Summary: A correlation survey has been carried out between the pathological, physiological, and radiological findings pertaining to emphysema in 247 deceased coal miners and ex-miners, most of whom had been diagnosed as suffering from coal workers' pneumoconiosis during life. The pathological findings, which included large lung sections and detailed histology in every case, were compared with similar findings in a contrast non-mining population matched for age and sex.The results indicated that emphysema was much more common among the coal miners, both with simple and with complicated pneumoconiosis, than among the contrast group. In addition the extent of the emphysema as measured by a recognized "counting" method carried out on paper-mounted lung sections was remarkably closely related to ventilatory impairment as evidenced by the forced expiratory volume in one second.Extensive emphysema was more commonly found in those pneumoconiosis cases, both simple and complicated, showing the finer punctiform type of radiological change than in cases showing the larger micronodular and nodular opacities.

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After successful thrombolytic treatment for acute myocardial infarction, recurrent ischemia and infarction may occur with little warning. Coronary lesion morphology was analyzed from angiograms performed in 72 consecutive patients at 1 to 8 days after streptokinase treatment for acute myocardial infarction and the data were evaluated in relation to the subsequent clinical course. All patients were clinically stable at the time of angiography and continued to receive heparin infusion for greater than or equal to 4 days after thrombolysis. The infarct-related artery was patent in 55 patients (76%). In the 10 days after angiography, 15 patients developed prolonged episodes of angina at rest; the condition of 4 stabilized with medical treatment, but 11 required urgent medical intervention (coronary angioplasty in 8 and bypass surgery in 3). There were no differences in age, gender, left ventricular function or extent of coronary artery disease between those patients who developed unstable angina and those who had a stable in-hospital course. However, the median plaque ulceration index of the infarct-related lesion was 6.7 (95% confidence limits 6.3, 10) in the 15 patients with an unstable course versus 3.3 (2, 4.4) in those with a stable course (p less than 0.001). There were no differences between the two patient groups in the severity of stenosis, length of diseased segment, symmetry/eccentricity, presence of a shoulder, location at branch point or bend, presence of globular or linear filling defects, contrast staining or collateral supply. These data show that after thrombolysis, the degree of irregularity of the infarct-related artery is a critical determinant of early clinical instability.(ABSTRACT TRUNCATED AT 250 WORDS)

Fertility Control-Zafiartu BRITISH ovulatory cycles with good sperm tolerance. The tests were performed from 10 to 18 days after the last additional oestrogen tablet was taken. DiscussionThe incidence of uterine bleeding and menstrual cycle modifications in women receiving oral continuous chlormadinone acetate in microdoses is significant. In our experience 153 (39.2 %) out of 390 women presented some alterations in uterine bleeding while using this contraceptive method; amenorrhoea, for instance, was observed in 15 % of our subjects.However, the modifications of menstrual cycles were slightly less frequent (in 147 (37.6%) out of 390 treated subjects). The most annoying symptoms indeed were amenorrhoea, prolonged cycles, and intermenstrual bleeding.These alterations are apparently related to the antioestrogenic effect of the progestogen and are shown by those subjects more sensitive to such action. Furthermore, our macroscopic and microscopical observations on ovaries of subjects treated with 0.5 mg. of chlormadinone daily, who presented prolonged menstrual cycles or amenorrhoea, showed that ovulation was inhibited. A marked effect of the compound at the endometrium stroma and glands was also evident (Zafiartu et al., 1967b).These findings help us to understand why additional oestrogen therapy given for a few days for bleeding and cycle regulation could eventually reverse the effect in cervical mucus of chlormadinone 0.5 mg. daily, and yet preserve the main contraceptive effect of the therapy at other levels of the reproductive system (endometrium, endosalpinx).The gratifying action of the accessory oestrogens by correcting uterine bleeding and regulating cycles significantly helps to improve the acceptability of this valuable contraceptive method. It has also been valuable in improving the acceptability of other progestogens in microdosage. SummaryFifty women presenting alterations of uterine bleeding and menstrual cycles while using oral continuous 0.5-mg. chlormadinone tablets for fertility control were given additional oral oestrogens to correct the condition. Conjugated oestrogens 2.5-or 5-mg. tablets were given for five to seven days in each calendar month. Ethinyloestradiol 0.05 mg. was also used when well tolerated. The continuous oral administration of chlormadinone tablets was maintained. Accessory oestrogens were useful in correcting the bleeding and cycle disturbances resulting from the anti-oestrogenic effect of microdoses of oral chlormadinone without interfering with the fertility inhibition effect. It is suggested that the addition of oral oestrogens is useful to improve acceptability of continuous chlormadinone in microdoses as a contraceptive while maintaining the outstanding properties of this therapy.Chlormadinone acetate 0. Established simple pneumoconiosis of coal workers is accompanied by a widening of the alveolar-arterial tension difference for oxygen (Brasseur, 1963) and a minimal reduction in the transfer factor (diffusing capacity) for the lung, measured by the steady state carbon mon...

