Poisoning mortality, 1985-1995

Poisoning was reported as the underlying cause of death for 18,549 people in the United States in 1995 and was ranked as the third leading cause of injury mortality, following deaths from motor vehicle traffic injuries and firearm injuries. Poisoning was the leading cause of injury death for people ages 35 to 44 years. Poisoning death rates were higher in 1995 than in any previous year since at least 1979. From 1990 to 1995, the age-adjusted rate of death from poisoning increased 25%; all of the increase was associated with drugs. About three-fourths of poisoning deaths (77%) in 1995 were caused by drugs. The age-adjusted rate of drug-related poisoning deaths for males (7.2 per 100,000) in 1995 was more than twice that for females (3.0 per 100,000). From 1985 to 1995, poisoning death rates for males ages 35-54 years nearly doubled to 20.4 per 100,000, and the drug-related poisoning death rate for males ages 35-54 years nearly tripled, reaching 16.1 per 100,000. From 1990 to 1995, death rates associated with opiates and cocaine more than doubled among males ages 35-54 years. The numbers of opiate and cocaine poisoning deaths for 1995 more than doubled when all multiple cause of death codes were examined instead of only the underlying cause of death codes.     

Listeriosis 1985-1995: microbiologic and epidemiologic aspects

Listeriosis is an emerging foodborne infection caused by L. monocytogenes (L. m.), mainly identified in industrialized countries. It is a severe disease (meningitis, septicaemia, abortion) which preferentially affects individuals whose immune system is perturbed (pregnant women, newborns, immunocompromized patients and the elderly). Epidemiology is characterized by a background of sporadic cases on which may be surimposed outbreaks. Progresses in microbiology during the last decade (detection and typing of L. m., better understanding of L.m. ecology...) and epidemiological investigations (increased use of case-control studies) demonstrated that all kind of foods, at each step of the food chain, can transmit the disease. In many respects, L.m. differs from most recognized foodborne pathogens: it is ubiquitously present in nature, resistant to various kind of environments, microaerophilic and psychrophilic. Its tenacity in industrial environment and its capability to survive in food over extended period of time under adverse conditions made this bacterium the hottest topic for industrials during the last decade.     

HMO market structure and performance: 1985-1995

This paper estimates the effect of market structure on hospital days and ambulatory visits in independent practice associations (IPAs) and group-model health maintenance organizations (HMOs) where market structure is measured by HMO penetration and the number of HMOs operating in a market. There was a steady decline in inpatient use in HMOs during the study period and a steady increase in use of ambulatory care. In multivariate analyses, inpatient use is significantly higher in IPAs, but there is no difference in ambulatory use. As HMO penetration increases and the number of HMOs increases, group-model HMOs have lower hospital use and greater ambulatory use. In contrast, use of both inpatient and ambulatory care decreases in IPAs but only at high levels of penetration and numbers of competitors.     

Hysterectomy trends in Finland in 1987-1995--a register based analysis

BACKGROUND: The study objective was to identify trends in the use of hysterectomy by nationwide register based analysis in Finland. METHODS: All women (n=89,069) undergoing hysterectomy in 1987-1995 according to the Finnish Hospital Discharge Register were the numerator. The annual denominator data were obtained from the population database of Statistics Finland. RESULTS: From 1987 to 1992 the hysterectomy rate increased by 22%, from 340 to 414 per 100,000 females, almost half of this being attributable to the changing age structure. From 1993 on, ambiguity in coding laparoscopically assisted vaginal hysterectomies prohibited detailed analyses. However, the overall trend continued at least among women 50 years and over until 1995. The age-adjusted 12% increase from 1987 to 1992 coincided with a rapid increase in operation rates in postmenopausal groups (60% or more among women aged 55 59 and 70-79 years). Among women aged 55-64 years, operations for fibroids and uterine bleeding more than doubled, suggesting an influence of increased use of estrogen replacement therapy. Among all women, operations due to bleeding disorders and genital prolapse showed the largest increase (41% and 42% respectively). Bilateral oophorectomy became more common in all age groups over 46 years. CONCLUSIONS: There was a modest increase in the overall hysterectomy rate. However, the operation became far more common in postmenopausal women, possibly due to the growing use of estrogen replacement therapy. Register data can be used for describing changes in clinical practice, but other methods are needed to confirm the causal relationships underlying the changes.     

