Annals of Occupational and Environmental Medicine

Review

Technetium-99m hand perfusion scintigraphy (Raynaud’s scan) as a method of verification in hand arm vibration syndrome: a review: Taewoong Ha, Hyeoncheol Oh, Jungwon Kim; Ann Occup Environ Med 2022;34:e26. Published online October 11, 2022; DOI: https://doi.org/10.35371/aoem.2022.34.e26

Abstract Abstract in Korean PDF PubReader ePub

It is important to assess the blood flow of fingers in the verification of hand-arm vibration syndrome. In the Republic of Korea, most assessments of the blood flow in the fingers are performed using a cold provocation test with finger skin color change. However, this test is a non-objective method with a relatively low sensitivity, leading to possible social and legal problems. Thus, we reviewed the characteristics of several tests that assess the blood flow in the fingers. Among these tests, using the radioactive isotope method, Raynaud’s scan has a relatively higher sensitivity and specificity than other tests, provides objective results, and is approachable in many hospitals. So we suggest using Raynaud's scan as an alternative test when cold provocation test with finger skin color change is negative in vibration exposed worker.

테크네튬-99m 레이노 스캔을 이용한 수완진동 증후군 진단 리뷰
수완진동증후군의 검증에서는 손가락의 혈류를 평가하는 것이 중요하다. 대한민국에서는 레이노증후군의 업무관련성 평가 시 대부분 손가락의 혈류량 평가를 냉각부하 손가락 피부색 변화 검사만으로 시행하고 있다. 그러나 이 검사는 상대적으로 민감도가 낮은 주관적인 검사방법으로 사회적, 법적 문제가 발생할 수 있다. 따라서 우리는 손가락의 혈류를 평가할 수 있는 여러 검사의 특성을 검토하였다. 이 검사 방법들 중, 방사성 동위원소법을 이용한 레이노스캔은 객관적인 결과를 제공하며 다른 검사방법들에 비하여 상대적으로 민감도와 특이도가 높고 많은 병원에서 접근성이 좋다. 따라서 진동노출작업자에서 냉각부하 손가락 피부색 검사 결과가 음성인 경우 대안검사로서 레이노스캔을 사용할 것을 제안한다.

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Raynaud’s Phenomenon: A Current Update on Pathogenesis, Diagnostic Workup, and Treatment
Hirut Yadeta Ture, Nan Young Lee, Na Ri Kim, Eon Jeong Nam
Vascular Specialist International.2024;[Epub] CrossRef

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Commentary

Health care strategy for ensuring work ability in an aging Korea: Jungsun Park, Jong-tae Park, Soo Geun Kim, Cheol-In Yoo, Junseok Son, Jun Yim, Dae-seong Kim, Kyung Young Rhee, Yangho Kim; Ann Occup Environ Med 2016;28:42. Published online September 7, 2016; DOI: https://doi.org/10.1186/s40557-016-0127-y

Abstract PDF PubReader ePub

The rapid aging trend in South Korea will cause a growing shortage of labor and decreasing quality of the labor force. The purpose of this commentary is to recommend a health care strategy to maintain and promote the work ability of employees in an aging Korea. Strategies to promote the work ability require the collaboration of governmental agencies at the central and local levels. First, the common goal should be the reinforcement of follow-up measure in general medical examinations and the promotion of healthy lifestyles for workers. Second, collaborating activities should be performed among the Worker’s Health Center, the Health Promotion Center, and community health centers. In conclusion, health care strategies for ensuring the work ability in an aging Korea require the collaboration of governmental agencies at the central and local levels.

