Respiratory health of cigar factory workers

OBJECTIVES: To determine whether occupational exposure to raw tobacco causes respiratory or allergic diseases, an excess of respiratory symptoms, a decrease in lung function, or parenchymal changes in chest radiography among Finnish cigar workers. METHODS: This cross sectional study included all Finnish cigar workers (n = 106) exposed to raw tobacco and also a group of unexposed matched referents. Data were collected with a self administered questionnaire, flow volume spirometry, measurements of diffusing capacity of the lung for carbon monoxide, chest radiography and skin prick tests. A questionnaire was also sent to former workers of the factory. RESULTS: There were no significant differences between the groups in the prevalence of respiratory symptoms and chest radiography findings. Nine of 102 tobacco workers had pulmonary fibrosis of at least 1/0 (according to the International Labour Organisation (ILO) 1980 classification) and the corresponding figure was five for the referents. The tobacco workers tended to have a low forced vital capacity (FVC), and they had impaired forced expiratory volume in 1 second and lower means of the maximal expiratory flow at 25% of the FVC significantly more often than the referents. Diffusing capacity tended to be lower among the referents. The referents more often had atopy and earlier atopic diseases than the exposed workers. These results indicate the possibility of selection among the exposed workers. CONCLUSIONS: No excess of prevalence of respiratory symptoms in the tobacco workers was found. According to the questionnaire episodes of allergic alveolitis may have occurred in the cigar factory workers. However, in the absence of impairments in lung function and radiological changes it was not possible to distinguish humidifier fever and allergic alveolitis. In exposure conditions that include humidification of the air humidifier, fever and allergic alveolitis constitute a risk for tobacco workers. No effects were shown of exposure to tobacco dust on lung function.       

Occupational exposure to asbestos as evaluated from work histories and analysis of lung tissues from patients with mesothelioma

The past occupational exposure to asbestos of 23 patients with mesothelioma (21 men and two women) has been evaluated by a personal interview of their work history and by determination of the fibre burden in their lung tissue with scanning electron microscopy (SEM) and x ray microanalysis. According to the work history, nine patients (39%) had definitely been or probably been exposed to asbestos, six patients (26%) had had possible exposures, and eight patients (35%) unlikely or unknown exposure to asbestos. The two female patients were in the unknown exposure category. The fibre concentrations in the patients' lung tissue ranged from less than 0.1 million to 370 million fibres (f) per g dry tissue. Concentrations of over one million f per g dry tissue were found in 15 patients (65%). The lung fibre concentrations of all nine male office workers analysed for reference were less than one million f per g dry tissue. Seventy eight per cent of the patients with mesothelioma had at least possible exposure according to their history of work or concentrations of more than one million f per g dry tissue.     

Occupational exposure to asbestos as evaluated from work histories and analysis of lung tissues from patients with mesothelioma.

The past occupational exposure to asbestos of 23 patients with mesothelioma (21 men and two women) has been evaluated by a personal interview of their work history and by determination of the fibre burden in their lung tissue with scanning electron microscopy (SEM) and x ray microanalysis. According to the work history, nine patients (39%) had definitely been or probably been exposed to asbestos, six patients (26%) had had possible exposures, and eight patients (35%) unlikely or unknown exposure to asbestos. The two female patients were in the unknown exposure category. The fibre concentrations in the patients' lung tissue ranged from less than 0.1 million to 370 million fibres (f) per g dry tissue. Concentrations of over one million f per g dry tissue were found in 15 patients (65%). The lung fibre concentrations of all nine male office workers analysed for reference were less than one million f per g dry tissue. Seventy eight per cent of the patients with mesothelioma had at least possible exposure according to their history of work or concentrations of more than one million f per g dry tissue.     

