Ellingsen DG, Mørland T, Andersen A
… +1 more, Kjuus H
Br J Ind Med
· 1993 Aug · PMID 8398861
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A cross sectional study of aspects of their neurology was carried out on 77 chloralkali workers previously exposed to mercury (Hg) vapour and compared with 53 age matched referents. The chloralkali workers had been expos...A cross sectional study of aspects of their neurology was carried out on 77 chloralkali workers previously exposed to mercury (Hg) vapour and compared with 53 age matched referents. The chloralkali workers had been exposed for an average of 7.9 years at a concentration of 59 micrograms Hg/m3 in the working atmosphere. The individual mean urinary concentration of Hg for each year of exposure was 531 nmol Hg/1. On average the exposure had ceased 12.3 years before the examinations. Both the median sensory nerve conduction velocity and the amplitude of the sural nerve were associated with measures of cumulative exposure to Hg. An association was also found between years since first exposure to Hg and aspects of the visual evoked response. Previously exposed subjects with postural tremor or impaired coordination also had alterations in visual evoked response. These results may indicate an effect of previous exposure to mercury vapour on the nervous system, possibly in the visual pathway, cerebellum, and the peripheral sensory nerves.
Br J Ind Med
· 1993 Aug · PMID 8398860
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Phagocytosis of quartz particles by rabbit alveolar macrophages and monocytes and human granulocytes and monocytes was accompanied by stimulation of substrate free reduction of nitroblue tetrazolium to formazan. This ref...Phagocytosis of quartz particles by rabbit alveolar macrophages and monocytes and human granulocytes and monocytes was accompanied by stimulation of substrate free reduction of nitroblue tetrazolium to formazan. This reflects activation of an oxygen dependent bactericidal system of phagocytes and total (exogenic and endogenic) generation of active oxygen species. Low fibrogenic and cytotoxic alumina dust tended to increase formazan production by comparison with quartz dust. During phagocytosis of quartz dust by alveolar macrophages and monocytes there was no exogenic generation of superoxide radicals and hydrogen peroxide by these cells. By contrast, incubation of human granulocytes with quartz dust caused a significant increase in exogenic generation of superoxide radicals and hydrogen peroxide. Under such conditions, low fibrogenic alumina dust had no effect on hydrogen peroxide generation and substantially decreased the level of superoxide radical generation by human granulocytes. During incubation of rabbit granulocytes with quartz dust, an increase in the level of superoxide radical generation was also detected. It is considered that the differences between alveolar macrophages and granulocytes in their response to quartz dust are important from a physiological point of view. Alveolar macrophages are permanently present in pulmonary alveolae in large quantities; therefore their uncontrolled generation of superoxide radicals and hydrogen peroxide might immediately cause damage to pulmonary parenchyma. At the same time, destruction products from alveolar macrophages that died during phagocytosis of quartz particles contain a factor attracting granulocytes. Presence of a significant number of granulocytes in bronchopulmonary lavage fluid in cases of silicosis indicates development of a pathological process. This agrees well with the data obtained on exogenic generation of superoxide radicals and hydrogen peroxide by granulocytes, and on stimulation of this process due to phagocytosis of the quartz dust.
