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R&S 110741 BIO-MEDICAL RESEARCH DOCUMENT DESCRIPTION FORM 63 68 Duplicate in all cards:-- year as-1961- 000030% File number [Right justify [Numeric only] Author(s), as Last Name FS (No Punctuation) and coden for journal as JAMA preceeded by one blank space 20 21 40 41 /. 77 78 Sub-Index Code 60 61 62 n 12 13 Title of Report; end with space-hyphen-hyphen-space. Follow with Index Terms, separated from each other with comma-space. Avoid other punctuation; do not abbreviate. 12 ^ ,, 61 62 21 22 23 57 24 Source (Journal, Vol., Number, Pages, Date) 12 61 62 31 32 Brief Summary 12 10 SUMMARY: 61 62 ` 61 62 63 64 ?$;SE i t>tiz li^ltco^t ttf*3 H?*, JKftl ^2.** QQn3Q2 A CASE OF OCCUPATIONAL ACROOSTEOLYSIS, PRESUMABLY CAUSED BY VINYL CHLORIDE Yasuhiro TAKEUCHlf and Chiyuki MABUCHltt R&S 110742 rm m e % is m % 4 $ so wj #15 4# SSW48ip 7 n *$g&eajg# 385 m A89I *z** A CASE OF OCCUPATIONAL ACROOSTEOLYSIS, PRESUMABLY CAUSED BY VINYL CHLORIDE Yasuhiro TAKEUCHlf and Chiyuki MABUCHIft 1. Japan is producing a large amount of vinyl chloride and is now second to the United States of America in its production. In 1954 Kubota reported that cases of Raynaud's phenomena had been found among a dozen or so workers engaged in the manufacture of vinyl chloride at a factory in the northeastern district of Japan. Later, during the years from 1964 to 1967, it was reported in foreign countries that hepatomegaly, Raynaud's phenomena, scleroderma, characteristic acroosteolysis, etc. were detected among workers engaged in the manufacture of vinyl chloride. But these reports did not atract particular attentions of Japanese physicians. In 1969 Magnuson et al. reported at the XVI International Congress On Occupational Health held in Tokyo that acroosteolysis had been found among workers engaged in the production of vinyl chloride. This presentation aroused our suspicion that similar diseases might exist among vinyl chloride workers in Japan. In 1970 Masuda re-examined the three workers,, who, according to Kubota, had been suffering from Raynaud's phenomena 17 to 18 years before and reported that Raynaud's phenomena and acroosteolysis were not found. These are the only suspected cases of vinyl chloride toxicosis documented in Japanese medical literature. 