Arsenic binding proteins from human lymphoblastoid cells.

Arsenic is a ubiquitous contaminant of drinking water and food. The mechanisms of the toxic action of inorganic arsenic are unknown. We report the isolation of proteins having a high affinity for arsenic in the +3 oxidation state that are induced by arsenite (AsIII) in human lymphoblastoid cells. The arsenic-binding proteins were isolated using a p-aminophenylarsine oxide affinity column. At least four proteins of 50, 42, 38.5 and 19.5 kDa were isolated by elution with 10 or 100 mM 2-mercaptoethanol. Two proteins were tentatively identified as tubulin and actin on the basis of their molecular weights and previously reported affinity for the arsenic column. The identities of the remaining proteins are unknown. Heme oxygenase 1 was induced by AsIII but did not bind to the arsenic affinity column. We conclude that AsIII induces multiple proteins that have variable affinities for arsenic in the +3 state as judged by the concentration of 2-mercaptoethanol required for their elution. The arsenic binding motif of these proteins may involve three thiol groups arranged 3-6 A apart by the tertiary structure of the protein as suggested by others. These proteins may serve as high affinity binding sites for AsIII and may be involved in the biological action of AsIII.

Human lymphocyte heme oxygenase 1 as a response biomarker to inorganic arsenic.

We propose the use of human lymphocyte heme oxygenase 1 (HO1) as a biomarker of response to environmental arsenic exposure. We report the induction of HO1 in human lymphoblastoid cells (LBs) by arsenite in a dose-related manner. HO1 was identified by SDS-PAGE from its molecular weight and from its detection by Western blotting with anti-HO1. HO1 levels in LBs treated with arsenite increased by de novo synthesis as demonstrated by incorporation of 35S-methionine and by inhibition of HO1 synthesis by actinomycin D. The amount of HO1 in LBs was estimated by quantifying Western blots. HO1 was also induced by 10 microM cadmium or mercuric chloride. We suggest that circulating lymphocyte HO1 levels may be useful in assessing the biological activity of arsenic exposure in vivo under properly controlled conditions of simultaneous urinalysis for arsenic, cadmium, and mercury.

Quality indicators for out-of-hospital emergency medical services: the paramedics' perspective.

OBJECTIVE: Out-of-hospital emergency medical services (EMS) need relevant and measurable indicators of quality. Those front-line workers who provide service directly to the customer are integral to the process of defining quality. The authors' objective was to obtain from paramedics, the front-line workers in the EMS system, their perspective on quality of care. METHODS: During regularly scheduled education sessions, 102 of the 140 field paramedics from a large municipal EMS system attended a presentation on total quality management. The paramedics were then assigned to focus groups and asked to identify quality indicators and provide recommendations for how they should be measured. RESULTS: Eighteen different quality indicators were identified. In addition, the paramedics suggested 17 ways to measure these proposed quality indicators. CONCLUSIONS: From the perspective of the study participants, indicators of the quality of out-of-hospital care differ from many used in traditional EMS quality assurance programs. Future studies should investigate the applicability of these indicators to the total quality management of EMS systems.

Agreement between rectal and tympanic membrane temperatures in marathon runners.

STUDY OBJECTIVE: To determine the agreement between rectal temperature and infrared tympanic membrane temperatures in marathon runners presenting to a field hospital at the finish line. METHODS: The subjects of this prospective, blinded, controlled study were runners 18 years or older who were triaged to the acute care medical area at the finish line for suspected hypothermia, hyperthermia, dehydration, or altered mental status. Rectal and tympanic temperatures were measured simultaneously in all subjects for whom rectal temperature measurement had been deemed necessary and recorded on separate data cards. RESULTS: Of the 239 runners treated in the acute care medical area, 37 required rectal temperature measurement and were enrolled in the study. The mean rectal temperature was 38.45 degrees +/- 1.20 degrees C (range, 35.9 degrees to 41.5 degrees C). The mean tympanic membrane temperature was 37.81 degrees +/- 95 degrees C (range, 36.3 degrees to 40.4 degrees C). Pearson's correlation coefficient revealed a moderate correlation (r = .6902, P = .00023). The mean temperature difference between the two thermometers, mean rectal minus mean tympanic membrane, was .64 degrees C (95% confidence interval, .35 degrees to .93 degrees C). Sixty-Two percent of the tympanic membrane readings were within 1 degree C of their rectal counterparts. Agreement ranged from 1.16 degrees (+2 SD) to -2.95 degrees (-2 SD). The 95% confidence interval was 1.67 degrees to -2.95 degrees C. CONCLUSION: We were able to demonstrate only a moderate correlation between the two thermometer readings, with a wide spread between the limits of agreement. This spread could be clinically significant and therefore limits the usefulness of tympanic temperature in the marathon race setting. Because of the potentially large and clinically significant differences in rectal and tympanic temperatures and the limitations inherent in our study, we cannot endorse the use of tympanic temperature in the setting of a marathon event.

