Cases reported "Occupational Diseases"

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11/18. Woodman's disease: hypersensitivity pneumonitis from cutting live trees.

    A 28-year-old man developed multiple episodes of fever, cough, shortness of breath, and leukocytosis several hours after cutting live oak and maple trees. Fungal cultures of wood chips from oak and maple trees were positive for penicillium (three species), paecilomyces sp., aspergillus niger, Aspergillus sp., and rhizopus sp. Gel-immunodiffusion studies demonstrated serum precipitins to extracts of oak chips, penicillium sp., and paecilomyces sp., and suggested that penicillium sp. and paecilomyces sp. shared cross-reactive antigens that were the significant antigens in the oak chips. ELISA studies demonstrated elevated serum levels of IgG to an oak chip extract, inhibition of that ELISA by preincubation of serum with penicillium sp., and absence of elevated IgG levels to an extract of freshly cut oak wood that had been stripped of bark to minimize mold contamination. The case analysis indicates that the patient likely had hypersensitivity pneumonitis on exposure to penicillium sp., when he was cutting trees, and identifies cutting live trees as another occupational exposure that may cause hypersensitivity pneumonitis.
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12/18. asthma and other symptoms in cinnamon workers.

    Cinnamon, which is the bark of the cinnamomum zeylanicum tree, contains cinnamic aldehyde, which is an irritant. Workers processing cinnamon before export are exposed to much cinnamon dust. Forty such workers with an average of four years' service in the industry were examined. Thirty five workers (87.5%) had symptoms, nine having had asthma (22.5%). Other symptoms, probably related to the irritant nature of cinnamon dust, were irritation of skin (50%), loss of hair (37.5%), and smarting of eyes while at work (22.5%). Loss of weight (65%) was the commonest finding. Contact dermatitis which has previously been described was not found in any of the workers.
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13/18. Corked up: clinical hyoscine poisoning with alkaloids of the native corkwood, duboisia.

    Australian native trees of the genus duboisia contain high concentrations of atropine-like alkaloids, especially hyoscine. occupational exposure to the dried plant material results in two clinical syndromes: "cork-eye", and being "corked up". Plant abuse, as an intoxicant and hallucinogen, also results in the "corked up" syndrome. This paper presents four cases of the duboisia syndrome. Central effects and peripheral anticholinergic effects are encountered in both occupational and accidental field exposure. The particular susceptibility of children, and management of the duboisia poisoning syndrome are discussed.
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14/18. Occupational rhinoconjunctivitis and bronchial asthma due to Phoenix canariensis pollen allergy.

    We report a case of occupational bronchial asthma and rhinoconjunctivitis caused by Phoenix canariensis (PC) pollen. The canary palm is a type of palm tree, belonging to the arecaceae family, which is widely distributed in frost-free regions as an ornamental tree. Our patient was referred because he suffered symptoms of bronchial asthma, rhinoconjunctivitis, and contact urticaria when pruning dried leaves from PC during the pollination months. The skin prick test (SPT) with a PC pollen extract was positive, as was the specific IgE to PC pollen determined by Phadezym RAST, indicating an IgE-mediated sensitization. The nonspecific bronchial provocation test (BPT) performed with methacholine disclosed a mild bronchial hyperreactivity, and specific BPT with PC pollen elicited an immediate fall of 25% in FEV1 with respect to baseline. On RAST inhibition studies, a significant cross-reactivity was found between PC pollen and date palm (P. dactylifera) pollen. These results suggest that PC pollen could be a potential allergen in PC-growing areas.
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15/18. arsenic toxicity in hawaii: a case report and review.

