New serum tumor markers S100, TFF3 and AIF-1 and their possible use in oncogynecology.

OBJECTIVE: To review a literature about possible new blood serum gynecologic tumor markers, S100 proteins family, trefoil factor 3 and AIF-1. DESIGN: Literature review. SETTING: Department of Obstetrics and Gynecology, Faculty of Medicine, Palacky University and University Hospital in Olomouc. METHODS: Literature review of articles published in PubMed database till January 2019. RESULTS: The association of S100A2, S100A4, S100A6, S100A7, S100A8, S100A9 and S100A11 with breast carcinoma has been demonstrated in the literature. The association of S100A2, S100A4, S100A6, S100A7A, S100A10, S100A14, S100A16, S100B, S100P (up-regulation associated with a lower survival) and S100A1, S100A13, S100A5, S100A13 and S100G proteins (up-regulation associated with a better survival) have been demonstrated in ovarian cancer patients. Cervical carcinoma has been shown to be associated with the S100A9 protein. TFF3 association with endometrial cancer, breast cancer (worse prognosis) and ovarian cancer (better prognosis) has been demonstrated. AIF-1 has been shown to increase expression in cervical cancer. CONCLUSION: Tumor markers can be a very useful tool for patient management when used appropriately. Further research in this area and the search for new tumor markers, including S100, TFF3 and AIF-1, are needed. In future studies, scientists should focus not only on one time point, but assess the trend of the tumor markers for a specific time axis.

[Elevated levels of TFF3 in endometrial cancer patients]. / Zvýsení hladin TFF3 u zen s karcinomem endometria.

AIM: Trefoil peptides are a family of small proteins that are expressed in a site-specific fashion by certain epithelial tissues. These peptides might be used as markers for neoplastic uterine disease. DESIGN: Experimental study. SETTING: Department of Obstetrics and Gynaecology, University Hospital, Medical Faculty, Palacký University, Olomouc; Department of Laboratory Biochemistry, Central Moravian Hospital Trust, Member of Agel holding, Prostejov. METHODS: During the time period from 2012 to 2015 eighty-nine women underwent hysteroscopy and endometrial biopsy for postmenopausal bleeding. Fifty three patients, at the age of (mean ± standard deviation) 63,4 ± 9,5 (33-80) years were diagnosed with endometrial cancer, six patients at the age of 62,9 ± 6,4 (55-74) years were diagnosed with endometrial hyperplasia and thirty patients at the age of 63,3 ± 9,3 (48-62) years diagnosed with endometrial atrophy represented control group. At the day of surgery the venous blood was sampled and subsequently examined for the levels of TFF1, TFF2 and TFF3. RESULTS: TFF3 levels were significantly higher in patients with endometrial carcinoma but not in endometrial hyperplasia subgroup. The levels of TFF1 and TFF2 were not different in selected histopathological subgroups. CONCLUSION: We have shown elevated levels of TFF3 but not of TFF1 and TFF2 in patients with endometrial cancer. TFF1, TFF2 and TFF3 levels were not elevated in patients with endometrial hyperplasia.

Laparoscopic and robotic sacropexy: retrospective review of learning curve experiences and follow-up.

