Humoral immunosuppression in men exposed to polycyclic aromatic hydrocarbons and related carcinogens in polluted environments.

We evaluated humoral immunity by measuring IgG, IgA, IgM, and IgE concentrations in 274 male workers in an iron foundry in Cracow, Poland. There were two groups: 199 coke oven workers and 76 cold-rolling mill workers. The groups were similar with respect to age, length of work (average 15 years), and smoking habits. Exposure to polycyclic aromatic hydrocarbons (PAHs), assessed by personal and area monitoring, ranged from 0.2 to 50 micrograms/m3 benzo[a]pyrene in coke plant workers and was of 3-5 magnitudes higher than in the cold-rolling mill employees. Comparison of the two groups revealed a marked depression of mean serum IgG and IgA in coke oven workers (p < 0.001, Student's unpaired t-test). In the same subjects, serum IgM had a tendency to decrease, whereas serum IgE showed a trend toward higher values. Thus, workers exposed chronically to complex mixtures of air pollutants, composed primarily of PAHs, develop immunosuppression. It remains to be established whether the immunosuppression described here is related to the frequent development of lung cancer reported in coke plant employees. Workers exposed chronically to PAHs should have serum immunoglobulins monitored regularly.

Obstruction of the small airways in the spirometric diagnosis of occupational bronchial asthma.

The aim of this study was to evaluate spirometric changes after inhalation challenge in steel and tobacco factory workers suffering from bronchial asthma suspected to be of occupational origin. In 49 patients the spirometric changes were analyzed immediately after and 24 h (delayed reaction) after inhalation challenge at work. A decrease in spirometric parameters of 20% compared to baseline was considered significant. The suspicion of occupational bronchial asthma was based on anamnesis and skin patch tests. The atopy features in examined patients were evaluated according to anamnesis, skin prick tests with aeroallergens, as well as total IgE serum level and blood eosinophils. The significant decrease in spirometric parameters after the inhalation challenge at work was confirmed in 25 (51%) patients. In 16 of them (64%), the decrease of FEV1 value together with the decrease of the MEF 25-75% VC values were noted. A significant isolated decrease in the FEV1 was observed in only four (16%) patients. However, in five (20%) patients a significant decrease in MEF 25-75% VC values was only found as a confirmation of airways obstruction. The studies emphasize the diagnostic value of small airways obstruction in the evaluation of inhalation challenge tests in patients suspected of occupational bronchial asthma.

Fetal hemoglobin as a possible marker of susceptibility to working conditions for certain men exposed to industrial pollutants.

In 43 from 222 men (19.4%) employed in a coking plant a higher than normal concentration of fetal hemoglobin (HbF) was found, whereas an elevated level of HbF was detected in only two from 87 persons (2.3%) working in the cold rolling mill of the steel mill 'Huta Sendzimira', Krakow, Poland. Subjects employed in the coking mill worked in a much more polluted atmosphere than those in the cold rolling mill. It is speculated that synthesis of HbF may be a marker of the effect of unfavorable working conditions on some susceptible persons.

Regulation of breathing in cases of acute carbon monoxide poisoning.

The contribution of the central and peripheral nervous system to the regulation of breathing in acute carbon monoxide poisoning was evaluated through the analysis of respiratory pattern parameters, mainly the values of tidal volume to the inspiratory flow (VT/T(in)--driving component), and the relation of inspiratory time to the total cycle time (T(in)/T(tot)--timing component). In the examination performed as soon as possible after poisoning, an increase in the value of the VT/T(in) parameter and a diminishing of T(in)/T(tot) value were noted. Lightly poisoned subjects showed higher dynamics of changes in the regulation of breathing than the medium and severely poisoned patients. Both respiratory pattern components, measured after treatment, were in the lightly poisoned group comparable to the healthy subjects, whereas in the medium and severely poisoned group the value of VT/T(in) was elevated, and the value of T(in)/T(tot) was lessened in comparison to the control counterpart. Both respiratory pattern components significantly correlated to the blood lactace level, and to the degree of poisoning estimated in a complex way.

