Document qa4n7LQzQmYjmoYvOay96XZLj

V. Observations on Man ALAD were cbaracteristieally lower in the workers who had been exposed to the Pb hazard from 10-19 yr, The latter was the ease; with fluctuations, in all 3 exposure categories so that -this difference can be considered of sig; nificance* 46. Cardani, A*,, and Farina, G (Utiiv. Milan, Italy): Profilassi del saturnismo mediante somministrazione dl versene per via intramusco^ lare, (THE PROPHYLAXIS OF LEAD INTOXICATION BY INTRAMUSCULAR AD MINISTRATION OF VERSENATE.) Medicine del Lavoro 61:220-6 (Apr), 1970., In 2 groups of workers in a storage battery factory, who had been employed for an average of 20 (10-35) yr without symptoms of Pb poisoning, the possibility of preventing Pb poisoning by im administration of CaNa^EDTA in low doses was examined. Group I (10) received the drug for a short time (100 mg/day for 3 days) in order to establish its tolerance by working personnel. Group II (14) who showed signs of increased Pb absorption (increased coproporphyrin (CP) , Pb in urine and stippled erythrocytes (SE)) received 300 mg/day EDIA in 3 ml 5% glucose injected im in two 5-day courses with a 9-day interval* The local and general tolerance to the drug and its effect on the urinary Pb excretion and several laboratory indexes typical of increased Pb absorption were evaluated. In 2 workers of Group II, the administration of the drug had to be discontinued due to the appearance of massive albuminuria in l and a typical Pb colic in the other. The remain ing 12 workers tolerated the treatment well. During the 1st course, the urinary Pb excretion was significantly increased and remained satisfactory also during the 2nd course. Before treatment, urinary Pb excretioii ranged from 60-360 |jLg/l (mean, 228) (14 persons), On the 5th day of the 1st course, the excretion ranged from 620-2400 jj.g/24 hr (mean, 1338 pig) (13 persons) ; on the 5th day of the 2nd course, the excretion ranged from 520-1150 jig/24 hr (mean, 930 jug/24 hr) (12 persons); 10 days after the end of treatment, the excretion ranged from 44- 226 jig/24 hr (mean, 139 jug/24 hr) (12 persons) . Means of the other indexes before and 10 days after treatment were as fol lows, respectively : CP, 120 and 30 |xg%; SE, 1883 and 133/million; azotemia: 0.37 and 0.36 g/1, and Hb, 81% before and 89?0 after treatment. The values for azotemia in the group of 10 workers (1st group) were in the following ranges: 0.28-0.52 g/1 before treatment and 0,26-0.50 g/1 3 days after the end of treatment* In the authors1 opinion, prevention of Pb intoxication by im injection of EDTA at low doses can be performed by the factory physician provided that the subjects are carefully selected and that during treatment the renal function is checked regularly, (15 references) 47. Cat ton, M. J,, Harrison, M.j.G*, Fullerton, PM., and Kazantzis, G. (Divisional Med. Inspector Factories, London, England): SUBCLINXCAL NEUROPATHY IN LEAD WORKERS. British Medical Journal 2:80-2 (Apr, 11), 1970, A study involving the nature of peripheral nerve lesion in man and the level of exposure at which subclinical damage might occur was carried put on 19 men (19-44 yr old, mean age 26.8 yr) engaged in the manufacture of Pb acid accumulators and exposed to Pb between 5 mo-13 yr. Five of these were found to have excessive Pb absorption and were suspended from work. Seventeen 21 S N37519 Abstr. 48 L&4~J <x a>J 'A* jVv \$Lip0 wv-* ct, C^^vr^>` V?<7> t^Tj V. Observations on Man Qi&cAsA IXofisik f, male hospital personnel (same mean age) without industrial pb exposure or neurological disorders served as controls. Of the 19 in the Pb-exposed group, hemoglobin (Hb) values in 7 were <12 g/100 ml; in 2, 12-12.9; and in 10, =13. Blood levels showed 7 with *120 pg Pb/100 ml; 6, 80-119; and 6, 4-79. Two had symptoms related to their anemia; 3 had a Pb line on the gums; none had symptoms related to the nervous system or any history of previous neurological illness. Hy gienic standards of the work area were found to be poor. Electrophysioiogical studies, carried out with standard techniques, in dicated no difference in maximal velocity of motor fibers or of fibers con tributing to the afferent volley in Pb workers compared with those in con trols; amplitude of the afferent volley and muscle action potential ampli tude with stimulation at the ankle were the same in both groups. With stim ulation at the knee, there was a tendency for the amplitude to be smaller though not significantly so, in the Pb workers; however, when this value was expressed as a percentage of that following stimulation at the ankle, the ratio for control subjects was 94.5% and that for Pb workers 85.1%, a highly significant difference (P<Q.01). It was concluded that minimal nerve conduction defect existed in some of the Pb workers which was probably related to duration of exposure and degree of anemia present. However as previously reported for anemia (Abstr. No. 148, Vol. II, 1966) there was little relationship with the blood Pb level. Since their study was only on 1 group of workers so far, the authors raise the question whether minimal nerve damage can occur in those exposed to concentrations of Pb currently considered to be acceptable. However, in the absence of clinical effects, it is unlikely that this will necessi tate any significant change in the standards. (18 references) 48* Fullerton, P.M* (Middlesex Hosp*, London, England) TOXIC CHEMICALS V AND PERIPHERAL NEUROPATHY: CLINICAL AND EPIDEMIOLOGICAL FEATURES* Proceedings of the Royal Society of Medicine 62:201^4 (Feb), 1969* / Only those substances which are, or have been* a hazard in industry are reviewed. They are defined as (1) peripheral neuropathy predominant; pb, acrylamide, organophosphates , Tl; (2) CNS involvement predominant: C di** sulfide, methyl Hg, methyl bromide; (3) only after gross overdose; As, trich1oroethylene, tetrachlorethane, 2,4-D (d ie hlorophenoxyacetie acid), pentachlorophenol, DDT; (4) other systems more affected: C tetrachloride, CO* All drug-induced neuropathies have been excluded except to illustrate some general principles. Criteria used for establishing metabolic toxicity were: