Activities of an Environmental Analysis Van in the German Federal State Schleswig-Holstein.

A cooperation was started between the Union of Physicians of Schleswig-Holstein (Bad Segeberg, Germany) and an environmental engineer in 1992. A mobile unit for environmental analysis was set up, the Environmental analysis Van (EAV) or mobile umweltambulanz. Inspection of sites and collection of air and dust/material samples for analysis of xenobiotics were performed on request. The results of this cooperation were evaluated to show which sources of indoor pollutants could be particularly relevant to human health impairment. During a 30-month period form July 1993 to December 1995, 1793 site inspections wer conducted. Xenobiotic analysis and subsequent advising was performed in 1318 cases; enhanced concentrations of one or more toxic substances (mainly biocides such a pentachlorophenol, permethrin, and/or hexachlorocyclohexane) were found in 71% of the sites analyzed. Formaldehyde, volatile organic compounds, and contamination by molds were also documented. A follow-up was done on 80 clients of the Environmental Analysis Van, which had detected elevated concentrations of permethrin because of pyrethroid-treated carpeting. The effect of removing all contaminated carpeting on health improvement in comparison with nonremoval was statistically significant (p<0.0001). Pyrethroid-treated carpeting, which was already 5, 7 and 10 years old, revealed permethrin concentrations of 115, 100, and 150 mg/kg dust. This result indicates that indoor contamination of permethrin is highly persistent and may be the cause of adverse health effects.

Influences of gold on zinc, copper and metallothionein kinetics in liver and kidney of the rat.

1. Single, very low dose of gold (500 micrograms/kg body weight) was given intramuscularly to male Sprague-Dawley rats (mean body weight: 200 g) as aurothiokeratinate (Auro-Detoxin(R) dissolved in 0.9% NaCl. 2. Blood, liver and kidney were samples at autopsy 0.5, 1, 2, 3, 6 and 12 h after the gold injection (six animals per time). 12 rats were treated with 0.9% saline only as controls. The zinc (Zn), copper (Cu), gold and metallothionein (MT) concentrations were determined in homogenates and cytosols of liver and kidney using atomic absorption spectrometry and gel chromatography, respectively. 3. The main changes in metal and MT concentrations occurred in the kidney, where an increase of gold was found 0.5 h after the injection, followed by an increase in Cu and MT concentrations after 6 h. Zn homeostasis did not change. 4. The results suggest that gold by itself induces an increase of MT-like peptides in the kidney cytosol, which was accompanied by an increase in the concentration of Cu mainly bound to these MT-like peptides.

[Environmental pollution--assessment of environmental medicine questionnaires and data in Schleswig-Holstein from 1995-1997]. / Umweltmedizinische Belastung. Auswertungvon Dokumentations- und Verlaufsbögen in Schleswig-Holstein von 1995 bis 1997.

Physicians qualified in environmental medicine due to their participation in special training courses in the federal state Schleswig-Holstein (Germany) may use a standardized questionnaire to report on their environmental medicine-related cases. The course of the illness and recovery, respectively, if known, is to be documented on a separate data sheet. During a three year period from 1995 to 1997 716 cases and 216 courses of illness and recovery, respectively, have been reported. The relevant environmental factors/toxicants of exposure most frequently documented by these physicians and found to be related to symptoms of illness were biocides (mainly insecticides used indoors for pest control, 31%) molds (30%), dental amalgam (28%), solvents or volatile organic compounds (VOC, 23%) and formaldehyde (17%), respectively. In 47% of the documented cases an exposure to more than one environmental factor/toxicant was registered. Age distribution as well as the symptoms of illness of the patients were found to be dependent on the type of exposure. After the physicians diagnosis of an environmental medicine-related illness the exposure was stopped completely in 57% of those cases of whom the course of the illness was known. Recovery was reported in 62% of these patients, and additional 30% had improved but had not recovered completely at the time of data-assessment. From these results it may be concluded that research work in the field of environmental medicine should be enforced in order to prevent unnecessary illness and to lower the costs of the public health system.

