Two cases of paraoccupational asthma caused by toluene diisocyanate (TDI) are reported. The first patient was a metal worker in a machine shop situated near a factory producing polyurethane foam. Symptoms at work were not explainable by any specific exposure to irritants or allergens in the work site. As the patient recalled previous occasional work in the adjacent polyurethane factory with accompanying worsening of respiratory symptoms, a specific inhalation (SIC) test was performed with TDI, which confirmed the diagnosis of TDI asthma. The second case was a woman working part time as a secretary in the oYces of her son's factory for varnishing wooden chairs. TDI was present in the products used in the varnishing shed. The SIC test confirmed the diagnosis of TDI asthma, despite the fact that the patient's job did not present risk of exposure to the substance. In both patients, symptoms disappeared when further exposure was avoided. These two cases confirm that paraoccupational exposure to TDI must be considered when evaluating patients with asthma not mediated by immunoglobulin E. They also suggest the need for more prospective studies evaluating the health risk for the general population living near polyurethane factories or other firms that use TDI. (Occup Environ Med 2000;57:837-839) Keywords: paraoccupational exposure; toluene diisocyanate; asthma Occupational exposure to diisocyanate varnishes or to polyurethane foam are the main causes of TDI asthma, that aVects 5%-10% of workers exposed to diisocyanate.1 2 Paraoccupational exposure to TDI has seldom been reported, but this possibility must be considered when evaluating patients with asthma not mediated by immunoglobulin E (IgE).3 4 Identifying the aetiology of the symptoms means improving the prognosis of the disease by avoiding further exposure. The patient, however, may be hampered by the diYculties involved in having the exposure to TDI recognised as an occupational hazard. We report two recent cases. CASE 1 A men aged 60 had no personal or family history of atopy or pre-existing asthma, and had been an ex-smoker for 21 years (previously 15 cigarettes/day for 20 years). He was employed as a bricklayer for 38 years and then for 9 years as a metal worker in a machine shop near a factory producing polyurethane foam. In 1990, after a few weeks' work in the machine shop, he began to complain of upper respiratory irritation with a dry and then productive cough, and self limiting episodes of wheezing and shortness of breath. Symptoms progressively worsened, both at work and during the night. In September 1998, he went sick because of these respiratory symptoms. At that point his symptoms improved, but he still took short and long 2 agonists, mucolytics, and antihistamines. A chest x ray film and spirometric evaluation during this period were within normal limits. He resumed work, but soon after re-exposure in the workplace he complained again of the same respiratory symptoms.The patient was admitted to our department 4 months later, once again oV ...
To investigate the applicability of piezosurgery for cervical ventral slot (CVS), comparing it with the conventional technique of using high-speed burs for bone wear. Methods: Thirty rabbits (Oryctolagus cuniculus) were divided into two treatment groups (T1 and T2) corresponding to CVS between C3-C4. In T1, the surgery was performed with piezoelectric apparatus, and in T2 with highspeed burs. The evaluated parameters were: duration of each stage of surgery, temperature variations during CVS, visibility of the surgical field, intra and postoperative complications, and anesthetic monitoring. At 14, 28, and 56 postoperative days, five animals from each treatment group were submitted for histopathological study of the surgical site. Results: Compared with T2, T1 had more precise bone cut, and better visibility of the operative field, although it required longer total surgical time (p = 0.02) and triggered a greater number of intraoperative complications (p < 0.01), microscopic lesions in the spinal cord (p < 0.05), and transient neurological deficits in the postoperatively (p < 0.05). Conclusion:It is necessary to perform surgical planning and have several tips of the piezoelectric instrument available for the safe use of the piezoelectric device in neurosurgery.
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