Annals of Occupational and Environmental Medicine

Case Report

Nickel dust-induced occupational contact dermatitis by welding and grinding work in shipyard workers: a report of nine cases: Daehwan Kim, A Ram Kim, Hanjun Kim, Sunghee Lee, Byeonghak Seo, Ho Seok Suh, Chang Sun Sim, Heun Lee, Cheolin Yoo; Ann Occup Environ Med 2022;34:e7. Published online March 24, 2022; DOI: https://doi.org/10.35371/aoem.2022.34.e7

Abstract Abstract in Korean PDF PubReader ePub

Background

Occupational skin diseases are skin conditions that occur or worsen in relation to work and known to be the second most common type of occupational disease affecting individuals in the United States. In Korea, epidemiological reports related to occupational skin diseases are rare. But, no cases of occupational contact dermatitis caused by welding and grinding work have been reported previously.

Case presentation

Nine male workers working in the production department for liquefied natural gas (LNG) ships in Ulsan complained of erythematous papules/patches and itching in various areas of the body after welding and grinding work. The work environment monitoring report revealed that the amount of nickel dust exceeded the time weighted average (TWA) and poor local ventilation status. Based on the symptoms and the overall results of surveys, several tests, and work environment monitoring report, the 2 workers who had positive patch-test reactions to nickel were diagnosed with nickel dust-induced allergic contact dermatitis. The other 7 workers were diagnosed that there was a high probability that they had nickel dust-induced irritant contact dermatitis. The 2 workers who had nickel dust-induced allergic contact dermatitis were recommended to switch their jobs.

Conclusions

Nickel is one of the most common cause of allergic contact dermatitis. In this case, the dust was assumed to be created by welding work with a high nickel content new welding rod and subsequent grinding work, and the concentration of this dust exceeded the time weighted average. Thus, it is thought that the nickel dust may have caused contact dermatitis through continuous contact with the workers' exposed skin in a poorly ventilated space. Currently, several domestic shipbuilding companies are manufacturing LNG tankers using a new construction method. Consequently, it is highly likely that similar cases will occur in the future, which makes this case report meaningful.

조선소에서 용접 및 그라인더 작업 중 발생한 니켈 분진에 의한 직업성 접촉피부염 사례 : 9 cases
배경
직업성 피부질환은 업무와 관련되어 발생하거나 악화하는 피부질환을 말하며 미국에서 직업성 질환 중 2번째로 흔한 질환으로 알려져 있다. 국내에서는 직업성 피부질환과 관련하여 역학적인 보고는 가끔 있었으나, 용접/사상 작업을 하는 근로자들에게서 니켈에 의한 직업성 접촉피부염이 발생한 보고는 없었다.
증례
울산 소재의 한 조선회사의 LNG선 생산부에 근무 중인 9명의 남성 근로자가 용접/사상 작업 후 여러 국소 부위에 발진 및 가려움을 호소했다.
작업환경측정 보고에 따르면 니켈 분진의 양이 한계 수준을 초과했고 국소 환기 상태가 불량한 것으로 나타났다.
직업성 피부염의 증상, 문진, 여러 검사 결과, 작업환경측정 결과 등을 고려하였을 때 우리는 니켈에 양성 반응을 보인 2명을 니켈 분진에 의한 알레르기접촉피부염으로 진단하였다. 다른 7명은 니켈 분진에 의한 자극접촉피부염 가능성이 높음으로 진단하였다. 니켈 분진에 의한 알레르기접촉피부염으로 진단한 2명에게 작업 전환을 권고하였다.
고찰
니켈은 직업 환경 및 일반 인구에서 피부에 노출 시 발생하는 알레르기접촉피부염의 가장 흔한 원인이다. 본 사례에서 높은 니켈함유량을 가진 새로운 용접봉을 이용한 용접작업 및 이어진 사상 작업으로 인해 고농도의 니켈 분진이 발생한 것으로 추정되며, 이 분진의 농도는 기준치를 초과했다. 따라서 환기가 잘 되지 않는 공간에서 니켈 분진이 근로자들의 노출된 피부에 지속적으로 닿아 접촉피부염을 일으켰을 것으로 생각된다. 현재 국내 여러 조선사들이 새로운 공법으로 LNG 탱크를 생산하고 있다. 결과적으로 우리의 사례와 유사한 여러 사례가 향후 발생할 가능성이 매우 높아 이를 보고하는 바이다.

