Document KGZgdBByqzaMZXoJrn28M2Xrw

T ^ c /S o 'i **,*V' : - /v * : *>c; ::: 'scard } work environ h r d i l t 7 (J38i) 257-- 252 c. A ca i.f-i->V7 ^ .I at` ic d i s o r : ' ^ ! ' 'o sol v cat*.1t : f i i j n 07G) l i - V ^ J r i r . Currcs; ' T R e l a t i o n s h i p b e tw e e n c lin ic a l a n d e le c tro p h y s - pationaj-;',*-;l i - i o ! o g i c a l f i n d i n g s a n d i n d i c a t o r s o f h e a v y & * e x p o s u r e to 2 , 3, 7, 8 - te tra c h lo ro d iOlog3y.V4? terger Pa -tLI*.! j j e n z o - d i o x i n `d u ce d > ^.jv '< i.;:` 0 > - Vl-O-I U978) 222T ^ ^ j |: ,.`t)y Grazie^3 Filippini. MD, B ianca Bordo, MD, P aolo C renna, MD. i(y q 2. v ::*r>' 'Nicoletta M assetto, MD, M assim o M usicco, MD, R en ato Boeri, MD 1 2, 4, 5-trU ! $ * : 'O.-t on lheif'i?S-i ds. Arch vlic -e-.. : n Jrt. Perl- irr-S ' ;i surc lo aaij'rfi issoc (sss^Jtigjly ; F IU PPIK I C. DOnDO B. CRF.NNA P. MASSKTTO N. M U S U V O M. hOKIil I; 1ii*l:itionship between clinical and clcclrophystologk'nl fintlinrs and milieu tors uf heavy exposure to 2,3.7,8-Lctrnchlororiibenzo-dioxin. Srrtitif j irurk cnrirmi tirnlth 7 (liUll) 257--2U2. In this study UK' prcvulvitet1 rale nf | mi niln-r.il iu-ih <>)<iliy in a f>1m1Jalion living in an area polluted with 2,3.7,lMclraehturiiililu'ii/.(>-iliuxiii (d l u x ii i-T d i l )) was determined. Of the 723 subjects invited to the firsl MTivniug in l!t77. -J71> (65 V,,) ?idemiolosic*W|,:' -orm cilccu!:!?: il s. Scand S3 159. n'derson ' ers expos Siif 5f| . Quantitative||i|3 ,v. : scalar f u n c - i ^ i c 097E) S7S-- attended. Al th e 'se c o n d screening in IflTH, of the 710 invited subjects, Ha "A) attended. Prevalence rate ratios for peripheral neimipnthv anti llu: associated rfi confidence limits were calculated for subgroups dvli*nnim*d l>y the pivscncv uf (i) predisposing factors lo neuropathy (alcoholism, diabetes, nevupatmnnl exposure in uni* roloxic agents, etc) or (ii) conditions thought lo result from exposure lo dioxm-TCDID such as chloracne or abnormal serum hepatic enzyme levels. The prevalence rale of peripheral neuropathy among those subjects with predisposing factors and among those with chloracne or abnormal scrum hepatic enzyme levels was nearly three times greater than among those without these manifestations. 'Hie results d erived from tin's study may be useful qualitative pointers for identifying subjects at risk in the neuro logical follow-up. f'941) &6S^|;`3 :::.; . Key icrms.* chlurucnc, dioxin, environmental poMulaul;:. liver damage, periplier.d n e u ropathy, raised serum hepatic enzyme levels. of car-ii'ir? ;: ;; :n c-- ,, ^ ' S u b j e c t s w it h o c c u p a t i o n a l o r a c c i d e n t a l , larmacol 3 fiijg yposure-to 2 3/? 8- i e t r a c h l o r o d i b e n z o - d i - ! estjmatioar-J!^-;oxin (d io x in -T C D D ) h a v e b e e n f o u n d to j epfdcraio^^ij'-ijjg^jop a w id e v a r ie ty o f le sio n s and urai his* =VJ^f ^symptoms. N e u r o l o g i c a l f i n d i n g s m a y in - d* 3i 2> {]97}?7t2 ' rclluudee ppoollyyn..e-u--r-o-,p--a--t-h--ie--s-,----l-o-w---e-r----e--x-t-r-e-m--i-t y weakness, or sensorial im pairm ent (sight, Jrofessionaie;;;S faring, smell, taste), all of which have , j . Ji'il 'keen recorded for dioxin-exposed subjects ^ p H n ^ p r ^ i # 2 vhoni olhsr long-term effects such as retrospective "'3 fcMorncne, raised levels of cholesterol, s sizes. idglyceride, gam m a-glutam yl transpepli- mismus '? tOv;tscul5 r-c<ni ::i!u cr- SchefeJ- -.'J "i Cewerbt- *' j42-- 552. iifl 'lit dzse (;*GT), glutamic oxalacetic transininase (GOT), and glutamic pyruvic transaminase (GPT) were manifest (1, 3, 5 7, ]0, 11, 12,,13, 14, 17, 18). An associa- 1 istituto Neurologico "C. Bcstn," Jviilun, Italy. .Reprint requests lo: Dr G Filippini, Istituto jffurologico "C. Besta,*' Via Celora 11, 1-20133 >!Uan. Italy. lion of chloracne with increased -C T GOT, and GPT neiivjtim and abnormal lipid levels has also been reporkcl (ID, personal commitnirnlinn from M .