Hereditary late-onset lymphedema with pleural effusion and laryngeal edema.

We examined two middle-aged male cousins with unexplained edema of postpubertal onset involving the upper and lower limbs, face, and larynx and, in one of them, a persistent pleural effusion. Scintilymphangiography detected an apparent paucity or absence of lymph nodes in the axillae and above the inguinal ligaments, indicating a defect in the lymphatic systems. Laryngeal edema, confirmed endoscopically, produced changes in one of them in the flow volume loop characteristic of a variable extrathoracic obstruction. A family study showed autosomal dominant transmission of the disorder. The nosology of late-onset lymphedema is briefly discussed, with particular reference to the so-called yellow nail syndrome.

Lithium carbonate therapy in severe Felty's syndrome. Benefits, toxicity, and granulocyte function.

Lithium carbonate was administered to six patients with severe Felty's syndrome, five of whom had problems with infection. Two patients had granulocyte increments that persisted after therapy was discontinued; in one of them problems with infections resolved. In another patient a transient granulocyte rise accompanied treatment. There was no response in three patients. Granulocyte function was measured in three patients during treatment. It was normal except for subnormal hexose monophosphate shunt activity in two patients. Although serum lithium levels were less than 1.5 mmole/L, serious toxic effect occurred in one patient and significant side effects in the other five. These results support a short trial of lithium carbonate therapy in patients with severe symptomatic Felty's syndrome. Potentially beneficial granulocyte increases occur in a minority of patients only, however, and side effects and toxic effects are common.

Pulmonary hemorrhage and edema due to inhalation of resins containing tri-mellitic anhydride.

Seven young men developed acute pulmonary hemorrhage and edema from the inhalation of powder or fumes of a bisphenol epoxy resin containing tri-mellitic anhydride (TMA) while working in a steel pipe-coating plant. The illness was characterized by cough, hemoptysis, dyspnea, fever, weakness and nausea or vomiting. Chest roentgenograms showed either a bilateral or unilateral pulmonary infiltrate. All patients had a normochromic type of anemia. Pulmonary function studies demonstrated a restrictive defect, hypoxemia, and increased A-a DO2 gradients. Light and electron microscopic studies of lung tissue revealed extensive bleeding into alveoli but no basement membrane deposits were seen and no antiglomerular basement membrane antibodies were detected. The patients improved quickly without treatment. Follow-up studies of six patients three weeks to one year after their illness revealed apparent recovery. A detailed medical survey carried out on all 29 workers currently employed in the plant revealed five additional men had experienced severe recurrent pulmonary problems.

Lung health in sawmill workers exposed to pine and spruce.

Workers exposed to a variety of wood dusts have been shown to exhibit occupational asthma, lung function deficits, and elevated levels of respiratory symptoms. Despite the popularity of pine and spruce, the health effects of exposures to these woods have not been extensively investigated. A study was undertaken to investigate the respiratory health of a group of sawmill workers processing pine and spruce (n = 94). Data collection included a respiratory symptom questionnaire, spirometry, and allergy skin testing. The sawmill workers were compared with a group of oil field workers from the same geographic area who underwent the same study protocol (n = 165). The results showed that the sawmill workers had significantly lower average values for FEV1 and FEV1/FVC (%), adjusted for age, height, and smoking. The largest differences were for current smokers. Significantly elevated age and smoking-adjusted odds ratios (OR) were detected for shortness of breath (2.83; 95% confidence interval [CI], 1.47 to 5.46) and wheeze with chest tightness (2.58; 95% CI, 1.18 to 5.62). Nonsignificant elevations were also seen for usual cough (1.47; 95% CI, 0.68 to 3.16), usual phlegm (1.94; 95% CI, 0.98 to 3.87), shortness of breath with exercise (1.45; 95% CI, 0.66 to 3.20), chest tightness (1.43; 95% CI, 0.80 to 2.57), and attacks of wheeze (1.70; 95% CI, 0.79 to 3.68). Sawmill workers were 2.5 times as likely as oil field workers to report current asthma (95% CI, 0.76 to 8.32). Workers employed more than 3 years showed significantly more asthma (OR = 3.67; 95% CI, 1.00 to 13.5) and bronchitis (OR = 2.14; 95% CI, 1.02 to 4.52). Sawmill workers were only 43% as likely to report a history of hay fever (95% CI, 0.20 to 0.94). These health effects were noted despite an average concentration of respirable dust of 1.35 mg/m3 (range, 0.1 to 2.2 mg/m3). These levels are below the present occupational standard.

Pulmonary effects of simultaneous exposures to MDI formaldehyde and wood dust on workers in an oriented strand board plant.

