Juhani Juntunen

Postural body sway and exposure to high-energy impulse noise.

Detailed neurological and audiological examinations and body-sway measurements with a stable platform were carried out on 60 subjects who had been exposed to high-energy intermittent noise from firearms and had various degrees of noise-induced hearing loss. The results were compared with those for 115 healthy controls. The exposed subjects showed significantly more body sway, estimated as movement of the centre of gravity in the horizontal plane, than the controls. This swaying correlated poorly with the recalled level of noise exposure, though subjects with more severe hearing loss (by audiometric deterioration of high-frequency sound, 4 kHz and 6 kHz) showed more sway than those with less severe hearing loss. Age was not significantly correlated with body sway among the controls but men seemed to sway more than women. These results suggest subclinical disturbance of the vestibular system among subjects with impulse-noise-induced hearing loss.

Nervous system effects of long-term occupational exposure to toluene

ABSTRACT – Forty‐three male rotogravure printers with long‐term toluene exposure and 31 age‐ and sex‐matched offset printers without toluene exposure were examined in detail. Clinical, neurophysiological, neuropsychological and neuroradiological examinations and assessment of autonomic functions did not reveal any statistically significant differences between the groups. The results suggest that occupational long‐term exposure to toluene under these circumstances does not have clinically significant adverse effects on the nervous system. Exposure to toluene seemed to be associated with heavy drinking.

Peripheral neuropathy and vibration syndrome

SummaryHundred and three patients with suspected or diagnosed vibration syndrome caused by the prolonged use of chain saws were examined during 1978–1980. Neurological or neurophysiological examinations revealed slight changes suggesting polyneuropathy in the lower extremities of 42 patients. Peripheral neuropathy in the upper extremities was only detected in 39 patients. No evidence of peripheral neuropathy was found for 22 patients. The polyneuropathic patients did not significantly differ from the non-polyneuropathic patients with regard to other clinical symptoms and signs, laboratory findings, or data on exposure. We concluded that patients with neuropathic diathesis tend to be selected into groups of patients with suspected vibration syndrome. This study emphasizes the need for the careful neurological examination of each patient with suspected vibration syndrome.

Exposure, skin protection and occupational skin diseases in the glass-fibre-reinforced plastics industry.

A total of 100 workers, 86 from the glass‐fibre‐reinforced plastics (GRP) industry, 11 from polystyrene production and 3 from polyester resin coating manufacture, were examined for occupational skin hazards and for evaluation of skin protection. The workers had been exposed to many chemicals. Those working in the GRP industry had also been exposed to glass fibre and to dust produced by finishing work. 94% used protective gloves. 22 workers, all employed in the GRP industry, had contracted occupational skin disorders. 6 had allergic and 12 irritant contact dermatitis. 4 workers had an accidental injury caused by a peroxide catalyst, fire, hot air and Constant mechanical friction. Allergic dermatoses were due to natural rubber (latex) (4 cases) in protective gloves, phenol‐formaldehyde resin (1 case) and cobalt naphthenate (1 case). Irritant hand dermatoses (5 cases) were caused by the combined hazardous effect of unsaturated polyester or vinyl ester resins, organic solvents, glass fibre and dust from finishing work on the skin. Other cases of irritant dermatoses (7 cases) were due to the dust, promoted by mechanical Friction of clothes. Skin disorders in the GRP industry were common (26%) but the symptoms were mild and only 3 patients had been on sick leave because of occupational skin disease.

Effects of recombinant α‐2b‐interferon therapy in patients with progressive MS

The effects of systemic recombinant interferon‐α‐2b were studied in 6 carefully selected patients with progressive multiple sclerosis. 3.0 million IU were given as daily subcutaneous injections for 6 months, 5 patients showed worsening disability, and in 4 of them new or enlarged lesions were detected in MRI. In one patient no change in disability was found; his MRI showed regressed changes. The mean progression index during the treatment was significantly higher (p < 0.02) than during the previous 2 to 3 years’ period of continuous progression. The frequency of peripheral blood natural killer (CD16 +) cells declined significantly 3 months during the treatment, but returned to the pretreatment values after termination the treatment. An increase of intrathecal IgG synthesis and oligoclonal bands was demonstrated in 4 and 3 patients, respectively. Our experience suggests that long‐term recombinant IFN‐α‐2b treatment may activate the immunological process of MS.

