An Unusual Laboratory Accident: Bromine Burn.

Bromine is a water-soluble, severely toxic element. It leads to tissue injury by causing the release of radical oxygen species from mucosal membranes. Redness or brownish discoloration of the skin, pain, measles-like rash, vesicles, blisters, pustules, furuncles, burns, and ulcers may be seen in the acute phase. A 32-year-old male presented to the emergency department after an accidental spill of bromine on his left forearm. Erythematous skin, including brownish discoloration and occasional small blisters, were seen on the forearm and wrist. The affected extremity was washed with plenty of water. The lesions were covered with antibiotic cream and wrapped with sterile gauzes; they healed without any complications. Mild burn scars with slightly pale discoloration of the affected skin remained after the lesions healed. Although bromine burn is rare, it causes severe damage to the skin, and injury starts insidiously without causing a visible skin reaction at the beginning. Irrigation with plenty of water in the early period is critically important in reducing the severity of the injury. Key Words: Bromine, Burn, Skin, Radical oxygen species.

Behavioral and Neuronal Effects of Inhaled Bromine Gas: Oxidative Brain Stem Damage.

The risk of accidental bromine (Br2) exposure to the public has increased due to its enhanced industrial use. Inhaled Br2 damages the lungs and the heart; however, adverse effects on the brain are unknown. In this study, we examined the neurological effects of inhaled Br2 in Sprague Dawley rats. Rats were exposed to Br2 (600 ppm for 45 min) and transferred to room air and cage behavior, and levels of glial fibrillary acidic protein (GFAP) in plasma were examined at various time intervals. Bromine exposure resulted in abnormal cage behavior such as head hitting, biting and aggression, hypervigilance, and hyperactivity. An increase in plasma GFAP and brain 4-hydroxynonenal (4-HNE) content also was observed in the exposed animals. Acute and delayed sympathetic nervous system activation was also evaluated by assessing the expression of catecholamine biosynthesizing enzymes, tryptophan hydroxylase (TrpH1 and TrpH2), and tyrosine hydroxylase (TyrH), along with an assessment of catecholamines and their metabolites. TyrH was found to be increased in a time-dependent manner. TrpH1 and TrpH2 were significantly decreased upon Br2 exposure in the brainstem. The neurotransmitter content evaluation indicated an increase in 5-HT and dopamine at early timepoints after exposure; however, other metabolites were not significantly altered. Taken together, our results predict brain damage and autonomic dysfunction upon Br2 exposure.

Evaluation of the Effect of Selected Brominated Flame Retardants on Human Serum Albumin and Human Erythrocyte Membrane Proteins.

Brominated flame retardants (BFRs) have been using to reduce the flammability of plastics contained in many products, such as household articles, furniture, mattresses, textiles or insulation. Considering the fact that these compounds may be released into the environment leading to the exposure of living organisms, it is necessary to study their possible effects and mechanisms of action. Proteins play a crucial role in all biological processes. For this reason, a simple model of human serum albumin (HSA) was chosen to study the mechanism of BFRs' effect on proteins. The study determined interactions between selected BFRs, i.e., tetrabromobisphenol A (TBBPA), tetrabromobisphenol S (TBBPS), 2,4-dibromophenol (2,4-DBP), 2,4,6-tribromophenol (2,4,6-TBP) and pentabromophenol (PBP), and HSA by measurement of fluorescence of intrinsic tryptophan and absorbance of circular dichroism (CD). In addition, in order to understand the possible effect of these compounds in their native environment, the effect of BFRs on membrane proteins of human erythrocytes (red blood cells, RBCs) was also assessed. Among bromophenols, PBP had the strongest oxidative effect on RBC membrane, and 2,4-DBP demonstrated the weakest fluorescence-quenching effect of both membrane tryptophan and HSA. By contrast to PBP, 2,4-DBP and 2,4,6-TBP caused spatial changes of HSA. We have observed that among all analyzed BFRs, TBBPA caused the strongest oxidation of RBC membrane proteins and the model HSA protein, causing reduction of fluorescence of tryptophan contained in them. TBBPA also changed albumin conformation properties, leading to impairment of the α-helix structure. However, TBBPS had the weakest oxidative effect on proteins among studied BFRs and did not affect the secondary structure of HSA.

Effects of brominated and organophosphate ester flame retardants on male reproduction.

