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Clinical response of human subjects to rear-end automobile collisions.

OBJECTIVE: Forty-two persons were exposed to controlled low-speed rear-end automobile collisions to assess the relation between both gender and impact severity and the presence, severity, and duration of whiplash-associated disorders (WAD). Individual measures were also assessed for their potential to predict the onset of WAD. DESIGN: Experimental study subjecting individuals to a speed change of 4 km/h and 8 km/h and utilizing pretest and posttest physical examinations (immediately after and 24 hours after impact) to quantify subjects' clinical response. RESULTS: Approximately 29% and 38% of the subjects exposed to the 4 km/h and 8 km/h speed changes, respectively, experienced WAD symptoms, with cervical symptoms and headaches predominating. Objective clinical deficits consistent with WAD were measured in both men and women subjects at both 4 km/h and 8 km/h. At 4 km/h, the duration of symptoms experienced by women was significantly longer when compared with that in men (p < .05). There were no significant differences in the presence and severity of WAD between men and women at 4 km/h and 8 km/h or in the duration of WAD at 8 km/h. There was also no significant difference in the presence, severity, and duration of WAD between 4 km/h and 8 km/h. No preimpact measures were predictive of WAD. CONCLUSION: The empirical findings in this study contribute to establishing a causal relationship between rear-end collisions and clinical signs and symptoms.

Accidents, Traffic↗

Automobile air bag-mediated injury: a case presentation.

Because of the growing number of automobiles equipped with air bags, it is virtually certain that patients will seek treatment in the emergency department for air bag-mediated injury. The emergency nurse must be aware of air bag-mediated injury patterns and prepared for triage and management of any of the potential concurrent injuries caused by air-bag deployment.

Accidents, Traffic↗

A nested case-control study of stomach cancer mortality among automobile machinists exposed to metalworking fluid.

PURPOSE: In a nested case-control study of 140 stomach cancer deaths (1941-1984) among 46,384 automobile workers, we examined risk in relation to lifetime exposure to metalworking fluid (MWF) in machining and grinding operations.METHODS: Exposure was defined during varying windows of biologic time (<10 years before death, 10-20 years before death, and > 20 years before death) and evaluated using a nonparametric smoothing technique and conditional logistic regression. Exposure was measured by duration, intensity (mg/m(3)), and cumulative exposure (mg/m(3)-years) to each MWF type (straight, soluble, or synthetic), as well as by duration of exposure to selected metals, additives, and components of the fluids.RESULTS: When data from three plants were combined, grinding with water-based synthetic or soluble MWF increased the risk of stomach cancer mortality. Those grinding with synthetic MWF with more than 1.3 mg/m(3)-years exposure during the 10 years just prior to death experienced a 4.4-fold risk of stomach cancer (95% CI 1.5-13.1). Increased risk was also observed among those in the highest category of soluble grinding grading exposure (OR 1.9; 85% CI 1.0-3.6). In plant-specific analysis, there was evidence of increased risk of stomach cancer associated with exposure to straight MWF and iron, as well as the water-based fluids.CONCLUSIONS: Study findings suggest that stomach cancer mortality was associated with exposure to each MWF type. Results suggesting that synthetic MWF may act as a stomach cancer promoter are of particular concern because this MWF is widely used in today's high speed grinding operations.

Journal Article↗

The influence of automobile exhausts on mutagenicity of soils: contamination with, fractionation, separation, and preliminary identification of mutagens in the Salmonella/reversion assay and effects of solvent fractions on the sister-chromatid exchanges in human lymphocyte cultures and in the in vivo mouse bone marrow micronucleus assay.

