08311cd2. 7921KB Mar 29 2010 04:46:41 AM
The research register for this journal is available at
http://www.mcbup.com/research_registers/emh.asp
EMH
11,3
The current issue and full text archive of this journal is available at
http://www.emerald-library.com
Toxic encephalopathy
William J. Rea and Yaqin Pan
Environmental Health Center, Dallas, Texas, USA
250
Keywords Pollution, Formaldehyde, Brain
Abstract Describes a study involving 30 non-smoking, white-collar patients (aged 25-50), 12
male, 18 female, chronically exposed (over 90 days) to non-lethal doses of solvents ± formaldehyde
and chlorinated pesticides ± in their offices. They exhibited short-term memory loss, lack of
concentration and balance, odor sensitivity and fatigue. When compared to control individuals,
these people had objective brain dysfunction on triple camera brain (SPECT) CAT scan, brain
mapping by multiple behavioral analysis, computerized balance testing, computerized Iriscorder
for automatic nervous system measuring, inhaled double blind challenge, intradermal challenge
and blood toxics. Toxic encephalopathy could then be diagnosed.
Introduction
Environmental physicians have observed that there is a subset of patients who
have received chronic (over three months) exposure to non-lethal doses of
pollutants such as exposures to solvents, formaldehyde and pesticides. There is
a clinical syndrome that occurs in these patients characterized by short-term
memory loss, inability to concentrate, imbalance, vertigo, dizziness or lightheadedness, chronic fatigue, fibromyalgia and the adverse reactions to ambient
doses of many chemicals (odor sensitivity). This study involves 30 nonsmoking, white-collar patients (age range 25-50) (M-12, F-18) who developed
this syndrome.
Materials and methods
Thirty (30) patients (ages 25-50, 20 female, ten male) chronically exposed (over
three months) to non-lethal doses of solvents and pesticides, complaining of
short-term memory loss, lack of concentration, vertigo, dizziness, chronic
fatigue, fibromyalgia and sensitivity to the odors of many ambient chemicals
and having a positive Romberg test, were studied. After an adequate history
(including a 20-page system review environmental exposure questionnaire) a
physical exam was performed.
The following tests were performed and compared with the control group.
Triple camera computerized brain Tomography (SPECT) scans, by the method
of Simon and Hickey (Fincher et al., 1996), brain mapping using a composite
behavioral analysis profiled by the method of Butler and Didriksen (Didriksen,
1998), computerized balance testing by the method of Martinez (1990), blood
toxic levels by the method of Laseter (Laseter and Dowry, 1977), and inhaled
Environmental Management and
Health, Vol. 11 No. 3, 2000,
pp. 250-262. # MCB University
Press, 0956-6163
Research supported by a grant from The American Environmental Health Foundation and the
Environment Health Center, Dallas. The authors wish to thank Drs Theodore Simon, David
Hickey, Nancy Didriksen, John Laseter, Daniel Martinez and Satoshi Ishikawa for their
generous time and resources for running the objective tests and controls and criticisms for
developing and instituting these complete testing tools.
double blind ambient dose challenges (exposure for 15 minutes after four days'
avoidance) under environmentally controlled conditions (less polluted clean
environment that is solvent and pesticide free), intradermal skin titration tests
by the method of Rinkle (1949) and Lee (1961) and autonomic nervous system
evaluation using an Iriscorder (Hamamatsu) by the method of Ishikawa et al.
(1970).
Results
All patients had a history of over three months' non-lethal chronic exposure to
solvents (benzene, toluene, xylene, tetra- and trichloroethylene, trichloroethane,
chloroform, pentane, hexane or heptane) from the construction and inside
finishing material. In addition, they were exposed to the ambient doses of
formaldehyde emanating from new carpet, pressboard, plywood, and other
synthetics. All were white-collar workers who were exposed to monthly
sprayings of chlorinated pesticides or solvents used for cleaning of printing
machines, copy machines, cleaning of carpets or use in graphics. On physical
examination, all patients had positive tandem Romberg tests and also usually
had intracellular edema, acne, spontaneous bruising and Raynaud's
phenomenon. Complaints were short-term memory loss, lack of concentration,
vertigo, dizziness, fatigue, fibromyalgia and odor sensitivity to ambient doses
of many chemicals.
