Charles E. Ross

Synthetic pyrethroid insecticides: a dermatological evaluation.

Synthetic pyrethroids are lipophilic insecticides whose biological activity seems to be directly related to their chemical structure. In this investigation differences in cutaneous sensation were detected by human participants between synthetic pyrethroids with a cyano group in the (S)-configuration of the 3-phenoxybenzyl alcohol of their molecular structure (fenvalerate) and those that do not (permethrin). A strong relation was noted between insecticidal potency and degree of induced cutaneous sensation for the alpha-cyano and non-cyano pyrethroids, with a prominent difference between the two. No sensation was observed by any of the same participants on topical exposure to the inert ingredients of these agents. A linear correlation between concentration and degree of induced dysaethesia was observed for both pyrethroids. Regressing the cutaneous sensation on the common logarithm of concentration resulted in a regression equation of Y = 84.0 + 31.0X1 for fenvalerate and Y = 27.5 + 15.8X1 for permethrin. A highly efficacious therapeutic agent for pyrethroid exposure was noted to be dl-alpha tocopherol acetate. An impressive degree of inhibition of paraesthesia resulted from the topical application of vitamin E acetate, with a therapeutic index of almost 100%.

Long-term follow-up mortality study of petroleum refinery and chemical plant employees

A previous report presented the 1948-1983 mortality patterns of the Shell Deer Park Manufacturing Complex employees who were employed for at least 3 months from 1948 through 1972. The present study updates the earlier investigation by extending the vital status follow-up through 1989 and by expanding the cohort to include employees hired after 1972. As in the previous study, the overall mortality and cancer mortality for both refinery and chemical employees were quite favorable compared to residents in the local population. Among refinery workers, cancers for which a suspicion of work-relatedness was raised in the previous study, i.e. leukemia and cancers of the central nervous system and biliary passage/liver, no supportive evidence was found in this update. For both refinery and chemical plant employees, the mortality rate due to cancers of all lymphopoietic tissue increased with increasing duration of employment; this finding was also noted by the original study. This was also evident for lymphoreticulosarcoma in refinery employees and for leukemia in chemical plant employees. However, elevations of cancers of all lymphatic and hematopoietic tissue are primarily confined to employees who started work at the complex before 1946. By contrast, deaths from cancer of all lymphatic and hematopoietic tissue for employees hired after 1945 were 22% lower than the comparison population. Seven deaths with mesothelioma mentioned on the death certificates were identified, with 3.2 deaths expected, resulting in a statistically nonsignificant SMR of 219.

Mortality, morbidity, and haematological results from a cohort of long-term workers involved in 1,3-butadiene monomer production.

A retrospective mortality analysis and prospective morbidity and haematological analyses were performed for Shell Deer Park Manufacturing Complex (DPMC) male employees who worked in jobs with potential exposure to 1,3-butadiene from 1948 to 1989. 614 employees qualified for the mortality study (1948-89), 438 of those were still employed during the period of the morbidity study (1982-9), and 429 of those had haematological data available for analysis. Industrial hygiene data from 1979 to 1992 showed that most butadiene exposures did not exceed 10 ppm (eight-hour time weighted average (8 hour TWA)), and most were below 1 ppm, with an arithmetic mean of 3.5 ppm. 24 deaths occurred during the mortality study period. For all causes of death, the standardised mortality ratio (SMR) was 48 (95% confidence interval (95% CI) = 31-72), and the all cancer SMR was 34 (95% CI = 9-87). There were only two deaths due to lung cancer (SMR 42, 95% CI = 5-151) and none due to lymphohaematopoietic cancer (expected = 1.2). Morbidity (illness absence) events of six days or more for the 438 butadiene employees were compared with the rest of the complex. No cause of morbidity was in excess for this group; the all cause standardised morbidity ratio (SMbR) was 85 (95% CI = 77-93) and the all neoplasms SMbR was 51 (95% CI = 22-100). Haematological results for the 429 with laboratory data were compared with results for the rest of the complex. No significant differences occurred between the two groups and the distributions of results between butadiene and non-butadiene groups were virtually identical. These results suggest that butadiene exposures at concentrations common at DPMC in the past 10-20 years do not pose a health hazard to employees.

