Young man with severe metabolic acidosis after transformer oil ingestion: a case report.

BACKGROUND: Transformer oil is used in oil-filled transformers for its insulating as well as coolant properties. Transformer oil ingestion for attempted suicide is seldom heard of. Our patient's case presented us with a major diagnostic as well as treatment challenge because we encountered such a case for the first time and were totally unaware of the fact that methanol might make up the main component of an aged transformer oil. CASE PRESENTATION: A 19-year-old Pakistani/Asian man was brought to our hospital with altered sensorium. He was found to have elevated anion gap acidosis, increased osmolal gap, and acute kidney injury. He had no evidence of rhabdomyolysis or hemolysis. Computed tomography of his head showed cerebral edema. He was resuscitated with intravenous fluids and bicarbonate. Three days later, he confessed taking transformer oil with suicidal intention. His clinical picture mimicked acute methanol intoxication. With an initial improvement in his neurological status, he started complaining of constant headache with episodes of agitation and delirium. His renal function continued worsening despite an adequate urine output. He showed a remarkable improvement in his neurological state after just one session of hemodialysis. CONCLUSIONS: There is evidence that aged transformer oil contains methanol, and a patient who consumes it can present with features mimicking acute methanol intoxication.

Developing estimates of frequency and intensity of exposure to three types of metalworking fluids in a population-based case-control study of bladder cancer.

BACKGROUND: A systematic, transparent, and data-driven approach was developed to estimate frequency and intensity of exposure to straight, soluble, and synthetic/semi-synthetic metalworking fluids (MWFs) within a case-control study of bladder cancer in New England. METHODS: We assessed frequency using individual-level information from job-specific questionnaires wherever possible, then derived and applied job group-level patterns to likely exposed jobs with less information. Intensity estimates were calculated using a statistical model developed from measurements and determinants extracted from the published literature. RESULTS: For jobs with probabilities of exposure≥0.5, median frequencies were 8-10 hr/week, depending on MWF type. Median intensities for these jobs were 2.5, 2.1, and 1.0 mg/m3 for soluble, straight, and synthetic/semi-synthetic MWFs, respectively. CONCLUSIONS: Compared to case-by-case assessment, these data-driven decision rules are transparent and reproducible and may result in less biased estimates. These rules can also aid future exposure assessments of MWFs in population-based studies.

Hypersensitivity pneumonitis in workers exposed to metalworking fluids.

BACKGROUND: This study used data from a large UK outbreak investigation, to develop and validate a new case definition for hypersensitivity pneumonitis due to metalworking fluid exposure (MWF-HP). METHODS: The clinical data from all workers with suspected MWF-HP were reviewed by an experienced panel of clinicians. A new MWF-HP Score was then developed to match the "gold standard" clinical opinion as closely as possible, using standard diagnostic criteria that were relatively weighted by their positive predictive value. RESULTS: The new case definition was reproducible, and agreed with expert panel opinion in 30/37 cases. This level of agreement was greater than with any of the three previously utilized case definitions (agreement in 16-24 cases). Where it was possible to calculate, the MWF-HP Score also performed well when applied to 50 unrelated MWF-HP cases. CONCLUSIONS: The MWF-HP Score offers a new case definition for use in future outbreaks.

Elaioconiosis--case report.

Elaioconiosis is a work-related acneiform dermatosis which affects the exposed skin of individuals working with oils or greases. Its incidence has decreased with the introduction of personal protective equipment, personal hygiene measures and the cleaning of work clothes. Although not a rare disease, elaioconiosis is seldom reported in the literature, particularly in Brazil. Sufferers need to take time off work to proceed with the prolonged treatment to resolve the lesions caused by this condition.

Elaioconiose: relato de caso / Elaioconiosis: case report

Elaioconiose é uma dermatose ocupacional do tipo acneiforme que afeta as áreas expostas de trabalhadores que lidam com óleos ou graxas. Atualmente, com o uso dos equipamentos de proteção individual, medidas de higiene pessoal e lavagem dos uniformes de trabalho, sua incidência diminuiu. Apesar de não ser uma doença rara, é pouco relatada na literatura, principalmente na nacional. Seu tratamento é lento e para a resolução das lesões, requer o afastamento do trabalhador de suas atividades laborativas.

