Annals of Occupational and Environmental Medicine

Volume 20 (1); March 2008

Case Reports

A Case of Trichloroethylene Intoxication with Neuropsychiatric Symptoms: Ja Hyun Kim, Seong Jin Ryu, Byoung Gwon Kim, Hyung Joon Jhun, Jong Tae Park, Hae Joon Kim; Korean Journal of Occupational and Environmental Medicine 2008;20(1):54-61. Published online March 31, 2008; DOI: https://doi.org/10.35371/kjoem.2008.20.1.54

BACKGROUND
Trichloroethylene (TCE) has been widely used as a typewriter correction fluid, paint remover, adhesive, spot removers and, particularly, as a degreasing agent in metal-fabricating operation. However, few studies have reported on the effects of TCE intoxication, in spite of numerous occupational accidents arising from TCE intoxication, even until quite recently used in small companies. TCE affects mainly the central nervous system (CNS) and is carcinogenic, even when carefully used and managed.
CASE
REPORT: A 48-year-old male worker visited our hospital complaining of decreased motivation and general weakness. In history taking, the patient had suffered insomnia, memory disturbance, stuttering, loss of interest and sexual desire, depressive mood for 4 years, dysesthesia with tingling sensation and pain in both extremities, and a nauseas feeling similar to a hangover which had been aggravated for 4 months before admission. The patient had been engaged in metal degreasing with TCE for 8 years. Electromyography indicated disturbance of autonomic function, but there was neither peripheral neuropathy nor cervical radiculopathy. Organic abnormalities including cerebellar atrophy and CNS infection were ruled out, while there was no indication of malignancy in magnetic resonance imaging (MRI) and metabolic disorders and electrolyte imbalances in laboratory test. The authors performed biological monitoring for the possible exposed chemicals. Urinary 2,5-hexanedione, a metabolite of n-hexane, was undetected but 3,331.1 mg/g creatinine of urinary trichloro-compounds, a metabolite of TCE, was detected. The patient was diagnosed as TCE intoxication due to a level of urinary trichloro-compounds in excess of the normal range (300 mg/g creatinine), in addition to an occupational history and clinical symptoms. TCE exposure was stopped in admission and the neuropsychiatric symptoms of the patient were improved as the urinary trichloro-compounds were decreased from 3,331.1 mg/g creatinine to 64.6 mg/g creatinine in 5 days.
CONCLUSION
Low-dose, chronic TCE intoxication shows neuropsychiatric symptoms, which are often misrecognized merely as a psychiatric disorder; its appropriate diagnosis, early treatment and exposure assessment are therefore difficult. The neuropsychiatric symptoms in workers who have been exposed to TCE should be monitored, detailed job history should be taken and biological monitoring should be conducted to gain early insight of chronic TCE exposure.

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Occupational Psychiatric Disorders in Korea
Kyeong-Sook Choi, Seong-Kyu Kang
Journal of Korean Medical Science.2010; 25(Suppl): S87. CrossRef
Occupational Neurologic Disorders in Korea
Yangho Kim, Kyoung Sook Jeong, Yong-Hun Yun, Myoung-Soon Oh
Journal of Clinical Neurology.2010; 6(2): 64. CrossRef
Occupational Neurological Disorders in Korea
Eun-A Kim, Seong-Kyu Kang
Journal of Korean Medical Science.2010; 25(Suppl): S26. CrossRef

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A Case of Goodpasture's Syndrome in a Foundry Worker: Min Gi Kim, Dong Hee Koh, Sun Wong Lee, Min Heui Jo, Hee Yong Yoo, Bo Yeon Kim, June Hyuk Lee; Korean Journal of Occupational and Environmental Medicine 2008;20(1):46-53. Published online March 31, 2008; DOI: https://doi.org/10.35371/kjoem.2008.20.1.46

