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Geriatric Assessment is a structured interdisciplinary process for the diagnosis of the functional status and potential for rehabilitation of geriatric inpatients. This paper describes the possibilities and scope of the Vienna Model of Geriatric Assessment oriented in terms of practicability and focused implementation of resources. By using this multidimensional proceeding the rehabilitation-quotient of patients has increased more than 39%. From this point of view Geriatric Assessment in a geriatric hospital is a practical instrument to prevent hospitalization, to increase survival at home, and to improve functional status in elderly patients.

Little is known about syncarcinogenic effects of occupational and environmental substances although it is supposed that different exogenous factors may play critical roles in the development of many human tumors. Epidemiologic results prove syncarcinogenesis for asbestos exposure and smoking (lung cancer), radon exposure and smoking (lung cancer), exposure to aromatic amines and smoking (bladder cancer) and alcohol abuse and smoking (oral, larynx and oesophagus cancer). Animal experiments point to additive effects in carcinogenesis for different nitrosamines and substances like benzo(a)pyrene, carbon tetrachloride, ethanol, vinyl chloride and ionising radiation. It can be concluded from modern concepts of carcinogenesis that syncarcinogenic mechanisms may not only result from genotoxicity but also from influences on cell proliferation and mitogenesis as well as toxicokinetics, DNA repair, intercellular communication, immune system and hormonal effects. New methods of molecular epidemiology seem very promising to study syncarcinogenic effects in animals and humans.

It is a long-standing question whether the paraxial head mesoderm of vertebrate embryos is segmentally organized into somites like the trunk or not. On the one hand, no somites are seen in the anterior head mesoderm in vertebrate embryos, on the other hand, such a segmental pattern has been described under the name of somitomeres. In order to investigate the patterning of mesodermal cells in the head of avian embryos we performed scanning electron microscopy, computer assisted reconstructions of the head mesoderm and density analyses of head mesoderm cells. We observed regional differences within the head mesoderm of avian embryos, but we could not see a consistent somitomeric pattern in the head mesoderm. In sum, we consider that the avian head mesoderm is not arranged in a metameric pattern.

The objective of the present study was to investigate nasal function by active anterior rhinomanometry with respect to spirometric data and bronchial hyperresponsiveness to methacholine in 9-year-old children. The study population consisted of 300 children (ages 8 to 11 years; mean, 9.3 years; 161 male, 139 female), who underwent basal rhinomanometry followed by a decongestion test and a lung function test consisting of spirometry and a methacholine provocation test. The flow values of the basal rhinomanometry showed a significant correlation with height and bronchial hyperresponsiveness. The consecutive decongestion test showed a marked increase in flow rates at each level, which was found to be significantly higher in children with bronchial hyperresponsiveness (p < 0.01). The spirometric data showed no influence on rhinomanometric values. These results suggest that nasal dysfunction and reactivity in terms of the decongestion test may be associated with bronchial hyperresponsiveness in children.

The renal excretion of arylamines in occupationally exposed and nonexposed subjects was measured by a gas chromatography-electron capture detector method. Additionally, in the occupationally exposed persons hemoglobin adduct levels of arylamines were determined by a liquid chromatography-electrochemical detector method, together with the individual acetylator status. The aromatic amines aniline, p-toluidine, 2-naphthylamine, and 4-chloro-o-toluidine were detected in the urine of nonsmoking subjects who were not occupationally exposed to arylamines. Significantly higher concentrations of aniline, o-toluidine, m-toluidine, 2-naphthylamine, and 4-methyl-1,3-phenylenediamine could be observed in the urine of smoking control persons in comparison to nonsmokers. Comparison of smokers and nonsmokers in a group of workers primarily exposed to aniline and 4-chloroaniline revealed significant differences (P < 0.05) in the formation of 4-aminodiphenyl hemoglobin adducts and in the renal excretion of 2-naphthylamine. The slow acetylators in this group produced significantly more hemoglobin adducts of aniline and 4-chloroaniline than did the fast acetylators. In slow acetylators among the smoking workers there was a significant increase in the formation of 4-aminodiphenyl hemoglobin adducts and in the renal excretion of 4-chloroaniline and m-toluidine. The results indicate that there are influences of smoking habits and acetylator status on the levels of arylamine hemoglobin adducts as well as urinary arylamine concentrations. Hemoglobin adducts seem to be good parameters for monitoring aniline and 4-chloroaniline exposure at the workplace, especially if the acetylator polymorphism can be taken into account. 4-Aminodiphenyl hemoglobin adducts might be good parameters for monitoring individual smoking habits. The determination of urinary arylamine concentrations provides additional information concerning acute exposures to aromatic amines.

