Mortality and cancer morbidity in a cohort of Canadian petroleum workers.

AIMS: To assess mortality and cancer morbidity in Canadian petroleum workers and explore exposure-response relations for specific petroleum agents. METHODS: A total of 25 292 employees hired between 1964 and 1994 were linked to the Canadian tumour registry and national mortality database. Exposure-response trends were assessed for hydrocarbon solvents/fuels, hydrocarbon lubricants, petroleum coke/spent catalyst, and hydrogen sulphide (H2S). RESULTS: External comparison analyses (mortality and incidence) showed deficits for all causes and all malignant neoplasms combined and were consistent with expectation for most malignant and non-malignant sites analysed. Gall bladder cancer mortality was increased among males based on four deaths, but cases had no common job assignments and the increase was focused in workers employed <10 years. Mesothelioma incidence was increased. Most exposure-specific analyses were compromised by small numbers. Statistically significant increases were observed for H2S exposure and a subgroup of accidental deaths as well as for petroleum coke/spent catalyst exposure and lung cancer. While both findings have a degree of biologic plausibility, the H2S association, which exhibited a clearer exposure-response pattern, could be subject to unmeasured confounders. Additionally, interpretation was complicated by the high correlation between hydrocarbon and H2S exposures. With regard to lung cancer, the analysis could not adequately control for smoking, was based on small numbers, and exhibited a tenuous exposure-response pattern. CONCLUSION: The findings for mesothelioma suggest the need for continued attention to asbestos in the petroleum industry. The relation between accidental deaths and H2S exposure deserves closer scrutiny in similarly exposed populations. Further analyses of lung cancer are underway and will be reported separately.

Updated mortality among diverse operating segments of a petroleum company.

OBJECTIVES: To update mortality for 34 560 employees from diverse operating segments of a Canadian petroleum company; and to investigate potential relations with occupational factors. METHODS: Employees from 1964-83 were linked to the Canadian mortality data base to provide 11 years additional follow up. There were 6760 deaths and 750 683 person-years of follow up compared with 3909 and 428 190, respectively, in the earlier study. Analyses used standardised mortality ratios (SMRs) to compare worker cause specific mortality with the Canadian general population. Duration of employment and latency analyses were performed for causes previously found to be increased in this and other petroleum cohorts, as well as any findings of interest. RESULTS: For the period 1964-94, employees experienced significantly low overall mortality (SMR=0.86 men, SMR=0.80 women). Kidney cancer, which has been increased in some studies of petroleum workers, was not increased. Acute non-lymphocytic leukaemia in exposed operating segments was consistent with the expected or only slightly, non-significantly increased. The most notable finding was increased deaths from mesothelioma among refinery and petrochemical workers (SMR 8.68; 95% confidence interval (95% CI) 5.51 to 13.03), most of whom were long term employees in jobs with presumed exposure to asbestos (mechanical and pipefitters). Deaths from multiple myeloma among marketing and distribution workers, which were previously increased, remained increased (SMR 2.08; 95% CI 0.95 to 3.95) in the update period 1984-94; however, there was no clear pattern by duration of employment or latency. Aortic aneurysms, which also were previously significantly increased among marketing and distribution workers approached the expected in the update period (SMR 1.18; 95% CI 0. 65-1.98). Analyses by duration of employment showed suggestive trends for aortic aneurysms, but earlier studies of this cohort have not found a relation between aortic aneurysms and exposure to hydrocarbons. CONCLUSION: The additional 2851 deaths and 322 493 person-years of follow up strengthened the assessment of mortality patterns relative to occupational factors. With the exception of mesothelioma, no clear work related increases in disease were identified.

Lymphohaematopoietic malignancies and quantitative estimates of exposure to benzene in Canadian petroleum distribution workers.

OBJECTIVE: To evaluate the relation between mortality from lymphohaematopoietic cancer and long term, low level exposures to benzene among male petroleum distribution workers. METHODS: This nested case control study identified all fatal cases of lymphohaematopoietic cancer among a previously studied cohort. Of the 29 cases, 14 had leukaemia, seven multiple myeloma, and eight non-Hodgkin's lymphoma. A four to one matching ratio was used to select a stratified sample of controls from the same cohort, controlling for year of birth and time at risk. Industrial hygienists estimated workplace exposures for benzene and total hydrocarbons, without knowledge of case or control status, for combinations of job, location, and era represented in all work histories. Average daily benzene concentrations ranged from 0.01 to 6.2 parts per million (ppm) for all jobs. Company medical records were used to abstract information on other potential confounders such as cigarette smoking, although the data were incomplete. Odds ratios (ORs) were calculated with conditional logistic regression techniques for several exposure variables. RESULTS: Risks of leukaemia, non-Hodgkin's lymphoma, and multiple myeloma were not associated with increasing cumulative exposure to benzene or total hydrocarbons. For leukaemia, the logistic regression model predicted an OR of 1.002 (P < 0.77) for each ppm-y of exposure to benzene. Duration of exposure to benzene was more closely associated with risk of leukaemia than other exposure variables. It was not possible to completely control for other risk factors, although there was suggestive evidence that smoking and a family history of cancer may have played a part in the risk of leukaemia. CONCLUSION: This study did not show a relation between lymphohaematopoietic cancer and long term, low level exposures to benzene. The power of the study to detect low-such as twofold-risks was limited. Thus, further study on exposures to benzene in this concentration range are warranted.