Elaioconiosis is a work-related acneiform dermatosis which affects the exposed skin of individuals working with oils or greases. Its incidence has decreased with the introduction of personal protective equipment, personal hygiene measures and the cleaning of work clothes. Although not a rare disease, elaioconiosis is seldom reported in the literature, particularly in Brazil. Sufferers need to take time off work to proceed with the prolonged treatment to resolve the lesions caused by this condition.

Effects of environmental stresses on the responses of mangrove plants to spent lubricating oil.

The influence of different environmental stresses, including salinity (5-35‰), tidal cycle (6/6, 12/12 and 24/24 h of high/low tidal regimes) and nutrient addition (1-6 times background nitrogen and phosphorus content) on Bruguiera gymnorrhiza and Aegiceras corniculatum grown in sediment contaminated with spent lubricating oil (7.5 L m(-2)) were investigated. The oil-treated 1-year-old mangrove seedlings subject to low (5‰) and high (35‰) salinity had significantly more reduction in growth, more release of superoxide radical (O2·-) and higher activity of superoxide dismutase (SOD) than those subject to moderate salinity (15‰). Extended flooding (24/24 h of high/low tidal regime) enhanced O2·- release and malondialdehyde (MDA) content in both oil-treated species but had little negative effects on biomass production (P>0.05) except the stem of A. corniculatum (P=0.012). The addition of nutrients had no beneficial or even posed harmful effects on the growth and cellular responses of the oil-treated seedlings.

A field study on clinical signs and symptoms in cleaners at floor polish removal and application in a Swedish hospital.

AIM: To study health effects in hospital cleaners (N = 21) at floor polish removal and application. METHODS: The cleaners were investigated before exposure (Monday = day 1), after polish removal work (day 2), and after application of floor polish (day 3). Ratings of symptoms, tear-film break-up-time (BUT), nasal patency and biomarkers in nasal lavage were studied. RESULTS: There was a significant increase both day 2 and day 3, as compared to pre-exposure, in ocular, nasal, throat symptoms, solvent smell, dyspnoea, and general symptoms such as headache and fatigue. Posterior nasal patency was decreased day 2 (p < 0.01) and day 3 (p < 0.01). No change of nasal biomarkers (ECP, MPO, lysozyme, albumin) was seen. BUT was decreased after polish removal (p < 0.01), but not after polish application. Separate test of the weekday effect in non-exposed showed slight improvements, or no change of symptoms or clinical signs from Monday to Wednesday. Air concentrations of ethylene glycol monoethyl ether, ethylene glycol monobutyl ether, diethylene glycol monoethyl ether, dipropylene glycol monomethyl ether, diethylene glycol monoethyl ether and ethylene glycol phenyl ether 103, 666, 13,650, 7,000, 67, and 27 microg/m(3), respectively, at polish application. Glycol ether levels were reduced to 3% after 2 days and 0.3% after 17 days. CONCLUSIONS: Emissions from a common water-based polish remover and floor polish system may cause ocular and airway irritation and general symptoms, and reduce tear-film stability and nasal patency. The levels of glycol ethers had a rapid decay.

Time-course study of the early lysosomal responses to pollutants in mussel digestive cells using acid phosphatase as lysosomal marker enzyme.

Lysosomal biomarkers are early warning signals of the biological effects caused by environmental pollutants but the promptness of lysosomal responses to pollutants has not been investigated yet. This work is aimed to determine the response-time of digestive cell lysosomes in mussels exposed to metals and hydrocarbons. Mussels, Mytilus galloprovincialis, were exposed, under laboratory conditions to Cd and to the water-accommodated fraction of a lubricant oil. One mussel per experimental group was sacrificed and processed every hour from 0 h to 30 h. Changes in AcP activity, immunoreactivity and LMS test based on AcP histochemistry, discriminates significantly control and exposed mussels within 5 h exposure. The present results suggested that after 15-20 h exposure digestive cell loss might be accompanied by increased AcP activity (extralysosomal) without a parallel increase in the levels of immunoreactive AcP protein, especially after Cd-exposure. The reduced labilisation period of lysosomal membrane constitute a cost effective early warning signal that, however, is not necessarily correlated with the exposure time. The routine application of immunochemical techniques deserves more research efforts before its implementation although, these techniques are very valuable to understand and interpret correctly lysosomal responses to pollutants.

