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Two cases of liver angiosarcoma among polyvinyl chloride (PVC) extruders of an Italian factory producing PVC bags and other containers.

Two cases are reported of liver angiosarcoma occurring among polyvinyl chloride (PVC) extruders from a small Italian factory producing PVC bags and other containers. The possibility that PVC extrusion carries a risk of liver angiosarcoma is important because of the very large number of people working with extruding, manufacturing and handling PVC, as compared with the number of people working in PVC polymerization and/or VC production. In the past, the level of vinyl chloride (VC) concentration in PVC extrusion workplaces has been thought to be "safe".

Hemangiosarcoma↗

Tetramethylsuccinonitrile in polyvinyl chloride products for food and its release into food-simulating solvents.

The content of tetramethylsuccinonitrile (TMSN), the main decomposition product of 2,2'-azobis-isobutyronitrile, in polyvinyl chloride (PVC) products used for food packaging, were examined as well as food-simulating solvents. The TMSN concentration in 17 PVC products ranged from below the detection limit, 0.05 mg/kg, up to 523 mg/kg. The release of TMSN from two PVC products into five kinds of food-simulating solvents at 60 degrees C for 30 min was observed, except for 1 +/- 1 micrograms/kg of TMSN in n-heptane from a PVC bottle containing 523 +/- 30.4 mg/kg of TMSN. The detection limit of TMSN in the food-simulating solvents was 1 micrograms/kg. When pieces of the bottle were stored in olive oil at 40 degrees C for 120 days, 5 +/- 1 micrograms/kg of TMSN was detected in the oil. The release of TMSN from the pieces of the bottle into olive oil between 80 and 140 degrees C depended on the formula ln y = 0.08786x-5.696, r = 0.9927, where y is the concentration (microgram/kg) of TMSN in olive oil, x is the temperature (degrees C), and r is the correlation coefficient.

Food Contamination↗

Evaluation of the pulmonary toxicity of plasticized polyvinyl chloride thermal decomposition products in guinea pigs by repeated CO2 challenges.

Male guinea pigs were exposed to thermal decomposition products of plasticized polyvinyl chloride (PVC-A) at different concentrations up to levels inducing acute lethality. Several groups exposed at sublethal levels were then evaluated for pulmonary performance for a period of 57 days following exposure. Pulmonary performance was evaluated by challenging each animal with a mixture containing 10% CO2, 20% O2, and 70% N2. In control animals, this mixture induced an increase in both tidal volume and respiratory frequency. This hyperventilatory response was greatly depressed during the first 3 days following exposure and gradually returned to normal during the following weeks with the exception of the highest exposure group which still showed a diminished response 57 days after exposure. The pulmonary toxicity induced by thermal decomposition products of PVC-A is probably related to the very large amount of HCl released during thermal decomposition. The CO2 response test, a nonintrusive and noninvasive method to evaluate pulmonary performance in guinea pigs, is easily performed and appears to be a very promising type of pulmonary function test for toxicological evaluations.

Animals↗

Carcinogenicity and epidemiological profile analysis of vinyl chloride and polyvinyl chloride.

The carcinogenicity of vinyl chloride and polyvinyl chloride (VC/PVC) is reviewed with specific attention to the gaps in knowledge for risk estimation and epidemiological presentation of the available data. Although experimental studies have demonstrated the carcinogenicity and mutagenicity of VC/PVC in general, the epidemiologic studies available for review do not include an assessment of carcinogenic risk among humans exposed to these chemicals. This conclusion is based on the observation that the majority of cohort studies reviewed lacked sufficient statistical power because of small sample sizes. Further, in epidemiological studies, individuals were not followed over an adequate period of time during which cancer could become clinically manifest.

Animals↗

Radiolabeled polyvinyl alcohol particles: a potential agent to monitor embolization procedures.

Polyvinyl alcohol sponge (PVA) is a widely used angiographic embolic agent. The radiolabeling of PVA can accurately identify particle localization and may decrease the possibility of patient morbidity from embolization to distal sites. We incorporated 99mTc sulfur colloid (SC) into PVA by heating. Animal experiments demonstrated the in vivo stability of the 99mTc SC-PVA complex and the efficacy of external imaging. 99mTc SC-PVA biodistribution data and external NaI(T1) scintillation probe counts were performed, to assess anatomic localization. Embolization with this complex was performed in a patient.

Angiography↗

Plasticizer migration from polyvinyl chloride film to solvents and foods.

