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On behalf of the Medical Advisory Committee for occupational diseases at the German Federal Ministry for Work and Social an interdisciplinary working group with medical experts in the field of casualty surgery, occupational health, orthopaedics, and radiology discussed the description of meniscopathy in the sense of the German occupational disease No. 2102. According to the medical guideline "Meniscopathy" of the German Society of Orthopaedics and Casualty Surgery (2015) meniscopathy is diagnosed clinically and radiologically by magnetic resonance imaging (MRI). The working group came to the conclusion that a bilateral, at least third-grade meniscopathy according to Stoller, in the posterior part of the inner meniscus should be required in the MRI.

Ein Beweisnotstand bei der Exposition der Versicherten fuhrt zur Ablehnung einer Berufskrankheit (BK) durch die gesetzlichen Unfallversicherungstrager (UVT). In dieser Arbeit wurden solche Falle im Rahmen der gewerbearztlichen Bearbeitung gemas § 4 BKV evaluiert. Gewerbearzte wurden mittels eines strukturierten Fragebogens zu BK-Fallen befragt, bei denen Versicherte eine gefahrdende Exposition angegeben haben. Der Begriff „Beweisnotstand“ gefahrdender Exposition wurde zuvor definiert. Beweisnotstand entsteht dann, wenn UVT eine geeignete Exposition verneint haben, weil die Arbeitsplatze nicht mehr vorhanden waren, betriebliche Unterlagen bzw. Messergebnisse fehlten, Beweise nicht erhoben oder betriebliche Zeugen nicht ermittelt werden konnten. Eine systematische Archivrecherche erfolgte nicht. Im Zeitraum 2015 bis 2017 wurden 21 Falle (darunter 17 Krebserkrankungen) aus 7 Bundeslandern diskutiert. In 3 Fallen (Lungenkrebs, BK-Nr. 4104; Harnblasenkrebs, BK-Nr. 1301; akute myeloische Leukamie, BK-Nr. 1318) wurde anhand der Schilderung der Versicherten, der langjahrigen Exposition und der Literaturerkenntnisse eine gefahrdende Exposition als plausibel bewertet. Ein Beweisnotstand ergab sich aus der fehlenden betrieblichen Dokumentation. Es wurden wenige Falle des Beweisnotstandes gesichert. Kontrovers diskutiert wurden 4 abgelehnte Mesotheliome. In 2 weiteren Fallen war das BK-Verfahren nicht abgeschlossen und die Anerkennung noch moglich. Da in einigen Bundeslandern BKen gewerbearztlich kaum bearbeitet werden, ist von einer erheblichen Dunkelziffer nicht identifizierter Falle mit Beweisnotstand auszugehen. Eine gesetzliche Verankerung der Glaubhaftmachung in Anlehnung an andere Rechtsgebiete wurde zu einem hoheren Mas an Einzelfallgerechtigkeit fuhren.

