Objectives-Sewer workers are used to unpleasant smells, but may be required to investigate unusual ones. Twenty six men were involved in investigation of episodes of such a smell after neighbourhood complaints over several weeks. Methods-Workers exposed to the smell were investigated by clinical follow up, lung function tests, and measurement of pituitary function. Results-14 of the 26 developed subacute symptoms including sore throat, cough, chest tightness, breathlessness, thirst, sweating, irritability, and loss of libido. Severity of symptoms seemed to be dose related. Minor symptoms resolved over several weeks but those more seriously affected have shown deteriorating respiratory symptoms and lung function and remain unable to work a year after the incident. In one, evidence of mild cranial diabetes insipidus was found. Analysis of gas from the sewer showed the presence of a mixture of thiols and sulphides, known to be highly odorous and not normally found in sewers. The source remains unknown. Conclusions-Several of these men seem to have developed delayed airways disease and disturbances of hypothalamic fimction. Such an outcome has not to our knowledge been described before. Despite the presence of the smell, standard safety gas detection equipment used to ensure the sewer was safe to enter failed to indicate the presence of a hazard. Protection against such incidents can only be provided by the use of positive pressure breathing apparatus. (Occup Environ Med 1997;54:277-280)
management. Goodman & Kruskal's l was used to determine whether the diagnosis and management of splenic and liver complications could be predicted by practice level, previous training and annual PCNL volume.RESULTS: A total of 323/2000 members began the survey (response rate 16%), with a completion rate of 89% (n[288). Respondents were mostly academic (59%), from North America (36%) or Europe (16%) & had 10þ years of independent practice (63%). About 40% performed 20-60 PCNLs per year, while 26% did <20 per year. In terms of training, only 42% had done fellowship training in PCNL, while almost half (43%) of respondents reported no formal PCNL courses or training. When asked about injuries at their institution over the past 15 years, respondents recalled 36 splenic, 39 liver & 133 colonic injuries. Current practice level was predictive of splenic injury management & time of diagnosis (p<0.05), while number of PCNLs performed per year was predictive of diagnosis & management of all three injuries (p<0.05). Interestingly, the most common complication (colonic injury) was more appropriately managed by fellowship trained urologists, 27.3% vs. 13.9% (p<0.05). CONCLUSIONS: As PCNL becomes more common worldwide, urologists must appropriately recognize & manage potentially fatal complications. Our results show that experience and formal training lead to improved recognition and management of visceral complications during PCNL. As volume during post-graduate training continue to decrease, formal endourology training might be necessary for safe PCNL practices.
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