二硫化碳作业女工受孕时间影响因素的研究

目的 探讨二硫化碳影响女工受孕时间的危险因素.方法前瞻观察欲生育女工妊娠所需的月经周期数,采用Cox回归分析方法筛选影响女工受孕时间的危险因素.结果接触组女工的平均受孕时间中位数为2.25个月,对照组女工的平均受孕时间中位数为1.70个月,接触组女工的受孕时间明显延长(P＜0.001);接触组女工的早早孕丢失率(29.57%)明显高于对照组的早早孕丢失率(13.11%,P＜0.001);Cox回归分析提示,二硫化碳作业女工受孕时间延长的主要危险因素是女工接触二硫化碳(P=0.001,RR=0.327)和工作紧张(P=0.001,RR=0.694).结论女工接触二硫化碳和工作紧张可能是导致该行业作业女工受孕时间延长的主要危险因素.     

二硫化碳作业女工早早孕丢失的研究

目的　探讨二硫化碳（ Ｃ Ｓ２） 对作业女工孕早期胚胎发育的影响。方法　采用早早孕丢失为观察指标进行了研究,在观察期间共征集到１３９ 名欲要生育的女工,于每个月经周期２１ 天开始收集晨尿及隔日晨尿,至月经来潮或临床确诊妊娠止,共３４０ 个月经周期,２ ０４５ 份尿样,单克隆酶免方法定量测定尿样中绒毛膜促性腺激素含量。结果　接触组女工早早孕丢失率为４８ ．７ ％ ,明显高于对照组（２６ ．３ ％ , Ｐ＝ ０ ．００４ １） 。夫妻双方均接触 Ｃ Ｓ２ 时,早早孕丢失率明显升高（ Ｐ＝ ０ ．００７ ４） 。作业地点 Ｃ Ｓ２浓度与早早孕丢失率相关（ ｒ ＝ ０ ．９９９ , Ｐ＝ ０ ．００１） 。结论　接触 Ｃ Ｓ２ 的女工早早孕丢失的危险性升高, Ｃ Ｓ２ 浓度与早早孕丢失率之间有明显的剂量反应关系。     

Effect of barbiturates on the liver of rats exposed to carbon disulphide vapour

Summary Three-day pretreatment of rats with a daily dose of 80 mg/kg phenobarbital sodium i.p. and subsequent 8-hour exposure to 20 or 200 ppm CS₂, followed by a narcotic dose of 100 mg/kg hexobarbital sodium i.p., did not cause appreciable fat accumulation in the liver cells, SGOT and SGPT also remaining normal. Fat accumulation also was absent when exposure to 200 ppm CS₂ (48 hrs and 7 days, respectively) was preceded by hexobarbital treatment. By contrast, extensive accumulation of fat in the Kupffer cells as well as in the centrilobular, intermediate and acino-peripheral hepatic areas was found in phenobarbital-pretreated rats 24 hrs after oral administration of a very high CS₂ dose of 1 ml/kg in 1 ml/kg olive oil. At the same time, SGOT and the esterified fatty acids in the liver were raised. Accumulation of fat in the liver cells was less extensive in rats not having received phenobarbital pretreatment. Administration of olive oil alone remained without effect. From the results obtained it is concluded that degenerative hepatic damage (e.g. fat accumulation or necroses) is not likely to develop in individuals without hepatic disease receiving barbiturate-containing drug therapy, who at the workplace are exposed to a concentration of 20 ppm CS₂ (maximum acceptable concentration, threshold limit value), with occasional peak concentrations around 200 ppm.     