Busfahrer sind einer erhohten psychischen Arbeitsbelastung (Zeit- und Termindruck, Kundenkontakt) ausgesetzt. Konnen bei Busfahrern im Vergleich zur allgemeinen Erwerbsbevolkerung erhohte subjektive und objektive Stressparameter nachgewiesen werden? Bei 101 Busfahrern und 100 Zufallskontrollen wurden von 2011 bis 2012 verschiedene objektive Stressparameter erhoben und eine standardisierte Fragebogenerhebung durchgefuhrt. Als Mas des relativen Risikos wurde die Pravalenzratio berechnet, mit Hilfe der Cox-Regression fur Confounder adjustiert. Mit dem T-Test fur unabhangige Stichproben wurde der Mittelwert (MW) der subjektiven Stressparameter zwischen Kontrollgruppe und Busfahrern verglichen. Innerhalb der Busfahrergruppe wurden die MW der objektiven mit denen der subjektiven Parameter verglichen. Die Berechnung erfolgte computergestutzt mit dem Statistikprogramm SPSS Version 20. Im Mittelwert- und Pravalenzvergleich zeigten sich fur Busfahrer signifikant erniedrigte Werte bei Zeitspielraum, Partizipation, Kooperationsnotwendigkeit, Handlungsspielraum, Unterstutzung durch Kollegen, sozialen Beziehungen, Entscheidungsspielraum, Einfluss bei der Arbeit, Unsicherheit am Arbeitsplatz, Rollenkonflikten, quantitativen und emotionalen Anforderungen und erhohten Werte bei Zeitdruck, sozialer Ausgrenzung, negativem Gruppenklima, Dauerkonflikten, Entwicklungsmoglichkeiten, Vorhersehbarkeit, Bedeutung der Arbeit und Rollenklarheit. Der Kortisolwert war in der 1. Schichthalfte, der Blutdruck in der 2. Schichthalfte, auf dem Heimweg und in der Freizeit bei den Busfahrern signifikant bzw. grenzwertig signifikant erhoht. Signifikante Unterschiede in Schlafrigkeit und Herzfrequenz lagen nicht vor. Erhohte Arbeitskomplexitat korrelierte mit erhohten Diabetesmarkerwerten und erniedrigter Handlungsspielraum mit erhohten Adrenalinwerten. Psychische Arbeitsbelastungen sind bei Busfahrern durch subjektive und objektive Stressparameter nachweisbar.

Hintergrund Eine der Zielstellungen der DWS-Richtwertestudie (DWS2) war es, auf der Basis der in der 1. Deutschen Wirbelsaulenstudie (DWS1) erhobenen Daten Richtwerte fur die lebenslange kumulative Belastungsdosis von wirbelsaulenbelastenden Tatigkeiten abzuleiten. Fur die Bewertung der ermittelten „odds ratios“ (OR) war eine Abschatzung der Pravalenz der untersuchten Krankheitsbilder lumbaler Prolaps und lumbale Chondrose notwendig.

Die Anamnese der arbeitstechnischen Voraussetzungen bei der Berufskrankheit Nr. 2108 der Berufskrankheiten-Verordnung (BKV) stutzt sich in der Regel auf eine detaillierte retrospektive Expositionsermittlung. Das zu diesem Zweck entwickelte Mainz-Dortmunder Dosismodell (MDD) bietet eine standardisierte Methode zur Abschatzung der Bandscheiben-Druckkraft auf Basis von 6 Bestimmungsgleichungen fur das Heben und Tragen von Lasten sowie 1 Bestimmungsgleichung fur Tatigkeiten in extremer Rumpfbeugehaltung. Das MDD zahlte in der Deutschen Wirbelsaulenstudie (DWS1) nicht zu den besten Dosismodellen, sodass es ein Ziel der DWS-Reanalyse oder DWS-Richtwertestudie (DWS2) war, modifizierte Bestimmungsgleichungen zur Abschatzung lumbosakraler Bandscheiben-Druckkrafte abzuleiten und somit ein fur die Berufskrankheitenpraxis verbessertes Instrument zu entwickeln. Die Ableitung der Bestimmungsgleichungen erfolgte auf Grundlage der DWS1, in der die berufliche Exposition von etwa 1200 Probanden detailliert per Experteninterview und anschliesender individueller biomechanischer Modellierung der Bandscheiben-Druckkrafte ermittelt wurde. Der Datensatz beinhaltete insgesamt etwa 1900 verschiedene Belastungskombinationen fur Hebe-, Absenk-, Umsetz-, Halte- und Tragevorgange, aus denen sich mittels linearer Regression Bestimmungsgleichungen zur Abschatzung der Bandscheiben-Druckkraft ableiten liesen. Um einen in der Praxis anwendbaren Satz an Bestimmungsgleichungen zu erhalten, waren die Kombinationen durch reprasentative Auswahl und sinnvolle Zusammenlegung entsprechend zu reduzieren. Zur Validierung der formelbasierten Druckkraftabschatzung erfolgte ein Methodenvergleich durch Gegenuberstellung der formelbasierten und der biomechanisch modellierten vorgangsspezifischen Expositionen (via des Simulationsprogramms „Der Dortmunder“) fur insgesamt 4450 Arbeitsschichten. Nach Prufung einzelner Zwischenschritte konnte ein finaler Formelsatz abgeleitet werden, der aus insgesamt 11 Bestimmungsgleichungen fur Hebe-, Halte- und Tragevorgange sowie 4 Faktoren zur Beschreibung einhandiger, korperferner oder asymmetrischer Lastenhandhabung besteht. Die Prufung auf Validitat der entsprechend berechneten Expositionen ergab gute bis akzeptable Ubereinstimmungen mit den als Referenz definierten Berechnungen auf der Grundlage vorgangsspezifischer biomechanischer Simulationsrechnungen. Die Kernergebnisse der vorliegenden Reanalyse lassen sich mit dem finalen Formelsatz gut reproduzieren und die Anzahl von 11 Bestimmungsgleichungen und 4 Faktoren fur manuelle Lastenhandhabungen erscheint praxistauglich. Die Anwendung der abgeleiteten Berechungsformeln kann unabhangig von der Diskussion um die Einfuhrung und Hohe von Richtwerten bei der BK Nr. 2108 erfolgen.