OBJECTIVE: To compare conventional laparoscopic (LSC) and robotic (RSC) sacrocolpopexy in the treatment of apical pelvic prolapse during robotic surgery "learning curve". Operative characteristics, prolapse treatment outcomes, and postoperative results were assessed. DESIGN: Retrospective comparative study. SETTING: Department of Obstetrics and Gynecology, University Hospital and Palacky University, Olomouc. METHODS: We analyzed consecutive 51 patients treated with laparoscopic sacropexy and 13 women operated with robotic system. Data on patient age, body mass index (BMI), operation history, estimated blood loss, operation time, surgical outcomes (including pelvic organ prolapse quantification - POP-Q), and concomitant surgeries were retrospectively obtained from patient medical records. Subjective outcomes were measured through PGI-I and PISQ-IR questionaires when available at last follow up (n = 26). RESULTS: In both groups all procedures were performed correctly without conversion. The mean operative time was longer in robotic group: 212 (128-394) min, as compared to 164 (80-342) in the laparoscopic group. Blood loss was lower for the robotic 52 (10-200) ml compared to laparoscopic group 58 (10-350) ml. Differences in operative time and blood loss were not statistically significant. Differences between LSC and RSC groups in postoperative results were not statistically significant. Learning curve for robotic sacrocolpopexy was shorter than for laparoscopic procedure in case of experienced laparoscopic surgeons. No recurrences occurred during follow-up. Most patients were satisfied with surgical results. CONCLUSION: The present study demonstrated that RSC may be comparable in surgical safety and efficacy. The decision regarding the best surgical approach has to be individualised according to the characteristics of the patient and their preferences as well as the local clinical setting and the surgical expertise of physicians.

[The role of trefoil factor family in gynecological disease]. / Význam trifolátu u gynekologických onemocnení.

AIM: Trefoil peptides are a family of small proteins that are expressed in a site-specific fashion by certain epithelial tissues. These peptides appear to be important in mucosal healing processes, in neoplastic disease and in human reproduction. DESIGN: Literature review. SETTING: Department of Obstetrics and Gynaecology, University Hospital, Medical Faculty, Palacký University, Olomouc, Czech Republic; Department of Laboratory Biochemistry, Central Moravian Hospital Trust, Member of Agel holding, Prostejov. METHODS: Literature review. RESULTS: Trefoil peptides are aberrantly expressed by a wide range of human carcinomas and gastrointestinal inflammatory conditions. Outside the gastrointestinal tract, members of this group of peptides have also been identified in the normal hypothalamus and pituitary, and in normal breast tissue where it is responsive to oestrogen stimulation. Evidence of peptide expression has been found in a range of urological, gynaecological, gastrointestinal, pulmonary and breast carcinomas. Furthermore, possible associations between recurrent spontaneous abortion susceptibility and genetic varia-tion in the TFF3 gene were shown.Conclusion In the future, serum levels of trefoil peptides might be used as markers for neoplastic and inflammatory diseases, as well as some defects of reproduction.

[Robotic sacrocolpopexy - two case reports and literature overview]. / Robotická sakrokolpopexe - dve kazuistiky a literární prehled.

OBJECTIVE: To describe first two cases of robotic sacrocolpopexy in the Czech Republic. DESIGN: Two case reports with literature overview. SETTING: Department of Obstetrics and Gynaecology, Faculty of Medicine and Dentistry, Palacky University in Olomouc. CASE REPORT: Robotic sacrocolpopexy was performed in two patients of the age 36 and 59 at the department of obstetrics and gynecology in Olomouc in 2009. We describe vaginal prolapse treatment in one case, and supracervical hysterectomy with cervicosacropexy in the other. These two cases are compared with literature overview, including long-term follow-up. CONCLUSION: Robotic sacrocolpopexy encompasses all advantages of minimally invasive surgery. Our results, as well as published data show very good long term results of vaginal prolapse treatment using this approach.

["Learning curve" robotic radical hysterectomy compared to standardized laparoscopy assisted radical vaginal and open radical hysterectomy]. / Robotem asistovaná radikální hysterektomie ve fázi "learning curve" a její srovnání se standardní laparoskopicky asistovanou radikální vaginální a otevrenou radikální hysterektomií

