Raphael H. Warshaw

Prevalence of symptoms of systemic lupus erythematosus (SLE) and of fluorescent antinuclear antibodies associated with chronic exposure to trichloroethylene and other chemicals in well water

Criteria for the recognition of systemic lupus erythematosus (SLE) were applied to 362 subjects exposed to trichloroethylene, trichloroethane, inorganic chromium, and other chemicals in water obtained from wells in an industrially contaminated aquifer in Tucson, Arizona. Their antinuclear autoantibodies were measured by fluorescence (FANA) in serum. Ten patients with clinical SLE and/or other collagen-vascular diseases were considered separately. Results were compared to an Arizona control group, to published series, and to laboratory controls. Frequencies of each of 10 ARA symptoms were higher in exposed subjects than in any comparison group except those with clinical SLE. The number of subjects than in any comparison group except those with clinical SLE. The number of subjects with 4 or more symptoms was 2.3 times higher compared to referent women and men. FANA titers greater than 1:80 was approximately 2.3 times higher in women but equally frequent in men as in laboratory controls. ARA score and FANA rank were correlated with a coefficient (cc) of .1251, r2 = .0205 (p less than 0.036) in women and this correlation was almost statistically significant in men cc = .1282, r2 = .0253 (p less than 0.059). In control men and women neither correlation was significant. Long-term low-dose exposure to TCE and other chemicals in contaminated well water significantly increased symptoms of lupus erythematosus as perceived by the ARA score and the increased FANA titers.

Formaldehyde Impairs Memory, Equilibrium, and Dexterity in Histology Technicians: Effects Which Persist for Days after Exposure

Results of neurobehavioral testing in 305 histology technicians were studied by regression analysis with age, years of cigarette smoking, and hours per day of exposure to formaldehyde and to solvents as major independent variables. Increasing age was associated with poorer performance on visual memory, block design, trails, dexterity by pegboard, sharpened-Romberg, finger writing, as well as with longer choice reaction time. Increased daily hours of exposure to formaldehyde were correlated with reduced performance on story memory, visual memory, digit span, pegboard and sharpened-Romberg, as well as with errors on trails. Exposure to solvents was associated only with diminished recall of story.

Neurobehavioral and respiratory symptoms of formaldehyde and xylene exposure in histology technicians

Disturbances of memory, mood, equilibrium, and sleep that occurred simultaneously with headache and indigestion, were experienced more frequently among women working in histology who had daily exposure to formaldehyde, xylene, and toluene than in unexposed female clerical workers working in the same hospitals. Neurobehavioral symptoms were accompanied by irritation of eyes, upper airways, and trachea. Formaldehyde exposure correlated better with neurobehavioral symptoms and with respiratory and mucous membrane symptoms than did exposure to xylene/toluene or to other agents.

Cluster of systemic lupus erythematosus (SLE) associated with an oil field waste site: a cross sectional study

BackgroundThis is a community comparison study that examines persons living in a subdivision exposed to petroleum products and mercury.MethodsWe compared their health status and questionnaire responses to those living in another community with no known exposures of this type.ResultsPristane house dust among the exposed homes was higher than in the comparison communities. The exposed subdivision has higher ambient air mercury levels compared to the control community. The prevalence of rheumatic diseases (OR = 10.78; CI = 4.14, 28.12) and lupus (OR = 19.33; CI = 1.96, 190.72) was greater in the exposed population compared to the unexposed. A higher prevalence of neurological symptoms, respiratory symptoms and several cardiovascular problems including stroke (OR = 15.41; CI = 0.78, 304.68) and angina (OR = 5.72; CI = 1.68, 19.43) was seen.ConclusionThere were statistically significant differences in B cells, Natural Killer Cells, gamma glutamyl transferase, globulin and serum calcium levels between control and exposed subjects.

Pulmonary and Neurobehavioral Effects of Formaldehyde Exposure

Two groups of male workers who were exposed to formaldehyde, the first group in phenol-formaldehyde-plastic foam matrix embedding of fiberglass (batt making), and the second in the fixation of tissues for histology, were studied for work-related neuro-behavioral, respiratory, and dermatological symptoms; and for pulmonary functional impairment. Forty-five male fiberglass batt makers who were studied across the initial work-shift after a holiday had average frequencies of combined neurobehavioral, respiratory, and dermatological symptoms of 17.3 for the hot areas and 14.7 for the cold areas of the process. Their symptom counts were significantly greater than those for 18 male histology technicians who averaged 7.3, and for 26 unexposed male hospital workers who averaged 4.8. During their first workshift after holidays, 58% of the batt makers had a decrease in one or more tests of pulmonary function. Nine nonsmokers had decreases more frequently than did 35 smokers; forced expiratory volume in one second FEV1.0 decreased in 16%, diffusing capacity for carbon monoxide (sb) decreased in 30%, forced expiratory flow 25-75 decreased in 16%, and forced expiratory flow) 75-85 decreased in 36%. Thirty-five percent of all 44 men had drops in FEV1.0, forced vital capacity, or in diffusing capacity (sb).