The present study investigated the sensitization to inhalatory allergens in a randomized cross-section of the population of Vienna (altogether 3000 men and women). A representative sample of 600 persons was invited to an examination consisting of a skin prick test and determination of serum total IgE and allergen-specific IgE. In addition, the same tests were performed in persons with asthma or allergic rhinitis on the basis of a history of these conditions in the replies to a screening questionnaire. Our results showed comparatively high sensitization rates to grass pollen (28%), house dust mite (25%) and cat dander (20%) in the randomized group A. In the symptom-free "healthy" subgroup of the randomized population sample (Group B) there were remarkably high sensitization rates to house dust mite (21%), grass pollen (17%) and cat dander (12%). For the group with allergic rhinitis (Group D) sensitization to grass pollen exceeded 60%, followed by cat dander (44%), birch pollen (36%) and house dust mite (35%). In the asthmatic persons (Group C) the leading allergens were cat dander (40%) and the house dust mite (37%), followed by grass pollen (33%) and birch pollen (20%). Regarding the overall sensitization to inhalatory allergens 61% of the asthmatic group showed a positive prick test. Increased serum levels of total IgE or specific IgE were found in 76% of cases, which underlines the allergic origin of this disease. In the randomized group 51% were sensitized to inhalatory allergens, whilst 39% were subclinically sensitized without ever having had any allergic complaints.(ABSTRACT TRUNCATED AT 250 WORDS)

A 78-year-old patient with an ulcerous, purulent, exophytic fist-sized breast carcinoma (FIGO IVd) and a pulmonary metastasis who refused radiation, chemotherapy and operation, was treated with oral tamoxifen and metronidazole daily and with local antiseptics. After two months she was pain-free without analgesics. After eight months the exophytic part of the tumor had completely gone. One year after the beginning of treatment, during which she had led a normal life, metronidazole was withdrawn due to neuropathy, and the wound worsened within a few days. One month later opioids were required to treat tumor-induced pain. Two months later the patient died. The surprisingly long survival with good quality-of-life may indicate important effects of metronidazole combined with tamoxifen in the treatment of ulcerous breast cancer.

Using a stepwise logistic regression analysis, we investigated clinical data, allergologic findings, spirometric data, and the cellular and humoral immune system in order to gain new insights into the role these parameters play in bronchial hyperresponsiveness to methacholine in children and to create a model for the prediction thereof. Bronchial hyperresponsiveness, which was found in 124 of 462 children (26.8%), was observed to have been influenced by an increased level of eosinophils, the positivity of the skin prick test for any of the allergens tested, a decreased baseline forced expiratory volume in 1 second (FEV1) (percent predicted), a decreased maximum expiratory flow at 50% expiration as a percent of forced vital capacity, and a decreased level of kappa-chain-assembled immunoglobulins. Logit analysis disclosed that the influence of all other parameters on the occurrence of bronchial hyperresponsiveness was of no further statistical significance. The degree of bronchial hyperresponsiveness (provocative dose causing a 20% fall in FEV1) showed a statistically significant correlation with the eosinophil count (Spearman's r = -0.198) and FEV1 (percent predicted) (Spearman's r= 0.203). Our findings suggest that allergic sensitization and eosinophilic reaction in children are major factors in contributing to the occurrence of bronchial hyperresponsiveness to methacholine.

The lymphocytes of 25 hospital workers exposed to ethylene oxide and of a standardized control group were investigated for DNA damage (measured by alkaline filter elution) and sister chromatid exchange (SCE) frequencies. Additionally, the excretion of hydroxyethyl mercapturic acid (HEMA) in the 24-h urine of ten workers and ten control persons was determined. The peak levels of ethylene oxide in air during the first 8 min after opening of the sterilization unit were measured. Peak levels of ethylene oxide in the air of up to 417 ppm after opening of the sterilization unit were detected. In the alkaline filter elution assay we found significantly reduced elution rates in the exposed workers, indicating DNA-protein cross-links. The reduction of the elution rates through HVLP filters correlated significantly with the exposure classification (low, medium, high) (r = -0.45, P < 0.05) and the ethylene oxide peak level after opening of the sterilization unit (r = -0.42, P < 0.05). The SCE frequencies in the standardized control group were significantly elevated. With respect to (n = 78) historic control SCE values of our institute, the SCE values of the disinfectors were not significantly elevated (6.54 vs 6.27). The ethylene oxide-exposed workers did not have a greater percentage of high-frequency SCE cells. The mean HEMA concentration in the urine of the exposed workers was significantly elevated, but there were wide variations in HEMA concentrations and no correlation to ethylene oxide exposure. We conclude that the alkaline filter elution assay may be a sensitive parameter for ethylene oxide-exposed workers.(ABSTRACT TRUNCATED AT 250 WORDS)

Immunological functions of the tonsils and possible effects of their removal are still controversial. One reason for this is the lack of long-term follow-up investigations after tonsillectomy. In the present study selected parameters of the cellular and humoral immune systems of 160 children 0.5-11 years after tonsillectomy (mean 6.6 +/- 2.1 years) were compared to those of 302 age-matched non-tonsillectomized children. In tonsillectomized children the incidence of infections of the upper respiratory tract was not increased compared to the non-tonsillectomized control group. Slightly increased percentages of CD 21 + cells, raised counts of CD4+ cells, absolute and relative increases in DR+ cells and a raised CD4+ DR count was found mainly in tonsillectomized boys, while lymphocyte subpopulations of tonsillectomized girls remained unaffected. Tonsillectomized children had lower IgA levels, but the complement system was not altered in either sex. These findings show that while tonsillectomy may lead to certain changes in the cellular and humoral immune systems, these alterations are clinically insignificant and no increased frequency of immunomodulated diseases should be expected.

