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Occupational and Environmental Mustard Exposure, Prevention and Chemical Weapons Convention

  • Slavica VucinicEmail author
  • Branka Djurovic
  • Biljana Antonijevic
Chapter

Abstract

Literature on occupational sulfur mustard (SM) exposure is limited, contrary to extensive data on acute effects of this vesicant as a chemical weapon. Workers can be occupationally exposed accidentally and/or chronically. Accidental occupational SM exposure is always short-term exposure to higher concentrations, depending also on the duration of exposure. Chronic occupational exposure is usually related to low-level concentration exposure due to leakage or protocol breakage. It develops as intoxication with mild symptoms that may not manifest immediately, and also can produce potential health consequences that become evident months or years after the exposure, as late or delayed effects or just a reduction in working ability. Environmental releases might occur near the places where SM is produced and stored, but also due to the disposal of this chemical weapon, by dumping them into the sea. Fate and behavior of this blistering agent in the environment is strongly related to its concentration. SM is lipophilic, negligible soluble in water and relatively stable in the environment. After years of efforts and peace negotiations, on April 20, 1997, Chemical Weapons Convention entered into force, and the OPCW began its work providing its implementation, and conditions for a world safe from chemical weapons.

Keywords

Vesicants Sulfur mustard Occupational exposure Environmental exposure Chemical weapons convention 

Notes

Glossary

Acute toxicity

Describes the adverse effects of a substance that result either from a single exposure or from multiple exposures in a short space of time (usually less than 24 h). Adverse ecological effects Refers to any harmful effects on the environment

Aphonia

The inability to produce voice. It is more severe than dysphonia

Bronchospasm

Sudden constriction of the muscles in the walls of the bronchi

Carcinogenicity

The ability to produces cancer

Chronic bronchitis

A chronic inflammatory condition in the lungs that causes the respiratory passages to be swollen and irritated

CWA:chemical warfare agents

A chemical substance whose toxic properties are used to kill, injure or incapacitate human beings

CWC: Chemical Weapons Convention

An international treaty which prohibits the development, production, stockpiling, transfer and use of chemical weapons and imposes their destruction

CX:Phosgene oxime

A manufactured chemical warfare agent, also called urticant or nettle agent

Dyspnea

Shortness of breath or breathlessness is the feeling or feelings associated with impaired breathing

Ecological risk assessment

The process that evaluates the nature and likelihood

Ecotoxicology

Study of the effects of toxic chemicals on biological organisms, especially at the population, community, ecosystem level.

Exposure assessment

The determination of the extent of human exposure.

Exposure

The condition of being subjected to something, as to infectious agents, extremes of weather, radiation, or chemical agent which may have a harmful effect.

First Responder

Personnel who have responsibility to initially respond to emergencies (firefighters, HAZMAT team members, ambulance attendants)

HN-1, HN-2, HN-3: Nitrogen mustard

A class of organic compounds similar to mustard gas in their molecular structure, important for the treatment of cancer

IARC

International Agency for Research on Cancer

Inhalation

The flow of air into an organism. In humans, it is the movement of air from the external environment, through the airways, and into the alveoli.

Inspiratory

Relating to the act of breathing in

L: Lewisite

A blister agent

Lipophilic

The ability of a chemical compound to dissolve in fats, oils, lipids, and non-polar solvents

Median effective concentration (EC50)

A concentration that is statistically estimated to cause a specified effect in 50 % of a group of test organisms under specified experimental conditions.

Median lethal concentration (LC50)

A concentration that is statistically estimated to be lethal to 50 % of a group of test organisms under specified experimental conditions.

Median lethal dose (LD50)\

A dose that is statistically estimated to be lethal to 50 % of a group of test organisms under specified experimental conditions.

Monitoring of environmental conditions

Systematic, complete control and measurements of risk factors in the environment

Mutagenic

Capable of inducing mutation or increasing its rate

No Observed Effect Concentration (NOEC)

The concentration of chemical at which there were no statistically or biologically significant increases in frequency or severity of adverse effects seen between the exposed population and its appropriate control. Effects may be produced at this dose, but they are not considered to be adverse.

Occupational exposure

Exposure to harmful agent in a workplace.

Octanol-Water Partition Coefficient (Kow)

The equilibrium ratio of the concentrations of a chemical in n-octanol and water, in dilute solution.

Adverse ecological effects: any adverse effect to the environment

Of adverse ecological effects from exposure to one or more stressors.

Periodic examination

Is annual examination of worker exposed to some harmful agent in a workplace.

