1/36. ozone exposure: a case report and discussion.A 45-year-old man working with ozone presents with evidence of sinusitis, mucus membrane irritation, sleep disturbance and shortness of breath. Naturally occurring or manmade, ozone may damage pulmonary alveolar type I cells at significant exposure levels. EPA and OSHA regulate exposure concentrations. Studies show dose responses with exposures. Supporting epidemiological studies are reviewed briefly. Limiting potential for excess exposure is key to prevention. Recognition of ozone as a potential exposure in the oklahoma workplace is key to symptom management.- - - - - - - - - - ranking = 1keywords = disturbance (Clic here for more details about this article) |
2/36. A case of an electrical burn in the oral cavity of an adult.Electrical burns in the oral cavity account for 2.2% of all electrical burns and only 0.12% of all burns; thus, the incidence of electrical burns in the oral cavity is relatively low. As this type of injury occurs in the oral cavity when an individual sucks or chews on a live electrical wire, extension cord, plug, or outlet, most cases occur in toddlers or preschool children, and adult cases are extremely rare. Here we describe a case of an electrical burn in a 56-year-old man who accidentally bit the electric wire of a cleaner while carrying out repairs. Conservative treatment, without surgery, was performed. Two years after the injury, a slight scar and a small tongue deformity remain, but no functional disturbance has been observed.- - - - - - - - - - ranking = 1keywords = disturbance (Clic here for more details about this article) |
3/36. decompression illness associated with underwater logging: 6 case reports from Kenyir Lake, malaysia.The formation of Kenyir Lake as part of a hydroelectric project in the 1980s caused much forest area to be submerged. From 1991, underwater divers were employed to log these sunken trees at depths of up to 100 meters. At least 6 mishaps involving underwater logging personnel were recorded from March 1994 to August 1996. We retrospectively reviewed 5 cases who were managed in Hospital Kuala Terengganu. The patients presented with marked cardiorespiratory and neurological disturbances. One diver died in the Hospital while another died at the recompression chamber. Three divers were treated with recompression and improved. Average delay before the start of recompression was 14 hours. Underwater logging has definite dangers and steps must be taken to ensure that both the divers and the equipment are appropriate for the task. Availability of a nearby recompression facility would greatly enhance the management of diving accidents, not only for commercial divers but also for recreational divers who frequent the islands nearby.- - - - - - - - - - ranking = 1keywords = disturbance (Clic here for more details about this article) |
4/36. Peripheral neuropathy in chronic occupational inorganic lead exposure: a clinical and electrophysiological study.BACKGROUND AND OBJECTIVES: Traditionally the neuromuscular disorder associated with lead poisoning has been purely motor. This study assessed peripheral nerve function clinically and electrophysiologically in 46 patients with neuropathic features out of a total population of 151 workers with raised blood and/or urinary lead concentrations. RESULTS: Average duration of occupational exposure for the neuropathic group ranged from 8-47 years (mean 21.7). Their mean blood lead concentration (SD) was 63.9 (18.3) microg/dl (normal <40), urinary lead 8.6 (3.3) microg/dl (normal<5.0), urinary coproporphyrins 66.7 (38.4) microg/g creatinine (20-80), urinary aminolaevulinic acid 1.54 (0.39) mg/g creatinine (0.5-2.5). All 46 had distal paraesthesiae, pain, impaired pin prick sensation, diminished or absent ankle jerks, and autonomic vasomotor or sudomotor disturbances. Reduced vibration sensation and postural hypotension were present in all 20 studied. None of these 46 patients had motor abnormalities. Motor conduction velocity and compound muscle action potential amplitudes were normal, with marginally prolonged distal motor latencies. Sensory nerve action potential amplitudes lay at the lower end of the normal range, and the distal sensory latencies were prolonged. No direct correlation was found between the biochemical variables, and the clinical or electrophysiological data. CONCLUSIONS: One additional patient was seen with shorter term exposure to lead fumes with subacute development of colicky abdominal pain, severe limb weakness, and only minor sensory symptoms. Unlike the patients chronically exposed to lead, he had massively raised porphyrins (aminolaevulinic acid 21 mg/g creatinine, coproporphyrins 2102 microg/g creatinine). patients with unusually long term inorganic lead exposure showed mild sensory and autonomic neuropathic features rather than the motor neuropathy classically attributed to lead toxicity. It is proposed that the traditional motor syndrome associated with subacute lead poisoning is more likely to be a form of lead induced porphyria rather than a direct neurotoxic effect of lead.- - - - - - - - - - ranking = 1keywords = disturbance (Clic here for more details about this article) |
