The Physician and Sportsmedicine
ISSN: 0091-3847 (Print) 2326-3660 (Online) Journal homepage: http://www.tandfonline.com/loi/ipsm20
Toxic Vapor Exposure and Aerobic Exercise Daniel C. Larson To cite this article: Daniel C. Larson (1985) Toxic Vapor Exposure and Aerobic Exercise, The Physician and Sportsmedicine, 13:1, 76-83, DOI: 10.1080/00913847.1985.11708728 To link to this article: http://dx.doi.org/10.1080/00913847.1985.11708728
Published online: 11 Jul 2016.
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Citing articles: 1 View citing articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ipsm20 Download by: [Australian Catholic University]
Date: 21 August 2017, At: 10:04
Toxic Vapor Exposure and Aerobic Exercise
Downloaded by [Australian Catholic University] at 10:04 21 August 2017
Daniel C. Larsen, MD ln brief: Seventeen track team runners were evaluated after complaining of wheezing, coughing, rhinitis, or shortness of breath after practicing in a facility under construction. Investigation revealed levels of ethyl acetate and toluene low enough to meet federal guidelines but apparently sufficient to cause symptoms in the athletes. Therefore, current standards for regulating potentially taxie organic chemicals may be inadequate when aerobic exercise is performed in the polluted environ ment.
erobic activity perfonned in the presence of potentially toxic va pors can present unexpected health hazards. However, exposure to toxic vapor during aerobic activity has been studied only in conjunction with generalized air pollution.•-3 It seems that standards established for industrial workers may not apply to athletes exercising at or near their aerobic capacity. Artificial athletic surfaces have increased in popularity, number, and variety in recent years. Sorne are constmcted elsewhere and assembled on location; others involve work with liquid surfaces that solidify or gel at the site, resulting in the rclease of va pors of potentially toxic organic chemicals. We report here a case of track athletes exposed to ethyl acetate (CH 3COOC2 H 5), a skin, mucous membrane, and respiratory tract irritant, and toluene (C6 H 5CH 3), a skin, eye, and respiratory tract irritant. So far, medical attention has conccntratcd on industrial exposure to the liquid chemicals or their vapors 4 · 5 and not on exposure during aerobic exercise. Polyurethane is often used in the constmccontinued
A
Dr. Larson is director of athletic medicine at the Yale University Health Services in New Haven, Connecticut.
76
Vol13• No. l •January85 • THEPHYSICIANAHDSPORTSMEDICIHE
Downloaded by [Australian Catholic University] at 10:04 21 August 2017
lllus1rat101l ConiHC Cunnally
THEPHYSICIANANDSPORTSMIEDICINE e Vo113 • No. 1 • January &5
77
©
1~8!",
toxlc vapor continued Table 1. Gas Chromatographie Analysls of lndoor Ethyl Acetate and Toluene Concentrations in Track and Field Practice Area
Ethyl acetate Toluene
Tube 1* (ppm)
Tube 2t (ppm)
94
170 16
18
Downloaded by [Australian Catholic University] at 10:04 21 August 2017
• Exposed on the !rack 5 ft from work area. tExposed directly over edge of work area.