Effects of exposure to carbon disulfide (CS2) on electrocardiographic features of ischemic heart disease among viscose rayon factory workers

The objective of the study was to evaluate viscose plant workers for electrocardiographic manifestations resulting from exposure to carbon disulfide (CS₂). A total of 162 workers (118 in an exposure group and 44 in a reference group) were evaluated using a health questionnaire, physical check-up, biochemical analysis of blood samples and electrocardiograms (ECG). The exposure group consisted of workers in the following areas: viscose manufacturing, cellophane processing, ripening, and filament spinning. Reference group workers were from the administrative office, rolling area, pulp processing, and testing office. Only slight differences were found in the biochemical analyses of the two groups, with the exception of sodium (Na) levels. Personal and area sampling results were found to have a high variation due to different locations within the plant and a wide range of manufacturing processes. Highest CS₂ concentrations were found in the ripening area (54.60 ppm) and the filament spinning area (19.60 ppm). Using a multiple logistic regression model to control variables (age, gender, body mass index, duration of employment, cholesterol, smoking, and alcohol), we found a relative risk for ECG abnormalities 4.18 times significantly higher for the exposure group. The authors feel that the installation of an adequate ventilation system could greatly reduce the risk of workers developing CS₂-induced cardiovascular abnormalities. Received: 29 August 1995 / Accepted: 17 January 1997     

老年缺血性心脏病患者颌面部手术围麻醉期安全性分析

目的本研究主要就老年缺血性心脏病患者行颌面部手术的麻醉安全性展开分析讨论。方法选择我院所收治的80例缺血性心脏病患者,利用随机数字法将其均分成对照组与观察组,对照组患者给予丙泊酚、瑞芬太尼、舒芬太尼等药物进行麻醉处理,观察组患者在此基础上给予地卡因、利多卡因等药物进行治疗,比较两组患者在插管前后的脉搏波动情况以及血压。结果两组患者在插管后的脉搏波动情况以及血压存在明显差异,具有统计学意义,P〈0.05。结论在对老年缺血性心脏病患者行颌面部手术治疗时,一定要根据患者的具体情况来对麻醉药物进行适当的选择,并做好相应的准备工作,以便于提高患者在手术过程中的麻醉安全性。     

TTCA measurements in biomonitoring of low-level exposure to carbon disulphide

Objectives: The biomonitoring of carbon disulphide exposure is currently performed by measuring the concentration of 2-thiothiazolidine-4-carboxylic acid (TTCA) in the urine of exposed workers. Methods: In this study the effect of TTCA, which is found in some vegetables, on the biomonitoring of low-level carbon disulphide exposure was evaluated. In addition the upper reference limit (URL) of TTCA in the non-exposed Finnish population was estimated by analysing TTCA in urine samples from 116 people. The samples were collected at health centres all over Finland from people in employment and in the age group 24–64 years. The analytical measurements were made using a modern column-switching technique and the results were compared with those from the same samples using the extraction method generally in use and, until now, recommended for the determination of TTCA in urine. Results: The results obtained with the two analytical methods correlated very well with each other (r=0.9). The liquid-liquid extraction method gave results constantly about 3.5 μmol/l higher than the column-switching method. The results of this study also confirmed that many cruciferous vegetables (Cruciferae) contain endogenous TTCA (0.6–5.0 mg/kg), which is excreted unchanged in the urine. After a normal meal which included these vegetables, the TTCA concentration did not rise above the biomonitoring action level even if this was as low as 2 mmol/mol creatinine, but was easily above the URL of TTCA in the non-exposed population. The URL, calculated as the 95th percentile, was 0.3 mmol/mol creatinine. Conclusion: The results showed that the extraction method was not sufficiently specific or sensitive when the TTCA concentrations were lower than 10 μmol/l. In contrast, the column-switching method seemed to give reliable results even at these low levels, which are the levels of interest in current practice. Received: 29 September 1999 / Accepted: 27 December 1999     

