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Biomedical subjects

J E Lessenger

Publications and source records attributed to J E Lessenger.

11 recordsLinked to original sources
PubMed1993

A cholinesterase testing program for pesticide applicators.

Illnesses associated with the increased use of cholinesterase-inhibiting pesticides have brought about recommendations for monitoring pesticide applicators. The State of California requires medical supervision; however, the supervision and monitoring guidelines are often incorrectly followed. In this retrospective cohort study, 103 worker-years of cholinesterase monitoring are reported. Twenty-four (24%) workers were temporarily removed from spraying (five were removed twice) because their cholinesterase plasma activity levels were below 60% of baseline. Five workers (5%) had mild symptoms of toxicity but none reported a specific incident of exposure. Hispanic workers had fewer significant drops in plasma activity levels and fewer toxic symptoms than white workers. The relative risk of pesticide poisoning was increased in workers whose initial baseline plasma levels were low or if their levels had already dropped to 60%-80% of their baseline previously in the season. Case studies and differences in baselines by month of determination suggest poor monitoring compliance by the companies and employees. Suggestions of how the physician can overcome these problems and improvements of the guidelines are discussed.

Adolescent↗
PubMed1992

Five office workers inadvertently exposed to cypermethrin.

Five cases of poisoning by cypermethrin, a pyrethroid pesticide, are presented. The chemical was inadvertently introduced to the air-conditioning ducts and the patients inhaled it. Exposed patients experienced shortness of breath, nausea, headaches, and irritability. The exposure was compounded by repeated entry into the contaminated area and slow referral to a physician experienced in pesticide exposures.

Adult↗
PubMed1992

An analysis of 2846 industrial illnesses and injuries seen in a family practice.

We analyzed 2846 industrial illnesses and injuries in 2430 patients seen in a family practice with a large occupational medicine component over a three-and-a-half-year period. Of the 268 medical diagnoses made, back injuries and cumulative trauma disorders to the upper extremities comprised the majority. A large number of pesticide and chemical exposures were also seen. Consultations were obtained in 16.7% of the cases and 61.7% of the cases were closed as resolved. There were 17 patients hospitalized and no deaths. We recommend that family practice residents be trained in the procedures and laws of the workers' compensation system as well as in treating specific occupational health problems.

Adolescent↗
PubMed1991

Neurotoxicities and behavioral changes in a 12-year-old male exposed to dicofol, an organochloride pesticide.

The case of a 12-yr-old male exposed to a substantial amount of dicofol, a DDT analog, is presented. The patient was still contaminated 3 wk after exposure. Blood and fat analysis documented the presence of dicofol. The patient demonstrated subjective and objective evidence of neurological injury, which resolved. Other organ injury was not present. Cognitive and emotional difficulties persisted over an 18-mo period.

Child↗
PubMed1985

Prisoners in the emergency department.

Eight issues in the care of prisoners in the ED have been examined. Close to one-half million persons are incarcerated at any time in the United States, and the numbers can be expected to increase. When seeing prisoners in the ED, the physician must keep in mind two facts: 1) prisoners have a right to medical care; and 2) incarceration demands that certain considerations be made regarding the correctional environment when evaluating, treating and, most importantly, discharging a prisoner back to the cell.

Emergency Medicine↗
PubMed1982

Health care in jails: a unique challenge in medical practice.

Prisoners deserve to be taken seriously and treated with respect by the physician, as does any person seeking medical care. Treatment should include an adequate history and physical examination as well as indicated laboratory tests. Anxiety is a ubiquitous problem in prison life and can adversely affect any medical condition. The diagnosis of malingering is and should be one of exclusion, and the physician should keep in mind that a seemingly healthy prisoner might have several other reasons for seeking medical help. The physician needs to be confident of the diagnosis before returning the person to the cell block, as prisoners do not have freedom of access to medical care. New standards, programs, literature, journals, and conferences have drawn attention to the jail as a place where the physician can intervene in a positive way to decrease the recycling of crime and illness. It is not enough to be able to practice good medicine in a jail. Such practice must recognize the special needs of prisoners and the special problems inherent in the jail environment.

Adult↗
PubMedDate not supplied

Rational use of cholinesterase activity testing in pesticide poisoning.

