Early sensitization to farming-related antigens among young farmers: analysis of risk factors

It was the aim of this study to investigate the prevalence of and risk factors for IgE- and IgG-mediated allergy in young farmers. We investigated 147 young men attending a farming college in the Austrian Tyrol and 57 age-matched pupils at a grammar school. All individuals completed a questionnaire and had spirometry, skin prick tests, total and specific IgE analysis, and testing for precipitins against thermophilic actinomycetes and true fungi. In the farming group, a family history of atopy or asthma was reported less frequently than in the control group (p < 0.001) but there were no differences in the frequencies of actual respiratory symptoms. Forced expiratory volume in the first second (FEV1) was slightly lower in the farmers than in the pupils (p < 0.05). There was no difference in the prevalence of IgE-mediated allergy. Nine of the farmers but none of the pupils had precipitating antibodies against Faeni rectivirgula (p < 0.05). Overall reactivity (as defined by at least one positive finding with the skin prick test, specific IgE, or precipitins) was associated with larger farming estates, lack of a haydrying device, use of mouldy hay, and positive family history of asthma (p < 0.05). We conclude that in farmers, precipitin formation may occur at an early age and that even in younger age groups there is a clear relationship between allergic sensitization and occupational allergen exposure.

[How can the success of a glaucoma operation be predicted?]

PURPOSE

The effect of glaucoma surgery can simply be measured in terms of intraocular pressure (IOP) reduction. However, IOP reduction is not the final goal of glaucoma surgery, but rather long-term visual field preservation. Visual field preservation, on the other hand, can only be judged many years after surgery. Therefore, a formula that could be used to define the success of a pressure-lowering operation soon after surgery should take account of IOP reduction, but the correlation between "successful IOP reduction" and "long-term visual field preservation" should be as high as possible.

METHODS

In an attempt to find such a formula, we examined the long-term course with reference to both IOP and visual field in 108 patients (mean follow-up 7.9 years). Several criteria were tested for their ability to predict the long-term visual field preservation.

RESULT

The best correlation was obtained by a combined criterion specifying both an absolute upper limit and a relative IOP decrease (i.e. IOP postoperatively < 0.8*IOP preoperatively and IOP postoperatively < 21 mmHg).

CONCLUSION

We recommend use of this criterion whenever the effect of a pressure-lowering operation has to be estimated shortly after surgery.

Cluster headache syndrome associated with middle cerebral artery arteriovenous malformation

Cluster headache (CH) is an idiopathic cephalalgic syndrome, although several pathological processes have been described in association with this syndrome. We report two cases of cluster headache in hospitalized patients with middle cerebral artery dependent arteriovenous malformation (AVM). After surgical removal of the AVM the headache completely resolved, suggesting that complementary studies and treatment of the underlying aetiology may be indicated for secondary forms of cluster headache.

Cerebrospinal fluid ceftazidime kinetics in patients with external ventriculostomies

Ceftazidime has proven to be effective for the treatment of bacterial meningitis caused by multiresistant gram-negative bacteria. Since nosocomial central nervous system infections are often accompanied by only a minor dysfunction of the blood-cerebrospinal fluid (CSF) barrier, patients with noninflammatory occlusive hydrocephalus who had undergone external ventriculostomy were studied (n = 8). Serum and CSF were drawn repeatedly after the administration of the first dose of ceftazidime (3 g over 30 min intravenously), and concentrations were determined by high-performance liquid chromatography by using UV detection. The concentrations of ceftazidime in CSF were maximal at 1 to 13 h (median, 5.5 h) after the end of the infusion and ranged from 0.73 to 2.80 mg/liter (median, 1.56 mg/liter). The elimination half-lives were 3.13 to 18.1 h (median, 10.7 h) in CSF compared with 2.02 to 5.24 h (median, 3.74 h) in serum. The ratios of the areas under the concentration-time curves in CSF and serum (AUCCSF/AUCS) ranged from 0.027 to 0.123 (median, 0.054). After the administration of a single dose of 3 g, the maximum concentrations of ceftazidime in CSF were approximately four times higher than those after the administration of 2-g intravenous doses of cefotaxime (median, 0.44 mg/liter) and ceftriaxone (median, 0.43 mg/liter) (R. Nau, H. W. Prange, P. Muth, G. Mahr, S. Menck, H. Kolenda, and F. Sörgel, Antimicrob. Agents Chemother. 37:1518-1524, 1993). The median AUCCSF/AUCS ratio of ceftazidime was slightly below that of cefotaxime (0.12), but it was 1 order of magnitude above the median AUCCSF/AUCS of ceftriaxone (0.007) (Nau et al., Antimicrob. Agents Chemother. 37:1518-1524, 1993). The concentrations of ceftazidime observed in CSF were above the MICs for most Pseudomonas aeruginosa strains. However, they are probably not high enough to be rapidly bactericidal. For this reason, the daily dose should be increased to 12 g in cases of P. aeruginosa infections of the central nervous system when the blood-CSF barrier is minimally impaired.

