[Six cases of occupational skin diseases caused by cement: considerations from the aspect of occupational dermatology].

Cement, in particular Portland cement, is now widely used in the field of civil engineering and the construction industry. High alkalinity of wet cement and its tiny content of water-soluble chromate can cause occupational skin diseases. In this paper, we report four cases of contact dermatitis by cement and two cases of cement burn. The occupation of the patients included two plasterers, a truck driver, a manufacturer of cement ware and two construction workers. Skin of the hands and fingers of the cement dermatitis cases was dry and fissured, and had hyperkeratotic papules and erythemas or acute exudative eczematous lesions. In one of these cases, the eczematous lesions spread to the face, extremities and trunk. All cases resulted in a positive patch testing for sodium dichromate. The cement burn cases developed severe necrotic ulcers on the leg and/or foot following prolonged contact with wet cement inside their boots. Patch testing was negative for chromate. A field trip to a construction worksite showed that method of working as well as worker's clothing at present could not thoroughly protect the skin. Therefore we concluded that better protective clothing and gloves should be used and that working conditions be improved. Most skin diseases caused by cement occur among workers at small-scale enterprises. Therefore it is desirable that regional occupational health centers, which were established to promote the health care system for workers at small-scale enterprises, take prompt measures to avoid the skin diseases.

A rippled-pattern trichoblastoma: an immunohistochemical study.

BACKGROUND: Since the first description by Hashimoto et al., there have been only a few case reports of rippled-pattern tricogenic tumor. In addition, there are no reports on detailed immunohistochemical analyses of this rare neoplasm. We describe here an additional case of rippled-pattern trichogenic tumor with a special reference to its immunohistochemical features. METHODS: A nodule arising on the occipital area of a 62-year-old Japanese woman was histologically and immunohistochemically investigated. RESULTS: Histopathologically, the lesion contained various-sized lobular nests, which consisted of oval to elliptical shaped basaloid cells without any atypia and were embedded in the collagenous stroma. Some elongated basaloid cells were arranged in a palisading fashion forming parallel rows of epithelial ribbons in a rippled-pattern. Cytokeratin (CK) immunohistochemistry showed constant expressions of CK1/5/ 10/14, CK5/8, CK14 and CK7, and focal expressions of CK17 and CK19 in the basaloid cells, suggesting a keratin phenotypical similarity to the cells in small nodular type trichoblastoma. CONCLUSIONS: The present tumor is a variant of trichoblastoma, and considered to be in close association with the outer root sheath and/ or follicular germinative cells.

[Occupationally induced hydrofluoric acid burns: an analysis of 9 patients from the aspect of occupational health].

We report here 9 patients suffering from hydrofluoric acid burn who visited our clinic from July, 1979 to February, 2000. These 9 cases occupied 25% of all chemical burn cases experienced in our clinic. All the patients were men ranging in age from 20 to 53 (mean age 35 years; average 36.8 years). At the time of accidental exposures, 6 patients had been engaged in washing or cleaning work, and 2 had been changing the parts of instruments containing hydrofluoric acid. Eight patients received burns on the hands and/or fingers. During the work, 2 patients had used vinyl chloride or rubber gloves, but three patients employed no protection for the hands. After the symptoms began to develop, it was found that the glove of one patient had a pin hole. Coupled with the occasions described in previous reports, the causal factors of hydrofluoric acid burn could be divided as follows: 1) negligence or carelessness of workers, in particular skilled persons, in handling hydrofluoric acid, 2) ignorance of the dangerousness of hydrofluoric acid, 3) the presence of pin hole (s) in protection gloves, and 4) unexpected accident. Hydrofluoric acid is one of the most corrosive inorganic acids, and can produce progressive and serious tissue necrosis with severe pain. To prevent burns due to this chemical, enlightenment and reeducation of the workers regarding the hazard of hydrofluoric acid are necessary.

Triage of patients out of the emergency department: three-year experience.

Because of severe emergency department (ED) overcrowding, the authors initiated a program of referring certain patients who were assessed as not needing emergency care away from the ED. A selected group of patients who presented to a busy university ED were refused treatment and triaged away following a medical screening examination performed by a nurse. In this 3-year study 136,794 patients presented to the triage area in the ED, of which 21,069 (15%) were refused care and referred elsewhere. Letters and calls to all referral clinics, eight local EDs, and the coroner's office identified no patients who had been grossly mistriaged, and only insignificant adverse outcomes could be identified. Additional follow-up on 3,740 individuals triaged away was performed by telephone. Responses from this survey indicated that 42% of persons received care elsewhere the same day, 37% within 2 days, and 22% decided not to seek medical care. A group of 1.6% sought care at other hospital EDs for minor complaints. The authors concluded that a group of patients can be selectively triaged out of the ED without significant adverse outcomes, which may offer one approach to the problem of ED overcrowding.

Refusing care to patients who present to an emergency department.

In July 1988, our emergency department adopted a policy of refusing to treat patients in the ED if they failed to have what was considered an emergency condition. Screening examinations were performed by triage nurses to determine whether patients were eligible to be seen in the ED. Patients whose vital signs fell within specific categories and who had one of 50 minor chief complaints were refused care in the ED and referred to off-site clinics. The referral of these patients out of the ED after a screening examination falls within the scope of legislation governing ED care and transfer (federal COBRA, Cal SB-12, and Title 22) as determined by the University of California legal counsel. In the first six months of this new triage system, 4,186 patients were referred from the ED; this represented 19% of total ambulatory patients who presented to the triage area. Of the 4,186 patients refused care, 84% were referred to off-site nonuniversity clinics, and 15% were referred to a university-affiliated faculty-staffed clinic. Follow-up letters and telephone calls to their clinics identified no patients who needed retriage to an ED, and only 54 patients (1.3%) complained about their referral out of the ED. Only 42 patients returned to the ED within 48 hours of initial triage, and none had a deterioration of their condition. In conclusion, a selective triage system may be used to effectively decompress an ED, although further study is needed to identify potential rare adverse outcomes.