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BIBLIOGRAPHY
GLUTARALDEHYDE AND OTHER CHEMICALS RELEVANT TO X-RAY AND THEATRE ENVIRONMENTS
Medical Journal Papers and Magazine/Newspaper Articles
Updated; August, 1998
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YEAR's 1968-80 | 1981 | 1982 | 1983 | 1984 | 1985 | 1986 | 1987 | 1988 | 1989 |
1990 | 1991 | 1992 |1993 | 1994 | 1995 | 1996 | 1997 | 1998
Sanderson K V, Cronin E. Glutaraldehyde and contact dermatitis. British Medical Journal. 28 Sept, 1968. (2 theatre sisters; one devel. cracking and hardening of skin in 3 wks and 3 mnths later rash on hands, arms and R chin, with papules. Improved on holiday. Second had sore nail bed then rash on hands. Both had handled formalin. Both patch-tested positive to GA but neg to fomalin. Withdrawing GA from the theatre.)
Jordan W P , Dahl M V, Albert H L. Contact dermatitis from glutaraldehyde. Arch Derm 1972, 105, 94-95. (5 patients with allergic contact dermatitis to pure GA - 3 dental assistants; one male with excessive perspiration of the feet treated with 10% glut; one male with fingernail tinea. Positive patch tests to GA and GA-tanned leather, both the wool and the skin. Thus enough GA is free or dissociates from the collagen of the leather to cause a reaction.)
Maibach H. Glutaraldehyde: cross reactions to formaldehyde? Contact Dermatitis 1975, 1:326-327. (21 patients who patch-tested positive to GA at 96 hrs had no patch-test reaction to formaldehyde. 6 had neg reaction to 25% GA on soles but severe dermat to 2.5% on inside elbow test.)
Belanii K G & Priedkalns M D. An epidemic of pseudomembranous laryngotracheitis. Anesthesiology 1977 47: 530-531.
(7 patients who were intubated devel either sore throats, hoarseness or dypsnea [difficulty breathing] - 4 had to have tracheostomies. Larynxes were edematous and swollen; not bacterial or fungal. Trace GA was found inside the endotracheal tubes. One still had hoaresness 14 mnths later. GA is the suspected cause - no problems since, after using disposable tubes.)
Martin H. Connective tissue reactions to acid glutaraldehyde. Oral Surg, 1978, 46,433-440.
Osterberg B. Residual glutaraldehyde in plastics and rubbers after exposure to alkalinized glutaraldehyde solution and its importance on blood cell toxicity. Arch Pharm Chem Sci Ed. 1978, 6, 241-248.
Rea William J. Environmentally triggered cardiac disease. Annals of Allergy 1978, 40, 243-251, April. (12 highly selected patients with non-arteriosclerotic cardiac arrhythmias and/or chest pain refractory to medication and having symptoms related to smooth muscle sensitizaion were studied in a rigidly controlled relatively fume- and particle-free environment. The majority of signs and symptoms cleared in 10 patients without medication while under environmental control and in 10 of the 12 patients all arrhythmias were reproduced with controlled repeated individual-blind and double-blind incitant challenges. Blood abnormalities occurred in the complement and T-lymphocyte systems. One patient, a 38 year old physician devel symptoms related to smooth muscle sensitisation incl. gastrointestinal bloating, belching, gas, cramping; also urinary urgency, chest tightness, and peripheral arterial spasm when exposed to X-Ray developer fumes. When forced to stay in developing area, symptoms progressed to shortness of breath and frequent premature ventricular contractions. Withdrawal resulted in cessation. Same over at least 20 exposures.)
Reed Charles R, Allergy/Immunology, Introduction Post Graduate Medicine 65, 4, April, 1979. (Allergic syndromes eg rhinitis can follow exposure to antigens or to chemical or physical stimuli. GA in photographic or radiographic chemicals is suspected of causing non-IgE mediated occ asthma.)
Zach Robert .J. How prevalent is glutaraldehyde sensitivity? Consultant May, 1980, 116. (Zach asks "Can inhalation produce membrane sensitisation resulting in allergic contact dermatitis and allergic nasal, bronchial, laryngeal or vocal chord edema?" and how to test for sensitisation - any danger, what form of GA to use? Response: 1. Don Brown, Envir H&S, Univ of Michigan - Varpela et al (1971) studies indicate proposed TLV 0.03ppm adequate - few toxic effects on animals with 10x exposure. GA can be acute sensitiser - the manufs of Cidex report small amount of contact allergic dermatitis and once sensitised, some individuals manifested allergic reactions when exposed to even the vapours of GA. Manufacturer unaware of any sensitation. by inhalation. 2. Marshall Guthrie: Contact sensitisation and edema of mucous membranes, and other symptoms suggestive of allergic response are possible following repeat exposure.)
Axon A T R et al. Disinfection in upper-digestive-tract endoscopy in Britain. Lancet 1981; i: 1093-94. (British Society of Gastroenterologists’ Survey. 37% of staff (36 members) in 16 units performing more than 500 endoscopies/month reported symptoms including skin, conjunctivitis, and nasal symptoms, even when working below GA limits.)
Fisher A.A. Reactions to glutaraldehyde with particular reference to radiologists and technicians. Cutis 1981, 28, 113-12. (First report of radiologist and x-ray tech with allergic contact dermatitis. Zack’s suspicions of contact dermatitis of the fingers from handling freshly processed film confirmed by Fisher - in a radiologist. and a technician both with positive patch test to 1% GA. Zack’s question as above in Cutis. Zack suspects several radiologists and techs have developed asthma and laryngeal edema. Special study planned by Zack. GA used for sterilising scopes etc and artificial kidneys. 2% water solution for sterilising. Stable for long periods if stored cool but once sodium bicarb is added the new alkaline solution undergoes polymerisation and loses antimicrobial properties within 2-3 wks.
Other reports of allergic GA dermatitis in nurses from handling sterilised instruments:
a)Sanderson and Cronin 1968.
b) Skog E, Sensitivity to glutaraldehyde, Contact Derm Newsletter 1968, 4: 79.
c) Harman R O’Grady K J, Contact dermatitis due to sensitivity to Cidex (activated glutaraldehyde), Contact Derm Newsletter, 1972, 11: 279.
d) Lyon T C, Allergic contact dermatitis due to Cidex, Oral Surg, 1971, 32:895.
e) Neering 1974. f) Gordon H H, GA contact dermatitis. Contact Derm Newsletter. 1974, 15:442 - inhalation therapy assistant with acquired allergic contact dermatitis from GA cold sterilant.
Does GA cross react with formaldehyde?
a) Neering H and van Ketel W G, Glutaraldehyde and formaldehyde allergy, Contact Derm Newsletter 1974, 16:518 - one renal dialysis assistant who had been in contact with both GA and formald had positive patch tests to both.
b) Garcia R L Delayed hypersensitivity reaction to to glutaraldehyde and formaldehyde, Bull Assoc Military 1972, 21:11 - one positive to both who had formaldehyde contact as a prosecutor’s assistant but no apparent GA contact. c) Fisher’s 6 formaldehyde cases did not react to GA..
Comaish S, Glutaraldehyde lowers skin friction and enhances skin resistance to acute friction injury, Acta Derm Venereol 1973, 53: 455 recommended that GA made skin tougher to prevent blisters - a single application lasted up to 3 days. GA has known antiperspirant action.
Gordon H H, Herpes zoster and simplex, Cutis 12: 918, 1973, recommended GA treatment for herpes zoster and simplex, and for Pseudomonas infections, Arch Dermatol, 1974,:106:261.)
Family practioners may develop contact dermatitis from handling dry X-Rays. Family Practice News. Approx 1981, Vol 12, 2, p7. (Zack warning. GA vapour may also cause nose, throat and resp symptoms in those with dermatitis as with Zack himself. GA used because partially replaces the need for expensive silver. [Accuracy of this is questionned.] Dr Fisher confirmed chronic dermatologist in a radiologist and tech. Fisher says GA sensitisation develops in about 1% who handle X-Rays, but about 5% of radiologists and techs develop sensitivity to GA.. Zach conducting survey of radiologists to correlate asthma, sinus and respiratory problems.)
Hansen K S. Glutaraldehyde occupational dermatitis. Short Communications. 1981, 81-82. (Case report 1: 50 yr old cleaning woman using Korsolin for 6 mnths with rubber gloves devel dermatatis on hands and arms. Improved weekends. Positive patch GA test. Korsolin contains glut/formald/glycol/urea/solvents/boric acid. Case 2: 42 yr old nurse working on same ward as case 1 developed eczema after 3 mnths of disinfecting respirators - also used rubber gloves. Patch posiive to GA and rubber.)
Lind T, McDonald J A, Avioli L V. Adult Respiratory Distress Syndrome Arch. Intern. Med 1981, 141, 1749-1753, Dec. (Inhaled toxins (plus shock, infection, trauma, liquid aspiration, drug overdose, hematologic and metabolic disorders etc) can cause acute local lung injury. Whatever the cause, grossly similar patholological changes occur in the alveoli and capillaries. Injury to the alveolar-capillary unit causes injury to pulmonary capillary and epithelial cell permeability which allows flooding of alveoli. Four hallmarks: 1. hypoxemia, (lack of oxygen in the blood) 2. decreased lung compliance, 3. decreased functional residual capacity, 4. diffuse alveolar infiltrates on chest roentgenogram.)
Reed Charles E . (Mayo Clinic). Occupational asthma Postgraduate Medicine 1981, 70, 2. (Occupational asthma does not include non-specific aggravation of chronic asthma by irritating fumes or dusts at work. Workers with pre-existing IgE-mediated allergy are predisposed to asthma in occupations where the offending agent is a protein antigen eg baking, but in industries involving chemicals, allergic patients are not predisposed to asthma. Reaction may be prompt or delayed for several hrs or recur night after night for a week or so after a single exposure, depending on dose inhaled and more so on individual reactivity. The pattern of remission away from work is a valuable diagnostic tool. Remission may take days or weeks especially for instance from toluene diisocyanate, probably because of greatly increased airway irritability which renders the airways highly reactive to nonspecific irritants, exercise and cold air. A positive skin test may only reflect exposure to an antigen, not prove the antigen is causing symptoms. Skin testing may be highly dangerous in highly sensitised persons. With agents like toluene which seem to act as pharmacologic agents, skin tests or RASTS (estimation of antigen-specific IgE antibodies) are of no value. )
ACGIH C Glutaraldehyde 1981 (Properties. Toxicity data. Summary of literature. GA in water is stable but when sodium bicarbonate is added, the glut is activated and its sporicidal, bacterial, viricidal, fungicidal, activity lasts for 14 days. GA has two active carbonyl (CO=) groups which react with tissue proteins by cross-linking. The irritant effect is also increased with activated glutaraldehyde.
Varpela E et al, Liberation of alkalinized glutaraldehyde by respirators after cold sterilization, Acta Anasth Scand, 1971, 15, 291. Mice exposed to 8% and 33% glut for 24 hrs reacted with nervous behaviour, panting, face washing; symptoms disappearing after a few hours. Livers of mice exposed to the 33ppm showed definite toxic hepatitis, possibly reversible as the mice sacrificed 24 hrs later showed less liver damage. OSH, California detected 0.38ppm in the breathing zone from a 2% activated solution in a simulated sterilising procedure. At the end of the procedure when equipment was being air-hose dried, the operator and investigators all experienced eye, nose, throat irritation and sudden headaches. C E Colwell at Union Carbide, New York, questioned MBTH testing and found by gas chromatography that exposures above 0.5ppm are intolerably irritating. This method could detect 0.1ppm. An odour panel judged odour threshold recog to be 0.04ppm by volume and irritation response to be 0.3ppm. Therefore TLV ceiling for GA vapour set at 0.2ppm)
Ballantyne B. Glutaraldehyde: Bibliography on health-related studies. Union Carbide Corpn., 1982.
Zach Robert. Cidex. Reader Tip. American Family Physician, January 1982. (Warning of dermatitis, rhinitis, occupational asthma from GA vapour, and residuals on endotracheal tubes causing laryngotracheitis.)
Zach Robert. Diagnostic Tips. Primary Cardiology April, 1982 (Warning of edema of larynx, bronchospasm, chemical rhinitis after lung function testing or respiratory therapy, if GA used to sterilise mouthpieces and tubing. Report in Am J Hosp Pharmacy (20:465,1963) said that GA levels of 6 ppm persisted in rubber tubing after as many as 5 washings.)