Polyvinyl chloride (PVC) films used for food wraps contain significant concentrations of plasticizers, along with other additives. The rate of migration of these plasticizers to foods and food-simulating solvents is the principal concern of this paper, which reviews prior experimental studies and presents new data for radiolabelled dioctyl adipate. Analytical models are described to correlate many of the data, criteria are presented for identifying the controlling step in the mechanism of transfer of plasticizer from PVC films into foods and food-simulating solvents, and tentative recommendations are offered for the selection of food simulants and for the type of experiment necessary to allow an unambiguous interpretation of the data.

Diffusion↗

Plasticized polyvinyl chloride film as a primary burns dressing: a microbiological study.

Twenty-four patients were studied after the application of plasticized polyvinyl chloride (PVC) film as a temporary burns dressing. The burns were assessed as being partial thickness (nine patients) and full thickness (15 patients) in depth and involving 2 per cent to 35 per cent of the body surface area. Microbiological cultures were performed on the exudate beneath the plasticized PVC film and then at each dressing change until the burn was healed. Bacterial isolates showed no unexpected organisms and there was no predominant organism to suggest contamination from the plasticized PVC film. Indeed, bacteria were only rarely isolated from the initial exudate (three of 37 burn wounds), and subsequent bacterial cultures did not differ from those normally found in burn wounds. In addition, incorporation of the plasticized PVC film into nutrient broth and agar with Staph, aureus and Ps. aeruginosa did not influence the recovery of these organisms, indicating that plasticized PVC film does not exert any antibacterial effect.

Adolescent↗

The 24-hour shelf-life of cytapheresis platelet concentrates stored in polyvinyl chloride containers should be extended only with caution.

A recent publication suggested that the 24-hour allowable shelf-life of apheresis platelet concentrates collected by open-system techniques be extended to 48 hours because platelets collected in this fashion usually remain sterile for that length of time. The current studies, however, show that the quality of platelet concentrates deteriorates rapidly after storage for more than 24 hours in the relatively small-volume, polyvinyl chloride containers of currently marketed, open-system software, as evidenced by the falling pH, the disintegration of platelets, and the inability of platelets to recover from hypotonic shock. Platelets were markedly defective within 48 hours. Thus, it seems unwise to extend the shelf-life of such platelet concentrates beyond 24 hours solely because they are likely to remain sterile. Collection techniques and software must also be modified to ensure satisfactory platelet quality before the period of storage should be extended.

Blood Component Removal↗

Storage of platelets on flatbed agitators in polyvinyl chloride blood bags plasticized with tri(2-ethylhexyl) trimellitate.

Data are presented showing that platelets in polyvinyl chloride blood bags plasticized with tri(2-ethylhexyl) trimellitate can be stored on flatbed agitators (shakers) without the pH falling below 6.0. The lowest pH seen after 7 days of storage in 46 units with platelet yields ranging from 3.6 to 13.3 X 10(10) per unit was 6.43. These bags have a O2 transmission rate of 13.3 mumol per hour per bag. Platelet bags with a O2 transmission rate of 7.9 mumol per hour per bag experience a pH fall after 5 days of storage on the shaker in units whose platelet yield on average exceeds 10 X 10(10). Platelets can be stored on first-generation shakers (70 cycles/min, stroke = 1 inch) without an attempt at manual resuspension of the platelet button. The count after 30 minutes on the shaker averaged 89 +/- 15 percent of the expected count, indicating that resuspension was nearly complete after a relatively short period. Red cells, but not platelets, settled out during storage on the shaker.

Benzoates↗

Toxicity of vinyl chloride and polyvinyl chloride as seen through epidemiologic observations.

In 1974, vinyl chloride (VC) was first reported in the scientific literature to induce angiosarcoma of the liver in animals and humans. Further research has now demonstrated the carcinogenicity of this agent to other organs. Target organs for VC now include the liver, brain, and lung, and probably the lymphohematopoietic system. The carcinogenic risk has been extended to jobs associated with polyvinyl chloride (PVC) exposure. This is evidenced by cases of liver angiosarcoma reported among individuals employed in or residing near PVC fabrication facilities and by epidemiologic study demonstrating a significant association between lung cancer and exposure to PVC dust. An association between PVC dust and pneumoconiosis has been demonstrated. On the basis of these findings, experimental bioassays and epidemiologic studies of the carcinogenicity of PVC are clearly in order. Prudent control of PVC in the industrial setting is also clearly indicated.