中国儿童肥胖的遗传易感性与成年期缺血性心脏病发病风险的研究

目的分析儿童肥胖的测量学指标BMI相关基因序列变异与发生缺血性心脏病(IHD)、急性冠心病事件(MCE)的关联。方法利用中国慢性病前瞻性研究中6.9万余名具有全基因组遗传数据的样本, 剔除基线时患有冠心病、脑卒中、恶性肿瘤的个体, 最终纳入64 454人。采用既往全基因组关联研究显著性遗传位点构建儿童BMI遗传风险评分, 并根据其五分位数进行分组, 最低五分位组为低遗传风险组, 最高五分位组为高遗传风险组。采用Cox比例风险回归模型计算儿童BMI的遗传风险评分与IHD、MCE发生风险的关联。结果研究对象平均随访10.7年, 期间新发IHD 7 073例, MCE 1 845例。调整了性别、年龄、地区及前10个遗传主成分后, 与低遗传风险组相比, 高遗传风险组发生IHD、MCE的HRs值(95%CIs)分别为1.10(1.02～1.18)、1.10(0.95～1.27)。遗传风险评分每增加一个标准差, IHD的发病风险增加4%(2%～6%)(线性趋势P=0.001)。进一步调整基线BMI后, 高遗传风险组与低遗传风险组的效应值差异无统计学意义, 但遗传风险评分与IHD发病风险间仍具有线性...     

The pattern of ischemic heart disease 1931-1980

The rise in ischemic heart disease in the U.S. after 1920 has been described in the literature both as a 20th century epidemic and as an artifact of the decline of competing causes of death, particularly the infectious, parasitic and diarrheal diseases. Shifting medical terminology and occasional major revisions in cause of death codes have aggravated efforts to resolve the debate. Through regression analysis and ordinary and cause-deleted life tables we trace the course of the disease. The accumulated evidence points to a major epidemic but one largely confined to males. Reversals in patterns are now beginning.     

Biological monitoring of carbon disulphide and phthalate exposure in the contemporary rubber industry

Objectives: We studied the range in urinary levels of 2-thiothiazolidine-4-carboxyl acid (TTCA), a metabolite of CS₂ and phthalic acid (PA), a common metabolite of phthalates, across factories and departments in the contemporary rubber manufacturing industry. Methods: Spot urine samples from 101 rubber workers employed in nine different factories were collected on Sunday and during the workweek on Tuesday, Wednesday and Thursday at ∼4 pm. In total, 386 urine samples were successfully analyzed. Results: Levels of both biomarkers increased significantly by a factor 2 (paired t-test P-value <0.05) during the working week as compared to the Sunday biomarker levels with absolute increases of approximately 70 μg/l and 5 μmol/mol creatinine for PA and TTCA, respectively. Levels in both biomarkers did not differ markedly between working days. Increases seemed to be restricted to specific factories and/or departments (e.g. molding and curing). Conclusions: The results of this study demonstrate that rubber workers in the contemporary rubber industry are exposed to phthalates and low levels of CS₂ (∼0.05 ppm) as measured by PA and TTCA, respectively. Exposures to both compounds are largely driven by specific circumstances in factories. Therefore, when estimating exposures to phthalates and CS₂ detailed information should be collected on the type and amount of phthalate containing ester plasticizers, dithiocarbamates and thiurams used. Preferably, personal exposure data should be collected. In this case, biological monitoring seems a reasonable approach. However, in the case of PA attention should be given to individual background levels as this could lead to a substantial overestimation of the occupational contribution to total phthalate exposure.     

郑州地区缺血性心脑血管病患者二级预防用药现状及用药依从性调查

目的 探讨缺血性心脑血管病患者二级预防用药现状,并对影响其用药依从性的相关因素进行分析。方法 纳入2021年1月至2022年1月于郑州市某医院接受治疗的缺血性心脑血管病患者作为研究对象,对该人群进行二级预防用药情况的问卷调查,采用描述性分析方法对用药类型及用药依从性等结果进行分析,并采用单、多因素分析方法对该人群二级预防用药依从性的影响因素进行分析。结果 本研究共对763例缺血性心脑血管病患者进行调查,有效调查患者750例,有效率为98.29%。其中缺血性心脏病患者306例,缺血性脑卒中患者422例,22例患者合并缺血性心脏病及缺血性脑卒中。750例缺血性心脑血管病患者中198例患者自报服用抗血小板药或他汀类药物,占比为26.40%,仅服用抗血小板类药物和仅服用他汀类药物的患者占比分别为45.95%(91/198)、29.29%(58/198)。112例患者依从性较好,服药依从率为56.57%。二分类Logistic回归分析结果显示性别（OR=2.289）、年龄（OR=0.624）、文化程度（OR=2.020）、工作情况（OR=3.391）、家庭年收入（OR=1.723、2.164）、...     

