[Fever and dysphagia of a young woman]. / Fieber und Dysphagie einer jungen Frau.

We report the case of a 39-year old patient with septicemia treated for pharyngitis with antibiotics since a few days. She wasn't able to swallow her antibiotics anymore because of dysphagia. Radiologic examination revealed pulmonary infiltrates and Vena iugularis interna-thrombosis. These findings and anamnesis led to the diagnosis of Lemierre syndrome inspite of lacking detection of bacteria. After changing the antibiotic therapy and start of anticoagulation further course of illness was favorable. The long duration of hospitalization was indepted to high morbidity typically seen in Lemierre syndrome.

Validity of empirical models of exposure in asphalt paving.

AIMS: To investigate the validity of empirical models of exposure to bitumen fume and benzo(a)pyrene, developed for a historical cohort study of asphalt paving in Western Europe. METHODS: Validity was evaluated using data from the USA, Italy, and Germany not used to develop the original models. Correlation between observed and predicted exposures was examined. Bias and precision were estimated. RESULTS: Models were imprecise. Furthermore, predicted bitumen fume exposures tended to be lower (-70%) than concentrations found during paving in the USA. This apparent bias might be attributed to differences between Western European and USA paving practices. Evaluation of the validity of the benzo(a)pyrene exposure model revealed a similar to expected effect of re-paving and a larger than expected effect of tar use. Overall, benzo(a)pyrene models underestimated exposures by 51%. CONCLUSIONS: Possible bias as a result of underestimation of the impact of coal tar on benzo(a)pyrene exposure levels must be explored in sensitivity analysis of the exposure-response relation. Validation of the models, albeit limited, increased our confidence in their applicability to exposure assessment in the historical cohort study of cancer risk among asphalt workers.

Human toxicokinetics of inhaled monochlorobenzene: latest experimental findings regarding re-evaluation of the biological tolerance value.

OBJECTIVE: The aim of this study was to obtain toxicokinetic data on the absorption and elimination of monochlorobenzene (MCB) in blood and its main metabolite 4-chlorocatechol (4-ClCat) as well as on the isomeric chlorophenols (o-ClPh, m-ClPh, and especially p-CIPh as the main ClPh metabolite) in urine for reevaluation of the biological tolerance (BAT) value of MCB. METHODS: Eight subjects performed 8-h inhalation tests daily over five successive days in an exposure chamber, at a maximum allowable concentration at the workplace (MAK) value of 10 ppm MCB. Five and two probands carried out the test series during physical activity levels of 75 and 50 W, respectively, for 10 min/h on a bicycle ergometer, and one subject was exposed continuously while at rest. MCB and its metabolites were analyzed by gas chromatography in combination with mass spectrometry. RESULTS: The mean MCB blood concentration of the five subjects exposed during physical activity of 75 W was 217 +/- 42 microg/l. The relationship of the mean blood concentration measured under the conditions of rest or 50 and 75 W activity levels was in a ratio of about 1:1.7:2.8. The half-life values in the first hour after ending the exposures were 53 min and 150 min for the ensuing period, with steady-state being reached after 45 min. The mean 4-ClCat concentration in urine at the end of the five days was 150 +/- 13 mg/g creatinine in the case of the subjects exposed at 75 W, which decreased to 25 mg/g creatinine at the beginning of the next exposure. The analogous p-ClPh concentrations were 25 +/- 2 and 9 +/- 2 mg/g creatinine. The elimination half-life values of the ClPh isomers ranged from 12.4 to 16.5 h, and the half-life of 4-ClCat was 6.4 h. There was no apparent tendency for MCB and its metabolites to accumulate in blood or urine. CONCLUSIONS: The results are in accordance with relevant field and laboratory studies. Taken into consideration with the 95th percentile, the evaluated BAT values should be set at levels of 300 microg MCB/l blood, 175 mg 4-ClCat/g creatinine or alternatively at 30 mg p-ClPh/g creatinine in urine after the end of a shift. At the beginning of the next shift, the BAT values of the metabolites should be 35 and 15 mg/g creatinine, respectively.

Biological monitoring of standardized exposure to ethylbenzene: evaluation of a biological tolerance (BAT) value.