characteristic clinical features (ie, wrist drop and Pb poisoning); relation to exposure, individual susceptibility; time relation; reproducible in animals* Criteria used for implicating an immunological mechanism in the production of neuropathy were: clinical features with abrupt onset, asymmetrical, other allergic manifestations; unrelated to dose. Examples from the literature are given and discussed. In relation to Pb, it is stated that as a result of high standards in industry today, most cases of clinical neuropathy are either a result of accidents or are due to new substances* However, it is important to con* sider whether workers exposed to low levels of known toxic substances may develop minor degrees of peripheral nerve damage insufficient to cause any O symptoms or signs. This problem has been discussed by Davies (Abstr* No. > 41, Vol. Ill, 1967) in relation to other aspects of Pb p o is on ing^^Pfeltm- x 22 DUP050044021 v. Observations on Han Abstr, 49-50 inary findings in an investigation by the author Vs Group (Abstr. No, 47) describing electrophysiplogic studies on peripheral nerves in Pb workers are discussed in some detail,. These were explained by the fact that cenduetiqti velocity was reduced in only a few fibers which would not affect maxi mal velocity; however, the potential would become more dispersed the greater the conductance distance and thus would affect the ratio. In closing, the author raises the question of the degree of exposure that can be accepted as tolerable, since with increasingly refined methods it should be possible to detect damage, not causing any clinical effbet, by a number of substances. Decision must be made whether this matters and what standards are possible in economic terms, 49. Fusco, M*, and Rossi, A, (Univ, Naples, Italy); II ve t torcard io- gramma uel saturnismo professionale, (VECTORCARDIOGRAPHY IN OCCU- >vV> PATiONAL LEAD POISONING.) Folia Medtea (Naples) 50:921-33 (Dee), /-/i 1967* !V . '/ Of 20 patients ranging in age nrom 19-70 yr with clinical and/laboratory signs of Pb intoxication, 15 had\normal EKGVs and blood pressures. However, all 20 had abnormal VKG (vectorcardiography) results as evidence of myoeard* ial impairment due to Pb intoxication, Laboratory findings, tabulated for each patient, together with occupation, blood pressure/ EKG and VKG findings, : were the following: Blood Pb, from 30-102 pg%; free/erythrocytic protopor phyrin, 12-269 jig?.; urinary Pb, beforeNDTA, 40-600r4nd after EDTA, 138.7-1584,7 pg/24 hr; urinary coproporphyrin befpre\EDTA, 30-:438, and after EDTA, 25-805 ptg/24 hr; urinary Al a , 1.7-5,4 mg/24 hr;\stippl4d cells, 300-650/million; sideremia, 80-135 pg%. The vectorcardiogMphic data were found to correlate well with the results of the laboratory anaMses and the ages of the patients, 50, Great Britain Department of Employment and Productivity: ANNUAL ; REPORT OF HM CHIEF INSPECTOR OF/iACToklES, 1968, London, Her V Majesty's Stationery Office, 1969, llsXpp, The annual report is presented under/the following headings: The general inspectorate (organization, training, proceedings,, services); safety, health and welfare activities (new and projected legislation; advisory and super visory councils; committees for specific industries and processes; education and training in safety, etc;' international activities); particular industrial hazards (chemical technical developments, explosion and fire, construction industry, electricity, dock york, new techniques and processes); the work of the medical branch (surWys, occupational cancer, toxicology, medical laboratory, medical exaraii^ations); statistics; appendices (includes detailed statistical tables). / \ In the section on tox)4ology in Chapter IV, the problemVof Pb poisoning is Covered extensively / There were 107 cases of poisonings during 1968. The number of Pb work/rs examined under the Lead Processes \(Medical Examina- tions) Regulations totaled 48,496 (42,118 males; 6,378 females) with 182 suspensions or transfers. The number of hemoglobin (Hb) determinations made and findings were: 50,937, ^13 g/100 ml; 2366, 12-13 g/100 ml; 327, 11-12 g/100 ml, anp 47, <11 g/100 ml. Four cases of poisoning are described in some detail to Illustrate effects of Pb: (1) Male, age 27/intermittent ly employed as a burner on demolition of bridges; history of 3 wk of nausea, loss of appetite, abdominal pain; Hb 9.4 g/100 ml, presence of stippled cells (SC), serum Pb 92 p.g/100 mi (thought to be probably an error) ; urinary 23 DUP050044022 , (57*r V, Observations on Han Abstr. 56-58 : 60 min, 3-9 and 12-24 hr after libation of the artery. For the determination of the effect of the operative intervention and narcosis, the elements were determined in above tissues of 25 rabbits with experimental myocardial infarct after ; administration of pituitrin with thrombin, and in ;33 rabbits 6 and 24 hr after im administration of ^lO OAOTi/kg or 0 . $ mg adrenaiin/kjg. As stanmarlzed, a decrease of practically all elements occurred in the blood during the 1st 6 hr af ter myocardial infarct, and an increase in the heart and aorta. This is considered as a gen eral reaction of the body to pain and hypoxia, and is probably of a compensatory nature. Similar changes were seen in rabbits after administration of ACTH and in the transitory form of ischemia, with microfocal necrosis. The concentrations of Pb did hot change significantly. There was some decrease in the content in liver, kidneys and pancreas. Hie concentrations in plasma and eryth rocytes during 'and 6 wk after myocardial infarct were 14-18 vg/100 ml and 84-96 vg/101^ cells* respectively; during transitory stenocardia, 7,5-8%31 and 75-79, respectively. In athero sclerosis, plasma and erythrocyte Pb levels were 17.