Pharyngeal cancer mortality among chemical plant workers exposed to formaldehyde

Objectives: To assess the possible relationship between formaldehyde exposure and mortality risk from pharyngeal cancer (PC), in particular nasopharyngeal cancer (NPC). Methods: Subjects were 7328 workers employed at a plastics-producing plant (1941-1984). Vital status for 98% of the cohort and cause of death for 95% of 2872 deaths were determined. Reconstructed exposures to formaldehyde, particulates and pigment were used to compute several exposure measures. Standardized mortality ratios (SMRs) were computed for several demographic, work history and formaldehyde exposure variables. In a nested case-control study, seven cases of NPC and 15 cases of other PC were matched on race, sex, age and year of birth to four controls from the cohort. Among interviewed subjects, lifetime smoking history was determined using respondents or proxies for all but one control subject. Results: Statistically significant 2.23-fold and fivefold excesses for PC and NPC, respectively, were observed. Fivefold range NPC excesses were observed for both short (B / 1 year) and long-term workers and were concentrated among workers hired during 1947-1956. Only three NPC cases were exposed to formaldehyde for longer than one year, and each had low average intensity of formaldehyde exposure (0.03-0.60 ppm). Only a few exposure measures revealed some evidence of an association with all PC or NPC. For all PC combined, adjustment for smoking and year-of-hire in the case-control study generally corroborated findings from the cohort study. Conclusions: Overall, the pattern of findings suggests that the large, persistent nasopharyngeal and other PC excesses observed among the Wallingford workforce are not associated with formaldehyde exposure, and may reflect the influence of nonoccupational risk factors or occupational risk factors associated with employment outside the Wallingford plant.

Formaldehyde carcinogenicity research: 30 years and counting for mode of action, epidemiology, and cancer risk assessment

Formaldehyde is a widely used high production chemical that is also released as a byproduct of combustion, off-gassing of various building products, and as a fixative for pathologists and embalmers. What is not often realized is that formaldehyde is also produced as a normal physiologic chemical in all living cells. In 1980, chronic inhalation of high concentrations of formaldehyde was shown to be carcinogenic, inducing a high incidence of nasal squamous cell carcinomas in rats. Some epidemiologic studies have also found increased numbers of nasopharyngeal carcinoma and leukemia in humans exposed to formaldehyde that resulted in formaldehyde being considered a Known Human Carcinogen. This article reviews the data for rodent and human carcinogenicity, early Mode of Action studies, more recent molecular studies of both endogenous and exogenous DNA adducts, and epigenetic studies. It goes on to demonstrate the power of these research studies to provide critical data to improve our ability to develop science-based cancer risk assessments, instead of default approaches. The complexity of constant physiologic exposure to a known carcinogen requires that new ways of thinking be incorporated into determinations of cancer risk assessment for formaldehyde, other endogenous carcinogens, and the role of background endogenous DNA damage and mutagenesis.

Exposure to formaldehyde and its potential human health hazards

A widely used chemical, formaldehyde is normally present in both indoor and outdoor air. The rapid growth of formaldehyde-related industries in the past two decades reflects the result of its increased use in building materials and other commercial sectors. Consequently, formaldehyde is encountered almost every day from large segments of society due to its various sources. Many governments and agencies around the world have thus issued a series of standards to regulate its exposure in homes, office buildings, workshops, public places, and food. In light of the deleterious properties of formaldehyde, this article provides an overview of its market, regulation standards, and human health effects.

[Isocyanates and formaldehyde--low molecular weight xenobiotics]

Isocyanates and formaldehyde are a low molecular weight environmental xenobiotics. Acute poisonings are relatively rare, chronic exposure not enough recognized. A source, mechanism of toxicity and ability of those low molecular weight compounds to stimulation of different types of immune response are presented in the study.

[Advancement of methanol poisoning mechanism research]

The methanol poisoning by oral intake or skin contact occurs occasionally, which may have serious consequences including blindness and/or death. Methanol and its metabolites, formaldehyde and formic acid, are associated with metabolic acidosis, visual dysfunction and neurological symptoms. At present, the mechanism of methanol poisoning primarily focuses on the cell hypoxia, the alteration of structure and biological activity induced by free radical and lactic acid. Meanwhile, methanol poisoning causes changes in the balance between the production of free radicals and antioxidant capacity and in the proteases-protease inhibitors system, which lead to a series of disturbances.