Field G B. Assessment of Occupational Asthma Patient Management. 12, 9, 35-44, Sept 1983. (Work envir may cause asthma by sensitising the worker to a specific substance, or aggravate asthma by non-specific irritation of the bronchial tree. Detailed occupational and clinical history is the best guide and diagnosis can often be made on history alone. Patient will usually have worked in the environment for mnths or yrs. Most cases progress relentlessly but when exposure is mild or intermittent, symptoms may fluctuate. Symptoms appearing towards end of shift and reaching a peak in the evening after work are typical. Symptoms occurring within a few minutes are more often the result of non-specific irritation. There is periodicity over the working week with symptoms more severe in latter part of week and remitting over weekend, but this may become blurred. Remission over holidays is a striking feature but this may not begin for a week or more. On return to work, attacks may take a week to regain their former severity (cf non-specific bronchial irritation which will occur first day back). Bronchial hyper-reactivity of occ asthma usually, but not always remits over mnths or yrs. Dyspnoea with exercise is a consistent feature - may be last feature to resolve. Conventional allergic mechnisms appear to be involved in only a minority, and atopic indiidual no more likely than non-atopic to devel occ asthma. Antibodies are inconsistent and bear no close relationship to severity of symptoms therefore skin testing and RAST testing (the estimation of antigen-specific IgE antibodies) are rarely indicated. Bronchial challenge is the most definitive test but should only be ttempted under a specialist thoracic physician. Requires patient in hospital for 48 hrs, baseline meas of forced expiratory function in one second (FEV1), or peak expiratory flow fate (PEFR). After challenge, measurements taken at intervals for 24 hrs and repeated with stronger dose if no reaction. BRONCHIAL CHALLENGE SHOULD NOT BE ATTEMPTED WITH POTENT SENSITISING AGENTS eg toluene di-isocyanate, NOR IF MEASUREMENTS REVEAL CONSIDERABLE IMPAIRMENT OF BREATHING. No weight should be attached to a neg. reaction if the patient has left the job (this is rather like the absence of symptoms on Mondays and after hols). A useful assessment is to give the patient a mini peak flow meter and diary, recording 4-5 times daily.)
Gordon M.A. ARE RADIOGRAPHERS AT RISK? Shadows 1983; 26:4; 8-12. (NZ Silver Jubilee Conference paper. Marjorie Aline Gordon history - had spent last 9 mnths investigating the problem of hypersensitivity to X-ray chems. Qualified 1950, worked Wgtn Hosp 5 yrs, married, 4 children, returned to work 1967 setting up small private Xray dept in Otaki Med Centre under Dr John Weston, Radiologist. Small darkroom, hand processor, no outside ventn, sole charge for 11½yrs, 2,500 patients/yr. 1979 moved to new Med Centre with auto processor plus hand processor for non-screen film. From 1971 had nocturnal arrthmia and tachycardia, dyspnoea after exercise. Sore throat/husky voice cleared in weekend. Developed severe arrthythmia and tachycardia and worsening ENT symptoms with increasing frequency. June 1982, very severe heart smptoms and onset of tinnitus, inc mucosal exudate and excessive fatigue. Medication unsuccessful. ECG taken duting 23 hr cardiac attack showed reaction typical of thyrotoxicosis - but thyroid tests normal. ENT specialist Oct ‘82 confirmed no sinus infection and no explanation of the tinnitus - stated the mucous membranes had all the appearance of a hypersensitivity, not an allergy. Returned to Rhythmadon med but worsening of nausea, tremor, weakness, excessive tiredness, blurred vision, and tinnitus. All except tinnitus improved at wknds. Nov ‘82 realisation that had to withdraw from work situation. Employer contacted Agfa-Gavaert, NZ, who denied any problems. Symptoms subsided over 3 wks sick leave. Returned to work December and symptoms all returned in a few days. Cardiologist stated condition pointed to a toxic chem reaction. Jan ‘83 cleaners spilt waste fixer - caused such severe symptoms that Agfa suggested a darkroom fan and ducting waste fixer to outside. Left on visit to UK and J Weston paid airfare to AGFA in Belgium. GP had previously contacted Agfa’s Dr De Wever who stated if the prob was respiratory only non-contact would prevent further occurrences. Agfa gave product info usually only available to senior sales staff. Agfa’s chem containers only warn of danger of skin contact but this info contained inhalation and toxic warnings. Attended July British Radiographers’ Conference. Question at the AGM - others affected? The Society had had other complaints they were beginning to look at. Warren Town, Society’s Industrial Relations Officer sending 316 quest to 82 H&S Reps - result: 494 identified physical discomfort. Home to NZ and 25 letters from radiographers all around the world: 13 with heart probs, 41 ENT, 40 chest, 41 excessive tiredness, 6 eye symptoms, 6 nausea, 3 painful joints. eg Coby, Sth Africa doing quality control in primitive conditions: "...attacks similar to anxiety neurosis. High pulse, perspiration, exudate in larynx, tinnitus, gross fatigue, often painful joints. During inspections in summer, admitted to hosp with ?rheumatic fever, ?viral myocarditis. All haematology/ endocrinology tests neg". Linda, UK: "...chest uncomfortable and tight, and palpitations I assumed to be from anxiety". Mr MC, UK: "...referred to consultant for ?cardiac arrhythmia, chest pains, tinnitus and excessive tiredness...on holiday my tinnitus was much improved. We know of 5 radiogs who have had serious URII heart probs...". From Wales: "...the dkrm is very small and problems started in 1982 when second processor installed. 12 on staff. ...furry mouth, catarrh, sneezing, headaches, sinusitis, chest pains, coughs, conjunctivitis... only stop on hol...I think they believe we are a bunch of neurotic women.". Mr H, Germany, "...suffering for 3 yrs.. We spend 1½ hrs/day in darkroom.. My general stuffiness has been described as hay fever but I have never suffered from this..". Maire, Ireland: "I did not suffer sinus or respiratory infections until 1st yr as a student... sinus, nasal stuffiness, headaches, 4 virus infections, 2 pneumonias, sinuses washed out 4x.. NO RELIEF ..now sore throats, gums, fatigue.". Patricia, S Africa, "...laryngitis for 9 yrs...radiol gave me a talking to and asked if I would have any voice left in 5 yrs...gave up full-time radiog...". Graham, Scotland: "...tech suffers headaches, nausea, vomiting, tinnitus only when working in one small poorly ventilated darkroom.". John, England: "..doing 5,000 exams/yr. Began with feeling of burned sore mouth, white deposit on tongue, difficulty in swallowing, intense dryness, catarrh...Jan ‘82 found breathing difficult...my blood pressure much below normal...felt as though I would faint. ECG and barium meal neg....told either a worn-out workaholic or had a phobia about work or off my chump, or going thru the change...hot vapours at 95°F for many hrs/wk...I admire your nerve in writing as there is a risk you could make a fool of yourself and look like some sort of nutter" . T F Chitty from May and Baker made contact; concerned - had written article on sulphur dioxide. MAG’s AIMS: Education, ventilation, need to work with the chem companies. Questionnaire planned. Returned to work - a week back and even with change to door position and an assistant, could no longer work.)
Hansen K S. Occupational Dermatoses in Hospital Cleaning Women. Contact Dermatis. 1983, 5, 81-82, Sept 9.
Hansen K S. Glutaraldehyde Occupational Dermatitis. Contact Dermatitis 1983, 1, 81-82
Benson W G Case report - Exposure to Glutaraldehyde J Soc Occup Med 1984, 34, 63-64. (Endoscopy sister with constantly irritating eyes /conjunctivitis and increased breathlessness. Did peak flow meas. 2 hrly: 300 Litres/min at work. Peak flows improved at weekends to 410 L/min. In the week with an alternative sterilant, the only day with a fall was when another nurse was disinfecting with glut in the room next door. Support for GA being strong irritant and sensitiser)
Goncalo, S. et al. Occupational Contact Dermatitis to Glutaraldehyde. Contact Dermatitis. 1984, 10, 183-4. (Five cases of allergic contact dermatitis to glutaraldehyde from occupatonal exposure to Cidex. All reacted to several concentrations of activated Cidex and glut. Two reacted to formaldehyde. None of the 42 controls reacted (18 worked with Cidex manipulators, 24 no Cidex contact.....the precocious occurence of sensitization in all patients (4 to 6 mnths) suggests, as in Hansen's cases, that it is a strong allergen, and that the use of rubber gloves does not seem to afford complete protection.)
Tolerton J. Toxic Fumes - Marjorie fights for others at risk. NZ Women's Weekly, Sept 24, 1984, 4-6 (MAG's story from 1982, travel to UK, Aust, USA, then UK again to prove that radiographers are at risk. Her job in private practice, and health - falling asleep eating dinner, cardiac attacks, tinnitus, throat like heavy smoker, chronic laryngitis, tested for toxic thyroid, bad reaction to cleaning out a tank and the penny dropped. 3 wks off - better, cardiologist suggested looked like a toxic reaction. Visit to Agfa, Belgium, then Wales Conference, "Radiography News" article, 25 replies. Tried work again - immediately affected. Accepted by ACC (Workers’ Compensation). NZ survey with Spicer and Hay, Massey University. Medline search revealed Dr Zach's theory that glut was cause. Visit to Zach but NZ "the only place to really bring it into the open". Chemical companies willing to give info/help.)
"Occupational Asthma: Help is on the Way." June 19, 1984. Monroe Evening Times. (Dr Robert Zach/MAG meeting: asthmatic reactions in 5% of radiologists, skin plus eye, ear, nose and throat reactions, sensitisation to glut., ventilation the key, employees should be pre-screened, 1978 Univ of Oregon/Zach GA survey (aborted).)
Gordon M.A. The effects on health of inhaling toxic chemical fumes given off during the processing of x-ray films. Shadows 1984, 27, 4, 28-33, Dec. (Letter from photog company [Agfa] "We believe you have highlighted an area in radiography which obviously needs more attention and research....size and ventilation of the darkroom is a factor of almost equal importance...". One page quest. (compiled from symptoms described in letters from all over the world and from symptoms described by NZ control sample group) devised. This went to radiogs with symptoms in the UK (21 sent, 60 ret), Aust (16 sent, 48 ret), S Africa, NZ; total 130 returned. Results: Headaches 103 / 79%, Sore throat/hoarseness 102 / 78.5%, Unexpected fatigue 93 / 71.5%, Bad taste in mouth 84 / 64%, Sore eyes 80 / 61.5%, Sinus probs 73 / 56%, Catarrh 73 / 56%, Nasal discharge 66 / 51%, Nausea 62 / 48%, Tight chest 60 / 46%, Painful joints 52 / 40%, Chest pains 50 / 38%, Shortness of breath 50 / 38%, Skin rash 44 / 38%, Mouth ulcers 43 / 33%, Lip sores 34 / 26%, Unusual heart rhythms 32 / 25%, Tinnitus 27 / 21%, Loss of feeling in extremities 22 / 17%.
Brit Soc. of Radiogs questionnaire of 82 Xray depts: 61 depts reported sore throats, 49 bad taste in mouth, 42 tight chest, 40 nausea, 31 mouth ulcers, 29 nasal discharge, plus eye, sinus probs, headaches, drowsiness. MAG’s work - Medline search had revealed Zack’s observations on GA. Contacted and met Zack who had begun research with the Univ of Oregon, 13,000 postcard quests to USA Xray personnel at cost of $20,000. Zack only received back 600 of the many which were returned as the university was not prepared to continue the investigation for fear of losing philanthropic support [from a photog co]. Dr Charles Reed lists GA as suspected of causing non-IgE mediated occ asthma (1979).
Meetings: on to the UK and discussions with Dr Cronin - had seen no contact dermatiits in radiogs. Dr Sanderson suggested skin patch tests. Dr Anthony Newman-Taylor (Brampton Hosp) agreed research must continue with a medical team. Prof C Rossiter (London Sch Hygiene and Occ Med) stated he was convinced there was a problem and suggested morbidity study (agreed this already achieved) and personal aldehyde monitoring devices. He could do air monitoring study if funding available. He discussed the problem with Kodak who are looking to safer processors and better labelling.
ISRRT/Brit Soc Radiogs Conference, Eastbourne, June, met G Care (Photosol), T Chitty (May and Baker) and discussed prob of measuring 0.2ppm accurately. Dr Conix ( AGFA-Gavaert) working on new hardener. Meeting with H&S Exec in Bristol - now testing for GA/formald/acetic acid/SO². Serious health probs at the Royal United Hosp, Bath. Further meetings: Dr Hughes, Immunologist (Royal Postgrad. Med School, Hammersmith); Dr C Bishop, H&S Exec re thesis on formald; Dr Bernard Hogben re formald case similar to MAG’s; Dr F Chandra (Sen Med Officer, DHSS); Dr M Greenberg, (toxicologist, DHSS) who referred to the lethal cocktail; Dr Ward (DHSS) re cover as an occ disease; M Jordan, Secretary, Coll of Radiogs - MAG to write for"Radiography"; Warren Town/Dr Audrey Jacobs, Society of Rads.
