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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.

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%.

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)

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.

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.

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.