[The effects of a novel local ventilation system to reduce the health hazard to students during gross anatomy courses]

Formaldehyde or formalin is indispensable not only as a preservative but also as a disinfectant of cadavers for gross anatomy. It has recently attracted a great deal of attention as a health hazard for students and lecturers. To reduce the concentration of formaldehyde gas (FAG), we improved a novel local ventilation system of the push-pull type. This is the first report dealing with the effects of this ventilation system on the health of students before (over 1 ppm) and after (0.1 ppm) the installation. The percentages of students with lacrymal symptoms or airway irritation were reduced to a third of what they were before the installation. In particular, the number of those with continuously strong symptoms was reduced to a sixth of the pre-installation levels. This local ventilation system draws in fresh air from outside, and directs it to the breathing zone of the students, effectively reducing their symptoms.

[Accidental intravenous injection of formaldehyde]

BACKGROUND

Formaldehyde can be found in operating theatres where it is used for preservation of biopsied tissues. Several misuse accidents have been described previously.We present a case where formaldehyde was mistakenly injected intravenously.

CASE REPORT

A 33-year-old man, scheduled for excision of a knee meniscus under spinal anaesthesia, was to receive an intravenous antibiotic at the end of surgery. The attending anaesthesiologist received a vial of cephazolin, marked with the patient name from a scrub nurse and injected its contents intravenously. Immediately after injection, the patient complained about strong pain at the site of injection and started to cough.The vial was checked again and a piece of meniscus preserved with 4% formaldehyde was found inside. It was intended to be offered to the patient on departure. The possible amount offormaldehyde injected was 400 mg (a lethal dose has been described as 12 g). The patient, despite the lack of cardiorespiratory failure, was intubated, ventilated and dialysed for six hours, and then extubated without further consequences. His biochemical markers remained in the normal range. Based on the case as described, the possible medico-legal consequences of poor organisation and preventive measures are discussed.

[Work-related disease]

Work-related health complaints occur frequently. Occupational health departments and primary and secondary care physicians are confronted with these patients. Awareness of work-related disease is crucial. Three case histories with work-related diseases are described. The first concerned a 39-year-old woman who showed acute neurotoxicity due to inhalation of formaldehyde and methanol after opening a coffin with an embalmed corpse. Within weeks the symptoms diminished and complete recovery occurred within nine months. The second was a 61-year-old carpenter who experienced acute and chronic pulmonary and neurotoxic effects after exposure to organic solvents during ground and carpenter's work on a terrain of a former gas plant. He developed severe chronic toxic encephalopathy. The last patient was a 61-year-old man who developed acute and chronic manganese toxicity leading to inability to work while employed at a brick factory where manganese was used to colour the bricks. The acute effects subsided, but chronic neuropsychological symptoms remained.

Chemical colitis

Chemical colitis can occur as a result of accidental contamination of endoscopes or by intentional or accidental administration of enemas containing various chemicals. Most cases have occurred after accidental contamination of endoscopes with glutaraldehyde and/or hydrogen peroxide. There have been multiple case reports of chemical colitis resulting from unintentional administration of caustic chemicals. Intentional administration of corrosive enemas has been implicated in sexual practices, bowel cleansing, or in suicide attempts. Patients present with nonspecific symptoms including abdominal pain, rectal bleeding, and/or diarrhea. As chemical colitis remains rare, the literature consists of scattered case reports and small series. Agents implicated in chemical colitis that are covered in this review include alcohol, radiocontrast agents, glutaraldehyde, formalin, ergotamine, hydrofluoric acid, sulfuric acid, acetic acid, ammonia, soap, sodium hydroxide, hydrogen peroxide, herbal medicines, chloro-m-xylenol, and potassium permanganate. Clinical, endoscopic, and histologic features are outlined for each agent in addition to the existing literature. Given the nonspecific presentation of many cases of chemically induced colitis, the diagnosis can be challenging if the pertinent history is not obtained. Most patients demonstrate the resolution of chemical-induced colitis after conservative or medical therapy. Depending on the depth and extent of injury, patients rarely require colectomy for ischemic colitis and/or peritonitis. Other postingestion complications include colonic strictures and rectovaginal fistulae. The benefits of medical therapy compared with conservative therapy are not known, as comparative clinical management trials have not been performed.

