Reflex Epilepsy Triggered by Smell.

Reflex epilepsies can be provoked by various types of external stimuli, but triggered by smell is rare in the literature. In this case report, we present a patient whose reflex epilepsy is triggered by smell. Physical examination findings and electrophysiologic studies of the patient are discussed.

Survival with 98% methemoglobin levels in a school-aged child during the "festival of colors".

Methemoglobin levels more than 70% have almost always been reported to have been fatal. The case of a 4-year-old boy who survived with methemoglobin levels of 98% is presented here. He was brought to the emergency department with complaints of vomiting, pain abdomen, and altered sensorium following accidental ingestion of paint thinner mixed with "Holi" colors. On examination, the child was in altered sensorium, cyanosed with saturations of 55%, who did not respond despite positive pressure ventilation with 100% oxygen. A possibility of toxic methemoglobinemia was considered and confirmed by finding of elevated methemoglobin levels of 98%. The child survived with definitive therapy with methylene blue and aggressive goal-directed approach.

Role of xenoestrogens and endogenous sources of estrogens on the occurrence of premenopausal breast cancer in Iran.

Breast cancer affects Iranian women one decade younger than their counterparts in other countries and the underlying risk factors have remained controversial. The aryl hydrocarbon receptor (AhR) mediates endocrine disruptive activities of polyaromatic hydrocarbons (PAHs) and dioxins, which may compromise ovarian functions of women in polluted environments. This study focused on tissue expression levels of AhR and associations with exposure to chemicals with estrogen-like activities (xenoestrogens) and other reproductive factors in premenopausal breast cancer patients. Fifty cases who underwent surgery from June 2009 to June 2010 were matched with 100 controls by age and hospital records. AhR overexpression was detected in 87% of epithelial cells of young breast cancer patients. Living near factories generating PAHs and dioxins was considered as a major risk factor in premenopausal breast cancer (p=0.001, OR=4.8). History of idiopathic infertility was identified as a second significant risk factor (p=0.002, OR=3.50), which could be affected by endogenous estrogen levels. Long term (>5 yrs) consumption of oral contraceptive pills was identified as the third most important risk factor (p=0.006, OR=2.27). Adiposity and abnormal weight gain after 18 years were considered as two major background factors, which may contribute to the levels of endogenous estrogens. Direct and indirect exposure to cigarette smoke (p=0.005, OR=1.43) was considered as a weak risk factor without association with AhR levels. It seems that AhR overexpression is affected by exposure to xenoestrogens and by adiposity. Early occurrence of breast cancer in Iran may be a result of interactions between hormonal and environmental factors.

Aromatic amines: mechanisms of carcinogenesis and implications for risk assessment.

Carcinogenic aromatic amines are widespread and need to be regulated. Genotoxic and non-genotoxic effects are both necessary for tumor development. The common mode of action includes metabolic activation, the reaction of metabolites with nucleic acids and cellular macromolecules as well as toxic effects. The dose-response relationship of irreversible DNA damage is linear down to background concentrations and a no-effect level (NEL) cannot be defined. The dose-response relationships of reversible toxic effects are often non-linear and have been used to derive no-observed adverse effect levels (NOAEL). However, this procedure does not account for background exposure, the activity of structurally related, and those structurally unrelated chemicals which compete for the same biochemical systems. Fixed limit values for acceptable risk are therefore unacceptably uncertain. The perspective should change from "risk" to the "contribution to risk". The ALARA principle (as low as reasonably achievable) is part of such an approach. It does not say how much exposure is acceptable. Scientific risk assessment and risk management should be kept distinct and the input of scientific data and expert judgement documented.

Concentrations and risk assessment of selected monoaromatic hydrocarbons in buses and bus stations of Hangzhou, China.

Air pollution surveys of ten selected monoaromatic hydrocarbons (MAHCs) were conducted in buses and bus stations in Hangzhou, China. The mean concentrations of MAHCs in the air of buses and bus stations were 95.9 and 36.5 microg/m(3), respectively, of which toluene was the highest in all the sampling sites. Mean concentrations of all MAHCs in buses were statistically higher than those nearby bus stations (p<0.05). MAHCs concentrations in buses largely depend on vehicle conditions (including vehicle type, fuel type, interior decoration, etc.) and traffic conditions (mainly traffic density). Among the investigated buses, microbuses had the highest MAHCs level, while electric buses had the lowest. Buses driven in downtown had the highest MAHCs level, followed by those in suburban areas and tourist areas. The mean concentration ratio of toluene to benzene was 2.1+/-0.9, indicating that vehicle emission was the dominant source of MAHCs. Interior decorations, such as painting and surface coating, could also contribute to the MAHCs in the buses. The mean lifetime carcinogenic risks for passengers and bus drivers were 1.11x10(-5) and 4.00x10(-5), respectively, which were way above the limit set by USEPA. The health risk caused by MAHCs in bus microenvironment should be cautioned.