$ and 84.1; in the heart, traces were found in healthy and necrotic portions; in the liver, 29.3 ug/100 g wet- weight; in kidneys, 10; in pancreas, 22.2, (13 references) 56 Berman, 8. (Cook County Hosp., Chicago, 11) ; DIAGNOSIS OF POISONING, Journal of Occupa tional Medicine 13:14-8 (Jan), 1971. In her discussion, the author points out that diag noses of poisonings are best made through the co ordinated efforts of the examining physician and the laboratory scientists. While >50% of the poisonings seen today are diagnosed On the basis of presenting signs and history of exposure, vari ous instrumental applications and refinement of technique have amplified the laboratory's role in these diagnoses:. Hie clinical pictures and an evaluation of analytical procedures of various poisons (pesticides, organophosphates, solvents, and heavy metals) are briefly described. Concerning Pb poisoning, mention is made of an exposure that is seldom recognized: that of ex pert firearms men who are exposed to Pb fumes and dusts wherever guns are fired, and of evidencetechnicians who use a mixture of Pb carbonate and French chalk for dusting the scene of a crime for fingerprints. Atomic absorption spectrometry is the current method of choice for determination of Ph in biological materials. Attention is called to the changing concepts in diagnosis of pb poisoning, eg: of blood Pb levels, from 80 |ig% considered normal by Kehoe down to 25 pg considered with sus picion by Selander; in respect to so-called signs . of Pb poisoning (gingival Pb line, basophilic stippling, and other indicators (urinary coproporphyrin, ALA)) which are seen in poisoning by other metals and drugs, or are considered question able. (12 references) 57 Dyck, P.J,: PERIPHERAL NEUROPATHY. CHANGING CONCEPTS, DXFJPRENTIAL DIAGNOSIS AND CLASSIFI 1 CATION. Medical Clinics of North America 52:895-908 (July), 1968. Peripheral neuropathy includes all diseases which affect peripheral nerve tissue* But since it is 9' J / difficult to know what disorders should be in- Is eluded, for many of them affect both central and peripheral nerve tissue, the author discusses the subject from the following points of view: Diag nostic investigation, classification of peripheral neuropathy, dorsal-root ganglion-cell disorders, peripheral-nerve disorders, disorders with predom inantly sensory symptoms. In most cases of polyneuropathy, special studies are needed to determine a specific diagnosis, especially when the polyneuropathy precedes other clinical manifestations of systemic disease. The tests to be used depend on what diagnostic possi bilities are suggested by history and routine determinations. Thus, for accidental, suicidal or. homicidal poisoning, measurements of urinary Pb, As, Tl, and Hg are important. The classifi cation of peripheral neuropathies can be done in several ways (basis of their courses, predominant symptoms, distribution of nerves affected, nature of pathologic alterations, type of myelinated fiber ij degeneration, etc)* As an example, segmental demy- j elination is a predominant feature in Pb and diphtheritic neuropathy* However, the author points // out that the ingestion of enough Pb to produce neuropathy is relatively uncommon today, (45 ref erences) 58 European Economic Community Commission: Raceoraandazione della Commissioiie del 27 luglio 1966, rivolta agli Stati raembri riguardante il control to sanitario del layoratori esposti a rischi particolari* (Cazzetta Ufficiale delle Community europee n. 151 del 17-8-1966) (66/464/CEE). (RECOM MENDATIONS OF THE COMMISSION DATED JULY 27 * 1966, APPLYING TO MEMBER STATES, CONCERNING THE MEDICAL CONTROL OF WORKERS EXPOSED TO SPECIFIC RISKS, (OFFICIAL GAZETTE OF THE EUROPEAN COMMUNITY NO. 151, AUGUST 17, 1966) (66/464/CEE).) Securitas 55, No. 1:59-62, 1970. The recommendations of the Commission of the Euro pean Economic Community (EEC) are aimed at a uni form examination schedule in the participating nations despite their different industrial develop ment* A table indicates: (1) chemicals to which workers are exposed, (2) production processes in each type of industry, and (3) the intervals at which periodical examinations of workers are to be made in each type of industry, Workers engaged in the manufacture of Pb and Pb compounds are to be examined every 3-6 mo; workers in TEL manufac ture, weekly; workers in the blending of TEL in gasoline, every month, and workers engaged in clean ing and repair of gasoline tanks, every 3 mo. Work ers engaged in the manufacture of F2 nnd F com pounds are to be examined every 3 mo. Listed sep arately are skin and bronchopulmonary diseases and other conditions caused by contact or inhalation of irritants, occupational infections, and physi cal hazards in Industry such as caused by atomic radiation, noise, etc. TO realize its objectives of greater safety, the Commission recommends immediate legislative, ad ministrative and other steps to be taken so as to make conformance to its schedule of medical super vision in industry obligatory for all member states 13 DUP050044023 Abut** 59-63 Vi. Observations on Nan tip l*tct than 2 yt from data of this cpinmunlcatlon 59 Goldberg# A, (Univ. Dept, Had. Gardiner ii Inst,# Western Infirmary# Glasgow, Scotland) r II JM/0 POISONING AS A DISORDER OR HEME StNTREIf SIS, Seminars in Hematology 5:424-33 (Oct), 1968, The review begins by pointing out that it seems paradoxical that diseases of such diverse etiology as Pb poisoning and the porphyrias should be com pared, It is known that Pb poisoning existed in the time of Hippocrates whereas the porphyrias as diseases have only been recognized within the past 10 yr, The fact that many of the clinical manifestations of these 2 diseases can be explain ed on a neurogenic basis is of importance to the pathogenesis of both of them, Pb provides the only means yet known by which an experimentally induct disorder of heme biosynthesis can be elic ited in animals* While at the same t ime causing clinical and histopathoipglcal manifestations of a disorder of the nervous System, These and other facts led the author to define Pb poisoning as a disorder of heme biosynthesis and to compare Pb poisoning with the clinical# pathologic# and bio chemical aspects of the human experimentally^ induced porphyrias, in presenting his review, the author then covers the following details: (1) Clinical comparison between Pb poisoning and .