Impact of Firefighting Aqueous Film-Forming Foams on Human Cell Proliferation and Cellular Mortality

Abstract

Objective

Evaluate the toxic effects of Aqueous Film-Forming Foams used by firefighters for Class B fire suppression in human-derived kidney cells (HEK-293).

Methods

Three widely used AFFFs were collected from fire departments and were added to HEK-293 cells in various concentrations. Seventy-two hours post-treatment, cellular proliferation and toxicity were examined using commercially available kits.

Results

All AFFFs evaluated induced cellular toxicity and significantly decreased cell proliferation, even when cells were treated with concentrations 10-fold lower than the working concentration used for fire suppression.

Conclusion

Despite the reduced usage of PFAS-containing AFFFs in the firefighter work environment, the evaluated AFFFs demonstrated significantly altered cellular proliferation, while also inducing toxicity, indicating the presence of toxic compounds. Both stronger implementation of PFAS-containing AFFFs restrictions and robust evaluation of fluorine-free and next-generation AFFFs are warranted.

In Brief

Firefighters are routinely exposed to per- and polyfluoroalkyl substances (PFAS) through the use of Aqueous Film-Forming Foams (AFFFs) for the suppression of Class B fire, which derive from flammable and combustible liquids, such as gasoline and alcohol. The addition of surfactants and PFAS in the AFFFs allows them to form an aqueous film that can extinguish the fire, while also coating the fuel. As such, AFFFs are often used for fire extinction in airports and military bases.

Exposure to PFAS in the general population may arise from ingestion of contaminated food or water, usage of consumer products containing PFAS, such as non-stick cookware or stain resistant carpets and textiles, and inhalation of PFAS-containing particulate matter. Detection of increased serum PFAS concentrations has been linked to an elevated risk for kidney cancer in humans, and firefighters are known to have increased serum concentrations of certain PFAS after attending training exercises. In the same study it was also observed that the average urinary excretions of 2-butoxyacetic acid (2-BAA) a surfactant often added in AFFFs exceeded the reference limit of the occupationally unexposed population, ranging from 0.5 to 1.4 mmol/mol creatinine.

Furthermore, an increased risk of mortality from kidney cancer has been observed in firefighters compared to the U.S. population. The detrimental health effects of PFAS are exacerbated by their increased half-lives in humans. A recently published study examined the half-lives of short- and long- chained PFAS in the serum of 26 airport employees and observed a wide range of half-lives which was dependent on the length and chemical structure of each substance that was examined. Indicatively, the shortest half-life was described for perfluorobutanesulfonic acid (PFBS), while the linear isomer of perfluorooctanesulfonic acid (PFOS) had the longest half-life (average of 44 days and 2.93 years, respectively), findings which are in agreement with other sources in the literature.

One aspect of this phenomenon could be attributed to renal reabsorption, as humans actively transport PFAS in the proximal tubules. A recently published scoping review of 74 epidemiologic, pharmacokinetic, and toxicological studies examined the relationship between PFAS exposure and kidney-related health outcomes. It was observed that exposure to PFAS was associated with lower kidney function, including chronic kidney disease (CKD), and histological abnormalities in the kidneys, as well as alterations in key mechanistic pathways, that can induce oxidative stress, and metabolic changes leading to kidney disease.

The alarming number of studies showcasing the harmful health effects pertaining to PFAS exposure has led to the banning of the production of AFFFs containing highly toxic, long chain PFAS, such as perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) since 2015. However, this regulation is gradually being implemented across states and little is known about the toxicity of the next generation AFFFs. Based on the above, in the present study we evaluate cellular proliferation and toxicity in kidney-derived cells (HEK-293) that were exposed to three widely used AFFFs.

Read full study below

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Organic solvents and Multiple Sclerosis susceptibility

Abstract

Photo of dichloromethane (DCM) as stored by Irish Air Corps in 2015. DCM was banned in the EU in 2012.
Objective

We hypothesize that different sources of lung irritation may contribute to elicit an immune reaction in the lungs and subsequently lead to multiple sclerosis (MS) in people with a genetic susceptibility to the disease. We aimed to investigate the influence of exposure to organic solvents on MS risk, and a potential interaction between organic solvents and MS risk human leukocyte antigen (HLA) genes.

