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ABSTRACT: The aim of this study was to assess the reliability of asbestos fibre concentration in bronchoalveolar lavage fluid (BALF) by carrying out the mineralogical analysis of BALF at different times in the same patient and comparing the results.
Twenty two patients underwent diagnostic fibreoptic bronchoscopy twice: the first was to assess the past asbestos exposure and the second for different clinical reasons. Mineralogical analysis of BALF was carried out.
In 16 patients (72.7%), a reduction of concentration in BALF of all asbestos fibres was observed. The concentrations of both chrysotile and amphiboles in the first bronchoalveolar lavage (BAL) were related to their concentrations in the second BAL and the observed differences were not statistically significant. A significant decrease in asbestos body concentration between the first and the second BAL was found (Wilcoxon test, P < 0.01).
The reliability of the fibre concentration in BALF as a marker of past asbestos exposure seems quite good. In most cases, it allows us to distinguish workers in different classes of exposure and gives useful information on the pattern of exposure. Uncertainties related in general to lung residues and in particular to mineralogical analysis of BALF (mainly due to the high coefficient of variation (CV) at low fibre concentrations and the results of the statistical analysis on total fibres) suggest that this biomarker is more likely suitable for a qualitative/categorical approach to exposure assessment than a quantitative one.
Annals of Occupational Hygiene 07/2007; 51(5):495-500. · 1.95 Impact Factor
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J J M van de Sandt,
J A van Burgsteden,
S Cage,
P L Carmichael,
I Dick,
S Kenyon,
G Korinth,
F Larese,
J C Limasset,
W J M Maas,
L Montomoli,
J B Nielsen,
J-P Payan,
E Robinson, P Sartorelli,
K H Schaller,
S C Wilkinson,
F M Williams
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ABSTRACT: To obtain better insight into the robustness of in vitro percutaneous absorption methodology, the intra- and inter-laboratory variation in this type of study was investigated in 10 European laboratories. To this purpose, the in vitro absorption of three compounds through human skin (9 laboratories) and rat skin (1 laboratory) was determined. The test materials were benzoic acid, caffeine, and testosterone, representing a range of different physico-chemical properties. All laboratories performed their studies according to a detailed protocol in which all experimental details were described and each laboratory performed at least three independent experiments for each test chemical. All laboratories assigned the absorption of benzoic acid through human skin, the highest ranking of the three compounds (overall mean flux of 16.54+/-11.87 microg/cm(2)/h). The absorption of caffeine and testosterone through human skin was similar, having overall mean maximum absorption rates of 2.24+/-1.43 microg/cm(2)/h and 1.63+/-1.94 microg/cm(2)/h, respectively. In 7 out of 9 laboratories, the maximum absorption rates of caffeine were ranked higher than testosterone. No differences were observed between the mean absorption through human skin and the one rat study for benzoic acid and testosterone. For caffeine the maximum absorption rate and the total penetration through rat skin were clearly higher than the mean value for human skin. When evaluating all data, it appeared that no consistent relation existed between the diffusion cell type and the absorption of the test compounds. Skin thickness only slightly influenced the absorption of benzoic acid and caffeine. In contrast, the maximum absorption rate of testosterone was clearly higher in the laboratories using thin, dermatomed skin membranes. Testosterone is the most lipophilic compound and showed also a higher presence in the skin membrane after 24 h than the two other compounds. The results of this study indicate that the in vitro methodology for assessing skin absorption is relatively robust. A major effort was made to standardize the study performance, but, unlike in a formal validation study, not all variables were controlled. The variation observed may be largely attributed to human variability in dermal absorption and the skin source. For the most lipophilic compound, testosterone, skin thickness proved to be a critical variable.
Regulatory Toxicology and Pharmacology 07/2004; 39(3):271-81. · 2.43 Impact Factor
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Bulletin of Environmental Contamination and Toxicology 01/2004; 71(6):1091-9. · 1.02 Impact Factor
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P Sartorelli
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ABSTRACT: The importance of dermal exposure has increased during the last few years, mainly because of the reduction of respiratory exposure to toxicants. Pesticides, aromatic amines and polycyclic aromatic hydrocarbons are considered to be the chemicals at highest dermal risk. In the occupational exposure limit lists of the American Conference of Governmental Industrial Hygienists (ACGIH) and of many countries, compounds that can be absorbed through the skin are identified by a skin notation. However, a generally accepted criterion for assigning skin notation does not exist. The recent attempts to develop health-based dermal occupational exposure limits (DOELs) have not been accepted, thus in practice their use has remained limited. To predict the systemic risk associated with dermal exposure and to enable agencies to set safety standards, penetration data are needed. Moreover, there is a need for a practical risk assessment model, particularly for small and medium-sized enterprises.