OBJECTIVE: To compare intraoperative, pathologic and postoperative outcomes of "learning curve" robotic radical hysterectomy (RRH) with laparoscopy assisted radical vaginal hysterectomy (LARVH) and abdominal radical hysterectomy (ARH) in patients with early stage cervical carcinoma. DESIGN: Comparative study. SETTING: Department of Obstetrics and Gynecology, University Hospital, Olomouc. METHODS: The first twenty patients with cervical cancer stages IA2-IIA underwent RRH and were compared with previous twenty LARVH and ARH cases. The procedures were performed at University Hospital Olomouc, Czech Republic between 2004 and 2011. RESULTS: There were no differences between groups for age, body mass index, tumor histology, number of nodes removed or preoperative hemoglobin levels. The median theatre time in the learning period for the robot procedure was reduced from 400 min to less than 223 min and compared well to the 215 min for an open procedure. We found differences between the pre- and postoperative hemoglobin levels (RRH, 14.9 ±7 .6; LARVH, 23.0 ± 8.5; ARH, 28.0 ± 12.4). This difference was statistically significant in favor of RRH group ( p= 0.0012). Mean length of stay was significantly shorter for the RRH group (7.2 versus 8.8 days,p = 0.0005). Mean pelvic lymph node count was similar in the three groups. None of the robotic or laparoscopic procedures required conversion to laparotomy. The differences in major operative complications between the two groups were not significant. CONCLUSION: Based on our experience, robotic radical hysterectomy showed better results than traditional laparoscopically assisted radical vaginal hysterectomy in early stage cervical carcinoma cases. Introduction of this new technique requires a learning curve of less than 20 cases that will reduce the operating time to a level comparable to open surger.

Is accommodation a confounder in pupillometry research?

Much psychological research uses pupil diameter measurements to investigate the cognitive and emotional effects of visual stimuli. A potential problem is that accommodating at a nearby point causes the pupil to constrict. This study examined to what extent accommodation is a confounder in pupillometry research. Participants solved multiplication problems at different distances (Experiment 1) and looked at line drawings with different monocular depth cues (Experiment 2) while their pupil diameter, refraction, and vergence angle were recorded using a photorefractor. Experiment 1 showed that the pupils dilated while performing the multiplications, for all presentation distances. Pupillary constriction due to accommodation was not strong enough to override pupil dilation due to cognitive load. Experiment 2 showed that monocular depth cues caused a small shift in refraction in the expected direction. We conclude that, for the young student sample we used, pupil diameter measurements are not substantially affected by accommodation.

Characterization of cytochromes P-450 purified from untreated and 14C-2,3,7,8-tetrachlorodibenzo-p-dioxin--treated marmoset monkeys: identification of the major form as a possible orthologue of P-450 1A2.

Three purified cytochrome P-450 (P-450) forms obtained from liver microsomes of marmoset monkeys induced with 14C-2,3,7,8-tetrachlorodibenzo-p-dioxin (14C-TCDD) were characterized. Comparison of electrophoretic and spectral properties and reconstituted methoxy-and ethoxyresorufin O-dealkylase (MROD and EROD) activities with those of forms isolated from untreated marmosets indicated that one of these (form F) is likely constitutive. Another form (D) had MROD and EROD activities which were 100 and 15 times those observed for form F. A form having biophysical properties similar to those of form D was also found in untreated animals. A third form (C) had an appreciable capacity to bind its inducing agent and showed a TCDD-to-P-450 molar ratio for detergent-free solutions of 0.66 +/- 0.13 to 1. In immunoblot analyses of these forms with antibodies raised against specific peptide sequences derived from rat P-450 1A1 and 1A2, the only positive reactions seen were those for untreated and inducible forms D with anti-rat 1A2. This provides evidence that the main or sole P-450 1A form in marmoset liver microsomes is 1A2, as in humans, and that this is inducible by TCDD.

Inducibility of cytochromes P-450 by dioxin in liver and extrahepatic tissues of the marmoset monkey (Callithrix jacchus).