Methods

Using a Swedish population-based case-control study (2,042 incident cases of MS and 2,947 controls), participants with different genotypes, smoking habits, and exposures to organic solvents were compared regarding occurrence of MS, by calculating odds ratios with 95% confidence intervals using logistic regression. A potential interaction between exposure to organic solvents and MS risk HLA genes was evaluated by calculating the attributable proportion due to interaction.

Results

Overall, exposure to organic solvents increased the risk of MS (odds ratio 1.5, 95% confidence interval 1.2–1.8, p = 0.0004). Among both ever and never smokers, an interaction between organic solvents, carriage of HLA-DRB1*15, and absence of HLA-A*02 was observed with regard to MS risk, similar to the previously reported gene-environment interaction involving the same MS risk HLA genes and smoke exposure.

Conclusion

The mechanism linking both smoking and exposure to organic solvents to MS risk may involve lung inflammation with a proinflammatory profile. Their interaction with MS risk HLA genes argues for an action of these environmental factors on adaptive immunity, perhaps through activation of autoaggressive cells resident in the lungs subsequently attacking the CNS.

Read full study below

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Anecdotal evidence has been emerging for some time of potential illness clusters at Casement Aerodrome to which Multiple Sclerosis has now been added. We are calling for these potential clusters to be investigated by competent authorities.

Suspected illness clusters currently include.

What did the British ever do for us? A fit for purpose solvent extraction system at Irish Air Corps!

The British Royal Flying Corps built a solvent exhaust stack at the now Irish Air Corps airbase at Baldonnel over 100 years ago. This exhaust stack stack featured a powerful fan for safely removing solvent fumes from a degreasing bath.
In the mid 1980s the Air Corps Machine Shop was moved to this location at the front of the ERF (Engine Repair Flight) building. To facilitate this move the “Trike Bath”, a heated trichloroethylene solvent vapour degreaser, was located to a new Non Destructive Testing (NDT) Shop to the rear of Engine Repair Flight (ERF). The 25 foot extractor chimney was replaced with an inadequate 6 inch fan which was ducted through a nearby window. 
Around 2006 an NDT technician in ERF turned yellow from jaundice due to a chemical induced liver injury. After the NDT technician turned yellow the officer in charge of Health & Safety ordered that the Safety Data Register and adverse air quality tests be destroyed.
The ERF building was condemned in September 2007, a fact that was denied in the Dáil by the former Junior Minister for Defence Paul Kehoe TD.
After some serving & former ERF personnel sought their medical files throught their solicitors in early 2008 the building vanished.
#97dead #DelayDenyDie #TCE #Trike

Trichloroethylene used to clean the floors in Irish Air Corps cookhouse!

Every now and again when investigating poor health & untimely deaths of colleagues in the Irish Air Corps at Casement Aerodrome we come across a cluster of unexplained deaths or illness in particular work locations.

Exposures are briefly explained by location below those in RED were unexplained until personnel came forward to highlight misuse of chemicals in these locations.

Apprentice Hostel

Exposure to asbestos was the main problem in the apprentice hostel and it does not appear to have been fully removed until the mid 1990s although some efforts were made to remove the bulk of it in the late 1980s. The 1990s effort used a professional removal service while the late 1980s effort used apprentices without any PPE whatsoever. Persistent black marks on lino or floor tiles would be dealt with by calling to the nearest hangar or workshop to borrow some MEK or Trike

Avionics, ERF & Parachute Shop

Illness & untimely deaths in Avionics Squadron and Engine Repair Flight (Engine Shop) can be explained by unprotected exposure to the chemicals used in both locations and by their exposure to exhaust fumes from the Spray Paint Facility. The Parachute Shop which was part of ERF establishment also used toxic glues and exposed personnel to fumes from PU coated drysuits.

Basic Flight Training School

Illness & untimely deaths in BFTS can be explained by the IRAN inspections where DCM/Phenol paint strippers were used without PPE and the extensive use (like in heli) of corrosion inhibitors like Mastinox. Of course the fuel for the Marchettis was leaded gasoline with its own issues.

Battery Shop

Illness in the battery shop can be explained by exposure to battery electrolytes & charging fumes. The personnel walking around here with holes in their jumper, trousers and shirts from sulphuric acid was almost comical if it wasn’t such a serious risk to their health.

