Characterization of workplaces in interventional radiology using active dosemeters ALARA OD.

Because of progressive development and extended use of interventional radiology (IR) procedures it is highly recommended that all individuals involved in the process should be aware of the potential for both stochastic and deterministic effects due to occupational exposure. IR procedures are performed in such a manner that certain number of medical staff are always needed near the patient, near the X-ray unit. The new challenge to regular radiation protection is to ensure 'safe' working environment in such radiation X-ray field geometry. In this work the patient is physically regarded as a secondary radiation source emitting scattered X-rays. Passive dosemeters will give us clear data only about the monthly integrated occupational dose; there is concern over the frequency and duration, actual pattern of receiving this dose. We have developed active electronic dosemeter (AED) device, which provides additional dosimetry data about the frequency and duration of professional low level X-ray exposure burden.

Differences in mite fauna between the continental and Mediterranean climates of Croatia: microscopy and Dustscreen test findings.

BACKGROUND: The aim of this study was to evaluate the difference between the mite fauna in the inland and coastal Croatia. METHODS: Ninety-nine floor house dust samples were collected: 28 from the coastal area, 31 from the inland rural and 40 from the inland urban area. Data on basic household characteristics were collected for 81 of 99 households. The mites were separated from the dust using the floatation method and then microscopically identified. The levels of Dermatophagoides pteronyssinus (Der p) 1, Dermatophagoides farinae (Der f) 1 and Der 2 were measured using the Dustscreen test. Ordinal descriptive statistics and nonparametric tests were used for data analysis, assuming statistical significance at P < 0.05. RESULTS: More than 70% of mites identified in all areas were pyroglyphids. Nonpyroglyphid mites accounted for 20-25% of all identified mites in the coastal areas (Blomia, Lepidoglyphus and Glycyphagus) and with 15% in the inland areas (Lepidoglyphus and Acarus). The highest Der p 1 median levels were found in the coastal area, with significantly lower levels in the inland rural and inland urban areas (4.5; 2; 0.85 microg/g of dust; P = 0.0001). The highest Der f 1 median levels were found in the inland urban area, with significantly lower levels in the inland rural and coastal areas (0.88; 0.75; 0 microg/g of dust; P = 0.0013). The levels of Der f 1 were significantly higher in samples taken from households with central heating than from those with traditional heating (1; 0.25 microg/g of dust; P < 0.01). CONCLUSIONS: Separate diagnostic dust mite lists for the coastal and inland areas because of climatic and dwelling differences required to be implemented. Compared with traditional heating, central heating significantly increases the risk of exposure to Der f 1 levels >2 microg/g of dust (odds ratio, 7.35; 95% confidence interval, 1.43-37.87; P = 0.01).

The 3 mm skin prick test (SPT) threshold criterion is not reliable for Tyrophagus putrescentiae: the re-evaluation of SPT criterion to dust mites.

BACKGROUND: The mean wheal diameter >/= 3 mm is the usual criterion for positive skin prick test (SPT) reaction to dust mites. The study assessed the accuracy of this SPT criterion with respect to specific IgE values of above 0.35 kUA/l (+ sIgE). METHODS: Specific IgE (ImmunoCAP, Pharmacia AB Diagnostics, Uppsala, Sweden) and standard SPT to Dermatophagoides pteronyssinus (DP) and farinae (DF), Lepidoglyphus destructor (LD) and Tyrophagus putrescentiae (TP) (ALK, Hørsholm, Denmark) were performed in a random sample of 457 subjects, of whom 273 men (mean age 35.3 +/- 11.0 years) and 184 women (mean age 37.9 +/- 9.5 years). Statistical analysis was performed using the chi-square test, regression analysis and discriminant analysis. RESULTS: When the mean wheal diameter of >/= 3 mm was considered positive (+ SPT), the correlation between + SPT and + sIgE was 0.47 for DP (P < 0.001), 0.43 for DF (P = 0.004), 0.35 for LD (P = 0.03) and 0.37 for TP (P = 0.014). Regarding + sIgE, this SPT criterion has a specificity of 92.2% for DP, 82.3% for DF, 80.8% for LD and 70.1% for TP. When the value 4.5 mm was taken as the threshold for the positive SPT reaction to TP, specificity increased significantly from 70.1% to 86.4% (chi2 = 32.04, P < 0.001). CONCLUSIONS: The 3 mm SPT threshold criterion is not reliable in evaluating sensitization to TP due to an insufficient specificity of the allergen extract to this mite. It is advisable either to re-evaluate the TP allergen extract or change the threshold criterion for positive SPT reaction to TP.

