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Biomedical subjects

M Rüegger

Publications and source records attributed to M Rüegger.

8 recordsLinked to original sources
PubMed1992

[Peak flow profile and expert testimony. The significance of peakflow self assessment for pneumological expert testimony].

Quantitative assessment of pulmonary obstructive diseases, such as asthma, may be difficult because of variability of obstruction. This is particularly true with regard to expert evidence pulmonary physicians deliver to insurances. Severity of obstruction, degree of impairment by an obstructive ventilatory defect, and temporal relationship of bronchial obstruction to exposure, may not be detected by physiological measurements in the pulmonary function laboratory. Much of the expert's opinion on these matters will depend on the credibility he assigns to the insured individual. The insured individual, in the other hand, has no other proof available than the description of his complaints, which puts him at a disadvantage. Serial peak flow measurements can be instrumental in clarifying such issues. They add an objective dimension to the case history. Six cases in which expert evidence was commissioned by insurances are described in detail, to exemplify how the thinking of the experts was modified by peak flow profiles. The greater usefulness of serial peak flow measurements in occupational asthma is emphasized and problems that may arise with peak flow measurements are discussed.

Adult↗
PubMed1991

[Silo filler's syndrome].

In 1975 an acute febrile bronchopulmonary illness after massive inhalation of fungal spores in silos was described as "pulmonary mycotoxicosis". Subsequently the disorder was referred to as "silo unloader's syndrome" or as a special form of "organic dust toxic syndrome" (ODTS). In this article the three cases of silo unloader's syndrome recognized by the Swiss National Accident Insurance Company (SUVA) between 1978 and 1989 as being an occupational disease are described. Two of the three patients with ODTS were wrongly diagnosed as suffering from allergic alveolitis and a change of occupation was proposed. Therefore, it is important to recognize ODTS in order to avoid unnecessary treatment and a change of occupation. ODTS can be prevented by technical measures such as prevention of mould formation and, in the case of exposure to fungal spores, use of an adequate breathing mask or a powered dust respirator helmet.

Adult↗
PubMed1991

[Occupational asthma].

The recognition of bronchial asthma as occupational disease is essentially a matter of legislation and not of medical definitions. Swiss law accepts an occupational nature of asthma when its causes derive to more than 50% from the work place. Causes are extremely diverse, whereby in Europe flour (bakers) and isocyanates (spray lacquers) dominate. Together, these causative agents contribute close to 50% of all cases of occupational asthma. The clinical picture is that of classic bronchial asthma. Peculiarities are seen only regarding the temporal dependence between exposition and beginning of airway obstruction. Regarding diagnosis of occupational asthma the following questions should be answered. 1. Is the dyspnea described by the patient real bronchial asthma? 2. Is there a documented temporal connection between exposition and complaints? 3. Is there a causative agent at the work place? Peak-flow measurements are particularly useful for documentation of connection of symptoms with occupation. They demand, however, a certain degree of cooperation by the patient. The prime therapeutic measure is avoidance of further contacts with the responsible agent. The Swiss health authorities (SUVA) have the power to issue decisions of unsuitability for certain workplaces or exposures. Such a measure is however severe and requires therefore a careful diagnosis and an evaluation of risk and benefit for the patient.

Air Pollutants, Occupational↗
PubMed1990

[Isocyanate-induced respiratory tract diseases in Switzerland].

From 1980 to 1986 the Swiss National Accident Insurance Company (SUVA) recognized isocyanate-induced airway diseases as an occupational illness in 245 cases, which are presented retrospectively. Since isocyanates are widely used they are found at a large variety of workplaces. At present, isocyanates are the most frequent cause of occupational asthma in the Swiss industrial field. After complete avoidance of any further exposure respiratory symptoms persisted or airway obstruction could still be documented in one third of patients. An unfavourable prognosis is significantly associated with the following factors: (1) bronchial obstruction (FEVl/VC) at first pulmonary function test; (2) RAST positive for isocyanates; (3) long latency period between onset of symptoms and end of exposure. Therefore, individuals with isocyanate-induced airway diseases must be immediately removed from any further exposure to these substances.

Adolescent↗
PubMed1989

[Occupationally-induced pneumopathies].

Today chronic obstructive airways diseases rank amongst the most important occupational pneumopathies in Switzerland. As far as asthma is concerned, the baker's (flour) and the spray painter's (Isocyanates) types are the most important. Despite their frequent occurrence the two forms of asthma seem to differ in their pathogenetic mechanisms. Due to technical precautions another type of occupational pneumopathology namely pneumoconiosis was considerably reduced. Among asbestos induced diseases the cases of asbestosis are decreasing. However, there still are quite a lot of events of malignant mesotheliomas actually heading the list of occupational malignomas. The most numerous asbestos induced disturbances, however, are pleural plaques which seem to be of no considerable importance. Another group of occupational lung disorders is that of hypersensitivity pneumonitis (extrinsic allergic alveolitis), among which the "farmer's lung" and in more industrial settings the "humidifier lung" are most frequently seen. For the diagnosis and evaluation of occupational pneumopathies work related symptoms and individual work place exposure are of decisive importance.

Alveolitis, Extrinsic Allergic↗
PubMed1985

Smoking pattern of smokers with and without tobacco-smoke-related lung diseases.

The number of cigarettes smoked, the duration of the smoking habit, and the tar content of the smoke influence the occurrence of tobacco-smoke-related lung diseases, as may also patterns of smoke inhalation. We therefore determined the smoking pattern, especially the time relation between cigarette puff and inhalation, in smokers with and without tobacco-smoke-related lung diseases. On the basis of clinical and radiologic findings as well as pulmonary function tests, 91 smokers were classified as smokers without lung disease, with small airway disease, with simple chronic bronchitis, with obstructive bronchitis, with pulmonary emphysema, and with lung cancer. Smoking and breathing patterns were recorded, using a smoke-flow machine and a strain-gauge belt while the subject smoked a cigarette. Blood levels of COHb were determined before and after smoking. Of the smoking characteristics assessed, puff-inhalation time, puff peak pressure, and the venous difference in COHb level before and after smoking varied significantly among the smoker groups. Puff-inhalation time, reflecting the duration of smoke retention in the mouth, was only 0.08 s (i.e., practically zero) in smokers with pulmonary emphysema and differed significantly from the time in the other groups. This puffing characteristic may be the consequence or the cause of emphysema. If the latter is true, smokers with emphysema may perhaps lack the acute airway response to smoke inhalation that normally protects most smokers from immediately inhaling tobacco smoke.

Adolescent↗
PubMed1978

[A candida bezoar in the Chiari reticulum of the right heart atrium].

An incidental finding at autopsy in a 55-year-old woman who died of complications of uterine cervical carcinoma was a 3 cm long polyp attached to the rete of Chiari in the right atrium. The lesion was interpreted grossly as either a pedunculated metastasis to the heart or an unusual atrial tumor. Histologic examination revealed it to be a fungus ball composed of regularly grouped Candida mycelia. The patient's history revealed Candida septicemia several months prior to death for which she had been treated by heavy doses of antibiotics administered through indwelling catheter. The causes of this unusual anatomo-pathologic finding are discussed in the light of our observations and those reviewed in the literature.

Autopsy↗