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In a retrospective epidemiological study, 127 patients with malignant tumours of the nose and paranasal sinuses were studied during a period of ten years. There was a remarkable coincidence between adenocarcinomas and adenocystic carcinomas on the one hand, and patients who were occupationally exposed to wood dust on the other; it was established that the duration of this exposure in the course of their professional life had been between 15 and 35 years. Adenocarcinomas represented 22.8% of the total amount of malignant tumours. The share of the woodworkers in the total number of occupationally active patients in our area of examination was 2.14%, whereas 17.2% of the patients with adenocarcinoma and adenocystic carcinoma had been occupationally exposed to wood dust. The statistical examination of the postulated connection between exposure to wood dust and the occurrence of malignant tumours of the histological type of the adenocarcinoma and adenocystic carcinoma, showed a highly significant correlation.

Wood preservation products have been applied in the domestic field for many years. Until 1977, formulations containing the insecticide lindane and the fungicide pentachlorophenol (PCP) had been used. In 90% of 217 households examined, wood protection products of this type had been applied and between 25 and about 1000 g lindane and between 5 g and about 10 kg PCP (including contaminating substances) had been used in a single house. Consequently, these active ingredients (e.g. PCP) could be detected increasingly in the environment and the organisms of persons living in the respective homes, i.e. in the air and in dust sampled indoors, in foodstuff and in urine. In comparison to samples of indoor air samples of domestic dust seem to be a much better indicator for exposure, as regards representativeness over an extended period. House dust is especially suitable for screening purposes because of its easy sampling and high biocide contents.

In recent years an increasing number of cases of primary irritant and allergic contact dermatitis has been observed after using the South-American timber Pao ferro (Machaerium scleroxylum). Since 1978 140 cases have come to our knowledge. The patients were mainly cabinet and furniture makers occupied in the sanding of veneer. Perioral dermatitis and cheilitis was also seen in persons playing the flute made of Pao ferro wood. Guinea pig sensitization experiments revealed a strong sensitizing capacity of the main wood constituent R-3,4-dimethoxydalbergione. Amounts of up to 2% were found in the heartwood. Mix-up of Brazilian rosewood (Dalbergia nigra) with its substitute (Machaerium scleroxylum) may occur accidently due to their similar appearance. However, a chemical differentiation is easily possible by determination of their constituents: while Pao ferro exclusively contains the strong sensitizer R-3,4-dimethoxydalbergione, the botanically related Brazilian rosewood (and also the East Indian rosewood--Dalbergia latifolia Roxb.) yields several other and weaker dalbergiones. In 41 of 55 patients tested epicutaneously with R-3,4-dimethoxydalbergione an acquired sensitivity could be demonstrated. The high amount of R-3,4-dimethoxydalbergione in Machaerium scleroxylum is primarily responsible for the outbreak of toxic dermatitis in veneer factories, half of which resulted in a sensitization. The risk of active sensitization is high if epicutaneous tests are carried out with the native wood dust. To avoid active sensitization it is better to test the pure constituent, if available, in a dilution of 0.1%.

Wood dust is known as a cause of asthma and chronic bronchitis. From 1979 to 1983 we observed 115 patients with chronic lung diseases, who were exposed to wood dust during many years. We found an irritative pathogenesis in 101 patients with asthma or bronchitis. Twenty nine patients had got a positive skin test, especially with makoré, beech, koto, ash, pine. The inhalation test was positive in 7 of them. The occupational etiology was verified in 5 patients. Besides wood dust itself chemicals for wood protection or wood adhesives can have importance in the pathogenesis of these diseases. Fourteen patients had got alveolitis or lung fibrosis after wood-dust exposition. In each case we found precipitating antibodies against moulds, which could be cultivated from wood dust to which the patients were exposed.

Three cases of allergy to Tetrachlorphthalonitril, a fungicidal wood preservative, are reported. It is stated, that in opposition to producers technical data bulletin there is some stronger toxic and sensitization capacity, which also leads to problems in diagnostic skin tests. The responsibility and problems for the practicing dermatologist facing the increasing number of new chemical products is stated.

