Trajectories of PTSD risk and resilience in World Trade Center responders: an 8-year prospective cohort study.

BACKGROUND: Longitudinal symptoms of post-traumatic stress disorder (PTSD) are often characterized by heterogeneous trajectories, which may have unique pre-, peri- and post-trauma risk and protective factors. To date, however, no study has evaluated the nature and determinants of predominant trajectories of PTSD symptoms in World Trade Center (WTC) responders. METHOD: A total of 10835 WTC responders, including 4035 professional police responders and 6800 non-traditional responders (e.g. construction workers) who participated in the WTC Health Program (WTC-HP), were evaluated an average of 3, 6 and 8 years after the WTC attacks. RESULTS: Among police responders, longitudinal PTSD symptoms were best characterized by four classes, with the majority (77.8%) in a resistant/resilient trajectory and the remainder exhibiting chronic (5.3%), recovering (8.4%) or delayed-onset (8.5%) symptom trajectories. Among non-traditional responders, a six-class solution was optimal, with fewer responders in a resistant/resilient trajectory (58.0%) and the remainder exhibiting recovering (12.3%), severe chronic (9.5%), subsyndromal increasing (7.3%), delayed-onset (6.7%) and moderate chronic (6.2%) trajectories. Prior psychiatric history, Hispanic ethnicity, severity of WTC exposure and WTC-related medical conditions were most strongly associated with symptomatic trajectories of PTSD symptoms in both groups of responders, whereas greater education and family and work support while working at the WTC site were protective against several of these trajectories. CONCLUSIONS: Trajectories of PTSD symptoms in WTC responders are heterogeneous and associated uniquely with pre-, peri- and post-trauma risk and protective factors. Police responders were more likely than non-traditional responders to exhibit a resistant/resilient trajectory. These results underscore the importance of prevention, screening and treatment efforts that target high-risk disaster responders, particularly those with prior psychiatric history, high levels of trauma exposure and work-related medical morbidities.

Dimensional structure and course of post-traumatic stress symptomatology in World Trade Center responders.

BACKGROUND: Post-traumatic stress disorder (PTSD) in response to the World Trade Center (WTC) disaster of 11 September 2001 (9/11) is one of the most prevalent and persistent health conditions among both professional (e.g. police) and non-traditional (e.g. construction worker) WTC responders, even several years after 9/11. However, little is known about the dimensionality and natural course of WTC-related PTSD symptomatology in these populations. METHOD: Data were analysed from 10 835 WTC responders, including 4035 police and 6800 non-traditional responders who were evaluated as part of the WTC Health Program, a clinic network in the New York area established by the National Institute for Occupational Safety and Health. Confirmatory factor analyses (CFAs) were used to evaluate structural models of PTSD symptom dimensionality; and autoregressive cross-lagged (ARCL) panel regressions were used to examine the prospective interrelationships among PTSD symptom clusters at 3, 6 and 8 years after 9/11. RESULTS: CFAs suggested that five stable symptom clusters best represent PTSD symptom dimensionality in both police and non-traditional WTC responders. This five-factor model was also invariant over time with respect to factor loadings and structural parameters, thereby demonstrating its longitudinal stability. ARCL panel regression analyses revealed that hyperarousal symptoms had a prominent role in predicting other symptom clusters of PTSD, with anxious arousal symptoms primarily driving re-experiencing symptoms, and dysphoric arousal symptoms primarily driving emotional numbing symptoms over time. CONCLUSIONS: Results of this study suggest that disaster-related PTSD symptomatology in WTC responders is best represented by five symptom dimensions. Anxious arousal symptoms, which are characterized by hypervigilance and exaggerated startle, may primarily drive re-experiencing symptoms, while dysphoric arousal symptoms, which are characterized by sleep disturbance, irritability/anger and concentration difficulties, may primarily drive emotional numbing symptoms over time. These results underscore the importance of assessment, monitoring and early intervention of hyperarousal symptoms in WTC and other disaster responders.