Anaphylactoid reaction to adenosine.

Adenosine (Adenocard) is an endogenous purine nucleoside that has been approved recently for intravenous treatment of paroxysmal supraventricular tachycardia. With a serum half-life of 10 seconds, reported side effects including facial flushing, dyspnea, and chest pressure are common, but very transient. An elderly woman who received adenosine for paroxysmal supraventricular tachycardia had a prolonged anaphylactoid reaction that required pharmacological treatment. This is the first reported case of a prolonged anaphylactoid reaction to adenosine.

Horner's syndrome in the emergency department.

We present a case of a 47-year-old female who was followed for 7 months with complaints of musculoskeletal pain involving the shoulder and scapula until she presented to the emergency department with Horner's syndrome and was diagnosed as having a superior pulmonary sulcus tumor. A review of the literature shows that although such tumors are a frequent cause of Horner's syndrome there are numerous other benign as well as malignant causes of Horner's syndrome. The differential diagnosis can be significantly narrowed by a knowledge of the anatomy and a careful physical examination. We present the anatomy, pathophysiology, differential diagnosis, and evaluation of patients who present to the emergency department with Horner's syndrome.

Hyperthyroidism and thyroid storm.

Thyrotoxicosis and thyroid storm are disease states that result from thyroid hormone-induced hypermetabolism. The excess thyroid hormone is released from the thyroid gland as a result of excess thyroid hormone production, or by processes that disrupt the follicular structure of the gland with subsequent release of stored hormone. True hyperthyroidism results from increased synthesis and release of thyroid hormone and can be distinguished from other causes of thyrotoxicosis by the thyroid 131I uptake. Graves' disease is the most common cause of hyperthyroidism and occurs most often in women aged 30 to 50 years. The classic features of a patient with fully developed Graves' disease are difficult to overlook, but the clinical features of thyrotoxicosis vary with the etiology of the disease and the sensitivity of the patient's peripheral tissues. Thyroid storm presents with an exaggeration of the features of uncomplicated thyrotoxicosis and, in addition, an alteration in mental status. Thyroid storm may lead to irreversible cardiovascular collapse and death if proper treatment is not initiated in the Emergency Department. Specific therapy of hyperthyroidism follows several strategies, including inhibition of hormone synthesis and release, inhibition of peripheral conversion of T4 to T3, and blocking of the systemic effects of excess thyroid hormone. Treatments directed at these ends may be initiated rapidly in the emergency setting.

Retrograde ileo-ileal intussusception.

A case of retrograde ileo-ileal intussusception in a boy of 16 years is reported. There was no apparent predisposing cause. The patient was treated by resection-anastomosis of the ileum and recovered uneventfully.

A spontaneous metastasizing exocrine adenocarcinoma of the pancreas in the rat.

A naturally occurring adenocarcinoma of the exocrine pancreas was found in a male, 12-month-old rat. The tumor was found in the mesentery adjacent to the stomach. It consisted of highly anaplastic cells in combination with large strands of collagenous connective tissue indicating desmoplastic properties. Local metastases were found in the mesentery. Distant metastases were seen in the heart, lungs, mediastinal lymph nodes, liver, spleen, both kidneys, one adrenal, one testis and the sternum. This is the first reported tumor of the exocrine portion of the pancreas in which zymogen granules were demonstrated and multiple distant metastases were found in a rat.