Sources and incidence of airborne Aspergillus fumigatus (Fres)

Specific surveys of the air for Aspergillus fumigatus were carried out in rural and urban situations over a 2-year period. Overall, low concentrations of spores were recorded with a higher incidence during the ‘winter’ months. Counts in the open air and in a hospital ward showed similar fluctuations, the indoor counts being consistently lower. Plant debris in the form of compost heaps and stacks of hay and straw baled with a high moisture content in which self-heating occurs, produces large numbers of spores which may be liberated into the air causing high but localized counts if disturbed. The widespread distribution of decaying leaves following leaf fall represents a potential source of smaller concentrations of spores but over a much larger area. This availability of decaying plant debris with high water content fulfils the growth requirements of Aspergillus fumigatus and is the probable explanation of its winter seasonality.     

Major Neurological Disease and Occupational Exposure to Organic Solvents

Five patients are described who presented with major organicbrain disease affecting one or more of pyramidal and extrapyramidaltracts, cerebellum, and higher cortical functions. All had ahistory of 10 years or more of regular occupational exposureto solvents in confined spaces, three in painting inside shipsand the others in weapons maintenance and printing. All hadbeen regularly exposed to high air vapour peaks as well as toskin contamination. Four showed some evidence of improvementafter the exposure ceased. None was initially suspected of havinga toxic encephalopathy by the consultant to whom he was referred.The spectrum of neurological disease presented by these menmirrors closely that described in solvent abusers. All wereforced by illness to retire from their work, a circumstancewhich might have in the past have led to such conditions beingmissed in cross-sectional studies, which in general have notshown evidence of major disease. We suggest that when such diseaseoccurs nowadays, its cause is usually not suspected. Furtherepidemiological study of the problem is necessary.     

THREE-DIMENSIONAL RECONSTRUCTION OF NON-HODGKIN'S LYMPHOMA IN BONE MARROW TREPHINES

The objective of this study was to analyse the location in the bone marrow of deposits of low-grade non-Hodgkin's lymphoma. This was achieved using computer-generated three-dimensional reconstruction techniques applied to serial tissue sections of five bone marrow trephines involved by lymphoma. For comparative purposes, previously published three-dimensional models of benign lymphoid aggregates in the bone marrow were used. The images generated by this new study showed that deposits of low-grade non-Hodgkin's lymphoma involving the bone marrow always assumed a paratrabecular pattern of infiltration at some point. This is in direct contrast to the pattern of bone marrow infiltration shown by benign lymphoid aggregates. It is concluded that location within the marrow space is a crucial factor in distinguishing between benign and low-grade malignant lymphoid infiltrates in the bone marrow. © 1997 by John Wiley & Sons, Ltd.     

Management of allergic bronchopulmonary aspergillosis without maintenance oral corticosteroids: a fifteen-year follow-up

Five non-smoking patients were diagnosed as having allergicbronchopulmonary aspergillosis in 1978/9. All have been treatedsince then with inhaled corticosteroids, using short coursesof self-administered oral corticosteroids for symptomatic exacerbations.Over a mean 15 years of follow-up, they have required on averageless than one course of oral drugs per annum. Regular monitoringof spirometry has shown no evidence of deterioration, and allhave close to normal gas transfer. All have some localized bronchiectasison CT scanning, in two cases probably occuring after treatmentstarted, but in no case is there any respiratory disability.We conclude that this is a safe and effective method for themanagement of allergic bronchopulmonary aspergillosis when diagnosedbefore persistent hyphal colonization of the airways has occurred.     

Accidents in the Workplace

A prospective survey of patients attending the central Accidentand Emergency Department and Eye Casualty Department in Aberdeenwas made to determine the contribution of accidents at workto the workload of the departments and to estimate risks ofinjury in different industrial sectors. Work-related injuriesaccounted for 16.5 per cent of new patients attending the generalaccident department and 21.7 per cent of those attending eyecasualty. Analysis by industrial sector led to estimates thatalmost one in 10 workers employed in manufacturing industriesand in agriculture/forestry/fishing will attend casualty inthe course of a year for a work-related injury. The relativelylow-risk service sector, because of the large numbers of peopleemployed, contributed the greatest number of individuals withwork-related injuries. Two industries had very high rates ofspecific and preventable injuries - food and fish processingwith an estimated 17 knife lacerations per 1000 per annum andmechanical engineering with 60 eye injuries per 1000 per annum.We give reasons for believing that our estimates of risk inthe different industrial sectors are conservative. Requests for reprints should be addressed to: Dr C. Harker, Environmental and Occupational Medicine, University Medical School, Foresterhill, Aberdeen AB9 2ZD, UK