Document 108JY0wkyqZN0GwrED0a3vzno

7.2*7 T RAN SLATION %r JM3 m' H >A -- SCIHRODERMA-LIKE SKIN CHANCES, RAYNAUD'S SYNDROME, AND ACRO-OSTEOLYSES IN WORKERS IN THE JVC MANUFACTURING INDUSTRY .J by^Jtlfie S. and^Longe C.-E. University Dermatological Hospital, Bonn (Director; Prcf. Dr. A. Leinbrock) |_Dtsch. med. Wschr. 97 : 1922-1923, December 8, 197zT| Jf'urScftf ft'lps&'d- /s.As X'p c4&4*rA Since 1963 there have been reports from abroad of a syndrome which occurs in people vo.rW.na on autoclaves in the polymerization of vinyl chloride ./ [1-3, 8, 91. Until the spring of this year no observations from Germany have been available. Then, in March 1972, ve made a similar diagnosis in two auto clave workers employed in a factory manufacturing PVC [4], In our present total of 7 patients the first symptoms appeared 1 to 3^/g years after starting work as an autoclave worker. The complaints were an increased sensitivity to cold, formication, numbness and pallor of the fingers, tenderness in individual fingertips, and thickening and feeling of tension in the hands. These vere followed later by distension of endphalanxes and changes in the nails. In addition, there was one complaint of reduction in vision, one of pain in the epigastrium and one of giddiness. During the clinical examination Raynaud's syndrome was found in varying stages of advancement in 5 patients (the only symptom in two patients), and also in 3 patients individual end-phalanxes were thickened vith simultaneous shortening and deformation of the nail plates, the latter for the most part assuming a vatchglass shape. Further characteristics (observed in 5 patients) were swollen fingers, and nodular infiltrations on the extensor surfaces of the fingers, the back of hands, and distally of the olecranon (Fig. 1), In 4 patients there were ivory-colored infiltrations, vith a trabecular structure, in the distal third of the flexor sides of the forearm. 3 pr.tients showed rather puffy, aasklike f!ATia::.u c:::..: TJib transition Is bz'rz f -I C rr prir ;j use and re::rrcli c~':j. \l Mt f'fl sold or publish In cny C, I w..auut trie permission cf t*:n r " \ Hgy 0008701 2 features accompanied by flat indurations in the upper cheek area. Pone alterations were found in 5 of the 7 patients: band-like osteolyses of the end-phalanxes in the transition of the processus unguicularis to the diaphysis as well as shortening and/or thickening of the end-phalanxes of the fingers in question. The 1st, 2nd, and 3rd fingers of both hands were the ones mainly affected by the change, and the clinical and X-ray changes correlate '?i^. 2)f Clinical internal examinations and the clinical and chemical results compiled Indicated disturbances of the liver function in two patients and an obstructive ventilation disturbance in one. These still require further clarification. Arteriography was carried out on both arms of two patients. In one of them this revealed a blockage of the Interosseous artery to the left above the wrist Joint and strikingly thin calibers of the radial end ulnar arteries (Findings: Prof. Schlttssel, Municipal Hospital, Siegburg). Qualitative analyses of IgG, IgA, IgM and complement fraction as well as tests for antinuclear factors, L.E. cells, and rheumatoid factors on four patients did not Indicate any auto-aggression disorder. The histological findings on skin samples In 3 patients corresponded to the early Inflammatory stage of a progressive scleroderma. The clinical symptoms of the disease also resemble the early stages of progressive scleroderma. However, there are the following distinguishing factors [5.61:3) relatively frequent appearance of the syndrome as compared with scleroderma, 2) restriction of the syndrome to men; 3) absence of important early symptoms such as shortening of the frenulum of the tongue and esophagus sclerosis; U) thickening and shortening of the end-phalanxes (fingers become atrophied and more conical with progressive sclerodermr); 5) almost regular occurrence of acro-ostc-olyses, which is rare In progressive scleroderma [7,10], * For Figs, 1 and 2 see the plate on p*2a RSV 0008702 - m u m H i-" .. ij f tu 2a Fig. 1 - lhickeuing c. the end-phalanges, similar to drumstick finger. In all 5 fingers of the right hand and in the 1st and 3rd of the left hand; shortening of tlie nail plates vhlch have also assumed a vatchglaas shape. Diffuse swelling in hoth hands and plate like Infiltrations on the hacks of hoth hands r <l Fig. 2 - X-ray of hoth hands (patient of Fig. 1); hand-like osteolyses of the end-phlanges of all 5 fingers of the right hand and of the 1st and 3rd of the left hand In the transition of the processus ungulculsris to the dlaphysls. RSV 0008703 - . ranrv-.