Fuel chip-induced hypersensitivity pneumonitis caused by penicillium species.

Two cases of Penicillium-induced hypersensitivity pneumonitis in farmers handling fuel chips are presented. Attention should be paid to safe handling of all types of solid fuel (wood, chips, and peat) and other materials in which mold may grow.

Patients with rheumatoid arthritis and gold-induced pneumonitis express two high-risk major histocompatibility complex patterns.

Gold salt therapy-induced pneumonitis is a rare complication in patients with rheumatoid arthritis (RA). We studied HLA-A, B, C, D/DR, and complement factor B (Bf) and C4 alleles in 17 patients with RA and gold-induced pneumonitis and found that these patients had strikingly homogeneous major histocompatibility complex (MHC) markers. Eight of them (47 percent) had the alleles HLA-A3 B35 Dwl BfF C4A3,2 (BO), which were shown by family studies of some patients to be inherited as an extended MHC-haplotype with an apparent gene duplication in the C4A locus. The other high-risk phenotype, HLA-B40 with a C4 null allele, was found in eight patients (47 percent). All but three of the 17 patients had at least one of the two high-risk markers, the frequency of these combinations being clearly higher than in the two control groups: patients with RA but with no gold-induced side effects and healthy individuals. Our study shows that use of several MHC markers together results in a strong association between the markers and the disease.

Priority classification of patients according to a modified 'Norwegian model'.

A priority classification was evaluated according to a modified 'Norwegian model.' Many diseases do not belong to any specific priority category based only on the diagnosis. The classification also depends on the condition's type, site, and phase as well as the patient's age and overall condition. Savings cannot be achieved by the model used because 89% of the patients belonged to the priority categories I-III, the care of which can be classified as necessary.

Bronchospasm induced by vanillin and lactose.

Bronchospasm caused by vanillin and lactose was detected in controlled double-blind challenge tests in an asthmatic patient. It is recommended that all flavouring agents and dyes should be removed from drugs. Lactose is not a suitable placebo for challenges in asthmatic patients. A better choice is cellulose, which is not resorbed by man.

Leucopenia caused by two rifampicin preparations.

Leucopenia (= leucocyte count 3000 cells/microliters or less) caused by 2 rifampicin preparations used in daily tuberculosis chemotherapy was studied. In a group of 140 patients treated with Rimapen (Orion, Finland ), 11 cases (7.9%) of leucopenia were detected. In a group of 132 patients treated with Rimactan (Ciba-Geigy, Switzerland) one case of leucopenia (0.8%) occurred. The difference is statistically significant (p less than 0.01). The frequency of leucopenia in the Rimapen group was much higher than that reported in the literature. In cases of leucopenia caused by rifampicin the recommended measure is withdrawal of the drug or continued treatment under careful observation. If possible, rifampicin treatment should not be resumed after a pause, irrespective of its length.

Sarcoidosis of the thyroid gland.

A case of thyroid gland sarcoidosis is reported, which mimicked a tumour at scintiscan, ultrasound investigation and operation.

Diffuse pulmonary injury associated with gold treatment.

A patient showing a gold-induced diffuse pulmonary reaction is described. An open lung biopsy specimen showed thickening of alveolar septa due to inflammation. The alveolar walls were lined by cuboidal epithelium. On electron microscope examination electron-dense structures were observed within lysosomes of endothelial cells of the alveolar capillaries and interstitial macrophages. Electron probe microanalysis showed that these structures contained gold. The accumulation of gold in endothelial cells and macrophages and a direct toxic effect might be an important feature in the pathogenesis of gold-induced pulmonary reactions. On the other hand the accumulation of gold may reflect exposure rather than disease.

Pulmonary haemangiopericytoma with multiple metastases.

A case of primary pulmonary haemangiopericytoma with hundreds of nodular pulmonary, liver, lymph node, spleen, kidney and subcutaneous metastases is presented. Even if multiple metastases in the lungs from haemangiopericytoma are extremely rare, this possibility should be remembered in differential diagnosis.

Association of different HLA antigens with various toxic effects of gold salts in rheumatoid arthritis.

An association of gold induced proteinuria with HLA-D(R)3 has been reported. To investigate other possible relationships between gold toxicity and HLA antigens we studied 85 patients with rheumatoid arthritis (RA) divided into four subgroups: patients with gold induced interstitial pneumonitis, mucocutaneous lesions, proteinuria, and patients without gold toxicity. The HLA frequencies in patient groups and 283 healthy controls were compared in different pairwise combinations. Gold induced pneumonitis was associated with HLA-B40 and Dw1. An association between gold induced proteinuria and HLA-Dw3 was also seen. The increased prevalence of Dw4 in RA was observed only in the control patient group without gold induced side effects. The frequencies of HLA-B7 and Dw2 were decreased in all patient groups compared with the control population. These results further support the view of the heterogeneity of RA as manifested by the unique HLA associations with resistance and susceptibility to gold induced side effects characterising different subgroups.

Rarity of mineral fibre pleurisy among persons exposed to Finnish anthophyllite and with low risk of mesothelioma.

Endemic pleural plaques are reported from many parts of the world. In Central Europe and in Finland no connection with malignant mesotheliomas has been found, whereas this tumour is often encountered in areas in Turkey where endemic plaques also occur. There seem, however, to be differences in the radiological appearances found in these areas. In the present study chest radiographs of 317 persons with pleural plaques from the endemic area of Finland were scrutinized. It was found that 4.7% showed a blunted costophrenic angle unilaterally and 0.9% bilaterally. The prevalence of sequelae of pleurisy is statistically very highly significantly lower than in people with pleural plaques in Turkey. As the risk of mesothelioma appears to be low in Finland, the results are in accordance with the hypothesis that the risk of mesothelioma in a given population is higher if in that population there is a high incidence of benign asbestos pleurisy.