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Original Article

Distribution of Lung-RADS categories according to job type in a single shipyard workers: Eui Yup Chung, Young Hoo Shin, Young Wook Kim, Jun Seok Son, Chan Woo Kim, Hyoung Ouk Park, Jun Ho Lee, Seung Hyun Park, Sung Joon Woo, Chang Ho Chae; Ann Occup Environ Med 2021;33:e22. Published online June 23, 2021; DOI: https://doi.org/10.35371/aoem.2021.33.e22

Abstract Abstract in Korean PDF PubReader ePub

Background

Recently, lung cancer screenings based on age and smoking history using low-dose computed tomography (LDCT) have begun in Korea. This study aimed to evaluate the distribution of lung imaging reporting and data system (Lung-RADS) categories in shipyard workers exposed to lung carcinogens such as nickel, chromium, and welding fumes according to job type, to provide basic data regarding indications for LDCT in shipyard workers.

Methods

This study included 6,326 workers from a single shipyard, who underwent health examinations with LDCT between January 2010 and December 2018. Data on age, smoking status and history, medical history, and job type were investigated. The participants were categorized into high-exposure, low-exposure, and non-exposure job groups based on the estimated exposure level of nickel, chromium, and welding fumes according to job type. Cox proportional hazard regression analysis was used to determine the difference between exposure groups in Lung-RADS category ≥ 3 (3, 4A, and 4B).

Results

Out of all participants, 97 (1.5%) participants were classified into Lung-RADS category ≥ 3 and 7 (0.1%) participants were confirmed as lung cancer. The positive predictive value (ratio of diagnosed lung cancer cases to Lung-RADS category ≥ 3) was 7.2%. The hazard ratio (HR) of Lung-RADS category ≥ 3 was 1.451 (95% confidence interval [CI]: 0.911–2.309) in low-exposure and 1.692 (95% CI: 1.007–2.843) in high-exposure job group. Adjusting for age and pack-years, the HR was statistically significant only in the high-exposure job group (HR: 1.689; 95% CI: 1.004–2.841).

Conclusions

Based on LDCT and Lung-RADS, among male shipyard workers, Lung-RADS category ≥ 3 were significantly higher in the high-exposure job group. Their HR tended to be > 1.0 and was statistically significant in the high-exposure job group. Additional studies should be conducted to establish more elaborate LDCT indications for occupational health examination.

일개 조선소 근로자의 직종간 Lung-RADS 비교
목적
최근 폐암의 조기 발견을 위해 저선량 흉부CT (LDCT)를 이용하기 시작했으며, 국내에서도 연령과 흡연력을 기준으로 한 국가폐암검진이 시작되었다. 니켈, 크롬, 용접흄은 조선소 근로자에서 흔히 노출될 수 있는 폐암 발암물질로 알려져 있으나, 이러한 위험 요인은 아직 폐암 검진의 기준이 되지 못하였다. 이 연구는 LDCT를 이용하여 니켈, 크롬, 용접흄에 노출되는 일개 조선소 근로자들에서 직종과 폐 CT 선별 판독 시스템 (Lung-RADS) 양상을 비교하여, 조선소 근로자의 LDCT 적응증에 대한 기초 자료를 생성하고자 하였다.
방법
2010년 1월부터 2018년 12월까지 건강검진에 참여한 경남지역 조선소 근로자 6,326명이 연구에 참여했다. 문진과 자기기입식 설문지를 이용하여 연령, 흡연력, 과거력, 직종 등을 확인하여, 직군에 따른 크롬, 니켈, 용접흄의 노출 추정 정도에 따라 고노출 직군, 저노출 직군, 비노출군으로 분류하였다. 그룹 간 Lung-RADS 3 이상인 군에 차이가 있는지 cox 비례위험 회귀분석을 시행하였다. 또한 연령과 갑년을 보정하여 그룹간 hazard ratio (HR)를 비교하였다.
결과
전체 대상자 6,326명 중 Lung-RADS 3 이상인 군은 97명, 폐암으로 확진된 대상자는 7명으로, 양성예측도 (PPV)는 7.2%이였다. Lung-RADS 3 이상에 대하여 직군에 따른 HR은 저노출 직군 1.451 (95% confidence interval [CI]: 0.911-2.309), 고노출 직군 1.692 (95% CI: 1.007-2.843)으로 나타났다. 연령과 갑년을 보정했을 시 HR은 고노출 직군에서만 유의하게 1.689 (95% CI: 1.004-2.841)로 나타났다.
결론
현행의 폐암검진 방법인 LDCT와 진단기준인 Lung-RADS를 이용하였을 때, 일개 조선소 남성 근로자 중 니켈, 크롬, 용접흄 노출 직군에서 Lung-RADS 3 이상군이 유의하게 많으며, HR이 1.0보다 높은 경향을 보이고, 고노출 직군에서는 유의한 결과를 보였다. 향후 추가적인 연구를 통해 보다 정밀한 근로자 건강검진 상 LDCT 적응증을 만들어야 한다.