tion ofartificial athletic surfaces. Solvents used in polyurethane include ethyl acetate and toluene 2,4 diisocyanate (TDI). Industrial-grade toluene is sometimes used as a thinning agent. While each of thcse substances can cause respiratory irritation, TDI exposure results in the most severe respiratory symptoms, including prolonged bronchospasm and even pulmonary fibrosis. 4·5
Case Reports Approximately 45 male and female membcrs of the college track team were practicing on the new indoor track at Yale University in New Haven, Connecticut, which had bcen constructed elsewhere and assembled on the site. The track was in a large, one-room facility that was undergoing renovation. The tloor surrounding the track was being covered with a polyurethane surface. The volume of the main room was approximately 3 million cu ft, with floor dimensions of 156 X 320 ft and a height varying from 56 to 83 ft. Track practices took place during the preparation of the polyurethane tlooring. Seventeen runners from the track team were evaluated at the University Health Services over a two-day period. Ali complained of cough, rhinitis, or shortness of breath after practicing in the new facility. On the day their symptoms began, they had participated in aerobic exercise and pcrformed vigorous interval workouts requiring sustained elevations of heart rate and ventilation. Those who simply lifted weights or practiced nonaerobic exercise did not develop symptoms. Case 1. A 19-year-old male hurdler developed sudden on set of cough and wheezing after a workout on the indoor track. His symptoms
78
were partially relieved after running outdoors and were exacerbated after retuming to the indoor facility. He was treated for tracheitis with symptomatic therapy of tluids, humidity, and cough suppressants. He was markedly improved within 48 hours. Case 2. An 18-year-old male middle-distance runner with a history of bronchitis developed sudden onset of wheezing after practice on the indoor track. Examination revealed diffuse wheezing and retractions. He was treated with tluids, humidity, oral theophylline, and an inhaled bronchodilator and had resolution of symptoms in 24 hours.
Air-Sample Analysis Air samples were taken with two charcoal tubes and three gas bulb "grab samples." The charcoal samples were analyzed by gas chromatography. The grab samples were analyzed by mass spectrophotometry (Baron Laboratories, Milford, Connecticut) using a PerkinEimer Mode! 99B gas chromatograph in conjunction with Hitachi Mode! AMUGE mass spectrophotometer. The results are listed in table 1. Tube 1 was exposed on the corner of the track 5 ft from the work arca. Tube 2 was exposed direct! y over the edge of the work arca. Each tube was exposed at 0.188 liters·min- 1 for 20 minutes. The three grab sam pies were taken in two different parts of the work a rea and on the track. There were no measurable values of other organic gases; in particular, TDI was not detected. The facility was closed (with the full cooperation ofthe University Athletic Department) until measurements were reported. Work in the immediate arca of the track was finished, and the facility reopened. Finishing work continued for severa! days in a separate room that was ventilated through an outside door. Discussion The Occupational Safcty and Health Administration (OSHA) of the US Department of Labor sets a permissiblc exposurc limit (PEL) of 400 parts of ethyl acetate pcr million parts of air (ppm). 4·5 This value is averaged over an eight-hour shift. The OSHA standards were developed for workplace exposure. The PEL for toluene over an eight-
Vol13 • No. 1 • January 85
e
THE PHVSICIAN AND SPORTSMEDICINE
Table 2. Properties of Potentlal Toxic Substances Substance
PEL* (ppm)
Vapor Denslty
Mucous membrane irritation (severe), asthma, pulmonary fibrosist
Toluene 2.4 diisocyanatet
Downloaded by [Australian Catholic University] at 10:04 21 August 2017
Toxiclty
Toluene
200
3.14
Mucous membrane irritation (mild), hematopoietict and hepatic dysfunctiont
Ethyl acetate
400
3.0
Mucous membrane irritation (moderate), cough, bronchospasm
'Permissible exposure limit tNot found in our testing. tChronic effects
