[Neurological symptoms and syndromes in municipal transport drivers]. / Objawy i zespoly neurologiczne u kierowców pojazdów komunikacji miejskiej.

BACKGROUND: The way the municipal transport drivers perform their job contributes to varied burdens linked with the body posture at work, stress, shift work, vibration, noise and exposure to chemical agents. The aim of the study was to assess the condition of the nervous system (NS) in municipal transport drivers. MATERIAL AND METHODS: The study covered 42 men, aged 43.4 years (standard deviation (SD): 8.3), employed as bus drivers in the municipal transport enterprise. The duration of employment was 11.8 years on average (SD: 8.6). The condition of the nervous system was assessed on the basis of clinical neurological examinations. RESULTS: Chronic lumbosacral syndrome was found in 54.8% of the subjects. A significant relationship between the incidence of lumbosacral syndrome and the duration of employment (p=0.032) was observed; significantly higher in drivers employed for 11-15 years (90.9%) in comparison to the remaining groups. Nervous system functional disorders were characterized by the increased emotional irritability (47.6%), sleep disorders manifested by excessive sleepiness (33.3%) or insomnia (28.6%) and headaches (3%), mostly tension headaches. Excessive daytime sleepiness was significantly age-dependent (p=0.038). CONCLUSIONS: The evidenced NS disorders indicate the need to undertake preventive measures tailored for the occupational group of bus drivers.

Neurological and neurophysiological examinations of workers exposed to arsenic levels exceeding hygiene standards.

OBJECTIVES: The assessment of the neurotoxic effect of arsenic (As) and its inorganic compounds is still the subject of interest due to a growing As application in a large array of technologies and the need to constantly verify the principles of prevention and technological parameters. The aim of this study was to determine the status of the nervous system (NS) in workers exposed to As at concentrations exceeding hygiene standards (Threshold Limit Values (TLV) - 10 µg/m(3), Biological Exposure Index (BEI) - 35 µg/l) and to analyze the relationship between the NS functional state, species of As in urine and As levels in the workplace air. MATERIAL AND METHODS: The study group comprised 21 men (mean age: 47.43±7.59) employed in a copper smelting factory (mean duration of employment: 22.29±11.09). The control group comprised 16 men, matched by age and work shifts. Arsenic levels in the workplace air (As-A) ranged from 0.7 to 92.3 µg/m(3); (M = 25.18±28.83). The concentration of total arsenic in urine (As(tot)-U) ranged from 17.35 to 434.68 µg/l (M = 86.82±86.6). RESULTS: Syndrome of peripheral nervous system (PNS) was manifested by extremity fatigue (28.6%), extremity pain (33.3%) and paresthesia in the lower extremities (33.3%), as well as by neuropathy-type mini-symptoms (23.8%). Electroneurographic (ENeG) tests of peroneal nerves showed significantly decreased response amplitude with normal values of motor conduction velocity (MCV). Stimulation of sural nerves revealed a significantly slowed sensory conduction velocity (SCV) and decreased sensory potential amplitude. Neurophysiological parameters and the results of biological and environmental monitoring showed a relationship between As(tot), As(III) (trivalent arsenic), the sum of iAs (As(III)+As(V) (pentavalent arsenic))+MMA (monomethylarsonic acid) concentration in urine and As levels in the air. CONCLUSIONS: The results of the study demonstrate that occupational exposure to inorganic arsenic levels exceeding hygiene standards (TLV, BEI) generates disorders typical of peripheral neuropathy.

Health effects and arsenic species in urine of copper smelter workers.