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A randomized controlled trial to evaluate the effectiveness and safety of electro acupuncture and transcranial direct current stimulation with computerized cognitive rehabilitation in patients with vascular cognitive impairment
Hyeng Kyu Park, Min Keun Song, Jae Hong Kim, Jae Young Han
Medicine.2020; 99(29): e21263. CrossRef
The history of occupational health in South Korea
Jungsun Park, Yangho Kim
Archives of Environmental & Occupational Health.2019; 74(1-2): 50. CrossRef
Vulnerability of employees in businesses with fewer than five workers (micro‐enterprises) to occupational safety and health problems
Jungsun Park, Jong‐shik Park, Boyoung Han, Yangho Kim
American Journal of Industrial Medicine.2017; 60(12): 1056. CrossRef
Hazards and health problems in occupations dominated by aged workers in South Korea
Jungsun Park, Soo Geun Kim, Jong-shik Park, Boyoung Han, Kab Bae Kim, Yangho Kim
Annals of Occupational and Environmental Medicine.2017;[Epub] CrossRef

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Review

Health Effects of Manganese and Some Recent Issues in Manganese Neurotoxicity Research: Yangho Kim; Korean Journal of Occupational and Environmental Medicine 2009;21(1):87-105. Published online March 31, 2009; DOI: https://doi.org/10.35371/kjoem.2009.21.1.87

Abstract PDF

INTRODUCTION: This article reviews the health effects of manganese (Mn) and introduces readers to recent issues in Mn neurotoxicity research.
METHODS
An extensive Medline search that covered publications up to December 2008 was conducted and the relevant papers and their references were evaluated for review.
RESULTS
AND DISCUSSION: Exposure to excess levels of the essential trace element Mn produces cognitive, psychiatric, and motor abnormalities. The lungs and the gastrointestinal tract both absorb Mn, but homeostatic mechanisms limit the absorption of Mn by the gastrointestinal tract. Elimination of Mn occurs primarily by excretion into the bile. Average Mn levels in the blood reflect the total body burden on a group basis, but not on an individual basis. Previous studies have shown that blood Mn contributes to a high pallidal signal in a T1-weighted brain MRI and that the high signal is an effective predictor of neurobehavioral performance. Thus, a high pallidal signal on an MRI may offer clues concerning the target organ dose from Mn exposure in the spectrum of Mn symptomatology. Neuroimaging as well as a clinical evaluation with exposure history is very important in a differential diagnosis that can distinguish manganism from Parkinson disease (PD). Recent research on Mn neurotoxicity has focused on several issues. First, concerns about the interaction between manganism and PD have been raised, but further research is needed. Second, epidemiological studies on non-occupational Mn exposure have suggested that environmentally induced neurotoxicities may have features that are different from the classic features of occupational manganism, but, again, this requires further research. Third, liver cirrhosis could be used as a model of manganism. Finally, functional neuroimaging such as magnetic resonance spectroscopy, functional MRI, or diffusion tensor imaging appears to have promising applications in Mn research.
CONCLUSION
Reviewing the health effects of Mn and recent issues in Mn neurotoxicity research provides us with important suggestions for how to pursue other lines of toxicological research as well as for how best to develop a systematic understanding of Mn symptomatology.

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Fundamental Study on Adsorption of Manganese in Water using Manganese-oxide coated Sand (MCS) Generated in a Filtration Tank of a Mine Drainage Treatment Facility
Sangwoo Ji, Dong-Wan Cho, Gil-Jae Yim, Jong-Man An, Gi-O An, Jeong-Yun Jang, Young-Wook Cheong
Journal of the Korean Society of Mineral and Energy Resources Engineers.2020; 57(3): 249. CrossRef
A large, nationwide, longitudinal study of central nervous system diseases among Korean workers exposed to manganese
Jin-Ha Yoon, Yeon-Soon Ahn
Parkinsonism & Related Disorders.2015; 21(3): 194. CrossRef
Associations between Airborne Manganese and Blood Manganese in the Korean General Population according to KNHANES 2008-2009
Kyung Sick Jung, Jong Dae Lee, Yong Bae Kim
Journal of Environmental Science International.2013; 22(12): 1589. 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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Original Article

Quantitative Assessment of Magnetic Resonance Imaging for the Noninvasive Evaluation of Bone Marrow Cellularity in Workers with Long-term Exposure to Solvents: Hae Kwan Cheong, Dae Seob Choi, Keon Uk Park, Hwan Jung Yun, Jung Ran Kim, Kyung Im Ha, Seoung Oh Yang, Yang Ho Kim; Korean Journal of Occupational and Environmental Medicine 2002;14(2):183-198. Published online June 30, 2002; DOI: https://doi.org/10.35371/kjoem.2002.14.2.183