[What is the current age and sex-related cadmium burden of the human kidney cortex?]. / Wie sieht die derzeitige alters- und geschlechtsabhängige Kadmiumanreicherung in der menschlichen Nierenrinde aus?

55 persons of either sex in the age bracket between 0.02 and 87 years had to be examined by experts in forensic medicine. In these examinations, slices of kidney cortex were removed and prepared for cadmium(Cd)-determination by atomic absorption spectrophotometry. The samples were wet ashed by a special and quick method developed in our laboratory, using concentrated (65%) HNO3 for a short period of 1 hour at 90 degrees C. The main results of the present study were that Cd accumulation in the kidney cortex was delayed in the age group between 0.02 and 40 years. The highest Cd concentration of 27 micrograms/g wet weight was found in the age group between 50-59 years. In persons of higher age, above 60 years, the Cd concentrations were generally lower than in persons of the age group between 50-59 years; however, this decline does not seem to be significant. Summing up, we can say that the delayed increase in Cd concentrations in the kidney cortex of persons in the age group between 0.02 and 40 years might be regarded as the first positive result of the restrictive use of Cd materials, resulting in food intake with lower Cd contamination. The present study should be repeated after about 5 years to confirm whether this hopeful assumption is true.

[A cancer mortality atlas on a small geographic scale: procedure, validity and possibilities for its use]. / Erstellung eines kleinräumigen Krebsatlanten: Vorgehensweise, Validität und Nutzungsmöglichkeiten.

Cancer mortality in two counties (Dithmarschen and Nordfriesland) of the Federal State of Schleswig-Holstein (Germany) was assessed by analysing the death certificates for the period from 1980 to 1991. Age-adjusted cancer mortality rates were calculated for the more common cancers for counties as well as for smaller sub-scales. The procedure in respect of data base, data protection, data flow, calculation of rates and mapping of cancer mortality rates on small geographic scales is described and discussed. The data collected by us was compared with the data provided by the offices of statistic affairs on a county scale (only for the more common cancers). The comparison was done for each gender and each county, respectively. The agreement was high (> 95%) for 16 of 22 compared items, and below 90% for two items only. The validity of the data, therefore, was considered sufficient for epidemiological studies. As an example, results regarding female breast cancer rates are shown. The possibilities for the utilization of cancer registries on small geographic scales are discussed: Depending on the incidence of the occurrence of different cancers, cancer registries should provide data on multiple regional scales. A more flexible use of the possibilities of the assessment of regional cancer rates is imperative to utilise the very expensive and time-consuming instruments of analytical epidemiological studies of the causes of cancer more effectively.

[Kinetics of arsenic in human blood after a fish meal]. / Kinetik von Arsen im Blut des Menschen nach einer Fischmahlzeit.

It is well known that fish contains high amounts of arsenic (As) compounds (mean values per wet weight [mg x kg-1] Ballin [1]: 41; Falconer et al. [2]: 14; Staveland et al. [3]: 5.2), which are mainly represented by organic As compounds, especially by arsenobetaine. It is generally assumed that arsenobetaine is rapidly eliminated via the urine and therefore seems to be non-toxic for humans. However, the kinetics of arsenobetaine in human blood are unknown to date. Therefore, the following experiments were performed: 14 women of 24 to 32 years of age voluntarily ingested 179 to 292 g of cooked plaice fillet containing 44 (minimum) to 276 (maximum) mg As x kg-1 dry weight. Hence, the volunteers ingested 2.5 (minimum) to 20 (maximum) mg As per person, equivalent to 0.04 to 0.35 mg As x kg-1 body weight. The element As was measured by atomic absorption spectrometry using the graphite furnace technique in order to detect the total amount of As including that of the stable arsenobetaine. In the blood, the highest As values of 55 +/- 5.8 micrograms x L-1 (median) were found 2 hours after fish ingestion. Subsequently the As concentrations declined reaching 16 +/- 0.69 micrograms x L-1 (median) 48 hours after fish ingestion. In respect of the As values in blood recorded between 2 and 10 hours after fish ingestion, rapid elimination could be observed leading to a half-life of 7.1 hours (first value) recorded by linear regression analysis. With regard to the As values in blood between 10 and 48 hours after fish ingestion, a lower elimination rate was estimated with a longer half-life of 63 hours (second value). The reason for this delayed elimination of As is not known. The results indicate that As mainly absorbed as arsenonetaine due to ingestion of fish is not eliminated as fast as had been expected on the basis of published data. As long as it is not known what happens to arsenobetaine remaining for longer periods in the blood with a half-life of 63 hours, caution is advised regarding the general opinion that arsenobetaine is rapidly eliminated and non-toxic for human consumption.

