Combined laparoscopic-endoscopic method using an omental plug for therapy of gastroduodenal ulcer perforation.

BACKGROUND: Laparoscopic techniques have been proposed as an alternative to open surgery for therapy of peptic ulcer perforation. They provide better postoperative comfort and absence of parietal complications, but leakage occurs in 5% of cases. We describe a new method combining laparoscopy and endoluminal endoscopy, designed to ensure complete closure of the perforation. METHODS: Six patients with anterior ulcer perforations (4 duodenal, 2 gastric) underwent a concomitant laparoscopy and endoluminal endoscopy with closure of the orifice by an omental plug attracted into the digestive tract. RESULTS: All perforations were sealed. The mean operating time was 72 minutes. The mean hospital stay was 5.5 days. There was no morbidity and no mortality. At the 30-day evaluation all ulcers but one (due to Helicobacter pylori persistence) were healed. CONCLUSIONS: This method is safe and effective. Its advantages compared with open surgery or laparoscopic patching as well as its cost-effectiveness should be studied in prospective randomized trials.

Transpalpebral proton beam radiotherapy of choroidal melanoma.

BACKGROUND: Collateral damage to upper eyelid margin during proton beam radiotherapy (PBR) for choroidal melanoma may cause squamous metaplasia of the tarsal conjunctiva with keratinisation, corneal irritation, discomfort and, rarely, corneal perforation. We evaluated transpalpebral PBR as a means of avoiding collateral damage to the upper eyelid margin without increasing the risk of failure of local tumour control. METHODS: Retrospective study of consecutive patients who underwent PBR for choroidal melanoma between 1992 and 2007 at the Royal Liverpool University Hospital and the Douglas Cyclotron at Clatterbridge Cancer Centre, UK. RESULTS: Sixty-three patients were included in this study. Mean basal tumour diameter and tumour thickness were 11.8 mm and 3.6 mm, respectively. PBR mean beam range and modulation were 26.5 mm and 16.9 mm respectively. The eyelid margin was included in the radiation field in 15 (24%) eyes. The median follow-up was 2.5 years. Local tumour recurrence developed in 2 (3.2%) patients. In these two cases that developed tumour recurrence the transpalpebral treatment did not involve the eyelid margin. Six (9.5%) patients died of metastatic disease. No eyelid or ocular surface problems developed in any of the 48 patients who were treated without eyelid rim involvement, while 7 of the 15 patients with unavoidable irradiation of the eyelid rim developed some degree of madarosis. These seven patients all received more than 26.55 proton Gy to the eyelid margin. Symptoms, such as grittiness occurred in 12% of 48 patients without eyelid margin irradiation as compared with 53% of 15 patients whose lid margin was irradiated. CONCLUSIONS: Transpalpebral PBR of choroidal melanoma avoids eyelid and ocular surface complications without increasing failure of local tumour control.

Health effects of occupational exposure in a dairy food industry, with a specific assessment of exposure to airborne lactic acid bacteria

OBJECTIVE:: Lactic acid bacteria (LAB) are used in food industries as probiotic agents. The aim of this study is to assess the potential health effects of airborne exposure to a mix of preblend (LAB and carbohydrate) and milk powder in workers. METHODS:: A medical questionnaire, lung function tests, and immunologic tests were carried out on 50 workers. Occupational exposure to inhalable dust and airborne LAB was measured. RESULTS:: Workers not using respiratory masks reported more symptoms of irritation than workers using protection. Workers from areas with higher levels of airborne LAB reported the most health symptoms and the immune responses of workers to LAB was higher than the immune responses of a control population. CONCLUSIONS:: Measures to reduce exposure to airborne LAB and milk powder in food industries are recommended.

Tabagisme passif

Les spécialistes en santé au travail ont très tôt insisté pour établir des lois et des mesures de protection contre la fumée passive pour les employés, comme l'article de J. Perrenoud ["Tabagisme passif : avancées et pièges dans l'évolution du droit suisse"] le montre. Dans la recherche également, les premières études sur les effets nocifs et gênants ont été réalisées par les spécialistes en santé au travail. Dans les années 70 et 80, c'est plus particulièrement A. Weber et ses collègues de l'IHA ETH Zurich qui ont montré que l'irritation des yeux, le clignement des paupières et la sensation de gêne augmentent en fonction de la concentration de la fumée passive et de la durée de l'exposition. Ces travaux ont été pris en compte dans le fameux rapport américain du Surgeon General sur la nocivité de la fumée passive : le point de départ de la lutte contre la fumée passive aux Etats-Unis. Au niveau de l'exposition, les hygiénistes de l'Institut universitaire romand de santé au travail (IST) ont développé des techniques de mesure et de prélèvement. [Auteure (extrait)]

Neonatal Minimally Invasive Surgery for Congenital Diaphragmatic Hernias: a multicenter study using thoracoscopy or laparoscopy.