Anorexia nervosa has been related to alterations in brain activity in terms of hyperactive EEG patterns. This case report illustrates the principles and results of a five-week neurofeedback treatment in a 29-year-old woman suffering from anorexia nervosa. A neurofeedback protocol to enhance alpha activity (8 - 12 Hz) was developed and conducted additionally to the standardized treatment for eating disorders in training sessions twice a week. Pre- and post-test measurements included resting state EEG measurements and a psychological test battery. The results show improvements from pre- to post-test in eating disorder psychopathology including psychological wellbeing, emotional competence, and eating behavior traits. In addition, a decrease in theta power (4 - 7 Hz), a well-known trait marker of anorexia nervosa, was measured. However, our data should be interpreted with caution because this is a single case study. Nevertheless, this report documents the practicability and method of neurofeedback as treatment adjunct in eating disorders from the clinical perspective. Although the use of neurofeedback in the treatment of anorexia nervosa is recommended in literature, empirical studies are still lacking. Randomized controlled trials to evaluate short- and long-term effects of neurofeedback are needed.

We present the case of an orbital fracture and a wooden foreign body found during surgery. The patient had undergone a pre-operative computed tomography scan but the foreign body had not been seen on these images. We discuss the difficulties in demonstrating wooden objects on CT and describe indicators in patient history, examination findings and radiological signs that might suggest the presence of a wooden object. We emphasise the necessity to explore any orbital injury if there are clinical signs suggesting an intraorbital foreign body.

Self-inflicted impalement is a rarity in forensic autopsies. The case of a 32-year-old man, who was found dead lying on a suburban street, is reported and compared with the relevant literature. A 5-cm-thick wooden stick with blood traces protruded from the oral cavity. At autopsy, it was found that the wooden post, which had a total length of 28 cm, filled the entire oral cavity with the pointed end being located at the entrance of the larynx with lacerations of the posterior wall of the pharynx. There were no signs of asphyxia or involvement of another party. As secondary findings, fresh hesitation cuts could be demonstrated on the right forearm. Death was assumed to have been caused by reflectory cardiac or respiratory arrest similar to bolus death. The police investigations showed that the man had suffered from paranoid hallucinatory schizophrenia for 12 years with 3 previous attempts to commit suicide and had been discharged from inpatient treatment in a psychiatric institution only 4 days before his death. The pattern of injuries is described and an attempt is made to reconstruct the course of events on the basis of the results of the police investigations and the psychiatric documentation. The rare case of self-inflicted fatal impalement is compared with other reports in the literature.

Abdominal fistula caused by an ingested wooden spit, which penetrated the intestinal wall and remained in the abdominal wall: a laparascopy was performed in a 41-year-old man suffering from acute appendicitis and an inflamed Meckel's diverticulum. After removal of the appendix and the diverticulum, a fistula developed in the excision channel of the left quadrant of the abdominal wall post-operatively. Despite repeated incision of the abscess in the course of 2 months, the fistula did not heal. Ultrasound examination of the abdominal wall was therefore performed. The postoperative status was without conspicuous findings. We could, however, detect a foreign body, a few centimetres long and 2-3 mm thick, displaying a smooth surface, deep down in the abdominal wall. A fistulography confirmed the diagnosis. After removal of the wooden spit, complete healing of the fistula in the abdominal wall was observed. Subsequently, the patient reported to have eaten a beef roulade, fixed with a wooden spit, 7 weeks before the abdominal operation.

We report on a 37-year old patient with a simple viral infection who presented with acute bronchitis with bronchospasm, a productive cough and severe dyspnoea. Because of his specific occupational history--the patient is a forester and was exposed to wood dust and fungi--he was at high risk for extrinsic allergic alveolitis with mucoid impaction, so that the cause of hypoxemia and cyanosis was obvious. Repeated immunological parameters including gel-precipitations were negative: The lung function pattern (reduced vital capacity, a reduced FEV1, reduced flow values at low vital capacity and with the characteristic shape of the flow volume-curve but normal airway-resistance) suggested the diagnosis of intrinsic asthma limited to the small airways - "bronchiolar asthma" - severe small airway disease.

The aims of the population-based, cross-sectional survey "Study of Health in Pomerania" (SHIP) are to describe prevalences and distributions of a broad range of diseases, as well as environmental and behavioural risk factors in the region of Pomerania (North-eastern Germany). The examinations are performed in two study units by different physicians, technicians and interviewers and laboratory analyses in two separate laboratories. In addition, the study will take at least 3 years and approximately 7000 persons will be examined. Because of the design of the study a special concept of quality assurance is indispensable. In the present paper methods are presented for quality assurance and control in anthropometry, ECG, echocardiography, abdominal sonography, carotid ultrasound, sonography of the thyroid gland, blood pressure measurements as well as clinical laboratory analyses. The technical control protocols, the training programmes of the observers and methods to establish observer and method variabilities are presented by means of typical examples. The logistic, personal and technical measures for quality assurance and control require appropriate attention. The methods and procedures presented here are expected to provide an effective instrument to continually monitor the quality of medical examinations in the SHIP study.