Hintergrund Der vorliegende Beitrag erlautert im Wesentlichen den Hintergrund und die Vorgehensweise einer Reanalyse der Daten der Deutschen Wirbelsaulenstudie (DWS) in der sogenannten DWS-Richtwertestudie (DWS2) und greift ausgewahlte Ergebnisse auf. Zur Prufung der arbeitstechnischen Voraussetzungen in Feststellungsverfahren zur Berufskrankheit (BK) 2108 werden Dosisansatze genutzt, bei denen die Wirbelsaulenbelastungen fur alle relevanten Vorgange mit definierter Korperhaltung oder Lastenhandhabung uber typische Schichten und das Berufsleben aufsummiert werden. In der DWS wurden fur alle 4 Fallgruppen (Manner/Frauen mit Prolaps/Chondrose) erhohte Risiken fur bandscheibenbedingte Erkrankungen bei Anwendung von Dosismodellen gefunden, die Belastungen auch unterhalb der Kriterien des gegenwartig angewendeten Mainz-Dortmunder Dosismodells (MDD) sowie Lastenhandhabungen zusatzlich zum Heben oder Tragen einbeziehen.

German legislation with respect to occupational health during recent years is reviewed. Discussed is the occupational safety law and related legislation as the hazardous substances act and the biological hazard act, the occupational health and safety act and the social act VII. Most improvements of occupational standards in Germany are induced by regulations of the European Union. Furthermore initiatives of the federal government and the federal states according to an amendment of the social act VII and the occupational health and safety act, which would induce a reduction of social standards, are discussed. The role of occupational medicine in companies by some of the above mentioned laws is improved. On the other hand the situation of occupational physicians in companies, universities and other agencies is characterized by budget cuts, reduction of occupational standards and loss of importance.

PURPOSE The present study examines the differences of radiological diagnosis of lumbar prolaps with quantitative and morphological criteria. Advantages and disadvantages of both methods were analysed. METHOD Concerning the "Deutsche Wirbelsaulenstudie" (DWS) 286 male and 278 female patients between 25 and 70 years of age undergoing clinical or ambulant therapy for radicular symptoms and the diagnosis of a lumbar prolaps in CT and/or MRT were integrated into our study. Actual MRT and CT pictures of the patients' lumbar spine were analysed by an independent radiologist (primary radiologist). Radiological diagnosis was concerned with quantitative and morphological criteria. Radiological images of 100 selected patients were reexamined by another radiologist (secondary radiologist). On the basis of these results, the interobserver reliability (kappa) was calculated. RESULTS In 95.2% of all segments a prolaps was seen with quantitative and morphological criteria, in 4.5% a prolaps was analysed with quantitative and in 0.3% a prolaps was seen with morphological criteria. The radiological diagnosis of prolaps by quantitative criteria was confirmed by the operative findings. Many prolapses with lateral localisation were seen in these cases. Therefore radiological diagnosis on the basis of morphological criteria could be difficult. For both radiological methods similar interobserver reliabilities were calculated. To sum up both radiological methods are even equivalent. It is also possible to graduate the diagnosis with quantitative criteria. Detrimental effects of quantitative criteria could be difficulties in measurement with non-digital images. CONCLUSION Besides several recommendations in the international literature on the radiological analysis of prolaps with morphological criteria, diagnosis with quantitative criteria is also an effective method.