Primary irritant contact dermatitis from synthetic pyrethroid insecticide exposure

Synthetic pyrethroids are widely used insecticides with numerous applications, varying from food protection to general pest control. Humans are capable of tolerating greater acute and chronic exposures to the pyrethroids than to many other insecticides. An abnormal cutaneous sensation (paresthesia) is known to occur after dermal contact with the pyrethroids. Recent field studies have indicated that a primary irritant contact dermatitis may also develop. This investigation evaluated dermal irritancy from cutaneous synthetic pyrethroid application to albino rabbits. Through repeated daily applications of either fenvalerate or permethrin, a slight erythema was noted visually which correlated with increased cutaneous blood flow measured by laser Doppler velocimetry. Histopathological changes were also documented, but no significant differences were detected in edema or thermal variation.

Prospective morbidity surveillance of Shell refinery and petrochemical employees

Results for a prospective morbidity study of 14,170 refinery and chemical workers from 1981 through 1988 are presented. Illness/absence data for this study were extracted from the morbidity section of the Shell Health Surveillance System which includes records of all illness/absences in excess of five days. Age adjusted annual morbidity frequency rates and annual durations of absence are presented by age, sex, job, and work status. Generally, rates and durations of absence were highest for older age groups, women, and production workers. Increased risk was associated with the presence of known disease risk factors. Overall, 48% of the employees had at least one illness/absence in excess of five days during the eight year period. Twelve per cent of the employees had four or more absences, which accounted for 54% of the total number of absences and 52% of the total work days lost. Among men, the five most common conditions accounted for 72% of all illness/absences. In descending order they were injuries (25%), respiratory illnesses (17%), musculoskeletal disorders (14%), digestive illnesses (9%), and heart disease (7%). Similar patterns were noted among women. These findings may be useful in setting priorities and directing efforts such as health education programmes and other strategies for the prevention of disease.

Medical surveillance for leukemia at a petrochemical manufacturing complex: four-year summary.

Four-year results are presented on 2086 participants of a medical surveillance program of current and retired employees at a manufacturing complex in Illinois. Annual complete blood cell count testing and intensive follow-up of all out-of-normalrange results began in 1985 on a voluntary basis. The program to date has not identified any evidence for an unusual distribution of out-of-range complete blood cell count results. Active employees with out-of-range complete blood cell count values had no increase in adverse health outcomes compared with those with in-range values. Retired employees with out-ofrange values were more likely to have a serious underlying medical condition, but this appeared to be more a function of age than of occupational exposure. Four cases of myelodysr plastic syndrome were brought to our attention as a result of the program, but there is no similarly followed population available for comparison to determine whether this represents an increase over expected cases. The lack of correlation of out-of-range complete blood cell count results in active employees with serious hematologio disease raises significant questions about the utility of such surveillance for chemically exposed groups (eg, benzene-exposed workers) when exposure levels are low and well controlled.

Morbidity prevalence study of workers with potential exposure to epichlorohydrin

This study examined the morbidity experience from 1981 to 1988 of two cohorts (Shell cohort and Enterline cohort) of workers who had potential exposure to epichlorohydrin (ECH). The morbidity prevalence data for this study were extracted from the morbidity section of the Shell health surveillance system which included all illness and absence records in excess of five days. For both cohorts, the standardised morbidity ratios (SMRs) for all causes and all neoplasms were similar to an internal comparison group. There were no increases in heart disease morbidity for the Shell cohort (SMR = 97) or the Enterline cohort (SMR = 90). The SMRs for heart disease in the lower exposure group of the Shell cohort were 101 and 93 for the corresponding Enterline cohort. They were 92 and 87, respectively, in the higher exposure group. The increased risk of heart disease mortality reported by Enterline et al in workers more heavily exposed to ECH was not confirmed in this morbidity study. Morbidity from skin and subcutaneous tissue disorders, however, was found to be increased significantly in the Shell cohort. The SMR was 98 for the lower exposure group and 195 for the higher exposure group. A review of the original morbidity reports for each case suggested that factors unrelated to exposure to ECH such as the physical demands of a particular job, amount of time outside--for example, exposure to poison ivy--and other underlying medical conditions may be of greater importance than exposure to ECH.

