Immunopathogenesis of extrinsic allergic alveolitis

Inhalation of a variety of organic dusts may cause the onset of hypersensitivity pneumonitis (HP) finally leading to irreversible pulmonary fibrosis in some individuals. So far, the pathogenesis of HP remains partially unclear. Besides patient-related factors this is probably attributable to the complex composition of the causative dusts: in addition to specific antigens that may induce type III and type IV reactions they contain a variety of additional components like particles and toxins with the ability to promote several antigen-independent reactions. During an acute episode of HP a marked alveolitis dominated by polymorphonuclear cells develops. As we showed these polymorphonuclear cells are in an activated state and may therefore cause pronounced damage in the lung interstitium. Based on these and other findings we believe that polymorphonuclear cells are of predominant importance for the pathogenesis of HP.     

Morbidity of occupational diseases in Poland in the years 1994-1996

The authors analysed all cases of occupational diseases diagnosed in Poland over the last three years. The following variables were considered: age, gender of patients, duration of exposure to factors inducing occupational disease, nosologic units, and the types of work places by the European Activity Classification and their localization by voivodships. The obtained results helped to formulate the following conclusions: 1. The number of occupational diseases in the period under study ranged annually between 11,156 and 11,320 cases. The incidence rates (number of cases/100,000 employed) fell within 116-131. 2. The general incidence of occupational diseases was shaped by: hearing impairment, chronic diseases of voice organs, communicable and invasive diseases, pneumoconioses, skin diseases, vibratory syndrome and poisoning. 3. The majority of diagnosed diseases occurred at least after 10 years of occupational exposure to causal factor. 4. The highest incidence of occupational diseases by the European Activity Classification was observed in mining and quarrying, manufacture, education and health services. 5. The analysis of the occupational disease incidence in individual work places indicated a number, however small, of enterprises which are a major source of these diseases.     

Health effects of occupational diseases diagnosed in Poland during the years 1990 and 1994]

Three experiments investigated assumptions of the process-dissociation procedure for separating consciously controlled and automatic influences of memory. Conditions that encouraged direct retrieval revealed process dissociations. Manipulating attention during study or manipulating study time affected recollection but left automatic influences of memory relatively invariant. However, paradoxical dissociations were found when conditions encouraged use of a generate-recognize strategy, violating assumptions underlying the estimation procedure. Use of subjective reports to gain estimates produced parallel results. Easily observed correlations are shown to be not useful for testing assumptions underlying the process-dissociation procedure. A multinomial model produced results that agree with those from the process-dissociation approach.     

Increased expression of the monocyte differentiation antigen CD14 in extrinsic allergic alveolitis

Expression of the CD14 antigen was studied on alveolar macrophages in extrinsic allergic alveolitis (EAA), using immunocytochemistry and cytometry. Compared to control donors, EAA patients had higher percentages of My4 positive cells (40 versus 22%), and the antigen density was fourfold higher (410 versus 92 channels). Levels of soluble CD14 (sCD14) in serum were found to be increased in EAA patients with an average of 4.6 +/- 1.5 micrograms.ml-1 compared to 3.2 +/- 0.7 micrograms.ml-1 in controls. Follow-up of patients with antigen avoidance revealed a concomitant decrease of CD14 staining of alveolar macrophages (AMs) and of sCD14 in serum, whilst allergen exposure induces both parameters. These data are consistent with the concept that antigen contact upregulates CD14 expression on AMs in EAA, followed by shedding and increase of sCD14 in serum.     

The pattern of acute poisonings with pesticides in Poland during the periods 1989-1990 and 1994-1995

Pesticide constitute a large group of commonly used chemicals with diverse chemical structure and toxicity. They are intended mostly to protect plants and plant products from the activity of various harmful organisms but they can also be used as biocides. Pesticide poisonings may be due to suicidal attempts or accidental ingestion associated with improper storage in unlabelled containers. Severe cases are treated at the regional poison units while others in the in-patient and out-patient clinics all over the country. The study made us draw the conclusion that poisonings with organophosphates and dipyridyl derivatives pose an essential toxicological problem. They are usually severe and require long hospitalisation. The highest morality rate was noted also for the poisonings with organophosphates and dipyridyl derivatives. Suicidal attempts constitute the most frequent cause of the poisonings. The results of the analysis imply a necessity to replace the most harmful organophosphate and dipyridyl pesticides with others of a lower toxicity class. It should be underlined that in order to avoid an accidental misuse, pesticides should be stored in the original, labelled containers.     

