PCB Reductions Through Detoxification

PCB Reduction and Clinical Improvement by Detoxification: An Unexploited Approach?

1. A detoxification trial was administered to a female worker from a capacitor factory who had been exposed to polychlorinated biphenyls (PCBS) and other lipophilic industrial chemicals.

2. The patient presented with severe abdominal complaints, chloracne, liver abnormalities, and a spontaneous nipple discharge of approximately 50 ml d-1.

3. PCB levels were high in adipose tissue (102 mg kg 1), serum, (512 [tg I-'), skin lipids (66.3 mg kg-'), and in the nipple discharge (712 [tg I-').

4. The patient's history, the medical evaluation and prior unsuccessful symptomatic treatments were indicative of consequences elicited by occupational exposure to chemicals.

5. Detoxification treatment reduced the PCB levels in adipose tissue to 37.4 mg kg-, and in serum to 261 [ig I 1, a 63% and 49% reduction, respectively.

6. The nipple discharge ceased and the symptoms improved.

7. Excretion of intact PCBs in sebum was appreciable before treatment and was enhanced by up to five-fold during detoxification.

8. This therapeutic approach appears promising for cases involving occupational exposure to lipophilic chemicals.

Introduction

Occupational exposure to industrial chemicals is of increasing relevance to medical evaluation. Among the toxic compounds having had widespread use are PCBS. Though currently banned in most industrial countries, they were commercially used in the electrical industry for more than 40 years and are present in extant electrical equipment throughout the world.^1.2

PCBs have a high propensity for accumulation in adipose tissue.3 Although long-term health effects in humans are still being investigated, most reports support an association between the clinical symptoms and the occupational exposure to aromatic hydrocarbons, including PCBs.4 In industrial settings, however, this issue remains confounded by the influences of other chemicals used concurrently with PCBS. A capacitor factory in Semic, a small town in Slovenia, Yugoslavia, used PCBs as the main impregnated substance from 1962 to 1985.

Aroclor 1242 (42% chlorine content) and 1254 (54% chlorine content) were the main PCB mixtures. Their inappropriate handling and disposal resulted in occupational exposure and broad environmental contamination, which were detected in 1983 .5 Several patients from that region, both occupationally and inadvertently exposed, were referred to the University Medical Centre of Ljubljana, Yugoslavia, for evaluation of their symptoms.6 This incited a ban on the use of PCBs in the production lines in 1985. We present the case of a female patient who was admitted to the University Medical Department of Gastroenterology. The patient was occupationally exposed to PCBs and had elevated levels of these chemicals in serum, adipose tissue and in her spontaneous nipple discharge. She had gradually developed a clinical picture with symptoms of abdominal pains and bloating, general fatigue and muscle pains, chloracne eruptions and sun sensitivity, joint pains and swelling of her limbs, menstrual irregularities, and a nipple discharge of 50 ml d-1.

The clinical assessment and the results of medical evaluations corroborated the conclusion that complaints followed exposure to chemicals. Since previous treatment with analgesics, skin lotions, and steroids had been ineffective, as was an appendectomy, we explored an alternative therapeutic approach designed to remove chemicals from the body. The assumption underlying this approach was that the observed toxic manifestations may have been related to the continuous presence of certain lipophilic chemicals in the tissues. A recently reported detoxification treatment seemed promising as it had reduced levels of lipophilic chemicals, including PCBS, in adipose tissue.7 We present the favourable outcome of this treatment.

Methods

Case Presentation

The female patient, 33, was admitted because of frequent attacks of abdominal cramps with visible bloating and nausea. Vomiting, diarrhea, and meteorism were not present. Serum transaminases were periodically increased: aspartate aminotransferase (AST) 20 U I '; alanine aminotransferase (ALT) 29 U 1-1; and g-glutamyl transferase (gGT) 52 U I 1 (Table 1).

History: The patient had an unremarkable childhood. She was a healthy, non-alcoholic, nonsmoking mother of two children and had been capable of full-time employment and the care of her home until 1969. At that time she first noticed eruptions of chloracne, associated in the following years with skin thickening, eye watering, sun sensitivity, muscle pains and a progressive loss of endurance.

From 1970 on, she reported the onset of headaches, non-productive cough and recurrent sinusitis with common-cold like symptoms. Two successive bronchopneumonias required Admission to the hospital. In 1975, she observed a spontaneous, bluishgreen coloured, nipple discharge appearing daily, unrelated to the then regular menstrual cycle. Its quantity increased from a few drops, barely staining her clothes, to approximately 50 ml d-' in 1984. When expressed for diagnostic procedures, 200 ml could be collected in one day.

Since 1979, the patient reported morning joint pains, swelling of the fingers, and sharp bursts of pains in her extremities leading to a momentary loss of strength. Sudden attacks of dull abdominal pains, accompanied by visible abdominal bloating, began in that year. In time the attacks increased, from an initially mild discomfort, to episodes with symptoms of intolerable level. The attacks occurred up to three times per month and could be exacerbated by heavy physical work. Her menstrual cycle became irregular in 1982.

An increasing requirement for sleep beyond her usual 8 h, with general fatigue present even after 16 h of uninterrupted sleep, was apparent in late 1986. Symptomatic treatments relieved some of the symptoms for brief intervals. They included application of skin lotions and topical steroids for the rashes and chloracne eruptions, dental repairs for chronic sinusitis and headaches, and oral contraceptive agents and dilatation and curettage for the irregular menstrual cycle. The acute nature and the pronounced clinical signs of an abdominal attack prompted an urgent exploratory laparotomy in 1984. Regional mesenteric lymphadenitis was found, while the removed appendix was histologically unremarkable.

Occupational history: The patient was first employed at the Semic factory in 1967. Direct contact with PCBs could be confirmed for 9 months in 1979, when she tested approximately 20,000 small capacitors per day for leakage of PCBS. The work was done by hand, using little or no protection. Though she otherwise did not work directly with PCBS, her working places were close to the uninsulated impregnating hall. The production process made handling of trichloroethylene (TCE), epoxides, neoprene and similar chemicals unavoidable. Although the patient reported common exposure to these chemicals, the precise timings of the exposures are not available.

Initial Examination: Clinical findings upon Admission revealed a normally developed, well nourished young white female, body temperature 36.7'C,respirationsl2min 'pulse68min 'and blood pressure 112/79 mmHg. The skin of the face and extremities appeared thickened. Scars from healed chloracne and fresh eruptions were present on the face, trunk and extremities. The lower eyelids appeared hyperpigmented. No peripheral oedema or lymphadenopathy were found. Her height was 154.9 cm, weight 57.6 kg, and the lean/fat ratio was 28.8%.

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