A prospective study of morbidity patterns in a petroleum refinery and chemical plant.

This study examined the morbidity experience from 1981 to 1988 of a prospective cohort of 3422 refinery and petrochemical plant employees from the Shell Deer Park manufacturing complex. The morbidity data for this study, which include all illness and absence records in excess of five days, were extracted from the morbidity section of the Shell health surveillance system. Standardised morbidity ratios (SMRs) of disease prevalence in this cohort were calculated using an internal comparison group of all manufacturing employees of the Shell Oil Company. Among production employees, the overall morbidity was statistically significantly higher (SMR = 109) than that of the comparison group. Illness due to hypertension (SMR = 144), haemorrhoids (SMR = 149), diseases of the nervous system (SMR = 120), respiratory system (SMR = 108), and digestive system (SMR = 117) were also raised for this group. The increased risk due to these medical conditions does not appear to be associated with occupational factors. Lymphatic and haematopoietic tissue neoplasms were raised (SMR = 124), but were based on only four cases.

Mortality study of employees with potential exposure to epichlorohydrin: a 10 year update.

OBJECTIVES: A 10 year extension of follow up (up to 1993) of 863 employees who had potential exposure to epichlorohydrin at two chemical plants between May 1948 and December 1965 was conducted to further evaluate the previously reported potential association between exposure to epichlorohydrin and heart disease. METHODS: The mortality observed was compared with that expected from the death rates from the local male population where these chemical plants are located. Workers were assigned to one of five exposure categories based on their job with the highest level of potential exposure. Vital status was ascertained to the end of 1993. RESULTS: Among diseases of particular interest, there were no excess deaths from heart disease (standardised mortality ratio (SMR) 63.3), lung cancer (SMR 63.8), or non-malignant respiratory disease (SMR 37.7) for employees with 20 or more years after first exposure. Based on the level of potential exposure to epichlorohydrin, mortality for heart disease was slightly higher (SMR 75.7, 95% confidence interval (95% CI) 51.8-106.7) in the moderate to heavy exposure group than in the none to light exposure group (SMR 59.5, 95% CI 37.7-89.3); this difference is well within the range of random variation. The SMR for heart disease was 90.4 among employees who had both probable exposure to allyl chloride and moderate to heavy exposure to epichlorohydrin, although it was 88.1 among employees who had moderate to heavy potential exposure to epichlorohydrin but no exposure to allyl chloride. CONCLUSIONS: This study does not support an association between exposure to epichlorohydrin and heart disease or lung cancer. There were no additional deaths from leukaemia in this update; the raised SMR for leukaemia noted in the previous study has substantially decreased from 500.0 to 161.3 (95% CI 33.2-471.0) and is not significant. The overall mortality and cancer mortality of employees potentially exposed to epichlorohydrin continued to be lower than that of the local population.

Medical Surveillance for Hematological Disorders Among Active and Retired Oil Refinery Workers

Ten-year (1985-1995) results of an expanded medical surveillance program of 2475 active employees and retirees of an oil refinery and petrochemical complex in Illinois are presented. At the end of the program, 116 participants with persistent abnormalities of complete blood cell count had been referred for hematologic evaluation, and most were found to have benign conditions. Fifteen of the 116 were referred for bone marrow and cytogenetic studies. All of the referred active employees (seven) were found to have completely normal bone marrows with no evidence of any myelopathic process. Among the eight retirees, two had normal bone marrows, one was diagnosed with Philadelphia chromosome-positive chronic myelogenous leukemia, one declined to participate, and four were diagnosed to have myelodysplastic syndrome (MDS) of various subtypes. A total of eight cases of MDS were identified, including six cases among program participants and two cases among nonparticipants. The MDS standardized incidence ratio of 1.26 (95% confidence interval = 0.54-2.47) was not statistically significant, and there was virtually no increase of MDS in persons less than 80 years of age (4 observed and 3.8 expected). This MDS increase was entirely from program participants, probably because of intensive follow-up and diagnostic screening. Routine surveillance of complete blood cell count information did not identify any new cases of leukemia or MDS in active employees. These findings suggest that the utility of expanded medical surveillance program in this population is very limited.