Personal Protective Equipment (PPE)

Protective suits, gloves, foot covering, respiratory protection, hoods, safety glasses, goggles, and face shields.

Preplacement examination

Is an examination before entrance in the working environment with potential health risk.

Prolonged toxicity

Describes the adverse effects of a substance that result either from continuous or repeated exposure.

Risk

The probability that an adverse effect will occur under a particular condition of exposure.

Risk assessment

A scientifically based process of evaluating the toxic properties of a chemical and conditions of human exposure to it in order to ascertain the likelihood that exposed people will be adversely affected and to characterize the nature of these effects.

Self-contained Breathing Apparatus (SCBA)

A respirator that provides fresh air to the facepiece from a compressed air tank (usually worn on the worker’s back).

SM:Sulfur mustard

A class of related cytotoxic and vesicant chemical warfare agents with the ability to form large blisters on the exposed skin and in the lungs

Teratogenic

A drug or other substance capable of interfering with the development of a fetus, causing birth defects

Threshold

Dose or exposure concentration of an agent below that a stated effect is not observed or expected to occur.

Toxic unit (TU)

It represents the ratio between the exposure concentration and fish no observed effect concentration (NOEC).

Toxicity

Inherent property of an agent to cause an adverse biological effect.

Toxicological end point

Effect observed in a toxicity study.

Tracheobronchitis

A condition involving inflammation of the windpipe orbronchi

Triage

The process of screening and classifying sick, wounded, or injured persons to determine priority needs in order to ensure the efficient use of medical personnel, equipment, and hospitals.