German legislation with respect to occupational health during recent years is reviewed. Discussed is the occupational safety law and related legislation as the hazardous substances act and the biological hazard act, the occupational health and safety act and the social act VII. Most improvements of occupational standards in Germany are induced by regulations of the European Union. Furthermore initiatives of the federal government and the federal states according to an amendment of the social act VII and the occupational health and safety act, which would induce a reduction of social standards, are discussed. The role of occupational medicine in companies by some of the above mentioned laws is improved. On the other hand the situation of occupational physicians in companies, universities and other agencies is characterized by budget cuts, reduction of occupational standards and loss of importance.

The present study examines the differences of radiological diagnosis of lumbar prolaps with quantitative and morphological criteria. Advantages and disadvantages of both methods were analysed.Concerning the "Deutsche Wirbelsäulenstudie" (DWS) 286 male and 278 female patients between 25 and 70 years of age undergoing clinical or ambulant therapy for radicular symptoms and the diagnosis of a lumbar prolaps in CT and/or MRT were integrated into our study. Actual MRT and CT pictures of the patients' lumbar spine were analysed by an independent radiologist (primary radiologist). Radiological diagnosis was concerned with quantitative and morphological criteria. Radiological images of 100 selected patients were reexamined by another radiologist (secondary radiologist). On the basis of these results, the interobserver reliability (kappa) was calculated.In 95.2% of all segments a prolaps was seen with quantitative and morphological criteria, in 4.5% a prolaps was analysed with quantitative and in 0.3% a prolaps was seen with morphological criteria. The radiological diagnosis of prolaps by quantitative criteria was confirmed by the operative findings. Many prolapses with lateral localisation were seen in these cases. Therefore radiological diagnosis on the basis of morphological criteria could be difficult. For both radiological methods similar interobserver reliabilities were calculated. To sum up both radiological methods are even equivalent. It is also possible to graduate the diagnosis with quantitative criteria. Detrimental effects of quantitative criteria could be difficulties in measurement with non-digital images.Besides several recommendations in the international literature on the radiological analysis of prolaps with morphological criteria, diagnosis with quantitative criteria is also an effective method.

Using a combined analysis of 11 case-control studies from Europe, we have investigated the relationship between cigarette smoking and bladder cancer in women.Available smoking information on 685 female bladder cancer cases and 2416 female controls included duration of smoking habit, number of cigarettes smoked per day, and time since cessation of smoking habit for ex-smokers.There was an increasing risk of bladder cancer with increasing duration of smoking, ranging from approximately a two-fold increased risk for a duration of less than 10 years (odds ratio (OR) = 1.9, 95% confidence interval (CI) 1.1-3.1) to over a four-fold increased risk for a duration of greater than 40 years (OR = 4.1, 95% CI 3.0-5.5). A dose-response relationship was observed between number of cigarettes smoked per day and bladder cancer up to a threshold limit of 15-20 cigarettes per day, OR = 3.8 (95% CI 2.7-5.4), after which no increased risk was observed. An immediate decrease in risk of bladder cancer was observed for those who gave up smoking. This decrease was over 30% in the immediate 1-4 years after cessation, OR = 0.68 (95% CI 0.38-1.2). However, even after 25 years the decrease in risk did not reach the level of the never-smokers, OR = 0.27 (95% CI 0.21-0.35).The proportion of bladder cancer cases among women attributable to ever smoking was 0.30, (0.25-0.35) and to current smoking was 0.18 (0.14-0.22). These attributable proportions are less than those observed among men, although they are likely to increase in the future as the smoking-related disease epidemic among women matures.