GA Usage; no warnings on chem containers, nothing on inhalation dangers. TLV - Threshold Limit Values - these are airborne concentrations of substances to which it is believed nearly all workers may be exposed day after day; some people react below the TLVs; danger from aldehydes as well as the recognised SO² and acetic acid. Hazard control must include processor exhaust and extra room ventilation etc, plus checks on those who have worked with aldehydes before or have allergy history. Grants received: ISRRT WRETF $460, NZ Rouse Educ Trust $350, AGFA-Gavaert $200 travel. $24,000 of her own money. Dr W J Weston, her employer, "There is no doubt that this will be the most important contribution you will make to radiography and radiology in your lifetime".)
von Wartburg J P, Buhler R. Biology of Disease. Alcoholism and aldehydism: new biomedical concepts. Laboratory Investigation 1984, 50, 1, 5-15. (New research in alcoholism shows great variability with respect to metabolism of alcohol and its first oxidation product, acetaldehyde. Hypothesis that individual and racial differencess in alcohol metabolism are based on genetically determined variability of the enzymes alcohol dehydrogenase(ADH), and aldehyde dehydrogenase (ALDH). As a toxic intermediate of alcohol metabolism, acetaldehyde plays a central role. Three positive ranges of acetaldehyde levels can be defined: a) normal b) the "acute aldehyde syndrome" with extremely high levels of acetaldehyde, c) "chronic aldehydism" with aldehyde levels elevated 2-5 times. In Orientals lacking mitochondrial isoenzymes of the liver (the enzyme is present but inactive) , acetaldehyde accumulates and produces symptoms of intoxication: facial flushing, dilation of blood vessels, tachycardia, hypotension (abnormally low blood pressure), headache, nausea, vomiting, muscle weakness, sleeplessness after ethanol ingestion. This syndrome is highly aversive and thus prevents individuals from drinking. Alcoholics have slightly elevated levels of blood acetaldehyde. In alcoholic liver disease the mitochondria suffer severe damage, thus aldehyde oxidation is disturbed producing an accumulation of acetaldehyde which leads to a further disturbance of mitochondria. Acetaldehyde is also oxidised in the cytoplasm of the liver by cytosolic liver ALDH - this activity is reduced with alcoholic liver disease and could explain the disturbed acetaldehyde metabolism. Alcohol toxicity leads to the devel of fatty liver. One study suggested that test subjects with alcoholism in their families had higher blood acetaldehyde levels after a test dose of ethanol (alcohol). High concentrations of ADH were found in just a few cells of the kidney, gastrointesinal tract, liver, brain (cerebral cortex, cerebellum, hypothalamus), testes, pancreas (acetaldehyde also has a marked effect on insulin and glucogen release). "Therefore many of the organs could be direct targets of acetaldehyde ... even at low blood acetaldehyde levels".)
Bardazzi F, Malino M et al. Glutaraldehyde dermatitis in nurses. Contact dermatitis. 1985, 14, 5, 319. (541 hospital cleaning women showed a very low prevalence (0.2%) of sensitisation to GA but several cases of dermatitis in hospital staff.)
Brooks S M, Weiss M A, Bernstein I L Reactive Airways Dysfunction Syndrome (RADS). Persistant Asthma Syndrome after High Level Irritant Exposures Chest, 1985, 88, 376-384 (10 individuals developed asthma-like illness after a single exposure to high levels of a highly irritating fume, vapour, or smoke, most the result of a workplace accident. (One was a fumigating fog aerosol containing aldehyde and glycol etc - 6 mnths later she had sensitisn to cat/dog/house dust/ragweed/spores. One was bookstore fire smoke [? formaldehyde]; her symptoms began to develop the next day - had had a past history of allergic rhinitis). The illness simulated bronchial asthma and was associated with airways hyperreactivity but differed from typical occ asthma because of its rapid onset, specific relationship to a single environmental exposure and no apparent exposure presenstitisation with an apparent lack of allergic or immunologic etiology. None had any apparent respiratory complaints at the time of the accident, although two had allergic rhinitis. Mean duration of RADS was 3 years, one case was evaluated 12 yrs after the event. In some, an apparent delayed response from time of exposure was noted. Methacholine challenge method. "While our definition of RADS is restrictive ... it is conceivable that a low-level chronic exposure could cause a similar type process in some individuals."
Other long-term reactions reported:
Harkonen et al (1983): 3 miners had persistant airways hyperreactivity 4 yrs after SO² exposure in an explosion.
Charon (1979): SO² exposure, 3 severe/1 mild airways obstruction.
Flury et al (1983): concentrated ammonia fumes exposure; developed documented airways obstruction over 5 yrs.
Axford et al (1976); single severe toluene exposure. 4 yrs later 20 men with persistent respiratory symptoms.)
Denning J, The hazards of women's work New Scientist 17 Jan, 1985 (Body strength, shape/size issues. Women have proportionately less muscle but more fat (20-25% compared with 10-15%) which may make women more sensitive to chem pollutants eg organic solvents which are stored in body fat. The more rapid detoxifying liver metabolism in men may make them more susceptible if the metabolites are more toxic than the original chemical. Hirokawa, 1955 noticed women took longer to eliminate benzene from tissues and were more sensitive to toxic effects such as decreases in number of white blood cells. Female and castrated rabbits more sensitive than males to benzene. Men and women suffer greater toxic effects if fat rather than lean. Much of testing of safe chemical limits has been done on males. In a sex hormone factory, 12/30 f. employees had symptoms of excess oestrogen (4.3 x the rate of a matched group) from breathing, swallowing, skin absorbtion. Nurses at risk from cytostatic cancer drugs. A long list of chemicals including solvents can upset the menstrual cycle. Chemical pollutants pass through the placenta - most dangerous time is when babies develop their organ systems. Significant risks from halothane and nitrous oxide - high rates of infertlity and spontaneous abortions in these workers. Pregnant lab workers susceptible to viruses inhaled from aerosols - lost more pregnancies.)
Gordon M.A. A review of the toxicological effects of inhalation of fumes from photographic and radiographic chemicals during processing. Shadows 1985; 28:4; 8-9. (From Honolulu presentation. Some chemical companies now giving warnings on products. Damage:1. irritability or contact symptoms 2. systemic and toxic illnesses. Results of NZ survey showed most symptoms positively correlated to length of time spent in darkroom. Formaldehyde detected in Xray rooms indicates it is given off during processing [this is incorrect - comes from other things in the envir.]. Formald and SO² are sensitisers. 1. Pre-sensitisation: small amount of the chemical absorbed and slowly builds up a reaction which may be rapid or take years. 2. Senstisation: when the immune system is triggered. 3. Reaction can happen within hours causing inflammation of respiratory tract and susceptible tissues in the individual. (Case1) 43, f, 18 yrs without problems. New job 1980, unventilated darkroom in which used fixer/devel stored. Spillages frequent and "blow-back" from processor into waste fixer. Exhaust from rapid processor not connected. Painful joints, rash, ulcers, loss of feeling in extremities, laryngitis. SLE diag. Withdrawn from work - dramatic improvement. Returned to work - within 4 days painful joints, rash, ulcers, laryngitis returned. 5 radiogs diag SLE. (Case 2) 33, m, no problems until 1981 sole-charge in darkroom with small fan and leaking auto processor ducting fumes into the ceiling. Nasal pain, tinnitus, catarrh, nasal discharge leading to tight chest, shortness of breath, unexplained. pneumonia. More bronchitis, pneumonia; by 1984 all the above plus painful joints and arrythmias. ECG showed typical toxic reaction. [This is Case 2 in 1987 paper.] (Case 3) MAG’s. Case (4): 42, f. New processor, 1978, sore eyes, ulcers, sore throat, voice loss, painful stiff joints, marked tiredness leading to 1981 with L facial weakness (L motor neurone facial palsy). New processor with leaking exhaust. Another new processor1983 - palsy subsided but respiratory symptoms debilitating. Case (5): 64, m, radiologist. Used auto processor from 1970 and did silver recovery. Following inflammatory reaction to fumes, infection seemed to travel down bronchial tubes to cause alveolitis with resultant pneumonia. SO² mask - no further pneumonia. Permanent damage to mucous membranes of nares which became thickened and elevated - it was thought this might be a collagen prob. [Same person, Case No 4 in MAG’s 1987 paper].
Gordon M.A. Danger-toxic fumes! Radiography News April 1985. (Hazardous chems: Hydroquinone symptoms reported from 1945 - tinnitus, nausea, dizziness, increased respiration, headache, dyspnoea. Diethylene Glycol ingestion causes vomiting, cyanosis, headache, tachypnoea, pulmonary oedema. Acetic acid - ingestion causes burning of mucous membranes of mouth, throat, stomach, nausea. Glutaraldehyde. Sodium sulphite. Potassium hydroxide. Ammonium thiosulphate. Sodium sulphite. Acetic acid. Aluminium chloride. Breathing rather than swallowing can deliver the chemicals straight into the bloodstream, bypassing the detoxifying liver and damaging delicate membranes en route. In the ‘60s glutaraldehyde was added, and ammonium thiosulphate replaced sodium. Now have a mixture of chemicals (synergism), minimal washing of film and heated chemicals!!
NZ workplace survey results/tables. 72% response rate. Analysis, Dr J Spicer: most symptoms correlated positively with length of time in darkoom. Those with symptoms in the last 12 mnths: headache 76%; sore throat/hoarseness 69%; nasal discharge 61%; soreness of eyes 57%; unexpected fatigue 56%; sinus problems 50%; nausea 47%; painful joints 46%; bad taste in mouth 44%; mouth ulcers 35%; catarrh 29%; ringing in ears (tinnitus) 27%; tight chest 25%; skin rash 25%; lip sores 23%; shortness of breath 22%; unusual heart rhthms 19%; chest pains 18%; loss of feeling in extemities 15%.
British Society of Radiographers H &S survey of 82 Xray depts: sore throats 61 depts; bad taste 49; tight chest 42; nausea 40; mouth ulcers 31; nasal discharge 29 [plus eye, sinus, drowsiness, headache - MAG 1984 paper]. Zack’s, and Belani and Priedkalns (1977) work on GA. Zach left with paralysed vocal chord and severe sensitisation - insurance paid compensation but wouldn’t admit liability. Epidemiological survey urgently needed.)
Cold disinfectants led to closure. Occupational Health. 1987 , p102.
Collier S. Hazards in the darkroom. Health and Safety at Work. May 1986. (Carole Sewell, senior hospital radiographer, London, England; acute sinus pains, sore eyes, aching and ringing ears, infections, exhaustion, lost voice, bad taste, skin dry and split. Has to wear respirator to work. Warren Town of Society of Radiographers believes 30% of technicians could be in trouble. Survey by Society of Radiographers showed 500 radiogs in 82 British Hospitals experienced health problems. HSE say chems detected below limits, no obvious agent responsible, only very very few had reported problems. MSDS (Material Safety Data Sheets) are completely inadequate. Carole S says poor machine design a problem. The chems are agitated and heated, hot humid air rises, exhaust air from film drying compartment can blow back over the chemical tank and vice versa. In one double strength processor the dryer fans were activated as the film entered the drying section causing a gust to blow back into the eyes and nose of the operator. An extractor fan in her dept created more problems by drawing fumes out of the processor - these then blown into the room.).
Corrado O J et al. Asthma and rhinitis after exposure to glutaraldehyde in endoscopy units. Human Toxicology. 1986, 5, 325-327. (The first report to use provocation testing to confirm, in two out of four endoscopy nurses, a relation between exposure to alkaline glutaraldehyde and respiratory disease. 1) Nurse, 33, with hay fever and pollen asthma, 2 wks after starting work in endoscopy unit developed severe nasal symptoms. FEV in 1 sec was 2.7 litres - in normal range. No improvement with salbutamol inhalant. 2) Nurse, 30, with rhinitis and asthma noticed marked deterioration. Better using Dettox. Normal FEV 1.9. 3) Nurse, 43, devel asthma and rhinitis 2 wks after starting in endoscopy. Had history of both but never so severe and only in May-Aug. FEV normal. 4) Nurse, 37, 5 yrs in endoscopy, had chest tightness. Improved with Dettox. No improvement on salbutamol. Lung FT normal.
Conducted provocation testing. Blind testing impossible because of glut’s odour. Patient 1 had both an immediate (within 20 mins) rhinorrhoea and sneezing response and late, (2h), nasal airways resistance, (NAR), response after 20 min of exposure to open trough. Patient 2 had 22% fall in FEV1 after 80 min. NAR levels too high to measure. 1 and 2 had no change with saline control. 3 and 4 had no change with either. The development of the late reactions after provocation suggests that the underlying mechanism is allergic in nature and not simply an irritant effect on the airways. Findings have far wider implications as glutaraldehyde is used in several hospital departments as a histological fixative, a hardener for X-ray film and in the treatment of certain skin conditions.)
Gordon M A. Occupational stress and the radiographer, Letter to the editor. Radiography May/June 1986, 52, 603 (Fatigue, headaches, gastro-intestinal upsets, irritability etc far more likely to result from unhealthy work environment.) Shim C and Williams M.H. Effect of odors in asthma. American Journal of Medicine. 1986, 80, 18-22, Jan. (Many patients complain that some odors worsen their asthma. Perfume amd cologne are two of the most frequently mentioned offenders....A survey of 60 asthmatic patients revealed a history of repiratory symptoms in 57 on exposure to one or more common odours. Four patients with a history of worsening of asthma on exposure to cologne underwent challenge with a cologne, and their pulmonary function was tested before, during and after the exposure. Forced expiratory volume, FEV, in one second declined 18 to 58 percent below the baseline period during the 10 minute exposure and gradually increased in the next 20 minutes.... Odours are an important cause of worsening of asthma.)