Estimation of the impact of prevailing weather conditions on the occurrence of oil-contaminated dead birds on the German North Sea coast.

Chronic oil pollution by illegal oil dumping in the North Sea is difficult to quantify. Beached, oil-contaminated sea birds, however, may be used as an indirect indicator. Reconstructing the drift of oil slicks and sea bird corpses in the southern North Sea for the period 1992-2003 by means of a two-dimensional numerical transport model driven by re-analysed weather data, we show with an example of two common sea bird species that the variability observed within the number of corpses registered during beached bird surveys for the German coast primarily reflects the inter-annual variability of prevailing weather conditions. This should be taken into account when interpreting the data. We propose normalisation of beached bird survey data based on numerical drift simulations to improve the recognition of trends in the level of chronic oil pollution.

Self inflicted, bilateral oleogranuloma of the breast: report of a bizarre case.

A 30-year-old male was admitted with bilateral painful breast enlargement of 6 months duration. There was a past history of surgery for similar bilateral swellings, which was then diagnosed as fibrocystic disease. On examination both breasts were firm to hard, tender & adherent to deeper structures. A single axillary lymph node was palpable on each side. The clinical diagnosis was sarcoma of the breast. After initial denial, the patient confessed to having injected gear oil into both the breasts,for the purpose of augmentation. He was a homosexual.

Clinical investigation of an outbreak of alveolitis and asthma in a car engine manufacturing plant.

BACKGROUND: Exposure to metal working fluid (MWF) has been associated with outbreaks of extrinsic allergic alveolitis (EAA) in the USA, with bacterial contamination of MWF being a possible cause, but is uncommon in the UK. Twelve workers developed EAA in a car engine manufacturing plant in the UK, presenting clinically between December 2003 and May 2004. This paper reports the subsequent epidemiological investigation of the whole workforce. The study had three aims: (1) to measure the extent of the outbreak by identifying other workers who may have developed EAA or other work-related respiratory diseases; (2) to provide case detection so that those affected could be treated; and (3) to provide epidemiological data to identify the cause of the outbreak. METHODS: The outbreak was investigated in a three-phase cross-sectional survey of the workforce. In phase I a respiratory screening questionnaire was completed by 808/836 workers (96.7%) in May 2004. In phase II 481 employees with at least one respiratory symptom on screening and 50 asymptomatic controls were invited for investigation at the factory in June 2004. This included a questionnaire, spirometry and clinical opinion. 454/481 (94.4%) responded and 48/50 (96%) controls. Workers were identified who needed further investigation and serial measurements of peak expiratory flow (PEF). In phase III 162 employees were seen at the Birmingham Occupational Lung Disease clinic. 198 employees returned PEF records, including 141 of the 162 who attended for clinical investigation. Case definitions for diagnoses were agreed. RESULTS: 87 workers (10.4% of the workforce) met case definitions for occupational lung disease, comprising EAA (n = 19), occupational asthma (n = 74) and humidifier fever (n = 7). 12 workers had more than one diagnosis. The peak onset of work-related breathlessness was Spring 2003. The proportion of workers affected was higher for those using MWF from a large sump (27.3%) than for those working all over the manufacturing area (7.9%) (OR = 4.39, p<0.001). Two workers had positive specific provocation tests to the used but not the unused MWF solution. CONCLUSIONS: Extensive investigation of the outbreak of EAA detected a large number of affected workers, not only with EAA but also occupational asthma. This is the largest reported outbreak in Europe. Mist from used MWF is the likely cause. In workplaces using MWF there is a need to carry out risk assessments, to monitor and maintain fluid quality, to control mist and to carry out respiratory health surveillance.