To investigate the association between lung cancer and occupational exposure to man-made vitreous fibers (MMVF), a pooled analysis of two case-control studies was conducted in the years 1988-1994.The case series consisted of 3498 males who were histologically or cytologically verified primary lung cancer cases. 3541 male population controls were drawn at random from the general population and matched to cases by sex, age, and place of residence. To examine the relationship between MMVF and lung cancer we asked all study subjects who worked for at least 6 months as construction and installation workers whether they ever installed or removed insulations and what kind of insulation material they used.Some 304 (8.7%) cases and 170 (4.8%) controls reported to have insulated with glass wool or mineral wool mats. Coded as ever/never exposed, the odds ratio was 1.48 (95% CI: 1.17-1.88), adjusted for smoking and asbestos. To be sure to exclude any confounding effect of asbestos, we tried to identify those cases and controls who insulated with glass wool or mineral wool mats only and never reported any asbestos exposure. For this group we calculated an odds ratio of 1.56 (95% CI: 0.92-2.65), after adjustment for smoking. An elevated risk was also estimated on the basis of an expert rating which was done for a subgroup of cases and controls. Ever exposure to MMVF (but not to asbestos) in this subgroup yielded an odds ratio of 1.30 (95% CI: 0.82-2.07).Our study provides some indication for an excess risk of man-made vitreous fibers. This result also persists after adjustment for smoking and asbestos.

We examined the importance of occupational exposures for bladder cancer in women.We combined data from 11 case-control studies conducted between 1976 and 1996 in six European countries. The pooled data comprised 700 incident female cases and 2425 population or hospital controls, aged 30-79 years. Lifetime occupational and smoking history were examined using common coding.Excess risks were found in only a few of the occupations previously identified at high risk for bladder cancer. Statistically significant excess risks were observed for metal workers, particularly blacksmiths, toolmakers and machine tool operators (OR: 2.0, 95% CI: 1.1-3.6), tobacco workers (OR: 3.1, 95% CI: 1.1-9.3), field crop and vegetable farm workers (OR: 1.8, 95% CI: 1.0-3.1), tailors and dress makers (OR: 1.4, 95% CI: 1.0-2.1), saleswomen (OR: 2.6, 95% CI: 1.0-6.9), and mail sorting clerks (OR: 4.4, 95% CI: 1.0-19.5). About 8% (95% CI: 3.1 19.9) of all bladder cancers in women could be attributed to occupation after adjusting for smoking. The attributable risk was higher in women aged less than 65 years (12%), compared to older women (4%).The calculation of the attributable risk on the basis of results from this analysis may have caused some overestimation of the proportion of occupational bladder cancer in women. A significant proportion, however, of bladder cancer cases among European women less than 65 years is likely to be attributed to occupation. This link between bladder cancer in women and occupational factors has received little recognition, probably because studies addressing these issues have predominantly been done in men.

In a hospital-based case-control study conducted between 1989 and 1992 in Hessen (West Germany) 300 cases (239 male and 61 female) of histologically confirmed cancer of the lower urinary tract (LUT) were individually matched to controls from the same hospitals with respect to sex, age and area of residence. Smoking of cigarettes was associated with an elevated risk of 2.80 in males (95% confidence interval (CI): 1.65-4.76) and 5.33 (95% CI: 1.55-18.33) in females, as compared with nonsmokers. Variables like daily amount of smoked cigarettes, duration of smoking, age at beginning of cigarette smoking and time since smoking cessation showed a clear dose- and time-response relationship in males, but not in females. Elevated risks were observed for higher consumption of coffee, beer and wine, but - especially for the consumption of coffee were drastically reduced after adjustment for smoking. A weak association was found between the daily fluid intake and bladder cancer in males. Among females a significantly decreased odds ratio (OR) of 0.34 (95% CI: 0.11-0.99) was found for a daily fluid intake of more than two liters. Protective effects and risk reductions of approximately 50% were found for the regular intake of raw carrots, kale, salads and fruits. The findings of this investigation support an association between lifestyle factors and cancer of the lower urinary tract.