BACKGROUND: Environmental chemicals that interfere with the production and/or action of hormones may have adverse effects on male reproduction. This review focuses on the possible impact of exposure to flame retardant chemicals on male reproduction. Flame retardants are added to a wide variety of combustible materials to prevent fires from starting, slow their spread, and provide time to escape. However, these chemicals are often additive so they leach out into the environment. Governments have restricted the use of polybrominated diphenyl ether flame retardants based on evidence that they are persistent and bioaccumulate and have adverse effects on health. The phasing out of these "legacy" flame retardants has resulted in their replacement with alternatives, such as tetrabromobisphenol A and the organophosphate esters. OBJECTIVE: To review the literature on the effects of brominated and organophosphate ester flame retardant chemicals on male reproduction. METHODS: PubMed database was searched for studies reporting the effects of brominated and organophosphate ester flame retardants on male reproduction. RESULTS: Cell-based, animal model, and human studies provide evidence that the polybrominated diphenyl ethers act as endocrine-disrupting chemicals; further, exposure during critical windows of development may be associated with a permanent impact on male reproduction. In vitro and animal model data are accumulating with respect to the effects of tetrabromobisphenol A and organophosphate esters, but few studies have evaluated their impact on human health. CONCLUSIONS: More research on human exposure to replacement flame retardants and the possibility that they may be associated with adverse reproductive health outcomes is a high priority.

Case with bromine exposure leading to respiratory insufficiency.

A 21-year-old male had a chemical burn on the right forearm when he inadvertently spilled bromine during an experiment. Since he inhaled vaporized bromine and had dyspnea and pharyngalgia, he arrived at our hospital in an ambulance as an emergency patient. On arrival, he kept a clear consciousness with a pulse rate of 98, body temperature of 36.8 degrees C, blood pressure of 132/80 mmHg, respiratory rate of 25, and oxygen saturation of 100%. (10 L/min of oxygen were administered.) He had marked dry coughs. His clothes had a foreign odor with mucosal irritation. Arterial blood gas analysis and blood biochemistry were normal. Based on these findings, he was diagnosed with chemical airway damage and bulbar conjunctiva from the exposure to bromine and a chemical burn on the right forearm. His respiratory condition became worse after admission, resulting in pulmonary edema. He was endotracheally intubated and controlled with an artificial ventilator on Day 3 after his injury. He was continuously treated with steroids and sivelestat sodium hydrate, which gradually improved his respiration. He was released from the artificial ventilator and extubated on Day 7. Although dyspnea associated with body movement and hoarseness persisted after extubation, the symptoms decreased and he was discharged on Day 41. This rare case is worth attention because serious respiratory insufficiency requiring artificial ventilation due to pulmonary edema from bromine exposure has not been reported in Japan.

Skin irritation in users of brominated pools.

This study investigated adverse skin and eye effects in swimmers using pools with three different disinfection systems (chlorine, chlorine/ozone and bromine/ozone) and monitored water quality parameters that may be related to adverse health effects. A cross-sectional study of 770 children swimming in three school pools was carried out over a 4 week period in November 1994 using a postal questionnaire. Physico-chemical and bacteriological parameters of water quality were monitored on a weekly basis. Responses were obtained for 385 swimmers. Skin rashes with an onset less than 24 h after swimming in the school pool were reported by 4-8% of swimmers. Compared with the bromine/ozone pool, the odds ratio (OR) of having a rash that started less than 24 h after pool use was 1.91 (CI 0.71-5.10) for the chlorine pool and 1.88 (CI 0.61-5.81) for the chlorine/ozone pool. Adjustment for possible confounders made no significant differences to these results. Eye redness, itch or irritation was reported by 23-33% of swimmers and 24% of non-swimmers, and wearing swimming goggles had a protective effect (OR 0.40; CI 0.24, 0.65). Disinfectant levels were more consistently maintained in the pools with automatically controlled systems. The bromine disinfection system was not associated with a greater risk of the development of skin rashes than other disinfection systems, but the numbers were small, and need to be interpreted with caution.

Management of scrap computer recycling in Taiwan.

It is estimated that approximately 300,000 scrap personal computers are generated each year in Taiwan [S.-L. Chang, A Study on the Scrap Computer Treatment Cost, Environment Protection Administration of Taiwan, December 1998 (in Chinese)]. The disposal of such a huge number of scrap computers presents a difficult task for the island due to the scarcity of landfills and incineration facilities available locally. Also, the hazardous materials contained (i.e., phosphor coatings of cathode ray tubes (CRTs), batteries, polychlorinated biphenyl capacitors, mercury-containing parts, liquid crystal display, high-lead content CRT funnel glass, and plastic containing flame-retardant bromine, etc.) in the scrap computers may seriously pollute the environment if they are not properly disposed of. Therefore, the EPA of Taiwan declared scrap personal computers the producer's recycling responsibility as of July 1997. Under this decree, the manufacturers, importers and sellers of personal computers have to properly recover and recycle the scrapped computers which they originally sell. On June 1, 1998, a producer responsibility recycling program for scrap computers was officially implemented in Taiwan. Under this program, consumers can bring their unwanted personal computers to the designated collection points and receive reward money. Currently, only six computer items are mandated to be recycled in this recycling program. They are notebooks, monitors, hard disks, power supplies, printed circuit boards and main frame shells. This article outlines the current scrap computer recycling system in Taiwan.

In vitro analysis of bromine chemical burns with use of full-thickness human skin.