Two year observation of patients with chronic extrinsic allergic alveolitis during steroid treatment

In 53 patients (37 females, 16 males, aged 17-64) with chronic extrinsic allergic alveolitis after two years of prednisone treatment (40 mg as initial dose reduced to 20 mg after 6 weeks and to 15 mg after 6 months) the significant increase (p < 0.05) of mean values of FVC, FEV1 and DCO and of clinical improvement were observed. No radiological improvement was seen. Complete allergen cessation (16 patients) had very limited influence on pulmonary function parameters and chest X-ray picture, but clinical symptoms were diminished in comparison with patients who stayed on their farms and were potentially exposed to allergens.     

Occupational disorders of the larynx in Poland and in the Poznan province in the years 1985-1994

Our initial experience with intracoronary stenting without oral anticoagulant is presented. From december 1994 to december 1995 we implanted 58 stents in 43 patients (36 males). Indications were: retraction 1, restenosis 3, dissection 8, acute myocardial infarction 13 and de novo 33. All patients received ticlopidin, aspirin and diltiazem before the procedure, heparin and intracoronary nitroglycerin were given during the procedure, and ticlopidin and aspirin for the next six weeks. Non-compliant balloons at 14-16 atmospheres were used for stent implantation. The balloon/artery ratio was 1:1. Implant sites were: 29 in left anterior descendent, 17 in right coronary artery, 7 in circumflex and 5 in vein grafts. This procedure was successful in 40/43 (93%) patients. One patient died and 2 had acute occlusion. One patient underwent coronary artery bypass grafting and the other underwent a new dilatation with higher pressure. There were no subacute occlusions. During 140 days mean time follow up: 2 patients had angina (incomplete revascularization) and 27 patients with negative stress test. No myocardial infractions or deaths were present during the follow up period. Stent implantation with high pressure technique and without oral anticoagulant in coronary arteries greater than 3.0 mm is a safe and effective method with high rate success and very low acute complication rate.     

90年代前5年中国金分析测定的成就

评述了１９９０～１９９４年中国金分析测定的成就。内容涉及含金试样的加工处理、金的分离富集和各种测定方法。５年来共发表５５６篇论文并确立了符合中国国情，具有中国特色的金分析测定方法，在实践中得到普遍应用。     

Bulletin of breast disease: results of the 1990-1994 quinquennium

All mammary lesions diagnosed at the Institute of Pathological Anatomy of the University of Modena have been systematically filed since 1990 and reported in a bulletin, which is issued twice a year and delivered to health operators. So far, 5.188 cases of breast lesions, comprising 1.999 non-neoplastic pathologies, 1.040 benign tumors, 1.943 primary malignant neoplasms and 206 recurrences, have been filed. During the quinquennium 1990-1994, a progressive numerical reduction in diagnoses of non-neoplastic lesions coupled to an increase of benign tumors has been observed, whereas the number of primary malignant tumors has not changed. In particular, a statistically significant increase in diagnoses of carcinoma-in-situ and of fibrocystic disease associated with moderate-risk lesions (atypical hyperplasias) has been detected, whereas the number of cases of single fibrocystic disease has decreased. This reduction, however, is not significant. A slight increase of breast carcinomas smaller than 1 cm and 2 cm, coupled to a decrease of those exhibiting dimensions between 2 and 5 cm, has been found. The collection and systematic analysis of cases of mammary lesions appears to represent a useful tool to study the incidence of different breast pathologies in the general populations. It can also be viewed as a simple way to test the reliability of diagnostic methods used for selection of surgical cases.     

Extrinsic allergic alveolitis: a review for the practitioner

Extrinsic allergic alveolitis (EAA) or hypersensitivity pneumonitis (HP) is a clinical syndrome characterised by an inflammatory, partly granulomatous, immune disorder involving interstitial and alveolar spaces secondary to inhalation of organic substances. The disorder is mainly due to occupational exposure, farmer's lung being the best-known example. Acute, subacute or chronic forms can be clinically differentiated. Given the fact that chronic forms may present a pattern of irreversible pulmonary fibrosis, clinicians must be aware of the diagnosis of EAA in every situation where the history shows a potential antigenic exposure. Prevention should be reinforced by increasing individual protective measures and by improving techniques used at the workplace.     