BACKGROUND: Minimally invasive surgery (MIS) for late-presenting congenital diaphragmatic hernia (CDH) has been described previously, but few neonatal cases of CDH have been reported. This study aimed to report the multicenter experience of these rare cases and to compare the laparoscopic and thoracoscopic approaches. METHODS: Using MIS procedures, 30 patients (16 boys and 14 girls) from nine centers underwent surgery for CDH within the first month of life, 26 before day 5. Only one patient had associated malformations. There were 10 preterm patients (32-36 weeks of gestational age). Their weight at birth ranged from 1,800 to 3,800 g, with three patients weighing less than 2,600 g. Of the 30 patients, 18 were intubated at birth. RESULTS: The MIS procedures were performed in 18 cases by a thoracoscopic approach and in 12 cases by a laparoscopic approach. No severe complication was observed. For 20 patients, reduction of the intrathoracic contents was achieved easily with 15 thoracoscopies and 5 laparoscopies. In six cases, the reduction was difficult, proving to be impossible for the four remaining patients: one treated with thoracoscopy and three with laparoscopy. The reasons for the inability to reduce the thoracic contents were difficulty of liver mobilization (1 left CDH and 2 right CDH) and the presence of a dilated stomach in the thorax. Reductions were easier for cases of wide diaphragmatic defects using thoracoscopy. There were 10 conversions (5 laparoscopies and 5 thoracoscopies). The reported reasons for conversion were inability to reduce (n = 4), need for a patch (n = 5), lack of adequate vision (n = 4), narrow working space (n = 1), associated bowel malrotation (n = 1), and an anesthetic problem (n = 1). Five defects were too large for direct closure and had to be closed with a patch. Four required conversion, with one performed through video-assisted thoracic surgery. The recurrences were detected after two primer thoracoscopic closures, one of which was managed by successful reoperation using thoracoscopy. CONCLUSIONS: In the neonatal period, CDH can be safely closed using MIS procedures. The overall success rate in this study was 67%. The indication for MIS is not related to weeks of gestational age, to weight at birth (if >2,600 g), or to the extent of the immediate neonatal care. Patients with no associated anomaly who are hemodynamically stabilized can benefit from MIS procedures. Reduction of the herniated organs is easier using thoracoscopy. Right CDH, liver lobe herniation, and the need for a patch closure are the most frequent reasons for conversion.

Pheomelanin-based colouration is correlated with indices of flying strategies in the barn owl

Resource polymorphism refers to individuals from the same population foraging in alternative habitats or on alternative food. Food specialization can be associated with adaptations such as colour polymorphism, with pale and dark colours conferring differential camouflage in different habitats. Pale and dark-reddish pheomelanic Barn Owls (Tyto alba) forage on different prey species in closed and open habitats, respectively. We show here that darker-reddish owls have heavier stomach content when found dead, and their 5th secondary wing feather is more deeply anchored inside the integument. These correlations suggest that their feathers bend less when flying, and that darker-reddish Barn Owls are able sustain more intense flying than their paler conspecifics.

Dietary folates and cancer risk in a network of case-control studies.

Background Folate deficiency leads to DNA damage and inadequate repair, caused by a decreased synthesis of thymidylate and purines. We analyzed the relationship between dietary folate intake and the risk of several cancers. Patients and methods The study is based on a network of case-control studies conducted in Italy and Switzerland in 1991-2009. The odds ratios (ORs) for dietary folate intake were estimated by multiple logistic regression models, adjusted for major identified confounding factors. Results For a few cancer sites, we found a significant inverse relation, with ORs for an increment of 100 μg/day of dietary folate of 0.65 for oropharyngeal (1467 cases), 0.58 for esophageal (505 cases), 0.83 for colorectal (2390 cases), 0.72 for pancreatic (326 cases), 0.67 for laryngeal (851 cases) and 0.87 for breast (3034 cases) cancers. The risk estimates were below unity, although not significantly, for cancers of the endometrium (OR = 0.87, 454 cases), ovary (OR = 0.86, 1031 cases), prostate (OR = 0.91, 1468 cases) and kidney (OR = 0.88, 767 cases), and was 1.00 for stomach cancer (230 cases). No material heterogeneity was found in strata of sex, age, smoking and alcohol drinking. Conclusions Our data support a real inverse association of dietary folate intake with the risk of several common cancers.