Cytochrome P-450 induction was investigated in the marmoset monkey, a non-human primate, using dioxins as inducing agents. Animals received a single subcutaneous dose of 1.6 nmol tetrachlorodibenzo-p-dioxin or tetrabromodibenzo-p-dioxin/kg body weight. Microsomal fractions were prepared from liver, lung and kidney, and homogenates were prepared from gut and adrenal glands. Anti-peptide antibodies which bind to CYP1A1, CYP1A2, CYP2B6 and CYP3A4 in human were used to identify related forms in the marmoset. The results indicate that CYP1A2 is constitutively expressed in liver, but not in lung, kidney, gut or adrenal gland and that CYP1A1 is not expressed in any of these tissues in untreated animals. Treatment with dioxin induced both CYP1A1 and CYP1A2 in liver, but only CYP1A1 in lung. No induction of CYP1A1 or CYP1A2 was found in kidney, small intestine or adrenal glands. Methoxy-, ethoxy-, pentoxy- and benzoyloxyresorufin O-dealkylases and high affinity phenacetin O-deethylase activities were induced in the liver, whereas ethoxycoumarin O-deethylase and aryl hydrocarbon hydroxylase activities were not affected by dioxin treatment. High-affinity phenacetin O-deethylase and CYP1A2 apoprotein were detected only in liver, consistent with this activity being specifically catalysed by CYP1A2. Furafylline was found to be a competitive inhibitor of methoxyresorufin O-demethylase activity with a Ki of 10 microM. In the lung the induction of CYP1A1 was accompanied by 15- and 23-fold increases in ethoxyresorufin O-deethylase and methoxyresorufin O-demethylase activities, respectively, suggesting that both activities are catalysed by CYP1A1. In contrast, there was no induction of aryl hydrocarbon hydroxylase activity in lung or liver showing that, unlike in many other species, marmoset CYP1A1 does not catalyse this reaction efficiently. The expression, distribution, induction and substrate specificities of marmoset monkey P-450 enzymes differ from the situation found in rodents and other species, demonstrating that caution has to be exercised when making cross-species extrapolations.

Assessment of P450 induction in the marmoset monkey using targeted anti-peptide antibodies.

The identity and expression of hepatic P450 enzymes in marmosets was investigated using a panel of anti-peptide antibodies originally targeted against human P450 enzymes. In immunoblotting, of 12 antibodies examined, 10 bound specifically to bands in marmoset liver microsomal fraction corresponding to P450 enzymes. It is proposed that these represent marmoset CYP1A1, CYP1A2, CYP2A, CYP2B, CYP2C forms (CYP2C-1 and CYP2C-2), CYP2D19, CYP3A21 and another CYP3A form (CYP3A-m). The antibodies, together with an anti-marmoset CYP2E1 antibody, were used to investigate the expression of 10 P450 enzymes in marmosets treated with P450-inducing chemicals. Treatment with phenobarbitone caused CYP2B, CYP2C-2 and CYP3A21 levels to increase, rifampicin caused increases in CYP2B and CYP2C-1 and a decrease in CYP3A21 levels, whereas dioxin caused CYP1A1 and CYP1A2 levels to increase and CYP2E1 levels to decrease. Clofibric acid did not induce any P450. P450 enzyme activities were assessed using 8 different substrates and increases were found after treatment with phenobarbitone, rifampicin, and dioxin. However, due to species differences in substrate selectivity, it proved difficult to ascribe these changes to individual P450 enzymes. Thus, the use of anti-peptide antibodies provides a more informative way of assessing the levels of specific P450 enzymes than enzyme activity measurements.

2,3,7,8-tetrachlorodibenzo-p-dioxin (TCCD) affects keratin 1 and keratin 17 gene expression and differentially induces keratinization in hairless mouse skin.