Occupational Medicine 06/2002; 52(3):151-6. · 1.14 Impact Factor
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ABSTRACT: Mineralogical analysis of bronchoalveolar lavage fluid (BALF) by electron microscopy can represent the most suitable method for assessing asbestos exposure. However, it has been claimed that no standardized or systematic approach to the subject of mineralogical analysis exists. This study aimed to evaluate BALF mineralogical analysis by transmission electron microscopy as biomarker of asbestos fiber load. BALF was examined in 108 exposed workers and 57 patients who underwent diagnostic fiberoptic bronchoscopy for various clinical purposes. Asbestos bodies in BALF were counted with a phase-contrast microscope. Fibers were counted and analyzed by transmission electron microscopy, which showed a significant difference between the two populations and positive results for all exposed subjects. Only 82.2% of the exposed population tested positive for asbestos bodies. Subjects with long-term exposure had higher concentrations of fibers than did those with more recent exposure, probably because of the higher workplace exposure levels in the past. The results of the study confirm that fiber concentration in BALF can be considered as a reliable biomarker of past asbestos exposure, even many years after the end of exposure.
Journal of Occupational and Environmental Medicine 11/2001; 43(10):872-81. · 2.06 Impact Factor
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ABSTRACT: To understand the dermal uptake of chemicals bound to soil and dust, information on the neat substance is helpful but does not seem sufficient. Because of its content of polycyclic aromatic hydrocarbons (PAHs) coal is suspected to be carcinogenic. However, experimental carcinogenity studies on coal dust never succeeded in demonstrating a higher incidence of cancer in treated animals. The aim of the study was to assess dermal penetration through human skin of PAHs from coal dust. A sample of coal dust was grinded and sieved, using the particle size of < 30 microm. An in vitro static diffusion cell system validated by in vitrolin vivo comparison has been used to study dermal penetration through human skin of PAHs from coal dust compared with their percutaneous absorption as pure compounds. No percutaneous penetration of PAHs was observed in the cells where coal dust was applied, while dermal penetration was demonstrated for PAHs applied in an acetone solution. Results agree with the literature that PAHs are poorly absorbed through the skin from solids. Dermal risk assessment of PAHs should take into account not only the degree and the extent of skin contamination, but also their bioavailability, which is heavily influenced by the physico-chemical characteristics of the matrix.
Toxicology and Industrial Health 03/2001; 17(1):17-21. · 1.42 Impact Factor
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P Sartorelli,
H.R Andersen,
J Angerer,
J Corish,
H Drexler,
T Göen,
P Griffin,
S.A.M Hotchkiss,
F Larese,
L Montomoli,
J Perkins,
M Schmelz,
J van de Sandt,
F Williams
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ABSTRACT: During the last few years the general interest in the percutaneous absorption of chemicals has increased. It is generally accepted that there is very few reliable quantitative and qualitative data on dermal exposure to chemicals in the general population and in occupationally exposed workers. In order to predict the systemic risk of dermally absorbed chemicals and to enable agencies to set safety standards, data is needed on the rates of percutaneous penetration of important chemicals. Standardization of in vitro tests and comparison of their results with the in vivo data could produce internationally accepted penetration rates and/or absorption percentages very useful for regulatory toxicology. The work of the Percutaneous Penetration Subgroup of EC Dermal Exposure Network has been focussed on the standardization and validation of in vitro experiments, necessary to obtain internationally accepted penetration rates for regulatory purposes. The members of the Subgroup analyzed the guidelines on percutaneous penetration in vitro studies presented by various organizations and suggested a standardization of in vitro models for percutaneous penetration taking into account their individual experiences, literature data and guidelines already in existence. During the meetings of Percutaneous Penetration Subgroup they presented a number of short papers of up to date information on the key issues. The objective was to focus the existing knowledge and the gaps in the knowledge in the field of percutaneous penetration. This paper is an outcome of the meetings of the Percutaneous Penetration Subgroup and reports the presentations on the key issues identified throughout the 3-year duration of the Dermal Exposure Network (1997–1999).
