Reports on cases of Stevens-Johnson syndrome (erythema multiforme major) have seldom related it to occupational exposure to chemicals. Serious liver involvement is also uncommon. This report describes 5 cases of the syndrome who had been occupationally exposed to trichloroethylene. The circumstantial evidence suggested that the chemical might have been a causative factor in the disease. The liver was involved in all and in 3 it was serious, with one death. The degree of exposure to trichloroethylene varied. The duration of exposure ranged from 2 to 5 weeks. It seemed likely that there was a hypersensitive reaction to trichloroethylene in these cases.

Tinnitus is said to be a common complaint of workers who are exposed to noise. We studied the prevalence and characteristics of tinnitus in 647 noise-exposed workers who had been notified as cases of noise-induced deafness. One hundred and fifty-one had tinnitus, giving a prevalence of 23.3 per cent. The tinnitus was bilateral in 42.4 per cent of cases, and of high frequency in 44.4 per cent. In 23.8 per cent it was associated with other symptoms. About 30 per cent of those with tinnitus complained that it interfered with daily activities like telephone conversation and sleep. The workers with tinnitus had consistently higher hearing thresholds at both high and low frequencies than those with no tinnitus. This finding remained even after adjusting for differences in sex, age and ethnic group composition and in the noise exposure duration. Workers are often told that noise exposure causes deafness, but little is mentioned about tinnitus. Awareness of the possible occurrence of tinnitus may encourage workers to cooperate more actively in a company hearing conservation programme.

Objectives-To investigate the risk factors predicting radiological progression in silicosis in a prospective cohort study of patients with silicosis who were previously exposed to silica from granite dust. Methods-From among a total of 260 patients with silicosis contracted from granite work, 141 with available serial chest x ray films of acceptable quality taken over a period of 2 to 17 (mean 7.5) years, were selected for study. Ninety four (66.7%) had ended exposure 5 or more years perviously (mean 10.1 years, maximum 28 years). Radiological progression was assessed by paired comparison of the initial and most recent radiographs, with two or more steps of increase in profusion of small opacities according to the 12 point scale of the International Labour Organisation (ILO) classification of radiographs of pneumoconiosis, taken from the majority reading by a panel of three independent readers. Results-Overall, 37% of patients with silicosis had radiological evidence of progression. From the initial radiographs, 24 (31.6%) of those with radiological profusion category 1, 15 (37.5%) of those with radiological profusion category 2, and 13 (52%) of those with complicated silicosis (including all seven with category 3 profusion of small opacities) showed radiological progression. As expected, progression was more likely to be found after longer periods of follow up (the interval between the two chest x ray films) with a 20% increased odds of progression for every additional year of follow up. After adjustment for varying intervals of follow up, the probability of radiological progression was found to be significant if large opacities were present in the initial chest x ray film. Progression was also less likely to be found among those who had ended exposure to silica longer ago, although the result was of borderline significance (p=0.07). Tuberculosis was also associated with increased likelihood of progression (borderline significance). Conclusions-There is a high probability of radiological progression in silicosis after high levels of exposure to granite dust among workers who were followed up for up to 17 years. A significant risk factor is the extent of radiological opacities in the initial chest x ray film. The probability of progression is also likely to be reduced with longer periods after the end of exposure. (Occup Environ Med 2001;58:467-471)

It has previously been shown that granite workers with heavy exposure to silica had glomerular and proximal tubular dysfunction evidenced by increased urinary excretions of albumin, a-l-microglobulin (AMG), and -Nacetyl-glucosaminidase (NAG). The investigation was replicated in another group of granite workers to further elucidate the exposure effect relation. The urinary excretion of albumin, a-l-microglobulin (AMG), /-2-microglobulin (BMG), and /-N-acetylglucosaminidase (NAG) was determined in two groups of granite workers with low and high exposure to silica. Low molecular weight proteinuria and enzymuria were significantly correlated with duration of exposure in the high but not the low exposure group. These increases were most pronounced in those with 10 or more years of heavy exposure, and in those with radiological evidence of pulmonary fibrosis, particularly those with rounded small opacities denoting classical silicosis. These results provide further evidence that prolonged and heavy exposure to silica is associated with nephrotoxic effects in granite workers. (British J7ournal ofIndustrial Medicine 1993;50:907-912).The evidence that silica is nephrotoxic in occupationally exposed persons is limited. Anecdotal reports and uncontrolled studies of clinical and pathological case series suggest that severe pulmonary silicosis, especially acute silicosis, is associated with glomerulotubular disease. [1][2][3][4][5][6][7][8] We have also reported preliminary findings from a recent cross 907 sectional study of an increased urinary excretion of albumin, a-l-microglobulin (AMG), and [-Nacetyl-glucosaminidase (NAG) in granite workers with high exposure to silica compared with healthy unexposed subjects.9 Some of these alterations in renal function, particularly for albumin and NAG, were apparently greater and persistent in silicotic subjects who were assumed to have had greater exposure to dust and who had not been exposed to silica for many years. We have replicated the study in another larger group of granite workers, with the further aim of elucidating the exposure-effect relation between the urinary alterations on the one hand and the intensity and duration of exposure to silica on the other. Materials and methodsThe study subjects were selected from among a total of 159 workers in three granite quarries (not covered in the previous study), who held jobs with differing intensities of exposure to dust. A high dust exposure group of workers included those who were employed regularly in rock drilling and rock crushing jobs for at least a year; whereas a low exposure group included the rest of the workers who were mostly employed in equipment and vehicle maintenance and servicing work in the workshops, as loader operators and dumper truck drivers, and other administrative workers (clerks, office assistants, storemen etc). The exclusion criteria were a known history of glomerulonephritis, urinary calculi, or other renal diseases or diabetes, hypertension, or regular recent ingestion of analgesics. A total ...

The purpose was to determine if solderers had increased diurnal variation (DV) in peak expiratory flow rate (PEFR) and chronic impairment of lung function. A cross-sectional study of 150 female operators doing manual soldering using flux-cored (rosin-based) solder wire and 52 administrative staff from two electronics factories was carried out. They answered a questionnaire, had their forced expiratory volume in 1 sec (FEV1) and forced vital capacity (FVC) measured and their 3-hourly PEFR monitored for 5 working days. The DV in PEFR was the difference in the daily maximum and minimum PEFR expressed as a percentage of the maximum. Six solderers with smoking history were excluded from the analysis. Solderers had a significantly higher prevalence of work-related eye (14.6%) and nose (10.4%) irritation. The prevalence of cough, breathlessness, and wheezing was low. There was no overt case of occupational asthma. The DV in PEFR of 6.0% was not increased. The analysis of FEV1 and FVC was restricted to Chinese only (101 solderers and 51 controls): these were not significantly different. Solderers with 5 or more years of exposure had a significantly lower FEV1/FVC (%) of 88.4% after adjustment for age. In conclusion, solderers with 5 or more years of exposure may have a mild obstructive effect apart from smoking, asthma, or age.