The environmental pollutant 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) causes chloracne in humans by mechanisms that are as yet poorly understood. Because TCDD is known to affect keratinocyte differentiation in vitro, we have studied TCDD-dependent morphologic changes and the expression of murine keratin 1 (MK1; differentiation associated) and keratin 17 (MK17; presumably hyperproliferation associated) in HRS/J hr/hr hairless mouse skin. TCDD (0.2 microg in acetone) applied topically to the dorsal skin caused epidermal acanthosis and hyperkeratosis of the dermal cysts as well as an involution of the utricles and the sebaceous glands. By means of in situ hybridization with digoxigenin-labeled riboprobes of sections from untreated and vehicle (control)-treated skin, we localized MK1 mRNA to the epidermal spinous cell compartment. MK17 transcripts were detected only in the derivatives of the hair follicle-utricle epithelium and dermal cysts. No spatial overlap was observed between MK1 and MK17 expression. After TCDD application, MK17 was newly expressed in the upper spinous cell layers of the interfollicular epidermis, although it was suppressed in the involuting utricles. In contrast, MK1 expression in the interfollicular epidermis was not affected by TCDD. Furthermore, MK1 expression was induced in the epithelium of the utricle remnants and in some dermal cysts. These data suggest that increased keratinization of the part of the follicular epithelium corresponding to the dermal cyst epithelium of hairless mice most probably explains the pathogenesis of TCDD-induced chloracne. The results demonstrate, furthermore, that TCDD can differentially affect keratinocyte differentiation in vivo as well as in vitro.

Effects of angiocardiographic contrast media on the pulmonary circulation in pigs.

In 12 open-chest pigs, mean weight 18 kg, simultaneous beat-to-beat measurements of pressure in the right and left atria and right and left ventricles, and of pressure and flow in the pulmonary artery, were performed before, during and after the injection of 0.8 ml/kg with 10 to 15 ml/s of diatrizoate, ioxaglate and iopamidol as well as mannitol, normal saline solution and own blood into the right atrium, right ventricle and pulmonary artery. Within 5 beats after injection, all determined hemodynamic values reached their maxima of change independent of site of injection and kind of injectate. After 10 to 20 beats, pulmonary resistance diminished, and the reduction was more pronounced and longer lasting the higher the osmolality of the injectate. Hemodynamic changes during the first beats were a result of the rapidly injected volume; longer lasting hemodynamic changes were associated with an osmolality-dependent decrease in pulmonary resistance.

Enoxacin is an inducer of CYP1A2 in rat liver.

The induction of cytochrome P450 by enoxacin, ciprofloxacin, and ofloxacin was investigated in female Wistar rats. Animals were treated orally with daily doses ranging from 10 to 400 mg enoxacin per kg body wt, 400 mg ciprofloxacin, or 400 mg ofloxacin per kg body wt for up to 7 days. Activities of methoxyresorufin O-demethylase (MROD) and ethoxyresorufin O-deethylase (EROD) were determined fluorimetrically in hepatic microsomes. MROD activity was increased 2.6-fold after treatment with 100 mg enoxacin per kg body wt for 7 days. Lower doses of enoxacin did not induce MROD activity significantly. Antipeptide antibodies directed specifically against different rat cytochrome P450 enzymes demonstrated that CYP1A2, but not CYP1A1, was induced in rats treated with enoxacin. After ciprofloxacin or ofloxacin treatment, no induction of MROD or EROD activity was observed. Neither ciprofloxacin nor ofloxacin caused any change in CYP1A1 or CYP1A2 apoprotein levels. Further investigations with antipeptide antibodies showed that there was no induction of CYP2B1, CYP2B2, CYP2E1, CYP3A1, CYP3A2, CYP4A1, or CYP4A2 following treatment with enoxacin, ciprofloxacin, or ofloxacin. It is concluded that enoxacin, but not ciprofloxacin or ofloxacin, is an inducer of CYP1A2 in rat liver.

Results of in vivo and in vitro studies for assessing prenatal toxicity.

Examples of a combined approach using in vivo as well as in vitro methods for the assessment of prenatal toxicity are presented. The topics discussed include the analysis of the possible embryotoxic potential of valproic acid (VPA), female sex hormones, bis(tri-n-butyltin) oxide (TBTO), and acyclovir and the problem of supplementing in vitro systems with drug-metabolizing activity.

High-dose chemotherapy with autologous stem cell rescue in children with retinoblastoma.