The aim of this study was to compare indices of exposure in workers employed at different work posts in a copper smelter plant using neurophysiological tests and to evaluate the relationship between urinary arsenic species with the aid of sensitive respiratory and renal biomarkers. We have attempted to elucidate the impact of different arsenic speciation forms on the observed health effects. We focused on the workers (n = 45) exposed to atmospheres containing specific diverse mixtures of metals (such as those occurring in Departments of Furnaces, Lead and Electrolysis) compared to controls (n = 16). Subjective symptoms from the central (CNS) and the peripheral (PNS) nervous system were recorded and visual evoked potential (VEP), electroneurography (ENeG) and electroencephalography (EEG) curves were analysed. Levels of airborne lead (PbA), zinc (ZnA) and copper (CuA) and Pb levels in blood (PbB) and the relationships between airborne As concentrations (AsA) and the urinary levels of the inorganic (iAs); As(+3), As(+5) and the organic; methylarsonate (MMA(V)), dimethylarsinate (DMA(V)) and arsenobetaine (AsB) arsenic species were determined by Inductively Coupled Plasma Mass Spectrometry (ICP-MS). Effects of exposure were expressed in terms of biomarker levels: Clara cell protein (CC16) in serum as early pulmonary biomarker and ß2-microglobulin (ß2M) in urine and serum, retinol binding protein (RBP) as renal markers, measured by sensitive latex-immunoassay (LIA). Abnormal results of neurophysiological tests, VEP, EEG and ENeG showed dominant subclinical effects in CNS and PNS of workers from Departments of Lead and Furnace. In group of smelters from Departments of Furnace exposed to arsenic above current TLV, excreted arsenic species As(+3) and As(+5) seemed to reduce the level of Clara cell protein (CC16), thereby reducing anti-inflammatory potential of the lungs and increasing the levels of renal biomarker (ß2M) and copper in urine (CuU). The study confirmed deleterious arsenic effects to the kidney by increased levels of low-molecular weight protein in urine and the extent of the renal copper accumulation/excretion. The results of our work also support the usefulness of application of the sensitive neurophysiologic tests, such as VEP, EEG and ENeG, for the detection of early subclinical effects of the exposure of the nervous system in copper smelters.

[Borreliosis in occupational medicine practice]. / Borelioza w praktyce lekarza medycyny pracy.

Lyme borreliosis is a multisystem infectious disease that can occur from bites by infected ticks. It can appear at persons exposed professionally for staying in tick feeding environment as well as persons staying in such an environment occasionally. For a few years the Lyme disease is taking the leading place amongst occupational diseases and first amongst infectious occupational diseases. Lyme disease is a major problem especially in wooded areas of Poland however it can occur throughout the country. The variety of clinical and serological pictures is creating everyday diagnostic problems. The aim of this publication is to collect, methodize and remind the medical knowledge about pathogenesis, symptoms, diagnostics, prevention and medical certification of this disease. Disease symptoms were specified to appearing in various organs and systems in order to clarify this difficult to diagnose disease. Diagnostics of Lyme disease was divided into standard and highly specialized, performed in special cases.

[Certain issues concerning medical certification and driving fitness assessment after craniocerebral traumas]. / Wybrane zagadnienia orzekania o stanie zdrowia i zdolnosci do prowadzenia pojazdów: osób po przebytych urazach czaszkowo-mózgowych.

BACKGROUND: The incidence of craniocerebral traumas increases with a growing number of road accidents. It should be emphasized that it is rather difficult to determine precisely the craniocerebral traumas incidence rate, however, it is well known that road accidents are the major cause of these injuries. MATERIAL AND METHODS: The study embraced 43 men (mean age: 47.1; SD: 11.4) after craniocerebral traumas. Of the 43 men, 23 drivers had driving license of the following classes: A, Al, A2, AM, B, B1 and BE without professional driving permit, and 20 men worked as professional drivers licensed according to the following classes: C, CE, C1, C1E, D, DE, D1 and DIE. The duration of drivers' employment ranged from 4 to 33 years (mean: 19 years; SD: 7.7). The clinical diagnosis was based on the patient's medical history, medical records, neurological examination complemented with other specialist examinations. RESULTS: Posttraumatic encephalopathy diagnosed in 23 (53.5%) patients was characterized by varied clinical symptoms. Posttraumatic simple encephalopathy diagnosed in 13 patients was the most frequent contradiction to run motor vehicles. Posttraumatic epilepsy was a contradiction in 5 and posttraumatic subarachnoid haemorrhage in 2 patients (one with neurological deficiency hemiparesis, the other with frontal lobe syndrome. Following the treatment 46.5% of men under study did not show neurological deficits and were allowed to run motor vehicles. CONCLUSIONS: The certification procedure in cases of past craniocerebral traumas should not follow the routine and careful examination of each individual case is required prior to assessing a driver's ability to run motor vehicles.

