title: Liver damage among shoe repairers.
abstract: BACKGROUND
  The risk of hepatotoxicity in the shoe industry has already been suggested, however, there has been no investigation among the craftsmen who repair shoes.
  
  
  METHODS
  A group of 33 shoe repairers who work in supermarkets, and who use the same glues which contain mixtures of potentially hepatotoxic solvents were identified. A control group of 61 workers not exposed to hepatotoxic substances was also examined. All participants completed a questionnaire designed to identify potential risk factors and the main non-occupational confounding factors for hepatotoxicity. Laboratory tests, commonly used in clinical practice, were done to check whether they were useful markers of hepatotoxicity due to exposure to solvent mixtures, and to investigate which tests should be used in the screening campaigns.
  
  
  RESULTS
  The exposed workers had a higher prevalence of elevated mean alanine aminotransferase (ALT), aspartate aminotransferase (AST), conjugated bilirubin (P=0.0001), and alkaline phosphatase (AP) (P=0.004) than controls did. The number of workers who had values outside the upper limit of normal for our laboratory was significantly higher (ALT P=0.034, AST P=0. 037, conjugated bilirubin P=0.014). Exposed workers all had a ratio of ALT to AST greater than 1, with a mean of 1.5; it was > 1.6 in more than half the exposed workers.
  
  
  CONCLUSIONS
  The findings suggest that there is the possibility of liver involvement among even asymptomatic shoe repairers, and that periodic liver screening may be useful; furthermore, use of these tests (especially the ratio of ALT to AST) for craftsmen who repair shoes, and are exposed to solvent mixtures, is advisable even when environmental monitoring indicates levels below the threshold limit values (TLVs).
authors.affiliation: Occupational Medicine Department, La Sapienza University, Rome, Italy. Tomei@axrma.uniroma1.it
authors.forename: F
authors.initials: F
authors.lastname: Tomei
authors.forename: P
authors.initials: P
authors.lastname: Giuntoli
authors.forename: M
authors.initials: M
authors.lastname: Biagi
authors.forename: T P
authors.initials: TP
authors.lastname: Baccolo
authors.forename: E
authors.initials: E
authors.lastname: Tomao
authors.forename: M V
authors.initials: MV
authors.lastname: Rosati
mesh_terms: D000085:Acetates / Q000009:adverse effects; D000096:Acetone / Q000009:adverse effects; D000269:Adhesives / Q000009:adverse effects; D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D000469:Alkaline Phosphatase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D001663:Bilirubin / Q000097:blood; D015415:Biomarkers / Q000032:analysis; D002074:Butanones / Q000009:adverse effects; D056486:Chemical and Drug Induced Liver Injury; D015986:Confounding Factors, Epidemiologic; D004784:Environmental Monitoring; D006586:Hexanes / Q000009:adverse effects; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009784:Occupational Diseases / Q000139:chemically induced*; D016273:Occupational Exposure; D015995:Prevalence; D012307:Risk Factors; D012775:Shoes; D012997:Solvents / Q000009:adverse effects; D011795:Surveys and Questionnaires; D020711:Threshold Limit Values; D014050:Toluene / Q000009:adverse effects; D005723:gamma-Glutamyltransferase / Q000097:blood
chemical_list: D000085:Acetates; D000269:Adhesives; D015415:Biomarkers; D002074:Butanones; D006586:Hexanes; D012997:Solvents; D000096:Acetone; D014050:Toluene; C005222:methylethyl ketone; C007650:ethyl acetate; D005723:gamma-Glutamyltransferase; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D000469:Alkaline Phosphatase; D001663:Bilirubin