hour shift is 200 ppm 4.s; its toxicity is predom9 inantly hepatic and renal. Although respira8 tory-tract irritation can occur, it is more prom'C' inent with ethyl acetate. The vapor density of ::.. 7 toluene is 3.14 ppm and of eth yi acetate is 3.0 :!:: -e PPm (table 2). Therefore, both gases remain !9 ·6 o..J 1-41 near ground leve!, where an exercising athlete u ::::1 might be exposed despite the high ceiling of 5 Ill Il) 410 the structure. a:~ 4 oW The normal oxygen exchange (Vo") of a 70... 41 kg man at rest is 4 ml·kg- 1·mitr 1, or approxi411i E·- 3 ·-Il) mately 280 ml·milr 1•6 Peak values of Vo" in 1- .!!! endurance-trained athletes reach 60 to 80 2 41 ml·kg- 1·min- 1.' This represents up to a twena. tyfold increase in respiratol)' exchange, result1 ing in potentially higher exposure to environ0 mental toxins. 10 20 30 40 50 60 70 The maximum measured leve! of eth yi acetate in this case was 170 ppm, measured diOxygen Exchange (ml·kg-lomin- 1) rectly over the work arca. The value measured on the track was 94 ppm, while the highest Figure 1. Ath/etes running at 80% of \i'o, max for 30 minutes would be exposed to the same total amount of toluene value was 18 ppm. The athletes spent ethyl acetate that sedentary workers would be in an an average of one to two hours per day in the eight·hour shift. Equation: Time equivalent= 8 hr x 4 arca. Total exposure to an airborne substance ml-kg '·min ' (sedentary)j'1o 2 (exercise). can be expressed as an effective dose-effective dose= (concentration X time exposed X adjuste? PEL= sedentary PEL X (4 ml·kg·'· ventilation). . 1 If one assumes that athletes run at 80% of min- /Vo" exercise). In this case, the result of Vo" max for 30 minutes, they would be ex- this equation for a highly skilled distance run1 1 posed to the same total amount ofethyl acetate ner at 64 ml·kg· ·min- would be exercise adthat sedcntary workers would be in an eight- justed PEL= 400 X (4 ml·kg-'·min-'/64 ml ml·kg- 1·min- 1) = 25. The 94 ppm that was mcahour shift (figure 1). It is noteworthy that symptoms occurred sured on the track ütr excceds this revised PEL. weil below the PEL. One could calculate an Similar calculations pcrformed for toluene inverse rclationship in the following manner would also reveal that the reviscd PEL had to determine a hypothetical new PEL: cxercise- been exceeded.
....
\
\
\
e
"
..._.,_
contin ucd THEPHYSICIANANDSPORTSMEDICINE
e Vol13 • No. 1 • January 85
79
toxlc vapor continued Analogous situations have been documented in the air pollution Jiterature for carbon monoxide, 8 and the Environmental Protection Agency's first-alert leve! for ozone has been proved inadequate for vigorously exercising cyclists. 9· 10 These case studies raise important issues. Should there be a different PEL for athletes or workers performing vigorous physical exercise? The new track facility at Yale represents state-of-the-art design; many others may follaw. We believe that ali solvent-related con-
struction should be finished before athletes are allowed to practice in a facility. It is impossible to separate the effects of ethyl acetate from those of toluene because of the possible synergy of pollutants. The obvious symptoms appearing at relatively low levels of pollutants in our case studies should cause concern for both athletes and physicians when exercise is pcrformed in a polluted environment. Address corrcspondencc to Daniel C. Larson, MD, Yale University Health Services, 17 Hillhousc Ave, New Haven, CT 06520.
Downloaded by [Australian Catholic University] at 10:04 21 August 2017
References 1. Horvath S: Impact of air quality in exercise performance. Exerc Sport Sei Rev 1981 ;9:269-296 2. McCafferty WB: Air Pollution and Athlctic Performance. Springfield, IL, Charles C Thomas, 1~81 3. Hage P: Air pollution: adverse effect on athleuc per· forrnance. Ph ys Sportmed 1982; 1O(March): 126-132 4. US Dept of Health and Human Serv1ces: Occupational Health Guide li nes for ct.~mical Hazards, Dept ofHealth and Human Services (NIOSH), publication No. 81-123, January 1981 5. Patty F (ed): lndustrial Hygiene and Toxicology, cd 3. New York City, Interscience, 1963, pp 1850-1879 6. West JB: Disturbances of respiratory function. in Harrison's Principles oflntemal Medicine, ed 9. New York City, McGraw-Hill Book Co, 1980, p 1191
