Guidelines for recognition of occupational cancers in Korea: the results of scientific review by Korean Society of Occupational and Environmental Medicine (2013–2016)

This thematic collection includes the articles to review eleven occupational cancer related risks or working conditions and to propose the guidelines of S. Korea.

Levels of blood lead and urinary cadmium in industrial complex residents in Ulsan

BACKGROUND: Populations neighboring industrial complexes are at an increased health risk, due to constant exposure to various potentially hazardous compounds released during industrial production activity. Although there are many previous studies that focus on occupational exposure to heavy metals, studies that focused on environmental exposure to lead and cadmium are relatively rare. The purpose of this study is to evaluate the extent of the environmental exposure of heavy metals in residents of industrial area. METHODS: Four areas in close proximity to the Ulsan petrochemical industrial complex and the Onsan national industrial complex were selected to be included in the exposure group, and an area remotely located from these industrial complexes was selected as the non-exposure group. Among the residents of our study areas, a total of 1573 subjects aged 20 years and older were selected and all study subjects completed a written questionnaire. Blood and urine samples were obtained from about one third of the subjects (465 subjects) who provided informed consent for biological sample collection. Total 429 subjects (320 subjects from exposure area, 109 subjects from non-exposure area) were included in final analysis. RESULTS: The geometric mean blood lead level among the subjects in the exposed group was 2.449 μg/dL, which was significantly higher than the non-exposure group's level of 2.172 μg/dL. Similarly, the geometric mean urine cadmium levels between the two groups differed significantly, at 1.077 μg/g Cr. for the exposed group, and 0.709 μg/g Cr. for the non-exposure group. In a multiple linear regression analysis to determine the relationship between blood lead level and related factors, the results showed that blood lead level had a significant positive correlation with age, the male, exposure area, and non-drinkers. In the same way, urine cadmium level was positively correlated with age, the female, exposure area, and smokers. CONCLUSIONS: This study found that blood lead levels and urine cadmium levels were significantly higher among the residents of industrial areas than among the non-exposure area residents, which is thought to be due to the difference in environmental exposure of lead and cadmium. Furthermore, it was clear that at a low level of exposure, differences in blood lead or urine cadmium levels based on age, gender, and smoking status were greater than the differences based on area of residence. Therefore, when evaluating heavy metal levels in the body at a low level of exposure, age, gender, and smoking status must be adjusted, as they are significant confounding factors.

Detection of Helicobacter pylori in Gastric Aspirates Using a Monoclonal Antibody-Based Test

BACKGROUND/AIMS: The objective of this study was to evaluate a monoclonal antibody-based test to detect Helicobacter pylori-specific antigen in gastric aspirates from humans. METHODS: Sixty-one volunteers were enrolled in the study. All of the subjects underwent a 13C-urea breath test (UBT) before esophagogastroduodenoscopy. Gastric aspirates were analyzed for pH and ammonia and used for polymerase chain reaction (PCR), culture, and monoclonal antibody-based detection of H. pylori. Multiple biopsies of the gastric antrum and body were obtained for a rapid urease test (RUT) and histological evaluation. RESULTS: Thirty-six subjects were H. pylori-positive and 25 were H. pylori-negative according to the UBT results. Compared with the H. pylori-negative subjects, H. pylori-positive subjects had a higher pH (4.77+/-1.77 vs 3.49+/-1.30, p<0.05) and ammonia level (1,130.9+/-767.4 vs 184.2+/-126.3, p<0.0001). The sensitivities and specificities of the PCR test, RUT, culture test, and monoclonal antibody-based test were 100% and 72%, 89% and 100%, 47% and 100%, and 78% and 100%, respectively. CONCLUSIONS: The monoclonal antibody-based test for diagnosing H. pylori infection in gastric aspirates has increased sensitivity compared with the culture test and specificity as high as that of the RUT. The test may be useful as an additive test for examining gastric aspirates.

