TITLE: Optic neuritis with residual tunnel vision in perchloroethylene toxicity.

AUTHORS: Onofrj M; Thomas A; Paci C; Rotilio D

AUTHOR AFFILIATION: University G. D'Annunzio, Chieti, Italy. onofrj@phobos.unich.it OR onofrj@ibmpe.unich.it

SOURCE: J Toxicol Clin Toxicol 1998;36(6):603-7

CITATION IDS: PMID: 9776966 UI: 98450129

ABSTRACT: CASE REPORT: In a 57-year-old female owner of a dry-cleaning shop, we describe the association of severe bilateral optic neuritis with unexpectedly high concentrations of perchloroethylene/metabolites in the blood and of chloroform in urine. Visual disturbances consisted of complete blindness for 9 days in the left eye, for 11 days in the right eye, with bright phosphenes and pain on eye rotation. Only central (2-3 degrees radius) vision recovered in the following months. CONCLUSION: Although environmental concentrations of perchloroethylene were within normal limits, we measured five-fold increases in vapors emitted when ironing freshly dry-cleaned fabrics, and suggest that inhalation of perchloroethylene vapors was the cause of this case of ocular nerve toxicity, recapitulating a previous report of major perchloroethylene toxicity.

AUTHORS: Salahudeen AK

AUTHOR AFFILIATION: Renal Division, Department of Medicine, University of Mississippi Medical Center, Jackson 39216, USA.

SOURCE: Nephrol Dial Transplant 1998 May;13(5):1122-4

CITATION IDS: PMID: 9623539 UI: 98284997

MAIN MESH HEADINGS: Kidney Diseases/*chemically induced, Nephrons/*drug effects, Occupational Diseases/*chemically induced, Tetrachloroethylene/*adverse effects

AUTHORS: Vaughan TL; Stewart PA; Davis S; Thomas DB

AUTHOR AFFILIATION: Program in Epidemiology, Fred Hutchinson Cancer Research Center, Seattle, WA 98104, USA.

SOURCE: Occup Environ Med 1997 Sep;54(9):692-5

CITATION IDS: PMID: 9423585 UI: 98085643

ABSTRACT: OBJECTIVES: To investigate whether employment in dry cleaning, and potential exposure to perchloroethylene (PCE), were associated with increased risk of carcinoma of the oral cavity and pharynx, larynx, oesophagus, and gastric cardia. METHODS: Two population based case- control studies were carried out. There were 491 cases of carcinoma of the oral cavity and pharynx, 235 of the larynx, and 404 of the oesophagus and gastric cardia. 724 controls were selected by random digit dialing. Personal interviews ascertained information on lifetime job histories, cigarette use, alcohol consumption, and other potential risk factors. The probability and level of exposure to PCE were estimated from the scientific literature. RESULTS: People who worked in dry cleaning tended to consume less alcohol and cigarettes than the general population. The adjusted odds ratio (OR) associated with ever having worked in dry cleaning was 1.6 (95% confidence interval (95% CI) = 0.6 to 4.4) for all cancer types together. The strongest associations were with laryngeal (OR 2.7; 95% CI 0.6 to 10.9) and oesophageal squamous cell carcinomas (OR 3.6; 95% CI 0.5 to 27.0). For laryngeal cancer, the relative risk increased with number of years employed in the dry cleaning industry (P = 0.14. The two cases of oesophageal squamous cell carcinomas had worked in dry cleaning for only a short time. Analyses of subsites showed higher risks for supraglottic laryngeal cancer (OR 5.7; 95% CI 1.0 to 32.1) and cancer of the tongue (OR 2.3; 95% CI 0.4 to 12.6). Analyses of exposure to PCE yielded similar results. CONCLUSIONS: These findings could easily be explained by chance; nevertheless, they are consistent with previous reports of excess risk of oesophageal, laryngeal, and tongue cancer, and suggest that previous studies of dry cleaners that could not control for alcohol and cigarette use may have underestimated the relative risks of such cancers.

AUTHORS: Andrys C; Hanovcova I; Chylkova V; Tejral J; Eminger S; Prochazkova J

AUTHOR AFFILIATION: Department of Clinical Immunology and Allergology, University Hospital, Hradec Kralove, Czech Republic.