7. Pollock ML: Submaximal and maximal working capacity of elite distance runncrs. Part 1: Cardiorcspiratory aspects. Ann NY Acad Sei 1977;301:310-322 8. Pcterson JE, Stewart RD: Prcdicting carboxyhemoglobin levels resulting from carbon· monoxidc exposures. J Appt Physiol 1975;39(0ctober):633-638 9. Folinsbec U, Horvath SM, Raven PB, et al: Influence of exerci~e and hcat stress on pulmonary function dunng ozone cxposure. J Appl Physiol 1977; 43(September):409-413 10. ~edi JF, Folinsbee U, Horvath SM: Pulmonary funcllon changes of ch te cychsts following a one-hour exposure to 0.20 ppm ozone during hcavy excrcise, ahstractcd. Med Sei Sports Exerc 1983; 15(2): 112
PHILADELPHIA
HU
March 29·30·31, 1985 "Modern Dissection Techniques Of Bona, Biometals, And Bloplastics" (ORTHO 700)
An Orthopaedic Symposium presented by
THE DEPARTMENT OF ORTHOPAEDIC SURGERY of
HAHNEMANN UNIVERSITY and
THE MIDAS REX PSYCHOMOTOR INSTITUTE
at the Philadelphia Marriott Hotel Course Directors: ~rnold T. Berman, M.D., Stephen J. Bosacco, M.D., Susan Mitchell, Ed.D., Norman McDanniel, Ph.D. Symposium Format WORKSHOPS: The Midas Rex Hands·On Workshops will be held each day from 7:30 am to 1:30pm. The workshops will emphaslze a series of hands·on exerclses, utilizing appropriate animal bones, skeletal bonas, bioplastlcs and biometals for dissection in small bones, large bonas, spines, joint replacement, revision surgery, methylmethacrylate, polyethylene, and metal, including broken stem extraction. CREDITS: 18 Hours of CME Category 1
ENROLLMENT: Sand lelter and check payable to "Philadelphia Sympos 1um" Surgeon·$965.00; Resldent-$585 00 (wJth lelter from Depart ment Head); OR/Tech/Ass't·$250.00. DETAILS AND REGISTRATION: Susan Mitchell, Ed.D. 3001 Race Street Fort Worth, TX 76111 (800) 433-7639 Texas: (817) 831-2604
ACCOMMODATIONS: Philadelphia Marriolt Hotel City Line Avenue and Monument Road Philadelphia, PA 19131 Phone: (215) 667·0200
TH.PHYSICIANAND.--raiiiiDICIN.
e
Vol 13 • No. 1 • January 85
83
ISSN: 0091-3847 (Print) 2326-3660 (Online) Journal homepage: http://www.tandfonline.com/loi/ipsm20
Toxic Vapor Exposure and Aerobic Exercise Daniel C. Larson To cite this article: Daniel C. Larson (1985) Toxic Vapor Exposure and Aerobic Exercise, The Physician and Sportsmedicine, 13:1, 76-83, DOI: 10.1080/00913847.1985.11708728 To link to this article: http://dx.doi.org/10.1080/00913847.1985.11708728
Published online: 11 Jul 2016.
Submit your article to this journal
Article views: 1
View related articles
Citing articles: 1 View citing articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ipsm20 Download by: [Australian Catholic University]
Date: 21 August 2017, At: 10:04
Toxic Vapor Exposure and Aerobic Exercise
Downloaded by [Australian Catholic University] at 10:04 21 August 2017
Daniel C. Larsen, MD ln brief: Seventeen track team runners were evaluated after complaining of wheezing, coughing, rhinitis, or shortness of breath after practicing in a facility under construction. Investigation revealed levels of ethyl acetate and toluene low enough to meet federal guidelines but apparently sufficient to cause symptoms in the athletes. Therefore, current standards for regulating potentially taxie organic chemicals may be inadequate when aerobic exercise is performed in the polluted environ ment.
erobic activity perfonned in the presence of potentially toxic va pors can present unexpected health hazards. However, exposure to toxic vapor during aerobic activity has been studied only in conjunction with generalized air pollution.•-3 It seems that standards established for industrial workers may not apply to athletes exercising at or near their aerobic capacity. Artificial athletic surfaces have increased in popularity, number, and variety in recent years. Sorne are constmcted elsewhere and assembled on location; others involve work with liquid surfaces that solidify or gel at the site, resulting in the rclease of va pors of potentially toxic organic chemicals. We report here a case of track athletes exposed to ethyl acetate (CH 3COOC2 H 5), a skin, mucous membrane, and respiratory tract irritant, and toluene (C6 H 5CH 3), a skin, eye, and respiratory tract irritant. So far, medical attention has conccntratcd on industrial exposure to the liquid chemicals or their vapors 4 · 5 and not on exposure during aerobic exercise. Polyurethane is often used in the constmccontinued
A
Dr. Larson is director of athletic medicine at the Yale University Health Services in New Haven, Connecticut.
