Quantitative relations between exposure to respirable coalmine dust and coalworkers' simple pneumoconiosis in men who have worked as miners but have left the coal industry

Present estimates of the quantitative relations between exposure to mixed respirable coalmine dust and risk of developing coalworkes' simple pneumoconiosis are based on studies of working miners. These studies did not include men who had been miners but had left the coal industry, and it was not known whether the estimates of risk were also appropriate for these men. The results are reported of a study in which the dust/disease relations in men who have been miners but have left the industry have been compared with those in men who have remained in it. A sample of 17738 men who were first examined when working in 24 British collieries in the 1950s has been followed up about 22 years later. It was possible to examine 61% of the survivors, 44% of the original sample. Simple pneumoconiosis was more frequent among men (particularly older men) who had left the industry than among those who had stayed in it. A detailed analysis did not show any systematic or statistically significant difference between men who stayed and men who left in the quantitative relations between dust exposure and simple pneumoconiosis. Present estimates of risk of simple pneumoconiosis in relation to exposure to mixed respirable dust in working miners adequately describe the relation found in men who have been miners but have left the industry.     

Oilseed rape and seasonal symptoms: epidemiological and environmental studies.

BACKGROUND--There is widespread concern that the cultivation of oilseed rape leads to seasonal epidemics of respiratory symptoms in populations living in the neighbourhood, and it has been suggested that the plant is a potent allergen. A study was therefore undertaken to determine the prevalence of seasonal symptoms in rural populations close to and far from areas of oilseed rape cultivation, and to measure the levels of allergen and other potentially harmful substances released by the crop. METHODS--Random samples of 1000 adults from the general practice populations of two villages surrounded by oilseed rape fields, and 1000 adults from one village far from such cultivation, were taken. The subjects completed a previously validated questionnaire on respiratory and other symptoms, including questions on symptom seasonality, occupation, and smoking habits. Pollen and fungal spore counts were made around fields of oilseed rape and in the villages. The chemicals released by oilseed rape were measured in the field. RESULTS--Overall, 86.8% of the subjects completed the questionnaires and the populations of the two samples were generally comparable. Spring and summer exacerbations of symptoms occurred equally in the two areas in approximately 25% of the population. There were small but significant excesses of cough, wheeze, and headaches in spring in the oilseed rape area (2.3% v 1.1%, 6.8% v 4.6%, and 4.8% v 2.8%, respectively), and cough, wheeze, and itchy skin were more prevalent in smokers. Counts of oilseed rape pollen were generally low except adjacent to fields, and counts of fungal spores were mostly higher in the rape than the non-rape areas. Oilseed rape was shown to give off terpenes and these were detected close to fields. CONCLUSIONS--While it is likely that a proportion of the spring symptoms occurring in people living in close proximity to oilseed rape is caused by the plant, the excess of such symptoms is small. This, together with the low levels of pollen in the area, suggests that allergy to oilseed rape pollen is uncommon. The general prevalence of seasonal symptoms in rural areas is of interest, and a proportion of these cases is likely to be caused by factors other than allergy. Release of chemicals by plants and natural rises in summer ozone levels may be contributors.     

To thin or not to thin: the use of the anterolateral thigh flap in the reconstruction of intraoral defects.

The anterolateral thigh (ALT) flap has achieved popularity recently for free-flap reconstruction of intraoral defects following excision of squamous cell carcinoma. We have assessed the feasibility of the ALT flap as a free flap for oral lining and the potential use of the thinned ALT flap in a one-stage reconstruction. We used the ALT flap to reconstruct the oral cavity in 18 consecutive patients between December 2000 and December 2001 following intraoral resection of squamous cell carcinoma. Twelve patients underwent reconstruction using a standard ALT flap, four patients received a thinned ALT flap in a one-stage procedure, one patient received a standard ALT flap in combination with a fibula flap and one patient received a combination of a standard ALT flap and vascularised iliac bone. There were no complications in any of the 14 cases in which a standard ALT flap was used. Two of these flaps were thinned subsequently as secondary procedures. Of the four thinned ALT flaps, one flap failed completely and two flaps experienced partial necrosis. In all but one case the donor site was closed directly with minimal donor-site morbidity. The ALT flap is a versatile flap that can be used in combination with other flaps for more complex defects with minimal donor-site morbidity and is a useful alternative in the armamentarium of the head and neck surgeon. Thinning of the flap is best performed as a secondary procedure, should it be required.     

Catheter tip position in central vein thrombosis

Clinical central venous thrombosis (CVT) was found to be associated with a catheter tip position in the superior vena cava (SVC), but not in the right atrium (RA), in patients receiving a standard parenteral nutrition regime in which dextrose was the sole energy source. CVT was rare with standard lipid containing three in one mixes, even when the catheter tip lay in the SVC. The reasons for this are discussed and the complications associated with catheter tip position are reviewed.     