Due to spine-loading activities nursing professionals have a relatively high incidence/prevalence of low back pain. As lumbar disc disorders can be regarded as occupational diseases (since January 1993, occupational disease BK 2108, normally more than 10 years of exposition, lumbar disc disorders with pain and reduced motility) international literature is reviewed. Own results of different prevalence-, case-control- and incidence studies (relative risk for lumbago sciatica/odds ratio for disc prolaps appr. 3-6 depending on age and occupational age) are presented. Finally the question of compensation and prevention of disc disorders is discussed.

Due to spine-loading activities nursing professionals have a relatively high incidence/prevalence of low back pain. As lumbar disc disorders can be regarded as occupational diseases (since January 1993, occupational disease BK 2108, normally more than 10 years of exposition, lumbar disc disorders with pain and reduced motility) international literature is reviewed. Own results of different prevalence-, case-control- and incidence studies (relative risk for lumbago sciatica/odds ratio for disc prolaps appr. 3-6 depending on age and occupational age) are presented. Finally the question of compensation and prevention of disc disorders is discussed.

Im folgenden sollen die wesentlichen Studien dargestellt werden, die fur die Aufnahme der bandscheibenbedingten Erkrankungen in Anlage 1 der Berufskrankheiten-Verordnung (BeKV) masgeblich waren. Ich mochte mich in dem Beitrag wegen der besonderen Bedeutung auf die Studien beschranken, die fur die Definition der BK 2108 masgeblich waren. Die Ubersicht mochte ich gliedern in Studien, die zur Haufigkeit von LWS-Beschwerden sowie speziellen bandscheibenbedingten Erkrankungen wie Bandscheibenvorfall, Osteochondrose, Spondylose oder Spondylarthrose Stellung nehmen.

A pooled reanalysis of twelve case-control studies on sinonasal cancer and occupation from seven countries was conducted in order to study associations with occupations other than wood- and leather-related occupations. The pooled data set included a total of 930 cases (680 men and 250 women) and 3,136 controls (2,349 men and 787 women). All the studies included a detailed occupational history for cases and controls. Each job was coded using the same classifications for occupation and industry. Two approaches were used in the analysis: systematic analysis of occupations; a priori analysis using a preestablished list of occupations and industries. The results confirmed associations observed in several studies not included in this analysis. For agricultural workers, significant excesses were observed for squamous cell carcinoma among women (OR = 1.69) and men (OR = 3.72 for ten years or more of employment as an orchard worker), and adenocarcinomas among men (OR = 2.98 for ten years or more of employment). Associations with textile occupations were observed for adenocarcinoma among women (OR = 2.60) and squamous cell carcinoma among men (OR = 5.09 for fiber preparers, 3.01 for bleachers). Elevated risks for both histologic types were observed among men employed in food manufacturing (OR = 3.25, adenocarcinoma), or as food preservers (OR = 13.9, squamous cell carcinoma), and among men employed as cooks (OR = 1.99, squamous cell carcinoma). A positive association with squamous cell carcinoma was observed for male transport equipment operators (OR = 1.21), and also with adenocarcinoma for male motor-vehicle drivers (OR = 2.50). A number of other associations were observed in the systematic analysis.