Environmental Toxicology and Pharmacology. 02/2000;
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ABSTRACT: Percutaneous penetration of polycyclic aromatic hydrocarbons (PAHs) is affected by various factors connected to exposure conditions. The nature of the matrix, such as that of oil, can strongly affect their percutaneous penetration. Risk assessment should consider these effects. We examined the effect of matrix on percutaneous penetration of PAHs, particularly that of lubricating oil.
The test apparatus consisted of an in vitro static diffusion cell system using full-thickness monkey (Cercopithecus aetiops) skin as the membrane and saline solution with gentamycin sulfate and 4% bovine serum albumin as receptor fluid. Chemical analysis of PAHs in the samples obtained from cells was carried out by inverse-phase HPCL, and the results were read by spectrofluorimetry.
Comparing the penetration of 13 PAHs from a lubricating oil and from acetone solution with artificial sweat resulted in a significantly slower passage from the oil matrix for acenaphthene, anthracene, phenanthrene, fluoranthene, naphthalene, pyrene, fluorene (Mann-Whitney U test, P < 0.05). No significant differences in the passage were found for chrysene because, in the test with oil, its concentration was very often below the detection limit. For benzo[a]anthracene, benzo[b]fluoranthene, benzo[k]fluoranthene, and benzo[a]pyrene it was possible to demonstrate a passage through the skin only when compounds were applied in acetone solution with artificial sweat.
The results of the study suggest the necessity of dermal penetration data relevant for risk assessment, obtained under experimental conditions similar to the real exposure conditions.
Archiv für Gewerbepathologie und Gewerbehygiene 12/1999; 72(8):528-32. · 1.89 Impact Factor
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ABSTRACT: The results of environmental and biological (five subjects) monitoring of exposure to fenitrothion during manual operations on treated ornamental plants in greenhouses are reported. Urinary excretion [GM (GSD)] of alkylphosphates [dimethylphosphate (DMP) + dimethylthiophosphate (DMTP)] (nmol/g creat) was 244.8 (1.8), 174.0 (2.0), and 354.4 (1.6) respectively, on the first (Monday), third (Wednesday), and fifth (Friday) days of work. These levels were not significantly higher than those recorded in a control group (21 subjects) in which urinary excretion [GM (GSD)] of DMP + DMTP was 102.8 (4.2) nmol/g creat. Air concentrations of fenitrothion (nmol/m3) ranged from 45.5 to 81.2 on Monday, 17.3 to 27.1 on Wednesday, and 9.7 to 19.1 on Friday. Dose estimates showed that the respiratory-absorbed doses of fenitrothion accounted, on the average (GM), for 94.7%, 93.1%, and 91.5% of the total absorbed dose on Monday, Wednesday, and Friday, respectively. Multiple regression analysis showed a significant correlation (r2 = 0.595) between urinary excretion of DMP + DMTP, respiratory-absorbed dose, and skin-absorbed dose, estimated on Monday and Wednesday. Total estimated absorbed doses did not exceed the acceptable daily intake for fenitrothion. Serum and erythrocyte cholinesterase activities were not significantly different before and after exposure.
Archives of Environmental Contamination and Toxicology 06/1999; 36(4):490-7. · 1.93 Impact Factor
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ABSTRACT: Correlations between in vitro percutaneous absorption data and physicochemical properties of industrial chemicals are evaluated in order to develop predictive mathematical models based on said properties. Percutaneous diffusion of 16 pounds of occupational interest, eight of which were polycyclic aromatic hydrocarbons (acenaphthene, anthracene, benzo(a)anthracene, chrysene, phenanthrene, fluorene, naphthalene, pyrene), six organophosphorus insecticides (acephate, chlorpyrifos, dimethoate, fenitrothion, methamidophos, omethoate) and two phenoxycarboxylic herbicides (2,4-D, MCPA), were tested in vitro using monkey (Cercopithecus aetiops) skin. The test apparatus consisted of nine static diffusion cells with normal saline, gentamycin sulphate and 4% bovine serum albumin as receiving solution. Test compounds were applied at various concentrations in 30 microliters of acetone solution and determined, in the receiving phase, by chemical analysis. Values for ln Kow (octanol/water partition coefficient) were correlated with experimentally determined values of the permeability constant Kp (r = 0.90, P < 0.001) and lag time (r = 0.81, P < 0.01). Analysis of variance in a model of multiple linear regression between Kp, ln Kow and water solubility [water] of the compounds, showed that the data had a highly significant fit (P < 0.0001). A more general model which also included molecular weight (MW) and vapour pressure was evaluated as well, but the two variables made no substantial difference. Multiple regression analysis between lag time, ln Kow and [water] was significant (P < 0.0001), whereas introduction of vapour pressure and MW as independent variables did not significantly improve the predictive effect on lag time. Our experimental system, therefore, enables the values of Kp and lag time to be predicted with reasonable precision on the basis of ln Kow and [water] values, using the algorithm derived from the multiple linear regression equation.
