Lead in urine has been determined by an ashing technique to give total lead and by a standard coprecipitation technique to give precipitable lead. In 44 normal subjects values obtained by both methods were the same. In 72 subjects exposed to lead, of whom 57 had clinical lead poisoning, the precipitable lead was significantly less than the total lead. As much as 40 % of urinary lead can escape determination by the coprecipitation methods of estimation. Preliminary findings suggest that the non-precipitable lead may be present as a natural chelate. The significance of these observations is discussed. The danger is stressed that cases of threatened lead intoxication may be overlooked if only coprecipitation methods of estimating lead in urine are used.
Popa, V., Gavrilescu, N., Preda, N., Teculescu, D., Plecias, M., and Cîrstea, M. (1969).Brit. J. industr. Med.,26, 101-108. An investigation of allergy in byssinosis: sensitization to cotton, hemp, flax, and jute antigens. The authors investigated allergy to cotton, hemp, flax, and jute in 41 subjects with byssinosis. In contrast with immediate skin reactions, which were seldom observed, delayed reactions were nearly always present. The incidence of positive skin tests in byssinosis was similar to that observed in all textile workers. Inhalation tests with textile allergens were negative in all but four subjects who also had a concomitant bronchial asthma. Fifteen out of 31 subjects with byssinosis had positive inhalation tests to acetylcholine but only one of the 13 tested had a positive response to the inhalation of textile macerate. Haemagglutinating antibodies to low titres could be observed in byssinosis as well as in chronic bronchitis, in bronchial asthma, and in the general population. The significance of various types of antibodies existing in byssinosis is further discussed. The authors stress the need to standardize textile allergens.
Background: Previous reports suggest that patients with suspected heart failure are inadequately investigated and that patients who do have heart failure are sub-optimally treated. Guidelines on the diagnosis and treatment of heart failure have been published by the European Society of Cardiology and provide a framework for the management of heart failure against which to judge current medical practice. Both primary care and hospital physicians are responsible for ensuring appropriate management of patients with heart failure. This programme concentrates on management of heart failure in primary care and Ž . is complementary to a similar exercise that will be conducted in 50 European regions EUROHEART-CHF . Aims: The IMPROVEMENT of HF initiative investigates, in Europe, how primary care physicians perceive heart failure should be diagnosed and treated and whether they perceive that they are provided with adequate support to implement best medical practice. Subsequently, their perceptions are compared to their actual practice by reviewing relevant case notes. The results will be used to recommend changes in practice. A future study is planned to analyse the impact of the initiative. Methods: The Ž initiative comprises a research phase and an educational phase. For the research phase, 10 regional centres to include both . urban and rural areas from each of 14 participating countries have been identified and each region has randomly selected 10 primary healthcare physicians. The primary healthcare physicians are participating in two surveys: a 'perception' survey and an 'actual practice' survey. For the 'actual practice' survey, the physicians are supplying case notes of nine patients who have or are at high risk of having heart failure. The results of these surveys will be used to organise an educational programme. Conclusion: This study is expected to provide valuable data on the perceptions of primary care physicians about heart failure, possible deficiencies in the current provision of care and how any deficiencies may be corrected. ᮊ
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