Most common dermatologic problems identified by internists, 1990-1994

BACKGROUND: Internists in all settings see many patients with skin conditions. Thus, their education in dermatology is important. Information on which areas of dermatology are most commonly seen in internal medicine practices is necessary for designing effective educational programs on skin disease. OBJECTIVE: To determine what types of dermatologic problems internists most commonly diagnose. METHODS: National Ambulatory Medical Care Survey data from 1990 to 1994 were analyzed for dermatologic diagnoses. Physicians specializing in internal medicine and all its subspecialties were compared with dermatologists and with other physicians. RESULTS: The most common skin disorders diagnosed by internists were dermatitis (15.8% of all diagnoses) and bacterial skin infections (14.0% of all diagnoses). Combined, bacterial, fungal, and viral infections included 28.3% of the most common dermatologic diagnoses made by internists. The top 10 most common diagnoses accounted for 57.9% of all skin-related diagnoses and the top 20 most common diagnoses accounted for 72.8%. Internists were more likely to see patients for bacterial skin infections, herpes infection, exanthem, urticaria, and insect bites while dermatologists more commonly saw patients for actinic and seborrheic keratoses, warts, benign and malignant skin tumors, and psoriasis. CONCLUSIONS: The most common dermatologic diseases diagnosed by internists differ considerably from those diagnosed by dermatologists. Because dermatologists do much of the dermatology teaching of internal medicine residents, it is important to recognize these differences to place emphasis on the proper areas of study. Some common or serious skin conditions not often diagnosed by internists such as psoriasis and melanoma also deserve attention in internal medicine training programs.     

Temporary work disability in Poland--analysis of morbidity causes in the years 1985-1994

Observation and analysis of sickness absenteeism, its morbidity causes, range and trends in certain periods of time, help to identify major health problems in the working population and the dynamic of changes. They also permit to anticipate the consequences reflected in permanent work disability. Certificates recording temporary work disability serve as a reference source for the analysis. The material under study comes from the national sickness absenteeism data base developed and managed by the Nofer Institute of Occupational Medicine in Lodz. It covers a 15-percent random sample of those cards. During the last decade, temporary work disability showed a rapidly growing tendency. During the years 1985-1994 mean annual rate of sickness absenteeism growth accounted for 6.4%, and since 1990 this rate has evidently increased reaching 10% per year. The rate of sickness absenteeism growth was considerably higher among males (9.8%) than among females (4.1%). The highest mean annual rates of growth were noted in absenteeism caused by diseases of the musculoskeletal system (33%--males; 15%--females), the nervous system (18%--males; 4% females) and the circulatory system (12% in general) including arterial hypertension (52%--males; 17% females). A differentiated trend in work disability due to individual disease categories observed during the analysed decade was responsible for changes in the structure of sick absenteeism noted in the same period. Thus, sickness absenteeism because of diseases of the respiratory system has decreased while diseases of the musculoskeletal system have contributed to its increase (at present they account for 18.2% in males and 15.4% in females), the same applies to diseases of the nervous system (17.2% in males) and to gynecological diseases (17.1% of female absenteeism). During the past five years a high dynamics of sickness absenteeism growth can be mostly attributed to a modified system of sickness allowances as well as to social and economic transformations, restructuring of industry and an increased unemployment in our country.     

The course of allergic alveolitis based on personal experience

The course of allergic alveolitis was observed in 19 patients. The diagnosis was based on medical history, exposition to organic dust, clinical findings, respiratory function and in selected cases on results of transbronchial lung biopsy. All patients presented restrictive patterns of lung function abnormalities. Although a clinical improvement was seen, in none of the patients was a normalization of respiratory function observed. The results of treatment were more promising in patients with a shorter time between the onset of symptoms and making of diagnosis. Isolation from allergens resulted in better effect without prophylactic treatment with prednisone. Steroid therapy did not effect the relapses nor worsening of the respiratory function.