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The article presents the results of the dynamic clinical observation for persons suffered from occupational chronic mercury intoxication in the remote post-exposure period of the disease. The estimation of the dynamics of syndrome manifestations of chronic mercury intoxication and co-morbidity are presented. The important role of mercury exposure load as a predictor of deterioration of actual health of the patients in the remote period of intoxication is demonstrated.

Objectives: The aim of this study is to investigate the effect of elemental mercury exposure on renal function and antioxidative enzymes activity as a possible mechanism of renal affection among dental staff., Methods: This study was performed on a group of dental staff exposed to elemental mercury (N = 32) and matched control group (N = 37). Urinary and blood level of mercury, albumin α1 microgloblin in urine, glutathione peroxidase and superoxide dismutase blood level were measured for the exposed and control group., Results: Compared to the control group, urinary and blood mercury were significantly higher in the exposed group. Glutathione peroxidase and superoxide dismutase activities in blood were significantly decreased and were negatively correlated with duration of work., Conclusion: Oxidative stress is an important molecular mechanism for renal dysfunction in mercury exposure, manifested by decreased activities of antioxidant enzymes.

In 2003 UNIDO (United Nations Industrial Development Organization) conducted an environmental and health assessment in a small-scale mining area in Tanzania. BGS (British Geological Survey) performed the environmental assessment. The Institute of Forensic Medicine - University of Munich performed the health assessment. The results of the medical, neurological and neuro-psychological examination of 180 participants from the affected area of Rwamagasa and 31 controls were analyzed. Urine, blood and hair samples were analyzed to detect the level of mercury body burden. Mercury concentrations in the bio-monitors urine, blood and hair were statistically significantly higher in the exposed population from Rwamagasa compared to the control group from Katoro. Only amalgam burners showed mercury levels above the toxicological threshold limits. A speciation of mercury in hair indicated that mainly elemental mercury vapor contributed to the high body burden of the artisanal miners. 104 amalgam-burners, the most exposed population group, were examined. 25 of these workers were found to be intoxicated. Small-scale mining is a serious health hazard for amalgam burners. Reduction of the exposure is essential to prevent further damage., (Copyright 2009 Elsevier B.V. All rights reserved.)

Small scale miners use mercury to extract gold from ore in many countries. An environmental and health assessment was performed in Indonesia in two regions, Galangan in Central Kalimantan and Talawaan in Northern Sulawesi. The environmental assessment showed severe mercury contamination of the sediments, and increased mercury levels in local fish. For the health investigation 281 volunteers were recruited and examined by a standardized questionnaire, a neurological examination and neuro-psychological tests. A medical score was used consisting of significant factors of mercury intoxication. Mercury exposed workers showed typical symptoms of mercury intoxication, such as movement disorders (ataxia, tremor, dysdiadochokinesia, etc.). Blood, urine and hair samples were taken from any participant and analyzed for mercury. The mercury concentration in the biomonitors was high, partly extreme high in the working population, increased in the population living in the same habitat and low in the control group. By a standard protocol which includes a combination of threshold values of mercury in the biomonitors and a medical sum score the diagnosis of chronic mercury intoxication was made for highly burdened workers (amalgam smelters) in 55% in Sulawesi and in 62% in Kalimantan. Less exposed mineral processors and the general population in the mining areas were also intoxicated to a high percentage., (Copyright 2009 Elsevier B.V. All rights reserved.)

Visual field losses associated with mercury (Hg) exposure have only been assessed in patients exposed to methylmercury. Here we evaluate the automated visual field in 35 ex-workers (30 males; 44.20+/-5.92 years) occupationaly exposed to mercury vapor and 34 controls (21 males; 43.29+/-8.33 years). Visual fields were analyzed with the Humphrey Field Analyzer II (model 750i) using two tests: the standard automated perimetry (SAP, white-on-white) and the short wavelength automated perimetry (SWAP, blue-on-yellow) at 76 locations within a 27 degrees central visual field. Results were analyzed as the mean of the sensitivities measured at the fovea, and at five successive concentric rings, of increasing eccentricity, within the central field. Compared to controls, visual field sensitivities of the experimental group measured using SAP were lower for the fovea as well as for all five eccentricity rings (p<0.05). Sensitivities were significantly lower in the SWAP test (p<0.05) for four of the five extra-foveal eccentricity rings; they were not significant for the fovea (p=0.584) or for the 15 degrees eccentricity ring (p=0.965). These results suggest a widespread reduction of sensitivity in both visual field tests. Previous reports in the literature describe moderate to severe concentric constriction of the visual field in subjects with methylmercury intoxication measured manually with the Goldman perimeter. The present results amplify concerns regarding potential medical risks of exposure to environmental mercury sources by demonstrating significant and widespread reductions of visual sensitivity using the more reliable automated perimetry.

