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hich lasted three to four i irritated by the dust or by cid solution of vanadium :ous lesions have occurred, there was an allergic re,ts with sodium vanadate.5 set at a level to prevent ritation.2 and symptoms include eye igue, metallic taste; throat me rales, wheezing, bron:ema. gnosis: Differentiate an ck due to vanadium pentauses of asthma and from uction by tumor or larynronchial disease, acute left \ and eosinophilic pneu- ignostic studies should inagram, sputum gram stain irential white blood cell blood gas analysis. Vana- may be evidence of abtion of this element, since lormally found in human anchospasm occurs, refer ommended therapy. Preplacement and periodic on with emphasis on the 4" x 17" chest roentgenoV(1 sec.). eferences lett, J. P., and Thiede, inadium pentoxide intoxiEnviron. Health, 5:542, nadium V. Documentation Substances in Workroom '5-276. Cincinnati, 1976. Follow-up investigation of adium factory. Acta Med. . 1956. Berg, B. A.; Human reoiled vanadium pentoxide . Environ. Health, 14:709, Vinyl Chloride 505 Supplemental 5. Sjoberg, S. G.: Health hazards in the pro duction and handling of vanadium pent oxide. Arch. Ind. Health,5:631, 1951. 6. Hudson, T. G. F.: Vanadium, Toxicology and Biological Significance, pp. 72-77, 100-119, 124-135. New York: Elsevier Publishing Company, 1964. 7. Hygienic Guide Series: Vanadium pent oxide. Am. Ind. Hyg. Assoc. Quart., 18: 172, 1957. sions in the distal phalanges of the hands, in the styloid processes of the ulna and radius, and in the sacroiliac joints.4 Of 20 autoclave cleaners with exposure to vinyl chloride, 16 had thrombocytopenia, seven had spleno megaly, six had hepatomegaly, 14 had fibro sis of the liver capsule, and four had signs of acroosteolysis.5 In four facilities engaged in the polymeriza tion of vinyl chloride for at least 15 years, a study of workers exposed for at least five years revealed a significant number of excess deaths due to malignant neoplasms (35 deaths VINYL CHLORIDE observed, 23.5 expected).6 The excesses were found for four organ systems: CNS H2C=CCIH OSHA Std. I ppm (three observed, 0.9 expected), respiratory system (12 observed, 7.7 expected), hepatic Synonyms: Chlorethene; chlorethylene; system (seven observed, 0.6 expected), and ethylene monochloride; monochloroethene; lymphatic and hematopoietic systems (four monochloroethylene observed, 2.5 expected).6 Physical Form: A colorless gas, but usually Over 30 cases of angiosarcoma of the liver handled as a liquid underpressure have been reported among vinyl chloride Uses: Production of vinyl chloride resins; polymerization workers in the United States production of methyl chloroform; component and nine other nations.7- Because this tumor of propellant mixtures is extremely rare, the occurrence of these Exposure: Inhalation cases under similar occupational conditions Toxicology: Vinyl chloride exposure has strongly suggests a causal relationship to some been associated with an increased incidence phase of vinyl chloride production. Clinical of malignant tumors, acroosteolysis, Ray features of seven patients with the carcinoma naud's syndrome, scleroderma, thrombocy varied from no signs or symptoms to weak topenia, circulatory disturbances, and im paired liverfuoction; very highconcentrations cause central nervous system depression. Humans exposed to 20,000 ppm for five minutes experienced dizziness, light-headed ness, pleuritic pain, abdominal pain, weight loss, gastrointestinal bleeding, and hepato- splenomegaly; liver function abnormalities were present in all subjects but without a con sistent pattern. In addition to the malignant ness, nausea and dulling ofvision and auditory cues.1 No clinical changes nor abnormal neurologic responses were found in 13 volun teers exposed 7.5 hours to 500 ppm, although exposure to TWA levels of 300 ppm for a working lifetime caused impairment in liver function tests, but there was no overt clinical tumors, four cases of nonmalignant hepatic disease characterized by portal fibrosis and portal hypertension have been attributed to vinyl chloride exposure. In animal experiments vinyl chloride has been shown to be oncogenic: zymbal gland carcinomas, nephroblastomas, and angiosar disease.2 comas were the prevailing tumors in rats; re Twenty-five cases of acroosteolysis (degen eration of terminal phalanges) have been re ported in vinyl chloride workers; Raynaud's phenomenon was the first manifestation noted by a majority of subjects, suggesting that the vascular lesion antecedes