Document K6Mmg1K50d6zN4jV2Z0kvLv2

Pbliihd Ufidr tilt Auipicts of Th Boord of Truitwi THE JOURNAL of the American Medical Association VOL 201, NO 8, AUGUST 21, 1967 Occupational Acroosteolysis ' Report of 31 Cases Rex H Wilson, MD, William E. McCormick, MS, Caroll F. Tatum, MD, and John L. Creech, MD In 31 cases of acroosteolysis of the hands of workmen derma. Some have clubbing of the fingers. Only a few associated with vinyl chloride (CH^CHCI) polymerization of the cases have sought medical attention because processes, the osteolysis was specific to the distal pha of symptomatic complaints; the majority have been langes of hands and was frequently associated with Ray found through x-ray examinations of the hands. naud's symptoms. Affected personnel ranged in age from A summary of the physical findings of the ob 26 to 47. The disorder is believed to have resulted from served cases is shown in Table 1, and a detailed de a combination of physical insult, chemical insult, and scription of the two predominantly common symp personal idiosyncrasy. The specific causes are unknown. toms follows; The prevalence was found to be less than 3% among Raynaud's Phenomenon.--This symptom com employees performing similar work. No cases were found plex has occurred in varying degrees, with one or in workmen using or processing the polymer or manu both hands involved. Generally, its effect is observed facturing commercial resins. as marked discomfort on exposure to cold. None of the cases have exhibited vascular changes of the feet. uring mid-1964, several complaints came to our A unilateral sympathectomy performed on one of D attention of soreness and tenderness of the the most seriously affected cases relieved most of fingertips of workmen in a manufacturing plantthe symptoms on that side. The acroosteolysis was polymerizing vinyl chloride (CHjCHCl). Compre not altered by the sympathectomy. hensive examinations of these individuals revealed Roentgenological Changes.--The most unique nothing of significance except a "Raynaud-like phe characteristic of this syndrome is the unusual roent nomenon" of the hands, and in some cases, definite genological findings. These are described as acroos changes of the distal phalanges were apparent on teolysis and are illustrated in Fig 1. It may be present roentgenograms of the hands. Since then we have observed additional cases of this unusual syndrome. in all of the fingers and readily observable, or only in one finger and barely discernible, as illustrated in It is the purpose of this manuscript to summarize Fig 2. X-ray films of the feet, as well as those of the our observations. long bones and of the skull have been made in some of these cases, with no osteolysis found other than Description of Syndrome in the distal phalanges of the hands. To date we have observed 31 cases of hand dis orders among 3,000 personnel involved in vinyl chloride manufacturing and polymerization. All have been men, between the ages of 26 and 47. We have not observed any ethnic or racial tendency for the syndrome. The great majority have been char acterized by two common factors: symptoms likened to those ascribed to Raynaud's phenomenon and acroosteolysis of the distal phalanges. A few have had no symptoms but have the roentgenographic evidence of acroosteolysis. Several of the patients have external skin lesions on the dorsal surfaces of the hands and forearms, with a rope-like appear ance resembling changes sometimes seen in sclero- From the Medical Division, B F. Goodrich Cov Akron, Ohio. Reprint requests to 500 S Main St, Akron, Ohio 44318 (Dr. Wil son). Acroosteolysis is a rare clinical entity, with only 72 cases of the familial type reported up to 1965, ac cording to Cheney in his excellent review.1 The diagnosis of acroosteolysis requires expert roent genological technique and knowledge. It has been our observations that early cases of acroosteolysis will be missed by the roentgenologist not familiar with this condition. All of the cases on which we are reporting have been confirmed by at least two ex perienced roentgenologists working independently. We established the following roentgenographic criteria for our diagnoses. These are the result of our having viewed several thousand x-ray films of the hand in our search for the cause of the syn drome. 1. General: Roentgenographically, acroosteolysis, as found in workers who are exposed to vinyl 577 S3 BFG02758 20268002