A case of attempted suicide from the ingestion of formalin

The ingestion of formalin causes disorders in the oral cavity, the gastrointestinal tract, liver, kidney, lung, heart, and central nervous system in the early phase of reaction. The stomach suffers the most severe damage in such cases because the formalin is in contact with the gastric mucosa longer than in the other parts of the gastrointestinal tract. Gastric ulcers and mild hemorrhaging are frequently seen. There are no reported cases of gastric perforations in Japan (n= 15), and there are only two reported cases in other countries since 1950 (n = 11). The ingestion of formalin could lead to peritonitis without perforation because of gastric wall inflammation. Cicatrical stricture of the stomach tends to be a major problem in the late phase of formalin ingestion. Similar to our case, seven of twelve reported cases of cicatrical deformity survived without operation. Therefore, a gastrectomy for the cicatrical deformity might not be always indicated if the patients are able to feed themselves sufficiently or if parenteral nutrition can be provided.

N-Methylenvaline in a group of subjects occupationally exposed to formaldehyde

Aim of this pilot study was to correlate the human exposure to formaldehyde (F) with N-methylenvaline, a molecular adduct formed by addiction of F to the N-terminal valine in hemoglobin. A group of 21 subjects employed in a plywood factory and a laminate factory, and occupationally exposed to F, together with a group of 30 controls, were recruited as volunteers to test this biomarker. Each subject received a questionnaire and a passive personal F sampler. Exposure to F vapors and occurrence of N-methylenvaline in blood were measured. Integrated F concentrations always proved lower than threshold limit value as a ceiling (TLV-TWA) (0.37 mg/m(3), 0.3 ppm). N-Methylenvaline distribution in blood, as measured by GC/MS upon derivatization, showed direct positive relationship to F exposure, with r=0.465. Prevalence of the molecular adduct expressed in nmol/g of globin was significantly higher in the exposed group (p<0.04) than in the control group. However, the N-methylenvaline marker was unable to provide significant distinction between the subjects exposed to F through tobacco smoke habit and the non smokers. Despite this interference, in this pilot study the usefulness of N-methylenvaline as a biomarker for testing occupational exposure to F was demonstrated.

[Early genetic effects on workers occupationally exposed to formaldehyde]

OBJECTIVE

To investigate the DNA and chromosome damage in peripheral blood lymphocyte of workers occupationally exposed to formaldehyde (FA).

METHODS

All 151 workers occupationally exposed to FA from two plywood factories and 112 workers without occupational FA exposure working in a machine manufactory were recruited into this study. Comet assay and cytokinesis-block micronucleus technique was used to evaluate the DNA and chromosomal damage of peripheral blood lymphocyte. The air FA samples were collected with SKC 224-PCXR8 air samplers. Gas chromatography was used to analyze the FA level. Personal information including occupational history, age, sex, smoking and drinking status was collected by the questionnaire.

RESULTS

The time weighted average concentration (TWA) of FA in the working environment of FA-exposed workers (range 0.10 - 7.88 mg/m(3)) was higher than those in controls (< 0.01 mg/m(3)). The olive tail moment (Olive TM) in low FA-exposed workers [3.03 (2.49 - 3.67)] was lower than that in high FA-exposed workers [3.95 (3.53 - 4.43)], but higher than that in controls [0.93 (0.78 - 1.10)], the differences were statistical significant (P < 0.05). Comet trail length in FA-exposed workers were significantly higher than that in controls [6.78 (6.05 - 7.60)], but no significant differences ware found between the high FA-exposed workers [12.59 (11.80 - 13.43)] and the low FA-exposed workers [11.25 (10.12 - 12.50)]. The frequency of micronuclei per 100 binucleated cells in low FA-exposed workers (0.41 +/- 0.25) was lower than that in high FA-exposed workers (0.65 +/- 0.36), but higher than that in controls (0.27 +/- 0.13), the differences were statistical significant (P < 0.05). The increased tendencies with the exposure levels were found in those three indices. In stratification analysis, the same results were found.

