Dennis J. Bregman

Public Health Service Study on Reye's Syndrome and Medications Report of the Pilot Phase

Between February and May 1984, we conducted a pilot study to examine the methods for a larger study of a previously reported relation between Reyes syndrome and medications. Thirty patients with Reyes syndrome, whose diagnosis was confirmed by an expert panel, and 145 controls were matched for age, race (black or not black), and antecedent illness (respiratory infection, chickenpox, or diarrhea) and selected from the same hospital, emergency room, or school, or identified by random digit dialing. Significantly more cases (93 per cent, 28 of 30) than members of each of the four control groups or all controls combined (46 per cent, 66 of 145) had received salicylates during matched antecedent illnesses (odds ratio of all 30 cases vs. all controls = 16.1; lower 95 per cent confidence limit = 4.6). The prevalence and mean severity score of signs, symptoms, and selected events during the antecedent illness tended to be lower among cases than controls. Thus, differences in the severity of this illness between cases and controls did not explain differences in medication exposures. This pilot study suggests an association between Reyes syndrome and the use of salicylates during an antecedent illness.

Injuries from the Wichita Falls Tornado: Implications for Prevention

We examined the circumstances of death and injury among victims of the tornado that struck Wichita Falls, Texas, on 10 April 1979. We also assessed the protective measures taken by a representative sample of community residents who suffered no major injury in order to estimate the relative risk of injury to people directly in the tornados path. Twenty-six (60 percent) of the 43 traumatic deaths and 30 (51 percent) of the 59 serious injuries occurred in people who, despite ample warning, went to their cars to drive out of the storms path. These people had a risk of serious or fatal injury of 23 per 1000. People who remained indoors and in stationary homes were at relatively low risk (3 per 1000) if they took simple precautions; people in mobile homes were at greatest risk (85 per 1000). Current safety recommendations and housing codes for single family homes and mobile homes need to be amended to decrease the impact of future tornadoes on human health.

Fatal Guillain‐Barré syndrome after the national influenza immunization program

Fifty-eight fatal cases of Guillain-Barré syndrome (GBS) were reported during the 1976 to 1977 National Influenza Program: Thirty-two (58%) of these patients had received the A/New Jersey influenza vaccine. The mean interval from vaccination to onset was 3.9 weeks, and the incidence of preceding illness in vaccinated or unvaccinated patients was similar. Fifty-eight percent had at least one chronic disease before onset. The clinical features were similar in vaccinated and unvaccinated patients. Most deaths followed medical complications of respiratory paralysis: Fifteen had pneumonia, 29 (83%) died suuddenly, 15 had sudden arrhythmias or hypotension, and 7 had myocardial infarction or pulmonary embolus.

Comparative Efficacy of Injectable Calcium and Magnesium Salts in the Therapy of Hydrofluoric Acid Burns

Hydrofluoric acid (HF) causes severe skin burns which often progress in severity despite physiologic neutralization. The currently accepted therapy is the subcutaneous injection of calcium (Ca) gluconate to precipitate the residual free fluoride ion. Magnesium (Mg) also forms an insoluble fluoride salt and is less tissue irritating than Ca. This study compared the effects of subcutaneous injection of saline, Ca gluconate, Mg acetate (MgAc), and Mg sulfate (MgSO4) on lesions resulting from HF burns in rats. Burns treated with either Mg compound healed 3.7 +/- 1.7 days faster (p less than 0.05) developed less severe lesions (p less than 0.01) and exhibited left untreated or treated with saline. There was no difference in the incidence of infection between the study groups. The effects of burns treated with calcium were statistically similar to the control groups. This study suggests that Mg may be more effective than Ca in minimizing the duration, depth, and progression of dermal HF burns.

Results of the national surveillance for Guillain‐Barré syndrome

The preliminary results of the national surveillance for Guillain-Barré syndrome (GBS) are reported. In the first 6 months of 1978, 327 cases of GBS were reported to the Center for Disease Control (CDC). A statistically significant difference was observed between sex-specific attack rates, and a direct correlation also was observed between advancing age and increasing risk of GBS.