^(]xc.s). The rale of roporled congenital anomalies in men fathering at least `one child afte r service in Viel Nam was nearly twice as high among those with rceum-r.i .tene. skin rash with blisters, and skin color changes consistent with conditions thought lo result from exposure to dioxin-contaminaled substances as among t h o s e with out them (13). For men w ith these "indi cators of exposure" g re a te r fre<|i;-*:icies have also been reported for gastininu-stinal disturbances, swelling or numbness of joints, and sleep and psychological dis turbances (15). These previous findings prompted us to compare the prevalence r a te (PR) of peri pheral neuropathy in exposed subjects 0:1:0 - i-io m o ;-2:)7- g w i t h r h lu t'.'u in- in in*fi- jim *(I G O T . ;inci C 'l 'T ;irl i \*i 11*< w i t h lh:il f n u n d in vx*p o s e d s u b j e c t s u*illi->u! l l i o t * in .i ii ii i- s l.i lh i n s in :i p o p u l a t i o n l i v i n g in :i d i o x m - p u l l i i t e d a r e a in th e Sevosu n g im i of Italy, :nsor ix;-irezsed * enzyme act brevis muscles at a surface ; wKen )*GT was a: Subjects and methods above 27 r C. Minimum conduction K,^ 2 ^ - ^ rS:ige:'u p to 3G U/l, * to Szasz [16]), G* In Jills* 1!>7C. ;m accident ;M :i Iriehlorophennl-prud wring factory in Meda. luily, resulted in the contamination of a large, densely populated area. Seven hundred and thirls-three residents were ev;ieu:itcd ]5 to 20 d after the accident from the most polluted zone (an area of 1OS ha with an average dioxin-TCDD level of 2-tO n g m ", r. m axim um level of 5.-57" o g 'm ; . and an iiiii-s-jluablr minim um level) (-5). These residents were invited by letter and per sona! invitation during visits at home to itormal range: up to by the "optimized distance of 6 cm. A Disa law ^ a b o v e 50 U/l [ myograph (Dis2 Elektronik, S Denmark) was used. k i^ determined ' : * *t^.rc**.y*.x..ir (2m)]. A nonexposed population living ^ statistical analyst: unpolluted area was used as a sours "^ ^ ^ S icrT n e d w ith in the ex "normal" reference values of the `relationship betwee: physiological parameters. A toUl o* . viTrS&lhy and indicators t (91.6 /o of the randomized s a r n p lO ^ ^ ^ r ^ ^ d u n d n . being tested, jeets, representative of all ages, ^ ^ ^ r T t a l e n c e ra te ratio (F cipaled. Seventy-five of these p^rdpathy were calculr. ar. initial neurological screening in March were alcoholic, occupationally 1077 and to a second screening in April neurotoxic agents, or had diseases 'w ith chloracnt* enzyme levels v ]i!7it. At the first screening five subjects posing to peripheral neuropathy and -jgj.Kjiis w ithout `them . K had died and rive had moved front the thus excluded from the calculation o: .&Tt:Hhiideni'P> timite rq*--y area. Of Lhe 722 inhabitants invited to participate in the screening in Seveso. -570 (fi"< ''7) attended. During the period March 1077 to April five tiled and nine moved from the area. Of the 7(10 inha bitants invited tu the second screen in", reference v.luex. The norni.!** f e n e o r ^ t o tte L values obtained are given by age ^'>'-pfooli (20) in table 1. Conduction velocity and dL'~i '$1 f -. latency were considered to be in `T - | . i \ pathological range when the former lower than the mean -- 2 SD and ' 1- Motor conduction 210 (-5a m. h) attended. 