Inhalant-Abuse Myocarditis Diagnosed by Cardiac Magnetic Resonance

Multiple reports of toxic myocarditis from inhalant abuse have been reported. We now report the case of a 23-year-old man found to have toxic myocarditis from inhalation of a hydrocarbon. The diagnosis was made by means of cardiac magnetic resonance imaging with delayed enhancement. The use of cardiac magnetic resonance to diagnose myocarditis has become increasingly common in clinical medicine, although there is not a universally accepted criterion for diagnosis. We appear to be the first to document a case of toxic myocarditis diagnosed by cardiac magnetic resonance. In patients with a history of drug abuse who present with clinical findings that suggest myocarditis or pericarditis, cardiac magnetic resonance can be considered to support the diagnosis.

Sudden Deaths Among Oil and Gas Extraction Workers Resulting from Oxygen Deficiency and Inhalation of Hydrocarbon Gases and Vapors - United States, January 2010-March 2015

In 2013, an occupational medicine physician from the University of California, San Francisco, contacted CDC's National Institute for Occupational Safety and Health (NIOSH), and the Occupational Safety and Health Administration (OSHA) about two oil and gas extraction worker deaths in the western United States. The suspected cause of these deaths was exposure to hydrocarbon gases and vapors (HGVs) and oxygen (O2)-deficient atmospheres after opening the hatches of hydrocarbon storage tanks. The physician and experts from NIOSH and OSHA reviewed available fatality reports from January 2010 to March 2015, and identified seven additional deaths with similar characteristics (nine total deaths). Recommendations were made to industry and regulators regarding the hazards associated with opening hatches of tanks, and controls to reduce or eliminate the potential for HGV exposure were proposed. Health care professionals who treat or evaluate oil and gas workers need to be aware that workers might report symptoms of exposure to high concentrations of HGVs and possible O2 deficiency; employers and workers need to be aware of this hazard and know how to limit exposure. Medical examiners investigating the death of oil and gas workers who open tank hatches should consider the contribution of O2 deficiency and HGV exposure.

[The rescue modalities and etiology of acute organic solvent poisoning]

OBJECTIVE

To investigate the rescue modalities and etiology of acute organic solvent poisoning.

METHODS

A total of 776 cases of acute organic solvent poisoning were analyzed retrospectively. The kinds of organic solvents, the modes of exposure, the characteristics of poisoning and the methods of treatment were analyzed.

RESULTS

Poisoning was due to occupational exposure to organic solvents in 87.4%, the other was exposed in daily life. The total number of organic solvents harming the patients was 55. The most common three of the organic solvent poisoning were halogenated hydrocarbons poisoning, hydrocarbons poisoning, amino- and nitro-hydrocarbons poisoning. The accidents of mass poisoning were increasing in numbers recently, especially the acute halogenated hydrocarbons poisoning.

CONCLUSION

To know the numerous poisonings responsible for acute solvent poisoning is essential for enhancing the pre-hospital care, emergency treatment and following treatment. Also, extensive clinical knowledge and numerous biologic laboratory tests are needed to improve the diagnosis and rescue of acute solving poisoning. Effect of therapeutic plasma exchange treatment on sever acute poisoning is with a positive attitude.

Nephrotic syndrome due to subacute glomerulonephritis -- association with hydrocarbon exposure?

A 59-year-old man developed a nephrotic syndrome 40 days after hydrocarbon exposure of 3 days' duration. Renal biopsy gave evidence of a subacute proliferative glomerulonephritis. A lasting remission was obtained with immunosuppressive therapy. The case history is discussed in the light of recent studies indicating a causal relationship between hydrocarbon exposure and glomerulonephritis. The reversible nature of the disease in the present case is discussed in relation to the disease in experimental animals induced by a single administration of heterologus antigen.

Surfactant therapy in acute respiratory distress syndrome due to hydrocarbon aspiration

Hydrocarbon aspiration causes acute lung injury, which may lead to acute respiratory distress syndrome. Surfactant has been shown to be beneficial in experimentally-induced hydrocarbon-associated acute respiratory distress syndrome. However, there has not been a clinical study evaluating the effect of surfactant application on hydrocarbon aspiration in humans. We report a 17-month-old boy with acute respiratory distress syndrome due to hydrocarbon aspiration and was successfully treated with surfactant application.

Effect of Asphalt Fume Inhalation Exposure at Simulated Road Paving Conditions Prior to Bacterial Infection on Lung Defense Responses in Rats

Asphalt fume inhalation has been suspected of affecting immune function in exposed workers. The objective of this study was to evaluate the effect of asphalt exposure on lung immune responses in rats using a bacterial infectivity model. Pathogen-free male Sprague-Dawley rats were exposed by inhalation to asphalt fumes (72.6 +/- 4.95 mg/m3) or filtered air for 6 h/day for 5 days. One day after the final asphalt exposure, rats were intratracheally inoculated with 5 x 10(5) Listeria monocytogenes. At 0 (prior to bacterial inoculation), 3, and 7 days after L. monocytogenes instillation, the lungs of each animal were divided. Bronchoalveolar lavage (BAL) was performed on right lungs. The recovered BAL cells were then differentiated and counted, and alveolar macrophage (AM) function was determined. Albumin and lactate dehydrogenase (LDH), two indices of lung injury, were measured in the acellular BAL fluid. To assess bacterial clearance, the left lungs were removed, homogenized, and bacterial colony-forming units (CFUs) were counted. In addition, lung-draining lymph nodes were removed, and lymphocyte phenotype and lymphocyte-induced cytokine production were examined. Asphalt fume exposure did not cause lung injury or inflammation in rats in the absence of infection. Infection induced elevations in AMs, neutrophils (PMNs), albumin, and LDH. Importantly, no significant differences were seen when comparing the asphalt group with the air and nonexposed naive groups at any time before or after infection. Also, asphalt fume inhalation exposure did not affect the rate of pulmonary clearance of L. monocytogenes or AM production of reactive oxygen and nitrogen species. However, asphalt-related increases in lymphocyte secretion of interferon (IFN)-gamma, interleukin (IL)-6, and IL-10 were observed at different times after bacterial infection, whereas the total number of lymph-node cells and the percentage of CD4+ and CD8+ cells were not significantly different among the treatment groups. Despite the asphalt-induced changes observed in lymphokine secretion, adaptive immune function seemed to function properly in lung defense against bacterial infection. Because innate nonspecific lung responses and pulmonary clearance of L. monocytogenes were unaffected by asphalt fume exposure, lung defenses were sufficient to control the infection. It was concluded that acute inhalation of asphalt fumes at a high concentration had a minimal effect on lung immune responses to infection in rats.