76
Vol13• No. l •January85 • THEPHYSICIANAHDSPORTSMEDICIHE
Downloaded by [Australian Catholic University] at 10:04 21 August 2017
lllus1rat101l ConiHC Cunnally
THEPHYSICIANANDSPORTSMIEDICINE e Vo113 • No. 1 • January &5
77
©
1~8!",
toxlc vapor continued Table 1. Gas Chromatographie Analysls of lndoor Ethyl Acetate and Toluene Concentrations in Track and Field Practice Area
Ethyl acetate Toluene
Tube 1* (ppm)
Tube 2t (ppm)
94
170 16
18
Downloaded by [Australian Catholic University] at 10:04 21 August 2017
• Exposed on the !rack 5 ft from work area. tExposed directly over edge of work area.
tion ofartificial athletic surfaces. Solvents used in polyurethane include ethyl acetate and toluene 2,4 diisocyanate (TDI). Industrial-grade toluene is sometimes used as a thinning agent. While each of thcse substances can cause respiratory irritation, TDI exposure results in the most severe respiratory symptoms, including prolonged bronchospasm and even pulmonary fibrosis. 4·5
Case Reports Approximately 45 male and female membcrs of the college track team were practicing on the new indoor track at Yale University in New Haven, Connecticut, which had bcen constructed elsewhere and assembled on the site. The track was in a large, one-room facility that was undergoing renovation. The tloor surrounding the track was being covered with a polyurethane surface. The volume of the main room was approximately 3 million cu ft, with floor dimensions of 156 X 320 ft and a height varying from 56 to 83 ft. Track practices took place during the preparation of the polyurethane tlooring. Seventeen runners from the track team were evaluated at the University Health Services over a two-day period. Ali complained of cough, rhinitis, or shortness of breath after practicing in the new facility. On the day their symptoms began, they had participated in aerobic exercise and pcrformed vigorous interval workouts requiring sustained elevations of heart rate and ventilation. Those who simply lifted weights or practiced nonaerobic exercise did not develop symptoms. Case 1. A 19-year-old male hurdler developed sudden on set of cough and wheezing after a workout on the indoor track. His symptoms
78
were partially relieved after running outdoors and were exacerbated after retuming to the indoor facility. He was treated for tracheitis with symptomatic therapy of tluids, humidity, and cough suppressants. He was markedly improved within 48 hours. Case 2. An 18-year-old male middle-distance runner with a history of bronchitis developed sudden onset of wheezing after practice on the indoor track. Examination revealed diffuse wheezing and retractions. He was treated with tluids, humidity, oral theophylline, and an inhaled bronchodilator and had resolution of symptoms in 24 hours.