2. We happened to come across a 36-years-old male patient who had been working in the production of vinyl chloride. He was operated on to remove the right thoratic sympathetic nerve ganglia (n. III) at Nagoya University Hospital for the relief of'Raynaud's phenomena, spontaneous pain in the right hand fingers, etc. We studied the patient's record, the physicians' findings and .the job the patient had and tried .to., find any relation between them. ,&&& J 3. Since he was 23 years old he has been working's a cleaner of the polymerizing reactor for four years and a half. It used to take him from 30 to, 45 minutes to ^{ean one reactor and he cleaned three to four reactors in one day. J ' 4. After he had been engaged in reactor cleaning he began to suffer from diarrhoea, Raynaud's phenomena, scleroderma, indurations of both hands and spontaneous pain in the right hand fingers (II, III). An X-Ray examination revealed acroosteolysis of the right hand fingers (II, III, IV). Pathohistological findings of the skin of the left hand were as follows: epidermis was normal, collagen fibres were edematous, and thickened wall and infarction of vessels were present in the corium. 5. The nature of his job and his physical disorders well coincided with those of the patients engaged in the production of vinyl chloride and with the results of the animal experiments report ed by foreign authors. Thus it was thought logical to presume that his physical disorders were ** BBD48S3J328Bgfj- t Department of Hygiene, School of Medicine, Nagoya University, tt 1st Department of Internal Medicine, School of Medicine, Nagoya University. Received for publication, May 28, 1973 ( 39 ) R&S 110743 R&S 110744 386 caused by handling vinyl chloride. 6. At present, nine years since he gave up his cleaning job, shortening of his right hand fingers (II, III, IV), paresthesis of the right half of his body, abnormal EEG, hypertention, hyper bilirubinemia and slight angiosclerotic changes in the optic fundi still exists. Literature seems to point out that these disorders are some of the segualae of the vinyl chloride poisoning. 7. As there have been a large number of the manufacturers of vinyl chloride in Japan, there may exist many workers who are already poisoned by vinyl chloride. 8. Among biological effects of vinyl chloride are Raynaud's phenomena, acroosteolysis, sclero derma, increase of blood pressure, etc. And we think it may be very useful to make its toxicity clear in order to help reestimate the toxicity of all the doubtful substances. 9. MAC. of vinyl chloride in Japan is 500 ppm at present, but we think that it is too high and should be revised. -Cl'S1', -tt-C, i-eeAftHii1' PB?B29 (1934^) K, fltttitrfiV&ZXtoX, / -fttssttat&e.fch, -erase*:.