Effects on Neurobehavioral Performance of Chronic Exposure to Chemically Contaminated Well Water

Occupational exposure lo trichloroethylene (TCE) and other solvents impairs neurobehavioral performance. Use of well water contaminated with TCE and solvents has been associated with excessive symptoms, cancers, birth defects and impaired blink reflex. We extended these observations by measuring the neurophysiological (NPH) and neuropsychological (NPS) status of subjects who used water contaminated with 6 to 500 ppb of TCE for 1 to 25 years. The 170 well-water exposed subjects who resided in southwest Tucson, Arizona overlying the Santa Cruz River aquifer, were compared to 68 referent subjects for NPH and NPS tests. Also, 113 histology technicians (HT) were referents for blink reflex latency only. Affective status was assayed by a Profile of Mood States (POMS). Exposed subjects were statistically significantly impaired when compared to referents for NPH tests. These impairments included sway speed with eyes open and closed, blink reflex latency (R-1), eye closure speed, and two choice visual reaction time. NPS status was statistically significant impaired for Culture Fair (intelligence) scores, recall of stories, visual recall, digit span, block design, recognition of fingertip numbers, grooved pegboard and Trail making A and B. POMS scores were elevated. Prolonged residential exposure to well-water containing TCE at lower levels than occupational exposures, but without time away from exposure for metabolism and excretion of toxins, was associated with neurobehavioral impairment.

Are hearing loss and balance dysfunction linked in construction iron workers

The objective was to determine whether an association existed between hearing loss and balance dysfunction in construction workers exposed to noise. Screening pure tone audiometry and balance testing were performed using a sound emitter and dual microphone system to evaluate 78 iron workers who were compared with 128 histology technicians. Most iron workers showed hearing loss at frequencies below 3000 Hz. Their sway speeds were significantly faster both with the eyes open (1.05 (SD 0.39) v 0.91 (SD 0.22) cm/s) and with eyes closed (1.66 (SD 0.82) v 1.31 (SD 0.51) cm/s) than those of histology technicians. Coefficients for sway speed with the eyes closed and hearing loss in the left ear were significantly correlated at 500 to 8000 Hz. They were also correlated with the sway speed, eyes open, at low and high Hz. It is concluded that the use of air impact power tools in an inordinately noisy work environment makes iron workers prematurely deaf and impairs their balance. Falls may be related to balance dysfunction and impaired equilibrium. Falls from height injure and kill iron workers. Further investigations will determine whether injuries from falls are linked to these impairments.

Airway Disease in Non-Smoking Asbestos Workers

Ninety-seven non-cigarette-smoking white male insulators from the midwestern United States had significantly reduced forced expiratory volume in 1 second (FEV1.0) (P less than .0017) and forced expiratory flow from 75 to 85% of expired volume (FEF75-85) (P less than .042) when compared to a reference population of Michigan male nonsmokers. There were parenchymal opacities with a profusion of 1/0 or greater in 7 and pleural changes in 13 of these 97 nonsmokers. Asbestos, in the absence of cigarette smoke effects and other diseases, appears to decrease airflow, probably by the distortion of small airways (less than 2mm) by peribronchiolar fibrosis. This stiffening of the lung parenchyma protects midflow (FEF25-75) as the fibrosis increases the lungs radial traction on airways larger than 2 mm. This observation contributes to the natural history of physiological impairment due to asbestos disease.

Balance measured by head (and trunk) tracking and a force platform in chemically (PCB and TCE) exposed and referent subjects.

To determine comparability of methods, postural sway was measured simultaneously with a force platform and a device that registers head (and trunk) movements (head tracking). The effects of age, sex, height, weight, shoe area, and grip strength on both measurements were examined in 162 subjects. To determine whether either method had advantages in detecting abnormal balance 46 reference subjects were compared with 116 people randomly selected from 500 residents whose well water was contaminated with polychlorinated biphenyls (PCBs) and trichloroethylene (TCE) from a metal casting plant. Speed, mean radius, and distance of sway were equally reproducible with both methods. Correlation coefficients were 0.672 with the eyes closed and 0.588 with the eyes open. The balance of those exposed to PCBs and TCE was significantly worse than that of unexposed subjects by both head tracking (1.50 + 71 cm/s v 1.27 + 0.36 cm/s; p < 0.034) and the force platform (4.93 + 1.56 N (kg force) v 4.29 + 1.14 N; p < 0.013) with the eyes closed and differences were also significant with the eyes open. Head tracking and the force platform produced equivalent results. Measurement by head tracking is recommended for field studies because the device is more portable and is less influenced by weight and height. Both methods showed impaired balance associated with years of exposure to PCBs and TCE.

Health effects on nearby residents of a wood treatment plant

OBJECTIVES The aim of the study was to evaluate the health status of nearby residents of a wood treatment plant who had sustained prolonged low-level environmental exposure to wood processing waste chemicals. METHODS A population of 1269 exposed residents who were plaintiffs or potential plaintiffs in a lawsuit against the wood treatment plant were evaluated by questionnaire for a health history and symptoms. A representative sample of 214 exposed subjects was included in the analysis. One hundred thirty-nine controls were selected from 479 unexposed volunteers and matched to the exposed subjects as closely as possible by gender and age. Subjects and controls completed additional questionnaires and were evaluated by a physician for medical history and physical examination, blood and urine testing, neurophysiological and neuropsychological studies, and respiratory testing. Environmental sampling for wood processing waste chemicals was carried out on soil and drainage ditch sediment in the exposed neighborhood. RESULTS The exposed subjects had significantly more cancer, respiratory, skin, and neurological health problems than the controls. The subjective responses on questionnaires and by physician histories revealed that the residents had a significantly greater prevalence of mucous membrane irritation, and skin and neurological symptoms, as well as cancer. (Exposed versus unexposed, cancer 10.0% versus 2.08%, bronchitis 17.8% versus 5.8%, and asthma by history 40.5% versus 11.0%) There were significantly more neurophysiologic abnormalities in adults of reaction time, trails A and B, and visual field defects. CONCLUSIONS Adverse health effects were significantly more prevalent in long-term residents near a wood treatment plant than in controls. The results of this study suggest that plant emissions from wood treatment facilities should be reduced.