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Case Study 35: Polynuclear Aromatic Hydrocarbon (PAH) Toxicity
Pages 605-621

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From page 605...
... This monograph is one in a series of self-instructional publications designed to increase the primary care providers knowledge of hazardous substances in the environment and to aid in the evaluation of potentially exposed patients. The Agency for Toxic Substances and Disease Registry (ATSDR)
From page 606...
... . The chest X ray reveals a 3.3-cm central, thick ' walled, cavitating lesion with irregular, spicular margins in the right upper lobe, and atelectasis and prominence of the right hilar Iymphatics.
From page 607...
... Structural formulas of selected polyaromatic hydrocarbons (PAHs)
From page 608...
... Coal tar pitch and creosote, which are complex mixtures of liquid and solid aromatic hydrocarbons produced in coke ovens, contain significant amounts of B(a) P and other PAHs.
From page 609...
... Workers in industries or trades using or producing coal or coal products are at highest risk of PAH exposure and include, but are not limited to, the following: aluminum workers asphalt workers carbon black workers chimney sweeps coal-gas workers coke oven workers fishermen (coal tar on nets) graphite electrode workers machinists mechanics, auto and diesel engine printers road (pavement workers)
From page 610...
... Genetic variation in AHH inducibility has been implicated as a determining factorfor susceptibility to lung and laryngeal cancer. Several studies support the hypothesis that persons with lung cancer have higher AHH inducibility in cultured lymphocytes or in peripheral lung tissue than those who do not develop lung cancer.
From page 611...
... Some parent PAHs are weak carcinogens and require metabolism to become more potent carcinogens. Diol epoxides, proposed PAH intermediate metabolites, are presumed to be mutagenic and may affect normal cell replication when they react with DNA to form abducts.
From page 612...
... studies among coke oven workers confirmed an excess of lung cancer mortality with the suggestion of excessive genitourinary system cancer mortality. Later experimental studies showed PAHs in soot were probably responsible for the increased incidence of scrotal cancer among London chimney sweeps noted by Percival Pott.
From page 613...
... O Effects reported from occupational exposure to PAHe include chronic bron" chitle, dermatitis, cutaneous photosenaltizatlon, and pilosebaceous reactions. Pertinent history includes the patient's occupational history, occupation of spouse and other household members, medications including coal tar-containing dermatologic preparations, and diet, especially charbroiled meats, alcohol consumption, and smoking habits.
From page 614...
... High costs of testing and lack of knowledge of normal background levels in humans limit their clinical usefulness. Indirect Biologic Indicators The most common tests for determining exposure to PAHs involve examining tissues, blood, and urine for the presence of metabolites.
From page 615...
... Chronic Exposure Treatment of PAH-related disease begins with patient education. Persons exposed to potentially significant levels of PAHs should be aware of the increased risk of cancer and the additive effect of cigarette smoke and other toxic agents.
From page 616...
... Because estimation of additional risk due to PAH exposure is often impossible, the challenge to the clinician is maintaining a balance between appropriate concern and undue alarm. Chin, (7J The diagnosis for the patient described in the case study is lung cancer with classification T2, N3, MO.
From page 617...
... ~ ~no S~ and Regu~ffons Workplace ^Ir The OSH^ PEL 10r P^Hs In 1he workpIece ls 0.2 mg/m,. The P^H work~om ak ~andard manda1ed by 1he OccupaBonaI S~- and Heakh ~mini~=ion (OSH~ is an 8-hour 11meweigh1ed averaQe (TW^} permissible exposure limi1 (PEL)
From page 618...
... level for carcinogenic PAHs in ambient water. Because attainment of this level may be currently impossible, EPA will recommend maximum contaminant level goals (MCLG)
From page 619...
... Benestad C et al. Determination of polycyclic aromatic hydrocarbons in the urine, benzo~a~pyrene diol epoxide-DNA adducts in lymphocyte DNA, and antibodies to the adducts in sera from coke oven workers exposed to measured amounts of polycyclic aromatic hydrocarbons in the work atmosphere.
From page 620...
... (5) The patient's problem list includes weight loss, fatigue, muscle weakness, skin lesions on exposed areas, exertional dyspnea, and a roentgenographically identified cavitating lesion in the right upper lobe with associated Iymphadenopathy.
From page 621...
... However, in view of the patient's medical, social, occupational, and family history, workplace and environmental factors emerge as the most likely causal factors in the development of his neoplastic disease. When the potential exists for others to be exposed, serious illness related to occupational or environmental factors should be reported to the appropriate state and federal authorities.


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