[Health effects of diesel exhaust: a state of the art]. / Effets sur la santé des émissions des moteurs diesel: revue des connaissances.

INTRODUCTION: This review presents the state of knowledge regarding the acute and chronic toxicity of diesel engine exhaust in humans. STATE OF ART: The health effects of diesel engine exhaust, which is a complex mixture of gas and particulate matter (ultrafine and fine particles), are mainly irritation of the respiratory tract and carcinogenicity. They may also facilitate the development of respiratory allergies. A recent reassessment by the International Agency for Research on Cancer concluded that there is sufficient evidence of a causal association between exposure to diesel engine exhaust and lung cancer. PERSPECTIVES: The epidemiologic data collected during the last two decades also show limited evidence of increased risks of bladder cancer, as well as of chronic obstructive pulmonary disease in diesel engine exhaust exposed workers. Both experimental and epidemiological studies have involved the effect of emissions from traditional diesel engine technology. Major developments in this technology have occurred recently and the toxicity of emissions from these new engines is still to be characterized. CONCLUSION: Further studies are needed to explore the link between diesel engine exhaust exposure and the risks of bladder cancer, as well as of chronic obstructive pulmonary disease and respiratory allergies. Research is also needed to get more information about the toxicity of the new diesel technology emissions.

Tender Nesting Polypore (Hapalopilus rutilans) poisoning: report of two cases.

INTRODUCTION: Only four cases of Hapalopilus rutilans poisoning have been previously published. We report two new cases. CASE REPORTS: A father and his 13-year-old daughter picked mushrooms identified as Fistulina hepatica specimens and ate an unknown quantity (Hour 0). At Hour 12 post-ingestion, both subjects complained of abdominal pain, then nausea, vomiting, anorexia, asthenia, diplopia, and blurred vision. The father also had visual hallucinations. On Day 2 post-ingestion, clinical examination showed multidirectional nystagmus. The father also had balance disorders and both subjects emitted purple urine. Laboratory tests showed elevated serum creatinine and blood urea levels, proteinuria and leukocyturia in both subjects, and mild elevation of hepatic enzymes in the father. Urine color returned to normal on Day 2 and Day 7 post-ingestion in the girl and her father, respectively. Complete clinical and biochemical recovery was obtained within one week in both cases. DISCUSSION: Signs and symptoms are similar to those previously reported after H. rutilans ingestion. This mushroom can be easily confused with F. hepatica. Purple discoloration of the urine after ingestion of a polyporic mushroom is highly suggestive of H. rutilans poisoning. Polyporic acid is probably the active toxin.

Level of agreement between Nexfin non-invasive arterial pressure with invasive arterial pressure measurements in children.

BACKGROUND: We compared Nexfin non-invasive arterial pressure measurements using a novel small finger cuff with intra-arterial pressure in the paediatric setting in order to establish the level of agreement between both methods. METHODS: The study included 41 children aged 2-16 yr admitted for surgery or paediatric intensive care with an intra-arterial catheter as part of standard monitoring. Values of systolic (SAP), diastolic (DAP), and mean arterial pressure (MAP) were obtained simultaneously from the intra-arterial catheter and the non-invasive Nexfin monitor. Data were analysed using intra-class correlation (ICC) coefficients and the Bland-Altman analysis. RESULTS: A non-invasive arterial pressure signal was obtained in the majority of patients. The reproducibility of arterial pressure measurements over time by both non-invasive and invasive techniques was high, with ICC coefficients ranging from 0.94 to 0.98. The Bland-Altman analysis for SAP, DAP, and MAP revealed a bias with 95% limits of agreement of -13.5 (-39.7; +12.8), -0.2 (-12.8; +13.2), and -2.6 (-17.7; +12.5) mm Hg, respectively. Linear regression suggested a weak correlation of SAP and the bias between intra-arterial and Nexfin SAP measurements (intercept 4.9 mm Hg, ß -0.29; P=0.01). CONCLUSIONS: Nexfin non-invasive arterial pressure measurements are feasible in paediatric patients. Nexfin accurately reflects the intra-arterial MAP and DAP curves, but seems to underestimate SAP compared with intra-arterial pressure. These results suggest that Nexfin may be used in low-to-moderate risk children without severe systemic hypotension, who require beat-to-beat haemodynamic monitoring but do not have an indication for invasive measurements.

