Occupational solvent exposure and adult chronic lymphocytic leukemia: No risk in a population-based case-control study in four Nordic countries.

The aim of this study was to assess the effect of occupational solvent exposure on the risk of adult chronic lymphocytic leukemia (CLL). The current case-control study was nested in the Nordic Occupational Cancer Study (NOCCA) cohort. 20,615 CLL cases diagnosed in 1961-2005 in Finland, Iceland, Norway, and Sweden, and 103,075 population-based controls matched by year of birth, sex, and country were included. Occupational histories for cases and controls were obtained from census records in 1960, 1970, 1980/1981, and 1990. Exposure to selected solvents was estimated by using the NOCCA job-exposure matrix (NOCCA-JEM). Odds ratios (OR) and 95% confidence intervals (95% CI) were estimated by using conditional logistic regression models. Overall, nonsignificant CLL risk elevations were observed for methylene chloride, perchloroethylene, and 1,1,1-trichloroethane. Compared to unexposed, significantly increased risks were observed for cumulative perchloroethylene exposure ≤13.3 ppm-years (OR = 1.85, 95% CI 1.16-2.96) and average life-time perchloroethylene exposure ≤2.5 ppm (1.61, 95% CI 1.01-2.56) among women, and cumulative methylene chloride exposure ≤12.5 ppm-years (OR = 1.19, 95% CI 1.01-1.41) and 12.5-74.8 ppm-years (OR = 1.23, 95% CI 1.01-1.51) among men in an analysis with 5 years lag-time, though without dose-response pattern. Decreased CLL risk was observed for aliphatic and alicyclic hydrocarbon solvents and toluene. This study did not support associations for solvent exposure and CLL. Observed weak associations for methylene chloride, perchloroethylene, 1,1,1-trichloroethane exposures, aliphatic and alicyclic hydrocarbons and toluene were not consistent across sexes, and showed no gradient with amount of exposure.

Death due to acute tetrachloroethylene intoxication in a chronic abuser.

Volatile substances are used widespread, especially among young people, as a cheap and easily accessible drug. Tetrachloroethylene is one of the solvents exerting effects on the central nervous system with experiences of disinhibition and euphoria. The case presented is that of a 27-year-old female, found dead by her father at home with cotton swabs dipped in the nostrils. She was already known for this type of abuse and previously admitted twice to the hospital for nonfatal acute poisonings. The swabs were still soaked in tetrachloroethylene. Toxicological and histological investigations demonstrated the presence of an overlap between chronic intake of the substance (with high concentrations in sites of accumulation, e.g., the adipose tissue, and contemporary tissue damage, as histologically highlighted) and acute intoxication as final cause of death, with a concentration of 158 mg/L in cardiac blood and 4915 mg/kg in the adipose tissue. No other drugs or medicines were detected in body fluids or tissues, and to our knowledge, this is the highest concentration ever detected in forensic cases. This peculiar case confirms the toxicity of this substance and focuses on the importance of complete histological and toxicological investigations in the distinction between chronic abuse and acute intoxication.

Perchloroethylene: acute occupational poisoning and a proposal for its replacement with other less toxic substances.

Perchloroethylene is used mainly as a solvent in dry cleaning, cleaning of electrical equipment, and degreasing of metal parts. The authors report a case of acute poisoning with perchloroethylene contracted by a maintenance worker when cleaning an electric transformer. Since perchloroethylene may cause severe poisoning and the International Agency for Research on Cancer has classified it as a probable carcinogen for humans, the authors have revised the main substances that may replace perchloroethylene in the workplace. Med Pr. 2019;70(3):393-5.

Cancer in persons working in dry cleaning in the Nordic countries.