The diagnostic value of chest X-ray following the ILO standards was compared with bronchoalveolar lavage (BAL) and the histology of transbronchial forceps biopsy in 83 patients with collagen vascular diseases. BAL in the middle lobe was considered abnormal in case of increased cell count per milliliter and/or lymphocytosis and/or neutrophil granulocytosis and this was found in 32 out of 42 cases (76.2%) with, and in 33 of out 41 cases (80.5%) without abnormal radiological finding. Pathological changes in the histology were found in 14 out of 20 cases (70.0%) with and in 40 out of 63 cases (63.5%) without abnormal chest X-ray in the upper lobe from which the transbronchial forceps biopsy specimens were obtained. In histological specimens obtained from transbronchial forceps biopsy, only fibrosis correlated with abnormal radiological findings in this region. Other inflammatory processes defied prediction by chest X-ray. This suggests that, regardless of chest X-ray findings, BAL should be performed together with transbronchial forceps biopsy for the histological examination of patients with collagen vascular diseases in which interstitial lung involvement is suspected.

Different parameters of biological monitoring were applied to 26 benzene-exposed car mechanics. Twenty car mechanics worked in a work environment with probably high benzene exposures (exposed workers); six car mechanics primarily involved in work organization were classified as non-exposed. The maximum air benzene concentration at the work places of exposed mechanics was 13 mg/m3 (mean 2.6 mg/m3). Elevated benzene exposure was associated with job tasks involving work on fuel injections, petrol tanks, cylinder blocks, gasoline pipes, fuel filters, fuel pumps and valves. The mean blood benzene level in the exposed workers was 3.3 micrograms/l (range 0.7-13.6 micrograms/l). Phenol proved to be an inadequate monitoring parameter within the exposure ranges investigated. The muconic and S-phenylmercapturic acid concentrations in urine showed a marked increase during the work shift. Both also showed significant correlations with benzene concentrations in air or in blood. The best correlations between the benzene air level and the mercapturic and muconic acid concentrations in urine were found at the end of the work shift (phenylmercapturic acid concentration: r = 0.81, P < 0.0001; muconic acid concentration: r = 0.54, P < 0.05). In conclusion, the concentrations of benzene in blood and mercapturic and muconic acid in urine proved to be good parameters for monitoring benzene exposure at the workplace even at benzene air levels below the current exposure limits. Today working as a car mechanic seems to be one of the occupations typically associated with benzene exposure.

Inspiratory muscle performance, ventilation, and gas exchange were studied during exercise in healthy subjects to look for typical changes of pattern of contraction at the ventilatory threshold (VT). The steepening of the slope of carbon dioxide output (VCO2) vs oxygen uptake (VO2) at the VT was accompanied by a nonlinear increase of the mean rate of esophageal pressure development (Pes/TI) vs the esophageal pressure time index (PTIes) reflecting both the relative force (Pbreath/Pesmax) and duration (TI/TTOT) required for inspiration. The esophageal pressure time integral within one breath (Pbreath.dTI) was one of the best single predictors of the ventilatory equivalent for oxygen (VE/VO2) at the VT. Moreover, we presented inspiratory muscle load indices as a mirror image of breathing pattern, with the obvious advantage that the ventilation component can be compared with better established methods of presenting ventilatory output. Inspiratory muscle performance during exercise should link the increased metabolic rate to ventilatory output. We conclude that 1) there exists an inspiratory muscle threshold that is well correlated to commonly used gas exchange thresholds, and 2) the efficiency of ventilation and gas exchange during exercise could be linked to pressure and timing of inspiratory muscle contraction.

The investigation was performed in winter 1990 and 1991 when measurements were taken in 16 dwellings of patients, recruited from a pulmologic outpatient centre. Patients suffered from repeated respiratory irritations which they attributed to dwelling conditions. Inhabitants reported by means of questionnaires and standardized scales the dwelling situation and their dwelling behaviour, subjective ratings of indoor environmental quality as well as ratings of wellbeing. The load of indoor pollutants (CO2, CO, NO2, HCHO), biological agents (fungal spores, house dust mites) as well as indoor climate factors were assessed. The measurements revealed an evident load at least in one parameter; in the majority of dwellings combined loads of air pollutants and biological agents were apparent. Homes supplied with gas as main energy source had significantly higher concentrations of CO2, CO and NO2. At noon, exposure limits of CO2 and NO2 were frequently exceeded. Inhabitants of homes being supplied with electricity instead of gas gave significantly better air quality ratings. The correlations between the average score concerning the rated health quality of their homes and the rate of excess of exposure limits are significant: The health quality ratings are significantly related to the concentrations of "air quality indicators", which induce the feeling of stale air (CO2) and mucosa irritations (NO2). Ratings of wellbeing are significantly connected to objective parameters, i.e. NO2 baseline load, fungal spores in the air and the difference between wall-air temperature. Our study suggests that people suspecting a connection between their health impairment and dwelling conditions should be taken serious. The measurement program proved to be a suitable screening procedure to assess adverse environmental influences in homes. More homes should be investigated to further support our findings.

To estimate reliability of self-reported compliance with nasal continuous positive airway pressure (CPAP) therapy for obstructive sleep apnea (OSA), we studied 63 OSA patients aged 53.7 +/- 1.2 years (mean +/- SEM) with an apnea hypopnea index (AHI) of 50.8 +/- 2.9 and lowest sleep SaO2 of 65.6 +/- 2.3 percent receiving nasal CPAP for 539 +/- 44 days. During a follow-up polysomnography (PSG) on the pressure prescribed for home therapy (10.3 +/- 0.3 cm H2O), the hours of operation shown on the built-in time counter of the patients' devices were read to determine objective compliance by dividing the run time by the days since initiation of therapy. This parameter was compared with subjective compliance reported in a self-administered questionnaire. Mean measured use time was 4.9 +/- 0.3 h per night, whereas reported daily use time calculated from reported nights a week and hours a night was 6.1 +/- 0.3 h per night. As predominantly patients with poor compliance misestimated daily use time, we conclude that self-reports are unable to distinguish between compliant and noncompliant patients.