Sensitization rates of airborne pollen and mold in children / 소아과

PURPOSE: Aeroallergens are important causative factors of allergic diseases. Previous studies on aeroallergen sensitization rates investigated patients groups that had visited pediatric allergy clinics. In contrast, we investigated sensitization rates in a general population group of elementary school to teenage students in Incheon, Jeju, and Ulsan. METHODS: After obtaining parental consent, skin-prick tests were performed on 5,094 students between March and June 2010. Elementary school students were tested for 18 common aeroallergens, whereas middle and high school students were tested for 25 allergens. The 25 allergens included Dermatophagoides pteronyssinus, Dermatophagoides farinae, pollen (birch, alder, oak, Japanese cedar, pine, willow, elm, maple, Bermuda grass, timothy grass, rye grass, orchard grass, meadow grass, vernal grass, mugwort, Japanese hop, fat hen, ragweed, and plantain), and mold (Penicillatum, Aspergillus, Cladosporium, and Alternaria). RESULTS: The sensitization rates in descending order were 25.79% (D. pteronyssinus), 18.66% (D. farinae), 6.20% (mugwort), and 4.07% (willow) in Incheon; 33.35% (D. pteronyssinus), 24.78% (D. farinae), 15.36% (Japanese cedar), and 7.33% (Alternaria) in Jeju; and 32.79% (D. pteronyssinus), 30.27% (D. farinae), 10.13% (alder), and 8.68% (birch) in Ulsan. The dust mite allergen showed the highest sensitization rate among the 3 regions. The sensitization rate of tree pollen was the highest in Ulsan, whereas that of Alternaria was the highest in Jeju. The ragweed sensitization rates were 0.99% in Incheon, 1.07% in Jeju, and 0.81% in Ulsan. CONCLUSION: The differences in sensitization rates were because of different regional environmental conditions and distinct surrounding biological species. Hence, subsequent nationwide studies are required.

Two Case of Erythroleukemia and Myelodysplastic Syndrome in a Non-Destructive Inspector / 대한산업의학회지

BACKGROUND: Ionizing radiation is a group 1 carcinogen according to the IARC(International Agency for Research on Cancer) classification. With the development of the radiation related industry, the number of radiation exposed workers has been increasing. There have been several reports on AML(Acute Myeloid Leukemia) on exposure to ionizing radiation; however, there are no reports of occupational malignant lymphohematopoietic disease related to non-destructive inspection. CASE REPORT 1: A 35-years-old male, who had worked for 10 years in non-destructive inspection, was diagnosed with myelodysplastic syndrome. He worked 8 hours a day, for three weeks per months, where he was exposed to 192Ir and 60Co radiation sources. Because he had not worn a film badge for monitoring his radiation exposure dose, the accurate exposure dose was not reported. The estimate exposure dose calculated via a chromosomal study was 1.20 Gy, which exceed the dose limits of Korean radiation dose standards, which are 50 and 100 mSv annually and quinquennially respectively. CASE REPORT 2: A 26-years-old male, who had worked for 2.5 years in the same company was also diagnosed with myelodysplastic syndrome. CONCLUSION: Non-destructive inspection is the main source of ionizing radiation in the workplace, which could be the cause of malignant lymphohematopoietic diseases. Therefore, more practical plans and guidelines are needed to prevent non-destructive inspectors from workplace radiation exposure.

Two Cases of Successful Clipping Closure of Iatrogenic Duodenal Perforation Occurred during Endoscopic Procedure / 대한소화기내시경학회지

The risk of complications associated with endoscopic procedures, including bleeding and perforation, tends to increase due to the magnification of the therapeutic endoscopic spectrum. In cases of duodenal perforation, surgical closure is the treatment of choice; however, there have been some cases in which the nonsurgical treatment of an iatrogenic duodenal perforation during an endoscopic procedure was effected via endoscopic clipping closure. Here, we report two cases of successful endoscopic clipping closure of an iatrogenic duodenal perforation occur ring during a duodenoscopy insertion for ERCP and endoscopic mucosal resection for the treatment of duodenal adenoma.

Two Cases of Juvenile Retention Polyp of Right Colon in Adult / 대한소화기내시경학회지

Colorectal polyps are classified histologically as either neoplastic or nonneoplastic polyps. A juvenile polyp, which is sometimes referred to as a retention polyp, is a type of nonneoplastic polyp. Juvenile polyps are found most commonly in children less than 10 years of age. However, they are also encountered, albeit rarely, in adolescents or adults of all ages. The most common clinical problem is painless rectal bleeding. Most juvenile polyps are found in the rectosigmoid colon, and more than 90% are detected within 20 cm from the anal verge. In Korea, there are some reports of juvenile polyps located in the rectosigmoid colon in adults. We report two cases of juvenile colon polyps in adult that presented as a hematochezia, which were located at the hepatic flexure and ascending colon.