The results of standardized 8 h lasting exposures of n = 18 volunteers to ethylbenzene (EthBz) at levels of 25 and 100% of the maximum allowable concentrations at the workplace (MAK) value of 100 ppm as well as the results of field studies are considered to evaluate a biological tolerance (BAT) value for EthBz. On the basis of the relationship between the external and internal exposure a BAT value of 1.5 mg/l has been set for the EthBz concentration in blood as the most sensitive and specific parameter of exposure to this aromatic hydrocarbon. The interpretation of EthBz blood values has to take into account the short half-life of t1/2 = 0.5 +/- 0.08 h in the first hour after the end of exposure in which this aromatic hydrocarbon is eliminated from the blood. The additional determination of the EthBz metabolites mandelic acid (MA) and phenylglyoxylic acid (PGA), respectively, excreted in post shift urine as well as in urine samples at the beginning of the next shift shows good correlations with the external exposure. The biological half-life of MA was calculated to t1/2 = 5.3 +/- 1.1 h. Because the time of sampling can vary the relationship between the levels of MA to PGA the total concentration of the excreted metabolites depends less on this influence and is therefore better suited for monitoring exposed persons. On the basis of the standardized experiments a BAT value has been proposed of 2 g MA plus PGA corrected per gram creatinine. Both BAT values are adjusted to data which result from earlier standardized exposures during 30 min to EthBz under physical activity of 50 watt on a bicycle ergometer.

Occupational exposure to dioxins by thermal oxygen cutting, welding, and soldering of metals.

This paper focuses on one aspect of occupational dioxin exposure that is novel and unexpected. Exposures in excess of the German threshold limit value of 50 pg international toxicity equivalent (I-TEQ)/m3 are very frequent, unpredictable, and sometimes very high--up to 6612 pg I-TEQ/m3--during thermal oxygen cutting at scrap metal and demolition sites. The same procedure involving virgin steel in steel trade and mass production of steel objects gave no such evidence, even though no final conclusions can be drawn because of the low number of samples analyzed. Low dioxin exposures during inert gas electric arc welding confirm previous literature findings, whereas soldering and thermal oxygen cutting in the presence of polyvinyl chloride give rise to concern. The consequences of occupational dioxin exposure were studied by analysis of the dioxin-blood concentration, the body burden, of men performing thermal oxygen cutting at scrap metal reclamation and demolition sites, in steel trade and producing plants as well as for industrial welders and white-collar workers. The results concerning body burdens are in excellent agreement with the dioxin exposure as characterized by dioxin air concentration in the workplace. The significant positive correlation between duration and frequency of performing thermal oxygen cutting at metal reclamation and demolition sites expressed in job-years and dioxin body burden speaks for the occupational origin of the observed overload after long times. The results reported here lead to consequences for occupational health, which are discussed and require immediate attention.

N-acetyl-S-(dichlorophenyl)cysteines as suitable biomarkers for the monitoring of occupational exposure to 1,2-dichlorobenzene.

A method has been developed for the simultaneous analysis of the isomeric N-acetyl-S-(dichlorophenyl)cysteines (also known as dichlorophenylmercapturic acids, DCPMAs) in urine. This procedure allows the determination of 2,3- and 3,4-DCPMAs at the concentrations expected in the urine samples of employees occupationally exposed to 1,2-dichlorobenzene (1,2-DCB). The results of a 1,2-DCB exposure study under standardized conditions show a first-order kinetic for the excretion of DCPMAs, as well as acceptable linear correlations between the urinary concentrations of DCPMAs and the amount of inhaled 1,2-DCB. It therefore seems it would be possible to derive a biological tolerance value for 1,2-DCB based on isomeric DCPMAs as analytical parameters.

Atmospheric concentrations of polycyclic aromatic hydrocarbons during chimney sweeping.

