Chronic cardiac toxicity after inhalation of 1,1,1-trichloroethane.

Two patients showed evidence of chronic cardiac toxicity after repeated exposure to 1,1,1-trichloroethane. In both cases there was circumstantial evidence of a deterioration after routine anaesthetic use of the related compound halothane. An adolescent boy who sniffed trichloroethane presented with multiple ventricular arrhythmias during tonsillectomy. Follow up showed mild chronic left ventricular impairment. A 54 year old man had repeated industrial exposure to trichloroethane and deteriorated from mild stable cardiac failure to end stage cardiac failure after halothane anaesthesia for herniorrhaphy. Chronic cardiac toxicity is a previously unreported feature of this type of solvent exposure. Related compounds such as halothane may have a toxic interaction after exposure to trichloroethane.     

Spontaneous malignomas in Tupaia (tree shrew)

Nine spontaneous malignomas of the tree shrew were detected and analysed during an observation period of nine years. The tumours were histopathologically examined and classified. All malignomas developed in imported Tupaia only. From the tumour cells of two different animals new Tupaia herpesviruses were isolated. This is the first. report on spontaneous malignomas of Tupaia in captivity.     

Induction of chromosome aberrations in lymphocytes of mice after subchronic exposure to benzene

The induction of chromosome aberrations in lymphocytes of mice after subchronic exposure to benzene was investigated. 4 groups of 5 Swiss (ICR) male mice were given orally a solution of benzene every day for 14 days except days 5 and 10. The daily doses were 0, 36.6, 73.2 and 146.4 mg/kg. Mice were sacrificed on day 15, lymphocytes were obtained by perfusion of the spleen and the cells were cultured in RPMI 1640 medium. After 48 h of culture, cells were harvested for cytogenetic analysis. A significant dose-dependent increase in the frequency of cells with chromatid aberrations were found (p less than 0.001). A significant increase in polyploid cells were also observed (p less than or equal to 0.05). This study represents the first report on the induction of chromosome aberrations and polyploid cells in lymphocytes of mice after subchronic exposure to benzene. Such dual activity of benzene suggests that benzene may be responsible for more human health problems than currently estimated.     

How can we best prolong life? Benefits of coronary risk factor reduction in non-diabetic and diabetic subjects.

OBJECTIVE--To compare the theoretical benefits of different approaches to reduce risk factors for coronary heart disease in subjects at risk. DESIGN--The results of findings from meta-analyses of intervention studies on cause specific mortality and of observational studies on smokers and ex-smokers were applied to observational data on 10 year cause specific mortality derived from the multiple risk factor intervention trial. Lifetable analyses were used to estimate gains in life expectancy. SUBJECTS--Diabetic and non-diabetic men initially 35-57 years of age. MAIN OUTCOME MEASURES--10 year mortality from coronary heart disease, 10 year total mortality, man years of intervention to prevent one death and one death from coronary heart disease, gain in life expectancy, and drug costs per year of additional life in diabetic and non-diabetic men of 45. RESULTS--In non-diabetic men a 10 year mortality from coronary heart disease of 14.4 per 1000 would be reduced by a mean of 0.58, 0.82, 2.64, and 2.74 per 1000 by antihypertensive treatment, lowering cholesterol concentration, taking aspirin, and stopping smoking respectively; a 10 year total mortality of 44.1 per 1000 would fall by a mean of 1.06, 5.16, and 8.65 per 1000 with antihypertensive and aspirin treatment and stopping smoking respectively and increased by a mean of 0.07 per 1000 with the lowering of cholesterol concentration. In diabetic men the reductions in mortality from coronary heart disease would be between three and five times greater, and total mortality would show mean reductions of 5.81, 0.56, 16.17, and 20.84 per 1000 respectively, with all interventions of significant benefit except the lowering of cholesterol concentration. Between 2400 and 3800 man years of pharmacological intervention were calculated as being necessary to prevent one death from coronary heart disease in a non-diabetic man, and between 800 and 1200 man years in a diabetic man. The loss of life expectancy associated with smoking and hypertension is greater than that accruing from hypercholesterolaemia, but stopping smoking would prolong life by a mean of around four years in a 45 year old non-diabetic man and three years in a diabetic man, whereas aspirin and antihypertensive treatment would provide approximately one year of additional life expectancy in both categories. CONCLUSIONS--Studies to date have shown little impact of drugs that lower cholesterol concentration and blood pressure on either coronary heart disease or total mortality. Although new treatments for hypercholesterolaemia and hypertension might help prevent coronary heart disease, other approaches to reduce the burden of premature death are required.     