A study was undertaken in a plant producing oriented strand board (OSB) from aspen and balsam wood, bonded by methylene diisocyanate (MDI) and phenol formaldehyde. A group of 127 production workers in the plant was compared to 165 oil workers from the same geographic area. Measurements of MDI ranged from 6 to 33 micrograms/m3 (0.001-0.003 ppm), of respirable dust ranged from 0.05 to 0.5 mg/m3, and of formaldehyde were 0.05 ppm or less. The ratio of forced expiratory volume in 1 second to forced vital capacity (FEV1/FVC) was significantly lower among the OSB workers compared to the oil workers, and this was more pronounced for ex-smokers and current smokers. A number of respiratory symptoms suggestive of airway reactivity were significantly more common among the OSB workers. It was known that changes to reduce worker exposure had been made in the plant before the study, and it is unclear whether the health effects documented were the result of these low levels or if previous, probably higher levels were responsible.

Lung health among electricians in Edmonton, Alberta, Canada.

Respiratory symptoms, lung function, and radiographic changes among 100 actively employed electricians in Edmonton, Alberta, Canada, with 20 or more years of union membership were compared with those of 100 telephone workers. Posteroanterior chest radiographs were evaluated by two experienced chest physicians, with a third arbitrating films that were disagreed upon. Employment in a number of industrial sectors was compared for time and for time-weighted exposure to dust and fumes. Compared with telephone workers, electricians had more usual cough (odds ratio [OR] = 3.36; 95% confidence interval [CI], 1.36-8.31), usual phlegm (OR = 2.44; 95% CI, 1.01-5.86), chronic phlegm (OR = 2.74; 95% CI, 1.13-6.60), and shortness of breath (OR = 2.26; 95% CI, 1.10-4.67), but no differences in lung function. The prevalence of radiographic changes in both groups was low. The electricians had more radiographic changes, but only for the category "any change" was the difference statistically significant (OR = 5.2; 95% CI, 1.06-23.93). Only two electricians had small irregular opacities. Phlegm, chronic phlegm, and chest tightness were significantly associated with cumulative exposure to fumes in the gas and oil industry and to total industrial construction.

Respiratory consequences of exposure to wood dust and formaldehyde of workers manufacturing oriented strand board.

A cross-sectional study was performed at a plant in which 99 workers were employed in the manufacture of oriented strand board. This group was compared with 165 unexposed workers from the petroleum industry. Both groups were assessed, using a questionnaire, spirometry, and skin prick tests to common environmental antigens. Environmental studies showed a low dust level of 0.27 mg/m3, consisting of particles of a mass median aerodynamic equivalent diameter of 2.5 microns. There were variable concentrations of formaldehyde, up to 0.27 ppm. A significant difference between the oriented strand board workers and oil field workers was noted for the forced expiratory volume in 1 s/forced vital capacity ratio, without significant differences in either the forced expiratory volume in 1 s or the forced vital capacity. Oriented strand board workers who were current smokers were three times as likely to have a forced expiratory volume in 1 s/forced vital capacity ratio of less than 75% of that found in the currently smoking oil field workers. Significant reductions in forced expiratory volume in 1 s (p = .044) and forced vital capacity (p = .022) in oriented strand board workers were noted across the work shift. The oriented strand board workers complained of self-reported asthma and of lower respiratory tract symptoms significantly more frequently than did oil workers for all of the symptoms examined. The prevalence of atopy was not different in the two groups. Lung function was significantly better in oriented strand board workers who had no symptoms, compared with oriented strand board workers who were symptomatic.(ABSTRACT TRUNCATED AT 250 WORDS)

Sensitivity to hymenoptera in adult males.

The authors studied the sera of 86 selected adult male office workers for IgE antibodies to yellow jacket and honey bee venoms and to environmental inhalants and foods. Structured histories provide information about the experiences of these men with the Hymenoptera and other immunological information. Three men (3%) gave a history of a local or general reaction to the Hymenoptera but no antibodies were detected. Ten men (12%) had IgE antibodies to yellow jacket or honey bee venoms but none gave a history of a reaction. Nine of these men were atopic. The authors speculate that IgE antibodies to the Hymenoptera in atopic adult males may be more common than is currently recognized.

Validation of the smoking habits of a sample of the patient population seen in a pulmonary function laboratory.