References

  1. Agency for Toxic Substances and Disease Registy (2003): Toxicological Profile for mustard Gas (Draft for public Comment). ATSDR; Atlanta, pp. 191.Google Scholar
  2. Balali-Mood M, Hefazi M. The pharmacology, toxicology, and medical treatment of sulfur mustard poisoning. Fundam Clin Pharmacol. 2005;19:297–315.CrossRefPubMedGoogle Scholar
  3. Balali-Mood M, Hefazi M. Comparison of early and late toxic effects of sulfur mustard in Iranian veterans. Basic Clin Pharmacol Toxicol. 2006;99:273–82.CrossRefPubMedGoogle Scholar
  4. Bignold LP. Alkylating agents and DNA polymerases. Anticancer Res. 2006;26:2B1327–36.Google Scholar
  5. Bullman T, Kang H. A fifty year mortality follow-up study of veterans exposed to low level chemical warfare agent, mustard gas. Ann Epidemiol. 2000;10:333–8.CrossRefPubMedGoogle Scholar
  6. Committee on Toxicology. Review of the department of defense research program on low-level exposures to chemical warfare agents. Washington, DC: The National Academies Press; 2005.Google Scholar
  7. CRDEC-Chemical Research and Development Engineering Command. Persistency times of chemical agents on CARC painted vehicles and sand. Aberdeen Proving Ground: CRDEC; 1990.Google Scholar
  8. Dacre JC, Goldman M. Toxicology and pharmacology of the chemical warfare agent sulfur mustard. Pharmacol Rev. 1996;48:289–326.PubMedGoogle Scholar
  9. Dahl H, Glund B, Vangstad P, Norn M. Eye lesions induced by mustard gas. Acta Ophthalmol. 1985;63 Suppl 173:30–1.Google Scholar
  10. Davis G, Aspera G. Exposure to liquid sulfur mustard. Ann Emerg Med. 2001;37:653–6. Disease Prevention, Committee to Survey the Health Effects of Mustard Gas and Lewisite. Washington, D.C; National Academy Press.CrossRefPubMedGoogle Scholar
  11. Easton DF, Peto J, Doll R. Cancers of the respiratory tract in mustard gas workers. Br J Ind Med. 1988;45:652–9.PubMedPubMedCentralGoogle Scholar
  12. Ellenhorn MJ, Schonwalds S, Ordog G, Wasserberger J. Ellenhorn’s medical toxicology – diagnosis and treatment of human poisoning. 2nd ed. London: Williams & Wilkins; 1997.Google Scholar
  13. Fitzgerald GJ. Chemical warfare and medical response during world war I. Am J Public Health. 98:611–25. doi: 10.2105/AJPH.2007.11930.
  14. Fox M, Scott D. The genetic toxicology of nitrogen and sulphur mustard. Mut Res. 1980;75:131–68.CrossRefGoogle Scholar
  15. Georgopoulos PG, Fedele P, Shade PJ, Lioy M, Hodgson A, Longmire M, Sands M, Brown MA. Hospital response to chemical terrorism: personal protective equipment training, and operations. Am J Ind Med. 2004;46(5):432–45.CrossRefPubMedGoogle Scholar
  16. Ghabili K, Agutter PS, Ghanei M, Ansarina K, Shoja MM. Mustard gas toxicity: the acute and chronic pathological effects. J Appl Toxicol. 2010;30:627–43.CrossRefPubMedGoogle Scholar
  17. Graham J, Schoneboom B. Historical perspective on effects and treatment of sulfur mustard injuries. Chem Biol Interact. 2013;206(3):512–22.CrossRefPubMedGoogle Scholar
  18. Grant MW, Schuman JS. Toxicology of the eye. 4th ed. Springfield: Charles C. Thomas; 1993.Google Scholar
  19. Hall AH, Rumack BH (eds) (1999) TOMES System® Micromedex, Englewood, Colorado. CD ROM. vol. 41. (exp. 31 July 1999)Google Scholar
  20. Hefazi M, Attaran D, Mahmoudi M, Balali-Mood M. Late respiratory complications of mustard gas poisoning in Iranian veterans. Inhal Toxicol. 2005;17:587–92.CrossRefPubMedGoogle Scholar
  21. Heinen JH, Carhart HW, Taylor WH, Stolp BN, Conner JC, Clausen NM (1945) Chamber tests with human subjects. IV. Basic tests with H Vapor. Naval Research Laboratory Report NRL-P2579 (AD 396275025), Washington, D.C. (duplicated, in part, in Appendix D. “Excerpts from Chamber Tests with Human Subjects I, II and IX. Naval Research Laboratory Reports Nos. P-2208 and P-2579.” p. 340–369 of IOM 1993)Google Scholar
  22. Henemyre-Harris CL, Murrow ML, Logan TP, Gibson BR, Gum R. Chapter 18: Occupational health and the chemical surety mission. In: Tuorinsky SD, editor. Medical aspects of chemical warfare. Washington, DC: Borden Institute, Walter Reed Army Medical Center; 2008. p. 593–612.Google Scholar
  23. Hick JL, Hanfling JL, Burstein J, Markham AG, Macintyre JA, Barbera D. Protective equipment for healthcare facility decontamination personnel: regulations, risks, and recommendations. Ann Emerg Med. 2003;42(3):370–80.CrossRefPubMedGoogle Scholar