青岛地区某医院12年甲状腺癌发病模式变迁

目的:探讨青岛地区某医院12年甲状腺癌的发病趋势和病理类型分布。方法:回顾性分析2001-2012年于青岛大学附属医院行手术切除的甲状腺癌患者的发病年龄、性别比例、手术数量以及病理类型构成比的变化。结果:12年来手术治疗甲状腺癌2421例,其中乳头状癌(PTC)占94.13%,滤泡状癌(FTC)占3.02%,髓样癌(MTC)占2.15%,未分化癌(ATC)占0.70%。甲状腺癌手术数量呈逐年递增趋势,尤以近4年升高显著,其病理类型以PTC为主,构成比例由79.63%上升至97.47%。四类甲状腺癌均以女性多见(男女比例1:1.38-1:4.37)。甲状腺癌的平均确诊年龄为46.80岁,PTC最低(46.48岁),ATC最高(64.25岁)。结论:青岛地区甲状腺癌发病数量呈逐年递增趋势,PTC是最常见的病理类型,其构成比例上升明显,其他类型相对下降。PTC的发病可能与高碘有关。     

Toxicogenomic analysis of gene expression changes in rat liver after a 28-day oral benzene exposure

Benzene is an industrial chemical, component of automobile exhaust and cigarette smoke. After hepatic bioactivation benzene induces bone marrow, blood and hepatic toxicity. Using a toxicogenomics approach this study analysed the effects of benzene at three dose levels on gene expression in the liver after 28 daily doses. NMR based metabolomics was used to assess benzene exposure by identification of characteristic benzene metabolite profiles in urine. The 28-day oral exposure to 200 and 800 mg/kg/day but not 10 mg/kg/day benzene-induced hematotoxicity in male Fisher rats. Additionally these upper dose levels slightly reduced body weight and increased relative liver weights. Changes in hepatic gene expression were identified with oligonucleotide microarrays at all dose levels including the 10 mg/kg/day dose level where no toxicity was detected by other methods. The benzene-induced gene expression changes were related to pathways of biotransformation, glutathione synthesis, fatty acid and cholesterol metabolism and others. Some of the effects on gene expression observed here have previously been observed after induction of acute hepatic necrosis with bromobenzene and acetaminophen. In conclusion, changes in hepatic gene expression were found after treatment with benzene both at the toxic and non-toxic doses. The results from this study show that toxicogenomics identified hepatic effects of benzene exposure possibly related to toxicity. The findings aid to interpret the relevance of hepatic gene expression changes in response to exposure to xenobiotics. In addition, the results have the potential to inform on the mechanisms of response to benzene exposure.     

Bone marrow depressant and leukemogenic actions of benzene

Chronic benzene toxicity is expressed as bone marrow depression resulting in leucopenia, anemia or thrombocytopenia. With continued exposure the disease progresses to pancytopenia resulting from a bone marrow aplasia. In recent years evidence has accumulated implicating benzene in the etiology of leukemias in workers in industries where benzene was heavily used. It has been suggested that leukemia is as frequent a cause of death from chronic benzene exposure as is aplastic anemia. This review explores some current ideas on the mechanisms by which benzene may produce these diseases and emphasizes recent work suggesting that the causative agent is a metabolite of benzene.     

Successful plasma exchange in type 1 leprosy reversal reaction.

A 24 year old man admitted to hospital with borderline lepromatous leprosy was treated with rifampicin, dapsone, and clofazimine. After four months he developed a reversal reaction and the diagnosis was modified to borderline tuberculoid leprosy. The dose of clofazimine was raised and prednisolone added to the regimen without any symptomatic response. His condition improved dramatically after five plasma exchanges on five successive days.     

Woody species and nutrient accumulation during the fallow period of milpa farming in Belize,C.A.

Plant lifeform composition and levels of nutrients accumulated by fallows aged 1, 2 and 3 years under shifting (milpa) cultivation in Belize were measured. Levels of N, P and K allocated to leaves rapidly reached a plateau in 1 year old fallows with little increase in 2 and 3 year old sites. In stem material, K was accumulated rapidly, with little increase after the first year of fallow growth, while N and P accumulation proceeded at steady rates during three years of fallow development. Total biomass in 3 year old fallows averaged 2070 g m^–2 with 10.3 g m^–2 N, 0.73 g m^–2P and 13.2 g m^–2K. Nutrient concentrations in early successional species were higher than in species of later successional status, suggesting different strategies for nutrient utilization.Woody lifeforms dominated the fallow vegetation, accounting for 80% of total biomass in first year fallows and eliminating herbaceous species after 2 and 3 years of fallow growth. The importance of rapid recovery of woody species is discussed as it relates to fallow management and weed control.     