Spicer J, Hay D M, Gordon M A. Workplace exposure and reported health in New Zealand diagnostic radiographers. Australasian Radiology 1986, 30, 3, 281-286. (Postal survey of 349 practising radiogs correlating length of time in the darkroom with symptoms. Results suggested to be underestimates of exposure-symptom relationships. Headache, sore eyes, tight chest, unusual heart rhythms appeared to be uncorrelated with length of exposure. All other symptoms showed a correlation. Tables given. The inhalation or ingestion or absorbtion pathways are implicated in the bad taste, sinus, nasal discharge, catarrh and lip sores. Lip sores, fatigue, painful joints, and numb extremities correlate with greatest exposure to the workplace; the latter three raise the possibility of systemic disorders. Other symptoms: sore throat/ hoarseness, nausea, mouth ulcers, ringing ears, rash, chest pains. Further more focussed studies now needed especially on URT disorders.
Gordon M A, Laird I. Guidance Notes for the Provision of a Safe Work Environment and Safe Work Practice for Radiographers and Darkroom Technicians. 1986. ACC, NZ. (Revised 1990) (See under "Reports".)
Gordon M.A. Reactions to chemical fumes in radiology departments. Radiography 1987, 52, 607, 85- 89. (Four case reports. No 1. Exhaust to processor not connected; puffy hands/feet, blurred vision, May ‘83 collapsed, loss of feeling in left foot and rt side of face. Spots over whole body. Bad taste. May ‘85, collapsed - loss of feeling left side of body, weakness, cold; atropine injection. No evidence of heart disease. After that, severe chest pain, nausea, pins and needles in lip, palate and tongue, numb R face, left arm and leg, pain left scapular, weakness, speech slurring. Most symptoms improved 2 wks away.All recurred within hours back. Still sensitive to traffic fumes, red wine, hair spray, cigarette smoke, aint,newsprint
No 2. Processor fumes vented into ceiling; small fan. 1981, nasal pain, earache, tinnitus. 1982 catarrh, rhinitis, shortness of breath, chest tightness, sore throats, lack of energy. 1983, unexplained pneumonia, wouldn’t clear. Still URT symptoms, tinnitus, fatigue, plus prostatitis which improved on hol. Continual chest infections not respondong to antibiotics. By 1984 arrythmias, prostatitis, tinnitus, catarrh, rhinitis, fatigue, sinuses blocked, wheeziness; 1985 medically unfit for radiography. New job but particle board walls with formaldehyde forced him to give up. Now sensitive to paint, petrol, cigarette smoke. [Case 2 in 1985 paper]. Case No 3. MAG. 1970-1979 - manual processor - cardiac arrthmias, tachycardia began. 1979 auto processor, worse cardiac, tinnitus, headache, URT, lip sores, severe sore throats, hoarseness. 1982 tachycardia: weakness, tremor, nausea, blurred vision. Aug: increased fibrillation, severe retrosternal burning pain, irritability, shakiness. Sept, cardiologist. (Xrays pictured.) Normal thyroid. Oct, ENT surgeon: suggestive of hypersensitivity and systemic illness. May 1983, left work, symptoms subsided. Sept returned to work and suffered atrial fibrillation. Left work. Intermittent tinnitus, headaches, lip sores went, recurrent laryngeal/tracheal infections. Reactions to petrol, cig smoke, hot dry air, cold winds, paint, red wine, radiographic chems. ENT assessment; permanent damage to vocal chords. No 4. Radiologist who did silver recovery in unventilated area. 1970-83 had 9 bouts of unexplained pneumonia following URT infection. Leaky tap nose stopped once on holiday. Nostrils became fissured, thickened. 1981 - area of consolidation about the R hilum - not a lesion. Final pneumonia 1983 - used full face mask from then on. 1986 lymphoid lymphoma. [Case 5 in 1985 paper])
Gordon M.A. Darkroom diseases and how to combat them. Journal of the Royal Society of Health 1987, 107, 3, 102-103. (The chemicals, synergism, symptoms, pulmonary transfer of toxic substances by-passes the detoxifying liver. Sensitisation. Prevention: Engineering/ventilation/ safe practice/ personal protection/ training/darkroom finish.)
Jaworski C et al. Allergic contact dermatitis to glutaraldehyde in a hair conditioner. Cleve Clin J Med. 1987, 54, 443-444. (22 yr old, f , with scalp eczema and secondary infection, hair loss. 90% improvement after 2 wks non-contact with the 1% glut conditioner. Pos patch test after 72 hrs to 0.1% glut. 74 cosmetics with GA were US registered between 1973-1984).
Laverton Sue. Letter to Ed. Shadows, 1988. (Wanganui Hospital. After new automatic processor, one radiographer began to complain of nausea/vomiting/headache after a session. Ineffectual expelair. 42°. Extra expelair useless - despite frequent requests for better ventilation, told nothing could be done. ?change of recipe - smell became stronger - difficulty with speech then total voice loss for 5 mths. ENT surgeon stated hypertrophy of false vocal chords consistent with toxic chemical inhalation over long period. Left with husky voice and severe sensitivity to wind, smoke, paint fumes etc.)
Menne Torkil Regional variations in contact sensitization. Cleveden Clinic J of Med 1987, 54, 5, 377-8, Sept/Oct. (Main prerequisites for allergic contact sensitization are (a) a genetically susceptible individual, (b) a hapten [absorbed through the skin in an appropriate conc, (c) normally functioning Langerhans cells [probable antigen-presenting cells involved in immune responses] in the epidermis. Great variation on absorption depending on site. Skin response on back more pronounced than on arms. 25% GA popular for treating plantar warts etc. Contact dermatitis on soles rare - low density of Langerhans cells and probably also because of strong binding of GA to keratin. "GA must be regarded as one of the ubiquitous allergens".)
Straughn J. Avoiding glutaraldehyde irritation of the mucous membranes. Gastrointestinal Endoscopy 1987, 33, 5, 396-7. (Some staff found GA irritating but a modification to the Scope Guard system eliminated this with a system of long tube holders for dirty and clean endoscopes sunk into the bench).
Cold disinfectants led to closure. Occupational Health. April 1987. (2 hospital endoscopy units forced to close after staff sensitised to GA. Recent survey of 200 members of British Society for Gastroenterology showed up to 1/3 in endoscopy were affected by fumes or contact with Cidex, Asep, Gigasept, Tutacide etc. Christianne Newman, nurse advisor to BSH, sensitised after 2 yrs - says fume cupboards and special gloves impractical for routine cleaning of endoscopes. Do 15 in 3 hrs - would need many new ones (at £10,000 each) if to observe full precautions. RCN reluctant to take up nurses’ cause because of lack of nurses willing to put details in writing.
Gordon M.A. Darkroom diseases. Shadows 1988; 31:4; 18-20. (Radiographerss at risk are those using daylight/tabletop processors without adequate ventilation - ultrasound, radiotherapy, theatre and sole charge. Sensitisation after cumulative low-level, or eg a single spillage. Symptoms. Minute quantities prod non-IgE mediated response - asthma-like reaction is not a histamine release (unless it’s to sulphur dioxide). Blood tests by immunologist on 2 sick radiographers from different hospitals showed similar blood abnormalities even though different symptoms. 32 radiogs with no reported symptoms filled in brief personal questionnaire on age, sex, number of yrs exposure, allergies etc. Random blood tests showed blood abnormalities in 13/32 [41%] and evidence of immune stimulation in 31.2%: 5 positive ANA titres, 3 elevated antibodies to single-stranded DNA, positive auto-antibody readings in 2; minor deviation in peripheral blood mononuclear cell types were seen in another 3. A variety of minor blood screen abnormalities probably attributable to upper resp or other infections noted."Sufficient cause for concern to look at the matter in a ...controlled study". [Note, this never took place because of ethical concerns in NZ at the time.] )
Gordon M A. Chemical hazards in film processing. An update on research. Shadows, 1988, 31, 2, 28-29. (Publication achieved of Guidance Notes by ACC with 2,500 distributed and 2nd edition planned plus poster for the ISRRT.
3 months in the UK helping sick radiographers obtain compensation. ISRRT Teachers’ Seminar in Canada to persuade Schools of Radiography to incorporate the Guidance Notes into syllabus. One firm working on GA free developer. Blood testing for evidence of immune stimulation planned.)
Gordon M A. Chemical hazards in film processing. ISRRT Newsletter: The Control of Hazards in Radiographic Practice. 1988, 24, 1, 9-12. (Changes in processing, chemicals used, symptoms, control of hazards, health and safety in the work environment, health questionnaires, instruction in schools of radiography, wall charts.)
Nethercott J R, Holness D L, Page E. Occupational contact dermatitis due to glutaraldehyde in health care workers. Contact Dermatitis 1988, 18, 193-196. (Hand dermatitis in 13 healthcare workers, 4 yrs plus exposure. GA patch test strips in place for 48 hrs. Best reading at 96 hrs; only every two in four had a positive skin patch test. Hand eczema persisted even after subjects left their jobs. Sensitisation in 10 to formald and latex probably took place at the same time from the work envionment.)
Norback D. Skin and respiratory symptoms from exposure to alkaline glutaraldehyde in medical services. Scand. J Wk.Environ.Hlth. 1988, 14, 366-371 (Eye, skin, airway, headache, nausea, fatigue studied re cold sterilisation. Measurements revealed that GA exposure was intermittent and well below Swedish OES, but the exposed group showed significantly increased frequency of rashes, nasal and throat symptoms, headache and nausea. Results of patch testing were negative in those with rashes, suggesting that GA has its effect through direct irritation rather than allergy. Those who used GA most had 3x as many symptoms as those who used it least.)
Prima T, Pasquale R de, et al. Contact dermatitis from glutaraldehyde. Contact Dermatatis 1988, 19, 3 (Cleaner developed eczematous dermatitis after using Cidex for disinfection of instruments. Patch testing showed positive reaction to GA - should be considered a potent allergen.)
Bakke JV. Photochemicals and their effects on health. Tidsskr Nor Laegeforen 1989, 109, 3, 361-362. Jan.
[Article in Norwegian] PMID: 2916222, UI: 89130514. (Health hazards related to chemicals used in X-ray
departments and photographic laboratories need looking at. The chemicals which pollute the environment in such premises may cause symptoms related to the skin, mucous membranes, eyes and airways. Teratogenic, mutagenic and neurotoxic effects cannot be excluded).
Bakke J V, Bjerkvik P S, Pedersen I L, Eldoen G, Seim H. Occupational diseases among personnel at a radiology department. Tidsskr Nor Laegeforen. 1989, 109, 3, 345-349, Jan 30. [Article in Norwegian]. (Little attention hitherto paid to health injuries to personnel in X-ray departments after exposure to photochemicals. 24/30 employees at the X-ray department in Molde were shown to have health problems related to their work, including symptoms relating to the eyes, the upper and lower respiratory tract, and headache and lassitude. Analysis of the work environment showed constant extensive exposure of the employees to chemicals over a long period. After improvements to the environment, health problems were reduced appreciably, but not nullified. Some personnel had acquired permanent impairments. Bronchial hyperreactivity was discovered in 19 of the personnel, 13 of whom had subjective symptoms of obstruction and asthma but no manifestation of allergy. Relation between the work environment and impaired health; advice on how to avoid similar problems in the future.)
Burge P S Occupational risks of glutaraldehyde. Brit. Med.J. 1989, 299, 342. Aug. (Review of glut lit with the conclusion that some hospital workers developed symptoms under current limits. GA is the best sterilant therefore better to reduce exposure with appropriate measures).
CCH International. Hazard Alerts: gluteraldehyde and chemicals used in Xray processing. 1989, 90-102. (Two hazard alerts issued in the UK: 1) Glutaraldehyde - Occ Asthma documented plus respiratory, skin, and mucous membrane problems at levels below limits of 0.2ppm ceiling. Health authority fined £1000 plus £984 costs for causing occupational asthma. 2) Xray film processing chems - two out-of-court settlements for £62,000 centred around SO², hydroquinone, glut etc.
Cotes J E, Steel J, Leathart G L. Work Related Lung Disorders. Blackwell Scientific Publications. 1989. (Chap 16. Occ Asthma. Asthma is a disease which is characterised by wide variations over short periods of time in resistance to flow in intrapulmonary airways. the common feature is airflow limitation which varies in intensity from hour to hour. Types of work-related asthma: a) extrinsic atopic asthma where bronchoconstriction is mediated by IgE immunoglobulins; recognised by immediate reaction to inhalation allergen or allergy skin tests. b) extrinsic non-atopic asthma: asthma caused by an external agent i.e. mediated by some mechanism other than IgE. May show an immediate or delayed response, or both. (Isocyanates can cause both a) and b) types). [Atopic: genetic predisposition to allergens.]
