A case of bilateral aldosterone-producing adenomas differentiated by segmental adrenal venous sampling for bilateral adrenal sparing surgery.

Primary aldosteronism due to unilateral aldosterone-producing adenoma (APA) is a surgically curable form of hypertension. Bilateral APA can also be surgically curable in theory but few successful cases can be found in the literature. It has been reported that even using successful adrenal venous sampling (AVS) via bilateral adrenal central veins, it is extremely difficult to differentiate bilateral APA from bilateral idiopathic hyperaldosteronism (IHA) harbouring computed tomography (CT)-detectable bilateral adrenocortical nodules. We report a case of bilateral APA diagnosed by segmental AVS (S-AVS) and blood sampling via intra-adrenal first-degree tributary veins to localize the sites of intra-adrenal hormone production. A 36-year-old man with marked long-standing hypertension was referred to us with a clinical diagnosis of bilateral APA. He had typical clinical and laboratory profiles of marked hypertension, hypokalaemia, elevated plasma aldosterone concentration (PAC) of 45.1 ng dl(-1) and aldosterone renin activity ratio of 90.2 (ng dl(-1) per ng ml(-1 )h(-1)), which was still high after 50 mg-captopril loading. CT revealed bilateral adrenocortical tumours of 10 and 12 mm in diameter on the right and left sides, respectively. S-AVS confirmed excess aldosterone secretion from a tumour segment vein and suppressed secretion from a non-tumour segment vein bilaterally, leading to the diagnosis of bilateral APA. The patient underwent simultaneous bilateral sparing adrenalectomy. Histopathological analysis of the resected adrenals together with decreased blood pressure and PAC of 5.2 ng dl(-1) confirmed the removal of bilateral APA. S-AVS was reliable to differentiate bilateral APA from IHA by direct evaluation of intra-adrenal hormone production.

Subtle increase in leukocyte counts in association with drinking and smoking habits.

Peripheral leukocyte counts were examined in venous blood of more than 800 male workers exposed to toluene, xylenes, a combination of the two, or neither. Information on the social habits of smoking and drinking was obtained in an occupational health interview. The analysis showed that smoking (15 cigarettes/day on average) induced a significant increase (by 7%) in leukocyte counts, and that an additional increase was induced when the drinking habit was coupled with smoking. Drinking alone tended to increase the leukocyte counts but the effect was statistically nonsignificant, possibly because the number of nondrinking smokers was limited. The study stresses the importance of paying attention to smoking and drinking habits when evaluating hematological parameters such as peripheral leukocyte counts in solvent-exposed workers.

Effects of smoking and drinking habits on urinary o-cresol excretion after occupational exposure to toluene vapor among Chinese workers.

The relationship between the time-weighted average intensity of exposure to toluene and o-cresol concentration in shift-end urine was investigated in nearly 500 factory workers of both sexes in China, together with a similar number of nonexposed control subjects. Toluene concentration (25 ppm as geometric mean and 550 ppm as the maximum) was monitored by diffusive sampling using carbon cloth as adsorbent followed by gas chromatographic (GC) analysis. o-Cresol (up to 7 mg/l) was measured by GC after acid hydrolysis of samples. Urinary o-cresol levels correlated significantly (r = 0.69-0.77; p < 0.01) with toluene exposure in men, women and the two sexes in combination, regardless of correction for urine density. When compared with hippuric acid, however, o-cresol was less sensitive as an indicator of exposure to toluene and is not a suitable biological marker for detecting low level toluene exposure. Since urinary o-cresol level was significantly reduced by smoking, drinking, and the two habits combined, it cannot be considered reliable as an indicator of exposure to toluene.

Absence of mutagenicity in peripheral lymphocytes of workers occupationally exposed to methyl methacrylate.

Chromosome aberration rates and sister chromatid exchange frequency were examined in the peripheral lymphocytes of 38 male workers who were engaged in organic glass production and exposed to methyl methacrylate (MMA) vapors at the concentrations of 0.9 ppm to 71.9 ppm. The results were compared with the findings in the concurrent nonexposed male subjects. Comparison of the exposed group with the nonexposed controls showed that there were no exposure-related changes in chromosome aberration rate. SCE frequency was higher in the exposed group than in the controls, but this was considered to be due to higher ages of the former group than that of the latter. In fact, selection of nonsmokers and further classification of the exposed nonsmokers into two groups of those with exposure below and above a median MMA concentration (ca. 4 ppm) failed to show any difference among the three nonsmoking groups in cytogenetic parameters, or any dose-dependency. The present results, although in a limited number of subjects, indicate that occupational methyl methacrylate exposure under the conditions studied is not associated with mutagenicity. This conclusion confirms the absence of mutagenicity of methyl methacrylate in humans, and is in general agreement with a majority of the results of studies on mutagenicity in vitro, animal carcinogenicity and occupational cancer epidemiology of methyl methacrylate.