[Comments on diagnostic problems and procedures in certifying the ability of epileptic patients to drive motor vehicles based on published articles and our own cases]. / Uwagi do postepowania diagnostyczno-orzeczniczego w padaczce przy kwalifikowaniu do prowadzenia pojazdów silnikowych w swietle pismiennictwa i obserwacji wlasnych.

Epileptic seizures prevent the affected persons, partly or completely, from performing certain occupational tasks. Due to their widely differentiated etiology, seizures and related conditions pose a serious diagnostic and certification problem. Epilepsy is thought to be one of the essential contraindication for driving a vehicle. The aim of this work was to analyze current diagnostic and certification problems and the procedures used to determine the ability of drivers to run motor vehicles on public roads. The nature of seizures, their frequency, circumstances in which they occur, the results of neurological and EEG tests and, in some cases, the results of neuroimaging tests were taken into account when diagnosing clinical epilepsy. The conditions most commonly mistaken for epileptic seizures are syncope, transient ischemic attack (TIA) and non-epileptic psychogenic seizures. There is a tendency toward a greater liberalization of driving standards for people with epilepsy. The certification procedure in cases of epilepsy should not be schematic; careful examination of each individual case is required before judging a driver's ability to run motor vehicles on public roads.

Effects of occupational exposure to arsenic on the nervous system: clinical and neurophysiological studies.

OBJECTIVES: A number of metals, especially heavy metals, exhibit neurotoxic properties. Neurological and neurophysiological studies indicate that the functions of the central (CNS) and peripheral nervous system (PNS) may be impaired under conditions of exposure to arsenic (As). The aim of the present study was to assess the effects of inorganic arsenic on the central and peripheral nervous system. MATERIALS AND METHODS: The study covered a group of 21 male workers (mean age: 41.9 yr; SD: 7.6; range: 31-55 yr) employed in a copper smelting factory. Their employment duration ranged from 5 to 33 years (mean: 18.1 yr; SD: 7.8). Arsenic concentrations in workplace air amounted to 0.01003 mg/m3 on average (SD: 0.00866). Urine arsenic concentrations ranged from 3.48 to 23.63 µg/l (mean: 11.91 µg/l; SD: 9.5). The control group consisted of 16 males non-occupationally exposed to As, matched for gender, age and work shift pattern. The evaluation of neurological effects was based on the findings of neurological examination, electroencephalography (EEG), visual evoked potentials (VEPs) and electroneurography (ENeG). RESULTS: Clinical symptoms, such as sleeplessness or sleepiness, irritability, headache, painful spasms in extremity muscles, extremity paresthesia and pain, and muscular fatigue prevailed among functional disorders of the nervous system in workers chronically exposed to As. Neurological examination did not reveal any organic lesions in the CNS or PNS. In EEG records classified as abnormal, generalized changes were most common. VEP examinations revealed abnormalities in evoked response latency. Stimulation of the motor fibers of the peroneal and medial nerves resulted in a decreased amplitude of the motor potential. Stimulation of the sensory fibers of medial nerves brought about a decreased amplitude of the sensory potential and a lower conduction velocity of the sural nerves. CONCLUSION: The findings of the study indicate that exposure to As concentrations within the threshold limit values (TLV) can induce subclinical effects on the nervous system, especially subclinical neuropathy.

Association between occupational exposure to arsenic and neurological, respiratory and renal effects.