  24. Hurst CG, Petrall JP, Barillo DJ, Graham JS, Smith WJ, Urbanetti JS, Sidell FR. Vesicants. In: Sidell FR, Takafuji ET, Franz DR, editors. Chapter 8: Medical aspects of chemical and biological warfare. Washington, DC: Borden Institute; 1997. p. 259–97.Google Scholar
  25. Hurst CD, Petrali JP, Barillo DJ, Graham JS. Chapter 8: Vesicants. In: Tuorinsky SD, editor. Medical aspects of chemical warfare. Washington, DC: Borden Institute, Walter Reed Army Medical Center; 2008. p. 259–309.Google Scholar
  26. Jakubowski EM, Sidell FR, Evans RA, et al. Quantification of thiodiglycol in human urine after an accidental sulfur mustard exposure. Toxicol Meth. 2000;10:143–50.CrossRefGoogle Scholar
  27. Jeffery S, Al M, Hill BA, Kok AB. Chapter 4: Chemical terrorism, and its implications for military medicine. In: Lenhart MK, editor. Medical aspects of chemical warfare. Washington, DC: Published by the Office of The Surgeon General at TMM Publications Borden Institute Walter Reed Army Medical Center; 2008. p. 115–54.Google Scholar
  28. Jowsey PA, Williams FM, Blain PG. DNA damage, signalling and repair after exposure of cells to the sulphur mustard analogue 2-chloroethyl ethyl sulphide. Toxicology. 2009;257:105–12.CrossRefPubMedGoogle Scholar
  29. Kenyon IR. Chemical Weapons in the Twentieth Century Their Use and Their Control. In: The CBW Conventions Bulletin. Quaterly Journal of the Harward Sassex Program on CBW Armament and Arms Limitation 2000;48:1-44 (ISSN 1060-8095)Google Scholar
  30. Khateri S, Ghanei M, Keshavarz S, Soroush M, Haines D. Incidence of lung, eye, and skin lesions as late complications in 34000 Iranians with wartime exposure to mustard agent. J Occup Environ Med. 2003;45:1136–43.CrossRefPubMedGoogle Scholar
  31. Kuperman RG, Phillips CT, Checkai RT. Toxicity of chemical warfare agent HD (mustard) to the soil microinvertebrate community in natural soils with contrasting properties. Pedobiologia. 2007;50:535–42.CrossRefGoogle Scholar
  32. Lan C-H, Lin T-S, Peng C-Y. Aquatic toxicity of nitrogen mustard to Ceriodaphina dubia, Daphnia magna, and Pimephales promelas. Ecotoxicol Environ Saf. 2005;61:273–9.CrossRefPubMedGoogle Scholar
  33. Macintyre AG, Christopher GW, Eitzen E, et al. Weapons of mass destruction events with contaminated casualties: effective planning for health care facilities. JAMA. 2000;283(2):242–9.CrossRefPubMedGoogle Scholar
  34. Maibach HI, et al. Chapter 4: Irritants and vesicants. In: Ecobichon D et al., editors. Possible long-term health effects of short-term exposure to chemical agents. Washington, DC: National Academy Press; 1984. p. 101–35.Google Scholar
  35. Manley RG (2000) Overview of the status of the chemical demilitarization worldwide and the way ahead. OPCW SynthesisGoogle Scholar
  36. Manning KP, Skegg DCG, Stell PM, Doll R. Cancer of the larynx and other occupational hazards of mustard gas workers. Clin Otolaryngol Allied Sci. 1981;6:165–70.CrossRefPubMedGoogle Scholar
  37. Marrs TC, Maynard RL, Sidell FR. Chemical warfare agents. Symptomatic and supportive care. Chichester: Wiley; 1996.Google Scholar
  38. Mayor A. Greek fire, poison arrows, and scorpion bombs: biological and chemical warfare in the ancient world. New York: The Overlock Press; 2003.Google Scholar
  39. Medvedeva N, Polyak Y, Kankaannpa H, Zaytseva T. Microbial responses to mustard gas dumped in the Baltic Sea. Mar Environ Res. 2009;68(2):71–81.CrossRefPubMedGoogle Scholar
  40. Meylan WM, Howard PH. Computer estimation of the atmospheric gas-phase reaction rate of organic compounds with hydroxyl radicals and ozone. Chemosphere. 1993;26:2293–9.CrossRefGoogle Scholar
  41. MMWR. Nosocomial poisoning associated with emergency department treatment of organophosphate toxicity – Georgia, 2000. Morbidity Mortality Weekly. 2001;49(51):1156–8.Google Scholar
  42. Munro NB, Talmage SS, Griffin GD, Waters LC, Watson AP, King JF, Hauschild V. The sources, fate, and toxicity of chemical warfare agent degradation products. Environ Health Perspect. 1999;107:933–74.CrossRefPubMedPubMedCentralGoogle Scholar
  43. Newmark JM, Langer B, Capacio J, Barr RG. Liquid sulfur mustard exposure. Mil Med. 2007;172:196–8.CrossRefPubMedGoogle Scholar
  44. Nishimoto Y, Yamakido M, Shigenobu T, et al. Long-term observation of poison gas workers with special reference to respiratory cancers. J UOEH. 1983;5(Suppl):89–94.PubMedGoogle Scholar
