ABSTRACT
Abstract: Background: Metals are common agents of allergic contact dermatitis, occupational or not, with decreasing incidence over the last years in some countries that have regulated the amount of nickel in objects. Objectives: To analyze and compare with previous studies the profile of metal sensitization between 2003-2015. Methods: Patients who underwent patch testing between 2003-2015 were evaluated retrospectively regarding the sensitization rates to metals, the associations between them, the relationship with profession and epidemiology. Results: Of the 1,386 patients tested, 438 (32%) had positive test to some metal, similar results to the 404/1,208 (33%) of the previous study (1995-2002) performed at the same service (p=0.32). The frequency of nickel (77%), cobalt (32%) and chromium (29%) changed slightly (p=0.20). Most cases of sensitization to chromium were related to the occupation (64%), in contrast to nickel and cobalt (p<0.0001). There was a predominance of females among those sensitized to metal in both studies (p=0.63) and the age group of 20-49 years old (p=0.11); the number of fair-skinned individuals increased (p<0.001), as well as the lesions in the cephalic segment (50.5%; p<0.0001) and hands (45%; p<0.0001), which are not the most frequent location anymore. The number of cleaners decreased (39% vs. 59%; p<0.0001), which still lead in front of bricklayers/painters, which increased (14% vs. 9%; p=0.013). The frequency of wet work reduced (65% vs. 81%; p<0.0001). Study limitations: The study included a single population group; only patients with positive tests to metals were considered - the others were not evaluated for the possibility of false negatives. Conclusion: The sensitization to metals, occupational or not, has been significant over the last 21 years, with few epidemiological changes.
Subject(s)
Humans , Male , Female , Child , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Allergens/adverse effects , Chromium/adverse effects , Immunization/methods , Cobalt/administration & dosage , Dermatitis, Allergic Contact/etiology , Nickel/adverse effects , Time Factors , Patch Tests , Retrospective Studies , Cobalt/adverse effects , Dermatitis, Occupational/etiologyABSTRACT
Abstract: Nickel and cobalt are often responsible for metal-induced allergic contact dermatitis. With the increasing use of cell phones, we observed an increase in cases reports on telephone-related allergic contact dermatitis. The present study evaluated nickel and cobalt release from mobile phones used in Brazil. We evaluated devices of 6 brands and 20 different models using nickel and cobalt allergy spot tests. Of the 20 models, 64.7% tested positive for nickel, with 41.1% positive results for the charger input and 23.5% for other tested areas. None of them was positive for cobalt. Nickel release was more common in older models.
Subject(s)
Humans , Cobalt/analysis , Cell Phone/instrumentation , Nickel/analysis , Brazil , Patch Tests , Cobalt/adverse effects , Dermatitis, Allergic Contact/etiology , Nickel/adverse effectsABSTRACT
ABSTRACT Objective: To describe diagnostic and treatment aspects of hard metal lung disease (HMLD) and to review the current literature on the topic. Methods: This was a retrospective study based on the medical records of patients treated at the Occupational Respiratory Diseases Clinic of the Instituto do Coração, in the city of São Paulo, Brazil, between 2010 and 2013. Results: Of 320 patients treated during the study period, 5 (1.56%) were diagnosed with HMLD. All of those 5 patients were male (mean age, 42.0 ± 13.6 years; mean duration of exposure to hard metals, 11.4 ± 8.0 years). Occupational histories were taken, after which the patients underwent clinical evaluation, chest HRCT, pulmonary function tests, bronchoscopy, BAL, and lung biopsy. Restrictive lung disease was found in all subjects. The most common chest HRCT finding was ground glass opacities (in 80%). In 4 patients, BALF revealed multinucleated giant cells. In 3 patients, lung biopsy revealed giant cell interstitial pneumonia. One patient was diagnosed with desquamative interstitial pneumonia associated with cellular bronchiolitis, and another was diagnosed with a hypersensitivity pneumonitis pattern. All patients were withdrawn from exposure and treated with corticosteroid. Clinical improvement occurred in 2 patients, whereas the disease progressed in 3. Conclusions: Although HMLD is a rare entity, it should always be included in the differential diagnosis of respiratory dysfunction in workers with a high occupational risk of exposure to hard metal particles. A relevant history (clinical and occupational) accompanied by chest HRCT and BAL findings suggestive of the disease might be sufficient for the diagnosis.
