Hydroquinone, a benzene metabolite, and leukemia: a case report and review of the literature.

Hydroquinone is a phenolic metabolite of benzene, a known human carcinogen. Hydroquinone is widely used in the industry. We report a case of a 43-year-old male diagnosed with antecedent myelodysplastic syndrome and acute myeloid leukemia following 16 years of occupational exposure to hydroquinone in radiographic developer solution. Cytogenetic studies revealed aberrations in chromosome 5 and chromosome 7. We review the literature on hydroquinone as a potential cause of hematolymphatic cancers and discuss the role of hydroquinone as a genotoxic and leukemogenic agent.

Occupational kidney cancer: exposure to industrial solvents.

We report seven cases of renal cell carcinoma in workers diagnosed with occupational exposure via skin contact and inhalation to industrial solvents containing benzene. The clinical significance of these cases are: (a) all seven patients diagnosed with kidney cancer were seen by private physicians who missed addressing occupational history to industrial solvents; (b) emphasize the importance of taking an in-depth history including occupational history in any patient presented to the clinician, especially like in these cases, kidney cancer; and (c) demonstrate the importance of educating workers. We believe that there exist more patients with renal cancer whose diagnosis has been rendered "idiopathic" due to the lack of detailed occupational, environmental, personal, and family history.

Industrial solvents and kidney disease.

Scientific literature addressing the association of industrial exposures to solvents with glomerular kidney disease is reviewed. The role of the practicing physician in taking an occupational history of exposures to solvents in every case of glomerulonephritis is emphasized. Based on case studies and epidemiologic findings, it is highly probable that exposures to industrial solvents should be considered as a factor in the causation of kidney disease. The need for more frequent reporting is discussed.

Systemic vasculitis and prior recent exposure to organic solvents: report of two cases.

The authors describe two patients with systemic vasculitis and prior occupational exposure to organic solvents. Systemic vasculitis should be considered a sentinel event for such exposures.

Creatine phosphate kinase elevations signaling muscle damage following exposures to anticholinesterases: 2 sentinel patients.

In this study, the authors describe 2 patients who experienced confirmed exposures to anticholinesterases that commenced in the 1970s. Subsequently, elevations in creatine phosphate kinase (CPK) were initially detected more than a decade following the first acute exposure. Beginning in the early 1980s, the patients suffered from progressive generalized muscle weakness, chronic fatigue, myopathy, neuropathy, and severe neurobehavioral impairments. Previous occupational exposures included pyridostigmine, as well as isopropyl methylphosphonofluoridate (percutaneous lethal dose [LD50] < 28 mg/kg body weight), and 1 patient had exposure to agricultural organophosphates. The authors hypothesize that the workers' CPK elevations, first detected more than a decade following acute exposures to anticholinesterases, were sentinel events for impending muscle damage and necrosis. Many Gulf War veterans with Gulf War disease who reported exposures to anticholinesterases 1 decade earlier currently suffer from vague neuromuscular and cognitive impairments. Therefore, medical programs for Gulf War veterans with Gulf War Syndrome should include surveillance for elevated CPK, abnormalities of neuromuscular conduction, and genetic susceptibility, and they should promote therapeutic trials for palliation.

Chronic ammonia inhalation and interstitial pulmonary fibrosis: a case report and review of the literature.

Ammonia is an irritant gas with a characteristic pungent odor, which is widely used in industry. Inasmuch as ammonia is highly soluble in water and, upon inhalation, is deposited in the upper airways, occupational exposures to ammonia have commonly been associated with sinusitis, upper airway irritation, and eye irritation. Acute exposures to high levels of ammonia have also been associated with diseases of the lower airways and interstitial lung. In this study, the authors report on a patient with long-term, repetitive occupational exposure to ammonia at levels at or above odor recognition who developed interstitial lung disease. The scientific literature on inhaled ammonia exposure is reviewed and discussed. The authors conclude that the taking of a careful occupational exposure history for patients presenting with shortness of breath associated with ammonia exposure may assist with an early diagnosis, thus allowing for treatment early in the disease process and prevention of further exposure.

Industrial solvents and liver toxicity: risk assessment, risk factors and mechanisms.

Organic solvents utilized in various industrial processes may be associated with hepatotoxicity. The hepatotoxicity of some of the solvents was recognized as early as 1887, 1889 and 1904. Factors contributing to the hepatotoxicity of solvents include 1) species differences, 2) liver blood flow, 3) protein binding, 4) point of binding intracellularly, 5) genetic factors, 6) different cellular enzymatic degradation, 7) age, 8) nutritional condition, 9) interaction with alcohol, and 10) interaction with medications of use and abuse. The hepatotoxicity of solvents in general and of carbon tetrachloride, trichloroethylene, tetrachloroethylene, toluene, and 1,1,1-trichloroethene are discussed. Experimental animal data, human data, and in vitro studies are explored. Suggested mechanisms of direct toxicity, indirect toxicity and autoimmune mechanisms are elaborated. The most important message from this review is that laboratory testing that is commonly used by clinicians to detect liver toxicity may not be sensitive enough to detect early liver hepatotoxicity from industrial solvents and new methodologies are being encouraged and utilized in the early recognition and diagnosis of hepatotoxicity for solvents. The final clinical assessment of hepatotoxicity and industrial solvents must take into account synergism with medications, drugs of use and abuse, alcohol, age, and nutrition. Early recognition and reporting will be helpful in further understanding the incidence, cofactors and possible mechanisms.

Phosphine toxicity: report of two cases and review of the literature.

Aluminum phosphide is a commonly used fumigant in the agricultural community. This article reviews the toxic effects of phosphine on the lungs and central nervous system in two workers and reviews the available scientific literature. Education for prevention of exposure and more frequent monitoring for exposure are recommended.