  45. Nishimoto Y, Yamakido M, Ishioka S, et al. Epidemiological studies of lung cancer in Japanese mustard gas workers. In: Miller RW et al., editors. Unusual occurrence as clue to cancer etiology. Tokyo: Japan Sci Press\Taylor & Frances, Ltd; 1988. p. 95–101.Google Scholar
  46. Ong C, Chapman T, Zilinskas R, Brodsky B, Newman J (2009) Chemnical weapon munitions dumped at sea: an interactive map. James Martin Centre for Nonproliferation Studies. Monterey Institute of International Studies. Available at: http://www.cns.miis.edu/stires/090806_cw_dumping.htm
  47. Organisation for the Prohibition of Chemical Weapons (OPCW). Basic facts on chemical disarmament. Available at: www.opcw.org/news-publications/publications/history-of-the-chemical-weapons-convention/
  48. Organization for the prohibition of hemical weapons (OPCW). Chemical weapons convention. Available at https://www.opcw.org/chemical-weapons-convention/retreived december 2014
  49. Organization for the Prohibition of Chemical Weapons (OPCW) Web site. Convention on the prohibition of the development, production, stockpiling and use of chemical weapons and on their destruction. Available at: www.opcw.org/news-publications/publications/history-of-the-chemical-weapons-convention/
  50. OSHA (2005) Best practices for hospital-based first receivers of victims from mass casualty incidents involving the release of hazardous substancesGoogle Scholar
  51. Papirmeister B, Feister AJ, Robinson SI, Ford RD. Medical defense against mustard gas: toxic mechanisms and pharmacological implications. Boca Raton: CRC Press; 1991.Google Scholar
  52. Pechura CM, Rall DP, editors. Institute of medicine, division of health promotion and disease prevention, committee to survey the health effects of mustard gas and lewisite. Washington DC: National Academy Press; 1993.Google Scholar
  53. Pechura CM, Rall DR, ed (1993). Committee on the Survey of the Health Effects of Mustard Gas and Lewisite. Institute of Medicine National Academic Press, Washington (DC), USA.Google Scholar
  54. Pita R, Vidal-Asensi S. Cutaneous and systemic toxicology of vesicants used in warfare. Actas Dermosifiliogr. 2010;101(1):7–18.CrossRefPubMedGoogle Scholar
  55. Pitschmann V. Overall view of chemical and biological weapons. Toxins. 2014;6(6):1761–84. doi: 10.3390/toxins6061761.CrossRefPubMedPubMedCentralGoogle Scholar
  56. Razavi SM, Salamati P, Saghafinia M, Abdollahi M. A review on delayed toxic effects of sulfur mustard in Iranian veterans. DARU J Pharm Sci. 2012;20:51.CrossRefGoogle Scholar
  57. Renshaw B (1946) Mechanisms in production of cutaneous injuries by sulfur and nitrogen mustards. In: Chemical warfare agents, and related chemical problems. Parts 3–6. Office of Scientific Research and Development, National Defense Research Committee, Div 9, Washington, DC, pp 478–520Google Scholar
  58. Roushan N, Abtahi HR, Daneshfar G, Akhlaghpur S, Shabestari A, Yavari MR. Long term pulmonary complications of war related sulfur mustard exposure. J Mil Med. 2008;10:143–50.Google Scholar
  59. Rowell M, Kehe K, Balszuweit F, Thiermann H. The chronic effect of sulfur mustard exposure. Toxicology. 2009;263:3–8.CrossRefGoogle Scholar
  60. Ruhl CM, Park DJ, Danisa O, et al. A serious skin sulfur mustard burn from artillery shell. J Emerg Med. 1994;12(2):159–66.CrossRefPubMedGoogle Scholar
  61. Saladi RN, Smith E, Persaud AN. Mustard: a potential agent of chemical warfare and terrorism. Clin Exp Dermatol. 2006;31:1–5.CrossRefPubMedGoogle Scholar
  62. Salem H, Ternay A, Smart JK. Brief history and use of chemical warfare agents in warfare and terrorism. In: Romano JA, Lukey BJ, Salem H, editors. Chemical warfare agents. Chemistry, pharmacology, toxicology and therapeutics. 2nd ed. Boca Raton: CRC Press Taylor & Francis Group; 2008. p. 1–20. ISBN 978-1-4200-4661-8.Google Scholar
  63. Sanderson H, Fauser P, Thomsen M, Vanninen P, Soderstrom M, Savin Y, Khalikov I, Hirvonen A, Niiranen S, Missiaen T, Gress A, Borodin P, Medvedeva N, Polyak Y, Paka V, Zhurbas V, Feller P. Environmental hazards of sea-dumped chemical weapons. Environ Sci Technol. 2010;44:4389–94.CrossRefPubMedGoogle Scholar
  64. Shakarian MP, Heck DE, Gray JP, Sinko PJ, Gordon MK, et al. Mechanisms mediating the vesicant actions of sulfur mustard after cutaneous exposure. Toxicol Sci. 2010;114:5–19.CrossRefGoogle Scholar
  65. Sidell FR, Urbanetti JS, Smith WJ, Hurst CG. Vesicants. In: Sidell FR, Takafuji ET, Franz DR, editors. Medical aspects of chemical and biological warfare. Washington, DC: Borden Institute; 1997. p. 197–222. Chapter 7.Google Scholar
