Metastasis of squamous cell carcinoma of the head and neck to the thyroid: a single institution's experience with a review of relevant publications.

The thyroid gland is a rare site of metastasis, and in particular of those of squamous cell carcinoma (SCC) from the head and neck region. We have reviewed the aetiology, pathogenesis, clinical characteristics, radiological features, immunohistochemical profile, prognosis, and management of metastatic SCC from the head and neck region to the thyroid, and searched current publications on the Medline, Embase, and Cochrane databases using the following keywords: "SCC of thyroid", "secondary SCC of thyroid", and "metastasis to the thyroid", for papers published during the last 33 years (April 1984 to October 2017).We found a total of 19 papers that reported a total of 32 cases that were relevant. Four further cases were discovered as an incidental finding on follow-up positron emission tomographic/computed tomographic scans with magnetic resonance imaging of the head and neck at our hospital, which were confirmed with an ultrasound-guided core needle biopsy followed by immunohistochemical examination. For patients who are doing well, whose disease is controlled at the primary site, and who have no evidence of distant metastatic disease, total thyroidectomy could be considered followed by adjuvant radiation or chemoradiotherapy, depending on the presence of intermediate or high-risk features on pathological examination and previous history of radiation. This may help to control the disease and avoid local morbidity.

Cancer survival in Bhopal, India, 1991-1995.

The Bhopal population-based cancer registry was established in 1986 under the national cancer registry programme to investigate the after-effect of a gas leak in 1984. Cancer registration is done entirely by active methods. The registry is contributing data on survival for 16 cancer sites or types registered during 1991-1995. Follow-up of cases was done by active methods with median follow-up time ranging between 8-44 months for different cancers. The proportion with histologically verified diagnosis for various cancers ranged between 61-100%; death certificates only (DCOs) comprised 0-2%; 50-92% of total registered cases were included for survival analysis. The 5-year age-standardized relative survival rates for common cancers were mouth (34%), cervix (31%), breast (25%), tongue (12%), oesophagus (3%) and lung (1%). The 5-year relative survival by age group showed that survival was the highest in the youngest age group (45 years and below) for a majority of cancers. A decreasing survival with increasing clinical extent of disease was noted for most cancers studied.

Stability ofAlternaria toxins in fruit juices and wine.

Alternaria alternata is a common fungal parasite on fruits and other plants and produces a number of mycotoxins, including alternariol (3,7,9-trihydroxy-1-methyl-6H-dibenzo [b,d]pyran-6-one), alternariol monomethyl ether (3,7-dihydroxy-9-methoxy-1-methyl-6H-dibenzo[b,d]pyran-6-one), and the mutagen altertoxin I {[1S-(1α,12aß,12bα)] 1,2,11,12,12a, 12b-hexahydro-1,4,9,12a-tetrahydroxy-3,10-perylenedione}. Alternariol and alternariol monomethyl ether have previously been detected in some samples of fruit beverages. Stability studies of these toxins as well as altertoxin I added to fruit juices and wine (10-100 ng/mL) were carried out. To include altertoxin I in the analysis, cleanup with a polymer-based Varian Abselut solid phase extraction column was used, as recoveries from C-18 columns were low. The stabilities of alternariol and alternariol monomethyl ether in a low acid apple juice containing no declared vitamin C were compared with those in the same juice containing added vitamin C (60 mg/175 ml); there were no apparent losses at room temperature over 20 days or at 80°C after 20 min. in either juice. Altertoxin I was moderately stable in pH 3 buffer (75% remaining after a two week period). Furthermore, altertoxin I was stable or moderately stable in three brands of apple juice tested over 1-27 day periods and in a sample of red grape juice over 7 days. It is concluded that altertoxin I is sufficiently stable to be found in fruit juices and should be included in methods for alternariol and alternariol monomethyl ether.

Tobacco habits and risk of lung, oropharyngeal and oral cavity cancer: a population-based case-control study in Bhopal, India.

BACKGROUND: Tobacco habits in India are unique and vary in different regions. Few studies, and none from central India, have reported on type of tobacco used and risk of the most common cancer types in India. We conducted a population-based case-control study to evaluate the risk of tobacco particularly bidi smoking and tobacco quid chewing on the most common cancer sites among males in Bhopal. METHODS: In all, 163 lung, 247 oropharyngeal and 148 oral cavity cancer cases from the Population-Based Cancer Registry records and 260 controls randomly selected from a tobacco survey conducted in the Bhopal population formed the study population. RESULTS: A significant risk of bidi and cigarette smoking with a dose-response relationship was observed for lung and oropharyngeal cancer. Tobacco quid chewing showed no risk for lung, marginally increased risk for oropharyngeal and about a sixfold increased risk for oral cavity cancer. Population-attributable risk per cent (PARP) was observed to be 82.7% and 71.6% for smokers for the development of lung and oropharyngeal cancer, while the same was found to be 66.1% for tobacco chewers for the development of oral cavity cancer. CONCLUSIONS: These data provide strong evidence that smoking bidi is even more hazardous than cigarette smoking in the development of lung and oropharyngeal cancer. An intervention study to prevent the use of tobacco will be useful in this population as it also underwent gas exposure due to a chemical accident in 1984.

