Estimation of residential radon exposure and definition of Radon Priority Areas based on expected lung cancer incidence.

Radon is a naturally occurring gas, classified as a Class 1 human carcinogen, being the second most significant cause of lung cancer after tobacco smoking. A robust spatial definition of radon distribution in the built environment is therefore essential for understanding the relationship between radon exposure and its adverse health effects on the general population. Using Ireland as a case study, we present a methodology to estimate an average indoor radon concentration and calculate the expected radon-related lung cancer incidence. We use this approach to define Radon Priority Areas at the administrative level of Electoral Divisions (EDs). Geostatistical methods were applied to a data set of almost 32,000 indoor radon measurements, sampled in Ireland between 1992 and 2013. Average indoor radon concentrations by ED range from 21 to 338 Bq m-3, corresponding to an effective dose ranging from 0.8 to 13.3 mSv y-1 respectively. Radon-related lung cancer incidence by ED was calculated using a dose-effect model giving between 15 and 239 cases per million people per year, depending on the ED. Based on these calculations, together with the population density, we estimate that of the approximately 2,300 lung cancer cases currently diagnosed in Ireland annually, about 280 may be directly linked to radon exposure. This figure does not account for the synergistic effect of radon exposure with other factors (e.g. tobacco smoking), so likely represents a minimum estimate. Our approach spatially defines areas with the expected highest incidence of radon-related lung cancer, even though indoor radon concentrations for these areas may be moderate or low. We therefore recommend that both indoor radon concentration and population density by small area are considered when establishing national radon action plans.

Logistic regression model for detecting radon prone areas in Ireland.

A new high spatial resolution radon risk map of Ireland has been developed, based on a combination of indoor radon measurements (n=31,910) and relevant geological information (i.e. Bedrock Geology, Quaternary Geology, soil permeability and aquifer type). Logistic regression was used to predict the probability of having an indoor radon concentration above the national reference level of 200Bqm-3 in Ireland. The four geological datasets evaluated were found to be statistically significant, and, based on combinations of these four variables, the predicted probabilities ranged from 0.57% to 75.5%. Results show that the Republic of Ireland may be divided in three main radon risk categories: High (HR), Medium (MR) and Low (LR). The probability of having an indoor radon concentration above 200Bqm-3 in each area was found to be 19%, 8% and 3%; respectively. In the Republic of Ireland, the population affected by radon concentrations above 200Bqm-3 is estimated at ca. 460k (about 10% of the total population). Of these, 57% (265k), 35% (160k) and 8% (35k) are in High, Medium and Low Risk Areas, respectively. Our results provide a high spatial resolution utility which permit customised radon-awareness information to be targeted at specific geographic areas.

The Dublin SURGE Project: geochemical baseline for heavy metals in topsoils and spatial correlation with historical industry in Dublin, Ireland.

The Dublin SURGE (Soil Urban Geochemistry) Project is Dublin's first baseline survey of heavy metals and persistent organic pollutants in topsoils and is part of a Europe-wide initiative to map urban geochemical baselines in ten cities. 1,058 samples were collected as part of a stratified random sampling programme in the greater Dublin area to give an overview of baseline conditions in the city. Samples were analysed for 31 inorganic elements including heavy metals. Analysis of results indicates that the concentrations of lead, copper, zinc and mercury are strongly influenced by human activities, with elevated concentrations in the city docklands, inner city and heavy industry areas. Sources of heavy metals in these areas may include historical industry, coal burning, re-use of contaminated soil, modern traffic and leaded paint and petrol. Concentrations of other inorganic elements in topsoil show patterns which are strongly related to regional bedrock parent material. The spatial distributions of heavy metals, in particular Pb and As, are explored in detail with respect to regional geology and the influence of historical industry on soil quality. Exploratory data, geostatistical and correlation analyses suggest that the concentrations of heavy metals tend to increase as the intensity of historical industrial activity increases. In particular, drinks production, power generation, oil/gas/coal, metals and textile historical industries appear to be the contamination source for several heavy metals. The data provide a geochemical baseline relevant to the protection of human health, compliance with environmental legislation, land use planning and urban regeneration.

Prophylactic gastrostomy tubes for patients receiving radical radiotherapy for head and neck cancers: a retrospective review.

Patients undergoing radical radiotherapy for head and neck cancers often experience significant complications. We sought to evaluate the impact of prophylactic gastrostomy tubes (PGTs) among these patients on four easily evaluable adverse outcomes, namely, absolute weight loss, percentage weight loss, admissions for nutritional reasons and treatment interruptions. A retrospective review was carried out on patients undergoing radical radiotherapy for primary head and neck cancers from September 1999 to October 2005 at the Wellington Blood and Cancer Centre (n = 71). PGTs were placed in 7 (10%) patients. Patients with PGTs were compared with the patients without PGTs (the control group) by univariate and multivariate analyses. By univariate analysis, there was no significant difference in absolute or percentage weight loss between those with PGTs and the control group. By multivariate analysis, those with PGTs lost 5.2% (P = 0.016) less weight than the control group. There were no significant differences between the two groups with regard to admissions for nutritional reasons or treatment interruptions. The use of PGTs can reduce weight loss in patients undergoing radical radiotherapy for head and neck cancers, and its use should be further evaluated in future studies.