Bronchoalveolar lavage (BAL) and histology of transbronchial forceps biopsy was performed in 59 patients with rheumatoid arthritis (RA) to evaluate the in vivo effects of disease modifying drugs (DMARD). All patients had no clinical pulmonary symptoms and there was no evidence of drug induced alveolitis. Patients were divided into 5 subgroups according to drug treatment: 9 patients taking chloroquine, 15 patients gold, 8 patients penicillamine, 8 patients methotrexate (MTX) and 19 patients not taking DMARD. Duration of DMARD regimen was more than 3 months. No patient was treated with corticosteroids. BAL results revealed an increased percentage of lymphocytes and a diminished proportion of alveolar macrophages in patients treated with gold, penicillamine, MTX and no DMARD. In contrast, patients receiving chloroquine had a normal distribution of lymphocytes and macrophages as seen in a control group of 15 persons. Patients taking MTX showed a normal distribution of T and B lymphocytes and DR positive cells, whereas patients receiving chloroquine, gold, or penicillamine had an elevated proportion of T lymphocytes and DR positive cells and a diminished percentage of B lymphocytes. The latter was also observed in patients not taking DMARD. The percentage of natural killer cells was significantly elevated only in the penicillamine group. Patients receiving gold had higher absolute values of CD3, CD4 and DR positive cells. Abnormal lung histology was associated with an increased percentage of lymphocytes and with higher DR positive cells in BAL. Patients not receiving DMARD had a significantly higher percentage (42.1%) of abnormal histologic features of lung tissue than patients receiving DMARD (17.5%).(ABSTRACT TRUNCATED AT 250 WORDS)

A review of the impact of chlorinated biphenyls (PCBs) on reproduction is presented. PCBs are able to pass the placenta; accumulation in offspring is mainly achieved by breast feeding. Disturbances of fertility and embryotoxicity were detected in animals; teratogenicity without maternal toxicity was only observed in mice. In animal experiments disturbances of fetal and postnatal development were detected as well as in human studies. Neurotoxicity was observed even at low-level exposures in monkeys, which are most comparable to humans because of the development of the same clinical symptoms. Technical PCBs which are dominating in occupational and environmental exposure until now must be judged as toxic for reproduction: dermal exposure (especially in accidents) should be considered as an important route of exposure beside inhalation. Work to list possible PCB exposure risks and to develop ways to reduce these risks are necessary now.

In the present study the incidence of bronchial asthma, airway complaints, and allergic rhinitis was investigated in a randomized population section including 3000 male and female inhabitants of Vienna (sex ratio 1:1), aged 20-44. Data on complaints in the respiratory tract were obtained from a total of 71% of the study population. Our results suggest that 14.7% of the entire population was suffering from allergic rhinitis (16.4% male versus 13.0% female; p < 0.05). Airway complaints such as wheezing, whistling, and feeling of tightness in the chest, awakening because of shortness of breath or cough were frequently reported, with no major differences between male and female subjects. The overall percentage of study subjects stating that they had suffered from airway complaints in the year before, i.e., the percentage of those giving affirmative answers to one of the questions, was 29%. Bronchial asthma was calculated to be present in 5.1% of the entire population (5.9 male versus 4.4 female). Attacks of asthma were reported by only 2.2% of the subjects, which gives an indication of the discrepancy between identified and unidentified bronchial asthma. Allergic rhinitis is correlated to, and constitutes a risk factor for the occurrence of complaints in the respiratory tract; public health policy should therefore be aimed at the prevention or early treatment of allergic rhinitis, and at reducing the proportion of cases suffering from unidentified bronchial asthma.

Bronchial epithelial cells obtained by brush biopsy during fiberoptic bronchoscopy performed in 12 patients with chronic bronchitis and 12 healthy control subjects, were investigated for HLA-DR antigen expression and nucleolar silver staining patterns. In all patients with chronic bronchitis the number of bronchial epithelial cells positive to HLA-DR antigen was highly increased (> 90%), whereas in the controls only a few epithelial cells (< 10%) showed a weak HLA-DR antigen expression. Patients with chronic bronchitis showed an increased lymphocytic reaction compared to the control subjects. Both in the patients with chronic bronchitis and in the healthy controls the number of nucleoli was the same. The number of silver stained dots per nucleus was significantly higher in patients with chronic bronchitis than in the control subjects (7.70 +/- 0.87 as against 5.11 +/- 0.52; p < 0.0001). The intensity of the lymphocytic reaction correlated with the HLA-DR antigen expression and the increase in silver staining (Spearman's r = 0.543; p < 0.01). This indicates the influence of inflammation on the activation of epithelial cells derived from the respiratory tract.

