某厂镀铬作业重度铬鼻病调查

分析10例镀铬工的临床资料及现场卫生学调查结果。主要表现为鼻干,鼻塞,鼻痛,鼻衄,头痛及嗅觉减退,鼻黏膜干燥、充血、糜烂、结痂。鼻中隔穿孔最大3.5 cm×2.5 cm,最小0.5 cm×0.7 cm。车间空气中铬浓度(TWA)为0.075~0.23 mg/m3,平均(0.146±0.08)mg/m3,远超过国家卫生标准。卫生监督部门应加强对企业的职业卫生监督执法力度,以减少职业性重症铬鼻病的发生。     

Clinical findings of irritation among chromium chemical production workers

BACKGROUND: Several reports of workers in chromate production and chromeplating have indicated that exposure to hexavalent chromium is associated with skin and nasal irritation. METHODS: A cohort of 2, 357 workers first employed between 1950 and 1974 at a chromate production plant was identified. Clinical findings of irritation were identified by a physician as a result of routine examinations or visits to the medical clinic by members of the cohort. Percentages of the cohort with various clinical findings, the time from hire to occurrence of the first finding, and the mean and median annual hexavalent chromium (measured as CrO(3)) concentration for the job title where the clinical finding first occurred were determined. A proportional hazards model was used to evaluate the relationship between hexavalent chromium exposure and first occurrence of each of the clinical findings. RESULTS: Nasal irritation and nasal ulceration were the most common clinical findings reported, occurring in more than 60% of the cohort. The average time to first occurrence of these findings was less than 3 months, whereas the time to first occurrence of the other findings ranged from 10 to 22 months. Median exposure to hexavalent chromium at the time of occurrence for most of the findings was about 20 microg/m(3). The proportional hazards model indicated that ulcerated nasal septum, irritated skin, and perforated eardrum were significantly associated with ambient hexavalent chromium exposure; all clinical findings with the exception of conjunctivitis and irritated skin were associated with the calendar year of hire, with the risk being lower as the calendar year of hire became more recent. Annual average ambient hexavalent chromium concentrations generally dropped in the plant over the period of the study. CONCLUSIONS: Workers in the chromate production plant in this study experienced a variety of nasal and skin irritations. Irritated and ulcerated nasal septa, in particular, were quite common clinical findings, occurring in over 60% of the cohort, and they occurred in relatively short periods of time-less than 3 months from date of hire. Annual average concentrations of chromium may not be a good predictor of clinical findings of irritation. Am. J. Ind. Med. 38:127-131, 2000. Published 2000 Wiley-Liss, Inc.     

Some characteristics of women with abnormalcervical cytological findings

A sample of 1317 women with positive cervical smears was compared with a similargroup of 1325 women whose smears were negative. The positive cases were found to be older, of lower social class, more multiparous and more likely to be widowed or divorced than the controls. The positive cases were also more likely to have symptoms and also showed a higher incidence of trichomonas than the controls. They became parous at an earlier age.The findings confirm evidence from mortality statistics of the role of early exposureto some venereally acquired oncogenic agent.     

Clinical and biochemical aspects of chromium deficiency

The essentiality of chromium (Cr) in animal and human nutrition is now well accepted. In animals, Cr deficiency can cause a diabetic-like state, impaired growth, elevated blood lipids, increased aortic plaque formation, and decreased fertility and longevity. The ability of Cr to potentiate insulin sensitivity has considerable experimental support. In the human, Cr deficiency has been demonstrated unequivocally in only one clinical situation, patients on total parenteral nutrition without added Cr. In such patients, impaired glucose tolerance, hyperglycemia, relative insulin resistance, peripheral neuropathy, and a metabolic encephalopathy have been noted with reversal of the clinical phenomena by Cr repletion. Many studies have been performed to determine whether Cr deficiency may be important in other clinical conditions, namely, diabetes mellitus, pregnant and parous women, and the aged population. Available data indicate that Cr supplementation can improve glucose metabolism in glucose intolerant individuals and decrease the total/HDL cholesterol ratio regardless of the status of glucose tolerance. However, whether Cr supplementation has long-term health benefits is unknown. Further, despite many tantalizing observations, it is still unclear whether Cr deficiency, latent or overt, is common in any human situation other than generalized malnutrition and total parenteral nutrition without added Cr. Technical uncertainties in the analysis of Cr, Cr contamination of food by the use of stainless steel processing equipment and eating utensils, and the lack of a clinically feasible test for Cr deficiency continue to impede progress in Cr research. Nevertheless, there is considerably more clarity as to plasma and urine Cr levels, food and tissue Cr content, and metabolic pathways of Cr metabolism than existed a decade ago. It is expected that progress will accelerate, since critical questions can now be addressed regarding the role of Cr in human nutrition.     