Cookhouse / NCOs Mess

Until now we had not been able to satisfactorily explain the unusual body count & illnesses of personnel who served in the old cookhouse kitchen, new cookhouse kitchen and NCOs Mess kitchen.

Recently we were made aware of a practice in the old cookhouse as far back as the mid 1970s whereby personnel who worked there procured solvent degreaser from up camp. We believe this degreaser again to be trichloroethylene.

This solvent was provided sometimes in 25 litre drums and sometimes in gallon containers where it was usually decanted into smaller vessels like milk bottles or coke bottles to be spread on the floor and then mopped and squeegeed until the floor was spotless.

And it turns out that this practice continued in the new cookhouse and technicians from ERF who dropped down 25 litre drums of Trike were rewarded with a wrap up of some food like steaks.

We believe this floor degreasing practice occurred in the NCOS Mess kitchen but we have no evidence yet that it occurred in the Officers Mess Kitchen but given the fluidity of personnel movements between the various catering locations it is a distinct possibility.

For some information on Illnesses caused by trichloroethylene click here.

Engineering Wing Hangar & Workshops

Illness & untimely deaths in Engineering Wing Hanagar can be explained by unprotected exposure to Paint Shop chemicals including isocyanates & thinners, Hydraulic Shop chemicals, Sheet Metal Shop chemicals, wood dust from the Carpentry Shop, welding fumes from the Welding Shop as well as paint stripper fumes and mastinox fumes from Marchetti IRANs or Alouette equivalent teardowns.

Fire Crew

Members of the fire crew would have had exposure to exhaust gasses of idling aircraft engines and would have also had exposure to fuel fumes  and burning fumes from training exercises. The Fire Crew also used PFAS based fire fighting foams.

Heli Wing

Illness & untimely deaths in Heli Wing are easily explained by unprotected exposure to the chemicals used maintaining helicopters, by exposure to fuel vapours from gravity refueling, exposure to exhaust gasses from gas turbine engines and the immune sensitisation capabilities of polyurethane coated immersion suits.  Toxic tubbing in Heli was also a thing.

Light Strike Squadron

Similarly illness & untimely deaths in Light Strike Squadron can be explained by unprotected exposure to refueling fumes, exhaust gasses and other lubricants, greases, hydraulic fluids and sealants used to maintain the Fougas. Toxic tubbing in LSS was also a thing.

Main Block

Illness & untimely deaths in the Main block can be explained by unprotected exposure to photographic film & printing chemicals. These photographic chemicals used in photo section drove death, illness & harm to offspring in personnel throughout the main block

Chemicals in use by workshops in Air Sp Coy Signals further exposed personnel in the mainblock to chemicals they would not have expected to be exposed to like trichloroethane etc.

Units exposed in the main block would include 

  • Admin Wing HQ
  • AE Section
  • Drawing Office
  • Air Corps INT
  • Medical Aid Post
  • Sgt Majors Office
  • Signals Bottom Workshop
  • Signals Top Workshop
  • Signals COMCEN
  • Signals Orderly Room & CO’s Office
  • Signals PC Maintenance Workshop
  • Signals Stores
  • Station Commanders Office

Main Tech Stores

Illness & untimely deaths in Main Technical stores can be explained by the fact that the building is sited on the old Camp Stables where hundreds if not thousands of litres of toxic chemicals such as Ardrox 666 were dumped into the ground. Complaints were made by civilian & military personnel about poor air quality  in MTS and studies were carried out but the reports have disappeared. There is also evidence that used chemical drums containing isocyanates were stored in MTS in an open state.

Photo Section

When photo section moved out of the Main Block to the old cookhouse in the early 1990s they brought their dangerous chemicals to this new locations. This new location was better equipped than the expellair in the main block. But faulty equipment and lack of chemical health & safety training meant illness & death continued.

Photographers who flew regularly exposure to refueling fumes, exhaust gasses from gas turbine engines and the immune sensitisation capabilities of polyurethane coated immersion suits.

Refuelers

Obviously refuelers were exposed on an ongoing basis to high amounts of refueling fumes and aircraft exhaust gasses but also to other dangerous additives like FSII.

Training Depot

On at least two occasions that we are aware of there was catastrophic damage caused to floors and walls by misuse of chemicals in ACTD.