The effect of acute carbon monoxide poisoning on the respiratory system efficiency. I. Values of spirometric parameters in different degrees of poisoning.

The examination of 91 patients, performed as soon as possible after CO poisoning, revealed that the values of ventilatory parameters obtained from the flow-volume loop recorded by a computer-aided spirometer were significantly lower then those after treatment. Ventilatory efficiency closely related with the degree of poisoning, was assessed according to age, COHb concentration, blood lactate level, and neurological symptoms. Ventilatory parameters in 48 persons with medium and acute poisoning were significantly lower than in the group of slightly poisoned patients. The strong relationship between the major spirometric parameters, blood lactate level and duration of exposure to carbon monoxide was noted. However, the correlation between ventilatory parameters and the degree of poisoning taken as a total of all mentioned parameters was strongest.

The effect of acute carbon monoxide poisoning on the respiratory system efficiency. II. Types of ventilatory disorder and dynamics of changes according to the severity of carbon monoxide poisoning.

As a result of acute carbon monoxide poisoning ventilatory disturbances were found in 62.2% of 91 examined persons, who had never before suffered from any respiratory diseases. An obturation of the central and small bronchi and mixed disorders proved to be the most frequent ventilatory disturbance. In a larger group of patients regression of respiratory disorders was observed after treatment. However, in 44% of medium and severe poisoned persons respiratory disorders, mainly small bronchi obturation, persisted after medication.

Occurrence of pulmonary diseases in steel mill workers.

The 'Sendzimir' Steel Mill, Cracow, Poland, gives employment to approximately 17,000 workers. During the years 1994-98, 1396 compensation claims for diseases related to occupational hazards were registered. After a scrupulous investigation, 851 cases were certified as occupation-related diseases. Of this number, 481 cases (56.5%) were diagnosed as pulmonary diseases, including silicosis (n = 225, 46.7%); chronic bronchitis (n = 138, 28.7%); lung carcinoma (n = 59, 12.3%); epithelial cancer (n = 42); adenocarcinoma (n = 12); microcellular carcinoma (n = 5); asthma, 12 atopic and 24 non-atopic (n = 36, 7.5%); and asbestosis (n = 23, 4.8%). Chronic bronchitis was diagnosed in patients exposed to industrial dusts, containing SiO2, NOx, and SO2. Asthma occurred most frequently among those exposed mainly to Cr+6, Co and Ni containing dusts, and lung carcinoma in those exposed to policyclic aromatic hydrocarbons, including benz(a)pyren, asbestos, chromium, vapours of oils and lubricants. In 1994-96, chronic bronchitis and silicosis, and in 1997-98, lung carcinoma and asthma were most frequently diagnosed in the workers under study. It is likely that the diminishing frequency of chronic bronchitis and silicosis was the consequence of technological progress, and greater concern for hygiene standards. Increasing incidence of lung cancer reflects long latency characteristic of this illness.

[Spirometric studies in clinically healthy metallurgy workers. II. Reference values of basic respiratory indicators]. / Badania spirometryczne klinicznie zdrowych pracowników hutnictwa. Czesc II. Wartosci nalezne podstawowych wskazników wentylacyjnych.

In a group of 520 clinically healthy men employed in metallurgy, predicted values in the function of age, height and body weight were set up by multiple regression for VC, FEV1 RV, ERV, FRC, RV%TLC and for FEV1%VC in the function of age and for TLC in the function of height. In the tables are given predicted values for VC, FEV1, RV%TLC (based on equations of regression) for 9 intervals of age, height and body weight.

[Spirometric studies in clinically healthy workers in steel mills. I. Effect of age, body height and body weight on the variability of selected ventilation indicators]. / Badania spirometryczne klinicznie zdrowych pracowników hutnictwa. Czesc I. Wplyw wieku, wzrostu i ciezaru ciala na zmiennosc wybranych wskazników wentylacyjnych.

