Gingiva squamous-cell carcinoma in a non-smoking patient with occupational exposure to solvent siphoning using mouth: case report and literature review

Background

While overall head and neck cancer incidence decreases due to reduced tobacco and alcohol consumption, the incidence of HPV negative oral cavity squamous cell carcinoma (SCC) is raising in several industrialized countries, especially in non-smoking and non-drinking patients.

Case presentation

We document a case of gingiva SCC in a 56 years old never-smoker patient reporting low alcohol consumption and unusual occupational solvent exposure. The HPV-negative lesion was surgically removed in 2018, and the patient remains in complete remission 4 years after recurrent surgery in 2019. In 2021, the patient was referred to the occupational cancer consultation. The patient worked as screen printer for 18 years. He reported mouth siphoning every 2-3 days to transfer organic solvents (mainly aromatic hydrocarbons and ketones) from containers into smaller recipients, with regular passage of solvents into his mouth.

Conclusion

According to the literature, the frequency of solvent siphoning using mouth is likely to be underestimated. While our review did not find studies reporting longterm consequences to the oral cavity of mouth siphoning, current evidence supports a positive association of upper aero digestive tract SCC with occupational exposures to organic solvents and printing processes. In absence of major extraprofessional factors, the HPV-negative gingiva SCC of this patient might be attributable to the regular occupational oral solvent exposure. While the available evidence remains limited to formally establish a causal relationship, clinicians should investigate this hazardous work practice in patients with OSCC and history of solvent exposures.

Solvent-Induced Raynaud's Phenomenon

Raynaud's phenomenon (RP) is a vasospastic disorder characterized by an exaggerated vasoconstrictive response to cold or emotional stress. It can be classified as primary (PRP) or secondary (SRP) depending on its association with an underlying condition. We present a case of a young female with severe RP, with trophic changes and abnormal capillaroscopy. After a detailed investigation, a diagnosis of secondary RP due to solvent exposure was made. The patient was treated with calcium channel blocker in low doses, due to hypotension, without improvement of symptoms. Vitamin C and pentoxifylline were added with an unsatisfactory response. Given the progressive worsening of RP and the appearance of trophic lesions, the patient's treatment was reviewed, and continuous intravenous iloprost infusion through an elastomeric pump was started. This resulted in significant symptom improvement and normalization on the capillaroscopic examination.

Activation Mechanism of RhoA Caused by Constitutively Activating Mutations G14V and Q63L

RhoA, a member of Rho GTPases, regulates myriad cellular processes. Abnormal expression of RhoA has been implicated in various diseases, including cancers, developmental disorders and bacterial infections. RhoA mutations G14V and Q63L have been reported to constitutively activate RhoA. To figure out the mechanisms, in total, 1.8 μs molecular dynamics (MD) simulations were performed here on RhoA^WT and mutants G14V and Q63L in GTP-bound forms, followed by dynamic analysis. Both mutations were found to affect the conformational dynamics of RhoA switch regions, especially switch I, shifting the whole ensemble from the wild type's open inactive state to different active-like states, where T37 and Mg²⁺ played important roles. In RhoA^G14V, both switches underwent thorough state transition, whereas in RhoA^Q63L, only switch I was sustained in a much more closed conformation with additional hydrophobic interactions introduced by L63. Moreover, significantly decreased solvent exposure of the GTP-binding site was observed in both mutants with the surrounding hydrophobic regions expanded, which furnished access to water molecules required for hydrolysis more difficult and thereby impaired GTP hydrolysis. These structural and dynamic differences first suggested the potential activation mechanism of RhoA^G14V and RhoA^Q63L. Together, our findings complemented the understanding of RhoA activation at the atomic level and can be utilized in the development of novel therapies for RhoA-related diseases.

Can scleroderma be induced by anesthetics? Case report

Occupational exposure to solvents is consistently associated with the risk of systemic sclerosis. We pose the question of whether the occupational exposure to anesthetics may favor the occurrence of this disease. This paper describes an incidence of systemic sclerosis in the case of an anesthesiologist who had been occupationally exposed to high doses of anesthetic in the operating room. Anecdotal cases in the literature give limited support to the causal association of the occupational exposure to anesthetics and systemic sclerosis. The extremely limited number of workers exposed makes it necessary to report all cases observed in order to assess the degree of the occupational risk for anesthesiologists. Med Pr 2016;67(4):557-560.

Exposure Characteristics of Construction Painters to Organic Solvents

Background

Construction painters have not been studied well in terms of their hazards exposure. The objective of this study was to evaluate the exposure levels of total volatile organic compounds (TVOCs) for painters in the construction industry.

