Damage to the lung caused by glass wool

Nakon kratkog općeg prikaza o staklenim vlaknima i staklenoj vuni navode se oboljenja, koja mogu nastati kod rada s tim produktima. Ukratko se spominju već dobro poznata oštećenja kože, očiju i gornjih respiratornih organa. Oštećenja pluća staklenom vunom su manje poznata. Nakon prikaza podataka iz literature o tom pitanju iznosi se jedan vlastiti slučaj pneumonije desnog donjeg režnja pluća, koja se razvila kao posljedica jednokratne inhalacije snopića staklene vune. Konačni je ishod bolesti bio povoljan, vjerojatno zbog spontanog odstranjenja staklene vune kašljanjem.A brief review of physical properties, production and use of fiberglass and glass wool is presented. Occupational health hazards due to fiberglass and glass wool are described, and mechanical irritation as the main cause of these hazards is specially pointed out. Skin, eyes and upper respiratory tract are commonly affected presenting signs of inflammation and marked irritation. A rare case of lung damage by glass wool, being the second in the literature, is presented. During the repair of an incubator the worker inhaled glass wool. Severe cough lasting a few minutes followed inhalation. Three weeks later signs of right lower lobe consolidation developed, accompanied by a marked enlargement of the right hilar glands. The diagnosis of acute bacterial infection of the lung was established. The patient responded very well to penicilin, streptomycin and sulfamethazine treatment. The true nature of the disease was recognized only in the convalescent stage when the history of glass wool inhalation was obtained. The inhaled glass wool had been coughed out a few days before chemotherapy was applied, and this seemed to produce complete recovery. The mechanism of the action of glass wool is discusse

