Markku Nurminen

Clozapine-induced agranulocytosis

SummaryAn epidemic of agranulocytosis and granulocytopenia occurred in 1975 in conjunction with clozapine treatment of mental patients in Finland. An attempt was made to assess the epidemiologic and genetic factors contributing to the adverse drug effect. The estimated incidence rate in Finland was 2.1/1000 patient-months. This figure could not be compared with rates from other countries because of the inexact nature of the figures reported so far. All 16 cases occurred in seven hospitals in southwestern Finland, whereas the overall hospital net use of the drug was geographically evenly distributed. The difference between the observed and the proportionally expected incidence of cases amongst the hospitals where clozapine was used was statistically significant. The average consumption of the drug did not differ between the hospitals where cases occurred and those where no definite cases could be diagnosed. Six-generation pedigree analyses failed to reveal significant parental consanguinity or genetic kinship between probands. Neither did the birth places of the ancestors of the probands disclose a typical isolate pattern. In conclusion, the cases appeared to be confined to a few hospitals in southwestern Finland. Although a genetic factor is not excluded, we found no evidence in support of a genetic mechanism.

Sewing-machine operators' work and musculo-skeletal complaints

The purpose of the study was to obtain information about the possible occupational origin of the high occurrence of musculo-skeletal (rheumatic) complaints among sewing-machine operators. The subjects were chosen by random sampling and comprised 40 sewing-machine operators with short work cycles (30-60 s) and 20 seamstresses as the reference group. The two groups were matched with respect to age and length of service. A survey of working postures showed that the sewing-machine operators work was more static. Musculo-skeletal complaints occurred more frequently among the sewing-machine operators, especially in the neck and shoulders (p<0.01) and the lower limbs (p<). It is concluded that the occupational change from seamstresses work to sewing-machine operators work is associated with an increase in the occurrence of musculo-skeletal complaints.

Microcirculation of ocular fundus in viscose rayon workers exposed to carbon disulfide

A neuro-ophthalmological examination, including fluorescein angiography, has been made of 100 male viscose rayon workers occupationally exposed to carbon disulfide (CS2), and 97 control males (paper-mill workers). Corrected visual acuity, visual field, eye motility, pupillary reactions and biomicroscopy, were found to be normal in all the eyes examined. Fluorescein angiography revealed the filling of retinal vasculature before choroid in 76% of the exposed subjects, and in 70% of the controls. Delayed peripapillary filling, either circumferential or segmental, or both, occurred in 68 exposed and 38 nonexposed; the difference was highly significant (p<0.01). This phenomenon was not correlated with ageing, smoking habits, serum cholesterol level, or glucose tolerance. The intraocular pressures in these eyes were normal. General narrowing and irregularity of vessel calibre were almost equally common findings in both groups. The mean widths of eight arterioles and the narrowest vein were significantly wider in the exposed group (p<0.01, and p<0.05, respectively). No evidence was found for retinopathy attributable to carbon disulfide exposure. Eine neuro-ophthalmologische Untersuchung und Fluorescein-Angiographie wurde bei 100 Arbeitern einer Viscose-Industrie mit Schwefelkohlenstoffaussetzung (CS2) durchgeführt. Als Kontrollen dienten 97 Arbeiter einer Papierindustrie. Die Sehschärfe mit Korrektur, das Gesichtsfeld, die Augenbewegungen, die Pupillenreaktionen und die Biomikroskopie waren normal. Die Fluorescein-Angiographie ergab eine initiale Füllung der Netzhautarteriole in 76% der CS2 ausgesetzten Gruppe und in 70 % der Kontrollgruppe. Eine verlangsamte Füllung entweder von zirkumferentem oder segmentalem Typ wurde in 68 Viscosearbeitern und in 38 Kontrollen vorgefunden; der Unterschied war statistisch hochsignifikant (P<0.01). Eine Korrelation zum Alter der Untersuchten, zu den Rauchgewohnheiten, zum Serum-Cholesteringehalt und zur Glucosetoleranz ließ sich nicht erkennen. Der intraoculare Druck war normal. Allgemeine Arteriolenverengung und Kaliberunregelmäßigkeiten waren etwa in gleicher Anzahl in beiden Gruppen vorhanden. Das mittlere Kaliber von acht Arteriolen und der kleinsten meßbaren Venolen fand sich signifikant weiter in der CS2 ausgesetzten Gruppe (P<0.01 und P<0.05). Eine Schwefelkohlenstoffretinopathie wurde nicht vorgefunden.