女大学生宫颈细胞学检查的临床分析

目的探讨对女大学生进行宫颈细胞学检查的临床意义。方法对未婚有性生活或已婚的女大学生采用新柏氏液基超薄技术（TCT）技术进行检查,对其宫颈细胞学结果进行分析、对比。结果检出异常结果有：不能明确意义的非典型鳞状细胞（ASCUS）8例,鳞状上皮内低度病变（LSIL）6例。检出霉菌感染26例,滴虫感染2例,HPV感染2例。结论对于女大学生采用TCT技术进行宫颈细胞学检查,必要可行。     

Clinical and biochemical aspects of chromium deficiency.

The essentiality of chromium (Cr) in animal and human nutrition is now well accepted. In animals, Cr deficiency can cause a diabetic-like state, impaired growth, elevated blood lipids, increased aortic plaque formation, and decreased fertility and longevity. The ability of Cr to potentiate insulin sensitivity has considerable experimental support. In the human, Cr deficiency has been demonstrated unequivocally in only one clinical situation, patients on total parenteral nutrition without added Cr. In such patients, impaired glucose tolerance, hyperglycemia, relative insulin resistance, peripheral neuropathy, and a metabolic encephalopathy have been noted with reversal of the clinical phenomena by Cr repletion. Many studies have been performed to determine whether Cr deficiency may be important in other clinical conditions, namely, diabetes mellitus, pregnant and parous women, and the aged population. Available data indicate that Cr supplementation can improve glucose metabolism in glucose intolerant individuals and decrease the total/HDL cholesterol ratio regardless of the status of glucose tolerance. However, whether Cr supplementation has long-term health benefits is unknown. Further, despite many tantalizing observations, it is still unclear whether Cr deficiency, latent or overt, is common in any human situation other than generalized malnutrition and total parenteral nutrition without added Cr. Technical uncertainties in the analysis of Cr, Cr contamination of food by the use of stainless steel processing equipment and eating utensils, and the lack of a clinically feasible test for Cr deficiency continue to impede progress in Cr research. Nevertheless, there is considerably more clarity as to plasma and urine Cr levels, food and tissue Cr content, and metabolic pathways of Cr metabolism than existed a decade ago. It is expected that progress will accelerate, since critical questions can now be addressed regarding the role of Cr in human nutrition.     

Clinical findings in workers exposed to pentachlorophenol

Comparative findings are presented on the health and exposure status of groups of individuals in Hawaii with and without occupational exposure to pentachlorophenol (PCP). Occupational exposure to PCP occurred through employment at firms engaged in the treatment of wood with either PCP alone or PCP plus other compounds as preservative chemicals. Mean serum levels were 0.32 ppm for 32 control individuals, 1.72 ppm for 24 workers exposed to PCP and other wood preservative chemicals, and 3.78 ppm for 22 workers exposed to PCP as the sole preservative chemical.Age-standardized prevalence rates were significantly higher among the PCP-exposed than among the controls for low-grade infections or inflammations of the skin and subcutaneous tissue, protective membrane of the eyes and the mucosa membrane of the upper respiratory tract. Strong to moderate statistical associations were observed between PCP exposure and increased occurrence of bands (immature leucocytes) and basophils, increased plasma cholinesterase, alkaline phosphatase, gamma globulin and uric acid, and decreased serum calcium. Despite these statistical associations, laboratory values considered to be clinically abnormal were few and not significantly greater in occurrence among the PCP-exposed individuals.Research supported through a contract with the Epidemiologic Studies Program, Human Effects Monitoring Branch, Technical Services Division of the U.S. Environmental Protection Agency, Washington, DC 20460, and a grant from the American Wood Preservers' Institute, 1651 Old Meadows Road, McClean, VA 22101.     