-? fcatKHfii'S 11 ft bhK\.' 5 *ei8SS L -CUi otetaSUTl'S. *&, 1964^a>e>1967^ tz at*-7* U**U St* -CHfiSSIt7&16II]ffl0K#StS (1969^9 J3) <0 ffiMfC Magnuson'*w) (pitffl-ffc fc* Lxi'*##enR w j fc. -ea^-fs. a74ot#A.ibh.s is A MtxarnoB*. 8 aw. (27), SiiJsK: fijBE(30, *** (^SISS.S^) (SIS) ffiflEfc-ttffTFlSfiS; 23t (1959^12^) AJfl J: 9M<t^a*SXeattU 1960^lM^b fi-B-3fla5ffiftft*a*i: 9, Xge&Sfttt-tf. l^eot30~45S-fi`A'9. SH3 ~4*^aawfw*ctti.fi:. #. 3% t 5 e*: 1960^1^fi`?>19&1^3^*t?ttJ4^3 Utfc -o7-, 1970^efaBll>liXaffl" oaSLfcgWCH /-afe^e>Jxf-3,eoi,'!-C, *&ja&Sfifc b7c. *a|gfMt* LfcSMt 1 #e&#Lt#7c. I964*M JSeAEsL. #fl5fcgStt 8 Ji eilK tfcit. ^ita^56^seite*; Fig- i ife ^et-f-cea=eacroosw- olysls 'iiS* bhtci-')izi~%k%LX'.'Z. ` Li*L, 9-e**. 'Stto&iB; **Mc3tex*ASetS<Pt5i D! X- * S. -CA'ibTSt-f **$< ftofc. SEWg 197I^ei Dinman""i4) T&ffc k" ~ iStfcJi, &*>*< rtt-ofcat, 3#3&&;M-:7c 3SL-cv'5t> y ftiS-otWc. gitSO-CiBi t s&L-i )c4-> ea#SH7c. Li`L, fcatffl-CiiA&ffl" iiSH1" 7c. Jt*{g*&2fFfc-a7.:, I962^l%tfcA*6ffiieSa** J$fc<i8C<'>JtSJ;5efc9, ^JfiSEf&^e. PSflJ^ it, 7ct7c*, w / ~S$^l&&*IS7c>e;*;: BRtf. iSftSeaSJBftfitfci-jfc. S3S^4^aoi963^e it, i7c'ttlfii;^^,^.7jc<.'10^ -/i'ae&*LTWct**n9, *&ttjt& Jgoews^tiuai-?. J: 5e79. See-rtiiSB *&. jfctK&bfc. Sit+^StHi-eaj:j:5e*:-o7c. *AltSWf t: v* / t- - 7Sff*S!f <*7ce, *HJ5l5e^*Seoittgft; JK.'fit5ft<, ^H6.SttiH^*et. i 5eL7cat, %A'btktx<omsb #BfiSEaf2> fj Ji, >atg-?j$n 7ci6ft k' - ( 40 ) R&S 110745 387 Work history Diarrhoea, poor appetite Sleep disturbance Cool feeling of the fingers White finger attack ,60 ,61 ,62 ,63 ,64 ,65 .66 .72 (year) 1 1 1 111 %(23 y.o.) <28 y.o.) 1 -Si- 6 (month) (36 y.o.) Working as a cleaner of the Vinyl chloride |n hospital Working in the same factory, never polimerizing reactor contacted with vinyl chloride vapor ------------- ------------------- Sclerosis of the hands Several indurations on the hands Spontaneous pain of the fingers (r-11,1) Aero osteolysis of the fingers (r-n.I.K) Shortening of the fingers (r-n.I.HT} Hypertension Married ' ope in hospital Fig. 1. The course of the complaints and findings of the patient. U0 l964*P3J!K:&5i, *1% <o * -c-0Sftj:is fch. 5. bfcd*. ? -Cgtt.'iyiJgttS! n, 2: $<El L T v' * A*> w h. lb SSi^fiBfJUiS! t 5 cflcofc. t < cfisitnffifiSgottjiA; itteu &m<o , L, m&kmzhtz, ,N4UAeDARtcARCV'. JT *ittolE-e**n, tz. K-t?ftj4LeiatitEt6 6h,a:**r fc. SfltiftftBfftli. Table 1 OiSsOT?* 5. *. 