* acute intermittent porphyria# including neuropatho-|| logical features; (2) biochemical features (urin-r f ary ALA# urinary porphobilinogen# uroporphyrin# and cppropprphyrin (CP) , sequence of urinary ex cretion of ALA and CP, fecal and blood porphyrins in inorganic Pb vs organic Pb poisoning); Pb poi soning in childhood; heme enzymes (ALA synthetase, ALA dehydrase# heme synthetase) 5 mechanism of in hibition of heme synthesis by Pb# including rele vance of disorder of heme synthesis to neurological manifestations in Pb poisoning and acute porphyria, 60 Goldin, A,$,, Magno# P. J,, Kauffman, P,E,# and Coats# G,X. (Publ. Health Serv.# Winches ter# Ha) : MEASUREMENT OF THORIUM AND DAUGH TER PRODUCTS IN TiSSUE: EFFECT OF TIME ON THE RESULTS. Annals of New York Academy of Sciences 145:654-9 (pec 11) # 1967, A procedure for tissue analysis of Thorotrast patients and data on 2 autopsies are presented. If samples are to be measured quickly after col lection and repetitively over a period of time, nondestructive y spectrometrlc analysis is essen tial, In the Th series only 20**T1# 228ac , and 2l2pu sufficient y radiation for direct meas urement, By subsequent measurements over a period of time all the nuclides except 232x0 may be deter mined by calculations from the 208x1 y line. After all possible Information from y spectrometry has been obtained the samples may be ashed and 232th, 228ga, and 228th determined chemically. Problems involved in quick examination of biopsy, surgical, and autopsy materials are discussed. The routine use of blood samples from patients receiving whole-body counting is proposed, 61 Haeger-Atonsen, B. (Univ* Lund, Sweden): AN ASSESSMENT OF THE LABORATORY TESTS USED TO MONITOR THE EXPOSURE OF LEAD WORKERS, British journal of Industrial Medicine 28: 52-8 (dan), 1971, in order to determine Which laboratory tests are valuable for monitoring pb workers, 168 men exposed to Pb at 8 factories (78 at 2 storage battery fac tories, 72 at 2 plastics plants, 16 at 3 foundries using material containing pb, t who clean Pb gaso line storage tanks) were examined for pb, protb* porphyrin (PP), hemoglobin (Hb), And basophilic stippling of red cells (BSC) in blood and for ALA and coproporphyrin (CP) in urine. The 2 tank cleaners had been exposed to TEL fumes only 4 days; the other 166 had been exposed to inorganic Pb dust for at least 3 mo. The methods used were: spec-' trographic for Pb; Wranne^s (I960) for pp; HangerAronsen (I960) for BSC; Mauzerall and Granick (1956) or Grabecki et al (1967) for ALA; HsegefArhnsen (i960) for CP, ALA concentrations varied closely with those of Pb in blood and still more closely with CP (r * 40.85), A highly significant, negative correla tion between ALA and Hb was found (-0*35), as was a highly significant correlation between BSC and AtA in urine (40,65). PP in red cells unexpectedly correlated more closely with that of Pb in blood (40.50) than with ALA in urine (40,34), Comparison of these results with those of other authors is given and discussed* In summary, the author concludes that the deter mination of BSC and pp in red cells are complicateed and time consuming and therefore less suitable as routine tests in the supervision of pb workers# whereas AtA and CP measurement in urine are both satisfactory. Since ALA excretion seems to in crease sooner than CP, it is a more sensitive in dicator of Pb poisoning and can be regarded as the method of choice, all the more so because of the availability of an excellent quick method (Grabecki et al, 1967), Determinations of Hb and Pb in blood are good supplementary indicators for esti mating the degree of pb Intoxication but are sel dom needed in routine work. (57 references) 62 Hursh, j.B, (Univ, Rochester School Med, and Dentistry, NY): LOSS OF THORIUM DAUGH TER BY THORIUM DIOXIDE PATIENTS, Annals of New York Academy of Sciences 145:634-41 (Pec II)# 1967, The excretion patterns in man for daughters of 232jh injected as Thorotrast (Th02 in aqueous solution), were described. Advantages and dis advantages of collection of excreta and direct measurement of body loss and tissue or whole-body analysis yielding the ratio of daughter to immedi ate parent were considered. A special detector is described for measurement of 220gn in expired air and data for such loss in expired breath of Thoro- trast patients were given. Previous results in dicated that 212pjj may be excreted by Thorotrast patients. Because tissue measurements indicated an appreciable washout of from liver and spleen, movement of both Tn and 212^ frqXji the site of principal Thorptfast deposit may be assum ed , 63 jacobi# W, # and Martin, D, (Berlin, Germany): Regionale Abscheidung feindisperser Aero- spitelichen im bberen menschlichen Atemtrakt. (REGIONAL SEPARATION OF FINELY DISPERSED AEROSOL PARTICLES IN THE HUMAN UPPER RESPI RATORY TRACT,) Schwebstofftechnische Arbeitstagung 1970, Oct 14-15, Frankfurt, Main, 14 DUP050044024 V, Observations on Kan Abstr. 81-85 the bematoi^iWtio system; (5) Pb and the nervous system; (6) Summery, The conference reaffirmed the long-known fact that poisonings doe to ,,mDonshine,, containing Pb, pica for Pb-*cpntaiming materialand excessive occupation-* si exposure to Pb continue to occur. Points stressed were that (1) increasingly sophisticated methodology is being used to study the manlfes tations of excess give Pb absorption and (2) the best indicators of early response to Pb are being used* The state of % current knowledge about how Pb interacts with man and experimental living systems was reviewed, and needs for the immediate future were listed * $1 Thomas> P.K* (Royal Free and Royal Natl. Orthopaedic Hosp., London, England): PERIPHy ERAL NEUROPATHY. British Medical Journal. 