title: Lung function, biological monitoring, and biological effect monitoring of gemstone cutters exposed to beryls.
abstract: OBJECTIVE
  Gemstone cutters are potentially exposed to various carcinogenic and fibrogenic metals such as chromium, nickel, aluminium, and beryllium, as well as to lead. Increased beryllium concentrations had been reported in the air of workplaces of beryl cutters in Idar-Oberstein, Germany. The aim of the survey was to study the excretion of beryllium in cutters and grinders with occupational exposure to beryls--for example, aquamarines and emeralds--to examine the prevalence of beryllium sensitisation with the beryllium lymphocyte transformation test (BeLT), to examine the prevalence of lung disease induced by beryllium, to describe the internal load of the respective metals relative to work process, and to screen for genotoxic effects in this particular profession.
  
  
  METHODS
  In a cross sectional investigation, 57 out of 100 gemstone cutters working in 12 factories in Idar-Oberstein with occupational exposure to beryls underwent medical examinations, a chest radiograph, lung function testing (spirometry, airway resistance with the interrupter technique), and biological monitoring, including measurements of aluminium, chromium, and nickel in urine as well as lead in blood. Beryllium in urine was measured with a newly developed direct electrothermal atomic absorption spectroscopy technique with a measurement limit of 0.06 microgram/l. Also, cytogenetic tests (rates of micronuclei and sister chromatid exchange), and a BeLT were performed. Airborne concentrations of beryllium were measured in three factories. As no adequate local control group was available, the cutters were categorised into those with an exposure to beryls of > 4 hours/week (group A) and < or = 4 hours/week (group B).
  
  
  RESULTS
  Clinical, radiological, or spirometric abnormalities indicating pneumoconiosis were detected in none of the gemstone cutters. Metal concentrations in biological material were far below the respective biological limit values, and beryllium in urine was only measurable in subjects of group A. Cytogenetic investigations showed normal values which were independent of the duration of beryllium exposure. In one subject, the BeLT was positive. Beryllium stimulation indices were significantly higher in subjects with detectable beryllium in the urine than in those with beryllium concentrations below the detection limit (p < 0.05). In one factory, two out of four measurements of airborne beryllium concentrations were well above the German threshold limit value of 2 micrograms/m3 (twofold and 10-fold), and all gemstone cutters working in this factory had measurable beryllium concentrations in urine.
  
  
  CONCLUSIONS
  No adverse clinical health effects were found in this cross sectional investigation of gemstone cutters working with beryls. However, an improvement in workplace hygiene is recommended, accompanied by biological monitoring of beryllium in urine.
authors.affiliation: Zentralinstitut für Arbeitsmedizin der Freien und Hansestadt Hamburg, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Wegner
authors.forename: R
authors.initials: R
authors.lastname: Heinrich-Ramm
authors.forename: D
authors.initials: D
authors.lastname: Nowak
authors.forename: K
authors.initials: K
authors.lastname: Olma
authors.forename: B
authors.initials: B
authors.lastname: Poschadel
authors.forename: D
authors.initials: D
authors.lastname: Szadkowski
mesh_terms: D000328:Adult; D001608:Beryllium / Q000009:adverse effects*; D003430:Cross-Sectional Studies; D004391:Dust / Q000009:adverse effects*; D004784:Environmental Monitoring / Q000706:statistics & numerical data*; D062665:Epidemiological Monitoring; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D006967:Hypersensitivity / Q000453:epidemiology; D008171:Lung Diseases / Q000453:epidemiology; D008297:Male; D009152:Mutagenicity Tests; D016273:Occupational Exposure / Q000009:adverse effects*; D015995:Prevalence
chemical_list: D004391:Dust; D001608:Beryllium