2.3 mg/dl (jE#ft0.2- ' 1.0) * t* W air fc* V 0.4 mg/dl OEflf 0-0- 2) t, jk+'otsS yfflj4**SSb'0i^U EiSii.5. j4iE li 120-60 mmg, 130- 70 ramHg JJfjlti, CRP(-) ASLO 50 TOdd, RA(-), BSG 1 )t. 0r3ta& b"f BtIHfl 8, ^^468X10*, 8,600, j&Sl^ / -jKS&SK-7/!fi;eSfrn, ma:3.S3Sii!J ft, 16.2g/dl, 29X10*, HJ]Jl^rn12^0Sr, Efet3Sifib, ,e*lt8^&SKL.fc. 0^fii)5^45t?*ot. i> '} 9 u-f = -<?E, -y-y FS-(Ffri:'<Ofi!jlS4:fTfc5 k L-t0jSo fc. 1 fcl965^0SfCfiS: drf, 5/1200, 0Htt< itofcii, ^<o^oA.iij+sc'ajg3SfFa*`2 ~ 3nmigii>fc. lj>`U < ib^-c. #s*ii o', e>itfc)Sifgose tttzt^tz. *<d&ii,niigttwasu. Ea*Ej> bixtz. asn, m. ivjgK. <fcD, gJSfifi:j-9fc. ^og:^-Biw$5 4-ca 1972^7 ^fflffiODfft-CiiCD^O^n. *t-o#0L.fc#ig5ig)S*'Ee>h,5 (Fig. 2) . ^m<t->xap (Fig. 7), n. m, iv ($ntS4^S8S5<Df8iai5) Fig. 3-6oi^ot, ^oasaictis lSft$d*`j&LTt'*ffij5Uga&ibh.5 (Fig. 8). Ji^i^fFo^itoStO^i'-JSibibno. fi&Bf eSfbiJ2ib;h.fci.`. Li*u ft-eitiB$Olfft0teit 10 c/s. 50 pv ( 41 ) 388 /' / Fig. 2. Right hand shows transverse defects in distal phalanges of the second and the third fingers, and marginal defects in the distal portion of distal phalanges of the fourth and the fifth fingers. (21, the May. '64) ( 42 ) R&S 110746 389 Fig. 5. A thick-walled vessel is found in the corium. X2400 (May, *64) Fig. 6. A thick-walled vessel is found in the corium. X600 (May, *64) Body weight Red blood cell counts Hemoglobin contents White blood cell counts Platelets counts Bleeding time Coagulation time Sedimentation rate of erythrocytes CRP ASLO RA > Total protein 4 Alulwmin , Globhlin ^ A/G . Total bilirubin Direct bilirubin GOT GPT Alkali phosphatase ;^id phosphatase Thymol turbidity test 'Cholesterol Cholinesterase Wa R Urine Blood pressure EEG - V Table 1. Findings of the Patient April--May, 1964 57 kg (Height 163 cm) 468 x 10*, 445 X 107mm3 16.2 g/dl, 100% (Sahli) 8,600, 9,800/mm3 29 x 107mm3 2'0" 5'45" 8 mm (1 hr) July, 1972 58 kg 483 X 107mm3 103% (Sahli) 8,300/mm3 31.9 X 107mm3 3'30" 3.5 mm (med.) 53 *0 - O ^ (-) 50 TU. 100 TU (-), (-) 6.8 g/dl 4.2 g/dl ' 2.6 g/dl 1.6 2.3 mg/'dl (norm. 0.2--1.0) 0.4mg/dl (norm. 0--0.2) 15 Unit 8 Unit 3.9 Unit 2.7 Unit t -- -- (-) sugar (-), alb. (-), urob. (n) 120-60 mmHg(r) 1 130--70mmHg(l) i i -- (-) 50 TU (-) 7.4 g/dl 4.6 g/dl 2.8 g/dl 1.6 1.2 mg/di (norm. 0.17--0.98) 0.8 mg/dl (norm. 0--0.2) j 22 Unit 15 Unit -- !_ ii 1 Unit j 142 mg/dl J 0.84 dPH ! (-) sugar(--). alb. (--), urob. (-r + +> ' 182--104 mmHg(r) 164--94 mmHg(r) abnormal record ( 43 ) R&S 110748 390 lr Fig. 7. Right hand shows shortening of the second to the fourth fingers. (July, '72) lr Fig. 8. Right hand shows shortening and widening of distal phalanges of the second to the fourth fingers. (11, July, '72) ( 44 ) K.T. 3! ,, I l4ki r |lnHiUtl<i. Me Hi* 391 *.