Quantitative determination of ochratoxin A by liquid chromatography/electrospray tandem mass spectrometry.

Mass spectrometry of ochratoxin A (OTA) and B (OTB) under electrospray ionization (ESI) and atmospheric pressure chemical ionization (APCI) was studied. ESI offers higher sensitivities and less fragmentation than APCI. A sensitive LC/MS/MS method for the determination of ochratoxin A (OTA) in human plasma samples was developed. The absolute minimum detection limit was around 10-20 pg per injection, corresponding to 0.5 ppb in an injection equivalent to 20-40microg of human plasma. Ochratoxin B (OTB) was used as an internal standard and its absence in real-life samples was carefully checked before samples were spiked with the internal standard. It was found that these two ochratoxins are susceptible to sodium adduct formation. Fragment ions from the [M + H](+) and [M + Na](+) ions of both OTA and OTB were monitored in the multiple reaction monitoring mode. Three quantitative approaches, standard addition method, internal standard method (using ochratoxin B as an internal standard) and external standard method, were compared in the analysis of human blood plasma. Results from the mass spectrometric method were comparable to those from a conventional LC/fluorescence method. The LC/MS/MS method was also applied to the analysis of contaminated coffee samples.

Does treatment change the outcome of seizures and computerized tomographic lesions in intracranial granulomas?

In children, intracranial granuloma diagnosed on computerized tomography (CT) scan and presenting with seizures as the sole manifestation has traditionally been treated with antitubercular (ATB) therapy or albendazole (Alb) in addition to antiepileptic drugs (AED). This study was conducted to determine whether AED therapy alone or specific treatment (ATB + Alb) influences the outcome of seizures and the CT lesion. Sixty-eight children presenting with seizures along with intracranial granuloma on CT scan were selected for the study. They were randomly divided into two groups. Group A (n = 34) was treated with AED alone and group B (n = 34) received antitubercular therapy and albendazole in addition to AED. Seizure type was noted and electroencephalogram (EEG) and CT scan were done in all. They were followed up for a period of 2 to 9 years, during which a record of seizure count and type was maintained. CT scans were repeated at 3 monthly intervals and EEGs were repeated whenever indicated. Four patients in each group were lost to follow-up. Seizures persisted in four out of 30 in group A and six out of 30 in group B. There was no statistically significant difference (p > 0.05) in the outcome of seizures in the two groups. Taking the whole group together (n = 60), of the 13 who had presented with multiple seizures at onset, epilepsy was a sequela in five (p < 0.05); and of the 17 in whom the lesion had calcified, seizures persisted in seven (p < 0.05), irrespective of treatment modality. In conclusion, though specific treatment did not alter the outcome of seizures, children with multiple seizures at presentation and calcification of CT lesion had epilepsy as a sequela.

Cryptophthalmos.

Cryptophthalmos, a very rare congenital anomaly of the eye, is characterised by skin passing continuously from the forehead to the cheek over a malformed eye. It may be isolated or more commonly as a part of Fraser syndrome. Cryptophthalmos is classified into three types: complete, incomplete and abortive. Surgical reconstruction is the modality of treatment available. We present a case of bilateral, complete, isolated cryptophthalmos, who has undergone stage 1 of reconstructive surgery.

Cancer patterns of lung, oropharynx and oral cavity cancer in relation to gas exposure at Bhopal.

BACKGROUND: In Bhopal, India, on 2 December 1984, a chemical disaster caused by a gas leak mostly of methyl isocyanate (MIC) from the Union Carbide Factory led to massive mortality and morbidity of the population. This is the first study to shed light on the cancer experience of the Bhopal population as a result of exposure to a mixture of gases which have highly toxic and potentially carcinogenic properties. To observe the effect of gas exposure, incidence rates of the three most common cancer sites (lung, oropharynx and oral cavity) from 1987 to 1992 among the municipal wards were studied in males. METHODS: Relative risks (RR) using cases from the cancer registry and controls from a tobacco survey were estimated for the gas-affected regions. RESULTS: Based on a descriptive study the relative risks of 1.4, 1.3 and 0.7 for lung, oropharynx and oral cavity cancer, respectively, for gas-affected regions in the year 1992 in comparison to gas-unaffected regions and the year 1987-1990 combined were estimated. In the case-control study the RRs of 0.9, 1.4 and 1.2 for lung, oropharynx (adjusted for smoking) and oral cavity cancer, respectively, (adjusted for tobacco chewing) were estimated as the effect of the gas accident. CONCLUSION: The full potential of excess risk, if any, may not manifest for 15-20 years after the accident.