Annals of Occupational Hygiene 05/1998; 42(4):267-76. · 1.95 Impact Factor
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ABSTRACT: The results of environmental (11 subjects) and biological (57 subjects) monitoring of exposure to mancozeb, ethylenethiourea (ETU), and dimethoate are reported for employees of a firm producing commercial formulations containing these active ingredients. Urinary excretion [GM(GSD)] of ETU (microg/g creatinine) and alkylphosphates [dimethylphosphate (DMP) + dimethylthiophosphate (DMTP) + dimethyldithiophosphate (DMDTP)] (nmol/g creatinine) was 65.3(4.8) and 419.2(2.1), respectively, for employees engaged in the formulation of a product containing 80% mancozeb (n = 9), 36.6(1.9) and 296.4(2.4) for those formulating a product containing 35% mancozeb (n = 9), 9.5(6.1) and 1022.4(3.0) for those engaged in plant maintenance and internal transport of materials (n = 6), 10.3(4.2) and 322.8(3.3) for those engaged in packaging the mancozeb formulations (n = 16), 4.4(3.3) and 2545.4(3.9) for those formulating a product containing 40% dimethoate (n = 11), and 3.0(2.7) and 871.7(3.3) for those bottling the same dimethoate formulation (n = 10). Air concentrations (microg/m3) ranged from 25.3 to 194.4 for dimethoate, from 0.2 to 1.3 for ETU, and from 139.9 to 949.0 for mancozeb. Urinary excretion of ETU and alkylphosphates showed a significant correlation with mancozeb (r2 = .971), and ETU (r2 = .858), and dimethoate (r2 = .955) contamination of the hands. Potential dose estimates showed that the potential respiratory doses of mancozeb and dimethoate accounted, on the average, for 38% of the total potential dose. The potential respiratory dose of ETU was 7% of the total potential dose. Total estimated absorption did not exceed the accepted daily dose (ADI) for ETU and mancozeb, but the ADI for dimethoate was exceeded. Serum and erythrocyte cholinesterase activities in workers formulating dimethoate products were not significantly different before and after exposure.
Journal of Toxicology and Environmental Health Part A 03/1998; 53(4):263-81. · 1.83 Impact Factor
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ABSTRACT: A number of studies on the health of occupational exposure to lead of workers from various industrial sectors are summarized. These studies document the disappearance of severe cases of saturnism, as seen in the past, and the occurrence nowadays, mainly of sub-clinical manifestations, such as alterations of blood levels of lead and protoporphyrin IX, in the large majority of cases. For the period 1984-95, a statistical analysis of the results obtained for these parameters is reported, together with other clinical data, for seven industrial sectors: crystal, ceramics, chemistry, metallurgy and mechanics, iron and steel, printing and painting. These results show a drop of the mean concentrations of blood lead levels in all sectors but the ceramic industry, especially since 1991, when the law, Decreto Legislativo 277/91--in accomplishment of European directives on protection of workers, including the directive 82/605/EEC--has been put into force.
Annali dell'Istituto superiore di sanita 02/1998; 34(1):145-56. · 0.94 Impact Factor
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ABSTRACT: To compare in vitro percutaneous absorption of methyl-parathion dissolved in an acetone vehicle and in the form of a commercial formulation.
Penetration through the human skin was measured in Franz diffusion cells with full thickness skin from a human cadaver as the membrane. The two tailed non-parametric Mann-Whitney U test was used to compare the cumulative diffusion of methyl-parathion in the receptor fluid of the cells at various time intervals.
In vitro skin penetration of methyl-parathion was significantly higher with the commercial formulation. The percentage of the applied dose absorbed after 24 hours was 5.20% v 1.35%. The mean lag time was < 8 hours.