Tetanus in P.R. Croatia from the epidemiological and clinical point of view

Tetanus predstavlja u Jugoslaviji kao poljoprivrednoj zemlji važan problem u nacionalnoj patologiji, jer po svom mortalitetu dolazi na prvo mjesto među akutnim zaraznim bolestima. Na temelju analize 360 slučajeva tetanusa, koji su liječeni u Bolnici za zarazne bolesti u Zagrebu od 1939.-1954., pokušalo se osvijetliti epidemiologiju i kliniku tetanusa u NR Hrvatskoj, a i u ostalim dijelovima Jugoslavije. Tetanus je najviše proširen u nizinskim dijelovima Jugoslavije s razvijenom poljoprivredom i stočarstvom. Od njega obolijevaju većinom (u 78% slučajeva) seljaci i njihova djeca, a od gradskog stanovništva oni s periferije, koji se bave i sitnom poljoprivredom. No od tetanusa obolijevaju kod nas i industrijski radnici te ljudi zaposleni u nekim obrtima (stolari, krojači, postolari i t. d.). Tetanus pokazuje kod nas izrazito sezonsko kretanje i javlja se, kad ljudi rade, većinom bosonogi, u polju i vrtu. Prema dobi tetanus je često oboljenje novorođenčadi te mladih dobnih skupina (od 5-20 godina). U mlađim dobnim skupinama je mnogo češći kod muških nego kod ženskih, svakako zbog češćih povreda kod muške omladine. Kudikamo najveći broj naših bolesnika se zarazio ubodom na različite predmete (trn, trijeska i t. d.), a najčešće mjesto povrede je bila noga. Ukratko je izneseno moderno shvaćanje o patogenezi tetanusa. Prema kliničkoj slici daleko najveći broj slučajeva je pripadao generaliziranom tetanusu, no bilo je i nekoliko slučajeva lokaliziranog tetanusa. Analiziran je odnos letaliteta prema lokalizaciji povrede, dužini inkubacije i dužini intervala između prvih simptoma bolesti i pojave reflektornih grčeva. Letalitet je u analiziranom materijalu iznosio 30,55%. Opširnije se raspravlja o terapiji tetanusa, naročito o modernoj primjeni relaksantnih sredstava. Spominje se uspješna terapija kroničnog tetanusa cijepljenjem tetalpanom. U profilaksi tetanusa se najviše preporučuje aktivna imunizacija ljudi, kod kojih postoji veća vjerojatnost povreda i infekcije.Yugoslavia is an agricultural country and tetanus is of great importance in the national pathology since: 1. it has one of the highest mortality rates among acute infectious diseases, 2. the disease has a fatality rate of 43% and 3. it has shown a steady increase during the last years. This paper presents an analysis of 360 cases of tetanus which were treated in the Fever Hospital, Zagreb, from 1939-1954 (table 1). This analysis is intended to show the epidemiological and\u27 clinical aspects of tetanus in P.R. Croatia and other parts of Yugoslavia. The highest regional incidence of tetanus is in the northern agricultural parts of Yugoslavia. In the great majority of cases (78%) it is a disease of peasants and their children. Among inhabitants·of towns it is a disease of those from the peripheral parts who are occupied with some agricultural work as well. Industrial workers and some tradesmen (joiners, tailors, shoemakers etc.) also suffer from tetanus (table 4). Tetanus has a characteristic seasonal incidence and the great majority of cases occurs between May and October (table 2) i. e. in the season when people do agricultural work in fields and gardens (table 3). It is of great importance that most of our peasants work bare-footed on manured soil. Tetanus very often occurs among newborns and younger age groups (from 6-20 years of age). In this age group the occurrence is more common in males than females (126:53) because of the much greater exposure to injuries of male youth during their work, play and sport (table 5). In 47,51% of cases the type of injury was a puncture (table 6) with different instruments (thorn, wooden splinter etc. - table 7). The most common site of injury was the foot (table 11). Modern concepts of pathogenesis of tetanus are briefly described. Most of our cases of tetanus presented themselves as a generalised tetanus (table 8) of moderate severity, whereas there were only a few cases of localised tetanus, all of them mild. The number of cases of tetanus in the newborn is small because these cases have been admitted to our hospital only since 1952. The number of cases of gynaecological tetanus is also small; this is probably due to the unreliable data. The .case fatality rate depended on the clinical form of the disease and was the highest in the cephalic and gynaecological forms and in tetanus of the newborn (table 9). Clinical relation of fatality rate to incubation period (table 10), location of injury (table 11) and interval between the first signs of tetanus and first spasms (table 12) is analysed. The average fatality rate in the analysed material was 30,55%. The treatment of tetanus is discussed in more detail. Since 1953 all moderate and severe cases of tetanus were given muscle relaxant Tolserol beside the usual therapy (antitoxic serum. hypnotics, narcotics, antibiotics etc.). The best results with this drug have been achieved in moderately severe cases as regards the subjective state of the patients, by facilitating the intake of food and fluids. In some patients with retention of urine this condition was overcome by the drug. In most of the severe cases, however, Tolserol was not able to control reflex spasms and save the life of the patient. In cases with spasm of the pharyngeal muscles we have also used a gastric tube for feeding and drug administration. The tube was maintained in position for a period of several days. In two cases with chronic tetanus satisfactory therapeutic result has been obtained with active immunisation. Seroprophylaxis and active immunisation against tetanus are briefly discussed. Active immunisation of people most exposed to infection with tetanus is recommended

Replication and validation of higher order models demonstrated that a summary score for the EORTC QLQ-C30 is robust.

Objective: To further evaluate the higher-order measurement structure of the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ-C30) questionnaire, with the aim of generating a summary score. Study design and setting: Using pretreatment QLQ-C30 data (N=3,282), we conducted confirmatory factor analyses to test seven previously evaluated higher-order models. We compared the summary score(s) derived from the best performing higher-order model with the original QLQ-C30 scale scores, using tumor stage, performance status and change over time (N=244) as grouping variables. Results: Whereas all models showed acceptable fit, we continued in the interest of parsimony with known-groups validity and responsiveness analyses using a summary score derived from the single higher-order factor model. The validity and responsiveness of this QLQ-C30 Summary Score was equal to, and in many cases superior to the original, underlying QLQ-C30 scale scores. Conclusion: Our results provide empirical support for a measurement model for the QLQ-C30 yielding a single summary score. The availability of this Summary Score can avoid problems with potential Type I errors that arise due to multiple testing when making comparisons based on the 15 outcomes generated by this questionnaire, and may reduce sample size requirements for HRQL studies using the QLQ-C30 questionnaire when an overall summary score is a relevant primary outcome