Conservative Treatment of Colonoscopic Perforations / 대한소화기내시경학회지

BACKGROUND/AIMS: Colonoscopic perforation can be treated by both operative or non-operative methods. Non-operative management, and especially conservative management, may be appropriate for selected individuals. We wanted to verify the usefulness of performing conservative management for treating colonoscopic perforations. METHODS: We reviewed the medical records of the colonoscopic perforation cases that occurred in the recent 5 yrs. 11 cases of perforation occurred from among 8,536 colonoscopic procedures. RESULTS: Ten cases occurred from a therapeutic procedure (five from polypectomy and another five occurred from an endoscopic (submucosal dissection) and one case occurred from a diagnostic procedure. The perforation sites were the ascending colon (three cases), transverse colon (two cases), descending colon (one case), sigmoid colon (two cases), and rectum (three cases). There were five intraperitoneal perforations and five retroperitoneal perforations. All the cases were detected within 12 hours and all the cases had received good bowel preparation. 10 cases were managed conservatively (nothing by mouth, broad spectrum antibiotics and, Levin tube suction). One case was managed by an operative procedure due to the large size of the defect and the patient's wish. All the patients recovered without complications. The mean hospital stay was 9.5 days. CONCLUSIONS: Colonoscopic perforation can managed conservatively in selected cases, such as for those cases that will undergo post-therapeutic colonoscopy and those cases that have undergone good bowel preparation.

A Case of Mesenteroaxial Gastric Volvulus Diagnosed Using Endoscopic Procedure / 대한소화기내시경학회지

Gastric volvulus is characterized by an abnormal rotation of the stomach typically 180degrees left to right around a line joining the relatively fixed pylorus and the esophagus. Gastric volvulus can be classified anatomically as organoaxial, mesenteroaxial or combined, and symptomatically as acute or chronic. Acute gastric volvulus is an extremely rare emergency surgical condition. The classical triad of gastric volvulus are severe nausea with a paradoxical inability to vomit, localized epigastric pain and an inability to pass a nasogastric tube. Gastric volvulus may be suspected on a plain radiological examination of the abdomen as well as by its symptoms. It is confirmed by the specific findings on the esophagogastroduodenoscopy. We report a case of acute mesenteroaxial gastric volvulus, that was treated using laparoscopic reduction and anterior gastropexy.

A Case of Appendicular and Rectal Metastasis from Gastric Cancer Detected by Endoscopic Resection / 대한소화기내시경학회지

A hematogenous or lymphogenous metastasis and a direct or disseminated invasion can occur in cases of a gastrointestinal metastasis. Moreover, a hepatic or peritoneal metastasis is common in advanced gastric cancer. However, a colonic metastasis, particularly an appendicular metastasis, is quite rare. Recently, we experienced a case with an appendicular submucosal tumor-like elevated lesion and multiple rectal elevated lesions during a colonoscopy in an advanced gastric cancer patient. The appendicular lesion was resected endoscopically and a biopsy of the rectal lesions was performed. The pathologic diagnosis was an appendicular and rectal metastasis of a signet ring cell carcinoma. We describe a case of appendicular and rectal metastasis from gastric cancer. The results highlight the importance of considering a metastatic carcinoma when an appendicular or rectal mass is found incidentally in a malignant neoplasm patient.

A Case of Serrated Adenoma Presenting as Colon Cancer / 대한소화기내시경학회지

Serrated adenoma (SA) is a distinct form of colorectal neoplasia and it is defined as a neoplastic lesion composed of a monotonous cell population with atypical nuclei proliferating in serrated glandular architectures. Hyperplastic polyp is considered a benign lesion with no malignant potential. However, SA progressed into frank carcinoma has been demonstrated in an individual case, and 'serrated neoplasia pathway' is suggested by some authors as an alternative to classical adenoma-carcinoma sequence. Distinguishing between hyperplastic polyp and SA is important because of the different management implications and the increased potential for neoplastic progression in the latter, but sometimes it is very difficult. SA is usually small and sessile polypoid lesion. We report a case of SA presenting as large fungating mass similar to colon cancer, diagnosed as hyperplastic polyp initially by colonoscopic biopsy and confirmed as after SA the surgery.

