Accidents in the workplace

A prospective survey of patients attending the central Accident and Emergency Department and Eye Casualty Department in Aberdeen was made to determine the contribution of accidents at work to the workload of the departments and to estimate risks of injury in different industrial sectors. Work-related injuries accounted for 16.5 per cent of new patients attending the general accident department and 21.7 per cent of those attending eye casualty. Analysis by industrial sector led to estimates that almost one in 10 workers employed in manufacturing industries and in agriculture/forestry/fishing will attend casualty in the course of a year for a work-related injury. The relatively low-risk service sector, because of the large numbers of people employed, contributed the greatest number of individuals with work-related injuries. Two industries had very high rates of specific and preventable injuries--food and fish processing with an estimated 17 knife lacerations per 1000 per annum and mechanical engineering with 60 eye injuries per 1000 per annum. We give reasons for believing that our estimates of risk in the different industrial sectors are conservative.     

Features of correction of phosphate-calcium metabolism disorders in terminal renal failure]

Mineral metabolism was studied in 27 hemodialyzed patients with terminal chronic renal failure (CRF). Because of progressing hyperparathyroidism the initial treatment included calcium drugs, active forms of vitamin D (videchol, oxidevit), almagel, bicarbonate hemodialysis and hemosorption. The condition improved in 8 and stabilized in 12 patients. Conservative treatment was ineffective in 7 patients who consequently underwent total (4 cases) or subtotal (3 cases), parathyroidectomy. The response was achieved in 3, stabilization in 3, the disease advanced in 1 patients.     

Clinical reactions to Aspergillus niger in a biotechnology plant: an eight year follow up.

The manufacture of citric acid by fermentation of molasses with Aspergillus niger has previously been described as a cause of occupational asthma in a factory. A longitudinal survey of the workforce of this factory has been carried out from 1984 to 1991. Over this period 160 of the original 278 workers left the workforce, together with 39 of 76 new recruits. Partial enclosure of the process and exhaust ventilation, installed in 1984, was effective in preventing any new cases of occupational asthma over the eight year period, and no new skin sensitisation was detected. Spore counts of A niger averaged about 100 times those in the outside air. Health in the 1984 survey had a striking influence on subsequent retiral; only 11 of the 79 with respiratory symptoms remained in 1991, compared with 90 of the 182 with no symptoms. In conclusion A niger is a weak antigen and simple hygiene measures protect the workforce. Exclusion of recruits with positive skin tests is not necessary if such measures are taken. The survey provided evidence of the selection factors operating within a workforce over this period contributing to retiral of the less healthy.     

Increase in bronchopulmonary infection due to branhamella catarrhalis

In a six month prospective study during the winter Branhamella catarrhalis was isolated from the sputum of 63 patients with symptoms of bronchopulmonary infection: 49 isolates were in pure culture and 14 were with another pathogen, Haemophilus influenzae being the commonest (found with 10 of the 14 B catarrhalis isolates). Of 36 patients infected in the community, 26 required admission to hospital. The remaining 27 patients were infected while in hospital. Forty four of the 63 isolates produced beta lactamase; 26 of these had been acquired in the community. As a result 29 patients were treated inappropriately with ampicillin and did not respond to this treatment. beta Lactamase produced by B catarrhalis may also protect other pathogens normally susceptible to beta lactam antibiotics. Most patients had chronic lung diseases or lung cancer, but three otherwise healthy patients who did not smoke developed bronchitis. B catarrhalis contributed to the death of five patients. A survey of the antibiotic prescribing habits of the referring general practitioners together with the sensitivity results of B catarrhalis suggest that changes in antibiotic prescribing habits in the community may be responsible for the increase in B catarrhalis infection.     

Hypersensitivity pneumonitis after exposure to isocyanates.

Four patients exposed to isocyanate vapour developed dyspnoea associated with restriction and reduced gas transfer as well as moderate airways obstruction on lung function testing. In one patient bilateral radiographic shadowing was present and an open lung biopsy was performed. The microscopic appearances ranged from acute inflammation to end-stage fibrosis but the centribular accentuation of disease and the presence of areas resembling bronchopulmonary aspergillosis suggested that the process was a hypersensitivity response to inhaled allergen. Challenge tests with albumin and toluene diisocyanate-albumin were carried out in sensitized and control rabbits. The sensitized animals developed extensive lung damage of the type associated with an Arthus reaction. It is suggested that patients exposed to isocyanates may occasionally develop a hypersensitivity pneumonitis rather than the more usual asthmatic syndrome.