Assessments of uptake and internal dose after exposure to pesticides should be based on the commercial products rather than active ingredients, because of the crucial role of the vehicle, as shown in this study.
Occupational and Environmental Medicine 07/1997; 54(7):524-5. · 3.02 Impact Factor
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ABSTRACT: The results of biological monitoring by assay of urinary 3,5,6-trichloro-2-pyridinol and alkylphosphates (DMP, DMTP) in groups of 9 and 2 workers exposed to chlorpyrifos-methyl during vine spraying and manual leaf thinning 5-11 d after spraying, respectively, are reported. The results are compared with those of a control group of 46 subjects not occupationally exposed to organophosphate insecticides. Significantly higher urinary excretion of metabolites (Mann-Whitney U-test) was found in both groups than in controls. Levels of 3,5,6-trichloro-2-pyridinol (mean +/- SD) were 15.9 + 10.6 nmol/g creatinine (n = 33) for controls, 92.4 + 162.5 nmol/g creatinine (n = 20) for manual workers, and 675.5 + 1110.8 nmol/g creatinine (n = 48) for workers spraying and mixing the insecticide. Levels of DMP (mean +/- SD) were 63.8 + 100.1 nmol/g creatinine (n = 42), 123.0 + 79.0 nmol/g creatinine (n = 20), and 577.2 + 1003.2 nmol/g creatinine (n = 61), respectively, for the same 3 groups. Levels of DMTP (mean +/- SD) were 153.4 + 164.4 nmol/g creatinine (n = 43), 489.3 + 288.3 nmol/g creatinine (n = 20), and 297.6 + 215.4 nmol/g creatinine (n = 61), respectively, for the same 3 groups. Good correlations were found between urinary excretion of 3,5,6-trichloro-2-pyridinol and DMP (r = .776 for manual workers; r = .775 for workers mixing and spraying the insecticide) or DMTP (r = .558 and r = .746, respectively for the same 2 groups). The peak of excretion of the three metabolites was found in urine samples collected the night after the spraying or leaf thinning operations.
Journal of Toxicology and Environmental Health 05/1997; 50(6):581-94. · 1.81 Impact Factor
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ABSTRACT: Since several workers engaged in polishing and engraving crystal articles were found to have higher than average blood levels of lead (560 micrograms/liter, range 80-560 micrograms/liter), we investigated the hypothesis that crystal dust releases lead in the human body. To test the hypothesis, two types of crystal polishing dusts, having different lead contents, were mixed with human serum diluted 1:3 (pseudointerstitial fluid), gastric juice, and phosphate buffer at pH 9. After 14 days of contact, the diluted serum had extracted 0.620% of the lead in the crystal dust (particle size < 20 microns) containing 25.2% lead and 0.425% of that containing 19.9% lead. After 48 hr in gastric juice, 0.235 and 0.556% of the lead was extracted from crystal dusts (unsieved crystal dusts) containing 25.2 and 19.9% lead, respectively. After 28 days in alkaline solution, 0.358 and 0.304% of the lead was extracted respectively from the same two crystal dusts (unsieved crystal dusts).
Environmental Research 01/1997; 74(2):169-73. · 3.40 Impact Factor
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ABSTRACT: The aim of the study was to test the hypothesis that high blood lead levels are associated with depressed serum erythropoietin concentrations in workers occupationally exposed to lead. The results in exposed workers and in a control group of unexposed subjects were compared. Blood lead values were < or = 20 micrograms/dl in unexposed subjects and > or = 30 micrograms/dl in exposed subjects. The two groups of exposed workers and the control population were matched for sex and age. Hemoglobin levels were not affected by blood lead values and did not differ significantly between the three groups. The two-tailed, nonparametric Mann-Whitney U-test was used to compare unpaired groups. The Spearman rank correlation test was used to evaluate the dose-effect relationship between Pb and EPO. The analysis of the data indicate that erythropoietin values are significantly lower in exposed subjects than a controls. However no correlation was demonstrated between blood lead concentrations and erythropoietin in any group.