Vanadium poisoning of cattle with basic slag. Concentrations in tissues from poisoned animals and from a reference, slaughterhouse material

In northern Sweden, 23 heifers out of 98 cattle died of acute vanadium toxicity in a 10-day period. Eight months earlier a pasture had been fertilized with basic slag, containing 3% vanadium. The fertilizer was laid on the surface without being ploughed in. Mainly heifers, and some cows, were fed with basic slag-contaminated fresh hay. The first signs of illness appeared 11 days later, and the first case of death appeared 14 days after the initial clinical signs. The signs were diffuse and difficult to interpret. Inappetence, black diarrhea, lethargy, dehydration and spontaneous abortions occurred. Further, pulmonary lesions, conjunctivitis, neurological disturbances such as depression, leg incoordination, and paralysis of the hind limbs and face were also noted. Although feeding with the contaminated hay was stopped at the outbreak of the toxicity, the 23 animals died or had to be slaughtered, and at necropsy of another heifer 4 weeks later, large amounts of basic slag were still found in the alimentary tract. High vanadium concentrations were found in the liver, kidneys, spleen and urine, 5.9, 5.5, 1.9 and 4.8 mg/kg w.w., respectively. In bone tissue (coccygeal vertebrae), the highest value in an acutely poisoned heifer was 0.680 mg/kd d.w., in the same range as that of an experimentally poisoned sheep. Surviving heifers were more affected than cows; the state of health of these heifers gradually deteriorated and, therefore, a few were slaughtered 3 months later. Because of residual neurological disturbances and decreased milk production, the rest of the herd was slaughtered 5 months after the outbreak, and samples were collected and analyzed. Elevated vanadium concentrations were found in the organs, especially in the spleen, where values of 1.40 and 1.42 mg/kg w.w. were found in 2 heifers at 3 months. The values in heifers (n = 6) were decreased 5 months after the outbreak. The median concentrations were somewhat higher in the liver than in the spleen, and lowest in the kidney (0.244, 0.213 and 0.058 mg/kg w.w., respectively). In the organs of the cows (n = 24), which were less exposed, the corresponding values were 0.012, 0.095 and 0.013 mg/kg w.w., respectively. Vanadium concentrations were also determined in livers of cows and calves at regular slaughter in four geographic regions of Sweden. In one of the regions, where basic slag (with 3% vanadium) had been used for many years, the values were significantly higher than those in the other regions. In a material of 293 specimens, an upper reference limit of 0.012 mg/kg liver w.w., with a 90% confidence interval of 0.011-0.019 mg/kg w.w., was found to be normal for cattle in Sweden. Concentrations above the Highest Swedish Reference Value, 0.019 mg/kg liver can be considered elevated. Vanadium-containing basic slag used as fertilizer caused poisoning in a herd of cattle and its regional use was detectable in livers from cattle at regular slaughter. Such fertilizer must be applied in a proper way. It should be ploughed in and any direct contact of grazing animals with the hazardous fertilizer should be prevented.

[Gleno-humeral arthroscopic arthrolysis for shoulder stiffness. Apropos of 26 cases. Société Française d'Arthroscopie]

Shoulder stiffness is a problem which covers many different conditions. In fact there is still a semantic and pathogenetic confusion. The words: capsulite retractile, frozen shoulder, adhesive capsulitis, stiff shoulder contracture have been successively used and this ambiguity renders the literature difficult to interpret. Moreover the cause of the stiffness which depends on the aetiology, is not always clearly known: capsular contraction, capsular adhesion, capsular scarring following trauma or surgery, extra capsular phenomenons in the subacromial bursa, muscles or tendons.