[Chemical pneumonia following ingestion of lamp oil]

A 20-months-old girl developed a cough and became drowsy after drinking lamp oil. In the Emergency Ward, her oxygen saturation was 85%. The day after admission to hospital she showed a clinical and radiological picture of chemical pneumonia. After 3 days the patient could be discharged in good condition. The most important symptoms after the ingestion of hydrocarbon compounds such as lamp oil are respiratory problems due to aspiration and effects on the central nervous system following gastrointestinal absorption. Severe symptoms can develop in a short period of time. The treatment is supportive. The prognosis is favourable.

Utility of urinary 1-naphthol and 2-naphthol levels to assess environmental carbaryl and naphthalene exposure in an epidemiology study

We recently reported associations between urinary 1-naphthol (1N) levels and several intermediate measures of male reproductive health, namely sperm motility, serum testosterone levels, and sperm DNA damage. However, because 1N is a major urinary metabolite of both naphthalene and the insecticide carbaryl, exposure misclassification stemming from differences in exposure source was probable and interpretation of the results was limited. As naphthalene, but not carbaryl, is also metabolized to 2-naphthol (2N), the relationship of urinary 1N to 2N within an individual may give information about source of 1N. Utilizing data from two previous studies that measured both 1N and 2N in urine of men exposed to either carbaryl or naphthalene, the present study employed several methods to differentiate urinary 1N arising from exposures to carbaryl and naphthalene among men in the reproductive health study. When re-evaluating the reproductive health data, techniques for identifying 1N source involved exploring interaction terms, stratifying the data set based on 1N/2N ratios, and performing an exposure calibration using a linear 1N to 2N relationship from a study of workers exposed to naphthalene in jet fuel. Despite some inconsistencies between the methods used to distinguish 1N source, we found that 1N from carbaryl exposure is likely responsible for the previously observed association between 1N and sperm motility, whereas 1N from naphthalene exposure is likely accountable for the association between 1N and sperm DNA damage. We demonstrate that studies of health effects associated with carbaryl should utilize a 1N/2N ratio to identify subgroups in which carbaryl is the primary source of 1N. Conversely, studies of naphthalene-related outcomes may utilize 2N levels to estimate exposure.

Status of worker exposure to asphalt paving fumes with the use of engineering controls

Since 1996, industry, labor, and government have partnered to minimize workers' exposure to asphalt fumes using engineering controls. The objective of this study was to determine the use after some years of experience and to benchmark the effectiveness of the engineering controls as compared to the current exposure limits. To accomplish this objective, the current highway class pavers equipped with controls to reduce asphalt fumes, occupational exposure levels, and ventilation flow rates were monitored, and a user acceptance survey was conducted. Personal breathing-zone sampling was administered to determine concentrations of total particulate matter (TPM) and benzene soluble matter (BSM). Personal monitoring of workers yielded a BSM arithmetic mean of 0.13 mg/m3 (95% confidence limits (0.07, 0.43) mg/m3). All site average worker BSM values are below the American Conference of Governmental Industrial Hygienists (ACGIH) adopted threshold limit value (TLV) time weighted average (TWA) of 0.5 mg/m3 as benzene soluble inhalable particulate, although five sites contained 95% confidence limits slightly above the ACGIH TLV. The TPM arithmetic mean was 0.35 mg/m3 (95% confidence limits (0.27, 0.69) mg/m3). All sites showed average worker and area TPM values below NIOSH's recommended exposure limit for asphalt fumes (5 mg/m3, 15 min). One screed area sample and one operator area sample were also taken each day. Area samples followed a similar pattern to the worker breathing zone samples, but were generally slightly higher in TPM and BSM concentration. The effect of work practices and application temperatures appears to have an impact on the ability of the engineering controls to keep exposure below the TLV for BSM. To gain a better understanding of the aerodynamic properties of asphalt fumes, particle size and airborne concentrations were also monitored using a TSI model 3320 aerodynamic particle sizer spectrometer. The geometric mean particle size was between 0.64 and 0.98 micrometers for the worker breathing zone samples, with a geometric mean of 0.73 micrometers for all sites. Total airborne concentrations were typically higher for the asphalt fume exposed groups than for the background samples. During high fume events, four 15-minute samples were taken each day. Only one 15-minute sample was above the limit of quantification. Stack flow rates were measured, and results are discussed and compared to the manufacturers' nominal values. Survey results were generally positive, with recommendations discussed for continuous improvement.

Predictors of outcome in children with hydrocarbon poisoning receiving intensive care

The retrospective study included 48 children between 8.5 months--10 years, admitted to the PICU of an urban, tertiary care, teaching hospital in northern India from January 1995 to December 2001. Eighteen (38%) patients were hypoxemic on arrival, of which 8 (45%) required mechanical ventilation. Compared to the non-hypoxemic children, the hypoxemic patients were more likely to have received gastric lavage before arrival to our center (Odds Ratio 23.2, 95% CI 2.4 - 560.7) and had higher frequency of severe respiratory distress and leucocytosis (Odds Ratio 8.0, 95% CI 1.79 -38.6). On multiple regression analysis, we could not identify any particular variable that could predict hypoxemia. Secondary pneumonia developed in 16 (33.3%), with the duration of PICU stay being longer in these patients as against those who did not (144 hours vs 72 hours, p <0.05). Two (4.2%) children died and one suffered hypoxic sequelae. Prior lavage, hypoxemia at admission, need for ventilation, secondary sepsis and ventilator related complications were associated with poor outcome.

