Background The risk of hepatotoxicity in the shoe industry has already been suggested, however, there has been no investigation among the craftsmen who repair shoes. Methods A group of 33 shoe repairers who work in supermarkets, and who use the same glues which contain mixtures of potentially hepatotoxic solvents were identi®ed. A control group of 61 workers not exposed to hepatotoxic substances was also examined. All participants completed a questionnaire designed to identify potential risk factors and the main non-occupational confounding factors for hepatotoxicity. Laboratory tests, commonly used in clinical practice, were done to check whether they were useful markers of hepatotoxicity due to exposure to solvent mixtures, and to investigate which tests should be used in the screening campaigns. Results The exposed workers had a higher prevalence of elevated mean alanine aminotransferase (ALT), aspartate aminotransferase (AST), conjugated bilirubin (P 0.0001), and alkaline phosphatase (AP) (P 0.004) than controls did. The number of workers who had values outside the upper limit of normal for our laboratory was signi®cantly higher (ALT P 0.034, AST P 0.037, conjugated bilirubin P 0.014). Exposed workers all had a ratio of ALT to AST greater than 1, with a mean of 1.5; it was b1.6 in more than half the exposed workers. Conclusions The ®ndings suggest that there is the possibility of liver involvement among even asymptomatic shoe repairers, and that periodic liver screening may be useful; furthermore, use of these tests (especially the ratio of ALT to AST) for craftsmen who repair shoes, and are exposed to solvent mixtures, is advisable even when environmental monitoring indicates levels below the threshold limit values (TLVs). Am.

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Abstract:Liver Damage among Environmental Disinfestation Workers: Francesco TOME1, et al. OccupationalMedicine Dept., "La Sapienza" University, Rome-It has been reported that exposure to high doses of insecticides can damage the liver. It is now becoming apparent that even exposure to low doses may affect the liver and blood. Studies on the effects on the health of disinfestation workers are scant. This study investigated 37 males doing environmental disinfestation work. They all employed the same types and amounts of pesticides. They were compared with 60 controls not exposed to hepatotoxic substances. In the presence of a physician, all subjects completed a clinical-history questionnaire. They all underwent a general clinical examination and specific blood chemistry tests were done. In the exposed group we found liver test values to be higher than controls (p<0.001), including AST (p<0.025), alkaline phosphatase (p<0.001), and total bilirubin (p<0.001). We found no abnormal hematological changes. The findings indicate that the use of pesticides in environmental disinfestation alters liver function and that this screening protocol is valid for identifying subjects at risk for hepatotoxicity. (J Occup Health 1998; 40: 193-197)

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