Occupational asthma in poultry workers

Sixteen poultry workers with poultry house--related rhinitis and/or asthma underwent clinical and laboratory evaluation that included history and physical examination, skin tests with common inhalant and PAg, total- and specific-IgE levels, and pulmonary-function studies. Sixteen age- and sex-matched atopic subjects who were not occupationally exposed to poultry and 12 asymptomatic veterinarians with occupational exposure to poultry served as controls. Rhinitis and asthma developed only in symptomatic poultry workers after exposure to poultry; only in these individuals could immediate wheal-and-flare reactions to poultry antigens be detected (p less than 0.001). The elapsed time between the initial poultry exposure and the onset of poultry house--related symptoms averaged 10 yr. In the symptomatic poultry workers, immediate skin test reactivity and RAST reactions were most frequently associated with NFM. The association between respiratory symptoms temporally related to poultry house exposure and the demonstrable IgE antibody-mediated reaction suggests a relationship between the two.     

Hemodialysis: sexual functioning

Twenty-one male patients on chronic hemodialysis were studied for factors that might influence potency. Nine patients were found to have normal potency, five decreased potency, and seven were totally impotent. A strong relationship was found between decrease in libido and potency as well as between potency and vocational rehabilitation. The impotent patients showed subnormal scores on hostility, while depression was most prominent in the patients with decreased potency.A relationship was found between potency and the patient's self-image and sick role as measured by the Attitude Toward Disabled Persons (ATDP) scale. Wives of the impotent patients were more negative than the other wives, but no relationship was found between potency and marital discord; a relationship was found between dominance and potency.     

Multicenter controlled study of oxazepam in anxious elderly outpatients

In this double-blind multicenter study, 220 elderly outpatients with a primary diagnosis of anxiety neurosis received oxazepam (N = 108) or placebo (N = 112) according to a randomized schedule over a four-week study period. Based on four different clinical measures of effectiveness (Hamilton Anxiety Scale, Physician's Target Symptom Scale, Hopkins 35-Item Symptom Checklist, Physician's and Patient's Global Improvement Scale), oxazepam reduced symptoms significantly more than placebo, with minimal side effects. Its safety, efficacy, and lack of interaction with other drugs make oxazepam, a short-acting benzodiazepine, suitable as an antianxiety agent for the older patient.     

Psychiatric symptoms in medical illness: hyperthyroidism revisited

This brief review of the relationship of thyrotoxicosis to psychotic behavior stresses the importance of combined psychiatric and medical management of patients with medically related psychotic illnesses. A detailed case report is presented, and the role of the psychiatrist in recognizing and altering stresses that precipitate psychiatric and psychosomatic illnesses is discussed.     

Differential diagnosis of somatopsychic disorders

A substantial number of patients who present with psychiatric symptoms are suffering from underlying or unrecognized medical illnesses. Only by an awareness of differential diagnostic factors and a high index of suspicion can the clinician avoid misdiagnosis and inappropriate treatment of these somatically ill patients. The authors discuss some of the general characteristics that can help differentiate medical illness from primary psychiatric illness, and outline the psychiatric findings commonly associated with a number of physical illnesses.     

Cardiovascular changes during acute depression

To evaluate the effect of depressed mood on cardio vascular response, we studied 43 office psychotherapy patients. Eleven of these patients manifested acute depression, 18 had overt anxiety, and 14 showed anger. We found that the heart rate and blood pressure increased, and electrocardiographic changes occurred more frequently in depressed patients, in a degree comparable to the changes seen in patients with anxiety or anger. These findings are consistent with other reports indicating in creased sympathoadrenal activity in other organ systems during depression and suggest that the treatment of depression must in clude attention to the patient's physical arousal state as well as to his mental status.     

Capillary pH and blood gas determinations in asthmatic children.

Earlobe capillary pH and blood gases in asthmatic children were compared to arterial values. Hyperemia of the earlobe was produced by applying thurfyl nicotinate (Trafuril). Approximately 15 min later capillary blood was obtained simultaneously with a radial arterial sample. Earlobe capillary PO2, PO2, and pH correlated well with arterial values. This technique is simple, safe, and appears to be a satisfactory substitute for arterial blood in normotensive asthmatic children.     

Allergy to laboratory animals: Epidemiologie,clinical, and physiologic aspects,and a trial of cromolyn in its management

A survey was conducted by personal interview with all identified subjects in a large medical center who had regular exposure to laboratory animals. Of 399 subjects, 59 (15%) had symptoms suggestive of allergy to laboratory animals. Such allergy was more likely to occur in subjects with previously known allergies, especially to domestic pets, and was most likely to become manifest within a few months of the first exposure. In the group with allergy to laboratory animals, nasal symptoms were invariably present and tended to precede pulmonary symptoms, which occurred in half of the group. Twelve subjects with pulmonary symptoms were challenged by exposure to laboratory animals and each had immediate bronchospasm by objective criteria. Half of these also had bronchospasm which persisted or recurred 5 hr or more after challenge. A double-blind controlled trial in 10 subjects with laboratory animal-induced bronchospasm showed that prior use of cromolyn offered considerable or complete protection against both immediate and late bronchospasm in all subjects but one.     