Br J Ind Med
· 1993 Aug · PMID 8398859
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45 granite crushers and 45 age and smoking matched referents underwent pulmonary function tests in 1976 and 1988. On average, the granite crushers at follow up had worked for 22 years, were 52 (range 36-78) years old, an...45 granite crushers and 45 age and smoking matched referents underwent pulmonary function tests in 1976 and 1988. On average, the granite crushers at follow up had worked for 22 years, were 52 (range 36-78) years old, and had inhaled a cumulated amount of 7 mg of silica in the respirable dust fraction. Between 1976 and 1988 the average concentration of respirable quartz in air was 0.16 mg/m3 (threshold limit value (TLV) = 0.10 mg/m3). In 1988 the granite crushers had somewhat lower forced expiratory flows (forced expiratory volume in one second/vital capacity (FEV1/VC) -4.5% and forced midexpiratory flow FEF50 -15%) compared with the referents and a more uneven ventilation distribution (17% higher slope of phase III in the nitrogen single breath curve). Five smoking granite crushers, but none of the referents, had an FEV1 < 80% of the predicted. During the 12 year interval the granite crushers had--compared with the matched referents--a greater decrease in FEV1 (-4.6%), FEV1/VC (-5.4%), maximal expiratory flow, (-8%) and FEF50 (-14%), and a larger increase in phase III and static compliance (p < 0.02 in all variables). The functional changes suggest the presence of airways obstruction and increased compliance of the lungs. Exposure to silica at concentrations of about twice the present TLV was thus associated with airways obstruction and loss of elastic recoil rather than fibrosis and a restrictive function loss as seen in silicosis. The changes were on average small, but in some tobacco smokers more pronounced changes were found.
Br J Ind Med
· 1993 Aug · PMID 8398858
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A case-control study of malignant and non-malignant respiratory disease among employees of the Owens-Corning Fiberglas Corporation's Newark, Ohio plant was undertaken. The aim was to determine the extent to which exposur...A case-control study of malignant and non-malignant respiratory disease among employees of the Owens-Corning Fiberglas Corporation's Newark, Ohio plant was undertaken. The aim was to determine the extent to which exposures to substances in the Newark plant environment, to non-workplace factors, or to a combination may play a part in the risk of mortality from respiratory disease among workers in this plant. A historical environmental reconstruction of the plant was undertaken to characterise the exposure profile for workers in this plant from its beginnings in 1934 to the end of 1987. The exposure profile provided estimates of cumulative exposure to respirable fibres, fine fibres, asbestos, talc, formaldehyde, silica, and asphalt fumes. Employment histories from Owens-Corning Fiberglas provided information on employment characteristics (duration of employment, year of hire, age at first hire) and an interview survey obtained information on demographic characteristics (birthdate, race, education, marital state, parent's ethnic background, and place of birth), lifetime residence, occupational and smoking histories, hobbies, and personal and family medical history. Matched, unadjusted odds ratios (ORs) were used to assess the association between lung cancer or non-malignant respiratory disease and the cumulative exposure history, demographic characteristics, and employment variables. Only the smoking variables and employment characteristics (year of hire and age at first hire) were statistically significant for lung cancer. For non-malignant respiratory disease, only the smoking variables were statistically significant in the univariate analysis. Of the variables entered into a conditional logistic regression model for lung cancer, only smoking (smoked for six months or more v never smoked: OR = 26.17, 95% confidence interval (95% CI) 3.316-206.5) and age at first hire (35 and over v less than 35: OR = 0.244, 95% CI 0.083-0.717) were statistically significant. There were, however, increased ORs for year of employment (first hired before 1945 v first hire after 1945: OR = 1.944, 95% CI 0.850-4.445), talc (cumulative exposure >1000 fibres/ml days v never exposed: OR = 1.355, 95% CI 0.407-5.515), and asphalt fumes (cumulative exposure >0.01 mg/m(3) days v never exposed: OR 1.131, 95% CI 0.468-2.730). For non-malignant respiratory disease, only the smoking variable was significant in the conditional logistic regression analysis (OR = 2.637, 95% CI 1.146-6.069). There were raised ORs for the higher cumulative exposure categories for respirable fibres, asbestos, silica, and asphalt fumes. For both silica and asphalt fumes, ORs were more than double the reference groups for all exposure categories. A limited number of subjects were exposed to fine fibres. The scarcity of cases and controls limits the extent to which analyses for fine fibre may be carried out. Within those limitations, among those who had worked with fine fibre, the unadjusted, unmatched OR for lung cancer was (1.0 (95% CI 0.229-4.373) and for non-malignant respiratory disease, the OR was 1.5 (95% CI 0.336-6.702). The unadjusted OR for lung cancer for exposure to fine fibre was consistent with that for all respirable fibre and does not suggest an association. For non-malignant respiratory disease, the unadjusted OR for fine fibre was opposite in direction from that for all respirable fibres. Within the limitations of the available data on fibre, there is o suggestion that exposure to fine fibre has resulted in an increase in risk of lung cancer. The increased OR for non-malignant respiratory disease is inconclusive. The results of this population, in this place and time, neither respirable fibres nor any of the substances investigated as part of the plant environment are statistically significant factors for lung cancer risk although there are increased ORs for exposure to talc and asphalt fumes. Smoking is the most important factors in risk for lung cancer in this population. The situation is less clear for non-malignant respiratory disease. Unlike lung cancer, non-malignant respiratory represents a constellation of outcomes and not a single well defined end point. Although smoking was the only statistically significant factor for non-malignant respiratory disease in this analysis, the ORs for respirable fibres, asbestos, silica, and asphalt fumes were greater than unity for the highest exposure categories. Although the raised ORs for these substances may represent the results of a random process, they may be suggestive of an increased risk and require further investigation.
