1/6. Too hot to handle: an unusual exposure of HDI in specialty painters.BACKGROUND: Hexamethylene Diisocyanate (HDI) is a color stable aliphatic isocyanate that is used in specialty paints as a hardener. Due to the lower vapor pressure of its commercial biuret form, it is considered a relatively "safe" isocyanate from an exposure standpoint. This case series reports on an unusual toxic exposure to HDI. Between November 1993 and May 1994, seven specialty painters and one boiler maker who were working at three different power plants were examined at the Institute of Occupational and environmental health at west virginia University. At their respective work sites, HDI was applied to the hot surfaces of boilers that were not shut down, and allowed sufficient time to cool. Consequently, these workers were exposed to volatile HDI and its thermal decomposition products. methods: All of these workers underwent a complete physical examination, spirometry, and methacholine challenge testing. RESULTS: All 8 workers complained of dyspnea, while 4 of the 8 also complained of rash. On examination 3 workers were methacholine challenge positive and 2 had persistent rash. At follow-up 4 years later, 5 workers still had to use inhalation medication and one had progressive asthma and dermatitis. All 8 workers, by the time of the follow-up, had gone through economic and occupational changes. CONCLUSIONS: This case series reports on an unusual exposure to HDI. It is unusual in that: 1) There were two simultaneous sentinel cases with two different material safety data sheets (MSDS) for the same product, 2) Exposure was to volatile HDI and its decomposition products and 3) Hazardous conditions of exposure occurred at three different sites.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/6. Long-standing dermatological manifestations in a patient with chronic heavy metal intoxication.A patient with chronic metal intoxication is described, presenting during four years after the cessation of her exposure to industrial substances, maculo-papular eruptions with several ulcerated lesions and excoriations on her abdomen and buttocks. She also had pallor of her face, greyish-dark discoloration of the hair, while the fingernails were brittle and sensitive. Scrupulous physical examination excluded further cutaneous involvement. The immunological workup revealed both phenotypic and functional defects in cellular immunity.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
3/6. Contact dermatitis to white petrolatum.A 31-year-old Caucasian woman presented with a 20-year history of presumed atopic dermatitis. She complained of severe pruritus and the presence of extensive patches of erythema and scale. Her previous treatments included: multiple topical corticosteroids, tacrolimus 0.1% ointment, pimecrolimus 1% cream, and cyclosporine with no improvement of her symptoms. Her past medical history was unremarkable and she was on no other oral medications, including over-the-counter products. On physical examination, multiple erythematous, scaly patches were present on the chest, abdomen,back, and upper extremities. Lichenification of both antecubital fossa was present. Extensive excoriations on her arms and abdomen were also noted. Although the patient had a long-standing history of presumed atopic dermatitis, she had never undergone a skin biopsy. A skin biopsy was performed which demonstrated a perivascular lymphocytic infiltrate with eosinophils and dermal edema (Figures 1, 2). The biopsy was suggestive of possible hypersensitivity dermatitis. The patient then underwent patch testing. The following patch tests were applied to normal back skin using IQ chambers:North American Contact dermatitis Group (NACDG) expanded standard, textile, fragrance trays, and ingredients found in her products (Chemotechnique, Malmo, sweden). A total of 89 patches were applied, removed at 48 hours, and read both at 48 and 96 hours. At 48 hours, a total of 70 allergens were positive, 69 of those allergens were in a petrolatum vehicle.There were 50, 3 reactions to sites of allergens in petrolatum (Figure 3). There were only two sites with petrolatum that were negative: budesonide (a corticosteroid) and melamine formaldehyde. In contrast, all of the sites where there were allergens in liquid vehicles were negative, with the exception of a 1 reaction to cocamidopropyl betaine. At 48 hours,four additional patch tests were applied to plain petrolatum. Two of these patches were in plastic IQ chambers and two in aluminum Finn Chambers. At 48 hours, all four of the sites showed 3 reactions (Figure 4). By 96 hours, all of the patch test sites that were positive at 48 hours, and much of the surrounding skin, showed a diffuse "angry back" reaction, which made an accurate 96-hour reading impossible.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
4/6. Incarceration for excoriation.A thirty-six-year-old man experienced acute, severe, generalized pruritus. His scratching was erroneously interpreted as lewd and indecent behavior. He was arrested. Results of the history and physical examination led to the diagnosis of fiberglass dermatitis, which prompted a dismissal of the charges. Although many societies have looked askance at persons with certain skin diseases (such as leprosy) and at scratching in public since at least biblical times, we are not aware of any prior reports of incarceration for excoriation.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
5/6. Prevention of occupational skin disease through use of chemical protective gloves.Selection of chemical protective gloves for use against industrial liquids in the controlled workplace is accomplished by risk analysis, in which the appropriate physical and chemical glove properties needed by the worker to perform the job are determined. Candidate protective gloves are then subjected to chemical permeation testing. Three representative case studies illustrate risk analysis and glove selection.- - - - - - - - - - ranking = 0.054267275561268keywords = physical (Clic here for more details about this article) |
6/6. Symptomatic dermographism.urticaria is caused by physical factors in almost 12 percent of cases. These factors include pressure. Dermographism is the appearance of whealing and erythema within minutes where skin has been exposed to pressure or mechanical irritation. Symptomatic dermographism is present when "normal" pressures, such as those encountered in the activities of daily living, cause urticaria. Individuals with symptomatic dermographism can be shown to have a lower pressure threshold for the production of dermographism than normal individuals. A case of symptomatic dermographism is presented, and the differential diagnosis is discussed.- - - - - - - - - - ranking = 0.054267275561268keywords = physical (Clic here for more details about this article) |