CONCLUSION

In the current FA exposure levels, the DNA and chromosomal damage in peripheral blood lymphocyte might be induced by FA exposure, and be increased with the levels of exposure.

[Functional activity of blood and liver cells under formaldehyde intoxication via inhalation]

The influence of formaldehyde (of 5 and 10 mg/m3) on the state of the antioxidant system the blood and liver of rats, the activity of pentose phosphate pathway enzymes, and weight of immune organs was investigated. Formaldehyde intoxication led to activation of lipid peroxidation processes in red blood cells and hepatocytes. In the liver cells these changes were accompanied by activation of the antioxidant and detoxification systems. Formaldehyde depleted thiamine diphosphate in the liver, and this effect was not dose-dependent. The number of blood cells remained unchanged. Formaldehyde at the concentration of 10 mg/m3 exerted the negative effect on the thymus. This effect may be related to stimulation of lipid peroxidation.

Mortality from solid cancers among workers in formaldehyde industries

In industrial workers, formaldehyde exposure has been associated with cancer of the nasal cavities, nasopharynx, prostate, lung, and pancreas; however, these associations are inconsistent and remain controversial. Animals exposed to formaldehyde show excesses of nasal cancer. In an extended follow-up of a large cohort of formaldehyde-exposed workers, the authors evaluated mortality from solid cancers (1,921 deaths) among 25,619 workers (865,708 person-years) employed in 10 US formaldehyde-producing or -using facilities through 1994. Exposure assessment included quantitative estimates of formaldehyde exposure. Standardized mortality ratios and relative risks were calculated. Compared with that for the US population, mortality from solid cancers was significantly lower than expected among subjects exposed and nonexposed to formaldehyde (standardized mortality ratios = 0.91 and 0.78, respectively). Relative risks for nasopharyngeal cancer (nine deaths) increased with average exposure intensity, cumulative exposure, highest peak exposure, and duration of exposure to formaldehyde (p-trend = 0.066, 0.025, <0.001, and 0.147, respectively). Formaldehyde exposure did not appear to be associated with lung (744 deaths), pancreas (93 deaths), or brain (62 deaths) cancer. Although relative risks for prostate cancer (145 deaths) were elevated for some measures of formaldehyde exposure, the trend was inconsistent. In this cohort of formaldehyde-industry workers, some evidence was found of an exposure-response relation with mortality from nasopharyngeal cancer (based on small numbers) but not for cancers of the pancreas, brain, lung, or prostate.

Measurements of carbonyls in a 13-story building

BACKGROUND, AIM AND SCOPE

Formaldehyde and acetaldehyde are emitted by many mobile and stationary sources and secondary aldehydes are intermediates in the photo-oxidation of organic compounds in the atmosphere. These aldehydes are emitted indoors by many materials such as furniture, carpets, heating and cooling systems, an by smoking. Carbonyls, mainly formaldehyde and acetaldehyde, have been studied because of their adverse health effects. In addition, formaldehyde is a suspected carcinogen. Therefore, the concentrations of formaldehyde and acetaldehyde were determined to assess the inhalation exposure doses to carbonyls for people who work in a 13-story building and in order to evaluate the cancer hazard.

METHODS

Carbonyl compounds in indoor and outdoor air were measured at a 13-story building located in Mexico City. The mezzanine, fifth and tenth floors, and the third level-parking garage were selected for sampling. Samples were collected in two sampling periods, the first from April 20 to 29, 1998 and the second from December 1 to 20, 1998. Carbonyls were sampled by means of DNHP-coated cartridges at a flow rate of 1 l min(-1) from 9:00 to 19:00 hours, during 2-hour time intervals and analyzed by HPLC with hours, during 2-hour time intervals and analyzed by HPLC with UV/VIS detection.

