Rhizarthrosis in banknote processing workers: a retrospective cohort study.

BACKGROUND: Rhizarthrosis, or osteoarthritis of the base of the thumb, is a common condition affecting 10-30% of the population over the age of 60. Whether it is an occupational disease has been the subject of debate as epidemiological studies on the correlation between physical stress and the presence of rhizarthrosis have shown conflicting results. AIMS: To study the correlation between the prevalence of rhizarthrosis and the time spent by employees manually processing banknotes at the National Bank of Belgium (NBB). METHODS: We followed NBB employees currently or previously holding job titles involving the manual or automated processing of banknotes. Each participant's job history was carefully reconstructed and the number of months holding certain job titles determined. Each participant was clinically and radiologically examined for the presence of rhizarthrosis in both hands. Its presence was scored by a combination of clinical and radiological criteria. RESULTS: There were 195 participants. The prevalence of rhizarthrosis was 27% in women (mean age: 52.3 ± 4.4 years) and 17% in men (mean age: 53.2). The odds ratio (OR) for rhizarthrosis after 10 years' full-time overall exposure was significantly higher [OR 10 years: 1.53 (1.03-2.28)]. However, one particular job, 'manual counting', described by participants as highly straining and severely taxing on the thumbs, did not show a significantly higher prevalence of rhizarthrosis. CONCLUSIONS: Our study confirmed the correlation between the presence of rhizarthrosis and age, gender and general manual labour, in particular banknote processing, but found no link with one specific job-manual counting.

Equivalent therapeutic ratio of salbutamol given by Turbuhaler and Diskus.

Some inhalers have been claimed to give better deposition, resulting in higher efficacy. In a previous study we did not find any evidence of different potency of salbutamol given either via pMDI or Turbuhaler. The aim of the present study was to compare the efficacy and safety of salbutamol given via Diskus or Turbuhaler. Twenty-five asthmatics with step-wise reversible airflow obstruction (total reversibility of at least 15%) were included in a randomized, double-dummy, placebo-controlled cross-over study. On each study day, the patients were given placebo repeatedly, or cumulative doses of 200, 400, 800, 1600 and 3200 microg salbutamol given via either device (double-blind, placebo-controlled). Salbutamol caused a dose-related increase in FEV1 when given by Diskus or Turbuhaler. The improvement in FEV1 was similar regardless of whether salbutamol was given via Diskus or Turbuhaler, at equivalent microgram doses. After a total cumulative dose of 3200 microg, mean FEV1 for Diskus was 2.46 l (change from baseline of 20.5%), for Turbuhaler 2.50 l (change from baseline 24.6%) and for placebo 2.11 l (3% change from baseline). After correcting for different baseline differences, the percentage difference between Diskus and Turbuhaler was -1.8% (P = 0.2). Systemic effects (potassium and heart rate) did not differ between Diskus or Turbuhaler. We conclude that the efficacy of salbutamol given at equivalent microgram doses, as well as side-effects, are comparable when the drug is given via Diskus or Turbuhaler. The present data shows that salbutamol given by these devices have similar therapeutic ratios.

Similar bronchodilation with formoterol delivered by aerolizer or turbuhaler.

BACKGROUND: In many countries, two dry powder formulations of inhaled formoterol are available for clinical use; one uses a single-dose device (Foradil, Aerolizer), and the other uses a multiple-dose device (Oxis, Turbuhaler). OBJECTIVES: To study the bronchodilating effect of formoterol 12 mg when delivered via the Aerolizer and Turbuhaler devices over 12 h. STUDY DESIGN: Randomized, double-blind, placebo controlled crossover study. Forced expiratory volume in one second (FEV1) was monitored during a 12 h period. PATIENTS: Nineteen nonsmoking asthma patients were included in the trial on the basis of reversibility of symptoms in response to inhaled salbutamol (either 200 or 400 mg given cumulatively; minimum reversibility 15%). RESULTS: There were no significant differences between the two dry powder devices regarding the change from baseline of FEV1 over 12 h, the area under the curve of FEV1 over 12 h or the maximum value of FEV1. The improvement in FEV1 with formoterol 12 mg versus placebo was highly significant for both devices. CONCLUSIONS: Formoterol is similarly effective when used as a dry powder when given by either Aerolizer or the Turbuhaler.

Comparison of the relative efficacy of formoterol and salmeterol in asthmatic patients.

Studies performed on airway smooth muscle in vitro have indicated that salmeterol is a partial agonist on the beta2-receptor in comparison to formoterol. In the present study we evaluated whether these pharmacological differences between salmeterol and formoterol also are applicable to asthmatic patients. The protective effects by increasing cumulative doses of formoterol (12, 60, 120 micrograms) and salmeterol (50, 250, 500 micrograms) on methacholine-induced bronchoconstriction were evaluated in a double-blind, crossover, placebo-controlled design. Patients were regularly treated with salbutamol 200 micrograms twice daily during the study period, to avoid variability in beta2-adrenoceptor tolerance. S-potassium, heart rate corrected Q-T interval (Q-Tc), and tremor score were followed as measures of systemic effects. Formoterol dose-dependently protected against methacholine responsiveness (4.6 doubling doses after 120 micrograms). Salmeterol, however, showed a flatter dose-response curve, and a significantly weaker maximal protective effect (2.8 doubling doses after 250 micrograms). Formoterol caused a significantly higher tremor score and a larger drop in S-potassium than salmeterol at the highest doses. These data show that salmeterol is a partial agonist on the beta2-receptor in relation to formoterol in human airways in vivo. Further studies are required to document the clinical consequences of this finding, for example in severe asthmatic patients.

Equivalent bronchodilation with salbutamol given via pMDI or turbuhaler.

Several breath-activated multidose powder devices for inhaled anti-asthma drugs are now available. Some of these inhalers have been argued to give higher drug deposition in the airways than conventional pressurized metered dose inhalers (pMDI). The aim of the present study was to compare the efficacy and safety of salbutamol given via pMDI or Turbuhaler (both 100 microgram per inhalation). Adult asthmatic patients of either sex (n = 22) and with reversible airflow obstruction were included in a randomized, placebo-controlled study. On the study days, salbutamol was given with increasing doses (200 to 3,200 microgram cumulative) or placebo, via pMDI or Turbuhaler. A dose-related increase in FEV1 was observed after administration of salbutamol given via either device, versus placebo. The improvement in FEV1 was similar whether salbutamol was given via pMDI or Turbuhaler, at microgram equivalent doses. After a total cumulative dose of 3,200 microgram, mean FEV1 for Turbuhaler was 2.98 (change from baseline of 23.1%), for pMDI 2.93 (change from baseline of 23.6%), and for placebo 2.36 (change from baseline of 0. 42%). Changes in potassium, glucose, and heart rate did not show any significant differences between pMDI and Turbuhaler. We conclude that the efficacy of salbutamol is comparable when the drug is given via the Turbuhaler or pMDI.

Perforated adenocarcinoma of the appendix during pregnancy.

Ruptured appendicitis was suspected in a primigravid woman at 31 weeks' gestation. Invasive adenocarcinoma of the appendix was diagnosed pathologically. To our knowledge, this is the first reported case during pregnancy.