Annals of Occupational and Environmental Medicine

Case Report

An aggravated return-to-work case of organic solvent induced chronic toxic encephalopathy: Sangyun Seo, Jungwon Kim; Ann Occup Environ Med 2018;30:27. Published online April 27, 2018; DOI: https://doi.org/10.1186/s40557-018-0232-1

Background

Organic solvent-induced chronic toxic encephalopathy (CTE) is known as a non-progressive disorder that does not progress after diagnosis. The authors present a case those symptoms worsened after continued exposure to organic solvent after returning to work. Because such a case has not been reported in South Korea to the best of our knowledge, we intend to report this case along with literature review.

Case presentation

A 59-year-old man, who performed painting job at a large shipyard for 20 years, was receiving hospital treatment mainly for depression. During the inpatient treatment, severe cognitive impairment was identified, and he visited the occupational and environmental medicine outpatient clinic for assessing work relatedness. In 1984, at the age of 27, he began performing touch-up and spray painting as a shipyard painter. Before that he had not been exposure to any neurotoxic substances. In 2001, at the age of 44, after 15 years of exposure to mixed solvents including toluene, xylene and others, he was diagnosed with CTE International Solvent Workshop (ISW) type 2A. After 7 years of sick leave, he returned to work in 2006. And he repeated return-to-work and sick leave in the same job due to worsening of depressive symptoms. He had worked four times (2006–2010, 2011–2011, 2011–2011, 2016–2017) for a total of 5 years as a shipyard painter after first compensation. During the return-to-work period, the mean values of the mixed solvent index ranged from 0.57 to 2.15, and except for a one semiannual period, all mean values were above the standard value of 1. We excluded other diseases that can cause cognitive impairment like central nervous system diseases, brain injury, psychological diseases and metabolic diseases with physical examinations, laboratory tests, and brain image analysis. And finally, throughout neuropsychological tests, an overall deterioration in cognitive function was identified compared to 2002, and the deterioration types was similar to that often shown in the case of CTE; thus a diagnosis of CTE (ISW) type 3 was made.

Conclusion

This case is showing that CTE can go on with continued exposure to mixed solvents. Appropriate “fitness to work” should be taken to prevent disease deterioration especially for the sick leave workers.

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Case Report

A case of multiple myeloma in a poultry worker: Pil Kyun Jung, Inah Kim, Inhyo Park, Chinyon Kim, Eun-A Kim, Jaehoon Roh; Ann Occup Environ Med 2014;26:35. Published online November 1, 2014; DOI: https://doi.org/10.1186/s40557-014-0035-y

Abstract PDF Supplementary Material PubReader ePub

Background

Livestock breeders including poultry workers are exposed to various agricultural chemicals including pesticides and/or organic solvents. Multiple myeloma is a rare disease in Korea, and few reports have investigated the influence of occupational exposures on multiple myeloma occurrence.

Case presentation

A 61-year-old male poultry farm worker presented with bone pain and generalized weakness. A bone marrow biopsy was performed, and he was diagnosed with multiple myeloma. The patient had worked in a poultry farm for 16 years and was exposed to various pesticides and organic solvents such as formaldehyde without any proper personal protective equipment. Results of the work reenactment revealed that the concentration of formaldehyde (17.53 ppm) greatly exceeded the time-weighted average (0.5 ppm) and short-term exposure limit (1.0 ppm) suggested in the Korean Industrial Safety and Health Act.

Conclusions

This case report suggests that poultry workers may be exposed to high levels of various hazardous chemicals including pesticides and/or organic solvents. Numerous previous studies have suggested an association between multiple myeloma and exposure to agricultural chemicals; thus, multiple myeloma in this patient might have resulted from the prolonged, high exposure to these chemicals.

Electronic supplementary material

The online version of this article (doi:10.1186/s40557-014-0035-y) contains supplementary material, which is available to authorized users.