Assessment of human skin penetration of two irritant herbicides

Two common herbicides; isoproturon and bentazon, are strong skin irritants and cross the skin barrier easily. Assessment of percutaneous absorption of these substances is a very important step in the evaluation of any dermal or transdermal dose, especially among agricultural workers who frequently have dermal exposures during crop treatment. The aims of the study were to determine the permeation rate of human skin for both herbicides in vitro, and histologically evaluate skin damage due to irritation at different concentrations. Skin penetration was assessed using a dynamic flow-through in vitro penetration system and analysis were performed with ion trap LC-MS (acidified water: acetronitile, C18 column). Two concentrations of bentazon (75 and 150 μg/mL) and isoproturon (125 and 250 μg/mL) in saline solution were applied on excised human skin from several donors. Saline water was used as receptor fluid. Collection times were: 4, 8, and 24 hours. After the experiments, the skin was removed and examined by histopathology for apoptosis, acanthosis, acantholysis and epidermolysis. The skin permeation rate, J, was calculated from the slope of the cumulative amount permeated as a function of time. The lag time, tL, was assigned from the time-axis intercept of the extrapolation of this linearity. Our results showed that tL for bentazon and isoproturon for both concentrations tested were similar; 2, 1.5 hours, respectively. Bentazon had a lowerer J compared to isoproturon; 350, 600 ng/cm2/h, respectively. Some acanthosis was observed after 8 hours of exposure to either of the two substances. In conclusion, our in vitro experiments demonstrate that bentazon and isoproturon cross the skin barrier within 2 hours even at very low concentrations, and showed some signs of skin damage. Future tests involve concentrations found in commercial products.

Red meat and cancer risk in a network of case-control studies focusing on cooking practices.

BACKGROUND: Consumption of red meat has been related to increased risk of several cancers. Cooking methods could modify the magnitude of this association, as production of chemicals depends on the temperature and duration of cooking. METHODS: We analyzed data from a network of case-control studies conducted in Italy and Switzerland between 1991 and 2009. The studies included 1465 oral and pharyngeal, 198 nasopharyngeal, 851 laryngeal, 505 esophageal, 230 stomach, 1463 colon, 927 rectal, 326 pancreatic, 3034 breast, 454 endometrial, 1031 ovarian, 1294 prostate and 767 renal cancer cases. Controls included 11 656 patients admitted for acute, non-neoplastic conditions. Odds ratios (ORs) and confidence intervals (CIs) were estimated by multiple logistic regression models, adjusted for known confounding factors. RESULTS: Daily intake of red meat was significantly associated with the risk of cancer of the oral cavity and pharynx (OR for increase of 50 g/day = 1.38; 95% CI: 1.26-1.52), nasopharynx (OR = 1.29; 95% CI: 1.04-1.60), larynx (OR = 1.46; 95% CI: 1.30-1.64), esophagus (OR = 1.46; 95% CI: 1.23-1.72), colon (OR = 1.17; 95% CI: 1.08-1.26), rectum (OR = 1.22; 95% CI:1.11-1.33), pancreas (OR = 1.51; 95% CI: 1.25-1.82), breast (OR = 1.12; 95% CI: 1.04-1.19), endometrium (OR = 1.30; 95% CI: 1.10-1.55) and ovary (OR = 1.29; 95% CI: 1.16-1.43). Fried meat was associated with a higher risk of cancer of oral cavity and pharynx (OR = 2.80; 95% CI: 2.02-3.89) and esophagus (OR = 4.52; 95% CI: 2.50-8.18). Risk of prostate cancer increased for meat cooked by roasting/grilling (OR = 1.31; 95% CI: 1.12-1.54). No heterogeneity according to cooking methods emerged for other cancers. Nonetheless, significant associations with boiled/stewed meat also emerged for cancer of the nasopharynx (OR = 1.97; 95% CI: 1.30-3.00) and stomach (OR = 1.86; 95% CI: 1.20-2.87). CONCLUSIONS: Our analysis confirmed red meat consumption as a risk factor for several cancer sites, with a limited impact of cooking methods. These findings, thus, call for a limitation of its consumption in populations of Western countries.

A link between FXYD3 (Mat-8)-mediated Na,K-ATPase regulation and differentiation of Caco-2 intestinal epithelial cells.

