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NETWORKS

 Sharon  Sowers and  Janet Kanepp, 157 Maple Dr, New Holland,  PA 17557,  USA  or  email:   <SSowers1@aol.com>    have a questionnaire investigating some of these health effects.  WASTE  (Workers Against Senseless Toxic Exposure) is their group in the  USA - currently they have 92 medical personnel injured by GA. 

WASTE Web site:  <http://www.n-i.com/NCchem/waste.htm> . 

GASPING  (Glutaraldehyde Affected Support Persons) -sub group of Injured Nurses’ Group operates in Victoria, Australia.  Contact:  Irene Gregory  ph:  9470-099   <irenevic@alphalink.com.au> ,  Gaby Barnewall  ph: 9439-9652 or Anne Rutter  ph:  9 808-1509,    P O Box 49, Burwood, Victoria 3125.

Rick Carlton has set-up the: GLUTARALDEHYDE,  ALDEHYDE,  AND SOLVENT SENSITIVITY LISTSERVER - GASSLIST!)  This list has been established to serve persons interested in these sensitivities (especially Xray personnel and nurses) - to promote internet-wide exchange of research and information.  20 subscribers joined in the first 24 hours.

To subscribe to the list send a normal email message to:   listserv@crow.astate.edu   with a message of                 subscribe gasslist    

For  MCSS Networks  see Web site list p. 54.                                       

                **Be awarethat if you are having surgery with instruments sterilised in GA, there are in the Bibliog several papers reporting reactions from improperly rinsed instruments. (Cidex-induced synovitis, Harner et al, 1989.  Endoscope induced colitis, Rozen et al, 1994.  Glutaraldehyde Colitis,  Birnbaum, 1995).  

                Because the chemicals have such wide-ranging effects, and because many GPs,  who generally make the first contact with the patients, and specialists, lack  knowledge of the chemicals, confirmation of these wide-ranging effects is sometimes difficult to obtain.  Specialists with excellent knowledge of chemical poisoning must be used.  Good taking of  work history is very important if chemical damage is suspected.   Most research has so far focussed on the skin, eye, nose and respiratory effects of glutaraldehyde, with  published and unpublished studies since 1968.  Many show that people are affected at  levels far below the accepted standards and in unsuspected ways.   (See  SNFTAAS Bibliography:  Axon et al,  Collier,  Norbach,  Jachuk et al,  Binding/Wittig,  Campbell/Cripps,  Carslake,  Calder, Trigg et al,  Ide,  Leinster et al,  Tkaczuk et al,  Griffiths,  Gannon et al,   Scobbie et al,  Vyas,  Care G. )  Neurotoxic effects have been looked at more recently in  NZ, Australia and the USA. 

GLUTARALDEHYDE-INDUCED  NEUROTOXICITY 

(See also The Solvent Connection  p. 34)

                Good information is beginning to emerge in this area of glutaraldehyde damage.  Professor  Des Gorman states that research conducted in Adelaide, Australia by the Faculty of Medicine and Health Sciences, University of Auckland, shows that glutaraldehyde removes the surfactant lining of cerebral

endothelium and hence  damages the blood-brain- barrier.  “Any agent that impairs the BBB can cause both direct and secondary  (by allowing the ingress of other toxins)  brain damage.  Hence glutaraldehyde is a plausible cause of neurotoxicity.”  (Letter to Dr John Monigatti,  ACC Workwise,  8 Aug, 1997). 

                In an Australian paper, three staff cleaning endoscopes in a theatre had been exposed to GA.  Testing was by the auditory evoked response potential  (AERP) method which measures how long the brain takes to react to stimuli.   They showed prolonged response time and a dysfunction related to depression of the brain’s cortical function[1] [the area which controls higher mental functions, perception and behaviour, movement, and the functioning of the main organs].   Dr Teo has subsequently investigated a further 50 nurses;  he received his PhD for the development of the AERP test.  He has also seen 6 workers in the mining industry affected by glutaraldehyde. [Dr Richard Teo,  PO Box 109,  Jannali,  NSW, 2226, Australia, ph: 041-9268 874, <AERP@intercoast.com.au>.]  

                Other neuropsychological testing is underway in West Australian health care workers as part of work by Leonie Coxon for a doctorate in forensic psychology. 

                Of  50 New Zealand  SNFTAAS members with glutaraldehyde or formaldehyde exposure,  21 have had neuropsychological testing and all 21 have demonstrated neuropsychological damage classified as mild or moderate.  Of these, 13 have been accepted for ACC compensation,   7 are awaiting ACC decisions,  1 is in dispute (with associated epilepsy which post-dates and which she is sure is associated with her chemical exposure).  The label  is often “chronic glutaraldehyde-induced neurotoxicity with fatigue as a significant feature”. [GIN - no tonic!].  Three members have formaldehyde exposure and the rest, 18, are glutaraldehyde-exposed in either X-ray or theatre. 

                Two papers presented at the Marj Gordon Memorial Seminar,  Palmerston North,  NZ,  March, 1997, examine neuropsychological effects.  Dr Bill Glass looked at 13 patients who were mainly nurses using GA as a sterilant or bench wipe (Group A), and 13 who had worked with a chemical cocktail which included GA or, for 2, formaldehyde and benzaldehyde (Group B) in hospital photographic or X-ray departments.   12/13 in Group A,  and 7/13 in Group B reported mood, memory, and concentration problems.  10 of  Group A were given Hogstedt et al’s ‘Questionnaire 16’  (a recently validated test for early disturbance in CNS function for suspected solvent neurotoxicity). “Evidence of memory, mood and concentration impairment was evident.”  More detailed short battery neuropsychological tests were completed by 4 patients,  and a full clinical evaluation was carried out on 6 patients. “These tests further confirm the neuropsychological damage suffered by patients”.[2]

Dr Dorothy Gronwall presented a composite case study, “Jane”, based on 3 cases. “Jane’s” pre-morbid ability was in the above average intellectual ability group.  In visual perception her copy of the muddly Rey- Osterreith complex figure was not well-organised and was inaccurate and incomplete... This was probably the result of poor frontal lobe function rather than perceptual deficit.  Memory for non-verbal material was significantly below average.  Attention and concentration:  Several tests given including PASAT (Paced Auditory Serial Addition) which showed significantly slowed information processing.  Language:  significantly below average on controlled word fluency and a faster than normal falloff over time on task which is typical in cases of frontal lobe dysfunction.  Executive function: the ability to organise and check what has been done showed impairment consistent with frontal lobe dysfunction.  Reaction times:  Significantly slower on a computer target test and more so to targets on the right.

Other factors:  Intellectual handicap was unlikely;  poor motivation unlikely - she did poorly on some tests not on others, and poorly on more interesting tests yet produced excellent scores on more tedious tests; malingering - perhaps she had done some homework and knew the sorts of results she should produce eg low scores on verbal memory, but she scored above average here.  Also PASAT is very hard to fake believable scores on.  Depression:  one would not expect only some scores to be depressed, and only one peripheral vision field to be slower.  Closed head injury:  no traumatic brain injury - never been knocked out.   Substance abuse:  “Jane” denied taking alcohol or other mind-altering drugs.  Substance abuse is unlikely to have resulted in this pattern of scores.

                “It is never possible to produce a definite diagnosis from a neuropsychological assessment.  All that can be produced are probabilities, not certainties.  So what I can do is to make the statement that these tests are entirely consistent with the history of chemical exposure.”[3]

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