A retrospective mortality study within operating segments of a petroleum company.

This retrospective mortality study was conducted among 34,597 oil industry workers in diverse operating segments. Employees were traced through Statistics Canada, and overall mortality (SMR = 0.85) was lower than general population rates and similar to other petrochemical cohorts. The most notable finding was a significant excess of malignant melanoma [observed deaths (N) = 16, SMR = 1.87, 95% CI = 1.07, 3.04], which concentrated among upstream workers (N = 6, SMR = 6.00, 95% CI = 2.19, 13.06), and was directly related to employment duration and latency. Specific substances or hydrocarbon (HC) streams could not be implicated, although possible explanations include dermal HC exposure, ultraviolet light exposure, or a synergistic effect between these two factors. Marketing/transportation workers showed a non-significant excess of multiple myeloma (SMR = 1.81), which was also related to employment duration, latency, and commencement of employment before 1950. Lymphatic cancer, skin cancer, and kidney cancer mortality was not elevated in refinery workers, a finding at odds with some previous refinery worker studies. Although the malignant melanoma and possibly the multiple myeloma mortality patterns are consistent with an occupational link, further studies are needed to investigate the relationship of these diseases with particular exposures.

An analysis of death ascertainment and follow-up through statistics Canada's Mortality Data Base system.

The Canadian Mortality Data Base (MDB) was utilized in mortality follow-up of 17,446 refinery and petrochemical workers throughout Canada. The performance of the system in detecting 757 previously known deaths was evaluated. Of the deaths submitted, 93.1% (90% confidence interval (CI) 91.5-94.5) were detected, including 97.6% (90% CI 96.5-98.4) of deaths which occurred in Canada. Detection was generally unaffected by age, year of death (1964-1973), and the presence of middle initial or the remainder of first name. Slightly lower ascertainment was found for deaths occurring in Quebec (94.5%) and Newfoundland (93.3%). This could be due to several factors, including fewer MDB records with complete identifier information for these provinces, or lower accuracy of linking fields for records supplied to the Agency. Few links were made to employees presumed to be alive, indicating 99.8% specificity for these records.

Clostridium difficile. Colonization and toxin production in a cohort of patients with malignant hematologic disorders.

We examined 45 (80%) of 56 consecutive adult patients with malignant hematologic disorders who were hospitalized during a 15-week period at Emory University Hospital, Atlanta. Stool samples for Clostridium difficile culture and cytotoxin assay were obtained on admission and then weekly during each patient's hospitalization. On admission, four patients had detectable C difficile in their stool samples, which was associated with prior antimicrobial use but not with prior cancer chemotherapy. One of the four patients with positive stool samples also had toxin present in the stool sample and was the only one with diarrhea. Eight (36%) of 22 patients hospitalized for one or more weeks had C difficile isolated from at least one stool specimen. The positive cultures showed no clustering in time, and no risk factors were identified for colonization. Only seven of 15 culture-positive stool samples and three of seven toxin-positive samples were associated with diarrhea.

Norleucine-tyrosine broth for rapid identification of Clostridium difficile by gas-liquid chromatography.

A new medium, norleucine-tyrosine (NT) broth, was developed for rapid identification of Clostridium difficile on the basis of caproic acid and p-cresol production. The NT broth consists of 0.5% Trypticase (BBL Microbiology Systems, Cockeysville, Md.), 0.5% yeast extract (Difco Laboratories, Detroit), 0.2% L-norleucine and 0.2% L-tyrosine (wt/vol; final concentrations), and a mixture of salts. The procedure for demonstrating caproic acid and p-cresol production involves extracting NT broth cultures with ether or chloroform and analyzing the extracts with a gas-liquid chromatograph equipped with a thermal conductivity detector, as is customary for analysis of volatile fatty acids. A total of 120 strains of C. difficile from diverse geographic locations were tested by this procedure, and they all produced caproic acid and p-cresol in NT broth. No other Clostridium species or other microorganisms tested have been found to produce both products in NT broth.

