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ACRO-OSTEOLYSIS IN PVC WORKERS cncc. It is believed by Wilson ct al. that the condition is the result of three factors all of which must he present for occurence: (1) a chemical insult, (2) a physical insult, (3) a personal idiosyncrasy. The chemical insult could occur from one or more of the monomers, catalysts and/or intermediate reaction products existing in polvmerizers. A low decree of exposure to these could occur from con tact with the solid, slightly moist, residue in the polymerizcr or to small quantities of vapor, absorbed either pcrcutancously or by inhalation. The physical insult is present in all "polycleaners" to some degree through the prolonged hand scraping operations as well as the occasional use of hammers to remove the residues. Personal idiosyncrasy appears to be an important factor because of the low incidence of occurence of the disorder and because of the fact that although all polycleaners are subjected to essentially similar chemical and physical insults, relatively few of them develop the disorder. A point of general interest is the possible relationship of this condition to collagen disease. One patient of Harris and Adams (1967) two eases, had in fact, been diagnosed as a case of sclero derma on clinical grounds 10 vears previously. Cordieret al. (1966)1 mentions an unusual skin condition seen in their cases. Several of the cases of Wilson ct al. (1967)3 also had external skin lesions on the dorsal surfaces of the hands and forearms. Finally Suciu ct al. (1963)4 in a paper describing conditions produced by vinyl chloride also referred to a skin lesion resembling scleroderma, but aeroosteolysis was not mentioned. Epidemiological Study Late in 1966 after the first information about occupational aeroosteolysis became available, the Manufacturing Chemists' Associa tion arranged with the University of Michigan to carry out a large epidemiological study both for the MCA and for the industry. This study was carried out in the vinyl chloride industry and included questionnaires, x-ray examinations of the hands, job history and industrial hygiene studies. There were 5011 employees in 32 plants of 19 corporations in the United States and Canada in the survey. Controls totalling 2407 were drawn from the Tccumsch, Michigan, epidemiologic study. Of the 5011 workers, 1302 were found to have an x-ray abnormality of the hands. Most were found to be unrelated to aero-osteolysis. The roentgen findings were correlated with the 51 SPI -13003 THE MEDICAL BULLETIN history of Raynaud's phenomenon. anil diagnostic categories estab lished. Raynaud's phenomenon and characteristic x-ray changes establish the diagnosis of acro-ostcolvsis. An additional category involves severe roentgen changes of several fingers and is believed to represent the end stages of the disease. The investigators established a total of 25 cases with an addi tional 16 "possibles" in whom x-ray changes were seen but Raynaud's phenomenon was not. The ratio of patients with clinical disease to those exposed to the chemical hazard was 1:31. Esso Pappas PVC Operation Esso Pappas has operated a PVC plant since early 1967, with a work force of about 35 persons. Our PVC plant consists of 8 reactors and was originally designed to produce 12,000 metric tons/year. It is a batch operation and the vinyl chloride monomer used in the process is received through pipeline from the supplier. During the past 18 months after continuing experiments in improving PVC processing, a capacity of 20,000 mr/year was reached. Figure 1 is a view of the reactor room. The reactors are installed in two rows. The greater part of the 5.5 meter long reactor lies below the floor as you can see in Figure 2. Figure 3 gives you an idea of the shape and the dimensions of each reactor. After the process is completed the product is.transferred from the bottom of the reactor to the finishing section where it is dried, screened and then fed into a bin for subsequent bagging. Figure 4 shows a close up view of the reactor. Although the materials of industrial hygiene concern in PVC production include vinyl chloride, methanol, catalyst, bisphend A, carbon monoxide and PVC dust, vinyl chloride monomer seems to be the most important. Since the polymerization operations are carried out in closed process, this provides little opportunity for employee exposure. The first industrial hygiene survey done by ER and E group on Dec. 1967 demonstrated that during normal operations the level of vinyl chloride throughout the plant is relatively low. 57 SPI - 13004 ACROOST CO LYSIS IN PVC WORKERS SPI -13005 THE MEDICAL BULLETIN FIGURE 3 54 SPI -13006 ACHO