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[Individual protection devices--opinion and practice of occupational medicine physician].

Technological developments have led to changes in work conditions and the character of work itself that modify the responsibilities and tasks of occupational medicine physicians. Their major task is to protect workers' health through primary prevention, which means the employment of all available measures to prevent adverse health effects resulting from working conditions unfavorable to human health. Statistical data on the incidence of occupational diseases and accidents at work in Poland show that despite many beneficial changes, better labor organization or new technologies in production and services, social and economic consequences of exposure-related diseases induced by so called hard harmful agents in the work environments are still the major problem, hence the significance of prevention. Activities aimed at preventing hazards at workplace should be carried out by employers, safety and work hygiene services and physicians involved in prophylactics. In addition, the selection and supply of individual protectors as well as their use by workers to protect themselves against dangerous and harmful factors occurring in the work environment play an essential role. The authors discuss the significance of using individual protectors from the viewpoint of occupational medicine physicians, and the tasks of this group of physicians in the light of epidemiology of occupational diseases induced by various agents present in the work environment.

Attitude of Health Personnel↗

Diffusion-weighted magnetic resonance imaging in carotid angioplasty and stenting with balloon embolic protection devices.

We compared the results of two procedures to protect against distal embolism caused by embolic debris from carotid angioplasty with stent deployment (CAS) using diffusion-weighted magnetic resonance imaging (MRI). The study group comprised 39 men and 3 women (42 and 3 CAS procedures, respectively) with severe carotid stenosis (average age 70.0 +/- 6.6 years). During 20 CAS procedures the internal carotid artery was protected with a single balloon. A PercuSurge GuardWire was used for temporary occlusion. During 25 CAS procedures the internal and external carotid arteries were simultaneously temporarily occluded with a PercuSurge GuardWire and a Sentry balloon catheter, respectively. Diffusion-weighted MRI was performed 1 to 3 days after CAS. Data from 26 patients undergoing conventional angiography for diagnosis of cerebral ischemic disease, cerebral aneurysm or brain tumors were included as controls. Diffusion-weighted MRI after conventional diagnostic angiography showed ischemic spots in 3 of the 26 controls (11.5%). Ischemic spots were observed during 11 of 20 CAS procedures with the internal carotid artery protected with a single balloon (55.0%), and were observed during 9 of 25 CAS procedures with both the internal and external carotid arteries protected (36.0%). This difference was significant (P = 0.0068). Ischemic lesions appeared not only ipsilateral to the carotid stenosis but also in the contralateral carotid artery (31.9%) and vertebrobasilar territory (25.3%). Better protection was obtained with simultaneous double occlusion of both the internal and external carotid artery than with single protection of the internal carotid artery during CAS.

Aged↗

[A new radiation protection device for cardiologists active in interventional radiology].

The radiation protection system up to now has been in the form of a lead glass pane and a lead curtain on the examination table. As new equipment we used a leaded rubber cover (Pb 0.75 mm) extending from the foot to the rib cage of the patient and a 60-cm high and 70-cm wide stand, reinforced with leaded rubber (Pb 1.0 mm) fixed onto the foot switch. During the period of 2 months the total radiation dose in 156 coronary angioplasties and 71 diagnostic heart catheterizations was measured on the hand, thorax, lower leg and foot of the examiner using ring and placet dosimeters. The dose was measured for a further 2 months, during 152 coronary angioplasty and 66 diagnostic heart catheterizations without the new extra radiation protection equipment. The catheterization procedure was not basically impeded through the lead cover and the lead stand. The radiation dose experienced by the examiner was reduced by 96.8% on the hand, 98.6% on the thorax, 98.8% on the lower leg, and by 99.5% on the foot.

Angioplasty, Balloon, Coronary↗

Detection of embolic particles with the Doppler guide wire during coronary intervention in patients with acute myocardial infarction: efficacy of distal protection device.