Irritative effects of fumes and aerosols of bitumen on the airways: results of a cross-shift study

Possible health hazards of fumes and aerosols of bitumen are in discussion, and data on their adverse effects on human airways under current exposure conditions are limited. To assess the irritative effects of exposure to fumes and aerosols of bitumen on the airways, a cross-sectional cross-shift study was conducted including external and internal exposure measurements, spirometry and especially non-invasive methods like nasal lavage collection and induction of sputum in order to identify and evaluate more precisely inflammatory process in the upper and lower airways. The cross-shift study comprised 74 mastic asphalt workers who were exposed to fumes and aerosols of bitumen and 49 construction workers without this exposure as reference group. Questionnaire, spirometry, ambient monitoring and urinary analysis were performed. Humoral and cellular parameters were measured in nasal lavage fluid (NALF) and induced sputum. For data analysis, a mixed linear model was performed on the different outcomes with exposure group, time of measurement (pre-, post-shift), current smoking, German nationality and age as fixed factors and subjects as random factor. Based on personal exposure measurements during shift, mastic asphalt workers were classified into a low (< or =10 mg/m(3); n = 46) and a high (>10 mg/m(3); n = 28) exposure group. High exposure was accompanied by significant higher urinary post-shift concentrations of 1-hydroxypyrene and the sum of hydroxyphenanthrenes. Acute respiratory symptoms were reported more frequently in the high exposure group after shift. Significant cross-shift declines in lung function parameters (forced expiratory volume in 1 s [FEV(1) (% predicted)] and forced vital capacity [FVC (% predicted)]) were measured in mastic asphalt workers. Pre-shift FEV(1) (% predicted) and FVC (% predicted) were higher in the low exposure group. In pre- and post-shift NALF samples, interleukin (IL)-1beta-, IL-8- and total protein concentrations were lower in the low exposure group compared to the reference and the high exposure group. Pre- and post-shift neutrophil percentages in both nasal and sputum samples were also lower in the low exposure group. Significantly higher pre- and post-shift sputum concentrations of IL-8, IL-6, nitrogen oxide (NO) derivatives and total protein were detected especially in highly exposed workers. Irritative effects of exposure to fumes and aerosols of bitumen on the upper and lower airways were apparent, especially in mastic asphalt workers with exposure above 10 mg/m(3).

Inhalant abuse in New Zealand

AIM

To describe patterns of inhalant abuse in New Zealand and discuss management.

METHODS

Calls to the National Poisons Centre (NPC) from January 1 2003 to December 31 2004 were analysed. In addition, deaths following inhalational abuse were identified from the Institute of Environmental Science and Research Limited (ESR) database for 2001 and 2002 and available data for 2003.

RESULTS

Seventy calls were classified as relating to inhalational abuse incidents. In abusers whose age was known, 83% were between 11 and 20 years, and 61% were male. Over half (44/70) of the calls involved abuse of propane or butane, either alone or in combination with a synthetic pyrethroid. ESR coronial data identified 11 inhalant abuse related deaths, most commonly attributed to cardiac effects. 73% of deaths were in teenagers and all but one fatality involved propane and/or butane.

CONCLUSIONS

Inhalant abuse is a persisting problem in New Zealand. NPC and ESR data demonstrate that teenagers are more likely to abuse inhalants than other age groups and butane and propane are the inhalants of choice. Acute management can be difficult, with significant mortality and morbidity. Continued education and other preventive measures are essential to help curb an extremely dangerous practice.

Differential induction of micronuclei in peripheral lymphocytes and exfoliated urothelial cells of workers exposed to 4,4'-methylenebis-(2-chloroaniline) (MOCA) and bitumen fumes

Cytogenetic end-points used to estimate risk of genotoxic events in workers include the measurement of micronuclei (MN) in exfoliated cells, lymphocytes, and other tissues. Micronuclei are chromatin-containing bodies outside the cell nucleus resulting from contaminant-induced DNA damage. A review of 71 reports of human genotoxic responses to chemical or physical agents published between 1999 and 2001 revealed that 14% of such studies measured genotoxicity endpoints in specific target tissues relevant to the site of disease for the agent examined; 18% used endpoints in surrogate or non-target tissues but considered the relations between endpoints in surrogate and disease target tissues, and 68% measured genotoxicity endpoints in accessible tissues without reference to specific targets for disease. Methylenebis-(2-chloroaniline) (MOCA), used in polyurethane manufacture, is a suspected bladder carcinogen. Bitumen, used in road surfacing, contains skin and lung carcinogens. In this study, we aimed to compare genotoxicity in urothelial cells and in lymphocytes of workers exposed to these materials. Twelve men employed in polyurethane manufacture, twelve bitumen road layers, and eighteen hospital stores personnel (controls) were recruited and all provided blood and urine samples on the same day. Blood cultures were prepared using a cytochalasin B-block method. Exfoliated urothelial cells were collected from urine and stained for light microscopy. The number of MN in urothelial cells was higher in MOCA-exposed (14.27 +/- 0.56 MN/1000, 9.69 +/- 0.32 MN cells/1000) than in bitumen exposed workers (11.99 +/- 0.65 MN/1000, 8.66 +/- 0.46 MN cells/1000) or in control subjects (6.88 +/- 0.18 MN/1000, 5.17 +/- 0.11 MN cells/1000). Conversely, in lymphocytes, MN were higher in bitumen-exposed (16.24 +/- 0.63 MN/1000, 10.65 +/- 0.24 MN cells/1000) than in MOCA-exposed workers (13.25 +/- 0.48 MN/1000, 8.54 +/- 0.14 MN cells/1000) or in control subjects (9.24 +/- 0.29 MN/ 1000, 5.93 +/- 0.13 MN cells/1000). The results of this study suggest that genotoxins can cause different rates of micronuclei formation in different tissues. Thus, the sensitivity and relevance to cancer risk may be greater if the tissues selected for genotoxicity studies reflect the target tissue for the chemicals concerned.