This report deals with radiologic examinations outside official working hours in a German university hospital and the influence of new government regulations. A total of 65,113 radiologic examinations were requested and performed outside official working hours between 1 July 1990 and 30 Juni 1994. The data were analyzed according to the age and sex of this patient population compared with the entire population studied within this 4-year period. Further analysis included the time of the study, the organ systems investigated, and the radiologic technique. About one-third of requests occurred between 16.00 and 20.00 hours on normal working days and, thus, could be taken care of by late shifts. Another third covers the time between 20.00 and 08.00 hours in the morning, which requires inhouse staff (medical and technical). The remainder of the requests occurred during holidays and weekends in the daytime. The most common request in this analysis was for portable chest examination. About 50% of all portable chest examinations were performed outside regular working hours. In all, 17.2% of all requests involved CT and MRT studies. Government regulation did not change the number, technique, and frequency of radiologic examinations outside official working hours.

The value of measuring the urinary concentration of alpha 2-macroglobulin in addition to that of C-reactive protein (CRP) was assessed in a prospective study of 78 consecutive patients (29 women, 49 men; mean age 48.7 [19-75] years) after renal transplantation. alpha 2-Macroglobulin was never demonstrated in urine when the course was normal (n = 38), cytomegalovirus infection had occurred (n = 26) or acute cyclosporin nephrotoxicity (n = 5) or glomerular disease in the transplant (n = 10). CRP was present in only a few such cases. Interstitial rejections (n = 26) always led to urinary alpha 2-macroglobulin and CRP excretion without haematuria, while in vascular rejection (n = 3) the haemoglobin test was also positive. Urinary infection (n = 20) and urosepticaemia (n = 6) always brought about the urinary excretion of alpha 2-macroglobulin and CRP, as well as a usually highly positive haemoglobin test. alpha 2-Macroglobulin was absent but CRP always present in extrarenal bacterial infections (n = 30). Postrenal blood admixture was always characterized by a positive haemoglobin test and alpha 2-macroglobulin in urine, while in most cases (83%) CRP was absent. --These results indicate that the constellation "alpha 2-macroglobulin negative/CRP positive" is a pathognomonic for extrarenal bacterial infection (sensitivity 100%, specificity 98.9%). The presence of alpha 2-macroglobulin alone makes postrenal blood admixture probable. If both proteins are present in the urine, rejection and urogenital bacterial infection must be excluded by further tests.

Since the measurement of quality of life is a relevant endpoint of patient assessment, an international team of methodologists and surgeons have developed a new system-specific index. In different phases, items were collected, tested, rejected or retained and finally verified by international experts. The instrument was also validated against other generic measures, it was compared to 150 normals, tested for reproducibility with 50 stable patients and for responsiveness with 159 patients undergoing laparoscopic cholecystectomy. The product is a bilingual (German and English) questionnaire containing 36 items. Although further testing is in order, we conclude that the Gastrointestinal Quality-of-Life Index is ready to be used in clinical practice and research.

Kinematic and kinetic data were collected of 6 male and 6 female healthy subjects. For downhill walking a dismountable slope of 6 m length and a grade of 19.3% was built. Planar net joint moments and mechanical power at the knee joint were calculated for the sagittal view using force platform records based on standard inverse dynamics procedures. On the basis of a two dimensional knee model the patello femoral joint compressive forces were calculated. While the maximal extension moment for level walking was only 1.2 +/- 0.5 Nm/kg bw at a knee flexion angle of 20 degrees it was 2.6 +/- 0.6 Nm/kg bw at an angle of 40 degrees for downhill walking. This increased moment and knee flexion angle yields a 3 to 4 times bigger femoropatellar joint compressive force for downhill walking compared to level walking. Due to a smaller moment arm of female subjects the patello femoral joint compressive forces were bigger for females compared to males (14 N/kg bw for male subjects, 18 N/kg for female subjects during level walking and 50 N/kg bw for male subjects, 70 N/kg for female subjects during downhill walking). The femoropatellar joint compressive force for downhill walking is comparable to running, squatting or downstairs walking. Based on this investigation downhill walking must be considered a strenuous task for the femoro patellar joint and explains well why patients with anterior knee pain or osteoarthritis have problems during downhill walking.