1:349-52 (Feb 7), 1970. The Salient clinical features are briefly givenof the commoner types of disorder affecting peripheral nerves, techniques employed in their diagnosis* and general principles adopted in treats ment. Clinical features include: symmetrical neuropathy* autonomic neuropathy, and mononeuro*pa thy and multiple mononeufopathy. The following neuropathies are listed as causations: toxic (ineludes Pb neuropathy), deficiency, metabolic, in flammatory and infective vascular, nerve compresSion syndromes, neoplastic, and hereditary. The precise clinical features of the neuropathy fre quently provide a guide as to its likely cause* Therefore, a careful history and examination may narrow down the diagnostic possibilities and reduce unnecessary investigation by indicating the most profitable initial tests* When the neuropathy is due to some general metabolic disorder, or is of the order of nutritional or toxic, treatment Should be primarily directed towards the causative condition* (17 references) 02 Tsuchiya, K.: (DIAGNOSIS AND THERAPY OF fcEAD POISONING.) Journal of the Japan Medi* cal Association (Tokyo) 56:959-83 (Nov 1), 1966, This paper is a guide for physicians for the diag nosis and treatment of Pb poisoning. The- author discusses the difficulties in diagnosis and empha sizes that Pb concentrations in blood and urine are not necessarily consistent. Repeated estima tions of Pb in these biological materials may be required for the final diagnosis, sometimes with the aid of the EDIA mobilization test* 83 Drbanowicz, H., Grabecki, J., and Kozlelska, J, (Inst, 0ccup. Health, Zabrze, Poland): THE URINARY EXCRETION OF 5-HYDROXYINDOLEACETIC ACID IN INDUSTRIAL LEAD EXPOSURE. Medicina del Lavoro 60:582-6 (Oct), 1969. The urinary concentration of 5-hydroxyindoleacetic acid (HIM) was studied by the spectrofluorometric method of Kimura et al in .55 healthy people occu pationally exposed to Pb, and compared with a control group of 39 nonexposed persons. Of the 55, 30 (Group I) had been exposed to Pb concentrations of MJ.6 mg/m3 for periods ranging from 2 mo to several years. Group II, 25, had been exposed '''2,0 mg/m^; .13 of the latter for <2 mo, the rest for longer periods. Parallel determinations were performed of ALA (Mauserall et al)., coproporphyrins (CP) (Haegerr Aroused) and Pb (Jacobs et al), Samples of urine were collected at the 4 th hr of the morning shift. Airborne Pb was determined (Kogan) at the time of urine collection as well as over a period of 10 mo prior to the inyestiga- tion* The controls showed a mean HIM excretion of 6.16 * 2.78 mg/1. A highly increased excretion (mean, 17.17 5*45) was found in Group I (t * 10,7) and in Group II (t - 10,2 and 10,7 (20,92 * 7.54 and 19,72 A 5.30) in its 2 respective sub divisions). jHffei^ncM:^ timer and Pb concentration did not bring about signifi cant differences in the urinary concentration of HIM* the excretion of ALA, CP and Pb was also highly Increased in Group I; ALA 33,7 mg/1* CP 620 yg/1, Pb 277 yg/1, In Group II,however, strong con trasts in these excretions were found as a result of differences in exposure time* ie, <2 mp and >2 mo, respectively: ALA 13.6 * 10,5 mg/1 and 36,3 A 21.3 mg/1; CP 342 A 261 Ug/1 and 911 A 567 yg/1; Pb 108 A 69 yg/1 and 191 A 11$ yg/1* ' The authors consider that disorders in porphyrin metabolism need a longer time than 2 mo to be manifested by maximum ALA and CP excretion, while derangements in tryptophan metabolism, responsible for increased HIM excretion^ seem to have developed very early and attained their maximum expression within the first 2 wk* Therefore, increased HIM excretion may be used as a new laboratory index of increased Pb absorption. The mechanism of HIAA excretion is assumed to be the effect of Pb on monoamine oxidase* 84 Vahl, J*, Pfefferkorti* G. > And Rohling, H.J* (Uhiv# Munster, Germany): Sublichtmikrpskopische Untersuchungen am mehschlichen Speichelstein, II, Mitteilung. (ELECTRONMICROSCOPIC AND CRYSTALLOCHEMICAL STUDIES OF HUMAN SIALOLITHS. II. REPORT, Deutsche Zahnarztlicbe Zeitschrift 23, NO. 1:39-44 (Jan), 1968. Morphological investigations by means of electronoptical methods showed a change of density of crystallization corresponding to a zonal structure in micro ranges. Crysfa1lochemical studies by means of electron and X-ray diffraction primarily showed the presence of hydroxyapatite, plus small quantities of 0-tri-Ca phosphate and CaCp3. IRspectroscopy demonstrated a carbonate component. By means of fluorescence analysis, ca, Fe, Zn, Cu, Sr, Ni, Pb, Cr, Ba, Y were shown to be present above atomic number 20, (16 references) 05 Walsh, P.J. (Natl. Inst. Environ. Health Sci., Research Triangle Park, NC): RADIATION DOSE TO THE RESPIRATORY TRACT OF URANIUM MINERS A REVIEW OF THE LITERATURE. Environmental Research 3:14-36 (Jan), 1970. The title subject is reviewed on the basis of 47 references. The Rn daughters include RaB, H4pb; RaD, 210pb; RaG, 306^^, The reasons for the dif-. ferent results obtained by various workers who have calculated the dose are discussed, and the dose has been recalculated on the basis of presently avail able information* The relationship between exposure in working level months and dose in rads Is quanti- 19 DUP050044025 V, Observations on Man Abstr. 288-290 Administration and the owner is billed. To imple plicated impedence of brain hemodynamics with ment this program, the Bureau of Pb Poisoning Control changes in both white and gray matter. Therapy in has *200 people and an annual budget of $2,400,000, cludes iy EDTA to remove blood Pb and either urea In 1970, 79245 blood specimens were analyzed by or mannitol to reduce cerebral edema. Cortico the Health DepartmentVs Bureau of Laboratories, and steroids have also been used. Usually poor indus 2469 new cases were found; 2344 apartments were in trial hygienic practices produce adult Pb poisoning spected from which paint samples were taken, with and more time is required for its development. In 1564 positive results, and 967 apartments repaired, . adult* It presents a nonspecific symptom complex with low hemoglobin, gastrointestinal upsets, in 298 Cuinee, V.P, (New York City Dept, Health, creased ALA and cop*porphyrin in the urine, possi NY) 5 PICA AND LEAD POISQNiNG. Nutrition ble basophilic stippling and Pb lines on the gums, ,, Reviews 29:267-9 (Dec), 1971. and, with development, pronounced neuromuscular in-iy In dan 1970 the NY City Health Department embarked volvement. Blood and; urine Pb levels by q competent on a major drive against Pb poisoning:: (1) an educa laboratory are the most valuable diagnostic aids, tion program aimed at children, their parents, and The ALA Pb mobilization test can also be Valuable, the professions; (2) a detection program based on EDTA is the effective therapy, and in its absence, screening venous biood samples of children living penicillamine, (130 references) In lower socioeconomic areas of the city; (3) a housing repair program based on strict health code 290 King, B.G. (Bur, Community Environ, Management, provisions which are enforced. It is estimated that PHS, Cincinnati, Oh): MAXIMUM DAILY INTAKE *129,000 children (1-6 yr old)living in *450,000 sub OF LEAD WITHOUT EXCESSIVE BODY LEAD-BURDEN IN standard apartment units are exposed to the hazard CHILDREN. American Journal of Diseases of of Pb paint poisoning (associated with pica), with Children 122:337-40 (Oct), 1971. 