RESULTS

Mean carbonyl concentrations were highest in the 3rd level-parking garage, with the formaldehyde concentration being the highest ranging from 108 to 418 microg m(-3). In working areas, the highest carbonyl arithmetic mean concentrations (AM) were observed on the 5th floor. Acetone and formaldehyde concentrations were highest in April ranging from 161 to 348 microg m(-3) (AM = 226) and from 157 to 270 microg m(-3) (AM = 221), respectively. Propionaldehyde and butyraldehyde were present in smaller concentrations ranging from 2 to 25 and 1 to 28 microg m(-3), respectively, considering all the samples. Mean indoor/outdoor ratios of carbonyls ranged from 1.8 to 9.6. A reduction of inhalation exposure doses of 41% and 45% was observed in the fifth floor air after the air conditioning systems had been repaired. Formaldehyde and acetaldehyde concentrations were higher in smoking environments.

CONCLUSION

Indoor carbonyl concentrations were significantly greater than outdoor concentrations. Tobacco smoke seems to be the main indoor source of formaldehyde. After the air conditioning system was maintained and repaired (as was recommended), an important reduction in the emission of formaldehyde and acetaldehyde was achieved on all floors, except for the 3rd level parking garage, thereby reducing the inhalation exposure doses.

RECOMMENDATION

The results obtained in this research demonstrated that maintenance of air conditioning systems must be carried out regularly in order to avoid possible adverse effects on health. Additionally, it is mandatory that isolated smoking areas, with air extraction systems, be installed in every public building.

Association between lung function and exposure to smoke among firefighters at prescribed burns

We investigated the short-term effects of exposures to PM3.5, acrolein, formaldehyde, and carbon monoxide on lung function in a group of firefighters performing prescribed burns. Spirometric measurements were made on 65 firefighters at the beginning, midpoint, and end of their work shift, while exposure was measured over the entire day. The interquartile range (IQR) of daily personal PM3.5 exposures was 235 micrograms/m3 to 1317 micrograms/m3, with an average daily exposure of 882 micrograms/m3. Concentrations of acrolein (IQR: [0.002, 0.018] ppm), formaldehyde (IQR: [0.008, 0.085] ppm), and carbon monoxide (IQR: [2.10, 10.48] ppm) were similarly elevated. In this group of firefighters, FEV1 changed by -0.125 L from preshift to postshift (p < .001). We examined the association between this cross-shift lung function decrement and smoke exposure. A 1000 micrograms/m3 increase in PM3.5 was associated with a -0.030 L change in the cross-shift FEV1 (95% CI [-0.087, 0.026]). Acrolein, formaldehyde, and carbon monoxide exposure were also not significantly associated with changes in FEV1, FVC, or FEF25-75. We concluded that while firefighters' lung function significantly decreased from preshift to postshift, firefighters exposed to greater concentrations of respiratory irritants did not experience greater lung function decrements. We could not establish a significant link to any of the individual toxic components of smoke we measured.

Successful reduction of morticians' exposure to formaldehyde during embalming procedures

A case study of the effectiveness of upgraded ventilation engineering controls in a military mortuary facility was performed. Worst-case mortician formaldehyde exposures generated during the use of highly concentrated embalming fluid (required to meet a 2-week preservation standard for overseas case processing and return of the deceased to the continental United States) were documented. A detailed exposure evaluation via consecutive short-term exposure limit (STEL) samples facilitated characterization of the hazard potential for each distinct phase of the embalming process. After baseline screening with 3M passive formaldehyde dosimeters, a total of 145 personal and area STEL sorbent tube samples were collected during six embalming cases between 1994 and 1998. Prior to the installation of local exhaust ventilation controls, personal time-weighted average (TWA) exposure values during embalming activities were 3.19-7.69 ppm for a mean of 4.80 ppm (calculated 8-hour TWA exposures for mortician workshifts were 1.32-2.86 ppm, mean 1.93 ppm). Initial STEL exposures ranged from a low of 0.14 during preembalming body preparation to 20.89 ppm during aspiration of arterial fluids (mean = 4.16 ppm). Embalming room general area samples revealed a mean concentration of 0.76 ppm. With ventilation upgrades installed in 1997, calculated personal 8-hour TWA exposure values during embalming procedures were reduced. STEL exposures decreased to between 0.11 to 3.44 ppm (mean of 0.55 ppm); embalming room general area sample concentrations decreased to a mean of 0.089 ppm. Because occasional 15-min peak exposures continued to exceed the 2.0 ppm Occupational Safety and Health Administration STEL during tasks involving large volumes of embalming fluid or direct contact with paraformaldehyde preservative powders, general room ventilation was further upgraded to 25 room air changes per hour.

