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AIHA J (Fairfax, Va). 2002 Sep-Oct;63(5):605-9.
Crab allergen exposures aboard five crab-processing vessels.

Beaudet N, Brodkin CA, Stover B, Daroowalla F, Flack J, Doherty D.

Occupational and Environmental Medicine Program, Departments of Medicine and Environmental Health, University of Washington, Box 359739, 325 Ninth Ave., Seattle, WA 98104, USA.

Aerosolized crab allergens are suspected etiologic agents for asthma among crab-processing workers. The objectives of this study were to characterize crab allergen concentrations and respiratory symptom prevalence among processing workers aboard crab-processing vessels. A cross-sectional survey of five crab-processing vessels was conducted near Dutch Harbor, Alaska. Crab allergen concentrations were quantified during specific work activities with 25 personal air samples collected on polytetrafluoroethylene filters and analyzed by a competitive IgE immunoassay technique. Two standardized respiratory questionnaires were used to assess respiratory symptoms suggestive of bronchitis or asthma in 82 workers. Aerosolized crab allergen concentrations ranged from 79 ng/m3 to 21,093 ng/m3 (mean = 2797 ng/m3, SD = 4576 ng/m3). The highest concentrations were measured at butchering/degilling work stations, which were combined on the smallest vessel. A significant percentage of workers reported development of respiratory symptoms during the crab-processing season. Cough developed in 28% of workers, phlegm in 11% of workers, and wheeze and other asthma-like symptoms developed in 4% of workers. Despite variations in crab allergen levels, respiratory symptom prevalence was similar across all job categories. Substantial concentrations of crab allergen exposure were measured, as well as the potential for wide variability in exposure during crab processing aboard vessels. The high prevalence of reported respiratory symptoms across all job categories suggests potential adverse respiratory effects that should be further characterized by prospective studies using pulmonary function and serology testing, and rigorous exposure characterization.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12529915&dopt=Abstract

Neurology. 2003 Jan 14;60(1):17-21.
The morbidity of Guillain-Barre syndrome admitted to the intensive care unit.

Henderson RD, Lawn ND, Fletcher DD, McClelland RL, Wijdicks EF.

Department of Neurology, Saint Mary's Hospital, Rochester, MN, USA.

Patients with severe forms of Guillain-Barre syndrome (GBS) require intensive care. Specific treatment, catheterization, and devices may increase morbidity in the intensive care unit (ICU). To understand the spectrum of morbidity associated with ICU care, the authors studied 114 patients with GBS. Major morbidity occurred in 60% of patients. Complications were uncommon if ICU stay was less than 3 weeks. Respiratory complications such as pneumonia and tracheobronchitis occurred in half of the patients and were linked to mechanical ventilation. Systemic infection occurred in one-fifth of patients and was more frequent with increasing duration of ICU admission. Direct complications of treatment and invasive procedures occurred infrequently. Life-threatening complications such as gastrointestinal bleeding and pulmonary embolism were very uncommon. Pulmonary morbidity predominates in patients with severe GBS admitted to the ICU. Attention to management of mechanical ventilation and weaning is important to minimize this complication of GBS. Other causes of morbidity in a tertiary center ICU are uncommon.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12530364&dopt=Abstract

Surg Laparosc Endosc Percutan Tech. 2003 Feb;13(1):6-10.
Complications of laparoscopic fundoplication in the elderly.

Coelho JC, Campos AC, Costa MA, Soares RV, Faucz RA.

Department of Surgery, Hospital N.S. Gracas and Hospital de Clinicas, Federal University of Parana, Rua Bento Viana 1140, Ap. 2202, 80240-110 Curitiba (PR), Brazil. juliocoelhbs2.sul.com.br

Our objective was to assess the complications of laparoscopic fundoplication in 77 patients older than 70 years of age. The indications for surgery were (1) complications of reflux esophagitis (n = 17), (2) large hiatal hernia (n = 10), (3) asthma and bronchitis (n = 7), (4) the need for other surgery (n = 13), and (5) a patient's desire to discontinue medical treatment that was controlling reflux esophagitis (n = 30). Operative time varied from 34 to 250 minutes (mean [standard deviation], 116 +/- 20). Hospital stay varied from 12 hours to 19 days (mean, 1.2). No patient needed conversion to open operation. Intraoperative complications were observed in 4 patients (5.2%): left pneumothorax in 2, major operative bleeding in 1, and minor spleen lesion in 1. The most common postoperative complications were gas-bloating syndrome and dysphagia. Gastric ulcer was diagnosed in two. Other postoperative complications included acute delirium, acute urinary retention, and acute ischemia of the lower extremity. One patient died of congestive heart failure. It is concluded that laparoscopic fundoplication is an effective procedure for treating geriatric patients with reflux esophagitis and may be performed with low morbidity and mortality rates.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12598750&dopt=Abstract

Ann Allergy Asthma Immunol. 1999 Mar;82(3):311-4.
Thorax high resolution computerized tomography findings in asthmatic children with unusual clinical manifestations.

Nuhoglu Y, Bahceciler N, Yuksel M, Kodalli N, Barlan IB, Yildizeli B, Basaran MM.

Marmara University Hospital, Department of Pediatrics, Istanbul, Turkey.

BACKGROUND: It has been consistently observed in high resolution computerized tomography (HRCT) scans that asthmatic patients manifest more abnormalities related to airways remodeling than do normal subjects. OBJECTIVE: To find the underlying abnormalities in the lungs of asthmatic children with unusual manifestations. METHOD: Asthmatic children not responding as expected to inhaled steroid therapy with or without localized permanent or temporary recurrent auscultation findings (rales) were evaluated with chest radiographs and HRCT scans. Bronchoscopy was performed on the ones with localized rales. RESULTS: The sample consisted of 16 asthmatic children (6 girls and 10 boys, mean age = 7.75+/-4.43 years). Chest radiograph abnormality rate was 44% and the thorax HRCT scan abnormality rate was 75% (56% fibrotic retractions, 38% atelectasis, 19% bronchiectasis, and 19% bronchial wall thickening). Two patients with localized permanent rales and with right middle lobe (RML) atelectasis in HRCT scan underwent bronchoscopy which revealed RML syndrome due to mucus plugging in one and lymph node pressure in the other. In one patient with localized temporary recurrent rales and major bronchiectasis in HRCT scan, bronchoscopy revealed bronchitis. The patient with RML syndrome due to mucus plugging required lobectomy. CONCLUSION: We conclude with this experience that thorax HRCT scanning may be a helpful adjunct in the evaluation of an asthmatic children with atypical clinical findings.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10094224&dopt=Abstract

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