To investigate the impact of sleep-disordered breathing events on daytime hypertension (HT) in patients with increased upper airway resistance during sleep, we studied 191 male snorers aged 49.9 +/- 0.8 years. In 116 of them, an apnea-hypopnea index (AHI) above 10--defined as the presence of obstructive sleep apnea (OSA)--was found; the other 75 subjects had an AHI lower than 10 and were classified as habitual snorers (HSN). Prevalence of HT was not different between OSA (56 of 116 = 48 percent) and HSN (33 of 75 = 44 percent) and there was also no difference in systolic, diastolic, and mean blood pressures between the two groups. Hypertensive OSA patients had higher body mass index (BMI) than normotensive OSA subjects (31.4 +/- 0.7 vs 29.4 +/- 0.6; p less than 0.05), but there was no difference in age, AHI, and nocturnal oxygenation parameters. The same was true for the HSN group, with hypertensive subjects being more obese than normotensive subjects (BMI: 30 +/- 0.8 vs 27.3 +/- 0.8; p less than 0.05), but no difference in age and polysomnographic features. Discriminant analysis with HT as the classification variable and age, BMI, AHI, mean, and lowest nocturnal oxyhemoglobin saturation as independent variables, revealed an independent influence on HT only for BMI (F-prob = 0.001). Thus, our results stand against the hypothesis of a causal relationship between sleep-disordered breathing events and daytime hypertension. We conclude that the high prevalence of HT in male snorers is more directly linked to obesity than to sleep apnea, but an independent effect of snoring per se cannot be excluded.

In biological effect monitoring the alkaline filter elution is a suitable method to detect DNA strand breakage and cross-linking in peripheral blood lymphocytes. We applied this method to three groups of workers occupationally exposed to carcinogens: n = 39 welders with exposure to chromium and nickel, n = 20 female shoemakers with exposure to benzene and n = 25 disinfectors in hospitals with exposure to ethylene oxide. In comparison to standardised control groups our results must be interpreted as indicating an increased rate of DNA cross-linking in welders and disinfectors whereas the female shoemakers showed an increased rate of DNA strand breakage. The differences between the results of the exposed groups and the stratified control groups were significant in most cases. We could reexamine 6 shoemakers 4 months after cessation of exposure to benzene; at this moment the results were indicating a clear decrease of the DNA strand breakage. Therefore the method of alkaline filter elution seems to be a valuable tool in biological effect monitoring of groups occupationally or environmentally exposed to carcinogens, especially if the exposure is low, but persistent over a long period.

We initiated the present study to predict interstitial lung involvement in rheumatoid arthritis (RA) by means of logistic regression analysis of clinical data, lung function, chest roentgenogram, and serologic parameters. Fifty-eight nonsmoking patients with RA were randomized from the rheumatologic unit and sent for investigation to the pulmonary department. Bronchoalveolar lavage (BAL) was performed in the middle lobe and the BAL fluid was considered abnormal in case of increased cell count per milliliter and/or lymphocytosis and/or neutrophil granulocytosis; these findings or combinations thereof were found in 42 (72.4 percent) of 58 cases. The patients' data that had an impact on the normality of BAL were the sex (p = 0.001), vital capacity (p = 0.028), peripheral blood T-helper cells (OKT4+) (p = 0.025), DR(+)-lymphocytes (p = 0.002), and antinuclear antibodies (p = 0.025). By means of the logistic regression analysis, it was possible to reach high significance in the prediction of interstitial lung involvement, with a sensitivity of 92.9 percent and a specificity of 75.0 percent (p less than 10(-6)). The efficiency of prediction was 87.9 percent. From these results, we conclude that interstitial lung involvement in RA is predictable from laboratory findings that have been yielded by noninvasive diagnostic techniques. These data should be used in clinical routine monitoring and they may help to facilitate the assessment of whether bronchoscopy is indicated.

Between 1982 and 1990 seven cases of bladder cancer were detected in a group of 49 workers who were synthesising chlordimeform from 4-chloro-o-toluidine. Latency periods ranged from 15 to 23 years. The incidence of bladder tumours in this group was significantly higher than that of the cancer registers of the former GDR, Saarland, and Denmark by factors of 89.7, 53.8, and 35.0 respectively. This provides further evidence that monocyclic aromatic amines such as 4-chloro-o-toluidine may be carcinogenic in humans.

Bronchoalveolar lavage lymphocytes from 15 patients with pulmonary sarcoidosis and 8 healthy controls were investigated for nucleolar silver staining patterns and lymphocyte subpopulations. Patients with sarcoidosis had increased numbers of silver stained dots versus controls (2.20 +/- 0.24 versus 1.78 +/- 0.07; p less than 0.001). The number of silver stained dots showed the strongest positive correlation to helper cells (OKT 4+) (r = 0.781; p less than 0.0001). These results may be interpreted as further evidence of lymphocytic activation, especially of helper cells (OKT 4+) in pulmonary sarcoidosis.

Perhaps the greatest strategist of all time was not a business executive but a general. Helmuth von Moltke, chief of the Prussian and German general staffs from 1858 to 1888, issued "directives" to his officers rather than specific commands. These guidelines for autonomous decision making encouraged Moltke's subordinates to show individual initiative. In this article, Hans Hinterhuber and Wolfgang Popp translate Moltke's example into business terms. According to Moltke, strategy is applied common sense and cannot be taught. The authors suggest that good entrepreneurs and managers--along with generals--are born with the qualities that make them successful. But even if managers have the potential to be good strategists, they must develop and hone their natural talents. And CEOs and top management can help by identifying and promoting such talents in their employees. Hinterhuber and Popp have created a questionnaire that helps measure strategic management competence. Managers and entrepreneurs take this test themselves, answering ten questions such as, "Do I have an entrepreneurial vision?", "Do I have a corporate philosophy?", and "Do I have competitive advantages?" Using the questionnaire, company management can evaluate managers being considered for a promotion. At the same time, those who take the test can use it to determine their own performance as strategists. Strategic managers provide subordinates with general guidelines, just as Helmuth von Moltke issued directives to his officers. And outstanding entrepreneurs create a corporate culture in which their vision, philosophy, and business strategies are implemented by employees who think independently.