Triple Camera SPECT Brain Scans
Figures 1a-d show the triple camera SPECT brain scans compared with the
control. Tables I-IV show the 30 exposed patients compared with the controls.
The normal controls had smooth, uniform brains, all scans had a uniform
consistency and color. Blood flow and brain cell dye uptake indicated that
function was equal. The patients with neurotoxicity showed a pattern of
discrepancy between flow and function, hot and cold areas throughout the
brain, unequal temporal lobes, often soft tissue dye involvement and unequal
coloring.
Brain mapping by multiple behavioral analysis showed objective short-term
memory loss, 50 percent verbal and 30 percent visual, 51 percent general
memory loss, 46 percent had below average attention and concentration and 49
percent delayed new concept formulation, new problem-solving, abstract
reasoning and new learning ability, especially numbers, loss of equilibrium 100
percent, loss of IQ, loss of innovation and/or judgment (Table V).
Computerized balance testing
Table VI shows that 93 percent of the 27 patients tested with objective balance
abnormalities compared with the control group.
This Table also shows that 93 percent of the objective balance tests were
also abnormal for sensory or motor or a combination of the two suggestive of
central brain neuropathy.
Toxic
encephalopathy
251
EMH
11,3
252
Figure 1a.
Triple camera (SPECT)
brain scans
Toxic
encephalopathy
253
Figure 1b.
Triple camera (SPECT)
brain scans
EMH
11,3
254
Figure 1c.
Triple camera (SPECT)
brain scans
Toxic
encephalopathy
255
Figure 1d.
Triple camera (SPECT)
brain scans
EMH
11,3
256
Table I.
(SPECT) scan
Table VII shows the blood toxic levels compared with normal ranges. All
patients with solvent or pesticide exposures had multiple solvents for
pesticides in their blood. Those exposed to chlorinated pesticides had them in
their blood. These levels were in the 0.1-100ppb.
Double blind ambient dose challenges of either an active ingredient or
inhaled placebos were performed.
Table VIII shows the inhaled double blind challenges for 15 minutes under
less polluted environmentally controlled conditions (after the patient had been
deadapted in a less polluted room for four days) to the ambient doses of
chlorine < 0.33ppm, phenol
http://www.mcbup.com/research_registers/emh.asp
EMH
11,3
The current issue and full text archive of this journal is available at
http://www.emerald-library.com
Toxic encephalopathy
William J. Rea and Yaqin Pan
Environmental Health Center, Dallas, Texas, USA
250
Keywords Pollution, Formaldehyde, Brain
Abstract Describes a study involving 30 non-smoking, white-collar patients (aged 25-50), 12
male, 18 female, chronically exposed (over 90 days) to non-lethal doses of solvents ± formaldehyde
and chlorinated pesticides ± in their offices. They exhibited short-term memory loss, lack of
concentration and balance, odor sensitivity and fatigue. When compared to control individuals,
these people had objective brain dysfunction on triple camera brain (SPECT) CAT scan, brain
mapping by multiple behavioral analysis, computerized balance testing, computerized Iriscorder
for automatic nervous system measuring, inhaled double blind challenge, intradermal challenge
and blood toxics. Toxic encephalopathy could then be diagnosed.
Introduction
Environmental physicians have observed that there is a subset of patients who
have received chronic (over three months) exposure to non-lethal doses of
pollutants such as exposures to solvents, formaldehyde and pesticides. There is
a clinical syndrome that occurs in these patients characterized by short-term
memory loss, inability to concentrate, imbalance, vertigo, dizziness or lightheadedness, chronic fatigue, fibromyalgia and the adverse reactions to ambient
doses of many chemicals (odor sensitivity). This study involves 30 nonsmoking, white-collar patients (age range 25-50) (M-12, F-18) who developed
this syndrome.
Materials and methods
Thirty (30) patients (ages 25-50, 20 female, ten male) chronically exposed (over
three months) to non-lethal doses of solvents and pesticides, complaining of
short-term memory loss, lack of concentration, vertigo, dizziness, chronic
fatigue, fibromyalgia and sensitivity to the odors of many ambient chemicals
and having a positive Romberg test, were studied. After an adequate history
(including a 20-page system review environmental exposure questionnaire) a
physical exam was performed.
The following tests were performed and compared with the control group.
