Bone aluminum measured in miners exposed to McIntyre powder.

A small pilot study was conducted to test whether the technique of in vivo neutron activation analysis could measure bone aluminum levels in 15 miners who had been exposed to McIntyre Powder over 40 years prior. All miners were over 60 years of age, had worked in mines that used McIntyre Powder, and were sufficiently healthy to travel from northern to southern Ontario for the measurements. Individual aluminum levels were found to be significantly greater than zero with 95% confidence (p < 0.05) in 7 out of the 15 miners. The inverse variance weighted mean of the 15 participants was 21.77 ± 2.27µgAl/gCa. This was significantly higher (p < 0.001) than in a group of 15 non-occupationally exposed subjects of a comparable age from Southern Ontario who had been measured in a previous study. The inverse variance weighted mean bone aluminum content in the non-occupationally exposed group was 3.51 ± 0.85µgAl/gCa. Since the use of McIntyre Powder ceased in 1979, these subjects had not been exposed for more than 40 years. Calculations of potential levels at the cessation of exposure in the 1970s, using a biological half-life of aluminum in bone of 10 to 20 years predicted levels of bone aluminum comparable with studies performed in dialysis patients in the 1970s and 1980s. This pilot study has shown that the neutron activation analysis technique can determine differences in bone aluminum between McIntyre Powder exposed and non-exposed populations even though 40 years have passed since exposure ceased. The technique has potential application as a biomarker of exposure in cross-sectional studies of the health consequences of exposure to McIntyre Powder.

A seafood risk tool for assessing and mitigating chemical and pathogen hazards in the aquaculture supply chain.

Intricate links between aquatic animals and their environment expose them to chemical and pathogenic hazards, which can disrupt seafood supply. Here we outline a risk schema for assessing potential impacts of chemical and microbial hazards on discrete subsectors of aquaculture-and control measures that may protect supply. As national governments develop strategies to achieve volumetric expansion in seafood production from aquaculture to meet increasing demand, we propose an urgent need for simultaneous focus on controlling those hazards that limit its production, harvesting, processing, trade and safe consumption. Policies aligning national and international water quality control measures for minimizing interaction with, and impact of, hazards on seafood supply will be critical as consumers increasingly rely on the aquaculture sector to supply safe, nutritious and healthy diets.

Evaluation of a carp primary hepatocyte culture system for screening chemicals for oestrogenic activity.

The presence of endocrine disrupting chemicals (EDCs) in the environment has driven the development of screening and testing assays to both identify chemicals with hormonal activity and evaluate their potential to cause adverse effects. As the number of animals used for research and regulatory purposes rises, and set against a desire to reduce animal testing, there is increased emphasis on the development and application of in vitro techniques to evaluate chemical risks to the environment. Induction of vitellogenin (VTG) in isolated fish liver cells has been used successfully to identify a wide range of EDCs, including both natural and synthetic oestrogens and a variety of other xenoestrogens. However, the vitellogenic response reported for hepatocytes in culture has been shown to vary widely, making comparisons between studies difficult. The work presented in this paper explored the variability of the vitellogenic response in primary cultures of common carp (Cyprinus carpio) hepatocytes following exposure to the model oestrogenic compound, 17beta-oestradiol (E2). As expected, variability in the vitellogenic response was observed, both in terms of the sensitivity and magnitude of VTG induction, for hepatocytes isolated from different fish. An apparent difference was observed in the response of isolated hepatocytes based on the sex of the donor fish; maximum levels of E2-stimulated VTG synthesis in hepatocytes derived from females appeared higher (1962 ng mL(-1)+/-487 [n=9] compared with 1194 ng mL(-1)+/-223 for hepatocytes from males [n=9]) and EC(50) values lower (1.61+/-0.4 microM E2 for females and 2.12+/-0.2 microM E2 for males). However, these differences were not statistically significant, likely in part due to the variation observed in the vitellogenic response. In particular, hepatocytes derived from female fish showed more variation than their male counterparts (the co-efficient of variation for females was 77% compared to 28% for males). Despite the variation observed in the vitellogenic response between different cultures, data from the different donor fish could be compared by standardising responses relative to the maximum VTG induction in each culture following exposure to E2. Adopting this approach in the future will allow for data from different hepatocyte cultures and from donor fish of different sexes, age and stage of maturity to be compared with greater consistency. Measurement of vtg mRNA expression was relatively more sensitive to the oestrogenic effects of E2 exposure than measurement of VTG protein (the LOEC at the transcriptome level was 10-fold lower [0.01 microM E2] than at the protein level [0.1 microM E2]) and changes in vtg mRNA expression showed less variation between individual hepatocyte isolations. Measurement of vtg mRNA in the hepatocyte culture system therefore may offer the most sensitive and consistent option for the screening of chemicals with oestrogenic activity in fish primary hepatocyte cultures.