MATERIALS AND METHODS

26 shoulders (25 patients) were reviewed with a follow up of 21 months using the Constant's scoring system. Patients had an average duration of symptoms for 13 months (1 to 27). Pre op passive motion was: abduction: 74 degrees, external rotation: 6 degrees, forward flexion: 84 degrees. The average motion core was 12.9/40. We distinguished three groups: primary frozen shoulder (13 cases) ; bipolar stiffness (3 cases) due to rotator cuff disease ; acquired "surgical" stiffness, (10 cases). The capsular release was performed, at the anterior rim of the glenoid fossa, purely anterior or anterior and inferior, followed by gentle manipulation. If external rotation was not improved the coraco-humeral ligament was detached from its coracoid attachment. Additional procedures were performed:acromioplasty (5 cases), bursectomy (3 cases), SLAP lesion debridement (1 case). Only 2 out 13 primary shoulders required an additional procedure.

RESULTS

1-There were no intra-operative complications (vascular or neural). 2-Range of Motion: the average gain under anesthesia was: abduction: 72 degrees, external rotation: 34 degrees, forward flexion: 86 degrees. Final result was obtained with a mean duration of seven months. There was no difference according to the aetiology. Gain was more important in the primary group (9.69 to 34.9 vs 15.8 to 30.6). 3-Subjective results were better in the primary group. 4-Objective results demonstrated an absolute Constant's score of 70.3, that is to say 83.4 per cent of the contralateral supposed healthy shoulder. There were 3 excellent, 5 very good, 7 good, but 11 fair or poor results. The relative Constant's score was 91 per cent in the primary group and only 76 per cent in the acquired group. The difference was due to the pain and strength which were greatly improved in the primary group.

DISCUSSION

Arthroscopic release of shoulder contracture is feasible, safe and effective. For primary frozen shoulder, there is usually spontaneous recovery. Indications for surgery are very few. There is no evidence that arthroscopic release shortens spontaneous evolution. Therefore, we propose it in very selected cases of dramatically limited motion. One year of evolution is an acceptable time. For bipolar stiffnesses, arthroscopy allows one to recognize the exact cause of the stiffness and to treat it, especially the subacromial pathology. In this occurrence, buroscopy must be performed and cuff pathology treated. For acquired surgical stiffnesses, gain of motion is significant. Subjective and objective results are less satisfactory than those of primary frozen shoulder, due to persistance of pain and lack of strength. The alternative is open release, but arthroscopic release has less morbidity. It can be proposed early as soon as capsular tissue has healed (for instance 6 months).

The Revised Helping Alliance Questionnaire (HAq-II) : Psychometric Properties

The concept of the therapeutic alliance and its operationalization have received much attention in recent years. One of the early self-report measures of the therapeutic alliance was the Helping Alliance questionnaire (HAq-I). This scale was recently revised to exclude the items that explicitly reflect improvement. Using the revised 19-item HAq-II on a sample of 246 patients diagnosed with DSM-III-R cocaine dependence, the authors found that the new scale had excellent internal consistency and test-retest reliability. Further, the HAq-II demonstrated good convergent validity with the California Psychotherapy Alliance Scale (CALPAS) total score. Alliance levels as measured by the CALPAS or the Helping Alliance questionnaire during early sessions were not associated with pretreatment psychiatric severity or level of depression.