Physiological characterization of nutritionally variant streptococci.

Twenty-five isolates of nutritionally variant streptococci submitted to the Streptococcus Laboratory of the Center for Disease Control over a 2-year period were tested for growth requirements and for biochemical reactions. After they were recovered from storage in blood at -170 degrees C, all isolates grew within 48 h in both thioglycollate broth and Todd-Hewitt broth supplemented with 0.001% pyridoxal.HCl. They grew better in the latter, even though they all grew on unsupplemented infusion agar, anaerobe blood agar, and chopped meat-glucose medium. Biochemical patterns of the isolates resemble those of five viridans streptococcal species. Two isolates had patterns which did not resemble those of any viridans species. Biochemical reactions obtained with heart infusion broth base biochemicals and carbohydrate fermentation media compared favorably for an overall agreement rate of 86.5% for key tests. Lactic acid and acetic acid were the major fermentation products detected with gas-liquid chromatography.

Evaluation of Port-A-Cul transport system for protection of anaerobic bacteria.

The protection of anaerobes in Port-A-Cul (PAC) transport system (Bioquest, Div. of Becton, Dickinson &Co., Cockeysville, Md.) tubes and vials was studied. Ten species of obligately anaerobic bacteria commonly isolated from clinical specimens were used to prepare simulated swab and fluid specimens in high and low concentrations. Samples in PAC tubes and vials were held for 2, 24, and 48 h at ambient temperature and in a refrigerator. In addition, samples of the simulated specimens were exposed to controlled anaerobic and aerobic conditions in vented tubes and vials, with and without PAC medium, at ambient and refrigerator temperatures. Viable bacterial colony counts from specimens in PAC tubes and vials used as recommended by the manufacturer were consistently greater than those from specimens exposed to the different controlled conditions. The protection in PAC was about equal for specimens with either high or low concentrations of bacteria. Protection of the anaerobes in PAC was more obvious with swab than with fluid specimens. Quantitative recovery of anaerobes from refrigerated PAC samples, with few exceptions, was comparable to that from PAC samples held at ambient temperature.

Modification of the Minitek Miniaturized Differentiation System for characterization of anaerobic bacteria.

The Minitek Miniaturized System (BBL) was modified for characterization of anaerobic bacteria. The modified system and the conventional Center for Disease Control method were used to test a variety of anaerobic bacteria, and results were compared. Tests performed by both techniques were indole and H2S production, esculin hydrolysis, nitrate reduction, and fermentation of glucose, mannitol, lactose, sucrose, maltose, salicin, glycerol, xylose, arabinose, mannose, rhamnose, and trehalose. The manufacturer's recommended procedure for the Minitek system was modified by using a new suspension medium (Lombard-Dowell broth) and an inoculum equivalent to the density of a McFarland no. 5 nephelometer standard. The Minitek results, recorded after 48 h, agreed satisfactorily with the conventional test results, usually recorded after 5 to 7 days of incubation. In the examination of 80 strains representing 22 different species or subspecies of anaerobic bacteria, with 16 biochemical tests performed in triplicate, 93.8% of the Minitek test results agreed with those of the corresponding conventional tests. Only tests for indole, H2S, and nitrate reduction gave less than 90% agreement. It was concluded that the modified Minitek system is a suitable substitute for the more expensive and time-consuming conventional procedure for determining carbohydrate fermentation and esculin hydrolysis by anaerobes. This system, when used in conjunction with other tests, can effectively aid in the definitive identification of commonly isolated anaerobes.

Micromethod system for identification of anaerobic bacteria.

A micromethod multitest system prepared by Analytab Products, Inc. and conventional tests employed at the Center for Disease Control for identification of anaerobes were compared. All procedures were conducted in an anaerobic glove box. A total of 104 cultures, including 18 reference strains and 86 diagnostic cultures, were examined. Ninety-one percent of the total tests performed with the two systems were in agreement. Greater than 90% agreement between the two systems was obtained with 12 of the 17 differential tests compared. The tests for nitrate reduction and H(2)S production gave the poorest agreement, 77.8 and 80.8%, respectively. Only 66% of the 86 diagnostic cultures could be presumptively identified with the micromethod system supplemented only with microscopy and colonial characteristics. However, when appropriate supplementary tests and gas-liquid chromatography were used with the micromethod system, 85% of the 86 strains could be identified. When Ehrlich reagent, instead of Kovac reagent, was used with the micromethod to test for indole, the agreement in identification was raised to 93%.