Indicators of cardiovascular risk among workers exposed to high intermittent levels of carbon disulphide

The effects of exposure to carbon disulphide have been studied mostly among workers in the viscous rayon industry, where the usual exposure profile has been relatively steady exposure over work shifts. We investigated 13 workers in a small chemical company who were exposed to low levels, peaking intermittently to relatively high levels in the range of 100-200 ppm at the end of the work shift, a pattern that may change the risk profile. Our investigation was part of a compliance order that was fought by the company and our access and follow-up was limited. Two workers had burns on their bodies associated with exposure to caustic. Four had elevations in total serum cholesterol, one had elevated serum triglycerides and three had elevations in fasting blood glucose--two of them were known to be diabetics before employment and one had a history of unexplained peripheral neuropathy. No consistent pattern suggestive of a defined lipoprotein abnormality was obvious but several atherogenic profiles were observed. Five had abnormalities on electrocardiogram, four of whom appeared to be among the most heavily exposed. The presence of these changes taken together in this context may suggest accelerated atherosclerotic changes. Tests of liver and kidney function were within the normal range for all workers, as was a complete blood count. Four of the workers had evidence of a bilateral reduction in hearing threshold at 4,000 Hz. A complete set of recommendations was forwarded to the employer, emphasizing further control of exposure to carbon disulphide, personal protection requirements and a cardiovascular risk reduction programme. Conditions improved in the plant following modifications introduced in response to a stop work order from the provincial government's occupational health and safety agency. However, a fire in 1998 put the company out of business and ended further follow-up or interventions. We conclude that these findings, while difficult to interpret because of the circumstances of the investigation, are compatible with an atherogenic effect of exposure to peaking levels of carbon disulphide. The observation should be tested in a larger population with fewer confounding factors and greater control over the investigation.     

Biological monitoring of workers occupationally exposed to carbon disulphide in a rayon plant in Brazil: Validity of 2-thiothiazolidine-4-carboxylic acid (TTCA) in urine samples taken in different times, during and after the real exposure period

Fifteen workers from a rayon plant in Brazil were monitored. Air samples were taken during a mean period of 5.8 hours out of an 8 hour workshift, in three different adsorbing tubes. Five urine samples were taken at 4 hour interval from the beginning of the shift, and at the beginning of the next shift in which 2-thiothiazolidine-4-carboxylic acid (TTCA) concentration was analysed. Data from seventeen individuals were statistically studied, with the aim of establishing the best and the most practical sampling strategy of biological monitoring for workers occupationally exposed to CS₂. For those chronically exposed to CS₂, TWA air concentration lower than 30 and higher than 10 mg/m³, it was found that the higher the exposure levels, the lower was TTCA concentration in the end of shift urine samples. The results may be explained by dietary habits and/or by the small number of examined population or even eventual casualty. On the other hand they raise other hypothesis involving the chronicity of exposure which may lead to important changes in metabolism influencing the excretion rate of TTCA.     

Effects of annual influenza vaccination on mortality and hospitalization in elderly patients with ischemic heart disease: a nationwide population-based study

Objective

The effects of influenza vaccination on ischemic heart disease (IHD) patients remain controversial. The purpose of this study was to evaluate the effects of influenza vaccination on all-cause mortality and hospitalization for cardiovascular disease in elderly IHD patients.

Methods

Elderly patients (> 65 years old) with IHD, including ischemic heart failure and coronary artery disease between January 1997 and September 2002 were identified by using the Taiwan National Health Insurance Research Database. The association between influenza vaccination and all-cause mortality and hospitalization due to cardiovascular disease was analyzed.