Clinical findings and diagnosis in genetic prion diseases in Germany

To describe the clinical syndrome and diagnostic tests in patients with genetic prion diseases (gPD) in Germany. Clinical features, MRI, EEG, and CSF markers were studied in 91 patients (28 D178N, 20 E200K, 17 inserts, 13 V210I, 8 P102L, 5 E196K). Dementia (35 %) and ataxia (29 %) were the most common initial symptoms and signs. A wide variety and high frequency of neurological/psychiatric symptoms and signs was found during disease course in all patients independently of the type of the mutation. Psychiatric manifestations were frequent (87 %). Neuropsychological abnormalities were observed in 67 %, and aphasia was the most common disturbance (45 %). In E200K, V210I and D178N patients, visual/oculomotor deficits were followed by ataxia early in the disease. Dementia followed by ataxia at onset was common in patients with insert and E196K mutation. P102L patients had isolated ataxia over a longer time period followed by pyramidal signs. Dementia was present only late in the disease course. All clinical routine tests such as MRI, EEG and CSF tests were less sensitive than in sporadic CJD. We provide the first detailed analysis of clinical signs and symptoms in a large group of patients with gPD. Frequency of clinical symptoms and signs was similar in different mutations in a later disease course, but the sequence of occurrence may be of great diagnostic importance. CSF markers were shown to be more sensitive than MRI and EEG.     

EB病毒感染相关性噬血细胞综合征患者的临床诊断与骨髓细胞学特点分析

目的分析EB病毒(EBV)感染相关性噬血细胞综合征(EBV-HPS)患者的临床诊断和骨髓细胞学特点,为临床诊断提供依据。方法选取2009年6月-2015年6月医院收治的52例EBV-HPS患者作为观察组,选取同一时期健康体检者100名作为对照组,记录观察组的临床特点和骨髓细胞学特点,比较两组的EB病毒与外周血检查结果。结果观察组患者最高体温(39.7±0.6)℃,发热持续时间(13.4±4.8)d,部分患者表现为肝脾肿大及呼吸系统、神经系统症状;观察组患者的EBV-DNA为(7.12±2.84)105copies/ml,EB病毒阳性率为90.38%,对照组的EBV-DNA为(0.06±0.05)105copies/ml,EB病毒阳性率为5.00%,差异有统计学意义(P0.05);两组的血红蛋白、白细胞计数、血小板计数、甘油三酯、纤维蛋白原、凝血酶原时间、活化部分凝血活酶时间和凝血时间比较,差异有统计学意义(P0.05);37例患者表现为骨髓增生度活跃占71.15%,15例患者表现为明显活跃占28.85%;所有患者均发现噬血细胞、粒细胞有毒性改变。结论噬血细胞综合征应结合患者的临床特征、外周血检查和骨髓细胞学检查等依据进行诊断。     

子宫内膜细胞学检测在取出宫内节育器时的临床应用

目的:应用子宫内膜细胞学方法探讨宫内节育器(IUD)对子宫内膜的影响。方法:应用子宫内膜细胞采集器在募集对象取出IUD时采集子宫内膜组织制片,样本集中寄往北京大学附属医院妇产科宫腔细胞学检测中心阅片。结果:有症状组和无症状组子宫内膜细胞病理未见异常率及不典型增生发生率差异有统计学意义(P<0.01),良性增生性改变发生率差异有统计学意义(P<0.05)。阴道流血症状发生细胞学诊断未见异常人群组与良性增生人群组差异有统计学意义(P<0.05),与不典型增生人群组差异有统计学意义(P<0.01);肥胖情况细胞学诊断非典型增生人群组和良性增生人群组均高于未见异常人群组,但差异无统计学意义(P>0.05),高血压、初潮早等其他高危因素情况细胞学诊断不典型增生人群组和良性增生人群组均高于未见异常人群组,但差异无统计学意义(P>0.05)。宫内节育器类型组两两对比,良性增生和不典型增生的发生率均无统计学意义(P>0.05)。结论:放置IUD后子宫异常出血常伴有子宫内膜良性增生及非典型增生,子宫内膜细胞学异常与宫内节育器类型无明显关系。取器时行子宫内膜细胞学检测,可以对子宫内膜状况有初步了解,以便正确拟定诊治方案。     

Hair chromium concentration and chromium excretion in tannery workers.

Hair and urine samples were collected from 34 male tannery workers and from 12 normal adults. Eighteen of the workers dealt directly with chromium and the remaining 16 (controls) worked in the offices and kitchen of the same factory. All were found to be clinically healthy. Chromium was determined by flameless atomic absorption spectroscopy. When compared with normal adult values, urinary chromium concentration, Cr/Creatinine ratio, daily chromium excretion, and hair chromium, concentrations were significantly higher and urinary beta 2-microglobulin/Cre ratios significantly lower in both tannery workers and in controls. A significant negative correlation was found between urinary beta 2-microglobulin/Cre and Cr/Cre ratios of tannery workers and controls. A significant positive correlation was shown between hair chromium and urinary Cr/Cre values in all workers. No correlations between the duration of exposure to chromium and hair and urinary chromium values were found. Nevertheless, high values observed in workers with short exposures show that chromium is readily absorbed through the respiratory system.