Lung function in asthma (readily meas by FEV or PEF). Basic immunology: Immediate (Type 1) reactions; the mechanism of a) whole antigens (eg pollens) and, b) antigenic substances of low molecular weight chems (haptens).
Skin testing. RAST test (for detecting the presence in serum of IgE antibody which is specific for a particular antigen. Inhalation challenge testing at work or in the hospital lab. (Should "not be undertaken in the lab for medico-legal purposes and where occ asthma is a recognised hazard - monitoring at work should be used instead."). Testing for non-specific bronchial hyperreactivity by methacholine or histamine; sensitivity to non-specific bronchoconstrictor agents is increased in people recovering from occ asthma particularly those with delayed onset type; reactivity can be increased by inhalation challenge or the ingestion of the sensitizing substance in a dosage too small to cause bronchoconstriction. Diagnosis of occ asthma, often not clear-cut, prevalence - usually affects about 5%. Management and prevention. Examples of asthma: from drugs - aspirin, antibiotics; birds and animal residues; crustacea, insects, mites; tree dust/bark/sap, veg products including grains, gum, etc; spores - mouldy hay, grain, compost, mushroom; enzymes - eg in detergents and papain from pawpaw; dyes including tartrazine; metal salts; chemicals - isocyanates used to make polyurethanes (foams for upholstery, packaging; paints, sealants, plastics); colophony (pine resin) used in soldering, sticking plaster adhesive; epoxy compounds for making PVC, resins, paints, dyes, laquers esp if heated; formaldehyde - the starting point for the resins phenol-, melamine-, para-formaldehyde for glue and plastic foams. Formaldehyde liberated when these are heated. Also formald used as disinfectant, fungicide, hardener. Can cause immediate or delayed-onset asthma.)
Fowler J. F. Allergic contact dermatitis from glutaraldehyde exposure. J of Occ Med. 1989, 31, 10. (Hospital maintenance employee developed airborne contact dermatitis cleaning respiratory therapy equipment. Patch tested allergic to GA.)
Gordon M.A. Dangers in the darkroom. The Radiographer 1989, 36, 3, 114-115. (Summary of chems; pulmonary transfer of toxic substances means material is delivered directly into the bloodstream - access to the liver with its detoxifying enzymes is delayed. Delicate membranes of respiratory passages are irritated and damaged en route. Symptoms.
Sensitisn process. Hydroquinone, a benzene derivative, ?found in urine of darkroom technicians as a sulphate ester or malondialdehyde. GA a known sensitiser. Detection in atmosphere - mass spectograph necessary. Gas chromograph or dreger tubes not sensitive enough. Prevention.)
Harner, C.D. et al. Cidex-Induced synovitis. The American Journal of Sports Medicine. 1989, 17, 1, 96-102. (Microscopic evidence of inflammation was observed in the synovium of rabbit knees that had been injected with 10ppm of Cidex (2% glutaraldehyde). Stronger soln produced greater synovial inflammation. No evidence of delayed allergic component. Rinse solutions between operations had signif. levels of Cidex at several hospitals: 1,000 ppm by 5th rinse. Arthroscopic (endoscopes used for examining joints) complications could be linked to Cidex-induced synovitis, although this has not been proven clinically. Previous lab studies on toxic effects of 2% glut on epithelial lined tissues of gastro-intestinal, urological, pulmonary, skin, occular tissues have concluded GA only mildly toxic to living tissue.)
Jachuck S J, Bound C L, Steel J, Blain P G. Occupational Hazard in Hospital Staff exposed to 2 per cent glutaraldehyde
1989 in an endoscopy unit. Soc.Occup.Med 1989 39, 69-71. (Studied 8/9 wrkrs in endosc unit, 2 of whom had presented with symptoms. One worker had airways obstruction (breathlessness), 6 eye irritation, 6 rhinitis, 3 dermatitis, 1 nausea, 1 headache. GA below limit. MBTH testing used measures all aldehydes. 60 min TWA of 0.42 mg/m³ found.)
Parish N, "Darkroom disease expert interviewed." The Chronicle, NZ. Aug 14. 1989. (Report of BBC interview with MAG: Glasgow radiog dept closed because staff refuse to work there, first test case coming before court, Valerie Hughes' case featured on BBC’s "You and Yours", bill before English Parliament calling for Health Dept enquiry into toxic fumes.)
Pollard J. 'Dread of darkroom disease’, and 'Half X-ray staff have symptoms.' Pollard J. (Western Australia - Adrian Bertino-Clarke/Health Dept's survey in 1989 showed 64% of respondants reported symptoms. Rural hosps especially lacking ventilation.)
Tam M, Freeman S. Occupational allergic contact dermatitis due to glutaraldehyde: a study of 6 cases due to Wavicide and Aldecyde. J Occ Health and Safety 1989, 5, 6, 487-491. (6 non-atopic patients. Contact derm. on hands, (also face and forearms of 3). Strong positive patch tests. Two had positive only on the 4th day reading. Also positive to formalin,...thiuram (rubber), ...fragrance mix.)
Watson J. "Hospital staff claim chemicals poisonous." Scotland on Sunday. June 4 1989.(Rose Paterson, one of 17 out of 25 sick technicians at Southern General Hosp, Glasow, taking legal action. 20 yrs as MRT, mouth ulcers, frightening breathing probs, voice lost, eyelids swelled, skin came off top lip. Tried 5 times to go back to work.)
Wiggans P, McCurdy S A, Zeidenberg W. Epistaxis due to gluteraldehyde exposure. J Occ Med 3,10, 854-856. (Hosp employee with recurrent nosebleed and other URT irritation symptoms plus skin rash. Poor ventn and uncovered containers.)
'Bath pays £62,500 compensation for radiographers in toxic fumes case.' Radiography Today 1990, January, p 1. (Exposure to SO², hydroquinone, GA etc in poorly ventilated rooms.)
Linda's darkroom disease. Woman. 7 April 1990. (13 yrs exposure at Avon Hosp, sore throats, stuffy nose, husky voice, cough progressed to violent chest pains, lethargy, numb arm, palpitations, asthma, excruciating earache and severe headache; settled out-of-court).
Aw T.C., Barnes A. Occupational health and the use of chemical disinfectants: what is needed under COSHH regulations. ISSM Journal July/Aug, 1990, 7-8. (GA asthma resulted in £1,000 fine and equiv costs against district health authority in case taken by endosc nurse - The Independent, 22/2/89. Sterilants: GA, formald - causes irritant and allergic dermatitis, urticaria, irritn of respiratory tract, asthma and ?carcinogenic; phenols - skin and eye irritn; hydrogen peroxide, iodine and chlorine all irritant to resp tract and skin; alcohols - defatting can result in irritant derm.)
Babb J R. Chemical Disinfection and COSSH - safe and effective work practices. ISSM Journal July/Aug, 1990, 9-12. (West Midlands RHA survey of GA usage. 377 replies. 9% had no formal ventn, 76% no local exhaust ventn, 26% made no attempt to dilute discharge, 10% used a fume cupboard. Most GA use was for endosc. What sterilant should be used where - auto claving preferable but GA use in lab as a wide-spectrum non-corrosive disinfectant appears justified. GA
GA not rec for respiratory equipment. Table of properties of disinfectants. Fume cupboards are the most effective, over the whole work station for GA fumes. Need for dentists to use glut fast diminishing (Glenwright & Shovelton, 1989). Glut introd in 1963. Axon et al, 1981 - 37% of units performing more than 500 endoscs/mnth reported staff became sensitive. Study of theatre users, Trigg, 1984 - 55% reported reactions to GA. In Neumann (unpublished), 75% endosc nurses complained of reactions to glut. None of these studies included a control group. Safe practices - incl. do not use as bench wipe; rinse well and change water freq; tight fitting lids; dilute discharge; activated charcoal filter etc.)
Binding N, Wittig K. Exposure to formaldehyde and glutaraldehyde in operating theatres. Int Arch Occup Envir Health. 1990, 62, 233-8. (Meas 5 min TWA exposures up to 2.0 mg/m³ when a 3% soln was used to wipe down theatre benches;
0.53 mg/m³ detected over the duration of the cleanup. OES is 0.7mg/m³ for a 10 min TWA.)
Fisher A A. Allergic contact dermatitis of the hands fom Sporicidin (GA phenate) used to disinfect endoscopes. Cutis. 1990, 455, 4, 193-196.
Gibbs J. Glutaraldehyde: handle with care Nursing Times 1990, Vol 86, 21, May 23. (Survey of depts using GA in Middlesex Hospital. - Used only for delicate/expensive equip. Some proper soaking baths but also open bucket, washing up bowl 1990 1990 and other uncovered trays. Undated activated glut. Only one area with special ventn. In one room GA vapour so overpowering everyone’s eyes watered. Little knowledge of dangers or safety equip. Extra money for fume cabinets and ventn to meet COSHH regulations will be required.)
Gordon M.A. Radiographers at risk. Shadows Dec, 1990, 38-39. (MAG’s story of the 7 years of research. Survey results published in ‘Australasian Radiology’ took 2 yrs and much watered down. No matter what evidence, the ‘experts’ will never agree. "One has to drive on and leave everyone else to catch up with you." At the 1984 ISRRT conference enthusiasm for MAG’s findings had evaporated and the impression was that the authorities wished she would go back to NZ and forget the whole thing. Advised the London Hazards Centre and the UK COHSE Union. Details of grants/help received - ISRRT World Educ Trust Fund (3 grants), ACC published the Guidance Notes; NZ Health Dept paid (reluctantly) for 2nd printing of Guidance Notes; WRETF and AGFA for poster. Improvements being made in exhausts by processor manufacturers. Chemical company guidelines; Photosol’s glut-free devel. Six cases acepted by ACC, NZ.
UK compensations for 2 radiographers and one tech. Court cases pending. Sensitisation - one radiog collapsed at wheel of car at the lights, from petol fumes. University of Bristol detected high levels of GA on radiographer’s hands.)
Gordon M A, Laird I. Guidance Notes for the Provision of a Safe Work Environment and Safe Work Practice for Radiographers and Darkroom Technicians. 1990. ACC, NZ (See under "Reports".)
Morning Star "Safety fine for health authority." Aug 22. 199? (Bristol and Western Health Authority fined £1000, costs £963 for exposing Patricia McCormack to chemical fumes from glut - acute breathing difficulties. Proper fume cupboard now installed.)
Barry M. "Danger in the Dark". Evening Times, Nov 11, 1991 (Seminar in Glasgow attended by 100 sufferers, to press for mandatory Code of Practice and Darkroom Disease to be officially recognised. Glasgow University Occ Health says Darkroom Disease: "not been subject to thorough epidemiological analysis..... There is not a huge occupational hazard". Rose Paterson, technician, caught in blowback from the machine - couldn't breathe. Told symptoms were mass hysteria. Allergic to suede, leather, benzoate preservatives in food, cig smoke in a few seconds, alcohol. Shopping in town takes a week to recover. Given job in pay office - reacted to the ink on payslips. Marlene Barrie, radiographer - reacts to passport photo machines, some plastic chairs, new photocopying (can't breathe); certain chems cause mouth to burn and blister. Anne Clarkson, technician for 25 yrs, loses voice reacting to plastic chemicals in phone, allergic to polycotton especially in washing machine, nail polish, bubble bath, glue in shoes, cellophane, diesel (little bus travel), limited sense of taste and smell. Finger-nails went black and teeth discoloured, aches/pains, bloodspots in mouth.)
Ballard J, Nursing Times (UK) Use and abuse of glutaraldehyde. 1991, 87, 38, 70-71. (1989-90, 11 hosp theatre and out-patient depts studied . Some smaller hospitals using salad bowls/buckets etc with/without lids to sterilise endoscopes. Some had had COSHH assessments. 8/307 staff were identified with work-related problems especially the units using open systems. Theatre staff aware of high level of irritant symptoms but occ connection not always made. Surgeons more reluctant to admit to health probs. Recommendations made. Revisited in 6 mnths - many improvements. Older hospitals most problems.
Campbell M, Cripps N F. Environmental control of glutaraldehyde. Health Estate Jnl . Nov 1991. (New COSHH regs 1988, new limit - 0 .7mg/m² (2ppm) over 10 mins not 8 hrs; short term exposure must be limited. GA readily vaporises at room temp.
W. Midlands RHA survey: 377 responses, 10% used fume cabinet, 76% no local exhaust, 10% relied on natural ventn, 15% did not clean equip before sterilisation. A glut alternative could be used in 50% of uses. Measurements were well below GA std.. Higher readings: decanting/filling/drainage. Air readings 30 mins after spill gave 0.18mg/m². Control strategies include discharge direct to drain and dilute, ventilation systems, fume cabinet design, charcoal filters, required tests.)
Carslake P. "Sad tale that ended a twenty year career" Radiography Today. Sept 1991, 37 (Joyce Davis, 20 yrs in radiography at Royal Liverpool Children's Hosp. Had symptoms from 1982, saw allergy and ENT specialists - terrible sinus problems, totally lost sense of smell, palpitations (given beta blockers), cortisone for rhinitis - became allergic to that. Headaches and nausea at work. Thickening of sinuses - ENT said "nothing could be done". 1990 chem poisoning diagnosed; sacked on grounds of incapacity. Forced into clerical job sending ambulance invoices. Reacts to paints etc. Scared friends suffering in silence.)
