Feasibility study of bilateral radical ethmoidectomy in ambulatory surgery

OBJECTIVES

To assess the feasibility of bilateral radical ethmoidectomy in ambulatory surgery by risk analysis, and to calculate possible medico-economic savings.

METHODS

This study was performed retrospectively over a 2-year period and prospectively for 1 year. It included all patients undergoing bilateral ethmoidectomy, associated to sphenoidotomy and/or septoplasty or not, in a university hospital department. Data were collected on demographics, disease etiology, previous surgery, operative details, postoperative course, complications and satisfaction assessed by questionnaire at days 1 and 30. Ambulatory surgery eligibility criteria were applied to this population, and an economic analysis compared savings between inpatient and outpatient management.

RESULTS

Hundred and sixty-five patients were included. Surgical indications comprised nasal polyposis (87%), chronic sinusitis without nasal polyps (6%) or cystic fibrosis (7%). Seventy-five septoplasties were associated (45.5%). Operating time depended on associated septoplasty (P=0.005), surgeon experience (P<0.0001) and previous sinus surgery (P=0.041). Only 37% of the patients wished for same-day discharge; reasons for refusal were home-to-hospital distance and bleeding risk. Considering anesthesia contraindications, immediate complications and operating time, 107 patients were eligible for outpatient treatment, although only 13 patients underwent ambulatory surgery. Medical-economic savings with outpatient management would have been about €20,000 per year.

CONCLUSIONS

Bilateral radical ethmoidectomy, associated to septoplasty or not, could be performed on an outpatient basis in more than 60% of cases, without increased risk, and with cost savings of 28.4%.

Short-term health effects in the general population following a major train accident with acrylonitrile in Belgium

BACKGROUND

Following a train derailment, several tons of acrylonitrile (ACN) exploded, inflamed and part of the ACN ended up in the sewage system of the village of Wetteren. More than 2000 residents living in the close vicinity of the accident and along the sewage system were evacuated. A human biomonitoring study of the adduct N-2-cyanoethylvaline (CEV) was carried out days 14-21 after the accident.

OBJECTIVES

(1) To describe the short-term health effects that were reported by the evacuated residents following the train accident, and (2) to explore the association between the CEV concentrations, extrapolated at the time of the accident, and the self-reported short-term health effects.

METHODS

Short-term health effects were reported in a questionnaire (n=191). An omnibus test of independence was used to investigate the association between the CEV concentrations and the symptoms. Dose-response relationships were quantified by Generalized Additive Models (GAMs).

RESULTS

The most frequently reported symptoms were local symptoms of irritation. In non-smokers, dose-dependency was observed between the CEV levels and the self-reporting of irritation (p=0.007) and nausea (p=0.007). Almost all non-smokers with CEV concentrations above 100pmol/g globin reported irritation symptoms. Both absence and presence of symptoms was reported by non-smokers with CEV concentrations below the reference value and up to 10 times the reference value. Residents who visited the emergency services reported more symptoms. This trend was seen for the whole range of CEV concentrations, and thus independently of the dose.

DISCUSSION AND CONCLUSION

The present study is one of the first to relate exposure levels to a chemical released during a chemical incident to short-term (self-reported) health effects. A dose-response relation was observed between the CEV concentrations and the reporting of short-term health effects in the non-smokers. Overall, the value of self-reported symptoms to assess exposure showed to be limited. The results of this study confirm that a critical view should be taken when considering self-reported health complaints and that ideally biomarkers are monitored to allow an objective assessment of exposure.

Gender dependent accumulation of dioxins in smokers

AIMS

To evaluate the contribution of tobacco smoking to dioxin accumulation.

METHODS

Dioxin (17 PCDD/F) concentrations in fasting blood from 251 subjects (161 never smokers, 54 past smokers, and 36 current smokers) were quantified.

RESULTS

Whereas serum dioxin concentrations of male smokers were on average 40% higher than those of non-smokers, in women, smoking was associated with significantly lower serum dioxin levels. A synergistic potentiation of dioxin metabolism by tobacco smoke in women is postulated to explain these paradoxical findings.

CONCLUSIONS

Current smoking is associated with gender dependent effects on dioxin body burden and is a potential source of confounding in human studies using blood dioxins as indicators of exposure.

The Belgian PCB/dioxin incident: a critical review of health risks evaluations

The Belgian PCB/dioxin incident is a food contamination that occurred in Belgium in January 1999 when a tank of recycled fats used to produce animal feeds was accidentally contaminated by approximately 100 L of polychlorinated biphenyl (PCB) oil containing 50 kg PCBs expressed as the sum of the seven markers, 1 g (TEQ) dioxins (PCDD/Fs) and 2 g toxic equivalent (TEQ) dioxin-like PCBs. The incident was discovered when a poultry poisoning resembling the classic chick edema disease broke out in several farms that had received contaminated feeds. The delay in making public this incident resulted in a major political and food crisis and caused much concern in the population. We review here the health risk evaluations that were made after this incident and we assess the likelihood of the different scenarios by taking into account recent data on the real scale of the contamination and on the dioxin body burden of the general population in Belgium. These new data confirm that the incident was too limited in time and in scale to have increased the PCB/dioxin body burden of the general population at large, a conclusion supported by a survey of dioxin levels in blood conducted at the end of 1999. Only farmers in poultry farms affected by the incident (about 30 farms) and having regularly consumed their own products could have increased their PCB/dioxin body burden. It is unlikely, however, that these farmers could have increased their PCB/dioxin body burden above levels prevailing in the 1980s or now found in communities regularly consuming seafood.