Abstract PDF

BACKGROUND
Smoking, upper respiratory tract infection, genetic factors and hydrocarbons are known as risk factors of Goodpasture's syndrome. We studied a patient with Goodpasture's syndrome who had worked for 27 years in a foundry company. Based on a study on the work-relatedness of the syndrome, we describe and discuss our study results.
CASE
A 46-year-old man, who had worked as a foundry worker for 27 years and had a 12 1/2 packyear history of smoking cigarettes, was admitted into a hospital on 15th February 2006 with coughing, chest pain and dyspnea. On admission, he had hematuria, proteinuria, severe restrictive pulmonary function disorder and rapid elevation of blood urea nitrogen/creatinine. Immunological examination showed ANA (+), ANCA (-) and Anti-GBM Ab (+). Kidney biopsy showed pauci-immune crescentic glomerulonephritis. Mild bleeding was revealed through bronchoscopy and no vasculitis and granuloma were present on at lung biopsy. Finally, we diagnosed the worker's illness as Goodpasture's syndrome and carried out hemodialysis and plasmapheresis. In the workplace survey, the exposure level of respirable crystalline silica exceeded the TLV-TWA (0.0106 mg/m3), which was calibrated for overtime.
CONCLUSION
Based on both the clinical test and industrial hygiene examination, we concluded that the Goodpasture's syndrome in this case was caused by long-term silica exposure.

Citations

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Cause-Specific Mortality Due to Malignant and Non-Malignant Disease in Korean Foundry Workers
Jin-Ha Yoon, Yeon-Soon Ahn, Suminori Akiba
PLoS ONE.2014; 9(2): e88264. CrossRef
Goodpasture’s Syndrome and p-ANCA Associated Vasculitis in a Patient of Silicosiderosis: An Unusual Association
Amanjit Bal, Ashim Das, Dheeraj Gupta, Mandeep Garg
Case Reports in Pulmonology.2014; 2014: 1. CrossRef
Goodpasture's Syndrome and Silica: A Case Report and Literature Review
James Dahlgren, Marla Wardenburg, Trevor Peckham
Case Reports in Medicine.2010; 2010: 1. CrossRef

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A Case of Hypersensitivity Pneumonitis in a Worker Exposed to Metal Working Fluid: Sun Wung Lee, Dong hee Ko, Ku Won Chin, Dong Uk Park, Jung Tak Lee, Yoon Hee Song, Sang Yoon Lee; Korean Journal of Occupational and Environmental Medicine 2008;20(1):37-45. Published online March 31, 2008; DOI: https://doi.org/10.35371/kjoem.2008.20.1.37

Abstract PDF

INTRODUCTION: There have been no reports of hypersensitivity pneumonitis caused by metal working fluids in Korea, despite their existence in other countries. Here, we report the first such case, along with an assessment of work-relatedness through exposure assessment.
CASE
REPORT: A 64-year old male patient visited the hospital with dyspnea after metal pipe cutting for about a year. He was diagnosed with hypersensitivity pneumonitis from the evidence of specific exposure history, clinical symptoms, and radiologic findings. The air exposure levels of the oil mist, endotoxin, total bacteria and fungus in the work environment was TWA(8-hr) 0.531 mg/m3, 6.33 EU/m3, 100 CFU/m3 and 75 CFU/m3, respectively. The concentrations of the endotoxin, total bacteria and fungus within the metal working fluid was 1.5x10(4) EU/mL, 4.6x10(5) CFU/mL and 1.8x10(5) CFU/mL, respectively.
DISCUSSION
Although the patient did not receive a specific precipitating antibody test, the microbial concentration within the metal working fluid was higher than normal and similar to previous case reports, The oil mist level in the air exceeded the NIOSH REL and ACGIH NIC, and were similar or higher than previous cases. By excluding other causes of hypersensitivity pneumonitis, we concluded that the disease developed from exposure to microbial antigens in the metal working fluid.