Br J Ind Med
· 1993 Aug · PMID 8398857
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Men assigned to the chlorohydrin unit of Union Carbide's South Charleston plant in the Kanawha Valley of West Virginia were followed up for mortality from 1940 to the end of 1988. This 10 year update was conducted to ver...Men assigned to the chlorohydrin unit of Union Carbide's South Charleston plant in the Kanawha Valley of West Virginia were followed up for mortality from 1940 to the end of 1988. This 10 year update was conducted to verify previous findings of excesses of cancer among the 278 men assigned to the chlorohydrin unit, which primarily produced ethylene chlorohydrin from 1925 to 1957. This process produced ethylene dichloride and bischloroethyl ether as byproducts. Mean duration of assignment was 5.9 years and mean duration of follow up was 36.5 years. Standardised mortality ratios (SMRs) were calculated based on comparisons with the United States white male population. Duration-response trends were assessed by internal comparisons with two different groups of unexposed chemical workers in the Kanawha Valley. The evidence that the earlier finding of an excess of pancreatic cancer was work related is strengthened by the occurrence of two additional cases (0.9 expected). The SMR for pancreatic cancer was 492 (95% CI 158-1140), based on eight observed v 1.6 expected deaths. There were no additional deaths due to leukaemia, but the three to four-fold excess risk for lymphopoietic cancers persisted due to new cases of non-Hodgkin's lymphoma and a death from multiple myeloma. The SMR for lymphatic and haematopoietic cancers was 294 (eight observed v 2.7 expected; 95% CI 127-580). Pronounced increases in risk were seen for total cancer, pancreatic cancer, all lymphatic and haematopoietic cancers, and leukaemia with increasing durations of assignment to the chlorohydrin unit. Most of the cases were first assigned to the unit in the 1930s when chemical manufacturing was in its infancy and exposures were less controlled. These data are insufficient to identify conclusively the causative agent or agents. The weight of evidence, however, based on probable exposure, known toxicity of the chemicals, and animal responses suggest that high exposures to ethylene dichloride, perhaps in combination with other chlorinated hydrocarbons, is the most likely explanation.
Br J Ind Med
· 1993 Aug · PMID 8398856
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Men assigned to units producing ethylene oxide by the chlorohydrin or direct oxidation processes and to other departments using ethylene oxide in two chemical plants were followed up for mortality from 1940 to 1988 (n =...Men assigned to units producing ethylene oxide by the chlorohydrin or direct oxidation processes and to other departments using ethylene oxide in two chemical plants were followed up for mortality from 1940 to 1988 (n = 1896). Based on findings from a previous study of these workers to the end of 1978, which identified confounding exposures, workers assigned to one unit with low ethylene oxide exposure potential were excluded (n = 278). Average duration of exposure was over five years and average follow up was 27 years, with all subjects at least 10 years from first exposure. The data did not support associations of ethylene oxide with all cancer types combined, leukaemia, non-Hodgkin's lymphoma, or brain, pancreatic, or stomach cancers. There were also no duration-response trends. The standardised mortality ratio (SMR) for total cancer was 86 (95% confidence interval 71-104) and did not increase for those hired the earliest and with long duration assignments. The results of this 10 year update and those of other recent studies of ethylene oxide workers do not confirm findings from animal studies and are not consistent with the earliest results reported among ethylene oxide workers.
