Acute health effects among firefighters exposed to a polyvinyl chloride (PVC) fire.

Firefighters are frequently being called on to fight fires that are chemical in nature. In the aftermath of a chemical fire in Plainfield, New Jersey on March 20-21, 1985, the authors conducted a retrospective cohort study which surveyed 80 firefighters exposed to burning polyvinyl chloride (PVC) as well as 15 nonexposed firefighter subjects. By means of an 81-item symptom checklist, exposed firefighters reported more frequent and severe symptoms at 5-6 weeks post incident. This was true for a total symptomatology score as well as 19 individual items. Some of the items with an elevated risk were consistent with exposure to hydrogen chloride, the main pyrolysis product of polyvinyl chloride. Other items with an elevated risk appeared to be related to smoke inhalation while others seemed psychosocial in nature. Analyses conducted within the exposed firefighter group showed that fighting the fire the first day, being a truckman, and residence within 1 mile (1.6 km) of the firehouse were significant risk factors for high total symptom scores. These risk factors may have been associated with level or duration of exposure to the toxic substances produced during the fire.

Long-term psychological distress among chemically exposed firefighters.

Long-term psychological effects of exposure to a dangerous chemical were evaluated in a sample of firefighters who fought a large polyvinyl chloride (PVC) fire. When compared with nonexposed firefighter controls (n = 22), the exposed firefighters (n = 64) had significantly higher levels of demoralization and specific emotional distress 22 months after the incident. Longitudinal analyses of a subsample of exposed firefighter subjects (n = 55) surveyed 5 to 6 weeks after the fire and again 22 months later revealed that there was no reduction in symptomatology over time. Some psychological distress scores actually rose significantly between time points. Distress scores were also significantly correlated between time points. These results have a number of intervention and public health implications.

Psychological response of firefighters to a chemical fire.

Samples of firefighter subjects (n = 80) and a comparison group (n = 15) were contrasted on a number of postincident psychological distress measures in the aftermath of a polyvinyl chloride (PVC) fire. Using a structured, self-administered questionnaire, firefighter subjects were found to be more psychologically distressed on demoralization, specific emotional distress, and perceived threat to physical health. After controlling for baseline characteristics on which subjects and the comparison group differed, these between-group effects remained significant. The three outcome scales, while correlated, measure different components of psychological distress.

Across-shift changes in the pulmonary function of meat-wrappers and other workers in the retail food industry.

Pulmonary function was measured before, during, and after the end of the workshift in 83 workers in the retail food industry. All acute changes in forced expiratory volume in 1 s were standardized for lung size before the magnitude of the changes were compared between the workers exposed and unexposed to the use of hot wires for cutting plastic film. No association was found between acute drop in pulmonary function and either direct or indirect exposure in the absence of a history of asthma or allergy to inhaled materials. The borderline significance of an interaction term between exposure and asthma/allergy in a regression analysis suggests that workers with a history of asthma or atopy may have an acute response to hot-wire wrapping emissions.

Occupational hazards in the VC-PVC industry.

Overall, the results of the analysis of 12 studies of VC production and polymerization workers demonstrate an enormously elevated risk of liver malignancies, the possibility of a twofold increased risk of brain and central nervous system tumors and perhaps, also, of malignancies of the lymphatic and hematopoietic system. However, the role of other agents cannot be excluded in the etiology of nonhepatic malignancies. Bronchogenic carcinoma does not appear to be increased from exposures to VC monomer, although a relationship to PVC dust was suggested in one study. These conclusions must be considered in light of limited data on workers followed more than 25 years from onset of exposure. Considering the numbers of observed and expected deaths in all studies, it would appear that the excess of malignancies at nonhepatic sites is less than the excess of liver tumors. Data presented elsewhere in this volume (Nicholson and Henneberger, 1983) suggest that exposure reductions in 1974 may have virtually eliminated the VC-associated risk of liver cancer if the current U.S. standard is met. To the extent that VC exposure is associated with other cancers, a similar risk reduction would be expected. Raynaud's phenomenon, acroosteolysis, scleroderma-like skin lesions, hepato- and splenomegaly with noncirrhotic hepatic fibrosis, and severe portal hypertension have been associated with past heavy exposures to VC. Evidence exists that the liver disease and portal hypertension may progress following cessation of exposure. However, all of the above syndromes were found largely in heavily exposed individuals. Their occurrence would be much less likely in workers exposed only to concentrations currently allowed. Pulmonary deficits, X-ray abnormalities, and, perhaps, lung cancer have been associated with VC/PVC exposure. Because of the possible contribution of PVC dust to these findings, engineering controls during polymer drying, bagging and usage are warranted.

[Use of functional telethermography in the diagnosis of some occupational diseases (due to vibrating tools; carbon disulfide; polyvinyl chloride]. / Sull'impiego della teletermografia funzionale nella diagnosi precoce di alcune tecnopatie (da strumenti vibranti; da solfuro di carbonia; da cloruro di vinile).

