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Environmental Medicine: Integrating a Missing Element into Medical Education (1995)
Institute of Medicine (IOM)

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. "Case Study 32: Infertility in Male Pesticide Workers." Environmental Medicine: Integrating a Missing Element into Medical Education. Washington, DC: The National Academies Press, 1995.

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Environmental Medicine: Integrating a Missing Element into Medical Education

cular and pituitary hormone production in these workers.

The 2 women workers not currently using oral contraceptives had normal F.S.H. and L.H. results.

Preliminary evaluation of the testicular-biopsy results of the severely affected men indicated loss of spermatogonia, with no evidence of inflammation or severe fibrosis.

The 3 men not included in the comparison who had sperm-counts of 10 million–30 million had exposures between one and three years—an observation that supports the notion of a direct relationship between length of exposure and degree of oligospermia.

DISCUSSION

Chemically reduced male infertility related to occupation has seldom been reported. Lancranjan et al.3 reported that lead-poisoned workers had lowered sperm-counts, decreased sperm motility, and a higher propertion of abnormal forms. Diminished libido and difficulty in erection and ejaculation were also found. Kepone, an organochlorine insecticide, severely poisoned workers in Virginia in 1975. Most of the affected workers had severe neurological abnormalities, and some were also reported to be infertile.4

The chemical suspected in the present investigation to be the cause of infertility had previously been shown to produce sterility in animals. D.B.C.P. was shown by Torkelson et al.5 to be toxic to the testes of rats, guineapigs, and rabbits. In the rat testis it caused degeneration of the seminiferous tubules, increase in Sertoli cells, reduced sperm-count, and abnormal sperm morphology. Rats with these effects also showed hepatic and renal degeneration. D.B.C.P. was found to produce these changes through skin absorption as well as ingestion or inhalation. Faidysh et al.6 showed that D.B.C.P. damaged the testes, liver, and kidneys of rats, but these organs regenerated in the survivors.

Airborne concentrations of D.B.C.P. in the factory we investigated are believed to be lower than the 1 p.p.m. limit recommended by Torkelson et al.5 D.B.C.P. levels measured in early 1977 in the A.C.D. were 0·4 p.p.m. (averaged for an eight-hour day). These measurements were made with personal air-sampling devices.7

Research is being continued at this plant, together with studies in other areas. Follow-up studies of the affected workers are being planned. Our findings have raised a number of important issues. One is the significance of duration and intensity of exposure. Although all severely affected workers (group A) were, or had been, production workers for at least three years, the shortest time of exposure associated with oligospermia was only one year. Another question is whether the observed sterility is reversible in man as it has been shown to be in animals. Finally, since D.B.C.P. is carcinogenic in animals8 and mutagenic in bacterial systems,9 the possibility of such damage in man must also be considered seriously.

How big a problem D.B.C.P.-induced infertility is we do not yet know, but our communications with medical officers of other companies manufacturing D.B.C.P. clearly indicate that it extends beyond the formulating plant described here.

This study would not have been possible without the support and cooperation of the Occidental Chemical Company, Western Division, and the Oil, Chemical, and Atomic Workers Union, Local 1–5. We thank Dr William Palmer, Dr Louis Brahen, and Dr Edward Smuckler for advice on pathology, Dr John Linfoot for assistance with endocrine assays, and Dr Ken Dod, Claire Lalor, and Mary Ann Gustavson for administrative support.

Requests for reprints should be addressed to D.W., 2521 Channing Way, University of California, Berkeley, California 94720, U.S.A.

REFERENCES

1. Amelar, R.D., Dubin, L., Walsh, P.C. Male Infertility. Philadelphia, 1977.

2. Odell, W.D., Swerdloff, R.S. West. F. Med. 1976, 124, 446.

3. Lancranjan, I., Popescu, H.I., Gavanescu, O., Klepsch, I., Servanescu, M. Archs envir. Hlth, 1975, 30, 396.

4. Zavon, M. Personal communication.

5. Torkelson, T.R., Sadek, S.E., Rowe, V.K., Kodama, J.K., Anderson, H.H., Loquvam, G.S., Hine, C.H. Toxicol. appl. Pharmac. 1961, 3, 545.