Of 2750 examined workers of the Lenin steel mill a group of 520 so called healthy men aged 20-60 has been selected, who had developed chronic specific and inspecific diseases of the respiratory tract, and circulatory diseases during myocardial insufficiency and arterial hypertension. This population underwent tests performed by the F function, test of significance of differences between coefficients of multiple determination in the function of age, growth and body weight, and in the function of: age and height; age and body weight, height and body weight, which allowed to determine the contribution of age, height and body weight in the significance of the following spirometric indices: VC, FEV1%VC, RV, ERV, FRC, RV% TLC, TLC. Age exhibited statistically significant contribution to the total variance of VC, FEV1%VC, RV, ERV, FRC RV%TLC, and insignificant--in case of TLC. Height exhibits significant impace on VC, RV, ERV, FRC, TLC, RV%TLC. Statistically insignificant dependence on height was obtained in case of FEV1%VC. Inclusion of body weight showed a statistically significant explanatory value for VC, RC, ERV, FRC RV%TLC, and insignificant for TLC and FEV1%VC.

[Comparison of spirometric indicators in smoking and non-smoking metallurgical workers]. / Porównanie wartosci wskazników spirometrycznych u hutników palacych i niepalacych.

In a population of 327 "clinically healthy" metallurgists (140 non-smokers, and 187 smoking 15-24 cigarettes daily), categorized into seven 4-year age groups, the following spirometric parameters were determined: VC, FEV1, %VC, RV, ERV, FRC, TLC, RV%TLC. A significantly higher VC was found among non-smokers only in those aged 25-23, whereas FEV1%VC--in those aged 37-40. In smokers statistically higher ERV values were found in those aged 37-40 and 41-44. As to RV and RV%TLC statistically worse results were found among smokers aged 29-32. The best FRC index among smokers was found in the group 41-44 years old. TLC was not significantly different in any of age groups concerned. The above data comparing 49 subgroups of smokers and 49 subgroups of non-smokers indicate that the smoking of 15-24 cigarettes a day does not significantly enhance the ventilation parameters in "clinically healthy" metallurgists.

[Prospective studies of the respiratory system in coke plant workers]. / Prospektywne badanie ukladu oddechowego u pracowników zakladu koksochemicznego.

In standardized conditions of 24 hours clinical hospitalisation the group of men employed as cooking battery staff was examined twice in a 16 years interval. The examined men worked all the time at the same workshops and were exposed to harmful chemical and physical agents. All the subjects underwent routine medical examination, spirometric tests and the questionnaire of Medical Research Council extended to a smoking habit was gathered for each of men. After 16 years occupational exposition an incidence of chronic bronchitis increased from 6.1 to 24.6%. Also the significant decline of ventilatory parameters was noted. About 80% of examined workers showed greater than expected related to natural process of growing old, decline of ventilatory functions. Non significant differences between smokers and non-smokers were noted.

[Effect of obesity on the ventilatory capacity of the respiratory system. I. Relation between basic spirometric indicators: vital capacity (VC) and forced expiratory volume (FEV1) and obesity]. / Wplyw otylosci na sprawnosc wentylacyjna ukladu oddechowego. Czesc I. Zwiazek pomiedzy podstawowymi wskaznikami spirometrycznymi: pojemnoscia zyciowa (VC) i natezona objetoscia wydechowa 1 s (FEV1) a otyloscia.

The following procedures have been applied for evaluation of obesity of 1087 men, steel mill workers: all examined men have been divided into intervals of relative body weight (after Lorentz), indices including measurements of the current body weight and height, indices including measurements of the current body weight, height and skinfolds thickness. All examined persons have undergone measurements of spirometric parameters. The strongest correlation with spirometric values was that of the index of obesity including, apart from the body weight and height, also skinfolds thickness. This index of obesity provides good estimation of respiratory efficiency, which diminishes as obesity intensifies.

[Effect of obesity on the ventilatory capacity of the respiratory system. II. Reference spirometry values of VC and FEV1 for overweight males]. / Wplyw otylosci na sprawnosc wentylacyjna ukladu oddechowego. Cz. II. Nalezne wartosci spirometryczne VC i FEV1 dla mezczyzn nadmiernie otylych.

