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Medical examinations were performed in a group of 51 Polish farmers heavily exposed to flax dust during harvesting and scutching (threshing) and in a group of 50 healthy urban dwellers not exposed to organic dusts (controls). The examinations included: interview concerning the occurrence of respiratory disorders and work-related symptoms, physical examination, X-ray examination of chest, lung function tests, oxymetric examinations, determination of the concentration of cytokines (IL-1alpha IL-6, TNFalpha) in blood serum and allergological tests with microbial antigens associated with organic dust, comprising: skin prick test with 4 antigens, agar-gel precipitation test with 12 antigens and test for specific inhibition of leukocyte migration with 4 antigens. As many as 32 farmers (62.7%) reported the occurrence of work-related symptoms during harvesting, transporting and scutching of flax. The most common complaint was general weakness reported by 15 farmers (29.4%), followed by headache reported by 14 (27.5%), blocking of the nose - by 11 (21.6%), dry cough, shivering, and eyes itching - each by 10 (19.8%), chest tightness and hoarseness - each by 9 (17.6%). No control subjects reported these work-related symptoms. The mean spirometric values in the examined group of farmers were within a normal range and did not show a significant post-shift decline. In contrast, a significant post-shift decline of oxymetric values was found among flax farmers. The farmers showed a frequency of the positive early skin reactions to environmental allergens in the range of 0-19.6%, a frequency of positive precipitin reactions in a range of 0-56.9%, and frequency of positive reactions of leukocyte migration inhibition in a range of 7.8-21.6%. The members of the control group responded to the majority of allergens with a significantly lower frequency of positive results compared to the farmers. Elevated concentrations of IL-1alpha and IL-6, but not TNFalpha, were found in blood sera of flax farmers. In conclusion, farmers engaged in harvesting and scutching of flax represent a group of elevated professional risk because of high incidence of work-related symptoms and high frequency of allergic reactions to bacteria and fungi associated with organic dust.
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PMID:Effects of exposure to flax dust in Polish farmers: work-related symptoms and immunologic response to microbial antigens associated with dust. 1115 40

The authors report a case of a 53-year-old woman who developed symptoms and signs of compression of the left medulla oblongata by the elongated and curved left vertebral artery with normal diameter. Twelve days before admission to the hospital, the patient suddenly noticed severe occipital-nuchal headache and nausea with vomiting, while she was unloading a burden. Neurological examination revealed left facial hyperalgesia, right hemihypesthesia and mild right hemiparesis. Hoarseness was observed, but the movement of the uvula and tongue was normal. Hypertension was noticed (180/100). Cerebral and vertebral angiography revealed no aneurysm, but demonstrated an elongated and curved V4 portion of the left vertebral artery with normal diameter. Coronal plain of T2 weighted image of MRI and CT scan with metrizamide administered into the CSF, clearly demonstrated an elongated and curved left vertebral artery compressing the ventro-lateral portion of the left medulla oblongata, neurovascular decompression of the V4 from the medulla oblongata was performed. Through the operating microscope, it was observed that the elongated and curved V4 portion of the left vertebral artery with normal configuration was compressing the left medulla oblongata ventro-laterally, making a compression notch at the outlets of the cranial nerves IX and X. Transposition of the V4 portion was impossible. Some pieces of Taflon felt, thick enough to prevent the pulsatile movement of the V4 from compressing the medulla oblongata, were inserted between the V4 and the medulla oblongata. Two months after the operation, the patient's right hemiparesis and sensory disturbances were gradually improving and her blood pressure had become normal. The authors emphasize that, among patients with symptoms and signs of compression of the medulla oblongata, there is at least one patient for whom neurovascular decompression was an effective treatment.
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PMID:[A case report of hemiparesis due to compression of the medulla oblongata by an elongated vertebral artery]. 1132 94