Effect of petroleum-containing wastewater irrigation on bacterial diversities and enzymatic activities in a paddy soil irrigation area

Effects of petroleum contamination on bacterial diversities and enzymatic activities in paddy soils were investigated in the Shenfu irrigation area, the largest area irrigated by oil-containing wastewater for more than 50 yr in northeastern China. Bacterial diversities were determined by conventional colony morphology typing techniques and 16S rDNA polymerase chain reaction (PCR)-denaturing gradient gel electrophoresis (DGGE). Dehydrogenase, hydrogen peroxidase, polyphenol oxidase, urease, and substrate-induced respiration (SIR) were measured to evaluate the effects of petroleum-containing wastewater irrigation on soil biochemical characteristics. Results showed that paddy soil total petroleum hydrocarbon (TPH) concentration in the irrigation area varied from 277.11 to 5213.37 mg kg(-1) dry soil. Soil TPH concentration declined along the gradient of the irrigation channel from up- to downstream. At the current pollution level, the paddy soil TPH concentration was positively correlated with the colony forming units (CFU) of aerobic heterotrophic bacteria (AHB) (r = 0.928, p < 0.001) and the genetic diversity based on DGGE profiles (r = 0.655, p < 0.05). The bacterial diversities in the soils based on colony morphotypes of AHB also increased with TPH concentration (r = 0.598), but not significant statistically (p = 0.052). Analysis of soil enzyme activities indicated a significant positive correlation between soil TPH concentration and activities of dehydrogenases (r = 0.974, p < 0.001), hydrogen peroxidases (r = 0.957, p < 0.001), polyphenol oxidases (r = 0.886, p < 0.001), and SIR (r = 0.916, p < 0.001). On the contrary, the urease activity showed a negative correlation with paddy soil TPH concentration (r = -0.814, p = 0.002), and could be used as a sensitive indicator of petroleum contamination.

Benthic diatom community response to environmental variables and metal concentrations in a contaminated bay adjacent to Casey Station, Antarctica

This study examined the effects of anthropogenic contaminants and environmental variables on the composition of benthic diatom communities within a contaminated bay adjacent to an abandoned waste disposal site in Antarctica. The combination of geographical, environmental and chemical data included in the study explained all of the variation observed within the diatom communities. The chemical data, particularly metal concentrations, explained 45.9% of variation in the diatom communities, once the effects of grain-size and spatial structure had been excluded. Of the metals, tin explained the greatest proportion of variation in the diatom communities (28%). Tin was very highly correlated (R2>0.95) with several other variables (copper, iron, lead, and sum of metals), all of which explained similarly high proportions of total variation. Grain-size data explained 23% of variation once the effects of spatial structure and the chemical data had been excluded. The pure spatial component explained only 1.8% of the total variance. The study demonstrates that much of the compositional variability observed in the bay can be explained by concentrations of metal contaminants.

Constraints on spatial variability in soft-sediment communities affected by contamination from an Antarctic waste disposal site

A small-scale (<500 m length) transect-based survey was conducted in December 1998 to examine the spatial distribution of soft-sediment communities and of concentrations of heavy metals and hydrocarbons in sediments in Brown Bay, adjacent to an abandoned waste dump, at Casey Station, Antarctica. Samples were taken along three transects at increasing distances (nine stations) from the shore-line waste dump. A gradient of contamination was detected, but concentrations of contaminants were very variable with "hotspots" or high levels of contaminants at some stations. Multivariate analysis revealed that the distribution of soft-sediment communities was distinctly different between the inner, middle and outer stations. Abundances of most taxa were very variable with few patterns apparent, but some fauna displayed an abundance gradient from the inner to the outer part of the bay. Many taxa had maximum abundances at outer stations and minimum at inner stations. Multivariate correlations between environmental variables and soft-sediment communities indicated that combinations of some metals (Cd, Cu, Sn, Pb) and grain size (mainly finer fractions, fine sands and coarse silts) were the variables that best "matched" the community patterns within Brown Bay. This study indicated that there were significant correlations between the presence of contaminants and the distribution and composition of soft-sediment communities over very small spatial scales.

Pneumonitis and pneumatoceles following accidental hydrocarbon aspiration in children

Accidental ingestion and aspiration of hydrocarbons in children are common. Among the various clinical and pathological manifestations of hydrocarbon (HC) poisoning, pneumonitis is the most significant and occurs in up to 40% of children, whereas formation of pneumatoceles is believed to be a rare event. We report two children with HC pneumonitis and pneumatoceles as a reversible complication after ingestion and aspiration of lamp oil with very low viscosity. Patient 1, a 21-month-old boy, started to cough and developed tachypnea, sternal retractions and mild cyanosis immediately after aspiration. Patient 2, a 24-month-old girl, was asymptomatic during the first days after the accident; subsequently, she started to cough and developed fever, dyspnea and chest pain. Chest x-ray and computed tomography revealed multiple patchy infiltrates in both cases; after several days, these confluent infiltrates developed into pneumatoceles. Both children were treated with antibiotics and steroids. They recovered within three and four weeks, respectively, with complete remission of the radiologic abnormalities and had an uneventful follow-up after discharge.