277 of whom had been examined at the first screening anti -12 of *t. *fe i* whom were examined fur the first time. Of the latter 42. 11 children under the age of 5 a refused tu participate in the electrophysiological examination and were thus excluded from the prevalance calculation. No acute polyneuropathy was found du r ing the study. hach subject w;ls examined according to a standardized protocol requiring a med ical history questionnaire, a clinical exa of muscle action potential were consider?1 abnormal when the former was below Marro - !*V 4 ; Number O re le te n l* . Ape W lower range limit and the latter was sbort the upper range limit of the reference P0?ulation of the same age group. For an electrophysiological diagnosis cperipheral neuropathy two or more ab tS n a /ls iu ille - w iill 172 118 15 Pmonoal (u p ltu lu m lib u ta v m U b) 168 115 1 6-- 29 JO -59 60 -9 JO-- 59 60 normal param eters, among which condiii- v Me v. Si Si s: s:; mination. and an elecirojihysiolugical in tion velociiy was obligatory, were con*.:^:. vestigation. The neurological symptoms sidcrcd necessary, regardless of the i r r T e b l e 2. Prevalence f'e specifically identified were paresthesia, vo]\*ed nerve. All Seveso subjects w e i t B ^ p s . o f Seveso resi en hypcslhcsia, pain, and hyposlhcnin, and investigated for the following factors pr*- the clinical signs w e ie <r.;n*rfinal and deep disposing to neuropathy: akoholism (morf \ sensory im pairm ent, m uscular weakness, than 1 1 of wine consumed daily), persor.il |.* and ti.ndon hypo- or areflcxia. The cleciro- history of diabetes or fasting plasma gl'J' pi:_vM'. logical study included maximum and minimum motor conduction velocity along the ulnar (axilla-wrist) and peroneal (capilu)um fibulae-anklc) nerves and needle electromyography on the first inIciosseous muscle. However, electroinyography was abandoned during the course cose 2 100 g%ti, cancer, nutritional defici ency, infectious and inflam m atory diseases oslcoarlicular diseases, use of ncuroloxic drugs, possible occupational exposure W ncuroloxic agents [chemical workers, shoe' makers, plastic workers, painters, cabinet makers, printers, tanners, ceramic work- Aclual cases of peripheral neuropath* Total number ot sut . PR (7 .) *4 PRR BS e/a conlldence limit * Evaluated versus QroU 2:n ; subjects re~ ers-- according lo the International Stnn- Results Muscle sclion . srd. Classification of Occupations (9)). .. a superficial rom the digit -,0r digi'orum temperature ton velocity .ichron'.xation Motor distal lo a s tan d ard a 1500 electro- ik Skovlunde, ' * i IM.; Chloracne was diagnosed by a dermalo- lo^ist. Increased enzyme activities were recerded when ;-G7 was above 50 U/i (norma! range: up to 30 U/J, as determined ac cording to Szasz [10]), GOT was above 50 U/l [normal range: up to 26 U/l, as deter mined by the "optimized method" (2)), and G?T was above 50 U/l (normal range: up 32 U/l. as determ ined by the "optimized R c h u imtsh if* b r l m c c u th e uccit r r c a c c of p e r ip h e r a l n c u r v / w i l n / r.utl incltcnlors of hritrif exposure fn rJin.nii Ily 31 .111rtf 1iIT7, 22 c;im > wi t h syrnpU>rns or clinical ajuJ clectruphysiolugical signs of periphvnil neuropathy and 20 cases with cirri rophysiologicnl abnormalities had been found among the -170 subjects examined, for a total PR of it.!) "m (95 "/ CL, 6.2-- r method" (2)]. ll.i). Among the 3011 subjects who u n d e r jn living in an ' ^ as a source for ; of the electroj \ total of 380 ed sample) sub- The statistical analysis of the data \v;is Performed within the exposed population, the relationship between peripheral n eu ropathy and indicators of heavy exposure tq dioxin being tested. The PR and the went a complete exam ination. 