642 persons without respiratory and circulatory diseases were selected from 1087 steel mill workers. The examined persons were classified according to the intervals of relative body mass. The relations between spirometric parameters (VC and FEV1) and degree of obesity were studied. For each interval the equations of multiple regression were calculated, taking into account the dependence of VC and FEV1 on age, height and present body mass. The numeric factor from the equation of multiple regression of coefficient describing the dependence of VC on the present body mass was positive in 90-114% and 115-124% intervals but negative in 125-134% and 135% of body mass. In case of FEV1 the negative factor of the same coefficient was not negative until 135% of body mass. A positive correlation of VC and FEV1 with the present body mass in the whole population was shown. If the group of obese persons was formed on the basis of Wot anthropometric index (which included skinfolds thickness, present body mass and height), significantly lower values of VC and FEV1 were found in comparison to non-obese counterparts. For the persons with morbid obesity a new method of calculation of predicted VC and FEV1 values was presented. The equation of multiple regression used for this purpose takes into account the dependence of spirometric values on age and Wot index.

[Evaluation of health status in inhabitants of the protected zone near a steel mill. I. Incidence of certain diseases]. / Ocena stanu zdrowia mieszkanców strefy ochronnej kombinatu metalurgicznego. I. Czestosc wystepowania niektórych schorzen.

The state of health, with use of precise epidemiological criteria, of 232 inhabitants of villages located in the protective zone of Nowa Huta Steel-Mill was estimated. The reference group consisted of 137 inhabitants of Tokarnia village, matched with sex, age and occupation. Examinations were performed in the standard clinical conditions, including uniform set of criteria used to establish diagnosis for each subject of examination. It was found that the most important threat for their health were cardiovascular and/or respiratory tract diseases. Among diagnosed illnesses the most important place was occupied by arteriosclerosis in both sexes, arterial hypertension among women and chronic bronchitis as well as emphysema of lungs in men. Inhabitants of the protective zone had generally higher incidence of above mentioned diseases than inhabitants of Tokarnia.

[Evaluation of respiratory function in coke plant workers. I. Analysis of absenteeism]. / Ocena stanu czynnosciowego ukladu oddechowego pracowników koksochemii. I. Analiza absencji chorobowej.

The analysis of sick-levels of all employees of Nowa Huta Steel-Mill, including coke plant workers was performed. Disablement for work on account of different diseases, expressed per hundred of employees, and dynamics of absence in period from 1986-1988 years was presented on a background of general national work-absenteeism due to diseases. Disablement for work in Nowa Huta Steel-Mill, particularly in the coke division was higher than in the general population. The diseases of airways had the highest contribution to the coefficient of morbidity.

[Risk factors of ischemic heart disease in various occupational groups. II. Complex analysis of risk factors]. / Czynniki ryzyka choroby niedokrwiennej serca w róznych grupach zawodowych. II. Kompleksowa analiza czynników ryzyka.

Four hundred four men aged 30 to 59 years, belonging to one of 4 occupational groups were investigated in a standard clinical conditions. Two from those groups were characteristic for steel mill professions: 121 blast furnace workers; exerting strenuous physical effort and working in hot microclimate. 131 operators (the second group) performed work in comfort microclimate conditions not demanding much effort. The third group comprised 73 executives of industry. The fourth group consisted of 79 monks. For all subjects of investigations 8 selected risk factors of ischemic heart disease were evaluated. They included: age, sex, family history, habit of smoking, systolic blood pressure, fasting blood cholesterol level, obesity index and professional physical activity. The level of each risk factor had numerical value in a span from "0" to "8". The sum of all points was decisive to which of 3 groups of risk given man should be accounted. Those 3 groups were arbitrary divided into "low, intermediate and high risk". The highest risk was found for the executives group, and the lowest for blast furnace workers. From the risk factors under investigation highest overall influence on incidence of ischemic heart disease had habit of smoking and obesity. Described here point classification system seems to be very simple and useful for estimation of risk of ischemic heart disease in a given population.

[Comparison of 2 methods of determining excessive body weight in relation to spirometric indicators]. / Porównanie dwóch sposobów okreslania nadwagi w relacji z wielkoscia wskazników spirometrycznych.