From a structured history of 32 current smokers seen in the pulmonary function laboratory of a community hospital, we determined the number of cigarettes they smoked in 24 h. We also asked them to estimate their cigarette butt lengths from a visual model and to collect all cigarette butts over the next 24 h and mail them to us. We counted the butts, individually measured their lengths, and compared these with their previous estimates in order to validate their claims. While in the laboratory, we determined the level of carboxyhemoglobin in the peripheral blood of each patient. Patients tended to estimate the numbers of cigarettes that they smoked in units of five. Light smokers returned more butts and heavy smokers returned fewer butts than the numbers they reported as usually smoking. All patients were able to precisely estimate the average length of their cigarette butts, and they left butts of consistent lengths. There was no association between the numbers of cigarettes smoked and the butt lengths. Carboxyhemoglobin levels were positively associated with the numbers of cigarettes smoked in 24 h and negatively associated with the butt length and the time elapsed since the last cigarette was smoked, but these were not associated with the amount of tar in the cigarettes or with the number of years the person had smoked.

Serum total IgE and allergen specific IgE in an adult asthmatic population.

Serum levels of total and allergen specific IgE were estimated in 75 adult asthmatics. The total IgE results were found to be distributed in a log-normal fashion with a mean of 124.0 U/ml and 28% were above the upper limit of the normal range. The total IgE was related to the RAST number in a log-normal manner. Up to eight RAST discs could be positive in a patient with a normal total IgE and an elevated IgE could occur with no discs positive. There was also a log-normal relationship between total IgE and the RAST score with little change in score per disc with rise in total IgE. The data suggest that the more allergic individual reacts to more allergens rather than more strongly to a few allergens.

Cutaneous reactivity to different mycobacterial antigens in patients with tuberculosis.

Mycobacterium tuberculosis and the atypical mycobacteria may give rise to similar clinical pictures. Although the etiological separation of these diseases requires special cultural techniques, the identity of the causative mycobacteria may be suggested following the simultaneous use of a series of antigens. Thus, in spite of cross-reactivity to photochromogen and to a lesser degree to scotochromogen antigens, patients with typical tuberculosis had the largest reaction to Old Tuberculin. Such simultaneous tests, when carried out with careful measurements in a standardized manner, are of diagnostic value in identifying the responsible mycobacterium.

Comparison of responses to influenza A/New Jersey/76-A/Victoria/75 virus vaccine administered intradermally or subcutaneously to adults with chronic respiratory disease.

Serum HAI (hemagglutination inhibition) antibody responses were compared in two groups of 70 age-matched patients (age range, 17 to 82 years) who were vaccinated with bivalent influenza A/New Jersey/76-A/Victoria/75 whole-virus vaccine. The group that was vaccinated intradermally received 40 chick cell-agglutinating units of each viral antigen in 0.1 ml, and the group that was vaccinated subcutaneously received 200 chick cell-agglutinating units of each antigen in 0.5 ml. The serum HAI antibody response to A/New Jersey/76 antigen was significantly higher in the group that was vaccinated subcutaneously; this difference was particularly evident in patients less than or equal to 50 years old. The serologic response to A/Victoria/75 antigen did not differ significantly between the two groups. Levels of antibody before vaccination indicated previous widespread exposure of patients to influenza A/Victoria/75 virus, but not to influenza A/New Jersey/76 virus. Such differences in prior immunologic experience with a particular strain of influenza virus probably determine whether the intradermal route of vaccination is as effective as, or inferior to, the subcutaneous route.

RAST and skin test screening in the investigation of asthma.

We studied 72 adult asthmatics prospectively for the purpose of detecting atopy by the use of screening methods employing total serum IgE, RAST and prick tests. Fifty-one of the patients were considered to be atopic on the basis of prick test reactivity or a positive RAST. Although the total IgE values of the atopic and nonatopic individuals demonstrated some overlap, values over 150 U/mL were found only in atopics. We determined that 89% of the atopic individuals could be detected by a combination of total IgE greater than 150 U/mL and the use of five specific IgE determinations from the frequency of positive RAST to 20 environmental antigens. Ninety percent of the atopics were detected by four prick tests. Regional data are required to develop and effective set of screening tests. The use of such tests can reduce costs and technical time in the investigation of atopy.

Respiratory profiles of grain handlers and sedentary workers.

During 1978, grain handlers employed at three large inland grain terminals were studied along with an equal number of office workers matched for sex, age and smoking history. Respiratory symptoms and spirometric abnormalities were no more frequent in 16 grain handlers who were non-smokers than in their controls. However, 20 grain handlers who were smokers complained significantly more (P less than 0.01) of grade 1 dyspnea and had significantly lower ratios of forced expiratory volume in the first second to forced vital capacity (P less than 0.05) than their controls. Only 3% of the grain handlers were sensitive to grain dust, and 18% were found to be atopic but to have good lung function. A family history of asthma or allergic rhinitis was no more frequent in the grain handlers than in the control subjects. We conclude that the combination of cigarette smoking and exposure to grain dust causes a deterioration in lung function.