Tetrachloroethene concentrations in blood and trichloroacetic acid concentrations in urine were determined--primarily over the course of a week--for 29 persons living in the vicinity of dry-cleaning shops. The mean levels of tetrachloroethene increased during the week. In some neighbours concentrations were exceeding the German biological threshold limit value for tetrachloroethene (1000 micrograms/l blood), persisting over the whole week in one case. The concentrations of tetrachloroethene in blood depended on the floor and the construction type of the building where these people were living, but not of the type of system used in the dry-cleaning shops. 5 of 12 dry-cleaners were found to have tetrachloroethene levels exceeding the German biological threshold limit value, some of them by a considerable amount.

We investigated the changes in the cellular and humoral immune system in bronchoalveolar lavage (BAL) performed in 22 patients with pulmonary sarcoidosis and in 14 normal control subjects and their interactions with lung function parameters. Lymphocytosis, the increase in OKT4+ lymphocytes and OKT4+OKDR+ lymphocytes correlated with the increase in immunoglobulins, especially IgG, IgA and kappa chain assembled immunoglobulins. The transferrin levels obtained in BAL were found to be higher in patients with sarcoidosis, and they correlated with the cellular and, more closely, with other humoral findings. A negative correlation existed between the ventilatory parameters and the cell count and humoral findings. In addition, we found a negative correlation between the diffusing capacity for carbon monoxide and other cellular findings, which was most pronounced with reference to lymphocytes, OKT4+ lymphocytes and the OKT4+/OKT8+ ratio. These results underscore the role of OKT4+ lymphocytes, activated OKT4+OKDR+ lymphocytes and transferrin in the increase in immunoglobulins, mainly kappa chain isotypes. Because of the relationship between these changes and ventilatory parameters, and the diffusing capacity, the above results also reveal the clinical relevance of our findings.

To investigate the lasting effects of high ozone concentrations under environmental conditions, we examined the respiratory health, pulmonary function, bronchial hyperresponsiveness to methacholine, allergic sensitization, and lymphocyte subpopulations of 10- to 14-yr-old children. A total of 218 children recruited from an area with high ozone concentrations (Group A) were tested against 281 children coming from an area with low ozone concentrations (Group B). As to subjective complaints, categorized as "usually cough with or without phlegm," "breathlessness," and "susceptibility to chest colds," there was no difference between the two groups. The lung function parameters were similar, but in Group A subjects' bronchial hyperresponsiveness occurred more frequently and was found to be more severe than in Group B (29.4 versus 19.9%, p less than 0.02; PD20 2,100 +/- 87 versus 2,350 +/- 58 micrograms, p less than 0.05). In both groups the number of children who had been suffering from allergic diseases and sensitization to aeroallergens, found by means of the skin test, was the same. Comparison of the total IgE levels showed no difference at all between the two groups. As far as the white blood cells are concerned, the total and differential cell count was the same, whereas lymphocyte subpopulations showed readily recognizable changes.(ABSTRACT TRUNCATED AT 250 WORDS)

Although NCPAP is the most efficient nonsurgical treatment for patients with OSA, many patients do not accept sleeping with a nose mask. To determine the factors influencing acceptance, treatment with NCPAP was offered to 95 patients with an AHI greater than 15. After the first night on NCPAP, 47 of 65 patients decided to have NCPAP as a home therapy. Excessive daytime sleepiness was more frequently reported by acceptors than refusers. The frequency of complaints about psychomental symptoms such as poor mental performance and bad memory, was not different between the two groups. There was a close correlation between the rate of acceptance and the AHI as well as the number of positive answers to questions about symptoms of daytime sleepiness in a questionnaire, which correlated with the number and length of apneas. Acceptance of NCPAP was found to be dependent on the subjective feeling of impairment by hypersomnolence due to OSA.

To determine whether long-term NCPAP therapy influences severity of sleep disordered breathing during the second part of a night when NCPAP is applied for only the first four hours of sleep, we studied 21 patients with OSA receiving NCPAP therapy for 253 +/- 41.6 days. Results from polysomnography for the period after withdrawal from NCPAP (night B) were compared to the corresponding period of sleep prior to initiation of NCPAP therapy (night A). There was no significant change in RDI from night A (53.9 +/- 8.6) to night B (28.7 +/- 3.3), but maximal apnea length diminished from 55 +/- 2.9 s to 40 +/- 2.9 s (p less than 0.05). Whereas daytime Po2 and the amplitude of desaturations during sleep remained equal, overall oxygenation during sleep improved slightly (mean SaO2 night A = 90.6 +/- 0.9 percent; night B = 92.8 +/- 0.5 percent; p less than 0.05). Differences between nights A and B were more prominent the more severe sleep apnea had been prior to treatment and could not be explained by weight loss. There was strong correlation between improvements in oxygenation measurements and the daily time of NCPAP use. In conclusion, we found a subgroup of OSA patients receiving long-term NCPAP therapy with less disturbed ventilation during sleep following use of NCPAP for only the first part of the night, but in the majority of patients, sleep disordered breathing off NCPAP remained unchanged.