SOURCE: Cent Eur J Public Health 1997 Sep;5(3):136-42

CITATION IDS: PMID: 9386901 UI: 98048142

ABSTRACT: A panel of immunological parameters has been examined in a group of dry- cleaning workers (n = 21) and in a control group of administrators (n = 16) from the same plant. The results were also compared to long-term laboratory reference values (LRV) (n = 14-311). External exposure to tetrachloroethylene (PER) was represented by TWA (8 h) values in the range 11-752 mg PER/m3. Biological monitoring showed an amount from 9 to 344 mg PER/m3 in exhaled air by the end of workshift. 1. The exposed dry-cleaning workers compared to the controls from the plant had statistically significant changes in metabolic activity of phagocytes, alpha 2-macroglobulin, C3 and C4 complement component, salivary secretory IgA, and blastic transformation test. Most of the values were within the range of normal values. 2. The exposed dry-cleaning workers had several abnormal immune parameters compared to the long-term laboratory values (LRV) especially in the alpha 2-macroglobulin, C3 and percentage of T-lymphocytes. Most of the changes, even those that were statistically significant, were still within the range of normal values, but they might be classified as trends or shifts away from normal (spontaneous blastic transformation, absolute number of phagocyting cells, coeruloplasmin, circulating immunocomplexes, serum lysozyme). 3. The non-exposed controls from the same plant showed both quantitative and qualitative differences when compared to the LRV. Changes were seen in IgG, C4, CSI and in increased spontaneous metabolic activity of leucocytes, total leucocyte count, absolute number of phagocyting cells, alpha 2-macroglobulin, prealbumin, C4, circulating immunocomplexes and serum lysozyme. 4. The distribution analysis of all results detected a large number of abnormal values in both groups, more in the at-risk group. 5. As inhalation was the main route of PER exposure it was concluded that the changes might represent aspects of the response of the respiratory immune system, mainly of the alveolar macrophages. Additional postinfection effects could not be excluded in both studied groups. Individual differences in immune reactivity as well as individual range of exposure should be taken into consideration.

AUTHORS: Keen C; Dabill DW; Groves JA

AUTHOR AFFILIATION: Health and Safety Laboratory, Sheffield, U.K.

SOURCE: Ann Occup Hyg 1996 Jun;40(3):281-92

CITATION IDS: PMID: 8694491 UI: 96255518

ABSTRACT: Methods for monitoring personal exposure to tetrachloroethylene vapour in the dry cleaning industry have been investigated. A Draeger diffusive colorimetric gas detector tube and the Delta vapour detection system manufactured by Sabre Gas Detection were both shown to be suitable for preliminary on-site monitoring. A range of short-term pumped colorimetric tubes were also shown to perform well under a range of environmental conditions. Data on laboratory evaluations and field trials are presented.

AUTHORS: Garnier R; Bedouin J; Pepin G; Gaillard Y

AUTHOR AFFILIATION: Commission de la Securite des Consommateurs, Paris, France.

SOURCE: J Toxicol Clin Toxicol 1996;34(2):191-7

CITATION IDS: PMID: 8618253 UI: 96186261

ABSTRACT: BACKGROUND: Incorrect operations by customers are not uncommon in coin- operated dry cleaning establishments; dry cleaning machines may also be poorly maintained. This may result in retention of large amounts of the cleaning solvent in dry cleaned items. CASE REPORT: A 2-year-old boy was found dead in his bed, with a strong odor of solvent in the room. Toxicological analysis demonstrated tetrachloroethylene poisoning. The solvent had been retained in the double curtains of the bedroom which had been dry cleaned in a coin-operated establishment the same day. A retrospective study at the Paris Poison Center revealed 25 additional cases, all with a favorable outcome. Analysis of the circumstances of these accidents showed that the main causes of tetrachloroethylene retention in clothes are overloading of the machine and dry cleaning of bulky items. However, failure of the dry cleaning machine may also be involved. CONCLUSIONS: To immediately reduce the health risks, consumers were informed both via the mass media and by warnings in coin- operated dry cleaning shops. A second batch of preventive measures is in preparation including modifications of the machines to limit solvent exposure and a specific regulation concerning their inspection and maintenance.

AUTHORS: Brodkin CA; Daniell W; Checkoway H; Echeverria D; Johnson J; Wang K; Sohaey R; Green D; Redlich C; Gretch D; et al

AUTHOR AFFILIATION: Department of Medicine, University of Washington, Seattle 98104, USA.