Micosis fungoide foliculotropa. Análisis y evolución de 6 casos / Folliculotropic mycosis fungoides. Analysis and outcomes of six cases

La micosis fungoide foliculotropa (MFF) es considerada una variante rara de micosis fungoide con mala respuesta a la terapéutica, pronóstico severo y sobrevida más corta . Incluye casos con y sin mucinosis folicular (Mf) MATERIAL Y MÉTODO: Analisis de 6 casos de MFF que consultaron en la División Dermatología desde junio de 1994 a junio del 2010 incluyó el estudio clínico, histopatológico, e inmunohistoquímico, respuesta terapeútica y evolución de los mismos. Las biopsias de tres de los seis casos estudiados exhibieron Mf y en otros tres este aspecto estuvo ausente. OBJETIVO: Comunicar nuestros hallazgos, considerando para estimar la sobrevida, el período previo al diagnóstico de MF, a través de un nuevo examen de las biopsias previas. RESULTADOS Y CONCLUSIONES: En nuestra población: a) Esta forma de MF ofreció dificultades diagnósticas presentando aspectos clínicos inusuales y hallazgos microscópicos inespecíficos. b) El estadio previo de Mf o los hallazgos microscópicos inespecíficos pudo ser muy prolongado, hasta surgir los criterios diagnósticos de MF (2 a 11 años). c) Los tapones córneos foliculares tuvieron respuesta total al bexarotene. Placas y máculas respondieron temporalmente a la fototerapia. La eritrodermia persistió después de dos años de tratamiento con IFNα 2b y bexarotene oral. d) Aunque la muestra es pequeña, estos datos parecen aseverar el peor pronóstico a 10 años de esta variante si no se consideran los años previos a la confirmación del diagnóstico de MF. La sobrevida a 5 años fue 75% (3/4), y a 10 años 25% (1/4) . Teniendo en cuenta la etapa previa de MF no diagnosticada por otros observadores, la severidad se atenúa 100% de sobrevida a 5 años, y 60% a 10 años. Ninguno experimentó regresión espontánea de las lesiones durante el tiempo de observación

Folliculotropic mycosis fungoides is considered a rare variant of mycosis fungoides with a bad response to therapy, severe prognosis and shorter over-life. It includes cases with and without follicular mucinosis MATERIAL AND METHOD: We report the retrospective analysis of clinical, histopathological, and immunohistochemical aspects, therapeutic responses and follow-up of six cases of folliculotropic mycosis fungoides studied in the Department of Dermatology from May 1994 to June 2010. Three of them exhibited follicular mucinosis in cutaneous biopsies and other three failed to reveil this finding. OBJECTIVE: To report our findings taking into account the years previous to diagnosis of MF (by re-examination of previous biopsies) in order to stimate the ove rlife. RESULTS AND CONCLUSIONS: In this population: a) This variant of MF was very difficult to be diagnosed presenting unusual clinical lesions and unspecific microscopic patterns. b) Previous stage of primary follicular mucinosis or unspecific microscopic findings could be quite long (2 to 11 years) until MF criteria were fulfilled. c) Comedo-like lesions had a good response to bexarotene. Therapeutic responses of plaques and macules to phototherapy and systemic α2bIFNwere partial and brief. d) Although the significance was limited by the small number of the sample ,these data seems to assess the worser prognosis to ten years of this variant if the years previous to confirmation of MF diagnosis were not considered: The over life at 5 years was 75%(3/4), at 10 years 25% (1/4). Taking into account the period of undiagnosed MF the severity was atempered: overlife100% at 5 years (6/6), 60% at 10 years (4/6). Nobody experimentedthe spontaneous remission of the lesions during the time of observation

Nutritional value of dried fermentation biomass, hydrolyzed porcine intestinal mucosa products, and fish meal fed to weanling pigs.