Abstract PDF: OBJECTIVES
To develop a quantitative and noninvasive method of bone marrow cellularity evaluation in solvent-exposed painters.
METHODS
Six painters (mean age 46.5 years, 5 males and one female) with hypocellular marrow, and 132 controls were examined using magnetic resonance imaging (MRI). A full examination of the peripheral blood and a bone marrow biopsy was done on each patient. Signal intensities were measured at the vertebral bodies from T12 to S1 on both the T1- and the T2-weighted image (T1WI and T2WI). Signal indices were calculated by dividing the signal indices of the vertebral bodies by that of the paraspinal muscle and the subcutaneous fat in the same view.
RESULTS
The Bone marrow cellularities of the cases painters were between 20.3% and 33.6%. Signal indices based on the muscle at T1WI were greater in the cases of the painters compared to those of the controls (p<0.05, p<0.01). Signal indices based on the muscle at T1WI were significantly higher in older women compared with men (p< 0.05 ) . After adjusting for age and gender, the signal index of cases at S1 based on muscle of T1WI was higher than that of the controls by 0.364. Five of the six cases had a muscle signal index at S1 of T1WI higher than the mean + 1 standard deviation for the same age group and gender.
CONCLUSIONS
MR signal indices are influenced by constitutional factors such as fat content, bone density, and the presence of other pathology. However, after adequate adjustment, it can be used as a useful indicator of bone marrow cellularity in a high-risk population.

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Original Article

Low Back Pain Assessment Using Surface Electromyography and Digital Infrared Thermographic Imaging: Kang Jin Lee, In Sung Choi, So Young Lee, Jae Young Han, Sam Gyu Lee, Hong Jae Chai, Seong Kwan Lee, Jai Dong Moon; Korean Journal of Occupational and Environmental Medicine 2001;13(3):306-314. Published online September 30, 2001; DOI: https://doi.org/10.35371/kjoem.2001.13.3.306

Abstract PDF

OBJECTIVES
We studied the efficacy of surface electromyography(SEMG) and digital infrared thermographic imaging(DITI) in the assessment of low back pain both(LBP) quantitatively and qualitatively.
METHODS
We compared electromygraphic signals from electrodes placed in the lumbar area and the digital thermographic images in 16 LBP patients and 16 control subjects. The LBP patients and the control subjects were matched for age, gender, and body mass index(BMI) to adjust for any confounding effects RESULTS: In the static analyses of SEMG, median value was 198.1 microV for the LBP patients and 161.3 microV for the controls on the right side, and they were 194.2 microV and 180.5 microV on left side respectively. There was a statistically significant difference between the two groups on the right side(p<0.01), but not on the left side. In the dynamic analyses of the SEMG, the median values of the extension per flexion ratio of right side were 1.12 for LBP patients and 1.39 for controls. and those on the left side were 1.08 and 1.21 respectively. There were statistically significant differences in both sides(p<0.05). The sensitivity and specificity were 100% and 81.3% in DITI, 78.6% and 72.2% in SEMG .
CONCLUSIONS
These results indicate that SEMG and DITI are useful methods for indirect assessments of LBP, and that DITI is more sensitive and specific than SEMG.

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The effect of middle and lower trapezius strength exercises and levator scapulae and upper trapezius stretching exercises in upper crossed syndrome
Won-Sik Bae, Hyun-Ok Lee, Jae-Wook Shin, Keon-Cheol Lee
Journal of Physical Therapy Science.2016; 28(5): 1636. CrossRef

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Case Report

Three Cases of High Signal Intensity by Brain Magnetic Resonance Imaging in CO2 arc Welders: Young Seoub Hong, Myung Ah Lim, Yong Hee Lee, Hae Kwan Cheong, Ji Yong Kim, Hyun Sul Lim, Jung Jeung Lee, Kong Joon Sa, Joon Youn Kim; Korean Journal of Occupational and Environmental Medicine 1998;10(2):290-298. Published online May 31, 1998; DOI: https://doi.org/10.35371/kjoem.1998.10.2.290