the bone changes in most cases.3,4 Radiologic findings in pa tients with acroosteolysis included lytic le sults ranged from a 16 per cent tumor inci dence at an exposure level of 250 ppm to a 39 per cent incidence at 10.000 ppm; in mice, liv er angiosarcomas, pulmonary adenomas, and mammary carcinomas were observed after exposures ranging from 50 to 10.000 ppm. The development of some tumors was dependent on duration of than on concentration of vinyl c o 506 The Chemical Hazards A When vinyl chloride was used as an anes thetic agent in dogs, muscular incoordination, sensitization of the myocardium, and serious cardiac arrhythmias were observed.11 Mice exposed to 80,000 to 120,000 ppm were anes thetized, while 250,000 to 300,000 ppm was lethal in ten minutes. Guinea pigs were killed in a short time at 200,000 to 400,000 ppm; pulmonary edema and hyperemia of the liver and kidneys were observed. Contact of the skin or eyes with the liquefied gas can produce freezing and frost bite.12 Diagnosis: Signs and symptoms include weakness, pleuritic pain, abdominal pain, anorexia, weight loss, gastrointestinal bleed ing; hepatomegaly, splenomegaly; Raynaud's syndrome, lesions in the distal phalanges of the hands; central nervous system depres sion. Differential Diagnosis: Differentiate from the following other causes of liver dysfunc tion: intrahepatic, such as viral hepatitis, liver abscess, or alcoholic liver disease; extrahepatic obstruction, such as pancreatic tumors, gallstones, and carcinoma of the bile duct; increased bilirubin load from red cell defects or hemolytic anemia. Angiosarcoma of the liver is seldom recog nized until fairly late in its course, within months of death. Precursor physiologic alter ations, which might be reversible, have not been identified. Special Tests: Liver function tests and liver biopsy should be performed. Medical Control: The following medical procedures must be made available to each employee who is exposed to vinyl chloride in excess of the action level without regard to the use of respirators: A complete history and physical examination including examina tion of the liver, spleen, kidneys, skin, con nective tissues, and the pulmonary system.9 The medical history shall include the follow ing topics: alcohol intake, history of hepatitis, history of blood transfusions, history of hos pitalizations. work history, and past exposure to potential hepatotoxic agents, including drugs and chemicals. Liver function tests -- a serum specimen shall be obtained and deter minations made of: total bilirubin; alkaline phosphatase; serum glutamic oxalacetic trans aminase (SGOT); serum glutamic pyruvic transaminase (SGPT); and gamma glutamyl transpeptidase. The above medical examin ations are to be repeated every six months for each employee who has been employed in vinyl chloride or polyvinyl chloride manufac turing for ten years or longer and annually for all other employees. When tests in this sec tion show abnormalities, the tests should be repeated as soon as practicable, preferably within three to four weeks. If tests remain abnormal, consideration should be given to withdrawal of the employee from contact with vinyl chloride, while a more compre hensive examination is made. The following additional tests may be useful: urinalysis-- a determination of urine albumin and a test for the presence of blood or exfoliated abnor-; mal cells in the urine; FVC and FEV (1 sec.); 14" x 17' chest roentgenogram; additional serum tests: lactic acid dehydrogenase, lac tic acid dehydrogenase isoenzyme, protein determination, and protein electrophoresis; hepatitis B antigen, and liver scanning for a more comprehensive examination on re peated abnormal serum tests. Reference Principal 1. Lester, D., Greenberg, L. A., and Adams, W. R.: Effects of single and re peated exposures of humans and rats to vinyl chloride. Am. Ind. Hyg. Assoc. J., 24:265, 1963. 2. Kramer, C. G., and Mutchler, J. E.: The correlation of clinical and environmental measurements for workers exposed to vinyl chloride. Am. Ind. Hyg. Assoc. J., 33:19, 1972. 3. Dinman, B. D. et al.: Occupational acroosteolysis. I. An epidemiological study. Arch. Environ. Health,22:61, 1971. 4. Dodson. V. N. et al.: Occupational acroosteolysis. III. A clinical study. Arch. Environ. Health,22:83, 1971. 5. Marstellar, H. J. et al.: Chronischtoxische Leberschaden bei Arbeitem in der PVC Produktion. Dtsch. Med. Wschr..95:2311, 1973. 6. Waxweiler, R. J. et al.: Neoplastic risk among workers exposed to vinyl chloride. Ann. N.Y. Acad. Sci..27/:40, 1976.