A Case of Successful Endoscopic Therapy in Iatrogenic Perforation of the Colon during Colonoscopy / 대한소화기내시경학회지

Colonoscopy is a safe and standard procedure for diagnosis and therapy of colonic disorders. Iatrogenic colonic perforation during diagnostic colonoscopy, a rare abdominal emergency, has an 0.3~0.8% incidence rate. The choice of treatment for this complication remains controversial. Prompt operative intervention is preferred to minimize morbidity and mortality. However, operative intervention is invasive and needs a long-term recovery period. Conservative treatment is less invasive but can lead to more extensive surgery in case of treatment failure. Very important point on the treatment of iatrogenic perforation of the colon during diagnostic colonoscopy is to avoid the leaking of intestinal contents into the intraperitoneal cavity. We report here a case in which an iatrogenic perforation of the colon during diagnostic colonoscopy was successfully treated by endoscopic clip therapy.

Mental Disorders and Fitness for Work in Korea / 대한산업의학회지

OBJECTIVES: This study investigated the actual state of people with mental disorders in Korea, in order to present an alternative proposal for their work fitness and vocational rehabilitation. METHODS: The authors conducted this study through a review of statistics on the prevalence of mental disorder, labor laws, and the literatures related with work fitness and vocational rehabilitation of people with mental disorders. RESULTS: According to recent surveys, about 3 million people in Korea are likely to have mental disorders which could lead to discrimination in social life and dishonor in occupational career, either in the present or near future. Therefore, evaluation of work fitness and vocational rehabilitation for persons with mental disorders are important. At present, work fitness for psychiatric patients is evaluated without suitable guidelines regarding the kinds and severity of mental disorders that impede work capacity. Furthermore, mental disorder-specific fitness for work is not under consideration. CONCLUSION: It is true that most psychiatric patients have some limitation in performing their job. However, judging from the results of some research, proper displacement, apprehension of co-workers, and adjusted workplace could help them complete their tasks properly despite their troublesome psychiatric symptomatology. The government must help all citizens to do their best in their social life, and show a deep interest in the employment of all disabled people including those with psychiatric disorders. Above all we have to change our attitudes and preconceptions against people with mental disorders. Some labor laws, which presently impede employment of people with psychiatric disorders, need to be revised in their favor. Future work capacity evaluation should be done on the basis of ability to function in the workplace rather than symptomatology.

Epidemiologic Characteristics of Hand-Arm Vibration Syndrome through Occupational Disease Surveillance System in Busan, Ulsan, Kyungnam Province / 대한산업의학회지

OBJECTIVES: The objectives of this study were to estimate the epidemiologic characteristics of hand-arm vibration syndrome (HAVS) due to occupational exposure of hand transmitted vibration and to identify the occupations and industries where such exposures arises, and the main sources of exposure. METHODS: In April 2001 the Busan, Ulsan, and Kyung-Nam Province occupational disease surveillance system was established to measure the incidence and prevalence of work-related HAVS and other occupational diseases in these Korean provinces. Occupational physicians of nine hospitals in Busan, Ulsan, and Kyung-nam Province were involved in this project between April 2001 and November 2002. Physicians collected information through questionnaires and interviews. Information gathered included age, occupation, types of vibration tools used and presence of subjective symptoms such as vibration-induced white finger (VWF), numbness and tingling. RESULTS: A total 192 cases were reported with 188 males and 4 females. The shipbuilding industry was the most common type of industry and grinders were the most common source of exposure. Symptoms of neurological disorder were more common than those of vascular disorder. CONCLUSIONS: The authors concluded that exposure to hand transmitted vibration is common and that HAVS is one of the most common occupational diseases in Korea. However, the range and extent of hand transmitted vibration and the overall prevalence of HAVS in Korea is still unknown. More extensive research on this syndrome in order to priorite necessary preventive measures is required.

Distribution of Blood pressure and Current State of Life Style Modification on Male Workers in a Large Factory: Analysis According to JNC-6 Guideline / 대한산업의학회지

