Wolfgang Dott

Predictive value of human biomonitoring in environmental medicine: Experiences at the outpatient unit of environmental medicine (UEM) of the University Hospital Aachen, Germany

There is little data on the distribution of biomonitoring parameters in patients at outpatient Units of Environmental Medicine (UEM). We evaluated the biomonitoring parameters of 646 UEM outpatients from our University Hospital 1988-1998. Few patients were exposed to specific substances. Data of patients who were not obviously exposed was analysed statistically (geometric mean, standard deviation, median, 95th percentile). Results were compared with reference values in literature. Normal distribution of biomonitoring parameters was rare. 95th percentiles for arsenic, chromium, selenium, zinc, phenol and toluene were below standard, 95th percentiles for copper and mercury above, and 95th percentiles for lead, cadmium, pentachlorophenol, lindane, and beta-hexachlorocyclohexane were within the published range of reference values. Thallium as well as most volatile organic compounds analyzed were below detection levels. Aluminum and fluorine exposure was rarely analysed. In view of these results, it is concluded that the indication for biomonitoring needs to be stringent as levels of biomonitoring parameters are generally not risen in patients of the UEM.

Potential health risk of allergenic pollen with climate change associated spreading capacity: Ragweed and olive sensitization in two German federal states.

BACKGROUNDnGlobal climate changes may influence the geographical spread of allergenic plants thus causing new allergen challenges.nnnOBJECTIVEnAllergy patients from two German federal states were compared for their status quo sensitization to ragweed, an establishing allergen, olive, a non-established allergen, and the native allergens birch, mugwort, and ash.nnnMETHODSnBetween 2011 and 2013, 476 adult allergy patients per region were recruited. Patients completed a questionnaire, participated in a medical interview, and underwent skin prick testing and blood withdrawal for analysis of specific IgE to allergen components (ISAC technology). Data on regional pollen load from 2006 to 2011 were acquired from the German Pollen Information Service Foundation.nnnRESULTSnPrick test reactivity to ragweed and ash, respectively, was lower in Bavaria than in NRW (ragweed: p=0.001, aOR=0.54; ash: p=0.001, aOR=0.59), whereas prick test reactivity to olive was higher (p=0.000, aOR=3.09). Prick test reactivity to birch and mugwort, respectively, did not significantly differ. 1% (1/127) of patients with prick test reactivity to ragweed showed sIgE to Amb a 1, and 65% (86/132) of olive-but-not-ash reactive patients showed sIgE to Ole e 1 (NRW: 67%, Bavaria: 65%; p=0.823, OR=0.91). Regional differences in sensitization pattern were neither explainable by cross-reactivity to pollen pan-allergens nor non-exposure variables nor by reported plant population or pollen data.nnnCONCLUSIONSnSpread of ragweed and particularly olive may result in prompt occurrence of allergic symptoms. Early identification of invasive allergens due to climate change does need time and spatial close meshed measurement of respective indicator allergens and sensitization pattern.