Carslake P. Poison in the Air Radiography Today Sept 1991, 36-37. (10 radiographers in UK claiming compensation from employers. Many others remain silent in fear of losing jobs. 1991, Society of Radiographers’ survey of 3,000 members showed 1/3 had pre-sensitisation symptoms. Only 5% of depts were adequately ventilated. Tests of fumes show nothing above limits. Society of Radiographers prefers to work with employers to find people alternative employment and pay compensation rather than face more expensive legal action for loss of job.)
Response: Alan Budge, British Photographic Assoc. Letter, Radiography Today, Nov 1991. (May and Baker’s low sulphur dioxide fixer early ‘80s; mid-’80s - reduction of GA concentration and complexed with bisulphite; recent introd of safer glycols eg diethylene/propylene glycol; chemical mixers; funds must be available for proper installation of processors.)
Carslake P. Preventing darkroom disease - Editorial Radiography Today Sept 1991. (Co-operative approach needed from govt, unions and employers.)
Lange L. "Radiographers at risk from darkroom disease", Medical Imaging May 1991, pp1,8,9. (Report of MAG's address to Australian Institute of Radiographers. Story of her research; Aust NHMRC release of "Guidelines for lab personnel working with carcinogenic or highly toxic chemicals".)
Middleton J. Under the COSHH. Technic. February, 1991. (COSHH, UK - Control of Substances Hazardous to Health - 1989, required employers to assess risks to employees’ health at work and prevent exposure to hazardous substances where possible, introduce and maintain controls, and monitor the controls.`... COSHH Advisory Code of Practice: total enclosure - partial enclosure with local exhaust - local exhaust alone - general ventn for small amounts - reduce no. of people exposed - personal protective equipment - proper cleaning - safe storage/disposal - prohibition of eating/drinking/smoking - spillages - maintenance. Monitoring of levels yearly. Health surveillance is no substitute for the above. COSHH surveillance records must be kept for 30 yrs.)
Naughton M. "Danger lurking in the darkroom". Morning Star, 7 Sept, 1991. (MSF Seminar, inadequate British COSHH Regulations.)
Poteet M. "Darkroom Disease Plagues RTs". R.S. Wavelength USA, Aug/Sept 1991 (Symptoms, MAG's story.’Guidance Notes’
Tibbotts Audrey. Letter, Radiography Today. Nov, 1991. (One of Bath radiogs; tribute to MAG. Disheartening that radiographers still being affected. Compensation does not make up for loss of one’s job and health. NZIMRT awarded MAG an honorary fellowship.)
Tilke B 7 "New Zealand Technologist tells of Chemical Risk". Advance July 8, 1991. Conference of Americas - Report: MAG's work: summary of hazards. Kodak response: - use gloves and other safety precautions for skin irritation; "extremely rare" for sensitations to occur.
Alexander R. Proving chemically induced asthma symptoms; Reactive Airways Dysfunction Syndrome, a new medical development. 1992 (Internet). (RADS is identical to asthma but induced by chemical exposure. Occurs after one exposure to a lung irritant and respiratory symptoms occur within 24 hrs. Many resolve in 6 mnths but some continue for 5 yrs. Methacholine testing confirms airway hyperresponsiveness. PEFR documents a greater than 20% drop in PF over 24 hrs. Case study: RADS from acetic acid. RADS from glutaraldehyde exposure now a provable claim.) [Richard Alexander is a Californian attorney and founding member of the National Association of Consumer Advocates. The Alexander law firm specialises in negligence, chemical ...consumer fraud cases.]
Beauchamp R .O, St Clair M.B.G, Fennell T.R, Clarke D.O, Morgan K.T. A Critical Review of the Toxicology of Glutaraldehyde. Critical Reviews in Toxicology 1992, 22, 3, 4 143-174. (Substantial review of the GA toxicity literature to this date. Properties, uses, human effects, regulations, studies on animals, metabolism of GA in the body by enzymes, etc. Further studies needed on irritation of respiratory tract, potential neurotoxiciy, developmental effects and mechanism of action.)
Calder, I.M. et al. Glutaraldehyde Allergy in Endoscopy Units, The Lancet. 1992, 339, 433, Feb 15. (65% of 167 survey respondents from 17 hospitals reported symptoms and 38% had two or more, including: eye irritation, skin discolouration or irritation, headache, cough or shortness of breath. At two hospitals, environmental measurements of glutaraldehyde were below the UK occupational exposure standard).
Cullinan P., Hayes J., Cannon J., Madan I., Heap D, Newman Taylor A. Occupational asthma in radiographers. Lancet 1992, 340, 12 Dec. (Case No 1. 28, f, radiog for 5 yrs. GA challenge with 11% solution. Had hay-fever since adolescence and immediate reaction to skin test allergens - late asthmatic response at 3 hrs to GA. Case No 2. 24, f. Radiographer for 5
yrs.Hay-fever/bronchitis during childhood. New job - poor ventilation - developed wheezing at work, severe reaction after fixer spillage. Immediate reaction to skin test allergens. Single blind testing to 2 part fixer provoked fall in FEV (max 35%). Did not react to 2% or 1% GA.)
Ferriman A. Sterilising chemical ‘is harming NHS staff’. ?Sunday Times. 25 Oct, 1992. (Increased day surgery with rocketing use of endoscopes means damage to health of National Health Service staff from glutaraldehyde sterilant. Royal College of Nursing and Cohse are fighting cases for their members. Almost 1,000 radiographers are affected. Kathleen Garland, 47, ended up in one day as a respiratory cripple. 12 mnths later, lung capacity still down 25%.)
Glass B. Glutaraldehyde: Why Now? Safeguard, 1992, 16, 10-11. (Increase in worker consciousness; increase in exposure with existing workers being requiredd to work longer hours. M: can no longer work in radiography; mood and memory effects, sore eyes, nasal sores, headaches, tinnitus and severe respiratory tract sensitivity. With 6 mnths off work, symptoms became localised to respiratory tract with hoarseness and chest tightness. S: radiog, illness developed after spills on unsealed floor. Unexplained excessive tiredness, mood changes, skin tingling, repeated sore throats. Cross sensitivity to petrol fumes and solvents. P: tech exposed to formald, then GA. Developed migraines, tinnitus and joint pains. 3 mnths since exposure stopped - migraines less severe. R: tech who worked with GA for 15-20 hrs/wk for 12 yrs. Sore throats and occasional chest infection became more severe with a new cleaning room with fumes from sink full of GA exhausted straight upwards into his face. Repeated chest infections, memory problems, hoarse voice, blotchy facial skin, chest tightness. M: X-ray tech in small unventilated workplace with exposed containers of GA. Frequent spills of GA onto R calf - developed thickening of skin and joint pains - schleroderma diagnosis. GP Nurse: End-of-day exhaustion and blocked nose. Moods became unpredictable and sleep disturbed, short-term memory deteriorated. Unventilated 8x6 workspace; 2 open containers of GA.. Colleague in a better ventilated room, but not wearing gloves developed dermatitis on fingers and elbow flexures and became short of breath as an aerobics instructor. 4 hospital endoscopy staff: chest tightness, shortness of breath, sneezing, dermatitis of eyelids. Hospital nurse: working in X-ray in small, hot, unventilated room, developed U/LRT sensitivity and a multi-organ sensitivity. "GA is not a simple chemical in terms of its reported effects...It has irritant and allergic health consequences as well as those of immunotoxicity".)
Kuntz L. "Darkroom Disease." R.T. Image Aug 31, 1992 4-10, 59. (Beth Moore, Sth Carolina; exhaustion, loss of voice after 15 yrs. Took 1½ yrs to diagnose DD and discover venilation ducts weren't working. Terrible smell in room - Beth couldn't smell it. Took $10,000 pay cut but got out in time. Susan C: 17 yrs developing Xrays, mixing chems - eyes would burn, gagging. Then seisures; medication made superviser complain about her bad attitude. Now, all joints ache, 3 different arthritis medications didn't work, numb fingertips, ears hurt - no infection, constant stomach pains - no ulcer, tired, weak and confused. Offered hospital cafeteria job - refused. Seizures stopped, other ailments continued. MCS/chemical aids/DD debate; Mary Lamielle, President, National Centre for Environmental Health Strategies (NCEHS) describes MCS symptoms: sore throats, skin rashes, constant headaches, nausea, achy joints, fatigue, confusion and heart irregularities. MCS reactions: pre-sensitisation, sensitisation, reaction. Environmental physicians called "pseudoscientists". American Med Assoc: neutral. Am Coll of Physicians and Am Acad of Allergy and Immunology doubt MCS existence. National Academy of Science acknowledge need for more study: not enough evidence. Waddell: Professor of Pharmacology and Toxicology, University of Louisville, "It’s just a growing mass hysteria in the country". Fink, allergist:"Many MCS patients have psychiatric problems". Kodak toxicologist says "We are not aware of anything in photographic chemicals that would cause what has been called MCS...we’re not aware of any substantiated information that they cause asthma or bronchitis or any other respiratory problems". MAG's story. Theodore Simon: SPECT imaging showed significant reaction to a range of chems including formald, compared to control group. Patients reacted to diethylene glycol, 1-phenol, nitroindazole, and ammonium compounds. Earon Davis, lawyer - thousands of social security claims involving MCS settled and some workers compensation. Davidoff study of MCS planned. 3 Canadian CT techs were seated next to a processor and believe their miscarriages were linked to the clearly-smelled fumes.)
Kuntz L. "Help for darkroom disease." R.T. Image USA 28 Sept, 1992. p11, p28. (MAG's MCS; 140 USA MRTs have written to MAG for help. How to diagnose/avoid DD/MCS. OSHA requirements: written company policy for handling, proper labelling of chems, employee training, MSDS.). (Letter: M Highsmith. Headache, sinus, earache, pupil dilation of 1cm; good after vacation: chronic sinusitis with with possible mucosal reaction to noxious chems.)
3M NZ Ltd Gluteraldehyde - controlling the hazard October 1992. (Skin and respiratory symptoms, safe practices, eg do not use for routine cleaning, exhausts should operate 24 hrs/day, suitable respirators etc.)
Mulligan M. The Dunstan experience. Shadows 1992, 35,4, 28-29. (Her senstisation to many every day chems. Denial by radiographers because of fear of loss of jobs. Symptoms put down to lack of interest in work, obscure malaise , neurosis, pre/post menstrual/menopausal etc. Use now of Photosol’s glut-free devel, CD 77 and Rhone-Poulenc low SO² fixer in Dunstan Hosp. Helen Walker forced to stop work. Author thought she could keep going - a month later couldn’t breathe 1992 1992 in the X-ray dept. Applied for ACC)
Newman M A and Kachuba J B. Glutaraldehyde: A Potential Health Risk to Nurses, Gastroenterol Nurs. 1992, 14, 6, 296-300, June, discussion pp. 300-1. (Potential toxicity to GA, health effects, sampling methodology re OSH, air monitoring necessary, and recommendations for reducing exposure to glutaraldehyde).
Ryle G. "Nurse wins payout for chemical exposure at work." The Age. 19 November 1992. (June Grinter, Nurse, Bendigo, Victoria, Aust; headaches, exhaustion, gritty eyes, ...out-of-court settlement).
"Rush of Claims tipped." Sydney Morning Herald, 19, Nov, 1992. (June Grinter; took 20 mnths to get doctors to confirm her illness - no-one would listen, could hardly walk. Turned into a ‘zombie’. A supermarket trip causes severe reaction and exhaustion.)
Stodart K. Poisoned at work. NZ Nursing Journal, March 1992, 12-13 (40 yr old radiology nurse, from 1988 developed Raynaud's syndrome, cramps, bloating, wind and pain, bladder problemss, upset menstrual cycle, weight loss, bruising, vulnerability to infection, joint pain, headaches, inability to perspire, ankle oedema, rashes, mood swings, lack of concentration, short-term memory loss. [See Anne’s story also, Dec 1992]. Improved on holiday. Applied for ACC - ACC consultants were unhelpful, even abusive. CTU advised Prof Bill Glass who recognised chem poisoning; accepted for ACC. Tried to work 10 hrs and developed Bell's palsy and shingles. Had to sell house; used to forget where car was parked. Reacts to aldehydes in fungi, dairy and wheat foods, fruit sugars, paint, cig smoke, solvents etc.)
