[Open fracture of the shin as an occupational injury and work capacity evaluation--case report].

Injuries at work (occupational injuries) represent a big social and economic problem. This case report presents the patient who suffered occupational injury--open fracture of the left shin. He has been hospitalized for several times at Orthopedic-Surgical Hospital "Banjica" and underwent several surgical procedures, physical therapy and Hyperbaric Oxygen Therapy. After this treatment, he was hospitalized at Institute of Occupational Health for disability evaluation and work capacity evaluation.

Granulocytes' enzymes as biomarkers of radiotoxicity in individuals occupationally exposed to low-level radiation.

PURPOSE: To investigate the possibility of using the granulocytes' enzymes alkaline phosphatase (L-ALP) and myeloperoxidase (MPO) as biomarkers to study and analyse contamination of nuclear medicine personnel working with radionuclides (RN) when radiotoxic effects are very low, before occupational radiation illness or benign haematological disorders and malignant diseases have occurred. Also, to investigate the relationship between chromosomal aberrations in lymphocytes and the activity of L-ALP and MPO in neutrophil granulocytes (NphG). MATERIALS AND METHODS: The absorbed external doses of ionizing radiation (IR) were measured by thermoluminescent personal dosimeters (TLD) for the duration of occupational exposure (DOE). Urine radioactivity was measured by gamma- spectrometry. Venous blood was used for leukocyte count and search for chromosomal aberrations by conventional cytogenetic techniques. Blood smears were stained for L-ALP and MPO using a modified Kaplow's method and the classical method with benzidine dihydrochloride, respectively. The occupationally exposed group (E) consisted of 74 workers exposed to short-life radioactive isotopes I131 (beta and mostly gamma emission) and mTc99 (gamma emission). The control group (C) consisted of 52 subjects living in the same region, working in the same institution, occupationally not exposed to RN. A patients' group (P; n=31) took I131 or mTc99 for diagnostic purposes. RESULTS: Although the measured values did not exceed the yearly quota for professionally exposed individuals, characteristic chromosomal aberrations in peripheral blood lymphocytes (dicentrics, fragments, rings) were identified. L-ALP and MPO activity was inhibited in the NphG in occupationally exposed workers, especially in persons with chromosomal aberrations, working for a long time in ionizing radiations zones (p <0.01). CONCLUSION: Decreased activity of L-ALP and MPO can reveal effects of long-lasting exposure to low-dose IR. A significant relationship between chromosomal aberrations in lymphocytes and activity of the enzymes in granulocytes was found.

Chromosomal aberrations after exposure to low doses of ionizing radiation.

PURPOSE: To compare the incidence of chromosomal aberrations (CA) in healthy medical workers occupationally exposed to ionizing radiation (IR) and in non-exposed healthy population. METHODS: This was a 4-year study with 462 subjects, mean age 42.3 years, occupationally exposed to IR (exposed group - E), and 95 subjects, mean age 35.2 years, not exposed to IR (control group - C), during the same time period and from the same territory. Thermoluminescence dosimeters (TLD) were used for assessment of IR exposure. Modified Moorhead's micro method for peripheral blood lymphocytes and conventional cytogenetic technique of CA was used for analysis of CA. The karyotype of 200 lymphocytes in metaphase was analysed by immersion light microscope. RESULTS: The average annual absorbed dose measured by TLD was 14.5 mSv in group E and 2.8 mSv in group C exposed to natural level of radioactivity. The incidence of CA was 21.6% in group E and 2.1% in group C (p <0.05), while non-specific chromosomal lesions (gaps, breaks, elongations) were equal in both groups (22%). In group E, the highest incidence was found in nuclear medicine workers (42.6%), then in orthopedic surgeons (27.08%). Highly significant difference (p <0.001) was found in the number of aberrant cells and the sum of CA between group E and C. The sum of CA and the number of aberrant cells were positively correlated with the duration of exposure (p < 0.001), and to a lesser degree with age (p < 0.05) in group E. In group C, this correlation was negative and insignificant. In group E, subjects with duration of occupational exposure (DOE) up to 15 years (subgroup E I=327) had significantly less number of aberrant cells and CA in comparison with the subjects with DOE over 15 years (subgroup E II=135) (p < 0.01). CONCLUSION: Long-term occupational exposure to low doses IR contributes to the development and increased frequency of specific CA (like dicentrics), but varies in relation to different working places. The majority of subjects had no other genetic modifications (non-specific chromosomal lesions) affected by low doses of IR.

The incidence of malignant neoplasms in individuals working in areas of ionizing radiation in hospitals.

PURPOSE: To assess the radiation risk of carcinogenesis in individuals professionally exposed to low-level ionizing radiation in a longitudinal cohort study. MATERIALS AND METHODS: Analysed were the incidence and mortality induced by malignant neoplasms in a cohort of 1,560 occupationally exposed individuals (OEI) working in areas of ionizing radiation during 1992-2002 (study group). Assessment of exposure to radiation was recorded by personal thermoluminescent dosimeters (TLD), regular periodic health checkups, and bio-dosimetric data (chromosomal aberrations). Incidence and mortality were calculated using conventional epidemiological methods. The same methodology was applied in 5,480,408 individuals from the general population of central Serbia (PCS), not professionally exposed to ionizing radiation (control group). RESULTS: The annual incidence rate of malignancies was 163 for males and 282 for females, per 100,000 OEI and mortality 44 for males and 11 for females. For general PCS the annual incidence rate of malignancies was 374 for males and 347 for females per 100,000, while mortality was 267 for males and 191 for females. Solid malignant neoplasms prevailed in OEI. The frequency of chromosomal aberrations in the group of OEI with malignant neoplasms was 0.33%, compared with 0.20-0.50% of the general population. The incidence of pharyngeal carcinomas in the group of occupationally exposed males was 5-fold higher than in males of the general PCS. In females of OEI the risk of malignant neoplasms such as uterus, ovary, bone marrow, lymphomas, thyroid, larynx and breast was increased compared with the general PCS. CONCLUSION: The incidence rate of malignancies in the group of OEI to low-level ionizing radiation was not significantly different from the incidence rates of malignant diseases in the general PCS. The same applied for mortality. Differences were observed between the OEI and the general PCS in the localization of malignant neoplasms and sex.