No abstract

The report of a clinical study of 104 electrical accidents which befell 85 men is divided into two parts.Part I enumerates the different types of accidents as flash burn, Joule burn, arc eye, "held on" shock and "not held" shock, physical shock, and death. These are related to the different voltages involved ranging from 240/415 (medium) voltage to 33 kilovolts. There appeared to be no association between voltage and type of injury and no evidence to suggest that any of the voltages are free from hazard. There were 53 cases of flash burn, affecting mostly the face and extensor surface of the hands and arms. The 16 cases of arc eye caused no serious concern. Of the 15 Joule burns all except one occurred at medium voltages in "held on" accidents, the other being associated with an electric shock at 33 kilovolts. The majority of Joule burns affected the flexor surfaces.Part II of the paper deals with the 43 cases of electric shock (passage of current through the body). Thirty of these cases were "held on" to the circuit by the current. It was found that the longer a victim was held on to the circuit the greater appeared to be his chances of developing heart and chest symptoms suggestive of impending asphyxia, and of losing consciousness. Although about half of these men were released by an external agmncy and others struggled off, a number suddenly became free from the circuit without, they claimed, losing consciousness. This is difficult to explain. Artificial respiration was administered in two cases, one of whom was "held on" and was being asphyxiated. The other case received flash burns only and did not in fact receive an electric shock. PART I: GENERAL REVIEW AND NON-SHOCK CASESElectrical accidents receive little attention in British medical literature. In fact, in the electricity supply industry they account for only 1 % of the total number of accidents but they are the commonest cause of accidental death (Hughes and Corney, 1956). In factories, electrical accidents account for less than 0-5 % of all accidents, but more than 5% of these electrical accidents prove fatal (Emerson, 1961). This paper reports a clinical investigation into a series of electrical accidents; detailed consideration of the cases of electric shock (passage of current through the body) is given in Part II of this paper. MethodThe names of all men in an electricity supply undertaking who had sustained an electrical accident during the preceding three years were obtained. Of the total of 114, 107 were still employed by the undertaking. One man was killed; the remainder were contacted and 84 attended for interview. (The majority of those who were not seen worked in one small area and there is no reason to suppose that the nature of their accidents was any different from the whole.) They were all seen by one investigator and were questioned about the electrical and physical circumstances of the accident, about symptoms, and about subsequent medical history.

To identify potential risk factors and the yield of routine screens for early detection of malignancy associated with dermatomyositis (DM) and polymyositis (PM). Design: Retrospective study of malignancies in all patients with DM or PM followed up between the years 1981 and 2000 and a review of the relationship of DM and PM to malignancy, the usefulness of various tests or examinations for malignancy search, and the patients' course. Setting: Departments of internal medicine and dermatology in a teaching hospital. Patients: Forty consecutive adult patients with DM (33 cases) or PM (7 cases). Main Outcome Measures: (1) Rate of false-negative results of routine workup and yield (percentage of positive results) of blind malignancy search and (2) comparison of 16 characteristics in patients with malignancy vs those without. Results: Malignancy occurred in 16 patients: 13 with DM and 3 with PM. In all cases, the diagnosis of malignancy was made concurrently with or shortly after the diagnosis of DM or PM. Factors associated with malignancy were recruitment in the internal medicine department (P=.02), constitutional symptoms (PϽ.01), a rapid onset of DM or PM (P=.02), the lack of Raynaud phenomenon (PϽ .01), and a higher mean erythrocyte sedimentation rate (PϽ.01) and creatine kinase level (PϽ.01). Initial routine search failed to discover 4 malignancies, 3 of which were discovered at an advanced stage by more extensive investigations. The positive result yield of blind malignancy search was only 13% (11 of 87), but reached 28% (5 of 18) for blind abdominal-pelvic and thoracic computed tomographic scans. Conclusion: Extensive search for malignancy, particularly computed tomographic scans, may be warranted in at least a subset of patients with DM or PM and risk factors of malignancy.

The impact of ribavirin exposure on sustained virological response (SVR) in patients with chronic hepatitis C is unknown. Preliminary studies showed marked inter-individual variability of ribavirin concentrations despite dose adjustment for body weight (BW) and suggested there was a correlation between single time point concentrations and SVR. None of them evaluated the global exposure to ribavirin. This study was conducted to determine whether early ribavirin global exposure is related with SVR. An exploratory pharmacokinetic-pharmacodynamic (PK-PD) study was conducted in genotype 1 hepatitis C patients treated with peginterferon alfa-2a and ribavirin (dose-adjusted for BW) for 12 weeks, to which amantadine was added for the following 36 weeks. 03). Patients with D0AUCs above the cut-off values defined by receiver operating characteristic curves (3014 g/hour/L and 1755 g/hour/L for AUC 0-12h and AUC 0-4h , respectively) had a significantly better chance of achieving an SVR than patients with AUCs under the thresholds (odds ratio ‫؍‬ 16.0, 95% confidence interval 1.54-166.6, P ‫؍‬ 0.02 and odds ratio ‫؍‬ 8.9, 95% confidence interval, 1.4-56.6; P ‫؍‬ 0.02). Conclusion: Ribavirin exposure at D0 is significantly related to SVR. To our knowledge, this is the first study to give an early pharmacokinetic predictor of SVR. We propose a minimum AUC 0-4h threshold of 1755 g/hour/L at D0 as a target for ribavirin dose adjustment.