Triple camera computerized brain Tomography (SPECT) scans, by the method
of Simon and Hickey (Fincher et al., 1996), brain mapping using a composite
behavioral analysis profiled by the method of Butler and Didriksen (Didriksen,
1998), computerized balance testing by the method of Martinez (1990), blood
toxic levels by the method of Laseter (Laseter and Dowry, 1977), and inhaled
Environmental Management and
Health, Vol. 11 No. 3, 2000,
pp. 250-262. # MCB University
Press, 0956-6163
Research supported by a grant from The American Environmental Health Foundation and the
Environment Health Center, Dallas. The authors wish to thank Drs Theodore Simon, David
Hickey, Nancy Didriksen, John Laseter, Daniel Martinez and Satoshi Ishikawa for their
generous time and resources for running the objective tests and controls and criticisms for
developing and instituting these complete testing tools.
double blind ambient dose challenges (exposure for 15 minutes after four days'
avoidance) under environmentally controlled conditions (less polluted clean
environment that is solvent and pesticide free), intradermal skin titration tests
by the method of Rinkle (1949) and Lee (1961) and autonomic nervous system
evaluation using an Iriscorder (Hamamatsu) by the method of Ishikawa et al.
(1970).
Results
All patients had a history of over three months' non-lethal chronic exposure to
solvents (benzene, toluene, xylene, tetra- and trichloroethylene, trichloroethane,
chloroform, pentane, hexane or heptane) from the construction and inside
finishing material. In addition, they were exposed to the ambient doses of
formaldehyde emanating from new carpet, pressboard, plywood, and other
synthetics. All were white-collar workers who were exposed to monthly
sprayings of chlorinated pesticides or solvents used for cleaning of printing
machines, copy machines, cleaning of carpets or use in graphics. On physical
examination, all patients had positive tandem Romberg tests and also usually
had intracellular edema, acne, spontaneous bruising and Raynaud's
phenomenon. Complaints were short-term memory loss, lack of concentration,
vertigo, dizziness, fatigue, fibromyalgia and odor sensitivity to ambient doses
of many chemicals.
Triple Camera SPECT Brain Scans
Figures 1a-d show the triple camera SPECT brain scans compared with the
control. Tables I-IV show the 30 exposed patients compared with the controls.
The normal controls had smooth, uniform brains, all scans had a uniform
consistency and color. Blood flow and brain cell dye uptake indicated that
function was equal. The patients with neurotoxicity showed a pattern of
discrepancy between flow and function, hot and cold areas throughout the
brain, unequal temporal lobes, often soft tissue dye involvement and unequal
coloring.
Brain mapping by multiple behavioral analysis showed objective short-term
memory loss, 50 percent verbal and 30 percent visual, 51 percent general
memory loss, 46 percent had below average attention and concentration and 49
percent delayed new concept formulation, new problem-solving, abstract
reasoning and new learning ability, especially numbers, loss of equilibrium 100
percent, loss of IQ, loss of innovation and/or judgment (Table V).
Computerized balance testing
Table VI shows that 93 percent of the 27 patients tested with objective balance
abnormalities compared with the control group.
This Table also shows that 93 percent of the objective balance tests were
also abnormal for sensory or motor or a combination of the two suggestive of
central brain neuropathy.
Toxic
encephalopathy
251
EMH
11,3
252
Figure 1a.
Triple camera (SPECT)
brain scans
Toxic
encephalopathy
253
Figure 1b.
Triple camera (SPECT)
brain scans
EMH
11,3
254
Figure 1c.
Triple camera (SPECT)
brain scans
Toxic
encephalopathy
255
Figure 1d.
Triple camera (SPECT)
brain scans
EMH
11,3
256
Table I.
(SPECT) scan
Table VII shows the blood toxic levels compared with normal ranges. All
patients with solvent or pesticide exposures had multiple solvents for
pesticides in their blood. Those exposed to chlorinated pesticides had them in
their blood. These levels were in the 0.1-100ppb.
Double blind ambient dose challenges of either an active ingredient or
inhaled placebos were performed.
Table VIII shows the inhaled double blind challenges for 15 minutes under
less polluted environmentally controlled conditions (after the patient had been
deadapted in a less polluted room for four days) to the ambient doses of
chlorine < 0.33ppm, phenol