An alleged poisoning with methanol and formaldehyde

It was alleged that a defendant added an unspecified amount of undyed formalin solution, containing formaldehyde and methanol, to the victim's bottle of ice and drinking water. The medical report indicated that except for a slight elevation of total creatine kinase, all other chemistry profiles were within normal ranges. The elevation of creatine kinase suggested muscle injury and inflammation; however, the significance of this elevation was not clear. Toxicological evaluations were made by conducting risk assessments. Based upon the medical report and risk assessments, the following conclusions were made: The calculated exposure doses of methanol and formaldehyde were too low to cause appreciable adverse effects; however, formaldehyde may have irritated the gastrointestinal tract causing smooth muscle and mucosal inflammation. The doses of methanol and formaldehyde were too low to cause death. The exposure scenario (a single oral exposure to formaldehyde) would not likely increase the cancer risk in the victim. The risk assessments provided resulted in a reduction in charge from attempted murder to felony.

Gastric outlet obstruction as a late complication of formaldehyde ingestion: a case report

A patient who ingested formaldehyde in a suicide attempt is described. Although early clinical and endoscopic manifestations appeared relatively mild, after several weeks the patient developed signs and symptoms suggestive of gastric outlet obstruction that eventually required surgical intervention. Formaldehyde ingestion has only rarely been described in the literature. Formaldehyde is a corrosive that can produce late sequelae, similar to the more common ingestion of acids and alkali.

-Severe self-poisoning with formol-

We report a case of voluntary poisoning with formalin in a 47-year-old man. The initial status included respiratory failure, metabolic acidosis and coagulopathy. Medical therapy consisted of mechanical ventilation, a single prolonged haemodialysis session, N-acetylcysteine, and folic acid administration. The corrosive damage to the gastrointestinal tract required an oesogastrectomy and three months later a colic transplant.

[Formaldehyde in the occupational environment. A possible cause of chemically induced reactive arthritis]

A case is presented of a farmer aged 33 years who developed polyarthritis four to five days after having used formaldehyde for fumigation of his piggery. The farmer was admitted to the General Hospital in Herning for treatment. The course of the treatment was several months. Furthermore, two farm assistants and a bricklayer were exposed to formaldehyde in the piggery. They developed acute intoxication symptoms and, a few days after the exposure, arthralgia. There was no other collective exposure. Apart from the formaldehyde, there was a great amount of water in the piggery, leading to the conclusion that the exposure was due to the formaldehyde being absorbed in the water with following evaporation. In conclusion, a relationship between these particular circumstances of formaldehyde exposure and reactive arthritis is found to be likely.

"There's death in the cup, so beware!"

The proper investigation of deaths due to poisoning and the determination of the manner of death often depend upon knowledge and investigative skills that may have been allowed to deteriorate with lack of use. These case reports illustrate a wide variety of substances that people can ingest. This collection of case reports includes the ingestion of two insecticides and three different organic chemicals. A concise review of literature is provided, along with symptoms exhibited by those who ingest these poisons, and methodologies recommended for their determination in this series of cases.

Neurobehavioral impairment and seizures from formaldehyde

Three patients were evaluated for effects of formaldehyde on central nervous system function. Three patients had used formalin, formaldehyde with or without phenol, to fix whole animals for 14-30 y, and a fourth patient was covered several times by formaldehyde and phenol rainout from manufacturing spills. All were disabled, and two had developed seizures. They had elevated mood state scores (82 to 162) and elevated symptom frequency scores (111 to 138), compared with referent subjects. There was excessive fatigue, somnolence, headache, difficulty remembering, irritability, and instability of mood. Compared with referents, choice reaction time was prolonged in four of four (4/4) subjects, blink latency was delayed in 2/2, balance was abnormal in 3/4, and visual fields were constricted in 2/3. Cognitive functions, measured by Culture Fair, block design, and digit symbol tests, were impaired in all. Delayed verbal recall and visual reproduction were impaired in 3/4. Perceptual motor speed on slotted pegboard and trail making A and B tests was reduced in 4/4. Errors on fingertip number writing were abnormal in all. Long-term memory was decreased in only one. Extensive use of formaldehyde at work or repeated airborne exposure to formaldehyde and phenol appears to have impaired central nervous system function.