Intimal changes associated with arterial spasm induced by periarterial application of calcium chloride

Arterial spasm was induced by application of calcium chloride to the adventitial surface of the rabbit common carotid artery in vivo. Sodium chloride (NaCl) was applied to the contralateral vessel as control. Vessels were fixed in situ by intravascular perfusion after 15 min, 1 hr, or 24 hr and prepared for light and scanning electron microscopy (SEM). With SEM, the luminal surface at the site of calcium application showed severe longitudinal folding accompanied by endothelial desquamation with extensive platelet deposition on exposed subendothelium. The luminal cross-sectional area was reduced by 53 +/- 19.5% after 15 min and by 44 +/- 12% after 1 hr as compared with the contralateral control. Furthermore, the luminal area at the site of calcium application was found to be reduced by 42 +/- 8% after 1 hr when compared with segments of the same vessel distal to the site of calcium application. Blood flow rate, as measured by electromagnetic flow probe, was not reduced. Vessels examined after 24 hr showed a significant increase in luminal cross-sectional area as compared with contralateral control vessels (136 +/- 70%). Control vessels (NaCl) showed no significant change in luminal cross-sectional area and no endothelial desquamation or platelet deposition after 15 min, 1 hr, or 24 hr. Examination of histologic sections showed calcium precipitation within the attached thrombus after 15 min with calcium deposits also adherent to the adjacent luminal aspect of the internal elastic lamina (IEL). By 24 hr, this precipitation extended throughout the media. Marked deposition of leukocytes was seen after 24 hr which showed a preferential attachment for areas of endothelial damage and discontinuity of IEL.     

Effect of immunotherapy in chronic asthmatic children

Ten children with chronic intractable asthma whose airway sensitivity had been established by means of inhalation challenges to specific antigens were hyposensitized over a period of 5 to 12 months. Five additional asthmatic children acted as “controls.” Various aqueous antigens were used both for immunotherapy and for inhalational challenges. Therapy was given uninterruptedly. The total dose varied from 1,000 to 8,000 protein nitrogen units (PNU) in the controls and from 30,000 to 230,000 PNU in the subjects. Repeat challenges in the low-dose “control” group showed no changes in bronchial sensitivity. Ten children who received high total dosage all showed decreased bronchial sensitivity to specific antigens. Three children who were under study for 12 months could be evaluated clinically as well as physiologically since all four seasons were covered. There was no evidence of clinical, physiologic, or medication improvement in any of them, despite significant decreases in bronchial sensitivity. High-dose therapy appeared to decrease bronchial sensitivity significantly in all except two subjects. The effect was not related to the antigen dose but appeared to be an individual response of the subject.     

Chronic pain: the psychiatrist's role

The psychiatrist's task when treating chronic pain patients is to aid in diagnosing the primary source of pain; secure an understanding of what the pain means to the patient; recommend a pain management program to the referring physician; implement techniques for reducing the contribution made by psychologic factors to pain perception; and undertake psychotherapy to improve the patient's ability to handle personal problems and interpersonal relationships. Our experience has shown that any attempt to cure pain through psychotherapy alone will be unsuccessful. The goal must be rehabilitation, not cure.     

Prednisolone disposition in steroid-dependent asthmatic children

The pharmacokinetics of a 40-mg intravenous dose of prednisolone were determined in 10 steroid-dependent asthmatic children with highly variable prednisone requirements (5 mg every other day to 40 mg a day). Concentrations of prednisolone and cortisol in plasma over a 24-hr test period were measured by high-performance liquid chromatography. Eosinophil concentrations and the concentration-dependent protein binding of prednisolone were also determined. The mean (±SD) apparent half-life of prednisolone in these children was 2.5 ± 0.5 hr. The mean total volume of distribution was 52.8 ± 14.5 L/1.73 m² and mean plasma clearance was 246 ± 62 ml/min/1.73 m². These pharmacokinetic parameters, as well as the protein binding and eosinopenic response, were similar to values from healthy and steroid-dependent asthmatic adults. The data were also similar in both responsive and relatively resistant patients. The pharmacokinetics and protein binding of prednisolone are not responsible for the highly variable prednisone requirement and clinical response of these children to prednisone therapy.     

The use of humidity in asthmatic children.

Controversy exists as to the advisability of mist therapy in pulmonary disease. We studied the effects of several forms of humidity on asthmatic airways. Thirty-four children were tested over a period of 8 months as follows: (1) mist with a mean particle size of 3 mu was delivered for 30 min by an ultrasonic nebulizer to 11 children individually in a plastic tent; (2) to another 11 subjects in a tent, mist with a mean particle size of 10 mu was delivered by a jet nebulizer for 30 min;3) 15 patients in a croup room recieved for 30 min water droplets ranging from a microscopic fog to large rain particles (mean 16 mu) generated by a Melco natural fog generator; (4) 10 children were challenged with 3 solutions used commonly for the production of mist: distilled water, half-normal saline, and normal saline. Pulmonary functions were studied on each patient pre- and post-mist exposure. Approximately two thirds of the patients had a significant response, either improvement or deterioration, when challenged with the various forms of mist. No particular group trends were produced either by increasing the mean particle size of humidity, or by using solutions of increasing salinity.     

Exercise-induced bronchial lability in monozygotic (identical) and dizygotic (nonidentical) twins

Exercise tests and skin tests were carried out on 8 pairs of identical and 7 pairs of nonidentical twins. The pairs of twins were selected so that at least one member of each pair had clinical asthma or was a first-degree relative of a patient with asthma and had an increased bronchial lability on exercise. Clinical concordance for active asthma was found in 3 of the identical pairs but only one of the nonidentical pairs. In 2 further identical pairs, one subject had active asthma and the other had a past history of asthma. In 6 of the identical pairs, the other twin was also found to have an increased bronchial lability, while only one of the nonidentical pairs was concordant in this respect. From the point of view of atopy shown by skin tests, 6 identical pairs were concordant compared with one of the nonidentical pairs. Concordance for atopy and bronchial lability did not necessarily go together. The significantly higher rate of concordance among the identical twins, for both increased bronchial lability and atopy, shows the importance of inheritance for these characters.