Townsend Sue. Glutaraldehyde - should it have a place in general practice? NZ Practice Nurse Dec 1992, 50-53. "Anne’s" story. Radiology nurse - puzzling bruising and abdominal pain. Put down to emotional component. Other symptoms worsened [see above story also] - plus circulation, hypotension, jaundice, gritty eyes, sore throat, breathlessness, sinusitis, mouth ulcers, herpes, joint pain, headache, palpitations, fatigue. ACC 1991. Sold home. Reaction to paint, chlorine, cig smoke, petrol fumes. Dr Chris Walls: "It goes on in common with a number of other chems to cause in some people quite bizarre and peculiar symptoms which don’t fit the defined textbook examples." Nelson Hospital "clean-up" after nurse splashed in the eye. Sydney in-vitro fertilisation low success rate - ?glut fumes from exposed tray. Worksafe Aust Hazard Alert. 1981 Brit survey of 16 units found 37% of staff had sensitisation problems. 1989 Bristol Health Authority fined £1,000. GPs’ unintentional ignorance. Alternatives for sterilising.
Trigg C.J., Heap D.C., Herdman M.J., Davies R.J. A radiographer's asthma. Resp. Med., 1992, 86, 167-169. (Occ asthma diagnosed in 39 yr m. radiographer, headache, ulcers. Hole in processor ventilation tube. 3 mnths later during maintenance developed chest tightness, itchy eyes, acute sinusitis, earache, conjunctivitis, dyspnoea. Had hay fever and atypical pneumonia 4 yrs previously. Positive skin pricks to pollen, cat, Aspergillus f. Positive specific challenge - PEFR declined during week. 16% fall in FEV1 on active challenge day. Minimum chemical emissions from processing room but continued to experience symptoms when near. Unable to continue working as a radiographer - retrained.)
Waldron, H.A. Glutaraldehyde Allergy in Hospital Workers. Lancet. [letter] 1992, 339, 880. Apr 4. (A survey of 150 staff from 18 departments at St Mary’s and Middlesex Hosps who were exposed to glutaraldehyde . Although over 9% of all subjects complained of a wheezy chest when they were exposed to glutaraldehyde, none had abnormal lung function tests, not even those who smoked. Although a single test of lung function has limitations, these data do not provide any evidence for chronic airways disease in this group of hospital workers)
Warneminde Martin. Hazard in our hospitals. The Bulletin ? Aug 1992.
Blondell Jerome. Gluteraldehyde Bibliography. EPA, Washington DC. (Includes 40 papers/letters not referenced in the SNFTAAS Bibliog - many from anaesthetic, gastroenterology and dental journals.)
Godard Ph, Chanez P. Epithelium and Asthma. ?1993/4 http://www.asmanet.com/epit-va.html (Epithelial cells were thought to have simple barrier role of mucous secretion and removal of noxious agents by their cilia. Changes in the bronchial epithelium almost always found in asthmatics - a fragile appearance. In patients who died bronchial epithelium almost always shed. Epithelial cells now found to release pro-inflammatory mediators, to participate in regeneration of cilia, and initiate repair of epithelial cells. Epithelial cells of asthmatics can be directly activated by anti-IgE, therefore possible that cells can be directly triggered by allergens. Pollutants eg ozone can activate bronchial epithelial cells [from Davies RJ, Devalia Jl. Air pollution and airway epithelial cells. Agents Actions Suppl 43:87-96, 1993]. Asthmatic patients with an intact epithelium have inc number of inflammatory cells among epithelial cells - these are target cells easily accessible to allergens or non-specific irritants. Inhaled corticosteroids are able to repair bronchial epithelium.)
Single Photon Emission Computerized Tomography (SPECT) Scan of
MCS Patient's Brain Before and After Challenge with Perfume Inhalation. Doctor's Report.
Dec 1993. Internet. (With pictures. 30 minutes after inhalation of perfume. Findings: 1)
Diminished cerebral blood flow 2) Bilateral frontal, temporal and parietal hypofusion 3)
Marked scalloping pattern of perfusion in frontal and parietal lobes. 4) Vasculitis v
exposure to neurotoxic substances.)
Chan-Yeung M, McMurren T, Catonio-Begley F, Lam S. Clinical Aspects of Allergic Disease. J Allergy Clin Immunol, May, 1993, 91, 974-8. (Sterilising agents eg formald and GA have given rise to Occ Asthma. 33 yr old respiratory tech: mild asthma since childhood. At 26 yrs attacks only returned after a cold. For 4 years job was to clean bronchoscopes with Sporicidin (3.6% glut) and assist physicians. Normal chest X-Ray. Positive skin test to feathers and fur. Gold standard lab challenge performed: preshift and postshift spirometry showed postshift drop of 23% in FEV1 even though taking high dose beclomethasone. Serial measurement of peak expiratory flow rate (PEFR) done over one week at work and 2 wks on vacation showed progressive improvement first 4 days; FEV1 1.8L before, 2.4L on ret. from hol. Nonspecific bronchial hyperresponsiveness measured, and workplace challenge test which showed a progressive fall in FEV1 as she progressively cleaned three bronchscopes. Lung function tests did not return to normal 24 hrs after challenge indicating late asthmatic reaction in line with an allergic rather than irritant reaction. Unusual for occ asthma caused by low molecular weight compounds to develop in subjects with a pre-existing asthma. History of asthma should not exclude the diagnosis of occ asthma caused by a workplace agent).
Connaughton, Peter. "Occupational Exposure to glutaraldehyde Associated With Tachycardia and Palpatations," The Medical Journal of Australia. [letter]. 1993, 159, 567, 18 Oct. (7 patients, occupationally exposed to glutaraldehyde, presented with either palpitations or tachycardia, temporally related to exposure. No other causes were identified from their history, physical examination or ECGs. Symptoms ceased with change of job or workplace modification. Patients also had other recognised GA symptoms which also resolved. ECG details. Monitoring during exposure documented
these symptoms. Further investigation warranted.)
Dailey J, Parnes R, Aminlari A. Glutaraldehyde Keratopathy. Am J of Opthalmology. 1993, 115, 2, 256-8, Feb.
Gordon M.A. Prevention of darkroom disease. Shadows 1993, 36,3, 29-30. Presented at 1993 NZIMRT Conference. (Recent publication of Safe Occupational Use of Glutaraldehyde in the Health Industries, 1992, reinforces‘Guidance Notes’. Don’t stand around the processor. Dr Alan Broughton, Antibody Assay Lab, California, attempting to develop a test for GA to demonstrate antibodies in human serum albumen - "It is not surprising that hypersensitivity problems occur with it because as a chemical with two carbonyl groups it will be very reactive and probably adducts to albumen pretty much like formaldehyde." Work in Whangarei for 2 yrs by occ nurse, Eunice Nutman, on ANA levels in Xray staff. H &S Committee of NZIMRT has written asking about setting up GA register. Photosol’s work on airborne interaction between SO² reacting with GA. New European Code of Practice 1991, for labelling photographic chemicals allows companies at their discretion to omit mention of GA in their H &S data sheets. By complexing GA with bisulphate, they can claim the developer is non-hazardous. When the developer is mixed to working strength, the free aldehyde concentration is below 1% and also escapes the need for warning. Some companies still deny GA in their products.)
Hewitt P.J. Occupational health problems in processing of x-ray photographic films. Ann. Occup Hyg, 1993, 37, 3, 287-295. (Holistic approach to this complex microclimate is stressed; a single cause is unlikely. Design of rooms, surfaces, directional air flow, sealed drains, reduction of SO² and GA emissions, leakages, foil-covered bottles, sealed pipework, air-changes 10-15/hr (OK with attention to all other factors), temps 20-24°C, humidity 40-70%, specialist routine maintenance, PPE - personal protective equipment, (Respiratory Protective Equip (RPE) should only be necessary as an emergency), training, air monitoring of limited value - low readings need expert interpretation; health surveillance.)
Hopkinson G, "Glutaraldehyde may be asbestos of the '90s". ?Evening Standard, 16 Jan, 1993. (MAG's story. NZ/Australian govt warnings. Uses of GA in farming, timber, tanning, piggeries, chicken farms, dental and vet, clinics, embalming, liquid fabric softener, air-care products... Margaret Desborough, Palmerston North, NZ, 12 yrs radiography A & E, had to leave job with lupus and has damage to connective tissues, swollen hands, rashes, ulcers. Photosol’s
GA-free developer being trialled in Dunstan. 3M has sold 100 respirators to hospitals. World’s leading gastro-enterology teaching hospital, Middlesex in London, only uses GA in enclosed machines to sterilise instruments in contact with Aids or hep B. NZ nurses often told they have depression. GA is imported by Union Chems from Union Carbide, USA; BASF from Germany for leather, tanning and cleaners. J&J imports Cidex from the UK; Medic Corp imports Aidal plus and Wavicide from Aust; Douglas Pharmaceuticals mixes GA in NZ into Zenicide (lab instrument steriliser). Union Chemical says GA a lot safer than formald because not carcinogenic - problems are "isolated cases". BASF says a lot of hype is generated about ....chemical products. Kodak is trialling a GA free alternative.)
Ide W. Developments in the darkroom: a cross-sectional study of sickness absence, work-related symptoms and environmental monitoring of darkroom technicians in a hospital in Glasgow. Health and Safety Exec. Glasgow. 1993. (9 f. radiographic techs matched with OTs for age, sex, smoking. Symptom questionnaire including respiratory plus wider symptoms eg palpitations, unusual tiredness, nausea, sore joints etc. Sickness absence data for one year: techs had 204 days off, OTs 41 days. Respiratory symptoms: 1/3 of problems not statistically signif. Occ hygiene results within normal limits.)
Kaczuk M N, Crea J. Gluteraldehyde exposure of encoscopy nurses. Proceedings of 14th Annual Conference, Aust. Inst. Occ. Hygienists. Dec 1993.
Leinster P, Baum J M, Baxter P J. An sssessment of exposure to glutaraldehyde in hospitals; typical exposure levels and recommended control measures. British Journal of Industrial Medicine. 1993, 50, 107-111. (HPLC analysis of 77 samples at 14 locations in six SW England Hospitals. In personal monitoring, levels between 0.003-0.17mg/m³ measured (10 min TWA limit is 0.7mg/m³). X-Ray only recorded 0.003 to 0.006mg/m³. Acetic acid and diethylene glycol are likely to present a greater inhalation risk than GA. Static monitoring was between 0.002-0.23 mg/m³. Little ventilation and no openable windows. The greatest exposure risk was the 5 minutes every half hour as endoscopes put in or removed from solution. Two people commented they had rhinitis they attributed to GA. Non-essential uses like wiping walls and cleaning bedpans should be discontinued. Recommendations for safe use...)
Mulligan M. The Dunstan experience part II - ventilation. Shadows, 1993, 36, 3, 28-29. (Use at Dunstan Hospital of Photosol’s CD77 GA-free developer, plus low SO² fixer, plus ventn: exhaust fan installed inadequate. Argument with experts - the engineer designed cowling, venting to outside chimney. Air supply via light-tight grilles included diesel fumes and lunch! and probably recycled some of the fumes. Local glazier built perspex enclosure for the processor which has its own extraction system - $500-$600.)
Stevens A. B. (The Royal Hospitals, Belfast) Letter re Cowan R E, Harrison J. Aldehyde disinfectants and health in endoscopy units. Report of Working Party of the BSG Endoscopy Committee. ?1993 p717. (If an employee devels occ asthma, the employee should not be permitted to make the decision re continued exposure. Redeployment and retraining may be the best outcome which can be expected. Whether subjects with pre-existing asthma should be employed in jobs with GA exposure is a difficult issue. Response, Cowan/Harrison: Report states further exposure to GA should be avoided but sometimes this is not possible or desirable.)
Tkaczuk M, Pisaniello D, Crea J, Occupational exposure to glutaraldehyde in South Australia Occup Health & Safety 1993 9, 3, 237-243. (Testing by OSHA Method 64 (HPLC). Site 1): Operating theatre. 1% GA used. Lid buckled, good personal protection, 16 air changes/hr. Headaches reported on busy days. 2): Endosc prep room. 1% glut. 27 air changes/hr. Headaches and tingling of face when lid off. Dermatitis of feet probably from dripping endoscopes.
3): Dental surgery. 2% glut. Severe dermatitis when no gloves used. 4). Embalmer: 1.4 % formald/0.6% GA. Highest formaldehyde detected was 1.83ppm when the embalmer got between the body and the vent. 5). Darkroom large hosp:
0 .4% GA used. Reading 0.001 ppm during cleaning. No other GA detected. 6): Hosp darkrm. 0.001ppm detected. 7): Egg storage room at chicken farm. Eggs collected from floor and sprayed with 0.1-0.3% activated glut.to kill any bacteria on shells, minimising chick mortality. 0.007ppm in the area. Collectors complained of face and resp irritation. No gloves etc worn. GA sprayed onto unprotected skin. Recommended: - minimise dripping from endoscopes - do not rinse with spray rosette. Workers did not read MSDS or understand risk. Review exposure std of 0.02ppm.
Darkroom Hazards. Safetyline Magazine, Worksafe Western Australia. No. 20 Nov, 1993. (Many chemicals used give off hazardous vapours or harmful gases such as formaldehyde,glutaraldehyde, hydroquinone, ammonia, sulphur dioxide, and hydrogen sulphide. "Exposure to these can affect the liver, lungs, kidneys, reproductive system, gastro-intestinal tract or CNS"...)