Collaboration of a dentist and speech-language pathologist in the rehabilitation of a stroke patient with dysarthria: a case study

Objective: To elucidate the effectiveness of the collaboration of a dentist and speech‐language pathologist (SLP) in the rehabilitation of a stroke patient with dysarthria. Design: A clinical case report treated in the rehabilitation hospital and dental surgery. Subject: A 71‐year‐old Japanese man who was admitted to the rehabilitation hospital for speech rehabilitation 2 years and 5 months after a stroke. Methods: Provision of prosthesis (palatal lift prosthesis + palatal augmentation prosthesis) for improving velopharyngeal incompetence (VPI) and articulation by dentist, and speech behavioural management by SLP including self‐monitoring and bio‐feedback training using the See‐Scape. Results: Speech behavioural management proved useful for promoting improvement in speech intelligibility to a functionally sufficient level after improving VPI by prosthesis. Conclusion: The collaborative efforts of the dentist and SLP in the rehabilitation of post‐stroke patients with velopharyngeal incompetence should be encouraged.     

Carcinome urothélial de l’urètre: une nouvelle observation et revue de la littérature

Urothelial carcinoma of the male urethra is a rare tumour. We report a new case of urothelial carcinoma of the urethra in a 64-year old man who was examined due to a dysuria. Retrograde and voiding urethrocystography carried out had shown images of bulbopenile urethral stricture treated by urethroplasty. Histological examination of the urethrectomy part revealed a urothelial carcinoma of the urethra. The patient refused any additional treatment and survived 14 months after diagnosis.     

Breast carcinoma and malignant melanoma metastasis within a single axillary lymph node

A 58 year old lady presented with a right breast cancer and a prior history of malignant melanoma excised from the right chest wall eight years previously. An abnormal axillary lymph node resected contained features of both metastatic breast carcinoma and malignant melanoma. Following oncologic breast cancer management, the patient is well with no evidence of recurrence at three years.     

Conversion of an IGM secreting immunocytoma in a high grade malignant lymphoma of immunoblastic type

A case involving a 67 year old man with an immunocytoma initially presenting as Waldenstr?m's macroglobulinemia which transformed into a high grade malignant lymphoma of immunoblastic type after treatment with cyclophosphamide and corticosteroids over 5 months is presented. IgM (kappa) present in the serum in the phase of immunocytoma was demonstrated also on the less differentiated cells of the high grade lymphoma. The permanent production of the same immunoglobulin molecule suggests that both morphologically different malignancies derived from one B cell clone.     

Fine needle aspiration of urethral recurrence of urothelial carcinoma after radical cystectomy presenting as a perineal mass: a case report

BACKGROUND: Recurrence of urothelial (transitional cell) carcinoma in the urethra after cystectomy for invasive urothelial carcinoma is relatively uncommon. It is also uncommon for the recurring urethral tumor to present as a painful perineal mass. Fine needle aspiration (FNA) can be used to evaluate such perineal lesions and confirm tumor recurrence. CASE: A 5-cm-diameter mass was found in the perineum of a 63-year-old man 1 year after radical cystoprostatectomy for invasive urothelial carcinoma of the urinary bladder. The mass was detected on pelvic computed tomographic scanning. FNA cytology showed numerous urothelial carcinoma cells of high grade displaying squamous cell differentiation mimicking the histopathologic findings of the primary tumor found on cystectomy. Diagnosis of recurrent urothelial carcinoma was rendered. The FNA in this case spared the patient an open biopsy. CONCLUSION: Mass lesions arising in the perineum of patients who underwent cystectomy for urothelial carcinoma should raise the suspicion of urothelial carcinoma recurrence. Evaluation of perineal masses for recurrence of urothelial carcinoma can be made on FNA without the need for open biopsy.     

Novel translocation t(3;11)(p21;q24) in multiple myeloma characterised by FISH

We present a 72 year old man with multiple myeloma (MM). Cytogenetic and FISH analysis of bone marrow aspirate showed a novel translocation -der(11)t(3;11)(p21;q24). The unbalanced karyotype led to substantial partial trisomy for chromosome 3p and small partial monosomy 11q. Structural rearrangements of chromosome 3 are uncommon in MM and these are reviewed. The patient died 2 years after the diagnosis of MM was made.     

Resolution after radiotherapy of severe pulmonary damage due to paraquat poisoning.

