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FIG. 1

the subjects showed complete resolution of their eruption with careful avoidance of the monomer, but did not demonstrate a positive patch test. We do not consider their reactions to be allergic. The dermatitis was marked by the presence of dryness and fissuring of the finger tips, but without pruritis and vesicle formation. Three of the patients were identified through correspondence and have not yet been fully characterized as allergic.

The observations of Pegum and Medhurst led us to examine different types of surgical gloves in the hope of finding one that would successfully isolate the surgeon’s hands from the monomer. Glove fingers were cut off intact gloves and filled with small amounts of powdered polymer. The tips of these filled glove fingers were immersed in glass vials containing monomer. A test period of twenty minutes was chosen as the maximum time a surgeon might be in cedure. After twenty minutes the filled glove fingers were removed from the monomer and the contents were excontact with the bone cement during any one operative proamined. In all cases partial to complete polymerization of the powdered polymethylmethacrylate was noted, indicating that monomer had diffused directly through the gloves.

The majority of the gloves also showed evidence of direct attack by the monomer. One type of glove completely disintegrated. The vinyl glove tips were markedly affected, and most latex rubber gloves showed wrinkling and brittleness. In many of the trials the monomer solution was discolored by leaching of dye from the gloves. In approximately one-third of the samples the polymerized cement also took on coloration from contact with the gloves (Table I).

The unique and consistent feature of the dermatitis from bone cement was paresthesia. Deep tenderness was also common and outlasted the duration of the eruption.

Methylmethacrylate monomer is a lipid solvent. The irritant effect of the monomer is probably due to its ability to degrease the skin and penetrate the subcutaneous tissue. Apparently some surgeons with a mild sensitivity are able to avoid the dermatitis by using three layers of gloves during handling of the cement, and then immediately removing the outer two, or possibly all three gloves. Multiple gloves tend

TABLE I GLOVE TESTS

Type of Glove

Polymerization after 20 Min.

Glove Damage

Monomer Discolored

Polymer Discolored

Abbott—Latex Surgeon’s

+++

++

+

Arbrook Micro-touch, Latex Medical

++

+

Arbrook Micro-touch, Vinyl Medical

+++

++

+

Arlin Poly-Version (Polyethylene)

+

+

Bard-Parker, Thru-touch Vinyl

+++

++

++

+

Danpren Elastren

*

++++

+

*

Dart Industries “Seamless” Limber Latex Surgeon’s

++

+

Dart Industries “Seamless” Original Brown Milled Surgeon’s

+++

++

+++

+++

Dow Silastic Sheet

+++

++

Fisher Polygloves (Polyethylene)

+

Parke-Davis Eudermic Surgeon’s

+++

Parke-Davis Examination

+++

+++

++

Parke-Davis “Spectra” Surgeon’s

+++

+

+

Perry Latex Surgeon’s

+++

+

+

+

Perry Latex Surgeon’s Orthopaedic

++

+

+

Pioneer

++

+

Tomac Latex Exam

+++

+

+

Tomac “Thin-tip”

+++

+

+

*No polymerization, glove disintegrated.



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