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Green manufacturing—performance of a biodegradable cutting fluid
Rahul Katna, Kanwarjeet Singh, Narayan Agrawal, Swati Jain
Materials and Manufacturing Processes.2017; 32(13): 1522. CrossRef
Association of Exposure to Chemicals with Dyspnea among Employed Workers: Analysis of the 3rdKorean Working Conditions Survey
Moon-Young Park, Sung-Ho Hwang, Kimyong Hong, Se-Eun Oh, Kyoung-Mu Lee
Journal of Korean Society of Occupational and Environmental Hygiene.2016; 26(1): 64. CrossRef
Microbial Assessment in Metal-Working Fluids Handling Industry
Hyunhee Park, Dongjin Park, Hae Dong Park
Journal of Korean Society of Occupational and Environmental Hygiene.2014; 24(3): 300. CrossRef
Microbial Exposure Assessment in Sawmill, Livestock Feed Industry, and Metal Working Fluids Handling Industry
Hyunhee Park, Haedong Park, Inseop Lee
Safety and Health at Work.2010; 1(2): 183. CrossRef

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Original Articles

The Cost of Occupational Health and Safety in Manufacturing Factories: Wonki Oh, Hyeongsu Kim, Changsu Um, Sounghoon Chang, Kunsei Lee, Kyunghee Jung-Choi, Keunwhoe Kim, Kwanhyung Lee; Korean Journal of Occupational and Environmental Medicine 2008;20(1):25-36. Published online March 31, 2008; DOI: https://doi.org/10.35371/kjoem.2008.20.1.25

Abstract PDF

OBJECTIVE: This study evaluated the cost for occupational health and safety in manufacturing factories in Korea according to the factory's size and the industrial classification.
METHODS
The costs to prevent occupational injuries and promote the general health of the workers were calculated by using the data of The Occupational Safety and Health Survey in Korea in the year of 2005 and the data of the Industrial Accident Compensation Insurance (IACI) premiums at the same factories for the year of 2004.
RESULTS
The mean cost per one worker was as follows: 990,000 won for the factory with 5~49 workers, 869,000 won for the factory with 50~299 workers and 1,773,000 won for the factory with more than 300 workers. In the factories with 5~49 workers and 50~299 workers, the premium for the IACI was the largest portion of the cost (62.8% and 52.8%, respectively) and the cost for gear to protect workers from dangerous machineries was the next biggest portion of the cost (20.1% and 19.1%, respectively). The largest portion of the cost in the factories with more than 300 workers was the premium for the IACI (37.5%).
CONCLUSIONS
The investment costs to prevent occupational injuries and to promote the general health of the workers were very diverse according to the size of the factories and the industrial classification. To reduce the occupational injuries and to promote the general health of the workers, systematic and continuous approaches to evaluate the investment costs for the occupational health and safety are required.

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Type and Characters of Agricultural Injury Subjective Burden
Kanwoo Youn, Sanghyuk Im, Jinwoo Park, Kyungsuk Lee, Hyeseon Chae
Journal of agricultural medicine and community health.2016; 41(1): 1. CrossRef
A Predictive Model of Workers' Quality of Life
Bok-Im Lee, Hye-Sun Jung
Korean Journal of Occupational Health Nursing.2011; 20(1): 35. CrossRef

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Factors Associated with Occupational Injuries of Ship-building Supply Workers in Busan: Seung Hwan Shin, Dae Hwan Kim, Jin Hong Ahn, Hwi Dong Kim, Jeong Ho Kim, Hyun Man Kang, Jong Tae Lee; Korean Journal of Occupational and Environmental Medicine 2008;20(1):15-24. Published online March 31, 2008; DOI: https://doi.org/10.35371/kjoem.2008.20.1.15