6000-8000 of them having significant blood Pb levels. A total of 300 yg Pb from all sources is considered Since often parents are reluctant to admit or do not to be the maximum daily permissible intake (DPI) for recognize pica in their children, the program ap children. As the average intake increases above proaches this aspect by stressing exposure to deteri this value, the entire amount cannot be excreted orating housing environment rather than asking "does and accumulation in the body begins, increasing your child have pica?11 With this approach, the num progressively as long as undue ingestion continues. ber of children tested went from 10,000/yr to 10,000/ The DPI was established by an ad hoc committee to mo and detected cases rose from 727 in 1969 to 2649 serve as a reference base in developing measures in 1970, A TV program stressing the pica problem for prevention of Pb poisoning in children. It was is described. based upon the data available on levels of Pb in The value of 60 pg/100 ml blood was accepted as a blood of nonexposed and exposed children, including signifleantiy abnormal level, representing a border those with frank Pb poisoning; results of experi line of danger. This and higher values were found mental Pb ingestion by adults; fecal Pb output in in *3? of the children city-wide, and in some sec children; initial biologic effects of. increased Pb tions, in 5%, About 28% of the 3% have been admit intake (as related to blood Pb levels); rates of ted to the hospital where they remained from 1-4 wk. increase in Pb in the blood of exposed children, Of interest was the Shift in the distribution of and sequelae of Pb poisoning* blood Pb values as screening efforts expanded. In In the body of the report specific data are given 1969, *25% of tests were 50 yg while in 1970 only (based on statements by Surgeon General J.L, Stein- 11% were in this range. In 1969 children received feld, L.B. Tepper, J.J, Chisolm; publications by blood tests for Pb when there Was strong suspicion N.J, Robinson et al (1958) , R. A* Kehoe (1961), of Pb poisoning, whereas in 1970 they were tested Oiisolm et al (1956), BariCrop et al (1967), and if they lived in an environment which made Pb poison Marquette Department of Pediatrics report (C.J, ing possible. A 3rd set of percentages from children Haggerty et al, 1969)) for the following: Threshold where Pb poisoning would be considered unlikely is limit value of whole blood Pb indicating excessive being developed. It is hoped that in the future at absorption (MO yg/100 ml), values associated with least what the Pb level is in a normal individual, intoxication, mild and severe encephalopathy, and if not the normal Pb level, may be determined. The fatalities; estimates of ingested and inhaled Pb, ultimate solution to.the problem of Pb poisoning is taking into account caloric intake of young children the eradication of substandard housing. Until this (*50% of that of adult) and air exchange (6 m-3/24 hr Is realized, screening programs to seek out and pro for 1-3-yr-olds), and the other criteria given above. tect children in immediate danger from toxic Pb will The 4 tables included show comparative biological be necessary, measurements for children and adults; estimates of intake; data on experimental Pb ingestion vs blood 289 Haley, T.J, (Res, Triangle Inst*,NC): SATURN i Pb; increase in blood Pb as evidenced at intervals ISM, PEDIATRIC AND ADULT LEAD POISONING. Clin 1 between measurements as reported by Chisolm, The ical Toxicology 4:11-29 (Mar), 1971, \ latter is 1 of the 3 factors to be considered in A review is presented giving the biochemical and * evaluating Pb levels of >40 yg/100 ml : anemia (the physiological aspects of pediatric and adult Pb poi health consequences at any given level of blood Pb soning, along with accepted methods of diagnosis may be greater than those affecting a child with a and treatment. There are numerous differences be normal hemoglobin value); the increases in ALA, tween these 2 forms of Pb poisoning. In children, coproporphyrin and chelatable Pb which are exponen pica and Pb fumes are the usual causes of the disease tial with respect to Pb levels in the blood, so that which involves hematologic, gastrointestinal, and the margin of safety decreases at an exponential rate \neurologic symptoms, the latter including drowsiness, as the blood Pb increases arithmetically. coma, and epileptic seizures. Brain damage has lur 71 DUP050044026 Abstr. 474-476 V, Observations on Man centrations. Samples of soot from the walls of the thatched Swazi huts in 3 different areas (N, $, and central part of Swaziland, where different methods of heating are used) were also analyzed for the trace metals. Results showed that the Swazi snuff contained considerable amounts of Or, Ni> and Zn; American snuff, minimal amounts of Cr and Ni; spot, Mi and Or in larger concentrations than in American snuff. Pb and Cd concentrations in Swazi snuff, plant ash, and spot samples were lower than any of the other elements, pb concentrations, in ppm, were: Aloe snuff, 8; ubhoco snuff, 8; Amaranthus snuff, 6; Aloe ash, 39; Ubhoco ash, 164; Amaranthus ash, 42; N soot, 14; $ soot, 7; central soot, 14, Three samples of Aimerican snuff each showed a concentra tion of 4 ppm. It was concluded that since Hi and Cr in some forms ate known carcinogens, the associ ation between carcinoma of the maxillary antrum and snuff may be prevented if the source of the trace metal contamination is eliminated. (30 ref erences) 474# Rlanchard, R.L., and