The development of process-specific risk assessment and control in Germany

After reading the series of articles on a new approach to controlling chemicals, an initiative targeted especially on small and medium-sized businesses, in the Annals of Occupational Hygiene (1998; 42: 355-411), German specialists for health and safety at work realized that problems in this area are very similar in the UK and Germany. Also, in Germany different institutions have developed an array of solutions to help small and medium-sized enterprises during recent years. In this paper, we present these activities and hope to promote an international discussion about practical support for work with chemical substances.     

Biomechanical experiments for measuring traction lengthening of the lumbar spine during weight bath therapy

INTRODUCTION: Weight-bath as an effective traction therapy has successfully been applied in Hungary for nearly a half century, however, it has still been constrained exclusively to empirical bases until the numerical biomechanical analysis of Bene and Kurutz appeared in 1993. Due to their calculations, for cervical suspension in traction bath, the value and distribution of tensile force along the spine became known, however, the most important information, namely, the deformation of spine segments to be stretched by the therapy is so far unknown. AIMS: In this paper the results of a wide-ranging in vivo biomechanical experimental analysis are presented, aimed partly to obtain the traction deformation effects of weight-bath therapy, partly to obtain the biomechanical traction model of human lumbar segments. The analysis aimed to clear the effect of decompression, extra weights, sex, aging, body height and weight. PATIENTS/METHODS: The experiments have been executed during the prescribed 20 minutes long weight-bath treatment of patients having indication for cervical suspension. Patients with other forms of suspension, like armpit bars, have been excluded from the analysis. Two groups of patients have been distinguished: 67 patients without and 88 patients with extra weight loads of 20-20 N (2-2 kgf) applied on the ankles. Extension values of lumbar segments LIII-IV, LIV-V and LV-SI have been measured. Tensile deformations have been specified as the change of the distance between two spinous process of vertebrae, measured by a special subequal ultrasound method developed by the research group. The experimental results have been evaluated by using special software for analyzing ultrasound pictures. More than 3500 ultrasound pictures of 400 lumbar segments of 155 patients have been measured and evaluated. RESULTS: As for the results, at the end of the treatment, elongation of lumbar segments has been demonstrated practically in 60% of patients without and in 75% of patients with extra weights. The mean extension of a lower lumbar segment after a 20 minutes long weight-bath treatment is about 1.2-1.4 mm, while with extra weights it is about 1.3-1.6 mm, in the average of the deformed segments only. In the average of all segments, the above mean extensions are 0.7-0.9 mm, and with extra weights yield 0.8-1.4 mm. CONCLUSIONS: Just being suspended in water, due to the decompression, even without any extra weights, significant extension has been registered: a mean value of 1.0-1.2 mm per segments for the deformable, and 0.4-0.6 mm for all segments. The 20 minutes long treatment time in itself has a significant effect: the average additional extension is 0.2-0.4 mm per segments without, and about 0.5 mm with extra weights. The deformation capacity of lumbar segments decreases with increasing age of patients. Elongations increase with increasing body height. Body weight shows different tendency depending on the sudden elastic and time-dependent viscous deformations. Significant difference has been observed in reaction time of male and female patients: female patients react later, however the final traction effect seems to be equal.     

Severe congenital factor V deficiency: case report

Introduction: Congential deficiency of factor V is a rare condition, transmitted in autosomal recessive way. Heterozygote patients generally have no symptoms, homozygotes present with spontaneous and postoperative bleedings. About one-half of patients are diagnosed in adulthood. Methods: The presented case is a double heterozygote, which was confirmed using moleculare biological methods. The authors found many carriers in his family. Conclusions: This rare and sometimes severe disorder needs regular haematological controls. Carriers must have more attention during surgical procedures and labour, and the family doctor should be informed about there condition.     

A novel homozygous missense mutation in the myotubularin-related protein 2 gene associated with recessive Charcot-Marie-Tooth disease with irregularly folded myelin sheaths

Mutations in the myotubularin-related protein 2 gene on chromosome 11q22 are known to cause autosomal recessive Charcot-Marie-Tooth disease with irregularly folded myelin sheaths. We screened the coding region of the myotubularin-related protein 2 gene in a Turkish consanguineous Charcot-Marie-Tooth disease family compatible with linkage to chromosome 11q22. A homozygous cytosine to thymine missense mutation at nucleotide position 847, resulting in an amino acid substitution of arginine to tryptophan at codon 283, was detected in exon 9 of the MTMR2 gene. This is the second homozygous missense mutation associated with recessive Charcot-Marie-Tooth disease with focally folded myelin sheaths.     

