Five patients had asthma provoked by cyanoacrylates and one by methyl methacrylate, possibly because of the development of a specific hypersensivity response. Acrylates have wide domestic as well as industrial uses, and inhalation of vapour emitted during their use can cause asthma.Acrylates are widely used in the manufacture of adhesives, solvents, acrylic resins, and thermoplastics. Cyanoacrylate based glues give a high bond strength between a variety of materials and are available for domestic use as Superglue and for surgical use as tissue adhesives.' Methacrylates, which are chemically distinct from cyanoacrylates, serve as bases for acrylic resins, which have various applications, including use as adhesives and fillers in dental and orthopaedic procedures.23 Workers in pathology laboratories may be exposed as a result of their use in the plastic embedding of histological specimens.Low molecular weight acrylic monomers are irritant to the eyes and mucous membranes, and have been reported to produce dermatitis4 and pulmonary oedema,5 but there is no previous report of an association with asthma. We report five cases of asthma occurring in association with exposure to cyanoacrylate based adhesives, and one case occurring in relation to exposure to methyl methacrylate. In each case, inhalation testing that mimicked exposure at work6 provoked an asthmatic reaction.
MethodsIn patients 2 and 3 histamine reactivity was measured by a modification of the method of de Vries.
Since March 1980, 309 patients with anaplastic small cell carcinoma of the bronchus (ASCB) have received remission induction therapy prior to randomisation to maintenance (M) or no maintenance (NM) chemotherapy. Induction therapy consisted of six courses of vincristine, doxorubicin and cyclophosphamide (VAC) given IV every 3 weeks. Those with limited disease also received mediastinal irradiation. Consenting patients with no unequivocal residual disease were randomised to have no further treatment until relapse or a further eight courses of VAC, at a lower dosage, every 4 weeks. Patients failing to achieve randomisation status received palliative treatment only. The median survival for all patients with limited disease (LD) is 363 days and that for patients with extensive disease (ED) is 272 days (P less than 0.00001). Sixty-one patients with ED were randomised. Those having maintenance chemotherapy lived significantly longer (median 372 days) than those who did not continue therapy (median 259 days) (P = 0.006). An imbalance in the proportion of 'complete remitters' randomised to maintenance therapy does not account for this difference. There is no significant difference between the M and NM groups in the 32 randomised LD patients. Continuing treatment during remission with agents used to induce the remission can prolong survival in patients with extensive stage ASCB.
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