U.S. studies have reported an increased risk of esophageal and some other cancers in dry cleaners exposed to tetrachloroethylene. We investigated whether the U.S. findings could be reproduced in the Nordic countries using a series of case-control studies nested in cohorts of laundry and dry-cleaning workers identified from the 1970 censuses in Denmark, Norway, Sweden, and Finland. Dry-cleaning work in the Nordic countries during the period when tetrachloroethylene was the dominant solvent was not associated with an increased risk of esophageal cancer [rate ratio (RR) = 0.76; 95% confidence interval (CI), 0.34-1.69], but our study was hampered by some unclassifiable cases. The risks of cancer of the gastric cardia, liver, pancreas, and kidney and non-Hodgkin lymphoma were not significantly increased. Assistants in dry-cleaning shops had a borderline significant excess risk of cervical cancer not found in women directly involved in dry cleaning. We found an excess risk of bladder cancer (RR = 1.44; 95% CI, 1.07-1.93) not associated with length of employment. The finding of no excess risk of esophageal cancer in Nordic dry cleaners differs from U.S. findings. Chance, differences in level of exposure to tetrachloroethylene, and confounding may explain the findings. The overall evidence on bladder cancer in dry cleaners is equivocal.

ARF requiring hemodialysis after accidental perchloroethylene ingestion.

Perchloroethylene (PCE) is an unsaturated chlorinated hydrocarbon in the form of a colorless, volatile liquid that is used as an industrial organic solvent for metal degreasing and for dry cleaning. The majority of cases of PCE intoxication have occurred by chronic inhalation, and PCE has been implicated previously in the development of mild renal dysfunction. However, the acute effects of PCE on the kidney are not well characterized, and the authors know of no reports of renal biopsy findings in the human. Here the case of a 32-year-old man who manifested by semicomatose state and oliguric acute renal failure requiring dialysis after accidental ingestion of 75 g of PCE is presented. A renal biopsy performed on the 19th day after ingestion showed features characteristic of severe acute tubular necrosis: aggregations of triangular or rhomboid crystals in the tubular lumens. A von Kossa stain showed that the crystal deposits were strongly positive for calcium. After 5 hemodialyses and conservative treatment, renal function gradually returned to normal.

Human exposure to tetrachloroethylene: inhalation and skin contact.

There is considerable potential for worker exposure to tetrachloroethylene, both by skin contact and by inhalation, during its use in dry cleaning and degreasing operations. This paper reviews accounts of both accidental overexposures of workers and controlled exposures of human subjects by these two routes of exposure. Several reported cases of accidental overexposure to anesthetic doses of the chemical reveal that recovery was generally complete but prolonged, and accompanied by many days of measurable levels of the chemical in the patient's alveolar breath. Chronic overexposures of workmen have lessened since the general acceptance by the Western world of the recommended TLV of 100 ppm for 8 hr of daily exposure. Controlled inhalation studies with volunteer subjects at this level of exposure revealed no effects upon health but did indicate a slight decrement in performance on a coordination test. Additional behavioral and neurological tests revealed no interactive effects when alcohol or diazepam, two depressant drugs, were added singly to tetrachloroethylene exposures. Individual susceptibility to the vapor of this chemical, as evidenced by subjective complaints, was noted in approximately one of ten subjects. The authors conclude that the TLV concentration of 100 ppm in the workplace has a negligible margin of safety regarding unimpaired performance during repeated exposures which could be especially hazardous if the worker is physically active or is in a situation where skin absorption presents an added burden.

Pulmonary edema due to tetrachloroethylene.

A patient with massive exposure to tetrachloroethylene fumes presented with coma and severe pulmonary edema. Sequential blood gases, chest x-rays, and clinical findings showed dramatic improvement with conventional but aggressive management and the patient recovered completely. There was no evidence of permanent renal, hepatic, or central nervous system damage.

Establishment of an exposure level to tetrachloroethylene in ambient air in Vermont.