To test the assumption that automobile exhausts contribute to soil mutagenicity, two soils with low levels of mutagenic activities were exposed to traffic exhausts at a heavily charged junction of German motorways (Autobahnen) for 3, 7, 10, 13, 17, 21, and 26 weeks. Indeed, in the presence of a metabolic activation system from rat liver (S9), an average increase of 8 and 9 (4 and 12) revertants per gram per week was found in Salmonella typhimurium TA 98 (TA 100). In the absence of S9, meaningful measurements were impossible on account of a concurrent dose dependent increase of toxicity. No correlation between the increase of mutagenicity and the contents of polycyclic aromatic hydrocarbons (PAH) could be detected. In another series, soils sampled at the roadside and at distances of 10 and 50m of five roads near Mainz expressed 10-20-fold higher mutagenicity (revertants per gram) under identical test conditions as compared with the average of agricultural soils. Toxic effects, however, again confounded the results and no correlation between the distance from roads and the levels of mutagenicity could be demonstrated. Subsequently, Soxhlet-extraction with the solvent sequence dichloromethane, acetone, and toluene/diethylketone was found to be an optimum procedure for soils at roadsides. The mass balance of solvent fractionation of such soils revealed that <2% each belonged to organic acids and bases, approximately 4% to fractions designed polar neutrals, approximately 8% to polar aromatics, approximately 7% to dichloromethane solubles, and approximately 79% to cylohexane solubles, among them approximately 63% acetone soluble compounds. The major part of mutagenicity (55-65%) was present in the fraction of polar aromatics, followed by polar neutrals and the acetone subfraction of cyclohexane solubles ( approximately 10% each) summarizing the results obtained with S. typhimurium TA 98, TA 98NR, YG 1021, YG 1024, TA 100, YG 1026, and YG 1029 with and without addition of S9. The modified tester strains, either deficient in nitroreductase (TA 98NR) or overproducing nitroreductase (YG 1021, 1026) or O-acetyl-transferase (YG 1024, 1026), indicated a major contribution of nitroarenes to soil mutagenicity. With respect to mutagenic PAH, high pressure liquid chromatography (HPLC) revealed that >90% of dibenz[a,h]anthracene (4.18mg/kg soil), benzo[a]pyrene (1.96mg), benzofluoranthenes (0.14mg), and benz[a]anthracene (0. 18mg) were present in the acetone subfraction of cyclohexane solubles. Concentrations and mutagenic activities, however, did not correlate. Additional preparative and analytical HPLC of the solvent fractions of polar neutrals and polar aromatics, resulted in the tentative identification of 2-nitrofluorene. Analysis of the vertical profile of soil revealed an increase of mutagenicity per gram from the surface to a maximum at 5-15cm depth and a subsequent decrease with very little activity remaining deeper than 35cm. In human lymphocyte cultures, the fraction of polar aromatics, 0.01-0. 3microg/ml, induced 11.27+/-4.76-20.70+/-6.19 sister-chromatid exchanges (SCE) per cell in the absence of S9 (solvent control: 10. 16+/-4.83 SCE per cell) and 12.77+/-6.53-17.87+/-4.93 SCE per cell in the presence of S9 (solvent control: 8.37+/-3.92 SCE per cell). However, no activities could be detected in the fractions of polar neutrals and non-polar neutrals. Again, negative results were obtained in the in vivo mouse bone marrow micronucleus assay at 2000mg/kg p.o. with all fractions.

Animals↗

Genotoxicity and chronic health effects of automobile exhaust: a study on the traffic policemen in the city of Lanzhou.

A study on the health and genotoxic effects of occupational exposure to automobile exhaust was carried out among traffic policemen in Lanzhou (China) in 1996. A total of 78 traffic policemen working in the field was the exposed group, and 57 household register policemen working in the office was the control group. The health effects were evaluated by health questionnaires. Significant differences were observed between the exposed and control groups with respect to the morbidity of rhinitis, pharyngitis, trachoma, syndrome of neurasthenia and joint pain, apart from disorders in the digestive system. The percentage of rhinitis and pharyngitis obtained in the two groups was significantly higher among the smokers than among the nonsmokers. The frequencies of micronuclei (MN) and sister-chromatid exchanges (SCEs) were measured in peripheral blood lymphocytes from the two groups of volunteers. Compared with the control group, statistically significant increases of MN and SCE were found for the exposed group. The increase in the induction of MN and SCE among the traffic policemen and household register policemen is enhanced further by smoking.

Adult↗

Size analysis of automobile soot particles using field-flow fractionation.

