Case reports: arsenic pollution in Thailand, Bangladesh, and Hungary.

Although arsenic contamination in the three countries described herein differs, a number of common themes emerge. In each country, the presence of arsenic is both long term and of geological origin. Moreover, in each of these countries, arsenic was only recently discovered to be a potential public health problem, having been first formally recognized in the 1980s or 1990s. In Bangledesh, exposure of the public to arsenic arose as a result of the search for microbially safe drinking water; this search resulted in the sinking of tube wells into aquifers. In Hungary, the natural bedrock geology was responsible for contamination of aquifer water. The genesis of arsenic contamination in Thailand arose primarily from small-scale alluvial mining activities, which mobilized geologically bound arsenic. Because of the complex chemistry of arsenic, and variability in where it is found and how it is bound, multiple mitigation methods must be considered for mitigating episodes of environmental contamination. The Ron Phibun region of Thailand has a 100-yr history of tin mining. A geological survey of the region was conducted in the mid-1990s by the Department of Mineral Resources and Department of Industry of Thailand, and was supported by the British Geological Society. Skin cancer in Thailand was first reported in 1987, in the southern part of the country; among other symptoms observed, there was evidence of IQ diminutions among the population. Arsenic water levels to 9,000 pg/L were reported; such levels are substantially above any guideline levels. A long-term plan to mitigate arsenic contamination was devised in 1998-2000. The plan involved removal of arsenic-contaminated land and improved management of mining wastes. However, at $22 million, the cost was deemed prohibitive for the regional Thai economy. An alternative solution of providing pipeline drinking water to the exposed population was also unsuccessful, either because arsenic contamination levels did not fall sufficiently, or because the quantity of water delivered to the population was inadequate. Membrane technology treatment, using reverse osmosis, was successful during the summer months, but membrane filter replacement costs prevented wide implementation. Less expensive options, such as the use of rainwater jars, were feasible in areas with adequate rainfall. Algae and phytoremediation and wetland treatment of surface waters were useful, but the waste disposal necessitated by such treatments reduces acceptance. The development and population growth in Bangladesh from 1980 to 2000 resulted in improved water quality, primarily because of the drilling of about 10 million tube wells. The unintended consequence of this action resulted in exposure of about 40 million people to toxic levels of arsenic, which was a natural contaminant of the aquifers. Numerous remediation strategies have been implemented to deal with this problem, including the use of dug wells, pond sand filters, household filters, rainwater harvesting, deep tube wells, chemical-based options, and construction of village piped water supplies. Varying levels of success, which is largely dependent on local resources and conditions, have been reported for the different mitigation methodologies. Although Hungary has already invested huge sums of money to reduce arsenic levels in the most contaminated counties, further investments are needed to comply with the strict European threshold value. The fact that arsenic contamination is a natural ongoing process creates a barrier to long-term success. At present, the most appropriate option for securing safe water for drinking and cooking is treatment of water at the tap. Both adsorption and membrane filtration are efficient methods to remove arsenic from drinking water. The presence of contaminants other than arsenic may also require dual or multiple removal processes. Decision makers, as is common, must consider not only removal efficiency but also operating and investment costs of an operation.

Antibody response to topical streptokinase.

The aim of this study was to assess anti-streptokinase antibody levels in patients treated with intravenous streptokinase for acute myocardial infarction and in patients treated with topical streptokinase for cutaneous wounds. Sixty-two consecutive patients with acute myocardial infarction (age 65 +/- 12 years), 42 consecutive patients with streptokinase/streptodornase-treated wounds (age 74 +/- 14 years) and a control group of 40 patients with non-streptokinase-treated wounds (age 59 +/- 14 years) were studied over a period of 12 months. Blood was taken prior to commencement of treatment and subsequently at intervals of seven days, one month and six months. Serum was analysed for the presence of anti-streptokinase antibodies, using an ELISA technique. Baseline anti-streptokinase levels were similar in all three groups. Over the subsequent six months, the group treated with intravenous streptokinase developed a significant elevation of antibody levels, whereas antibody levels did not rise significantly in the control group. The group treated with topical streptokinase also developed a significant elevation of antibody levels at one month, but the mean level was significantly lower than that in the intravenous group. By six months, anti-streptokinase levels in the topical group had returned toward baseline values. Topical application of streptokinase causes a significant humoral response by one month, which then declines. The response is significantly lower than that caused by intravenous streptokinase. To ensure clinical thrombolytic efficacy, therefore, it may be preferable to avoid intravenous streptokinase in patients who have been treated with topical streptokinase in the preceding six months.