Abstract PDF

OBJECTIVE: This study was conducted to evaluate both personal and work-related factors associated with occupational injuries of ship-building supply workers in Busan, Korea.
METHODS
A self-administered, questionnaire survey, asking both personal and work-related factors associated with occupational injuries, was administered to 1,651 workers from 64 different ship-building supply companies in Busan, Korea. All occupational injuries had occurred within the previous 5 years. The workers were divided into three sub-groups: Group I, under 4 day-sick leave, Group II, 4 day-sick leave and over, and Group III, which consisted of both Groups I and II. The statistical significance of the factors associated with occupational injuries underwent cross tabulation analysis for each group. Afterwards, the relationships between the factors which had statistical significance and the occurrence of occupational injuries were analyzed through multiple logistic regression by using the SPSS 12.0 K program.
RESULTS
The prevalence of occupational injuries was 4.30% in Group II and 7.57% in Group III. The work activities which had the most frequent occupational injuries were 'Fit-up' and 'Welding', and 30.0% of injured workers were covered by workers' compensation in Group II. According to the multiple logistic regression analysis results, the factors which had statistical significance in occupational injury occurrence were education level above college (OR 2.78) and high level of fatigue (OR 2.18) in Group I, sleeping less than 5 hours per day (OR 3.47), high level of fatigue (OR 2.79) and working over 56 hours per week (OR 1.53) in Group II, and education level above college (OR 1.78), sleeping less than 5 hours per day (OR 2.98), poor sleep quality (OR 1.65) and high level of fatigue (OR 2.58) in Group III.
CONCLUSION
This study demonstrated that several factors of ship-building supply workers such as sleep hours, sleep quality, fatigue, working hours, and educational level exerted a statistical effect on the occurrence of occupational injuries. In association with occupational injuries occurrence, these factors need to be controlled by proper methods such as effective safety education, work condition modification, and life style management.

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Association between sleep disturbance and occupational injury among Korean employees
Jongwoo Lee, Seong-Sik Cho, JungIl Kim, Mo-yeol Kang, Suhwan Ju, Byoung Gwon Kim, Young Seoub Hong
Annals of Occupational and Environmental Medicine.2021;[Epub] CrossRef
Relationship between long work hours and self-reported sleep disorders of non-shift daytime wage workers in South Korea: data from the 5th Korean Working Conditions Survey
Hongsuk Choi, Sungho Lee, Man-Joong Jeon, Young-Sun Min
Annals of Occupational and Environmental Medicine.2020;[Epub] CrossRef
Mining Hidden Knowledge About Illegal Compensation for Occupational Injury: Topic Model Approach
Jin-Young Min, Sung-Hee Song, HyeJin Kim, Kyoung-Bok Min
JMIR Medical Informatics.2019; 7(3): e14763. CrossRef
3D motion analysis of the wrist splint effect to wrist joint movement
Joong-il Shin, Soo-hee Park
Journal of Physical Therapy Science.2017; 29(6): 1089. CrossRef
Association Night-Shift and Long Working-Hours Effects on Subjective Insomnia in Korean Workers: The Third Korean Working Conditions Survey
Chae-Bong Kim, Tae-Young Jung, Seoung-Min Han
The Korean Journal of Health Service Management.2015; 9(1): 41. CrossRef
Relationships of Self-esteem to Job Satisfaction and Turnover Intention among Ship-building Supply Workers
So Eun Choi, Sam Sun Lee, Sang Dol Kim
Korean Journal of Occupational Health Nursing.2014; 23(2): 106. CrossRef
Medical Managements of Musculoskeletal Diseases in Shipbuilding Industry
Jong-Eun Kim, Young-Ki Kim, Dong-Mug Kang
Journal of the Ergonomics Society of Korea.2012; 31(1): 157. CrossRef
An Investigation of Health Status in Male Workers
Sun-Young Choi, Jeong-Eun Bin, Sung-Hee Kim
The Korean Journal of Food And Nutrition.2012; 25(4): 1047. CrossRef
Ergonomic Research Trends in the Shipbuilding Industry: Present and the Future
Yu-Chang Kim
Journal of the Ergonomics Society of Korea.2012; 31(1): 131. CrossRef

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The Prevalence of Asbestos Exposure-induced Pleural Thickening on Chest Radiograph in Repairing Shipyard Workers: Byeong Jin Ye, Jung Il Kim, Hyun Jae Lee, Ki Nam Kim, Ki Nam Lee, Kap Yeol Jung, Joon Youn Kim, Sung Ho Yun; Korean Journal of Occupational and Environmental Medicine 2008;20(1):9-14. Published online March 31, 2008; DOI: https://doi.org/10.35371/kjoem.2008.20.1.9