Survey of bioavailable selenium in Sweden with the moose (Alces alces L.) as monitoring animal

Liver tissues were collected from moose (Alces alces L.) from the regular hunting seasons of 1981 and 1982. The material (from about 4300 animals) was stored at -20 degrees C at the National Veterinary Institute (SVA). From this material, 2080 specimens from 12 counties representing 14 regions were analyzed for selenium. The counties included were Norrbotten, Västernorrland (northern region), Uppsala, Kopparberg, Gävleborg, Jämtland (central region), north and south Kalmar (eastern region), Halland, north and south Alvsborg (western region), and Blekinge, Kristianstad and Malmöhus (southern region). The analysis was performed by a combination of continuous hydride generation using a flow-injection technique and atomic absorption spectrometry. The median selenium concentration in the liver in the entire material was 0.15 and the mean (+/- S.D.) 0.25 +/- 0.29 (range: 0.03-3.1) mg/kg wet wt. The highest median values obtained were 0.26, 0.28 and 0.29 mg/kg, in the counties of Gävleborg (central region) and north and south Alvsborg (western region), respectively. The lowest medians, 0.09-0.10 mg/kg, were found in the counties of Uppsala (central region), north and south Kalmar (eastern region), and Jämtland (central region). Intermediate median values were obtained in the other counties: 0.13 mg/kg in the county of Västernorrland (northern region), 0.15-0.16 mg/kg in the counties of Blekinge and Malmöhus (southern region) and Norrbotten (northern region), 0.18 mg/kg in the county of Halland (western region), and 0.23 mg/kg in the counties of Kristianstad and Kopparberg (southern and central regions, respectively). Selenium concentrations < 0.1 mg/kg in the liver of cattle are considered to be deficient. In some of the regions, 50-60% of the moose livers showed values below this level. The results indicate that the moose is useful for monitoring the amount of selenium available for wild-grazing animals and confirm that the Swedish environment is poor in selenium.

Weighing the options: criteria for evaluating weight-management programs. The Committee to Develop Criteria for Evaluating the Outcomes of Approaches to Prevent and Treat Obesity

The United States is experiencing an epidemic of obesity among both adults and children. Approximately 35 percent of women and 31 percent of men age 20 and older are considered obese, as are about one-quarter of children and adolescents. While government health goals for the year 2000 call for no more than 20 percent of adults and 15 percent of adolescents to be obese, the prevalence of this often disabling disease is increasing rather than decreasing. Obesity, of course, is not increasing because people are consciously trying to gain weight. In fact, tens of millions of people in this country are dieting at any one time; they and many others are struggling to manage their weight to improve their appearance, feel better, and be healthier. Many programs and services exist to help individuals achieve weight control. But the limited studies paint a grim picture: those who complete weight-loss programs lose approximately 10 percent of their body weight, only to regain two-thirds of it back within 1 year and almost all of it back within 5 years. These figures point to the fact that obesity is one of the most pervasive public health problems in this country, a complex, multifactorial disease of appetite regulation and energy metabolism involving genetics, physiology, biochemistry, and the neurosciences, as well as environmental, psychosocial, and cultural factors. Unfortunately, the lay public and health-care providers, as well as insurance companies, often view it simply as a problem of willful misconduct--eating too much and exercising too little. Obesity is a remarkable disease in terms of the effort required by an individual for its management and the extent of discrimination its victims suffer. While people often wish to lose weight for the sake of their appearance, public health concerns about obesity relate to this disease's link to numerous chronic diseases that can lead to premature illness and death. The scientific evidence summarized in Chapter 2 suggests strongly that obese individuals who lose even relatively small amounts of weight are likely to decrease their blood pressure (and thereby the risk of hypertension), reduce abnormally high levels of blood glucose (associated with diabetes), bring blood concentrations of cholesterol and triglycerides (associated with cardiovascular disease) down to more desirable levels, reduce sleep apnea, decrease their risk of osteoarthritis of the weight-bearing joints and depression, and increase self-esteem. In many cases, the obese person who loses weight finds that an accompanying comorbidity is improved, its progression is slowed, or the symptoms disappear. Healthy weights are generally associated with a body mass index (BMI; a measure of whether weight is appropriate for height, measured in kg/m2) of 19-25 in those 19-34 years of age and 21-27 in those 35 years of age and older. Beyond these ranges, health risks increase as BMI increases. Health risks also increase with excess abdominal/visceral fat (as estimated by a waist-hip ratio [WHR] > 1.0 for males and > 0.8 for females), high blood pressure (> 140/90), dyslipidemias (total cholesterol and triglyceride concentrations of > 200 and > 225 mg/dl, respectively), non-insulin-dependent diabetes mellitus, and a family history of premature death due to cardiovascular disease (e.g., parent, grandparent, sibling, uncle, or aunt dying before age 50). Weight loss usually improves the management of obesity-related comorbidities or decreases the risks of their development. The high prevalence of obesity in the United States together with its link to numerous chronic diseases leads to the conclusion that this disease is responsible for a substantial proportion of total health-care costs. We estimate that today's health-care costs of obesity exceed $70 billion per year.(ABSTRACT TRUNCATED AT 400 WORDS)