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Original Article

Pulmonary Functions and Related Factors in Shipyard Workers: Mi Hee Park, Chun Hui Suh, Chae Gwan Lee, Byung Chul Son, Dae Hwan Kim, Jeong Ho Kim, Jong Tae Lee; Korean Journal of Occupational and Environmental Medicine 2011;23(3):324-332. Published online September 30, 2011; DOI: https://doi.org/10.35371/kjoem.2011.23.3.324

Abstract PDF

OBJECTIVES
The purpose of this study was to evaluate the factors which affect pulmonary function in shipyard workers in order to build a body of basic information that can be used to prevent and manage pulmonary disorders in the future.
METHODS
We studied the respiratory symptoms, smoking history, chest radiographies, and pulmonary functions of 793 workers associated with two shipyards from April 2009 to July 2009. The workers were subdivided into 3 groups by job type: welders, grinders, and machinist-managers. The data was analyzed according to job type and other possible impact factors.
RESULTS
Significant differences among job type were seen with dyspnea and coughing during working hours and in the morning. In pulmonary functions, there were significant differences in forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), peak expiratory flow (PEF), and maximal mid-expiratory flow (MMEF) (except FEV1/FVC%) among job types. Grinders especially showed significantly lower figures in the indices of FEV1, FVC, and MMEF.
CONCLUSIONS
Pulmonary function was significantly lower in grinders. Grinders seem to be affected by exposure to a combination of dust particles (silica, lead, and manganese) and irritant gases in the workplace. These results suggested that workers and health officials should work together to adopt technical preventive measures, such as having well- ventilated work areas and appropriate respiratory protective devices.

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Ju-Hwan Choi, Jae-Hong Shin, Mi-Young Lee, In-Sung Chung
Annals of Occupational and Environmental Medicine.2014;[Epub] CrossRef

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Case Report

A Case of Nitrogen Dioxide-Induced Pulmonary Edema in Oxygen Torch: Jong Joon Ahn, Yangjin Jegal, Kwang Won Seo, Woon Jung Kwon, Nari Choy, Yangho Kim; Korean Journal of Occupational and Environmental Medicine 2007;19(3):244-249. Published online September 30, 2007; DOI: https://doi.org/10.35371/kjoem.2007.19.3.244

Abstract PDF

BACKGROUND
Welders tend to be exposed to a variety of hazards including metal fumes, toxic gases, electricity, heat, noise, and radiation such as ultraviolet and infrared light. Noxious gases generated during welding include carbon monoxide, ozone, and nitrogen oxide. Although the effects of metal fumes have been well studied, few reports have investigated the influence of noxious gas exposure in welders.
CASE
REPORT: We encountered a patient who developed non-cardiogenic pulmonary edema within a day after fairing up a steel plate with an oxygen/LPG torch. The patient was a 43-year-old female who complained of dyspnea which became exacerbated the following morning. Her chest X-ray and chest CT scan showed an extensive ground glass opacity which was more prominent in the both upper lungs. Both her symptoms and chest X-ray findings improved. We attributed the patient's symptoms to non-cardiogenic pulmonary edema caused by nitrogen dioxide exposure, by reasoning that: 1) the patient's clinical course and radiologic findings suggested pulmonary edema 2) the event happened following fairing work with oxygen/LPG torch that usually induces a high concentration of nitrogen dioxide, and 3) the other possible causes of pulmonary edema could be excluded.
CONCLUSION
Nitrogen dioxide-induced pulmonary edema should be considered in oxygen torch contrary to arc welding.

