Benzene-caused hematologic neoplasms may be recognized as an occupational disease (OD) according to the German ordinance on ODs. At present, the OD No. 1303 covers heterogeneous diseases and various chemical agents triggering these diseases. The members of the medical advisory board specializing in ODs within the Ministry of Employment and Social Affairs recently proposed excluding "diseases of the blood, the hematopoietic and lymphatic system caused by benzene" from OD No. 1303 and classifying them as a separate OD. Benzene is generally acknowledged as a cause of acute myeloid leukemia, proven by numerous epidemiologic studies. However, there is less epidemiologic evidence of its association with other hematologic neoplasms, notably non-Hodgkin's lymphoma (NHL). To clarify this issue, the experts evaluated international literature and concluded that all kinds of myeloid and lymphoid malignancies including their prestages can be caused by occupational benzene exposure. Hence, physicians should ask patients about occupational benzene exposure and report any kind of diagnosed hematologic neoplasms, including their prestages, as suspected OD. The advisory board considered that a dose range starting from 10 ppm-years (cumulative benzene exposure) is sufficient for a > 50% probability of causing leukemias according to the WHO classification, including chronic lymphatic leukemia, and the potential preleukemias aplastic anemia and myelodysplastic syndrome, but excluding chronic myeloid leukemia (CML). For NHL and myeloproliferative diseases (including CML) the present epidemiologic evidence is considered not to be sufficient to describe a precise dose-effect relationship.
Bei stoffwechselgesunden Versuchspersonen wurde die Abbaurate von langkettigen Triglyzeriden und von mittelkettigen Triglyzeriden im Gemisch mit langkettigen Triglyzeriden bestimmt. Bei einer über drei Stunden dauernden Infusion einer Lipidemulsion aus langkettigen Triglyzeriden (Infusionsrate 0,22 g/kg Körpergewicht und Stunde) wird eine maximale Abbaurate von 16,4 mg/kg Körpergewicht und Stunde erreicht. Die Abbaurate der mittelkettigen Triglyzeride (Infusionsrate 0,056 g/kg Körpergewicht und Stunde) im Gemisch mit langkettigen Triglyzeriden erreicht maximal 4,8 mg/kg Körpergewicht und Stunde. Auch im Gemisch mit langkettigen Triglyzeriden (25 %) führen mittelkettige Triglyzeride zu einer signifikant erhöhten Ketonämie und Ketonurie. Darüber hinaus steigt der Azetatspiegel im Blut ebenfalls signifikant an. Infusionen von Lipidemulsionen führen zur Beeinträchtigung des Aminosäurestoffwechsels. Bemerkenswert ist der Abfall der Alanin-, Leuzinund Isoleuzinkonzentration im Blut, während die Glutamatkonzentration ansteigt. Unter den klinischchemischen Parametern fällt lediglich eine Leukozytose auf. Aus den Befunden folgt, daβ die Abbaurate der mittelkettigen Triglyzeride entsprechend ihrer niedrigen Plasmakonzentration absolut gesehen niedriger, die Ketogenese aber signifikant höher als bei den langkettigen Triglyzeriden ist.
When diagnosing hematologic diseases, physicians should ask the patients about their occupational history and, in particular, consider benzene exposures dating back several decades. To improve the state of knowledge of OD No. 1303, it is important that diseases are consistently classified according to WHO criteria and any kind of myeloid and lymphoid disease, including NHL, is reported.
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