Abstract PDF

We experienced three cases of high signal intensity observed by Brain Magnetic Resonance Imaging in CO2 arc welders of steel-frame manufacturing industry. Case 1 was a 35 years old man who has been an CO2 arc welder for 10 years, admitted a sudden onset of tonic clonic seizure. He complained fever, chilling and myalgia since 3 days before admission. On admission, in the test of manganese exposure indices, manganese concentrations of blood, urine and scalp hair were 5.17 microgram/dL, 22.00 microgram/l and 31.25 ppm respectively. Case 2 was a 35 years old man who has been an CO2 arc welder for 20 years. On admission, He complained fatigue, numbness and weakness of extremities, and decrease of libido. In the test of manganese exposure indices, manganese concentrations of blood, urine and scalp hair were 6.34 microgram/dL, 14.62 microgram/l and 57.87 ppm respectively. In neurologic examination, Palmo-mentis reflex and Myerson sign were observed. Case 3 was a 33 years old man who has been an CO2 arc welder for 16 years. On admission, He complainer loss of appetite, numbness of extremities, fatigue and decrease of attention. In the test of manganese exposure indices, manganese concentrations of blood, urine and scalp hair were 5.14 microgram/dL, 13.79 microgram/l and 50.08 ppm respectively. In neurologic examination, Myerson sign was observed. In brain magnetic resonance imaging, T1WI showed symmetrical high signal intensity in basal ganglia and midbrain of three cases. Authors argued that they were developed by manganese exposure, and we considered that follow up study would be necessary.

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A Study on the Total, Particle Size-Selective Mass Concentration of Airborne Manganese, and Blood Manganese Concentration of Welders in a Shipbuilding Yard
Jong Su Park, Pan Gyi Kim, Jee Yeon Jeong
Journal of Korean Society of Occupational and Environmental Hygiene.2015; 25(4): 472. CrossRef
Occupational Diseases in Korea
Seong-Kyu Kang, Eun A Kim
Journal of Korean Medical Science.2010; 25(Suppl): S4. 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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Original Article

An Association between Brain MRI and Neurologic Findings in Welders Exposed to Manganese Fume: Hyeon Woo Yim, Ji Hong Kim, Young Gyu Phee, Jung Wan Koo, Kang Sook Lee, Chung Yill Park, Jeong Wook Lee, Si Ryung Han, Hye Suk Jang; Korean Journal of Occupational and Environmental Medicine 1998;10(2):161-171. Published online May 31, 1998; DOI: https://doi.org/10.35371/kjoem.1998.10.2.161

Abstract PDF

This study was carried out to investigate the relationship between brain magnetic resonance imaging (MRI) and neurological findings in welders exposed to manganese fume. Thirty five welders from a bus manufacturing factory who were occupationally exposed to low dose manganese fume were examined. We collected the information on the demo graphic factors and welding careers. Laboratory investigations included blood and urine manganese concentration and blood chemistry. Brain MRI was checked, and high signal intensity of the globus pallidus was graded from 0 to 3 compared to the white matter of the frontal lobe. Neurologic examination wart carried out. The results were as follows ; 1. The mean age of workers was 48.3+/-5.7 years, mean duration of welding was 21.4 +/-5.6 Years. 2. On brain MRI, high signal intensity in the globes pallidus was observed in 27 workers (77.1%) Among them, 18 cases (66.7%) showed remarkably high signal intensity (grade 2) Mean concentration of blood manganese was higher in those with high signal intensity and correlated to the grade of high signal intensity (p=0.02) 3. On neurologic examination, no workers showed the finding of typical parkinsonism. But 11 workers (31.4%) showed subtle neurological abnormalities such as gait without associated arm movement, postural instability, intention tremor, and so on. Blood manganese concentration of neurologically abnormal group was 2.4+/-0.7 microgram/dL, which was significantly higher, compared to 1.8+/-0.7 microgram/dL of neurologically normal group (p=0.03). 4. Among 27 workers who showed high signal intensity on brain MRI, 10 workers (37%) were neurologically abnormal. Higher grade of signal intensity on globus pallidus showed higher rate of neurologic abnormality (p<0.05) Especially postural instability and gait without associated arm movement were prominent findings. These bindings suggest that high signal intensity on brain MRI might be associated with a prodromal sign of manganese intoxication. Careful neurologic examination should be tool lowed up on welders showing high signal intensity in the golbus pallidus of brain MRI.