OBJECTIVES: We investigated whether embolic particles could be detected as high-intensity transient signals (HITS) with a Doppler guide wire during percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI) We also assessed whether these signals could be reduced using a distal protection (DP) device. BACKGROUND: Embolization of thrombi and plaque components to the microcirculation is a major complication of PCI in patients with AMI. Embolic particles running in the cerebral artery are detected as HITS by transcranial Doppler ultrasound. METHODS: We prospectively studied 16 consecutive patients with AMI who underwent direct PCI within 24 h after the onset of symptoms. A PercuSurge GuardWire (MedtronicAVE, Santa Rosa, California) was used as the DP device. Eight patients were randomly assigned to the non-DP group, and the remaining eight were assigned to the DP group. Coronary flow velocity was recorded continuously from before the first balloon inflation to after balloon deflation. RESULTS: All patients in the non-DP group had HITS detected (12 +/- 9 counts) within five consecutive beats (4 +/- 1 beat) after balloon deflation, but none were detected in any of the patients in the DP group. CONCLUSIONS: The Doppler guide wire can be used to visually detect and count emboli as HITS, and the DP device is effective for prevention of distal embolization.

Aged↗

Respiratory health status in swine producers using respiratory protective devices.

A cross-sectional survey on respiratory health in swine producers showed that 30% of 301 examined men usually used a dust mask when working inside a barn. They did not differ significantly from dust mask nonusers in respect to respiratory symptoms and lung function. This analysis was undertaken to determine whether the respiratory health of dust mask users was associated with reasons why they had started individual respiratory protection. The subjects were recontacted in order to identify those who started using a mask to deliberately prevent symptoms (42 men) and those who started protection because of pre-existing respiratory symptoms (44 men). Not unexpectedly, between-group comparisons of respiratory symptoms and lung function suggest that swine producers who wear dust masks for preventive purposes have better respiratory health than those who wear dust masks because of symptoms or those who do not use individual respiratory protection. The individual reasons for starting dust mask usage should be examined among potential determinants of the outcomes of prospective studies which can then provide more valid assessment of the effect of individual respiratory protection.

Adult↗

Stenting of a large thrombus-containing subclavian artery stenosis using a distal protection device.

Atheromatous obstructive lesions of the arch vessels that contain thrombi are at high risk for distal embolization during angioplasty. This can lead to catastrophic neurological complications. We report a case of acute-on-chronic ischemia of the left upper limb due to thrombus-containing subclavian artery stenosis. After placement of an intravascular filter device, angioplasty and stent implantation successfully relieved the stenosis without any complications.

Aged↗

Reduction of severe wrist injuries in snowboarding by an optimized wrist protection device: a prospective randomized trial.

BACKGROUND: The benefits of sport are well recognized, but many activities carry a sport-specific injury risk. Snowboarding has become an increasingly popular winter sport in Austria in recent years, with an estimated 900,000 participants annually. Roughly 6,000 of these suffer from injury and up to 2,000 sustain moderate or severe wrist injuries (mainly fractures of the distal radius and epiphysiolyses). METHODS: We conducted a prospective, randomized, controlled trial to test the protective effect of a wrist protector, which differs in position, stiffness, length, and fixation from conventional protectors. Seven hundred twenty-one snowboarders were randomized into two groups. The risk factors and the injuries that occurred were registered by questionnaires and, in case of medical treatment, by medical reports. Time until injury (in half-days) was compared by the proportional hazards model. RESULTS: Nine severe wrist injuries were sustained in the unprotected control group and only one in the protected group (hazard ratio, 0.13; 95% confidence limits, 0.02, 1.04). Twelve snowboarders of the protector group secretly discarded their protectors during the trial (including the snowboarder who suffered the one and only severe wrist injury of this group). A per-protocol analysis was therefore performed, which demonstrated a more accentuated result (p = 0.003). There was no statistically significant increase in the incidence of other types of injury. Experience was shown to be a further protective factor. CONCLUSION: We recommend the use of a wrist protector, particularly for novices participating in this sport. As in other domains of medicine, preventive measures can decrease morbidity also in terms of sport injuries.

Adolescent↗