BACKGROUND: The use of acetylcholinesterase (AChE) activity testing in pesticide poisoning often falls on family physicians when evaluating a suspected poisoning or when monitoring the health of pesticide applicators. METHODS: A review of the literature and consideration of three illustrative cases shows misunderstandings in the pathophysiology of the enzyme and in procedures for effective testing and monitoring of AChE levels. RESULTS AND CONCLUSIONS: The physiologic characteristics of acetylcholine neurotransmission are described and related to carbamate and organophosphate poisoning. Pre-exposure monitoring is described using the California plan. A 23 percent variance in AChE levels exists among normal patients. It is necessary, therefore, to establish baseline levels to overcome individual variance. The practice of measuring of AChE levels in acute poisoning is limited. In employees who have been monitored and for whom baseline AChE levels have been established, a diagnosis of poisoning can be made by comparing postexposure AChE levels with baseline levels. If there is no baseline level recorded, and if the offending chemical is in question, the clinician must base treatment on the clinical signs and symptoms.

Adult↗
PubMedDate not supplied

Occupational acute anaphylactic reaction to assault by perfume spray in the face.

BACKGROUND: Perfumes have been associated with rashes in employees exposed to scented soaps or with allergic conditions, such as rhinitis or asthma, in employees exposed to perfumes or fragrances in the air. METHODS: Reported here is a case of an anaphylactic reaction and respiratory distress as a result of a deliberate assault with a perfume spray. The medical literature was searched using the key words "fragrances," "respiratory distress," "assault," and "health care workers." RESULTS: A female medical assistant with no history of asthma or reactions to fragrances was assaulted by a patient, who pumped three sprays of a perfume into her face. The employee experienced an acute anaphylactic reaction with shortness of breath, a suffocating sensation, wheezes, and generalized urticaria, and required aggressive medical treatment, a long period of oral bronchodilator therapy, and, finally, weaning from the medications. CONCLUSIONS: Perfumes are complex mixtures of more than 4,000 vegetable and animal extracts and organic and nonorganic compounds. Fragrances have been found to cause exacerbations of symptoms and airway obstruction in asthmatic patients, including chest tightening and wheezing, and are a common cause of cosmetic allergic contact dermatitis. In many work settings the use of fragrances is limited. Assault is becoming more common among workers in the health care setting. Workers should be prepared to take immediate steps should an employee go into anaphylactic shock.

Adult↗
PubMedDate not supplied

An analysis of 190 cases of suspected pesticide illness.

BACKGROUND: The diagnosis of mild to moderate pesticide exposure presents a challenge because the signs and symptoms of exposure are similar to those of many other diseases. We reviewed all alleged pesticide injuries seen in a single office during a 6-year period to determine which findings were useful in discriminating between a pesticide-related illness and other causes. METHODS: We reviewed retrospectively the charts of 190 patients alleging pesticide illness who were treated in a standardized manner. RESULTS: One hundred sixteen (116) patients (61.1 percent) were found to have pesticide illness. Important predictors of pesticide illness were anxiety, vertigo, nausea, vomiting, tearing, and weakness. Seventy-four patients (38.9 percent) were found to have nonpesticide-related illness, with nonspecific irritant contact dermatitis and scabies the most common diagnoses. Rash was the only significant predictor of nonpesticide related illness. CONCLUSIONS: It is difficult to relate signs and symptoms to pesticide poisoning, and exposure history is very important. Alternative diagnoses need to be considered. Laboratory tests are not nearly as valuable as many might expect, and skin rash is not a common finding in mild to moderate pesticide poisoning.

Adolescent↗
PubMedDate not supplied

The pesticide-exposed worker: an approach to the office evaluation.

BACKGROUND: Pesticide exposures have clinical, epidemiological, legal, and political ramifications that go beyond the confines of a physician's office. The examination of the employee who has been exposed to a pesticide should be undertaken in an organized and methodical manner so that specific questions of causality can be answered and treatment can be initiated. METHODS: Five representative case studies illustrate different circumstances in which a pesticide injury can be seen in the office setting. RESULTS AND CONCLUSIONS: A wide range of pesticides is used in business and home, and the dangers of misdiagnosis, maldiagnosis, underdiagnosis, and overdiagnosis are especially common given the variety of chemicals used. The exposed employee must be removed from the source of exposure. Complete decontamination is a primary concern, and patients with unstable vital signs will need to be hospitalized. A methodical office examination, however, can be carried out on many exposed employees. A detailed description of the circumstances of the exposure should be elicited, and the chemical implicated in the exposure should be researched. A pesticide exposure is a sentinel event in the life of a patient and also suggests that other employees can be exposed. Such an exposure needs to be carefully assessed and documented, and proper treatment must be rendered. Further, the exposure can represent the first of many other exposures that might or might not be reported. Proper notification of authorities can limit exposures before they become severe.

Adult↗