In a sample of the male population (1087 men) aged 25-60, who made hard physical labour, groups of normal body mass and overweight were isolated. The overweighted group had a body weight of 125% of suitable body mass (according to Lorentz). Overweighted men were divided into two groups: a) with excessively developed muscular tissue, b) with excessively developed adipose tissue. This division was based on two indices: W--including height, present body mass and age, Wot--including height, present body mass and skin-folds thickness. In these subgroups the values of spirometric indices were studied and VC and FEV1 of all overweighted men and those of normal body mass were compared. In the case of W index the VC and FEV1 values of muscular men and fat men were practically the same and very near to the values of all those overweighted but lower than the values of men with normal body mass. In the case of Wot index the following tendencies were observed: muscular men had higher VC and FEV1 values than fat men and all those overweighted; these values were similar to those of men with normal body mass. fat men had significantly lower VC and FEV1 values than overweighted men and those with normal body mass.

[Evaluation of health status for inhabitants of the protected zone near a steel mill. III. Occurrence of pulmonary emphysema]. / Ocena stanu zdrowia mieszkanców strefy ochronnej kombinatu metalurgicznego. III. Wystepowanie rozedmy plluc.

In the groups of 232 inhabitants of the protective zone of Steel-Mill Nowa Huta in Kraków (181 women and 51 men) and 137 inhabitants of Tokarnia village, located appx 60 km from Kraków, far from industrial emitters of chemical and physical pollutants (100 women and 37 men), frequency of occurrence of emphysema was estimated. Diagnosis of that disease was based on clinical signs and symptoms, as well as on values of RV%TLC. It was shown that despite similar values of arithmetic mean, mode and median of RV%TLC in both groups, standardised curves representing normal distribution of this parameter were displaced toward higher pathological values in both sexes, inhabitants of the protective zone. Higher frequency of incidence of emphysema in the groups living in the protective zone could be connected with gaseous and dust pollutants present in the atmosphere.

[Evaluation of respiratory function in coke workers. II: Influence of 8 hour exposure on ventilation efficiency]. / Ocena stanu czynnosciowego ukladu oddechowego pracowników koksochemii. II. Wplyw 8-godzinnej ekspozycji zawodowej na sprawnosc wentylacyjna.

The functional status of airways was estimated in 2 groups of workers of Nowa Huta Steel-Mill--55 employees of coke division and 54 men working in the moulding metal channel division. Industrial pollution in these divisions highly exceeded hygienic standards. In the coke plant SO2 and NOx--irritants of respiratory tract were present. Determinations of respiratory parameters (FVC, FEV1, Raw and FEF25/75) were performed before and after work-shift. Excessive spastic reaction of respiratory tract defined by 20% decrease of FEV1 and FEF25/75 with simultaneous increase of Raw after the work-shift was found only in the group of coke plant workers. The excessive spastic reaction was observed in some workers with obturation diagnosed before shift and also in approximately 10% of "healthy" population.

[Evaluation of health status in inhabitants of the protected zone near a steel mill. II. Overweight and obesity]. / Ocena stanu zdrowia mieszkanców strefy ochronnej kombinatu metalurgicznego. II. Nadwaga i otylosc.

In the group of 232 inhabitants of the protective zone of Nowa Huta the Steel-Mill (181 women and 51 men) incidence of overweight and obesity was estimated using the Quetelet and Wot indices. The results were compared with appropriate data obtained for 37 men and 100 women, matched with age and occupation, inhabitants of Tokarnia village, known by favorable microclimate, rarely encountered in polluted areas of southern Poland. It was found that overweight and obesity was present in the group of the protective zone statistically more often than in Tokarnia. The differences were more pronounced for women than for men. Concentrations of serum cholesterol and triglycerides were also compared. Distribution of cholesterol in examined groups was similar to the distribution of the Quetelet index, differences of arithmetic means being statistically significant, whereas concentration of triglycerides was remarkably similar in all groups under investigation. In this paper rarely used method of data presentation was applied. From histograms of given parameter normalised curves were derived and served as a representation of parameter distribution in the studied population. This method grossly alleviated task of comparison and evaluation of obtained data.