26 cases `with symptoms or clinical and elcclrophysiolngical signs of peripheral neuro pathy and 1G eases with electrophysiolugical abnormalities were fvund by 31 Ju ly all aGes' Parti" ; these subjects: nally exposed to; 1 disease? predis-; -opathy and were calculation ol the Vormal" reference :a b v age groups elocity and distal , prevalence rate ratio (PRR) of peripheral neuropathy were calculated for the Seveso ybjects with chloracne or raised serum hepatic enzyme levels versus Seveso su b jects without them. Ninety-five percent confidence limits (95 /c CL) w ere estim at ed according to the method described by Woolf (20). 1978. for a total PR of 13.G (95 "/ CL, 9.5-- 17. ft). Table 2 reports the PR and the PRR of peripheral neuropathy for subjects with predisposing factors (group A) and for subjects- with chloracne ur raised serum hepatic enzyme levels (group 3 ) versus subjects without the sym ptom s of either -d to be in the t; n the form er was ij; 2 SD and the lat-V: - mean + 2 SD of \ Table 1- Motor conduction velocity, distal latency, ampliiudo. and duration of muscle action potenlizJ (surface electrodes) in the 305 reierenls. i of the same age eters w ere nor-f= ode and duration * were considered^? ^jer was below the- :; Number ol re le re n ti Age (*) M fliim um c o n d u c tio n velocity (m /s) M inim um . cnnrtciir>n v e lo c ity (m /s) M ean SD M edian M ean SD M eoian D istal J;m :ncy (m ^ | A m pliiud o mV] M ean 1 SD M edian Runge Total duration (m s j Ranee he latter was above. ; 172 6-- 29 60.2 i 5.3 60 55.5 i 6 1 65 { th e r e f e r e n c e popf;.` jilli* n s *3 0 -- 55 58.2 4.4 68 6<,3 I O 55 e group. >9 IS > 60 57.B 5.0 57 53.4 1 4.4 52 ft.'eeeal 168 ' 6-- 29 52.7 5.0 52 40.9 4.9 49 logical diagnosis of *; 115 30-- 59 50.9 O 51 47.9 3.7 47 Tv/o or m ore ab--i -,,lat- r*!fl 12 I - 60 <9.8 3.7 60 47.3 Z 4 1 47 nong which conduc- ; 26 1 0 n 2.5 *11 0 5 2 6 ' 05 3 0 11 0 5 3 3 ' OH 3 9 1 0G ?5 25 26 31 32 34 4 I-tS 4 6-- 15 4 5-- 15 2 -- 11 2-- 11 2-- 11 ` 11-- 13 11-- 15 n -- lb 10-- 17 10-- 17 10-- 17 .igatory, w ere conr ; gardless ol the in2veso subjects w e re' Tible 2. Prevalence rate (PR) and prevalence rate ratios (PRRs) tor peripheral neuropathy in subjpups ol Seveso residents in 1976. allowing factors pre- -jV: alcoholism (more :med daily), personal fasting plasm a glu- With predisposing taciors With indicators of exposure Without A or B >r, nutritio n a l ceiici- illammatory diseases, s use of neurotoxic' palionsl exposure to rnical w orkers, shoc k s . painters, cabinet j^taal cases of probers! neuropathy Tatzf number of subjects pflS Si */s confidence lim its 17 85 20 2.6 1.2-- 5.6 12 55 22 2.8 1.2 -G .5 13 168 7.7 1 niK-r's, ceram ic work I , =o!*jaied versus group C. group A ur li (group C). Kur the subjects nf group A IIn: Plill w:i< vigni ficnn 1ly g re a te r liK ii'. d i n '. :jn unc would expect. The I'Hlf wus significantly greater 11i:in une also for thi* subjects of group 11. T:ible -> shows the I'lfli of peripheral neuropathy for sitbjeels with increased pGT. GOT. ;mcl GRT activities :ind Cor subjects with eh Ioracue versus subjects without ;my of these manifestations. The PRR was significantly different from one for the subjects with abnormal hepatic enzyme levels and w:is greater than one fur the subjects with chloraene. even