Results

We included 5048 patients. During the influenza season, influenza vaccination was associated with a reduced risk of all-cause mortality [hazard ratio (HR), 0.42; 95% confidence interval (CI) 0.35-0.49] and hospitalization for cardiovascular disease (HR, 0.84; 95% CI, 0.76-0.93). During the non-influenza season, vaccination was associated with a reduced risk of mortality (HR, 0.78; 95% CI, 0.68-0.90) in elderly IHD patients.

Conclusion

Influenza vaccination was associated with a reduced risk of all-cause mortality in elderly IHD patients throughout the whole year, as well as a reduced risk of hospitalization during the influenza season.     

老年高血压合并高脂血症并发缺血性心脏病的高危因素探讨

目的 探讨老年高血压合并高脂血症并发缺血性心脏病的高危因素.方法 选取2009年2月～2011年2月入住某院的老年高血压患者96例,其中并发高脂血症的54例患者为观察组,未并发高脂血症的的42例患者对照组.观察患者年龄、家族史、吸烟史、饮食控制情况、糖尿病史、高血压病史时间、甘油三酯水平、总胆固醇水平、血尿酸水平、血清超敏c反应蛋白水平、心电图、冠状动脉造影等.结果 观察组患者缺血性心脏病发生率明显高于对照组(x2=4.22,P＜0.05);多因素Logistic回归分析发现老年高血压合并高脂血症患者并发缺血性心脏病的危险性与年龄、吸烟、高甘油三酯血症、高胆固醇血症、高水平超敏c反应蛋白、高尿酸血症有关.结论 年龄、吸烟、高甘油三酯血症、高胆固醇血症、高水平超敏c反应蛋白、高尿酸血症是老年高血压合并高脂血症患者并发缺血性心脏病的高危因素.     

Blood concentrations of carbon disulphide in dithiocarbamate exposure and in the general population

Summary Blood carbon disulphide (CS₂), both free and total, was determined by gas chromatography-mass spectrometry in 112 normal subjects and in 20 subjects employed in a dithiocarbamate factory, comprising ten blue-collar workers involved in dithiocarbamate production and ten white-collar office staff. The ten production workers were examined over two workshifts, the first at the beginning of the week (Monday) and the second after an intervening period of at least 1 day. Three blood samples were taken for each shift studied, one prior to starting work, one at the end of the shift and the third 16 h after the end of the shift (on the following morning). The mean CS₂ blood levels measured in the 112 normal subjects was 663 ng/l for the free fraction and 3178 ng/l for the total. In 16 blood samples taken from the ten dithiocarbamate factory office workers, the mean free and total CS₂ blood levels were 846 and 4140 ng/l, respectively, i.e. not significantly different from those observed in the normal subjects. At the end of the first 8-h shift, the ten dithiocarbamate factory production workers had free and total CS₂ values of 1070 and 8471 ng/l, respectively, which were significantly higher than those observed prior to starting work (240 and 4738 ng/l). All the total CS₂ levels measured in the shop-floor workers, with the sole exception of the values recorded prior to the start of the Monday shift (4738 ng/l), ranged from 7047 to 8471 ng/l and were significantly higher than those measured in the white-collar staff (4140 ng/l).     

冠状动脉造影对心房颤动患者的冠心病诊断价值

目的用冠状动脉造影(冠造)比较心房颤动(房颤)患者冠心病诊断的准确性。方法87例房颤患者包括阵发性房颤56例，持续性房颤31例，均行冠造检查，通过房颤患者冠脉狭窄的分布．评价两者冠心病的诊断价值。结果(1)87例心电图有缺血型ST-T改变36例中，阵发性房颤20例．冠造示冠脉有不同程度狭窄者8例(40．0％)；持续性房颤16例．冠造示不同程度冠脉狭窄者10例(62．5％)。(2)冠脉造影对房颤病因冠心病的诊断价值：阵发性房颤56例中确诊为冠心病者4例(7.1％)；持续性房颤31例中确诊为冠心病者16例(51．6％)。结论冠造诊断价值可靠、准确；房颤患者不能单凭房颤诊断冠心病。     