Health concerns related to the quality of the environment in offices, schools, homes, and residences have increased dramatically over the past 2 decades. One health problem frequently confronting medical practitioners and often attributed to environmental quality problems is idiopathic environmental intolerances (IEI). Formerly known as multiple chemical sensitivities, IEI is an acquired disorder characterized by adverse reactions attributed to exposure to a variety of substances under ordinary conditions. Alleged precipitants include solvents, pesticides, detergents, dusts, and fragrances. Symptoms include fatigue, malaise, headache, concentration and memory difficulties, lightheadedness, cough, hoarseness, and rhinitis without objective physical signs or consistent laboratory abnormalities. The role of the environment in precipitating these complaints continues to be controversial, and no intervention or treatment has thus far been proven to be effective. While not progressive or life threatening, IEI is often functionally disabling and very distressing to affected individuals. The investigation of IEI should involve, at a minimum, a clinical evaluation of the affected person and in most cases an environmental evaluation as well. IEI should be managed without overutilization of diagnostic tests or prescription of unnecessary environmental, occupational, or dietary restrictions.
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PMID:Idiopathic environmental intolerances. 1241 13

A cross-sectional study was carried out to evaluate lung function and the prevalence of work-related symptoms in workers of a potato processing plant located in Lublin region (eastern Poland). The study group comprised 61 workers employed in 2 departments. The examination included: physician-administrated questionnaire on occurrence of work-related symptoms, occupational history and smoking habits. Spirometry was performed before (7:00-8:00) and after (16:00-17:00) the morning shift. Altogether 41/61 (67.2%) subjects reported at least one symptom associated with their job. Pulmonary symptoms were recorded in 28/61 (45.9%) subjects. The most commonly recorded complaints were: cough (44.3%), hoarseness (19.7%), shortness of breath (18%), followed by headache and skin lesion (13.1% each), and eye and nose irritation (11.5%). The prevalence of work-related symptoms (except for eye and nose irritation) was higher in the group of subjects working longer than 4 years (the difference was statistically significant only for skin lesion). Among non-smoking workers a significantly higher prevalence of headache was seen compared to smokers (Fisher's test, p < 0.05). Smokers complained more frequently of respiratory symptoms such as cough, shortness of breath, hoarseness and chest pain. The difference was significant only for cough (p < 0.05). A statistically significant over-shift decline in all measured spirometric values: FVC, FEV(1) (p < 0.001), FEV(1)/VC (p < 0.05), PEF (p < 0.01) was observed.
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PMID:The effects of exposure to organic dust on the respiratory system of potato processing workers. 1249 94

The number of complaints about the quality of indoor air has increased during the past two decades. These complaints have been frequent enough that the term "Sick House Syndrome or Sick Building Syndrome" and "Multiple Chemical Sensitivity" has been coined. Complaints are likely related to the increased use of synthetic organic materials in house, furnishing, and consumer products; and the buildings, furnishings, and consumer products; and the decreased ventilation for energy conservation in homes. Approximately thousand volatile chemicals have been identified in indoor air. The main sources of these chemicals are house materials, combustion fumes, cleaning compounds, and paints or stains. Exposure to high levels of these emissions and to others, coupled with the fact that most people spend more time indoors than outdoors, raises the possibility that the risk to human health from indoor air pollution may be potentially greater than the risk posed from outdoor pollutants. The complaints most frequently voiced with respect to Sick House Syndrome are irritations of the eye, nose, and throat; cough and hoarseness of voice; headache and mental fatigue. The syndrome of multiple chemical sensitivities is controversial subject with increasing impact on the field of indoor air quality. The controversy surrounding Multiple Chemical Sensitivity includes its definition, theories of etiology and pathogenesis, diagnostic, and life style. Multiple Chemical Sensitivity is considered the hypothesis that is a disease caused by exposure to many chemically distinct environmental substances at very low.
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PMID:[Indoor air and human health--sick house syndrome and multiple chemical sensitivity]. 1263 82

The baroreflex maintains blood pressure through the glossopharyngeal (IX) cranial nerve. We report a 54-year-old man who developed a left sided headache, hoarseness, dysarthria, dysphagia, and sustained hypertension from a left internal carotid artery dissection. We hypothesise that interruption of the left IX nerve caused hypertension in this patient.
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PMID:Left internal carotid artery dissection presenting with headache, Collet-Sicard syndrome and sustained hypertension. 1464 21