Air-Sample Analysis Air samples were taken with two charcoal tubes and three gas bulb "grab samples." The charcoal samples were analyzed by gas chromatography. The grab samples were analyzed by mass spectrophotometry (Baron Laboratories, Milford, Connecticut) using a PerkinEimer Mode! 99B gas chromatograph in conjunction with Hitachi Mode! AMUGE mass spectrophotometer. The results are listed in table 1. Tube 1 was exposed on the corner of the track 5 ft from the work arca. Tube 2 was exposed direct! y over the edge of the work arca. Each tube was exposed at 0.188 liters·min- 1 for 20 minutes. The three grab sam pies were taken in two different parts of the work a rea and on the track. There were no measurable values of other organic gases; in particular, TDI was not detected. The facility was closed (with the full cooperation ofthe University Athletic Department) until measurements were reported. Work in the immediate arca of the track was finished, and the facility reopened. Finishing work continued for severa! days in a separate room that was ventilated through an outside door. Discussion The Occupational Safcty and Health Administration (OSHA) of the US Department of Labor sets a permissiblc exposurc limit (PEL) of 400 parts of ethyl acetate pcr million parts of air (ppm). 4·5 This value is averaged over an eight-hour shift. The OSHA standards were developed for workplace exposure. The PEL for toluene over an eight-
Vol13 • No. 1 • January 85
e
THE PHVSICIAN AND SPORTSMEDICINE
Table 2. Properties of Potentlal Toxic Substances Substance
PEL* (ppm)
Vapor Denslty
Mucous membrane irritation (severe), asthma, pulmonary fibrosist
Toluene 2.4 diisocyanatet
Downloaded by [Australian Catholic University] at 10:04 21 August 2017
Toxiclty
Toluene
200
3.14
Mucous membrane irritation (mild), hematopoietict and hepatic dysfunctiont
Ethyl acetate
400
3.0
Mucous membrane irritation (moderate), cough, bronchospasm
'Permissible exposure limit tNot found in our testing. tChronic effects
hour shift is 200 ppm 4.s; its toxicity is predom9 inantly hepatic and renal. Although respira8 tory-tract irritation can occur, it is more prom'C' inent with ethyl acetate. The vapor density of ::.. 7 toluene is 3.14 ppm and of eth yi acetate is 3.0 :!:: -e PPm (table 2). Therefore, both gases remain !9 ·6 o..J 1-41 near ground leve!, where an exercising athlete u ::::1 might be exposed despite the high ceiling of 5 Ill Il) 410 the structure. a:~ 4 oW The normal oxygen exchange (Vo") of a 70... 41 kg man at rest is 4 ml·kg- 1·mitr 1, or approxi411i E·- 3 ·-Il) mately 280 ml·milr 1•6 Peak values of Vo" in 1- .!!! endurance-trained athletes reach 60 to 80 2 41 ml·kg- 1·min- 1.' This represents up to a twena. tyfold increase in respiratol)' exchange, result1 ing in potentially higher exposure to environ0 mental toxins. 10 20 30 40 50 60 70 The maximum measured leve! of eth yi acetate in this case was 170 ppm, measured diOxygen Exchange (ml·kg-lomin- 1) rectly over the work arca. The value measured on the track was 94 ppm, while the highest Figure 1. Ath/etes running at 80% of \i'o, max for 30 minutes would be exposed to the same total amount of toluene value was 18 ppm. The athletes spent ethyl acetate that sedentary workers would be in an an average of one to two hours per day in the eight·hour shift. Equation: Time equivalent= 8 hr x 4 arca. Total exposure to an airborne substance ml-kg '·min ' (sedentary)j'1o 2 (exercise). can be expressed as an effective dose-effective dose= (concentration X time exposed X adjuste? PEL= sedentary PEL X (4 ml·kg·'· ventilation). . 1 If one assumes that athletes run at 80% of min- /Vo" exercise). In this case, the result of Vo" max for 30 minutes, they would be ex- this equation for a highly skilled distance run1 1 posed to the same total amount ofethyl acetate ner at 64 ml·kg· ·min- would be exercise adthat sedcntary workers would be in an eight- justed PEL= 400 X (4 ml·kg-'·min-'/64 ml ml·kg- 1·min- 1) = 25. The 94 ppm that was mcahour shift (figure 1). It is noteworthy that symptoms occurred sured on the track ütr excceds this revised PEL. weil below the PEL. One could calculate an Similar calculations pcrformed for toluene inverse rclationship in the following manner would also reveal that the reviscd PEL had to determine a hypothetical new PEL: cxercise- been exceeded.
....
\
\
\
e
"
..._.,_
contin ucd THEPHYSICIANANDSPORTSMEDICINE
e Vol13 • No. 1 • January 85
79
toxlc vapor continued Analogous situations have been documented in the air pollution Jiterature for carbon monoxide, 8 and the Environmental Protection Agency's first-alert leve! for ozone has been proved inadequate for vigorously exercising cyclists. 9· 10 These case studies raise important issues. Should there be a different PEL for athletes or workers performing vigorous physical exercise? The new track facility at Yale represents state-of-the-art design; many others may follaw. We believe that ali solvent-related con-
struction should be finished before athletes are allowed to practice in a facility. It is impossible to separate the effects of ethyl acetate from those of toluene because of the possible synergy of pollutants. The obvious symptoms appearing at relatively low levels of pollutants in our case studies should cause concern for both athletes and physicians when exercise is pcrformed in a polluted environment. Address corrcspondencc to Daniel C. Larson, MD, Yale University Health Services, 17 Hillhousc Ave, New Haven, CT 06520.