Exposure monitoring and health effect studies of workers occupationally exposed to cyclohexane vapor.

A survey was conducted in the second half of a working week on 33 women who either applied glue (with cyclohexane as an almost exclusive solvent component) or worked in the vicinity of glue application. Carbon cloth-equipped diffusive samplers were used for personal measurement of time-weighted average intensity of exposure to the solvent. The geometric mean and the highest cyclohexane concentration observed in air were 27 ppm and 274 ppm, respectively. Concentrations of cyclohexanol in urine samples and cyclohexane in whole blood and serum collected at the end of a shift showed significant correlations with the solvent exposure levels. Urinary cyclohexanone also correlated, but with a smaller correlation coefficient. The observation suggests that cyclohexanol in urine and cyclohexane in blood or serum collected at the end of a shift are useful indicators of occupational exposure to cyclohexane vapor. Quantitative estimation of balance at the end of the shift suggested that only a minute portion (< 1%) of cyclohexane absorbed is excreted in the urine as cyclohexanol, almost exclusively as a glucuronide. A survey of subjective symptoms revealed an increase in the prevalence of "dimmed vision " and "unusual smell", but hematology and serum biochemistry testing did not indicate any specific signs.

Effects of smoking and drinking on excretion of hippuric acid among toluene-exposed workers.

In order to investigate possible effects of smoking and drinking on the metabolism of toluene in occupational settings, 206 toluene-exposed men (mean age: 31.4 years) in shoemaking, painting, or surface-coating workshops together with 246 nonexposed control men (36.8 years) were studied for the time-weighted average intensities of exposure to toluene, hippuric acid concentration in shift-end urine samples, and the two social habits of smoking and drinking. The mean daily consumptions of cigarettes and ethanol were about 20 pieces and 10 g among smokers and drinkers, respectively. The geometric mean toluene concentration among the exposed subjects was about 20 ppm, with a maximum of 521 ppm. Regression analysis after classification of the subjects by smoking and drinking clearly demonstrated that the two social habits, when combined, markedly reduce the hippuric acid level in the urine of workers exposed to toluene. There was a significant association between smoking and drinking habits, which hindered separate evaluation of the effects of the two habits on toluene metabolism. Comparison of the present results with the findings reported in the literature, however, suggested that the observed effects may be attributable to smoking rather than to drinking habits.

Excretion of methylhippuric acids in urine of workers exposed to a xylene mixture: comparison among three xylene isomers and toluene.

The correlation between exposure to three xylene isomers and resulting urinary excretion of corresponding methylhippuric acid (MHA) isomers was studied among 175 Chinese workers of both sexes who had been predominantly exposed to xylenes (exposure to xylenes accounting for 70% or more of the total exposure on a ppm basis). Nonexposed controls (281 men and women) were also studied to define the background level of MHAs in urine. The solvent exposure of xylene-exposed workers during their workshift was monitored by diffusive sampling of breathing zone air, and MHAs in shift-end urine were determined by high-performance liquid chromatography. Regression analysis showed that the concentration of each MHA isomer correlated significantly with the time-weighted average intensity of exposure to the corresponding xylene isomer, and therefore the correlation between the sum of three xylene isomers in air and that of three MHA isomers in urine was also significant; the slope of the regression line was essentially the same among the three isomers. The calculated regression line suggested that the urinary MHA level after hypothetical exposure to xylenes at 100 ppm will be somewhat less than the proposed biological exposure index and biological tolerance value. Two social habits of smoking and drinking in combination suppressed the conversion of xylenes to MHAs in male workers.

Increase in sister chromatid exchange rates in association with occupational exposure to N,N-dimethylformamide.

The effects of occupational exposure to N,N-dimethylformamide (DMF) on sister chromatid exchange (SCE) rates were studied in peripheral lymphocytes from 22 DMF-exposed women (aged 22-52 years) in comparison with 22 sex-, age-, and residence-matched controls. All subjects were nonsmokers and nondrinkers as confirmed by medical interview. The 22 pairs were divided by the intensity of exposure to DMF into 3 subgroups of high-exposed (8 pairs with mean DMF exposure at 5.8 ppm), middle-exposed (5 pairs with DMF at 0.7 ppm in combination with toluene at 0.9 ppm), and low-exposed (9 pairs with DMF at 0.3 ppm). The SCE rates were significantly higher in the high (P less than 0.005) and middle (P less than 0.01) exposed than in their matched pairs, and the increase was related to the intensity of DMF exposure.