A case-control study was performed to assess various nonoccupational factors (smoking, eating and drinking habits, intake of analgesics) that may be aetiological factors in the development of tumours of the lower urinary tract, while vitamins may be protective.150 patients (125 men, mean age 66.4 years; 25 women, mean age 68.2 years) with histologically confirmed malignant tumour of bladder or other part of the lower urinary tract and a comparable group of controls, matched for age, sex and home location, were asked in a standardised personal interview about their life-long habits of smoking, eating and drinking, as well as intake of analgesics.Smoking was the greatest risk factor. In men there was a significant positive dose-effect relationship between the number of cigarettes smoked and relative carcinoma risk, compared with nonsmokers, by a factor of 3.68 among those with the highest dosage (40 pack-years). Because of the small number of cases this relationship could not be proven in women, but twice as many female tumour patients than controls were smokers (8 vs 4). In men, even after adjusting for smoking, increased coffee consumption increased the risk by a factor of 2 (2-4 cups: odds ratio 2.14 [P0.05];5 cups: odds ratio 2.22 [not significant]). An increased beer consumption had no apparent effect on the development of tumours. Findings regarding vitamin C were ambiguous. More prolonged and increased intake of phenacetin-containing analgesics in men showed a tendency towards a higher tumour risk.Smoking cigarettes is one of the main risk factors for the development of bladder and other lower urinary tract tumours. The influence of other risk factors needs to be elucidated.

Epidemiologic cohort and case-referent studies have shown an increased risk of lung cancer among various PAH-exposed occupations, such as coke, coal gas and aluminium production workers, road pavers, roofers and chimney sweeps. In different cohort studies, a positive dose response relationship between PAH exposure time and lung cancer have been described. On some workers, a relationship was found between coal for pitch volatiles (CTPV) and the risk of lung cancer. A doubling dose for lung cancer of20 [(mg CTPV/m3) years] or100 [micrograms BaP/m3) years] has been found among coke and aluminium production workers. Acknowledgement of lung cancer as an occupational disease is proposed after a cumulative dose of20 [(mg CTPV/m3) years] or100 [micrograms BaP/m3) years].

Die Bundesregierung hat durch Verordnung vom 18.12.1992 die Anlage 1 der Berufskrankheiten-Verordnung um folgende bandscheibenbedingte Erkrankungen der Hals-und Lendenwirbelsaule erweitert: Nr. 2108. Bandscheibenbedingte Erkrankungen der Lendenwirbelsaule durch langjahriges Heben oder Tragen schwerer Lasten oder langjahrige Tatigkeiten in extremer Rumpfbeugehaltung, die zur Unterlassung aller Tatigkeiten gezwungen haben, die fur die Entstehung, die Verschlimmerung oder das Wiederaufleben der Krankheit ursachlich waren oder sein konnen. Nr. 2109. Bandscheibenbedingte Erkrankungen der Halswirbelsaule durch langjahriges Tragen schwerer Lasten auf der Schulter, die zur Unterlassung aller Tatigkeiten gezwungen haben, die fur die Entstehung, die Verschlimmerung oder das Wiederaufleben der Krankheit ursachlich waren oder sein konnen. Nr. 2110. Bandscheibenbedingte Erkrankungen der Lendenwirbelsaule durch langjahrige, vorwiegend vertikale Einwirkung von Ganzkorperschwingungen im Sitzen, die zur Unterlassung aller Tatigkeiten gezwungen haben, die fiir die Entstehung, die Verschlimmerung oder das Wiederaufleben der Krankheit ursachlich waren oder sein konnen. In der Bundesrepublik sind danach bandscheibenbedingte Erkrankungen der Wirbelsaule durch Heben oder Tragen schwerer Lasten als Berufskrankheit ahnlich wie in anderen Industrielandern wie Japan, Schweden oder den USA anerkennungsfahig [27, 30, 48]. Chronische Erkrankungen der Bandscheiben konnten in der ehemaligen DDR seit 1950 als Berufskrankheit anerkannt werden. Seit 1981 lautete die entsprechende Berufskrankheit „Verschleis-krankheiten der Wirbelsaule (Bandscheibe, Wirbelkorperabschlusplatten, Wirbelfortsatze, Bander, kleine Wirbelgelenke) durch langjahrige Uberbean-spruchung“, wenn sie zur Aufgabe der schadigenden Tatigkeit gefuhrt hatten [2, 28].

