Upper and lower respiratory airway complaints among female veterinary staff.

OBJECTIVE: Working with animals is characterized by exposure to particulate, biological or chemical matter, and respiratory complaints are common. The aim of our cross-sectional study was to assess the prevalence of respiratory symptoms and diagnoses among veterinary staff. METHODS: Participants working in veterinary practices were examined and a detailed questionnaire was used to collect data. IgE tests to common and animal allergens were performed to specify sensitization. Associations with respiratory outcomes were analysed using logistic regression models while controlling for potential confounders. RESULTS: Atopy was seen in 31% of the 109 female participants. Symptoms of rhinoconjunctivitis were the most frequent complaints (n = 92; 84%). In 18% the diagnosis was confirmed by physicians. Symptoms of upper and lower airways were highly correlated and an asthma diagnosis was confirmed in 11% of participants. Modelling revealed that sensitization against cats/dogs was a significant risk factor for respiratory symptoms of upper [odds ratio (OR) 4.61; 95% confidence interval (CI) 1.13-18.81] and lower airways (OR 5.14; 95% CI 1.25-21.13), physician-confirmed rhinoconjunctivitis (OR 13.43; 95% CI 1.69-106.5) and asthma (OR 9.02; 95% CI 1.16-70.39) in assistant staff of small-animal practices. CONCLUSIONS: In several cases, rhinoconjunctivitis worsened after entering the profession. Atopy and specific sensitization to cats/dogs were risk factors for health impairments. Thus, to implement preventive measures, veterinary practice staff should be educated that upper respiratory tract symptoms are not harmless and should be diagnosed and treated early.

The Pattern of Sensitization Influences Exhaled and Nasal Nitric Oxide Levels in Young Adults.

Nitric oxide (NO) from upper (nasal NO, nNO) or lower airways (fractional exhaled NO, FeNO) is considered a surrogate marker for Th2-type inflammation, which is influenced by atopy. The aim of this study was to analyze nNO and FeNO in regard to qualitative and quantitative aspects of sensitization. We evaluated 244 non-smoking young adults. All of them were first-year students recruited for a longitudinal study. An inhalation allergy screening tool was used for atopy definition (specific immunoglobulin E (sIgE) to sx1 ≥ 0.35 kU/L), and also sIgE response to three inhalant perennial allergens, house dust mite (HDM, d1), cat (e1), and dog (e5), was determined in the non-pollen season. With respect to sx1, 100 subjects could be classified as atopic. Sensitization to one, two, or three perennial allergens could be demonstrated in 46, 10, and 16 students, respectively. The subjects with positive IgE response to sx1, but not sensitized to HDM, cat, and/or dog, had FeNO levels comparable to those of non-atopic subjects (13.5 vs. 13.0 ppb, respectively; p = 0.485). These levels were significantly lower compared to atopic subjects being sensitized to any perennial allergen (19.0 ppb; p = 0.0003). After grouping the atopic subjects for perennial sensitization patterns, significantly higher FeNO could be detected in subjects with poly-sensitization (n = 26; 26.0 ppb) compared to the mono-sensitized ones (n = 46; 18.0 ppb; p = 0.023). Regarding nNO, no differences could be observed. Applying a two-way ANOVA, we could reveal a significant correlation of specific HDM-IgE CAP-class with FeNO (p < 0.0001) and nNO levels (p = 0.007). Finally, a significant relationship was found between nNO and FeNO for the whole cohort (p < 0.0001). In summary, our findings support the argument that atopy and perennial sensitization should be considered for the interpretation of NO.

Methodological Implications and Repeatability of Nasal Nitric Oxide: Relevance for Challenge Studies.

There is an interest in assessing changes in nasal NO (nNO) levels as an effect marker of upper airways. In this study, we examined methodologic influences on short and long term repeatability of nNO levels assessed by a portable electrochemical analyzer. Nine atopic and eighteen healthy subjects were exposed for 4 h to ethyl acrylate concentration of 0.05 ppm (sham) and mean concentrations of 5 ppm (either constant 5 ppm or variable 0 to 10 ppm). Sampling of nNO was performed by using passive aspiration during both breath-holding (634 ppb) or calm tidal breathing (364 ppb, p < 0.0001). The intra-session (between-session) repeatability in terms of coefficient of variation was 16.4% (18.5%) using the tidal-breathing and 8.6% (13.0%) using the breath-holding method, respectively. Atopic subjects demonstrated a significant increase in nNO (breath-holding mean 16%, tidal-breathing mean 32%) after applying a constant ethyl acrylate concentration (5 ppm). Our findings suggest that the less elaborate tidal-breathing method might be sufficient to detect significant changes at a group level. Given a lower coefficient of variation of breath-holding we assume there is an advantage of that approach at an individual level. Further research is needed to validate the usefulness of nNO in the evaluation of irritative, non-allergic responses.

Impact of Internal and External Factors on EBC-pH and FeNO Changes in Humans Following Challenge with Ethyl Acrylate.