though the lower !J5 CL was ecjunl to one. in the upper and lower . limbs) vta* neuropathy was ob significantly associated with periphery v-'ho showed indica* neuropathy in the three subgroups of tf" dioxin (12 out of exposed population (table 4). Six subject' Jence was almost with symptomatic neuropathy and six vi*~ *han th a t of subje- asymptomatic neuropathy ana six these indicators. .1 clinical symptoms and signs only, withs-' . neuropathy found f clcctrophysiological evidence of periphe'1* p ; acne is interesting ncuropaLhy, were found in the group v"*-1- good indicator i indicators cf heavy exposure to dioxttt ft/1 Moreover, during The arms and legs were involved for si* R* i a-ne w as found o polyneuropalhic subjects with chloracne: jg*;' group (0 to 20 a) raised serum hepatic enzyme levels, fnf fre quency of neuropal legs of one and the arms of five (the h 5' l ) In fact, the PRR of five subjects were children with cblor' iects u n d e r 20 a or acne). i SUs those w ithout :;V CL. 1.2-- 18.1), a v Relationship hctirrcn clinical si/ttiplojns and xipiis. ami penpbertii nrnnijwtln/ Clinical symptoms and signs (paresthesia, Jiyposthenia. w eakness. hypo- ur nreflexia i;':;' *3e (2.6) observed Discussion C\ i^cts of all ages. I: j-T! hepatic enzyme- U is evident from the preceding rcsulthat a very high prevalence of periphery t. ^ nion in the adult a i i l ; ^on with peripher: . he so unusual. I lt must be sires; Table 3. Prevalence rate ratios to: peripheral neuropathy in Seveso ahnornm! hepatic enzyme levels in tOTfi Abnormal hepatic enzyme levels E With W iih b u t subjects with chlorscne c* Chlorscne1 With WithDUl neuropathy p* and th e polyru \ . r not sev ere. The el-, nosis of periphera'. sidered the most . ^ ith w hich to slut effects of dioxin-T Actual cases ol peripheral neuropathy Total subjects Prevalence tale ralio 95 % confidence limils 6 19 18 205 3.6 1.3-- 10.2 6 24 12? 2.6 1.0--7.2 3 Calculated only for subjects without predisposing factors to peripheral neuropathy. Peripheral nerves c ,, At the follow-up ' ` nonattendants was snalysis was corr Vr`h e th e t the group am ined in 1978 was Tabic 4. Refationshio between clinical symptoms and signs and peripheral neuropathy in subgroup5 cf Seveso residents. ^ regards the dise; i the presence of signs w hich could 1 looted subjects to Subjects Wiih predisposing factors With indicators of exposure Without A or B because of the pr disposing towards K , *^he frequency Df Symploms No symptoms and signs or signs Symploms No symploms and signs or signs Symploms No symP>rJ Psthy-related facto end signs or signs Y : h ig h er among* tho; Neuropathic Normal 11 (65) 130] 2u (361 [70] = 3. OS 6 (35) 112] 42 (02) IBS] p < 0.05 t> 6 !(50) [50] 6 (1J) [50) /-* = 7 .1 5 6 (50) [1<] 3? (3) [86] p < 0.01 9 (69) [60] 5 (4) 140] 7- = 63.01 4 pO Pi 149 (Si [S'! p < o.ooi *' spect to those not | m ere su b jects w it.1 f nisi scrum hepatic : ^ e x a m in e d in the `..'t ..hypothesis th at ; *;n*: ^ ere positively sc ** The row percenlagcs indictile the percentage distribution of the symptoms and signs of *ai ; `V- ^ th e disease j* ncu/opa'.Nc onC normal subjects for each subgroup, and Ihe column percentages indicate *ili percentage distribution ol the crises of n c u i o p n i h y end normality lor the symptoms and s'9r i b There v.'as significantly hiyMer prevalence of neuropathy for subjects with symptoms and s'irJ versus subjects with no symptoms and signs in each subgroup. U- Ire c o n firm e d ^ ,, aij:\existent neuropath r:N* subjects exposed t l r- rs b\ neuropathy was observed among subjects v ho showed indicators oi heavy exposure to dioxin (12 out o f . 