[Blood and hair arsenic, lead and cadmium analysis of adults and correlation analysis with special reference to eating habits and other behavioral influences]. / Untersuchungen von Arsen, Blei und Kadmium in Blut und Haaren von Erwachsenen und Korrelations-analysen unter besonderer Berücksichtigung von Essgewohn-heiten und anderen verhaltens-bedingten Einflüssen.

In the present work the background burden of arsenic (As), lead (Pb) and cadmium (Cd) was determined in blood (B) and hair (H) samples of male and female adults. The results were combined with personal data like food consumption habits and other confounding factors, and were evaluated by correlation analyses. As, Pb, and Cd determination was performed by atomic absorption spectrometry (AAS), using graphite-furnace AAS for the determination of Pb and Cd, and fluid injection AAS for the determination of As, respectively. All persons participating in this study were not unusually exposed to these elements, neither in their working places nor at home. As, Pb and Cd concentration in the B- and H-samples were in a very low range corresponding to similar data presented in the literature. Although the number of samples was too small for definite conclusions, the following significant correlations between the element concentration in B- and H-samples as well as between the other confounding factors should be considered: H-As depends on B-As; H-Pb depends on B-Pb; H-Pb corresponds to H-Cd; H-Cd, H-Pb distal > proximal; H-As distal < proximal; B-Cd, B-As, H-Pb in smokers > non smokers; H-As, B-Pb, H-Pb males > females; B-Pb positively correlated to wine drinking: B-Pb negatively correlated to daily consumption of mineral water; B-Pb positively correlated to daily consumption of vegetables; B-As positively correlated to fish consumption; B-Pb, H-Pb increase with increasing age of houses. Due to the low concentration of As, Pb and Cd found in the B- and H-samples contamination must be regarded as high risk. The application of AAS for the metal determination in blood is generally accepted and has become a routine method for this purpose. The possibilities of contamination are well known and can be avoided. However, the element determination in hair samples by AAS bares a great risk of falsification by contamination, especially, when the determination is performed only in one or two hair samples of normally exposed individuals with very low element concentrations. On the other hand, when element determination is performed in sufficiently large numbers of hair samples (with the chance to neglect occasionally extreme values). AAS may be applied for element analysis in hair samples, too. It may be a vulnerable analytical method in research programmes of epidemiology and environmental toxicology.

[Evaluation of environmental medicine documentation in Schleswig-Holstein 1995-1999]. / Auswertung umweltmedizinischer Dokumentationsbogen in Schleswig-Holstein von 1995-1999.

Physicians qualified in environmentally related disorders due to their participation in special training courses in the Federal State of Schleswig-Holstein (Germany) used a standardised questionnaire to report on their environmental medicine related cases. The course of the illness, if known, has been documented on a separate data sheet. During the period from 1995-1999 916 cases and 508 courses of illness were assessed. The environmental factors/toxicants of exposure most frequently documented by the 85 participating physicians and found to be related to symptoms of illness were biocides (mainly insecticides used indoors for pest control (32%), moulds (27%), dental amalgam (22%), solvents/volatile organic compounds (21%) and formaldehyde (16%), respectively. In 42% of the documented cases an exposure to more than one environmental factor/toxicant was registered. Age distribution, gender, location of exposure as well as the symptoms of illness of the patients were found to be dependent on the type of exposure. Cessation of exposure to harmful substances/environments was achieved in 54% of those cases where information regarding the course of the illness was given. In 65% of these cases recovery was reported and 30% recovered partially. In those cases where a cessation of exposure could not be achieved or was not complete, no or only partial recovery was mostly reported. From these results it may be concluded that research work on environmentally related disorders should be enforced in order to prevent unnecessary illness and to lower the public health system expenditure.