OSTEOLYSIS IN HVC WORKERS / There were stages in the production process, however, which resulted in brief exposure to high concentrations, for example: (.0 During the addition of water to the reactors the air displaced from the reactor contained as much as 10,000 ppm of vinyl chloride. This was due to a leakage at the manual control valve on the vinvl chloride monomer feed line and was corrected, (b) Vinyl chloride monomer was released to the workroom when the reactor was opened to obtain a sample of the I*VC following completion of the reaction, (c) Folvmcr removed from the reactors following cleaning was originally placed in open waste drums. The concentration of V.C.M. in these drums was as high as 600 ppm. This was a source of airborne contamination and was eliminated by covering the drums and emptying them at the end of each shift. . Following transfer of the product from a reactor to the finishing section the reactor is washed out with water and following this an air mover is attached by flexible duct to the reactor discharge outlet and operated until the concentration of V.C.M. inside the reactor is 50 ppm or less. This determination is made by using colorimetric .**-- V _______a> ~ri i ^ - l? W\ V A ' FIGURE 4 - TOP OK PVC REACTOR - ENTRY HATCH OPEN 55 SPI -13007 THE MEDICAL OIJLLETIN detector tubes. Entry of the technicians for cleaning is not per mitted until this level is reached. Reactor clean-out men arc supposed to wear coveralls (plastic-coated or neoprene), work gloves and hard hats during this procedure. Following the ER and E hygiene inspection the recommendation was made that neoprene gloves should he used by the polyclcancrs because through experiments it was found that this type of gloves 'was less permeable to V.C.M. In practice, however, these gloves were not found satisfactory for two reasons. First, they would tear easily, so that most of the time the gloves had holes and secondly, they were very uncomfortable to the technicians whose hands at the end of a reactor cleaning session were moist and the skin wrinkled. As a consequence the technicians were happy to see the gloves being torn and were not eager to change them. It was obvious that in this way the protection they were getting was minimal, if any, and so we had to return to the old canvas type work gloves. After all some protec tion was better than none. In addition to the industrial hygiene measures outlined we have established the following program of medical check-ups for all people engaged in PVC production, testing and handling: 1. Yearly x-ray's of the hands. 2. A yearly periodic examination. Up to this time we have had no abnormal x-ray findings nor have there been any clinical findings related to the above disorder. References 1. Cordier, J. M. ct al: Acroosteolysis et lesides cutanees, associees chez deux ouvriers. Affectes au nettoyage d'autoclaves. Cah. Med. Travail 4: (Jan.) 1966. 2. Harris, D. K. and Adams, W. G. F.: Acro-osteolvsis occuring in men engaged in the polymerization of vinyl chloride, Brit. Med. J. 5:712, 1967. 5. Wilson, R. H. ct al: Occupational Acroosteolysis, J.A.M.A. 201:577, 1967. 4. Suciu, L. Drejman J. Valaskai, M: Contriburii Studiul Imol- navirilor Produce dc Ciorura de Vinil. Med. Intern. 15:967, 1963. S6 SPI -13008 2739 |Sept. 1. 10721 PUD1JC HEALTH 28415-28424 1 putt re prnflLakttkl. [Characteristic* nnd prevention of vibration di sease In workers handling high-frequency rotary tools, (ill; Til I'hOF ZAllOL 1S(T2T: I!>-!. ll>7l|ivrri. 1972). ;lnrl. sum nl.]--Vibration disease was diagnosed In 10.5','. of 290 fitters. The disease manifested Itself after a service record of 5-7 yr. Its characteristic features were a mildly pronounced vcgctatlvc-scnsory polyneuritis or anglodystonlc syndrome and degcncrativc-trophtc chances In the bones and vertebral column with no concomitant lesion of the Internal organs. Most patients were able to continue their occupational activities. Neurotrophic disturbances of the hands prevailed, with a marked pain component and reduced muscle performance. Workers handling abra sive discs for processing developed vibration pathology after a lapse of 9-12 and 16-10 yr. In this group the anglodystonlc syndrome was of moderate Intensity with a mildly expressed pain component. A new pneumatic tool provided with vibration damping arrangement was de vised and a rational work schedule recommended.--J. F. L. 28415. SOLOV'EVA, V. P. and A. S YURCHENKO. (Inst. Ind. Hyg. Occup. Dls,, Acad. Med. Scl. USSR, Moscow, USSR.) Flzlologlchcstaya kharaktcrlstlka napryazhcnnostl truda prl rabote za pul'taml upravlenlya. (Physiological characterization of the intensity of work at control desks.l GIG TR PROF ZADOL 15(4): 13-17. 