Correlation between vibration-induced white finger and symptoms of upper and lower extremities in vibration syndrome

Summary The correlation was investigated between the frequency of attacks of vibration-induced white finger (VWF) and numbness or coldness of the fingers and legs in patients with vibration syndrome. Some 1687 patients with vibration syndrome were examined and of these 342 chain-saw operators and 277 rock-drill operators had no disease other than vibration snydrome. Then subjects were matched by age and period of treatment within three years. In the last analysis, 20 in the VWF almost everyday group or in the never group, and 40 in the occasionally group were selected from the chain-saw operators, and from the rock-drill operators 32 in the VWF everyday or the never group and 64 in the occasionally group. The present study showed that, with the frequency of VWF attacks, patients had a higher prevalence of coldness not only in the fingers but also in the legs. These findings suggest a correlation between the severity of circulatory disturbances of the upper extremities and that of the lower ones in patients with vibration syndrome. Further studies on circulatory disturbances in the leg are required.     

Raynaud's phenomenon of fingers and toes of miners exposed to local and whole-body vibration and cold

Summary In a study of 27 underground miners exposed to hand or whole-body vibration, cold or other vasoconstrictive environmental factors, higher prevalences of Raynaud's phenomenon in both fingers and toes were found than in a control group not exposed to vibration. There were no Raynaud-like phenomena among miners not exposed to vibration. There was a positive correlation between the two locations. This may mean a general susceptibility of vasospasm, but it seems more probable that the disorders are caused by vibration exposure to fingers and toes.     

Cutaneous signs (Raynaud's phenomenon,sclerodactylia, and efladema of the hands) and hand-arm vibration exposure

Summary Dermatological tests and examinations of the hand(s) were carried out in vibration-exposed and un exposed males. The subjects were 179 chain-saw workers in private forestry companies and 205 local inhabitants who had never used vibrating tools. The prevalences of Raynaud's phenomenon (RP), sclerodactylia, and edema of the hands were estimated in both groups, and associations between these cutaneous signs and vibration exposure were evaluated. The prevalences of RP and edema in the exposed group were 9.5% and 1.7%, respectively, and in the unexposed group, 2.9% and 1.5%, respectively. Sclerodactylia was seen in 31.8% of the chain-saw workers but in only 6.4% of the unexposed individuals. In statistical analyses based on unconditional logistic regression models with adjustment for age, RP was associated with long-term ( 20 years) vibration exposure [odds ratio (OR) = 7.06; 95% confidence interval (CI) = 2.51–19.87]. Sclerodactylia was associated with both short- and long-term vibration exposure (OR = 6.54, Cl = 3.30-13.36; OR = 7.05; CI = 3.41-14.60, respectively). There were significant dose-response relationships between RP and duration of exposure and between sclerodactylia and duration of exposure. Results of function tests indicated a longer recovery time and a higher vibration threshold for the workers with RP. The presence of sclerodactylia, however, did not have any significant influence on function test results. It is possible to conclude that not only RP but also sclerodactylia could be induced by vibration exposure. However, most cases of sclerodactylia were not so serious as to involve disturbances of peripheral circulatory and nerve function.     

Longitudinal study on factors related to the course of vibration-induced white finger

 Follow-up surveys were conducted in 1982 and 1988 to investigate factors affecting the course of vibration-induced white finger (VWF). Subjects were 353 patients, aged 40 to 70 at the start of the 1982 survey, who were receiving treatment for hand-arm vibration syndrome. Between 1982 and 1988, the attacks of VWF decreased, while numbness and pain in the hand changed slightly. Finger skin temperature showed a tendency to increase, but recovery time in nail compression tests was unchanged. Vibration perception threshold and grasping power tended to become worse. Of the 177 patients with VWF in 1982, 55 (31%) had no VWF in 1988. The improvement in VWF depended on its severity assessed by the frequency of attacks, the extent of the affected finger phalanges and the Stockholm vascular (V) stage at the start of the 1982 survey. The improvement was observed in 46% of the 1V (mild) stage cases, against only 17% of the 3V (severe) stage cases. Patients in the 2V (moderate) and 3V stages had lower finger skin temperature than those without VWF (the 0V stage). Patients with milder VWF seemed more likely to improve. Continued use of vibratory tools was found to be an unfavourable factor for improvement of VWF. Age, smoking and drinking habits, and medical complications showed no significant effects on the course of VWF. Received: 26 February 1996/Accepted: 2 May 1996     