Radiotherapy fractionation for the palliation of uncomplicated painful bone metastases – an evidence-based practice guideline

BACKGROUND: This practice guideline was developed to provide recommendations to clinicians in Ontario on the preferred standard radiotherapy fractionation schedule for the treatment of painful bone metastases. METHODS: A systematic review and meta-analysis was performed and published elsewhere. The Supportive Care Guidelines Group, a multidisciplinary guideline development panel, formulated clinical recommendations based on their interpretation of the evidence. In addition to evidence from clinical trials, the panel also considered patient convenience and ease of administration of palliative radiotherapy. External review of the draft report by Ontario practitioners was obtained through a mailed survey, and final approval was obtained from the Practice Guidelines Coordinating Committee. RESULTS: Meta-analysis did not detect a significant difference in complete or overall pain relief between single treatment and multifraction palliative radiotherapy for bone metastases. Fifty-nine Ontario practitioners responded to the mailed survey (return rate 62%). Forty-two percent also returned written comments. Eighty-three percent of respondents agreed with the interpretation of the evidence and 75% agreed that the report should be approved as a practice guideline. Minor revisions were made based on feedback from the external reviewers and the Practice Guidelines Coordinating Committee. The Practice Guidelines Coordinating Committee approved the final practice guideline report. CONCLUSION: For adult patients with single or multiple radiographically confirmed bone metastases of any histology corresponding to painful areas in previously non-irradiated areas without pathologic fractures or spinal cord/cauda equine compression, we conclude that: • Where the treatment objective is pain relief, a single 8 Gy treatment, prescribed to the appropriate target volume, is recommended as the standard dose-fractionation schedule for the treatment of symptomatic and uncomplicated bone metastases. Several factors frequently considered in clinical practice when applying this evidence such as the effect of primary histology, anatomical site of treatment, risk of pathological fracture, soft tissue disease and cord compression, use of antiemetics, and the role of retreatment are discussed as qualifying statements. Our systematic review and meta-analysis provided high quality evidence for the key recommendation in this clinical practice guideline. Qualifying statements addressing factors that should be considered when applying this recommendation in clinical practice facilitate its clinical application. The rigorous development and approval process result in a final document that is strongly endorsed by practitioners as a practice guideline

Enhancing treatment decision-making: pilot study of a treatment decision aid in stage IV non-small cell lung cancer

We developed a decision aid (DA) for patients with metastatic non-small cell lung cancer (NSCLC), to better inform patients of their prognosis and treatment options, and facilitate involvement in decision-making. In a pilot study, 20 patients with metastatic NSCLC attending outpatient clinics at a major cancer centre, who had already made a treatment decision, reviewed acceptability of the DA. The median age of the patients was 61 years (range 37–77 years), 35% were male, 20% had a university education, and most (75%) had English as a first language. Most had received chemotherapy, with 65% currently on treatment. Patients were not anxious at baseline and had clear understanding of the goals and toxicity of chemotherapy in advanced NSCLC. After reviewing the DA, patients' anxiety decreased slightly (P=0.04) and knowledge scores improved by 25% (P<0.001). Most improvements in understanding were of prognosis with and without chemotherapy, although patients still believed advanced NSCLC to be curable. Patients rated the DA highly with respect to information clarity, usefulness and were positive about its use in practice, although 40% found the prognostic information slightly upsetting. The DA for advanced NSCLC is feasible, acceptable to patients and improves understanding of advanced NSCLC without increasing patient anxiety

