Work in Department of Energy (DOE) facilities has exposed workers to multiple toxic agents leading to acute and chronic diseases. Many exposures were common to numerous work sites. Exposure to crystalline silica was primarily restricted to a few facilities. I present the case of a 63-year-old male who worked in DOE facilities for 30 years as a weapons testing technician. In addition to silica, other workplace exposures included beryllium, various solvents and heavy metals, depleted uranium, and ionizing radiation. In 1989 a painful macular skin lesion was biopsied and diagnosed as leukocytoclastic vasculitis. By 1992 he developed gross hematuria and dyspnea. Blood laboratory results revealed a serum creatinine concentration of 2.1 mg/dL, ethrythrocyte sedimentation rate of 61 mm/hr, negative cANCA (antineutrophil cytoplasmic antibody cytoplasmic pattern), positive pANCA (ANCA perinuclear pattern), and antiglomerular basement membrane negative. Renal biopsy showed proliferative (crescentric) and necrotizing glomerulonephritis. The patient's diagnoses included microscopic polyangiitis, systemic necrotizing vasculitis, leukocytoclastic vasculitis, and glomerulonephritis. Environmental triggers are thought to play a role in the development of an idiopathic expression of systemic autoimmune disease. Crystalline silica exposure has been linked to rheumatoid arthritis, scleroderma, systemic lupus erythematosus, rapidly progressive glomerulonephritis and some of the small vessel vasculitides. DOE workers are currently able to apply for compensation under the federal Energy Employees Occupational Illness Compensation Program (EEOICP). However, the only diseases covered by EEOICP are cancers related to radiation exposure, chronic beryllium disease, and chronic silicosis.

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Applying CSTE/NIOSH Occupational Health Indicator protocol and using both CFOI and NMVRHS data improved the characterization of occupational injury mortality and the setting of priorities for prevention intervention.

Working in mines is associated with acute and chronic occupational disorders. Most of the uranium mining in the United States took place in the Four Corners region of the Southwest (Arizona, Colorado, New Mexico, and Utah) and on Native American lands. Although the uranium industry collapsed in the late 1980s, the industry employed several thousand individuals who continue to be at increased risk for developing lung cancers. We present the case of a 72-year-old Navajo male who worked for 17 years as an underground uranium miner and who developed lung cancer 22 years after leaving the industry. His total occupational exposure to radon progeny was estimated at 506 working level months. The miner was a life-long nonsmoker and had no other significant occupational or environmental exposures. On the chest X-ray taken at admission into the hospital, a right lower lung zone infiltrate was detected. The patient was treated for community-acquired pneumonia and developed respiratory failure requiring mechanical ventilation. Respiratory failure worsened and the patient died 19 days after presenting. On autopsy, a 2.5 cm squamous cell carcinoma of the right lung arising from the lower lobe bronchus, a right broncho-esophageal fistula, and a right lower lung abscess were found. Malignant respiratory disease in uranium miners may be from several occupational exposures; for example, radon decay products, silica, and possibly diesel exhaust are respiratory carcinogens that were commonly encountered. In response to a growing number of affected uranium miners, the Radiation Exposure Compensation Act (RECA) was passed by the U.S. Congress in 1990 to make partial restitution to individuals harmed by radiation exposure resulting from underground uranium mining and above-ground nuclear tests in Nevada.

The International Labour Organisation (ILO) classification of radiographs of pneumoconioses was developed to limit variation in classification of parenchymal abnormalities. In this study the manner in which chest radiographs were interpreted in 134 investigations reported in four peer reviewed journals during the five year period 1985-90 was examined. The approach for applying the ILO system was poorly described in most studies. For example, of 86 investigations using more than one reader, 66-3% described the method of reconciliation, but methods were not consistent among investigations. Our results indicate a number of potential problems in application of the ILO system, and gaps in existing recommendations that should be considered. (British Journal of Industrial Medicine 1993;50:273-275) Classification of the pneumoconioses is based on the presence of characteristic patterns on chest radiographs. Interpretation of chest radiographs for pneumoconioses is, however, subject to limitations posed by film quality and to substantial intra and interobserver variability.'5 The Intemational Labour Organisation (ILO) system was developed to limit variation in interpretation of chest radiographs, but numerous studies of inter and intraobserver variability of observers trained in the system have documented persistent observer effects.5These studies, however, have not considered the manner in which the ILO system is applied. In this study we Information on the method of interpretation was abstracted with a standardised form developed for this investigation (available on request). The items covered were (1) system for radiographic classification, (2) number and training of those reading the radiographs, (3) use of standard radiographs for comparison, (4) randomisation of radiograph order, (5) use of control radiographs to examine inter and intrareader variability of readings, (6) blinding of readers to subjects' exposure state, and (7) method for reconciliation of interreader differences.With the standardised form, this information was collected by one ofus (KBM) from all manuscripts. A random one third sample was reviewed by JMS and DBC. Major discrepancies between the two reviews in this sample were then re-examined by KBM in all 134 manuscripts and appropriate corrections made. The data were analysed with standard programs of the Statistical Analysis System.7 ResultsThe numbers of readers interpreting the chest radiographs were described in 77-6% of the 134 articles, and the types of readers in 35 1%. Among 273 on 7 April 2019 by guest. Protected by copyright.