Atrazine in plasma and tissue following atrazine-aminotriazole-ethylene glycol-formaldehyde poisoning

A high performance liquid chromatography method has been used to study the plasma kinetics of atrazine in a human fatality after ingestion of a herbicide mix containing atrazine, aminotriazole, ethylene glycol and formaldehyde. A hemodialysis was performed in an effort to eliminate these toxic substances. The mean atrazine clearance over 4 h was 250 mL/min and the dialysance of atrazine was calculated as 76%. On autopsy, the kidney showed the highest concentration of atrazine (97.62 micrograms/g-1 wet tissue) with lesser concentrations in the lung, small intestine and liver, and the lowest concentration in the heart.

Formate levels following a formalin ingestion

Although formalin ingestions have previously been reported in the literature, technology has only recently been developed to measure both formaldehyde and formate levels in plasma. Methanol, formaldehyde, and formate levels were followed in the case reported here until the patient's death approximately 13 h after the ingestion. The clinical course was marked by an initial profound CNS depression followed by an apparent clinically quiescent period. Severe abdominal pain and retching preceded the development of seizures, DIC, severe hypotension, and cardiac arrest. Methanol levels rose throughout this 13-h course. Formate and formaldehyde levels increased until bicarbonate and ethanol therapy were instituted. The "fixing" of the stomach by formaldehyde may have produced delayed absorption following formalin ingestion. Therapeutic implications are discussed.

Suicidal ingestion of formalin with fatal complications

After ingestion of an unknown amount of formalin with suicidal intent, a 55-year-old female and a 34-year-old male were admitted to the hospital with extensive gastrointestinal corrosive damage, circulatory shock, metabolic acidosis, respiratory insufficiency and impairment of renal function, which rapidly progressed to acute renal failure. Metabolic acidosis was in part due to high plasma levels of formic acid, the main metabolite of formaldehyde, and hyperlactatemia. Both patients underwent hemodialysis and hemofiltration treatment. In the male patient, a gastrectomy had to be performed. The further clinical course in the patients was characterized by sepsis and protracted pulmonary complications. Both patients died after developing adult respiratory distress syndrome and global cardiac insufficiency. In vitro experiments on formaldehyde reactivity to proteins yielded evidence for almost complete but reversible binding to plasma and blood. Formaldehyde probably exerts systemic toxicity in the form of its labile Schiff's base with proteins, but not as free formaldehyde.

Acute resin phenol-formaldehyde intoxication. A life threatening occupational hazard

1. A 38-year-old previously healthy worker accidentally spilled phenol-formaldehyde resin over a large area of his skin. 2. Several days later he was hospitalized with extensive necrotic skin lesions, fever, hypertension, adult respiratory distress syndrome (ARDS), proteinuria and renal functional impairment. 3. All symptoms improved progressively and eventually disappeared. 4. We propose that toxic materials originating from the necrotic skin lesions and the continued facilitated absorption of the resin and/or its components via the skin lesions were the main factors responsible for this alarming multisystem involvement. 5. Workers handling this material should be instructed to take appropriate precautions and physicians should be alerted to the potential pathophysiological consequences.