Effects of a selective cyclo-oxygenase 2 inhibitor on colonic anastomotic and skin wound integrity.

BACKGROUND: Selective inhibitors of inducible cyclo-oxygenase (COX-2) are of potential benefit in the perioperative period for both their analgesic and, perhaps, antineoplastic actions. However, their effects on laparotomy and intestinal wound healing are unknown. METHODS: Forty adult Sprague-Dawley rats underwent laparotomy, descending colonic transection and handsewn reanastomosis. The animals were randomized to receive either a selective COX-2 inhibitor (rofecoxib, 10 mg/kg) or an equal volume of water by gavage before operation and then daily after surgery. Animals were killed after 3 or 7 days, and their wounds were evaluated by means of tensiometry (skin and colonic wounds) and bursting pressure measurement (colonic anastomoses). In addition, haematoxylin and eosin-stained intestinal sections were examined and scored by a blinded independent observer. RESULTS: Five animals that received rofecoxib had anastomotic leaks by day 7 compared with none in the control group (P = 0.048). Intact colonic suture lines were also significantly weaker in this group (tensile strength at day 3, P = 0.043; bursting pressure on days 3 and 7, both P = 0.019). Skin wound strengths were similar in the two groups at both time points. CONCLUSION: Although beneficial in the treatment of pathological inflammation, selective COX-2 inhibitors may adversely affect colonic anastomotic healing.

Ischemic fasciitis: an unusual vulvovaginal spindle cell lesion.

Ischemic fasciitis is a benign reactive lesion that most commonly occurs in elderly, immobile patients in weight-bearing areas that are subject to intermittent ischemia with subsequent tissue breakdown and regenerative changes. The lesion can be clinically and pathologically mistaken for malignancy. Here we describe the first reported case of ischemic fasciitis of the vulvovaginal region in a 20-year-old paraplegic woman who presented with a clinically suspicious vulvar swelling. Histologic examination showed surface ulceration and underlying fibrinoid necrosis with surrounding reactive atypical fibroblast-like cells and small blood vessels, the characteristic histologic features of ischemic fasciitis.

Role of food allergy in serous otitis media.

BACKGROUND: The relationship between IgE-mediated hypersensitivity and recurrent serous otitis media has not been completely established. OBJECTIVE: The purpose of the present study was to examine the prevalence of food allergy in patients with recurrent serous otitis media. METHODS: A total of 104 unselected patients (age range 1.5 to 9 years, mean 4.6 years) with recurrent serous otitis media were evaluated for food allergy by means of skin prick testing, specific IgE tests, and food challenge. Patients who were allergic to food(s) underwent an exclusion diet of the specific offending food(s) for a period of 16 weeks. A non-double blinded food challenge was performed with the suspected offending food(s). Their middle ear effusion was monitored and assessed by tympanometry (Welch Allyn Model 23600) during the pre-elimination, elimination and challenge diet phases. RESULTS: There was a significant statistical association, by chi-square analysis, between food allergy and recurrent serous otitis media in 81/104 patients (78%). The elimination diet led to a significant amelioration of serous otitis media in 70/81 (86%) patients as assessed by clinical evaluation and tympanometry. The challenge diet with the suspected offending food(s) provoked a recurrence of serous otitis media in 66/70 patients (94%). CONCLUSIONS: The possibility of food allergy should be considered in all pediatric patients with recurrent serous otitis media and a diligent search for the putative food allergen made for proper diagnostic and therapeutic intervention.

Measles cervicitis. Report of a case with cytologic and molecular biologic analysis.

We report on a 20-year-old woman who, in her third month of pregnancy, presented with a morbilliform rash, fever and diarrhea. Many multinucleate superficial, intermediate and metaplastic cells were noted in the cervical cytologic preparation. The presence of the measles virus in cells from the cervix was confirmed by the amplification of measles complementary DNA (cDNA) by the polymerase chain reaction. The patient's cervical Papanicolaou smear was unremarkable on reexamination four months after the onset of the disease. To our knowledge, this is the first verified reported case of infection of the uterine cervix by the measles virus.

In vitro studies of the modulatory effects of sensory neuropeptides on peripheral blood mononuclear leukocytes of normal and allergic subjects.

The purpose of the present study was to evaluate the modulatory effects of sensory neuropeptides on peripheral blood mononuclear leukocytes of normal and allergic subjects. Peripheral blood mononuclear leukocytes obtained from five normal subjects and from five patients with allergic rhinitis and asthma were incubated with morphine, ACTH, vasoactive intestinal peptide, or substance P at concentrations of 10(-9) M, 10(-7) M, 10(-6) M and suboptimal (0.0125 microgram/mL, 0.025 microgram/mL, and 0.05 microgram/mL) concentrations of PHA. Uptake of 3H-thymidine was evaluated at 72 hours of culture. An inhibitory effect was observed with morphine, ACTH, and substance P while stimulatory effects were seen with vasoactive intestinal peptide, both in normal and in allergic subjects. The results of these preliminary studies provide further evidence for a modulatory role of neuropeptides on the immune function in both normal and allergic subjects.

