2,4,6-Trinitrotoluene (TNT) air concentrations, hemoglobin changes, and anemia cases in respirator protected TNT munitions demilitarization workers.

PURPOSE: 2,4,6-Trinitrotoluene (TNT) is an explosive used in munitions production that is known to cause both aplastic and hemolytic anemia in exposed workers. Anemia in a TNT worker is considered a sentinel health event (occupational) (SHE(O)) in the United States (US). Deaths have been reported secondary to aplastic anemia. Studies have shown that TNT systemic absorption is significant by both the respiratory and dermal routes. No studies encountered looked at hemoglobin change or anemia cases in respiratory protected workers. It is hypothesized that respiratory protection is insufficient to protect TNT workers from the risk of anemia development and hemoglobin concentration drop. METHODS: A records review of eight groups of respiratory protected TNT workers' pre-exposure hemoglobin levels were compared with their during-exposure hemoglobin levels for statistically significant (alpha level 0.05) hemoglobin level changes, and anemia cases were recorded. A curve estimation analysis was performed between mean TNT air concentrations and mean hemoglobin change values. RESULTS: Statistically significant hemoglobin level drops and anemia cases were apparent at TNT air concentrations about the REL and PEL in respiratory protected workers. There were no anemia cases or statistically significant hemoglobin level drops at concentrations about the TLV, however. A statistically significant inverse non-linear regression model was found to be the best fit for regressing hemoglobin change on TNT air concentration. CONCLUSIONS: Respiratory protection may be inadequate to prevent workers who are at risk for TNT skin absorption from developing anemia. This study contributes evidence that the TLV should be considered for adoption as the new PEL.

Analytical monitoring of trinitrotoluene metabolites in urine by GC-MS. Part I. Semiquantitative determination of 4-amino-2,6-dinitrotoluene in human urine.

A routine procedure for the monitoring of occupational exposure to 2,4,6-trinitrotoluene (TNT) based on the semiquantitative determination of 4-amino-2,6-dinitrotoluene (4A2,6-DNT) in urine samples by gas chromatography (GC-MS) was developed. For calibration purposes, a standard sample of 4-amino-4,6-dinitrotoluene was prepared. Urine samples were collected from munition workers in a military plant in Hradec Kralove district. The samples were extracted into ethyl acetate, and analyzed by GC-MS without previous derivatization. The GC was equipped with a DB1701 column (30 m, 0.25 mm, 0.25 microm) for optimum separation. 4A2,6-DNT was detected at concentrations above the limit of quantitation (0.2 mg/L). This simple method is sufficient for the screening of high degree of TNT exposure and constitutes the first step of a broad project focused on this occupational medicine problem.

Exposure to armament wastes and leukemia: a case-control study within a cluster of AML and CML in Germany.

An unusually high incidence of acute myeloid leukemia (AML) and chronic myeloid leukemia (CML) concentrated in a specific locality of a region in Germany motivated a descriptive incidence study in that region which showed a near 10-fold increased risk of CML among males but not among females (Kolb G, Becker N, Scheller S, Zugmaier G, Pralle H, Wahrendorf J, Havemann K. Increased risk of acute myelogenous leukemia (AML) and chronic myelogenous leukemia (CML) in a County of Hesse, Germany, Soc Prev Med 1993;38:190-195). Since a serious environmental contamination of areas in this locality with armament wastes containing toluene-derivatives has been known for a long time, the hypothesis arose that TNT production and the related severe contamination of soil and water might be responsible for the observed higher risk. We carried out a case-control study within the cluster to test this hypothesis. Overall, the results do not confirm the hypothesis. There is an indication of a relationship of an increased odds ratio with the exposure for a small group of persons who lived at a particular site in one of the two communities involved during the peak phase of TNT production during the 1940s. However, this finding is spurious and cannot explain the large majority of cases which occurred in that area in the 1980s. At the moment, no other explanation can be given for the increased risk of leukemias in that area.

Lens opacifications detected by slitlamp biomicroscopy are associated with exposure to organic nitrate explosives.