Tumor markers and neurological signs in asbestosis patients

Ninety asbestosis patients were examined clinically with special emphasis on the function of the peripheral and the central nervous system. Serum specimens were analyzed for carcinoembryonic antigen(s) (CEA), ferritin, and beta 2-microglobulin (beta 2m) content. The patients were classified into four subgroups: (1) those with peripheral neuropathy, (2) those with involvement of central nervous system, (3) those with both types of neurological signs, and (4) those with normal neurological status. The levels of serum CEA, ferritin, and beta 2m were elevated in all four subgroups. No statistically significant differences were found between the groups in the prevalence of elevated values of the three tumor markers (equal or above the following limits: CEA, 5 micrograms/liter; ferritin, 400 micrograms/liter, and beta 2m, 3 mg/liter). The patients currently smoking had a higher level of serum CEA than nonsmokers or exsmokers, but the differences were not statistically significant. In the subgroup that comprised those asbestosis patients in whom the disease could be considered progressive according to the ILO 1980 classification of the chest radiographs, the mean level of CEA in serum was higher than that of the patient group without such progression of the disease (p less than 0.05, Student's t test). Although the prevalence of abnormal neurological signs was high in these asbestosis patients, no obvious correlation was found between the neurological findings and the tumor markers studied.     

Candida sepsis originating from bulbar abscess of the penis

We describe a patient with a very unusual penile abscess. Antibiotic treatment for Clostridium sordellii and Candida albicans infection and drainage of pus was curative. We propose that the penile abscess may have been an unusual manifestation of a rectal fistula.     

Electrocardiographic signs of cor pulmonale in asbestosis

Summary A cross-sectional study examining the prevalence of electrocardiographic (ECG) signs of cor pulmonale and their correlation with ventilatory capacity was carried out with 130 asbestosis patients and 121 referents. The ventilatory function of 120 of the 130 patients was measured, 41 having a normal FEV_1.0, 50 slight FEV_1.0 impairment and 29 moderate or severe FEV_1.0 impairment. The cor pulmonale signs were more prevalent in the asbestosis than in the reference group, the greatest differences being found in P_II,III,aVF amplitude, PV₁ amplitude, ÂQRS deviation to the right and shift of QRS transition to the left. These differences were not, however, statistically significant. The frequencies of electrocardiographic cor pulmonale findings in the three FEV_1.0 categories of asbestosis patients were established. The atrial parameters P_II,III,aVF, ÂP, and PV₁ correlated the best with FEV_1.0, but only the relationship PV₁/FEV_1.0 was significant (P<0.05). Most of the ventricular ECG parameters failed to show any association with FEV_1.0, especially SV_5,6 amplitude, which has displayed a strong positive correlation with FEV_1.0 in many studies dealing with obstructive lung diseases, and terminal notching of QRS. The present study suggests that the atrial ECG variables are the most valuable items for assessing right heart disease in patients with asbestosis.     

Activation of innate immunity system during aging: NF-kB signaling is the molecular culprit of inflamm-aging

Innate and adaptive immunity are the major defence mechanisms of higher organisms against inherent and environmental threats. Innate immunity is present already in unicellular organisms but evolution has added novel adaptive immune mechanisms to the defence armament. Interestingly, during aging, adaptive immunity significantly declines, a phenomenon called immunosenescence, whereas innate immunity seems to be activated which induces a characteristic pro-inflammatory profile. This process is called inflamm-aging. The recognition and signaling mechanisms involved in innate immunity have been conserved during evolution. The master regulator of the innate immunity is the NF-kB system, an ancient signaling pathway found in both insects and vertebrates. The NF-kB system is in the nodal point linking together the pathogenic assault signals and cellular danger signals and then organizing the cellular resistance. Recent studies have revealed that SIRT1 (Sir2 homolog) and FoxO (DAF-16), the key regulators of aging in budding yeast and Caenorhabditis elegans models, regulate the efficiency of NF-kB signaling and the level of inflammatory responses. We will review the role of innate immunity signaling in the aging process and examine the function of NF-kB system in the organization of defence mechanisms and in addition, its interactions with the protein products of several gerontogenes. Our conclusion is that NF-kB signaling seems to be the culprit of inflamm-aging, since this signaling system integrates the intracellular regulation of immune responses in both aging and age-related diseases.     