1971. |EngL summ.1 --Results of a comparative Investigation Into physiological shifts (EEC, ECG, rate of Information processing, speed of ocuto-motor reaction, etc.) occurring under the effect of work at control desks when on duty and In a laboratory are reported. A relationship between changes of physiological functions and the Intensity of work, determined by the amount of the Incoming Information, the sense of responsibility and the emotional stress, was discovered. The data was used In elaborating criteria of the Intensity of work at control desks.--J. F. L. 28416. FILATOVA, V. S. and V. A. ANTONYUZHENKO. (Inst. Ind. Hyg. Occup. Dls., Gorki, USSR.) Glglenlcheskle uslovlya truda 1 professlonal'naya zabolevaemost' rabochlkh prolzvodstva suspenzionnogo pollvlnllkhlorlda v dlnamlke za ryad let. [Hygienic conditions of work and occupational disease Incidence among workers engaged in the pro duction of suspension polyvinyl chloride.! GIG TR PROF ZABOL 15(4): 32-34. 1971. [EngL summ.j--Disease Incidence In workers In contact with polyvinyl chloride was studied for 16 yr (1953--1968). Introduction of Improved machinery and ventilation In the premises contributed to the Improvement of hygienic conditions. The clinical picture of the poisoning changed accordingly, with a longer period of development. However, the existence of technological operations which do not yet meet hygienic requirements, led to a subsequent rise in the air concentration of vinyl chloride and to the appearance of new cases of chronic occupational poisoning. A considerable variability In the clinical manifestations of chronic vinyl chloride poisoning as a func tion of the environmental air contaminations was established. A series Of measures designed to improve the air of work premises are sug gested.--J. F. L. 28417. LOMAREV, P. I., S. N. POPOV, A. M. TYURIN and Y. M. SHAPKAITS. (P. F. Lcsgaft Inst. Phys. Cult., Leningrad, USSR.) O vliyanli zanyat 11 sportom na chastotu 1 dlltcl'nost' nckotorykh zabolevanli. [Effect of sporting activities on the Incidence and duration of some diseases. | SOV MED 34(2): 100-103. 197i. [Engl, summ.]-- lThe frequency and duration of acute affections were studied In sports men and In non-athletic persons. Severe colds were much less frequent In the former while diseases of the locomotor apparatus were more frequent. This is attributed to the stress sportsmen are subjected to during training and performance. In sportsmen diseases last for a shorter time. Sporting activities do not change In the Incidence of "acute* morbidity.--J. F. L. 28418. RETNEV, V. M. (S. M. Kirov Inst. Postgrad. Med., Lenin grad, USSR.) Nekotorye voprosy gigleny truda v svyazl 1 kompleksnol avtomatlzatsleL [Industrial hygiene In relation to complex automatlon.1 GIG TR PROF ZADOL 15(4): 9-12. 197i. [EngL summ.j--Complex automation generally leads to Improved working conditions. Hygienic advantages Include: favorable working conditions In most premises ac comodating control desks, reduction of tho numlw'r of oiteralors engngod at work places presenting oceiqutlonal hazards, nnd n derreasn of phy sical efforts. Hygienic shortcomings attending complex automation nrd of a temporary and avoidable nature. They comprise a considerable nervous and psychic stress owing to a large volume of Information and adverse working conditions at the control desks. In Individual instances these factors tend to Increase the slck-rate among the operators. --J. F. L. 28419. KRYZHANOVSKI1, N, V, Glglenlcheskle uslovlya prl zachlstke neftenallvnykh sudov 1 Ikh vllyanie na zdorov*c rabochlkh. [Hvgicnlc conditions In cleaning oil tankers and their effect on the workers' health. | CICTR PROF ZAHOL 15(3): 14-17. 1971. |Engl. summ.] --When cleaning oil tankers the hydrocarbons In the air exceed the maximum permissible concentration In 54.37, of cases handling crude oil and In 64.17, of cases dealing with diesel oil. The hydrocarbon concentration Increases parallel to the rising temperature Inside the tanks undergoing cleaning. The disease-incidence among female wor kers is elevated by comparison with those doing ship repair work. There Is a higher rate of cardlo-vnscular diseases, reproductive sys tem disorders and respiratory disorders. Recommendations for the Improvement of work conditions are given.--J. F, L. 28420. SOETHER, HALVARD. Yrkesskader under hocst. fln)urles In forest work.1 TIDSSKR SKOGDRUK 79(1): 35-41. IIlus. 1971. [EngL summ.|--In forestry there arc more registered accldents/1000 man-years worked than In any other Norwegian trade or Industry, A total of 101 cutters were studied In 0stlandet and Trdndclag. Every 7th cutter suffered from Injuries during the season 1969/70. This was 143 lnjurlcs/1000 man-years worked. Many failed to use safety equipment, especially the older cutters. Only about 1/2 had first aid equipment with them.