Brain Neoplasms↗

Electron microscopic evaluation of bacterial adherence to polyvinyl chloride endotracheal tubes used in neonates.

Studies in adults suggest a possible association between pulmonary nosocomial infection and bacterial adherence to endotracheal tubes (ETT). Some strains of coagulase-negative Staphylococcus produce a mucoid extracellular material known as slime or glycocalyx that helps bacteria adhere to the surface of biomaterials. We examined by scanning and transmission electron microscope the surface of 29 polyvinyl ETT removed from neonatal patients, and ten unused ETT. Multiple surface irregularities were found in the unused tubes. These irregularities were most prominent in the tip and around the side hole. Amorphous material containing slime-producing bacteria was found on 29 ETT removed from patients. Tubes in place for longer times had greater areas of surface covered; the amorphous material was more concentrated in the areas where surface irregularities were most prominent. No clinical correlation with pulmonary nosocomial infection was established.

Bacteria↗

Polyvinyl chloride--its risk potential in the hospital.

A potential risk management problem for hospitals is the thermal degradation of polyvinyl chloride (PVC). PVC is a synthetic, plastic, polymer wire insulating material which releases hydrogen chloride (HCl) gas when it is thermally degraded. Inhalation of HCl, either as a gas or in combination with water vapor, is irritating to all mucous membranes. Thermal degradation of 25 feet of PVC wire yields 1.4 mg HCl/L, which is 70 times greater than the recommended maximum concentration. Because of the potential risks, ther is an immediate need to develop a safe, economical substitute for PVC.

Electric Wiring↗

Cuff failure in polyvinyl chloride tracheal tubes sprayed with lignocaine.

The incidence of tracheal tube cuff rupture was noted in 30 polyvinyl chloride tracheal tubes lubricated with three different solutions. All cuffs moistened with water were intact after 2 hours of cuff inflation whereas two of 10 lubricated with 4% lignocaine solution had burst. Both of these had leaked at the site of cuff attachment to the tube. Fifty percent of tubes lubricated with Astra lignocaine spray burst during the study. Four of the five had developed pinholes in the cuffs themselves. The remaining 50% of this group showed marked distortion and thinning of their intact cuff walls. The implications of these findings are discussed in view of the widespread use of PVC tracheal tubes.

Aerosols↗

Phenoxyethanol absorption by polyvinyl chloride.

Phenoxyethanol was found to be absorbed by polyvinyl chloride administration sets during continuous irrigation therapy. Depending upon the conditions of administration up to 20% loss of potency could occur. Absorption of the drug by the rigid plastic luer-lock fitting of the set caused softening and decreased rigidity of the plastic.

Absorption↗

Polyvinyl chloride dermatitis not caused by phthalates.

Seven cases of contact dermatitis in children due to identification bracelets made of polyvinyl chloride plastic are reported. Patch tests with the bracelets were negative in the five cases tested. It is concluded that the reactions were irritant due to some unknown chemical in the bracelets. The most widely used plasticizers in PVC, phthalates, must have very low sensitizing properties, as only one positive patch test was found in 1532 patch tests with phthalate mix, performed as a joint study by the International Contact Dermatitis Research Group.

Child, Preschool↗

Changes in pulmonary function in workers exposed to vinyl chloride and polyvinyl chloride.

To determine whether occupational exposure to vinyl chloride gas and polyvinyl chloride dust is associated with changes in pulmonary function, spirometry and maximum expiratory flow-volume curves were obtained in 348 workers in a VC polymerization plant. The major finding was diminution in air flow in 200 workers (57.5 percent). This abnormality correlated with age and duration of exposure. A relationship with smoking was noted only in younger workers with exposures of less than 10 years. When age exceeded 40 years or exposure 20 years, prevalence of this impairment was similar in smokers and nonsmokers, suggesting that occupational or other environmental factors were operative.

Adult↗

Pathology of angiosarcoma of the liver among vinyl chloride-polyvinyl chloride workers.

We described the histologic features of 13 hepatic angiosarcomas which developed in workers engaged in the polymerization of vinyl chloride to polyvinyl chloride. Although the histologic features varied considerably in different portions of the angiosarcoma in the same liver and in the angiosarcomas of the liver from different patients, many features were similar such as sinusoidal, papillary, and cavernous growth patterns coincident with the precursor lesions of proliferation and atypia of sinusoidal lining cells.

Hemangiosarcoma↗