Sister chromatid exchanges in peripheral lymphocytes of workers exposed to benzene, trichloroethylene, or tetrachloroethylene, with reference to smoking habits.

The frequencies of sister chromatid exchanges (SCE) were studied in peripheral lymphocytes from four groups of solvent workers, i.e. 36 nonsmoking women exposed to benzene at about 50 ppm on the average, 38 men and women (male smokers and nonsmokers, and female nonsmokers) exposed to trichloroethylene (TRI) at 7 ppm, 27 men and women (both smokers and non-smokers) with tetrachloroethylene (TETRA) exposure, and 19 workers (both smokers and nonsmokers in men, and nonsmokers in women) exposed to a mixture of TRI (at 8 ppm) and TETRA (at 17 ppm) (TRI + TETRA). The results were compared with the findings in control subjects matched by age, sex, smoking habits and place of residence. No significant increase in SCE frequencies was observed in association with exposure to benzene, TRI, TETRA or TRI + TETRA. The SCE frequency was, however, significantly higher in the TRI-, TETRA- or TRI + TETRA-exposed smoking men than in the concurrent nonsmoking controls of the same sex. Possible synergism between solvent exposure and smoking is discussed.

Excretion of 1,2,4-benzenetriol in the urine of workers exposed to benzene.

Urine samples were collected from 152 workers (64 men, 88 women) who had been exposed to benzene, 53 workers (men only) exposed to a mixture of benzene and toluene, and 213 non-exposed controls (113 men, 100 women). The samples were analysed for 1,2,4-benzentriol (a minor metabolite of benzene) by high performance liquid chromatography. The time weighted average solvent exposure of each worker was monitored by diffusive sampling technique. The urinary concentration of 1,2,4-benzentriol related linearly to the intensity of exposure to benzene both in men and women among workers exposed to benzene, and was suppressed by toluene co-exposure among male workers exposed to a mixture of benzene and toluene. A cross sectional balance study in men at the end of the shift of a workday showed that only 0.47% of benzene absorbed will be excreted into urine as 1,2,4-benzenetriol, in close agreement with previous results in rabbits fed benzene. The concentration of 1,2,4-benzenetriol in urine was more closely related to the concentration of quinol than that of catechol. The fact that phenol and quinol, but not catechol, are precursors of 1,2,4-benzentriol in urine was further confirmed by the intraperitoneal injection of the three phenolic compounds to rats followed by urine analysis for 1,2,4-benzenetriol.

Blood cadmium levels in the populations of 3 Chinese cities.

Blood samples were collected from male and female factory workers aged greater than or equal to 16 years (with no occupational exposure to metals including cadmium) in the 3 cities of Hefei (323 subjects), Shenyang (78 subjects), and Jinxi (137 subjects) in China from 1985 to 1987. The samples were analyzed for cadmium in a single laboratory by automated flameless atomic absorption spectrophotometry under strict quality control. The effect of smoking was evident in Hefei, Shenyang and Jinxi, while the effect of aging was not apparent. There were no sex or regional differences in blood cadmium levels in non-smokers in the 3 cities (e.g., 1.2, 1.3 and 1.4 micrograms/l as geometric means in non-smoking women in Hefei, Shenyang and Jinxi, respectively). There was general agreement in blood cadmium levels between the present results and the values reported in the literature, although the latter values were generally based on small study populations.

Blood cadmium levels in the populations of Masan, Korea, and Miyagi, Japan: an inter-regional comparison.

Blood samples were collected from factory workers (with no occupational exposure to metals including cadmium) in Masan (167 subjects), Korea, in 1986, and Miyagi prefecture (270 subjects) Japan, in 1987. The samples were analyzed for cadmium in a single laboratory by flameless atomic absorption spectrophotometry under strict quality control. The effect of aging was detected in Masan and possibly also in Miyagi. The effect of smoking was evident among male smokers in Miyagi. Comparison with findings in a sister study on blood cadmium levels in China (taking the effects of smoking and aging into account) showed regional differences: the levels were lower in China, higher in Korea and probably highest in Japan. The smoking-associated increase in blood cadmium level per cigarette was 2-3 times higher in China than in Japan. The blood cadmium levels in the study regions appeared to be associated with the cadmium content of local rice as well as with local rice-eating habits.

Urinary t,t-muconic acid as an indicator of exposure to benzene.