Abstract PDF

OBJECTIVES
This study evaluated the prevalence of asbestos exposure-induced pleural thickening on chest radiograph in repairing shipyard workers.
METHODS
A total of 2,114 incumbent and retired workers in a shipyard underwent chest radiograph, questionnaire study, interview, and physical exam from 2005 to 2007. Finally, 1,702 workers were selected and classified into two groups according to asbestos exposure: exposure and non-exposure groups. The characteristics in the exposure group were investigated.
RESULTS
The prevalence of pleural thickening on chest radiograph was 5.2 % and 3.1 % in the exposure and non-exposure groups, respectively (p<0.05). In those aged 50 years or above, the prevalence was 17.6 % and 8.7 % in the exposure and non-exposure groups, respectively (p<0.05). The prevalence was 16.5 % and 30.2 % and the odds ratio was 2.34 (95% CI; 1.15-4.77) and 2.95 (95%CI; 1.08-8.07) in the workers with an exposure duration of 20-29 years and more than 30 years, respectively. The prevalence was higher when considering tuberculosis history.
CONCLUSIONS
The prevalence was increased with increasing exposure duration was more than 20 years. The authors therefore suggest that this group should be followed up periodically by special program and that a longitudinal study with repairing shipyard workers as the cohort should be undertaken.

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Environmental health centers for asbestos and their health impact surveys and activities
Dong-Mug Kang, Jong-Eun Kim, Yong-Jin Lee, Hyun-Hee Lee, Chang-yeol Lee, Seong-Jae Moon, Min-Sung Kang
Annals of Occupational and Environmental Medicine.2016;[Epub] CrossRef
Health Effects of Environmental Asbestos Exposure
Dong-Mug Kang
Korean Journal of Environmental Health Sciences.2009; 35(2): 71. CrossRef

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An Outbreak of Acute Beryllium Disease in a Compound Metal Alloy Factory: Hyunjoo Kim, Woo Chul Jeong, Young Koo Jee, Dae Seong Kim, Seong Kyu Kang, Sangchul Roh, Kyutag Cho, Donghyun Kim; Korean Journal of Occupational and Environmental Medicine 2008;20(1):1-8. Published online March 31, 2008; DOI: https://doi.org/10.35371/kjoem.2008.20.1.1

Abstract PDF

OBJECTIVES
We conducted an epidemiological survey to inquire into an outbreak of acute pneumonitis after two reported cases of interstitial lung disease.
METHODS
The study subjects were 45 workers from a compound metal alloy factory. We reviewed the factory's industrial hygiene data along with the results of a special health examination, including pulmonary function tests, simple chest X-rays, and high resolution computed tomography.
RESULTS
The air concentrations of beryllium ranged from 0.42 microgram/m3 to 112.3 microgram/m3, and the mean concentration of urinary beryllium were 1.53+/-0.79 microgram/g of creatinine in the molding workers, 1.41+/- 0.50 microgram/g of creatinine in the casting workers, and 1.16+/-0.53 microgram/g of creatinine in the sorting workers. The rates for cough (p=0.054), dyspnea (p=0.030), and the use of medical services (p=0.018) were higher in the molding workers than in the non-molding workers. The incidence rate of acute interstitial lung disease was higher for the molding process (32.0%) than for the non-molding process (5.0%) (p=0.012). The time of employment for all patients was prior to December 1st, 2002.
CONCLUSIONS
Since most of the patients were molding workers, and all of the patients had worked without a ventilation system, this outbreak of acute interstitial lung disease was regarded as acute beryllium disease. Although the direct cause of the epidemic was the beryllium fumes, the fundamental cause was improper control of the work environment. Therefore, the means for preventing avoidable epidemics of occupational diseases are discussed.

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Effects of Beryllium on Human Serum Immunoglobulin and Lymphocyte Subpopulation
Ki-Woong Kim, DaeSeong Kim, Yong Lim Won, Seong-Kyu Kang
Toxicological Research.2013; 29(2): 115. CrossRef

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