Moore, J.B. (Radiol. Eng. Lab. , Cincinnati, Oh) : BODY BURDEN, DISTRIBUTION An d INTERNAL DOSE OF ?l0Pb and 210po IN A URANIUM MINER. POPULATION. Health Physics 21:499-518 (Oct), 1971. Concentrations of 210ph and 210po in tissues (bone, liver, iung, kidney, spleen, testes, heart, muscle, pancreas, lymph nodes, small intestine, stomach, aorta, brain, spinal cord, adrenal gland, prostate thyroid, blood) from 41 U miners (28-73 yr old) and 11 unexposed individuals were reported. Relative tissue concentrations and fractional body burdens of each tissue were determined. The largest amount of 310po and 31Ppb in the body was observed to be In skeleton (*78%)> while important soft tissue reservoirs were the lung, liver, muscle, lymph nodes, kidney, and blood. Body burdens of the miners were 4-50 times those of the non-miners, approaching 33 nCi ^lOpb and 23 nCi ?1.0po; the latter was 46% of the maximum permissible body burden. The dose cal^ culated for 2l0pp to bone assuming an RBE of 10 and a relative damage factor of 5 exceeded in some bases the maximum permissible dose-rate of 30 rem/yr. In all cases, the doses to soft tissues were below the maximum permissible limits set by ICRP. Relation ships observed between concentration of 210pb and 2.10po in blood and various body organs are discussed. Results indicated that blood could be a reasonable index of these nuclides in the body. (37 references) 475 California Department of Public Health, Bu reau of Occupational Health and Environmental Epidemiology: OCCUPATIONAL DISEASE IN CALI FORNIA, 1969. Report prepared with assist ance from the Communication Service Center. Berkeley, California, 1969, 26 pp* This review summarizes 18,153 doctors* reports of selected occupational disease among 6.9 million workers covered by the California Workmen * s Compen sation Law. Reports of chemical conjunctivitis and burns (HO,000) are not included. Manufacturing contributed the largest proportion of the reports, 437.; followed by government, 14%; agriculture, 11; services, 9; transportation and utilities, 9; con struction and trade, each 67.. Agricultural chemi cals accounted for 727 (47.) of the reports, of which 9 were attributed to pb and/or As compounds as follows: 4 in agriculture, 1 each in construc tion; manufacturing; transportation, communication, and utilities; service; state and local government. Under metals and their compounds, Pb totaled 457 reports (2.5%), 70 of these caused by Pb: 2 in construction; 65 in manufacturing; 1 each in trans portation, communication, and utilities; trade; state and local government. Reports of systemic effects and digestive disorders due to Pb totaled 47 and 3, respectively, with total time lost from work of 26 And 2 days, and 15 and 0 hospitaliza tions, respectively. Of the 47 reports of systemic effects 2 were in construction, 43 in manufacturing, and 1 each in transportation* etc, and state and local government,, The 3 digestive disorder cases were all in manufacturing. 476 Campbell, A.M.G., Williams, E.R. , and Baritrop D, (Royal infirmary, Bristol, England): MOTOR NEURONE DISEASE AND EXPOSURE TO LEAD* Journal :1of Neurology, Neurosurgery and Psychiatry 33, No. 6:877-85, 1970. In this study the authors determined the incidence of bone disease and of exposure to Pb in motor neu^ rone disease (MND) and investigated various aspects of tissue Pb concentration. Patients (100) showing wasting, weakness, and fasciculatlon of muscle, with or without physical signs of an upper motor neurone lesion and with no sensory loss, were stud ied. Of 74 patients (51 men, 23 women, mean age 55 yr) seen after June 1965, with a diagnosis of MND, who were interviewed, 23 (32%, 20 men, 3 women) gave a history of Pb contact (5-64 yr duration)* These were divided into 2 groups: (1) severe exposure (9 men, 2 women), (2) slight exposure (11 men, 1 woman). A control group (51 men, 23 women, mean age 56.2 yr) indicated 12 (10 men, 2 women) with slight exposure to Pb but only 4 (all males) with severe exposure. Slight exposure Was equally common in patients and controls, but incidence of severe ex posure was sharply different. The difference, 15% as against 5.4%, was statistically significant (p <0.05). Of the 11 patients with major Pb contact, 6 had survived for >5 yr and of these, 5 showed a clinical picture with symmetrical, predominantly lower motor neurone involvement similar to that of the control group. The 5-yr survival rate of these 11 patients was 54% but only 16% in the 89 without major contact with Pb, Of the 74 patients questioned, 22 had sus tained a fracture at some time before onset of their neurological disease, and in 9 of these the fracture had occurred in the 5 yr before onset. Disorders of the axial skeleton were present in 10 other patients. Other implications of MND were incidence of gastrec tomy (4 patients), previous peptic ulcer (I), and poliomyelitis (4). There was no significant dif ference between the 2 groups in the percentage of fractures, but fracture in the preceding 5 yr was significantly more frequent in the patient group (p = 0.05), Disease of the axial skeleton was also more common in the patient group. In 15 of 16 bone biopsy specimens (25 patients seen after Jan I960 and who died before 1965) osteoporosis graded slight to severe was demonstrated, possibly being a skele tal response to muscle wasting (Foyle et al, 1970), However, in 3 patients osteoporosis was demonstrated radiologically before the onset of MND, To explore possible environmental infuences on tissue Pb concentration, blood Pb levels were esti- 122 DUP050044027 V. Observations on Man Abs.tr.. 477-478 tasted in 12 patients and were compared with those from husband, wife, or (in 1 case) brother. Although X patient and 1 control had levels >40 pg/ml, the upper limit of normal (Lane, 1968), there was no significant difference between the means of the 2 groups.' In a preliminary study of bone Pb concentrations, iliac bone biopsies from 5 patients and 4 age- and sex^matched control specimens obtained at necropsy and analysed for Pb content, showed equivocal results. Because of this, an extended study of bone Pb con centrations in later patients was carried