In this article, the in vivo test results obtained from workers of two platinum separating plants are described. A total of 30 out of 102 workers in two platinum separating plants and 0/40 control subjects showed a positive skin reaction on being provoked with platinum compounds. Twelve out of 15 workers and none of 5 control subjects showed a positive reaction to the bronchial provocation test; this indicates that both tests are highly specific. Three workers with negative skin test reactions showed a clearly positive immediate reaction to the bronchial provocation test with platinum compounds.

Air sampled from the breathing zone of chimney sweeps during "dirty work" and soot samples were analysed for polycyclic aromatic hydrocarbons (PAH). A total of 20 PAH were quantified by gas chromatography-mass spectrometry in 115 air samples and 18 soot samples. These included benzo(b)fluoranthene, benzo(a)pyrene (BaP), chrysene, dibenz(a,h)anthracene, and indeno (1,2,3-cd)pyrene, all of which are animal carcinogens. The summed atmospheric concentration of these compounds depended on the type of fuel used and averaged 2.27 micrograms/m3 for oil fuel. If a mixture of oil and solid fuel was used the concentration was 5.06 micrograms/m3; pure solid fuel heating yielded 5.08 micrograms/m3. The air concentrations of BaP were 0.36, 0.83, and 0.82 micrograms/m3 respectively. The soot samples recovered after using the three different fuel types were 10.50, 109.10, and 51.25 mg BaP/kg. The maximum total concentrations of the five carcinogenic PAH were 243.70, 691.06, and 213.94 mg/kg respectively. The time weighted, shift mean concentrations of 0.02 to 0.21 micrograms/m3 benzo(a)pyrene obtained on 11 days form the basis for the industrial medical estimation of risk.

Adrenaline and noradrenaline as well as total cholesterol, HDL and LDL cholesterol and triglycerides were determined in 10 male subjects on the day of a public speech as well as on a control day. In the course of the public speech, a major rise of adrenaline and noradrenaline, by the factors of 2.7 and 1.9 respectively, was found. Furthermore, in comparison to the values of the control day, there was a rise in total cholesterol by 14.0 mg/dl as well as in LDL and HDL cholesterol. The triglycerides did not alter appreciably. The results are compatible with the hypothesis of a raised lipid level after acute emotional stress. The lipid mobilizing effect of catecholamines is discussed as a possible cause.

A long-time electrocardiogramm over a period of 12 h was recorded from ten test persons without cardiovascular diseases, and their blood pressure was checked at regular intervals on the day of a public speech. In order to determine plasma concentrations of epinephrine, norepinephrine, cortisol, human growth hormone (hGH), prolactin and gastrin, blood samples were taken from the subjects by inserting a venous catheter in the morning. The levels of epinephrine, norepinephrine and corticol were also examined in urine collected from the volunteers. During the public speech there was a distinct increase in blood pressure and pulse rate. Epinephrine and cortisol showed the clearest increase in serum and collected urine, whereas norepinephrine, prolactin, hGH and gastrin reacted less strongly. The epinephrine/norepinephrine ratio value is discussed as a parameter for psychomental and emotional strain.

A day vs. night comparison of type and frequency of cardiac arrhythmias documented by long-term ECG was done in 30 patients with nocturnal respiratory disorders in the form of the sleep apnoea syndrome. The commonest nocturnal arrhythmia was pronounced sinus arrhythmia during the apnoeic phases with variations of cardiac frequency between 40 and 120/min. Supraventricular and ventricular extrasystoles occurred significantly more frequently during the night than during the day. In three patients bradycardiac arrhythmias presenting as sinoauricular and atrioventricular blockades of the 3rd degree with node or ventricular substitute rhythm were seen during the sleep apnoea which could not be demonstrated during the day. Predominantly nightly occurrence of cardiac arrhythmias should lead to differential diagnostic consideration of the sleep apnoea syndrome.