SOURCE: Occup Environ Med 1995 Oct;52(10):679-85

CITATION IDS: PMID: 7489059 UI: 96096336

ABSTRACT: OBJECTIVE--To determine if subclinical hepatotoxicity is associated with exposure to perchloroethylene at concentrations commonly experienced in the workplace, and whether surveillance with serum hepatic transaminase activity underestimates such effects. METHODS-- Hepatic parenchymal echogenicity on ultrasonography and serum hepatic transaminase activity were compared in 29 community based dry cleaning operators exposed to perchloroethylene, and a control group of 29 non- exposed laundry workers. Perchloroethylene exposure was assessed by work history and air monitoring. RESULTS--Mean hepatic transaminase activities were minimally increased in dry cleaners compared with laundry workers. Increased alanine aminotransferase activities, between 1.0 and 1.5 times the normal limits, were found in five of 27 (19%) dry cleaners compared with one of 26 (4%) laundry workers. In contrast, diffuse parenchymal changes in echogenicity, as determined by hepatic ultrasonography, were increased nearly twofold in dry cleaners, occurring in 18 of 27 (67%) dry cleaners compared with 10 of 26 (39%) laundry workers (P < 0.05), and were most strongly associated with increased perchloroethylene exposure in older dry to dry or wet transfer operations (odds ratio 4.2, 95% confidence interval 1.1-15.3). Mean eight hour time weighted average perchloroethylene exposure for dry cleaners was 16 ppm, which is less than the permissible exposure limit of 100 ppm in the United States. CONCLUSIONS--It was concluded that mild to moderate hepatic parenchymal changes occur more frequently in workers exposed to perchloroethylene than in populations not exposed to chemical solvents, and that these effects are underestimated by serum hepatic transaminase activity.

AUTHORS: Altmann L; Neuhann HF; Kramer U; Witten J; Jermann E

AUTHOR AFFILIATION: Department of Neurotoxicology, Heinrich-Heine-University Dusseldorf, Federal Republic of Germany.

SOURCE: Environ Res 1995 May;69(2):83-9

CITATION IDS: PMID: 8608774 UI: 96190843

ABSTRACT: The effects of chronic low-level tetrachloroethene (TCE) exposure on functions of the central nervous system (CNS) were measured in subjects living in the neighborhood of dry cleaning shops with a mean residential time of 10.6 years. Neurobehavioral tests were performed using a German version of the NES battery. Additionally, a pattern reversal visual-evoked potentials (VEPs) were recorded. The mean blood TCE concentration in the subjects was 17.8 micrograms/liter and the median indoor TCE air concentration measured in the residences was 1.36 mg/m3. The outcome of the NES subtests for vigilance, simple reaction time, as well as visual memory differed statistically significantly between the exposed subjects and the controls, whereas for VEP latencies the differences were statistically not significant. It is concluded that despite the low exposure levels, CNS functions might be affected by TCE in subjects living close to a dry cleaning facility if the exposure lasts for several years.

AUTHORS: Weiss NS

AUTHOR AFFILIATION: University of Washington, Department of Epidemiology, Seattle 98195, USA.

SOURCE: Cancer Causes Control 1995 May;6(3):257-66

CITATION IDS: PMID: 7612805 UI: 95337289

ABSTRACT: Exposure to perchloroethylene (PCE) occurs in a number of occupational settings in which organic solvents are used, and, in particular, is widely prevalent in the dry-cleaning industry. This review summarizes the results of studies of the occurrence of the individual types of cancer in dry cleaners. Two of those cancers of greatest a priori concern (because of results in PCE-exposed experimental animals)--liver cancer and leukemia--have not occurred with increased frequency among persons employed in the dry-cleaning industry. Rates were elevated by about a factor of two for esophageal and bladder cancers, but not increased clearly for any other site. The excess mortality from esophageal cancer was well beyond the limits of chance, based on a total of 23 deaths that occurred in the two principal cohort-studies of dry cleaners. There was some indication of a particularly high risk associated with prolonged employment and a long interval since first employment. However, the possible confounding effect of the combination of cigarette smoking and heavy alcohol consumption, a very strong risk factor for the development of esophageal cancer, could be taken into account only partially in these studies. With regard to bladder cancer, the limited data available suggest that the observed increased risk could be due to exposure to other solvents than PCE used in dry cleaning. The potential influence of occupational exposure to PCE on the occurrence of esophageal and bladder cancer needs continued examination in further follow-up of existing cohorts of dry cleaners, the assembly of additional cohorts, and in large case-control studies that ascertain occupational exposures in some detail.