CONTEXT: Unusual cataracts (flecks) have been reported to occur at very low levels of trinitrotoluene exposure, but prevalence estimates vary widely. Cataracts have not been reported among workers in the United States exposed to organic nitrate explosives. OBJECTIVES: To determine the prevalence of unusual cataracts in a population of workers in the United States exposed to organic nitrate explosives, to determine whether associations exist with reported cataract risk factors, and to determine if other eye effects (eg, retinal hemorrhage) are associated with exposure. DESIGN: Cohort prevalence study. SETTING: A university-based ophthalmologic clinic. SUBJECTS: Sixty-one workers from an explosives plant comprised the exposed group. The comparison group consisted of 56 workers using chemicals other than organic nitrate explosives. OUTCOME MEASURES: The primary outcome measure was opacifications (flecks) of the crystalline lens, graded clinically on a scale of 0 to 4 +. Additional measures included visual acuity, applanation tonometry, and clinical evaluation using standard examination techniques. RESULTS: Sixty-three percent of the workers had anterior cortical lens opacifications in a pattern of peripheral flecks. Exposed subjects were 18 times more likely to exhibit changes than those not exposed, a statistically significant association (95% confidence interval [CI], 5.0-65.0; P<.001). A statistically significant association with the duration of exposure was also found. CONCLUSIONS: Asymptomatic, low-grade cataracts (flecks) were identified in 63% of the workers exposed to pentolite. No other eye effects were found to be associated with exposure. Cataracts were not associated with other known risk factors, but were associated with the duration of exposure. Biomicroscopy is widely available and useful for detecting changes in the asymptomatic stages.

Early equatorial cataracts in workers exposed to trinitrotoluene.

Twelve workers (nine men and three women with a mean age of 39.5 +/- 8.9 years) with occupational exposure to trinitrotoluene had a mean duration of exposure of 6.8 +/- 4.7 years. The general physical findings were minimal, but ophthalmologic examinations showed bilateral peripheral cataracts in six of the 12 workers. Cataracts were visible only with maximal mydriasis and were continuous or annular opacities at the equator. The cataracts did not interfere with visual acuity or visual fields. Only one worker with and one without cataracts had increased serum alanine aminotransferase and bilirubin levels, possibly associated with trinitrotoluene exposure.

Effects of exposure to trinitrotoluene on male reproduction.

A cross-sectional study was performed in 2 plants located in Henan Province in 1990 for observing the reproductive and sexual functions of male workers exposed to trinitrotoluene (TNT). The TNT concentrations in the workplace air, except the packing site, were found to have exceeded MAC (1 mg/m3). TNT exposed male workers complained of more sexual disorders such as impotence, the loss of libido and sexual hypoesthesia than the control group. Compared with the control group, the volume of semen and percentage of motile spermatozoa were found to have significantly decreased, and the sperm malformation incidence increased significantly in TNT exposed workers. The serum testosterone content in TNT exposed male workers was significantly decreased too.

Persistent ethanol drinking increases liver injury induced by trinitrotoluene exposure: an in-plant case-control study.

On the basis of a general survey conducted in a munitions plant, a case-control study was made on the various risk factors of liver damage induced by trinitrotoluene (TNT) exposure in the plant. One-hundred male cases with occupational TNT liver damage were paired with 100 male controls, one-by-one, for occupation, age and duration (years) of employment. A total of 55 possible risk factors were statistically analysed with a single factor analysis. On the basis of the single analysis, nine factors including drinking, smoking and education were further analysed with a conditional logistic regression model. A calculation was made on the odds ratio (OR) of each factor selected into the model. According to the estimated parameter of the established logistic model, the relative risk of the risk factors could be worked out. Finally, two factors, the amount of ethanol drunk on each occasion and the frequency of drinking every week were selected into the model at the level of a = 0.05. The result showed that these two factors have a dose-response relationship with their OR of occupational TNT liver damage, but there is no connection between smoking and occupational TNT liver damage and no interaction between drinking and smoking. The above results have revealed that people exposed to TNT and with a long history of heavy drinking, have a greater risk of suffering from chronic liver impairment than those that do not drink.

Biological remediation of explosives and related nitroaromatic compounds.