  66. Smart JK (1996) History of chemical and biological warfare fact sheets. Aberdeen Proving Ground: US Army Chemical and Biological Defense Command; Special Study 50Google Scholar
  67. Smith WJ. Vesicant agents and antivesicant medical countermeasures: clinical toxicology and psychological implications. Military Psychol. 2002;14(2):145–57.CrossRefGoogle Scholar
  68. Smith WJ, Dunn MA. Medical defense against blistering chemical warfare agents. Arch Dermatol. 1991;127:1207–13.CrossRefPubMedGoogle Scholar
  69. Smith WJ, Clark MG, Talbot TB, Caple PA. Chapter 9: Long-term health effects of chemical threat agents. In: Tuorinsky SD, editor. Medical aspects of chemical warfare. Washington, DC: Borden Institute, Walter Reed Army Medical Center; 2008. p. 311–37.Google Scholar
  70. Szinicz L. History of chemical and biological warfare agents. Toxicology. 2005;214:167–81.CrossRefPubMedGoogle Scholar
  71. Vogt R, Dannenberg A, Schofield B, Hynes N, Papirmeister B. Pathogenesis of skin lesions caused by sulfur mustard. Fundam Appl Toxicol. 1984;4:571–83.CrossRefGoogle Scholar
  72. Wada S, Miyanishi M, Nishimoto Y, et al. Mustard gas as a cause of respiratory neoplasia in man. Lancet. 1968;1:1161–3.CrossRefPubMedGoogle Scholar
  73. Walker P. Sea-dumped chemical munition. New York: United Nations Second Committee; 2010. Available at: www.globalgreen.org/docs/publication-168-1.pdf.Google Scholar
  74. Watson AP, Griffin GD. Toxicity of vesicant agents scheduled for destruction by the chemical stockpile disposal program. Environ Health Perspect. 1992;98:259–80.CrossRefPubMedPubMedCentralGoogle Scholar
  75. Weibrecht KS, Rhyee ME, Manuell C, Longo EW, Brush BE. Sulfur mustard exposure presenting to a community emergency department. Ann Emerg Med. 2012;59:70–4.CrossRefPubMedGoogle Scholar
  76. Weiss A, Weiss B. Carcinogenesis due to mustard gas exposure in man, important sign for therapy with alkylating agents. Dtsch Med Wochenschr. 1975;100:919–23.CrossRefPubMedGoogle Scholar
  77. WHO. Health aspects of chemical and biological weapons. Geneva: World Health Organization; 1970. p. 23–34.Google Scholar
  78. WHO. WHO guidance: public health response to biological and chemical weapons. 2nd ed. Geneva: World Health Organization; 2004. p. 164–70.Google Scholar
  79. Willems JL. Clinical management of mustard gas casualties. Ann Med Milit Belg. 1989;3S:1–61.Google Scholar
  80. Wulf HC, Aasted A, Darre E, Niebuhr E. Sister chromatic exchanges in fishermen exposed to leaking mustard gas shells. Lancet. 1985;1:690–2.CrossRefPubMedGoogle Scholar
  81. Yamada A. On the late injuries following occupational inhalation of mustard gas, with special reference to carcinoma of the respiratory tract. Acta Pathol Jpn. 1963;13:131–55.PubMedGoogle Scholar
  82. Yamada A, Hirose F, Miyanishi M. An autopsy case of bronchial carcinoma found in a patient succumbed to occupational mustard gas poisoning. Gan. 1953;44:216–8.PubMedGoogle Scholar
  83. Yamada A, Hirose F, Nagai M, Nakamura T. Five cases of cancer of the larynx found in persons who suffered from occupational mustard gas poisoning. Gan. 1957;48:366–8.PubMedGoogle Scholar
  84. Yamakido M, Ishioka S, Hiyama K, Maeda A. Former poison gas workers and cancer: incidence and inhibition of tumor formation by treatment with biological response modifier N-CWS. Environ Health Perspect. 1996;104(Suppl):3485–8.Google Scholar
  85. Yang YC, Baker JA, Ward JR. Decontamination of chemical warfare agents. Chem Rev. 1992;92(8):1729–43.CrossRefGoogle Scholar
  86. Zanders JP, Eckstein S, Hart J. Chapter 13: Chemical and biological developments and arms control. In: Stockholm International Peace Research Institute (SIPRI) Yearbook 1997; Armaments, Disarmament and International Security. Oxford: Oxford University Press; 1997.Google Scholar

Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  • Slavica Vucinic
    • 1
    Email author
  • Branka Djurovic
    • 2
  • Biljana Antonijevic
    • 3
  1. 1.National Poison Control CentreMilitary Medical Academy/Medical Faculty, University of DefenseBelgradeSerbia
  2. 2.Institute of Occupational MedicineMilitary Medical Academy, Medical Faculty/University of DefenseBelgradeSerbia
  3. 3.Faculty of PharmacyUniversity of BelgradeBelgradeSerbia

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