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Ethylene oxide(EO)is commonly used to sterilize heat-sensitive products used by hospital patients and personnel.Ethylene clorohydrin(EC),a by- product,is considered highly toxic.We report a cluster of 12 operating room nurses and technicians who developed symptoms after a 5 month exposure to high levels of EO and EC in disposable surgical gowns.All patients reported a rash on the wrist where contact was made with the gowns,headaches,and hand numbness with weakness.Ten of 12 patients complained of memory loss.Neurologic evaluation revealed neuropathy on examination in 9 of the 12 patients,elevated vibration threshold in 4 of 9,abnormal pressure threshold in 10 of 11,atrophy on head MRI in three of 10,and neuropathy on conduction studies in 4 of 10.Neuropsychological testing demonstrated mild cognitive impairment in 4 of 6 patients.Sural nerve biopsy in the most severely affected patient showed findings of axonal injury.Several patients in this group displayed signs of peripheral and CNS dysfunction following exposure to EO.Possible mechanisms of neurotoxicity include direct exposure of peripheral nerves through cutaneous absorption and central involvement through inhalation and vascular dissemination.The frequency of central and peripheral nervous system symptoms,supported by objective testing in these EO-exposed patients,suggests other healthcare personnel may be at similar risk. |
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cerebral cortical atrophy
ethylene oxide
hand numbness
hand weakness
headache
intellectual deficit
memory,impairment of
MRI,abnormal
nerve conduction studies
neuropathy
neuropathy,toxic
neurotoxin
occupational neurologic disorders
occupational neuropathies
psychological testing
rash
sensory loss
sensory testing,quantitative
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