Biological and electrochemical treatment of used metalworking fluids: a toxicity-reduction evaluation.

The aim of this study was to evaluate and compare the toxicity of spent metalworking fluids (MWFs) and two different effluents obtained by biologic and electrochemical treatment of spent MWFs toward aquatic organisms of different trophic levels. The obtained toxicity data was used to calculate safe concentrations of both effluents. The spent MWFs without treatment showed the highest toxicity among the tested samples and should be classified as "extremely toxic" (toward invertebrates) or "very toxic" (toward other test organisms). Both methods applied for MWFs treatment resulted in a significant decrease in toxicity of the treated MWFs, but the obtained effluents had still to be regarded as "toxic". The ranges of the values of acute toxic units for both effluents were significantly narrower than for the untreated spent MWFs. The values of the safe concentrations of the spent MWFs, the biologic effluent, and the water phase resulting from electrochemical emulsion breaking were equal to 0.013%, l.8%, and 1.3%, respectively, corresponding to chemical oxygen demand concentrations of 1.8%, 32, and 34 mg O(2)*L(-1). These values are far lower than the discharging limit of 125 mg O(2)*L(-1) for industrial effluents, according to the relevant Polish regulations. It is therefore recommended to include toxicity bioassay parameters into guidelines for wastewater discharges to surface waters because the existing chemical and physical parameters are not sufficient to describe the environmental impact of industrial wastewater. Toxicity bioassays can be a promising tool for evaluating the efficacy of unit operations in industrial wastewater treatment (toxicity reduction evaluation) as well as identification of toxic substances in effluents (toxicity identification evaluation).

Predicting survival of grass shrimp (Palaemonetes pugio) during ethylnaphthalene, dimethylnaphthalene, and phenanthrene exposures differing in concentration and duration.

Both exposure duration and concentration determine the lethal consequences of polycyclic aromatic hydrocarbons (PAHs) released during oil spills. Many factors, such as weathering, tidal transport, and addition of surfactants, can change the composition of individual dissolved compounds and the duration over which an individual is exposed. Conventional toxicity testing methods produce effect metrics, such as the median lethal concentration (LC50), that are not applicable to predicting mortality at all toxicant exposure durations that are likely to occur during a spill. In the present study, survival time models were developed that explicitly include toxicant exposure duration and concentration to predict time-to-death for grass shrimp (Palaemonetes pugio) exposed to three PAHs (1-ethylnaphthalene, 2,6-dimethylnaphthalene, and phenanthrene) commonly found in the water-soluble fraction derived from oil. Conventional 48-h LC50s also were calculated for the compounds (ethylnaphthalene, 295 microg/L; dimethylnaphthalene, 500 microg/L; and phenanthrene, 360 microg/L). In contrast to LC50s, survival models and associated response surfaces can be used to predict the proportions of shrimp that will die at various times throughout the exposure period.

Investigations on the effect of chlorine in lubricating oil and the presence of a diesel oxidation catalyst on PCDD/F releases from an internal combustion engine.