Effect of the Prestige oil spill on salt marsh soils on the coast of Galicia (northwestern Spain)

At four estuarine sites on the coast of Galicia (northwestern Spain), all of which were affected by the Prestige oil spill, soil samples were taken from polluted and unpolluted areas and their petroleum hydrocarbon contents, heavy metal contents, and other chemical and physical characteristics were measured. Oil pollution altered both chemical and physical soil properties, aggregating soil particles in plaques, lowering porosity, and increasing resistance to penetration and hydrophobicity. The chromium, nickel, copper, iron, lead, and vanadium contents of polluted soils were between 2 and 2500 times higher than those of their unpolluted counterparts and the background concentrations in Galician coastal sediments. In the cases of Cr, Cu, Ni, Pb, and V, their origin in the polluting oil was corroborated by the high correlation (r >/= 0.74) between the concentrations of these metals and the total petroleum hydrocarbon (TPH) content of the polluted soils. Soil redox potentials ranged from -19 to -114 mV in polluted soils and 112 to 164 mV in unpolluted soils, and were negatively correlated with TPH content (p < 0.01). The low values in the polluted soils explain why the soluble fractions of their total heavy metal contents were very small (generally less than 3%, and in many cases undetectable).

Quantitative risk assessment for lung cancer after exposure to bitumen fume

An international cohort of asphalt workers was assembled to study cancer risk after bitumen exposure. This article describes the combination of the exposure assessment with the exposure-response for a quantitative risk assessment for lung cancer mortality within the Dutch component of the study. We identified a retrospective cohort of 3,709 workers with at least one season of employment. Semi-quantitative exposure to bitumen fume was estimated by a job-exposure matrix. Exposure-response relations were fitted by Poisson regression, and excess lifetime risks through age 75 were calculated by a life table method. Working lifetime cumulative exposure to bitumen fume was calculated under different scenarios, representing past and future exposures. For workers with exposures accumulated in the past, excess risks for lung cancer varied from 7.8 to 14.3%. Calculations for future exposures resulted in considerably lower excess risks ranging from 0.6 to 2.6%. The calculated excess risks for lung cancer mortality after working lifetime exposure to bitumen fume depend strongly on when exposure was experienced and to some extent on the exposure-response model chosen, while confounding by smoking cannot be ruled out. Nevertheless, the excess lifetime risk for lung cancer in this Dutch cohort of asphalt workers is above benchmark risks as applied by the Dutch Health Council. Current exposure levels have decreased this risk considerably, but further exposure control may be required.

Immunological and hematological effects observed in B6C3F1 mice exposed to JP-8 jet fuel for 14 days

JP-8 is the primary jet fuel used by the U.S. Air Force and NATO allies. Exposure is likely to be widespread and to include both military and aviation industry personnel as well as residents living near fuel contaminated sites. This study examines the effects of JP-8 on humoral and cell-mediated and hematological parameters. A suite of immunotoxicological endpoints was evaluated in adult female B6C3F1 mice gavaged with JP-8 (in an olive oil carrier) ranging from 250-2500 mg/kg/d for 14 d. One day following the last exposure, significant increases in liver mass were detected beginning at exposure levels of 1000 mg/kg/d, while thymic mass was decreased at exposure levels of 1500 mg/kg/d and above. Decreases in thymic cellularity, however, were only observed at exposure levels of 2000 mg/kg/d and above. Mean corpuscular volume was increased (1500-2500 mg/kg/d), while the hematocrit, hemoglobin concentration, and red blood cell count were decreased only at the 2500 mg/kg/d exposure level. Natural killer cell (NK) activity and T- and B-cell proliferation were not altered. Decreases in the plaque-forming cell (PFC) response were dose responsive at levels of 500 mg/kg/d and greater, while unexpectedly, serum levels of anti-SRBC immunoglobulin M (IgM) were not altered. Alterations were detected in thymic and splenic CD4/8 subpopulations, and proliferative responses of bone marrow progenitor cells were enhanced in mice exposed to 2000 mg/kg/d of JP-8. This study establishes that humoral immune function is impaired with lower exposure levels of JP-8 than are required to affect primary and secondary immune organ weights and cellularities, CD4/8 subpopulations, and hematological endpoints.

Restoration of oiled mussel beds in Prince William Sound, Alaska

Natural loss of hydrocarbons was often low from mussel (Mytilus trossulus) beds (which were typically not cleaned after the Exxon Valdez oil spill), thus this habitat remained a long-term source of oil. Consequently, experimental restoration of nine contaminated beds was attempted in 1994; mussels were removed, contaminated surface sediment was replaced (33 metric tons), and original mussels were returned. Hydrocarbon concentrations and mussel populations were monitored for 5 years thereafter. Post-restoration mussel population fluctuations were indistinguishable from regional changes. Increased short-term oil loss was apparent, but long-term (5 year) improvement was equivocal and difficult to distinguish from natural losses. By 1999, oil concentrations in mussels were typically at baseline levels in restored and oiled reference beds; concentrations in replaced sediment were elevated in one third of restored beds, indicating recontamination from underlying or surrounding sediment. Our results suggest mussel relocation is feasible but suggest oil might more effectively be removed from sediment mechanically or chemically than manually.

Hepatic CYP1A levels and EROD activity in English sole: biomonitoring of marine contaminants in Vancouver Harbour

To assess chemical contaminant stress in the marine environment, ethoxyresorufin-O-deethylase (EROD) activity and cytochrome P450 1A (CYP1A) expression were measured in 88 English Sole (Pleuronectes vetulus) collected during May and June 1999 from four sites in Vancouver Harbour and at an expected reference site outside the harbour. Hepatic microsomes were prepared from the fish and analyzed for total CYP content, EROD activity, and CYP1A protein levels. Hepatic EROD activity and CYP1A protein levels were elevated in fish from two sites in the inner harbour. A comparison with sediment chemistry data showed that fish with increased EROD activity and CYP1A levels came from sites containing relatively high levels of polycyclic aromatic hydrocarbons and polychlorinated biphenyls. Unexpectedly high levels of EROD activity and CYP1A protein were also found in fish from a reference site near Gibsons, in Howe Sound. The elevated EROD activity and CYP1A expression in fish from this site cannot be explained by the chemical analysis data collected.