Quantitative observations on thermal and metabolic responses to cold of workers using vibrating tools

Summary Quantitative observations on thermal and metabolic responses of 32 patients exposed to moderate cold of vibration hazards due to using chain saw were performed. In this study, many cases showed trends of both in increase of metabolic rate and decrease of mean skin temperatures. The ratio of 60 min mean value of the increase of metabolic rate/decrease of mean skin temperature is 3.5±2.60. Twenty-two patients (68.8%) indicated the value larger than 3. There are many with markedly large increase of metabolic rate in those who affected Raynaud's phenomenon. It can be suggested that many of the patients with the vibration hazards indicate an decrease of the cold tolerance to the moderate cold exposure.     

Prevalence of vibration-induced white finger and assessment of vibration exposure among travertine workers in Italy

Summary Among 76 stonedrillers and stonecutters/chippers working in the Rapolano travertine quarries (Tuscany, Italy), 27 subjects (35.5%) were affected with vibration-induced white finger (VWF). The median latent period for VWF was ten years (range 0.1–26 years). A VWF prevalence of 8% was found among 60 comparable controls (P < 0.0001). Vibration measurements showed that the frequency-weighted accelerations for two rock-drills and two small chipping hammers ranged from 19.7 to 36.4 m/s². Weighted accelerations between 2.4 and 4.1 m/s². were measured on the handles of a vertical grinder and a hand cutter. Vibration data, daily exposure time and total duration of exposure period were used to calculate two indicators of vibration dose such as the four-hour, energy-equivalent, frequency-weighted acceleration (m/s²) and the vibration exposure level (dB). A significant association between the vibration exposure level and the severity of VWF stages was observed among the travertine operators. The dose-effect relationship proposed by ISO 5349 was not suitable for the data of the present study because it overestimates the risk due to hand-transmitted vibration in the travertine workers. Finally, the results of a cold test indicated that the rewarming time of fingertips to room temperature was more prolonged in the operators with VAT than in those without VWF and in the controls.     

Immunologic studies on the pathogenesis of Raynaud's phenomenon in vibration disease

Summary These examinations were designed to explain the role of immunologic reactivity in the pathogenesis of Raynaud's phenomenon due to vibration. Patients were divided into 3 groups: 81 with positive and 50 with negative Raynaud's phenomenon in vibration disease, and 37 with Raynaud's disease in patients not exposed to mechanical vibration. In the Raynaud's-positive group, increase of beta globulins, gamma globulins, and antiglobulin antibodies were found. The cold hemagglutinin reaction was detected more often in the Raynaud's-positive, than in the Raynaud's-negative group. IgG serum concentration in persons with prodromal symptoms and IgG immunoglobulins in the developed form of vibration disease was significantly increased. The role of the immunologic basis of Raynaud's phenomenon due to vibration was taken into consideration.     

Risk assessment of vibration exposure and white fingers among platers

Summary The dose-response relationship between vibration exposure and vascular disorders in the hands was examined in platers. The study was based on a cross section of 89 platers and 61 office workers divided according to exposure to vibration into four groups. Vibration exposure was assessed by measuring the acceleration intensity on a sample of tools, together with both subjective rating and objective measurements of the exposure time. The frequency-weighted energy equivalent acceleration for 4 h was 4.6–4.7 m/s². The point prevalence of white fingers was 42% for the plater category currently exposed with an odds ratio of 85. The time laps before contraction of white fingers (latency time) was four years for the 10th percentile, and was shorter than predicted according to the ISO-5349 standard. The prevalence of white finger symptoms staged according to the Taylor-Pelmear scale was comparable to the prevalences according to the Stockholm Workshop Scale. Vibration exposure was the dominant source of white fingers and each year of vibration exposure increased the odds ratio for white fingers by 11%. Distal circulation in the hands was assessed by a timed Allen test. The odds ratio for a positive Allen test was higher for the workers exposed to vibration compared to the non-exposed workers. The use of the timed Allen test is suggested in the clinical examination for vibration white fingers. The observed high risk for contracting white fingers could be prevented by exposure level reduction and/or restriction of exposure duration.     