**WM^V,w>... vVAVV,*,' 0 Fig. 9 EEG of the patient; diffuse alpha wave in awake state and photic driving response are found. (13, Sept., '72) **i5W #W`&fr9, RJffttAing*3l'lfefM oh-fti.'. 4~ioc/s vytmma ojt* ^^SSaM'^&Hfc (Fig. 9). DlE^tiiiiSJllE (180-104 mmHg, 160-94 mm Hg) bhZ. KEjJOE-ettttKoBBfMtW'B* B5fS&3E*>' t Table 1 o *> t> T A 5. &OSS, A+fS^fyatfr (1964^5^) fti'-C li*y^v: & t` y ^ x 1.2mg/dl GEffiiiS 0-17- 0;98).'jgfc'y*fc-x0.8mg/'dt (JEISCo-0.2) , bfc. X^USigii* ->fc< Ee>*tfc tz. % \if 1) E&-3V'-c;,giifgffct*=-^l^ SIel&4fF3*Jira&$L.Xii9, ~bo$& 8tf*ft3SBSfiiJ|i 0 1 ^r130#J-i` b 3 <* o fc Itjg ft 5. Dinman ip ,2> <0#^!;: J: Jti, gft - -*S&fiFmxft* LX\'Z3 5. Oil g<3? 2S*ew/-a**#*ffia!E fikicMh>Ll'i<016,y't'fc,ys fh i i ^ SjiOT&i-fii:# lt t' fc (> on* Wilson"tgfLfc'--^$i;iJ8-e& tfc3io^ffin-fajs)(?jgjB*o 5 fe27i;a-&goijr mmtciz* n am ui'fcto^efcisfiu -Ct'5. ffi&<0O&ft t`- "'i'-3 V'-C is. .asji'.ustrfcs&i.`cv'fc^aaottfflitssfts-t i'trl'firt'i', ViolaW) [ifit^'^F'3S(t fx jSy* 200 - 2,000 ppm ^30#i`^^ER-O^-OSH' a; iso ppm UT-efti*^My`isUToio#flS^ mt fcjso^ff^er i967^UKtci44rjafcEifc OPXfctfli, #rt:tr**+R3|ftL-C. ft (t'c =. -- A'jt/ t --if 50 ppm iUTi^ LXa>5>fF3l6 *2&&41t::Aft5.t?H-TS**L-C, ^KfSJJR Gitsios1" :i^LXl'2>. Kramer ^"'[iftftfc*= UXV'fcD 3Ka*&!L, 3a*`# ?? 2 iS IS? (TWA) e50ppmUJ;O*Bt5M-fc##*-c, && a'W<a:scffioXBSP, 2/IS:. jMaUc#L-ct' 5^t^(ha>iiLXV'. 2) : 1. .^<01964^3?- O xMt?(i5) Mfr ZZftbr'.Z (Fig. 2). i972po^oxaiftT-}iS^ ogr n, m ( 45 ) 392 TO, isJ:0'SSlVSO5fefflOSe*'*E4&ibK5!S*'. (Fig. 8). cH i, &m<offlh, 8Er. * ut:#ssjgiaKaiff-t5i,*e. #JS -c:t* ua*-j fci*.. ^un* c 4 -eji b i'k%*.bhZ. ZHbOltagltft Wilson ," fC-t =.-CfftfcSHfcy*&JSgi: i < SHtlLXV'S. "Wilson tfcA`*'frigifttEe>h.4V'ii^t'C<.'Sds Hards e> i 2ofltae9iM'c. 2 wt uiiMUB&fro 1 W-CiiKaE#K:, ftfiofiai-CitJgOspffi -|TiCflie)B*'-Efti!>lifciafiLXV'?>. Dodson bln 44*U l*-f;K4#JiriS*-e ft: < fillHi!S'SlJS*ISa> !?<'*. Viola1". [13 % -vu* / -r? v ^lcAS-fcSfet? 4'#'R%,$0f.aE`*, Basalaev175 P>fij 1216ppra Sffcfc',--/v-t/^-tf;*4;'>-y-<VccaA3 *fcgtf*mi-KR*s*6xi'. cKe.5tw Ka*` 13 C i am LX <-' 3. -fi-iffiS?*l* ipX> X i itcSfislt# 5< ft 3 C i ti Cheney ,w & i -e -c&fc s h*c v' 3 3 mtiiSfrWt?, JWM-4 k frcflElff# 4 B 3h3 ft * w emm*3M.nm{ f- - *JE &h,3 4 i tti'ft: 9 ftft: o -a. * 3. W a* &," ^frfcicifWe* W* - Sh.3. 