A prospective study was undertaken in 73 patients (24 women, 49 men; mean age 47.9 [21-64] years) after renal transplantation to discover whether the presence of C-reactive protein in urine (CRPu) and its serum concentration (CRPs) are of value in the differential diagnosis of abnormal function in the transplanted kidney. CRPu concentration was measured with a highly sensitive immunoluminometric assay (minimal threshold value 6 micrograms/l). CRPu was demonstrated in 36 histologically proven rejection episodes and 21 bacterial infections proven by culture. In contrast, no CRPu was demonstrated when the course was normal and in individual cases of cyclosporin renal toxicity, as well as in 27 of 34 cases of cytomegalovirus infection. In addition, the CRPs to CRPu ratio was a sensitive means of distinguishing between rejection (CRPs/CRPu less than 1) and bacterial infection (CRPs/CRPu greater than 1). Determining CRPu concentration thus proved to be useful in the initial monitoring of renal transplantation before starting any specific urinary protein diagnosis, as well as (together with CRPs) in the diagnosis of severe posttransplantation complications.

Neutrophilic granulocytes in the lower respiratory tract are of decisive importance for the elimination of pathogenic germs in bacterial pneumonia. On the other hand, the liberation of phagocyte products (e.g. elastase) can result in tissue damage in the parenchyma of the lungs. For this reason, we determined in patients suffering from acute pneumonia (n = 21), in patients with acute pneumonia associated with immunosuppression (n = 12), in patients who had overcome their pneumonia (n = 9) and in controls (n = 17) in bronchoalveolar lavage (BALF) and in plasma, the concentration of the locally produced granulocyte products myeloperoxidase (MPO), lactoferrin (LF) and elastase-alpha 1 proteinase complex (ELA) as well as of the alpha 1 proteinase inhibitor (alpha 1 Pi) and alpha 2 proteinase inhibitor (alpha 2 Pi) via chemoluminescence immunoassay, and compared the same with the differential cell count in the BALF. The protein concentrations were referred to the albumin concentration (Alb) for standardisation. This concentration did not differ significantly between the various patients and control groups. The BALF concentration of ELA in the group with pneumonia (median: 86.3 micrograms/l or 8.5 micrograms/mg Alb) was about eight times higher than in the group of patients suffering from pneumonia with immunosuppression (median: 16 micrograms/l or 1.0 micrograms/l Alb, p less than 0.001) or in whom the pneumonia was no longer present (17.6 micrograms/l or 0.5 micrograms/mg), and approximately 40 times higher than in the control group (3 micrograms/l or 0.2 micrograms/mg, respectively). Similar results were obtained for LF (61 micrograms/mg Alb vs. 11.3; 16.8 and 5.9 micrograms/mg; p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

In a prospective study the occurrence of cytomegalovirus (CMV) infection was diagnosed by demonstrating CMV-immediate early antigen (IEA) in the blood in 13 out of 68 (19%) patients who had undergone renal transplantation (27 women, 41 men, mean age 46.3 [21-64] years). Twenty-four hour urine samples were collected at the same time for quantitative determination of selected marker proteins by immunoluminometric assays (IgG and transferrin as glomerular markers, alpha 1-microglobulin and beta 2-microglobulin as tubular markers). In all 13 confirmed cases of CMV infection there was an isolated rise in urinary beta 2-microglobulin excretion amounting to more than three times the normal. In 11 of the 13 cases the beta 2-microglobulinuria was noted before the CMV-IEA test became positive. This suggests that quantitative assay of beta 2-microglobulin in the urine may be of value in the early diagnosis of CMV infection--a matter of some prognostic importance--and may hence offer additional support for therapeutic decisions.

In Great Britain and other countries there have been reports of an increased frequency of adenocarcinoma of the nose and paranasal sinuses, mimicking histologically mucinous colonic carcinoma, among workers exposed to wood dust and workers in the leather industry. No such cases have been reported so far in Switzerland. 31 patients with this type of adenocarcinoma of the nose and paranasal sinuses observed between 1953 and 1984 have been reviewed. In 13 of these patients there was occupational exposure to wood dust, and 4 were shoemakers. The study suggests an association of this type of nasal carcinoma with occupational exposure to wood dust and leatherwork. The nature of the postulated carcinogen is unknown. The authors propose further investigations to define the magnitude of the cancer risk associated with exposure to wood dust and leather.