RESUMO Objetivo: Descrever aspectos relacionados ao diagnóstico e tratamento de pacientes com doença pulmonar por metal duro (DPMD) e realizar uma revisão da literatura. Métodos: Estudo retrospectivo dos prontuários médicos de pacientes atendidos no Serviço de Doenças Respiratórias Ocupacionais do Instituto do Coração, localizado na cidade de São Paulo, entre 2010 e 2013. Resultados: Entre 320 pacientes atendidos no período do estudo, 5 (1,56%) foram diagnosticados com DPMD. Todos os pacientes eram do sexo masculino, com média de idade de 42,0 ± 13,6 anos e média de tempo de exposição a metal duro de 11,4 ± 8,0 anos. Os pacientes foram submetidos a avaliação clinica, história ocupacional, TCAR de tórax, prova de função pulmonar, broncoscopia com LBA e biópsia pulmonar. Todos apresentaram distúrbio ventilatório restritivo. O achado de imagem à TCAR de tórax mais frequente foi de opacidades em vidro fosco (em 80%). Em 4 pacientes, o LBA revelou presença de células gigantes multinucleadas. Em 3, foi diagnosticada pneumonia intersticial por células gigantes na biópsia pulmonar. Houve o diagnóstico de pneumonia intersticial descamativa associada à bronquiolite celular em 1 paciente e de pneumonite de hipersensibilidade em 1. Todos foram afastados da exposição e tratados com corticoide. Houve melhora em 2 pacientes e progressão da doença em 3. Conclusões: Apesar de ser uma entidade rara, a DPMD deve ser sempre considerada em trabalhadores com risco ocupacional elevado de exposição a metais duros. A história clínica e ocupacional associada a achados em TCAR de tórax e LBA sugestivos da doença podem ser suficientes para o diagnóstico.
Subject(s)
Humans , Male , Adult , Middle Aged , Alloys/adverse effects , Alloys/toxicity , Cobalt/adverse effects , Cobalt/toxicity , Lung Diseases, Interstitial/diagnosis , Occupational Diseases/diagnosis , Occupational Exposure/adverse effects , Tungsten/adverse effects , Tungsten/toxicity , Adrenal Cortex Hormones/therapeutic use , Biopsy , Lung Diseases, Interstitial/drug therapy , Lung Diseases, Interstitial/pathology , Lung/diagnostic imaging , Lung/pathology , Occupational Diseases/drug therapy , Occupational Diseases/pathology , Retrospective Studies , Tomography, X-Ray ComputedSubject(s)
Humans , Male , Female , Cobalt , Cobalt/adverse effects , Chromium , Chromium/adverse effects , Dermatitis, Contact , Nickel , Nickel/adverse effects , Patch Tests , Prostheses and Implants/adverse effectsABSTRACT
A 39-year-old female with elevated serum cobalt levels from her bilateral hip prostheses presented with a 3-week history of blurred vision in her left eye. Optical coherence tomography revealed patchy degeneration of the photoreceptor-retinal pigment epithelium (RPE) complex. The lesions were hypofluorescent on indocyanine green angiography. We postulate that this is a case of implant-related chorio-retinal cobalt toxicity.
Subject(s)
Adult , Choroid/drug effects , Cobalt/blood , Coloring Agents/diagnosis , Cobalt/adverse effects , Cobalt/toxicity , Female , Fluorescein Angiography/methods , Hip Prosthesis , Humans , Indocyanine Green/diagnosis , Retina/drug effectsABSTRACT
Metals, especially nickel, are the most common contact allergens in children. Recent data has shown increased incidence of allergy in industrialized countries. Sensitization can occur at any age, even in neonates. Costume jewelry, particularly earrings, is linked to increased sensitization to nickel. Sensitization to cobalt often occurs by the use of costume jewelry. The most common source of sensitization to chromium is leather. Due to the absence of a specific therapy, the main treatment is to identify and avoid the responsible allergens. This article presents an updated view on the epidemiological and clinical aspects of contact allergy to metals, focusing on prevention strategies and risk factors, and warns about possible and new sources of contact.