Brain norepinephrine: a possible role in bronchial asthma.

The purpose of this study was to evaluate the relationship between neuroendocrine function and the beta receptor activity of the lung in a group of 47 pediatric patients with bronchial asthma. It is postulated that since hypothalamic norepinephrine (NE) is known to inhibit corticotropin-releasing hormone (CRH), an increase in brain NE as measured by its metabolite 3-methoxy-4-hydroxy-phenylglycol (MHPG) could reflect the depression of the hypothalamic-pituitary-adrenal (HPA) axis as measured by urinary cortisol levels. Further, since cortisol influences epinephrine formation in the adrenal medulla and since cortisol and epinephrine contribute to beta receptor function, it is further postulated that an increase in brain NE by depressing the HPA axis could thereby, cause a relative decrease in both cortisol and epinephrine with resultant beta receptor dysfunction. In both age groups, the 3- to 11-year-olds and the adolescents, differences in NE were found among the three subgroups (P = .003) with the difference observed only between the wheezing (decreased NE) and control groups (P less than .05). There was a similar difference in MHPG (elevated) among these groups. In a similar manner, the MHPG/NE ratios (elevated) were statistically different in comparing the three groups in the 3- to 11-year-old range. In the adolescent group both the wheezing and nonwheezing groups were comparably elevated and showed statistically significant differences from their controls. The results of this study appear to support the hypothesis and suggests that brain NE may play a pivotal role in the beta-adrenergic dysfunction characteristic of bronchial asthma.

Rinkel injection therapy: a multicenter controlled study.

The American Academy of Allergy sponsored a 2-yr "double blind" multicenter study of the effect of Rinkel injection therapy (RIT) compared with a histamine placebo in subjects with atopic rhinitis. Accumulated data included the symptom, medication, and physical examination scores and specific IgE antibody levels measured by the radioallergosorbent test (RAST). A total of 155 subjects (81 treated, 74 placebo) entered the project from six centers during their respective ragweed, grass, and mountain cedar pollen (from one center) seasons for a total of 11 pollen seasons. The total mean cumulative dose of extract was 18.6 PNU, which is much lower than recommended for standard immunotherapy. With one exception, none of the centers reported a consistent significant difference between the pollen extract-treated and placebo-treated groups in any of the weekly mean scores or the RAST before, during, and after the pollen seasons. For 4 wk after the height of the mountain cedar season the group treated with pollen extract showed a significant decrease in weekly mean symptom and medication scores as compared with the placebo group. The overall comparison of the mean seasonal scores for the entire study, however, showed no significant difference between the treated and placebo groups. We conclude the RIT is no more effective than a histamine placebo in influencing the weekly mean symptom, medication, and physical examination scores or IgE antibody levels.

Milk hypersensitivity: RAST studies using new antigens generated by pepsin hydrolysis of beta-lactoglobulin.

RAST was performed on sera from 28 patients with a variety of allergic symptoms, giving histories compatible with milk allergy, to investigate the occurrence of IgE antibodies to new antigens (NA) generated by in vitro pepsin hydrolysis. A variety of symptoms were associated with positive RAST scores. A positive correlation was found between the degree of RAST reactivity with undigested milk proteins and reactivity with the NA's. Reactivity to the NA's was always associated with reactivity to at least one of the undigested proteins. These findings suggest that undigested milk proteins are more reactive than digested proteins. Furthermore, antigens derived from pepsin digestion do not elicit a significant antibody response in individuals who do not allow show antibody responses to undigested proteins.

Dissociation of active from immobility components of sexual behavior in female rats by central 6-hydroxydopamine: implications for CA involvement in sexual behavior and sensorimotor responsiveness.

Ovariectomized female rats were given a hormone treatment (2 X 8 micrograms/kg estradiol benzoate) that normally supports only low levels of lordosis responding and no soliciting behavior in tests with sexually active males. When subjected to an intraventricular 6-hydroxydopamine (6-OHDA) procedure (with pargyline pretreatment) that produced 85% and 95% depletions of caudate dopamine and cortical norepinephrine respectively, these females exhibited a dramatic increase in the intensity and frequency of lordotic responding but no soliciting behavior over 3 weekly tests. The increase in lordosis was not due to a drug- or stress-induced release of adrenal progesterone, since dexamethasone suppressed the progesterone levels, as documented by radioimmunoassay, but not the higher receptivity of 6-OHDA treated females. In other ovariectomized females given a hormone regimen (2 X 50 micrograms/kg estradiol benzoate plus 500 micrograms progesterone) that supported maximal levels of lordosis and soliciting, the same 6-OHDA treatment prolonged the average duration of lordosis while actually decreasing the incidence and duration of soliciting. The hypothesis is put forward that the differential effects of interfering with catecholamine, and more likely dopamine function on the soliciting and lordosis components of female sexual behavior might best be understood as a dissociation between mutually antagonistic behavior patterns such that responsiveness involving active orientation and forward locomotion is suppressed, whereas responses requiring immobility are augmented.