Dried fermentation biomass (DFB) and hydrolyzed porcine intestinal mucosa are co-products of L-Lys • HCl production and heparin extraction, respectively. Three experiments were conducted to determine standardized ileal digestibility (SID) of AA (Exp. 1), concentration of DE and ME (Exp. 2), and standardized total tract digestibility (STTD) of P (Exp. 3) in DFB and 2 hydrolyzed porcine intestinal mucosa products (PEP50 and PEP2+), and compare these values with values for fish meal. In Exp. 1, 12 ileal cannulated barrows (BW = 11.5 ± 1.1 kg) were allotted to a replicated 6 × 6 Latin square design with 6 diets and 6 periods. A N-free diet, diet based on soybean meal (SBM), and 4 diets based on a combination of SBM and DFB, PEP50, PEP2+, or fish meal were formulated. With the exception of Lys, there were no differences in SID of indispensable AA between DFB and fish meal. Except for Thr, no differences in SID of indispensable AA between PEP50 and fish meal were observed, but SID of all indispensable AA, except Lys and Trp, was less (P < 0.05) in PEP2+ than in the other ingredients. In Exp. 2, 40 barrows (BW = 12.8 ± 1.4 kg) were allotted to 5 diets with 8 pigs/diet. A basal diet containing 96.4% corn and 4 diets containing corn and DFB, PEP50, PEP2+, or fish meal were formulated. The DE (5,445 kcal/kg DM) and ME (5,236 kcal/kg DM) in DFB were greater (P < 0.01) than in PEP50 (4,758 and 4,512 kcal/kg DM for DE and ME, respectively) and fish meal (4,227 and 3,960 kcal/kg DM for DE and ME, respectively). Also, DE in DFB was greater (P < 0.01) than in PEP2+ (4,935 kcal/kg DM), but ME in DFB was not different from that in PEP2+ (4,617 kcal/kg DM). Furthermore, DE in PEP50 and PEP2+ were greater (P < 0.01) than in fish meal, but ME did not differ from that in fish meal. In Exp. 3, 40 barrows (BW = 12.4 ± 1.3 kg) were randomly allotted to 5 diets with 8 pigs/diet. A P-free diet and 4 diets in which the sole source of P was from DFB, PEP50, PEP2+, or fish meal were formulated. The STTD of P in DFB (96.9%) and PEP2+ (97.6%) were greater (P < 0.01) than in PEP50 and fish meal (76.2% and 68.5%, respectively), and STTD of P in PEP50 was greater (P < 0.01) than in fish meal. In summary, SID of most indispensable AA did not differ among DFB, PEP50, and fish meal, but DE and ME and STTD of P in DFB were greater than in PEP50 and fish meal.

Exposure, probable PTSD and lower respiratory illness among World Trade Center rescue, recovery and clean-up workers.

BACKGROUND: Thousands of rescue and recovery workers descended on the World Trade Center (WTC) in the wake of the terrorist attack of September 11, 2001 (9/11). Recent studies show that respiratory illness and post-traumatic stress disorder (PTSD) are the hallmark health problems, but relationships between them are poorly understood. The current study examined this link and evaluated contributions of WTC exposures. METHOD: Participants were 8508 police and 12 333 non-traditional responders examined at the WTC Medical Monitoring and Treatment Program (WTC-MMTP), a clinic network in the New York area established by the National Institute for Occupational Safety and Health (NIOSH). We used structural equation modeling (SEM) to explore patterns of association among exposures, other risk factors, probable WTC-related PTSD [based on the PTSD Checklist (PCL)], physician-assessed respiratory symptoms arising after 9/11 and present at examination, and abnormal pulmonary functioning defined by low forced vital capacity (FVC). RESULTS: Fewer police than non-traditional responders had probable PTSD (5.9% v. 23.0%) and respiratory symptoms (22.5% v. 28.4%), whereas pulmonary function was similar. PTSD and respiratory symptoms were moderately correlated (r=0.28 for police and 0.27 for non-traditional responders). Exposure was more strongly associated with respiratory symptoms than with PTSD or lung function. The SEM model that best fit the data in both groups suggested that PTSD statistically mediated the association of exposure with respiratory symptoms. CONCLUSIONS: Although longitudinal data are needed to confirm the mediation hypothesis, the link between PTSD and respiratory symptoms is noteworthy and calls for further investigation. The findings also support the value of integrated medical and psychiatric treatment for disaster responders.

Breast-feeding and serum p,p'DDT levels among Mexican women of childbearing age: a pilot study.

For almost 50 years, millions of Mexicans have been directly and/or indirectly exposed to (1,1,1-trichloro-2,2-bis[p-chlorophenyl]ethane) (p,p'DDT). The potential related health outcomes of this exposure are of international concern. The objective of the study was to determine the effect of breast-feeding on serum levels of 1,1-dichloro-2; 2'-bis(p-chlorophenyl)ethylene (p,p'DDE) and p,p'DDT in women of childbearing age who were residents of the state of Morelos, Mexico. In March 1999, we examined a sample of 24 women, ages 21 to 36 years, who came with their children to the outpatient facility of a county Health Center in the state of Morelos. The geometric mean for p,p'DDE was 21.8 ng/ml+/-2.58 (GSD) and 2.9 ng/ml+/-2.84 for p,p'DDT. For each month of breast-feeding we observed similar significant decreases for both p,p'DDE (beta=-0.0403 per log concentration unit, P=0.001) and p,p'DDT (beta=-0.0309, P=0.03) serum levels, adjusted by mothers' age and number of children. The adjusted half-life estimate for p,p'DDE serum levels was 17 months. It was concluded that breast-feeding leads to rapid removal of p,p'DDT from the body (<2 year half-life) compared to nonlactational elimination rates (<5 year half-life). In this population, serum p,p'DDE levels were similar to those found 20 years ago in the United States.

