塩化ビニール中毒による職業性四肢骨端溶解症と思われる1症例について

Abstract

1. Japan is producing a large amount of vinyl chloride and is now second to the United States of America in its production. In 1954 Kubota reported that cases of Raynaud's phenomena had been found among a dozen or so workers engaged in the manufacture of vinyl chloride at a factory in the northeastern district of Japan. Later, during the years from 1964 to 1967, it was reported in foreign countries that hepatomegaly, Raynaud's phenomena, scleroderma, characteristic acroosteolysis, etc. were detected among workers engaged in the manufacture of vinyl chloride. But these reports did not atract particular attentions of Japanese physicians.In 1969 Magnuson et al. reported at the XVI International Congress on Occupational Health held in Tokyo that acroosteolysis had been found among workers engaged in the production of vinyl chloride. This presentation aroused our suspicion that similar diseases might exist among vinyl chloride workers in Japan.In 1970 Masuda re-examined the three workers, who, according to Kubota, had been suffering from Raynaud's phenomena 17 to 18 years before and reported that Raynaud's phenomena and acroosteolysis were not found. These are the only suspected cases of vinyl chloride toxicosis documented in Japanese medical literature.2. We happened to come across a 36-years-old male patient who had been working in the production of vinyl chloride. He was operated on to remove the right thoratic sympathetic nerve ganglia (II, III) at Nagoya University Hospital for the relief of Raynaud's phenomena, spontaneous pain in the right hand fingers, etc. We studied the patient's record, the physicians' findings and the job the patient had and tried to find any relation between them.3. Since he was 23 years old he has been working as a cleaner of the polymerizing reactor for four years and a half. It used to take him from 30 to 45 minutes to clean one reactor and he cleaned three to four reactors in one day.4. After he had been engaged in reactor cleaning he began to suffer from diarrhoea, Raynaud's phenomena, scleroderma, indurations of both hands and spontaneous pain in the right hand fingers (II, III). An X-Ray examination revealed acroosteolysis of the right hand fingers (II, III, IV). Pathohistological findings of the skin of the left hand were as follows : epidermis was normal, collagen fibres were edematous, and thickened wall and infarction of vessels were present in the corium.5. The nature of his job and his physical disorders well coincided with those of the patients engaged in the production of vinyl chloride and with the results of the animal experiments reported by foreign authors. Thus it was thought logical to presume that his physical disorders were caused by handling vinyl chloride.6. At present, nine years since he gave up his cleaning job, shortening of his right hand fingers (II, III, IV), paresthesis of the right half of his body, abnormal EEG, hypertention, hyperbilirubinemia and slight angiosclerotic changes in the optic fundi still exists. Literature seems to point out that these disorders are some of the segualae of the vinyl chloride poisoning.7. As there have been a large number of the manufacturers of vinyl chloride in Japan, there may exist many workers who are already poisoned by vinyl chloride.8. Among biological effects of vinyl chloride are Raynaud's phenomena, acroosteolysis, scleroderma, increase of blood pressure, etc. And we think it may be very useful to make its toxicity clear in order to help reestimate the toxicity of all the doubtful substances.9. MAC of vinyl chloride in Japan is 500 ppm at present, but we think that it is too high and should be revised.