Children with metastatic retinoblastoma are considered to have a poor prognosis after conventional chemotherapy. We used high-dose chemotherapy (HDC) with peripheral hematopoietic stem cell transplantation in such patients in an attempt to improve their survival. Four patients with bone marrow metastases and one child with extraorbital disease were treated with HDC after achieving complete remission by enucleation and conventional chemotherapy. The child with extraorbital tumor was the only one to receive local irradiation. The conditioning regimen included thiotepa (900 mg/m(2)), etoposide (40 mg/kg) and carboplatin (1.5 g/m(2)) in four patients, and BCNU (300 mg/m(2)), cyclophosphamide (6.8 g/m(2)) and etoposide (1.6 g/m(2)) in one child. Hematologic recovery occurred without delay in all patients. The main toxicities were diarrhea, mucositis and infectious complications. No toxic deaths or any major late toxicities were observed. The child treated with the BCNU regimen developed a meningeal relapse 10 months after HDC, which was partially resected and treated with conventional chemotherapy, but not with radiotherapy. He is in complete remission (CR) 105 months off treatment. The other patients are in CCR for 107, 57, 9 and 8 months after HDC. HDC with thiotepa, etoposide and carboplatin may represent a curative option for children with extrabulbar or disseminated retinoblastoma responsive to chemotherapy. It may control occult CNS disease. The necessity to irradiate these children and the curative potential of this strategy for patients with bulky CNS disease remain to be determined.

Morphological and histochemical pattern of response in rat testes after administration of 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD).

Testes of rats, which had been injected with a single dose of 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) (0.3 micrograms/kg-25 micrograms/kg body weight [BW]), were studied after 7 days using morphological and histochemical means. Light and electron microscopic examination revealed that TCDD affected testicular morphology in a dose-dependent manner. TCDD led to decreased intercellular contact, indicated by wide intercellular spaces between Sertoli cells between and Sertoli cells and neighbouring germ cells. Morphological alaterations in rat testes after TCDD administration included the sloughing off of premature spermatids into the tubular lumen and numerical increase of necrotic germ cells, in particular pachytene spermatocytes. Compared with control animals, Sertoli cells of treated rats exhibited an increased amount of lipid droplets and phagolysosomes. Vacuolization of the cytoplasm and fragmentation of the Sertoli cells occurred frequently. Examination of the different spermatogenic stages revealed that no stage was specifically susceptible to TCDD. In Leydig cells a decrease in enzyme activity of 3 beta- and 17 beta-hydroxysteroid dehydrogenases became evident by histochemical investigation. This effect on steroidogenesis was already found at a dose of 1 microgram/kg BW TCDD, whereas morphological effects were seen in the germinal epithelium for the first time at 3 micrograms/kg BW.

Effects of small doses of dioxins on the immune system of marmosets and rats.

There is no doubt that TCDD is capable of inducing effects on a variety of components and functions of the immune system in a variety of species. In fact, such changes seem to belong to the most sensitive variables affected by TCDD. Some of the biological effects, induced at rather high doses of TCDD exhibiting general toxicity (> 3 micrograms TCDD/kg body wt), may be considered unspecific or the result of the pronounced thymus involution. However, other effects (such as that on lymphocyte subtype patterns in marmosets or a reduced resistance of mice to influenza viruses) have been reported to occur at dose levels far from those leading to thymic involution or general toxicity. It should be remembered that the pathognomonic relevance for man of subtle modifications in the pattern of lymphocyte surface receptors is largely unknown. Until now, such deviations are considered rather as biological phenomena than indications or causes of specific diseases. Nevertheless, such changes represent clear-cut biological effects induced by TCDD. Since effects of TCDD on components and defined functions of the immune system have been revealed in several species, it would be surprising if humans were largely resistant to such effects, but reliable data in humans with high exposures to defined dioxins verified by an appropriate quantification of the exposure are scarce as of now. Data published so far have not revealed pronounced alterations of such variables. However, no studies of well-defined human populations with quantified body burdens have been performed with modern methods (such as flow cytometry) analyzing a wide variety of surface receptors. Performance of such studies is essential for a better and reliable risk assessment, and the technology is available. Some of the effects observed (such as the changes in the pattern of lymphocyte subpopulations) must certainly be considered as biological effects induced by TCDD, and the situation is similar to the induction of hepatic monooxygenases, which are also observable in this dose range. However, the relevance of such changes with respect to adverse health effects in humans is presently difficult to judge in the absence of clear-cut functional deficits demonstrated so far either in vivo or in vitro.