This paper reports on an intensive study into releases of polychlorinated dibenzo-p-dioxins (PCDD), polychlorinated furans (PCDF) and polychlorinated biphenyls (PCB) from a diesel engine and the analysis of PCDD/F and PCB in crankcase lubricating oil. Experimental conditions were set and carefully controlled in order to maximize the possible impact of, and our ability to measure the effect of, changes in the levels of chlorine in the lubricant. Emissions to air were measured using modified EPA methods following the principles of the European EN 1948 standards. A series of 40 experimental runs were completed using three reference lubricants formulated to have three levels of chlorine present as a residual component (at levels of 12, 131 and 259 mg kg(-1) or ppm). The engine was run with and without the diesel oxidation catalyst. All lubricants were realistic oils and the use of unrealistic additives or doping of components - particularly chlorine - in the fuel and lubricant was carefully avoided. Analysis of fuel and lubricant (before and after testing) samples required strenuous attention to achieve acceptable recoveries and showed non-detectable levels of PCB and PCDD/F at a detection limit of around 1.5 ng I-TEQ kg(-1) (ppt), indistinguishable from the laboratory blank. The testing demonstrated the need for extreme care to be taken in developing measurement methods that are sufficiently sensitive for measuring chlorine content of fluids and PCDD/F in oils, the latter being particularly challenging. Mean emissions of PCDD/F with the diesel oxidation catalyst in place were 23 pg I-TEQ l(-1) of fuel and with the diesel oxidation catalyst removed 97 pg I-TEQ l(-1) of fuel. The results of this testing showed that the emissions of PCDD/F were greatly reduced by the presence of a diesel oxidation catalyst in the exhaust, a finding that has not been explicitly tested in previous work. They also show that emissions from the engine were not controlled by the level of chlorine in the lubricant and that emissions did not change in response to a much greater step change in the total chlorine entering the combustion chamber due to a change in the level of chlorine in the fuel. Emissions when the engine was configured with a diesel oxidation catalyst showed a consistent pattern that appears to be unique in the experience of the authors.

Rectal cancer and exposure to metalworking fluids in the automobile manufacturing industry.

BACKGROUND: Rectal cancer has been previously associated with exposure to metalworking fluids in a cohort mortality study of autoworkers. OBJECTIVE: To better specify the exposure-response relationship with straight metalworking fluids (mineral oils) by applying non-parametric regression methods that avoid linearity constraints and arbitrary exposure cut points and by lagging exposure to account for cancer latency, in a nested case-control analysis. METHODS: In addition to the classical Poisson regression with categorical exposure, survival models with penalised splines were used to estimate the exposure-response relationship between cumulative exposure to straight metalworking fluid and mortality from rectal cancer. Exposures to water-based metalworking fluids were treated as potential confounders, and all exposures were lagged by 5, 10, 15 and 20 years to account for cancer latency. The influence of the highest exposures was dealt with by a log transformation and outlier removal. The sensitivity of the penalised splines to alternative criteria for model selection and to the placement of knots was also examined. RESULTS: The hazard ratio for mortality from rectal cancer increased essentially linearly with cumulative exposure to straight metalworking fluid (with narrow confidence bands) up to a maximum of 2.2 at the 99th centile of exposure and then decreased (with wide confidence bands). Lagging exposure up to 15 years increased the initial steepness of the curve and raised the maximum hazard ratio to 3.2. CONCLUSIONS: Non-parametric smoothing of lagged exposures has shown stronger evidence for a causal association between straight metalworking fluid and rectal cancer than was previously described using standard analytical methods. This analysis suggests an exposure-response trend that is close to linear and statistically significant over most of the exposure range and that increases further with lagged exposures. Smoothing should be regularly applied to environmental studies with quantitative exposure estimates to refine characterisation of the dose-response relationship.

Acute suppression of serum IgM and IgA in tank workers exposed to benzene.

We investigated associations between benzene exposure and alterations of proteins and cells of the immune system among workers maintaining cargo tanks containing crude oil residues. Individual exposure to benzene, benzene in blood and urine, peripheral blood lymphocytes (total lymphocytes, lymphocytes in subpopulations CD3, CD4, CD8, CD19, CD56 and CD4/CD8 ratio), complement factors C3 and C4 and serum concentration of immunoglobulins (IgG, IgA, IgM and IgE) were analysed among 13 tank workers and nine unexposed referents (catering section). Benzene exposure was measured during three consecutive 12-h work days. Blood and urine samples were collected pre-shift on the first day (baseline), post-shift on the third day, and pre-next shift on the following morning. The time spent in the cargo tank was logged. The individual geometric mean benzene exposure in the breathing zone of tank workers over 3 days was 0.15 p.p.m. (range 0.01-0.62 p.p.m.) (n = 26). The geometric mean benzene concentration in blood post-shift was 12.3 nmol/l among tank workers versus 0.7 nmol/l among the referents. Tank workers showed a decline (versus referents) in IgM from baseline to post-shift (t-test, P = 0.04) and IgA from baseline to pre-next shift (t-test, P = 0.01). They also showed a decline in CD4 T cells from baseline to post-shift (t-test, P = 0.04). Suppression correlated with benzene exposure, benzene concentrations in blood and urine and time spent in the tank. The groups did not differ significantly in the change in other immune parameters. The clinical significance is unknown and warrants further studies.

