331 In this not
the association of cimetidine and fever does have been due to chance.
patient
seem to
Kliniek Maria’s Voorzienigheid,
Kortrijk, Belgium
C. RAMBOER
flushing of the face after a second pint. The symptoms cleared in 2 h and he slept normally. He has subsequently consumed his "normal" amounts of beer (4-6 pints) without effect. None of the other workers have complained of any sympcausing an ’Antabuse’ (disulfiram) effect has been workers in Germany,’ another exposed worker not being affected. Doctors who are responsible for workers in an area in which D.M.F. is used should be aware of the possibility of an antabuse effect if the chemical is absorbed and alcohol is subsequently consumed. toms. D.M.F. recorded in two
DISULFIRAM EFFECT FROM INHALATION OF DIMETHYLFORMAMIDE
SfR,—A 34-year-old maintenance fitter, whose medical history and pre-employment examination had been unremarkable and who had had no illness during 2 years of employment, repaired, with two workmates, a blocked pipe under a dimethylformamide (D.M.F.) reaction vessel. The job took about 4 h. Before work started the concentration of D.M.F. in the later working area was below the threshold limit value (10 p.p.m.). Later, the fitter noticed an unusual smell and asked for the atmosphere to be tested again. The concentration was now 30 p.p.m. The smell was not sufficiently unpleasant to cause them to stop work. None of the three workers complained of symptoms at the time, and only an hour after the completion of the job did the employee concerned notice that a patch of dampness (which could have been caused by D.M.F.) on his overalls had soaked through to his skin. He changed his clothing after showering and went home about 4 A.M. He had no further exposure to D.M.F.
At lunchtime that of beer and his face
day (July 20, 1977) he drank half a pint immediately became blotchy red and he a experienced tightness of the chest. These symptoms cleared after about 2 h. That evening the same sequence occurred with recovery within 2 h, this time after ingestion of at least two pints of beer. On the evening of July 21 he drank two pints of beer at 6 and noticed the same symptoms, but this time he went for walk and 2 h later drank about six pints. He felt well when he went to bed at about 11 P.M., but woke at 1 A.M. with a feeling of dyspnrea and tightness of the chest accompanied by a generalised red blotchiness of the skin. By 4 A.M. his symptoms had disappeared. When he reported to the works surgery he seemed well, and at 8.30 A.M. he had a forced expiratory volume of 3.7 1 and a forced vital capacity of 5.2 1. At 11 A.M. these values had improved and were identical to those at his pre-employment examination (F.E.v. 4.3 1, F.v.c. 5.7 1). Physical examination, apart from a blood-pressure of 180/95 mm Hg, revealed no abnormality. He was advised to stop drinking alcohol for a few days; he drank very little for a week and his symptoms were negligible. Since then he has returned to his usual consumption of 6-8 pints of beer per night without any adverse effects. On July 26 and Aug. 31 blood-samples were sent for liverfunction tests. ,-glutamyl transpeptidase values were 50 and 57 units (normal 5-17), the serum-bilirubin was 22 mol/1 on July 26 (normal 5-17), and S.G.O.T. values were 28 on both occasions (normal 0-30). Other results were normal, and the above findings may also be considered normal in view of his regular beer consumption over many years. One of the two workmates also drank 4 pints of beer on the second evening after exposure but experienced no abnormal reaction. Neither of these two were seen at the medical department, but they are understood to be perfectly well after the incident.t. On Nov. 5 and 6 this fitter again worked in the same plant on the same job. He worked for 7 h on the first day and for 4 h the following morning. During this period there was a smell of D.M.F. but not sufficient to merit him requesting a test. He noticed no contamination of his clothing or skin during or after work. He felt well at the end of both spells of work. Although advised to wear respiratory protection, neither he, his mate nor two process workers did so. Four pints of beer after the first day’s work produced no reaction, but the following evening after the further 4 h morning work he noticed a slight tightness of the chest after one pint of beer, followed by
Medical Department, I.C.I. Paints Division, Hyde, Cheshire SK14 4EJ
C. P. CHIVERS
DISPOSABLE SYRINGES FOR DIABETICS
SIR,-Fiona Toal (Jan. 7, p. 45) found that 66% of diabetic did not routinely sterilise their needles and syringes. The following case highlights this problem. A 19-year-old male, a diabetic for most of his life, was admitted to hospital with diabetic ketoacidosis after overindulgence at Christmas. He had multiple abscesses over the injection sites on his left thigh and right arm, and antibiotics were
patients
prescribed. On questioning, the patient admitted that he had never washed his syringe or needles and that he simply stored them in a dirty jar (see figure) and could not remember the last time
P.M.
a
Insulin
syringe
stored in contaminated water in
dirty jar.
he had changed the water. The water was cultured and found contain both Pseudomonas ceruginosa and Staphylococcus albus. Green slime in the water indicated the presence of algae. The patient made an uneventful recovery and was discharged, his diabetes stabilised and his abscesses healed, 28 days after admission. This situation would not arise if disposable syringes and needles were available on prescription. The cost of treating abscesses in hospital is far greater than the cost of providing disposable equipment. How long must we put up with this archaic situation? to
Pharmaceutical Department, North Manchester General Hospital, Crumpsall, Manchester M8 6RB
1.
Reinl, W., Urba, H. J. Int. Arch. Gewerbe, 1965, 22, 33.
