Cases reported "Occupational Diseases"

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1/12. platinum concentrations in sera of catalyst production workers are not predictive of platinum salt allergy.

    platinum (Pt) salts are potent occupational allergens in precious metal refineries and catalyst productions. The threshold limit value of 2000 ng soluble Pt/m3 enforced in many countries has been questioned because there is still a high incidence of Pt salt allergy. The objective of the present case series is to define the predictive value of biological monitoring by relating Pt in the serum of catalyst production workers and control subjects to sensitization to Pt salts as assessed by skin prick testing. A total of 38 Pt measurements were taken from sera of six workers investigated several times during a 5-year cohort study. Three subjects showed a conversion of skin prick test (SPT) with Pt salts from negative to positive during the cohort study (all considered highly exposed to Pt), and three did not show SPT conversion. Previous therapy with Pt-containing anti-cancer drugs and metallic dental alloys were considered as confounders. Only one of the three workers sensitized to Pt salt had clearly elevated serum Pt concentrations, but this elevation was not observed in each examination. Elevated Pt concentrations were also found in two subjects with low or no exposure to Pt. Both had metallic dental alloys. One control subject without metallic dental alloys showed low Pt concentrations in the serum in four examinations, but a single unexplained high concentration in his initial examination. In this small case series, serum Pt concentrations were neither sensitive nor specific for the prediction of Pt salt sensitization. Low specificity may be explained by Pt-containing metallic dental alloys, but additional unknown confounders may be of importance.
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2/12. The interpretation of zinc protoporphyrin changes in lead intoxication: a case report and review of the literature.

    BACKGROUND: zinc protoporphyrin (ZPP) has been used both as a screening and diagnostic test for overexposure to lead for nearly 30 years, although limitations for both purposes are recognized. methods: We present longitudinal findings for ZPP and whole-blood lead in a man with two episodes of acute lead intoxication and review the literature on the use of ZPP. RESULTS AND CONCLUSIONS: ZPP elevations in both chronic and acute exposure settings lag behind elevations in whole-blood lead by approximately 8-12 weeks. Therefore, ZPP measurement, in conjunction with whole-blood lead determination, has clinical utility in cases of substantial overexposure by providing information on how long an individual may have been overexposed to lead. A guide to the interpretation of various combinations of whole-blood lead and ZPP results is provided. However, while ZPP levels do correlate with whole-blood lead measurements in aggregate, the considerable individual variability of ZPP measurements, poor sensitivity at lower ranges of lead exposure, poor specificity and delayed changes in unstable exposure conditions indicate that this test contributes little to screening programs. Finally, our results confirm that basophilic stippling is seen in acute as well as chronic lead intoxication, and may provide the first indication of lead intoxication.
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3/12. Efficacy of sodium diethyldithiocarbamate (dithiocarb) in acute nickel carbonyl poisoning.

    A brief historical resume is presented on the use of dithiocarbamates for the treatment of persons exposed to nickel carbonyl. The specificity of the treatment is demonstrated in an industrial accident in which four men were simultaneously exposed to nickel carbonyl vapors. Three of the men received dithiocarb within 24 hours after exposure and the fourth was hospitalized by his family physician and treated for bronchopneumonia with antibiotics and without benefit of dithiocarb. The three workmen who received dithiocarb became symptomless and returned to work within 72 hours after exposure. The fourth man who had not received dithiocarb died within five days after exposure.
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4/12. Occupational sensitivity to Alphitobius diaperinus (Panzer) (lesser mealworm).

    Alphitobius diaperinus is an important beetle in the grain and poultry industries. We evaluated three individuals with work-related symptoms of asthma, rhinitis, conjunctivitis, urticaria, and angioedema on exposure to the insect. Prick skin tests with extracts prepared from the larval, pupal, and adult life stages were positive in all three patients. Specific IgE antibodies to these extracts were demonstrated by RAST or radioimmunoassay. RAST and radioimmunoassay inhibition confirmed the specificity of IgE binding and further demonstrated immunologic cross-reactivity between the three life stages. Peripheral blood leukocytes from two of the individuals demonstrated significant histamine release when they were compared with cells from nonexposed atopic and normal control subjects. The proteins in the extracts of each life stage were separated by sodium dodecyl sulfate-polyacrylamide gel electrophoresis. More than 30 protein bands were detected in each of the extracts; however, the patterns of separation were different for each life stage. After immunoblotting and autoradiography, IgE-binding proteins were recognized by sera from all three individuals in the larval extract at 90 kilodaltons (kd), in the pupal extract at 90, 64, and 38 kd, and in the adult extract at 84 kd. Additionally, several other proteins were identified as being allergenic in some of the patients. We conclude that these three patients developed IgE-mediated sensitivity to A. diaperinus antigens as the result of occupational exposure. To our knowledge, this is the first description of sensitivity to this grain beetle.
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5/12. Giant-cell interstitial pneumonia and hard-metal pneumoconiosis. A clinicopathologic study of four cases and review of the literature.