SOURCE: IARC Monogr Eval Carcinog Risks Hum 1995;63:33-71

CITATION IDS: PMID: 9139129 UI: 97278822

MAIN MESH HEADINGS: *Carcinogens, *Occupational Exposure, *Solvents, *Tetrachloroethylene

ADDITIONAL MESH HEADINGS: Human, Solvents/adverse effects, Solvents/toxicity, Support, Non-U.S. Gov't,
Support, U.S. Gov't, P.H.S., Tetrachloroethylene/adverse effects, Tetrachloroethylene/toxicity

AUTHORS: Aggazzotti G; Fantuzzi G; Righi E; Predieri G; Gobba FM; Paltrinieri M; Cavalleri A

AUTHOR AFFILIATION: Hygiene Institute, University of Modena, Italy.

SOURCE: Arch Environ Health 1994 Nov-Dec;49(6):487-93

CITATION IDS: PMID: 7818292 UI: 95118091

ABSTRACT: Perchloroethylene exposure in 28 dry-cleaning establishments and in 25 homes occupied by dry cleaners in Modena, Italy, was investigated. Environmental air samples and alveolar air samples from dry cleaners (n = 60) and from their family members (n = 23) were collected. The degree of perchloroethylene on the dry-cleaning premises varied widely from establishment to establishment. Spot sampling ranged from 0.6 to 75 mg/m3, whereas sampling by personal passive dosimeters ranged from 2.6 to 221.5 mg/m3 (8-h time weighted average values). Perchloroethylene in alveolar air samples collected at the end of the work day correlated closely with the 8-h time weighted average values (r = .750, p = .001), and correlated also with alveolar air samples collected at home in the evening (r = .665, p = .001) and the following morning (r = .549, p < .001). Perchloroethylene levels inside the homes of dry cleaners appeared significantly higher than in 29 houses selected as controls (Mann Whitney U test, p < .001). Perchloroethylene in alveolar air samples collected at home suggests that nonoccupational exposure to perchloroethylene for family members of dry cleaners exists.

AUTHORS: Rao VR; Levy K; Lustik M

AUTHOR AFFILIATION: Quantitative Analysis Division, Science Applications International Corporation, Falls Church, Virginia 22043.

SOURCE: Regul Toxicol Pharmacol 1993 Oct;18(2):233-47

CITATION IDS: PMID: 8278644 UI: 94105456

ABSTRACT: Unlike the impressive advancement of cancer risk assessment, the "cutoff approach" based on hazard quotient in noncancer risk assessments recommended by the EPA has crucial deficiencies. Several alternative approaches have been suggested in the literature to modify the noncancer risk characterization based on reference doses. Recent studies have indicated that the effects of perchloroethylene (PERC) on the central nervous system (CNS) is a much more sensitive noncancer endpoint than cancer which is currently the basis for deriving its public health criteria and standards. Studies indicate that 20 ppm of inhaled PERC concentration elicited adverse effects on the CNS in experimental animals and humans. However, the existing EPA oral reference dose (RfD), a noncancer toxicity parameter for PERC (0.01 mg/kg/day), is based on the induction of hepatotoxicity and increased body weight gain induced by PERC in rats. An attempt was made in this paper to examine whether logistic regression of dose-response data could be applied to assess the noncancer risks. In order to perform logistic regression the inhalation toxicity data of PERC were classified according to the severity of toxicity paradigm used in toxicity analysis. Based on the sensitive noncancer endpoints identified from severity classification, a logistic regression analysis of the data was performed and its potential applicability in noncancer risk characterization was described for workers exposure to PERC in dry- cleaning operations.

AUTHORS: Popp W; Muller G; Baltes-Schmitz B; Wehner B; Vahrenholz C; Schmieding W; Benninghoff M; Norpoth K

AUTHOR AFFILIATION: Institut fur Hygiene und Arbeitsmedizin, Universitatsklinikum, Gesamthochschule Essen, Federal Republic of Germany.

SOURCE: Int Arch Occup Environ Health 1992;63(6):393-5

CITATION IDS: PMID: 1544687 UI: 92184356

ABSTRACT: Tetrachloroethene concentrations in blood and trichloroacetic acid concentrations in urine were determined--primarily over the course of a week--for 29 persons living in the vicinity of dry-cleaning shops. The mean levels of tetrachloroethene increased during the week. In some neighbours concentrations were exceeding the German biological threshold limit value for tetrachloroethene (1000 micrograms/l blood), persisting over the whole week in one case. The concentrations of tetrachloroethene in blood depended on the floor and the construction type of the building where these people were living, but not of the type of system used in the dry-cleaning shops. 5 of 12 dry-cleaners were found to have tetrachloroethene levels exceeding the German biological threshold limit value, some of them by a considerable amount.