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Research Article

The Relationship of Liver Function Tests to Mixed Exposure to Lead and Organic Solvents: Won-Joon Chang, Kyu-Tak Joe, Hye-Young Park, Jong-Do Jeong, Duk-Hee Lee; Ann Occup Environ Med 2013;25:5-5. Published online May 21, 2013; DOI: https://doi.org/10.1186/2052-4374-25-5

Abstract PDF PubReader ePub

Objective

This study aims to compare liver function indices (aspartate aminotransferase [AST], alanine aminotransferase [ALT], and gamma glutamyl transferase [GGT]) among males who work with lead, organic solvents, or both lead and organic solvents, under the permissible exposure limit (PEL).

Methods

A total of 593 (out of 2,218) male workers who agreed to share their personal health information for medical research were selected for this study. Those excluded were hepatitis B carriers, individuals exposed to occupational risk factors other than lead and organic solvents, and individuals without liver function results. The 593 were divided into five groups: a lead-exposed group, an organic solvent-exposed group exposed to trichloroethylene (TCE co-exposed solvent group), an organic solvent-exposed group not exposed to trichloroethylene (TCE non-exposed solvent group), a lead and organic solvent-exposed group (mixed exposure group), and a non-exposed group (control group).

We performed a one way-analysis of variance (one way-ANOVA) test to compare the geometric means of liver function indices among the groups, using a general linear model (GLM) to adjust for age, work duration, body mass index (BMI), smoking, and alcohol intake. In addition, we performed a binary logistic regression analysis to compare the odds ratios among groups with an abnormal liver function index, according to a cut-off value.

Results

The ALT and AST of the mixed exposure group were higher than those of the other groups. The GGT of the mixed exposure group was higher than the TCE co-exposed solvent group, but there was no difference among the control group, TCE non-exposed solvent group, lead-exposed group, and mixed exposure group. The same result was evident after adjusting by GLM for age, work duration, BMI, smoking, and alcohol intake, except that ALT from the mixed exposure group showed no difference from the TCE co-exposed solvent group.

When the cut-off values of the AST, ALT, and GGT were 40 IU/L, 42 IU/L, and 63 IU/L, respectively, a logistic regression analysis showed no differences in the odds ratios of those who had an abnormal liver function index among the groups. However, if the cut-off values of the AST, ALT, and GGT were 30 IU/L, 30 IU/L, and 40 IU/L, respectively, the odds ratio of the AST in the mixed exposure group was 4.39 (95% CI 1.86-10.40) times higher than the control.

Conclusion

This study indicates that a mixed exposure to lead and organic solvents is dangerous, even if each single exposure is safe under the permissible exposure limit. Therefore, to ensure occupational health and safety in industry, a continuous efforts to study the effects from exposure to mixed chemicals is needed.

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Case Report

One Case of Parkinson's Syndrome in a Shipyard Painter Exposed to Mixed Organic Solvents: Min Heui Jo, Hyung Woo Ryu, Eun A Kim; Korean Journal of Occupational and Environmental Medicine 2009;21(2):192-200. Published online June 30, 2009; DOI: https://doi.org/10.35371/kjoem.2009.21.2.192

Abstract PDF

BACKGROUND
It is well-known that organic solvents can cause various neurologic toxicities, and in particular, it had been reported that Parkinson's syndrome can be caused by organic solvents.
CASE
REPORT: A 53-year-old man who had worked for 13 years as a shipyard spray and brush painter and manifested with moderate cognitive disorder and was diagnosed with chronic toxic encephalopathy. We can assume he had had considerable exposure to organic solvents considering the estimates of the amounts of organic solvents in his work place. He had no specific medical history. The Minnesota Multiphasic Personality Inventory (MMPI) showed mild cognitive deficit, depression, and anxiety. Single Photon Emission Computed Tomography (SPECT) indicated a slightly decreased flow at the edge of the left temporal brain area, while T2 brain Magnetic Resonance Imaging (MRI) showed no specific signs except for ischemic changes in small vessels in the periventricular and subcortical white matter. He was also diagnosed with both carpal tunnel syndrome and peripheral neuropathy through a neuroconductive study. Several years later, he developed progressive bradykinesia and rigidity and, later, resting tremors in the left hand. He was diagnosed with Parkinson's disease and treated with dopaminergic agents, but there was no effect. After that, he was given deep brain stimulation, both. As a result, his tremor is improved. but, the rigidity remained. Three years later, He has continuously received dopaminergic therapy. but, he complains about tremors in both hands and more greatly reduced cognitive function.
CONCLUSION
In this case, we assumed by patient's work history and exposure estimates that he was exposed to excessive levels of organic solvents. The clinical symptoms of this patient were very similar to those from Parkinson's disease, but the psychological symptom appeared earlier than the other symptoms and there was no response to dopaminergic agents. We conclude that this case is likely Parkinson's syndrome caused by organic solvents.