Nitroaromatics form an important group of recalcitrant xenobiotics. Only few aromatic compounds, bearing one nitro group as a substituent of the aromatic ring, are produced as secondary metabolites by microorganisms. The majority of nitroaromatic compounds in the biosphere are industrial chemicals such as explosives, dyes, polyurethane foams, herbicides, insecticides and solvents. These compounds are generally recalcitrant to biological treatment and remain in the biosphere, where they constitute a source of pollution due to both toxic and mutagenic effects on humans, fish, algae and microorganisms. However, relatively few microorganisms have been described as being able to use nitroaromatic compounds as nitrogen and/or carbon and energy source. The best-known nitroaromatic compound is the explosive TNT (2,4,6-trinitrotoluene). This article reviews the bioremediation strategies for TNT-contaminated soil and water. It comes to the following conclusion: The optimal remediation strategy for nitroaromatic compounds depends on many site-specific factors. Composting and the use of reactor systems lend themselves to treating soils contaminated with high levels of explosives (e.g. at former ammunition production facilities, where areas with a high contamination level are common). Compared to composting systems, bioreactors have the major advantage of a short treatment time, but the disadvantage of being more labour intensive and more expensive. Studies indicate that biological treatment systems, which are based on the activity of the fungus Phanerochaete chrysosporium or on Pseudomonas sp. ST53, might be used as effective methods for the remediation of highly contaminated soil and water. Phytoremediation, although not widely used now, has the potential to become an important strategy for the remediation of soil and water contaminated with explosives. It is best suited where contaminant levels are low (e.g. at military sites where pollution is rather diffuse) and where larger contaminated surfaces or volumes have to be treated. In addition, phytoremediation can be used as a polishing method after other remediation treatments, such as composting or bioslurry, have taken place. This in-situ treatment method has the advantage of lower treatment costs, but has the disadvantage of a considerable longer treatment time. In order to improve the cost-efficiency, phytoremediation of nitroaromatics (and other organic xenobiotics) could be combined with bio-energy production. This requires, however, detailed knowledge on the fate of the contaminants in the plants as well as the development of efficient treatment methods for the contaminated biomass that minimise the spreading of the contaminants into the environment during post harvest treatment.

[Effects of exposure to TNT on sex hormones in male workers].

Field investigation on labour hygiene in two plants producing trinitrotoluene (TNT) in Henan Province showed most air TNT levels in the workplace exceeded national maximum allowable concentration (MAC 1 mg/m3) and the skin of the workers exposed to TNT was severely contaminated. Determinations of serum levels of sex hormones showed those of testosterone were lower, but those of interstitial cell-stimulating hormone (ICSH or LH) and follicle stimulating hormone (FSH) were higher in workers exposed to TNT than that in controls with statistical significance (P < 0.01).

Military explosives and health: organic energetic compound syndrome?

Military explosives, which are Organic Energetic Compounds (OECs), might be initiating factors in clusters of warfare related illnesses. Substances such as HMX, RDX and TNT are neurotoxic and are possible human carcinogens. Not all the explosive material is consumed in an explosion so that the use of explosives generates harmful dust. In many clusters of illnesses a link can be defined with explosives. In researching for the cause of the illnesses several possibilities are mentioned, but explosives are rarely mentioned. This article considers the possible role of OECs, with the intention of encouraging studies to make the role of explosives clear: no cause, a link with insufficient evidence or the cause of many illnesses.

[Complex evaluation of health in patients with occupational eye pathology]. / Kompleksnaia otsenka zdorov'ia bol'nykh s professional'noi patologiei organa zreniia.

The article deals with data on epidemiology of occupational eye diseases in underground shotfirers. The author suggests method for complex evaluation of their health state.

[Occupational disease among miners of the Kursk Magnetic Anomaly (from the experience of the work of the Institute of Industrial Hygiene and Occupational Diseases in Heavy Metallurgy)]. / Professional'naia zabolevaemost' sredi rabochikh gornorudnykh predpriiatii Kurskoi magnitnoi anomalii (Iz opyta raboty instituta--kuratora po problemam gigieny truda i professional'nykh zabolevanii v chernoi metallurgii.

The materials are first to present analysis of occupational morbidity among miners of variable age, length of service, various occupations, who work at Kursk Magnetic Anomaly. The recommendations on lower occupational morbidity are presented.

[The impact of trinitrotoluene on eyes in miners]. / Vozdeistvie trinitrotoluola na glaza shakhterov.

Trinitrotoluene (TNT) effect on the eyes of 250 miners was studied. The length of service of the investigated group varied from one to twenty years. The specific trinitrotoluene cataract of various stages was observed in 54.7% of the examinees. The authors assume that the lens changes depend on the length of service and on the TNT concentrations in the body after predominant skin penetration.

Investigation of an outbreak of anemia cases at an Army trinitrotoluene munitions production plant from 2004 to 2005 and subsequent surveillance 2005-2013.