^ <1 3 The decisive characteristics remain, however, the link with the patient's occupation, present in every case, and the rather mild prognosis, which manifests itself in a clear involutional tendency of the skin changes, and to a smaller extent of the bone changes (observation of progress over 10 years). The pathogenesis of the disease picture has not yet been clarified. Received October U, 1972. References i 1. ChatelainA., P. Motilloo, Occupational acro-osteolysis syndrome newly found in France. J.Radiol.Electrol. U6 (1967) 277. 2. Cordier J.M., C. Flevez, M.J. Lef^vre, A. Sevrln, Acro-osteolysis and associated skin lesions in two workers engaged on cleaning autoclaves, Cah.Med.Travail k (1966)* si. 3. Karris D.K,, V.G.F. Adams, Acro-osteolysis occurring In men engaged in the polymerization of vinyl chloride. Brit.med.J.1967/3, 712. U. jUhe 3., G, Veltman, Symptoms of the so-called vinyl chloride disease picture. International Symposium of Factory Doctors in the Chemical Industry, April 27* 1972. 5. Kortlng G.V., H. Holtmana, Lines of development in present-day research into scleroderma, Ergebn. inn. Med.Kinderheilk 2k (1966) 1. 6. Korting O.V., H, Holtmann, Die Sklerodermie und ihr naheatehende Blndegevebsprobleme [Scleroderma and the related tissue problems) Hiieme, Stuttgart 1967. 7. Stein G., S. JUhe, C.-E. Lange, 0. Veltman, Band-shaped osteolyses t in the end-phalanxes of the hand skeleton, Fortschr. RBntgenstr., In press. 8. Suciu I., I. Drejman, M. Valaskai , Contribution to the study of workers producing vinyl chloride, Med. interna (Bue.), 15 (1963) 9*7. 9. Wilson R.H., W.E. McCormick, C.F. Tatum, J.L, Creech, Occupational acro-osteolysis. J.Amer.mad.Asa. 201 (1967) 577. 10. Yune H.Y., V.A, Yix, E.C. Klatte, Early fingertip changes in scleroderma. J.Amer,med,Asa. 215 (1971), 1113. fj{. j..---, C.-i. Si ..... ; ft$v 0008704 1440 1 BAJC8. AZERBAIDZHANSKII NAUCHNO-ISSLEDOVATELS' KII IK6TITUT GIQIENT , TRUDA I PROFESSIONAL1NYKH ZABOLEVANII. TRUDY. 1973, ,Nak''8*Cl05 - 109 <.------- ------------- y\ ^ -- --------- fsPECIFlC FEMALE ORGANISM FUNCTTofe IN WOMEN ENGAGED JDUCTION^ j \ v V, G.^Matysyak and V* K., Yaroslavskii P. 103 r < i The widespread introduction of automation and mechanization into production processes and improvement in the technology have made it possible for women to take part in nearly all of the ramifications of the national economy. Consequently, an important problem is a study of the effect of production conditions on the female organism as a whole and on Its specific functions, in particular. The involvement of women in production processes confronts the hygienists and gynecologists with the.important problems of studying the working conditions of the women, a study of ths specifie functions of the female organism, and alro the development of health measures. Recent studies have shown that many factors in the production area affect the functions of the female organism. This refers prlmag^ly to the menstrual and genital functions and gynecological ailments (S. V. Levcbuk, 1966; 0. I. Barsukova, 1967! V, G. Matysyak, 1967! V. K. Yaroslavskii, 1970). In connection with the expanded production of plasties the working conditions and the health of the workers In this branch of the chemical Industry are constantly becoming more frequent objects of study by hygienists, clinicians, and occupational pathologists. RSV 0008705 z 105 106 However, only bob* of the problas in the Indicated field heve baan discussed fully. This 1b especially true as regards the effeet of m the female organism. Polyvinyl chloride Is a basic component in the production of plastics. It is the polymerisation product of vinyl chloride. Valuable plasties, which find broad use in various branches of the national economy, are formed by the copolyaerlzatlon of vinyl chloride i with other compounds, and also by chemical modification. The process for the production of plastics consists of preparing / the raw material, mixing the components, milling, separation, heat treatment, and molding. Since polyvinyl chloride is subjected to heat treatment, the entrance of its decomposition products into the air can be expected. However, more frequently vinyl chloride la either absent or else .it is present only in small