DUSTS AS CARCINOGENS
1
175 placed on avoiding parenteral exposure to blood and body fluids. Patients with HIV infection need not be isolated unless the doctor thinks it is necessary for the welfare of the patient, when a secondary infection poses a risk to others, and when the patient is incontinent, lbleeding, or mentally disturbed. Laboratories must have a written ’code of practice for all work with HIV. Specimens that may contain :HIV should be handled at not less than containment level 2 except when the virus is being propagated or concentrated, when the work should be done in a microbiological safety cabinet at containment level 3. Analytical equipment need not be reserved solely for work on HIV unless a local decision it taken to do so because of the size of ;the workload. For large-scale non-urgent work specimens may be treated with p-propiolactone to inactivate the virus, but the procedure has hazards of its own and is not recommended for routine use. DESTROYING UNWANTED ANTINEOPLASTIC AGENTS SEVERAL drugs used in cancer therapy are themselves carcinogenic. Beginning with aflatoxins in 1980, the International Agency for Research on Cancer (IARC) has been publishing monographs on the safe disposal of many carcinogens, and the latest in the series1 will be more relevant to hospitals than most of the earlier volumes have been. Of 18 antineoplastic agents whose simple, safe chemical destruction has been considered in a joint IARC/NIH project, 13 have been evaluated for carcinogenicity by the IARC; 6 are categorised as human carcinogens or probable carcinogens. Full technical details of the chemical degradations are provided but the principles are simple. For example, methotrexate can be rendered safe by oxidation with potassium permanganate or sodium hypochlorite; cyclophosphamide is destroyed by dimethyl- formamide and sodium hydroxide. The precise application will depend on whether, for example, it is a solid that is to be disposed of or a liquid accidentally spilled. THE UNACCEPTABLE FACE OF OLD AGE "I am an old woman now And Nature is cruel It is her jest to make Old age look like a fool."’ THE ability to survive nowadays has turned into something of a disadvantage. The old have sometimes nothing to do, no role. They may be seen as socially redundant and a burden to the young. Anyone with an elderly mentally infirm relative will be familiar with the conflict-laden decisions about care that have to be made. The responsibility often devolves on to one family member’s weary shoulders-to the guilty relief of others. Caring for mentally infirm old people is a demoralising job with no apparent reward. Payment for the formal carer ensures continuity of adequate care. The unpaid carer, however, receives none of the usual gratification in caring for another. The Limits of Altruism2 explores the possibility of individuals and agencies collaborating to strengthen response to the needs of a vulnerable group of people. The book reports on a research project that attempts to bridge the gap between institutional care, community care, and informal care. The project takes elderly mentally infirm people as a test case for such collaboration-ie, working well together on a common task, to achieve something that none of the agencies could do on their own. The author investigates the idealism and the rhetoric that can mask true collaborative effort. By 1991 Britain may need to have 20 000 hospital beds for elderly demented people. The figure will be even greater as social factors, isolation, or the breakdown of family care increase the demand for hospital places. 1. Laboratory Decontamination and Destruction of Carcinogens in Laboratory Wastes: Some Antineoplastic Agents (IARC Sci Publ 73). Edited by M. Castegnaro, J. Adams, M. A. Armour, and others. Oxford. Oxford University Press, for the IARC. 1986. Pp 163. £10. 2 The Limits of Altruism Elderly Mentally Infirm People as a Test Case for Collaboration. By Tim Dartington. London King Edward’s Hospital Fund. 1986. Pp 102. £5 RETINITIS PIGMENTOSA ABOUT twenty-five thousand people are affected by retinitis pigmentosa in Great Britain alone. There is no cure for this progressive inherited disease, and with advances in treatment for other eye disorders this has meant that the number of people with retinitis pigmentosa in homes for the blind is disproportionately large. At a press conference in London on July 11 to re-launch the British Retinitis Pigmentosa Society’s eye donor scheme,* sup- ported with financial assistance from Lloyd’s Bank, Prof John Marshall of the Institute of Ophthalmology reported that twenty- eight pairs of affected eyes have been donated for research since the introduction of the scheme 5 years ago. Research workers have isolated the site of the genetic defect in one type of retinitis pigmentosa to within 500 of the length of the defective chromo- some. Studies of the effect of ageing and the development of transplantation techniques are underway, and there is now international exchange of dystrophic tissue. Research arising as a result of the scheme has led to the establishment of a new laboratory at the Rayne Institute, St Thomas’ Hospital, which will be opened in the autumn. The joint coordinators of the laboratory will be Professor Marshall and Prof Michael Neal of St Thomas’ Hospital, who will investigate the molecular biology aspects of inherited retinal dystrophies. *Inquiries to the BRPS, Greens Norton Court, Greens Norton, Towces- ter, Northamptonshire NN12 8BS. DUSTS AS CARCINOGENS THE curious feature of wood dust from the standpoint of cancer research is the fact that it has been possible to confirm an association between adenocarcinoma of the nasal cavity and sinuses and work with hard woods by epidemiological means, while laboratory proof has not been forthcoming. The association may now be waning, with changes in the woodworking industry. Wood dust is very complex