Where environmental contaminants pose potential health hazards, health departments are involved in complex and often controversial situations. Often the rapid formation of a threshold exposure level is required to protect public health. A decision making process was implemented in Vermont when it became necessary to have an interim ambient air exposure level to test for tetrachloroethylene contamination in the water, air, and soil of a community. Contamination of public and private drinking water and ambient air in schools and homes was discovered as a result of uncontrolled waste disposal from an industrial uniform laundry and drycleaning plant. A telephone survey was conducted to determine action taken by the other 49 States regarding emission standards for tetrachloroethylene into ambient air. There were no guidelines in 25 States, and there were guidelines in the remaining 25. Vermont's Commissioner of Health convened a multidisciplinary group of public health professionals to review various approaches to the establishment of an ambient air standard. A decision making action using modified Delphi and nominal group consensus methods set the interim standard at 67 micrograms per cubic meter in ambient air. The drycleaning plant had been closed voluntarily before the standard was established, and the interim standard was used to prevent reopening of the plant through a health order issued by the Vermont Health Department. The standard was also useful for guidance during environmental remediation.

Time course of electrophysiological findings for patients with solvent poisoning. A descriptive study.

The time course of electroencephalographic (EEG) and electroneuromyographic (ENMG) findings was studied among 87 patients (40 men and 47 women) with a diagnosis of chronic solvent intoxication after occupational exposure. Neurophysiological studies were initially performed around the time of diagnosis, and all the patients were reexamined three to nine years later. No control group was available for the follow-up. Upon diagnosis 67% of the patients had an abnormal EEG, the majority with diffuse slow-wave abnormalities. The reexamination showed improvement in the EEGs of 47%, but the percentage of patients with paroxysmal abnormalities had increased from the initial 6 to 17. The percentage of patients with neuropathic findings was 62 for the first and 74 for the second ENMG. Upon reexamination fibrillations were seen in 46% (in 38% in the initial examination), and some loss of motor units was found for 61% (for 54% in the initial examination). Mild improvement in the neuropathic findings was noted for 60%, but the neuropathic findings of 25% showed slight deterioration during the follow-up period. The EEG findings showed a time course resembling that described after external head injuries. The ENMG findings resembled those described in hexa-carbon-induced or carbon disulfide-induced neuropathy. Controlled studies are recommended to examine the observed slight associations between electrophysiological findings and the type of chemical exposure.

Tetrachloroethylene fatality: case report and simple gas chromatographic determination in blood and tissues.

We have described a simple, precise and sensitive assay of tetrachloroethylene in whole blood and tissues, suitable both for emergency cases and forensic medicine. The method employs gas chromatography and electron capture detection. The case report concerns a fatal exposure of a child to tetrachloroethylene. Concentrations of the chemical in different fluids and tissues were determined and compared to two other previously published fatalities.

Tetrachloroethylene and trichloroethylene fatality: case report and simple headspace SPME-capillary gas chromatographic determination in tissues.

We describe a simple, precise, and sensitive assay of tetrachloroethylene and trichloroethylene in tissues, suitable both for emergency cases and forensic medicine. The method employs headspace solid phase microextraction-capillary gas chromatography and electron capture detection. The case is relative to a 45-year-old woman discovered unconscious in a laundry area. The concentrations of the solvents in tissues were determined and compared to other previously published fatalities.

Study on kidney function in female workers exposed to perchlorethylene.

1. Biochemical markers of kidney damage were examined in 16 female workers chronically exposed to tetrachlorethylene (TCE) in five dry-cleaning shops. The results were compared with those obtained in 13 females non-occupationally exposed to organic solvents. 2. The intensity of exposure was monitored by personal environmental monitoring. The time-weighed average exposure to TCE amounted to 157 mg m-3 (range 9-799 mg m-3). A satisfactory agreement was found between the concentration of TCE in ambient air sampled with the charcoal tube method and with a passive dosimeter. 3. The urinary excretion of lysozyme was increased in the exposed group. No difference was found in the urinary excretion of albumin, beta 2-microglobulin, lactate dehydrogenase, total proteins or glucose. The prevalence of abnormal values of biochemical parameters in the exposed group did not differ from that observed in the control group. No correlation was found between the level of TCE exposure and biochemical parameters. 4. The present study suggests that chronic exposure to TCE does not lead to renal damage.

