Arsenic contamination in groundwater of Samta, Bangladesh.

In March 1997, we analyzed the water of all tubewells used for drinking in Samta village in the Jessore district, Bangladesh. It has been confirmed from the survey that the arsenic contamination in Samta was one of the worst in the Ganges basin including West Bengal, India. 90% of the tubewells had arsenic concentrations above the Bangladesh standard of 0.05 mg/l. Tubewells with higher arsenic concentrations of over 0.50 mg/l were distributed in the southern area with a belt-like shape from east to west, and the distribution of arsenic concentration showed gradual decreasing toward northern area of the village. In order to examine the characteristics of the arsenic distribution in Samta, we have performed investigations such as: 1) the characteristics of groundwater flow, 2) the distribution of arsenic in the ground, 3) the concentration of arsenic and the other dissolved materials in groundwater, and 4) the distribution of arsenic concentration of trivalence and pentavalence. This paper examines the mechanism of arsenic release to groundwater and explains the above-mentioned characteristics of the arsenic contamination in Samta through the investigations of the survey results for these years.

Prognostic value of impaired myocardial fatty acid uptake in patients with acute myocardial infarction.

Impaired cardiac fatty acid uptake, assessed by the radiolabelled fatty acid analogue beta-methyl-p-iodophenyl pentadecanoic acid (I-123-BMIPP), is observed in the myocardium following acute ischaemic events, but the long-term prognostic implication has not been established. This study aimed to determine the prognostic value of cardiac BMIPP uptake in patients with acute myocardial infarction. Following the assessment of thallium-201 and I-123-BMIPP uptake, 101 post-infarct patients were prospectively followed up with primary end points of cardiac death, heart failure and non-fatal infarction. During a mean follow-up of 28 months, three cardiac deaths, three non-fatal infarctions, 23 revascularizations and four recurrences of angina pectoris were observed. Multivariate analysis identified reduced uptake of BMIPP and perfusion, no beta-blocking treatment and greater thallium-BMIPP mismatch (i.e. larger BMIPP defect than thallium defect) as significant predictors for overall cardiac events. Prior myocardial infarction, reduced left ventricular ejection fraction and greater thallium-BMIPP mismatch were selected as independent predictors of harder cardiac events. Female patients, those with greater BMIPP defect or greater thallium-BMIPP mismatch showed worse clinical outcomes. The inclusion of BMIPP data improved the prognostic values of conventional significant predictors. In conclusion, impaired myocardial I-123-BMIPP uptake and perfusion-BMIPP mismatch are related to a high probability of fatal and non-fatal cardiac events, suggesting the aetiological relevance and prognostic value of impaired cardiac fatty acid metabolism in viable, but jeopardized, myocardium following acute myocardial infarction.

A female carrier of Duchenne muscular dystrophy complicated with cardiomyopathy.

A 45-year-old female carrier of Duchenne muscular dystrophy (DMD) complicated with cardiomyopathy is described. She had no symptoms of muscle weakness or heart failure. Her chest X-ray film revealed marked cardiomegaly. Echocardiogram showed marked enlargement and severe hypokinesis of the left ventricle. In myocardial scintigraphic images, perfusion defects of the myocardium were revealed. Dystrophin immunostaining of myocardial biopsy specimens showed a mosaic pattern of dystrophin-negative and -positive fibers. Cardiomyopathy is sometimes the only clinical symptom in female carriers of DMD. They are thought to be in a high risk group for developing heart failure.

Renovascular hypertension with massive proteinuria.

A 65-year-old woman with renovascular hypertension and massive proteinuria is reported. Her urinary protein ranged from 3 to 5 g/day. Serum potassium was 2.9 mEq/l. Plasma renin activity and plasma aldosterone concentration were very high. A CT scan disclosed atrophy of the left kidney. Renogram showed a non-functioning pattern of the left kidney. An abdominal aortogram showed complete occlusion of the left renal artery at its ostium. After left nephrectomy, her high blood pressure and urinary protein were normalized. It seemed that the massive proteinuria was mainly due to some endocrinological effect of the left kidney.

Increased serum level of interleukin-5 in a patient with episodic angioedema and eosinophilia syndrome.

A case of episodic angioedema and eosinophilia syndrome is reported. An 18-year-old male suffered from monthly episodes of angioedema, pruritic papules, weight gain, and fever for twelve years. During the episodes, peripheral eosinophils and serum levels of interleukin (IL)-5, an eosinophil proliferating cytokine were elevated. Extensive evaluations disclosed neither visceral involvement nor evidence of parasitic infections, collagen diseases, or neoplastic disorders. Corticosteroid treatment brought about a dramatic clinical improvement concomitant with decrement of eosinophils and serum IL-5 was observed. These observations suggest that IL-5 may be a causative factor for this pathological state.