[Long-term reduction of intraocular pressure by goniotrepanation or laser trabeculoplasty]

BACKGROUND

Reports concerning the long term efficacy of goniotrephination or lasertrabeculoplasty are still rather inconsistent. Therefore we once again investigated the long term IOP reduction of these two procedures.

PATIENTS AND METHODS

In 1983 we started a prospective monitoring of patients having either goniotrephination or lasertrabeculoplasty. We now reinvestigated the patients originally included in this study (mean follow up 7.7 years, n = 116 patients/143 eyes). IOP reduction was defined to be successful if the following two criteria were met simultaneously: 1. IOP post op < 25 mm Hg. 2. IOP post op < 0.8 x IOP prä op.

RESULTS

According to the criteria given above the long term success rate of goniotrephination was 67%, the long term success rate of lasertrabeculoplasty was 32%. There were no severe complications. The frequency of mild complications during the early postoperative period was the same for eyes with successful long term IOP reduction as for eyes with unsuccessful long term IOP reduction. When eyes with glaucoma chronicum simplex and eyes with secondary glaucomas were evaluated separately the following success rates were found: goniotrephination in eyes with glaucoma chronicum simplex 68%, goniotrephination in eyes with secondary glaucomas 67%, lasertrabeculoplasty in eyes with glaucoma chronicum simplex 37%, lasertrabeculoplasty in eyes with secondary glaucomas 18%. The correlation between successful lasertrabeculoplasty in the first eye and successful lasertrabeculoplasty in the fellow eye was marginally significant (p = 0.1).

CONCLUSIONS

The long term IOP reduction is clearly more pronounced after goniotrephination than after lasertrabeculoplasty. However, long term IOP reduction after lasertrabeculoplasty is still better than expected. Mild complications during the early postoperative period obviously do not influence the long term results of both procedures. The success rate of lasertrabeculoplasty in eyes with secondary glaucomas is clearly worse compared to eyes with glaucoma chromicum simplex. There is no difference between these two groups when goniotrephination was performed. The success of lasertrabeculoplasty in the first eye cannot really predict the success of the same procedure in the fellow eye.

Tau protein concentrations in cerebrospinal fluid of patients with dementia of the Alzheimer type

Tau protein concentrations were measured in the CSF of 23 patients with dementia of the Alzheimer type (DAT), 36 patients with multi-infarct dementia (MID), and 23 control subjects. Tau protein concentrations were significantly higher in patients with DAT than in controls (P < 0.001) and patients with MID (P < 0.001). A significantly positive correlation between CSF tau protein and glucose concentrations (r = 0.79, P < 0.001) and evolution of disease (r = 0.47, P < 0.05), and a negative correlation with Folstein's mental state examination test (r = -0.73, P < 0.001) were found in patients with DAT.

Decision logic for retreatment of asymptomatic lung cancer recurrence based on positron emission tomography findings

PURPOSE

The purpose of the study was to determine if Positron emission tomography (PET) 2-[F-18] fluoro-2-deoxy-D-glucose (FDG) imaging could detect subclinical local lung cancer recurrence and whether retreatment of such recurrence was feasible and beneficial.

METHODS AND MATERIALS

Twenty patients with biopsy proven lung cancer were studied with Positron emission tomography for the purpose of detecting subclinical lung cancer recurrence over a period of 4.25 years. All patients were treated with external radiation as part or all of their therapy. Twenty patients had baseline PET and computed tomography (CT) studies for comparison with later studies. Surviving patients had a total of 40 sequential PET scans and 35 CT scans. The follow-up interval ranged from 5 to 40 months posttreatment. The differential uptake ratio (DUR) was determined for regions of interest of increased FDG uptake.