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Case Report

Case Series for Occupational Dermatosis in a Factory Treating Liquid Waste Mixtures: Sue Kyung Park, Hyun Sul Lim; Korean Journal of Occupational and Environmental Medicine 2004;16(3):336-351. Published online September 30, 2004; DOI: https://doi.org/10.35371/kjoem.2004.16.3.336

Abstract PDF: OBJECTIVES
A dermatologic outbreak occurred in a factory usingliquid waste mixtures at Gyeongju. We conducted this study to identify causative factors.
METHODS
We conducted a questionnaire interview composed of general andjob characteristics. A dermatologist carried out medical examination, European standard patch test and 'as is' patch test. We evaluated the cases with over 5 criteria of Mathias's 7 definitions of occupational dermatologic diseases.
RESULTS
Seven of 9 workers were diagnosed with dermatosis and 3 subjects (cases 2, 4 and 6) with Mathias's 7 criteria were confirmed as having occupational dermatologic diseases and were diagnosed as irritant contact dermatitis. Two subjects (cases 1 and 9) with over 5 criteria were evaluated as suspicious status. The remaining 2 subjects (cases 3 and 5) were not compatible with those criteria. The main sources of this outbreak were suggested to be the wasted solvents in the factory of car accessories and aluminum products because the subjects (cases 2, 4, 6, 1 and 9) had the positive skin reaction against those sources in 'as is 'patch test. Furthermore, 4 of the 5 subjects cases 2, 4, 6 and 9) had some skin reactions against the waste solvents of chemical material in 'as is'patch test.
CONCLUSION
This outbreak occurred by direct skin contact of liquid waste mixtures of a factory making car accessories and aluminum products. The cutting oils and metal working fluids in those liquid waste mixtures were estimated as the most suspected materials. In addition, this outbreak may have been caused by the hazard effect of mixed waste organic solvents of manufacturing of chemical materials.

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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

Acquried Dyschromatopsia in Women Workers in Shoe Manufacturing Who were Exposed to Organic Solvents: Joo Hyun Byun, Kwang Young Lee, Young Kee Kim, Kwang Wook Ko, Yong Hwan Lee; Korean Journal of Occupational and Environmental Medicine 2001;13(3):232-241. Published online September 30, 2001; DOI: https://doi.org/10.35371/kjoem.2001.13.3.232

Abstract PDF

OBJECTIVES
This study was undertaken to investigate the relationship between color vision defects and occupational exposure to mixed organic solvents in women workers who were engaged in the shoe manufacturing industry.
METHODS
A total of 173 women workers were involved in this study, 85 of whom were exposed to mixed organic solvents and were defined as the exposed group, and 88 workers comprised the non-exposed control group. The patients were questioned as to their drinking history, the year in which they were exposed and whether they had eye symptoms of blurred vision, eye fatigue, and eye irritation. The exposed workers in the shoe manufacturing factory were engaged in 3 work areas which were pasting, trimming, and cleaning. Their Color vision was assessed using the Hahn's double 15 hue test under standard illumination and their current and cumulative exposure levels were measured.
RESULTS
The prevalence of color vision defect was 21.2% in the exposed group and 8.0% in the control group, and the blue-yellow defect was found to be 5.9 % in the exposed group. The logistic regression for the acquired dyschromatopsia and color confusion index showed that there were no variables that had significant relationships. Eye symptoms were more frequently developed in the exposed group.
CONCLUSIONS
There is a possibility of developing color vision defects when workers are exposed to mixed organic solvents. However, the results of the color confusion index showed that there was no significant relationship to the cumulative exposure level, because of the low exposure level and high occupational turn over rate of the workers. Because the workers in the present study were exposed to low level solvents it will be necessary to study workers exposed to higher levels of organic solvents.