    We report four cases of giant-cell interstitial pneumonia that occurred in association with exposure to hard metals. All patients presented with chronic interstitial lung disease and had open-lung biopsies that revealed marked interstitial fibrosis, cellular interstitial infiltrates, and prominent intraalveolar macrophages as well as giant cells displaying cellular cannibalism. We also review the literature to determine the sensitivity and specificity of giant-cell interstitial pneumonia for hard-metal pneumoconiosis. Although hard-metal pneumoconiosis may take the form of usual interstitial pneumonia, desquamative interstitial pneumonia, and giant-cell interstitial pneumonia, the finding of giant-cell interstitial pneumonia is almost pathognomonic of hard-metal disease and should provoke an investigation of occupational exposure.
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6/12. Diagnosing the tight building syndrome.

    formaldehyde is but one of many chemicals capable of causing the tight building syndrome or environmentally induced illness (EI). The spectrum of symptoms it may induce includes attacks of headache, flushing, laryngitis, dizziness, nausea, extreme weakness, arthralgia, unwarranted depression, dysphonia, exhaustion, inability to think clearly, arrhythmia or muscle spasms. The nonspecificity of such symptoms can baffle physicians from many specialties. Presented herein is a simple office method for demonstrating that formaldehyde is among the etiologic agents triggering these symptoms. The very symptoms that patients complain of can be provoked within minutes, and subsequently abolished, with an intradermal injection of the appropriate strength of formaldehyde. This injection aids in convincing the patient of the cause of the symptoms so he can initiate measures to bring his disease under control.
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7/12. Acquired intolerance to organic solvents and results of vestibular testing.

    Among 160 consecutive patients referred to the Clinic of occupational medicine, Rigshospitalet, for symptoms connected with exposure to organic solvents, 20 exhibited symptoms of acquired intolerance to minor amounts of organic solvents. Later, an additional 30 consecutive patients with symptoms of acquired intolerance were included, yielding a total of 43 men and 7 women. The characteristics of the clinical syndrome described are complaints of dizziness, nausea, and weakness after exposure to minimal solvent vapor concentrations. After having tolerated long-term occupational exposure to moderate or high air concentrations of various organic solvents, the patients became intolerant within a short period of time. Since dizziness was a frequent complaint, we tried to obtain a measure of the patients' complaints using vestibular tests. As a diagnostic test the combined vestibular tests had a sensitivity of 0.55 and a specificity of 0.87. No differences between patients with and without intolerance could be detected by the vestibular tests used. We conclude that acquired intolerance to organic solvents is a new but characteristic and easily recognizable syndrome, often with severe consequences for the patient's working ability.
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8/12. Nitrocellulose-based RAST to detect IgE antibodies in workers hypersensitive to diphenylmethane-4,4'-diisocyanate.

    RAST was performed using both nitrocellulose (NC) and paper discs to compare these solid supports for ability to detect IgE antibodies in sera from two patients with hypersensitivity to the industrial chemical, diphenylmethane-4,4'-diisocyanate (MDI). NC disc had distinct advantages in ease of coupling the hapten-conjugate antigen to discs, and in use of lesser amounts of antigen. With regard to sensitivity, NC discs were better able to distinguish the positive sera from 34 control sera including those with elevated levels of total IgE. In both RAST systems, inhibition studies indicated high specificity of antibodies for MDI, with no reactivity detected toward the serum albumin portion of the MDI-HSA conjugate antigen. However, only in the NC RAST did antibodies from both patients react with p-tolyl isocyanate inhibitor. Based on the above results, NC discs displayed several advantages in RAST and are recommended for routine serological assay of isocyanate-specific antibodies.
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9/12. Use of haptenizing ELISA to evaluate respiratory disease in a worker exposed to capacitor-coating powder.

    We were asked to evaluate respiratory disease in a worker exposed to a powder containing unidentified components that was heated and used to coat capacitors. Because the powder was used as a coating material, we hypothesized that the capacitor-coating powder (CCP) contained either an anhydride or an isocyanate. We modified the initial step of a standard ELISA so that we could use CCP as a hapten in this assay. With this modified ELISA technique and inhibition analysis with antisera of known specificity, we determined that CCP contained a substance that cross-reacted with trimellitic anhydride. Later, we confirmed from the manufacturer that it contained benzophenone tetracarboxylic dianhydride. With the modified ELISA assay we also determined that the worker we were to evaluate did not have antibody to CCP or trimellitic anhydride. From clinical and immunologic evaluation we diagnosed chronic obstructive lung disease. Thus, this modified assay has proved useful in the evaluation of a worker exposed to a powder whose contents were not initially known and may prove useful in immunologic evaluation of workers in other industrial settings.
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10/12. Diphenylmethane diisocyanate (MDI)-induced asthma: evaluation of the immunologic responses and application of an animal model of isocyanate sensitivity.

    A worker developed two episodes of severe asthma 90 min after cutting a polyurethane plate made of diphenylmethane diisocyanate (MDI) using a rapidly turning carbide blade. Intradermal skin testing with MDI-human serum albumin (MDI-HSA) and p-tolyl isocyanate-HSA (p-TMI-HSA) were positive at 0.002 mg/ml. Control subjects showed no reaction at 2 mg/ml. Bronchial provocations of the worker with MDI-HSA and p-TMI-HSA, made 1 year after the occupational asthmatic episode, were negative at 10 mg/ml. Bronchial reactivity to methacholine decreased toward normal during a 2-year follow-up. RAST using MDI-HSA or p-TMI-HSA were strongly positive when compared with binding by sera from atopic controls which contained the same amount of total IgE. RAST titres decreased during a 1-year follow-up. In the MDI-HSA RAST, inhibition studies indicated specificity of antibodies for MDI-HSA. In the p-TMI-HSA RAST, p-TMI-HSA was a very effective inhibitor whereas MDI-HSA was not. These results indicated the formation of at least two distinct groups of IgE antibodies: those reactive with MDI, and those reactive with p-TMI determinants. guinea pigs immunized with MDI formed antibodies with specificities similar to those of the patient. We conclude that the worker had occupational asthma accompanied by the formation of specific IgE antibodies of the specificities. The causal relationship of the antibodies to the occupational asthma remains uncertain.
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