Soot particles emitted from various automobile engines are analyzed for size distributions using field-flow fractionation (FFF). Soot samples are prepared for FFF analysis using a three-step procedure, where a layer of soot particles is focused between the layers of n-hexane and water, followed by dispersing of particles in water containing 0.05% Triton X-100. The mean diameters determined by FFF show similar trends with those obtained from dynamic light scattering (DLS) and scanning electron microscopy (SEM). Data from FFF are also compared with those from an on-line scanning mobility particle sizer (SMPS). SMPS size distributions extend further to larger size than those of FFF distributions, which indicates the three-step sample preparation procedure effectively disaggregates the agglomerated particles. Although the amount of particulate matter (PM) emitted from a heavy-duty diesel engine is much higher than that from a light-duty diesel engine, the size distributions of soot particles show no significant difference between heavy- and light-duty diesel engines. The engine-operating mode (engine speed and load rate) does not seem to affect significantly the size distribution of soot particles. It was found that the PM from a turbocharged diesel engine contains a higher percentage of particles smaller than 100 nm than an engine with a naturally aspirated (NA) air-inhalation system. As for gasoline engines, the PM collected after the catalytic converter has a narrower size distribution than those collected before and has a higher percentage of particles smaller than 100 nm.

Air Pollution↗

An automatic method for the determination of carcinogenic 1-nitropyrene in extracts from automobile exhaust particulate matter.

An automatic method for the determination of carcinogenic 1-nitropyrene in extracts from automobile exhaust particulate matter has been developed. Organic matter was extracted from particulate matter and the extract was concentrated. Then the extract was injected into a two-dimensional (2D) high-performance liquid chromatograph (HPLC) with a fluorescence detection system. To improve the sensitivity a large sample volume (300 microl) was applied to the HPLC system using the double on-column focusing technique. To achieve full automation and high selectivity a reduction column packed with platinum black was introduced after the 2D HPLC system using a C18 column as the primary column and a pentabromobenzyl column as the secondary column. This HPLC system could determine 0.01-3,000 ng ml(-1) of 1-nitropyrene in an extract from diesel and gasoline exhaust particulate matter at 40 min intervals.

Carcinogens↗

A portable fiber-optic chemical device for the quantitative determination of carbon monoxide from automobile exhaust emissions.

A colorimetric method for the quantitative determination of CO by diffuse reflectance is described. This method is based on the reduction by CO of Mo (VI) from the indicator reagent molybdosilicic acid (H8Si[Mo2O7]6). The reduction yielded a change of color from clear yellow to dark green on white disk filter chart paper wetted with reagent indicator solution. The gaseous mixture containing CO was forced to pass through this chart paper, initiating the reaction. The intensity of the color produced, measured by diffuse reflectance, was proportional to the CO concentration present in exhaust gases in the range from 0.02 to 12% volume/volume (v/v). A 650-nm light-emitting diode was used as a light source. A two-fiber-optic system carried the light from the source to the detection system, which was composed of a photodiode, an amplification circuit, and a digital display. The method was applied with success in field measurements for automobiles in the Otto cycle. In a previous paper, this method was used for the quantitative determination of exhaust emissions from diesel-fueled vehicles.

Carbon Monoxide↗

Secondary organic aerosol formation from the irradiation of simulated automobile exhaust.

A laboratory study was conducted to evaluate the potential for secondary organic aerosol formation from emissions from automotive exhaust. The goal was to determine to what extent photochemical oxidation products of these hydrocarbons contribute to secondary organic aerosol (SOA) and how well their formation is described by recently developed models for SOA formation. The quality of a surrogate was tested by comparing its reactivity with that from irradiations of authentic automobile exhaust. Experiments for secondary particle formation using the surrogate were conducted in a fixed volume reactor operated in a dynamic mode. The mass concentration of the aerosol was determined from measurements of organic carbon collected on quartz filters and was corrected for the presence of hydrogen, nitrogen, and oxygen atoms in the organic species. A functional group analysis of the aerosol made by Fourier transform infrared (FTIR) spectroscopy indicated

Aerosols↗

Catalytically and noncatalytically treated automobile exhaust: biological effects in rats.

