ABSTRACT
Background: Perfluoroalkyl substances (PFAS), a heterogeneous group of highly stable man-made chemicals, have been widely used since 1960s and can be detected almost ubiquitously in all environmental matrices. In Italy, on January 2014, drinking water contamination in an area of the Veneto Region was detected mainly due to the drain of fluorinated chemicals by a manufacturing company operating since 1964. Methods: The present ecological mortality study was aimed at comparing mortality for some causes of death selected on the basis of previous reported associations, during the period 1980-2013, in municipalities with PFAS contaminated and uncontaminated drinking water on the basis of the levels indicated by the Italian National Health Institute (ISS). Sex-specific number, standardized mortality rates and rate ratios (RR) for PFAS contaminated and uncontaminated areas were computed for each cause of death through the ENEA epidemiological database. Results: In both sexes, statistically significant RRs were detected for all causes mortality, diabetes, cerebrovascular diseases, myocardial infarction and Alzheimer's disease. In females, RRs significantly higher than 1.0 were also observed for kidney and breast cancer, and Parkinson's disease. Increased risk, although not statistically significant, was observed for bladder cancer in both sexes, and for testicular cancer, pancreatic cancer and leukemia in males only. Conclusions: Higher mortality levels for some causes of death, possibly associated with PFAS exposure, were detected in contaminated municipalities in comparison with uncontaminated ones with similar socioeconomic status and smoking habits. These results warrant further individual level analytic studies to delineate casual associations.
Subject(s)
Death , Drinking Water/analysis , Fluorocarbons/poisoning , Water Pollutants, Chemical/analysis , Adolescent , Adult , Age Distribution , Aged , Child , Child, Preschool , Cities , Environmental Monitoring/statistics & numerical data , Female , Humans , Infant , Italy/epidemiology , Male , Middle Aged , Water Pollution/analysis , Young AdultABSTRACT
We report the case of a 40-year-old man whose bone marrow metastases occurred 57 months after the initial diagnosis and 9 months after completing radiotherapy for an anaplastic oligodendroglioma. Four months before the demonstration of visceral metastases was obtained by bone marrow biopsy, the patient developed diffuse bone pain, pancytopenia, hypercalcemia, and panhypogammaglobulinemia. These abnormalities and other clinical signs of extracranial dissemination of the primary brain tumor were initially unrecognized until the patient was admitted with the suspicion of a nonsecretory multiple myeloma. We also briefly review the factors predisposing these tumors to spread outside the CNS, albeit rarely, and discuss the clinical implications of a misdiagnosis of extracranial invasion by anaplastic oligodendroglioma, whose chemosensitivity has been definitively demonstrated.
Subject(s)
Agammaglobulinemia/etiology , Bone Marrow Neoplasms/complications , Bone Marrow Neoplasms/diagnosis , Brain Neoplasms/pathology , Oligodendroglioma/secondary , Pancytopenia/etiology , Adult , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Biomarkers, Tumor/analysis , Bone Marrow Neoplasms/chemistry , Bone Marrow Neoplasms/drug therapy , Bone Marrow Neoplasms/secondary , Brain Neoplasms/radiotherapy , Fatal Outcome , Humans , Immunohistochemistry , Male , Oligodendroglioma/radiotherapyABSTRACT
A 44-year-old woman who had been suffering for 10 years from amenorrhea and hyperprolactinemia resistant to high doses of bromocriptine was hospitalized with erythrocytosis, normal serum erythropoietin (sEpo) levels, and hypertension. Erythrocytosis secondary to uterine myoma and a prolactin-secreting pituitary microadenoma were initially diagnosed. The hyperprolactinemia was bromocriptine resistant, despite gradual increase of the dosage to 30 mg/day. Both hyperprolactinemia and erythrocytosis unexpectedly regressed completely after the patient underwent hysterectomy for a uterine fibroid 9 months after the erythrocytosis was first disclosed. Given the well-known effects of prolactin on hematopoietic cells, we hypothesize that--in this very unusual case--the two main, apparently unrelated abnormalities (erythrocytosis with normal sEpo levels and hyperprolactinemia) may have been the clinical consequence of the functional redundancy and pleiotropy of the "pituitary" hormone prolactin, inappropriately secreted by a uterine fibroid for more than 10 years.