Introduction to the PICES practical workshop: objectives, overview of the study area, and projects conducted by the participants

We coordinated a collaborative research project to investigate environmental conditions in Vancouver Harbour, British Columbia, Canada, between 23 May and 7 June 1999. This special volume of Marine Environmental Research presents a collection of papers giving results of these studies. The project was part of a practical workshop sponsored by the Marine Environmental Quality (MEQ) committee of the North Pacific Marine Science Organization (PICES). Twenty-four scientists from PICES countries (USA, Canada, Russia, Japan, Korea, and China) participated. A wide variety of data was collected, including community structure of benthic invertebrates and fish, evaluation of fish health using biological markers and exposure data, evaluation of contaminant exposure in inter-tidal invertebrates, imposex in gastropods, and information about natural toxins produced by algae. The workshop provided an opportunity for PICES participants to gain an improved appreciation of the approaches and techniques used by other member countries to assess the effects of marine pollution. The purpose of this introductory paper is to briefly describe the project, provide background information on how it was organized, and give an overview of our knowledge about the harbour's environment.

Persistent organic pollutants and histological lesions in Mayan catfish Ariopsis assimilis from the Bay of Chetumal, Mexico

Livers of catfish (Ariopsis assimilis) from the Bay of Chetumal were analyzed for organochlorine compounds and hydrocarbons as part of a study to diagnose the environmental health of the Bay after a catfish mass mortality that occurred in 1996. The presence of histological lesions in several organs of the fish as result of chemical exposure was also evaluated. The concentrations of organic pollutants found in the Bay may be considered high if compared to the levels reported for sites affected by chemical pollution. High prevalences of cellular alteration histopathologies were found in liver, including hepatic tumors. The presence of some lesions may be related statistically to environmental pollution in the Bay, specially with chlorinated compounds.

Indirect effects of contaminants in aquatic ecosystems

Contaminants such as petroleum hydrocarbons, heavy metals and pesticides can cause direct toxic effects when released into aquatic environments. Sensitive species may be impaired by sublethal effects or decimated by lethality, and this ecological alteration may initiate a trophic cascade or a release from competition that secondarily leads to responses in tolerant species. Contaminants may exert direct effects on keystone facilitator and foundation species, and contaminant-induced changes in nutrient and oxygen dynamics may alter ecosystem function. Thus, populations and communities in nature may be directly and/or indirectly affected by exposure to pollutants. While the direct effects of toxicants usually reduce organism abundance, indirect effects may lead to increased or decreased abundance. Here we review 150 papers that reference indirect toxicant effects in aquatic environments. Studies of accidental contaminant release, chronic contamination and experimental manipulations have identified indirect contaminant effects in pelagic and benthic communities caused by many types of pollutants. Contaminant-induced changes in behavior, competition and predation/grazing rate can alter species abundances or community composition, and enhance, mask or spuriously indicate direct contaminant effects. Trophic cascades were found in 60% of the manipulative studies and, most commonly, primary producers increased in abundance when grazers were selectively eliminated by contaminants. Competitive release may also be common, but is difficult to distinguish from trophic cascades because few experiments are designed to isolate the mechanism(s) causing indirect effects. Indirect contaminant effects may have profound implications in environments with strong trophic cascades such as the freshwater pelagic. In spite of their undesirable environmental influence, contaminants can be useful manipulative tools for the study of trophic and competitive interactions in natural communities.

Hydrocarbon poisoning in children: a 5-year retrospective study

OBJECTIVE

To investigate the demographics, incidence, and symptoms and signs of hydrocarbon poisoning in admitted children from the Negev Desert area of Israel.

METHODS

The medical records of all children admitted for hydrocarbon poisoning from 1995 to 1999 were reviewed retrospectively.

RESULTS

Of the 274 admitted children, 61% were boys and 39% were girls, with ages ranging from 6 months to 18 years (median, 1.58 years). Ninety-four percent of the patients were Moslem Arab Bedouins, and 6% were Jews. The largest group of patients (106) was admitted during the summer months (P < .003). Also, more patients were admitted in spring (63) and autumn (67) than in winter (38) (P < .013). Thirty-two percent of the cases were seen in the Pediatrics Ambulatory Unit and then discharged, while 68% were hospitalized. The most commonly observed symptoms were tachypnea (73.7%), fever (63.5%), vomiting (51.1%), and cough (38.0%). About one third of the patients showed signs of central nervous system (CNS) impairment, including drowsiness, restlessness, stupor, and convulsions. These symptoms were significantly correlated with pneumonia, hypoxemia, and fever (P < .001). Of 274 patients, 43% (118 children) had pneumonia--usually interstitial pneumonitis (90%). Vomiting was significantly correlated with pneumonia (P < .05).

CONCLUSIONS

1) There is a higher risk of hydrocarbon poisoning during the hot months of the year; 2) the respiratory system is the main target organ affected; 3) pneumonia is in most cases interstitial and bilateral; 4) vomiting after hydrocarbon ingestion is related to the rate of development of pneumonia; 5) symptoms of CNS impairment were correlated with hypoxemia, pneumonia, and fever; and 6) CNS toxicity may occur without hypoxemia, concurrent pulmonary pathology, or other pathology.

[Severe acute White-Spirit poisoning with pulmonary hypertension]

The Authors report a case of acute White-Spirit poisoning with pulmonary hypertension associated to respiratory distress syndrome.

CASE REPORT

A 14-month-old infant drank an unknown quantity of White-Spirit while his parents were painting. After he spontaneously vomited, he presented a seizure at the emergency department. After a 36 h stay in Pediatric Intensive Care Unit (PICU), acute lung injury required mechanical ventilation and vasoactive support. Cardiac ultrasounds showed pulmonary hypertension, which rapidly resolved with inhaled nitric oxide. The child was discharged of PICU after five days. Respiratory follow-up two months after poisoning was normal.

CONCLUSION

Pulmonary hypertension should be checked for in case of White-Spirit ingestion complicated with severe acute lung injury.