Multicenter field trial on possible health effects of toluene. I. Toluene body burdens in workers of the rotogravure industry.

Ambient air toluene concentrations as well as corresponding individual blood toluene levels were measured under conditions of a field trial, as basis for a correlation with possible acute effects. While the results of various psycho-physiological and medical evaluations after acute (Neubert et al., 2001) and long-term toluene exposure (Gericke et al., 2001) are published in accompanying papers, this publication deals with the exposure levels and body burdens characteristic of workers in the rotogravure industry in Germany at the time of the investigation (1993-1995). Besides providing some information on the exposure at various work-areas under occupational conditions, the correlation between a time-weighted average of the ambient air concentration with the corresponding blood toluene levels is analyzed. Limitations of such an attempt and possible pitfalls are discussed. In the largest field study so far performed on toluene exposure, 12 companies of the German rotogravure industry (and a total of 1528 volunteers) participated. Altogether, complete data sets, i.e. on both ambient air as well as blood toluene levels, were obtained from 1244 male and 124 female participants of the rotogravure industry with quite different degrees of toluene exposure. Rotogravure printers and their helpers were exposed to the highest toluene concentrations in ambient air. On the day of the evaluation, of 806 male volunteers within this group (of 1261 with verified exposure in air), 35 were exposed to a time-weighted average of 100 ppm (i.e. 375 mg/m(3)) or above, and 155 of the printers to concentrations between 50 and 100 ppm. Of the remaining 455 male participants of the rotogravure factories ('non-printers and helpers'), only three were exposed to toluene concentrations above 50 ppm. Only one of the 124 women working in the rotogravure factories was exposed to an average toluene concentrations above 100 mg/m(3) (i.e. 27 ppm). In 66 of the male volunteers toluene levels in blood of >850 microg/l were measured and 14 showed levels exceeding 1700 microg/l. When attempting to predict the resulting individual blood toluene levels from measurements of ambient air concentrations under field conditions, a considerable uncertainty is to be expected. We found a correlation coefficient of the regression curve of about 0.70, with numerous outliers (and a variation of the 12 factories between 0.52 and 0.88).

Multicenter field trial on possible health effects of toluene. III. Evaluation of effects after long-term exposure.

