In comparison with reference values obtained by the same method for German patients with no indication of workplace asbestos exposure, increased concentrations of more than 0.2 million chrysotile fibres/g dry were obtained for six of the 25 Hungarian patients (24%). For one of them, the second highest estimate of a workplace exposure of 60 fibre-years and the highest tissue concentration of 7.38 million chrysotile fibres/g dry substantiate a high probability of a causal relationship to asbestos. A further comparison can be made with the results for 66 German patients treated by surgical lung resection for a disorder other than mesothelioma, mainly lung cancer. For the Hungarian lung cancer patients, similar amounts of chrysotile but distinctly lower amounts of amphibole fibres and distinctly higher amounts of OMFs were observed. A correlation between exposure estimates from occupational history and concentration of fibres in the lung tissue was observed for amphibole (Spearman: R = 0.66, P < 0.001, Pearson: R = 0.50, P = 0.01) and for chrysotile (Pearson: R = 0.48, P = 0.02).
The annual incidence of lung cancer in Hungary is about 6,000. Since in our series of lung cancer patients about 4% were observed, which could be accepted as representing occupational disease because of a cumulative exposure to 25 fibre-years or more, the annual asbestos related lung tumour incidences may be estimated to be approximately 150 or more. The proportion of nearly two estimated cases of lung cancer per case of pleural mesothelioma corresponds to international experience. Up to now, lung cancer cases only exceptionally have been registered as occupational diseases, i.e. they were seriously under-diagnosed in Hungary. For improving this situation, diagnostic assistance by a self-interview with a questionnaire covering the working history for all newly diagnosed lung cancer patients would be helpful.
Background and Goal of Study:Interventional radiology (IR) came of age with the medical profession's desire to develop minimally invasive therapies1. Some of these procedures cause significant patient discomfort, and yet require relative patient immobility for optimal results calling for an increasing need for sedation and anaesthesia. Our study aimed to assess the provision of sedation service in IR. Materials and Methods: 101 radiology departments in acute hospital trusts in England and Wales responded to a telephone survey using a standardised questionnaire which was analysed. Results and Discussion: 76% of respondents were from the district general hospitals, 80% of which have dedicated IR lists. These provide services for hepatobiliary (84%), vascular (82%), cancer (68%), Gynaecology (61%), neuroradiology (23%) and miscellanous (25%). In 88% of the departments, a dedicated person, which may be a nurse (52%), radiologist (41%), anaesthetist (35%) and others (10%), provides sedation. Half of the departments have a sedation protocol and 49% of departments require a competency-based training for giving sedation. 20% of departments have a lead anaesthetist responsible for IR. 52% of the IR lists have anaesthetic cover and 81% of them have a dedicated anaesthetic assistant. Concerns about the safety and need of training of non-anaesthetic staff in the provision of sedation, monitoring and recovery of patients have been widely publicised1. Our survey revealed suboptimal involvement of anaesthetic departments in IR, and the lack of training for sedation provision. This may be due to poor inter-departmental co-operation and a general lack of resources. The Royal College of Radiologists 2 and the Joint Commission for Accreditation of Healthcare Organizations recommend that sedation practice throughout the hospitals be 'monitored and evaluated by the Department of Anaesthesia'3 Conclusion(s): We identified the need for further participation of anaesthetists in IR to provide a service, support, and to develop training for sedation provision by non-anaesthetists. This can be achieved by a lead anaesthetist in IR who maintains close links between the departments especially with regard to producing local protocols.
After a period of 10 years the authors reexamined the respiratory health status of 381 dust-exposed males. Of the lung function values examined Raw, RV/TLC%, VC, TGV and PaO2 were found to be of significant prognostic importance. Among the radiological changes characteristic of silicosis the most serious B-C category, among the respiratory complaints dyspnoea accompanied by regular cough and expectoration, and among the physical changes extended rhonchi and rales accompanied by an emphysematous thorax are to be considered as most essential with respect to prognosis. Smoking habits significantly affected the total death rate, but did not prove to be significant with regard to respiratory death. In the development of bronchial obstruction recurrent febrile respiratory diseases proved to be more important than smoking habits and mild bronchitic complaints
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