3-(Bromomethyl)-2-chloro-4-(methylsulfonyl)- benzoic acid: a new cause of sensitiser induced occupational asthma, rhinitis and urticaria.

OBJECTIVES: 3-(Bromomethyl)-2-chloro-4-(methylsulfonyl)-benzoic acid (BCMBA) has not previously been identified as a respiratory sensitiser. We detected two cases who presented respiratory and urticaria symptoms related to BCMBA and had positive skin prick tests to the agent. Subsequently, we conducted outbreak investigations at the BCMBA-producing factory and performed clinical examinations to confirm occupational diseases. METHODS: The outbreak investigations included observations of work processes, assessment of exposure, a medical survey with a questionnaire and skin prick tests with 0.5% BCMBA water solution on 85 exposed workers and 9 unexposed workers. We used specific inhalation or nasal challenge and open skin application test to investigate BCMBA-related occupational asthma, rhinitis and contact urticaria. RESULTS: We identified nine workers with respiratory and/or skin symptoms and positive skin prick tests to BCMBA in a chemical factory. A survey among chemical factory workers indicated a BCMBA-related sensitisation rate of 8% among all exposed workers; the rate was highest (25%) among production workers in the production hall. Sensitisation was detected only in workers with the estimated highest exposure levels. Six cases of occupational asthma, rhinitis and/or contact urticaria caused by BCMBA were confirmed with challenge tests. Asthma-provoking doses in specific inhalation challenges were very low (0.03% or 0.3% BCMBA in lactose). CONCLUSIONS: We identified a new low molecular weight agent causing occupational asthma, rhinitis and contact urticaria. A typical clinical picture of allergic diseases and positive skin prick tests suggest underlying IgE-mediated disease mechanisms. Stringent exposure control measures are needed in order to prevent BCMBA-related diseases.

[Symptomatic treatment with a self-adjusting CPAP device of dyspnea caused by Reinke's edema and vocal cord paralysis]. / Reinken ödeeman ja äänihuulihalvauksen aiheuttaman hengenahdistuksen ylipainehengityshoito.

Prolonged external irritation to the vocal cords may cause an edematous state of the vocal cords known as Reinke's edema. This may lead to hoarseness and dyspnea. We describe a successful syptomatic treatment of severe dyspnea due to Reinke's edema with a self-adjusting CPAP device. An operation ended the symptom of dyspnea of our patient, but before that the CPAP therapy brought about an effective remedy for dyspnea.

[Effects of cognitive and behavioral treatments on primary insomnia in old age]. / Toiminnallisten ja kognitiivisten hoitomenetelmien vaikutukset iäkkäiden primaariseen unettomuuteen.

The aim was to provide a systematic evaluation of the effects of treatments with behavioral and cognitive components on primary insomnia in older persons. Randomized, controlled trials, uncontrolled trials and meta-analyses published in 1980-2009 were searched in PubMed and PsycINFO indexes. The material consisted of 24 original articles and four meta-analyses. Moderate effects of behavioral and cognitive-behavioral treatments on subjective sleep outcomes were found. Objective sleep outcome measures were used only in some studies, and the effects on objective measures were quite small. No side effects were noticed. Group treatment may be more effective than individual treatment. Group cognitive-behavioral treatments under the guidance of nurses familiar with the treatment are recommended to primary health care.