Fine needle aspiration biopsy of salivary gland, 1985-1995

Cellular insulin resistance in polycystic ovary syndrome (PCOS) has been shown to involve a novel postbinding defect in insulin signal transduction. To find possible mechanisms for this defect, adipocytes were isolated from age- and weight-matched obese normal cycling (NC) and PCOS subjects. Insulin sensitivity for glucose transport stimulation was impaired in PCOS adipocytes (EC50 = 290 +/- 42 pmol/L) compared to that in NC cells (93 +/- 14; P < 0.005). The lipolytic responses to isoproterenol as well as maximal suppression by insulin were similar in NC and PCOS adipocytes. However, PCOS cells were less sensitive to the antilipolytic effect of insulin (EC50 = 115 +/- 33 pmol/L) compared to NC cells (42 +/- 8; P < 0.01). Treatment of adipocytes from NC subjects with the adenosine receptor agonist N6-phenylisopropyl adenosine had no effect on either insulin responsiveness or sensitivity for glucose transport stimulation. However, N6-phenylisopropyl adenosine treatment was able to normalize insulin sensitivity in PCOS cells (EC50 = 285 +/- 47 vs. 70 +/- 15 pmol/L, before and after treatment; P < 0.05). In conclusion, our results suggest that insulin resistance in PCOS, as accessed in the adipocyte, occurs at an early step in insulin signaling that is common for glucose transport and lipolysis. In addition, this insulin resistance involves an impairment of the system by which adenosine acts to modulate insulin signal transduction.     

Experience with the Br?nemark implant system: 1985-1995

The osseo-integrated dental implant programme started at the University of the Witwatersrand, Johannesburg in 1985. This retrospective study describes the experience gained in the Division of Maxillofacial and Oral Surgery and the Department of Prosthetic Dentistry with the Br?nemark implant system. The numbers of fixtures placed, the types of prostheses prescribed and the surgical and prosthodontic successes and problems are described. The results of implant treatment have improved, and follow a marked learning curve.     

Smoking status and relative weight by educational level in Finland, 1978-1995

Nasal administration of soluble antigens is an exciting means of specifically down-regulating pathogenic T-cell reactivities in autoimmune diseases. The mechanisms by which nasal administration of soluble antigens suppresses autoimmunity are poorly understood. To define further the principles of nasal tolerance induction, we studied the effects of nasal administration of myelin basic protein (MBP) on experimental autoimmune encephalomyelitis (EAE) in the Lewis rat. EAE is a CD4+ T-cell-mediated animal model for human multiple sclerosis. Nasal administration of guinea-pig (gp)-MBP at a dose as low as 30 micrograms/rat can completely prevent gp-MBP-induced EAE, whereas nasal administration of bovine (b)-MBP is not effective even at a much higher dosage. Cellular immune responses, as reflected by T-cell proliferation and interferon-gamma (IFN-gamma)-ELISPOT, were suppressed in rats receiving the two different doses (30 and 600 micrograms/rat) of gp-MBP, but not after administration of b-MBP. Rats tolerized with both doses of gp-MBP had also abrogated MBP-induced IFN-gamma mRNA expression in popliteal and inguinal lymph node mononuclear cells compared with rats receiving phosphate-buffered saline nasally. However, adoptive transfer revealed that only spleen mononuclear cells from rats pretreated with a low dose, but not from those pretreated with a high dose, of gp-MBP transferred protection to actively induced EAE. Low-dose (30 micrograms/rat) gp-MBP-tolerized rats also had high numbers of interleukin-4 (IL-4) mRNA-expressing lymph node cells, while high-dose (600 micrograms/rat) gp-MBP-tolerized rats had low numbers of IL-4 mRNA-expressing lymph node cells. Our data suggest an exquisite specificity of nasal tolerance. Dose-dependent mechanisms also relate to nasal tolerance induction and protection against EAE in the Lewis rat.     

Heart surgery in Austria 1995

The European Heart Institute of the European Academy of Sciences and Arts compiles every year since 1990 an annual survey on open heart surgery, PTCA and heart catheterization. Those interventions are on the top of the parameter of cardiac care. These numbers can be used as an outside revision of a country. Within Europe enormous gaps are between incidences in open heart surgery and PTCA. Germany, Austria and Switzerland are in the upper area whereby Germany and Switzerland have near 1,000 operations per million inhabitants. Within the next years, there is a continuous increase in revascularisation by 10% to be expected as well in bypass-surgery and in PTCA. A specific impact is arising in stenting with 30% to 50% at PTCA cases.     