Survey of Canadian human blood plasma for ochratoxin A.

Blood plasma samples collected from 144 healthy volunteers in 16 locations across Canada in 1994 were analysed for ochratoxin A (OTA). The method of analysis included cleanup by C18 solid phase extraction and immunoaffinity columns followed by liquid chromatography (LC) with fluorescence detection, which gave 86.5% (s.d. = 9.7) recovery (n = 31) of OTA (added at 2 ng/ml) with a detection limit of 0.15 ng/ml. The arithmetic mean concentration found in the plasma samples, corrected for volume of anticoagulant added, was 0.88 ng/ml with a standard deviation of 0.35 ng/ml and a range of 0.29-2.37 ng/ml. Confirmation of identity of OTA was by methyl ester formation for 65 samples and by LC-tandem mass spectrometry for 17 samples (some of which were included in pooled samples). Statistical analysis, by ANOVA of the log OTA plasma concentrations, showed a highly significant effect due to location in Canada (p = < 0.0001) but no effect due to age, sex or blood group of donors. The highest mean concentration was found in Winnipeg, significantly different (p = 0.05) by the Student-Newman-Keuls multiple range test from the lowest levels found in Toronto, Vancouver and Saint John.

Gas chromatography-mass spectrometry of Alternaria mycotoxins.

Heptafluorobutyrate (HFB) derivatives have not previously been used for GC of Alternaria mycotoxins. Capillary (0.5 micron film) GC-mass spectrometry (MS) showed that full and partial derivatives of alternariol (AOH), alternariol monomethyl ether (AME) and altenuene (ALT); a structurally uncharacterized derivative of altertoxin I (ALTX-I); and a tris-HFB derivative of tenuazonic acid (TA) were formed with heptafluorobutyric anhydride and a basic catalyst. Full and partial trimethylsilyl (TMS) ethers of these mycotoxins were formed with Tri-Sil TBT. Apple juice extracts caused increased response in GC-MS of AOH bis-HFB and bis-TMS derivatives. Natural occurrence of AOH in apple juice has been demonstrated.

Determination of ochratoxin A in beer.

Because of concern about possible transmission of ochratoxin A (OA) from contaminated grain adjuncts, development of a sensitive method for its determination in beer was investigated. Solid phase extraction (SPE) on C-18 and silica gel columns in series and on an immunoaffinity column (OchraTest) were used to obtain extracts for quantitation by reverse phase liquid chromatography with fluorescence detection. The standard curve was linear in the range 2.5-50 pg OA injected and detection limits for both methods were of the order 0.05-0.1 ng/ml beer (signal to noise 3:1). Per cent recovery of OA from various beer samples spiked at a level of 1 ng/ml averaged 82-100% for three modifications of the SPE method and 97% for the immunoaffinity column method. Forty-one samples of Canadian and imported beers were analysed. Trace levels of OA (< or = 0.2 ng/ml) were detected in 26 samples by SPE and/or immunoaffinity column methods; there was generally good agreement between the methods. Identity of OA was confirmed by methyl ester formation in five samples cleaned up by the immunoaffinity column procedure.

Fermentation of wort containing added ochratoxin A and fumonisins B1 and B2.

Ochratoxin A (OA), fumonisin B1 (FB1) and fumonisin B2 (FB2) were added to wort at levels of 0.19, 0.95 and 0.95 micrograms/ml, respectively, and fermented for up to 8 days by three strains of Saccharomyces cerevisiae. Decreases of OA in the beer over this period were estimated from straight line slopes to be 2-13%. Losses of FB1 and FB2 were estimated to be 3-28% and 9-17% respectively. Some OA was taken up by the yeast, up to 21% in a detailed study with one strain. In contrast, uptake of fumonisins by yeast was negligible (< 1% FB1 and < 2% FB2). In control experiments, OA, FB1 and FB2 were found to be stable when added to yeast-free wort and kept for up to 8 days at 25 degrees C. In addition, spiking experiments with blank day 0-8 fermenting wort samples showed method recoveries averaging 87-91%. None of the mycotoxins was detected in control fermentations where they were not added to the wort.

Mycotoxin producing potential of Fusarium graminearum isolates from Uruguayan barley.