--J. F. L. 28421. MC DRIDE, M. E. (Daylor ColL Med., Houston, Tex., 77025, USA.), L. F. MONTES, W. J. FAHLBERG and J. M. KNOX. Microbial flora of nurses' hands; I. Quantitative differences In bacterial popuLatlon between nurses and other occupational grounsT INT J DERMA TOL 11(1): 49-53. 1972, [Fr. and Span. summ.)--The microbial flora of the palms and lnterdlgltal areas of the hands In nurses was determined quantitatively and compared with a control group. The numbers of bacterla/cm3 on the palm ranged between 0-log 3.81 In nurses and log 1.54-5.03 in controls with means of log 1.94 and 2.79 and medians of 2.00 and 2.69 for each respective group. The bacterial counts from the webs ranged from 8 to log 3.47/cm3 In nurses and log 0.48-3.43 in controls. Mean values were 0.10/cm3 for the nurses and 1.69 for the controls. Medians were log 0.94 and 1.67 tor each group respectively.--J. F. L. 28422. OLDER, HARRY J. and BERNARD J. CAMERON. (BloTechnoL, Inc., 3027 Rosemary Lane, Falls Church, Va., 22042, USA.) Human factors aspects of air traffic control. NASA (NATL AERONAUT SPACE ADM) CONTRACT REP CR(1957); 1-163. IUus. 1972. --This report presents an overview of human factors problems asso ciated with the operation of present and future air traffic control sys tems. A description Is Included of those activities and tasks per formed by air traffic controllers at each operational position within the present system. Judgmental data obtained from controllers con cerning psychological dimensions related to these tasks and activities are also presented. The analysis Includes consideration of psychophysiological dimensions of human performance. The role of the humar controller In present air traffic control systems and his predicted role In future systems Is described, particularly as that role changes as the result of the system's evolution towards a more automated con figuration. Special attention Is directed towards problems of staffing, training, and system operation. A series of 10 specific research and development projects are recommended and suggested work plans for their Implementation are included.--J. F. L. RADIATION HEALTH See also: Radiation Biology t 28423. MORGAN, K. Z. and E. G. STRUXNESS. (Health Phys. Dlv., Oak Ridge Nat. lab., Oak Ridge, Tenn., 37830, USA.) Criteria for the control of radioactive effluents. INT J ENVIRON STUD 2(2): lll119. IUus. 1971.--The risks to the population from the U.S. nuclear energy Industry are considered to be very small In comparison with other environmental risks. However, they are not zero and, on the as sumption that radiation damage increases linearly with the accumulated dose, they can be expected on a statistical basis to result In a few death In the exposed population. Thus, the routine operation of these nuclear power plants may cause about 18 deaths/yr and the serious accidents, which may occur at a frequency of once every 50 yr, may add another 6 deaths/yr on the average. This Is considered to be a small price to pay relative to the real but less-well-defined environmental risks from atmospheric pollution caused by fossil fuel power plants. Assuming the proper selection of a reactor site and all practicable precautions In the design and operation of a nuclear power reactor, adequate radia tion protection for nearby pointlotions can Iki assured by concentrating health physics attention on the critical radionuclides, critical pathways and critical segments of the population. 28424. GARN1ER, ARLETTE. (Comm. Encrg. Atom., Fontcnv-AuxRoscs, Fr.) Evaluation dcs doses d'lrradlatlon Interne dellvrees aux lndlvidus du public par suite de la pollution dcs aliments par le 9%r et le 137cs, en vuc de la determination dos nlveaux de rejet dcs ra dionuclides dans le milieu amblant. fEvaluation of the Internal radlatlon doses undergone by the general public as a result of Sr-OO and Cs137 pollution ol food and determination of the levels of radionuclide discharge Into the environment.! HEALTH PHYS 22(3): 267-277. lllus. 1972. [Engl. summ.|--1This study Is aimed at the Investigation of models for the determination of levels of discharge of radioactive substances Into the environment. For this purpose, it Is proposed to estimate the average internal radiation dose resulting from contamina tion of the food-chain by B0Sr and 137Cs, taking Into account the condi tions and transfer mechanisms of the environment, the various links in the food-chain, ami the characteristics of the population groups con- SPI -13009