[Work-related asthma in clinical practice]. / Werkgerelateerd astma in de klinische praktijk.

Work-related asthma is an underestimated problem. More awareness is needed for early identification of work-related lung diseases to prevent permanent damage in patients with lung diseases. Work-related asthma can lead to an increase in the burden of disease, the number of exacerbations and hospital admissions. Therefore, exposure to substances with irritating and/or sensitizing properties should be regarded as an additional treatable trait in asthma treatment. The number of occupations where such exposures plays a role is large and diverse. Inquiring about the profession, activities or future career choice of the (asthma) patient during the first consultation is of great importance for the correct diagnosis and treatment. Cooperation between pulmonologist, lung nurse, ENT specialist, dermatologist, company doctor and occupational hygienist can contribute to this. A regional organization with a 'multidisciplinary consultation' for occupational lung diseases is important to guarantee optimal care and advice. The clinical case series demonstrate work-related asthma in clinical practice.

Adding alpha-amylase to weaning food to increase dietary intake in children. A randomized controlled trial.

The addition of alpha-amylase to a food supplement for weaning-age children was proposed as an alternative to traditionally prepared Amylase-Rich Foods (ARF) for reducing the dietary bulk of weaning diets. In a self-controlled clinical trial including 30 healthy children, aged 10-24 months, the effect of the addition of alpha-amylase and extra cereal to a diet including three meals, was determined in terms of dietary intake. A mean increased intake of 23.8 per cent in energy and 10.4 per cent in protein was found. The addition of commercial alpha-amylase to maize-based weaning foods is a useful method of increasing the nutritional value of weaning diets.

Changes in the anthropometric status of rural African under-fives during a decade of primary health care.

Protein energy malnutrition (PEM) is a major cause of hospital admissions and death in most impoverished Third World countries. In the Gelukspan Health Ward, in rural Western Transvaal, a primary health care (PHC) programme, based on the GOBI-FFF strategy, commenced in 1980. Community health surveys on African under-five children were regularly undertaken. In 1990, to assess improvements achieved, anthropometric and other data were obtained on a representative series of 926 children. Harvard standards were used prior to 1984, and American NCHS reference standards thereafter. Low weight-for-age fell from 28 to 19%, low height for age from 33 to 17%, and low weight-for-height from 5 to 1%. The percentage with low arm circumference was unaffected, 3 and 4%, respectively. The improvements described are believed to be due in part to the PHC programme. Greater definition of the causes and extent of improvements are needed to optimize the State's present desire to intensify PHC, especially in rural areas.

Enhanced gallbladder absorption during gallstone formation: the roles of cholesterol saturated bile and gallbladder stasis.

Cholesterol saturated bile and gallbladder stasis are important factors in the pathogenesis of cholesterol gallstones. The degree to which either or both of these factors affect gallbladder transport of fluid remains obscure. The authors tested the hypothesis that both cholesterol saturated bile and gallbladder stasis, and not stasis alone, promotes gallbladder fluid absorption. Prairie dogs were maintained for 2 weeks on either a control chow, total parenteral nutrition (TPN), or a 1.2% cholesterol enriched chow. The bile acid pool was labeled with 14C-cholic acid and indexes for cholesterol saturation (CSI) and gallbladder stasis (Rsa) were determined. Fluid transport was indirectly measured by calculating the ratio of gallbladder to hepatic bile concentrations of individual and total biliary lipids. Despite evidence of stasis in prairie dogs maintained on TPN, bile was unsaturated, and gallbladder absorption was not appreciably changed. In contrast, cholesterol-fed animals had cholesterol supersaturated bile, gallbladder stasis, and altered gallbladder absorption, as manifested by a significant change in the ratio of gallbladder to hepatic bile concentrations of individual and total biliary lipids. These data suggest that both cholesterol saturated bile and gallbladder stasis, and not stasis alone, are essential in promoting the enhanced gallbladder absorption, which has previously been observed during early cholesterol gallstone formation.

Effects of cholesterol gallstone induction on gallbladder function and bile salt pool size in the prairie dog model.

The prairie dog gallstone model was used to test the following hypotheses: (1) gallbladder stasis occurs in association with gallstone formation, and (2) bile salt pool size decreases as gallstones develop. Bile salt pool sizes and the extent of equilibration of hepatic and gallbladder bile salt over the course of gallstone development were measured. No evidence for bile salt pool reduction was found, but there was significant evidence of progressively inefficient equilibration of hepatic and gallbladder bile salt very early during gallstone formation. These changes, suggestive of gallbladder stasis and observed only in the presence of cholesterol crystals in bile, persisted as cholesterol stones developed and antedated any reduction in bile salt pool size.

Synthesis of cysteine from methionine in normal adult subjects: effect of route of alimentation.

Parenteral alimentation solutions free of cysteine, probably an essential amino acid for premature infants, were administered continuously to eight healthy men through catheters in the superior vena cava and through nasogastric tubes. When the preparation was administered parenterally, the plasma cystine concentration dropped markedly. When feeding was switched to the oral route, the concentration rose immediately, but returned to baseline only when a cystine-containing diet was fed. These studies indicate that the synthesis of cysteine from methionine is limited, even in the adult subject, when cystine-free diets are administered parenterally.