2- P!)l?li$?Bft: v4 / -Sfcasgft ib It fc a**, Wilson 375 S3ri.3:&31'22lCW / -mSttSfe. Hams 3" & 2 0K 2 <JH, Dinman 3li,!l 4 0U41 4 ffjtc i"f / -m&fcfgifc'C'.'S. Snciu -'*'3frSSS168Ht? 6 fefcU-f -^S*S-C<-*3. *>a**IS-C4A&ffl5> **`S5h,fca^u-cv'. ufcA*o-c, aitf=- 9 &m&iz * < / -&&&. L "tV'3 kd'ibii' 9 , Cftlli&ftfc'- ~'<'4,;SSS:fs 4ft:Stt--?t^^bix, 4JjrJta'.gb ri.3. 3. *GJi?n, K^nt^Sfi:<:^;-iIffi v-3a**. fflifcfl9;fclJrJ!.l?tigSLS:iIEffi'?2> 9. Jtf&*&ftliEtf>3ri.-l`. BHCai&a:3L*M a'E 3h., 9J f,Acaa^iSiKtiftft: o 3*tfc. Harris e>* 4I^^S*I2L-CV^. Suciu ib1-" iil6S^50%f^&lffSft4-EA-CiJ 9, Wilson 3 lt^lfi-4SSHEOE*oKfc31ta e^is.fclFSarejf;ifc^HfcEi:'-*3. $3 1C, Harms b" 112B5Sii(5S"C, t'fhlirii ftJIEJS6)SrS*S%5*'C'.'o. Wi: Sffaib, ch-6fifeflf^Kafts:a-^4iS;iWa 691?, Li'i. a`fc98&ffiUiam-f3^S-o4: ^iLbix. ^Si!!^-%':ciiA'`J^iod,3. 4. S^1964^S^J!iliifh^fi!3[^3:i:-a!:f7i: y /n^y^iSIB^LXV'4. .S^:il6^i: tSJS u-c g^asa lt:vis Kai^Siiia f u /u t* vifiiffislftfflicSE < 1 k. 9, ix^S5f y a- f yjaa 4, m^Siaft: foR^Bif^jS'* E 3 H f. 5F%^(Sftn?^3i**t <iiftfltfiE3nft:V' -e, cj(iilt*9^t*yffliffiiti6ac%Fgtffiat atct>fo<*< 4it#A.i'fcV`. Harris 34>4ailj^ t** - k *k bn3 affiwoaasoEwai: 1 nS.SE{tSfy /uf vja^^E"Cy'3. Suriu3-" b 4Sftt'--^a^fT?*l684> 30.2f ;i!?!S3S **S*'C'''3. Kramer 1,5liaftf #H'4c, BSP, KJSi''55<^^'C'-'3ci4r E4e>"Cy'3. Kf&SSSfcUH. Torkelson biKi' 200ppm HC< 9JSL-SSL- fc3gi?. JfK^.C.'iS:tt$iiSFmfl:^*?5rEJ6 CV'3. fcLh*' - 9 f' - t 'f7 Sttoj^iOSojcV'. 5. .figictl, 1972^gIiE. S5i&EiSSJf?3gS Efti'*E5.h.3. Harris ib4,Sffl Cl'3 Ci:, Basalaev b17' 3 c I'lCr.-J 12 ~ 16 ppm 9SU53 Ufc^^ t?, i3i7 K n y vifiiS-!?iSiiE^4rEa 'i>5: t. Kramer ejl"liaftt`--^*"^iC$-< S3SivC ','fc45li"fiffliSlE, SbSifiEEi 4:cSi< ft:o*C',*3c t^rE^-CV'Scift:i'C^*`3. :ii%`HS ft b"-- oK4 C<- 31.' o b h.3. R&S 110750 ( 46 ) 393 VUbbhb. J8fr#^lM&??gffittJBs*i: *&.bitSi's mz.bh.-f, *Bi`6liMKto*fc*i`eW* *!*a4oSSJia. JBffiBf^.-ettflpftKiSKO'i A-tt aat*5>h,, ftSdStici 0^iA,ffio3eSSi*` 5. 3) *Efii4fc5fi*ffitttSZWi<>'-' *Lt*ai, Suciu S9Cf$SaoiSitS -1, jfttfaEtta&ogito*** la t t|od< BQH* SJ-Stt^ag Basalaev lb1" It tttesea-e, SSt Kvts U585l, asSBEa-e^Tffirc^Lt'gftaiEftp* hsetA'b, fcfltT $ ibt*;h,a;#g: fc4r4fc&-t'*jfC.'3. Dinman P>U) 4 40^4 < trb-6 ^aofi5JSi#i-Cv*5. 3 L,fc#Ktt*jMiSs wC4Wlc*riB-(#!>, 3 ilcJ:-a ftfcSM4 < mU 5 5Z>Xlifi'A>&ZX. bh S. A><LX, H*5-f*&S-?ffc&,iiTfi8 fi >v * t 9f 5 h *. 4) S^!-QV'-C; Danziger50' &<0q`<01tx<0&i&&frmU mitt'--*90%, CO8.5J& B-ry'WffiK, <r -#(!! Sitfcifc ft L -c i* 5. Gitsios"> Wftk'=-^S&&>ltifeftfc'=- ji # /-/u, jHilBE, bisphend A, -mtBtx, pvc o^^airaaiJtsA;. attt'* -/!*./ -v-jJ'4p 41i^"0& 5> X I' 5. Kramer1*' &ta'4l& 4 tc-Hz.\&&{tt* & ~ /u -CfaiiStOiaffct'- y 7* x^^*ix.