Acute effects of ethyl acrylate exposure at 5 ppm for 4 h include changes of pH in exhaled breath condensate (EBC-pH) and exhaled nitric oxide (FeNO). So far, few data have been reported for atopic persons or the impact of the exposure conditions on biomarkers, e.g., constant versus variable application of irritants. Nine atopic and eighteen healthy volunteers without bronchial hyperresponsiveness were exposed for 4 h to ethyl acrylate concentrations of 0.05 ppm (sham), 5 ppm (constant concentration), and 0-10 ppm (variable, mean concentration of 5 ppm) in an exposure laboratory. A positive atopic status was defined according to specific IgE concentrations to common inhalant allergens (sx1 ≥ 0.35 kU/L). Biomarker levels were assessed before and after challenge and adjusted for levels after sham exposure (net response). Ethyl acrylate at constant, but not at variable concentrations induced a significant change in the net responses of EBC-pH and FeNO. Concerning FeNO, this could be observed only for atopic persons. The changes of biomarker levels were related to their baseline values. Biomarker responses to challenge with ethyl acrylate may be influenced by the patterns of application as well as baseline airway inflammation and atopic status of the volunteers.

Clinical Effects, Exhaled Breath Condensate pH and Exhaled Nitric Oxide in Humans After Ethyl Acrylate Exposure.

Ethyl acrylate is an irritant known to affect the upper airways and eyes. An increase of the eye blink frequency in humans was observed during exposure to 5 ppm. Studies on the lower airways are scant and our study objective was the evaluation of pH in exhaled breath condensate (EBC-pH) and nitric oxide in exhaled breath (FeNO) as markers of inflammation. Sixteen healthy volunteers were exposed for 4 h to ethyl acrylate at a concentration of 5 ppm and to sham (0.05 ppm) in an exposure laboratory. Clinical irritation symptoms, EBC-pH (at a pCO2 of 5.33 kPa) and FeNO were assessed before and after exposure. Differences after ethyl acrylate exposure were adjusted for those after sham exposure. 5 ppm ethyl acrylate induced clinical signs of local irritation in the nose and eyes, but not in lower airways. Exposure produced a subtle, but statistically significant, decrease in breathing frequency (1 breath/min; p = 0.017) and a lower EBC-pH (by 0.045 units; p = 0.037). Concerning FeNO, we did not observe significant changes compared to sham exposure. We conclude that local effects induced by 5 ppm ethyl acrylate consist of sensory irritation of eyes and nose. In addition, acute ethyl acrylate exposure to 5 ppm resulted in a net decrease of EBC-pH. Whether that can be interpreted in terms of additional lower airway irritation or already inflammatory alterations set in needs further investigations.

Methodological implications in pH standardization of exhaled breath condensate.

The variable amount of dissolved carbon dioxide is one of the main confounding factors of exhaled breath condensate (EBC) pH measurements. There have been many attempts at identifying the optimal approach to displace CO2 as a way to gain reproducible and valid pH values in EBC samples. The aim of the present study was to assess the correlation of pH and pCO2 in untreated, neat EBC samples and, after deaeration, to reevaluate the standardization of CO2 as a means to obtain valid pH values. A further aim was to evaluate the impact of deaeration on the acid-base balance in EBC samples. EBC was collected from seven female and 31 male subjects. The pH and pCO2 values immediately determined in untreated, neat EBC samples were strongly correlated (rp = -0.723, p < 0.0001). This correlation was not observed after deaeration with argon (rs = 0.264, p = 0.109). Based on a regression function for the pH/pCO2 relationship, the calculated pH at a pCO2 of 5.33 kPa was 6.07 (IQR 5.99, 6.20). No significant difference was observed between the pH measured in neat EBC samples and those calculated after deaeration with regression function and measured neat pCO2. Our data suggest that pCO2 is the most important confounder of pH measurement in EBC samples and, when adjusting for pCO2, the acid-base balance of EBC samples is not significantly influenced by the process of deaeration. Furthermore, measurement with a blood-gas analyzer and standardization of pH for pCO2 allows sensitive assaying of EBC samples. Therefore, this method provides a basis for detection of even small changes in airway pH due to inhalative exposure or respiratory disease.

Flexor carpi ulnaris transfer successfully used to gain strengthening of flexor digitorum superficialis tendons.

Transfer of the flexor carpi ulnaris (FCU) to replace the power of the paralysed extensor digitorum communis and extensor pollicies longus has been described in the literature. However the use of FCU for strengthening flexor digitorum superficialis (FDS) is relatively not widely known. In this report the use of the technique is dicussed to successfully restore the strength of the fingers of a leprosy patient with considerable partial high median palsy to this patient's urgent need and at his request. This surgical procedure and results of a single case are shown as a preliminary report.

[Neurobiology and psychology of addictions]. / Neurobiologie et psychologie des addictions.