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Impaired colour vision in workers exposed to organic solvents: A systematic review
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Archivos de la Sociedad Española de Oftalmología (English Edition).2017; 92(1): 12. CrossRef
Discromatopsias y exposición a solventes orgánicos: una revisión sistemática
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Color vision impairments among shipyard workers exposed to mixed organic solvents, especially xylene
Eun-Hee Lee, Domyung Paek, Young Lim Kho, Kyungho Choi, Hong Jae Chae
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Original Article

Analysis of Korean Analytical Quality Assurance Program for the Special Health Examination from 1995 to 1999: Seong Kyu Kang, Jeong Sun Yang, Mi Young Lee, In Jeong Park, Ho Keun Chung; Korean Journal of Occupational and Environmental Medicine 2000;12(1):139-147. Published online March 31, 2000; DOI: https://doi.org/10.35371/kjoem.2000.12.1.139

Abstract PDF

OBJECTIVE: The accuracy of analytical results of blood and urine heavy metals came out to the main issue on occupational health from late eighties. The discrepancy of the results for same samples from different laboratories made the diagnosis for occupational diseases be unreliable. Therefore, a quality control program for analysis of samples taken from workplace had been introduced in Korea since 1992. This study aims to show the quality control program f'or analysis of blood and urine samples and its proficient rates from 1992 to 1999 and to know how they have been being used in occupational health.
METHODS
The quality control program runs twice a year with mandatory items of blood lead and urine hippuvic acid and voluntary items of blood cadmium and manganese and urine mandellic acid and methyl hippuric acid. Participant laboratories are receiving three levels for each items and two out of three samples have to be qualified for being a proficient laboratory for the item. The acceptable range of blood lead and urine hippuric acid is +/-15% and that of the others is within 3 SD(standard deviation) from the reference values.
RESULTS
The proficient rates of blood lead and urine hippuric acid was 89%, 90%, repectively, however those of the other voluntary items have been from 51% to 62%. The proficient rates of urine mercury and urine N-methylformamide(NMF), which are introduced since 1999, were very poor. Urine hippuric acid and blood lead were analyzed frequently for the purpose of biological monitoring conducting by special health examination organizations. Urine and blood manganese and urine metabolites of trichloroethylene, urine phenol, methylhippuric acid and cadmium were followed.
CONCLUSIONS
In conclusion, the quality control program for biological monitoring has dramatically improve the ability of analysing blood and urine samples and eventually contributes to diagnose occupational diseases and to prevent occupational poisoning. However, some biological monitoring data, such as urine manganese, mercury and NMF, have been still reported from laboratories that were not accepted as a proficient laboratory.

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Mi-Young Lee, Jeong Sun Yang, Seong-Kyu Kang
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Original Article

Neurobehavioral Performance Changes of Chronic Exposure to Organic Solvents among Textile Processing Workers: Seon Hee Yang, Moo Sik Lee, Dong Hoon Shin; Korean Journal of Occupational and Environmental Medicine 1998;10(2):227-239. Published online May 31, 1998; DOI: https://doi.org/10.35371/kjoem.1998.10.2.227

Abstract PDF: The study was conducted to predict the risk of chronic exposure by neurobehavioral test and to use it as a basic source of the management for workers exposed to organic solvents. The exposed group was selected from coating department of textile processing industry. The unexposed group was selected from those who visited the clinic to take an annual check-up. The author administered WHO-NCTB (neurobehavioral core test battery). Also, Scandinavian Questionnaire 16 was tested by self-administration to find the correlation between subjective symptoms and NCTB results, and to assess the availability of the Questionnaire in mass screening test concurrently. The final analysed subjects were 78 (27 in exposed group and 51 in unexposed group) workers except who had a neurologic disease or systemic disease affecting the central nervous system. In Questionnaire study, there was no significant difference in total neurotoxic symptom scores between the exposed and the unexposed group. In NCTB, the exposed group had lower mean scores than the unexposed group for all tests. When the effect by age and education were considered, there was a statistically significant difference only in pursuit timing test. This study suggests the availability of NCTB and the Questionnaire for the assessment of neurobehavioral change in workers exposed to organic solvents.