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Original Article

An Evaluation of the Ventilatory Function in Shipyard Welders Using the Lifetime Cumulative Exposure to Welding Fumes: Chun Hwa Jung, Hyeon Woo Yim, Jung Wan Koo, Chung Yill Park; Korean Journal of Occupational and Environmental Medicine 2002;14(4):364-376. Published online December 31, 2002; DOI: https://doi.org/10.35371/kjoem.2002.14.4.364

Abstract PDF: Objectives
This study was conducted to evaluate the ventilatory function in shipyard welders using the lifetime cumulative exposure to welding fumes.
METHODS
Ventilatory function tests were performed on 241 male welders at one large shipyard,exposed to welding fumes for over five years,and was compared to 80 male control subjects. Ventilatory function indices, such as forced vital capacity(FVC), one-second forced expiratory volume(FEV 1), ratio of FEV 1 to FVC(FEV 1%), maximal mid-expiratory flow(MMF), peak expiratory flow rate(PEFR)and maximal expiratory flow at 50 and 75% of expired FVC(FEF50 and FEF75), were obtained by analyzing forced expiratory spirograms and maximal expiratory flow-volume curves that were simultaneously measured by an Impulse ocillometry(IOS)program in the standing position.
RESULTS
FEF50 and FEF75 expressed as a percentage of the predicted values were significantly lower in the exposure group than in the controls, and the MMF tended to decrease.The means of all the ventilatory indices,expressed as percentage of the predicted values, were not significantly increased at the current exposure levels. The MMF, FEF50 and FEF75, expressed as a percentage of the predicted values, were significantly decreased with an increase in exposure duration.Only the FEF75 , expressed as a percentage of the predicted value, was significantly decreased with an increase in the cumulativeexposure to welding fumes(C1). The FEF75, expressed as a percentage of the predicted value, was significantly decreased with an increase in the cumulative exposure to welding fumes(C2). The above parameters were calculated to consider the current exposure level, exposure duration, application of the ventilatory system, production rate, personal protection evice, electrode and welding wire. The MMF and FEF50, expressed as a percentage of the predicted value, tended to decrease. The proportion of workers with abnormal MMF, FEF50 and FEF75 were significantly increased with an increase in the cumulative exposure to welding fumes(C2).
CONCLUSIONS
These findings suggested that the MMF, FEF50 and FEF75 are sensitive and practical indices for the evaluation of the ventilatory function of workers exposed to welding fumes, when the lifetime cumulative exposure(C2) is considered as a factor affecting exposure.

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Original Article

Tympanic Membrane Perforation Due to Metal Spark in a Welder: Kyoo Sang Kim, Tae Gee Jung; Korean Journal of Occupational and Environmental Medicine 1999;11(1):113-118. Published online March 31, 1999; DOI: https://doi.org/10.35371/kjoem.1999.11.1.113

Abstract PDF

Injury to the ear in welders is a recognized but poorly documented entity. The risk for ear injury from molten metal or hot sparks produced during welding procedures is low, but the effects can be significant. Burns, tympanic membrane perforations and chonic otorrhoea are the most common results. One case recently experienced at our institution highlight the risk that exists for middle ear injury. The traumatic thermal injury was caused by a metal spark perforating the tympanic membrane during welding. Neither subject was using ear protection at the time. The use of ear protection is strongly advocated during welding operations that place the ear at risk.