In rotogravure industry, contributing considerably to mass color printing of catalogues and magazines, toluene is still extensively used as paint solvent, and many printers have been exposed to this chemical for several decades. Information on adverse health effects associated with long-term toluene exposure is still controversial. In a multi-center study, adverse health effects possibly associated with long-term toluene exposure were evaluated. In 12 rotogravure factories, 1226 male volunteers were recruited, and sufficient information on exposure and on medical data was compiled for about 1077 of them. Evaluations included: physical examination, standard tests of psycho-physiological and psycho-motoric performances, self-report of subjective symptoms, and data on a variety of laboratory blood tests. The medical data were correlated with the length (months) of toluene exposure, and a rough estimate of the extent of exposure (i.e. highly exposed printers and their helpers versus employees working at locations with low or negligible toluene exposure). A small reference group (n=109) was selected from companies of the paper industry. When linear regression curves were calculated (test results versus duration of exposure), extremely low overall coefficients of determination (r(2) adj.) of a few percent were estimated within the data clouds, with sometimes statistically significant P-values. Closer analyses revealed a strong influence of the confounding factor age, no clustering of abnormal values of highly toluene-exposed volunteers, and the vast majority or all values of the highly and long-term toluene-exposed participants staying within the reference ranges. Thus, no medical relevance of P-values <0.05 could be recognized in this evaluation, and there may have been some border-line deviations or results largely occurring by chance in the large trial. In a small cluster of the many rotogravure printers toluene-exposed for more than 20 years, the highest systolic blood pressure values of the study were found, but many possible confounding factors were not taken into account. Data on acute exposure and possible effects are presented in accompanying papers (Neubert et al., 2001a, Neubert et al., 2001b). Restricting the conclusions to the end points evaluated as well as the apparent limitations of the evaluation, no evidence was found that long-term occupational toluene exposure extending over several decades in the rotogravure industry in the Western part of Germany was convincingly associated with chronic adverse health effects or convincingly altered surrogate markers in still working male volunteers. Several peculiarities and pitfalls arising when interpreting medical data associated with such a type of environmental exposure must be considered. Reversibility of alterations previously induced at higher levels of toluene-exposure, as well as a healthy workers effect, cannot be excluded for some of the medical end points evaluated.

Multicenter field trial on possible health effects of toluene. II. Cross-sectional evaluation of acute low-level exposure.

Data on possible acute effects of today's relevant low-level exposure to toluene are contradictory, and information on possible effects of exposure under occupational conditions is largely lacking. In a controlled, multi-center, blinded field trial, effects possibly associated with acute toluene exposure were evaluated in workers of 12 German rotogravure factories. Medical examinations (inquiries on subjective symptoms, and standard tests of psycho-physiological and psycho-motor functions) were performed on almost 1500 volunteers, of whom 1290 were toluene-exposed (1178 men and 112 women), and about 200 participants served as references (157 men and 37 women), but the main aim of the trial was to reveal dose-response relationships. All volunteers were of the morning work-shift (6 h exposure). Both individual ambient air concentrations (time-weighted average) during the work-shift, as well as blood toluene concentrations after the work-shift were measured. Therefore, the medical data could for the first time be correlated with the actual individual body burden (blood toluene level) at the time of testing. In order to largely exclude confounding by chronic toluene exposure, kinetic measurements as well as the psycho-physiological and psycho-motoric tests were performed before and after the work-shift. Except for minor statistical deviations, neither convincing dose-dependent acute effects could be demonstrated with regression analyses in male volunteers at the exposure levels evaluated, nor were significant differences found when applying group statistics (highly toluene-exposed group versus volunteers with negligible exposure). Due to the rather large number of participants, the predictive power of the study is high, especially when compared with previous publications. In two psycho-physiological tests, a few more female volunteers with quite low toluene body burdens (<340 microg/l blood) showed relatively low scores when compared with participants of the reference group. Although evidence for a medical relevance is meager, the small numbers of participants, in both the exposure and the reference groups, hamper a reliable interpretation of the results concerning exposure levels above 85 microg toluene/l blood, and it is difficult to take confounding factors adequately into account. For the end points evaluated and under occupational conditions, neither blood toluene levels of 850 to 1700 microg/l (in the highest exposure group [EXPO-IV] with 56 participants), as measured 1/2 (+/-1/2) h after the work-shift, nor ambient air concentrations (time-weighted average over 6 h) between 50 and 100 ppm (188-375 mg/m(3)) were convincingly associated with alterations in psycho-physiological and psycho-motoric performances or increased the frequency of subjective complaints in male volunteers. For higher dose ranges of toluene exposure (i.e. >1700 microg toluene/l blood [or >100 ppm in ambient air]), our data set is too small for far reaching conclusions. Our data are insufficient for conclusions on a possibly higher susceptibility to toluene of some female workers. Results of kinetic studies and possible effects of long-term exposure are discussed in two accompanying publications (Neubert et al., 2001; Gericke et al., 2001).