Chandler G. "The Unidentified Debilitating Disease." R.S. Wavelength, Aug 1994. (Opening a processor after a film jam caused her eyes to water and nose and throat feel as though on fire. Violent coughing and throat began to constrict - couldn't breathe, Emergency Room to restore breathing... Diagnosis: MCS - multiple chemical sensitivity. MAG’s work. Fighting to petition OSHA for protective regulations.)
Dewitte J-D, Chan-Yeung M, Malo J-L. Medicolegal and compensation aspects of occupational asthma. European Respiratory Journal. 1994, 7, 969-980. (Due to the significant medical, medicolegal, social and financial consequences, it is of the utmost importance that the diagnosis of occupational asthma be proved by objective means. Two types of occ asthma: 1) appearing after latency period 2) that without latency, or RADS. How to confirm? Questionnaires good but lack specificity. Immunological testing does not prove the bronchi have been affected and is only suitable for protein-derived high molecular weight agents. Documenting airway changes at work or with PEFR require an honest, co-operative subject and are less sensitive than FEV1. Also there are no objective criteria for assessing recordings and there may be false negs and positives. Specific inhalation challenge is still the gold standard though false positives and negatives do occur. Provision for compensation for temporary impairment and permanent disability/impairment (2 yrs after removal from exposure) should be considered. Subject should not be further exposed; threshold for symptoms/ hyper- responsiveness is much lower; subjects react to minute amount of causative agent. 60-90% fail to recover several years after exposure. American Thoracic Society chart for assessing impairment - score 0-11 pts. Compensation systems chart for different countries. eg Quebec. Causal agents lists should be regularly updated. Atopy only relevant in one in three lab animal handlers. Early detection very important in preventing permanent asthma. Skin testing cannot be performed for low molecular weight chems eg GA as the mechanism is not IgE-mediated. A combination of questionnaires and bronchial tests have to be relied on.)
Hotchkiss S. How thin is your skin? New Scientist, Jan 1994, No 1910, 24-27. (Research at St Mary’s, London into rates of absorption of different chems by the skin. Pieces of skin put into nutrient bath. Skin contains enzymes to breakdown toxic chemicals. Some enzymes may make chemicals more toxic or carcinogenic eg those that break down hydrocarbons. Structure of skin. Around 10% pesticides absorbed. Some rapidly absorbed can’t be washed off eg the phthallic acid esthers used as fragrances. Some barrier creams enhance absorbtion eg of phenol used in perfume manufacture. Up to 24% of fragrance chems may be absorbed through skin. This is increased if ethanol is added as in perfumes because ethanol temporarily alters the skin lipids. Cinnamaldehyde absorption may reach 50%. "Cinnamaldehyde may cause an 1994 1994 allergic response". Many aromatherapy oils are potent concentrated chems. Chemicals which damage the skin eg formaldehyde are thought to be too small to be recognised by the immune system and must be bound together with skin protein to stimulate an immune response. If the chemical is reactive enough it may combine directly with skin protein, or may be metabolised by enzymes into a compound which is sufficiently reactive to bind to skin protein.)
Griffiths R. The Presence of sulphur dioxide and other toxic fumes within processing environments, and associated health problems. Radiography Today Nov. 1994 60, 690, 13-16. (Summary of UK progress to date; COSHH regulations; survey of 100 radiogs on awareness of work dangers, testing by Drager tube for SO² - well below safe levels of 2ppm. Photosol XF2 and Kodak X-Omatic RA lowest SO² fumes. Traditional fixer solutions gave off most fumes (above EH40 limits). Few radiographerrs used masks; most hazardous place to stand is round the processor; monitoring had been covert; still a prevalence of darkroom disease symptoms probably because staff had been pre-sensitised or had past history of allergies (these people most susceptible); 18% identified menstrual disorders associated with work (J Tell, National Press Photographers’ Health Survey Art’s Hazard News, 12,5,12, 1989 had found a correlation between menstrual disorders, miscarriages, and potential darkroom fumes).
Hayes J P and Fitzgerald M X. Occupational asthma among hospital health care personnel: a cause for concern? Thorax. 1994, 49, 198-200. (A general review addressing the increase in individual case reports of health care workers, including radiographers, developing asthma as a result of substances encountered in the work place. Glutaraldehyde and ammonium thiosulphate (in fixer) classified as low molecular weight chemicals, which often makes the diagnosis of asthma less clear. "Similarly, an association between symptoms and exposure to a sensitising agent may not be apparent because asthma caused by low molecular weight chemicals may induce atypical non-specific symptoms such as cough or chest discomfort. More classic symptoms such as wheeze and chest tightness may not occur until late in the evening or during the night after exposure. "Furthermore, because the nature of health care involves working a variety of shifts and days, workers may be less readily able to correlate delayed symptoms with workplace exposure. Peak flow measurements are recommended. There is no accurate means of quantifying occupational asthma. Meanwhile carefully conducted studies would very like reveal a greater prevalence of work related asthma than is currently realized.)
Le Goaster A, Deschamps F, Kalis B. Four cases of contact dermatitis in hospital employees handling disinfectants. Semaine des Hospitaux. 1994, 70, 88-90.
McLaughlin D. Crying in the Dark. North & South, NZ. Nov 1994; 128-136. (MAG's story, ...by Sept ‘82 so weak couldn’t pick up new grandchild, heart arrhythmia at 170 beats/min. Cardiologist said "nervous tension". Off work 3 days - went back, massive tinnitus/and racing heartbeats. One of the GPs said her throat had the inflamed membranes of a heavy smoker - but didn’t smoke. He said: "You work with some very toxic chemicals". Cardiologist diagnosed toxic reaction. The Medical Centre had got new state of art developer in 1980 which blew straight into her face.... at AGFA in Belgium the head chemist said anyone who developed problems was transferred away from the chemicals....back in NZ, ACC accepted case in 6 wks. Glut’s uses; some react; women’s health issues not taken seriously; 1984 she and the Massey researchers took 1½ hrs to convince the Health Dept to issue a warning; Health Dept asked her to write guidelines with Ian Laird, Massey occ health lecturer - took 13 mnths to write and became international reference work. Workers still being exposed eg Northland Hosp. Marjan Creusan-Foot suing for exemplary damages. [Decision currently awaited.] - new CT suite 1991 - staff complained about the temperature and fumes. C-F developed memory loss, vocal chord ganuloma, crippling joint pains, hoarseness, general weakness. Improved on hol. Ill within hours on return. Told to stop work - hospital immediately took out the air conditioning; fumes were not measured. 6 mnths leave - quickly fell ill on return. ACC accepted. Problems of retraining and re-employment at 44. Health slowly improving but medication for joint pains... photographer husband can’t have darkroom in the house. Increasing use of GA as a sterilant with HIV, AIDS, laparascopes. Margaret Mulligan - Chief Radiog; sensitised; like having a heart attack; couldn’t breathe; management wanted proof so surveyed 12 other hospitals - similar problems; GA-free CD77 used. Pene Clifford, Helen Walker, MM underwent detox programme - exercise/ vitamins/ sauna. Dunedin Hospital using Kodak Rapid Access because two staff had to quit. Bill Glass, Assoc Professor Occ Health, Otago Univ, 20+ cases. Problems are well-known internationally. Sceptics are ostriches. Not everyone gets the flu and not everyone using GA has a problem. "The real problems begin with the one or two people who move from the more general response to sensitivity." A lot of doctors don’t take work histories but people spend 8 or 10 hrs a day at work. Eunice Nutman, Northland - blood tests found elevated antibodies in 19/38 staff - usually only 20% of the population. MAG did not want it to take the 50 yrs it took to get stronger controls on radiation.
Pickford Alison. The hhumph of the chemical djinn. Shadows 1994. (Disconnected processor exhaust caused her problems - headache, sore throat, tight chest, reduced peak flow, tiredness, poor recall, depressed over things which usually don’t matter. Could not return even after ventilation fixed. Sort help from Clinical Ecologist, vegan diet and vitamins etc.
Very low levels of GA were measured.)
Rosalski S B, Dooley J S. Liver function profiles and their interpretation. Btitish J of Hosp Med. 1994 51,1, 181-186
Rozen P, Somjen G J et al. Endoscope-induced colitis: description, probable cause by glutaraldehyde, and prevention.
Gastrointestinal Endoscopy. 1994, 40, 5, 547-553. (6 cases of acute colitis after sigmoidoscopy probably caused by GA residues. Residues in the rinse water contained the equiv of 0.2% GA..)
Stenton S C, et al. Glutaraldehyde, asthma and work - a cautionary tale. Occ Med (Oxf), 44, 2, 95-8, May. (Endoscopy nurse, 46, had symptoms suggestive of occ asthma. Inhalation challenge in endoscopy caused FEV1 fall 3.6 to 1.5 litres. Double blind inhalation challenges (up to 0.32ppm for 10 min) gave no obvious asthmatic reactions. Slight increase in airway responsiveness, PD20FEV1 from >6400 to 1850 micrograms. Even with sophisticated techniques clear-cut result may be elusive.)
Stump Fred D et al. Influence of oxygenated fuels on the emmissions from three pre-1985 light duty passenger vehicles. J of the Air and Waste Management Assoc. June, 1994, p781...(Car exhausts tested using regular gasoline and an ozygenated fuel containing 9.5% MTBE, more olefins and fewer aromatics [benzene, toluene, and xylene are the principal aromatics] than the base fuel. No reduction in emissions from oxygenated fuel. Total hydrocarbons (THCs), speciated hydrocarbons, speciated aldehydes, CO, oxides of nitrogen (NOx), benzene, and 1,3-butanedione emissions were measured. THC, CO, benzene, and 1,3-butanedial, formaldehyde, acetaldehyde, total aldehydes, decreased with increasing air temps. NOx increased with incr temp. More formaldehyde was emitted when MBTE fuel used.)
Teo R K C, Naidu V A. The effects of glutaraldehyde exposure on human brain function. Worksafe Australia paper presented to the 13 Annual Conference Australian Inst.itute Occ. Hygienists, 4/12/94. (3 staff exposed to GA in a theatre while cleaning endoscopes were tested by the auditory evoked potential method. They showed prolongation of the response time (p3 latency) a dysfunction related to the depression of the cortical function of the brain.)
Use and Management of Glutaraldehyde Solutions Safety Action Bulletin 1994, No 108 (Action reqd. GA is a respiratory sensitising agent and exposure to the vapour may cause occ asthma).
Barry M MSF Seminar Dangers of glutaraldehyde & other chemicals used in x-ray film processing. Glasgow, Sept 1995. (Speakers: Sherwood Burge, M Gordon, Geof Care, Photosol -[transient high exposures, aerosol theory], Warren Town - Soc of Radiog -(problems in getting Dept Health to lower OES and give a MEL), Glenn Johnson MSF Union.)
Batchelor Gerald L. Glutaraldehyde toxicity. Shadows 38 , 4, 20-21, Dec 1995. (Occ Health Advisor, Northland Health. Cases from radiology and theatre. Individuals can have any or all 4 different types of immune response (hypersensitivity). 1) IgE (?IgG4) mediated eg hayfever, anaphylaxis, extrinsic asthma, acute contact dermatitis, urticaria. 2) A chemical may affect certain cells which react with IgG or IgM antibodies and may cause cell destuction - ie auto-antibodies which may cause auto-immune diseases eg SLE (lupus) or following certain drugs or chems. Needs careful history taking. 3) From precipitation of antigen-antibody complexes in tissues which have tortuous arterioles eg kidneys, eyes. 4) Immune responses mediated by T-cells eg delayed contact dermatitis (several days later). Chems can trigger a similar response. Auto-immune diseases occur in ratio of 8 female to 1 male so high chance of seeing these in radiology and theatre. Those sensitised to GA may develop cross-sensitivities especially to aldehydes (in diesel/petrol exhaust) , and organic solvents. Also to perfumes, carpets, new clothes, cigarette smoke, new chipboard [these contain aldehydes] and some food preservatives. Some people complain of similar symptoms from agricultural chems, mercury, and silicone implants. GA symptoms - plus include difficulty concentrating and sleep disorder. Depression is common but is this a primary effect of the GA or secondary effect following continual fatigue, frustration etc? Those with long-term problems slowly improve but contact with, for instance, diesel fumes causes recurrence of symptoms. If sensitised, must be totally removed.)
Birnbaum, B.A. et al. "Glutaraldehyde colitis: radiologic findings," Radiology. 1995, 195, 1, 131-4, Apr. (Two percent GA on colonic mucosa may result in toxic colitis, and the clinical features may mimic those of colonic ischemia. A retropective review of four patients with GA-induced colitis who developed a self-limited syndrome of cramps and abdominable pains, tenesmus (straining) and rectal bleeding within 48 hours of uncomplicated sigmoidoscopy or colonoscopy. CT showed circumferential thickening of the left side of the colonic wall in all. From Hospital of University of Pennsylvania.)
Care G Feb, 1995, Photosol Ltd, 15 Bakers Court, Basildon, Essex, SS14 3EH, England. :