    As mentioned at the beginning of this article, many questions were raised in our one particular case including the problem of verifying true arsenic toxicity and in determining the source of the exposure. In our case, there was a markedly elevated concentration of arsenic in samples of pubic hair and in the sample of urine. While arsenic toxicity can present with GI symptoms, we felt that in this particular case the association of the abdominal pain with arsenic toxicity was unlikely. For one, the patient's symptoms persisted despite apparent adequate treatment for arsenic toxicity. Also, the usual symptom of chronic arsenic toxicity is peripheral neuropathy (which was not documented in our case) and not abdominal pain. After the exhaustive diagnostic workup, we felt that this patient had irritable bowel syndrome and that the discovery of arsenic toxicity was serendipitous. In regards to the etiology of the toxicity, the patient's occupation involved working in the construction industry for a number of years. He indicated a definite exposure to termite-treated wood throughout that period. wood for building houses, etc. is commonly pressure-treated with an arsenic-based compound; therefore, this source of occupational exposure appears to be a likely one. Another remotely possible source was the ingestion of contaminated illicit drugs. Cases of the use of illicit drugs laced with various toxic agents such as cyanide and strychnine have been reported. Although our patient required analgesics not commensurate with his symptoms, he categorically denied any use of "street" drugs. The random urine drug screen for such was negative.(ABSTRACT TRUNCATED AT 250 WORDS)
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ranking = 0.125
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16/18. hypersensitivity to carrot associated with specific IgE to grass and tree pollens.

    This study deals with a 34-year-old female cook with no previous history of atopy, who was studied because of allergic rhinoconjunctivitis and contact urticaria in both hands associated with severe itching when she handled raw carrot. The patient had had anaphylactic episodes after accidental ingestion of raw carrots, but she tolerated cooked carrots. skin prick tests with carrot, celery, and olive, and birch, grass, and mugwort pollens were positive. Total IgE was 411 UI/ml. Specific IgE to olive, grass, and weed pollens were 10.92, 6.17, and 2.4 AU/ml, respectively. The histamine release test was positive for carrot, celery, celeriac, and olive pollen up to a dilution of 1/10(6). Immunoblot of raw carrot showed a single IgE-binding 18-kDa band. IgE reactivity for raw carrot immunoblot was completely inhibited by carrot and by celery, but not by olive or grass pollens. Specific IgE to olive pollen was not inhibited by carrot. The existence of monosensitization to an 18-kDa protein in carrot and specific IgE to olive pollen has not been reported in the celery-carrot-mugwort-spice syndrome.
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17/18. Study of needlestick accidents and hepatitis c virus infection in healthcare workers by molecular evolutionary analysis.

    In the five-year period between 1989 and 1993, 87 needlestick accidents occurred among healthcare workers at our hospital. Thirty-seven (43%) of these needlestick accidents involved blood contaminated with hepatitis c virus (HCV), and two of them (5.4%) led to the occurrence of hepatitis c infection. Case 1 was a 43-year-old nurse who was accidentally injured by a needle contaminated with blood from a patient who had cirrhosis and hepatocellular carcinoma due to hepatitis c. Acute hepatitis c occurred after five weeks and HCV rna was positive after eight weeks. Case 2 was a 33-year-old nurse who was injured by a needle contaminated with blood from a patient who had chronic hepatitis c. liver function was normal at 11 days after the accident. However, hepatitis c was diagnosed 21 months later after she had successfully given birth to her baby. The nucleotide sequence of the HCV E2/NS1 region was determined in the two patients and the needlestick victims, and phylogenetic trees were constructed by molecular evolutionary analysis. On the basis of these trees, transmission of HCV could be confirmed in both cases. This method of analysis may be useful for confirming the transmission of HCV even long after the event.
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18/18. Subcutaneous phaeohyphomycosis caused by Geniculosporium species; a new fungal pathogen.

    A 70-year-old Japanese timberworker dealing with imported timber from the U.S.A. and russia had an asymptomatic subcutaneous nodule with a small fistula on his left knee. Histopathological examination of the nodule revealed brownish hyphal elements in encapsulated pyogranuloma. The fungus isolated from a discharge of the fistula and an excised specimen of the lesion was identified as Geniculosporium sp., which represents a conidial state (anamorph) of several genera such as Anthostomella, Biscogniauxia, Euepixylon, Leprieuria, Nemania, Phylacia and Rosellina in the Xylariaceae. Whereas this dematiaceous hyphomycete is commonly found on decaying wood and bark of various trees, to our knowledge, this is the first case of a phaeomycotic cyst caused by fungi belonging to the genus Geniculosporium.
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