Validity of the aphasia item from the Scandinavian Stroke Scale

We studied the validity of the aphasia item of a widely used stroke scale - the Scandinavian Stroke Scale (SSS) - in discriminating between aphasia and normal language function in 33 stroke patients of an acute stroke unit. They were assessed by a nurse using the aphasia item from the SSS and by a speech and language therapist carrying out a full evaluation of the language function. The latter served as the 'gold standard'. The agreement between the nurses' and the speech and language therapist's scoring was good (weighted kappa = 0.74, 95% CI 0.51-0.97), and the sensitivity and specificity of the SSS aphasia item were also satisfactory. However, the predictive value of a positive test was as low as 0.55 (95% CI 0.23-0.83), indicating nearly every second of the positives being false positive. Using the aphasia score of the SSS as a diagnostic aid for aphasia after stroke results in a high rate of false positives and inflates the prevalence figures for aphasia in epidemiological studies of stroke.     

High altitudes,anxiety, and panic attacks: is there a relationship?

People exposed to high altitudes often experience somatic symptoms triggered by hypoxia, such as breathlessness, palpitations, dizziness, headache, and insomnia. Most of the symptoms are identical to those reported in panic attacks or severe anxiety. Potential causal links between adaptation to altitude and anxiety are apparent in all three leading models of panic, namely, hyperventilation (hypoxia leads to hypocapnia), suffocation false alarms (hypoxia counteracted to some extent by hypocapnia), and cognitive misinterpretations (symptoms from hypoxia and hypocapnia interpreted as dangerous). Furthermore, exposure to high altitudes produces respiratory disturbances during sleep in normals similar to those in panic disorder at low altitudes. In spite of these connections and their clinical importance, evidence for precipitation of panic attacks or more gradual increases in anxiety during altitude exposure is meager. We suggest some improvements that could be made in the design of future studies, possible tests of some of the theoretical causal links, and possible treatment applications, such as systematic exposure of panic patients to high altitude.     

Familial association of neuropsychological traits in patients with generalized and partial seizure disorders

To investigate familial effects of neuropsychological deficits associated with seizure disorders, we studied 65 families, in which 1 member had epilepsy. The disorders included childhood absence epilepsy (CAE), juvenile myoclonic epilepsy (JME) and temporal lobe epilepsy (TLE). Age-appropriate tests were administered to assess sustained attention, encoding and verbal memory, executive and focused attention and attentional flexibility/impulsivity. CAE probands attained lower scores than other probands in visual sustained attention and the ability to focus on and execute a visual-motor task. Scores of the unaffected relatives tended to fall between those of the probands and the controls. JME relatives had lower scores than other relatives in tests of visual and auditory sustained attention and attentional flexibility, and showed greater variability in response time. Behavioral information of this type may aid in the specification and differentiation of genetic linkages in affected families.     

Schizophrenia and genetics: new insights

There is consistent evidence that the principal etiology of schizophrenia involves predisposing genetic factors. Recent years have seen several new insights in the genetics of schizophrenia. Several chromosomal regions show significant evidence that they contain schizophrenia susceptibility genes. A clinically relevant genetic subtype of schizophrenia (22q deletion syndrome) has been identified. There is new evidence that spontaneous mutations may play a role. There are new recommendations for genetic counseling. The progress to date suggests that understanding of a neurodevelopmental pathway from genetic susceptibility to schizophrenia will soon be fundamentally altered by molecular genetic advances in this complex disease.     

Effects of 14-methoxymetopon, a potent opioid agonist, on the responses to the tail electric stimulation test and plus-maze activity in male rats: neuroendocrine correlates

We have studied the effects of 14-methoxymetopon (HS 198), a potent opioid agonist, on the responses to the tail electric stimulation test and plus-maze activity of adult male rats. The prototype mu agonist morphine was used as the drug of reference. Besides we addressed the effects of HS 198 on the serum corticosterone levels and on serotonergic systems of discrete brain regions. Both drugs were administered subcutaneously. Morphine (5 mg/kg) and HS 198 (30 microg/kg) induced a similar effect on the nociceptive test, with both drugs significantly increasing the threshold for the vocalization afterdischarge, which is related to the emotional component of pain. In the plus-maze, morphine (5 mg/kg) and HS 198 (20 and 30 microg/kg) induced similar increases in the percentages of entries and time in the open arms, two parameters related to the anxiety state of the animals. The results indicate that HS 198 is far more potent than morphine in reducing the emotive/affective component of pain and in inducing an anxiolytic effect. HS 198 (30 microg/kg) also induced parallel increases in the serum corticosterone levels and the hypothalamic serotonin content. A possible correlation between the anxiolytic action of the drug and its effect on the hypothalamic serotonergic system is suggested.