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Original Article

Performance of Neurobehavioral Tests Among Welders Exposed to Manganese: Youngwoo Jin, Yangho Kim, Kyoo Sang Kim, Euna Kim, Young Sook Cho, Yong Chul Shin, Changho Chai, Younghyu Choi, Se Hoon Lee, Young Hahn Moon; Korean Journal of Occupational and Environmental Medicine 1999;11(1):1-12. Published online March 31, 1999; DOI: https://doi.org/10.35371/kjoem.1999.11.1.1

Abstract PDF

To study neurobehavioral effects for manganese fume exposure of welders, we administrated questionnaire about subjective symptom, related with manganese exposure. Neurobehavioral Core Test Battery of World Health Qrganization(NCTB) and finger tapping for 98 welders and 29 non-welding workers. We adopted welding duration as a criterion for exposure assessment, because of the lack of the longitudinal valid data and differences in airborne concentrations of manganese in welding types, such as shielded metal arc and CO2 arc welding. Neurologic, musculoskeletal and concentration symptoms were significantly increased by increase of welding duration. Performance of finger tapping preferred hand, Santa Ana dexterity test preferred hand and correct number of pursuit aiming were significantly decreased by increase of welding duration. These results comparable with previous studies that suggest neurobehavioral test, especially motor test, to be an appropriate tool to detect early neurobehavioral abnormalities related with manganeses exposure.

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Journal of Toxicology and Environmental Health, Part B.2007; 10(6): 417. CrossRef
High signal intensity on magnetic resonance imaging as a predictor of neurobehavioral performance of workers exposed to manganese
Yong Chul Shin, Euna Kim, Hae-Kwan Cheong, Sungil Cho, Joon Sakong, Kyoo Sang Kim, Jung Sun Yang, Young-Woo Jin, Seong-Kyu Kang, Yangho Kim
NeuroToxicology.2007; 28(2): 257. 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
Issues in neurological risk assessment for occupational exposures: The Bay Bridge welders
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NeuroToxicology.2006; 27(3): 373. CrossRef

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Original Article

Effects of Welding Fume on Ventilatory Function: Tae In Moon, Jung Wan Koo, Chee Kyung Chung; Korean Journal of Occupational and Environmental Medicine 1996;8(3):383-391. Published online December 31, 1996; DOI: https://doi.org/10.35371/kjoem.1996.8.3.383

Abstract PDF: In order to study the effects of welding fume on ventilatory function, forced expiratory spirogram was performed on 563 male workers exposed to welding fume in motor vehicles industry and 589 male control workers. Ventilatory indices such as forced vital capacity (FVC), forced expiratory volume in one second (FEV(1)), the ratio of one-second forced expiratory volume to forced vital capacity (FEV(1)%= FEV(1)/FVC) and maximal mid-expiratory flow(MMF) were obtained by analyzing forced expiratory spirogram which were measured by Vitalograph in standing position. The results were as follows: 1. Mean values of FVC, FEV(1), FEV(1)%, and MMF expressed as percent of the predicted were significantly lower in exposure group than in control group. 2. No significant differences for mean ventilatory indices were demonstrated between smokers and nonsmokers both in exposure group and control group. However, mean MMF of welders tended to reduce in smokers (77.4 %) than in nonsmokers (82.4 %). 3. In exposure group mean FEV(1) was significantly lower in more than 20 years than those of control group. However, mean MMF, FEV(1)% were significantly reduced with increasing exposure duration compared to control group, indicating 90.8 %; and 62.2 % of the predicted in more than 20 years group. 4. In exposure group workers with obstructive ventilatory impairment (7.5 %) was markedly higher than that with restrictive ventilatory impairment (2.0 %). 5. In exposure group the proportion of workers with low ventilatory indices was' the highest in MMF (26.8 %), and followed by FEV(1)(11.9 %), FEV(1)%(7.6 %) and FVC (2.1 %) in descending order. Workers with low MMF and PEV^% were significantly increased with increasing exposure duration compared to control group, indicating 64.3 % and 32.1 % in above 20 years group. With the above considerations in mind it suggested that the exposure to welding fume be associated with reduced pulmonary function and obstructive ventilratory impairment, increasing exposure duration be associated with reduced pulmonary function, and MMF be the most sensitive index in the evaluation of venfcilatory impairments of workers exposed to welding fume.

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