No abstract

No abstract

Background-Auto-CPAP machines used in the treatment of obstructive sleep apnoea (OSA) are designed to vary the treatment pressure automatically in order always to apply the actually needed pressure. Consequently they should be able to achieve at least identical therapeutic effects as conventional constant pressure CPAP with a lower mean treatment pressure. The present study was designed to evaluate the therapeutic eYcacy and the treatment pressure of an auto-CPAP machine (REM+auto ® , SEFAM) in comparison with a conventional CPAP device. Methods-Following CPAP titration, 16 patients with OSA were allocated to receive conventional CPAP and auto-CPAP treatment under polysomnographic control in a randomised order. After each treatment the patients were asked to assess the therapy using a questionnaire; a vigilance test was also carried out and subjective daytime sleepiness was evaluated using the Epworth Sleepiness Scale (ESS). 2)). The vigilance test showed normal values after both treatments in all patients with no significant diVerences. The mean pressure during auto-CPAP treatment (8.1 (2.9) mbar), however, was significantly higher than that employed in conventional CPAP treatment (7.6 (2.7) mbar; mean diVerence 0.5 mbar; 95% CI 0.1 to 0.9 mbar; p<0.05). Conclusions-Auto-CPAP was equally as eVective as conventional CPAP with respect to therapeutic eYcacy. The aim of reducing the treatment pressure with auto-CPAP, however, was not achieved. (Thorax 1998;53:643-648) Results-The

No abstract

Summary Vinyl chloride (VC) is a know animal and human carcinogen associated with liver angiosarcomas (LAS) and hepatocellular carcinomas (HCC). In VC-associated LAS mutations of the K-ras-2 gene have been reported; however, no data about the prevalence of such mutations in VC associated HCCs are available. Recent data indicate K-ras-2 mutations induce P16 methylation accompanied by inactivation of the p16 gene. The presence of K-ras-2 mutations was analysed in tissue from 18 patients with VC associated HCCs. As a control group, 20 patients with hepatocellular carcinoma due to hepatitis B (n = 7), hepatitis C (n = 5) and alcoholic liver cirrhosis (n = 8) was used. The specific mutations were determined by direct sequencing of codon 12 and 13 of the K-ras-2 gene in carcinomatous and adjacent nonneoplastic liver tissue after microdissection. The status of p16 was evaluated by methylation-specific PCR (MSP), microsatellite analysis, DNA sequencing and immunohistochemical staining. All patients had a documented chronic quantitated exposure to VC (average 8883 ppmy, average duration: 245 months). K-ras-2 mutations were found in 6 of 18 (33%) examined VC-associated HCCs and in 3 cases of adjacent non-neoplastic liver tissue. There were 3 G → A point mutations in the tumour tissue. All 3 mutations found in non-neoplastic liver from VC-exposed patients were also G → A point mutations (codon 12-and codon 13-aspartate mutations). Hypermethylation of the 5′ CpG island of the p16 gene was found in 13 of 18 examined carcinomas (72%). Of 6 cancers with K-ras-2 mutations, 5 specimens also showed methylated p16. Within the control group, K-ras-2 mutation were found in 3 of 20 (15%) examined HCC. p16 methylation occurred in 11 out of 20 (55%) patients. K-ras-2 mutations and p16 methylation are frequent events in VC associated HCCs. We observed a K-ras-2 mutation pattern characteristic of chloroethylene oxide, a carcinogenic metabolite of VC. Our results strongly suggest that K-ras-2 mutations play an important role in the pathogenesis of VC-associated HCC. prove the association of their cancer with VC exposure. As a control group, hepatocellular carcinoma tissue from 20 patients with chronic hepatitis B and C virus infection and alcohol-induced cirrhosis with HCC was used. The presence of K-ras-2 mutations was examined by direct sequencing after microdissection of the tumour nodules. MATERIALS AND METHODS Patients and tissue samplesData were extracted from the German industrial professional association for the chemical industry which is responsible for statutory accident insurance and provides medical and social rehabilitation and financial compensation to persons who incur an industrial injury or occupational disease. According to the German social legislation code VII, compensation for work-related impairment and disability is only possible in cases of a proven association of occupational factor and disease. The criteria for the patients included in this study were a documented chronic quantitated exposure to VC, which leads ...

No abstract

Upper airway dryness is a frequent side-effect of nasal continuous positive airway pressure (nCPAP) therapy in obstructive sleep apnoea (OSA). In this situation, heated humidification is often used. Alternatively, oily nose drops are frequently applied to relieve dryness. The present study aimed to investigate the efficacy of a heated humidifier in comparison with oily nose drops. Twenty-four OSA patients complaining of serious nCPAP-related upper airway dryness were randomized to 6 weeks of treatment either with heated humidification (HC 100, Fischer & Paykel, Inc., Auckland, New Zealand) or oily nose drops (Colda-Stop, Desitin, Inc., Germany). The patients completed questionnaires on the degree and frequency of upper airway dryness, compliance with nCPAP, intention to terminate nCPAP and comfort during the nCPAP therapy. All 12 patients treated with heated humidification improved in terms of the degree and frequency of upper airway dryness, and reported greater comfort when using the nCPAP device. All patients in the heated humidification group intending to terminate nCPAP therapy because of upper airway dryness persisted with nCPAP on addition of humidification. In contrast, only five out of 12 patients (42%) in the oily nose drops group reported their degree of upper airway dryness to be improved (P = 0.003), only three patients (25%) reported an improvement in the frequency of upper airway dryness (P < 0.001), and only five patients (42%) reported greater comfort when using the nCPAP device with oily nose drops (P < 0.001). In the group using oily nose drops none of the three patients who intended to terminate nCPAP therapy persisted with nCPAP. Heated humidification is highly effective and superior to oily nose drops in reducing the symptoms of upper airway dryness during nCPAP.

In the production of lead batteries two antimony compounds occur: in the casting of grids antimony trioxide (Sb2O3), and in the formation of lead plates stibine (SbH3). Seven workers from the grid-casting area and 14 workers from the formation area were examined with regard to the antimony concentration in blood (Sb-B) and urine (Sb-U). Antimony air concentrations (Sb-A) were measured by means of personal air samplers. Urine samples were collected at the end of the working week, at the beginning (U1) and the end (U2) of the shift, and at the beginning of work following a weekend without Sb exposure (U3). At U2 among the casters, the median Sb-A exposure was 4.5 (1.18-6.6) micrograms Sb/m3 and among the formation workers, 12.4 (0.6-41.5) micrograms Sb/m3. The exposure in both groups is more than 10 times lower than the present threshold limit values. The median Sb-B concentrations in the preshift samples was 2.6 (0.5-3.4) micrograms Sb/l for the casters and 10.1 (0.5-17.9) micrograms Sb/l for the formation workers. The average Sb-U values (U2) were 3.9 (2.8-5.6) micrograms Sb/g creatinine in the casting area and 15.2 (3.5-23.4) micrograms Sb/g creatinine in the forming area. Our investigation indicates that the two antimony compounds show virtually equal pulmonary absorption and renal elimination. The statistically significant correlations between Sb-A/Sb-B and Sb-A/Sb-U form the basis for proposals regarding appropriate biological exposure limits for occupational antimony exposure.