Salmeterol/fluticasone propionate is a fixed-dose combination of the long-acting beta2-adrenoceptor agonist salmeterol and the corticosteroid fluticasone propionate and is inhaled via the Diskus powder inhaler. In three randomized, double-blind, 24-week or 52-week studies in >2850 patients with chronic obstructive pulmonary disease (COPD), administration of salmeterol/fluticasone propionate 50/250 microg twice daily (in one study) and salmeterol/fluticasone propionate 50/500 microg twice daily (in the other studies) provided greater improvement in lung function than placebo or either component alone at the same nominal dosage. Both strengths of the combination product administered twice daily resulted in clinically meaningful increases in scores in health-related quality-of-life questionnaires that were specific for respiratory disease. Improvements in this and almost all other secondary measures of efficacy, including symptomatic outcomes, were significantly greater with the combination product than with placebo. Administration of salmeterol/fluticasone propionate as a combination product did not result in any untoward interactions that affected the pharmacodynamic, pharmacokinetic or tolerability profiles of the individual components. Candidiasis, hoarseness/dysphonia, throat irritation and headache occurred more frequently with salmeterol/fluticasone propionate than with placebo in patients with COPD.
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PMID:Inhaled salmeterol/fluticasone propionate combination in chronic obstructive pulmonary disease. 1472 47

A 65-year-old woman with diabetes mellitus and chronic otitis media developed headache, fever, and hoarseness, all of which did not responded to the oral antibiotics. As stiff neck and lower cranial nerve palsies appeared, bacterial meningitis was suspected. Neurological examination revealed the right hearing disturbance, right recurrent laryngeal nerve palsy, left sternocleidomastoid muscle atrophy and bilateral tongue atrophy. The CSF examination revealed mild pleocytosis and elevated protein, but no bacterial organism was cultured from the CSF. CT scans showed bilateral mastoiditis, and the right mastoid process and a posterior part of the petrous bone were eroded, indicating the exposed bony structures to the posterior fossa. MRI scans demonstrated the thickening of the dura mater of the posterior fossa and the right cerebellar tentorium. This is a rare example of bacterial pachymeningitis of the posterior fossa, the clinical symptoms and MRI findings of which resolved solely by antimicrobial agents without corticosteroid.
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PMID:[A case of hypertrophic pachymeningitis, resolved by antimicrobial therapy]. 1547 Oct 88

Historically, unpleasant odors have been considered warning signs or indicators of potential risks to human health but not necessarily direct triggers of health effects. However, citizen complaints to public health agencies suggest that odors may not simply serve as a warning of potential risks but that odor sensations themselves may cause health symptoms. Mal-odors emitted from large animal production facilities and wastewater treatment plants, for example, elicit complaints of eye, nose, and throat irritation, headache, nausea, diarrhea, hoarseness, sore throat, cough, chest tightness, nasal congestion, palpitations, shortness of breath, stress, drowsiness, and alterations in mood. There are at least three mechanisms by which ambient odors may produce health symptoms. First, symptoms can be induced by exposure to odorants (compounds with odor properties) at levels that also cause irritation or other toxicological effects. That is, irritation--rather than the odor--is the cause of the health symptoms, and odor (the sensation) simply serves as an exposure marker. Second, health symptoms from odorants at non-irritant concentrations can be due to innate (genetically coded) or learned aversions. Third, symptoms may be due to a co-pollutant (such as endotoxin) that is part of an odorant mixture. Objective biomarkers of health symptoms must be obtained, however, to determine if health complaints constitute health effects. One industry that is receiving much attention, worldwide, related to this subject is concentrated animal production agriculture. Sustainability of this industry will likely necessitate the development of new technologies to mitigate odorous aerial emissions. Examples of such "environmentally superior technologies" (EST) developed under the initiative sponsored through agreements between the Attorney General of North Carolina and Smithfield Foods and Premium Standard Farms are described.
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PMID:Science of odor as a potential health issue. 1564 42

Aortic dissection is a life-threatening medical emergency. While an abrupt, tearing pain in the chest or back is present in more than 90% of the patients, diagnosis of aortic dissection has been shown to be particularly difficult when such symptoms are not present. In this report we describe a 36-year-old man presenting with a 10-day history of new onset of hoarseness associated with several transient headache episodes. The possibility of aortic dissection was overlooked at the initial presentation, and unilateral vocal cord palsy due to a cerebrovascular accident was the initial diagnosis. The patient's abnormal chest radiograph led to a re-diagnosis, and a Standford type-B aortic dissection was confirmed using thoracic computed tomography. The unusual presentation of aortic dissection is emphasized, and its management is discussed.
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PMID:Hoarseness as an unusual initial presentation of aortic dissection. 1582 7


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