A method for rapidly determining t,t-muconic acid (MA) by high performance liquid chromatography was developed and successfully applied to urine samples from 152 workers exposed to benzene (64 men, 88 women) and 213 non-exposed controls (113 men, 100 women). The MA concentrations in urine correlated linearly with time weighted average benzene concentrations in the breath zone air of workers. A cross sectional balance study showed that about 2% of benzene inhaled is excreted into the urine as MA. The MA concentrations in the urine of the non-exposed was below the detection limit (less than 0.1 mg/l) in most cases, and the 95% lower confidence limit of MA for those exposed to benzene at 5 ppm (5.0 mg/l as a non-corrected value) was higher than the 97.5%-tile values for the non-exposed (1.4 mg/l). In practice, it was possible to separate those exposed to 6-7 ppm benzene from the non-exposed by means of urine analysis for MA. The urinary MA concentration was suppressed by coexposure to toluene.

Blood lead levels of the general populations of three Chinese cities.

Blood samples were obtained from 537 adults (age greater than or equal to 16 years) living in three cities in China; in Hefei in 1985, and in Shenyang and Jinxi in 1987. The samples were subjected to blood lead (Pb-B) analyses. The subjects were factory workers either in solvent-synthesizing or solvent application plants with no known exposure to metals (including lead). Their smoking and drinking habits were confirmed in medical interviews. Blood lead was significantly higher in smokers than in non-smokers, although no dose-dependency was observed. The Pb-B values in non-smokers were log-normally distributed. The Pb-B among non-smokers was significantly higher in men [104.0 micrograms l-1 (1.428) 87] [geometric mean (geometric standard deviation) number of determinations] than in women [75.5 micrograms l-1 (1.358) 225] when the data from the three cities were combined. There was a significant difference in the Pb-B levels of non-smoking men in the three cities studied, suggesting that regional food habits should be considered as a possible contributory factor of a non-occupational nature. The present findings are compared with observations from Korea and Japan from the viewpoint of environmental health.

Determination of catechol and quinol in the urine of workers exposed to benzene.

Time weighted average concentrations of benzene in breathing zone air (measured by diffusive sampling coupled with FID gas chromatography) and concentrations of catechol and quinol in the urine (collected at about 1500 in the second half of a working week and analysed by high performance liquid chromatography) were compared in 152 workers who were exposed to benzene (64 men, 88 women). The concentration of urinary metabolites was also determined in 131 non-exposed subjects (43 men, 88 women). There was a linear relation between the benzene concentrations in the breathing zone and the urinary concentrations of catechol and quinol (with or without correction for urine density) in both sexes. Neither catechol nor quinol concentration was able to separate those exposed to benzene at 10 ppm from those without exposure. The data indicated that when workers were exposed to benzene at 100 ppm about 25% of benzene absorbed was excreted into the urine as phenolic metabolites, of which 13.2%, 1.6%, and 10.2% are phenol, catechol, and quinol, respectively.

Mutual metabolic suppression between benzene and toluene in man.

The exposure intensity during a shift and the metabolite levels in the shift-end urine were examined in male workers exposed to either benzene (65 subjects; the benzene group), toluene (35 subjects; the toluene group), or a mixture of both (55 subjects; the mixture group). In addition, 35 non-exposed male workers (the control group) were similarly examined for urinary metabolites to define background levels. A linear relationship was established between the intensity of solvent exposure and the corresponding urinary metabolite levels (i.e. phenol, catechol and quinol from benzene, and hippuric acid and o-cresol from toluene) in each case when one of the three exposed groups was combined with the control group for calculation. Comparison of regression lines in combination with regression analysis disclosed that urinary levels of phenol and quinol (but not catechol) were lower in the mixture group than in the benzene group when the intensities of exposure to benzene were comparable, indicating that the biotransformation of benzene to phenolic compounds (excluding catechol) in man is suppressed by co-exposure to toluene. Conversely, metabolism of toluene to hippuric acid was suppressed by benzene co-exposure. Conversion of toluene to o-cresol was also reduced by benzene, but to a lesser extent. The significance of the present findings on the mutual suppression of metabolism between benzene and toluene is discussed in relation to solvent toxicology and biological monitoring of exposure to the solvents.

Quantitative relation of urinary phenol levels to breathzone benzene concentrations: a factory survey.

Urine samples were collected from 64 men and 88 women in shoe factories and printing plants at the end of a seven hour day shift in the latter half of a week in spring. Urine samples were also taken from 43 men and 88 women in the same factories but who were not exposed to solvents. Exposure to benzene during the shift was monitored by passive dosimeters. Both phenol in urine and benzene in activated carbon were analysed with FID gas chromatographs. The urinary concentrations of phenol were linearly related to the time weighted average concentrations of benzene in the breathzone air; the variation was so small that those exposed to 10 ppm benzene could be separated from the non-exposed at least on a group basis when the phenol concentration was corrected either for creatinine concentration or for specific gravity. The urinary phenol concentrations corresponding to 10 ppm benzene were 47.5 mg/l (as observed), 57.9 mg/g creatinine, or 46.6 mg/l (specific gravity 1.016).