Fatal injuries at work in California

We examined deaths due to injury on the job reported from three readily accessible data sources in California for a 1-year period. Of 682 deaths identified as of February 1990 as having occurred on the job in 1983, county coroners identified 607 (89.0%), workers' compensation records identified 294 (43.1%), and the California Occupational Safety and Health Administration investigated 141 (20.7%). Most fatal injuries at work resulted from events that are not covered by current California Occupational Safety and Health Administration standards: transportation vehicle accidents and homicides. Demographic patterns suggest that fatal injuries on the job are nonrandom events, which may be prevented by additions to existing standards or increased enforcement of workplace safety standards and by efforts to target groups at highest risk. Improved surveillance of fatal occupational injuries will require changes in existing reporting mechanisms, similar to those proposed by the US Bureau of Labor Statistics.

CARET, the beta-carotene and retinol efficacy trial to prevent lung cancer in asbestos-exposed workers and in smokers

CARET is a two-armed, double-blind, randomized chemo-prevention trial to test the hypothesis that oral administration of beta-carotene 30 mg/day plus retinyl palmitate 25,000 IU/day will decrease the incidence of lung cancer in high-risk populations: heavy smokers and asbestos-exposed workers who have smoked. The agents combine anti-oxidant and nuclear tumor suppressor mechanisms. Fastidious monitoring for possible side effects is facilitated by inclusion of a Vanguard population. As of 31 December 1990, 6,105 participants of the 18,000 needed have been randomized in the trial. Efficacy results are expected in 1999.

Soybean flour asthma: detection of allergens by immunoblotting

A 43-year-old woman developed asthma 6 years after beginning work in a food-processing plant in which soybean flour was used as a protein extender. Symptoms of sneezing, coughing, and wheezing would begin within minutes of exposure to soybean flour and resolve 2 hours after exposure ceased. Skin tests were positive to a soy extract prepared from the flour. Airway hyperreactivity was confirmed by a positive bronchial challenge to methacholine. Bronchial challenge with soybean flour produced an immediate increase in specific airway resistance from 5.0 to 22.7 L. cm of H2O/L/sec. There was no response to challenge with lactose. The patient's allergic response to soy-flour extract was further characterized by several immunologic methods. IgE binding to soy-flour protein by direct RAST was 5.98 times that of a normal control serum. The soy-flour extract was separated by dodecyl sulfate-polyacrylamide gel electrophoresis. Twenty-four protein bands were detected in the crude soy-flour extract. After immunoblotting and subsequent autoradiography, nine proteins with molecular weights ranging from 54,500 to 14,875 were found. Cross-reactivity studies with other legumes demonstrated apparent immunologic identity between a component in green pea extract and a soybean protein with a molecular weight of 17,000. The clinical significance of this cross-reactivity is not known. We conclude that in this case of occupational asthma to soybean flour, multiple allergens were involved. Immunoblotting may be useful in identifying the allergens involved in occupational asthma.

Pregnancy in a woman with severe pulmonary fibrosis secondary to hard metal disease

The effect of interstitial pulmonary fibrosis on pregnancy is unclear. We present the findings in a 31-year-old woman with severe pulmonary fibrosis (vital capacity, 37 percent of predicted) secondary to hard metal disease who went through a successful term pregnancy. The patient was a grinder of tungsten-carbide drill bits who developed pneumonitis and subsequent fibrosis. Her therapy required steroids and cyclophosphamide for stabilization of her pulmonary function prior to her pregnancy. At six months' gestation, right heart catheterization showed normal cardiac output and pulmonary arterial and wedge pressures. Stage 2 exercise study demonstrated a maximum oxygen consumption of 1.17 L/min (53 percent of predicted). The patient was able to exercise to a maximum workload of 300 kpm/min (32 percent of predicted). She became hypoxemic (arterial oxygen pressure, 54 mm Hg) at 150 kpm/min. Her pregnancy concluded with an uncomplicated normal vaginal delivery requiring only supplemental oxygen and spinal anesthesia. Review of the few similar cases suggests that a woman can have a successful pregnancy despite severe pulmonary dysfunction.