The study examined pulmonary function parameters of 36 patients with insulin-dependent diabetes mellitus and analyzed their inspiratory muscle performance. The control group consisted of 40 healthy reference persons of a sex ratio, age, height, and weight distribution similar to those of the patients. The pulmonary function test included the measurement of the lung volumes and the maximal expiratory flow-volume curves. The values of maximal sniff esophageal (Pes) and transdiaphragmatic pressures (Pdi) were used as parameters for global inspiratory muscle strength and diaphragm strength, respectively. The 12-s maximum voluntary ventilation (MVV) test supplied the parameter of inspiratory muscle endurance. The diabetic patients showed a highly significant decreased value for their inspiratory vital capacity (VCin) compared with that of the control subjects (4.75 +/- 0.84 versus 5.36 +/- 1.37 L; p less than 0.01). Inspiratory muscle performance in the diabetic patients was also restricted. Sniff Pes was significantly lower in the diabetic group (p less than 0.05); sniff Pdi (p less than 0.01) and MVV (p less than 0.05) were also low. The results did not correlate with either the duration of diabetes or the quality of metabolic control measured by glycosylated hemoglobin concentration. The reduction of VCin in diabetic patients may have been caused partly by the reduced capacity of the inspiratory muscles.

A total of 39 electric welders exposed to chromium and nickel were compared with 18 controls standardized for age, smoking habits and sex with respect to the frequency of sister chromatid exchange (SCE) and of DNA strand breakage and cross-linking (measured by the method of alkaline filter elution) in their blood lymphocytes. A significant correlation was found between the frequency of SCE and of individual DNA strand breakage and the concentration of chromium in the urine. Less DNA from the welders than from the control group was eluted through the two filter types used (polycarbonate and polyvinylidene fluoride filters). This must be interpreted as resulting from the presence of DNA-protein cross-links, which has the secondary effect of leading to a relative reduction in the measurable frequency of strand breakage amongst the welders. The present results are in good agreement with in vitro and in vivo investigations that confirm the importance of DNA-protein cross-links for the carcinogenic effect of chromium.

A computerized search for rapid resaturation (RES)--defined as increases in oxyhemoglobin saturation (SaO2) of 3% or more within 10 s--was used to detect apneas and hypopneas during sleep by the episodes of compensatory hyperventilation following them. Results were compared to those from computerized search for desaturations (DESAT)--defined as decreases in SaO2 of 4% or more within 40 s--and to simultaneous polysomnography. We studied 30 patients with obstructive sleep apnea (OSA) with an apnea plus hypopnea index (AHI) of 30.8 +/- 6.9 (median +/- SEM) and 23 habitual snorers (HSN) with an AHI of 7 +/- 1.5. Manual scoring of polysomnography revealed 7965 respiratory events (6192 apneas, 1773 hypopneas) in OSA patients and 940 events (411 apneas, 529 hypopneas) in the HSN group. In OSA patients, the computer found 96% of events by searching for RES and 87% by searching for DESAT. The percentage of computer-found events in OSA classified as true positive was 91% for RES and 97% for DESAT. In the HSN group, 83% of polysomnographically scored events were found by RES and 55% by DESAT, with 72% of RES and 84% of DESAT being true positive. The correlation of the number of computer-found RES with the number of events from polysomnography was better in OSA (r = 0.862, p less than 0.0001) than in HSN (r = 0.722, p less than 0.001). The same was true for DESAT (OSA: r = 0.896, p less than 0.0001; HSN: r = 0.637, p less than 0.01). In conclusion, computer-found rapid resaturations are more sensitive than desaturations for the detection of respiratory events during sleep from oximetry.(ABSTRACT TRUNCATED AT 250 WORDS)

Problems in the diagnosis of mould allergies arise from a large number of mould species, different expression of allergens and limited supply of allergens in test systems. Only the use of many different and special diagnostic methods enables an accurate clearing up of diseases. Not until all diagnostic problems are resolved, an adequate therapy is possible and should use new ways.

The diagnostic value of flow-volume curves for sleep apnea was studied in 32 patients with obstructive sleep apnea, 40 simple snorers, and 30 healthy nonsnorers. A sawtooth appearance of the flow-volume curve was seen in 22 of the sleep apnea patients (69%), 14 of the simple snorers (35%), and 10 of the nonsnorers (33%). The ratio of midexpiratory flow (FEF 50) to midinspiratory flow (FIF 50) was greater than 1 in 6 of the sleep apnea patients (19%), 3 of the simple snorers (8%), and 2 of the nonsnorers (7%). Thus, only the sawtooth sign was more frequently found in sleep apnea patients than in controls (p less than 0.01). Sleep apnea patients with a sawtooth appearance of the flow-volume curve had a higher apnea index (38.7 +/- 22 vs. 21.5 +/- 12.1; p less than 0.01) and lower nocturnal minimum oxygen saturation (68.1% +/- 16.8 vs. 81.3% +/- 9.97; p less than 0.01) than those without. In symptomatic snorers, sensitivity of the sawtooth sign for sleep apnea was 72% and specificity 61%, for a FEF50/FIF50 ratio above 1 sensitivity was 17% and specificity 83%. In asymptomatic patients, sensitivity of either sign was extremely poor (33%) and specificity was 67% for the sawtooth sign and 85% for FEF50/FIF50 greater than 1. We conclude that abnormal flow-volume curves are of limited value for predicting sleep apnea.