amounts. Consequently, polyvinyl chloride dust must be regarded aa being the main unfavorable factor that le common for the entire production CYu. I. Vertkin, 1970). As was shown by N. I. Karpova (1967), polyvinyl chloride dust is always present in the air of the working area, and at times it exceeds tbs permissible limits. Some communications exist on the effeet of polyvinyl ehlorlde on the human organism. Thus, the data of V. G, Artamonova and coworkers (1967) testify to the fact that about half of the examined vorkere, who ease in contact with polyvinyl chlorida, complained most frsquently of beadachee, indisposition, alssp disturbance, disagreeable eeneetlone around the heart, end at tinea loss of Bs?ry. In the objective studv the attention was ettraeted to the RS V 0008706 3 P 106 symptoms ef the disturbances of the central nervous syetea with the phenomena of vegetative disfunction. The fact that tha workers (97^ of which vara woman) had tha eaaa type of complaints, combir-i with tha objective symptoms, made It possible to conclude that the disclosed pathology Is related to the unfavorable effeot of occupational factors* If some information exists on tha effect of polyvinyl chlc~lde on the human organism, then we ware unable to find any data in the literature available to us on the effect of this compound on the specific functions of ths female organism* We made a study of the menstrual and genital functions and of the gynecological ailments of 130 female workers in a chemical plant who had contact with polyvinyl chloride* The control group represented 100 faaala workers who were not exposed to this substance* Tha method of study consisted In studying the general, occupational and obstetrle anamnesis, bimanual examination, and also In taking smears from the posterolateral fornix in order to ascertain the eytologieal picture of the vaginal region. The obtained anamnestle and objective data were recorded in special questionnaires that had been develo;- d by the Department of Obstretlce and Gynecology of the lGMI. aa The age contingent of the female workers wa^Tolloes; the largest group or 54 persona were 40-45 years old, 37 of the women ranged in age from 51 to 4o years, 19 were *ge 45-50 years, 16 persons had n age of 20 to 30 years, and four female workers were over 50 years old* Of these test persons, 78 women worked ss operators, 28 women operated the mills, and 24 persons were engaged RSV 0008707 . 107 In other operations* The work experience was aa follows* 36 of tha woman had up to 5 years of experience, 38 had a work axparlanea of 5 to 10 yee.-a, and 36 of tha taat parsons had a work axparlanea graatar than 10 years* As a result, tha studied contingent consisted mainly of workers ranging in age from 30 to 45 years and with a work axparlanea graatar than 10 years* The effeet of Industrial faetors on the menstrual function of female workers is confirmed by numerous studies* Thus, It was established by Kh* E. Mur&alleva and 0* A. Shereaet (I960) for woman workers in the lead industry that tha changes Incurred in tha menstrual eycla are on the type of hypermenorrhea, oligomenorrhea and metrorrhagia* It was observed by N. S, Tolehlnskli (1967) for women workers in the same Industry that in 12# of the cases tha women experienced the same disturbances of the menstrual function. A* P. Belyaeva (1966) detected various disturbances of the menstrual cycle for women working in the antimony industry in 47*5% of the cases* Of all of the types of disturbances, aenorrhagy and tha hypoaanstrual syndrome occupied a prominent position* A study of tha menstrual function for tha woman workers examined by us, who had bean exposed to polyvinyl chloride, disclosed that hypomenorrhea was incurred by 15*2#, and hypermenorrhea by 22*1# of tha woman. Oligomenorrhea was detected by us for 42 of tha workers (32*1#), and polymenorrhea for 7 women (5*3#). In the control group these indices were somewhat lower, but the atatlstleal differencee were insignificant (P>0.05>* It is important to mention ft$V 00GS708 ) 5 P. 107 P. 108 that irregular periods were encountered for 9*1% of the voaen in the main group* whereas in the control group acyclic senses occurred for 1* of the test persons (P ^0*05), In addition* the attention is attracted to the fact that while working in the given Industry the periods became copious for 2,5% of the workers* end painful for The following data were obtained for the genital function of the test woaen. In the sain group