Os metais, especialmente o níquel, são os sensibilizantes de contato mais comuns em crianças. Dados recentes revelam aumento na incidência da alergia deste em países industrializados. A sensibilização pode ocorrer em qualquer idade, mesmo em recém-nascidos. Bijuterias, especialmente brincos nas orelhas, são ligadas ao aumento da sensibilização ao níquel. A sensibilização ao cobalto geralmente ocorre pelo uso de bijuterias. A fonte mais comum de sensibilização ao cromo é o couro. Devido à ausência de terapia específica, o principal tratamento consiste em identificar e evitar os alérgenos responsáveis. Este artigo pretende apresentar uma visão atualizada sobre os aspectos epidemiológicos e clínicos da alergia de contato aos metais, focando estratégias de prevenção e fatores de risco, além de alertar sobre as possíveis e novas fontes de contato.
Subject(s)
Child , Humans , Chromium/adverse effects , Cobalt/adverse effects , Dermatitis, Allergic Contact , Nickel/adverse effects , Dermatitis, Allergic Contact/diagnosis , Dermatitis, Allergic Contact/epidemiology , Dermatitis, Allergic Contact/therapy , Histamine Antagonists/therapeutic use , Immunosuppressive Agents/therapeutic use , Risk FactorsABSTRACT
Cobalt alone and in combination with tungsten carbide known as hard metal is capable of causing lung damage. This may vary from development of pulmonary oedema to asthma and fibrosing alveolitis. We report a case of giant cell interstitial pneumonitis caused by exposure to cobalt dust which was not identified as the etiological agent initially and hence led to progression of the disease. The patient subsequently improved following cessation of exposure and treatment with oral corticosteriods, thereby stressing the importance of occupational history in all cases of interstitial pulmonary fibrosis.
Subject(s)
Adult , Cobalt/adverse effects , Giant Cells/drug effects , Humans , Lung Diseases, Interstitial/chemically induced , Male , Occupational Diseases/chemically induced , Tomography, Emission-ComputedABSTRACT
Se prsentan dos casos clínicos de fibrohistiocitoma maligno sobre radiodermitis. El primer caso se trata de un paciente de sexo masculino que presenta una lesión tumoral en mejilla derecha, zona de radiodermatitis crónica provocada por tratamiento de acné 25 años atrás. Luego de la escisión quirúrgica la lesión recidivaal año. En el segundo caso una paciente de sexo femenino portadora de carcinoma mamario presenta una lesión tumoral compatible con fibrohistiocitoma maligno localizada en cara anterior de tórax, sobre una radiodermitis crónica por tratamiento de cobalto realizado por su patología de base 23 años atrás. Se derivó al srvicio de cirugía, pero la paciente fallece antes por metástasis del carcinoma. Dada la escasa frecuencia de esta patología se realiza una revisión bibliográfica del tema
Subject(s)
Humans , Male , Female , Middle Aged , Cobalt/adverse effects , Radiodermatitis/complications , Skin Neoplasms/etiology , Skin Neoplasms/surgery , Skin Neoplasms/therapy , Cheek/pathology , Thorax/pathologyABSTRACT
Neste estudo avaliou-se o efeito da radiaçao ionizante em 12 coelhas (65 embrioes), em três diferentes momentos da gravidez: no momento do cruzamento / ovulaçao (hora zero), dois dias após, e quatro dias após, com duas diferentes doses de irradiaçao, cinco cGy e 10 cGy. Seis coelhas (36 blastocistos) foram usadas como controles. O momento do cruzamento foi considerado a hora "zero". Após seis dias (+60 minutos) os embrioes de cada coelha foram obtidos por lavagem do útero com meio de cultura. Os embrioes foram fixados em metanol por 48 horas, e corados com hematoxilina ácida de Mayer. Os seguintes parâmetros foram estudados: a) influência no número de mitoses atípicas; b) influência no grau de desenvolvimento do pólo embrionário. Nao se encontrou malformaçoes grosseiras do pólo embrionário. O número de mitoses atípicas foi alterado tanto pelo momento quanto pela dose irradiada. O grau de desenvolvimento do pólo embrionário relacionou-se com o momento da irradiaçao (atrasando-o), mas a dose irradiada nao influiu neste parâmetro.
