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Many workers in the textile industry have respiratory symptoms that are related to their work environment. In this study we observed the dust level conditions of eleven textile industries of the North of Portugal. The dust levels determined were between 0.1 mg/m3 and 1.25 mg/m3, in many cases above the Portuguese standard levels of exposure (VLE). For these dust levels we found a prevalence of 23% of workers with respiratory symptoms with occupational characteristics in 10.8%, and 5.7% presenting byssinosis. Workers exposed to cotton fibres in spinning areas have the highest prevalence of symptoms, and reduction of the FEV1. These characteristics were related to dust levels and were higher in the initial phases of the spinning processes. We found no cases of byssinosis in workers exposed to synthetic fibres, or in workers from weaving areas. Smoking habits were related to the reduction of the FEV1, and severity of respiratory illness but not to the presence of byssinosis.

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The author reviews the pathophysiology of angina pectoris. The first part concerns to the regulation of coronary blood flow: 1. Determinants of myocardial oxygen consumption (preload, afterload,contractility, heart rate); 2. Factors that control the myocardial oxygen supply (perfusion pressure, coronary vascular resistance). The second part concerns the coronary insufficiency and its clinical consequences (angina pectoris, myocardium infarction, heart failure, arrhythmias, primary cardiac arrest. The third part concerns the principal pathophysiologic mechanisms of the stable angina and of the unstable angina (progression of atherosclerosis, platelet aggregation, thrombosis and/or alterations in vasomotor tone).

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Some workers in the textile industry have respiratory symptoms related to their occupation. This study is aimed at evaluating the frequency of respiratory symptoms in textile industries in the North of Portugal. We evaluated 3529 workers from 20 factories (19 deal with synthetic fibres and cotton and the other deals with sisal.) Among the workers, there were 34.5% with respiratory symptoms - 24,5% referred nasal symptoms, 22,6% with bronchial symptoms and 12,6% associated both. The workers who dealt with cotton presented a higher frequency of bronchial symptoms (25,0%) than the ones dealing with synthetic fibres (12,7% p < 0,000001). The same was noticed among the workers in the opening and spinning areas, who showed a higher frequency of bronchial symptoms (28,3%) than the ones in weaving areas (12,7% p < 0,000001). We did not find any differences concerning the frequency of symptoms among the workers handling both natural fibres (cotton and sisal). Individually all the symptoms were more frequent among the workers handling natural fibres. The most frequent symptom depended on the fibre. Cough was more frequently mentioned among the workers handling synthetic fibres (9.6%) and cotton (15.7%). Among the workers who handle sisal, dyspnea was the most frequently mentioned (16.9%). Productive cough was the most frequent association (7.2% sisal; 2.8% synthetic; 8.0% cotton), and the association between dyspnea and wheezing the least mentioned (6.4% sisal; 0.5% synthetic; 5.9% cotton). The workers with bronchial symptoms (synthetic fibre and cotton) have more years of exposure and greater smoking habits. In a covariance adjusted for age and smoking habits, the workers with bronchial symptoms, exposed to cotton have more years of exposure.

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Adult respiratory distress syndrome (ARDS) could be related to upper airway obstruction. Mechanical obstruction and complement activation could lead to ARDS development. We describe a patient with hereditary angioedema, laryngeal edema, and ARDS.

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OBJECTIVE: to evaluate the statistical significance of the haemodynamic examination making use of the Swan-Ganz catheter (S-G) on the hospitalary mortality of patients (pts) with acute myocardial infarction (AMI). CONCEPTION: Not randomized, not controlled and retrospective study. SETTING: Intensive coronary care unit (CCU). PATIENTS: 2562 pts with AMI sequentially admitted to a CCU were studied. METHODS: The 2562 pts were divided in two groups: Group A--involving 2117 pts not submitted to haemodynamic examination; Group B-constituted by 445 pts (17% of all pts) submitted to haemodynamic examination. All pts admitted to the study were distributed according to the four classes of Killip. The pts included in each Killip class were distributed by the groups A (not catheterized) and B (catheterized). Hospitalary mortalities of the pts included in the global A and B groups, and the mortalities of the patients included in the particular A and B groups in each Killip class were determined. To evaluate the statistical significance of the differences in distributions of the number of pts who survived and who died in each set of A and B groups square chi test was used. Values of p less than 0.05 were considered as statistical significant. RESULTS: The distributions of the pts who died and who survived during the stay in the hospital by the A and B groups, be it in the total group of patients be it in each Killip class, were not significant different (p greater than 0.05). CONCLUSIONS: The mortalities of pts with AMI submitted or not to haemodynamic examination with S-G catheter did not significantly differ even in each Killip class, which means that it was not demonstrated a benefit with the S-G catheter use in the pts with AMI. In the presence of this conclusion and considering that retrospective studies must be interpreted with circumspection, it seems necessary to accomplish a prospective randomized and controlled study for evaluation the risk/benefit relation of the haemodynamic examination with the S-G catheter in pts with AMI.

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Inhalation of ultrasonically nebulized distilled water was used to evaluate non-specific bronchial reactivity and to investigate nonimmunologically mediated asthma. Release of histamine and other mediators from mast cells and stimulation of lung irritant receptors are mechanisms that may be involved in nebulized distilled water-induced bronchoconstriction. To investigate the contribution of these mechanisms the effect of terfenadine and ipratropium bromide on the bronchial response to this stimulus was assessed. A total of 30 asthmatics (mean 28.7 years) were submitted on three different days to distilled water challenge with or without prior treatment with oral terfenadine or inhaled aerosolized ipratropium bromide. The decrease in forced expiratory volume in 1 s induced by the same dose of distilled water was significantly (P less than 0.001) reduced from 35.6 +/- 15.8% to 19.5 +/- 16% with terfenadine and to 23.9 +/- 19.7% with ipratropium bromide. The results suggest that histamine release and reflex bronchoconstriction are mechanisms involved in asthma induced by ultrasonically nebulized distilled water.

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Forty out-patients with acute 'flare' of chronic rheumatoid arthritis were treated orally with either 150 mg proglumetacin or 250 mg naproxen twice daily over 3 weeks, according to a randomized, double-blind design. Before and after 1 and 3 weeks of treatment, the number of painful and of swollen joints, the intensity of pain and function tests (morning stiffness, time to walk over 15 metres and hand grip strength) were measured and recorded. Haematology was investigated before and after treatment. Two patients in the proglumetacin group did not report to control and were considered drop-outs; 2 more (1 in each group) interrupted treatment before completion because of the onset or aggravation of accessory symptoms. Efficacy, assessed in 17 patients on proglumetacin and in 19 on naproxen, was good with both drugs, even though only those patients given proglumetacin experienced a significant (p less than 0.01) decrease in the number of painful joints. None of the haematological tests showed clinically significant variations after either treatment. Tolerance could be assessed in 18 and 20 patients given proglumetacin or naproxen, respectively. Accessory symptoms appeared or were aggravated in 5 and 3 patients, respectively.

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