[Isokinetic diagnosis: rehabilitation in overuse injury syndromes]. / Izokineticka dijagnostika: rehabilitacija sindroma prenaprezanja.

Isokinetic testing of the musculoskeletal system is an important diagnostic method in the course of rehabilitation because it is adapted to individual and objective in measuring biomechanical parameters. Isokinetic dynamometer serves as a measurement and/or exercising device and helps user to achieve maximum force in through a range of motion, accommodating for potential pain or fatigue. Isokinetic dynamometer measures strength, torque, and generated power as well as the range of motion of the joint and distribution of strength in the range of motion. These results, as well as the relation between agonists and antagonists, acceleration time, velocity of motion reciprocity, maximum torque angle, and the fatigue/endurance index are computed and compared with standard values using software. Repeated testing shows changes in parameters in later stages, ensuring an accurate insight in the progress of rehabilitation. This paper describes the treatment of a 14-year-old boy engaged in rowing who suffered from suprapatellar pain and instability of the knee. After isokinetic testing and rehabilitation the boy resumed his sport activities.

Event-related potentials in medical workers with long-term exposure to xylene.

The effects of chronic exposure to xylene on cognitive ability were studied in a group of 35 medical workers occupationally exposed to low-level concentrations of xylene for at least five years by using event-related potentials (ERPs), and compared with a control group of 21 subjects. The exposure to xylene was confirmed through determination of m-methylhippuric acid, a reliable biological indicator of xylene exposure, in pre- and post-shift urine. A dose-effect relationship between log m-methylhippuric acid and ERP log latency (p = 0.032), and the ERP amplitude (p = 0.047) was statistically significant. The group of medical workers showed significantly longer ERP log latency (p < 0.001) than did the control group with respect to factors of exposure to smoking, education and age as covariates. For the ERP amplitude the difference was found not to be significant (p = 0.263), probably due to high between subject variability. The cognitive impairment may occur in workers chronically exposed to xylene.

Occupational histamine poisoning by fish flour: a case report.

Histamine poisoning due to inhalation and skin contact with fish products is rarely described in the literature. This study presents a case of occupational histamine poisoning by spoiled fish flour via inhalation, skin and eye contact. Shipments of fish flour transported in black or blue bags, depending on the source, were handled by 20 harbour workers. Ten workers handling blue bags developed allergy-like skin, eye, gastrointestinal, respiratory and cardiac symptoms within 30 min. Workers handling black bags were symptom-free, except for minimal eye irritation. After consultation with the Poison Control Centre histamine poisoning was suspected. The histamine content, as determined by thin-layer chromatography, was 10-fold higher in samples from the blue than from the black bags (510 mg/100 g flour compared with 50 mg/100 g flour, respectively). Part of the shipment was labelled as hazardous for human health with permission for further usage only under specific personal protective measures. It is suggested that the highest permissible levels of histamine in fish flour and similar products should be set and legally adopted.

Sensitization to non-pyroglyphid mites in urban population of Croatia.

AIM: Determination of prevalence of sensitization to Dermatophagoides pteronyssinus, Dermatophagoides farinae (pyroglyphid mites), Lepidoglyphus destructor, and Tyrophagus putrescentiae (non-pyroglyphid mites) in urban continental Croatia. METHODS: Specific IgE (sIgE) and skin prick test (SPT) for D. pteronyssinus, D. farinae, L. destructor, and T. putrescentiae were performed in 67 men. SPT was performed with Epipharm-ALK allergens. A urtica (D+d)/2 of 3 mm or greater was considered a positive skin reaction. SIgE was measured by immunoCAP technology (UNI CAP). Values <0.35 kUA/L were considered nonspecific and >0.35 kUA/L increased. RESULTS: The prevalence of subjects with positive SPT was 35.8% for T. putrescentiae, 26.8% for L. destructor (26.8%), and 22. 4% for D. pteronyssinus and D. farinae. The prevalence of increased sIgE for D. pteronyssinus and D. farinae was 23.9%, followed by T. putrescentiae (22.4%), and L. destructor (14.9%). Among subjects with increased IgE to D. pteronyssinus there were also increased IgE for D. farinae in 94%, for T. putrescentiae in 75%, and for L. destructor in 50%. Mean urtica diameter differed only for L. destructor between nonspecific and increased sIgE values in subjects with positive SPT (3.7+/-0.7 mm vs. 6.2+/-2.8 mm; p = 0.004). Sensitization to storage mites was accompanied by respiratory symptoms in similar proportions as that to house dust mites (51.8% and 54.5%, respectively; p = 0.8527). CONCLUSION: Sensitization to non-pyroglyphid mites is present in the general urban population of Croatia in similar proportions as to pyroglyphid mites, with the same range of respiratory symptoms. Testing with storage mites should be considered routine allergological diagnostic procedure.