out and valises found ranged from 8-3500 yg/g Ca in the MND group and from 9 **1800 in the control groups. The populations were markedly skewed, however, so that the upper limits were represented by few observations in either case and mean values were almost identical (415 and 410 yg/g Ca, respectively) There was no significant correlation between bone Pb concentra tion and previous exposure in individual cases, al though in 1 case there was an unexpected high bone Pb concentration and clinical improvement with chelat ing agents. Of the 6 patients in the severe exposure group who were blopsled, 4 had had previous treat ment with chelating agents which might have lowered their bone Pb concentration. In 1955, patients were treated With EDTA and 4 oilier cases of MND were also treated at that time with no clinical improvement. Urinary Pb excretion after administration of chelating agents in 2 of 3 patients who had major contact with Pb but who sur vived >5 yr, was greater than normal. If exposure to Pb were related to motor system disease in these patients i it would seem that neither duration nor severity of exposure was critical in the development of the disease* Seven of the authors9 cases appeared to form a clinical variant of MND characterized by symmetrical predominantly lower motor neurone weakness, slow progression, and a history of major contact with Pb. Treatment with chelating agents Seemed to have alter ed the disease in 5 of these 7. In only 1 case Was there a past history of frank Pb poisoning and his disease followed a typical course. The case histo ries of these 7 patients are presented in detail. In conclusion , it is stated that:: (1) A statisti cally significant relationship between antecedent bone disease or fracture and development of MND was demonstrated, which supports a relationship between skeletal demineralization and development of MND, (2) Impaired absorption of bone mineral, which might occur in the post-gastrectomy state or in intestinal malabsorption, was not statistically related to the subsequent onset of MND in the patients. (3) Al though this study of bone Pb concentration was too small for final conclusions, there was no evidence that the total body burden of Pb in patients with MND was abnormal. However , this does not disprove the hypothesis that Pb may be an etiological agent, since a transient intense exposure may be responsi ble and yet would contribute little to the bone Pb concentration. (4) The study demonstrated a clini cal variant of disease of the motor neurone charac terized by symmetrical predominantly lower motor neurone weakness, slow progression, and a history of major contact with Pb, 7 of the cases falling Into this group. It is suggested that this Pb motor neurone damage is the same condition as Kinnier Wilson's amyotrophy of chronic Pb poisoning, (5) Improvement in raptor system disease seemed to have occurred in 5 of the 7 patients treated with chelat~ ing agents. In some of these, the exposure to Pb was not immediately apparent, and clinical features of this group as a whole did not seem to differenti ate these cases from those of classical MND. (6) In the absence of any present therapeutic measures likely to improve MND, therapeutic trial of chelat ing agents in patients with major Pb contact is justifiable* (34 references) 477 Djurid, D., Fridman, V., and Novak, L, (Inst, Occup, Radiol. Health, Belgrade, Yugoslavia): Etilni alkohol i industrijski otrovi. (ETHYL ALCOHOL AND INDUSTRIAL POISONS.) Arhiv za Farmaciju 20, No. 1:33^8, 1970> Since the consumption of alcoholic beverages is in creasing, the author reviews on the basis of 46 refer ences the effect of alcohol on occupational exposure to Pb, Hg, C disulfide, aliphatic alcohols, C tetra chloride, cyanides and cyanamides. According to ex perimental and clinical findings, alcohol affects the permeability of various membranes in the human organism. In some cases it increases the permeabil ity for a toxic substance (Pb), in others, it de creases (Hg). Alcphol also affects the metabolism of. Some toxic substances and vice versa. This could explain intolerance toward alcphol (Antabus syndrome) in expos lire to C disulfide, chlorinated hydrocarbons and especially in tetraethylthiuram disulfide, The necessity to consider drinking habits of exposed workers and the possible effects of alcohol in the presence of various toxic agents is pointed put. 478 Dukes, K., and Friberg, L., Ed.: ABSORPTION AND EXCRETION OF TOXIC METALS. Report from a panel discuss ion at the meeting of the Subcom- , mittee on the Toxicology of Metals, held-in Slanchev Briag, Bulgaria, September 24, 1971. Nordisk Hygienisk Tidskrift 53> No. 2:70-104, 1971. The panel discussion was concerned with questions on absorption of metals and questions on excretion of biological half-lives with much consideration being given to Cd, Hg, and Pb, In relation to gastrointestinal absorption of Pb in humans, Kehoe1s work (Kehoe et al, 1943) was cited as presenting evidence that the clearance of unab sorbed Pb from the gastrointestinal tract accounts for all of the fecal excretion. Following cessation of chronic oral doses of Pb, fecal pb excretion with in a few days was essentially the same as before ex posure although the body burden and urinary excre tion were still elevated. This was also found by Hursh and Suomela (1968) by iv injection of ^^^Pb to human subjects* In the balance studies reported by Kehoe et al (1943) the amount of Pb retained over 2 yr plus that excreted In urine equals the amount absorbed. According to Hursh and Suomela (1968), the amount of radioactive Pb excreted in urine for the 1st 24 hr Is proportional to the amount of ab sorbed Pb in the body, Miler, Sattier, and Menden (1970) were quoted as showing that the retention of 2Pb increased by 7-49% by increasing protein con tent of isocaloric diets of experimental animals. In regard to Pb in bile work by Caste!lino and Aloj (1964) showed a recovery of 80% of injected labelled Pb. Cikrt also commented on work in his laboratory in regard to cumulative biliary excretion by rats 24 hr after iv administration of 7% 2XOpb as ^lOp^. (N03)2- 123 DUP050044028