Downloaded by [Australian Catholic University] at 10:04 21 August 2017
References 1. Horvath S: Impact of air quality in exercise performance. Exerc Sport Sei Rev 1981 ;9:269-296 2. McCafferty WB: Air Pollution and Athlctic Performance. Springfield, IL, Charles C Thomas, 1~81 3. Hage P: Air pollution: adverse effect on athleuc per· forrnance. Ph ys Sportmed 1982; 1O(March): 126-132 4. US Dept of Health and Human Serv1ces: Occupational Health Guide li nes for ct.~mical Hazards, Dept ofHealth and Human Services (NIOSH), publication No. 81-123, January 1981 5. Patty F (ed): lndustrial Hygiene and Toxicology, cd 3. New York City, Interscience, 1963, pp 1850-1879 6. West JB: Disturbances of respiratory function. in Harrison's Principles oflntemal Medicine, ed 9. New York City, McGraw-Hill Book Co, 1980, p 1191
7. Pollock ML: Submaximal and maximal working capacity of elite distance runncrs. Part 1: Cardiorcspiratory aspects. Ann NY Acad Sei 1977;301:310-322 8. Pcterson JE, Stewart RD: Prcdicting carboxyhemoglobin levels resulting from carbon· monoxidc exposures. J Appt Physiol 1975;39(0ctober):633-638 9. Folinsbec U, Horvath SM, Raven PB, et al: Influence of exerci~e and hcat stress on pulmonary function dunng ozone cxposure. J Appl Physiol 1977; 43(September):409-413 10. ~edi JF, Folinsbee U, Horvath SM: Pulmonary funcllon changes of ch te cychsts following a one-hour exposure to 0.20 ppm ozone during hcavy excrcise, ahstractcd. Med Sei Sports Exerc 1983; 15(2): 112
PHILADELPHIA
HU
March 29·30·31, 1985 "Modern Dissection Techniques Of Bona, Biometals, And Bloplastics" (ORTHO 700)
An Orthopaedic Symposium presented by
THE DEPARTMENT OF ORTHOPAEDIC SURGERY of
HAHNEMANN UNIVERSITY and
THE MIDAS REX PSYCHOMOTOR INSTITUTE
at the Philadelphia Marriott Hotel Course Directors: ~rnold T. Berman, M.D., Stephen J. Bosacco, M.D., Susan Mitchell, Ed.D., Norman McDanniel, Ph.D. Symposium Format WORKSHOPS: The Midas Rex Hands·On Workshops will be held each day from 7:30 am to 1:30pm. The workshops will emphaslze a series of hands·on exerclses, utilizing appropriate animal bones, skeletal bonas, bioplastlcs and biometals for dissection in small bones, large bonas, spines, joint replacement, revision surgery, methylmethacrylate, polyethylene, and metal, including broken stem extraction. CREDITS: 18 Hours of CME Category 1
ENROLLMENT: Sand lelter and check payable to "Philadelphia Sympos 1um" Surgeon·$965.00; Resldent-$585 00 (wJth lelter from Depart ment Head); OR/Tech/Ass't·$250.00. DETAILS AND REGISTRATION: Susan Mitchell, Ed.D. 3001 Race Street Fort Worth, TX 76111 (800) 433-7639 Texas: (817) 831-2604
ACCOMMODATIONS: Philadelphia Marriolt Hotel City Line Avenue and Monument Road Philadelphia, PA 19131 Phone: (215) 667·0200
TH.PHYSICIANAND.--raiiiiDICIN.
e
Vol 13 • No. 1 • January 85
83