On the first occasion in the late 1980s we are aware of a recruit using what we suspect to be a large quantity of MEK on twine backed traditional lino the last room on the left of the depot. The use of the chemical on this occasion melted the lino through to the twine backing.

On the second occasion in the mid 1990s at least 25 litres of trichloroethylene was used to clean the floor of some of the demonstration rooms that had been recently redecorated. The Trike was spread on the floor using mops and squeegees making the apprentices carrying out the job high. The next morning it was discovered that all the floor tiles had shriveled up and that all the paint on the walls up to about 1m had dissolved and flowed down the walls to the floor.

For some information on Illnesses caused by MEK click here.

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The physical layout of Baldonne means that the prevailing wind blows the exhaust gasses from idling aircraft over the whole camp.

There does not appear to have been any initiative whatsoever to reduce camp personnel exposure to exhaust gasses and in many cases aircraft exhaust into hangars due to the prevailing wind.

We have little information on chemical exposures at Gormanston except for tubbing and the use of JetA1 powered heaters inside hangars. We would welcome any information in this regards. 

Fourth study of mortality and cancer incidence in aircraft maintenance personnel: a continuing study of F1-11 Deseal/Reseal personnel 2016

Summary

From 1974 to 2000, the Royal Australian Air Force (RAAF) put in place formal Deseal/Reseal (DSRS) programs, in addition to informal repair methods, to correct fuel leaks in Australia’s F-111 fleet of aircraft. These programs were undertaken at RAAF Base Amberley in Queensland, and were suspended in early 2000 due to health concerns among DSRS personnel. A series of inquiries, investigations and scientific studies were commenced to determine the extent and impact of those health concerns.

As part of those investigations, the Mortality and Cancer Incidence Study (MCIS) was started to answer the following research question: did RAAF personnel involved either directly or indirectly in the F-111 DSRS maintenance programs (the DSRS-exposed Study Population) experience higher levels of mortality or cancer incidence compared with two groups of non-exposed RAAF personnel (the Comparison populations)—the RAAF Base Amberley (non-technical) Comparison Population and the RAAF Base Richmond (technical) Comparison Population?

Key findings

The results of the 4th MCIS show that involvement in the DSRS programs at RAAF Base Amberley was associated with a statistically significant 20–30% increase in the rate of cancer diagnosis, compared with both Comparison populations.

Involvement in the DSRS programs was also associated with a statistically significant 27% decrease in mortality compared with the Amberley Comparison Population.

Download the full study below.

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The key takeaway here is that a statistically significant 20-30% increase in cancer was turned into 27% lower mortality by awareness, vigilance and a coordinated medical response. 

  • Medical treatment for a range of conditions
  • Counselling through Open Arms – Veterans & Families Counselling;
  • Participation in Open Arms – Veterans & Families Counselling coordinated programs, including the Lifestyle Management Course and Heart Health;
  • Eligibility to participate in the Better Health Program – a cancer screening and disease prevention program; and
  • approved travel to attend medical consultations and counselling sessions and healthy lifestyle programs through Open Arms – Veterans & Families Counselling.

The policy of successive Taoisigh, Tánaistí, Ministers for Defence, Chiefs of Staff and Director Generals of the Department of Defence was, and appears still to be, to let personnel suffer and die unnecessarily without any targeted intervention whatsoever by the state. 

DELAY – DENY – DIE

 

 

Illnesses linked to dichloromethane aka DCM aka methylene chloride

CAS number: 75-09-2

Diseases linked to this toxicant grouped by strength of evidence.

Photo of DCM-based paint stripper as used by the Irish Air Corps in 2015. An EU ban on the use of DCM-based paint strippers came into force three years earlier on the 6th of June 2012.

Strong Evidence

  • Arrhythmias*
  • Myocardial infarction (heart attack)*

Good Evidence

  • Brain cancer – adult*
  • Fetotoxicity (miscarriage / spontaneous abortion, stillbirth)*
  • Reduced fertility – male (infertility and subfertility)*

Limited Evidence

  • Breast cancer*
  • Hepatocellular cancer (liver cancer)
  • Lung cancer*
  • Pancreatic cancer*
  • Peripheral neuropathy*
  • Prostate cancer*

Illnesses marked thus * have been suffered by Irish Air Corps personnel or their offspring.