A tetrachloroethylene fatality.

This case report concerns a fatal exposure to tetrachloroethylene at a dry cleaning establishment. A sensitive analytical method was developed and the distribution of the chemical in various fluids and tissues was determined. Although several fatalities from tetrachloroethylene have been reported, little previous quantitative toxicological data have been found in the literature.

Tetrachloroethylene intoxication in an autoerotic fatality.

This case report describes an accidental death due to the inhalation of tetrachloroethylene during an autoerotic episode. Tetrachloroethylene was administered from a can of Fix-A-Flat tire repair. Analysis of tetrachloroethylene was performed using headspace gas chromatography and electron capture detection. The blood tetrachloroethylene concentration of 62 mg/L was consistent with acute tetrachloroethylene intoxication.

Is neurotoxicity associated with environmental trichloroethylene (TCE)?

Individuals who lived near 2 electronic manufacturing plants were exposed to odorous chlorinated solvents by inhalation (directly) and by out gassing from well water. An exposure zone was defined by concentrations of trichloroethylene, 1,1,1-trichloroethane, tetrachloroethylene, and vinyl chloride in groundwater. The author adopted trichloroethylene as a "shorthand" for the exposure designation. Residents complained of impaired recall and concentration, and of dizziness; therefore, the focus of this investigation was brain functions. Neurobehavioral functions, Profile of Mood States, frequencies of 35 symptoms, and questionnaire responses provided by 236 residents from exposure zones were compared with responses provided by 161 unexposed regional referents and by 67 Phoenix residents who lived outside the exposure zone areas. Pulmonary functions were measured with spirometry. Residents of the exposure zones were compared with regional referents, and the former had significantly (p < .05) delayed simple and choice reaction times, impaired balance, delayed blink reflex latency R-1, and abnormal color discrimination. In addition, these individuals had impaired (1) cognitive functions, (2) attention and perceptual motor speed, and (3) recall. Individuals who lived in exposure zones had airway obstructions. Adverse mood state scores and frequencies of 33 of 35 symptoms were elevated. In conclusion, individuals who lived in the exposure zones had neurobehavioral impairments, reduced pulmonary functions, elevated Profile of Mood State scores, and excessive symptom frequencies.

[Retrospective diagnosis of a coma in an infant]. / Diagnostic rétrospectif d'un coma chez un nourrisson.

A four month old baby presented one morning a quiet, hypotonic, areflexive coma without any signs of localization, which vanished without any sequelae. Hepatic cytolysis and an isolated proteinuria with a maximum at about three days after the initial neurological problems completed the picture. A new interview with the parents looking for a toxic cause revealed without any doubt poisoning by tetrachloro-ethylene. Following this particular case, the main signs of poisoning by halogenated aliphatic hydrocarbons are recalled. One should always have in mind the possibility of poisoning at all ages, even with young babies.

[Chronic perchloroethylene poisoning]. / Az idült perklór-etilén-mérgezés.

The authors describe the clinical features of the chronic perchloroethylene poisoning discussing their own 7 cases (2 women and 5 men). The 2 women worked as dry-cleaner, the 5 men performed degreasing of metal objects. The mean age of the patients was 46 (36-55), the exposure time 9.1 (0.5-30) years. In 3 cases the level of the exposure exceeded the maximum allowable concentration verified by the measurement of the perchloroethylene in the air of the workplace. One patient suffering from a serious cranial nerve lesion was not informed on the toxic exposure, so worked without any protective devices. 3 patients had an isolated lesion of the nervous system, 4 one an isolated hepatic damage. The authors draw attention to importance of the prevention.