Chronic exposure to catalytically treated or noncatalytically treated automobile exhaust significantly depressed the spontaneous locomotor activity (SLA) of rats. Exposure to H2SO4 alone or CO at comparable levels did not alter the SLA. Exposure to noncatalytically treated exhaust resulted in significant reductions in growth rate and food and water intake. However, these effects were not evident in the exposure to catalytically treated exhaust or in the control H2SO4 and CO exposures. Blood acid-base analyses indicated that exposure to either catalytically treated exhaust or H2SO4 elicits a metabolic alkalosis, while exposure to CO alone results in a metabolic acidosis. All acid-base parameters were within the normal range several weeks after the termination of exposure.

Acid-Base Equilibrium↗

Relations among chronic medical conditions, medications, and automobile crashes in the elderly: a population-based case-control study.

Older drivers have elevated crash rates and are more likely to be injured or die if they have a crash. Medical conditions and medications have been hypothesized as determinants of crash involvement. This population-based case-control study sought to identify medical conditions and medications associated with risk of at-fault crashes among older drivers. A total of 901 drivers aged 65 years and older were selected in 1996 from Alabama Department of Public Safety driving records: 244 at-fault drivers involved in crashes; 182 not at-fault drivers involved in crashes; and 475 drivers not involved in crashes were enrolled. Information on demographic factors, chronic medical conditions, medications, driving habits, visual function, and cognitive status was collected. Older drivers with heart disease (odds ratio (OR) = 1.5, 95% confidence interval (CI): 1.0, 2.2) or stroke (OR = 1.9, 95% CI: 0.9, 3.9) were more likely to be involved in at-fault automobile crashes. Arthritis was also associated with an increased risk among females (OR =1.8, 95% CI: 1.1, 2.9). Use of nonsteroidal antiinflammatory drugs (OR = 1.7, 95% CI 1.0, 2.6), angiotensin converting enzyme inhibitors (OR = 1.6, 95 CI: 1.0, 2.7), and anticoagulants (OR = 2.6, 95% CI: 1.0, 73) was associated with an increased risk of at-fault involvement in crashes. Benzodiazepine use (OR = 5.2, 95% CI: 0.9, 30.0) was also associated with an increased risk. Calcium channel blockers (OR = 0.5, 95% CI: 0.2, 0.9) and vasodilators (OR = 0.3, 95% CI: 0.1, 1.0) were associated with a reduced risk of crash involvement. The identification of medical conditions and medications associated with risk of crashes is important for enhancing the safety and mobility of older drivers.

Accidents, Traffic↗

Blood concentration of milnacipran in a case of a fatal automobile accident.

A fatal automobile accident involving milnacipran and ethyl alcohol is reported. The drug was identified and quantitated in blood by high-performance liquid chromatography-diode-array detection. The concentration of milnacipran in peripheral blood was 3.15 microg/mL exceeded 10.5 times the therapeutic concentration. The blood ethyl alcohol level was 1.3 g/L.

Accidents, Traffic↗

Experimental studies on death by fire in automobiles and exhaust gas poisoning.

Studies were made on the acid-base balance, blood gases, and carbon monoxide (CO), cyanide, and sulfur dioxide concentrations in the blood of albino rabbits that died from automobile exhaust gas poisoning (group I) or fires in cars (complete combustion, group II; incomplete combustion, group III). In group I, the temperature and CO concentration increased gradually to 35 degrees C and 5.2% in 70 min. The animals died after 9 min, when the values were 20 degrees C and 5.2%, respectively. In group II the animals died after 9 min, when the values were 55 degrees C and 1.95%, respectively. In group III, the temperature was very high (870 degrees C), but the CO concentration was not (0.6-1.3%) after 4 min. The animals died after 5 min. In all experimental groups, marked acidosis and hypoxemia were seen, but the CO2 tension (PCO2) was high, in contrast to previous studies on pure CO poisoning. In group I, the level of carboxyhemoglobin (CO-Hb) was significantly higher (91.2 +/- 3.4% in arterial blood, 87.5 +/- 8.1% in venous blood; p less than 0.01) than in groups II and III. Although the O2 tensions of venous and arterial blood (PvO2, PaO2) were very low, that of arterial blood was higher, suggesting that O2 was still being utilized in the tissues at the time of death. In group II, CO-Hb was high (57.7 +/- 16.0% in arterial blood, 61.2 +/- 20.6% in venous blood) and the acid-base balance indicated marked acidosis. In group III, the CO-Hb, PCO2 and cyanide levels in the blood were very high.(ABSTRACT TRUNCATED AT 250 WORDS)

Accidents, Traffic↗

Fetal skull fracture from an automobile accident.

