Document 8OzNZ2EE8ZgkEkdVZvKeMrvaK

R&S 027763 Prevalence of disease among vinyl chloride and polyvinyl chloride workers by Ituth bills, JJ.P,, Henry Anderson, M.D., William J. Nicholson, Ph.D. Susan baum, II.D',,, Alf S. Fischbein,'M.b. and Irving J, Selikoff, U.U. The emergence In January 197.4, of vinyl chloride as a new occupational carcinogen, producing hemangiosarcoma of the liver focused new end much enhanced Attention on the toxicologic effects of this chlorinated hydro carbon. * A considerable number of studies had been published on the rather puz zling and unique syndrome of "ccroos teolysis" (Table 1) mainly describ ing the bone lesions in the distal phalanges of the fingers, but also the associated scleroderma-like skin lesions and the striking vascular (arterial and arteriolar) changes, pathologically the main lesion, leading to secondary bone and skin changes (Tables 2 and 3). lluch less attention had been given to the hepatotoxlc effects of vinyl chloride, although convincing experimental evidence had been produced (Torkelson et al., 1981) and scattered reports of ill-defined'liver changes were included in some of the studies of vinyl chloride exposed workers (Table 4). - v,, There was evidence that liver damage occurred in workers exposed to higher levels of vinyl chloride, T__ea the liver changes (hepatomegaly, tenderness on palpation^afeffi ` tes ts) were - found to be roversibleafter cesaatioh dlK*^ shre'^dn" the other hand, - of the liver changes, ''chronic hepatitia". s'tudjrof.. ^ Vdetniied^^v ic exposure^ plant. ,, the liypr;; - &brottsulphalein^ irjnie' pathaloslc^^. changes encoepasggd "Collagenous traWforation ft *3ie liver sinusoidsivr focal activation of Kupffor cells, ihci^seS?coxlLiagen deposition in the portal spaces.portal,fibrosis, septal and intralobular fibrosis. There aro a few mentions in the literature on.lung changes in FVC workers. Ono case of pncumoncontosis in a thirty year old worker who had inhaled PVC dust was rejiorted. The lung biopsy showed granulomatous lesions (foreign hotly type) to be present. Fibvotic changes mid altered pul monary function tests were reported in 96 workers exposed to polyvinyl 000001 In Ihw available literature on vinyl chloride and polyvinyl chloride ad verse health effects thoro wore no accurate data on the prevalence ol disease in exposed workers* the relative prelnvence of the various patho logic changes* their possible association and time sequence. Vi'o have undertaken clinical studies of a number of groups of vinyl chlo ride exposed workers in order to assess the prevalence of vinyl chloride induced changes and to define the natural history of this occupational disease. \e ai'C reporting the results of n survey (March 1D74) of 267 workers currently employed in n VC polymerization plant, including vir tually the entire current production workfovea. 87-former workers were examined as v/ell. In both groups, exposure for some had started in 1045, when the plant opened. Altogether 354 wen woro examined. Table 5 shows the duration of exposure, for the group and Table 6 the age distribution of the men. More than half were under 40 years* 20% were 51 or older. METHODS The medical examination included detailed occupational history* past medi cal history* complete physical examination* with special attention to the skin* hands and feet, arteries accessible.to palpation, liver and spleen. An Allen test for the assessment of the peripheral circulation In the areas supplied by the radial and ulnar arteries was performed. Each examined worker also had the following: X-rays of the chest, hands and feet; pulmonary function tests; complete blood.cell counts' including platelets; blood chcnistrios including bilirubin*SGOT, SGPT, IDH, alkaline phosphatase, total protein^' electrophoresis of senio proteins, fibrinogen .jsplit products; alpha fetoprotein," antinuclear antibodies, tfjf.tfsd^jdth.. muscle antibodies sintigen B by radio! including Si - .^examined w ^a.....ntigen.; m . chrempsdet^Bfoa'. mmm nation of % .ptwwytes werp;b?f `BE: .,n.W?5.T- . MM# 3. , ' 'V*' ltefdrtim^feylyffaap^pprroopp:n' atV3yp^er0&u?'^npi^had not beeri,'iaade in the pastr^ 'We haye/findings.,,whicAvsi^gesti^hone\'er (Table 7), that Vc levels may have been considerable attLmes^ sufficient to produce symptoms of acute overexposure;. for example, 14 of tho 354 workers had had loss' of consciousness at one time or another. R&S 027764 In any case, our data indicate that measured levels would bo of limited utility, unless integrated over time, since both total exposure and duration from onset of exposure seem to be of Importance in relation to likelihood of abnormality. Tho influence of these variables nay be dcsi^sti&tcd in a.number of aroas.f:'.^^ ..