Occupational exposure by inhalation in copper smelter is associated with several subclinical health phenomena. The respiratory tract is usually involved in the process of detoxication of inhaled noxious agents which, as arsenic, can act as inductors of oxidative stress (Lantz, R.C., Hays, A.M., 2006. Role of oxidative stress in arsenic-induced toxicity. Drug Metab. Rev. 38, 791-804). It is also known that irritating fumes affect distal bronchioles of non-ciliated, epithelial Clara cells, which secrete anti-inflammatory and immunosuppressive Clara cell protein (CC16) into the respiratory tract. The study group comprised 39 smelters employed at different workplaces in a copper foundry, matched for age and smoking habits with the control group (n=16). Subjective neurological symptoms (SNS), visual evoked potentials (VEP), electroneurographic (EneG) and electroencephalographic (EEG) results were examined in the workers and the relationships between As concentration in the air (As-Air) and urine (As-U) were assessed. Effects of exposure were expressed in terms of biomarkers: CC16 as early pulmonary biomarker and beta(2)-microglobulin (beta(2)M) in urine and serum and retinol binding protein (RBP) as renal markers, measured by sensitive latex immunoassay. The concentrations of arsenic exceeded about two times the Threshold Limit Values (TLV) (0.01 mg/m(3)). The contents of lead did not exceed the TLV (0.05 mg/m(3)). Low CC16 levels in serum (12.1 microg/l) of workers with SNS and VEP symptoms and highest level As-U (x(a) 39.0 microg/l) were noted earliest in relation to occupational time. Moreover, those effects were associated with increased levels of urinary and serum beta(2)M and urinary RBP. Results of our study suggested the initiative key role of oxidative stress in triggering the processes that eventually lead to the subclinical effects of arsenic on the nervous system.

[Nervous system disorders induced by occupational exposure to arsenic and its inorganic compounds: a literature review]. / Zmiany w ukladzie nerwowym w nastipstwie narazenia zawodowego na arsen i zwiizki nieorganiczne arsenu w swietle pismiennictwa.

This paper presents a review of the effect of arsenic (As) and its inorganic compounds on the nervous system. In humans, inhalation exposure mostly occurs in occupational conditions. In the occupational environment, the most extensive exposure to this element is observed in the copper industry. Chronic As poisoning is manifested by skin and mucous membrane lesions, impairment of the nervous system in the form of disorders of psychic functions and polyneuropathies, retrobulbar neuritis, disorders of peripheral circulation and the risk for Raynaud's syndrome. Arsenic-induced polyneuropathy is usually a very serious and chronic disease. A complete recovery is observed in only 15-20% of patients. As-induced encephalopathy is an irreversible process.

Early neurotoxic effects of inhalation exposure to aluminum and/or manganese assessed by serum levels of phospholipid-binding Clara cells protein.

Little is known on the disturbances of lung epithelium function in aluminum casting smelters and shipyard welders exposed by inhalation to irritant occupational pollutants, dust and fumes. The exact mechanism of aluminum and manganese toxicity is not known, but it is thought that they may potentiate oxidative and inflammatory stress, leading to impaired neurological function. The aim of the study was to investigate the subclinical effects of aluminum and manganese exposure on the nervous system and to assess their relationship to the biomarkers of exposure and effect in workers exposed to neurotoxic fumes. The relationship between the neurological and respiratory effects was investigated in 50 workers at aluminum casting smelters exposed to x(GM) = 0.29 Al(2)O(3) mg m(-3), and 59 shipyard welders exposed to x(GM) = 0.16 Mn mg m(-3), and the reference group. Serum anti-inflammatory, phospholipid-binding Clara cell protein (CC16) as a peripheral marker of the bronchiolar epithelium function measured. The lowest CC16 concentrations were found in workers showing subjective CNS symptoms and abnormal neurophysiological findings: EEG and visual evoked potentials. A strong inverse relationship was found between serum Al (Al-S) and CC16 concentrations (p = 0.006). Younger smelter workers and welders, with a shorter exposure duration, presented a higher number of VEPs than the workers employed for a longer period of time. The sub-clinical neurological symptoms (VEP) and low CC16 level can be associated with an internalization of Al ions with lipid fractions of the lung epithelium, which in turn may help Al ions overcome the blood-brain barrier. The inhibited secretion of anti-inflammatory Clara cell protein and low respiratory performance in younger Mn welders was found to enhance subclinical neurotoxic symptoms, especially VEPs, related to exposure to airborne Mn and Mn-B.