Trend analysis of dental expenditures by selected dentist and practice characteristics, 1985-1995

Using the reported gross billings from the annual ADA "Survey of Dental Practice," the authors estimated the total national dental expenditures according to various dentist characteristics for the period of 1985-1995. These selected characteristics are specialty, office time, number of dentists in the practice, sex, length of experience and U.S. region. As government agencies do not report dental expenditures by such dentist characteristics, the data presented in this article may be the first of their kind to be estimated and published.     

Postcastration eventration in 18 horses: the prognostic indicators for long-term survival (1985-1995)

Castration of horses is considered a common and routine surgical procedure, but the potential for complications is high. By far the most serious of these is eventration. The objectives of this study were to determine the long-term survival of horses undergoing surgical treatment of indirect (1) inguinal eventration of the small intestine following castration, and to identify prognostic indicators for survival. The case records of 18 horses undergoing surgical treatment of postcastration eventration (PCE) between 1985 and 1995 were reviewed. Follow-up information was obtained by telephone interviews 2 to 13 y postoperatively. A Cox proportional hazard regression model was fitted to determine which clinical features were of significant influence to survival. Clinical features with a significant negative influence on survival were an inguinal surgical approach for correction, an increased length of prolapsed bowel, and performance of bowel resection and anastomosis. Significant postoperative complications developed in 89% of cases; 44% of cases in the "inguinal" surgical approach group developed peritonitis, compared with 10% in the "midline" approach group. Of all horses in this study, 72% were discharged from the hospital; however, only 40% of horses in the inguinal approach group were discharged. The long term survival rate (> 1 y) for all horses in this study was 44%, with a median survival time of 3-1/2 mo.     

Endocrinology 1995-1996

In a brief review of advances in endocrinology in the last two years the author discusses above all the vain expectations of a drug against obesity-the adipose tissue hormone leptin. Its elevated blood level in human obesity indicates that its secretion depends on the mass of adipose tissue and it is not certain whether leptin reduces the food intake in humans. Perhaps resistance to leptin is involved. New receptor diseases were revealed: mutation of LH receptors leads in both sexes to hypogonadism. Mutation of the calcium receptor in parathyroid cells leads to familial hypocalciuric hypercalcaemia or autosomal dominant hypocalcaemia. The complex regulation of the tonus of the vascular wall by endothelins is still the object of interest. Aquaporin is a renal protein which mediates the action of vasopressin. In the sphere of stress evidence is emerging on the participation of CRH in brain activity and the possibility to influence autoimmune inflammations and perhaps even AIDS by interference with the CRH-proopiomelanocortin-ACTH-cortisol system.     

Knee arthroplasty in rheumatoid arthritis. A report from the Swedish Knee Arthroplasty Register on 4,381 primary operations 1985-1995

The aim of this study was to determine whether the use of an ileal Roux limb, rather than a jejunal Roux limb, would prevent the Roux stasis syndrome that can occur after Roux gastrectomy. An ileal Roux limb was constructed in eight dogs and anastomosed to the gastric remnant after distal hemigastrectomy. Flow of chyme through the jejunum was preserved via an ileojejunostomy and a jejunoileostomy. Six dogs with distal gastrectomy and a conventional Roux gastrojejunostomy served as a control group. Chronic enteric recording electrodes and intraluminal, open-tipped pressure catheters were implanted in all dogs. After recovery, the electrical activity and motility of the Roux limbs and the rates of gastric emptying of liquids and solids were measured. Dogs with a Roux gastroileostomy had a slower frequency of pacesetter potentials in the Roux limb, a greater Roux motility index, and a faster rate of gastric emptying of liquids and solids than did dogs with a Roux gastrojejunostomy. Stomal ulcers, however, developed in seven of the eight ileal Roux limbs but in none of the jejunal Roux limbs. It was concluded that Roux gastroileostomy does ameliorate the Roux stasis syndrome, but there is a greater risk of stomal ulceration in the limb.     

