedic braces. Patch testing should be done with the specific thiourea compounds, because testing with material from the suspected products may be negative. Cross-reactivity between thiourea compounds is uncommon.

Adult↗