[Occurrence of lead poisoning during follow-up of children at risk with initial screening lead blood levels below 100 microg/L]. / Risque de survenue d'une intoxication par le plomb lors du suivi d'enfants à risque dont la plombémie de primodépistage est inférieure à 100 microg/L.

BACKGROUND: Follow-up is recommended for children initially screened with a lead blood level below the threshold for lead poisoning of 10 microg/dL when they have one or more risk factors. At first, the frequency of a follow-up lead blood test was calculated in children at risk for lead poisoning. In second time, we calculated the rate of occurrence and independent factors for lead poisoning in the follow-up group. METHODS: Since 1992, the Greater Paris lead poisoning monitoring system (SSSIILF) has been systematically recording data on lead levels in blood tests conducted for screening and follow-up in Greater Paris. Children initially screened before the age of seven whose blood lead level was inferior to 10 microg/dL and who had one or more risk factors were selected. The association between qualitative variables and a follow-up lead blood test was compared using the Chi(2) test. For children given follow-up, the association between qualitative variables and occurrence of lead poisoning was compared using the Chi(2) test; independent factors for lead poisoning were estimated by logistic regression. RESULTS: A follow-up lead blood test was more frequent and the difference was statistically significant, for children with one or more of the following risk factors identified at the time of screening: home address in Seine Saint-Denis or central Paris, screened in mother/child healthcare centers (PMI) or through a private physician, a blood lead level 5 microg/dL on initial screening, young age (<24 months) at the time of screening and some others known risk factors. The rate of occurrence of lead poisoning during follow-up was 25.9% for children screened between 1992 to 1994 and decrease to 5.1% for children screened in 2004 to 2005 (p<0.001) and was lower in central Paris and Seine Saint-Denis than in other districts in Greater Paris (p<0.01). The rate of occurrence during follow-up, independent of known risk factors for lead poisoning (p<0.01), was higher for children screened before the age of two (p<0.01) and for children whose mothers were from Sub-Saharan Africa (p<0.01). CONCLUSION: It is essential to follow up children at risk with an initial lead blood level below 10 microg/dL, especially those initially screened before the age of 24 months. Local action on home environment could also be needed when the initial blood lead level is 5 microg/dL and more than one risk factor has been identified.

Follow-up of children suffering from lead poisoning or at risk of lead poisoning in Greater Paris, 1992--2002.

BACKGROUND: It is essential for children suffering from or at risk of lead poisoning to have regular follow-up, and specifically for their blood lead (Pb) levels to be monitored. The present study assessed the occurrence of late follow-up testing of blood lead levels in children in Greater Paris, and factors related to such delays. METHODS: Since 1992, the SSSIILF has been systematically recording data on lead levels in blood tests conducted for screening and follow-up in Greater Paris. For Pb greater or equal to 45 microg/dL (Group 4), a further blood lead test has to be done within three weeks. For levels of 25 microg/dL < or = Pb < 45 microg/dL (Group 3) and 10 microg/dL < or = Pb < 25 microg/dL (Group 2), a second test must be done within 6 months. For Pb less than 10 microg/dL combined with one or more risk factors (Group 1: children at risk of poisoning), a second test is required within 6 to 12 months. Children aged 1 to 6 years who were screened between 1992 and 2002 were selected. The occurrence of late follow-up testing was estimated, and the independent effect of each variable associated with a delay was measured using a logistic regression model. RESULTS: Delays in re-testing were reported for 66.9% of Group 4 children (n=356), 45.3% of Group 3 children (n=921), 74.1% of Group 2 children (n=5,466), and 88.7% of Group 1 children (n=15,612). In the three groups with Pb greater or equal to 10 microg/dL, there was better follow-up (i.e. less delay to re-testing) for children screened most recently, those whose initial blood lead test results were elevated, those who lived in sub-standard housing built before 1949, and those who lived in suburban districts of Paris. The delay was longer for children aged 4 to 6 compared to younger children. When the size of the group was large enough, these differences were significant. In Group 1, similar results were observed except for a home address in a suburban district. Furthermore, follow-up was better for children of Sub-Saharan African parents, children whose initial prescription had been issued by a "PMI" mother/child healthcare centre and children from large families. CONCLUSION: Despite substantial delays in carrying out follow-up blood lead level testing, these delays were shorter for the populations with the greatest exposure.