Lactation and lead body burden turnover: a pilot study in Mexico.

A pilot study was conducted in Morelos, Mexico in March 1999 to assess the body burden of lead in 24 Mexican women of childbearing age. Lead levels were measured in whole blood and at three bone sites: two primarily trabecular (calcaneus and patella) and one primarily cortical (tibia). Demographic and reproductive characteristics of the women and potential sources of lead exposure were gathered by a direct interview. An inverse relationship was noted between months of lactation and age-adjusted calcaneus lead level (P = 0.001). No association was observed between age-adjusted patella or tibia lead level and months of lactation (P = 0.15). Blood lead levels were positively associated with the use of lead-glazed ceramics (P = 0.01). Bone and blood lead levels were observed to be 77% higher in these rural Mexican women than in urban New York City women. This pilot study provides further limited evidence for the hypothesis that lead mobilization occurs during lactation.

Exposure to hazardous substances and male reproductive health: a research framework.

The discovery in the mid-1970s that occupational exposures to pesticides could diminish or destroy the fertility of workers sparked concern about the effects of hazardous substances on male reproductive health. More recently, there is evidence that sperm quantity and quality may have declined worldwide, that the incidence of testicular cancer has progressively increased in many countries, and that other disorders of the male reproductive tract such as hypospadias and cryptorchidism may have also increased. There is growing concern that occupational factors and environmental chemical exposures, including in utero and childhood exposures to compounds with estrogenic activity, may be correlated with these observed changes in male reproductive health and fertility. We review the evidence and methodologies that have contributed to our current understanding of environmental effects on male reproductive health and fertility and discuss the methodologic issues which confront investigators in this area. One of the greatest challenges confronting researchers in this area is assessing and comparing results from existing studies. We elaborate recommendations for future research. Researchers in the field of male reproductive health should continue working to prioritize hazardous substances; elucidate the magnitude of male reproductive health effects, particularly in the areas of testicular cancer, hypospadias, and cryptorchidism; develop biomarkers of exposure to reproductive toxins and of reproductive health effects for research and clinical use; foster collaborative interdisciplinary research; and recognize the importance of standardized laboratory methods and sample archiving.

Dietary flavonoids and hypertension: is there a link?

High blood pressure, defined as systolic blood pressure of greater than 140 mmHg or diastolic blood pressure of greater than 90 mmHg affects millions of people throughout the world. A number of studies have shown that consumption of fruit, vegetables, wine and tea may protect against stroke, for which hypertension is the major risk factor. Flavonoid compounds, including flavonols, flavones and isoflavones, represent an important source of antioxidants in the diet. Flavonoid intake has been inversely associated with mortality from coronary heart disease and stroke. We hypothesize that individuals with hypertension have lower circulating flavonoid levels. Increased consumption of flavonoid-rich foods may decrease rates of hypertension. Lowering blood pressure through increased dietary consumption of dietary antioxidants may decrease the rate of end-organ damage that is secondary to hypertension.

A cluster of pediatric metallic mercury exposure cases treated with meso-2,3-dimercaptosuccinic acid (DMSA)

Nine children and their mother were exposed to vapors of metallic mercury. The source of the exposure appears to have been a 6-oz vial of mercury taken from a neighbor's home. The neighbor reportedly operated a business preparing mercury-filled amulets for practitioners of the Afro-Caribbean religion Santeria. At diagnosis, urinary mercury levels in the children ranged from 61 to 1,213 microg/g creatinine, with a geometric mean of 214.3 microg/m creatinine. All of the children were asymptomatic. To prevent development of neurotoxicity, we treated the children with oral meso-2,3-dimercaptosuccinic acid (DMSA). During chelation, the geometric mean urine level rose initially by 268% to 573.2 microg mercury/g creatinine (p<0.0005). At the 6-week follow-up examination after treatment, the geometric mean urine mercury level had fallen to 102.1 microg/g creatinine, which was 17.8% of the geometric mean level observed during treatment (p<0.0005) and 47.6% of the original baseline level (p<0.001). Thus, oral chelation with DMSA produced a significant mercury diuresis in these children. We observed no adverse side effects of treatment. DMSA appears to be an effective and safe chelating agent for treatment of pediatric overexposure to metallic mercury.

Lead exposure among young urban women.