Water pollution and habitat degradation in the Gulf of Thailand

The Gulf of Thailand has been a major marine resource for Thai people for a long time. However, recent industrialization and community development have exerted considerable stress on the marine environments and provoked habitat degradation. The following pollution problems in the Gulf have been prioritized and are discussed in details: (1) Untreated municipal and industrial waste water are considered to be the most serious problems of the country due to limited waste water treatment facilities in the area. (2) Eutrophication is an emerging problem in the gulf of Thailand. Fortunately, the major species of phytoplankton that have been reported as the cause of red tide phenomena were non-toxic species such as Noctiluca sp. and Trichodesmium sp. (3) Few problems have been documented from trace metals contamination in the Gulf of Thailand and public health threat from seafood contamination does not appear to be significant yet. (4) Petroleum hydrocarbon residue contamination is not a problem, although a few spills from small oil tankers have been recorded. A rapid decrease in mangrove forest, coral reefs, and fisheries resources due to mismanagement is also discussed.

Generic scenario for the impact of cooling lubricants into the hydrosphere

According to directive 93/67/EEC of the European Commission, this paper deals with the generic exposition evaluation of the environmental concentration of cooling Lubricant chemicals from the metal working industry into the hydrosphere. After considering the relevant life-cycle steps and the selection of a representative point source for the 'reasonable worst case', the emission per day Elocal(water) is determined. It leads to the predicted environmental concentration (PEClocal(water)) for the local stage in the compartment water. In order to gain the PEClocal(water) for an example--a corrosion inhibitor as additive in a cooling lubricant--, the relevant emission paths and the corresponding representative point source are described for the reasonable worst case. For non-water-miscible cooling lubricants, none of the operations in the life cycle leads to a release into the compartment water. To evaluate the hazard potential for cooling lubricant chemicals, the complete risk assessment has to be done. Also, the assessment has to be done for all high production volume chemicals, new substances and existing hazard chemicals. This means that even industrial categories like chemicals used in the textile industry or biocides and others have to be evaluated.

The spectrum of accidental childhood poisoning in the Caribbean

OBJECTIVE

To assess accidental poisoning in children in the Caribbean country of Antigua and Barbuda, including the incidence, the types of substances ingested, the age of the children involved, and the clinical outcomes. The results from Antigua and Barbuda were compared with the results of other reports from the English-speaking Caribbean and from the United States of America.

DESIGN AND METHODS

We performed a retrospective review of the charts of all patients less than 13 years old admitted to the Children's Ward at Holberton Hospital in Antigua for accidental poisoning between March 1989 and March 1999. Those data were compared with data from earlier reports from Barbados, Guyana, Jamaica, and the United States of America.

RESULTS

In Antigua and Barbuda there were 255 hospital admissions for accidental poisoning among children below 13 years old over that 10-year period. Of the 255 ingestions, 115 of them (45%) were in 1-year-old children, 69 (27%) were in 2-year-old children, and 26 (10%) were in 3-year-old children. These proportions in Antigua and Barbuda are similar to the age patterns seen in the other countries with which we made comparisons. In Antigua and Barbuda there was an annual average of 26 hospital admissions for poisoning for the roughly 20,000 children below 13 years of age, for a rate of 1.3 per 1,000. In comparing the patterns of childhood poisoning in all the countries we studied, we found that, as economic levels rose, there was a shift in the substances ingested, with hydrocarbon and plant ingestions decreasing and chemical and medication ingestions increasing.

CONCLUSIONS

There is an increasing variety and complexity of poisonous substances ingested as economic conditions improve. This trend would make the establishment of a poison control center for the English-speaking Caribbean a logical step.

Soft tissue injection of hydrocarbons: a case report and review of the literature

Hydrocarbon injection, while commonly seen in domestic accidents or attempted suicide, is not extensively addressed in the literature. This article comprises a review of the various complications of intravascular and soft tissue injection of petroleum distillates, and provides recommendations for patient management. An illustrative case involving the subcutaneous injection of dripless oil, a mixture of mineral oil, nonionic detergents, and petroleum naphtha, is presented.

Abnormal liver function tests following inadvertent inhalation of volatile hydrocarbons

The use of aerosols containing volatile hydrocarbons in conditions of poor ventilation can result in accidental overexposure which can cause central nervous system effects and hepatic injury. We present a case in which inadvertent usage of an adhesive spray used to make greeting cards resulted in vague neurological symptoms and abnormal liver function tests both of which fully resolved on discontinuation.

[Characteristics of affect in chronic intoxication by non-symmetrical dimethylhydrazine, hydrocarbons and nitroglycols]

The authors analyze emotional features in workers with occupational exposure to hydrazines, hydrocarbons and nitroglycols. Chronic occupational poisoning with those chemicals induce numerous emotional symptoms that are specific and varying in severity. The materials presented by authors could be interesting for occupational therapist, internist and psychiatrist for early diagnosis of chronic occupational intoxications, treatment of emotional disorders in workers and better occupational safety.

Myocardial infarction after toluene inhalation

Hydrocarbon exposure occurs through both intentional and nonintentional substance abuse. We present the case of a young male who sustained an acute myocardial infarction temporally related to inhalation of toluene fumes. We propose possible mechanisms for this rare but serious complication of hydrocarbon inhalation and review the literature.

Artificial surfactant for therapy in hydrocarbon-induced lung injury in sheep

OBJECTIVE

To document the effect of administering artificial surfactant into the trachea, either by instillation or aerosolization, on acute lung injury experimentally induced with kerosene in sheep.

DESIGN

Randomized, prospective, controlled study.

SETTING

Research laboratory.

SUBJECTS

Sheep (n = 24), weighing 8.5 to 25.2 kg (average 16.6).

INTERVENTIONS

In anesthetized, tracheally intubated sheep with pulmonary and femoral artery catheters inserted, lung injury was induced by instilling kerosene (0.3 mL/kg) into the trachea. After 15 mins of spontaneous breathing, mechanical ventilation was instituted with a uniform F10(2) and a tidal volume of 10 mL/kg. Sheep were then assigned randomly to one of four regimens as follows: exogenous surfactant or saline (5 mL/kg each) was administered as a bolus intratracheally or by aerosolization for 6 hrs.