Parameters of bromine injury were studied in vitro with the use of full-thickness human skin (HS) specimens--discards from various surgical procedures. The morphology of in vitro-treated HS resembled that of in vivo-injured skin. The damage was pronounced in the epidermis (destruction of the stratum corneum, and extensive vacuolation of keratinocytes) and the dermis (collagen coagulation), depending on the bromine concentration, exposure time, and application method. A decreased viability of epidermal cells, assayed by dye exclusion, was observed as well. Permeation parameters of bromine via abdominal HS were determined by quantitating bromine concentration in the donor and receiving compartments. The amount of bromine that permeated HS was inversely related to the concentration gradient applied. This in vitro study suggests that prompt treatment and early medical intervention may be required for successful healing of both severe and mild cases of bromine injuries.

Irritative and systemic symptoms following exposure to Microban disinfectant through a school ventilation system.

Microban, a pesticide not registered in California, was sprayed into an operating heating/ventilation/air conditioning (HVAC) unit at an elementary school in San Francisco, California. This incident occurred on Monday, September 28, 1992, while 396 students and 67 staff members were in the school. The Microban formulation used contains ortho-phenylphenol (0.21%), a quaternary ammonium complex (di-isobutylphenoxy-ethoxy-ethyldimethylbenzyl-ammonium chloride, 0.69%), and bromine (0.04%). This study of the health effects of Microban mist exposure on the school staff was conducted as a result of legal and toxicological concerns. California registration for this formulation had been denied because of inadequate data and because there were concerns about inhalation toxicity in test animals. Predicted health effects from short-duration exposure to Microban are primarily skin and mucous membrane irritation. A self-administered health symptom questionnaire that covered the work week following the evacuation was used to determine a pattern of higher symptom risks for those who were at work on Monday and who reported that they felt they were exposed to a chemical. Symptoms, which were generally consistent with exposure to an irritating chemical, were elevated on Monday and Tuesday; the symptoms normalized by the end of the work week. No additional health effects were detected following application of chlorpyrifos to cracks and crevices for ant control 2 d following the Microban incident. Strict supervision and coordination of pesticide use in public schools are recommended to prevent adverse health effects and emotional trauma in students and staff.

[Late health sequelae of accidental bromine exposure].

Health and environmental assessment of the consequences of accidental contamination of an area in the Negev desert is described and the effects of exposure to bromine vapor in 6 persons evaluated. They were only mildly affected during the acute spillage of the bromine, with some respiratory symptoms and first and second degree skin burns of small exposed areas on the legs. All were treated in hospital and were released within 1-4 days. 6-8 weeks later they demonstrated a complex array of complaints, including cough, shortness of breath, chest tightness, eye irritation, headache, dizziness, fatigue, memory disturbances, sleep and sexual disturbances. These complaints could not be substantiated by objective clinical or laboratory examination. There was thus obvious magnification of the complaints 1-2 months after the accident.

Chemical pneumonitis due to exposure to bromine compounds.

A 60-year-old laboratory technician developed pulmonary infiltrates consistent with chemical pneumonitis following accidental exposure to a mixture of hydrogen bromide and phosphorus tribromide. A protracted clinical course ensued consistent with bronchiolitis obliterans. These problems may have been avoided if the potential for subsequent damage had been realized at the time of the initial exposure. Health personnel must be aware of the potentially delayed effects of accidental exposures to respiratory irritants.

Acne medicamentosa / Acne medicamentosa

Foram revistos os casos de acne medicamentosa atendidos em um período de 17 anos, sendo encontrados 66/22890 novas consultas (2,9:1.000 novas consultas). O quadro predomina em mulheres, na proporçäo 3,7 para cada homen. As drogas desencadeantes foram principalmente a vitamina B12 (29 casos - 43,9%) e os corticóides(17 - 25,7%); seguem-se iodo, bromo, hidrazida e lítio. Do ponto de vista clínico foram avaliados aspectos relacionados com duraçäo da erupçäo, presença de prurido, morfologia e distribuiçäo das lesöes, relaçäo com acne vulgar. Do ponto de vista histopatológico, foi discutida a possível sede de lesäo inicial, no folículo piloso

Burns caused by bromine and some of its compounds.

Our experience with infrequent and unfamiliar types of injury caused by various compounds of bromine are described and discussed. While bromine containing compounds share some of the characteristics of other common causes of chemical burns, they also have a specific, exclusive mode of affecting the skin. The delay in the appearance of clinical signs and symptoms is an important factor to be considered by those who treat injuries caused by bromine or some of its compounds, or by those who may be the first to see persons who are injured by these agents. As most of the injuries occur at work (92 per cent) it is in these industrial premises that considerable stress should be made of the importance of wearing protective clothing in order to reduce local damage and prevent systemic effects. Prompt first aid, by thorough washing with large volumes of water reduces the extent and depth of the injury.