-CV'5ii!E'<-Cl> >. Viola10' * Basalaev1" S&Ssa*&4JSffcfc' = HoaW4^ttoJtSt***9. 5) >&{t t* = - ^iS|SO^Ki1960^1f 12*fct'278f-1 , I965^taiisa-C446f-1, 1969^1ii 17am-1047 ^ t-c^ofc1'. ajia^aii, i962 ^a*e> 1964^;A'ft"CiK'F4'i''* -f 4 i- bft'<fa~9] 9 A'A. ip h77 '/ l* 4 jfcMftSJxfc1*. 5 i^S5JP^ *ao^SLi:^<ao4'T?. <agaii+S5S^ofi Kto*`+-*-afc l. -- X 10 a*Jftlu-f / -a*)4**^L-Ci.'5iU5 1954^.&fflJ> OftftRl -a "C 4+# 3 i*a** 5 i** eta. S5>1. &i;iSG''<'l.'51961~1964^B ft*tti5to`64. OlS*i(t)S*`ff3!8SaKisv-ci?g>4 t#jtl< Dodson bi,llt7 A ') *idsl-C4, 1968*Fi ft t* * - U'4>S.aai$ UTV'Sitl.-a'5. tfci`~sT, tohtoiilt fc*iHici.-\.'-c4Offieit|SIo*06Afi:-et''Cv* X^m^A^'jtz^Wi^A'ii.A'iZiiiA'ta 0 v-^T3gfio *&!.' *igjaLfcb'. -tbt. JgS*iifcA,tjfi +S?f:&f*3i.`t:*fce>-f. fcSfllTfl-H* S4ri4fl:'tiiR-r5TiIiEtt4*aftis!>i, 8*4-o4 <0t*HbhZ. 6) to^aafttf-/i'ffsasiassooppm ZhXl'ZA'`, Kramer bmiiS^M*55t-aftf-A-O#**iMI|fflr*W-e60ppmi.fe. *E #. BSP #jfittr.fl&. KSE&oJ^ft;^ E#>&it*i:*L-C**l>. Gitsios11' ffift&i J?ftatMA'Sftett SOppm KTCLT, ^=m 4rii-s-Cl'3iffb*Cl'5. Basalaev P)1"li^ SSSt? 12--16ppm o< 9igLSSfpt, jUl+T K ('!! yoits, JiiE^a'H-KRa:ff4rSt t'5. ite>5fifsfi`ip4^^Hfi:Saffi 500 ppm l!S5i-r5t-?fW*i-jSi%i5. *t a1 r 1. iti'P-f / -a*tSMfc&**g c, ft*ott1HU4lfM*. f^*nJ*J:0'. t it&MStt4r^WUfc. 2. aft^*-/i'^gisaf#;fi>4^ iMS^U-CVfc. *--9tt^3El*Kioir30 ~45frA*A> 9. &0 3-4&?J&f&ljfUtW. 3. ffi^Safff3liSe3fi"5 5 l*-tTm *+<&<>. A.,taiti:K*t. isfd*^^. xW-cBira**C6 h*. a#itftjff^tasafflttiEiffe* s is HtoBKHrtK**i!E bh tz. ( 47 ) R&S 110751 R&S 110752 394 4. 9, *-ArttM4<wffifli <-#L-c \.'%zbt'b. 0llo#S||*4aftf=-/i'KJ: #?&fffli, *J:iM'OJ8fFi3Co#l . RttSSJS. HlfilE. Ktfpsufy**. effioSSSK 6*1,5. 3ftfc*0H-t7*gfC-C 6 t-C4>#o^jS^oBTlg^ 6- fc*`Soffl<hfa-S& 2fits 9, **e*LT#fc##%Mtls:OHr&. i*o-C offlfefefr 4 b -CttteK. 4 t-c v' 5 rT *$*** 9, toWSrfcMBlcH &*> **.6*1.5. 8. ffl*fcf-~^*pJli|HJ?jftSElill?500ppm Tf* 5 5 A*>2& 5. **?*.$ CHS fc 9, r*i*fcv*il:!((#eflS. *JII#*. S, ASMSH. **. fc*KMjt;, RM<s^>fc#,fc &. ujaate, STa^oRifcscaa at t-r. fc*\ coSO*Blt47Ke^^*S*fe^'CJS *tte. X A-iS: 1) '<fclaasRi#fsi*aa:-ft^x*--a^wts SB. --224-237,1t^X3SHtt. 19704?. 2) *iSffiac(^aaaxBaffio*s, 33: 1--22, 1957. 3) Sueiu, I., Dcejman, I. and Valaskai, M.: Contribu tions to the study of affections caused by vinyl chloride, Med. Intern., 15: 967--978, 1963, (Ruma.). 4) Cordier, J. M., Fievei, C., LeFevre, M. J. and Servin, A.: Acroosteolyse et Lesides Cutanees Assoctees ehez Deux Ourriers, Affectes au Nettogage D'Autoclaves, Cah. Med. Travail., 4; 1 -39, 1966. 