Subject(s)
Animals , Female , Rabbits , Blastocyst/radiation effects , Cobalt/adverse effects , Radiation, Ionizing , Embryonic Structures/growth & development , Mitosis , Dose-Response Relationship, Radiation , Time FactorsABSTRACT
Neste estudo avaliou-se o efeito da radiaçao ionizante em 12 coelhas (65 embrioes), em três diferentes momentos da gravidez: no momento do cruzamento / ovulaçao (hora zero), dois dias após e quatro dias após, com duas diferentes doses de irradiaçao: 5 cGy e 1O cGy. Seis coelhas (36 blastocistos) foram usadas como controles. O momento do cruzamento foi considerado a hora "zero". Após seis dias (ñ 60 minutos), os embrioes de cada coelha foram obtidos por lavagem do útero com meio de cultura. Os embrioes foram fixados em metanol por 48 horas, e corados com hematoxilina ácida de Mayer. Os seguintes parâmetros foram estudados: a - índice mitótico; b - malformaçoes do pólo embrionário. Nao se encontrou malformaçoes grosseiras do pólo embrionário. O índice mitótico foi alterado tanto pelo momento quanto pela dose irradiada.
Subject(s)
Animals , Female , Rabbits , Blastocyst/radiation effects , Cobalt/adverse effects , Embryonic Structures/abnormalities , Mitotic Index , Radiation, Ionizing , Mitosis , Dose-Response Relationship, Radiation , Time FactorsABSTRACT
We report a case of occupational asthma caused by cobalt associated with systemic symptoms. He was a non-atopic, ex-smoker and had worked in a glassware factory for 14 months. A skin prick test with CoSO4 up to 100 mg/ml showed a negative result. A bronchoprovocation test with CoSO4 demonstrated an isolated asthmatic response with systemic symptoms such as fever, arthralgia and myalgia. Although an initial methacholine bronchial challenge test showed a negative result, the following methacholine bronchial challenge test which was done 24 hours after the challenge testing demonstrated an increased airway hyperresponsiveness at 2.5 mg/ml which recovered 7 days later. An intradermal skin test with 10 mg/ml and 100 mg/ml CoSO4 solution demonstrated positive responses respectively(13 x 12/40 x 32, 20 x 15/40 x 37 (mm), histamine 16 x 14/64 x 50). A patch test including cobalt showed a negative result. Bronchoalveolar lavage fluid after the cobalt inhalation testing and other laboratory findings showed no evidence of hypersensitivity pneumonitis. These results suggested that cobalt could induce occupational asthma with systemic illness in an exposed worker.
Subject(s)
Humans , Male , Alveolitis, Extrinsic Allergic/chemically induced , Asthma/chemically induced , Cobalt/adverse effects , Middle Aged , Occupational Exposure , Respiratory Function TestsABSTRACT
A associaçåo de câncer priomário da vagina com prolapso genital é uma entidade rara. Os autores apresentam um caso de carcinoma primário de vagina e prolapso genital de terceiro grau em uma paciente mulípara, atendida no Hospital-escola da Faculdade de Medicina do Triângulo MIneiro. Discutiram-se a incidência no serviço e as dificuldades na orientaçåo terapêutica
Subject(s)
Humans , Male , Adult , Carcinoma, Squamous Cell/complications , Uterine Prolapse/complications , Vaginal Neoplasms/complications , Carcinoma, Squamous Cell/radiotherapy , Cobalt/adverse effects , Vaginal Neoplasms/radiotherapySubject(s)
Adult , Middle Aged , Male , Female , Cobalt/adverse effects , Cobalt/analysis , Cobalt/toxicity , Lead Poisoning/complications , Lead Poisoning/diagnosis , Lead Poisoning/physiopathology , Manganese/adverse effects , Manganese/analysis , Manganese/toxicity , Occupational Diseases/diagnosisABSTRACT
Camundongos submetidos à aplicaçäo intraperitonial de sais de níquel e de cobalto (cloreto, sulfato, acetato e nitrato) apresentaram reaçäo anafilactóide suja intensidade foi avaliada através da perda plasmática. O pré-tratamento dos animais com pirilamina ou com metissergida reduzida a hemoconcentraçäo provocada pelo sulfato de cobalto, indicando que a histamina e a serotonina devem ser mediadora do choque