[Disturbances of hearing and balance in students starting their vocational education. Practical diagnostic and certification guidelines]. / Zaburzenia sluchu i równowagi u uczniów rozpoczynajacych nauke zawodu. Praktyczne wskazówki diagnostyczne i orzecznicze.

Hearing impairment and balance disturbances limit the ability to perform certain jobs and may cause accidents at work. Bearing this in mind a need for preventive examinations of young people starting their vocational education was discussed. Main causes as well as simple diagnostic techniques which facilitate to detect hearing and balance disturbances by physicians who certify the ability of students to undertake practical vocational education and employment were presented.

[Principles of medical expert testimony regarding adolescents' capacity for practical vocational training and work]. / Propozycje zasad lekarskiego orzekania o zdolnosci mlodocianych do praktycznej nauki zawodu i pracy zarobkowej.

The presented approach to adolescents' vocational guidance is based on the ILO principle that work should conform to psychophysical conditions of the worker which should be evaluated before the beginning of work. In the paper the main health problems influencing the work capability have been discussed. It is suggested that the student, his parents and tutor should be informed about his health impairments, the degree of disability and therapeutic possibilities. The psychophysical features characteristic of the adolescence justify the health protection against occupational exposure to harmful agents as well as the activities, for health education and health promotion at school.

[Cerebellar syndrome after long-term exposure to organic solvents. Case report]. / Zespól mózdzkowy po wieloletnim narazeniu zawodowym na rozpuszczalniki organiczne. Opis przypadku.

A clinical picture of cerebellar syndrome with cerebellar atrophy revealed by CT scan in a worker for 28 years occupationally exposed to petrol and trichloroethylene vapours has been described. The relationship between the illness and the occupational exposure to the organic solvents has been discussed.

[Late effects of toxic methemoglobinemia]. / Pózne nastepstwa toksycznej methemoglobinemii.

A psychological testing rendered it possible to reveal some disorders of the central nervous system in a chemical industry worker who suffered from a serious intoxication with chloronitrobenzene a year ago. Such symptoms as loss of consciousness, convulsions and serious methemoglobinemia were observed. This case indicated a possibility of the development of late effects of poisoning which demand a long-term medical control. The authors explain the necessity to include psychological testing in preventive examination of persons who are at risk of acute poisonings.

[Practical and disputable aspects of the effect of benzene-containing organic solvents exemplified by the case of hairy cell leukemia]. / Praktyczne i dyskusyjne aspekty dzialania rozpuszczalników organicznych zawierajacych benzen na przykladzie przypadku bialaczki kosmatokomórkowej.

The aim of this paper is to present difficulties in establishing the causal relationship between many years' combined exposure to benzene and other aromatic hydrocarbons and the occurrence of a rare form of leukemia (hairy cell leukemia) in a worker of patients and lacquers factory. Usefulness of experimental and points epidemiologic studies is critically discussed in order to show the consequences of the etiology of combined occupational exposure.

[Late sequelae of recurrent occupational lead poisoning--the status of the nervous system]. / Pózne nastepstwa wielokrotnych zatruc zawodowych olowiem--stan ukladu nerwowego.

In 44 men with a history of repeated occupational lead poisoning multidisciplinary clinical and laboratory investigations were carried out. The number of lead poisoning episodes was from 2 to 7. Apart from peripheral hypalgesia on the extremities (in 6 cases) no other neurological abnormalities were found. The motor nerve conduction velocity in the median, ulnar, radial, peroneal and tibial nerves was slightly slower in 27 cases and considerably slower in one case. Slowed down conduction velocity was most often observed in 2 nerves (12 cases) and in one nerve (9 cases), less frequently in three (4 cases) and four (2 cases) nerves. In one case this slowing down was found in all five studied nerves. Conduction changes were found in 21 peroneal nerves, 15 ulnar nerves, 12 median nerves, 7 tibial nerves and 2 radial nerves. The authors think that for the evaluation of the condition of the peripheral neuron in cases of past lead poisoning it would be sufficient to determine the conduction velocity in the ulnar and peroneal nerves. Plumbism neuropathy have the character of subclinical lesions not impairing motor skill.

[Effect of organic solvents on the central nervous system]. / Wplyw rozpuszczalników organicznych na osrodkowy uklad nerwowy.

Psychological tests and EEG investigations were applied for detecting early signs of neurotoxicity of organic solvents present in glues used in the production of shoes (extraction benzin, toluene and n-hexane). In 5% of the obtained samples the permissible benzin concentration was exceeded, and in 10% of samples this permissible concentration of toluene was exceeded. Psychological testing was done in 100 subjects. The intelligence level was at the lower normal range. Organic cortical changes were demonstrated in 35 cases, and borderline pathological changes in 28 cases. The test of L. Bender suggested damage to the occipital cortex in 31, and the Graham-Kendal test demonstrated abnormalities in 13 cases. EEG was done in 56 subjects in this group and in another 9 subjects with a high concentration of toluene metabolite. In 75.4% of subjects the EEG findings were classified as normal, within normal limits or borderline normal. Abnormal EEG tracings were found in 24.0%. Diffuse, slight or moderately intense abnormalities were present in 7 cases, focal abnormalities in 4 and seizure activity in 7. Most subjects with abnormal EEG findings worked under conditions of excessive exposure, with the summarized exposure index exceeding the acceptable one. No correlation was demonstrated between cortical pathological changes and the degree of occupational exposure and the type of EEG tracings. The authors suggest that organic occipital cortical changes may be regarded as an early phase of organic brain damage syndrome and disturbances of cerebral bioelectric activity as a sign of individual biological response to chronic action of organic solvents on the organism.

Vinyl chloride disease-neurological disturbances.

In a plant producing vinyl chloride by the emulsion method 200 workers who were exposed to vinyl chloride for 1 to 25 yr (mean 14), 58 (i.e. 29%) were free of complaints and nervous disturbances. An astheno-autonomic syndrome was found in 54 (i.e. 27%) and in 88 (i.e. 44%) in combination with positive neurological findings, i.e. pyramidal syndromes (in 52), cerebellar disturbances (in 38), trigeminal neuropathy (in 24) and extrapyramidal symptoms (in 3), in various combinations - pyramidal + cerebellar in 12, trigeminal + pyramidal in 7, trigeminal + cerebellar in 5. Headaches (48%), nervousness (26%), decrease in physical strength (16%), loss of memory (14%), sleeping disturbances and somnolence were the most frequent complaints. Scleroderma-like skin changes were found in ten subjects, but only six of them had any neurological disturbances. Occupational exposure to vinyl chloride was lower in workers without neurological findings. Frequency of the arterial hypertension was the same in both groups, whereas acroparesthesias, Raynaud's syndrome, and increased gamma GTP serum activity were significantly more frequent in workers with neurological disturbances. Sixty-two per cent of the neurologically positive group and only 24% of the negative group reported euphoric or narcotic states after exposure. This probably indicates episodic exposures to high concentrations of vinyl chloride. This difference points to a possibility that neurological disturbances may be related to short exposures to peak concentrations. The neurological injury may be both a direct neurotoxic effect of vinyl chloride and secondary to vascular disorders.