FXYD3 (Mat-8) proteins are regulators of Na,K-ATPase. In normal tissue, FXYD3 is mainly expressed in stomach and colon, but it is also overexpressed in cancer cells, suggesting a role in tumorogenesis. We show that FXYD3 silencing has no effect on cell proliferation but promotes cell apoptosis and prevents cell differentiation of human colon adenocarcinoma cells (Caco-2), which is reflected by a reduction in alkaline phosphatase and villin expression, a change in several other differentiation markers, and a decrease in transepithelial resistance. Inhibition of cell differentiation in FXYD3-deficient cells is accompanied by an increase in the apparent Na+ and K+ affinities of Na,K-ATPase, reflecting the absence of Na,K-pump regulation by FXYD3. In addition, we observe a decrease in the maximal Na,K-ATPase activity due to a decrease in its turnover number, which correlates with a change in Na,K-ATPase isozyme expression that is characteristic of cancer cells. Overall, our results suggest an important role of FXYD3 in cell differentiation of Caco-2 cells. One possibility is that FXYD3 silencing prevents proper regulation of Na,K-ATPase, which leads to perturbation of cellular Na+ and K+ homeostasis and changes in the expression of Na,K-ATPase isozymes, whose functional properties are incompatible with Caco-2 cell differentiation.

Dinámica espacio temporal en la ecología trófica de la anchoveta (Engraulis ringens Jenyns, 1842; pisces: engraulide) en el mar peruano

El objetivo de este trabajo es estudiar las variaciones ontogénicas, espaciales y nictemerales en la dieta de la anchoveta peruana (Engraulis ringens). El trabajo se basa en el análisis de contenido estomacal de 13 430 anchovetas (peces de 4 a 19,5 cm) muestreados durante 22 cruceros de investigación realizados a bordo de las embarcaciones científicas del Instituto del Mar del Perú durante el período 1996-2003. Previo a los análisis estadísticos la contribución de cada grupo de presa fue convertido a carbonó. Los datos fueron procesados por medio de estadística uni y multivariada en función de la talla de la anchoveta, la latitud, la distancia de la costa, la distancia del borde de la plataforma continental y el período nictemeral. Los resultados enseñan que la anchoveta se alimenta mayormente de zooplancton cualquier sea su tamaño o su distribución espaciotemporal. La anchoveta cambio gradualmente su dieta a lo largo de su ciclo de vida. Así, los individuos mas pequeños han ingerido mayormente copépodos calanoideos (68.0%) y eufausidos (23.3%), mientras que los individuos mas grandes ingirieron mayormente eufausidos (84.9%) y copépodos calanoideos (11.5%). Latitudinalmente, la mayor contribución de los copépodos calanoideos se observó en las zonas de afloramiento de Chicama y San Juan, con el 52.3% y 47.5%, respectivamente. Hasta los 160 km de distancia de la costa, no se ha observado un patrón regular en la contribución de las principales presas, mientras que por fuera, se insinúa un patrón caracterizado por el predominio de los eufausidos (>84%) y la menor contribución de copépodos calanoideos (<14,1%). En la plataforma continental los eufausidos contribuyeron con el 55.6% y los copépodos calanoideos con el 36.9%; mientras que por fuera de esa zona, los eufausidos se incrementaron al 75.3% y los copépodos calanoideos disminuyeron al 20.1%. Al considerar el período nictemeral, el ítem presa predominante durante el día fueron los eufausidos (52.7%) seguido de los copépodos calanoideos (40.9%); mientras que durante la noche, los eufausidos se incrementaron al 80.2% y los copépodos calanoideos disminuyeron al 15.7%. Estos resultados contradicen lo que se conocía acerca de la variabilidad de la dieta de la anchoveta, desestimándose: (i) que en el norte es fitoplanctívora y en el sur es zooplanctívora; (ii) que la fracción zooplanctónica es mayor en la zona oceánica. Asimismo, se ha demostrado que: (i) la anchoveta es principalmente zooplanctófaga durante su ciclo de vida, con modificaciones que corresponden a la mayor ingesta de presas pequeñas cuando son juveniles y de presas grandes cuando son adultas, (ii) en la zona de influencia de la plataforma continental consume aproximadamente el doble de copépodos calanoideos que en la zona oceánica, y aproximadamente una tercera parte menos de eufausidos en la zona interna que en la zona oceánica, y (iii) durante la noche y el día ingiere principalmente eufausidos pero la contribución de los copépodos calanoideos sube al 40%.