Examination of patients with chronic mercury poisoning and fire men subjected to complex of toxic chemicals during fire extinguishing revealed subclinical latent disorder of peripheral nerves due to chronic mercury intoxication and clinical manifestations of polyneuropathy involving nerves of upper and lower limbs in firemen.

In its elemental form, mercury is the only metal that is in a liquid state at room temperature. It readily volatilizes at standard temperature and pressure, and its presence in open containers can result in biologically significant air concentrations in unventilated or poorly ventilated spaces. In recent years, elemental mercury has proven to be a potential source of toxicosis through either unintentional exposure or exposure resulting from inappropriate handling of liquid mercury acquired from school science laboratories or abandoned industrial facilities or warehouses. The shiny, silvery appearance of mercury in its liquid form makes it particularly enticing to children, and its insolubility in water and tendency to form beads when disturbed add to its mystique. This paper presents two case studies in which excessive exposure to elemental mercury vapor has resulted in adverse health effects in the exposed individuals: one in the workplace and one in a residential setting. These case studies serve to emphasize that primary care physicians, public health officials, and science educators need to recognize the potential risk posed by inhalation exposure to mercury vapors, and health practitioners need to be able to recognize the health signs and symptoms of such exposure. Public health professionals and those in charge of public and private education facilities should also be keenly aware of the necessity of prompt mitigation of human exposure should a spill or other mercury exposure scenario occur.

Mercury is found in many of the devices used by healthcare professionals, including thermometers and sphygmomanometers. The growing awareness about exposure to mercury demands home care nurses understand the basics to teach patients and families about the dangers. This article outlines core concerns and provides specific information and resources about mercury.

A meta-analysis for neurobehavioural test results of subjects occupationally exposed to mercury was carried out in order to find general tendencies and express possible deficits numerically. Out of 44 studies investigating neurobehavioural functions of occupationally exposed individuals, 12 studies provided the data required and were included in the analysis. In all, 14 neuropsychological tests with 20 different tasks were analysed. The results related to 686 exposed and 579 control subjects. Nine significant performance effects were shown for mean urinary concentrations between 18 and 34 microg Hg/g creatinine. The effects sizes (D(W+)) referred to attention (D(W+)=-0.40 and -0.46), memory (D(W+)=-0.38 and -0.40), construction (D(W+)=-0.20) and motor performance (D(W+)=-0.24, -0.40, -0.44 and -0.47). Additionally there was evidence for a dose-response relationship of effect sizes, if all test results were taken into account. Whether the effect sizes could be subject to overestimation was discussed, but there were no reasons for such an assumption. The results can be used as suggestions for new discussions about threshold limit values.

Objectives: This paper aims to give the dental practitioner insight into the potential reproductive effects of handling dental silver amalgam, c.q. mercury., Data Sources: Experimental studies on animals, case reports and epidemiologic studies., Study Selection: Experimental animal studies show high doses/concentrations of mercury to increase the risk of reproductive disorders, e.g. infertility, spontaneous abortion, stillbirth and congenital malformations. Some case reports suggest an association between the disorders in humans and high levels of mercury. Therefore, the present article reviews epidemiological studies on the relationship between occupational exposure to mercury, mainly as vapour in the dental practice, and females' procreative ability. Studies concerning the reproductive effects of males' occupational mercury body burden are scarce. The reproductive risk of patients' mercury uptake from silver amalgam fillings is assessed., Conclusions: It seems warranted to conclude that negative reproductive effects from exposure to mercury in the dental office are unproven, but safe levels have not been established. Seemingly problems are unlikely to occur, unless a poor hygiene causes the mercury concentration in the air to exceed females' time-weighted long-term Threshold Limit Value (TLV). Consequently, in view of the in general low amounts of mercury stemming from dental amalgam fillings, the population at large is at even less risk than dental staff. The effects of occupational elemental mercury concentrations lower than the TLV on the menstrual cycle, conception, male fertility and children's behaviour need, however, more research.