OBJECTIVES: To describe the distributions of blood pressure level and risk group, and the current state of life style modification in the population of a large factory. METHODS: We surveyed 1,088 workers in a large factory from June 2002 to August 2002. Information related to hypertension was collected through a questionnaire and medical examination. We classified the blood pressure level and risk group using JNC-VI criteria, and the current state of life style modification and medication according to the blood pressure level in the entire study population. REULTS: The prevalence of hypertension was 30.1% in all workers. The distribution of blood pressure level was 656 (60.3%) in normal stage, 160 (14.7%) in high normal stage, 190 (17.5%) in stage 1, 67 (6.1%) in stage 2, and 15 (1.4%) in stage 3. The numbers of workers in risk groups A, B and C were 296 (27.2%), 690 (63.4%) and 102 (9.4%), respectively. Among all workers, 432 (39.7%) needed to modify their lifestyle; 106 of whom (24.5%) needed to go on hypertensive drug medication. Overweight subjects were more common in stage 2 than in other stages (p=0.02). The numbers of smokers and low-exercisers were signigicantly lower in the higher blood pressure group than the lower blood pressure group (p<0.01). Alcoholic drinking was evenly distributed in all blood pressure level. CONCLUSION: The prevalence of hypertension was 30.1% in all workers. The most common stage of blood pressure level was normal, followed by stage 1, high normal stage, stage 2, stage 3. The number of subjects in risk group B was more than that in the other risk groups. We recommend total worker education and the practice of lifestyle modification.

Placement of Tunneled Cuffed Hemodialysis Catheters Via Internal Jugular Vein by an Interventional Radiologist and a Vascular Surgeon Together / 대한신장학회잡지

BACKGROUND: The use of dacron-cuffed tunneled double-lumen catheters for hemodialysis has become more common as patients wait for creation and maturation of a permanent access. Placement of the catheters is done by interventional radiologists, vascular surgeons or nephrologists, and the differences in success rates, complications, blood flow rates and the durations of catheter uses are reported. This study evaluated the usefulness, complications, blood flow rates and duration of use of tunneled cuffed hemodialysis catheters implanted via the internal jugular veins by an interventional radiologist and a vascular surgeon together. METHODS: The outcomes were retrospectively analyzed of 31 hemodialysis catheters placed from December 1999 through January 2001. We investigated age, sex, indications and locations of insertion, catheter performance, complications and causes of catheter removal. All the catheters were placed via the internal jugular veins by an interventional radiologist and a vascular surgeon together. RESULTS: Catheter placements were successful in all patients. Procedural complication was limited to clinically unimportant minor local bleeding. No instances of pneumothorax, hemothorax, vessel injury, substantial bleeding, obstruction, malposition or stenosis occurred. The blood flow rate on the first hemodialysis after placement of the catheter was 230+/-35.5 mL/min and that after 1 month was 248+/-18.6 mL/min. Late complications included catheter breakage in two cases (6.5%) and bacteremia in four cases (12.9%). Catheters were removed because of catheter-related bacteremia in four cases (12.9%) and death of patients in three cases (9.7%). In 22 cases (71.0%) the catheters were removed because the A- V vascular accesses were available for hemodialysis. Mean duration of the catheter use before removal was 134+/-96 days. CONCLUSION: Tunneled cuffed catheters inserted via the internal jugular veins are safe and durable vascular accesses for hemodialysis with good blood flow rate and long duration of use, especially placed by the co-operation of an interventional radiologist and a vascular surgeon.

Gene Therapy with Adenoviral GDNF Vector in the Animal Model of Parkinson's Disease / 대한해부학회지

A recombinant adenoviral vector encoding human GDNF gene (Ad -GDNF) was developed to investigate the effect of GDNF gene in 6 -OHDA -induced Parkinson's disease rat. The changes of rotatory behavior and density of TH -immunoreactive axon terminals and number of cell bodies were observed by the GDNF expression. Adult male Sprague -Dawley rats were used. Parkinson's disease (PD) rat models were prepared by the injection of 6 -OHDA into the striatum. After 1 week, the animals showing apomorphine -induced rotatory behavior above 7 turns/ min were defined as PD rat model. Ad -GDNF was injected into the striatum of animal model and tested the apomorphine -induced rotatory behavior at 1 week after injection. These animals were perfused with Zamboni fixative to investigate the morphological changes after rotatory behavior test. Instead of Ad -GDNF, Ad -LacZ injected PD rats were used as a control. The following results are obtained: 1. The apomorphine -induced rotational behavior was significantly reduced by the treatment of PD rat by the injection of Ad -GDNF. The Ad -LacZ injected PD rat showed no change in rotatory behavior. 2. The density of TH -ir axon terminals in the striatum was significantly increased by the Ad -GDNF injection (75% of normal side), but there was no change in the density by the Ad -LacZ injection (37% of normal side) compared to 6 - OHDA lesioned striatum. This means the Ad -GDNF injection prevented the degenerative change of TH -ir axon terminals in the stritum of the PD rat. 3. The number of TH -ir cell body was significantly recovered by the Ad -GDNF (82% of normal side), but there was not recovered by the Ad -LacZ injection (60% of normal side) compared to 6 -OHDA lesion. This means the retrogradely transported Ad -GDNF induced the TH expression in the dopaminergic neurons of the substantia nigra. Gene therapy with Ad -GDNF prevented the degeneration of dopaminergic neurons and axon terminals in the 6 - OHDA -induced PD rat.