心电图和超声心动图检查对煤工尘肺并发肺心病患者的诊断和治疗的价值

目的探讨心电图及超声心动图检查在尘肺并发肺心病患者的诊断、治疗以及病情观察中的重要性。方法收集国家安全生产监督管理总局职业安全卫生研究中心2013年住院的89例煤工尘肺患者作为尘肺组,同时选择从事煤矿井下作业无尘肺病诊断的退休工人60名作为对照组,全部为男性,尘肺组与对照组年龄及接尘时间无显著性差异,同时排除其他心脏疾患。将尘肺组及对照组同时进行心电图及超声心动图检查并进行统计学分析。结果尘肺组和对照组心电图肺心病检出率分别为27.0%和11.7%,差异有统计学意义(χ2=5.091,P0.05)。尘肺组不同期别煤工尘肺心电图肺心病检出率分别为Ⅰ期16.7%、Ⅱ期30.0%、Ⅲ期34.5%。尘肺组和对照组的超声心动图肺心病检出率分别为48.3%、23.3%,差异有统计学意义(χ2=9.469,P0.01)。尘肺组不同期别煤工尘肺超声心动图肺心病检出率分别为Ⅰ期30.0%、Ⅱ期43.3%、Ⅲ期72.4%。尘肺组心电图及超声心电图肺心病检出率分别为27.0%和48.3%,差异有统计学意义(χ2=8.640,P0.01)。超声心动图右心室流出道增宽诊断煤工尘肺患者肺心病患病率优于右心室增大及左/右心室减小,差异有统计学意义(χ2=10.687,P0.01)。结论超声心动图对于尘肺并发肺心病患者的诊断、治疗以及病情观察比心电图检查更具有优越性。煤工尘肺对心血管系统的影响比较显著,应用超声心动图检查能够早期发现尘肺患者的肺心病并发症,及时采取治疗措施,对延缓其病情快速发展,改善患者预后均有非常重要的意义。     

1990-2019年江苏省居民缺血性心脏病及其危险因素疾病负担变化趋势

目的  探讨1990-2019年江苏省居民缺血性心脏病(ischemic heart disease,IHD)及其危险因素疾病负担变化趋势。方法  基于2019年全球疾病负担(global burden of disease, GBD)研究,利用早死损失寿命年(years of life lost, YLL)、伤残损失寿命年(years lived with disability, YLD)、伤残调整寿命年(disability-adjusted of life years, DALY)和人群归因分值(population attributable fraction, PAF)分析1990-2019年江苏省人群IHD疾病负担和归因疾病负担变化趋势,并采用分解法将年龄相关DALY分解为人口增长、年龄构成、年龄别患病率和疾病严重程度4个因素。结果  1990-2019年江苏省居民IHD患病数、死亡数和DALY均呈增长趋势;标化YLL率和DALY率呈下降趋势,2010-2019年年均降幅高于1990-2010年。2019年江苏省IHD DALY较1990年增长了75.78%;归因于年龄别患病率、年龄构成、人口增长和疾病严重程度增长率依次为52.06%、46.12%、23.52%和-45.92%。2019年,IHD 26种危险因素归因DALY占IHD总DALY的92.75%;其中环境/职业、行为和代谢危险因素比例分别为38.21%、68.03%和79.07%。2019年IHD归因标化DALY率前5位的危险因素分别为高收缩压、高低密度脂蛋白胆固醇、烟草、室外颗粒物污染和钠摄入过多。近30年间室外颗粒物污染、高BMI、红肉摄入过多、加工肉摄入过多和饮酒5个危险因素年均变化率(annual rate of change, ARC)呈上升趋势,ARC分别为1.29%、1.76%、0.36%、0.32%和4.19%。2010-2019年有10种IHD危险因素的标化DALY率顺位上升,8种危险因素的顺位下降。结论  1990-2019年江苏省居民IHD疾病负担总体增加,人口老龄化和年龄别患病率是江苏省IHD DALY增长的主要原因。加强对高血压、高血脂和肥胖的预防和控制,戒烟限酒、减少红肉和加工肉摄入水平,改善室外空气污染是今后江苏省IHD防治的重点。     