In vitro serum levels of metal ions released from orthopaedic implants

Metallic materials in orthopaedic implants must bear mechanical loads with resultant surface damage. In addition to mechanical load, the surface damage on the implants occurs due to electrochemical corrosion from the physiological environment in-vivo. This research investigates in vitro experimental test bodies (surface area: 4.71xa0cm2) of four different ISO (International Organization for Standardization) standardised, frequently used, artificial implant alloys (TiAl6V4, Ti, CoCr29Mo, FeCrNiMoMnNbN). The test materials were immersed in inert polystyrene test tubes filled with 1xa0ml of serum (pH 7.4) by avoidance of any friction and mechanical load. Here, they were subject to electrochemical corrosion independently of mechanical influences when in contact with body liquids. It was found that up to 80% of the entire dissolution of each ion occurred within the first 24xa0h of immersion. Additionally, the dissolution of the metal ions depended on the proportional mix of the individual elements in respective alloys. Therefore, the highest percent of ion concentration was found for Co (CoCr29Mo) followed by Fe (FeCrNiMoMnNbN) and Mo (FeCrNiMoMnNbN). The lowest percent of ion concentrations were evident for Ti (Ti), Cr (CoCr29Mo) and Cr (FeCrNiMoMnNbN).RésuméLes composants métalliques des implants orthopédiques doivent supporter des contraintes mécaniques entraînant des détériorations de surface. En plus de la charge mécanique les détériorations de surface des implants se produisent en raison de la corrosion électrochimique de l’environnement physiologique in vivo. Cette recherche étudie les matériaux expérimentaux testés in vitro (superficie : 4.71 cm2) de quatre alliages (TiAl6V4, Ti, CoCr29Mo, FeCrNiMoMnNbN) fréquemment utilisés et ISO (International Organization for Standardization) normalisés. Les matériaux d’essai ont été immergés dans les tubes à essais en polystyrène inerte remplis de 1xa0ml du sérum (pH 7.4) afin d’éviter tout frottement et charge mécanique. Dans ces tubes à essais, ils sont soumis à la corrosion électrochimique indépendamment des influences mécaniques quand ils sont en contact avec les liquides organiques. On a constaté que près de 80 pour cent de la dissolution entière de chaque ion s’est produite dans les 24 premières heures de l’immersion. En plus, la dissolution des ions métalliques dépend de la proportion des différents éléments de chaque alliage. Par conséquent les plus grands pourcentages de concentration ionique ont été trouvés pour le Cobalt (CoCr29Mo), puis du Fer (FeCrNiMoMnNbN) et du Molybdène (FeCrNiMoMnNbN). Les plus bas pourcentages de concentration ionique étaient évidents pour le Titane (Ti), le Chrome dans l’alliage (CoCr29Mo) et dans l’alliage (FeCrNiMoMnNbN).

Environmental agents as cause of health disorders in children presented at an outpatient unit of environmental medicine

There are no publications on the frequency of environmental agents causing diseases in children presented at centers of environmental medicine. The aim of this study was to perform a statistical analysis of the data of children who visited the outpatient Unit of Environmental Medicine (UEM) at the University Hospital of Aachen, Germany. Data of all UEM patient files from January 1988 to September 1996 were evaluated. From a total of 682 patients, 75 were children (40 girls, 35 boys, age range 1-12 years). Forty-six children were presented with unspecific health disorders, 12 to examine a possible relationship between environmental agents and a current condition, mostly atopy (n = 10). Complaints were mucosal irritations (n = 38), unspecific (n = 19), dermatological (n = 16), gastrointestinal (n = 4), heart/circulation-related (n = 2), musculoskeletal (n = 1) and neurological (n = 1) symptoms. Wood preservatives were mentioned as suspected environmental causative agents in 22 cases, followed by unspecific indoor factors (n = 15), factories/disposal sites near homes (n = 9), formaldehyde (n = 5) and unspecific exposures (n = 5). Biomonitoring was done in 44 cases, local inspections and ambient monitoring in 10 cases. No evidence for a cause-and-effect relationship was found in 55 children, but was deemed possible in nine cases. In nine other children, a relatively high degree of exposure was determined by chemical analysis, but clinical relevance remained unclear. One child suffered from subclinical mercury poisoning caused by inadequate homeopathic medication. In most children referred to an environmental medicine center, it is difficult or impossible to verify an environmental cause using the diagnostic instruments currently available.

Communication problems with environment-related health disorders as illustrated by a multiple chemical sensitivity (MCS) chatroom.

The problem of communication in treating multiple chemical sensitivity (MCS) was analysed and evaluated using the documentation of an MCS chatroom which was set up in April 2001 following the TV programme Gesundheitsmagazin Praxis (Health Magazine: Practice). Approaches were developed for solving communication problems in the chatroom. A total of 490 cases were evaluated, most of which (355) were directly or indirectly affected, 76 came from self-help groups and 10 were from 4 guest experts invited by ZDF (Zweites Deutsches Fernsehen, Second German TV channel). Of these 4 experts, 2 were environmental medicine specialists, 1 psychosomatics expert and 1 psychiatrist. Fourty-nine of the cases included a petition for chatroom participants to join a class-action law. Aside from exchanging basic information on MCS, frequent topics of discussion on the air were the assessment of physicians, clinics, self-help groups and experts. The participants also expressed their views on problems with society, politics, the economy, science and social security. Another common topic was communication in the chatroom itself, which for the most part consisted of sarcasm and insults, which were cause for conflicts in the chatroom. These communication problems led to the conclusion that a chatroom is not the best medium for discussing MCS. If a chatroom is to be used profitably to this end, it is imperative to have a well-defined organisational framework which allows the exchange of current, scientifically accurate information while keeping discussions from escalating and degenerating into arguments.