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In connection with our previous investigation,'-' we found ourselves faced with two further problems, the significance of which we should like to emphasize in this report. First, there is the question whether workers in polyvinyl chloride (PVC)-processing industries are liable to suffer occupational damage, and if so, to what extent and under what conditions. The major problem, however, is whether a causal relation exists between working in PVC production and the formation of malignant tumors with lethal results.The term "PVC-processing industries" is here taken to mean those sections of plants where various stabilizers, colors, and bulk materials are added to and mixed with the basic PVC powder. The resulting material then undergoes further processes, in which, for example, heated rollers are used to shape it into foil or squares. In these last-mentioned processes especially, gases, fumes, and smoke tend to develop.So far, medical and work histories of 15 workers employed in this type of plant were investigated. In all of them dermatological examinations and the following laboratory tests were performed: complete blood cell count; platelet count (i.v. blood); erythrocyte sedimentation rate (ESR) (Westergren method); serum electrophoresis; serum glutamic oxaloacetic transaminase (SGOT); serum glutamic pyruvic transaminase (SGPT); blood urea nitrogen; and Australia antigen. In 9 of the workers a bromosulphalein (BSP) test was performed and in 10 reticulocyte count was determined. X-ray films of the chest, both hands, and feet were taken in 12 of them, and in 11 a liver-spleen scintigram (using ""Tc-sulfur colloid) was performed.The workers were employed in PVC processing an average of 5 years, individually between 1% and 13 years. These workers had the following complaints: 7 had sensations of pressure and/or pain in the upper abdomen; 3 had frequent dizziness; 2 complained of cold hands and feet snd 1 of increasing weakness in his legs.Clinical changes such as scleroderma-like skin changes or Raynaud's syndrome were not observed. On the other hand, the following pathological laboratory findings were obtained (TABLE 1): in 7 patients, slight to moderate thrombocytopenia with figures ranging between 63,000-1 39,000/ pl; in 7 patients, increased BSP retention of 5.2-1 5.

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Ober die sogenannte Vinylchlorid-KrankheitSeitdem 1958 erste Mitteilungen über gesundheitliche Schäden bei Arbeitern der Vinylchlorid(VC)-herstellenden Industrie (10) und 1963 über solche bei Arbeitern der Polyvinylchlorid(PVC)-herstellenden Industrie (25) bekannt wurden, ist die Aufmerksamkeit durch weitere Berichte mehrfach auf diesen Zweig der chemischen Industrie gelenkt worden (3,4,7,8,12, 28). Es handelt sich dabei um ein in den I lautund Knochenverjinderungen sklerodermie-ähnliches, in Ätiologie und Pathogenese ungeklärtes Krankheitsbild, als dessen Leitsymptome bisher Raynaud-Syndrom, knotige bis flächenhafte derbe I-lautveränderungen und bandförmige Osteolysen der Fingerendphalangen galten.Uber erste Beobachtungen dieses Krankheitsbildes in Deutschland konnten wir 1972 berichten (15, 16, 17). Da das klinische Bild zunächst an eine Sonderform der progressiven Sklerodermie erinnerte, unterzogen wir alle Arbeiter einer sorgfältigen internen Untersuchung, um zu klären, ob auch hier eine viszerale Beteiligung vorhanden ist. Cber die bis Ende 1972 vorliegenden Ergebnisse, die für die Beurteilung der Krankheit neue Aspekte eröffnen undwie wir glaubenauch der weiteren Forschung neue Anregung geben dürften, haben wir kürzlich ausführlich berichtet (18). Hier sollen die wesentlichsten Gesichtspunkte zusammenfassend dargestellt werden.