Posturography and the dizzy patient: a neurological study of 133 patients

ABSTRACT A total of 133 dizzy patients under the age of 60 years were examined using a stable balance plate (posturography, PG). All the patients were thoroughly examined neurologically before PG and classified into 7 diagnostic categories. Comparison was made between these categories and PG results. The referent group consisted of 116 healthy individuals. The patients with CNS lesions had more body sway than controls or the patients with peripheral vestibular lesions, whose sway did not significantly differ from that of the controls. The PG parameters that most clearly separated the patients from the controls were the total length of the movement of the center of gravity, and the sway in lateral and antero‐posterior directions. Analysis of the frequency of the sway or calculation of the Romberg index did not reveal significant differences between the categories. Men swayed more than women. Age did not correlate with PG results. Stable posturography offers useful quantitative supplementary information as a part of the examination of a dizzy patient. Increased body sway suggests a lesion in the CNS.

MS and SLE in twins of successive generations

During a nationwide twin study on multiple sclerosis (MS) in Finland a dizygotic pair discordant for MS was found. The affected co‐twin had dizygotic twin daughters. The affected co‐twin of the second generation had systemic lupus erythematosus (SLE). Both pairs were thoroughly examined. No evidence of CNS involvement in the healthy co‐twins was found. In pairwise comparisons, virus‐specific IgG antibodies to measles and mumps were significantly increased in the MS patient whereas the same was true for rubella in the SLE patient. Both MS and SLE patient expressed HLA alleles most often found to be associated with these disorders. Reversed CD4/CD8 ratios were observed in both MS and SLE patient. No difference in interleukin‐2 receptor expression were found but gamma‐interferon secretion in the MS patient showed marked increase whereas that of the SLE patient was of the same magnitude as in the healthy members. A different triggering stimulus rather than the dissimilarity in the immunogenetic predisposition may be decisive as to whether or not they develop MS or SLE.

Serum selenium concentration, glutathione peroxidase activity and lipid peroxides in a co-twin control study on multiple sclerosis

Serum selenium concentration, glutathione peroxidase activity and lipid peroxides were determined in patients with multiple sclerosis (MS). The series consisted of 13 same-sexed twin pairs derived from the Finnish Twin Cohort of 15,815 pairs. Fourteen subjects had a definite and 1 a probable MS, and their 11 co-twins showed no evidence of central nervous system disease. No statistical differences were observed, but the 3 patients with active progressive MS had a higher mean level of lipid peroxides than the rest of the patients. We suggest that serum lipid peroxidation may be involved in the activity of MS.

Effect of unilateral sensory impairment of the sole of the foot on postural control in man: Implications for the role of mechanoreception in postural control

Abstract Body sway was measured in normal subjects and in patients with impaired mechanical sensitivity in limited areas of one or the other sole due to microvascular free flap reconstruction for a traumatic defect. This approach was used for evaluating the role of mechanoreception of the soles in postural control, and for determining the extent to which the sensitivity decrement affected the ability of these patients to control their posture. Mechanical sensibility was determined with vibratory stimuli of different frequencies which preferentially activate receptors of different types in the skin. Body sway was measured with a force platform technique with the eyes open and also closed. In both controls and patients the total extent of sway was larger when the eyes were kept closed. With the eyes open, the patients showed a normal extent of sway, but with the eyes closed the sway increased more than in the controls. The amount of sway increased both with the severity of the sensory impairment, and with the size of the affected skin region.

Cerebrospinal fluid cells and proteins in patients occupationally exposed to organic solvents

Cerebrospinal fluid (CSF) cells and proteins were determined for 33 patients exposed to industrial organic solvents. A lymphoid reaction, i.e., a pathologically elevated number or percentage of enlarged lymphoid cells was observed in one-third of the patients, more often in patients with chronic intoxication (40%) than in those currently exposed to organic solvents (32%). An almost significant decrease of small lymphocytes in the CSF was observed among patients who had a past history of chronic solvent intoxication but no recent exposure. No cytological evidence of tissue destruction was found. Signs of slight blood--CSF barrier damage occurred in 5 (23%) of the currently exposed patients, but intrathecal IgG synthesis was not observed. Increased cellular activity in the CSF was also accentuated in principal component analysis. The results suggest slight nonspecific immunoactivation in the central nervous system of subjects exposed to organic solvents.