Bégin R, Ostiguy G, Filion R
… +2 more, Colman N, Bertrand P
Br J Ind Med
· 1993 Aug · PMID 8398855
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Computed tomography (CT; both conventional (CCT) and high resolution (HRCT)) scans of the thorax were evaluated to detect early asbestosis in 61 subjects exposed to asbestos dust in Québec for an average of 22(3) years a...Computed tomography (CT; both conventional (CCT) and high resolution (HRCT)) scans of the thorax were evaluated to detect early asbestosis in 61 subjects exposed to asbestos dust in Québec for an average of 22(3) years and in five controls. The study was limited to consecutive cases with chest radiographs of the International Labour Organisation categories 0 or 1 determined independently. All subjects had a standard high kilovoltage posteroanterior and lateral chest radiograph, a set of 10-15 1 cm collimation CCT scans and a set of three to five 2 mm collimation HRCT scans in the upper, middle, and lower lung fields. Five experienced readers independently read each chest radiograph and sets of CT scans. On the basis of three to five readers agreeing for small opacities of the lung parenchyma, 12/46 (26%) negative chest radiographs were positive on CT scans, but 6/18 (33%) positive chest radiographs were negative on CT scan. On the basis of four to five readers agreeing on a chest radiograph, 36/66 (54%) subjects were normal (group A), 17/66 (26%) were indeterminate (group B), and 13/66 (20%) were abnormal (group C). By the combined readings of CCT and HRCT, 4/31 (13%) asbestos exposed subjects of group A were abnormal (p < 0.001), 6/17 (35%) of group B were abnormal, and in group C, 1/13 (8%) was normal, 2/13 were indeterminate, and 10/13 (77%) were abnormal. Separate readings of CCT and HRCT on distinct films in 14 subjects showed that all cases of asbestosis were abnormal on both CCT and HRCT. Inter-reader analyses by kappa statistics showed significantly better agreement for the readings of CT than the chest radiographs (p < 0.001), and for the reading of CCT than HRCT (p < 0.01). Thus CT scans of the thorax identifies significantly more irregular opacities consistent with the diagnosis of asbestosis than the chest radiograph (20 cases on CT scans v 13 on chest radiographs when four to five readers agreed, 13% of asbestos exposed subjects with normal chest radiographs or 21% of asbestos exposed subjects with normal or near normal chest radiographs. It decreased the number of indeterminate cases significantly from 17 on chest radiographs to 13 on CT scans. All cases of asbestosis detected only on CT scans were similarly seen on CCT and HRCT and did not have significant changes in lung function. The CT scans significantly reduced the inter-reader variability, despite the absence of ILO type reference films for these scans.
McConnell R, Anderson K, Russell W
… +4 more, Anderson KE, Clapp R, Silbergeld EK, Landrigan PJ
Br J Ind Med
· 1993 Aug · PMID 8104464
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A worker developed angiosarcoma, porphyria cutanea tarda, and skin lesions characteristic of mild chloracne. About 10 years earlier he had been employed at a truck terminal in Saint Louis, Missouri, at a time when it was...A worker developed angiosarcoma, porphyria cutanea tarda, and skin lesions characteristic of mild chloracne. About 10 years earlier he had been employed at a truck terminal in Saint Louis, Missouri, at a time when it was sprayed with waste oil contaminated with 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD). The occurrence of these three rare conditions in a single exposed worker supports the aetiological relation between environmental exposure to TCDD and the subsequent development of soft tissue sarcoma and porphyria cutanea tarda.