Adenovirus type 3 pneumonia causing lung damage in childhood.

An outbreak of adenovirus type 3 infection occurred in a hospital in 19 North American Indian infants and young children who were being treated for unrelated problems. Pneumonia occurred in 14 and was usually severe, with persistent signs of airway obstruction. Eleven of the 14 were followed periodically and complete medical reviews were conducted 8 to 10 years later. Ten had abnormal chest radiographs, and bronchography revealed bronchiectasis and minor airways changes in seven. In three cases there was clear evidence that these changes were directly related to the adenovirus type 3 infection. Pulmonary function studies showed a combination of restrictive and obstructive changes with minimal hypoxemia in most. Despite the presence of a persistent productive cough all were able to carry on a relatively normal life.

Lung health in relation to hydrogen sulfide exposure in oil and gas workers in Alberta, Canada.

A study was undertaken to assess pulmonary health effects of hydrogen sulfide (H2S) exposure in a group of workers (n = 175) extracting and processing oil and natural gas in west-central Alberta. Exposure to H2S was assessed by questioning the workers about "exposures strong enough to cause symptoms," and exposures that resulted in loss of consciousness (a "knockdown"). Exposures strong enough to cause symptoms were reported by 34% of the workers. Fourteen workers (8%) reported having had a knockdown. Exposures severe enough to cause symptoms were not associated with lower spirometric values or excess symptoms. Knockdowns were not associated with lower spirometric values but were associated with statistically significant excesses of (1) shortness of breath while hurrying on the level or walking up a slight hill (OR = 3.55; 95%CI = 1.02-12.4); (2) wheeze with chest tightness (OR = 5.15; 95%CI = 1.29-20.6); and (3) attacks of wheeze (OR = 5.08; 95%CI = 1.28-20.2). The pattern of excess respiratory symptoms is consistent with bronchial hyperresponsiveness, which has been documented in studies of high-level exposure to other irritant gases. Additional study is warranted and should include assessment of bronchial reactivity.

Pulmonary function associated with the Mmalton deficient variant of alpha 1-antitrypsin.

We have studied 78 members of a large family in which the Mmalton deficiency allele of alpha 1-antitrypsin (alpha 1AT) is present. Four patients of PI type MmaltonZ (alpha 1AT concentration, 16.4% of normal) had severe emphysema and marked depression in all flow and gas exchange parameters, significantly different from other members of the same family who were normal or had intermediate concentrations of alpha 1AT. Fourteen subjects with PI type MMmalton (alpha 1AT concentration, 63.3% of normal) were compared with 46 PI MM relatives (alpha 1AT, 103.8% of normal) and 14 relatives of PI type MZ (alpha 1AT concentration, 66.5% of normal). Spirometry, flow-volume loops, plethysmography, gas exchange at rest and exercise, and xenon 133 regional lung function were similar in those partially deficient when compared with the normal subjects. There was a trend for impairment of tests of lung function between smoking partially deficient (PI MZ, PI Mmalton) and normal (PI MM) relatives.

Lung health among plumbers and pipefitters in Edmonton, Alberta.

OBJECTIVES: A cross sectional study was undertaken to assess lung health among plumbers and pipefitters. Respiratory symptoms, lung function, and radiographic changes among 99 actively employed plumbers and pipefitters with > or = 20 years of union membership were compared with 100 telephone workers. METHODS: A respiratory symptom questionnaire was administered, including smoking and occupational histories. Spirometry was conducted according to standard criteria. Posteroanterior chest radiographs were evaluated by two experienced chest physicians, with a third arbitrating disagreed films. Members of the union were categorised as pipefitters (n = 57), plumbers (n = 16), or welders (n = 26), based on longest service, and compared with the telephone workers and internally (between groups). Lung health was also compared with employment in several work sectors common to Alberta for time, and for time weighted by exposure to dust and fumes. RESULTS: Compared with the telephone workers, plumbers and pipefitters had more cough and phlegm, lower forced vital capacity, and more radiographic changes (20% with any change), including circumscribed (10%) and diffuse pleural thickening (9%). None of the plumbers and pipefitters had small radiographic opacities. Among the three subgroups of workers, plumbers had the highest prevalence of radiographic changes. Both plumbers and pipefitters showed higher odds ratios for cough and phlegm than the welders. No differences between groups were found for lung function. Indicators of lung health were not related to work in any sector. CONCLUSIONS: Plumbers and pipefitters had increased prevalence of symptoms suggestive of an irritant effect with no evidence of bronchial responsiveness. The chest radiographs showed evidence of asbestos exposure, especially in the plumbers, but at lower levels than previously reported. Health screening programmes for these workers should be considered, although the logistical problems associated with screening in this group would be considerable.