La exposición a las mareas negras y sus efectos en la salud / Health effects of exposure to oil spills

El naufragio del petrolero Prestige frente a las costas gallegas no sólo supuso el mayor desastre ecológico en la historia de nuestro país, sino que también propició la exposición de miles de personas que participaron en la limpieza de las zonas contaminadas a compuestos potencialmente tóxicos para la salud. Teniendo en cuenta que la vía respiratoria es una de las principales puertas de entrada de estos compuestos en el organismo, los posibles efectos de estos vertidos preocupan especialmente a los profesionales que nos dedicamos a las enfermedades respiratorias. Sin embargo, la información clínica que tenemos es manifiestamente insuficiente. Por tal motivo se ha elaborado esta revisión. En ella se analizan los estudios científicos realizados a propósito de otros naufragios de petroleros. Finalmente se exponen los datos clínicos y epidemiológicos de las investigaciones publicadas hasta la fecha con ocasión del hundimiento del buque Prestige

The sinking of the oil tanker Prestige off the coast of Galicia was not only the worst ecological disaster ever to affect Spain, it also led to thousands of people who participated in the cleanup of the contaminated areas being exposed to potentially dangerous toxic substances. As the airway is one of the principal routes of entry into the body of these toxic compounds, the possible effects of exposure to such spills is of particular interest and concern to respiratory specialists. The paucity of clinical information available on the subject was the motive for this paper, which reviews the scientific studies undertaken in the aftermath of other accidents involving oil tankers and concludes with a summary of the clinical and epidemiological data published to date on the Prestige oil spill

An interesting thinner intoxication case: intrathoracic injection.

Thinners, including aromatic hydrocarbons such as toluene, xylene, and N-hexane, are widely used in industry for the production of plastics, varnish, paint, and glue. Use of these toxic agents frequently leads to chronic intoxication caused by abuse or misuse of solvents, which are usually taken in through inhalation. Thinners may have neurotoxic, myotoxic, hepatotoxic, nephrotoxic, and cardiotoxic systemic effects. The patient described in this report attempted to commit suicide by injecting 10 cc thinner into the left hemithorax. Acute chemical empyema developed at the left hemithorax. No bacterial growth was noted in empyema liquid and blood samples. Empyema was treated with tube thoracostomy, and full remission was observed after 33 d. No systemic toxic signs were noted, other than a low level of hepatotoxicity. Although pleural effusion, atelectasis, and pleural thickening were observed at the acute phase on computed tomography (CT) of the thorax, only pleural thickening persisted on CT of the thorax after 1 y. Investigators could not find a documented case of parenteral use of thinners in the medical literature.

Intoxicación por administración parenteral de insecticidas organoclorados e hidrocarburos aromáticos / Intoxication due to injection of organochlorines and aromatic hydrocarbons

La intoxicación por vía parenteral debida a insecticidas organoclorados e hidrocarburos aromáticos, es muy poco frecuente. La toxicidad comporta efectos locales y sistémicos que pueden llegar a comprometer la vida del paciente. Se presenta el caso clínico de un varón que desarrolló una importante reacción local necrótico-inflamatoria, con leve afectación sistémica hepática y renal, tras administrarse los mencionados productos por vía parenteral en una tentativa de suicidio. (AU)

[Acute poisoning with industrial products]. / Intoxications aiguës par les produits industriels.

Poisonings with industrial products represent approximately 7% of the cases reported to the poison centres. Ingestion of petroleum distillates induces irritation of the gastrointestinal tract, central nervous system depression and aspiration pneumonitis which may be severe; treatment is mainly supportive. Ethylene and diethylene glycol poisonings produce central nervous system depression, anion gap metabolic acidosis, osmolar gap and acute tubular necrosis; in severe cases, hypocalcaemia, cerebral oedema and heart failure may be observed; treatment often associates supportive measures, haemodialysis and administration of competitive inhibitors of alcohol dehydrogenase (ethanol or 4-methylpyrazole). Glycol ethers induce central nervous system depression and metabolic acidosis; in addition, ethylene glycol monobutyl ether produces haemolysis; monomethyl and monoethyl ethers are responsible for bone marrow and lymphoid organ toxicity, they adversely affect spermatogenesis and are teratogens.