. (1974). British Journal of Industrial Medicine, 31, 36-44. Significance of irregular opacities in the radiology of coalworkers' pneumoconiosis. A correlation study of ventilatory, morbid anatomical, and radiological findings in 95 deceased coal miners who suffered with simple pneumoconiosis during life was undertaken using the new ILO U/C International Classification of Radiographs of Pneumoconiosis, which now provides for the occurrence of irregular opacities in addition to the classical rounded opacities. The study was carried out with a view to ascertaining the frequency of occurrence and the significance of irregular opacities in coalworkers' pneumoconiosis. Two x-ray films with an average interval of 11 years between them were reported on,in each case. The results showed that irregular opacities amounting to category 1 or more were present in 20 % of the earlier films and in 48 % of the later ones. Exceptionally they occurred alone but were usually admixed with classical rounded opacities.

Lyons, J. P. and Campbell, H. (1976). Thorax, 31,[527][528][529][530][531][532][533] All three groups showed progressive impairment of ventilation over the whole period of observation. This was most marked in the category B cases but this group had already acquired a substantial proportion of their eventual impairment while still classified radiologically as category A or as simple pneumoconiosis. These findings are not compatible with the view that coalworkers' pneumoconiosis does not cause significant impairment of ventilation until the category B radiological stage is attained; they suggest rather that cases destined to progress to serious disablement show evidence of progressive impairment of ventilation at very much earlier radiological stages. Non-smokers showed a pattern of impairment similar to that of the smokers but were less disabled; the differences, however, were slight and not statistically significant.

A total of 124 coal workers and ex-coal workers receiving disability benefit for coal worker's pneumoconiosis and routinely reattending the Cardiff Pneumoconiosis Medical Panel during a 10-week period were studied. Those with complicated pneumoconiosis were excluded. Their current chest radiographs and their chest radiographs at the time of certification were read in random order by three readers using the 1980 ILO Classification of Radiographs. An irregularity score was derived from the readings. The x-ray findings were examined for changes since certification and for relationships with age, smoking, and underground coal work exposure. One-fifth of the current radiographs showed mainly irregular opacities, whereas nearly all of those from the time of certification showed mainly rounded opacities. Irregular opacities were related to age, smoking, and underground exposure. The exposure effect remained after excluding the older men. The findings suggest that radiological irregular opacities, and their associated pathology and lung function changes, commonly develop in coal workers with pneumoconiosis and should be considered part of the condition.There has recently been increasing interest in the importance of radiological small irregular opacities in coal workers. Coal workers with irregular opacities have reductions in ventilatory capacity' 2 and gas transfer factor3 4 compared with those with rounded opacities only. Postmortem surveys have shown more emphysema and interstitial fibrosis in coal workers with irregular, rather than only rounded, opacities.' 3 The frequency of irregular opacities among men with simple coal workers' pneumoconiosis is not known, however. There is also the question of whether they are an integral part of simple coal workers' pneumoconiosis. It may be argued that coal workers with irregular opacities are rare overall but tend to undergo special investigations and be included in studies, also that irregular opacities are not uncommon in other lung conditions and may be present only co-incidentally in coal workers. Studies on the

Coronary lesion morphology was analyzed in 72 patients 1 to 8 days after streptokinase treatment for acute myocardial infarction and compared with lesion morphology in a control group of 24 patients with stable angina. In the streptokinase group the infarct-related artery was patent in 55 patients (76%). Compared with stenoses in the stable angina group, there were no differences in the stenosis length, severity, calcification or in the proportion located at an acute bend or at a branch point. However, lesions in the streptokinase group were more often irregular (p less than 0.005) and eccentric (p less than 0.01), had a shoulder (p less than 0.0001), globular filling defects (p less than 0.01), linear filling defects (p less than 0.00005) and contrast staining (p less than 0.05). Plaque ulceration index was higher in the streptokinase than in the stable angina group (6.2 +/- 7.9 versus 3.5 +/- 3.4, p less than 0.001). Of the 72 streptokinase-treated patients, 35 were maintained on heparin infusion until angioplasty 2 to 10 days later. At repeat angiography before angioplasty, globular lesion filling defects seen in eight patients had disappeared, whereas linear filling defects persisted in 7 of 14 cases. Fewer lesions were irregular (p less than 0.0001) and the ulceration index decreased from 7.4 +/- 10.4 to 3.0 +/- 1.6 (p less than 0.001). These data show that the lesion in the infarct-related artery after streptokinase treatment is irregular and often associated with filling defects, perhaps corresponding to plaque fissuring and intraluminal thrombosis.(ABSTRACT TRUNCATED AT 250 WORDS)