[Occupational medicine worldwide and in Croatia]. / Medicina rada u svijetu i u Hrvatskoj.

The development of occupational medicine, its complexity and international position as well as the actual and anticipated tasks connected with modernisation of industry, workers' health protection and humanization of work is presented. Education in the field of occupational medicine is also evaluated. Eighteen countries: ten in Europe, United States of America, Canada, Brasil and Chile from the area of South America, Israel, Japan, China and Singapore in Asia are included in the review. At the end, the development of occupational health services in Croatia, its present organisation, legislation, education and training, future needs and goals are shortly discussed.

[Modern environmental and clinical aspects of sensitization to dust mites]. / Suvremeni ekoloski i klinicki aspekti senzibilizacije na prasinske grinje.

Sensitization to dust mites is in significant increase in the world and is known as independent risk factor for development of bronchial asthma. In this paper, important biological markers and environmental spread of dust mites are described as well as the epidemiology, the most frequent clinical patterns and standard diagnostic procedures of sensitization to dust mites. The importance of the environmental dust mites control is emphasized, particularly as a part of primary and secundary prevention of sensitization to dust mites.

Sensitization to storage mites in urban working environment.

This paper presents an analysis of a medical history questionnaire, skin prick test and specific IgE to storage mites Lepidoglyphus destructor and Tyrophagus putrescentiae performed on 26 male paper mill workers and 36 postmen. Positive prick test were considered urticas with the mean diameter of 3 mm or over. Increased specific IgE were considered values of over 0.35 kU/L. Paper mill workers manifested a significantly higher frequency of positive test results, increased specific IgE and positive prick test, to L. destructor and T. putrescentiae than did the postmen. Paper mill workers with increased specific IgE manifested significantly greater mean skin reactivity to T. putrescentiae than to L. destructor. Respiratory symptoms were found in 40% of paper mill workers with positive test results to L. destructor, and in 53.8% with positive test results to T. putrescentiae. All postmen with positive test results to L. destructor and 83.3% with positive test results to T. putrescentiae had respiratory symptoms. The study results indicate that it is necessary to monitor sensitization to mites and to establish methods for identification and quantification of mites in the working and general environment.

Individual variation in response to lead exposure: a dilemma for the occupational health physician.

Subclinical lead poisoning with no clinical symptoms is a dilemma for the occupational health physician. He is supposed to assess when and how to treat workers at risk mainly by the results of biological monitoring. The aim of this study was to demonstrate different responses of biological indices in 50 lead-exposed workers who have been working in the same plant of lead pigment production factory. Twenty-one had normal, that is, permissible blood lead concentrations (PbB), erythrocyte protoporphyrin (EP), and aminolevulinic acid activity (ALAD) measured during regular periodic examinations (group 1). No differences between two measurements were found, although they were continuously working with lead. In 18 of the 50 workers (group 2), PbB and EP concentrations increased, whereas ALAD activity decreased: those parameters improved after a 3- to 6-month cessation of lead exposure. Seven of the 50 workers also had altered values of biological indices, but their condition improved spontaneously without cessation of lead exposure (group 3), while in the remaining four workers, elevated concentrations of biological indices did not change during the observation period. The reasons for such discrepancies and indications for chelation therapy are discussed.

Can pre-employment patch testing help to prevent occupational contact allergy?

175 subjects (157 female, 18 male) were patch tested with a standard series of allergens (Epipharm Allergy Service, GmbH, Linz, Austria), during pre-employment examinations in the pharmaceutical industry, considered an industry at risk for the development of contact sensitization. None of those examined had contact dermatitis prior to testing and none gave a positive history of hand ecczema. Patch testing was positive in 12 (7%) subjects, of whom 7 showed a positive reaction to only 1 contact allergen and 5 reacted to several contact allergens. 5 subjects (2.9%) reacted positively to metal salts (nickel, cobalt, chromium), 5 (2.9%) had a positive skin reaction to mixtures of rubber additives, and the remaining 2 to other allergens.

Airway hyperreactivity in the electroceramic industry.