AUTHORS: Ferroni C; Selis L; Mutti A; Folli D; Bergamaschi E; Franchini I

AUTHOR AFFILIATION: Laboratory of Industrial Toxicology, University of Parma, Italy.

SOURCE: Neurotoxicology 1992 Spring;13(1):243-7

CITATION IDS: PMID: 1508425 UI: 92375385

ABSTRACT: The hypothesis that long-term low-level exposure to perchloroethylene (PERC) may impair the dopaminergic control of prolactin (PRL) secretion and negatively affect neurobehavioral performance, was tested in a cross-sectional survey of dry-cleaners. Sixty female workers exposed to PERC in dry-cleaning shops and thirty controls recruited in a cleaning plant not using solvents were examined. PERC air concentration during four-hour random periods varied from 1 to 67 ppm (median 15 ppm). PERC blood levels ranged 12-864 mg/l (median 145 mg/l). A set of tests from a computer-based performance evaluation system was administered, including Finger Tapping with both dominant and non-dominant hands, Simple Reaction Times, Digit Symbol, and Shape Comparison in two different versions constructed to test Vigilance and the response to moderate stress, respectively. During the proliferative phase of the menstrual cycle, PERC-exposed workers showed increased serum PRL (12.1 +/- 6.7 ng/ml) as compared to their matched controls (7.4 +/- 3.1 ng/ml, p less than 0.001). Prolonged reaction times were also observed in all tests. However, neither the duration of exposure nor air and blood PERC concentrations were significantly correlated with performance. Nor were exposure variables associated with the increased PRL levels.

AUTHORS: Skender LJ; Karacic V; Prpic-Majic D

AUTHOR AFFILIATION: Institute for Medical Research and Occupational Health, University of Zagreb, Yugoslavia.

SOURCE: Arch Environ Health 1991 May-Jun;46(3):174-8

CITATION IDS: PMID: 2039273 UI: 91247869

ABSTRACT: The rate of trichloroethylene (TRI) and perchloroethylene (PER) absorption was investigated in workers who were (1) occupationally exposed to TRI in four dry-cleaning shops (Group 1, n = 10) and (2) occupationally exposed to PER in one dry-cleaning shop (Group 2, n = 18). Concentrations of TRI and PER in blood were analyzed, and concentrations of trichloroethanol (TCE) and trichloroacetic acid (TCA) in blood and urine were analyzed. Results varied widely: PER was found in the blood of workers in group 1, but TRI was not detected in blood from any worker in group 2; most blood samples from group 2 workers did not contain a detectable quantity of TCE, and urine TCE concentrations in this group were very low. During the work week, a significant difference was found in group 1 for TRI in blood and TCE in blood and urine. In group 2, however, the only significant difference during the work week was for PER in blood. Therefore, the most reliable biological indicators for TRI and PER exposure are TCE in blood and PER in blood, respectively.

AUTHORS: Solet D; Robins TG

AUTHOR AFFILIATION: School of Public Health, University of Michigan, Ann Arbor.

SOURCE: Am J Ind Med 1991;20(5):601-14

CITATION IDS: PMID: 1793103 UI: 92170813

ABSTRACT: Perchloroethylene (PCE) is a widely used dry cleaning and degreasing solvent. Although there is evidence in animals and humans for renal effects at extremely high doses, there are few studies of its potential renal toxicity at typical occupational concentrations. This study reports on the relationship of PCE in breath and estimates of chronic exposure with the urinary ratios of total urinary protein, albumin, and n-acetyl-glucosaminidase (NAG) to creatinine in dry cleaning workers exposed to PCE. Regression models including one or more exposure variables, demographic variables, mean arterial blood pressure (MAP), and the presence of diseases affecting kidney function were examined. Urine samples, breath samples, exposure histories, and medical histories were obtained from 192 dry cleaning workers. The results failed to demonstrate any consistent relationship between exposure and renal outcome variables. However, protein/creatinine and albumin/creatinine were significantly, although weakly and positively, associated with MAP; NAG/creatinine was weakly but significantly positively associated with age; mean NAG/creatinine was also higher in non-whites. The reasons why an association between exposure and renal outcome was not found are discussed.

AUTHORS: Cai SX; Huang MY; Chen Z; Liu YT; Jin C; Watanabe T; Nakatsuka H; Seiji K; Inoue O; Ikeda M

AUTHOR AFFILIATION: Institute of Occupational Medicine, Chinese Academy of Preventive Medicine, Beijing.

