[Sick leave--rehabilitation--pension. A quality problem?].
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Biomedical subjects
Publications and source records attributed to A Askergren.
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The machining of cast concrete often produces heavy exposure to respirable silica dust. Work with concrete in general results in considerably less exposure, however, and only a few cases of silicosis due to work with concrete have been reported. Telephone interviews with detailed questions on occupational history were made with 271 construction workers specializing in concrete work for more than 20 years, and exposure data were evaluated for different work tasks. The mean cumulative exposure of subjects to silica was estimated to be 2.4 mg.years.m-3. Chest radiographs were classified according to the International Labour Office classification. There was no suspicion of silicosis for any of the workers. The risk of contracting silicosis from work with concrete in the Swedish construction industry in recent decades is considered to be slight and does not justify general, periodic chest radiographic screening.
The final facts, necessary to establish a certain association between light to moderate organic solvent exposure and kidney disease, have not yet been presented. The methodologic difficulties and flaws from which most of the studies suffer contribute to this situation. On the other hand the results certainly do not exclude the possibility of such an association. The mechanisms behind HC causing renal disease are obscure. A direct toxic effect does not seem probable considering the frequent exposure to HC in modern society and the fairly low incidence of this disease. The possibility of the solvents initiating, mediating or in some other way taking part in immunologic reactions appears more attractive. The general impression after reviewing the presented investigations is, that the possibility of a causal association between moderate hydrocarbon exposure and renal disease must be considered substantial. The indications are strong enough to state that individuals with signs of renal dysfunction or manifest renal disease should not be exposed to organic solvents.
The excretion of erythrocytes and leucocytes in the urine from 101 men professionally exposed to styrene or toluene or to a combination of xylene and toluene was compared with the cell excretion in the urine from 39 non-exposed controls. The men exposed to organic solvents excreted significantly more cells than the controls. The findings are in agreement with the present discussion regarding the role of organic solvents in glomerular disease.
Glomerular filtration rate (GFR) was studied by measuring the 51-Cr-EDTA clearance with single bolus injection technique in 107 men exposed to styrene, toluene or toluene and xylene in their professions and in 48 non-exposed male controls. The clearance values of the controls were significantly related both to body surface area (BSA) and age. These relations were used to calculate expected clearances for the exposed subjects. The clearances of the exposed subjects were on an average 3.8% higher than expected, according to BSA and age in this group. This divergence was not significant. Thus, no reduction in GFR was found in the subjects exposed to organic solvents.
The effect of fluid deprivation, antidiuretic hormone (DDAVP) and forced fluid intake on glomerular filtration rate (GFR) was studied in 41 healthy males by determining 51-Cr-EDTA clearance after a single bolus injection. GFR was the same on forced and on free fluid intake. A small, clinically insignificant decrease in GFR (-6.5%), compared to values on free fluid intake, was registered during the periods of fluid deprivation plus DDAVP. There seem to be no objections to combining a clearance study with a concentrating ability test when screening groups of subjects with normal or near normal GFR.
The urine of 134 subjects, exposed to different organic solvents, and 48 unexposed subjects has been analysed with reference to albumin and beta-2-microglobulin excretion. The exposed subjects excreted significantly larger quantities of albumin than the unexposed. Those exposed to styrene excreted the largest amounts. No significant difference in beta-microglobulin excretion could be demonstrated between the groups.
The renal concentrating ability was studied in 11 subjects by means of 14-16 hours of fluid deprivations, alone and in combination with the vasopressin analogue desmopressin. The effect of desmopressin without fluid deprivation on urinary osmolality was also studied. The combination of desmopressin and fluid deprivation was not superior to fluid deprivation alone for the production of concentrated urine. Desmopressin alone was inferior to the other two methods. No difference in renal concentrating ability could be demonstrated after 14 hours of fluid deprivation, when comparing 118 subjects exposed to various organic solvents with 48 controls.
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Photofluorography was performed on 1,542 male construction workers in the Stockholm area. Postero-anterior, lateral and two anterior oblique views were obtained. The pleural and pulmonary changes found were classified into six groups. The results were correlated to the subjects' calculated weight index and to the occupational history of asbestos exposure and previous lung or pleural disease. There was a strong positive association between a high weight index and changes interpreted as increased amount of extrapleural fat. There was also a positive association between irregular thickenings and adhesions located mainly around the base of the lung and a clinical history of pleural or pulmonary disease. The importance of taking other etiological factors than exposure to asbestos dust into consideration is emphasized when pleural changes are detected in apparently healthy people.
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Ten mental workers with varying exposure to complex copper salts to dust form, six other metal workers not exposed, and nine construction workers in other occupational categories, also unexposed to the salts, were compared with respect to history and mucosal changes in the nose. There were subjective symptoms of metal dust exposure in the group exposed to the copper salts. Suspected early atrophic changes in the mucous membranes were noted in subjects exposed for long periods of time. Protective equipment in the form of breathing masks should be used in this type of work unless moistening or a surface finish on the copper sheeting is capable of preventing the release of dust.
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