Heart transplantation in patients with diabetic end-organ damage before transplantation

Diabetes mellitus with preexisting end-organ damage (EOD) is considered a contraindication for heart transplantation. The outcome of such patients has not been well characterized. Among 138 patients transplanted between 12/88 and 7/94, 29 were diabetic (11 insulin-dependent); of these, 12 had preexisting EOD, defined as a creatinine clearance < or = 50 ml/min, a 24-hour urine protein concentration > or = 500 mg/L or typical symptoms of peripheral or autonomic polyneuropathy, and 17 had no EOD. We compared diabetics with and without EOD and non-diabetics (n = 109) for operative mortality, length of stay, serum creatinine, fasting glucose levels, and postoperative prednisone doses at 1,6, and 12 months. Actuarial survival and freedom from rejection and infection were analyzed. Both diabetic groups were significantly older than nondiabetics, Ischemic time, operative mortality, surgical technique, ICU- and total length of stay were similar. Actuarial survival and freedom from rejection were similar among the three groups. Infection rates including CMV did not differ. Serum creatinine levels increased in all groups compared to pretransplant levels (p = 0.001), but without significant differences among the groups. Post-transplant glucose levels at 6 and 12 months were higher for diabetic patients with EOD than for those without or for nondiabetics (183, 153, and 94 mg/dl at 6 months, p = 0.01; 202, 161, and 102 mg/dl at 12 months, p = 0.0001). Prednisone dosage was lower in diabetics with EOD at 6 months, but did not differ among the three groups at 12 months. The incidence of angiographically proven transplant vasculopathy did not differ at 1 and 2 years. Diabetics with preexisting EOD undergoing heart transplantation experience similar short- and intermediate-term results when compared to diabetics without EOD and nondiabetics. Metabolic control is more difficult to achieve, as indicated by higher fasting glucose levels. Larger and longer-term prospective studies have to confirm our findings, since the shortage of donor organs would increase if such patients were transplanted routinely.     

Eye banking in Europe 1991-1995

Variations in specific activities of the marker enzymes of Sertoli and germ cells during breeding (November-December) and non-breeding (May-June) seasons were investigated in rhesus and bonnet monkeys maintained under laboratory conditions. The marker enzymes selected for testicular cells were-Sertoli cells: beta-glucuronidase, gamma-glutamyl transpeptidase; pre-meiotic germ cells: glucose 6-phosphate dehydrogenase, malate dehydrogenase, alpha-glycerophosphate dehydrogenase; mature germ cells: LDH-X, sorbitol dehydrogenase. Results have indicated significant seasonal variation in marker enzymes only in rhesus testis. Marker enzymes of Sertoli cell increased while those of germ cell decreased significantly during non-breeding season. Marker enzymes of mature germ cells were affected much more drastically than those of the pre-meiotic germ cells.     

Bottle injuries in Denmark 1991-1995

In the period from 1991-95, 1843 injuries caused by bottles were reported to the Danish EHLASS register, the latter representing 14.2% of the total number of patients seen in the Emergency Room in Denmark. The reports were classified as sharp or blunt injuries; age, sex, and body localisation were registered, and the injuries were grouped into eight body localisations. Hand injuries made up largest group (62%), and of these 92% were sharp injuries. The rest of the injuries (38%) were spread over the other zones, each representing 3-11%. Among the injuries there was a significant overrepresentation of males and young people between 10-24 years of age. Nearly 30% of the injuries were associated with a fall. We estimate that the total number of injuries caused by bottles was 2596/year, and that the incidence rate was 4.98/10,000 person years.     

Increasing number and incidence of fall-induced severe head injuries in older adults: nationwide statistics in Finland in 1970-1995 and prediction for the future

RATIONALE AND OBJECTIVES: Tumor volume is an important parameter for clinical decision making. At present, semiautomatic image segmentation is not a standard for tumor volumetry. The aim of this work was to investigate the usability of semiautomatic algorithms for tumor volume determination. METHODS: Semiautomatic region- and volume-growing, isocontour, snakes, hierarchical, and histogram-based segmentation algorithms were tested for accuracy, contour variability, and time performance. The test were performed on a newly developed organic phantom for the simulation of a human liver and liver metastases. The real tumor volumes were measured by water displacement. These measured volumes were used as the gold standard for determining the accuracy of the algorithms. RESULTS: Variability of the segmented volumes ranging from 3.9 +/- 3.2% (isocontour algorithm) to 11.5 +/- 13.9% (hierarchical segmentation) was observed. The segmentation time per slice varied between 32 (volume-growing) and 72 seconds (snakes) on an IBM/RS6000 workstation. CONCLUSIONS: Only the region-growing and isocontour algorithms have the potential to be used for tumor volumetry. However, further improvements of these algorithms are necessary before they can be placed into clinical use.