Byssinosis and other respiratory symptoms and acute and chronic changes in FVC and FEVy.o were investigated in 77 workers in sisal spinning and 83 workers in sisal brushing departments in six Tanzanian sisal factories. Although the prevalence of byssinosis in spinning departments was found to be low (5.2 %), it was very high in brushing departments (48.2 %). Workers in brushing were exposed to sisal dust for a significantly longer period (I177 + 7.3 years) compared to workers exposed to sisal in spinning (2-85 + 2 56 years). Although the number of smokers in brushing (42 %) was similar to that in spinning (37 %), smokers were more prone to byssinosis than were non-or ex-smokers after standardisation for duration of exposure. We were unable to measure dust levels in this study, but dust levels in spinning and brushing are cited from previous studies. These confirm our impression that the dust level in spinning is higher than that in an average cotton carding department and far higher in brushing than in spinning. Acute falls in FVC and FEV1. o were found during the work shift. The extent of the fall in FEy1 0 correlated well with the severity of byssinosis; 75 % of the workers with grade II byssinosis and 33 % of those with grade i + I were found to have acute falls in FEVY o greater than 0-2 litres. However some workers, 10 % in spinning and 33 % in brushing, who denied symptoms of byssinosis, were also found to have acute falls in FE1.o. Some workers had slight or severe chronic ventilatory impairment from dust (FEV1.o less than 80 %, or less than 60 % of the respective predicted values), and these workers were mostly from the brushing department. The prevalence of chronic cough and chronic bronchitis was found to be negligible in workers in the spinning and in the brushing departments: 9-6% had a chronic cough and 12% had chronic bronchitis. It is concluded that a high prevalence of byssinosis associated with chronic and acute changes in FVC and FEy1.o occurs in the brushing departments of sisal factories, and that this is related to lengthy exposure, high dust level and smoking.

Blood coagulation and fibrinolysis were assessed in 55 cases of heat stroke who presented with or without bleeding tendencies during the Makkah pilgrimage of 1983. 17 patients were identified to have evidence of disseminated intravascular coagulation (DIC). Bleeders with DIC had a higher incidence of shock and a higher mortality when compared to non-bleeders. Thrombocytopenia and liver cell damage were not limited to cases with DIC. Coagulation factors and serum enzyme studies suggested non-specific tissue damage as the trigger mechanism for DIC possibly proceeding through the extrinsic system of blood clotting. We conclude that the breakdown of haemostasis in heat stroke is multifactorial: thrombocytopenia, liver cell damage and DIC.

The effects of temperature (37-45 degrees C) on pulmonary edema formation and transendothelial albumin clearance were investigated using isolated perfused guinea pig lungs and bovine pulmonary arterial endothelial cells grown to confluency on a gelatinized membrane. Perfusion of isolated lungs with Ringer-albumin solution at 37 or 41 degrees C for 90 min produced no change in lung wet-to-dry weight ratios (W/D) or in pulmonary capillary pressure (measured by the double-occlusion method). When perfused at 43 degrees C, lung wet weight increased 0.8 +/- 0.4 g over base line (final W/D = 7.43 +/- 0.7) within 90 min. Perfusion at 45 degrees C increased lung weight by 2.7 +/- 0.9 g over base line (final W/D 11.8 +/- 2.3 vs. control value of 5.2 +/- 0.23 at 37 degrees C perfusion) within 60 min. The changes in pulmonary capillary pressure were small (from a base-line value of 4.3 +/- 0.8 to 4.9 +/- 0.4 at 43 degrees C and from a base-line value of 4.9 +/- 0.8 to 5.9 +/- 0.6 at 45 degrees C). The clearance of 125I-albumin (microliter/min) across the endothelial monolayer system increased threefold (from 0.295 +/- 0.035 to 1.048 +/- 0.107) at 45 degrees C, an effect comparable to positive controls of trypsin (from 0.272 +/- 0.046 to 1.595 +/- 0.138) or oleic acid (from 0.278 +/- 0.043 to 0.672 +/- 0.26). An increase in temperature from 37 to 45 degrees C had no effect on the permeability of the gelatinized membrane alone.(ABSTRACT TRUNCATED AT 250 WORDS)

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Lung function was studied in 24 patients with advanced mitral stenosis scheduled for mitral valve replacement (MVR), and revealed an obstructive ventilatory pattern. Forty per cent of the patients had a forced expiratory volume in 1 s (FEV1)<60% of that predicted in the preoperative period. Twenty-five per cent of those operated upon showed a similar pattern up to 110 weeks postoperatively. A blind study of the effect of placebo and beta2 agonist (salbutamol) inhalation was performed preoperatively and 6 months postoperatively, to evaluate the reversibility of airflow obstruction in these patients, flow volume curve and body plethysmographic measurement of airway resistance (Rex) and intrathoracic gas volume (VTG). Patients in the pre and postoperative period showed a significant difference between the placebo and the beta2 agonist responses for FEV1, FEV1 as percentage of FVC (FEV1% FVC), peak expiratory flow rate (PEFR), flow rate of 50% of expiratory vital capacity (Vmax50), Rex and VTG (P<0.001). We conclude that salbutamol inhalation improves obstructive impairment in patients with MVR pre- and postoperatively.