Twelve isolates of Fusarium graminearum were obtained from barely grains collected from different Uruguayan regions (harvest 1993-94). This was the predominant fungal species contaminating the crop due to a particular humid and warm season with cold nights conductive to toxin production The isolates were grown on moist, sterile rice, extracted with aqueous methanol, and examined for mycotoxin production. Zearalenone (ZEA) and the trichothecenes deoxynivalenol (DON), 3- and 15-acetyl-DON (AcDON), nivalenol (NIV), nivalenol (NIV), fusarenon-X (FX) and T-2 toxin (T-2) were analyzed by thin-layer chromatography (TLC) and high-performance liquid chromatography (HPLC) and confirmed by gas chromatography-mass spectrometry (GC-MS). Eleven of the 12 strains were DON and/or ZEA producers and 9 were AcDON positive. No NIV, or FX were detected. One strain produced T-2. The predominant acetyl-DON isomer was 15-AcDON. Mass-spectral analysis yielded detectable levels of other mycotoxins, 13-OH-apotrichothecenes, 11-epiapotrichothecenes, culmorin, sambucinol, and isotrichodermol being the most numerous. From the metabolic profiles it is suggested that Uruguayan F. graminearum strains belong to the chemotype IB (DON/15-AcDON). The predominance of this chemotype is in accordance with data from Canada, United States, Mexico and Argentina which have similar climatic conditions that would favor F. graminearum growth and mycotoxin production.

Analysis of Canadian and imported beers for Fusarium mycotoxins by gas chromatography-mass spectrometry.

A sensitive method was developed for the determination of deoxynivalenol (DON), nivalenol (NIV), alpha-zearalenol (alpha-ZEL), beta-zearalenol (beta-ZEL) and zearalenone (ZEN) in beer by capillary gas chromatography-mass spectrometry (GC-MS) of their heptafluorobutyrate (HFB) derivatives. Recoveries averaging 90-103% were obtained from beers spiked with each mycotoxin in the 5-20 ng/ml concentration range. Limits of detection were 0.1-1.5 ng DON/ml, 0.01-0.3 ng NIV/ml, 2.5-3 ng alpha- and beta-ZEL/ml, and 1.5-2 ng ZEN/ml. Twenty-nine of 50 samples of Canadian and imported beer surveyed were found to contain DON; of these nine contained greater than 5 ng/ml (up to 50 ng/ml). The identity of DON was confirmed by response ratios at m/z 670 and m/z 884 for the HFB derivative and m/z 497 and m/z 512 for the trimethylsilyl (TMS) derivative. NIV was also detected in three beer samples (0.1-0.84 ng/ml) but no alpha-ZEL, beta-ZEL or ZEN was found.

Fermentation of wort containing deoxynivalenol and zearalenone.

Wort containing deoxynivalenol and zearalenone, each added at a level of 1.9 µg/mL, was fermented by 3 strains ofSaccharomyces cerevisiae for 7 or 9 days to make beer. Analysis showed that deoxynivalenol was stable during this process. The major metabolite of zearalenone was ß - zearalenol, which formed in up to 69% of the initial zearalenone concentration, while up to 8.1% of the initial zearalenone was converted to α - zearalenol. The major part of the metabolism of zearalenone occurred by 1 - 2 days. Control experiments, where the yeasts were omitted and deoxynivalenol, zearalenone and α - and ß - zearalenol were added, showed good recovery and stability of the mycotoxins over the 7-9 day time period. No deoxynivalenol, zearalenone, α-zearalenol or ß-zearalenol was detected in control yeast fermentations where they were not added to the wort.

Application of capillary gas chromatography to a survey of wheat for five trichothecenes.

A previously published method for the determination of deoxynivalenol (DON) and nivalenol (NIV) in grains by capillary gas chromatography (GC) with electron-capture detection (ECD) has been modified to include HT-2 toxin (HT-2), T-2 toxin (T-2) and diacetoxyscirpenol (DAS). Recoveries of the five trichothecenes from wheat averaged 71-92% in the range 0.8-4 micrograms/g. Detection or quantitation limits found in two laboratories were from 0.02 to 0.4 micrograms/g, with those for T-2 and DAS at the high end of this range. The method proved of practical use in survey work for the screening and determination of these trichothecenes in wheat from the 1987 western Canadian crop. There were no false positives for HT-2, T-2 and DON in durum and HY-320 wheat. However, interferences precluded the determination of 4- and 15-monoacetoxyscirpenol (MAS) by GC-ECD. The natural occurrence of HT-2 toxin (0.06-0.59 micrograms/g) was demonstrated by GC-ECD and confirmed by GC-mass spectrometry (MS) in 23 samples of durum and HY-320 wheats (1986 and 1987 crops); it was almost always accompanied by DON and in one sample a low concentration of NIV (0-05 micrograms/g). False positives for HT-2 and DAS in red spring wheat detected in 1987 by GC-ECD were 6% (nearly all identified as variety Katepwa) and 8%, respectively. Hence confirmation of suspected HT-2 and DAS by GC-MS is necessary, particularly with red spring wheat.