[Work performance as a risk factor for carpal tunnel syndrome]. / Sposób wykonywania pracy jako czynnik ryzyka zespolu ciesni nadgarstka.

Certification of carpal tunnel syndrome (CTS) as an occupational disease should be based on evidence that the job performance is a dominant factor responsible for its development. Features of the way the job is performed, which can increase the constriction in carpal tunnel and their quantitative analysis are presented. They include a specific position of the hand during the job performance (dorsal bending, alternate bending and extension), e.g., overcoming resistance with fingers, pincher grip, object catching and holding, exerting pressure on the hand, repeated movements or work with vibratory tools. These features characterize work of persons employed in meat processing, fitting of sub-assemblies, packing of products, or employed as supermarket cashiers. CTS occurrence in persons working with computers and thus using a keyboard or a mouse is now greatly limited owing to the improvement in ergonomic parameters of computer-equipped workposts. The paper indicates CTS risk factors (carpal tunnel size, post-traumatic lesions, rheumatoid arthritis, female gender, hormonal changes during menopause and pregnancy, and other hormonal disorders like hypothyreosis, diabetes, obesity, hypercholesterolemia, cigarette smoking, high alcohol consumption), which have been very well evidenced. In the summary, the attention was also paid to improper estimation of burden to upper limbs by listing jobs performed and stressing the need to quantitatively define hand burdening factors and estimate duration of such burdens.

[The effect of combined exposure to chemical and physical factors on the nervous system during aluminum production: a preliminary finding]. / Skutki zdrowotne w ukladzie nerwowym tacznego narazenia na czynniki chemiczne i fizyczne podczas produkcji aluminium. Doniesienie wstepne.

BACKGROUND: The authors present the results of medical examinations of workers employed in an aluminum electrolysis plant with occupational exposure to aluminum dust, polycyclic aromatic hydrocarbons, and magnetic field. METHODS AND MATERIALS: The study covered a selected group of 39 male workers (mean age, 44,9; SD = 7.5 years; range 29-55 years) involved in the aluminum production. Their employment duration ranged between 5 and 32 years (mean, 17.8; SD = 6.7 years). Urine aluminum concentrations in workers ranged from 8.9 to 70.2 microg/g creatinine (mean, 31.72; SD = 18.3 microg/g creatinine). Urine 1-hydroxypyrene concentrations recorded in workers ranged from 0.67 to 10.09 microg/g creatinine (mean, 3.42; SD = 2.1 microg/g creatinine). The control group consisted of 39 men matched by gender, age and work shifts. RESULTS: Clinical symptoms, such as headache (46.2%), increased emotional irritability (66.7%), concentration difficulty (25.6%), insomnia (30.8%), hypersomnia (15.4%), and mood lability (10.3%) predominated among functional disorders of the nervous system in workers chronically exposed to chemical and physical factors. The objective neurological examinations did not reveal organic lesions in the central or peripheral nervous system. In EEG recordings, classified as abnormal, paroxysmal changes were most common (20.5%). CONCLUSIONS: The authors emphasized great difficulty in evaluating the combined effects of toxic and physical factors exerted on the nervous system.

[Neurologic and neurophysiologic examinations of workers occupationally exposed to aluminium]. / Neurologiczna i neurofizjologiczna ocena pracowników zawodowo narazonych na glin.