5) Sueiu, I., Drejman, I. and Valaskai, M.: Stude des Maladies Dues au Chlorure de Vinyle, Med. Lavoro., 58(4): 261--271. 1967. 6) Harris, D.K. and Adams, W. G. F.: Acroosteolysis occurring in men engaged in the polymerization of vinyl chloride. Brit. Med. J. 3 : 712-714. 1967. 7) Wilson, R. H., McCornick, W. E., Tatum, C. F. and Creech. J. L. Occupational acroosteolysis, J. A. M. A. 201(3): 83-87. 1967. 8) Magnuson, H. J., Dinman, B. D.. Cook, W. A., Giever, P. M. and Whitehouse, W. M.: Occupatio nal acroosteolysis: an epidemiologic investigation of a new disease among polyvinyl chloride synthe sis workers. Proceeding of the XVI Int. Cong. Oecup. Health. 621-623, 1969. 9) Dinman, B. D., Dodson, V. N,, Magnuson, H. J. and Whitehouse, W. M.: Occupational acroosteoly sis; a clinical investigation of polyvinyl chloride synthesis workers, Proceeing of the XVI Int. Cong. Occup. Health, 293--296, 1969. 10) Viola, P. L.: Pathology of vinyl chloride. Proceeding of the XVI Int. Cong. Occup. Health, 296--297, 1969. 11) JSfflKS: W /-Sfc**fcft*I*E*fiewe. an-CoSSMft). 12 : 457. 1970. 12) Dinman. B. D.. Cook, W. A., Whitehouse, W. M., Magnuson, H. J. and et al.: Occupational acroos- teolysis. I An epidemiological study. Arch. Envi ron. Health, 22: 74-82, 1971. 13) Cook, W. A., Giever, P. M., Dinman, B. D,, Magnuson, H. J. and et al.: Occupational acroos teolysis. II An industrial hygiene study, Arch. Environ. Health. 22 : 74--82, 1971. 14) Dodson, V. N., Dinman, B, D., Whitehouse, W. M., Nasr, A. N. N., Magnuson. H. J. and et al.: Occupational acroosteolysis. Ill A clinical study. Arch. Environ. Health. 22: 83--91, 1971. 15) Gitsios, C. T.: Acroosteolysis in PVC workers, Med. Bull. Standard Oil Co., 31(1): 49-56, 1971. 16) Kramer, C. G. and Mutchler, J. E.: The correla tion of clinical and environmental measurements for workers exposed to vinyl chloride, Amer. Ind. Hyg. Assoc.J., 33: 19-30,' 1972. 17) Basalaev, A. V-, -Vatin, -A. N. and Kochetkov, A. G.: On the 'pathogenesis of changes developing due to a long-term exposure to the effect of vinylchloride (Russ.), Gig. Trud. Prof. Zabol., 16 (2): 24-27, 1972, 18) Cheney, W. D.: Acroosteolysis, Amer. J, Roent gen, 94 : 595--607, 1963. 19) Torkelson, T. R., Oyen, F. and Rowe, V. K.; The toxicity of vinyl chloride as determined by repeat ed exposure of laboratory animals, Amer. Ind. Hyg. Ass. J., 22: 354-361, 1961. 20) Danziger, H.: Accidental poisoning by vinyl chloride, report of two cases, canad. M. A. J., 82: 828-830, 1960. ( 48 )