OBJECTIVE: Investigate an outbreak of anemia that occurred at an Army trinitrotoluene (TNT) munitions production facility in 2004-2005 and describe subsequent medical surveillance efforts between 2005 and 2013. METHODS: A retrospective, cross-sectional investigation of anemia cases and exposure levels was conducted to target corrective engineering and administrative changes needed to reduce TNT levels and anemia cases. RESULTS: Mean TNT exposure levels decreased from 1.2 to 0.08 mg/m(3) between 2004 and 2012, but the trend was not statistically significant. Anemia cases rose from 17 to 38 between 2004 and 2011 and cases declined from 4 to 0 between 2012 and 2013. The overall trend in cases was not statistically significant. CONCLUSIONS: TNT levels rose at a munitions plant until ventilation changes reduced exposures. Despite this, anemia cases continued to rise until the commander held workers accountable for failing to wear PPE and motivated them to wear respirators to avoid a loss in pay. The case definition of anemia was revised to be consistent with the case definition used by private physicians who practiced in the community. Better coveralls are needed, which are easy to wear, reduce static discharge, and prevent TNT skin absorption.

Biomonitoring of workers cleaning up ammunition waste sites.

2,4,6-Trinitrotoluene (TNT) is an important occupational and environmental pollutant. In TNT-exposed humans, notable toxic manifestations have included aplastic anaemia, toxic hepatitis, cataracts, hepatomegaly and liver cancer. Therefore, it is important to develop protection measures and to monitor workers involved in the clean-up of ammunition sites. Haemoglobin (Hb) adducts of TNT, 4-amino-2,6-dinitrotoluene (4ADNT) and 2-amino-4,6-dinitrotoluene (2ADNT), and the urine metabolites of TNT, 4ADNT and 2ADNT were found in 22-50% of the exposed workers, but not in the control group. The exposed workers were wearing protective equipment. The levels of erythrocytes, haemoglobin, creatinine, serum glutamic pyruvic transaminase and lymphocyte levels were significantly lower in the exposed workers than in the non-exposed workers. The levels of blood urea and reticulocytes were significantly higher in the exposed workers than in the non-exposed workers. Headache (26%), mucous membrane irritation (16%), sick leave (18%), lassitude (8%), anxiety (6%), shortness of breath (3%), nausea (5%) and allergic reactions (8%) were reported by the exposed workers. In a further analysis the U-4ADNT levels and the Hb-adduct levels were compared to the blood parameter and the health effects. The blood parameters were not significantly different between the U-4ADNT positive and U-4ADNT-negative group. Headache, mucous membrane irritation, sick leave, lassitude, anxiety, shortness of breath and allergic reactions were statistically not different between the two groups. Also in the workers with Hb-4ADNT adducts no significant negative changes were seen in regards to the changes of the blood parameters or the health effects. According to the results of the present study, it appears that the blood parameter changes and the health effects are more influenced by other factors than by the internal exposure to TNT.

Trinitrotoluene (TNT)-induced cataract in Danish arms factory workers.

PURPOSE: To compare the prevalence of cataract in workers exposed to trinitrotoluene (TNT) to the prevalence in a group of unexposed workers, matched on age and sex, using Tiukina's description and grading of TNT-induced cataract. METHODS: A total of 23 TNT-exposed and 44 unexposed workers underwent an eye examination performed by an ophthalmologist who did not know the exposure status of the subjects. All lens opacities matching Tiukina's description were classified as TNT cataract and graded on Tiukina's scale of stages 1-4. RESULTS: Four cases of TNT-induced cataract were identified among the 23 TNT-exposed workers and none in the unexposed group (p < 0.01). CONCLUSION: Exposure to TNT may cause a unique type of cataract, which a general ophthalmologist, using Tiukina's description and grading scale, will be able to distinguish from other cataracts.

[Skin lesions in miners in contact with trinitrotoluene]. / Porazheniia kozhi u gornorabochikh, kontaktiruiushchikh s trinitrotoluolom.

A study is presented of morbidity with temporary loss of working capacity in mine workers of ore-mining enterprises contacting with trinitrotoluol. Three-year data were analyzed according to an international statistical classification (average 100 workers annually). The frequency of lesions of the skin and subcutaneous fat was higher in workers contacting with trinitrotoluol. Prophylactic measures are recommended.