Relaciones ontogénicas y espacio-temporales en la dieta del calamar gigante (Dosidicus gigas) en Perú, utilizando un Modelo Aditivo Generalizado

El calamar gigante Dosidicus gigas (d'Orbigny, 1835) es un depredador importante en el ecosistema del Perú. Se postula que el papel del calamar gigante varía teniendo en cuenta la talla, tiempo, hora, temperatura y distribución espacial. Para comprobar esta hipótesis se aplicó un modelo aditivo generalizado (GAM) en datos biológicos de alimentación de 4178 calamares gigantes capturados por la flota industrial pesquera a lo largo del litoral peruano (3ºS a 18ºS) desde 2 a 299 millas náuticas (mn) de distancia a la costa desde el año 2004 a 2009 realizados por el Laboratorio de Ecología Trófica del Instituto del Mar del Perú (IMARPE). La talla de los calamares estudiados fluctuó entre 14 y 112 cm de longitud de manto (LM). En total 43 item-presa fueron registrados, los grupos más importantes fueron los cefalópodos (Dosidicus gigas), Teleosteii (Photichthyidae, Myctophidae y Nomeidae) y Malacostraca crustáceos (Euphausiidae). Las presas principales fueron D. gigas (indicando canibalismo) en términos gravimétricos (% W=35.4), los otros cephalopodos en frecuencia de ocurrencia (FO=14.4), y los eufáusidos en términos de abundancia relativa (% N=62.2). Estos resultados reflejan una alta variabilidad de la dieta, y un espectro trófico similar en comparación con otras latitudes en ambos hemisferios (México y Chile). Los modelos GAM muestran que todas las variables predictoras fueron significativas en relación a la variable respuesta llenura estomacal (p <0.0001). La llenura estomacal fue mayor en los individuos juveniles, también durante la noche hubo mayor consumo, mientras no se reflejaron tendencias en la alimentación con relación a la temperatura superficial del mar (TSM), pero espacialmente se observan cambios en la dieta, aumentando el porcentaje de llenura a medida que esta especie se aleja de la costa. Por lo tanto se concluye que la dieta del calamar gigante depende de la talla y su distribución espacio-temporal.

Trophic ecology of jumbo squid and predatory fishes in the Northern Humboldt Current System

This work provides a contribution to a better understanding of the trophic ecology of important predators in the Northern Humboldt Current System, the jack mackerel (Trachurus murphyi), the chub mackerel (Scomber japonicus) and the jumbo squid (Dosidicus gigas) by the characterization of the highly variable feeding patterns of these species at different spatiotemporal scales. We provided new knowledge on the comparative trophic behaviour of these species, defined as opportunistic in previous investigations. For that purpose we applied a variety of statistical methods to an extensive dataset of 27,188 non-empty stomachs. We defined the spatial organization of the forage fauna of these predators and documented changes in prey composition according to predators’ size and spatiotemporal features of environment. Our results highligh the key role played by the dissolved oxygen. We also deciphered an important paradox on the jumbo squid diet: why do they hardly forage on the huge anchovy (Engraulis ringens) biomass distributed of coastal Peru? We showed that the shallow oxygen minimum zone present off coastal Peru could hamper the co-occurrence of jumbo squids and anchovies. In addition, we proposed a conceptual model on jumbo squid trophic ecology including the ontogenetic cycle, oxygen and prey availability. Moreover we showed that the trophic behaviour of jack mackerel and chub mackerel is adapted to forage on more accessible species such as for example the squat lobster Pleurocondes monodon and Zoea larvae. Besides, both predators present a trophic overlap. But jack mackerel was not as oracious as chub mackerel, contradictorily to what was observed by others authors. Fish diet presented a high spatiotemporal variability, and the shelf break appeared as a strong biogeographical frontier. Diet composition of our fish predators was not necessarily a consistent indicator of changes in prey biomass. El Niño events had a weak effect on the stomach fullness and diet composition of chub mackerel and jack mackerel. Moreover, decadal changes in diet diversity challenged the classic paradigm of positive correlation between species richness and temperature. Finally, the global patterns that we described in this work, illustrated the opportunistic foraging behaviour, life strategies and the high degree of plasticity of these species. Such behaviour allows adaptation to changes in the environment.