RESULTS

The median DUR value of the 20 baseline PET studies was 5.59. The DUR value of greater than 3 was empirically selected as being positive for tumor detection. On baseline studies, PET had a 100% correlation with the CT findings in regard to detection of the site of primary tumor involvement. Four of 20 patients showed areas of discordance in the mediastinal and hilar areas on initial PET and CT studies. Seven of 17 patients showed discordant posttreatment PET-CT findings. Two false positive PET studies were due to radiation pneumonitis and one to macrophage glycolysis in tumor necrosis. For detection of asymptomatic tumor recurrence, analysis of sequential PET and CT studies, biopsy results, and the patient's clinical course suggested that PET had a sensitivity of 100%, specificity of 89.3%, and accuracy of 92.5%. Computerized Tomography was found to have a sensitivity of 67%, specificity of 85%, and accuracy of 82% for detection of such early-stage recurrence. Five patients went on to have retreatment with external irradiation based upon the PET evidence. Four retreated patients had biopsies that corroborated the positive PET findings, and one patient was retreated on the basis of the qualitative appearance of the posttreatment PET study. Two of the five retreated patients remain alive without evidence of tumor to 34 months following initial therapy.

CONCLUSION

Positron emission tomography scanning appears to be effective in detecting and following the progression of recurrent lung cancer. Retreatment of patients with asymptomatic recurrent tumor has resulted in absent or decreased FDG activity. Monitoring of patients with PET may provide prolonged survival in patients who otherwise would fail treatment because of local tumor recurrence.

[Guidelines for the management of acute cerebrovascular disease in patients]

One of the challenges currently faced by Neurologists is to finish with the therapeutic nihilism that affects management of cerebrovascular disorders. It is possible to reduce damage resulting from stroke if adequate treatment is applied shortly after the beginning of symptoms, and within the 'therapeutic window'. This would mean that these disorders might be considered as treatable medical emergencies. The purpose of this report is to provide a guide for management of cerebrovascular disease, both ischemic and haemorrhagic, suggesting a diagnostic procedure, together with general and specific recommendations for the care of these patients, in order to avoid complications and improve outcome.

[Clinical trials in the Alzheimer's disease: evaluation of the therapeutic response]

The strategy, as regards the layout of any clinical study on Alzheimer's disease (AD) which aspires to an evaluation of the therapeutical efficiency of a drug, must take as its starting point a clear specification of the criteria of improvement and of how such criteria are to be quantified. The measuring instruments of therapeutical efficiency can be divided into two main groups: instruments for analysing the biological parameters of the illness and instruments which analyse functional efficiency. Between the latter, there are three types of basic tools: 1. Tests which allow psychopathological clinical changes to be evaluated, such as a complete neuropsychological examination, an analysis of the global clinical impression, and a cognitive mini-test; 2. Psychometric tests which allow certain parameters to be quantified, such as, for example, the IQ co-efficient; 3. Scales which, by means of information supplied by care experts or by family members, allow the ability to carry out normal daily tasks to be quantified. The selection of the most suitable test as an instrument with which the criteria of improvement may be established has given rise to controversy and none have been found which, on their own, can fully guarantee the necessary requirements of objectivity, reproduceability, validity and homogeneity. Within these limits, the most suitable are held to be those which explore psychopathological changes and the data provided by an informer, together with the global clinical impression. The high number of tests and batteries that have been proposed for the evaluation of the therapeutic response indicates their lack of real efficiency. We would like to see the setting up of an international committee for the standardisation and definitive validation of the measuring instruments for cognitive deterioration, and thus establish--with precision, unanimity and a general consensus--what might be considered to be the most suitable criteria of improvement when evaluating therapeutic efficiency in Alzheimer's disease.

Management of supraventricular tachycardia during hexoprenaline therapy for preterm labour: benefit of cardioselective beta blockade?

A 29-year-old woman presented with preterm labour at 32 weeks of gestation. Tocolytic treatment was started with intravenous hexoprenaline. Twenty-four hours after initiation of treatment, the patient developed supraventricular tachycardia, resistant to digoxin and verapamil. Medical treatment with metoprolol finally restored sinus rhythm. We observed no adverse effects on the fetal heart rate nor on the umbilical cord blood flow.