Measurements of the concentrations of smoke, lead, and five polycyclic hydrocarbons in the air have been made in the City of London in the middle of a busy street and at two control sites. Samples were taken only through...Measurements of the concentrations of smoke, lead, and five polycyclic hydrocarbons in the air have been made in the City of London in the middle of a busy street and at two control sites. Samples were taken only throughout the daytime hours on weekdays to enable us to assess the maximum contribution made by traffic to the pollution in the street. The results showed that during these periods the air in the middle of the street contained three times as much smoke, four times as much lead, and 1.7 times as much 3:4-benzpyrene as were present in the general atmosphere as the City of London as estimated from samples taken at the control sites. One of these sites was chosen because it was only 150 feet away from the street; analyses yielded no evidence that the traffic contributed to the pollution sampled there. Sulphur dioxide concentrations were determined in the early part of the study and the results showed that traffic appeared to add little to the background level. The concentrations of lead found were below those held to be safe by many authorities. Carbon monoxide concentrations, reported in greater detail elsewhere, sometimes reached the accepted industrial maximum allowable concentration of 100 p.p.m.
Fandrem SI, Kjuus H, Andersen A
… +1 more, Amlie E
Br J Ind Med
· 1993 Jul · PMID 8393697
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The incidence of cancer among 2023 male fertiliser workers has been investigated in a historical cohort study. Workers who had been employed for more than one year in work with possible exposure to dust containing nitrat...The incidence of cancer among 2023 male fertiliser workers has been investigated in a historical cohort study. Workers who had been employed for more than one year in work with possible exposure to dust containing nitrate between 1945 and 1979 were included. An individual cumulated exposure to dust expressed in level-years was calculated for each participant. The cohort was followed up from 1953 to the end of 1988, and the incidence of cancer was compared with the national rates. There were 467 deaths v 504.8 expected (standardised mortality ratio (SMR) = 0.93), and 185 cases of cancer v 195.5 expected (standardised incidence ratio (SIR) = 0.95). Thirty cases of lung cancer were found v 27.5 expected (SIR = 1.09). No overall excess of gastric cancer was found (15 cases v 17.0 expected; SIR = 0.89). No association was found between cumulated exposure to nitrate and gastric cancer, and there was no association between duration of employment or time since first employment and incidence of gastric cancer.
Hughes JM, Jones RN, Glindmeyer HW
… +2 more, Hammad YY, Weill H
Br J Ind Med
· 1993 Jul · PMID 8343428
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A survey of workers in seven man made mineral fibre (MMMF) production plants, the subject of a previous report, was conducted, with other blue collar workers serving as regional comparisons. Based on the median reading o...A survey of workers in seven man made mineral fibre (MMMF) production plants, the subject of a previous report, was conducted, with other blue collar workers serving as regional comparisons. Based on the median reading of chest radiographs by five readers, a low prevalence of small opacities, all at the 1/0 and 1/1 profusion levels, was again found: for workers with MMMFs, 23/1435 (1.6%); for comparison workers, 2/305 (0.7%). Spirometric measurements indicated generally healthy populations, and were not related to presence of opacities. Ninety three per cent (21/23) of MMMF workers with opacities worked at the two plants with the highest exposures to fine fibres, resulting in a dose-response relation across plants. For one location, the prevalences of opacities for the MMMF and comparison workers were not significantly different (5.9% (13/220) v 3.1% (2/65)). No comparison x ray films were obtained for the MMMF plant with the highest prevalence (6.6%), so a second phase of the study was conducted, with pre-employment films from these two plants. On this second reading, the prevalence of opacities was lower; there were no significant differences between the two groups of films, and no relation between opacities and exposure indices. There was considerable inter and intrareader variability. These results indicate no adverse clinical, functional or radiographic signs of effects of exposure to MMMFs in these workers.