A 40-year-old woman developed dermatitis of the left forearm after wearing a bracelet manufactured from Brazilian rosewood (Dalbergia nigra All.). Swelling of the lips, itching and vesicles recurred when she played a recorder made from the same timber some years later. Epicutaneous tests were strongly positive after 120 h with 2 of the wood constituents: R-4-methoxydalbergione and S-4,4'-dimethoxydalbergione. The third quinone (S-4'-hydroxy-4-methoxydalbergione) only elicited a weak reaction. Shavings of the wooden bracelet extracted with benzene and ethanol and separation of the residues by thin layer chromatography yielded all 3 dalbergiones in remarkable amounts (congruent to 0,8%). Cross-reactions to the chemically near related R-3,4-dimethoxydalbergione, known as the strongest sensitiser of the dalbergione group, were not obtained, although guinea pig experiments had revealed cross-reactivities. Of the racemic 4-methoxydalbergione the dextrorotatory form elicited stronger responses than the S-form.

Sinonasal cancers, although quite rare, have been shown to occur with greatly increased frequency among furniture workers. In the first epidemiological study of this problem in Switzerland, we use information drawn from the mortality statistics for the years 1979-1982 and from the 1980 national census to calculate the relative risk of mortality from sinonasal cancers among male Swiss furniture workers, aged 15-79, via both the odds ratio (OR) and the standardized mortality ratio (SMR). We verified the comparability of the occupation "furniture workers" on a random sample of death certificates and matched census records. There was an excellent concordance of 72%. The diagnosis "malignant neoplasms of the nasal cavity and paranasal sinuses" is also highly reliable on Swiss death certificates. In this 4-year period we observed 9 cases among the 41,667 furniture workers and 59 among the 1,813,798 male workers in the general population. Our SMR indicates a 6.6-fold relative risk for death due to cancers among Swiss furniture workers (p less than 0.0001; 95% confidence interval 3.0-11.6). When differential histological classification (obtained from regional cancer registers) is taken into consideration, we note an OR of 230 for death from adenocarcinoma. These results are in agreement with figures published by researchers elsewhere. Because of the long latency period, it is important to include populations over 65 in studies such as this, in order to avoid case selection bias. On the other hand, those over 80 had to be excluded from our study because of poor reliability of occupation on the death certificate.(ABSTRACT TRUNCATED AT 250 WORDS)

IgA concentrations in serum, sputum and bronchoalveolar lavage were determined in 11 patients with chronic obstructive lung disease exacerbated by infection and in 22 with similar disease during an infection-free period. Patients with infection had a higher serum-IgA concentration than those without. But there was no difference in sputum-IgA concentration between the two groups. Both for sputum and broncho-alveolar lavage there was a positive correlation between anti-elastolytic inhibition capacity and IgA concentration. In vitro it has been demonstrated that IgA concentration measured immunologically decreases with increasing elastase concentration, in line with increasing free elastolytic activity. Local IgA deficiency in patients with infection apparently results from proteolytic splitting of the immunoglobulin.

In a multicentre trial conducted in eight European centres, 232 recipients of cadaveric renal allografts were randomly allocated to receive either cyclosporin A (CyA, 117 patients) or azathioprine and steroids (control, 115 patients) for immunosuppression. After a follow-up period of up to eleven months, graft survival probability estimates are 73% in the CyA group and 53% in the control group. Two deaths have occurred In the CyA group and seven in the control group. 82% of the CyA group with functioning grafts are receiving CyA alone, 17% have been changed to azathioprine and steroids and one patient is receiving prednisolone in addition to CyA; 27% have never received steroids. At six months post-transplant renal function is similar in patients receiving CyA and in those receiving azathioprine and steroids. On the basis of these preliminary results CyA appears to be more effective than conventional immunosuppression and avoids the necessity of long-term steroid therapy.

In a prospective study, serial serum determinations of gentamicin were made after its intratracheal application (40 mg/8 h) to 14 patients on ventilators (seven with normal renal function, seven with compensated, preterminal or dialysis-requiring renal failure). The patients with normal renal function had no therapeutic or toxicologically significant gentamicin concentration in their serum: less than 0.1 mg/l, in one case maximally 0.67 mg/l. But in patients with renal failure even the first gentamicin dose increased the serum level up to 1.5 mg/l. After repeated endotracheal application gentamicin accumulation in serum led to maximal values of 6.2 mg/l after the sixth and 7.5 mg/l after the seventh dose. The absorption of the drug from the tracheobronchial system differed between individuals. Thus serum concentrations were reached in patients with renal failure which are systemically effective and potentially toxic.