Patterns of Posterior Chest Leads (V7, V8, V9) ECG in Normal Adults

BACKGROUND AND OBJECTIVES: Recently many studies have confirmed positive identification of patients with posterior infarction through ST segment elevation in the electrocardiogram of posterior chest leads V7 through V9. However, the ECG patterns from posterior chest leads in normal adults have not been investigated, so this study was designed to examine such patterns. SUBJECTS AND METHODS: We studied 100 patients with normal conventional 12-lead ECG, normal physical examination and without any history of cardiovascular disease. Leads V7, V8 and V9 were recorded immediately after routine 12-lead ECG at the same horizontal level as that of V6 on the posterior axillary line (lead V7), the posterior scapular line (lead V8), and the left border of the spine (ead V9). RESULTS: The upright P waves in leads V7, V8 and V9 were 99%, 99% and 95% upright, respectively, while the other P waves were isoelectric and none were inverted. The T waves were all upright in leads V7 and V8, while in lead V9, 98% were upright, 2% were isoelectric and none were inverted. None of the subjects had a Q wave duration greater than 0.04 second in any of the 3 leads. At 0.08 second after the J point, only 2 subjects (2%) showed 0.5 to 1.0 mm ST segment elevation, but ST segment elevation was not greater than 1.0 mm in any of the subjects. CONCLUSION: P wave and T wave inversion were absent in all 3 leads. Q wave duration of greater than 0.04 second was also absent in all 3 leads. ST segment elevation was not greater than 1.0 mm in any of the subjects.

Purulent Pericarditis Caused by Group G Streptococcus as an Initial Presentation of Colon Cancer

Bacterial pericarditis has been recognized as a rare disease since the development of antibiotics. Usually, the disease is associated with underlying conditions or a seeding of infection elsewhere to the pericardium. Here we describe a case of group G streptococcal pericarditis as an initial presentation of colon cancer. A 52-yr-old man was admitted because of dyspnea. An electrocardiogram showed a diffuse ST-segment elevation and a two-dimensional echocardiogram showed a large amount of pericardial effusion. A pericardiocentesis was done and purulent fluid was drained. Group G streptococci was cultured in pericardial fluid. The patient was treated with antibiotics and pericardiostomy with saline irrigation. A colonoscopy revealed a small mass with moderately differentiated adenocarcinoma in rectosigmoid colon. He underwent a mucosectomy and was recovered without any complication.

Evaluation of Finger Skin Temperature by Cold Provocation Test for Diagnosis of Hand-Arm Vibration Syndrome / 대한산업의학회지

OBJECTIVES: Various objective tests have been widely used worldwide for diagnosing the hand-arm vibration syndrome. Among these, the cold provocation test has been frequently used to confirm the presence of Raynaud's phenomenon. This study was carried out in order to evaluate finger skin temperature by cold provocation test(10 degrees C for 10 minute) for the diagnosis of hand-arm vibration syndrome METHODS: Fifty-eight workers who had been exposed to local vibration were examined. Information concerning age, occupation, types of vibration tools used, presence of subjective symptoms such as vibration induced white finger(VWF), and numbness and tingling were collected. The subjects were classified into three groups according to their symptoms(Vascular, Neural, and No symptom group). In order to examine the applicability of the cold provocation test using water at 10 degrees C for 10 minute, we compared finger skin temperature between the groups. RESULTS: The mean value of the finger skin temperature at 5 minutes and 10 minutes after cold provocation as well as the recovery rate in the vascular group were significantly lower than that seen in the other groups. CONCLUSIONS: The evaluation of finger skin temperature by cold provocation test is very useful method for the diagnosis of hand-arm vibration syndrome. The test results will assist in confirming the diagnosis of the hand-arm vibration syndrome.