chemically, as dusts tend to be-and a similar difficulty bedevils crystalline silica, the second topic covered by a review from the Health and Safety Executive staff. Dust exposure may contribute to the increased death rates from cancer of the stomach and lung that have been recorded in some occupational groups "but the specific role of silica is unclear". Inorganic arsenic compounds have also been reviewed Although these appraisals of industrial chemicals do not make recommendations on exposure limits they are used by the Health and Safety Commission’s Advisory Committee on Toxic Substances in deciding on what control measures may be necessary. DEATH ON THE FARM THE farming industry is second only to construction in the league table of Britain’s hazardous industries. Almost 300 people died as a result of accidents on the farm between 1981 and 1984, according to a report from the Health and Safety Executive’s accident prevention advisory unit. Working with self-propelled machinery is by far the most dangerous job-a farmer’s wife was killed by a blade that flew off a rotary mower. The figures for 1985 reflect the findings of the report; of 82 fatal accidents in Great Britain in 1985-15 more than in 1984-25 involved self-propelled machines. Deaths in children more than doubled, from 4 in 1984 to 10 in 1985, and there was a sharp increase in deaths from falling or swinging objects, from 5 to 13. The number of deaths from occupational diseases also rose; 7 were recorded in 1985, compared with a total of 10 recorded for the previous 4 years. The extent of death and illness attributable to pesticides and other chemicals has yet to be established. The report found that on many farms there were still Victorian working conditions which would not be tolerated in other industries. The main cause of accidents was a failure to provide safe working conditions and to comply with recognised good practice. 1. Carcinogenic Hazard of Wood Dusts, Carcinogenicity of Crystalline Silica (HSE Toxicity Rev 15). By J J B. Tinkler, M Greenburg, and H. P A. Illig. London: HMSO. 1986 Pp 39 £5 2. Inorganic Arsenic Compounds (HSE Toxicity Rev 16) By R. J. Fielder, E A Dale, and S D. Williams. London: HMSO. 1986. Pp 95 £12.50. 3. Health and Safety Executive Agricultural black spot: a study of fatal accidents London. HM Stationery Office, 1986 £2 50
Transcript of DUSTS AS CARCINOGENS
175
placed on avoiding parenteral exposure to blood and body fluids.Patients with HIV infection need not be isolated unless the doctorthinks it is necessary for the welfare of the patient, when a secondaryinfection poses a risk to others, and when the patient is incontinent,lbleeding, or mentally disturbed. Laboratories must have a written’code of practice for all work with HIV. Specimens that may contain:HIV should be handled at not less than containment level 2 exceptwhen the virus is being propagated or concentrated, when the workshould be done in a microbiological safety cabinet at containmentlevel 3. Analytical equipment need not be reserved solely for workon HIV unless a local decision it taken to do so because of the size of
;the workload. For large-scale non-urgent work specimens may betreated with p-propiolactone to inactivate the virus, but theprocedure has hazards of its own and is not recommended forroutine use.
DESTROYING UNWANTED ANTINEOPLASTICAGENTS
SEVERAL drugs used in cancer therapy are themselves
carcinogenic. Beginning with aflatoxins in 1980, the InternationalAgency for Research on Cancer (IARC) has been publishingmonographs on the safe disposal of many carcinogens, and the latestin the series1 will be more relevant to hospitals than most of theearlier volumes have been. Of 18 antineoplastic agents whosesimple, safe chemical destruction has been considered in a jointIARC/NIH project, 13 have been evaluated for carcinogenicity bythe IARC; 6 are categorised as human carcinogens or probablecarcinogens. Full technical details of the chemical degradations areprovided but the principles are simple. For example, methotrexatecan be rendered safe by oxidation with potassium permanganate orsodium hypochlorite; cyclophosphamide is destroyed by dimethyl-formamide and sodium hydroxide. The precise application willdepend on whether, for example, it is a solid that is to be disposed ofor a liquid accidentally spilled.
THE UNACCEPTABLE FACE OF OLD AGE
"I am an old woman nowAnd Nature is cruelIt is her jest to make
Old age look like a fool."’
THE ability to survive nowadays has turned into something of adisadvantage. The old have sometimes nothing to do, no role. Theymay be seen as socially redundant and a burden to the young.Anyone with an elderly mentally infirm relative will be familiar withthe conflict-laden decisions about care that have to be made. The
responsibility often devolves on to one family member’s wearyshoulders-to the guilty relief of others. Caring for mentally infirmold people is a demoralising job with no apparent reward. Paymentfor the formal carer ensures continuity of adequate care. The unpaidcarer, however, receives none of the usual gratification in caring foranother. The Limits of Altruism2 explores the possibility ofindividuals and agencies collaborating to strengthen response to theneeds of a vulnerable group of people. The book reports on aresearch project that attempts to bridge the gap betweeninstitutional care, community care, and informal care. The projecttakes elderly mentally infirm people as a test case for such
collaboration-ie, working well together on a common task, toachieve something that none of the agencies could do on their own.The author investigates the idealism and the rhetoric that can masktrue collaborative effort. By 1991 Britain may need to have 20 000hospital beds for elderly demented people. The figure will be evengreater as social factors, isolation, or the breakdown of family careincrease the demand for hospital places.