SOURCE: Ind Health 1991;29(3):111-21

CITATION IDS: PMID: 1765547 UI: 92112590

ABSTRACT: Subjective symptoms, hematology, serum biochemistry and other clinical signs were investigated in 56 dry-cleaning workers exposed to tetrachloroethylene at 20 ppm (as a geometric mean of 8-hr time- weighted average), and the results were compared with the findings in 69 non-exposed controls from the same factories. There were exposure- related increases in the prevalence of subjective symptoms during the work as well as in the past 3 month period, whereas there was no significant changes in hematology. Effects of the exposure on liver and kidney functions were also negative as judged by emission enzyme activities, BUN and creatinine in the serum.

AUTHORS: Solet D; Robins TG; Sampaio C

AUTHOR AFFILIATION: Occupational Health Program, School of Public Health, University of Michigan, Ann Arbor 48109.

SOURCE: Am Ind Hyg Assoc J 1990 Oct;51(10):566-74

CITATION IDS: PMID: 2251984 UI: 91068664

ABSTRACT: Perchloroethylene (Perc), the most widely used solvent in dry cleaning, is toxic to the liver, kidneys, and central nervous system and may be a human carcinogen. In the Detroit area, as part of a project investigating the health status of dry cleaning workers, an exposure assessment was carried out in dry cleaning plants using perchloroethylene. Breath samples were obtained from each participant, and time-weighted average (TWA) breathing zone air samples were obtained using passive dosimeters on a subset expected to experience a range of exposures. Perc in breath and Perc in air were highly correlated (r2 = 0.75, p less than 0.0001). On average, operators of dry cleaning equipment experienced significantly more exposure than nonoperators. Also, employees working in shops that use transfer equipment (requiring physical transfer of Perc-saturated clothing from washers to dryers) showed significantly higher exposure than those in shops utilizing dry-to-dry machinery (permitting washing and drying in one machine in a single cycle). One or more air samples in every transfer shop exceeded the recently revised Occupational Safety and Health Administration (OSHA) permissible exposure limit (PEL) of 25 ppm, while no air samples in dry-to-dry shops exceeded this limit. The results suggest concern for exposures to operators in transfer shops and that compliance with the PEL is achievable by engineering controls with presently existing technology.

AUTHORS: Seeber A

AUTHOR AFFILIATION: Institute of Occupational Health, Department of Work Physiology II, Dortmund 1, FRG.

SOURCE: Neurotoxicol Teratol 1989 Nov-Dec;11(6):579-83

CITATION IDS: PMID: 2626148 UI: 90174028

ABSTRACT: One hundred and one employees of dry cleaning shops exposed to tetrachloroethylene (time weighted average 205 mg/m3) and 84 employees of departmental stores and hotels were compared from the results of a psychological examination. Age, gender, the daily consumption of alcohol and the intellectual level were taken into consideration analysing the effects of tetrachloroethylene. Perceptual speed, digit reproduction as a memory test, the digit symbol test as a substitution task and variables of a choice reaction test as well as a cancellation test differed significantly between the controls on one hand, and the groups of low and high exposure on the other. But, the differences between the exposure groups were not significant. There was no effect of alcohol on the exposure-related group differences. By means of discriminant analyses the diagnostic effectiveness of the biochemical, neurological and psychological methods were compared to classify the subjects into exposure groups. The highest rate of correct classifications was performed by the multidisciplinary combination of approaches.

AUTHORS: Marth E; Stunzner D; Kock M; Mose JR

AUTHOR AFFILIATION: Institute of Hygiene, University of Graz, Austria.

SOURCE: J Hyg Epidemiol Microbiol Immunol 1989;33(4 Suppl):514-20

CITATION IDS: PMID: 2634072 UI: 90229698

ABSTRACT: Substitution of ethylene with halogen atoms leads to a highly effective compound with a strongly lipophilic character. The most important solvent in the dry cleaning process is tetrachloroethylene (PER). Owing to its physical-chemical properties, it has become a ubiquitous environmental pollutant. The uptake of small amounts of PER through polluted drinking water does not lead to liver damage as originally suspected. On the one hand, PER is taken up by erythrocyte membranes, on the other, it interacts with chylomicrons. Thereby two transportmechanisms are provided by for PER. Consequently, various physiological functions of both transport systems are disturbed. The erythrocytes increasingly disintegrate and are broken down in the spleen. Of all organs, the spleen shows the highest concentration of PER. Also, disturbances in the lipid metabolism occur because chylomicrons are broken down at a slower rate. Thereby, serum triglyceride concentration increases. These lipids are increasingly stored in the fatty tissue leading to the high accumulation of PER. A toxicological evaluation of chlorinated hydrocarbons should therefore take into account the changes in the blood system and in the lipoprotein metabolism.

