A case of hard metal lung disease resembling a hypersensitive pneumonia in radiological images.

A 42-year-old man was admitted to our hospital because of exertional dyspnea. He had worked as a metal grinder for 3 years, but had quit his job 1 month before admission. Chest radiography and high-resolution computed tomography showed diffuse ground-glass opacities like hypersensitivity pneumonitis shadows. The results of high-energy dispersion X-ray microanalysis indicated that the patient had hard metal pneumoconiosis associated with tungsten. Since the histological changes distributed terminal to respiratory bronchiole and surrounding alveoli, and macrophages engulfed black granules within the alveoli, in absence of giant cells, we considered this case to be a type of hypersensitivity pneumonitis of hard metal lung.

Pulmonary responses to welding fumes: role of metal constituents.

It is estimated that more than 1 million workers worldwide perform some type of welding as part of their work duties. Epidemiology studies have shown that a large number of welders experience some type of respiratory illness. Respiratory effects seen in full-time welders have included bronchitis, siderosis, asthma, and a possible increase in the incidence of lung cancer. Pulmonary infections are increased in terms of severity, duration, and frequency among welders. Inhalation exposure to welding fumes may vary due to differences in the materials used and methods employed. The chemical properties of welding fumes can be quite complex. Most welding materials are alloy mixtures of metals characterized by different steels that may contain iron, manganese, chromium, and nickel. Animal studies have indicated that the presence and combination of different metal constituents is an important determinant in the potential pneumotoxic responses associated with welding fumes. Animal models have demonstrated that stainless steel (SS) welding fumes, which contain significant levels of nickel and chromium, induce more lung injury and inflammation, and are retained in the lungs longer than mild steel (MS) welding fumes, which contain mostly iron. In addition, SS fumes generated from welding processes using fluxes to protect the resulting weld contain elevated levels of soluble metals, which may affect respiratory health. Recent animal studies have indicated that the lung injury and inflammation induced by SS welding fumes that contain water-soluble metals are dependent on both the soluble and insoluble fractions of the fume. This article reviews the role that metals play in the pulmonary effects associated with welding fume exposure in workers and laboratory animals.

Blood manganese and alcohol consumption interact on mood states among manganese alloy production workers.

Long-term exposure to manganese (Mn) can induce neurotoxic effects including neuromotor, neurocognitive and neuropsychiatric effects, but there is a great interpersonal variability in the occurrence of these effects. It has recently been suggested that blood Mn (MnB) may interact with alcohol use disorders, accentuating neuropsychiatric symptoms. The objective of the present study was to explore a possible interaction between alcohol consumption and MnB on mood states, using an existing data set on Mn exposed workers. Respirable Mn exposure in the plant averaged 0.23mg/m(3) and was correlated with MnB. All participants for whom all data on MnB concentration and mood (assessed with the Profile of Mood States (POMS)) were available and who reported currently drinking alcohol were included in the analyses (n=74). Workers were grouped according to their MnB concentration (<10 and > or =10 microg/l) and alcohol consumption (<400 and > or =400g per week). Two-way ANOVAs were performed on each POMS scale and Mann-Whitney tests were used to assess group differences. Workers in the higher alcohol consumption group had higher scores on three POMS scales: tension, anger and fatigue. There was no difference for POMS scale scores between MnB subgroups. Dividing the group with respect to alcohol consumption and MnB showed that the group with high alcohol consumption and high MnB displayed the highest scores. In the lower MnB category, those in the higher alcohol consumption group did not have higher scores than the others. The interaction term for alcohol consumption and MnB concentration was statistically significant (P<0.05) for the depression, anger, fatigue and confusion POMS scales. There was a tendency for tension (P<0.06), and it was not significant for vigor. This study shows the first evidence of an interaction between MnB and alcohol consumption on mood states among Mn exposed workers and supports the results from a previous population-based study.

Endocrine and immunologic markers in manganese alloy production workers.

OBJECTIVES: The aim of this study was to investigate selected hormones and immunologic markers in manganese alloy production workers with current and long-term manganese exposure. METHODS: One hundred randomly selected male workers exposed to manganese were compared with 100 male referents (matched for age) from similar process industries in a cross-sectional design. RESULTS: The geometric mean of the exposed workers' urinary manganese concentration was 0.9 (range 0.1-126.3) nmol/mmol creatinine (Cr) versus 0.4 (range 0.1-13.1) nmol/mmol Cr for the referents. The mean duration of exposure to manganese was 20.0 (range 2.1-41.0) years. The geometric mean of the prolactin serum concentration was higher for the exposed subjects than for the referents (229 versus 197 mIE/l, P=0.06). Serum prolactin was associated with current exposure to "soluble inhalable manganese", duration of exposure, and smoking habits. The subjects with the longest duration of exposure to manganese or the highest current exposure to "soluble inhalable manganese" had a statistically significantly higher serum prolactin concentration than the referents. The smokers had a lower serum prolactin concentration than the nonsmokers. The concentrations of the measured immunologic markers were similar in the groups. CONCLUSIONS: The study indicates that manganese exposure can increase the serum prolactin concentration. Both duration and current level of exposure are related to the slight increase, which also appears to be modified by current smoking habits. The serum prolactin concentrations were generally within the reference limits of the laboratory and thus not suitable as an exposure marker at these exposure levels.

[The alkaline phosphatase and aminotransferase activity of the blood serum and liver in rats with chronic poisoning by the dust from a mineral wool made of ferronickel slag]. / Aktivnost' shchelochnoi fosfatazy, aminotransferaz syvorotki krovi i pecheny krys pri khronicheskoi intoksikatsii pyl'iu mineral'noi vaty iz ferronikelevogo shlaka.

The authors investigated the activity of alkaline phosphatase, alanine- and aspartate-aminotransferases of the blood serum, mitochondria and postmitochondrial fraction of the liver in conditions of administration of mineral cotton from ferronickel slag. It was shown that 1 and 3 months after introduction of mineral cotton dust changes occurred in the activity of these enzymes. Restoration of these enzymes occurred 6 months after introduction of mineral cotton dust.

[Pulmonary pathology due to cobalt and hard metals]. / La pathologie pulmonaire due au cobalt et aux métaux durs.

For forty years, cases of interstitial pneumonia and bronchial asthma have been described in hard metal workers (i.e., alloys of tungsten carbide and cobalt). Recently we have reported comparable pulmonary lesions in workers in the diamond industry who were exposed to cobalt unassociated with tungsten carbide. The exposure came from the diamond cobalt discs used for polishing diamonds, which had as the hard element microdiamonds, cemented in an alloy of pure cobalt. The hard metals on the other hand consisted of cobalt and tungsten carbide. Forty-seven diamond cutters (i.e., nearly 1% of those exposed) presented with broncho-pulmonary pathology due to cobalt. Nineteen had a fibrosing alveolitis, sometimes documented by a pulmonary biopsy and more often by a broncho-alveolar lavage which revealed characteristic multinucleated giant cells. Thirteen had occupational asthma, often proved by specific inhalation provocation tests to cobalt or by lung function measurements at the place of work. Two patients had mixed forms and in thirteen a probable diagnosis was suggested. The pathogenesis of cobalt might be explained by cytotoxic action such as has been demonstrated in animal experiments. Either results suggest a sensitising or allergic action. Tungsten carbide does not produce pulmonary lesions but its association with cobalt intensifies the effects of the latter.