Question: One of my pregnant patients, a dental hygienist, uses mercury in her workplace, but appears to have no symptoms of mercury toxicity. She has heard that mercury might affect her fetus. What should I recommend to her? What is a safe level of mercury in the air for pregnant women?, Answer: Testing for levels of mercury in whole blood and, preferably, urine is useful for confirming exposure. Currently, mercury vapour concentrations greater than 0.01 mg/m3 are considered unsafe. Also, women of childbearing age should avoid contact with mercury salts in the workplace.

The counts of lymphocytes, (CD3+) T-cells, (CD4+) T-helper and (CD 8+) T-suppressor and (CD 16+) NK-cells were determined in the peripheral blood of 81 males with a history of occupational exposure to metallic mercury vapors and in 36 males without this exposure. For the determination of T-cell populations monoclonal antibodies were used in indirect immunofluorescence tests. The weighted mean of mercury concentrations in air was 0.028 mg x m-3. Mercury concentration in the urine of the exposed subjects ranged from 10-240 micrograms x l-1, and in blood it was from 4-30 micrograms x l-1. Stimulation of the T-cell line was noted as evidenced by increased number of T-cells by 35% in the workers with exposure to mercury vapors below or by 38% in the workers over 10-years, by increased number of T-helper cells by 42% (p < 0.001) in the workers with exposure below or by 60% (p < 0.001) in the workers over 10 years and by increased number of T-suppressor cells by 85% (p < 0.001) in the workers below or by 96% (p < 0.001) in the workers over 10 years exposure. Lower increase of T-helper cells population than T-suppressor cells population was the cause of decreased value of the T-helper/T-suppressor ratio by about 21% (p < 0.01) in the workers with exposure below and over 10 years. No changes were observed in the T-cell populations between workers with up to 10 and those with over 10 years exposure. The quantitative changes of T-helper cells and T-helper/T-suppressor ratio may represent an immunological indicator of exposure to mercury vapors. Presented changes in human T-lymphocytes population associated with occupational exposure to mercury vapors have been proposed to explain the origin of more frequent autoimmunity induced by mercury.

Urinary selenium excretion was studied in 21 mercury vapour (Hgo)-exposed workers involved in the demolition of a chloralkali plant. The subjects had no known previous occupational exposure to mercury. Their mean pre-exposure urinary mercury concentration, determined on average 1.2 days prior to the exposure, was 0.8 nmol mmol-1 creatinine (range 0.3-1.9). Their last mean urinary mercury concentration, determined on average after 51.4 days (range 19-103) of exposure, was 4.8 nmol mmol-1 creatinine (range 1.2-10.0). The exposure ceased on average 4.1 days after the last determined urinary mercury concentration. The corresponding concentrations of urinary selenium decreased from an average of 39.1 nmol mmol-1 creatinine (range 13.9-89.5) to 29.0 nmol mmol-1 creatinine (range 10.1-52.9) (P = 0.002). This finding may indicate that even a low to moderate work-related exposure to Hgo may reduce the urinary selenium concentration in humans in a manner that is not yet fully known.

Concern has surfaced over the recent discovery of human mercury exposure throughout the tropical rain forest of South America's Amazon River Basin. The probable source of mercury has been traced to gold mines located within the interior. The mining process involves the extraction of gold from ore by burning off a mercury additive, resulting in vaporization of elemental mercury into the surrounding environment. The purpose of this case series is to document mercury levels in miners and local villagers presenting with a history of exposure, or signs and symptoms consistent with mercury toxicity. Over a five year period (1986-91), the whole blood and urine mercury levels of 55 Brazilian patients demonstrating signs and symptoms consistent with mercury exposure were collected. Thirty-three (60%) of the subjects had direct occupational exposure to mercury via gold mining and refining. Whole blood mercury levels ranged from 0.4-13.0 micrograms/dL (mean 3.05 micrograms/dL). Spot urine levels ranged 0-151 micrograms/L (mean = 32.7 micrograms/L). Occupational mercury exposure is occurring in the Amazon River Basin. Interventions aimed at altering the gold mining process while protecting the workers and surrounding villagers from the source of exposure are essential. The impact of the gold mining industry on general environmental contamination has not been investigated.