Vibratory and tactile sense of the fingers after working with sanders

Summary Twenty-four volunteers worked four times in a laboratory under realistic conditions for 80 min with a relatively intensely vibrating planesander and a less intensely vibrating band-sander (each sander twice). Immediately before and after exposure, the left and right third finger was measured for vibratory sense with a 100 Hz rod-vibrameter and for width-und depth-sense by means of an apparatus modified after Carlson. The reproducibility of the parameters was poor: coefficients of intra-individual variation were 20 to 60%. After using the plane-sander the threshold of the width-sense in the right hand increased relative to the effect of the band-sander by 17% of the pre-exposure value; in the left hand no increase was found. The thresholds of the depth-sense and vibratory sense showed no change. The study suggests that brief vibration exposure below the ISO-guideline may cause some reduction of sensibility. One should be cautious in applying these tests. An exposure-free interval of at least several hours is recommended when studying chronic effects of vibration exposure.     

311例SARS患者康复后一年内血清IgG抗体变化分析

目的了解严重急性呼吸综合征(SARS)患者康复后一年内血清中SARS冠状病毒(SARS-CoV)特异性抗体IgG的产生水平及动态变化。方法SARS患者康复后,每隔2-4周抽取IgG抗体阳性的SARS康复期患者血液,经病毒灭活后分离血清,用酶联免疫吸附试验检测SARS-CoV特异性抗体IgG;利用Stata 7.0统计学软件对各月份的检测结果进行分析。结果各康复期患者的各次检测结果均为阳性,出院后约35天时抗体平均水平最高。一年内,IgG抗体平均水平呈逐渐下降趋势,下降幅度约为35.8%。结论SARS康复期患者康复后短期内具有较高水平的IgG抗体,但随着康复时间的推移,该抗体呈逐渐下降趋势。提示应对该抗体进行长期监测,直至该抗体消失。     

慢性重型乙型病毒性肝炎免疫学指标的检测及临床意义

目的:探讨外周血淋巴细胞亚群、血清免疫球蛋白及补体检测在慢性重型乙型病毒性肝炎(以下简称慢重肝)中的价值。方法:利用流式细胞术和免疫透射比浊法对慢重肝患者及其它HBV感染性肝病患者的外周血淋巴细胞亚群、血清免疫球蛋白及补体C3、C4进行检测,并以健康成年人为对照组,对检测结果进行统计学分析;同时对慢重肝患者分成生存组和死亡组,比较两组血清免疫球蛋白及补体C3、C4的血清水平差异。结果:慢重肝患者外周血CD19+、NK细胞计数在各组中结果最低,CD3+、CD4+、CD8+比肝硬化组略高外,均比其它组低;慢重肝患者IgG在各组中结果最高、C3、C4最低,IgA除了比肝硬化组略低外,均比其它组高;血清补体C3预测慢重肝预后ROC曲线下面积(AUC)为0.705。结论:慢重肝患者存在明显细胞免疫和体液免疫功能的紊乱,免疫学指标的检测对发病机理的研究、治疗及预后的判断均有一定的临床意义。     

First experiences with DIN ISO 14835-1 in the context of vibration-induced white finger disease

Objectives: In order to establish an international standard of cold provocation test in the assessment of vibration-induced white finger (VWF) disease, an ISO-working group tentatively created the DIN ISO 14835-1. Based on this new standard, previously existing testing conditions had to be modified. Since a comparison of current and previous evaluation procedures is necessary for both the individual assessment and the performance of metaanalyses, the revision and validation of criteria for the examination of the cold provocation tests are appropriate and necessary. Methods: Twenty-one individuals suffering from VWF disease whose disorder was accepted as an occupational disease underwent the cold provocation test on two successive days following a 2- and a 5-min-long exposure to the cold. As a benchmark for classification as ‘normal’ or ‘pathological’, the 15-min mark after a 2-min-long exposure was chosen. A skin temperature of 28°C was selected for discrimination between ‘non-pathological’ (at least 28°C) and ‘pathological’ test results. Results: It could be shown, that exposures to cold water (12°C) over 2 and 5 min lead to similar rewarming profiles, who differ in median systematically by 1°C. A modification of the former classification rule should be considered. After a 5 min exposure, the classification criterion can be based on the temperature assessments measured after 20 min; alternatively the cut point can be reduced from 28 to 27°C while maintaining the previous assessment time of t=15 min. Conclusions: The shown results represent the first attempt of modifying the previous classification criteria of the cold provocation test within the scope of the VWF disease. In view of the described problems of the study design there is no doubt that continuing modifications and their validation on the base of larger collectives groups are necessary.     

