Allergic contact hand dermatitis due to constituents of nitrile gloves

Purpose: This report of a case of allergic contact hand dermatitis due to constituents of nitrile gloves is to bring to the attention of practitioners four important practice points: 1) allergic contact dermatitis may occur due to exposure to chemicals in nitrile gloves; 2) skin patch testing is used to identify the causative allergens; 3) targeted allergens may be necessary in addition to the baseline European standard series if the standard series is unhelpful; and 4) there are potential interventions to manage nitrile glove dermatitis. Findings: A laboratory analyst had occupational exposure to several allergens and had worn latex gloves. She was exposed to laboratory chemicals and powdered ore dust, containing precious metals. She developed hand dermatitis and was relocated to administrative duties not requiring glove use. Her dermatitis cleared but recurred when she returned to the laboratory and started using nitrile gloves. On history, nitrile gloves and platinum group metal ore dust were consistently associated with her hand dermatitis, but laboratory chemicals were not. Latex-specific immunoglobulin E (IgE) was negative, as were skin patch tests for 13 allergens in the metal series, including salts of platinum group metals. She had positive allergic reactions to cobalt chloride, formaldehyde, nickel sulphate, and quaternium 15 in the European standard series patch tests. She did not react to the rubber chemicals in the European standard series, including thiuram mix. The patient was then tested with the rubber additives series because of the glove-relatedness of her hand dermatitis. She had positive reactions to three thiuram compounds used as accelerators in rubber gloves. The patient went on vacation during which time her dermatitis improved. She was relocated to a position without glove use or ore contact and her dermatitis did not recur. Conclusions: An analytic laboratory worker developed hand allergic contact dermatitis due to nitrile glove constituents. The diagnosis is supported by the improvement in her dermatitis after cessation of glove use, negative metal series patch tests, and positive patch tests to accelerators found in rubber gloves. Nevertheless, a contribution to the dermatitis by metals in the platinum group metal ore dust cannot be excluded. Recommendations: Nitrile glove constituents should be considered in wearers who develop hand dermatitis. Skin patch testing is recommended to investigate putative agents. Specific patch test series for more targeted testing may be required

Results of Radioactive Iodine (131I) Therapy in Well Differentiated Thyroid Carcinoma: A Retrospective Study from the Tygerberg Hospital.

Introduction: Well Differentiated thyroid carcinoma (WDTC) represents 80% of all thyroid malignant tumours, with good prognosis and a survival rate higher than 90% at 20 yrs. Total or subtotal thyroidectomy is the treatment of choice, with radioactive iodine (RAI) therapy reserved for adjuvant setting/ablation and/or as a curative treatment modality in patients with local recurrence and/or distant metastases. This retrospective study aimed to investigate the treatment outcome, survival rate and prognostic factors in our institution over the past half-decade. Methods: A retrospective study was conducted of 33 patients with WDTC. Data were collected from 1stJanuary 2007 to 31st December 2012 and included: Age at diagnosis, sex, histology, TNM stage, treatment received, indication for 131I therapy, doses of 131I, complication of treatment, follow-up diagnostic scan 123I / Thyroglobulin, time of recurrence since surgery and cause of death. Prognostic factors were analysed using chi-square test and crude mortality rate was used. Results: Papillary subtype is the most common type of WDTC (63.6%); mean age at diagnosis is 50 years and female to male ratio is cosmopolitan at 3.1:1 with female preponderance. RAI therapy after thyroidectomy (total or subtotal) offers complete remission in 26/33 (78.8%) and the overall mortality rate was 3/33 (9.1%) p=0.023. Conclusion: RAI therapy is safe and effective in management of patients with WDTC. The initial surgical approach is the cornerstone in the subsequent outcome of RAI therapy with very poor outcome registered in unresectable thyroid tumour and in patients with multiple organ metastases.