ABSTRACT
This study aimed to investigate the association between daily air pollution levels and the occurrence of acute respiratory signs and symptoms among people with asthma or asthma-like problems. Thirty eight subjects in the southern Swedish city of Landskrona kept a daily diary for 10 weeks. The daily prevalence of symptoms, supplementary bronchodilator use and peak flow deviations were compared with measurements of environmental nitrogen dioxide (NO2), sulphur dioxide, temperature and humidity in the city. The occurrence of severe asthma, both during the day and during the evening, was significantly positively associated with the concurrent 24 h average concentration of NO2, which never exceeded 72 microg x m(-3). A correlation of borderline significance was found between the use of on-demand medication and the NO2 level. However, peak flow deviations were not associated with air pollution or weather conditions, which may be explained by the beneficial effect of bronchodilators used by 28 of the subjects. The results of this study confirm those of some earlier studies and suggest that aggravation of asthma is related to daily variations in air quality, as indicated by relatively low ambient concentrations of nitrogen dioxide. These results also indicate that it may be appropriate to examine severe asthma symptoms separately.
Subject(s)
Air Pollutants/adverse effects , Asthma/epidemiology , Nitrogen Dioxide/adverse effects , Sulfur Dioxide/adverse effects , Acute Disease , Air Pollutants/analysis , Asthma/chemically induced , Asthma/diagnosis , Environmental Monitoring , Epidemiological Monitoring , Female , Health Surveys , Humans , Incidence , Linear Models , Male , Nitrogen Dioxide/analysis , Respiratory Function Tests , Risk Factors , Sampling Studies , Sulfur Dioxide/analysis , Sweden/epidemiology , Urban PopulationABSTRACT
Upper gastrointestinal bleeding occurred in a 64-year-old woman who was being treated with 1,000 mg acetylsalicylic acid and three times 5,000 IU heparin daily previous to a planned embolectomy because of occlusion of a lower leg artery. Radiology demonstrated multiple areas of osteolysis of the left thorax which were interpreted as recurrence of carcinoma of the breast, treated by mastectomy and radiotherapy 15 years previously. Acute renal failure, recurring severe back and abdominal pain, paraplegia of both legs and finally death from circulatory failure were explained as having been caused by multiple embolisation in the course of arteriosclerosis or a paraneoplastic increase in clotting activity. Autopsy revealed complete occlusion of the descending thoracic aorta by a malignant fibrous histiocytoma which had been the site of multiple emboli of thrombotic material and tumour tissue to spleen, kidneys, liver, intestinal segments, spinal cord and the artery to the left lower leg. Adrenal metastasis and osteolysis of the ribs were due to the histiocytoma and not the previously known carcinoma of the breast.
Subject(s)
Aortic Diseases/diagnosis , Histiocytoma, Benign Fibrous/diagnosis , Aorta, Thoracic/pathology , Aortic Diseases/pathology , Breast Neoplasms/complications , Breast Neoplasms/diagnosis , Breast Neoplasms/pathology , Female , Gastrointestinal Hemorrhage/diagnosis , Gastrointestinal Hemorrhage/etiology , Gastrointestinal Hemorrhage/pathology , Histiocytoma, Benign Fibrous/pathology , Humans , Intermittent Claudication/diagnosis , Middle Aged , Neoplasm Recurrence, Local/complications , Neoplasm Recurrence, Local/diagnosis , Neoplasm Recurrence, Local/pathology , Neoplasms/diagnosis , Neoplasms/pathology , Neoplastic Cells, Circulating/pathology , Osteolysis/diagnosis , Osteolysis/etiology , Osteolysis/pathology , Thromboembolism/complications , Thromboembolism/diagnosis , Thromboembolism/pathologyABSTRACT
The long term efficacy of class I antiarrhythmic drugs and of amiodarone was investigated in 34 patients with severe organic heart disease accompanied by frequent complex ventricular arrhythmias. All patients had undergone cardiac catheterisation which included coronary angiography, and each patient underwent a short and a long term study phase. During the short term study 6 class I antiarrhythmic agents were administered orally in a randomised, single-blind fashion. The drugs investigated were disopyramide, flecainide, mexiletine, prajmalium, propafenon and tocainide. The response was judged to be effective when there was a 90% reduction of couplets and a 100% reduction of salvos. For long term treatment the patient was given one of the agents found to be effective in the short term testing. Holter monitoring was performed after 1 week, and 1, 3 and 6 months. If the drug administered initially was later found to be ineffective, the patient was given another effective class I agent. If during the short term study or the follow-up phase there was no positive response to any class I agent, the patient was given amiodarone. In 78% of the patients, one or more of the class I agents administered short term was effective. The percentage of effectively treated patients after 1 week was 56%, and was 28, 14, and 9% after 1, 3, and 6 months' treatment, respectively. In amiodarone-treated patients there was an effective response rate of 40% after 10 days, 50% after 1 month and 70% after 3 and 6 months.