Relations between upper limb soft tissue disorders and repetitive movements at work

To make a preliminary assessment of whether upper limb soft tissue disorders might be associated with activities at work, we have conducted a case-control study of subjects attending orthopedic clinics in three cities. All subjects between the ages of 16 and 65 years, in whom defined soft tissue conditions of the upper limb were diagnosed by the participating orthopedic surgeons, were invited to take part. Controls were subjects attending the same clinics within the same age range whose clinical diagnosis did not include disease of the upper limb, cervical or thoracic spine. Information concerning repetitive movements of the upper limbs at work was elicited by questionnaire. Five hundred eighty cases and 996 controls were studied, representing 96% and 93%, respectively, of those invited to participate. The diagnoses of the cases included soft tissue conditions affecting the shoulder, elbow, forearm, wrist, thumb, hand, and fingers. The diagnoses of the controls included traumatic, degenerative, and inflammatory conditions, mostly of the legs and lower back. Women predominated among the cases (70%) and men among the controls (56%). Of 221 female cases with injury to the wrist and forearm, 32 were cleaner/domestics (14.5%) compared to 35 of 439 controls (8%), a difference statistically significant at the 2 1/2% level. Other jobs significantly overrepresented (5% level) among female cases with injuries at various anatomical sites included hairdressers, secretary/temps, assembly line workers, and machine operators (type unspecified). Among male cases, electricians were significantly overrepresented (5% level). Jobs for which there was a suggestion (p < 0.1) of overrepresentation among cases included butchers and teacher/ lecturers (both males only) and the combined job groups (chosen a priori for analysis) of keyboard operators, machine operators, and music teachers (all three jobs, females only).     

Immediate reconstruction of the mandible using a vascularized segment of radius

Resection of a segment of mandible, particularly when associated with malignant disease, carries a high morbidity and mortality. Traditional methods of autogenous bone grafting have proved unreliable in immediate reconstruction of such mandibular defects because of the variability of the recipient bed. These unfavorable conditions for bone graft survival can be largely overcome using vascularized bone and vascularized soft tissue reconstruction. The radial forearm free flap has proved a versatile and useful method in intraoral reconstruction and can be used together with a segment of radius as a composite flap. The technique of raising a segment of vascularized radius is described and its use in immediate reconstruction of the mandible at the time of resection illustrated in a series of 14 consecutive cases. There was one microvascular failure in this series and one postoperative death. The remaining 12 cases have had a successful outcome and show clinical union in the follow-up period varying from 11-36 months. There is evidence indicating that the bone maintains its viability even in the presence of preoperative or early postoperative radiotherapy.     

Relative effect of surgery and radiotherapy on the internal jugular vein following functional neck dissection

We examined the internal jugular veins in three groups of patients who had undergone (1) a functional neck dissection and radiotherapy, (2) a functional neck dissection alone, or (3) radiotherapy alone, using a noninvasive color Doppler ultrasound scan. The internal jugular veins were ultrasonically bilaterally normal in 18% of patients who had undergone a functional neck dissection and radiotherapy, in 88% of patients who had undergone a functional neck dissection alone, and in 57% of patients who had undergone radiotherapy alone. The combination of a functional neck dissection and radiotherapy significantly affected the internal jugular vein when compared with a functional neck dissection alone.     

Circulating human C-reactive protein binds very low density lipoproteins.

Native human CRP in solution formed complexes with the abnormal lipoprotein beta-VLDL in serum of patients with type III hyperlipoproteinaemia. CRP also formed complexes in sera from individuals with type IV and type V hyperlipoproteinaemia. The binding was calcium-dependent and inhibitable by free phosphoryl choline. No complexes were demonstrable in sera containing high LDL levels from cases of type IIa hyperlipoproteinaemia. Addition of isolated beta-VLDL, but not of isolated LDL, to acute phase normolipoproteinaemic serum caused the appearance of soluble CRP-lipoprotein complexes. In contrast, addition of an excess of isolated normal VLDL to acute phase serum or to isolated CRP was followed by agglutination (creaming) of the lipoprotein particles. Rabbit CRP, on the other hand, formed soluble complexes both with normal human apoB containing lipoproteins and with the abnormal beta-VLDL. Human CRP complexed with rabbit beta-VLDL but not with normal rabbit serum lipoproteins. These interactions may be important for the role of CRP in health and disease.     

Steroid hormone receptors in human salivary gland tumours.

Major salivary gland tumours were studied for the presence of hormone receptors for oestrogen and progesterone. Of the eight salivary gland tumours exhibiting varied histology, none showed high affinity receptors for oestrogen or progesterone. Salivary tissue from four patients with non-neoplastic salivary gland disease was also studied and found not to contain high affinity receptor sites. The absence of hormone receptors in these glands suggests that such tumours are not dependent on endocrine function.     

Use of patches and whole body sampling for the assessment of dermal exposure

There has been a growing awareness of the importance of dermal exposure in recent years. A wide range of techniques are employed to measure exposure, of which surrogate skin techniques such as patch sampling and whole body sampling are frequently used. One of the problems associated with dermal sampling is that different methods often produce different results due to differences in the principles involved in sample collection. As a consequence little progress towards establishing dermal exposure limits has been made. Both patches and clothing act as passive samplers and are intended to collect all of a substance deposited on them. This paper details the principles underlying patch and whole body sampling and outlines some of the advantages and disadvantages of each. A conceptual model has recently been proposed for dermal exposure and the role that surrogate techniques may play in the application of this model is discussed. Finally, suggestions are made as to how these techniques may be made more relevant and areas of future research highlighted.