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Original Article

Type of Anemia Due to Organic Solvents: Choong Ryeol Lee, Cheol In Ryu; Korean Journal of Occupational and Environmental Medicine 1998;10(2):180-188. Published online May 31, 1998; DOI: https://doi.org/10.35371/kjoem.1998.10.2.180

Abstract PDF: The purpose of this study Is whether we can presuppose the correlation between some type of anemia and exposure to organic solvents using some hematologic index such as MCV, RDW and MCHC. The authors conducted the hematological examination of 160 male workers who were exposed organic solvents and those of 167 control workers. The type of anemia was slightly macrocytic anemia, and the RDW was generally homogenous in workers exposed to organic solvents whereas those of control were normocytic and homogenous.

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Original Article

Neuroendocrine Effects in Occupational Solvents Exposure: Chae Un Lee, Jong Tae Lee, Ui Wha Chung, Hae Suk Sohn, Deog Hwan Moon, Jin Ho Chun, Jung Hak Kang, Chang Hee Lee, Hwi Dong Kim, Jong Ham Kim, Kui Oak Jung; Korean Journal of Occupational and Environmental Medicine 1995;7(2):362-374. Published online October 31, 1995; DOI: https://doi.org/10.35371/kjoem.1995.7.2.362

Abstract PDF

Long term occupational exposure to solvent mixtures may cause adverse effects to the central nervous system with neurobehavioral symptoms. And some organic solvents have been suggested to cause impairment of tuberoinfundibular dopaminergic activity and neurochemical mechanisms controlling pituitary secretion. For the purpose of assessing neuroendocrine effects in occupational solvents exposure, hormonal study settings (shoes-manufacturing industry & fishing products industry) and compared with nonexposed controls (33men, 85women). Male workers exposed to solvent mixtures had significantly lower plasma level of follicle-stimulating hormone (FSH) than nonexposed male controls. While female workers exposed to solvent mixtures had significantly lower plasma levels of growth hormone (GH), and thyroid-stimulating hormone (TSH) than nonexposed female controls. The results of significant decrease in plasma concentrations of pituitary hormones (FSH, GH, and TSH) in workers exposed solvent mixtures indicate that occupational exposure to solvent mixtures may induce neuroendocrine effects through an effect on hypothalamic pituitary axis.

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Original Article

A Study on the Urinary Metabolites and Sister Chromatid Exchanges of Peripheral Lymphocytes in Workers Exposed to the Organic Solvents: Don Kyoun Kim, In Kyung Hwang, Cheol In Ryu, Su Il Lee, Kap Yul Jung, Yong Hwan Lee, Choong Ryeol Lee, Won Il Hyun, Suk Bong Kim, Yong Duk Jeon; Korean Journal of Occupational and Environmental Medicine 1990;2(1):75-83. Published online February 28, 1990; DOI: https://doi.org/10.35371/kjoem.1990.2.1.75

Abstract PDF: In order to know the possibility of utilizing the sister chromatid exchanges as an index which could evaliiate the effect of organic solvents on Lhe health in industrial workers, the authors Studied the effects of the inductivity of sister chromatid exchanges in peripheral lymphocyces from 90 female workers espoxed to organic solvents .and 20 lion-exposed female workers. The results obtained were as follows: 1. The frequency of sister chromatid exchanges in peripheral iympnocytes from 90 female workers exposed to organic solvents was significantly increased in comparison with 20 coatiol subiect. 2. The frequency of sister chromatid exchanges was significantly Increased in the workers who were employed in the manufacture of plastic materials than the other manufactures. 3. There were no significant differences in the frequency of sister chrornatid exchanges by carriera of the exposed workers. 4. The correlation between the frequency of sister chromatid exchanges and urinary hippuric acid was significant with the coefficient of 0.5902 showing Y=1.867X+15.188 in which Y indicate the frequency of sister chromatid exchanges per cell and X indicate the urinary hippuric acid concentration by g/l.

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