Illnesses linked to #Trichloroethylene aka TCE aka TRIKE

Illnesses linked to trichloroethylene aka TCE aka TRIKE

CAS number: 79-01-6

Diseases linked to this toxicant grouped by strength of evidence.

Strong Evidence

  • Acute hepatocellular injury (hepatitis)*

Good Evidence

  • Acute tubular necrosis
  • Arrhythmias
  • Autoimmune antibodies (positive ANA, anti-DNA, RF, etc.)*
  • Cardiac congenital malformations*
  • Childhood leukemias
  • Cirrhosis*
  • Cognitive impairment (includes impaired learning, impaired memory, and decreased attention span) / mental retardation / developmental delay*
  • Decreased coordination / dysequilibrium
  • Fetotoxicity (miscarriage / spontaneous abortion, stillbirth)*
  • Hearing loss*
  • Hepatocellular cancer (liver cancer)*
  • Lymphoma (non-Hodgkin’s)*
  • Psychiatric disturbances (disorientation, hallucinations, psychosis, delirium, paranoias, anxiety/depression, emotional lability, mood changes, euphoria)*
  • Renal (kidney) cancer*
  • Scleroderma
  • Trigeminal neuropathy

Limited Evidence

  • ADD/ADHD, hyperactivity*
  • Adult-onset leukemias*
  • Brain cancer – adult*
  • Breast cancer*
  • Cervical cancer
  • Choanal atresia
  • Genito-urinary malformations (includes male and female)
  • Hodgkin’s disease (lymphoma)*
  • Immune suppression
  • Low birth weight / small for gestational age / intra-uterine growth retardation
  • Lung cancer*
  • Multiple myeloma*
  • Nephrotic syndrome
  • Neural tube defects / CNS malformations
  • Oral clefts (cleft lip and palate)
  • Pancreatic cancer*
  • Pancreatitis
  • Peripheral neuropathy*
  • Prostate cancer*
  • Raynaud’s phenomenon
  • Systemic lupus erythematosus*
  • Testicular cancer*

Illnesses marked thus * have been suffered by Irish Air Corps personnel or their offspring.

A review of health effects associated with exposure to jet engine emissions in and around airports

Background

Airport personnel are at risk of occupational exposure to jet engine emissions, which similarly to diesel exhaust emissions include volatile organic compounds and particulate matter consisting of an inorganic carbon core with associated polycyclic aromatic hydrocarbons, and metals. Diesel exhaust is classified as carcinogenic and the particulate fraction has in itself been linked to several adverse health effects including cancer.

Photo of Alouette III No 196 showing soiling of the tail boom with soot from exhaust gasses.
Method

In this review, we summarize the available scientific literature covering human health effects of exposure to airport emissions, both in occupational settings and for residents living close to airports. We also report the findings from the limited scientific mechanistic studies of jet engine emissions in animal and cell models.

Beechcraft 200 Super King Air No 240 showing soiling of the engine panels with soot from exhaust gasses.
Results

Jet engine emissions contain large amounts of nano-sized particles, which are particularly prone to reach the lower airways upon inhalation. Size of particles and emission levels depend on type of aircraft, engine conditions, and fuel type, as well as on operation modes. Exposure to jet engine emissions is reported to be associated with biomarkers of exposure as well as biomarkers of effect among airport personnel, especially in ground-support functions. Proximity to running jet engines or to the airport as such for residential areas is associated with increased exposure and with increased risk of disease, increased hospital admissions and self-reported lung symptoms.

Conclusion

We conclude that though the literature is scarce and with low consistency in methods and measured biomarkers, there is evidence that jet engine emissions have physicochemical properties similar to diesel exhaust particles, and that exposure to jet engine emissions is associated with similar adverse health effects as exposure to diesel exhaust particles and other traffic emissions.

Read full article journal at BMC

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The layout of the Irish Air Corps base at Casement Aerodrome ensures that aircraft exhaust gasses are blown over populated sections of the airbase when winds are from the south, south east or south west. This includes hangars, offices, workshops and living in accommodation such as the apprentice hostel and married quarters. Calm weather also creates conditions where exhaust gasses linger in higher concentrations.

This results in all Irish Air Corps personnel (commissioned, enlisted, civilian & living-in family) being exposed to emissions from idling aircraft engines, emissions that are known to cause harm.

In the mid 1990s a study of air pollution adjacent to the ramp area at Baldonnel was commissioned. This report relating to this study has gone missing. 