the number of women who had been pregnant was 522, and 26.3# of these pregnancies had ended in noraal births* Premature births were observed In 0,5% of the cases, while 5*5% of the women had spontaneous abortions. As a result, based on the results of our studies, the failure to carry to tera was 3*&# Based on the data of various authors, the frequency of the premature spontaneous termination of pregnancy (abortions and premature births) varies from 10 to 15% (I. A. Petrova, cited from S. M. Bekker (1964)). The results obtained by us are considerably lower than the data given by other authors. In the control group the premature termination of pregnancy occurred for 50# of the women (1. smaller than in the main group of workers by 1.5#), which Indicates that the given plasties industry falls to exert a harmful effect on the ability to carry to term. A large percent of the artificial abortions must be explained by the age of the examined group of workers, where the predominant group ranged in age from 55 to 45 years. An important criterion of the genital function Is the number of pregnancies and births incurred per woman worker. In the sain group the nuaber was 39 pregnancies and 1.5 births per worker. RSV 0008709 6 P. 108 and respectively 3*7 and 1*7 in the control group. According to the studies of E. I* Kachatova (19&3)t in tho viscose industry the number was 3 - * pregnancies and 1.6 births per worker, i. e. the results of our study are in agreement with the previously obtained data. The data of the gynecological examination disclosed that in the main group ailments of the sex organs occurred in *+4% of the eases. Inflammatory ailments of the genitalia were encountered moat frequently (16.7%). Polyps and erosion of the neck of the womb were detected for 13**+% of the women. In the control group of test psrsons thsas indices ware respectively equal to 23% and 17% (P > 0.03)* Prolapse of the sex organs and benign tumors of the uterus were observed to equal degree (8.3% and 6%) in both groups. is indicated by the greater frequency of acycllo menses in the main group of teat persons. A further study of the specific functions of women who ooae in eontact with various kinds of polymers while working, as well ea experimentally ascertaining the effect of the latter on the generative function, will make it possible to expand our concepts regarding the effect of polymers on the female organism. As a result, a study was made of the spsolfie functions of the female organism for 230 women engaged in the production of polymers. A certain dlaturb&nee of the menstrual function was observed, which RSV 0008710 7 P. 109 was manifested as Irregular monthly periods (for 9* of tha women). Vo failed to deteot any apaelal changes in tha ganital function or an ineraaaa in tha gynecological ailments for women workers expos** to polyvinyl chloride. w LITERATURE CITED /l/ Artamonova, V. G. , in tha bookt Problems in tha Sanitary Protaction of tha Atmosphere, Labor Hygiene, and Prophylaxis of Infaetloua Diaaaaaa /in Rubaion/, Leningrad (1967)* p. 12* /2/ Barsukova, 0* I., Tranaactlona of Second Convention of Obstetricians and Gynecologists of the Russian Soviet Federative Socialist Republic, Moscow, 1967, p. 5 /in Russian/. /3/ Bakkar* S. M., Pathology of Pregnancy /in Russian/, Leningrad (1964), p. 62. /4/ Belyaeva*.A. P.* Glgiana Truda 1 Prof. Zabol. 1967* No. 1, 32. /5/ Vartkin, Tu. I., and Maaontov, P. V*, Glgiana Truda 1 Prof. Zabol. 1970. No. 10, 6. /6/ Karpova, N. I., in tha books Problems in the Sanitary Proteetion of the Atmosphere, Labor Hygiene, and Prophylaxis of -Infectious Diseases /in Russian/, Leningrad (196?), p. 4o. /?/ Levchuk, S. V., Author's Abstract of Candidatal Disaertlon /in Russian/, Omsk (1966). // Mstysyak, V. G,, Transactions of Second Convention of Obstetrlolsns end Gynecologista of the Russian Soviet Federative Socialist Republic, Moscow, 1967, p. 46 /in Russian/. RSV 0008711 ft 109 /9/ Murzelieva, Kh. E., and Shereaet, 0. A., Abstract* of Papers Delivered at 31st Scientific Conference of the Kazakh Medical Institute, I960, p. 63 /la Russian/. /10/ Tolchinakaya, N. S. , Author's Abstract of Candldatal Dissertation /in Russian/, A line-A Ta (1967)* /ll/ Yaroslavskii, V* K*, in the monographs Problems in the Diagnosis, Special Prophylaxis, and Therapy of Occupational Diseases /In Russian/, Leningrad Scientific Research Institute of Labor Hygiene and Occupational Diseases, Leningrad (1970), pp. 33*64. '-1 RSV 0008712 I