Archiv für Gewerbepathologie und Gewerbehygiene 02/1996; 69(1):73-5. · 1.89 Impact Factor
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ABSTRACT: Xenobiotic residues and their metabolites in biological fluids of the general population are an important indicator of exposure to toxic substances dispersed in the environment. Urine samples collected from 124 subjects living in SW Tuscany, Italy were analyzed for alkylphosphates (dimethylphosphate, dimethylthiophosphate, dimethyldithiophosphate, diethylphosphate, diethylthiophosphate, diethyldithiophosphate), aspecific metabolites of organophosphorus insecticides. The compound most frequently found was dimethylthiophosphate which was detectable in 99% of the subjects analyzed, with a geometric mean of 70.7 nmol/g creatinine. The other substances were found in the following percentages of our population, at the following mean concentrations: dimethylphosphate, 87%, 62.8 nmol/g creat.; dimethyldithiophosphate, 48%, 21.1 nmol/g creat.; diethylphosphate, 81%, 27.4 nmol/g creat.; diethylthiophosphate, 73%, 22.8 nmol/g creat.; diethyldithiophosphate, 7%, 13.7 nmol/g creatinine. Subjects eating food (fruit, meat, vegetables) that was not their own produce showed higher urinary concentrations of nearly all the compounds. The other variables considered (sex, age, residence, alcohol, smoking, sampling period) seem to affect the percentages of positive values of the various substances but to different degrees. Age and source of foods were the most important variables for dimethylthiophosphate excretion when mean values were analyzed by Student's t-test and analysis of variance (ANOVA).
Science of The Total Environment 02/1996; 177(1-3):37-41. · 3.29 Impact Factor
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ABSTRACT: A group of 104 workers were examined. They were employed in selecting rags and separating the lining from wollen fabrics to be used again as thread waste in the textile industry. The aim of the study was to point out tendon and joint related disorders of the upper limb due to repetitive and forced movements. Twenty-eight (26.9%) workers complained of hand and wrist echography and thermography. In 19 patients (67.8%) clinical carpal tunnel syndrome was diagnosed. Eight workers (28.5%) had Dupuytren's contracture. Swelling of the fingers was found in 23 (82.1%). 14.2% and 28.5% of the workers showed respectively acro-osteolysis and acrosclerosis. The textile industry of Prato shows peculiar characters: the workers employed in selecting rags out a manual job which causes soft tissues and skeletal disorders in a great number of them. The acro-osteolytic and acrosclerotic changes of the fingers seem alike the bone disorders of chronic inflammatory rheumatic diseases as seronegative spondyloarthritis.
Minerva medica 12/1995; 86(11):467-4. · 0.90 Impact Factor
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ABSTRACT: "Trans-placental" exposure to polycyclic aromatic hydrocarbons (PAHs) in newborn babies of mothers smoking during pregnancy was investigated and compared with that in newborn babies of non smoking mothers. PAHs intake was evaluated by measuring urinary levels of 1-hydroxypyrene, a pyrene metabolita and a biological index of exposure. 42 mothers-babies couples (31 smoking and 11 non smoking mothers) were examined. Urinary concentrations of 1-hydroxypyrene in 42 controls, 18 non smoking and 24 smoking women, were determined at the same time. Mean values of 1-hydroxypyrene in non smoking women in labour and their babies were 0.15 (SD 0.11) and 0.15 (SD 0.10) micrograms/g creatinine respectively. In controls the mean was 0.15 (SD 0.09) micrograms/g creat. Mean values of 0.23 (SD 0.17) and 0.20 (SD 0.15) micrograms/g creatinine were determined in smoking mothers and their newborn babies, whereas in smoking controls 1-hydroxypyrene was 0.42 (SD 0.45) micrograms/g creatinine. The highest levels of 1-hydroxypyrene were detected in smokers (both controls and women in labour). Babies of smoking mothers also showed a higher mean value of 1-hydroxypyrene than babies of non smokers. However the only statistically significant difference found was between smoking and non smoking controls.
Minerva medica 07/1994; 85(6):307-11. · 0.90 Impact Factor
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ABSTRACT: The present study describes the medical history of two cases of pulmonary fibrosis in hard metal grinders. The poor chance of foreseeing the prognosis of this disease is particularly underlined. The two workers examined have been studied for about 6 years since the diagnosis. The disease was more severe in the subject who worked a shorter time and who left work because of the disease. In the other subject, who had worked longer and never left the job, the disease was less severe and has never deteriorated with time. Therefore, removing the affected subject from work is of major importance in preventing the progression of the disease, but this is in part connected to individual susceptibility, and the cessation of work and corticosteroid therapy are not always able to provide a cure.
Science of The Total Environment 07/1994; 150(1-3):219-21. · 3.29 Impact Factor
