[Biological monitoring of fluoride-exposed workers in Switzerland: development of the internal fluoride burden in the last 10 years]. / Biologische Uberwachung der fluorexponierten Arbeitnehmer in der Schweiz: Entwicklung der inneren Fluorbelastung über die letzten 10 Jahre.

In Swiss plants a risk of industrial fluorosis exists only for workers in the aluminum industry (electrolysis of Al2 O3, raffination of aluminium). Exposure to fluorides is assessed by ambient monitoring, by health surveillance (early detection of fluorosis) and by biological monitoring (urinary fluoride determinations, pre-shift und post-shift). The results of biological monitoring in the 4 plants in Switzerland are presented (1976/77-1986; 1977 264 workers, 1986 242 workers). During the period from 1976/77-1986 a significant reduction of the urinary fluoride excretion in exposed workers was observed. This reduction was correlated in time with technical measures to reduce external fluoride exposure of workers. Urinary fluoride excretion was within limits of biological exposure indices at the end of the observation period in all plants (on group base). Therefore the risk of industrial fluorosis seems to be eliminated in newly engaged workers and significant lowered in the other workers of the Swiss aluminium industry.

[Principles of decisional analysis applied to the screening for occupational diseases: the example of occupational fluorosis]. / Principes d'analyse décisionnelle appliqués au dépistage de maladies professionnelles: exemple de la fluorose industrielle.

In this paper, two oral presentations are combined. The first described the broad aspects of decision analysis and the second mentioned those medical data which need to be gathered in order to apply the model to industrial fluorosis. For this purpose, biological and medical observations were collected, both from workers of the aluminium industry and from controls. The five successive steps for building up a decision tree are then demonstrated, the aim of which being to evaluate the fitness of a screening strategy. A computer programme has been developed which may be applied both to occupational or non occupational diseases. Referring to industrial fluorosis, the computerized decision tree showed that screening with preshift urinary fluor, clinical and radiological signs, plus bone fluor rate is required, as soon as the risk corresponds to a 7% prevalence of the disease.

Hyperprolactinemia as a cause of delayed puberty: successful treatment with bromocriptine.

An 18-year-old male patient was referred because of galactorrhea and delayed puberty. There was no gynecomastia, but a white milky secretion could easily be expressed from each breast. The chest and skull X-rays were normal. The plasma prolactin was increased to 58 ng/ml and rose to 97 ng/ml after 200 microgram TRF iv. The patient was treated for one year with testosterone; his voice deepened, body hair developed, libido and sexual function became overt, and bone age advanced from 14 1/2 to 17 years, but the galactorrhea increased. After a satisfactory stage of pubertal development was reached, the testosterone was stopped. tthe galactorrhea then decreased to its pretreatment intensity; however, sexual potency diminished, sexual hair growth decreased, and the plasma prolactin levels rose to 246 ng/ml. After a 5-month interval without treatment, bromocriptine was given and brought about an impressive improvement. Virilization and general well being were superior to that during testosterone treatment, the galactorrhea vanished, plasma prolactin decreased, testosterone rose to normal values, and a normal semen analysis was recorded.