Liver functions in silica-exposed workers in Egypt: possible role of matrix remodeling and immunological factors

Abstract

Background:

Brick manufacturing constitutes an important industrial sector in Egypt with considerable exposure to silica.

Objectives:

We aimed for evaluating hepatic functions in silica-exposed workers in the clay brick industry, and the possible role of matrix remodeling and immunological factors.

Methods:

A case–control study, 87 workers as exposed and 45 as control subjects. Questionnaire, clinical examination, and laboratory investigations: liver functions, matrix metalloproteinase-9, immunoglobulins G and E, and anti-liver kidney microsomal antibody.

Results:

In the exposed workers, mean levels of liver functions, matrix metalloproteinase-9 (MMP-9), and IgG and IgE were significantly higher. In the silicotic subgroup the mean level of GGT was almost twice the level in the non-silicotic subjects. Logistic regression showed that abnormal GGT and ALT were associated with production workers.

Conclusion:

Workers in the clay brick industry showed evidence of liver disease that could be related to matrix remodeling.     

Liver functions in silica-exposed workers in Egypt: possible role of matrix remodeling and immunological factors

Background:

Brick manufacturing constitutes an important industrial sector in Egypt with considerable exposure to silica.

Objectives:

We aimed for evaluating hepatic functions in silica-exposed workers in the clay brick industry, and the possible role of matrix remodeling and immunological factors.

Methods:

A case–control study, 87 workers as exposed and 45 as control subjects. Questionnaire, clinical examination, and laboratory investigations: liver functions, matrix metalloproteinase-9, immunoglobulins G and E, and anti-liver kidney microsomal antibody.

Results:

In the exposed workers, mean levels of liver functions, matrix metalloproteinase-9 (MMP-9), and IgG and IgE were significantly higher. In the silicotic subgroup the mean level of GGT was almost twice the level in the non-silicotic subjects. Logistic regression showed that abnormal GGT and ALT were associated with production workers.

Conclusion:

Workers in the clay brick industry showed evidence of liver disease that could be related to matrix remodeling.     

Thoracic outlet syndrome--aspects of diagnosis in the differential diagnosis of hand-arm vibration syndrome

BACKGROUND: Thoracic outlet syndrome (TOS) is a cause of vascular and neurological compromise to the arm and hand, and may manifest as Raynaud's phenomenon. It may be under-diagnosed. AIM: This review was undertaken in order to clarify the diagnostic and investigative features of TOS that may differentiate it from hand-arm vibration syndrome. METHODS: A tiered review of the world literature was undertaken using Medline and Embase as the primary search engines. CONCLUSION: Thoracic outlet syndrome most commonly presents with neurological symptoms in the arm. Vascular symptoms, including Raynaud's phenomenon, may occur in approximately 10% of cases. Careful clinical assessment by history and examination may reveal the elements of forearm and upper arm symptoms with postural exacerbation, which distinguish this condition from hand-arm vibration syndrome. The usefulness of investigation is unclear, but Doppler and neuroelectric studies may be valuable. Magnetic resonance imaging scan is the investigation of choice.     