Methods

Activity-specific personal air samplings were carried out in three waterproofing activities [polyurethane (PU), asphalt, and cement mortar] and three painting activities (epoxy, oil based, and water based) by using organic-vapor-monitor passive-sampling devices. Gas chromatograph with flame ionization detector could be used for identifying and quantifying individual organic chemicals. The levels of TVOCs, by summing up 15 targeted substances, were expressed in exposure-index (EI) values.

Results

As arithmetic means in the order of concentration levels, the EIs of TVOCs in waterproofing works were 10.77, 2.42, 1.78, 1.68, 0.47, 0.07, and none detected (ND) for indoor PU-primer task, outdoor PU-primer task, outdoor PU-resin task, indoor PU-resin task, asphalt-primer task, asphalt-adhesive task, and cement-mortar task, respectively. The highest EI for painting works was 5.61 for indoor epoxy-primer task, followed by indoor epoxy-resin task (2.03), outdoor oil-based-spray-paint task (1.65), outdoor water-based-paint task (0.66), and indoor oil-based-paint task (0.15). Assuming that the operations were carried out continuously for 8 hours without breaks and by using the arithmetic means of EIs for each of the 12 tasks in this study, 58.3% (7 out of 12) exceeded the exposure limit of 100% (EI > 1.0), while 8.3% (1 out of 12) was in 50–100% of exposure limit (0.5 > EI > 1.0), and 4 tasks out of 12 were located in less than 50% of the limit range (EI < 0.5).

Conclusion

From this study, we recognized that construction painters are exposed to various solvents, including carcinogens and reproductive toxins, and the levels of TVOC concentration in many of the painting tasks exceeded the exposure limits. Construction workers need to be protected from chemical agents during their painting works by using personal protective devices and/or work practice measures. Additional studies should focus on the exposure assessment of other hazards for construction workers, in order to identify high-risk tasks and to improve hazardous work environments.

Neurotoxicity of solvents

Worldwide, several hundred million tons of organic solvents are used annually in household, industry, and other occupational settings. Millions of workers are regularly exposed to organic solvents considered neurotoxic. Acute neurotoxicity due to high exposure of solvent is usually evident, but the nature of long-term effects, such as chronic solvent encephalopathy (CSE), has raised uncertainty even among experts. Earlier studies were criticized for their methodology, mainly epidemiologic studies or investigations of exposed groups with many possible confounders and inadequate exposure assessment. However, an increasing number of studies have been performed since, also on workers with defined CSE based on differential diagnostics. During the last decade, evidence has emerged to enable identification of CSE, a necessity for the early recognition and prevention of progression of dysfunction and disability. Selected chemicals are presented here due to their widespread use, neurotoxic potential, and ability to cause solvent encephalopathy. Constant introduction of new chemicals may introduce new hazardous chemicals or known chemicals may reveal new health effects. It is important to keep an open mind for new findings of solvent-related neurobehavioral effects.

Occupational solvent exposure and brain function: an fMRI study

BACKGROUND

Deficits in cognitive function have been demonstrated among workers chronically exposed to solvents, but the neural basis for these deficits has not been shown.

OBJECTIVES

We used functional magnetic resonance imaging (fMRI) to compare pathophysiological changes in brain function between solvent-exposed and control workers.

METHODS

Painters, drywall tapers, and carpenters were recruited from the International Union of Painters and Allied Trades, District Council 9 in New York City and District Council 21 in Philadelphia, Pennsylvania, and from the Carpenters Union in New Jersey. Twenty-seven solvent-exposed and 27 control subjects of similar age, education, and occupational status completed the N-Back working memory test during fMRI. After controlling for confounders (age; lifetime marijuana, cocaine, and alcohol use; blood lead; symptoms of depression; verbal intelligence), voxelwise group analysis and regional activation levels were compared and then correlated with an index of lifetime solvent exposure.

RESULTS

Solvent-exposed workers' performance on the N-Back was significantly worse than that of controls. Activation of the anterior cingulate, prefrontal, and parietal cortices--areas serving working memory function and attention--was also significantly lower for solvent-exposed workers relative to controls. After controlling for confounders, we observed a negative correlation between lifetime solvent exposure and activation in these same regions among the solvent-exposed workers.

CONCLUSIONS

This study is one of the few to document neural structures affected by exposure to solvents. Our findings provide a biological mechanism for the neurobehavioral deficits in working memory and attention that have previously been reported by other groups studying the effects of chronic exposure to solvents. These imaging markers, which are consistent with the neurobehavioral measures in our subject population, are consistent with altered brain pathology caused by prolonged exposure to solvent mixtures during construction work.