6. Faidysh, E.V., Rakhmatullaev, N.N., Varshavskii, V.A. Medskii Zh. Uzbek. 1970, 1, 64.

7. Rappaport, S., Spear, R. Personal communication.

9. Olson, W.A., Habermann, R.T., Weisburger, E.K., Ward, J.M., Weisburger, J.H. F. natn. Cancer Inst. 1973, 51, 1993.

9. Rosenkranz, H.S. Bull envir. Contam. Toxicol. 1975, 14, 18.

10. Scharnweber, C., Joyner, R. Personal communication.

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587
Front Matter (R1-R12)
Executive Summary (1-4)
1 Introduction (5-13)
2 Curriculum Content (14-21)
3 Implementation Strategies (22-43)
4 Changing Medical Education (44-51)
5 Concluding Remarks (52-53)
References (54-58)
Appendixes (59-60)
A: Taking an Exposure History (61-96)
B: Medical School Courses and Clerkships: Access Points for Integrating Environmental Medicine (97-120)
C: Case Studies in Environmental Medicine (121-138)
Case Study 1: Arsenic Toxicity (139-163)
Case Study 2: Seasonal Arsenic Exposure from Burning Chromium-Copper-Arsenate-Treated Wood (164-167)
Case Study 3: Asbestos Toxicity (168-188)
Case Study 4: Benzene Toxicity (189-207)
Case Study 5: Beryllium Toxicity (208-223)
Case Study 6: Cadmium Toxicity (224-243)
Case Study 7: Fetal Death Due to Nonlethal Maternal Carbon Monoxide Poisoning (244-248)
Case Study 8: Carbon Tetrachloride Toxicity (249-266)
Case Study 9: Chlordane Toxicity (267-288)
Case Study 10: Chronic Reactive Airway Disease Following Acute Chlorine Gas Exposure in an Asymptomatic Atopic Patient (289-290)
Case Study 11: Chromium Toxicity (291-311)
Case Study 12: Cyanide Toxicity (312-331)
Case Study 13: Dioxin Toxicity (332-348)
Case Study 14: Ethylene/Propylene Glycol Toxicity (349-371)
Case Study 15: Formalin Asthma in Hospital Staff (372-373)
Case Study 16: Gasoline Toxicity (374-394)
Case Study 17: Hantavirus Pulmonary Syndrome: A Clinical Description of 17 Patients with a Newly Recognized Disease (395-401)
Case Study 18: Lead Poisoning from Mobilization of Bone Stores During Thyrotoxicosis (402-409)
Case Study 19: Lead Toxicity (410-435)
Case Study 20: Legionaires' Disease: Description of an Epidemic of Pneumonia (436-444)
Case Study 21: Mercury in House Paint as a Cause of Acrodynia: Effect of Therapy with N-Acetyl-D, L-Penixillamine (445-449)
Case Study 22: Mercury Toxicity (450-472)
Case Study 23: Methanol Toxicity (473-492)
Case Study 24: Methylene Chloride Toxicity (493-511)
Case Study 25: Paint Remover Hazard (512-515)
Case Study 26: Fatal Outcome of Methemoglobinemia in an Infant (516-517)
Case Study 27: Nitrate/Nitrite Toxicity (518-537)
Case Study 28: An Outbreak of Nitrogen Dioxide-Induced Respiratory Illness Among Ice Hockey Players (538-541)
Case Study 29: Pentachlorophenol Toxicity (542-557)
Case Study 30: Aldicarb Poisoning: A Case Report with Prolonged Cholinesterase Inhibition and Improvement After Pralidoxime Therapy (558-561)
Case Study 31: Cholinesterase-Inhibiting Pesticide Toxicity (562-584)
Case Study 32: Infertility in Male Pesticide Workers (585-587)
Case Study 33: Pesticide Food Poisoning from Contaminated Watermelons in California, 1985 (588-595)
Case Study 34: Poisoning of an Urban Family Due to Misapplication of Household Organophosphate and Carbamate Pesticides (596-604)
Case Study 35: Polynuclear Aromatic Hydrocarbon (PAH) Toxicity (605-621)
Case Study 36: Polychlorinated Biphenyl (PCB) Toxicity (622-638)
Case Study 37: Ionizing Radiation (639-673)
Case Study 38: Radon Toxicity (674-694)
Case Study 39: Residential Radon Exposure and Lung Cancer in Sweden (695-700)
Case Study 40: Community Oubreaks of Asthma Associated with Inhalation of Soybean Dust (701-706)
Case Study 41: Tetrachloroethylene Toxicity (707-726)
Case Study 42: Toluene Toxicity (727-743)
Case Study 43: Occupational Asthma Due to Toluene Diisocyanate Among Velcro-like Tape Manufacturers (744-749)
Case Study 44: 1,1,1-Trichloroethane (750-766)
Case Study 45: Trimethyltin Encephalopathy (767-771)
Case Study 46: Trichloroethylene Toxicity (772-792)
Case Study 47: Vinyl Chloride Toxicity (793-811)
Case Study 48: Work-Related Disorders of the Neck and Upper Extremity (812-813)
Case Study 49: Contact Dermatitis in Surgeons from Methylmethacrylate Bone Cement (814-816)
Case Study 50: Skin Lesions and Environmental Exposures: Rash Decisions (817-861)
Case Study 51: Acoustic Trauma Caused by the Telephone: A Report of Two Cases (862-867)
Case Study 52: Behavioral and Audiologic Manifestations of Noise-Induced Hearing Loss (868-871)
Case Study 53: Reproductive and Developmental Hazards (872-892)
Case Study 54: Childhood Asthma and Indoor Enviromental Risk Factors (893-903)
Case Study 55: Populations at Risk From Particulate Air Pollution - United States, 1992 (904-908)
D: Resources: Agencies, Organizations, Services, REferences, and Tables of Environmental Health Hazards (909-970)
E: Committee and Staff Biographies (971-975)