A 29 year old man was admitted 36 hours after ingesting about 5 g paraquat. His arterial oxygen pressure fell progressively to 3.4 kPa (34 mm Hg), and pulmonary damage induced by paraquat was diagnosed. His condition did not improve after treatment with prednisolone and cyclophosphamide, but after irradiation both lungs cleared and arterial oxygen pressure started to improve. Irradiation of the lungs should be considered in patients who, after surviving the acute phase of poisoning with paraquat, show progressive deterioration of respiratory function.     

A case of cutaneous phaeohyphomycosis caused byExserohilum rostratum,its in vitro sensitivity and review of literature

A 40 year old woman presented with the infection of skin of 3 years duration on the upper anterior aspect of fore-arm. Histologic examination of the skin tissue revealed dematiaceous hyphae, aggregated structures or single celled elements. On detailed mycological examination the isolate was identified asExserohilum rostratum. Among the antimycotic tested in vitro amorolfine was found to be most effective with MIC value of 3 mcg/ml. This is the first report ofE. rostratum infection of man from India.     

Use of in vivo genetic toxicity data for risk assessment

Mutagenicity studies have been used to identify specific agents as potential carconogens or other human health hazards; however, they have been used minimally for risk assessment or in determining permissible levels of human exposure. The poor predictive value of in vitro mutagenesis tests for carcinogenic activity and a lack of mechanistic understanding of the roles of mutagens in the induction of specific cancers have made these tests unattractive for the purpose of risk assessment. However, the limited resources available for carcinogen testing and large number of chemicals which need to be evaluated necessitate the incorporation of more efficient methods into the evaluation process. In vivo genetic toxicity testing can be recommended for this purpose because in vivo assays incorporate the metabolic activation pathways that are relevant to humans. We propose the use of a multiple end-point in vivo comprehensive testing protocol (CTP) using rodents. Studies using sub-acute exposure to low levels of test agents by routes consistent with human exposure can be a useful adjunct to methods currently used to provide data for risk assessment. Evaluations can include metabolic and pharmacokinetic endpoints, in addition to genetic toxicity studies, in order to provide a comprehensive examination of the mechanism of toxicity of the agent. A parallelogram approach can be used to estimate effects in non-accessible human tissues by using data from accessible human tissues and analogous tissues in animals. A categorical risk assessment procedure can be used which would consider, in order of priority, genetic damage in man, genetic damage in animals that is highly relevant to disease outcome (mutation, chromosome damage), and data from animals that is of less certain relevance to disease. Action levels of environmental exposure would be determined based on the lowest observed effect levels or the highest observed no effect levels, using sub-acute low level exposure studies in rodents. As an example, the known genotoxic effects of benzene exposure at low levels in man and animals are discussed. The lowest observed genotoxic effects were observed at about 1–10 parts per million for man and 0.04–0.1 parts per million in subacute animal studies. If genetic toxicity is to achieve a prominent role in evaluating carcinogens and characterizing germ-cell mutagens, minimal testing requirements must be established to ascertain the risk associated with environmental mutagen exposure. The use of the in vivo approach described here should provide the information needed to meet this goal. In addition, it should allow truly epigenetic or non-genotoxic carcinogens to be distinguished from the genotoxic carcinogens that are not detected by in vitro methods.     

An interesting case of defective HLA phenotype

In a 27 years old man whose parents had HLA phenotypes A 9/B 7, Bw 16 and Al/B 17, B 18 only HLA-B 18 could be reliably identified in lymphocytes by means of microlymphocytotoxic tests. It is probable that HLA-Bw 16 was also present in the lymphocytes of this test person. Even by applying the neutralisation test, the HLA antigens A 1 and a 9 could not be detected in the test person's serum. The cause for the existence of the defective HLA phenotype is discussed.     

The age distribution of neutralizing antibodies against varicella-zoster virus in healthy individuals

A seroepidemiological survey of varicella was made in the Nagoya area by the neutralization (NT) test. Of 1,473 recorded cases of varicella, 81.4% were under 6 years old and 9.6% were under one year old; of the 168 recorded cases under one year old, about 30% were under 5 months old. Examination of 11 pairs of mother and cord sera and 13 pairs of mother and infant sera showed that transfer of NT antibody was in general good, even in babies that were small for their age or smnall at birth after 28 weeks gestation. The transferred maternal antibody decreased rapidly, becoming undetectable in babies of 4 months old. Then with increase in age the percentgage of seropositive children gradually increased, being 53.3% at 4 to 5 years old, and 100% in those of over 9 years old, with a temporary decrease in young adults in their twenties.