BACKGROUND: Studies conducted to assess aluminum (Al)-induced toxicity to humans and environment. It has been implicated that Al is involved in the etiology of Alzheimer's disease and other neurodegenerative disorders, though this is controversial. The aim of the present study was to assess Al effects on the nervous system functions in workers chronically exposed to this metal. METHODS AND MATERIALS: The study covered a selected group of 67 male workers (mean age, 38.7 +/- 10.3 years; range 23-55 years) involved in aluminum production. Their employment duration ranged between 2 and 34 years (mean, 14.6 +/- 8.9 years). Aluminum oxide (Al2O3) concentrations varied from 0.2 to 1.95 mg/m3 (arithmetic mean, 0.40 mg/m3, geometric mean, 0.35 mg/m3, SD = 0.29). Urine aluminum concentrations found in smelters ranged from 8.5 to 93.0microg/l (mean, 42.9 +/- 20.5 microg/l). The control group consisted of 57 men non-occupationally exposed to Al matched by gender, age and work shifts. RESULTS: Clinically, headache (41,8%), increased emotional irritability (56,7%), concentration difficulty (22,4%), insomnia (22,4%) and mood lability (14,9%) predominated among functional disorders of the nervous system in workers chronically exposed to Al. The objective neurological examinations did not reveal organic lesions in the central or peripheral nervous system. In EEG classified as abnormal, generalized and paroxysmal changes were most common. Examinations of visual evoked potentials (VEP) revealed abnormalities, primarily in the latency of the response evoked. CONCLUSIONS: The results of this study suggest that exposure to Al2O3 at concentrations within MAC values induces subclinical effect in the nervous system.

Neurological and respiratory symptoms in shipyard welders exposed to manganese.

OBJECTIVE: The nervous system is the major target of the toxic effect of manganese (Mn) and its compounds in welding fumes. In humans, inhalation is the most frequent route of Mn access, therefore, the respiratory tract and lungs are usually involved in the process of translocation of inhaled noxius agent by blood to the brain. This study was performed to assess whether it is possible to use neurophysiological tests for the detection of early effects of exposure to low Mn concentrations. It is also known that irritating welding fumes affect distal bronchioles of nonciliated, epithelial Clara cells, which secret anti-inflammatory and immunossupresive Clara cell protein (CC16) into the respiratory tract. The examination of usefulness of CC16 as early pulmonary biomarker for neurophysiological abnormal results of welding fumes exposure was performed. MATERIALS AND METHODS: The study group comprised 59 welders employed at different workposts in a shipyard, matched for age and smoking habits with the control group composed of 23 mechanicians and electricians not exposed to welding fumes. Subjective neurological symptops (CNS), visual evoked potentials (VEP) and electroencephalography (EEG) were examined in welders and the relationships between Mn concentrations in the air, blood and urine as well as between cummulative exposure index (CEI) (Mn mg/m3 x years of exposure) were investigated. Effects of exposure were expressed in the form of biomarkers of the body burden, and CC16 as early pulmonary biomarker in welding exposure was examined by sensitive latex-immunoassay. RESULTS: Abnormal results of VEP and EEG and the lowest CC16 levels were found in the youngest welders exposed to welding fumes. Those changes were related to the highest Mn airborne levels (xg > 0.3 mg/m3) and high blood Mn concentrations (approximately 14.0 microg/dL). The highest values of correlation coefficients were found only in welders characterized by abnormal neurophysiological results, VEP (r = 0.83) and VEP and VEP+EEG (r = 0.82). The multiple linear regression analysis from all analyzed subgroups, indicated that those with only abnormal neurophysiological tests, VEP and EEG, showed the highest values of partial correlation. It also revealed partial correlation cofficiants between Mn in the air, CEI (Mn mg/m3 x years) and CC16, Mn-B and Mn-U in VEP and VEP+EEG groups. It was found that the highest partial correlations were between the magnitude of exposure--Mn mg/m3, CEI and Mn-B concentration (R2 = 0.72, R2 = 0.66) as well as between CC16 pulmonary biomarker effects and Mn-B concentration (R2 = 0.51). CONCLUSIONS: The subclinical effects revealed in neurological endpoints and abnormal results of neurophysiological tests, VEP and EEG, confirmed that those sensitive tests could be used for the detection of early effect of exposure to low manganese concentration. Inhibition of Clara cell protein secretion in younger welders not adapted to the Mn environment suppresses anti-inflammatory effect in the respiratory tract and probably enhances the absorption and thus the incidence of subclinical neurotoxic symptoms related to airborne Mn and Mn-B levels.