  • Anecdotal evidence suggests increased prevalence of occupational asthma & adult onset asthma amongst serving & former personnel who served in Baldonnel or Gormanston aerodromes. 
  • Older gas turbine engines produce dirtier exhaust gasses.
  • Idling gas turbine engines produce dirtier exhaust gasses.
Below are some of the gas turbine powered Air Corps aircraft that were powered by elderly engine designs.
AircraftRetiredEngine FamilyFirst Run
Alouette III2007Turbomeca Artouste1947
Fouga Magister1999Turbomeca Marboré1951
Gazelle2005Turbomeca Astazou1957
King Air 2002009Pratt & Whitney Canada PT61960
Dauphin II2005Turbomeca Arriel1974

DELAY – DENY – DIE

‘IT’S A SCANDAL’ RAF airman who flew with Prince William proves rare cancer was caused by the Sea King chopper

AN airman who flew choppers with Prince William has proved his rare form of bone marrow cancer was caused by the RAF Sea King.

Flight Sergeant Zach Stubbings was diagnosed with multiple myeloma after years of inhaling toxic exhaust fumes spewed from the powerful twin engines of the now retired aircraft.

Flight Sergeant Zach Stubbings, who flew choppers with Prince William, has proved his rare form of bone marrow cancer was caused by the RAF Sea King

And last month, the winch operator won a settlement from the Ministry of Defence after a six-year legal battle. Zach has been paid an undisclosed sum and the MoD had to admit in writing his 15 years of service in the RAF caused his life-threatening condition.

It will likely spark concern for the royals. Wills flew the Sea King in 150 search-and-rescue operations over a three-year period.  It is not known if he was affected by the fumes. Prince Andrew also flew the aircraft in the Falklands in 1982.

And The Sun can lift the lid on an apparent government cover-up of the issue.  Bombshell documents uncovered by Zach during his legal fight prove experts warned the MoD of the dangers of the Sea King exhaust as far back as 1999 but nothing was done.

Zach, 42, of Cardiff, said: “The Government chose to ignore it. It’s a scandal.”

Read more on the The sun

Baldonnel Bingo – Dichloromethane Edition

Baldonnel Bingo – Where only the good die young!

Who will be the champion ? ARF, Avionics, BFTS, ERF or MTS?

All the below illnesses are known* to be caused by dichloromethane (DCM) also known as methylene chloride.

DCM was banned after a vote in the European Parliament in January 2009. The ban came into place in 2011 but the Irish Air Corps were still happy to let unsuspecting personnel use DCM without PPE or training in 2015 & likely beyond.

The Irish Air Corps finally issued PPE to all personnel using chemicals in 2017 a full 20 years after being told to do so by state body Forbairt.

Click on image to download a 30 player PDF or organise a game online here

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References*

Klaassen CD, Ed. Casarett and Doull’s Toxicology: The Basic Science of Poisons, 6th Edition. New York: McGraw-Hill 2001.
LaDou J, Ed. Occupational and Environmental Medicine, 3rd Edition. New York: Lange Medical/McGraw-Hill Company, 2004.
Leikin JB, Davis A, Klodd DA, Thunder T, Kelafant GA, Paquette DL, Rothe MJ, Rubin R. Selected topics related to occupational exposures. Part V. Occupational cardiovascular disease. Disease-a-Month. 2000 Apr;46(4):311-322.
Lynge E, Anttila A, Hemminki K. Organic solvents and cancer. Cancer Causes and Control. 1997 May;8(3):406-19.
Rom WM. Environmental and Occupational Medicine, 3rd Edition. Philadelphia: Lippincott Williams & Wilkins Publishers, 1998.
Severe Optic Neuropathy Caused by Dichloromethane Inhalation
Atsushi Kobayashi, Akira Ando, Nobuko Tagami, Masahiko Kitagawa, Emi Kawai, Masako Akioka, Eiko Arai, Toshio Nakatani, Satoshi Nakano, Yoshie Matsui, and Miyo Matsumura Published Online:8 Dec 2008https://doi.org/10.1089/jop.2007.0100
Environmental and Chemical Toxins and Psychiatric Illness By James S. Brown. Publisher: American Psychiatric Association Publishing (27 Feb. 2002) Language: English ISBN-10: 0880489545