Assessing the use of dressings in practice.

An audit was carried out in an NHS trust to identify the degree to which wound management products were being selected and used appropriately. Fifty patients with various types of wounds were involved; observers noted the condition of wounds at dressing changes and the procedures used, then studied each patient's hospital documentation (medical notes, nursing care plan and drug chart). Nursing staff were interviewed to ascertain the input of various disciplines in dressing choice. The 'correct' choice of dressing was made in only 48% of wounds, and correct choice and use were identified in just 20%, with wide variations between different products. A quarter of patients reported pain associated with their wounds, but none received analgesia before dressing changes. As a result of the audit, new guidelines on dressing choice and use have been produced, with others in preparation, and the hospital formulary has been amended.

Assessing the use of dressings in practice.

An audit was carried out in an NHS trust to identify the degree to which wound management products were being selected and used appropriately. Fifty patients with various types of wounds were involved; observers noted the condition of wounds at dressing changes and the procedures used, then studied each patient's hospital documentation (medical notes, nursing care plan and drug chart). Nursing staff were interviewed to ascertain the input of various disciplines in dressing choice. The 'correct' choice of dressing was made in only 48% of wounds, and correct choice and use were identified in just 20%, with wide variations between different products. A quarter of patients reported pain associated with their wounds, but none received analgesia before dressing changes. As a result of the audit, new guidelines on dressing choice and use have been produced, with others in preparation, and the hospital formulary has been amended.

[Adenolymphoma of the salivary glands. The anatomicoclinical, epidemiological and therapeutic aspects of 76 cases]. / Adenolinfoma della ghiandole salivari. Aspetti anatomo-clinici, epidemiologici e terapeutici di 76 casi.

A series of 76 cases of adenolymphoma (Warthin's tumor) of the salivary glands is presented with emphasis on its epidemiological, clinico-pathological and therapeutic features; together with the analysis of the clinical records and of the epidemiological data, this study has reevaluated the histopathological features of the 76 cases of Warthin's tumor on hematoxylin-eosin stained slides. On these bases, the authors underline the frequent multifocality and/or bilaterality of Warthin's tumor (11.3% of cases), its frequent association with tumors of other sites (11.3% of cases), the prevalence in males (M:F ratio = 24:1) and in adults (mean age: 57 years) of this type of tumor. Furthermore, this study confirms the parotid gland as the elective site for Warthin's tumor and the possibility to categorize this entity into four different histological types. The latter finding should be kept in mind especially when fine needle aspiration (FNA) is used as a preoperative diagnostic procedure for Warthin's tumor to avoid misleading diagnosis and overtreatment. From the analysis of the results the authors underline the need for a complex and multidisciplinary approach to the diagnosis of Warthin's tumor in order to allow conservative surgery with preservation of the facial nerve.

[Bilateral adenolymphoma (Warthin's tumor) of the parotid. The anatomicoclinical, diagnostic and therapeutic aspects of 2 cases]. / L'adenolinfoma (tumore di Warthin) bilaterale della parotide. Aspetti anatomo-clinici, diagnostici e terapeutici di due casi.

Cystadenoma lymphomatosum or Warthin's tumor of the parotid glands appears bilateral in 8-10% of cases, synchronous (rarely), metachronous (frequently) and sometimes with multicentric aspects. After the review of the epidemiological, pathogenetic, clinical, radiographic and histologic data, the authors present two cases of bilateral Warthin's tumor, metachronous (7 years), nodular-isolated in the first one and metachronous (5 years), nodular-multicentric in the second one. The patients after CAT scan and NMR examinations, and a fine needle aspiration biopsy were treated with superficial parotidectomy with preservation of the facial nerve. In our experience the management of patients affected by Warthin's tumors, needs the following steps: CAT scan and NMR examinations to outline multiple and bilateral lesions, fine needle aspiration biopsy, superficial parotidectomy with preservation of the facial nerve, an extended follow-up (10 years after the last surgery).