Br J Ind Med
· 1993 Jul · PMID 8343427
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To study the incidence of and mortality from cancer among sewage workers a retrospective analysis was performed on a cohort of 656 men employed for at least one year at any one of 17 Swedish sewage plants during the year...To study the incidence of and mortality from cancer among sewage workers a retrospective analysis was performed on a cohort of 656 men employed for at least one year at any one of 17 Swedish sewage plants during the years 1965-86. Assessment of exposure was done by classification of work tasks. Lower than expected total mortality (standardised mortality ratio (SMR) = 0.75, 95% confidence interval (95% CI) 0.58-0.97) and cardiovascular mortality (SMR = 0.61, 95% CI 0.39-0.91) was found. This was interpreted as a result of the healthy worker effect. For all cancers combined the mortality (SMR = 1.08, 95% CI 0.68-1.67) and morbidity (SMR = 1.02, 95% CI 0.72-1.38) were comparable with those of the general population. There were increased incidences for brain tumours (SMR = 2.19, 95% CI 0.45-6.39), gastric cancers (SMR = 2.73, 95% CI, 1.00-5.94), and renal cancers (SMR = 1.68, 95% CI = 0.35-4.90). For lung cancer the risk was reduced (SMR = 0.70, 95% CI 0.15-2.05). Allowance for a latency period of 10 years from the start of exposure did not change the pattern. Logistic modelling was used to search for exposure-response relations. In a logistic model with the confounder age forced in, renal cancer had a significant positive relation with a weighted sum of employment times, where the weights describe the classification of exposure. No exposure-response relations were found for brain tumors or gastric cancers. The increased risks are based on small numbers of cases. A future follow up will add more conclusive power to the study. Specific exposures need to be identified to allow for a better dose-response analysis.
Nelemans PJ, Scholte R, Groenendal H
… +4 more, Kiemeney LA, Rampen FH, Ruiter DJ, Verbeek AL
Br J Ind Med
· 1993 Jul · PMID 8343426
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Several studies have reported excesses of risk of melanoma in specific industries. Data from a case-control study in The Netherlands, including 140 cases with a cutaneous melanoma and 181 controls with other types of mal...Several studies have reported excesses of risk of melanoma in specific industries. Data from a case-control study in The Netherlands, including 140 cases with a cutaneous melanoma and 181 controls with other types of malignancy, were used to evaluate whether the reported associations with these specific industries could be reproduced. Adjustment for characteristics of pigmentation and exposure to sunlight was made. Increased risks of cutaneous melanoma were found for subjects who had ever worked in the electronics industry (odds ratio (OR) = 2.03, 95% confidence interval (95% CI) 0.63-6.62), in the metal industry (OR = 2.61, 95% CI 0.96-7.10), and in the transport and communication branch (OR = 1.92, 95% CI 0.84-4.35). These ORs were adjusted for age, sex, education, hair colour, tendency to burn, freckling, and exposure to sunlight. No increased risks were seen for workers in the chemical industry, the textile industry, and among health care workers. Analyses according to duration and latency of exposure did not give consistent results, but existing patterns may be obscured by the imprecision of the estimates.
Br J Ind Med
· 1993 Jul · PMID 8343425
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An improved instrument for the fluorescence excitation measurement of concentrations of lead in bone has been developed. This is based on a large area high purity germanium detector and a point source of 109Cd. The sourc...An improved instrument for the fluorescence excitation measurement of concentrations of lead in bone has been developed. This is based on a large area high purity germanium detector and a point source of 109Cd. The source is positioned in a tungsten shield at the centre of the detector face such that 88keV photons cannot enter the detector directly. In vivo measurements are calibrated with plaster of Paris phantoms. Occupationally non-exposed men show a minimum detectable concentration of about 6 micrograms/g bone mineral. Measurements of tibia lead concentrations in 30 non-occupationally exposed men between the ages of 23 and 73 showed an annual increment of 0.46 microgram/g bone mineral/year. The mean deviation from the regression of tibia lead upon age was 3.5 micrograms/g bone mineral. Tibia lead concentration in one subject with a history of exposure to lead was 69.6 (SD 3.5) micrograms/g bone mineral. The improved precision of the point source large detector system means that greater confidence can be placed on the results of in vivo measurements of lead concentration. This will allow studies of the natural history of non-occupational lead accumulation in normal subjects and should permit investigations of the efficacy of therapeutic interventions in subjects poisoned with lead.