Development of a tracheal implant xenograft model to expose human bronchial epithelial cells to toxic gases

A tracheal implant model was developed which enabled exposure of differentiated normal human bronchial epithelial cells (NHBE) to a single exposure of a model toxic gas (formaldehyde). NHBE cells were grown in vitro in explant culture under defined serum-free conditions from previously frozen bronchial segments, harvested, and used to repopulate de-epithelialized rabbit tracheas. Rabbit tracheal segments repopulated with NHBE cells were implanted into the subcutis of congenitally athymic nude mice. Following graft vascularization, the xenografted NHBE cells differentiated and formed a mucociliary epithelial surface which lined approximately 50% of the surface of the implant lumen. Eight weeks post-implantation both ends of the implanted grafts were cannulated, and formaldehyde (HCHO) vapor (0, 6, or 15 ppm) in humidified air was passed through the tracheal lumens. Representative epithelial surfaces were examined by light and scanning electronmicroscopy, and autoradiography prior to, immediately after, and 48 hr following a 1-hr exposure to the test vapors. Light microscopic examination of implant sections immediately following exposure to 6 and 15 ppm HCHO detected cessation of ciliary activity, which recovered by 48 hr post-exposure. Scanning electron microscopic examination of the epithelial surface demonstrated mild morphologic changes, restricted to those implants exposed to 15 ppm. Findings immediately following HCHO exposure included swelling and exfoliation of individual cells, deciliation, and mucus release. Changes present after 48 hr included presence of flattened cells with few short microvilli and focal increase in the number of S-phase nuclei in the basal epithelium. These results demonstrate the utility of tracheal implants for single short-term exposure of differentiated human bronchial epithelial cells to gaseous agents.(ABSTRACT TRUNCATED AT 250 WORDS)

[Chronic formaldehyde exposure--a misunderstood disease?]

A family with chronic exposure to formaldehyde in a renovated apartment is reported. The source of exposure proved to be chipboard. The family members' symptoms were eye and upper airway irritation, malaise, headache, nausea, sleeping disturbances, irritability and lack of appetite. At first the syndrome was thought to be psychosomatic and the correct diagnosis was overlooked. Ten years after beginning of the chronic exposure a formaldehyde level of 0.35 ppm was still recorded in the apartment. Sources, symptoms and diagnosis of chronic formaldehyde immission are discussed.

Formaldehyde-related health complaints of residents living in mobile and conventional homes

This paper explores the dose-response relation between formaldehyde (HCHO) concentration and reported health complaints (eye irritation, nose/throat irritation, headaches and skin rash) of nearly 2,000 residents living in 397 mobile and 494 conventional homes. The study analyzes the effects of HCHO concentration, age and sex of respondent, and smoking behavior on each of the four health effects. The results demonstrate a positive dose-response relation between HCHO concentration and reported health complaints, with reported health complaints demonstrated at HCHO concentrations of 0.1 ppm and above. Concentrations of 0.4 ppm in manufactured homes as targeted by the Department of Housing and Urban Development (HUD), may not be adequate to protect occupants from discomfort and from acute effects of HCHO exposure.

The Massachusetts program for reducing the risk of formaldehyde exposure

Urea formaldehyde foam insulation in homes has caused increasing concerns about the adverse health effects associated with residential exposure to formaldehyde emissions. These health effects cover a broad spectrum of symptoms, including neurophysiological effects, respiratory irritations, and eye and skin irritations. Recent studies have also suggested a possible correlation between exposure to formaldehyde vapors and cancer. In 1979, following hundreds of complaints of adverse health effects from occupants of dwellings insulated with urea formaldehyde foam insulation (UFFI), the Massachusetts Department of Public Health issued regulations banning the new installation of UFFI in Massachusetts. New State legislation was adopted in 1986 which reformulated UFFI policy. The law established a minimum concentration of formaldehyde of 0.1 parts per million (ppm) below which removal of the insulation is not required or encouraged. A trust fund financed by industry was established to pay for air testing and for the removal of UFFI from homes if the formaldehyde level exceeds the statutory minimum of 0.1 ppm or if an occupant experiences adverse health effects attributable to the insulation. Based on the Massachusetts experience, these requirements have been identified: the need for flexibility and midcourse corrections in the development of health policy to allow for the incorporation of new scientific information or changes in the economic or political environment, the need for close coordination with all affected parties, and the need for scientific and technical policy development to be joined with economic and political perspectives to ensure smooth implementation of health policies.

Formaldehyde-induced corrosive gastric cicatrization: case report

A patient with poisoning due to formaldehyde ingestion is described. Endoscopy showed severe oesophageal burns and moderate gastric injury. Four weeks later endoscopy and barium examination revealed a normal oesophagus while the distal part of stomach was cicatrized.