DSA在缺血性脑血管病诊治中的应用

目的：探讨DSA在缺血性脑血管病诊断和血管内介入治疗中的应用。方法：通过对234例缺血性脑血管患者的全脑血管造影图像分析,得出病变血管的最佳投照角度。结果：基底动脉狭窄病变血管的最佳投照角度为向足倾斜28o±5o;椎动脉颅内段狭窄病变血管的最佳投照角度为右前斜或左前斜25o±3o;右椎动脉起始段狭窄病变血管的最佳投照角度为左前斜20o±5o并向头侧倾斜15o±5o;左椎动脉起始段狭窄病变血管的最佳投照角度为右前斜20o±5o;右侧锁骨下动脉起始段狭窄病变血管的最佳投照角度为左前斜50o±6o并向足侧倾斜20o±7o;左侧锁骨下动脉狭窄病变血管的最佳投照角度为左前斜50o±6o;大脑中动脉M1段近端狭窄病变血管的最佳投照角度为右前斜或左前斜15o±5o。结论：熟练操作机器,掌握机器的性能和技巧,正确应用最佳投照角度,有助于缺血性脑血管病的诊断和治疗。     

A follow-up study of coronary heart disease in viscose rayon workers exposed to carbon disulphide.

In 1967 two cohorts of 343 men each were formed and matched with respect to age, district of birth, and similarity of work. One cohort comprised viscose rayon workers with at least five years' exposure to carbon disulphide during any period between 1942 and 1967, and the other cohort consisted of workers from a paper-mill with no such exposure. The concentrations of carbon disulphide and hydrogen sulphide in the workroom air had been measured regularly since 1950, and about 4000 measurements were available. In all probability the concentrations had been very high in the 1940s, between 20 and 40 ppm in the 1950s, and about 10 to 30 ppm from 1960 onwards. On examination in 1967 it was confirmed that all of the relevant coronary risk factors had been kept under control. The only exception to this was blood pressure which was slightly higher among the exposed workers, a finding that was interpreted as a result of exposure rather than an independent risk factor. A five-year follow-up showed that 14 men had died from coronary heart disease (CHD) in the exposed group, against three in the control group (P smaller than 0:007). Other causes of death were evenly distributed. In addition, 11 nonfatal first infarctions had occurred in the exposed group as compared with four in the control group. On re-examination in 1972, nearly 25% of the exposed men, against 13% of the controls, had a history of angina (typical, probable, and possible) as measured by the World Health Organization questionnaire (P smaller than 0:0002). The prevalence proportions of typical angina were 12% and 5% respectively (P smaller than 0:001). As opposed to this, only slight differences were apparent for coronary ECGs. The higher degrees of prevalance in the exposed group may well have been attributable to chance. As in 1967/68, the mean systolic and diastolic blood pressures were slightly higher in the exposed group (P smaller than 0:001 and P smaller than 0:01, respectively). The relative risk was 4-8 for fatal attacks, 3-7 for all infarctions, 2-8 for nonfatal infarctions, 2-2 for angina, and 1-4 for ECG findings indicative of CHD. This implies that with increasing severity and specificity of the manifestations the causal role of CS2 in developing CHD becomes more evident. Further, it is inferred that exposure to CS2 seems to worsen the prognosis of CHD in addition to increasing its incidence. Although the exposure data in this study may not be representative of the personal exposure of the workers, the conclusion is drawn that a great deal of justification exists for lowering the threshold limit value of 20 ppm recommended by the American Conference of Governmental Industrial Hygienists.