OBJECTIVE: Blood lead levels have declined among every age group in the United States, but urban minority residents remain at disproportionate risk for elevated lead levels. Our objective was to measure lead burden in young women of childbearing age in New York City. We also describe successful means of recruiting this population into a cohort study. MATERIAL AND METHODS: Healthy women aged 18-25 attending a New York City health care center in 1995-1998 were eligible for participation. Participants were recruited by health care providers, the study coordinator and the participants themselves. Venous blood samples were obtained for whole blood lead, ferritin and hematocrit measurements, and detailed questionnaires were administered. RESULTS: 239 women have been recruited to date. The population is predominately minority: 62% African-American, 33% Hispanic and 5% Caucasian/Asian. The average age of participants is 19.3 years. Recruitment of participants into the study is predominantly (55%) through "word of mouth" from previously enrolled participants. Few participants learned of the study through their health care providers. The mean blood lead level among study participants is 2.1 +/- 1.7 micrograms/dl, which is consistent with the most recent United States national survey. CONCLUSIONS: Blood lead levels are low in young, urban minority women of childbearing age in New York City. In this population, recruitment efforts were substantially enhanced with the help of enrolled participants and the health care community.

Methodological issues related to studies of lead mobilization during menopause.

While there has been a substantial decline in lead exposure in the United States during the past two decades, mobilization of existing lead stored in bone potentially represents an important endogenous source of exposure for menopausal women. It has been hypothesized that lead may be mobilized from skeletal stores during conditions of high bone turnover, such as during menopause. However, such mobilization has not been documented in prospective studies. This discussion is focussed on some of the methodological difficulties to be anticipated in longitudinal studies of lead mobilization specific to menopause and the issues that need to be taken into account when evaluating the results of such studies. To evaluate whether lead mobilization occurs during menopause, a prospective repeated measures design is needed using X-ray fluorescence analysis of lead in bone and serial measurements of blood lead. Potential confounders and effect modifiers also need to be taken into account in the statistical analysis.

Male reproduction and environmental and occupational exposures: a review of epidemiologic methods.

Concerns that chemical exposures in the environment have been detrimental to male sexual development and fertility have been heightened by reports of declining sperm counts over the past 50 years. Marked geographic variation has been found in semen quality and in the incidence of testicular cancer and certain urogenital defects. Debate continues over the existence, magnitude and significance of these trends, and how best to evaluate the hypothesis that in utero and childhood exposures to estrogenic compounds may be to blame. Epidemiologic methods for assessing the impact of hazardous substances on male reproductive health have been developed mainly in the area of occupational medicine, and this paper will review the currently recommended methods. These include questionnaires to determine reproductive history and sexual function; reproductive hormone profiles; and semen analyses such as sperm concentration, motility, and morphology. New research tools that show significant promise from the fields of clinical reproductive medicine and reproductive toxicology are discussed as possible additions to epidemiologic studies, including assays of sperm function and genetic integrity, and biomarkers of DNA damage. For population-based studies involving occupational groups or communities with environmental exposures, issues related to the cost, validity, precision and utility of these methods must be carefully considered.

Women, work, and health.

The U.S. Bureau of National Affairs has conducted several surveys asking women to rate the seriousness of 11 hazards thought to affect female workers. In 1995 the women respondents ranked them in the following order: 1) stress, 2) repetitive motions, 3) AIDS, 4) violence, 5) VDTs, 6) indoor air pollution, 7) hepatitis, 8) injury on the job, 9) reproductive hazards, 10) tuberculosis, and 11) other infectious diseases. A parallel list of 11 hazards thought to affect male workers would look very different. The purpose of this paper is to explore why this is so and what it implies for the occupational health research agenda.

Risks of developing noise-induced hearing loss in employees of urban music clubs.

Noise-induced hearing loss has previously been reported among rock musicians. This study sought to determine whether a hazard of noise-induced hearing loss exists for music club employees other than musicians themselves. Sound levels at eight live-music clubs were measured and symptoms of noise exposure in 31 music club employees were assessed by questionnaire. The average sound level at the various clubs during performances ranged from 94.9 to 106.7 dBA. The overall sound level average, including both performance and ambient levels, ranged from 91.9 to 99.8 dBA. Symptoms of noise exposure, such as tinnitus and subjective hearing loss, correlated with sound intensity. Only 16% reported regular use of hearing protection. We conclude that employees of music clubs are at substantial risk of developing Noise-Induced Hearing Loss, due to chronic noise exposure which consistently exceeded safe levels. Hearing protection is used much too infrequently. The development of hearing conservation programs for this large group of workers is essential.