High levels of untreated distress and fatigue in cancer patients

The purpose of the study was to assess a large representative sample of cancer patients on distress levels, common psychosocial problems, and awareness and use of psychosocial support services. A total of 3095 patients were assessed over a 4-week period with the Brief Symptom Inventory-18 (BSI-18), a common problems checklist, and on awareness and use of psychosocial resources. Full data was available on 2776 patients. On average, patients were 60 years old, Caucasian (78.3%), and middle class. Approximately, half were attending for follow-up care. Types of cancer varied, with the largest groups being breast (23.5%), prostate (16.9%), colorectal (7.5%), and lung (5.8%) cancer patients. Overall, 37.8% of all patients met criteria for general distress in the clinical range. A higher proportion of men met case criteria for somatisation, and more women for depression. There were no gender differences in anxiety or overall distress severity. Minority patients were more likely to be distressed, as were those with lower income, cancers other than prostate, and those currently on active treatment. Lung, pancreatic, head and neck, Hodgkin's disease, and brain cancer patients were the most distressed. Almost half of all patients who met distress criteria had not sought professional psychosocial support nor did they intend to in the future. In conclusion, distress is very common in cancer patients across diagnoses and across the disease trajectory. Many patients who report high levels of distress are not taking advantage of available supportive resources. Barriers to such use, and factors predicting distress and use of psychosocial care, require further exploration

Determination of the melting temperature, heat of fusion, and purity analysis of different samples of zidovudine (AZT) using DSC

The determination of chemical purity, melting range, and variation of enthalpy in the process of characterizing medicines is one of the principal requirements evaluated in quality control of the pharmaceutical industry. In this study, the method of purity determination using DSC was outlined, as well as the application of this technique for the evaluation of commercial samples of zidovudine (AZT) (raw material) supplied by different laboratories. To this end, samples from six different laboratories (A, B, C, D, E, and F) and the standard reference (R) from the United States Pharmacopeia (USP) were analyzed. The DSC curves were obtained in the temperature range of 25 to 200 ºC under the dynamic atmosphere of N2 (50 mL min-1), heating rate of β=2 ºC min-1, using an Al capsule containing approximately 2 mg of sample material. The results demonstrated that the standard reference presented a proportion of 99.83% whereas the AZT samples presented a variation ranging from 97.59 to 99.54%. In addition, the standard reference was found to present a temperature of onset of melting point of 122.80 °C. Regarding the samples of active agents provided by the different laboratories, a variation ranging from 118.70 to 122.87 °C was measured. In terms of ΔHm, the samples presented an average value of 31.12 kJ mol-1._________________________________________________________________________________________ RESUMO: A determinação da pureza química, a faixa de fusão e a variação de entalpia envolvida no processo de caracterização de fármacos é um dos principais requisitos avaliados no controle de qualidade em indústrias farmacêuticas. Neste trabalho é feita uma breve abordagem sobre o método de determinação de pureza utilizando DSC, assim como a aplicação desta técnica para avaliação de amostras comerciais de zidovudina (AZT) (matéria-prima) fornecida por diferentes laboratórios. Para tal, foram analisadas amostras de seis diferentes laboratórios (A,B,C,D,E e F) e a substância química de referência (R) da United States Pharmacopeia (USP). As curvas DSC foram obtidas na faixa de temperatura entre 25 a 200 ºC, sob atmosfera dinâmica de N2 (50 mL min-1), β=2 ºC min-1, utilizando cápsula de Al contendo aproximadamente 2 mg de amostra. De acordo com os resultados, pode-se observar que a substância química de referência apresentou teor igual a 99,83% e que as amostras de AZT apresentaram uma faixa de variação entre 97,59 e 99,54%. Pode-se verificar, ainda, que a substância química de referência apresentou uma temperatura onset de fusão igual a 122,80 °C. Para as amostras dos princípios ativos fornecidos pelos diferentes laboratórios, pode-se verificar uma faixa de variação entre 118,70 e 122,87 °C. No que se refere ao ΔHm, as amostras apresentaram valor médio de 31,12 kJ.mol-1