[ Effects of electromagnetic fields generated by mobile phones on the nervous system]. / Wybrane zagadnienia wplywu pól elektromagnetycznych emitowanych przez telefony komórkowe na uklad nerwowy.

The authors present some data on the effects of electromagnetic fields (EMF) generated by mobile phones on the nervous system. The main attention was paid to the usefulness of some neurophysiological methods, such as electroencephalography (EEG), multimodality evoked potentials (MEP), and event related potentials (ERP) in the evaluation of the bioelectrical activity of the brain. The majority of the cited articles underline the difficulties in the evaluation of adverse effects of EMF generated by mobile phones, which can result from their nonspecific influence on biological structures.

Effects of occupational exposure to aluminum on nervous system: clinical and electroencephalographic findings.

OBJECTIVES: The aim of the present study was to assess the effects of aluminum (Al) on the nervous system functions in workers chronically exposed to Al. MATERIALS AND METHODS: The study covered a selected group of 67 male workers (mean age, 38.7 SD 10.3 years; range 23-55 years) involved in the Al production. Their employment duration ranged between 2 and 34 years (mean, 14.6 SD 8.9 years). Aluminum oxide (Al203) concentrations varied from 0.13 to 1.95 mg/m3 (arithmetic mean, 0.40 mg/3, geometric mean, 0.35 mg/m3 SD 0.29). Urine Al concentrations found in smelters ranged from 8.5 to 93.0 microg/l (mean, 42.9 SD 20.5 microg/l). The control group consisted of 57 men non-occupationally exposed to Al, matched by gender, age and work shifts. RESULTS: Clinically, headache (41.8%), increased emotional irritability (56.7%), concentration difficulty (22.4%), insomnia (22.4%) and mood lability (14.9%) predominated among functional disorders of the nervous system in workers chronically exposed to Al. Objective neurological examinations did not reveal organic lesions in the central or peripheral nervous system. In the EEGs classified as abnormal, generalized and paroxysmal changes were most common. CONCLUSIONS: The results of this study suggest that exposure to Al203 at concentrations below MAC values induces subclinical effect in the nervous system.

[Diagnosis and certification of the ability of epileptic patients to drive motor vehicles: cases consulted by the author]. / Postepowanie diagnostyczno-orzecznicze przy kwalifikowaniu do prowadzenia pojazdów silnikowych osób z padaczka w swietle wlasnych przypadków.

Epilepsy is a frequent diagnostic problem. It is also difficult to certify whether an epileptic patient is able to drive a motor vehicle. With the advent of efficient anti-epileptic treatment, a general practice of refusing epileptic patients driving license should be seriously reconsidered. However, the matter should be given careful consideration not to jeopardize public safety and patients' rights. The aim of the study was to highlight the problems encountered in rediagnosing and certifying people with diagnosed epilepsy or pseudoepileptic seizures. The authors discuss the diagnosis and certification procedures in persons with epileptic seizures after severe craniocerebral trauma. They also analyze a case of diagnosed epilepsy suggesting the syncope in a patient with cardiac defect; a case of psychogenous pseudoepileptic seizures and the course of the disease in a patient with febrile convulsions in childhood. The problems result from the fact that reliable medical histories are not available and thus the retroassessment of the clinical picture of epileptic seizures is not possible. Missing results of timely laboratory tests (EEG, ECG) and diagnostic errors concerning earlier episodes, especially epilepsy diagnosed inconsiderately, are additional obstacles.