The AA. have considered occupational technopathies due to vibrating tools, carbon disulphide and polyvinyl chloride. The functional or organic involvement in the peripheric vascular system, attributable to the disease, has been evaluated by thermographic examinations, carried out in 35 patients, in basal conditions and, when possible, after cold-test. The results have demonstrated that functional thermography may be a reliable tool both in the early diagnosis and in the prognosis of occupational vascular diseases, especially when it can replace more traumatic methods (such as angiography) in the periodic controls: in fact, it can be sufficient to carry out a simple thermoscopy and to compare the result with the previous photo-thermogram.

Squamous cell carcinoma of the buccal mucosa associated with chronic oral polyvinyl chloride exposure: report of a case.

The following case report describes a 22-year-old healthy man, non-smoker, non-drinker, who developed a squamous cell carcinoma of the buccal mucosa. The appearance of this unusual tumor in an unexpected clinical setting was unexplained until it was discovered that the patient had a lifetime habit of chewing plastic materials containing polyvinyl chloride (PVC). The extent and chronicity of his intense oral exposure to PVC is believed to be related to his subsequent development of an oral neoplasm. Attention is again focused on PVC as an important environmental toxin and carcinogenic agent. Clarification of the content of PVC in consumer products is urged. Physicians must remain aware of possible environmental carcinogens in patients presenting with unexpected or rare malignancies. Detection of such exposure may well prevent subsequent development of additional unexplained neoplasms.

Low mortality rates in industrial cohort studies due to selection for work and survival in the industry.

Occupational groups are often described as being relatively healthy because their mortality rates are lower than those of the national average. Although correct this confuses the issue for those who are interested in assessing the effects of exposure to a particular chemical. In a further analysis of data collected in a study of all men ever exposed to vinyl chloride monomer in the manufacture of polyvinyl chloride in Great Britain, three factors have been shown to contribute to the low mortality rates that were observed. The three factors: the selection of a healthy population for employment, the survival in the industry of the healthier men, and the length of time that this population has been pursued, have been quantified. The mortality experience within five years of entering this industry was shown to be as low as 37% of that expected; for circulatory disease and respiratory disease it was as low as 21%. There was a progressive increase in standardized mortality ratio with the length of time since entry so that the effect had almost disappeared 15 years after entry. To avoid confounding the selection effect with the survival effect the latter was measured by separating men who survived 15 years after entering the industry according to whether or not they were still in the industry after this period. Those who had left experienced an overall standardized mortality ratio some 50% higher than those still in the industry. This effect, although consistent in the age groups between 25 and 74 years and for all cause groups studied, was greatest in those aged between 25 and 44 years and for lung cancer and respiratory disease.

Special communication. Polyvinyl chloride - vinyl chloride disease: an occupational health hazard.

Poly Vinly Chloride (PVC) is a very durable, practical and economical plastic, which is so wide spread in its use that it may become difficult to replace it. The annual amount of world production has been constantly increasing and has reached the figure of 8.5m tons. While PVC is so useful, the health hazards which accompany this plastic are causing alarm in the industrially developed countries. The hazards are severe and include defects such as Haemangioendothelial sarcoma (Angiosarcoma) of the liver, Acro-Osteolysis of the fingers and Sclerodermic type skin lesions. This paper illustrates the recent developments, the clinical findings and the measures necessary to control the disease. Moreover, this paper should help alerting the health authorities in the developing countries about the health hazards involved in the manufacture and utilization of PVC. Due to the restrictions imposed on PVC producing plants, there is a real eventuality that these plants may be transferred to the developing countries, where this disease is still unknown.

[Sequential scintigraphy of liver and spleen in patients with polyvinyl chloride disease (author's transl)]. / Sequenzszintigraphische Untersuchungen von Leber und Milz bei Patienten mit Vinychlorid-Krankheit

Occurence of severe liver damage including angiosarcoma in polyvinyl chloride production workers necessitates regular control investigations of liver and spleen. Radioisotope techniques with small irradiation doses which give valid results should be used. Investigations of 15 patients with PVC-induced liver disease showed that hepatic perfusion as demonstrated by 99mTc pertechnate does not correlate with the uptake of sulphide colloid in the hepatic reticuloendothelial system. This provides evidence that in VC disease specific damage of the reticuloendothelial system of the liver occurs. Sequential scintigraphy also proved that the liver perfusion quotient can be considered as a measure of portal pressure. In practice this may be used for follow-up controls. Vascularized tumours described in VC disease can also be demonstrated by scintigraphy.

Liver disease among polyvinyl chloride production workers.

A protocol for systematic testing of all employees of a chemical plant is presented. This factory manufactures polyvinyl chloride compounds and resins, ABS compounds and resins, and synthetic rubber. The results were reviewed, which led to the discovery of 2 additional cases of angiosarcoma and 11 cases of portal fibrosis. Two of the 11 cases were found to have developed in employees other than polyvinyl chloride production workers.