Duration of heart disease visits by elderly patients: productivity versus quality.

A balance should be reached between physician productivity and clinical quality, since the first comes at the expense of the second. The study described here used the National Ambulatory Medical Care Survey (NAMCS) to demonstrate that visit length for elderly heart disease patients is related to both appropriate (i.e. clinical) patient differences and to less justifiable factors. Both demand management and managerial control strategies should be considered.

New world views: preparing physicians in training for global health work.

BACKGROUND AND OBJECTIVES: To determine the impact of international health experiences on physicians in training, we studied 60 US medical students who participated in an International Health Fellowship Program (IHFP). METHODS: In 1995 and 1996, US medical students were selected to participate in the IHFP, which included training at three US medical schools and at seven medical schools in developing countries. The program included a 2-week preparatory course at a US school and a 6- to 8-week field experience. Evaluative data were collected prior to the course, after the course, after the field experience, and 1-2 years later. RESULTS: A total of 60 students were selected from 145 applicants. At the end of the fellowship, a majority of participants noted that the exposure affected them in the following ways: changed world views; increased cultural sensitivity; enhanced community, social, and public health awareness; enhanced clinical and communication skills; more appropriate resource utilization; changes in career plans; and a greater understanding of the challenges of working in areas with scarce resources. After the international field experience, students more strongly agreed with the importance of oral rehydration, communication skills, and patient education. According to student self-assessments, the IHFP significantly improved core medical skills. Ninety-six percent of participants recommended international health experiences for other students. CONCLUSIONS: This study of IHFP fellows demonstrates multiple significant impacts of international health experiences on US medical students in training. The knowledge, attitudes, and skills gained through international health experiences are important for medical practice in the United States and abroad. Given the high interest of medical students in international health and the potential for positive educational impacts, medical schools should increase the availability of high-quality international experiences.

Sustained myoglobinuria: the presenting manifestation of dermatomyositis.

We describe two patients with sustained myoglobinuria that did not resolve with supportive treatment. After we established a diagnosis of dermatomyositis and started treatment with corticosteroids, there was rapid resolution of the myoglobinuria. Well-documented cases of inflammatory myopathy causing myoglobinuria are rare, but their prompt recognition has important therapeutic implications.

International health medical education consortium. Its history, philosophy, and role in medical education and health development.

The International Health Medical Education Consortium (IHMEC) is the first national organization created to link faculty in North American medical schools that teach international health. This article presents IHMEC's role in international medical education, including their mission, structure, and future agendas.

A reappraisal of the radiologic findings of acute inflammation of the epiglottis and supraglottic structures in adults.

PURPOSE: To evaluate the radiologic characteristic of acute inflammation of the epiglottis and supraglottic structures in adults. METHODS: The clinical and radiographic findings in 27 adult patients with epiglottitis (average age, 43 years; range, 28 to 81 years) were compared with those of a control group of asymptomatic subjects (n = 15; average age, 48 years; range, 24 to 79 years). Unusual clinical aspects in the current series included two patients who were positive for human immunodeficiency virus, 1 with acquired immunodeficiency syndrome and Kaposi sarcoma, 3 with emphysematous epiglottitis, 1 with abscess formation, and 1 with laryngeal carcinoma. One patient required emergency tracheostomy. One patient died of pneumonia. RESULTS: The ratio of the soft-tissue parameters to the anteroposterior width of the C-4 vertebral body yielded three key parameters of high statistical significance in adult epiglottitis. The ratio of the width of the epiglottis to the anteroposterior width of C-4 should not be greater than 0.33 (sensitivity, 96%; specificity, 100%). The ratio of the prevertebral soft tissue to C-4 should not exceed 0.5 (sensitivity, 37%; specificity, 100%) and the ratio of the width of the hypopharyngeal airway to the width of C-4 should be less than 1.5 (sensitivity, 44%; specificity, 87%). The aryepiglottic folds were enlarged in 85%, and the arytenoids were swollen in 70% of the patient population (specificity, 100%). CONCLUSION: These defined radiologic parameters should aid in the diagnosis of acute epiglottitis in adults.