AUTHORS: Freed DM; Kandel E

AUTHOR AFFILIATION: Department of Psychology, University of Southern California, Los Angeles 90089-1061.

SOURCE: Neurotoxicology 1988 Fall;9(3):391-400

CITATION IDS: PMID: 3200507 UI: 89071052

ABSTRACT: Several experiments are reported which concern the possible role of long-term occupational exposure in the etiology of dementia. A case study of a male with memory impairment thought to be due to Alzheimer's disease is reported. Neuropsychological testing revealed impairments in short-term memory, which gradually cleared over months. Analyses uncovered extremely high serum levels of a solvent (perchlorethylene) this individual had used for decades in a dry-cleaning business. A case- series is also reported in which four individuals with similar patterns of neuropsychological performance were noted to share occupational exposure to metal vapors. The results of a preliminary case-control study are also reported in which an increased incidence of long-term occupational exposure to metals and solvents was noted in patients with Alzheimer's disease. These results suggest that the role of long-term occupational exposure needs to be thoroughly investigated in patients diagnosed with Alzheimer's disease and other neurological disorders.

AUTHORS: Brown DP; Kaplan SD

SOURCE: J Occup Med 1987 Jun;29(6):535-41

CITATION IDS: PMID: 3612328 UI: 87282740

ABSTRACT: To evaluate the carcinogenic potential from occupational exposure to perchloroethylene (PCE), a retrospective cohort mortality study of workers employed in the dry cleaning industry was conducted among 1,690 workers from four labor unions. The majority of the cohort had potential exposure to petroleum solvents as well as to PCE while working in the dry cleaning industry. Mortality from primary cancer of the liver was of particular interest, due to the findings of excess liver cancer in mice exposed to PCE. Other sites of cancer were also of interest. A total of 493 deaths were observed, whereas 575.5 were expected based on US mortality rates. Mortality from all cancers combined was greater than expected (142 observed v 122.9 expected). No deaths due to liver cancer were observed. Urinary tract cancer was the only specific site where there was a statistically significant excess in observed deaths (12 observed v 4.7 expected). There was some consistency in these findings across the four individual unions and across race/sex groups. A subcohort of workers who were employed only in dry cleaning shops that used PCE as their primary solvent was identified from the union records. There was only one death from urinary tract cancer, whereas 1.3 deaths were expected in this subcohort.

AUTHORS: Materna BL

SOURCE: Am Ind Hyg Assoc J 1985 May;46(5):268-73

CITATION IDS: PMID: 4003279 UI: 85222190

ABSTRACT: Field surveys were conducted of 67 dry cleaning establishments to assess working conditions and potential for exposure to perchloroethylene, a solvent of choice in this industry. Evaluation of ventilation controls showed that 28% of cleaning machines (transfer type) did not have functioning local exhaust systems, and an additional 32% had inadequately maintained systems providing less than the recommended face velocity at the door opening. Personal sampling was performed in 20 firms to relate operator exposure levels to the process used and degree of local exhaust ventilation. Utilization of the dry-to- dry (closed system) process resulted in a lower mean TWA exposure, 28.3 ppm, as compared to 86.6 ppm for transfer operations. Five-minute peak samples taken during clothing transfer demonstrated significant exposure levels ranging from 11.3 to 533.8 ppm. A lower mean peak exposure (25.3 ppm) was found for firms with local exhaust ventilation at the recommended rate than for facilities with poorly or unventilated cleaning machines (159.7 ppm). The study points out the manner in which available control measures can be used optimally to reduce employee exposure. Increased involvement of trade associations and local health authorities is also recommended to promote the safe use of perchloroethylene in the dry cleaning industry.