The clinical observation of patients that are addicted to drugs allows the distinction between physical dependence and psychic dependence (addiction). Empirical research has made important breakthrough in the understanding of the mechanisms involved in the development of dependence and opens new therapeutic options. Neurobiologic findings concerning dopaminergic brain reward circuit provide a better insight on the incentiv aspects of drug seeking. The present article is a review of current models of addiction with a specific focus on the link between biological aspects and psychological observations.

Abductor pollicis longus deviation graft operation: modified for stabilizing CMC and MCP joints of 'intrinsic minus' thumb.

The original procedure abductor pollicis longus deviation graft operation by Beine (1996) was introduced to correct retroposition of the thumb and to balance the instability at the carpometacarpal (CMC) joint in cases of ulnar-cum-low median palsy in leprosy, so that bone-using procedures can be avoided to some extent. It provides an antagonistic force to the action of the abductor pollicis longus (abd. pol. long.) by giving this muscle a second insertion, with the result that the action of the abd. pol. long. now stabilises to a considerable extent the CMC joint in its mid-rotational position by a partial replacement of the action of the opponens pollicis (opp. pol.) and abductor pollicis brevis (abd. pol. brev.). Experience over five years with the original procedure showed us that it can make an ulnar deviation more visible at the MCP joint of the thumb. The modification of the procedure corrects this as well, as the results in 12 hands of 11 patients have shown. Interestingly, of the 11 patients who underwent operation, one was not a leprosy patient, but referred to us for partial triple palsy of the left hand and arm without sensory loss. It is shown that the indication of this procedure is wider than mentioned earlier.

Modification of the "wrap around" tendon anastomosis of fascia lata graft with a slim double tendon of palmaris longus.

A modification of Brand's "wrap around" technique of anastomosis is described, which allows joining a double tendon or split tendon of palmaris longus to fascia lata graft, when one of the slim tendons would not allow performance of the Brand tendon anastomosis. Four such cases have been done successfully.

Prevention of post-operative "sublimis minus" deformity by modified surgical procedure at the donor finger.

"Sublimis minus" deformity occurs quite often as a post-operative deformity in the donor finger after transfer of the flexor superficialis tendon e.g., for paralytic claw finger correction. Our experience with a new procedure to avoid this outcome is described here. Long term results in 35 cases are very encouraging and the new procedure promises to be useful to prevent sublimis minus deformity. It also opens out a wider range of discretion given to hand surgeons to use the sublimis tendon more freely for transfers.

Abductor pollicis longus deviation grant operation: a new procedure on the thumb in ulnar cum low median palsy for correction of subluxation of carpometacarpal (CMC) joint.

For correction of instability of the carpometacarpal joint (CMC joint) of the thumb in combined paralysis of ulnar and median nerves in leprosy bone fusing procedures have been used, but they are not desirable and can often be avoided. A procedure analogous to the "Extensor pollicis brevis deviation graft operation" for the correction of instability of the metacarpophalangeal joint of the thumb is described here. The new procedure appears to be useful to correct and stabilize the subluxated carpometacarpal joint of the thumb actively during the use of the hand. When thumb web contracture has occurred and the passive range of movement needed for successful opponents replacement of thumb is not available, this new procedure helps to prepare such a severe deformed thumb for correction at earlier time.

A modification of the surgical correction of the thumb--a long term follow up.

A modification of the commonest surgical procedure to restore Abduction-Rotation using the flexor superficialis transfer with Y-insertion is described. The modification consists of doing a triple insertion at the thumb instead of Y-insertion. After introducing the triple insertion the procedure shows 80-90% or more good results, whereas 50% or more failures are reported in the existing literature, when a Y-insertion only is used which cannot safely prevent 'Z' deformity. 60 cases were followed up.

Partial flexor carpi radialis many-tailed transfer for correction of claw fingers.

The method described shows, that correction of claw fingers is possible using a portion of the flexor carpi radialis as motor. Usually, this method is indicated, whenever it is desired to do a Palmaris Longus many-tailed transfer in the absence of palmaris longus (e.g. for correction of hyper-mobile claw fingers).

Modified suture technique for six-tailed fascia lata graft to slim palmaris longus tendon. A preliminary case report.

A modified suture technique is described, which allows to join a very slim tendon palmaris longus (below 3 mm wide) with a many-tailed fascia lata graft (15 mm wide). This technique is useful in case of ulnar palsy in children, where palmaris longus many-tailed graft is desired as lumbrical replacement and where Brand's anastomosis is considered too difficult. One successful case is also shown.

Extensor pollicis brevis deviation graft operation in case of Z-deformity of the thumb in ulnar palsy--a preliminary case report.

This new procedure is described as an analogous operation to Extensor Diversion Graft Operation for correction of claw fingers (Srinivasan H.) (5). The procedure is found useful to stabilise the metacarpophalangeal joint of the thumb preventing or correcting Z-deformity and weakness of the pinch showing many advantages compared to other procedures. A single case is shown as a preliminary report.