急性一氧化碳中毒大鼠脑血液流变学变化及其意义探讨

目的 探讨脑循环血液流变学在急性CO中毒后的变化及在急性CO中毒迟发脑病发病中的可能作用。方法 通过腹腔间隔注射CO制备急性CO中毒模型,动态检测染毒后大鼠(即刻组、1d、3d、7d、14d、21d)颈静脉血的全血粘度(1s^-1、5s^-1、30s^-1、200s^-1)、血浆粘度、纤维蛋白原,并作全血细胞分析。结果 在不同的切变率下(1s^-1、5s^-1、30s^-1、200s^-1),染毒即刻组大鼠脑循环全血粘度显著降低,染毒后1—14d显著增高;染毒后1、7、14d,大鼠脑循环血浆粘度均显著升高;染毒即刻组大鼠红细胞压积显著降低,后又逐渐恢复,染毒后7d,红细胞压积明显高于染毒前;染毒后脑循环血浆纤维蛋白原浓度急剧升高,14d后逐渐恢复正常;染毒即刻组大鼠RBC、Hb、HCV明显降低,后即恢复正常。结论 急性CO中毒大鼠恢复期脑血液全血粘度及血浆粘度升高,从而增加血流阻力和减慢流速,导致脑循环灌注不良,发生脑循环障碍。急性CO中毒大鼠早期脑血液全血粘度及红细胞压积、RBC、Hb、HCV明显降低,提示CO生理特性可能参与对血液的影响效应。     

哮喘患儿血清T细胞亚群、细胞因子和免疫球蛋白的动态变化及意义

目的探讨哮喘患儿血清T细胞亚群、细胞因子和免疫球蛋白的动态变化及临床意义，为哮喘的发病机制及抗变态反应治疗提供理论依据。方法对40例哮喘患儿（哮喘发作组和哮喘缓解组）及25例健康体检儿童（对照组）应用流式细胞仪测定CD3＋、CD4＋、CD8＋T细胞，应用ELISA法测定TNF—α、白细胞介素（IL）-6、IL-8和IgE，应用免疫比浊法测定IgG、IgA和IgM。结果哮喘发作组CD3＋、CD4＋T细胞及CD4＋／CD8＋显著高于对照组（P〈0．01），CD4＋T细胞及CD4＋／CD8＋明显高于哮喘缓解组（P〈0．05）；哮喘缓解组CD4＋T细胞及CD4＋／CD8＋明显高于对照组（P〈0．05）。哮喘发作组IL-6、IL-8及TNF—α均明显高于哮喘缓解组和对照组（P〈0．05或〈0．01），哮喘缓解组TNF—α与对照组比较差异有统计学意义（P〈0．05）。哮喘发作组IgE及IgG水平显著高于哮喘缓解组和对照组（P〈0．01或〈0．05），IgA水平显著低于对照组（P〈0．01）；哮喘缓解组IgE水平仍显著高于对照组（P〈0.01）。结论哮喘患儿发作期和缓解期均存在免疫失衡，提示哮喘患儿应长期抗变态反应治疗。     

Pain, nerve dysfunction and fatigue in a vibration-exposed population

The long term use of hand-held vibrating tools may cause vasospastic and neuromuscular problems. Symptoms include painful blanching of the fingers at low temperatures, intermittent paresthesia and numbness, impaired dexterity, a tendency to drop tools, and an increasing inability to identify small objects by touch alone. Neurological as well as vasospastic problems are graded according to the Stockholm workshop scales. Accurate and early diagnosis is particularly important (e.g., in vibration-exposed patients presenting a carpal tunnel syndrome, it is necessary to distinguish whether compression of the median nerve occurs at the digital, skin receptor or carpal tunnel levels). A variety of improved diagnostic techniques are discussed.     

Trends in cigarette smoking among US adults with diabetes: findings from the Behavioral Risk Factor Surveillance System

BACKGROUND: Smoking substantially increases morbidity and mortality rates in people with diabetes. Previous studies have shown that the prevalence of smoking among people with diabetes is similar to that among people without diabetes. We sought to examine temporal trends in the prevalence of smoking among people with diabetes since 1990. METHODS: We analyzed data from the Behavioral Risk Factor Surveillance System for 1990-2001. RESULTS: The age-adjusted prevalence of smoking among adults with diabetes was 23.6% (men, 25.4%; women, 22.2%) in 1990 and 23.2% (men, 24.8%; women, 21.9%) in 2001. In comparison, the prevalence among participants without diabetes was 24.2% (men, 25.7%; women, 22.8%) in 1990 and 23.2% (men, 24.8%; women, 21.5%) in 2001. Thus, the prevalence of cigarette smoking was similar and remained stable from 1990 through 2001. Among participants with diabetes, significant decreases in the prevalence of smoking occurred among African Americans and those aged >/=65 years. CONCLUSIONS: New efforts and commitments to promote smoking cessation among people with diabetes are needed.