5/36. Micronuclei in peripheral blood lymphocytes as a possible cancer risk biomarker: a cohort study of occupationally exposed workers in croatia.AIM: To describe the cohort of Croatian workers monitored for micronuclei in peripheral blood lymphocytes and validate predictive value of micronuclei for the risk of cancer development. methods: Between 1985 and 1999, peripheral blood lymphocytes were analyzed with in vitro micronucleus assay in a cohort of 200 subjects occupationally exposed to genotoxic agents. The follow-up for cancer incidence and mortality was performed through the Croatian National Cancer Registry and records of occupational medicine physicians. Micronucleated cell frequency values were compared by Kruskal-Wallis test. RESULTS: The median micronucleated cell frequency value in the cohort was 49 (range, 30-79) per thousand cells. Micronucleated cell frequency was significantly higher in men than in women, which could be attributed to the different distribution of exposures. Micronucleated cell frequency increased with age for both sexes. smoking habit had no influence on micronucleated cell frequency. The follow-up identified four cases of cancer. Three of them belonged to the highest micronucleated cell frequency tertile. CONCLUSION: Due to a small number of cancer cases, the predictive value of micronuclei for the risk of cancer development in the cohort of Croatian workers was not estimated, but 4 identified cases were more than expected in a similar non-exposed group. The Croatian cohort will contribute to the pooled analysis of the current European study of predictive value of micronuclei for the risk of cancer development.- - - - - - - - - - ranking = 122.24692493567keywords = habit (Clic here for more details about this article) |
6/36. Central neurological abnormalities and multiple chemical sensitivity caused by chronic toluene exposure.multiple chemical sensitivity (MCS) is a syndrome in which multiple symptoms occur with low-level chemical exposure; whether it is an organic disease initiated by environmental exposure or a psychological disorder is still controversial. We report a 38-year-old male worker with chronic toluene exposure who developed symptoms such as palpitation, insomnia, dizziness with headache, memory impairment, euphoria while working, and depression during the weekend. Upon cessation of exposure, follow-up neurobehavioural tests, including the cognitive ability screening instrument and the mini-mental state examination, gradually improved and eventually became normal. Although no further toluene exposure was noted, non-specific symptoms reappeared whenever the subject smelled automotive exhaust fumes or paint, or visited a petrol station, followed by anxiety with sleep disturbance. During hospitalization for a toluene provocation test, there was no difference between pre-challenge and post-challenge PaCO(2), PaO(2), SaO(2) or pulmonary function tests, except some elevation of pulse rate. The clinical manifestations suggested that MCS was more relevant to psychophysiological than pathophysiological factors.- - - - - - - - - - ranking = 1keywords = disturbance (Clic here for more details about this article) |
7/36. Diffuse white matter lesions in carbon disulfide intoxication: microangiopathy or demyelination.Long-term exposure to carbon disulfide (CS(2)) may induce diffuse encephalopathy with parkinsonism, pyramidal signs, cerebellar ataxia, and cognitive impairments, as well as axonal polyneuropathy. The pathogenic mechanisms of diffuse encephalopathy are unclear, although vasculopathy and toxic demyelination have been proposed. Recently, we have encountered a patient who developed headache, limb tremors, gait disturbance, dysarthria, memory impairment, and emotional lability after long-term exposure to CS(2). The brain magnetic resonance images (MRI) showed diffuse hyperintensity lesions in T(2)-weighted images in the subcortical white matter, basal ganglia, and brain stem. The brain computed tomography perfusion study revealed a diffusely decreased regional cerebral blood flow and prolonged regional mean transit time in the subcortical white matter and basal ganglion. To our knowledge, there have been few reports demonstrating diffuse white matter lesions in chronic CS(2) encephalopathy using brain MRI. In addition, the (99m)Tc-TRODAT-1 single photon emission computed tomography showed a normal uptake of the dopamine transporter, indicating a normal presynaptic dopaminergic pathway. We conclude that diffuse white matter lesions may develop after chronic exposure to CS(2), possibly through microangiopathy. In addition, CS(2) poisoning can be considered as one of the causes of chronic leukoencephalopathy.- - - - - - - - - - ranking = 1keywords = disturbance (Clic here for more details about this article) |