Br J Ind Med
· 1993 Jul · PMID 8343424
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Blood samples of miners heavily exposed to coal dust were examined for changes in glutathione S-transferase (GST) activity. Decreased GST activity was found in red blood cells of subjects with early stages of coal worker...Blood samples of miners heavily exposed to coal dust were examined for changes in glutathione S-transferase (GST) activity. Decreased GST activity was found in red blood cells of subjects with early stages of coal workers' pneumoconiosis (International Labour Office classification 0/1-1/2) when compared with control miners. At further progression of coal workers' pneumoconiosis (> or = 2/1), the activity of GST was not different from controls. In the same group with moderate coal workers' pneumoconiosis a decrease in GSH in red blood cells occurred. Decreases in GST activity in early stages of coal workers' pneumoconiosis, as well as the decreases in glutathione peroxidase (GPx) activity and in GSH concentrations reported earlier, may originate from damage caused by reactive oxygen species. These changes might imply an impairment of the detoxification capacity for electrophilic and oxidative compounds during this stage of the disease.
Br J Ind Med
· 1993 Jul · PMID 8343423
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Twelve workers from a coke plant in The Netherlands participated in an intensive skin monitoring programme combined with personal air sampling and biological monitoring during five consecutive eight hour workshifts. The...Twelve workers from a coke plant in The Netherlands participated in an intensive skin monitoring programme combined with personal air sampling and biological monitoring during five consecutive eight hour workshifts. The purpose of the study was to make a quantitative assessment of both the dermal and respiratory intake of polycyclic aromatic hydrocarbons (PAHs). Pyrene was used as a marker compound for both dermal and respiratory exposure to PAHs. The biological measure for the internal exposure to PAHs was urinary 1-OH-pyrene concentration. Measurements on exposure pads at six skin sites showed that mean total skin contamination of the 12 workers ranged between 21 and 166 micrograms pyrene a day. The dermal uptake of pyrene ranged between 4 and 34 micrograms/day, which was about 20% of the pyrene contamination on skin. The mean concentration of total pyrene in the breathing zone air of the 12 coke oven workers ranged from 0.1 to 5.4 micrograms/m3. The mean respiratory uptake of pyrene varied between 0.5 and 32.2 micrograms/day. Based on the estimates of the dermal and respiratory pyrene uptake it is concluded that an average 75% (range 28%-95%, n = 12) of the total absorbed amount of pyrene enters the body through the skin. Because of the difference in the pyrene:benzo(a)pyrene ratio between the air samples and the skin contamination samples, the dermal uptake of benzo(a)pyrene was also estimated. This was about 51% of the total absorbed amount (range 8%-92%, n = 12). The total excreted amount of urinary 1-OH-pyrene as a result of exposure to PAHs during the five consecutive workshifts varied between 36 and 239 nmol. A multiple regression model of the mass balance between pyrene dose (both dermal and respiratory) and 1-OH-pyrene excretion confirmed the relevance of the dermal exposure route. The variation in urinary 1-OH-pyrene excretion was determined more by the dermal pyrene dose than by the respiratory dose. The model showed an estimate of the percentage of the absorbed amount of pyrene that is metabolised and excreted as 1-OH-pyrene in urine. For the 12 workers this percentage varied between 13% and 49% depending on smoking habits and consumption of alcohol. The results of this study indicate that among coke oven workers, the skin is the main route of uptake of PAHs. Preventive measures to reduce exposure to PAHs should be focused more on the reduction of dermal contamination by PAHs than on the reduction of inhaled dose.