55, 22 Vo). This prevaicnee was almost three times greater than that of subjects who did not show these indicators. The high frequency of neuropathy found for subjects with chloroenc is interesting because chloracne is a good indicator of exposure to dioxin. an important qualitative finding for the identification nl subjects at risk. A neurological follow-up of this popu lation is in progress. The principal objec tives arc to increase the examination at tendance to at least 95 ".'u and to improve the information on the "exposure indi cators." Moreover, during the monitoring, chlor- ` acne was found only in the young age Acknowledgment group fO to 20 a) (S), for which the fre quency of neuropathic signs was very low. " a fact, the PRR of neuropathy for the sub jects under 20 a of age w ith chloracne ver- This work wax supported by a g ra n t from Regione Lombardia. sUs those w ithout it reached 4.7 (95 Vi> CL, 1.2-- 18.1), a value g re ater than the Ref erences one (2.6) observed in the chloracne sub jects of all ages. In contrast, since abnor mal hepatic enzyme levels w e re more com- I results !j)j: ; mon in the adult ngo group, their Jissocio- iripberal'i.'F V on with peripheral ., _tje so. unusual. neuropathy may not ' R must be stressed that no acute polv: *{:>. : neuropathy was found during the study, oracne or':;ir .sod the polyneuropalhic cases found were pot severe. The clectrophysiological diag :racne ;,-i r'V , Without ! nosis of peripheral neuropathy' was con sidered the most app ro p riate procedure R-jth which to study the possible chronic effects of dioxin-TCDD exposure on the peripheral nerves of a general population. 1. B a u e r Jl. Xeluilz K it. S p ie g e lb e rg U. Be- ruilit-he Vrvjiifnmpen bei der lferstcllung von Chtornphenuf-Vrihindungen. Arvti Gc- w e r h e p a ih t r v e v b e h y g III iltilit) 5.`ttt--555. 2. U c r g m e y r r HU. H u tln e r It, Il il lm u n n G, K r e n t s Kll. l- m g H. l a m e 1). Kick W, S c h m id t K. S chm id t SW. S t a m m 1'J, Sv.nsz ft. liivcmmi'dilaiiims of the (!cnn:m So ciety fui t'lioical C h em istry: S ta n d a rd isa tion of methods for the estimation of en z y m e activ ity in biological fluids. */ K lin C hein Klin Hiochcm H (IJlTtl) (i5!i--tilit), J. BJcibcrj; J. W allen M. D ro d k in R. A p p lc - banin ]1 Industrially arm ored pnrphyrin. A rrli dei ruali.l lit Tlltl 7UV, , Bollellino t'f finale della Itegiune I.ombaj- dia. Xiipplenienln si rai <p*i lin a ri i. al N.2I.: At the follow-up exam ination the ra te of P r o v v e d u n r n t i p-'r Sevesn. Milan. M l.wi;lio ) ! ' n . |ip HU52 -tiu54. 7.2 ponsttendants was high, about 56 Vo, An analysis was carried out to determ ine 5. Cos: V. t'iuelli P. T o n e K. fla n g e of c o n duction velocity nf m otor nerve fibres in ` -hether the group of 277 subjects reex a given mwsele; Mel lied of d esy n eh ru n isa- amined in 1978 was positively self-selected :S]i j5 regards the disease und er study because subgroup^? '*cf 'the presence of sym ptom s and clinical lion and method of delay of the partial antidromic block. Kiectrooocephniom- clin n eu ro p h y s io l 21 iliUith 515. , Fires ton1 l). The TCDD p ro b le m ' A review. *:*iiiJf ' s5<rns which could h av e encouraged the af- ' f^ted subjects to come to the clinic or because of the presence of factors pre- a, or B ______________ Jo sym ptome.i*fr.S^s disoosing towards p eripheral neuropathy. The frequency of these possible neuro pathy-related factors was not significantly or signs -------------- M higher among those reexam ined u-ilh rejpect to those not reexam ined. "Moreover, 4 (31) 3 ore subjects w ith chloracne and abnor- In : H am el C. t*d. C h lo r i n a te d p h e n o x y acids and their dioxin. Royal Swedish A c a d e m y of Sciences. S to c k h o lm t.'ifo. pp HO--52. iKcel ball no N'FK 27) G o ld m a u o J'.I. Sch worst e a k u te t'h l u r a e o e . c in e Mas.