8/36. Two cases of hypertrophic pachymeningitis associated with myeloperoxidase antineutrophil cytoplasmic autoantibody (MPO-ANCA)-positive pulmonary silicosis in tunnel workers.Two cases of hypertrophic pachymeningitis (HP) associated with pulmonary silicosis in tunnel workers are described. In both cases the myeloperoxidase antineutrophil cytoplasmic autoantibody (MPO-ANCA) was positive. Two patients with pulmonary silicosis developed headache and neurological disturbance, and a diagnosis of HP was made. In both cases the serum CRP level and the MPO-ANCA titer were elevated. Corticosteroid therapy produced a rapid improvement in all the clinical and laboratory parameters. Although an association has been noted between exposure to silica dust and ANCA-associated vasculitis, particularly glomerulonephritis, central nervous system involvement is rare. However, there have been some recent reports of HP cases that were positive for ANCA, and the association between HP and vasculitis has been discussed in the medical literature. HP may be one feature of multiorgan involvement in ANCA-associated disease, and the association between silica dust exposure and HP should be considered, as with other forms of ANCA-associated vasculitis.- - - - - - - - - - ranking = 1keywords = disturbance (Clic here for more details about this article) |
9/36. Parkinsonism due to manganism in a welder: neurological and neuropsychological sequelae.A 33-year-old welder with 3 years of exposure to manganese (Mn) bearing welding fumes was seen by neurologists for cognitive and motor complaints. He exhibited signs and symptoms of Parkinson's disease, including tremor, bradykinesia, gait disturbance and cogwheel rigidity. However, he was young and had significant inattention and forgetfulness, had found levodopa unhelpful and moved with a cock-walk gait, all of which suggested manganism. His serum and urine levels of Mn were, in fact, elevated, and his brain MRI had increased T1-weighted signal intensities in the basal ganglia bilaterally (globus pallidus) consistent with Mn deposition. Two years later, he underwent comprehensive neuropsychological testing. Clinical history indicated a mild tremor and emotional dysfunction with irritability, anxiety, and depression with psychotic features. He showed deficits in cognitive flexibility, information processing and speed, and greatly reduced motor speed, which are consistent with a fronto-subcortical process. These findings support a diagnosis of early onset parkinsonism from welding.- - - - - - - - - - ranking = 1keywords = disturbance (Clic here for more details about this article) |
10/36. Ten cases of acute lead intoxication among bridge workers in louisiana.We report the cases of ten construction workers who developed acute lead intoxication while repairing a bridge in louisiana. All but one patient received a five-day course of edetate calcium disodium (calcium EDTA) chelation therapy; one patient received five doses instead of five days of treatment. calcium EDTA 25 mg/kg q12h was administered for ten consecutive doses by intravenous infusion over two hours. Each dose was diluted in NaCl 0.9% 500 mL. No adverse drug effects were observed during treatment. The posttreatment mean whole blood lead (PbB) concentration was significantly reduced compared with the pretreatment mean PbB (1.48 /- 0.70 vs. 3.8 /- 1.68 mumol/L; p = 0.0012, Student's paired t-test). This indicates that the body lead burden of these patients was effectively reduced with calcium EDTA. Eight patients had complaints on admission that were suggestive of lead intoxication. These included malaise, numbness of the extremities, arthralgia, myalgia, abdominal discomfort, sleep disturbance, and lower back pain. patients had no complaints on discharge. Eight patients had mild anemia that was consistent with acute lead intoxication (mean pretreatment hemoglobin ( /- SD), 128.6( /- 17.2 g/L), but calcium EDTA therapy did not appear to effect any change in the pretreatment hemoglobin values. The Occupational safety and health Administration (OSHA) lead standard requires that manufacturers provide employees at risk for occupational lead exposures with proper respirators and medical surveillance to prevent lead intoxication. The construction industry is exempted from these standards except in maryland. We believe that amendment of the OSHA lead standards, to provide specific lead regulation of the construction industry, would be helpful in preventing similar cases of occupational lead intoxication.- - - - - - - - - - ranking = 1keywords = disturbance (Clic here for more details about this article) |
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