Seventy-four female shift workers employed in the oxide ceramics industry were examined: a group of 38 workers from the press workshop and a group of 36 controls from the mounting workshop from the same factory. The two groups did not differ by age, years of employment, smoking habit or height. Persons with atopic constitution and serious respiratory disease were excluded from the study. Interstitial lung disease was eliminated by X-ray examinations. All subjects underwent a clinical examination and completed a questionnaire. Measurements of ventilatory lung functions demonstrated no difference between the groups; lung function values were normal. Non-specific airway reactivity was expressed as PC50 Rt i.e. 50% increase in resistance in relation to the value measured after inhalation of the physiological solution. A significant difference was found for PC50 Rt between the exposed and control workers during (P < 0.001) and outside working hours (P < 0.01). Significantly different PC50 Rt values were also established within the group of exposed workers as well as within that of control workers during and outside working hours (P < 0.014 and P < 0.0018 respectively). The majority of hyperreactive persons were workers from the press workshop (n = 17) when measurements were performed during working hours. For early detection of respiratory diseases in workers employed in the oxide ceramics industry preemployment examinations and regular check-ups aiming to determine non-specific airway reactivity are suggested as necessary.

The value of cytogenetic monitoring versus film dosimetry in the hot zone of a nuclear power plant.

Cytogenetic analysis was carried out in 41 workers prior to and following regular maintenance work in a nuclear power plant. Although film dosimetry did not show the maximal annual permitted dose in any of the examined subjects, cytogenetic analysis carried out following the work detected dicentric chromosomes in peripheral blood lymphocytes of 20 workers. According to our findings smoking habits and previous exposure to ionizing radiation had no effect on the increased number of chromosomal aberrations.

Environmental effects on chromosomes in oncology and radiology department personnel.

Long-term, low levels of antineoplastic drugs and ionizing radiation in the work environment may have genotoxic effects on chromosomes in personnel. The effects of ionizing radiation is acknowledged in occupational medicine and therefore various measures have been undertaken to prevent such effects. However, there are no protective measures for workers exposed to antineoplastic drugs. In this study metaphase chromosome preparations were analyzed in 126 nurses and radiology technicians. They were divided into three equal groups. The first group consisted of shift nurses in an oncology department handling antineoplastic drugs. The second group consisted of radiology technicians in a radiology department and the third group acted as controls. Structural chromosomal aberrations were increased among those nurses exposed to antineoplastic drugs in comparison with technicians (P less than 0.05) and controls (P less than 0.01), respectively.

[Mutagenic changes in medical personnel occupationally exposed to antineoplastic drugs]. / Mutagene promjene u medicinskog osoblja profesionalno izlozenog antineoplasticnim lijekovima.

Not so long ago the unfavourable influence of antineoplastic drugs on personnel exposed to them was reported. Since then research has been carried out with the aim of clarifying and objectivizing this occupational danger. Agreement was reached on the need for measures of protection at work and regular medical check-ups of personnel exposed to these cancerogenic substances, which can also have a mutagenic and teratogenic effect. This paper presents the possible consequences of the effect of antineoplastic drugs in long-term exposure to low concentrations, and the means of protection from the unfavourable effect of exposure. In our country such means of protection and regular medical check-ups of personnel are not carried out in any oncological department, which is a serious oversight, particularly if we accept the fact that today 70-90% of all carcinomas are due to agents within our environment and diet.

Biological monitoring of three 60Co radiation incident victims.

Radiation-induced structural chromosomal aberrations were the only adverse effects found in three workers overexposed to 60Co gamma-radiation. Chromosomal analyses were performed on the 5th and 75th days after exposure. Hematologic follow-up was carried out on the 5th, 12th, 16th, and 75th days after exposure. Hematologic findings did not differ over time in any of the three exposed workers. In two workers, we found dicentric chromosomes, which are conventional indicators for exposure to ionizing radiation.

Acute intermittent porphyria and hormone disbalance.

A study of acute intermittent porphyria (AIP) in three female patients indicates the necessity of stressing that in cases of clinical and laboratory exacerbation of the disease in patients of reproductive age the possibility of the existence of pathological changes in the ovaries (polycystic ovary, anovulatory cycle) should be taken into consideration. By examination of patients' endocrinological status and on the basis of the experience of clinicians it can be concluded that in such cases of exacerbation of the disease, apart from conventional therapy with glucose, Panhematin, electrolyte correction and other symptomatic therapy, coexisting steroid deficiency should be corrected.