^en'e.Vaixillation d o r c h Z.ll.ti.l le t r u e h lo ro d iiie n /o d io x in , (]aular/.( 2-1 (tuTXj 14*1-- 152. 41 I A R C W orking G ro u p nit (lu* K v ah iatiu n of the Catvinoueme Risk of Chemicals to Man. Som e fuieaeaitts, th e herbicides 2.4-l> 149 ^ W (56) 1ST) * i.v |' : pal ^sa serum mined hep in atic the enzyme second levels were not screening. The p < 0.031 tvpolbesis that subjects who returned and 2.4.5-T. chlorinated aibenzodioxins and nt i>i *-Ita in-on - in d u s tria l eh e m ie a ts I n t e r- n a tio n a l Agency foi R e se a rc h on t'a r u 'er. ;J Lyon I!>T7, pp 1 !l*2. tlA K C nt.nogr lal. ere positively self-selected with respect In lero ab o n a) !.:ib.'iii ttfiice ln lern alim ial signs oi theWk -jo the disease under study was not ihere- indicate lhe;|^ ts and sigrut&L ms and signs'irlS 'iiore confirmed ^fiistent neurop by ath y this and analy chlo sis. racn The e am coong 'pjbjects ex'posed to dioxin m ay represent s t a n d a r d el.is'..'f ieatiim <( o e e n p atto n s. Geneva. JO. J i r a s e k I.. Isnienskv J. K nbev K. Razde- rov.'i J. I.ukas K. Arm* eid*n`m a, p o r p h y r i a cutanea tarda and other manifestations of general iutn\ieali.m duriuj; the utannfae- \ y-- f >$;"- * (.it< *ii in-) im't`lt*> I'r.'li tifi 111:1)1'! -N illC-jj N't If.'. I. !.. l\:i|i-iivl;.\ .1. K u l u v K. pjiriii'ri'Vii .1. 1.11U.fri- V!! (.`hlm '.il*ne. pnrphyi' i;i i`ii!:inim miel ;i:.il.-i i- n-ii rin irh !. i !:/! il.-. } l:nii;ii'/.l 27 (CCM :CH- -.".`Ci l-J '.i.-.lt`l 1 .1 - W jln p l.n v -,i .1. NY*imuv,< M, 'idluv:' .1. .lir.tsi'l: t. . l.nUfi.t ];. T lir dvvi'lj -in- 11: :>i 111 pi .ii:nn >iiv nf l'Iiiiinii ii 11iix i(.-;i- 15. S id lm o n S, Slellinon J. Hc3k5 i.inuMj; 535 V ietnam vclcrar.s exposed lo loxic herbicide?. An", j *7- ' II. ! 7, ff-* 1' ** ; A rili i-nvinm !n*al`.li riti ili'.su f.-- M. Ki l'i.aiH A l'. S m i:li I). M r l i e r G. 1\.vmc1; P. A ln-.il'.li M ti'ifv t>r w o iUi t S in a '.M-D and -l.'t-T j tinn, n i III sprem i a li e n lina lo el'.U*rnctu\ pmjt.'iyria eu ta n e a la rd a , and j>veli uln^ic p a i a m e t e i s . A r d i cavi rem lira]111 22 (li)Tn till--327. M. S d ; : ! / . K i t . X.111 Ululile 11 nel ili.ilngie tler ArlnalMiii'tl Sti/Jalined A rbeilsliy^ :i ti 'itisi -jfi--2'J. J l e o 'ji . -i r.ir pillili rii.! im i; 27 M a y IJll! IH. animal de la dioxine. Rev med (11177) 653--657. - lf). Walker AE, Marlin JV. Lipid diexin-exposed workers. Lance*. * . ......... -P 1' . ' i ,r:,6 t l n i nriQ -96 ' - 0. Woolf E`. On estimating ifce tween blood group and disease. t 'J> genet 19 n!>55) 251-- 253. ` MOLV/ under \ - . ' ol n rsi "- .buysed* Pin*. i-v't' .'.to a pr is alien - old in howevc is coni hearing Key le *5Kv'-i * * !`j^ ^ S " esring. Less M: increasing '*:^?:'|tnced b y . unde- ..fact th at -.l^ifii^garded as ha P ropeller nc "* *' r e la to tion tolex< `.. energy b< frequency ran; ' ^ '.tu d e of noisy ' FWcause of con . t-fa frequent findii V-audiogram s, w .in th is field. 1 :g;. ;gatin was to j;iin j: from th e . norr ^I'.&^i'.irock d rills an under w ater 1 Norwegian 1 N orw ay. . * Electronics B w egian Insti' -v.-i;:.* ol Trondheim 1i*n;:` K 1 Reprint re Underwater^ toilNorway. 262 r