1. Laboratory Decontamination and Destruction of Carcinogens in Laboratory Wastes:Some Antineoplastic Agents (IARC Sci Publ 73). Edited by M. Castegnaro, J.Adams, M. A. Armour, and others. Oxford. Oxford University Press, for theIARC. 1986. Pp 163. £10.
2 The Limits of Altruism Elderly Mentally Infirm People as a Test Case for
Collaboration. By Tim Dartington. London King Edward’s Hospital Fund. 1986.Pp 102. £5
RETINITIS PIGMENTOSA
ABOUT twenty-five thousand people are affected by retinitis
pigmentosa in Great Britain alone. There is no cure for this
progressive inherited disease, and with advances in treatment forother eye disorders this has meant that the number of people withretinitis pigmentosa in homes for the blind is disproportionatelylarge. At a press conference in London on July 11 to re-launch theBritish Retinitis Pigmentosa Society’s eye donor scheme,* sup-ported with financial assistance from Lloyd’s Bank, Prof JohnMarshall of the Institute of Ophthalmology reported that twenty-eight pairs of affected eyes have been donated for research since theintroduction of the scheme 5 years ago. Research workers haveisolated the site of the genetic defect in one type of retinitispigmentosa to within 500 of the length of the defective chromo-some. Studies of the effect of ageing and the development oftransplantation techniques are underway, and there is nowinternational exchange of dystrophic tissue. Research arising as aresult of the scheme has led to the establishment of a new laboratoryat the Rayne Institute, St Thomas’ Hospital, which will be openedin the autumn. The joint coordinators of the laboratory will beProfessor Marshall and Prof Michael Neal of St Thomas’ Hospital,who will investigate the molecular biology aspects of inheritedretinal dystrophies.
*Inquiries to the BRPS, Greens Norton Court, Greens Norton, Towces-ter, Northamptonshire NN12 8BS.
DUSTS AS CARCINOGENS
THE curious feature of wood dust from the standpoint of cancerresearch is the fact that it has been possible to confirm an associationbetween adenocarcinoma of the nasal cavity and sinuses and workwith hard woods by epidemiological means, while laboratory proofhas not been forthcoming. The association may now be waning,with changes in the woodworking industry. Wood dust is verycomplex chemically, as dusts tend to be-and a similar difficultybedevils crystalline silica, the second topic covered by a review fromthe Health and Safety Executive staff. Dust exposure maycontribute to the increased death rates from cancer of the stomachand lung that have been recorded in some occupational groups "butthe specific role of silica is unclear". Inorganic arsenic compoundshave also been reviewed Although these appraisals of industrialchemicals do not make recommendations on exposure limits theyare used by the Health and Safety Commission’s AdvisoryCommittee on Toxic Substances in deciding on what controlmeasures may be necessary.
DEATH ON THE FARM
THE farming industry is second only to construction in the leaguetable of Britain’s hazardous industries. Almost 300 people died as aresult of accidents on the farm between 1981 and 1984, according toa report from the Health and Safety Executive’s accident preventionadvisory unit. Working with self-propelled machinery is by far themost dangerous job-a farmer’s wife was killed by a blade that flewoff a rotary mower. The figures for 1985 reflect the findings of thereport; of 82 fatal accidents in Great Britain in 1985-15 more thanin 1984-25 involved self-propelled machines. Deaths in childrenmore than doubled, from 4 in 1984 to 10 in 1985, and there was asharp increase in deaths from falling or swinging objects, from 5 to13. The number of deaths from occupational diseases also rose; 7were recorded in 1985, compared with a total of 10 recorded for theprevious 4 years. The extent of death and illness attributable topesticides and other chemicals has yet to be established. The reportfound that on many farms there were still Victorian workingconditions which would not be tolerated in other industries. Themain cause of accidents was a failure to provide safe workingconditions and to comply with recognised good practice.
1. Carcinogenic Hazard of Wood Dusts, Carcinogenicity of Crystalline Silica (HSEToxicity Rev 15). By J J B. Tinkler, M Greenburg, and H. P A. Illig. London:HMSO. 1986 Pp 39 £5
2. Inorganic Arsenic Compounds (HSE Toxicity Rev 16) By R. J. Fielder, E A Dale,and S D. Williams. London: HMSO. 1986. Pp 95 £12.50.
3. Health and Safety Executive Agricultural black spot: a study of fatal accidentsLondon. HM Stationery Office, 1986 £2 50