Factors associated with severity of occupational asthma with a latency period at diagnosis.

BACKGROUND: Severity of occupational asthma at diagnosis is an important prognostic factor. The aim of this study was to determine which factors affect the severity of occupational asthma with a latency period at diagnosis. METHODS: The study population consisted of 229 consecutive subjects with occupational asthma with a latency period recruited by four occupational health departments and divided into two groups according to the severity of the disease at diagnosis. The moderate-severe (FEV(1) <70% predicted, or PD(20) methacholine /=70% predicted and PD(20) methacholine >300 microg, n = 128) groups were compared in terms of clinical and demographic parameters. Multivariate analysis using logistic regressions was performed to examine factors associated with asthma severity. RESULTS: Duration of symptoms before diagnosis was significantly longer in the moderate-severe group (mean +/- SD: 6.3 +/- 6.8 years vs 3.4 +/- 4.4 years, P < 0.001). Sex ratio, age, atopy, smoking habits, duration of exposure before symptoms, and molecular weight of the causal agent were not significantly different between the two groups. On multivariate analysis, only duration of symptoms before diagnosis was associated with asthma severity (aOR = 1.12, 95% CI 1.05-1.18, P < 0.001). CONCLUSIONS: Severity of occupational asthma with a latency period at diagnosis was associated with duration of symptoms before diagnosis, but not with the type of causal agent. This finding emphasizes the need for early diagnosis and avoidance of exposure.

Arsenic exposure in the wine growing industry in ten French departments.

OBJECTIVES: This study investigated exposure to arsenic, a carcinogenic fungicide used in wine growing. METHODS: The first phase compared urinary arsenic excretion of controls and workers exposed at the end of application. The second phase measured the increase in urinary arsenic excretion during the first day of use. RESULTS: A significant increase in urinary arsenic excretion was observed in arsenic applicators during the first phase. Urinary arsenic concentrations exceeded the American Conference of Governmental Industrial Hygienists (ACGIH) exposure index in one-third of the workers. The second phase showed a significant increase in urinary arsenic excretion by the first day of application. A closed tractor cabin provided a protective effect, but the efficacy of individual protection equipment was not demonstrated. CONCLUSION: This study showed the difficulties of achieving the effective protection of arsenic applicators and has led to the banning of the use of arsenic in French vineyards.

Healthy worker effect and changes in respiratory symptoms and lung function in hairdressing apprentices.

AIMS: To compare the prevalence and incidence of respiratory symptoms and lung function values between hairdressing apprentices and office apprentices. METHODS: A total of 322 hairdressing apprentices and 277 office apprentices (controls) were studied. Two cross sectional surveys were conducted in 1994 and 1996/97 with longitudinal follow up for a subgroup of apprentices (191 hairdressing apprentices and 189 office apprentices). RESULTS: In the initial phase, the prevalence of respiratory symptoms was significantly lower among hairdressing apprentices than among office apprentices. Lung function test results showed significantly higher values for hairdressing apprentices. Non-specific bronchial reactivity was similar in the two groups. In the final phase, results for respiratory symptoms were similar. The incidence of respiratory symptoms was not significantly different between hairdressing apprentices and office apprentices. Subjects who dropped out had lower values for FVC and FEV1 in the initial phase than those who completed the final phase. There was a significant deterioration of FEV1 and FEF25-75% in hairdressing apprentices compared to office apprentices. There was a link between atopy and the incidence of most of the respiratory symptoms (day/night cough, wheezing, dyspnoea, mucosal hyperresponsiveness) and between smoking and the incidence of bronchial hyperreactivity. There was no significant correlation between change in lung function tests and specific hairdressing activities reported at the end of the apprenticeship or with environmental working conditions in hairdressing salons. CONCLUSIONS: Although a healthy worker effect can be suspected, results showed a significant deterioration of baseline values of lung function tests in the hairdressing apprentice group. However, no clear link was shown between change in lung function tests and specific parameters of occupational activities.