Biología y pesquería del perico o dorado Coryphaena hippurus, febrero 2010

La prospección para evaluar la biología y pesquería de Coryphaena hippurus perico o dorado, se efectuó del 10 de febrero al 1 de marzo 2010, a bordo del BIC Imarpe V. El área de extracción fue de 4°59’32,8’’ a 10°15’20,1’’S y de 79°55’16,2’’ a 84°35’04,2’’W; la captura total fue 1.500,5 kg. La CPUE varió de 0,9 a 18,2 kg/Nº Anzuelos/1000*hora efectiva de pesca. Se encontró alta selección interespecífi ca del espinel superfi cial, al capturar 87,8% de perico y 8 especies de peces, tortugas y cefalópodos. El rango de tallas para hembras fue 79 - 141 cm de LT, en machos fue 100 - 157 cm LT. El factor de condición de Fulton en machos varió de 0,30 a 0,46 y en hembras de 0,32 a 0,40. Se determinó para hembras: L∞=148,92 cm, tasa de crecimiento anual (K) 1,081, se estimó t0 = -0,076 años, el Índice de performance Ǿ= 4,38; para machos, estos parámetros fueron L∞=169,75 cm, tasa de crecimiento anual (K) de 0,893, t0 = -0,115, índice de performance Ǿ= 4,40. La curva de crecimiento en talla para hembras, indica que a un año de edad la LT es 102,4 cm y en machos 107 cm. El máximo crecimiento en peso para hembras y machos fue a 1,5 años de vida. El Índice gonadosomático (IGS) fl uctuó de 3,2 a 4,6 mostrando comportamiento heterogéneo. La proporción sexual fue de 2:1 favorable a las hembras. La fecundidad parcial fue de 324.416 ovocitos por tanda de desove. La fecundidad relativa fue 56 ovocitos/ gramo de peso corporal. El tipo de alimento fue peces, cefalópodos y crustáceos con dominancia de Exocoetus volitans (%IRI = 31,6), Argonauta spp. (%IRI = 26,4) mostrando variaciones según zonas y tallas. El consumo de alimento fue 472,7 g/ind./día correspondiente a 7,4% de su peso corporal, presentando fl uctuaciones con respecto a la talla; alimentándose en horas de la mañana, con un máximo entre las 8:00 y 9:59 horas. Se encontraron 5.762 parásitos, identifi cándose 8 especies en cuatro taxas. La prevalencia parasitaria indica que Tentacularia coryphaenae y Bathycotyle coryphaenae alcanzan el 100%, seguido por Hysterothylacium sp. 62% y Caligus coryphaenae 46%. El mayor número de parásitos se encontró en el estómago. Los peces entre 96–100 cm de LT son los más parasitados. La mayor incidencia parasitaria se encontró en la zona norte, en el tramo Paita-Salaverry. Los registros de temperatura en la columna de agua fueron de 12,7 a 27,3 °C y las ATSM de 0,2 a 4,1 °C. Por el frente oceánico se observaron comportamientos térmicos cálidos asociados a las masas de Aguas Ecuatoriales Superfi ciales y Aguas Subtropicales Superfi ciales y por la zona costera se localizaron Aguas Costeras Frías tanto en Chimbote como en Chicama con temperaturas próximas a 22,0 °C. La concentración de oxígeno disuelto superfi cial se presentó favorable para el perico.

Motifs de consultation en médecine du travail [Reasons for consultation in occupational medicine].

The inability to characterize more precisely the extent of occupational diseases limits the implementation of an effective preventive policy. Furthermore, not all work-related conditions are reported by the Swiss workers' compensation system. A seven-year (1986 to 1992) retrospective study of medical visits in an Institute of Occupational Health Sciences is presented. The objective of this study is to expand data on occupational diseases for clinical and public health intervention. 298 patients have been examined for a possible work-related condition. In 140 cases (47%), an occupational disease according to the Swiss Law was found. Respiratory tract was the main target of industrial pollutants. Respiratory irritation , solvent intoxications, contact dermatitis and asthma were the most frequent conditions seen. 97 workplace visits (32% of all medical visits) were necessary for diagnostic purposes. Painters (construction, cars) and other solvent exposed workers were at particular risk. Rare alpha-1-antitrypsin phenotypes were found several times in workers with respiratory diseases confirming the value of this test in occupational medicine. Despite many referral biases, direct clinical and public health applications of the data are possible. This study confirms the hypothesis that occupational respiratory diseases and intoxications are probably underreported in the workers' compensation statistics. Activities with an increased risk of work-related diseases have been identified so workplace intervention could be highly targeted. This study shows also that a more intense collaboration between primary care physicians, hospital services and occupational medical specialists is necessary to improve clinical and epidemiological surveillance of work-related health conditions.