Toxic shock syndrome associated with use of latex nasal packing

Article Abstract:

Toxic shock syndrome (TSS) is a rare, severe disease consisting of fever, rash, skin peeling, low blood pressure, and involvement of several organ systems. TSS is caused by a toxin produced by certain strains of the bacterium Staphylococcus aureus and occurs mostly among menstruating women but has also been found in boys and men. Nonmenstrual TSS (NMTSS) has been associated with superficial S. aureus infections and deep abscesses. It has occurred following nasal surgery and has been associated with the use of absorbent wound packing, just as menstrual TSS has been associated with the use of highly absorbent tampons. A case is reported of a 20-year-old male who developed NMTSS after uncomplicated nasal surgery in which nonabsorbent packing was used. The packing consisted of gauze material packed into a the fingers of a latex surgical glove, so that there was no contact between nasal surfaces and absorbent material. Within two days, the patient suddenly developed fever, diarrhea, vomiting, and prostration, which could not be related to any recent activities or skin infections. The patient was initially seen in the emergency room and had low blood pressure, a rash, and his palms, soles, and mucous membranes showed signs of TSS. The nasal cavity was bloody and reddened, but discharge did not contain pus. Upon admission, the patient was given intravenous antibiotics and fluids plus medication to improve blood pressure and urinary output. Two days later, the patient's palms and soles began to peel, a characteristic of TSS. Infection appeared to be restricted to the nose. The patient was discharged with additional antibiotics and recovered well. The study suggests that local metabolic factors may be more important than the presence of absorbent material in wounds or mucous membranes in allowing growth of toxin-producing S. aureus bacteria. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Surgery, Toxic shock syndrome, Nose

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The association of selected cancers with service in the US military in Vietnam; III. Hodgkin's disease, nasal cancer, nasopharyngeal cancer, and primary liver cancer

Article Abstract:

Concern over the health of American soldiers who served in Vietnam led to a Congressional directive for health studies among Vietnam veterans. Because the incidence of cancers of the greatest concern were found to be low in an initial study, a second study, the Selected Cancers Study, was initiated. This study used different techniques to determine whether the risk of selected rare cancers was increased in these veterans, particularly with reference to exposure to the defoliant Agent Orange. Industrial and agricultural exposure to the herbicides and contaminants in Agent Orange is variably associated with an increased risk for some cancers. This article discusses the incidence of Hodgkin's disease, upper respiratory cancers, and cancer originating in the liver, while two other articles in the December 1990 issue of Archives of Internal Medicine discuss the risk of Non-Hodgkin's lymphoma and soft-tissue cancers in Vietnam veterans. All diagnoses of cancers were confirmed before inclusion in this study. Compared with other veterans and civilians, Vietnam veterans were not found to be at increased risk for the cancers discussed in this report. No subgroups of veterans with particular service experience or duties, including handling Agent Orange, were more likely to develop any of these cancers. The research evidence associating these cancers and exposure to the components of Agent Orange is weak. Because some of these cancers are very rare, this study could not have detected modest increases in risk of the tumors. The results support other studies which found no great elevation of risk for these four cancers in Vietnam veterans. (Consumer Summary produced by Reliance Medical Information, Inc.)

Hodgkin's disease, Risk factors, Vietnamese Conflict, 1961-1975, Liver cancer, Respiratory tract diseases, Vietnam veterans

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Latex and vinyl examination gloves: quality control procedures and implications for health care workers

Article Abstract:

Protective gloves are recommended to protect healthcare workers from contact with contaminated body fluids. As a result of this recommendation, increased use of gloves has caused shortages of gloves to the extent that supplies in some cases have been obtained from unknown sources which did not guarantee quality. Three nurses reported herpesvirus infections on their hands after routine use of gloves during their work in the intensive care (IC) unit. This led to an investigation of the integrity of seven brands of latex and vinyl gloves. The vinyl gloves failed a watertightness test an average of 11.1 percent of the time and latex gloves failed an average of 1.4 percent. The brand used in the IC unit where the nurses became infected failed 28 percent of the time. When the gloves were tested for permeability to the virus, none of the latex gloves failed while 10 of 1,068 vinyl gloves failed. The quality of gloves was extremely variable, a state of affairs which must be improved. Double-gloving may lower dexterity and therefore increase the amount of time spent in contact with infected patients, and is not recommended at this time. Handwashing, which was not previously considered necessary if gloves were worn, is now recommended in light of this problem with the reliability of gloves. Techniques to improve glove testing integrity and manufacturing quality are essential.

Evaluation, Medical personnel, Quality control, Rubber gloves, Gloves (Surgery)

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