Air sampled from the breathing zone of chimney sweeps during "dirty work" and soot samples were analysed for polycyclic aromatic hydrocarbons (PAH). A total of 20 PAH were quantified by gas chromatography-mass spectrometry in 115 air samples and 18 soot samples. These included benzo(b)fluoranthene, benzo(a)pyrene (BaP), chrysene, dibenz(a,h)anthracene, and indeno (1,2,3-cd)pyrene, all of which are animal carcinogens. The summed atmospheric concentration of these compounds depended on the type of fuel used and averaged 2.27 micrograms/m3 for oil fuel. If a mixture of oil and solid fuel was used the concentration was 5.06 micrograms/m3; pure solid fuel heating yielded 5.08 micrograms/m3. The air concentrations of BaP were 0.36, 0.83, and 0.82 micrograms/m3 respectively. The soot samples recovered after using the three different fuel types were 10.50, 109.10, and 51.25 mg BaP/kg. The maximum total concentrations of the five carcinogenic PAH were 243.70, 691.06, and 213.94 mg/kg respectively. The time weighted, shift mean concentrations of 0.02 to 0.21 micrograms/m3 benzo(a)pyrene obtained on 11 days form the basis for the industrial medical estimation of risk.

Risk of cancer from the use of tar bitumen in road works.

Tar bitumens are increasingly being used as a binder in road works. They consist of a standard product of about 70% bitumen and 25-30% tar. Tar bitumens are classifiable as the pyrolysis products of organic materials and are applied hot. Depending on the temperature used there are emissions of various intensities of polycyclic aromatic hydrocarbons (PAH), some of which are carcinogenic. A total of 250 one hour air samples was taken at breathing height on 20 days at 11 road works sites. The region of road paving operations in the immediate neighbourhood of the finishing machine operator and the screedmen were the chosen sampling points. A total of 19 unsubstituted chromatography/mass spectrometry. These included benzo[b]fluoranthene, benzo[a]pyrene, chrysene, dibenzo[a,h]anthracene, and indeno[1,2,3-cd]pyrene, all of which are carcinogenic. The median concentrations of chrysene and of benzo[b,j + k] fluoranthenes (determined en masse) were 9.3 and 2.8 micrograms/m3 respectively. The median concentrations of benzo[a]pyrene (BaP) and indeno[1,2,3,-cd]pyrene were 0.7 and 0.2 micrograms/m3 respectively. Dibenzo[a,h]anthracene had the lowest median concentration with about 0.03 micrograms/m3. Of the resulting shift means, the BaP concentration was over 1 microgram/m3 in about 50% of the cases, over 2 micrograms/m3 in 35%, and over 5 micrograms/m3 in about 15%. Even when the temperature of the paving mix was only between 120 degrees and 135 degrees C. 4.8% of the concentrations (identical to 3 samples) were greater than 2 micrograms BaP/m3, this value was exceeded in 34.9% of the determinations (identical to 30 samples) when the temperature of the tar bitumen was between 135 degrees and 150 degrees C. The highest concentration measured here was 17.8 micrograms BaP/m3. The recommended maximum paving temperature of the paving mix of 150 degrees C was exceeded in about 23% of all cases. The maximum concentration determined under any condition was 22 microgram/m(3). Thus the employment of tar bitumen as a binding material during road paving operations must be regarded as causing a considerable risk to health. The primary task is to ascertain whether tar bitumen can be replaced as a binder in paving for roads and what safety measures are practicable.

Gaseous and adsorbed PAH in an iron foundry.

The increased risk of lung cancer among foundry workers is assumed to be associated with the inhalation of gaseous and particle bound polycyclic aromatic hydrocarbons (PAH). These compounds are produced during pyrolysis of carbon containing loading material in the moulding sand. The concentrations of 20 PAH, some of which are carcinogenic, have been determined in the dusty casting area of an iron foundry by means of gas chromatography and mass spectrometry. The total dust was fractionated by means of a precision cascade impactor. It was possible to differentiate the PAH load in microgram/mg dust in seven particle size fractions ranging from 0.36- greater than or equal to 24.95 microns. Initially, there was an increase of the adsorbed PAH mass concentration with increasing particle diameter up to a maximum of 1.1 microgram/mg in the dust of the 1.57 micron fraction. Thereafter there was a continuous decrease of PAH mass concentration with increasing particle size. When the differing weights of the seven fractions are taken into account, however, the total PAH load of the individual fractions increases steadily with increasing particle size. The inhalable fine dust, 31.4% of the total dust, contains 49.9% of the total adsorbed PAH. The gas phase contained on average three times more carcinogenic PAH with four and five rings than was adsorbed on the dust. Thus the percentage of the gaseous substances amounts to 77% of the total PAH load at the place of work in an iron foundry.