Bronchoalveolar lavage (BAL) was performed to investigate pulmonary involvement in 39 patients with rheumatoid arthritis (RA) and in 7 patients with RA and secondary Sjögren's syndrome, and compared to 12 healthy controls. Lymphocytosis (more than 15%) was seen in 25, and more than 3% neutrophil granulocytes in 8 of 39 patients with RA. Lymphocytosis and/or neutrophil granulocytosis was seen in both seropositive and seronegative patients irrespective of clinical or radiologic findings. Patients with RA with or without secondary Sjögren's syndrome had increased DR+ lymphocytes in BAL compared with peripheral blood. In 7 patients with secondary Sjögren's syndrome an increased helper/suppressor cell index (OKT4+/OKT8+: 7.65 +/- 2.10) and increased natural killer cells (OKNK+: 27.3 +/- 5.5%) were found, as compared to 39 other patients with RA (OKT4+/OKT8+: 2.16 +/- 0.33, p less than 0.05; OKNK+: 14.5 +/- 2.3%, p less than 0.05). These BAL data are further evidence of frequent subclinical interstitial pulmonary involvement in RA with differences in the active autoimmune process from those in secondary Sjögren's syndrome.

Chlorine is used to disinfect swimming pools or as a constituent of other disinfection reagents. Pulmonary diseases are occasionally observed after exposure to chlorine. In 14 competitive swimmers and in 14 matched control subjects, we searched for clinically manifest allergies, subclinical sensitization to aeroallergens, imbalance of the cellular immune system, and bronchial hyperresponsiveness. Conjunctival or respiratory symptoms were found in 11 swimmers (2 cases of conjunctivitis, 4 rhinitis, 2 rhinoconjunctivitis, 1 laryngitis, and 2 bronchitis) and in 3 controls. Sensitization to aeroallergens was confirmed in 9 swimmers by skin test and in 11 swimmers by radioallergosorbent test (RAST), compared to findings in 4 and 5 controls, respectively. An altered cellular immune system, (i.e., imbalance in T-cell system, B-cell system, or natural killer cells) was detected in 7 swimmers and only 2 controls. Bronchial hyperresponsiveness to methacholine was seen in 11 swimmers and 5 controls. This higher incidence of allergic diseases and subclinical sensitization to aeroallergens, disorders of the cellular immune system, and bronchial hyperresponsiveness in competitive swimmers compared with control subjects could be due to repeated exposure to chlorine in swimming pools.

Radiographs an patient histories of 36 children were examined in order to determine radiological signs that would allow a prediction or an early diagnosis of the aseptic necrosis of the femur head nucleus (Luxations-Perthes) during the treatment of hip dysplasia. Necrosis of the nucleus appeared in 17 joints (of 15 children). We had the following findings: a) Mikroepiphyses have a high risk (59%). b) In all cases of necrosis the angles of the femur neck near epiphysis were rounded, while this sign was never found in dysplastic joints without necrosis.

In about 5% of 3355 patients the microscopic examination of the vaginal discharge in normal saline showed a characteristic fast moving rod. More than 80% of these patients complained of a discharge with a foul smell during the menstrual period. Bactriology showed an anaerob gram negative rod which was difficult to grow and is as yet unclassified. Following treatment with one gram of Mimorazol every 12 hours for 3 doses, 71,5% of the patients were cured and showed a normal vaginal flora without further treatment. In around 24,13% of the patients the gram negative rod disappeared but a persistent mixed flora required further treatment. In 4.3% of the patients a recurrence occurred. An attempt was made to prevent recurrent infection prior to the follow-up examination by prohibition of sexual intercourse with an untreated partner, bathing in public swimming pools, and the use of sponges or wash cloths. In the course of the investigation the suspicion of contamination from the water of public pools became apparent. The diagnosis, treatment and transmission and the pathogenecity of the fast moving negative rod is discussed.

Obstructive sleep apnea is frequently found in middle-aged men. Usually, these patients are obese and therefore predisposed to hypertension. This study aimed to elucidate the relationships between hypertension, obesity and obstructive sleep apnea in 48 men suffering from sleep apnea. Hypertension was found in 39 of them (= 81%), 27 patients (= 56%) were morbidly obese (Broca index above 125%), 17 patients (= 36%) were moderately obese (Broca index between 100 and 125%) and 4 patients (= 8%) showed normal weight (Broca index below 100%). Severity of sleep apnea did not correlate with obesity or hypertension. Patients with sleep apnea who were hypertensive were significantly (p less than 0.025) more obese than those with normal blood pressure. Compared with an unselected population showing a similar degree of obesity, patients with obstructive sleep apnea showed a higher prevalence of hypertension and this is independent of age. These findings establish sleep apnea as a risk factor for hypertension.

From diseased wild and cultured Oreochromis niloticus in Lower Egypt, 17 Aeromonas hydrophila isolates were recovered. The mortality was between 10% and 70% in among cultured fish. The course of the disease ran in an acute manner. For cultured fish, the disease outbreaks were found mainly in winter and for the wild Nile fish, mortalities were observed in late spring and summer. Additionally wild fish were affected with ectoparasites. The LD50 values of the isolates ranged between 10(3) and 10(7). Isolates of high virulence were resistant to 1 hr boiling and to the bactericidal effect of fresh normal guinea pig serum. Moreover, they did not agglutinate in acriflavin. Only the virulent isolates could agglutinate tilapia erythrocytes. The above effects were reversed for avirulent isolates while moderately virulent isolates showed no consistency in their reactions. Tube agglutination test using O and WC antisera prepared against 6 isolates versus O and WC antigens of 17 isolates indicated an antigenic heterogenicity of different isolates. While some isolates were identical, 4 antigens out of 17 did not react with any of the sera.