[Home environment and acute propylene glycol intoxication in a two-year old. An unusual case report]. / Environnement domestique et intoxication aiguë au propylène glycol chez un nourrisson de deux ans. A propos d'une observation inhabituelle.

BACKGROUND: Acute propylene glycol intoxication in a two-year-old toddler underlines the potentially serious toxicity in children of this chemical agent present as a diluent in many drugs and environmental products such as cosmetics, diapers, cleansing towels, despite a common consideration of safety and lack of toxicity. CASE REPORT: A two-years-old boy previously healthy was found in the morning by his parents in his cradle, lethargic, responsive only to sharp pain. On admission, vital signs were: temperature 38.5 degrees C, lethargy, polypnea; propylene glycol intoxication through disposable cleansing towels chewing was ascertained by anamnesis and blood urine analyses which revealed metabolic acidosis and serum propylene glycol peak. CONCLUSION: Environmental acute propylene glycol intoxication must be considered and searched for in front of a metabolic acidosis case of unknown origin in children.

Allergy to complex platinum salts: A historical prospective cohort study.

OBJECTIVE: To assess the incidence of allergy to complex platinum salts in a platinum refinery. METHODS: A historical prospective cohort study was carried out on 77 workers (67 men) who started work between 1 January 1979 and 31 December 1991 and who were not atopic on skin prick tests to three common allergens at the time of recruitment. Skin prick tests with complex platinum salts were carried out and diagnosis of allergy to complex platinum salts made by the company's doctor. Skin tests and medical examinations were carried out routinely every six months. Follow up was until 30 September 1992 or until leaving refinery work. RESULTS: 18 workers developed a positive result on skin tests and 23 developed symptoms, including all 18 subjects with positive skin tests; the probability of surviving (95% confidence interval (95% CI)) for 72 months after joining the company, with negative skin test results was 0.67 (0.51-0.79) or with no symptoms was 0.63 (0.49-0.75). The incidence of positive skin tests and symptoms was highest during the first two years of work. Symptoms occurred more frequently in September and October than during the other months of the year. The exclusion of atopic subjects did not seem to have resulted in a lower incidence of sensitisation. Smoking was a significant predictive factor for both positive skin tests (estimated relative risk 5.53) and symptoms (4.70). CONCLUSION: The findings confirm that smoking is and that atopy may not be a high risk factor for the development of allergy to complex platinum salts. The high incidence of sensitisation and the available data on the clinical course of sensitised workers show that sensitised workers must be promptly and completely removed from exposure.

Glutathione transferase activity and formation of macromolecular adducts in two cases of acute methyl bromide poisoning.

OBJECTIVES: To determine the activity of glutathione transferase and to measure the S-methylcysteine adducts in blood proteins, after acute inhalation exposure to methyl bromide. To examine the influence of the polymorphism of glutathione-S-transferase theta (GSTT1) on the neurotoxicity of methyl bromide. METHODS: Two workers acutely exposed to methyl bromide with inadequate respiratory protective devices were poisoned. Seven weeks after the accident, blood samples were drawn from both patients, for measurement of glutathione transferase activity in erythrocytes (conjugator status--that is, GSTT1 phenotype) and measurement of binding products of methyl bromide with blood proteins. Conjugator status was determined by a standard procedure. The binding product of methyl bromide, S-methylcysteine, was measured in globin and albumin. RESULTS: Duration and intensity of exposure were identical for both patients as they worked together with the same protective devices and with similar physical effort. However, one patient had very severe poisoning, whereas the other only developed mild neurotoxic symptoms. The first patient was a "conjugator" with normal glutathone transferase activity, whereas this activity was undetectable in the erythrocytes of the second patient, who consequently had higher concentrations of S-methylcysteine adduct in albumin (149 v 91 nmol/g protein) and in globin (77 v 30 nmol/g protein). CONCLUSIONS: Methyl bromide is genotoxic and neurotoxic. Its genotoxicity seems to be the consequence of the alkylating activity of the parent compound, and conjugation to glutathione has a protective effect. The data presented here suggest a different mechanism for methyl bromide neurotoxicity which could be related to the transformation of methylglutathione into toxic metabolites such as methanethiol and formaldehyde. If such metabolites are the ultimate toxic species, N-acetylcysteine treatment could have a toxifying rather than a detoxifying effect.