[State of health of children and structure of morbidity in the region of catastrophe of oil producing plant].

On September 9, 2004 in Sagarejo region, Ninotsminda village an ecologic catastrophe took place. As a result of explosion at the oil-producing plant there was an oil spill in the surrounding soil, which caused the pollution of the environment. Among children living in Ninotsminda village (the main zone) 370 children were investigated for evaluation of the state of their health and nosological structure of the morbidity. The observation was performed by stages. 1st stage: study of the zone 1 year before the catastrophe. 2(nc) stage: quarterly dynamic control over the state of health of the children in both zones for the purpose of comparison of definition of the absolute number of morbidity index. It was found that after the catastrophe the absolute number of diseases in the main zone increased 10.8 times, and in the control one significant alterations did not appear. According to the nosological structure of the morbidity the predominance of pathology of pulmonary-respiratory system was revealed.

Toxicity of weathered Exxon Valdez crude oil to pink salmon embryos.

Research was conducted at the University of Idaho (Moscow, ID, USA) on the toxicity of weathered Exxon Valdez crude oil to embryos of pink salmon from 2001 to 2003 for the purpose of comparing these data with those from the National Oceanic and Atmospheric Administration Fisheries Laboratory at Auke Bay (AK, USA). Mortality reported at Auke Bay for embryos chronically exposed to very low concentrations of aqueous solutions of weathered oil, measured as dissolved polycyclic aromatic hydrocarbons (PAHs), was inconsistent with that in other published research. Using the Auke Bay experimental design, we found that toxicity is not evident in pink salmon embryos until chronic exposure to laboratory weathered and naturally weathered oil concentrations exceeding 1,500 and 2,250 ppm, respectively, representing a total PAH tissue burden in excess of 7,100 ppb. Effluent hydrocarbons also drop well below concentrations sufficient to cause harm over the time frame of a few weeks, regardless of oiling level. Resolution of differences with Auke Bay involved the source of contributing hydrocarbons. The experimental design did not exclude dispersed oil droplets from the aqueous solution; thus, toxicity was not limited to the dissolved hydrocarbon fraction. The implications of the present results are discussed regarding the toxic risk of weathered oil to pink salmon embryos in streams of Prince William Sound (AK, USA).

Prostate cancer incidence in relation to time windows of exposure to metalworking fluids in the auto industry.

BACKGROUND: Exposure to metalworking fluids has been previously associated with prostate cancer mortality in a cohort of autoworkers. Our objective was to further explore this finding in a study of prostate cancer incidence in the same cohort, with reduced misclassification of outcome. METHODS: We conducted a nested case-control study in the General Motors cohort of autoworkers. Incident cases of prostate cancer (n = 872) were identified via the Michigan Cancer Registry from 1985 through 2000. Controls were selected using incidence-density sampling with 5:1 ratio. Using cumulative exposure (mg/m-years) as the dose metric, we first examined varying lengths of lags (0-25 years). Then, we evaluated consecutive windows of exposure: 25 or more years before risk age, and fewer than 25 years. We used penalized splines to model the relative risk as a smooth function of exposure, and adjusted for race and calendar year of diagnosis in a Cox model. RESULTS: Risk of prostate cancer increased with exposure to soluble and straight fluids 25 years or more before risk age but not with exposure in the last 25 years. The relationship with soluble fluids was piecewise linear, with a small increase in risk at lower exposures followed by a steeper rise. By contrast, the relationship with straight fluids was linear, with a relative risk of 1.12 per 10mg/m-years of exposure (95% confidence interval = 1.04-1.20). CONCLUSIONS: Exposure to oil-based fluids, soluble and straight, is modestly associated with prostate cancer risk among autoworkers, with a latency period of at least 25 years.