This is a case report of a fetal skull fracture that resulted in fetal death caused by a high-velocity automobile accident. As a 25-year old gravida 3, para 2, was pulling out of a driveway onto a highway, her car was struck in the left front end by a car traveling perpendicular to her vehicle. She died almost instantly from shock caused by massive injuries and internal hemorrhage. She had a fractured rib and multiple fractures of the pelvis as well as bilateral hemothorax and ruptured splenic and renal vessels. The fetus had depressed multiple skull fractures. The probable mechanism of fetal injury, as well as the influence of seat restraints on injury to the mother and fetus, are discussed.

Accidents, Traffic↗

Suicide by gunshot while driving an automobile.

Suicide by a motor vehicle occurs more commonly than is realized, and may be difficult to prove. Suicide by other means while driving a vehicle is far less common. An automobile driven by a young woman left a road at high speed, became airborne, and came to rest on its top in a front yard. This was initially assumed to be a fatal traffic accident. Upon righting the vehicle, a .357 revolver was found on the ground beside it. A single, fatal, self-inflicted gunshot wound was found in the decedent's midanterior thorax. A suicide note was found in her purse. She had been chronically depressed and had twice attempted suicide. Vehicular suicides may constitute 10-30% of fatal single-vehicle crashes, and must be considered in any vehicular mishap lacking another reasonable explanation. Suicide by other means while driving is far less common than suicidal vehicular collision and suicidal death from carbon monoxide in motor vehicles. An autopsy should be performed in each of these sometimes-low-priority single-vehicle deaths in order to certify vehicular accidents correctly; to discover and document vehicular suicides; and to detect homicides disguised as vehicular mishaps.

Accidents, Traffic↗

Identification of the driver in an automobile collision.

We report on a three-occupant automobile collision in which one of the two survivors claimed that the deceased had operated the vehicle. We attempted to identify the driver. The left face and neck of the deceased appeared to have struck the vehicle's interior. The survivors were slightly injured on the right side of their faces. In Japan, the passenger side is on the left, and in this case, the right side of the vehicle had been damaged. By comparing the injuries of the deceased and the survivors in relation to the vehicle damages, we concluded that the deceased occupant had probably been a passenger, not the driver.

Accidents, Traffic↗

Fatal high cervical spinal cord injury in an automobile accident complicating os odontoideum.

We report a case where spinal instability from incomplete fusion of the dens of C2 (os odontoideum) allowed anterior displacement of the skull and first cervical vertebra following right frontal impact against the A pillar in an automobile accident. Resultant crushing and laceration of the spinal cord occurred at the level of C1 and C2. Without either radiographic investigation or detailed examination of the spine, the fatal injury might have been overlooked and death attributed to acute alcoholic poisoning because the blood alcohol level was .613%.

Accidents, Traffic↗

Carboxyhemoglobin levels in a series of automobile fires. Death due to crash or fire?

The determination of death by trauma versus fire can be of major consideration, especially in civil product liability litigation. Blood carboxyhemoglobin levels can be instrumental in that differentiation. Twenty-eight fatalities involving fire in automobiles were reviewed. All subjects displayed some degree of body burn, and in 25 severe charring and/or incineration was present at autopsy. In only one case was there a history of explosion or flash fire. Carboxyhemoglobin levels varied from 92% to values of < 10%. In seven cases no collision occurred. In six of these subjects COHb values were > or = 47%. In all 16 cases with carboxyhemoglobin levels of < or = 10% a collision occurred. In 12 of 16 of these subjects, blunt force injury sufficient to cause death was discovered. Data presented in this article indicate that a carboxyhemoglobin level of > 30% strongly suggests inhalation of combustion products as the cause of death. In contrast, a level of < 20% should prompt a search for other causes.

Accidents, Traffic↗