Virtual reality for health care: a survey.

This report surveys the state of the art in applications of virtual environments and related technologies for health care. Applications of these technologies are being developed for health care in the following areas: surgical procedures (remote surgery or telepresence, augmented or enhanced surgery, and planning and simulation of procedures before surgery); medical therapy; preventive medicine and patient education; medical education and training; visualization of massive medical databases; skill enhancement and rehabilitation; and architectural design for health-care facilities. To date, such applications have improved the quality of health care, and in the future they will result in substantial cost savings. Tools that respond to the needs of present virtual environment systems are being refined or developed. However, additional large-scale research is necessary in the following areas: user studies, use of robots for telepresence procedures, enhanced system reality, and improved system functionality.

Unraveling the chronic toxicity of lead: an essential priority for environmental health.

Although population exposure to lead has declined, chronic lead toxicity remains a major public health problem in the United States affecting millions of children and adults. Important gaps exist in knowledge of the pathophysiology of chronic lead intoxication. These gaps have impeded development of control strategies. To close current gaps in knowledge of chronic lead toxicity, we propose an integrated, multidisciplinary, marker-based research program. This program combines a) direct measurement of individual lead burden by 109Cd X-ray fluorescence analysis of lead in bone, b) determination of ALA-D phenotype, an index of individual susceptibility to lead, and c) assessments of subclinical injury produced by lead in the kidneys, nervous system and, reproductive organs. Data from this research will provide answers to questions of great public health importance: a) Are current environmental and occupational standards adequate to prevent chronic lead intoxication? b) is lead mobilized from the skeleton during pregnancy or lactation to cause fetal toxicity? c) Is lead mobilized from bone during menopause to cause neurotoxicity? d) What is the significance of genetic variation in determining susceptibility to lead? e) What is the contribution of lead to hypertension, renal disease, chronic neurodegenerative disease or declining sperm counts? f) Is chelation therapy effective in reducing body lead burden in persons with chronic overexposure to lead?

Lung cancer mortality in a French cohort of hard-metal workers.

A cohort mortality study was carried out among workers of a plant producing hard metals using cobalt as a binder. This study was aimed at assessing possible lung cancer risks in relation with cobalt exposure. Seven hundred nine male workers with at least 1 year of employment were included in the cohort and followed for mortality from 1956 to 1989. Job histories were provided by the administration of the plant, whereas smoking habits were collected from medical records and by interview. The causes of deaths were ascertained from hospital and general practitioner records. The observed numbers of deaths (obs) were compared with the expected based on national rates with adjustment for age, sex, and calendar time (standardized mortality ratio; SMR). The overall mortality did not differ from that expected (obs = 75, SMR = 1.05), whereas mortality due to lung cancer was in significant excess (obs = 10, SMR = 2.13). This excess was higher among workers employed in the areas with the highest exposure (obs = 6, SMR = 5.03). No trend was observed, however, with duration of employment or time since first employment. Smoking data were available for 81% of the workers and 69% of the deceased and showed that smoking alone does not account for these lung cancer excesses, yet, because of the small numbers involved, no firm conclusion should be drawn from this study.

Medical surveillance for workers exposed to tuberculosis.

This detailed discussion of medical surveillance techniques addresses such issues as the administration and interpretation of the tuberculin skin test, the importance of BCG vaccine, preventive therapy with isoniazid, the identification of groups at high risk for TB, multidrug-resistant tuberculosis, and regulatory requirements for PPD testing, including CDC guidelines.

[Pulmonary siderosis and long-term respiratory risks of arc welders]. / Sidérose pulmonaire et risques respiratoires à long terme du soudage à l'arc.

Pulmonary siderosis and bronchial cancer are respiratory risks in the long term in arc welders. We report a case of siderosis discovered from radiological abnormalities in a patient of 56 who had been an arc welder for 30 years. An analysis of the broncho-alveolar lavage liquid and transbronchial biopsy confirmed an iron overload and revealed patchy interstitial fibrosis. The toxic risks in arc welders arise from the gaseous fumes produced and inhaled particles at the alveolar level. The pulmonary siderosis is currently considered as a simple pneumoconiosis with a good prognosis. Some recent studies suggest the possibility of a more serious outcome with fibrosis even in the absence of any associated silicosis. The risks of bronchial cancer seem to be principally linked to exposure to chrome. A better understanding of these risks could be furnished by data from epidemiological studies which are still lacking.