[Regional distribution of stomach and colon cancer mortality in the Dithmarschen and Nordfriesland districts--cartographic presentation]. / Regionale Verteilung der Magen- und Kolonkrebsmortalität in den Kreisen Dithmarschen und Nordfriesland--kartographische Darstellung.

In two counties (Dithmarschen and Nordfriesland) of the Federal State of Schleswig-Holstein (in the northern part of Germany) the cancer mortality rates, especially those of stomach and colon cancer, were evaluated for the time period 1980-1991. For this purpose the corresponding death certificates collected in these counties were analysed. The counties were subdivided into 16 and 17 smaller areas, respectively. The age-adjusted mortality rates were calculated and the obtained data scaled into eight sections, which were graphically mapped over the smaller areas of the two counties. The frequency of these cancer mortality rates reflects a wide range of distribution pattern in the smaller areas of the two counties, which greatly differ from the cancer mortality values calculated for the two counties as a whole. In comparison with the frequency of stomach cancer mortality for men published in the German Cancer Atlas in 1984 it could be demonstrated that this cancer mortality further decreased in these counties. However, in some smaller areas of these counties, especially in rural areas, the mortality rates of stomach cancer in men were still rather high. The opposite seems to be reflected regarding the frequency of colon cancer mortality. Here higher frequencies of mortality were seen in the small cities of these counties. We suggest that a more subtile cancer mortality mapping can be performed easily without any risk of hurting the requirements of personal data securities, because cancer mortality data are already continuously evaluated by a trained staff at the offices of statistical affairs. These data may be transferred and used for cancer mortality mapping as described in the present paper. In order to guarantee that there will be no violation of personal data secrecy the cancer mortality mapping must be restricted to cancer sites with high frequencies of mortality. All published data should be supervised by an official with special knowledge of the requirements of personal data protection. This study underlines the necessity for higher resolution (smaller areas) in cancer registries as essential prerequisite for systematical exploration of the origins of cancer mortality and as a basis for preventive measures.

[Effects of renovation measures on the health status of persons, exposed to pyrethroids through carpets and flooring]. / Auswirkungen von Sanierungs-massnahmen auf den Gesundheitszustand von Personen, die über Teppiche bzw. Auslegeware gegenüber Pyrethroiden exponiert waren.

80 clients of a mobile unit for environmental quality testing were contacted after monitoring for potential toxic substances in their homes or places of work. Elevated concentrations of pyrethroids (in all cases at least permethrin) were found in these 80 cases in dust or materials, mainly because of pyrethroid treated carpetings. The clients were questioned whether they removed one or all of the contaminated carpets. Furthermore, they were questioned as to their state of health and the period of time which had passed since the carpets were removed. 75 of the 80 contacted clients had initially called the mobile unit for environmental quality testing because of health impairments, whereas 5 clients had done this only for preventive reasons. 47 (59%) of the contacted clients had removed all carpetings which were contaminated with permethrin. 8 (10%) clients had got rid of a part of the contaminated carpets and 25 (31%) clients did not remove any carpet. 39 (83%) of the clients who had removed all contaminated carpetings, described a complete or at least partial improvement of their complaints. The complaints of 6 (13%) clients did not improve despite removal of their carpets. The lowest concentration of permethrin that was assessed at the homes of clients, who, after removing all contaminated carpet floorings, described complete recovery, were 10-15 mg/kg dust and 15 mg/kg carpet, respectively. The effect of removing all contaminated carpetings on health improvement in comparison with the results of not removing any carpet was statistically significant (test: chi 2, p < 0.0001). The corrected contingency coefficient amounted to 0.71. In 3 cases, where the contaminated carpets had already existed for 5, 7 and 10 years in the homes of clients, there were still permethrin-concentrations of 115, 100 and 150 mg per kg dust. This result indicates that indoor contamination of permethrin is highly persistent.