MEASUREMENTS AND MAIN RESULTS

Arterial and mixed venous blood gases, pH, airway pressure, and static respiratory system compliance were measured and compared between aerosol saline and aerosol surfactant and between bolus saline and bolus surfactant. For all variables except static respiratory system compliance, the hourly rate of change from 15 mins, 1 hr, and 6 hrs after kerosene instillation was determined for each animal, and group rank sums of hourly rates of change were compared. For static respiratory system compliance, the slope of the pressure-volume curve with volumes of 100, 200, 300, 400, and 500 mL was computed for each animal at baseline and at 3 and 6 hrs after kerosene instillation. Group rank sums for static respiratory system compliance at 3 and 6 hrs were compared. Also, the 3- and 6-hr static respiratory system compliance values at each of the volumes were compared. With saline, six of eight sheep died; with surfactant, no sheep died (p = .001). When compared with saline at 15 mins, 1 hr, and 6 hrs after kerosene instillation, surfactant, regardless of whether administered by aerosol or bolus, significantly increased rate of change of arterial oxygen saturation, mixed venous oxygen saturation, and PO2.

CONCLUSIONS

In the present animal study, artificial surfactant was an effective treatment for hydrocarbon aspiration. Aerosolized surfactant achieved results similar to instilled surfactant but at a lower total dose.

The impact of the 1993 Braer oil spill on grey seals in Shetland

Signs of acute respiratory distress were reported in moulting grey seals (Halichoerus grypus) hauled out on Lady's Holm, Shetland, following the Braer oil spill in January, 1993. Behavioural observations carried out between 16 January and 13 February 1993 showed that the proportion of animals exhibiting a discharge of nasal mucus was significantly higher than the proportion at a control site in the north (Papa Stour). The proportion of animals affected on Lady's Holm increased for up to one month following the spill. However, the time lag between exposure and peak response was approximately 30 days, longer than may be expected for an acute effect. The proportion of non-specific signs of respiratory distress in unexposed Shetland seals was assessed from observations made between 16 January and 25 January 1994. Symptoms similar to those seen in 1993 were also reported during this period, but the proportion of affected animals was higher in 1993. Symptoms were not observed at a grey seal moult site on the east coast of England in March 1993 and 1994. Grey seals moulting in Shetland during the time of the oil spill may have been acutely affected by exposure to hydrocarbons, but without sufficient baseline data on the occurrence of respiratory distress in grey seals it is difficult to determine the proportion attributable to other causes.

Retrospective benzene and total hydrocarbon exposure assessment for a petroleum marketing and distribution worker epidemiology study

A quantitative exposure-estimating algorithm for benzene and total hydrocarbons was developed for a case control study of petroleum marketing and distribution workers. The algorithm used a multiplicative model to adjust recently measured quantitative exposure data to past scenarios for which representative exposure measurement data did not exist. This was accomplished through the development of exposure modifiers to account for differences in the workplace, the materials handled, the environmental conditions, and the tasks performed. Values for exposure modifiers were obtained empirically and through physical/chemical relationships. Dates for changes that altered exposure potential were obtained from archive records, retired employee interviews, and from current operations personnel. Exposure modifiers were used multiplicatively, adjusting available measured data to represent the relevant exposure scenario and time period. Changes in exposure modifiers translated to step changes in exposure estimates. Though limited by availability of data, a validation exercise suggested that the algorithm provided accurate exposure estimates for benzene (compared with measured data in industrial hygiene survey reports); the estimates generally differed by an average of less than 20% from the measured values. This approach is proposed to quantify exposures retrospectively where there are sufficient data to develop reliable current era estimates and where a historical accounting of key exposure modifiers can be developed, but where there are insufficient historic exposure measurements to directly assess historic exposures.

Toxicopathology of oilfield poisoning in cattle: a review

The toxicologic pathology of petroleum and oilfield-related chemicals is reviewed, and a field guide for toxicopathologic evaluation of cattle is given. Cattle will voluntarily ingest petroleum and chemicals used in the exploration, production and transportation of crude petroleum. Variability in chemical composition of petroleum from different fields will alter the type and severity of lesions observed. When airborne pollutants are present, cattle are continually exposed and make excellent sentinel animals. The lung, kidney, liver, gastrointestinal tract, heart and brain are target organs for petroleum hydrocarbons. Exposure to elemental sulfur can produce pulmonary pathology. Sulfur-containing gases are irritating to the mucosa of the eye and respiratory tract. Arsenic and lead cause lesions in the gastrointestinal tract, brain, liver and kidney. Glycols are hepato-, nephro- and neurotoxic, and oral exposure to diethylene glycol produces corneal lesions. Invert drilling fluids are fetotoxic. Nonpesticide organophosphate esters target the peripheral and central nervous systems. Toxicopathy is a strategic tool in the diagnosis of intoxications occurring in cattle after exposure to oilfield chemicals. Cattle are sensitive to oilfield pollutants and are a useful biomonitoring species.

Risks of extracorporeal membrane oxygenation: is there a role for use in the management of the acutely poisoned patient?

OBJECTIVE

To review the use of extracorporeal membrane oxygenation in the support of poisoned patients and provide a basis for comparison to other methods of respiratory support for these patients.

METHODS

The medical literature was reviewed and selected cases of poisoning supported by extracorporeal membrane oxygenation and mechanical ventilation highlighted. Data from published outcome studies were reviewed. All cases found were included in the database. Case experiences were critiqued based on available clinical literature. Outcome studies were critiqued with respect to relevancy and bias. Many cases do not provide strong evidence of direct patient benefit. There are no data to support an improvement in outcome among poisoned patients.

CONCLUSION

The use of extracorporeal membrane oxygenation for respiratory failure following ingestion has the same limited indications as for other patients with respiratory failure. Data supporting an improvement in outcome are not available. Extracorporeal membrane oxygenation support for reversible cardiac toxicity has a sound basis but clinical experience is limited. Good supportive care for the poisoned patient is essential before considering extracorporeal membrane oxygenation.