AUTHORS: Ludwig HR; Meister MV; Roberts DR; Cox C

SOURCE: Am Ind Hyg Assoc J 1983 Aug;44(8):600-5

CITATION IDS: PMID: 6624647 UI: 84020843

ABSTRACT: The National Institute for Occupational Safety and Health (NIOSH) conducted industrial hygiene surveys at 44 commercial dry cleaning facilities in five states as part of an industry wide study to assess the health effects of long-term, low-level exposure to perchloroethylene (PCE). Time-weighted average (TWA) and peak exposures to PCE were determined by collecting personal air samples using activated charcoal tubes and battery-operated pumps. TWA exposures of the machine operators ranged from 4.0 to 149.0 ppm PCE. The geometric mean PCE exposure of the machine operators (22 ppm) differed significantly from the mean exposures of the pressers (3.3 ppm), seamstresses (3.0 ppm), and the concentrations in the front counter areas of the facilities (3.1 ppm). Te geometric mean 5-minute peak PCE exposure during textile transfer was 44 ppm while the mean 15-minute exposure was 33 ppm. No significant differences were found between exposures when either the TWA or the peak data were grouped by geographic location (i.e., state), or by the type of processing equipment used (i.e., "Combination" units vs. separate washing and drying units). Recommendations for work practices, ventilation, maintenance, plant layout and personal protective equipment are presented to reduce PCE exposures to lowest achievable levels.

SOURCE: JAMA 1983 Jun 17;249(23):3159-60

CITATION IDS: PMID: 6854837 UI: 83216491

MAIN MESH HEADINGS: Air Pollutants/*analysis, Air Pollutants, Occupational/*analysis, Tetrachloroethylene/*analysis

ADDITIONAL MESH HEADINGS: Human, Maximum Permissible Exposure Level, United States

SOURCE: MMWR Morb Mortal Wkly Rep 1983 May 27;32(20):269-71

CITATION IDS: PMID: 6406811 UI: 83218781

MAIN MESH HEADINGS: Air Pollutants/*analysis, Air Pollutants, Occupational/*analysis, Tetrachloroethylene/*analysis

ADDITIONAL MESH HEADINGS: Human, Maximum Permissible Exposure Level, United States

AUTHORS: Lauwerys R; Herbrand J; Buchet JP; Bernard A; Gaussin J

SOURCE: Int Arch Occup Environ Health 1983;52(1):69-77

CITATION IDS: PMID: 6874093 UI: 83264455

ABSTRACT: Behavioral, renal, hepatic and pulmonary tests were applied to 22 subjects exposed to tetrachloroethylene in 6 dry-cleaning shops. The results were compared with those obtained in 33 subjects non- occupationally exposed to organic solvents. The intensity of exposure was monitored by personal environmental monitoring and by urine analysis for trichloroacetic acid and expired air and venous blood analysis for tetrachloroethylene. The time-weighted average exposure to tetrachloroethylene amounted to 21 ppm (range 9 to 38 ppm). The correlation between the concentration of tetrachloroethylene in ambient air sampled with the charcoal tube method and with a passive dosimeter indicates that the latter can correctly estimate the time-weighted average exposure to the solvent. In view of the long biological half- life of tetrachloroethylene, the internal dose may be better estimated by measuring its concentration in blood 16 h after the end of exposure (i.e. before resuming work the next morning). The present study suggests that if the blood concentration of tetrachloroethylene does not exceed 1 mg/l, 16 h after the end of exposure, the time-weighted average exposure is likely to have been below 50 ppm. Exposure to such level for 6 years on the average does not seem to exert any adverse effect on the central nervous system, the liver and the kidney.

AUTHORS: Ohtsuki T; Sato K; Koizumi A; Kumai M; Ikeda M

SOURCE: Int Arch Occup Environ Health 1983;51(4):381-90

CITATION IDS: PMID: 6862652 UI: 83236973

ABSTRACT: Personal monitoring of exposure to tetrachloroethylene (TETRA) with carbon felt dosimeters and analyses of urine for total trichloro- compounds (TTC) were carried out in two groups of workers (36 males and 25 females), one group (20 males and 19 females) in dry-cleaning workshops and the other (16 males and 6 females) engaged in the removal of glue from silk cloth. Comparison of the urinary TTC levels with TETRA in the environment revealed that, while the metabolite levels increased essentially linear to TETRA concentrations up to 100 ppm, leveling off was apparent in the metabolite excretion when the exposure to TETRA was more intense (e.g. more than 100 ppm), indicating that the capacity of humans to metabolize TETRA is rather limited, as previously discussed. From the set of the data thus obtained, screening levels of 30 and 61 mg TTC (as TCA)/l urine as the lower 95% confidence limits for a group mean were calculated for the biological monitoring, by means of urinalysis, of exposure to TETRA at 50 and 100 ppm (TWA), respectively. A tentative calculation with additional exhaled-air analyses indicated that, at the end of an 8-h shift with exposure to TETRA at 50 ppm (TWA), 38% of the TETRA absorbed through the lungs would be exhaled unchanged and less than 2% would be metabolized to be excreted into the urine, while the rest would remain in the body to be eliminated later.