Effects of occupational lead exposure on motor and somatosensory evoked potentials.

In order to objectivate the effects of inorganic lead compounds on the nervous system, 17 men occupationally exposed have been recorded for Motor Electric Potentials (MEPs) of the abductor policis brevis muscles with transcranial, cervical root and peripheral electrical stimulations, for Somatosensory Evoked Potentials (SEPs) of median and tibial posterior nerves, and for Electromyography (EMG). Considering each subject, 16 out of the 17 lead exposed ones exhibited electrophysiological abnormalities, occurring at both peripheral and central levels for the somatosensory as well as for the motor systems. As compared to a normal control group, the lead exposed one showed decreased sensory and motor peripheral conduction velocities, increased motor central conduction time, and delayed cortical P22 SEPs component that could be interpreted as a sensory-motor cortical dysfunction. The respective contributions of MEPs and SEPs are compared to clinical, biological and EMG examinations in the evaluation of the neurotoxic effects of inorganic lead compounds.

4-Methylpyrazole may be an alternative to ethanol therapy for ethylene glycol intoxication in man.

4-Methylpyrazole (4 MP) is a strong inhibitor of alcohol dehydrogenase. Its use in acute ethylene glycol (EG) or methanol intoxication has been suggested in experimental studies about its efficacy and safety. We report three cases of accidental intoxication with ethylene glycol in man treated orally with 20 mg/kg/day of 4 MP. The treatment was maintained until plasma EG concentrations became unmeasurable. The patients were admitted early during the course of the poisoning. Their neurological status was good. A slight metabolic acidosis observed in two cases was easily corrected and did not recur. Renal function remained normal in all cases. No patient underwent hemodialysis. On admission plasma EG concentrations were 24.2 mmol/l, 13 mmol/l and 9.7 mmol/l respectively. Plasma EG half-lives were 14.5, 11.5 and 14.75 hours respectively. Plasma oxalate concentrations and the rate of urine oxalate elimination, determined in two patients, were high on admission but quickly returned to normal. Concerning possible side effects of 4 MP, a skin rash was observed in one patient and a possible eosinophilia in the others. These three cases suggest that 4 MP may decrease the metabolic consequences of EG poisoning in man and may be of therapeutic value when administered early during the course of the intoxication before coma, seizures and organic renal failure have occurred.

[Mutagenicity of urine after ingestion of saccharin in man]. / Mutagénicité des urines après ingestion de saccharine chez l'homme.

In vitro tests of mutagenicity help detect carcinogenic substances. A variation of the Ames test may be used to study the mutagenicity of urine after exposition of the organism in vivo. Saccharin is a widely used artificial sweetener excreted in the urine which can induce dose-dependent tumours of the bladder in the animal. We studied the mutagenicity of the urine of healthy volunteers after the ingestion of a single dose of saccharin. The results show a mutagenic effect related to the dose ingested in two types of Salmonella typhimurium (TA 98 and TA 38). These results are difficult to interpret as saccharin is not mutagenic in vitro alone or in the presence of control urine which eliminates a direct carcinogenic or cocarcinogenic effect; we were unable to detect impurities or metabolites. This study underlines the difficulty of prophylactic detection of chemical carcinogens.

[Critical approach to technics for the disinfection of respirators with formaldehyde]. / Approche critique des techniques de désinfection des respirateurs par le formaldehyde.

Method of artificial respirators desinfection by Formaldehyde is studied. Formaldehyde and ammoniac quantitative analysis are performed. Air samples are taken by dry process and by wet process. Two concentrations are in ceiling values for exposure of workers and exceed irritant concentrations during chronic exposition. Particular attention should be paid to perform measurement: air samples must be taken by wet process as artificial ventilation circumstances: indeed in this case air is humidified; potential toxicity is unappreciated in this use. Complementary studies are required.