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Yangwoo Kim, Inah Kim, Jung-Min Sung, Jaechul Song
Annals of Occupational and Environmental Medicine.2021;[Epub] CrossRef
Association of MRI T1 relaxation time with neuropsychological test performance in manganese- exposed welders
R.M. Bowler, C-L. Yeh, S.W. Adams, E.J. Ward, R.E. Ma, S. Dharmadhikari, S.A. Snyder, S.E. Zauber, C.W. Wright, U. Dydak
NeuroToxicology.2018; 64: 19. CrossRef
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Eun-A Kim, Seong-Kyu Kang
Journal of Korean Medical Science.2010; 25(Suppl): S26. CrossRef
State-of-the-Science Review: Does Manganese Exposure During Welding Pose a Neurological Risk?
Annette B. Santamaria, Colleen A. Cushing, James M. Antonini, Brent L. Finley, Fionna S. Mowat
Journal of Toxicology and Environmental Health, Part B.2007; 10(6): 417. CrossRef
Sequelae of fume exposure in confined space welding: A neurological and neuropsychological case series
Rosemarie M. Bowler, Sanae Nakagawa, Marija Drezgic, Harry A. Roels, Robert M. Park, Emily Diamond, Donna Mergler, Maryse Bouchard, Russell P. Bowler, William Koller
NeuroToxicology.2007; 28(2): 298. CrossRef

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Original Article

The Significance of Increased Signal Intensity in MR Imaging among Male Welders: Dong Mug Kang, Ho Chu Park, Hye Sook Son, Jun Han Park, Young Joon Lee; Korean Journal of Occupational and Environmental Medicine 1998;10(1):41-52. Published online February 28, 1998; DOI: https://doi.org/10.35371/kjoem.1998.10.1.41

Abstract PDF

A purpose of present study is to provide basic information evaluating the utility of Magnetic Resonance imaging as a biological marker estimating manganese effects to central nervous system among welders, which is conducted by comparing urinary and blood manganese concentrations and signal intensities of brain MR images between exposed group and non-exposed group, evaluating the objectivity of subjective grading estimated by correlations between Pallidal signal intensity index (P. I) and subjective grades among exposed group, and comparing the difference of signal intensities according to presence of neurologic symptoms, signs and exposure variables among the exposed group. The exposed group is composed of 11 welders complaining severe symptoms or showing neurological signs, and the non-exposed group is composed of 5 patients who admitted a hospital. Urinary manganese concentrations and signal intensities in T1-weighted MR images among exposed group were higher than those of the non-exposed group significantly, which exhibits that increased signal intensities in T1-weighted MR image represent the effect of manganese exposure. P. Is among the exposed group revealed relatively high correlations with subjective grades ( gamma =0.63, p=0.037) , which suggests the objectivity of subjective grade. Signal intensity in globus pallidus was a suitable single variable representing the effect of manganese accumulation in C.N.S system appropriately, which was verified as follows ; Increased signal intensities among the exposed group had the highest frequency and intensity in the globus pallidus, and the P.I. had a relatively high correlation coefficient ( gamma 0.62, p=0.044) with total score of subjective grades. Signal intensity with subjective grading in globus pallidus represented very high correlation gamma =0.97, p=0.00) with total score of subjective grades, and had a similar correlation coefficient with many variables. It is hard to argue that signal intensities are markers representing pathologic change in C.N.S system or can be used as a diagnostic tool for manganese intoxication, because signal intensities had no difference between the exposed group and the non-exposed group according to presence of neurological signs.

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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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