Miliary tuberculosis presenting as skin lesions in a patient with acquired immunodeficiency syndrome.

Acute miliary tuberculosis of the skin is an extremely rare infection that occurs in immunocompromised persons. We report an intravenous drug abuser with human immunodeficiency virus infection in whom erythematous papules developed on the trunk and proximal aspect of the extremities. Visceral lesions of unsuspected miliary tuberculosis were discovered at autopsy, and the cutaneous papules were found to contain Mycobacterium tuberculosis. This is the first reported case of this cutaneous infection in a patient with the acquired immunodeficiency syndrome.

Skin clues to medical emergencies.

In a medical emergency, when rapid diagnosis is essential, a thorough examination of the skin often provides clues to the underlying illness. Dermatologic lesions may suggest the etiology of common medical emergencies, such as coma, seizure, shock, chest pain, hemorrhage, respiratory distress, acute abdomen and acute psychosis. Since examination of the skin is rapidly and easily performed, it should be included in the evaluation of a patient with a medical emergency.

Comparison of direct fluorescent antibody, acridine orange, wet mount, and culture for detection of Trichomonas vaginalis in women attending a public sexually transmitted diseases clinic.

To define the performance characteristics of two newer tests for Trichomonas vaginalis (TV), the authors compared direct fluorescent antibody (DFA) (mixed monoclonal antibody, Integrated Diagnostics, Inc, Berkeley, CA) and acridine orange (AO) tests to standard wet mount (WM) preparations and culture (modified Diamond medium) of vaginal wash specimens in consecutively examined women presenting to a public sexually transmitted diseases (STD) clinic. Cultures for Neisseria gonorrhoeae (GC), Chlamydia trachomatis (CT), and yeast were also performed on all patients. Of 104 women, 59 (57%) were infected with one or more pathogens. Trichomonas vaginalis was detected by WM and/or culture in 38 (37%) women and was the most prevalent infection. Of the 38 patients with TV, 95% were detected by culture, 83% by DFA, 66% by AO, and 66% by WM. An additional patient was DFA positive but negative for TV by all other methods. The sensitivity of DFA was superior to AO and WM in women with TV infection alone (96% compared to 67% and 53%, respectively). It was comparable to AO and WM in women with multiple infections (67% compared to 53% and 73%). Even in the presence of other pathogens, DFA appears to be a reasonable alternative to culture for detection of TV. In addition, DFA is rapid, easy to perform, and relatively inexpensive.

Treatment of multiple apocrine hidrocystomas with the carbon dioxide (CO2) laser.

The apocrine hidrocystoma tends to occur as a solitary facial cystic lesion. We report an unusual patient in whom there were multiple apocrine hidrocystomas scattered over the periorbital region and ears. Although solitary apocrine hidrocystomas are easily treated with excision, we had good results employing carbon dioxide laser vaporization in the treatment of numerous hidrocystomas.

Chronic arsenicism with vitiligo, hyperthyroidism, and cancer.

Chronic arsenicism, which may result from medicinal administration of arsenic, can present typical cutaneous signs, and is associated with an increase in cutaneous and internal malignancies. Recognition of the cutaneous premalignant stigmata of chronic arsenicism can identify a patient at risk, and promote early detection and treatment of life-threatening cancers.

Atypical invasive external otitis from Aspergillus.

We report a rare case of invasive external otitis caused by aspergillosis in an elderly nondiabetic patient. Amphotericin B therapy was curative. Atypical features of the presentation delayed diagnosis. Early use of tissue biopsy and culture to guide prompt initiation of therapy is recommended. The clinical spectrum and microbiology of invasive aspergillosis are also reviewed.