L. A. GOLDBERG
the association of cimetidine and fever does have been due to chance.
patient
seem to
Kliniek Maria’s Voorzienigheid,
Kortrijk, Belgium
C. RAMBOER
flushing of the face after a second pint. The symptoms cleared in 2 h and he slept normally. He has subsequently consumed his "normal" amounts of beer (4-6 pints) without effect. None of the other workers have complained of any sympcausing an ’Antabuse’ (disulfiram) effect has been workers in Germany,’ another exposed worker not being affected. Doctors who are responsible for workers in an area in which D.M.F. is used should be aware of the possibility of an antabuse effect if the chemical is absorbed and alcohol is subsequently consumed. toms. D.M.F. recorded in two
DISULFIRAM EFFECT FROM INHALATION OF DIMETHYLFORMAMIDE
SfR,—A 34-year-old maintenance fitter, whose medical history and pre-employment examination had been unremarkable and who had had no illness during 2 years of employment, repaired, with two workmates, a blocked pipe under a dimethylformamide (D.M.F.) reaction vessel. The job took about 4 h. Before work started the concentration of D.M.F. in the later working area was below the threshold limit value (10 p.p.m.). Later, the fitter noticed an unusual smell and asked for the atmosphere to be tested again. The concentration was now 30 p.p.m. The smell was not sufficiently unpleasant to cause them to stop work. None of the three workers complained of symptoms at the time, and only an hour after the completion of the job did the employee concerned notice that a patch of dampness (which could have been caused by D.M.F.) on his overalls had soaked through to his skin. He changed his clothing after showering and went home about 4 A.M. He had no further exposure to D.M.F.
At lunchtime that of beer and his face
day (July 20, 1977) he drank half a pint immediately became blotchy red and he a experienced tightness of the chest. These symptoms cleared after about 2 h. That evening the same sequence occurred with recovery within 2 h, this time after ingestion of at least two pints of beer. On the evening of July 21 he drank two pints of beer at 6 and noticed the same symptoms, but this time he went for walk and 2 h later drank about six pints. He felt well when he went to bed at about 11 P.M., but woke at 1 A.M. with a feeling of dyspnrea and tightness of the chest accompanied by a generalised red blotchiness of the skin. By 4 A.M. his symptoms had disappeared. When he reported to the works surgery he seemed well, and at 8.30 A.M. he had a forced expiratory volume of 3.7 1 and a forced vital capacity of 5.2 1. At 11 A.M. these values had improved and were identical to those at his pre-employment examination (F.E.v. 4.3 1, F.v.c. 5.7 1). Physical examination, apart from a blood-pressure of 180/95 mm Hg, revealed no abnormality. He was advised to stop drinking alcohol for a few days; he drank very little for a week and his symptoms were negligible. Since then he has returned to his usual consumption of 6-8 pints of beer per night without any adverse effects. On July 26 and Aug. 31 blood-samples were sent for liverfunction tests. ,-glutamyl transpeptidase values were 50 and 57 units (normal 5-17), the serum-bilirubin was 22 mol/1 on July 26 (normal 5-17), and S.G.O.T. values were 28 on both occasions (normal 0-30). Other results were normal, and the above findings may also be considered normal in view of his regular beer consumption over many years. One of the two workmates also drank 4 pints of beer on the second evening after exposure but experienced no abnormal reaction. Neither of these two were seen at the medical department, but they are understood to be perfectly well after the incident.t. On Nov. 5 and 6 this fitter again worked in the same plant on the same job. He worked for 7 h on the first day and for 4 h the following morning. During this period there was a smell of D.M.F. but not sufficient to merit him requesting a test. He noticed no contamination of his clothing or skin during or after work. He felt well at the end of both spells of work. Although advised to wear respiratory protection, neither he, his mate nor two process workers did so. Four pints of beer after the first day’s work produced no reaction, but the following evening after the further 4 h morning work he noticed a slight tightness of the chest after one pint of beer, followed by
Medical Department, I.C.I. Paints Division, Hyde, Cheshire SK14 4EJ
C. P. CHIVERS
DISPOSABLE SYRINGES FOR DIABETICS
SIR,-Fiona Toal (Jan. 7, p. 45) found that 66% of diabetic did not routinely sterilise their needles and syringes. The following case highlights this problem. A 19-year-old male, a diabetic for most of his life, was admitted to hospital with diabetic ketoacidosis after overindulgence at Christmas. He had multiple abscesses over the injection sites on his left thigh and right arm, and antibiotics were
patients
prescribed. On questioning, the patient admitted that he had never washed his syringe or needles and that he simply stored them in a dirty jar (see figure) and could not remember the last time
P.M.
a
Insulin
syringe
stored in contaminated water in
dirty jar.
he had changed the water. The water was cultured and found contain both Pseudomonas ceruginosa and Staphylococcus albus. Green slime in the water indicated the presence of algae. The patient made an uneventful recovery and was discharged, his diabetes stabilised and his abscesses healed, 28 days after admission. This situation would not arise if disposable syringes and needles were available on prescription. The cost of treating abscesses in hospital is far greater than the cost of providing disposable equipment. How long must we put up with this archaic situation? to
Pharmaceutical Department, North Manchester General Hospital, Crumpsall, Manchester M8 6RB
1.
Reinl, W., Urba, H. J. Int. Arch. Gewerbe, 1965, 22, 33.
L. A. GOLDBERG