Dose monitoring in pediatric and young adult head and cervical spine CT studies at two emergency duty departments

Purpose

As the number of pediatric computed tomography (CT) imaging is increasing, there is a need for real-time radiation dose monitoring and evaluation of the imaging protocols. The aim of this study was to present the imaging data, patient doses, and observations of pediatric and young adult trauma—and routine head CT and cervical spine CT collected by a dose monitoring software.

Methods

Patient age, study date, imaging parameters, and patient dose as volume CT dose index (CTDI_vol) and dose length product (DLP) were collected from two emergency departments’ CT scanners for 2-year period. The patients were divided into four age groups (0–5, 6–10, 11–15, and 16–20 years) for statistical analysis and effective dose determination. The 75th percentile doses were evaluated to be used as local diagnostic reference levels (DRLs).

Results

Six hundred fifteen trauma head, 318 routine head, and 592 trauma cervical spine CT studies were assessed. All mean CTDI_vol values were statistically lower in hospital B (40.3?±?12.3, 30.03?±?11.1, and 6.9?±?3.1 mGy, respectively) than in hospital A (53.0?±?12.9, 43.2?±?8.7, and 18.3?±?7.3 mGy, respectively). Statistically significant differences were observed on scanning length between hospitals and between CTDI_vol values when protocol was updated. The 75th percentiles of trauma cervical spine in hospital B can be used as local DRL. Non-optimized protocols were also revealed in hospital A.

Conclusion

Dose monitoring software offers a valuable tool for evaluating the imaging practices and finding non-optimized protocols.

     

Cytochrome P4501A Induction and Porphyrin Accumulation in PLHC-1 Fish Cells Exposed to Sediment and Oil Shale Extracts

The present study describes the use of a fish hepatoma cell line (PLHC-1) in monitoring the biological effects of sediments collected from recipient waters of the oil shale industry. Sampling sites were located in River Purtse and River Kohtla in northeast Estonia. The effects of pure oil shale on the PLHC-1 cells were also studied. The cells were exposed to n-hexane–extracted samples in 48-well plates for 24 h, and 7-ethoxyresorufin O-deethylase (EROD) activity, total protein, and porphyrin content were measured in the exposed cells. Polycyclic aromatic hydrocarbon (PAH) contents in the samples were measured by high-performance liquid chromatography (HPLC). All the sediment and oil shale samples induced CYP1A activity and led to porphyrin accumulation in the cells. The most potent inducers were the sediments collected near the oil shale processing plants (site Lüganuse in River Purtse and Kohtla in River Kohtla), as well as those at the most downstream site in River Purtse (Purtse). These samples possessed high total PAH contents, ranging from 4,270 to nearly 150,000 μg/kg dry sediment. The presence of other lipophilic organic contaminants in the samples was not determined in this study. Both EROD activity and porphyrin content exhibited biphasic induction curves, and the ED₅₀ ¹ values for EROD activity were lower than the ED₅₀s for porphyrin content. 2,3,7,8-Tetrachlorodibenzo-p-dioxin induction equivalents (TCDD-EQs) calculated from EROD induction potencies correlated well with total PAHs (r ² = 0.827 and p = 0.003 for log-transformed data) and also with individual PAHs. TCDD-EQs for porphyrin content did not correlate significantly with total PAHs (log-log r² = 0.785, p = 0.116). The biological potency and PAH contamination of the samples showed the same rank order, except at Lüganuse, where sediment extracts induced CYP1A and porphyrins more than could have been expected based on PAH contents. Bioassay-derived induction EQs (normalized to dibenz(a,h)anthracene) were 20- to 3,200-fold greater than EQs calculated from the concentrations of five PAHs, suggesting important contributions from other compounds or nonadditive effects. The PLHC-1 cells proved to be a sensitive bioanalytical tool for sediments contaminated with PAH-type pollutants in the oil shale processing area. We suggest further use of this bioassay in screening and monitoring waters with similar background of pollution as in northeast Estonia. Received: 24 August 1998/Accepted: 22 July 1999