Fifty years of woodworkers' nasal adenocarcinoma in High Wycombe.

BACKGROUND: Since adenocarcinoma of the ethmoid sinuses was first described as an occupational disease in the woodworkers of High Wycombe, over the 50 subsequent years there has been a gradual decrease in the numbers to none over the last 12 years. Although this mirrored the decline in local industry, it seems the causative factor was first seen and then disappears over a 50-year period. METHODS: A total of 146 cases have been traced historically over this time as well as personal experience of 33 cases; these cases are reviewed and success with a new modality of treatment is discussed. CONCLUSION: This paper outlines how the disease was initially recognised, both its diagnosis and treatment development. It also describes how both the appearance and disappearance were seemingly caused by changes in manufacturing practice.

Cow-calf reproductive, genetic, and nutritional management to improve the sustainability of whole beef production systems.

Optimizing efficiency in the cow-calf sector is an important step toward improving beef sustainability. The objective of the study was to use a model to identify the relative roles of reproductive, genetic, and nutritional management in minimizing beef production systems' environmental impact in an economically viable, socially acceptable manner. An economic and environmental diet optimizer was used to identify ideal nutritional management of beef production systems varying in genetic and reproductive technology use. Eight management scenarios were compared to a least cost baseline: average U.S. production practices (CON), CON with variable nutritional management (NUT), twinning cattle (TWN), early weaning (EW), sire selection by EPD using either on-farm bulls (EPD-B) or AI (EPD-AI), decreasing the calving window (CW), or selecting bulls by EPD and reducing the calving window (EPD-CW). Diets to minimize land use, water use, and/or greenhouse gas (GHG) emissions were optimized under each scenario. Increases in diet cost attributable to reducing environmental impact were constrained to less than stakeholder willingness to pay for improved efficiency and reduced environmental impact. Baseline land use, water use, and GHG emissions were 188 m, 712 L, and 21.9 kg/kg HCW beef. The NUT scenario, which assessed opportunities to improve sustainability by altering nutritional management alone, resulted in a simultaneous 1.5% reduction in land use, water use, and GHG emissions. The CW scenario improved calf uniformity and simultaneously decreased land use, water use, and GHG emissions by 3.2%. Twinning resulted in a 9.2% reduction in the 3 environmental impact metrics. The EW scenario allowed for an 8.5% reduction in the 3 metrics. The EPD-AI scenario resulted in an 11.1% reduction, which was comparable to the 11.3% reduction achieved by EPD-B in the 3 metrics. Improving genetic selection by using AI or by purchasing on-farm bulls based on their superior EPD demonstrated clear opportunity to improve sustainability. When genetic and reproductive technologies were adopted, up to a 12.4% reduction in environmental impact was achievable. Given the modeling assumptions used in this study, optimizing nutritional management while concurrently improving genetic and reproductive efficiency may be promising avenues to improve productivity and sustainability of U.S. beef systems.

A case study of the carbon footprint of milk from high-performing confinement and grass-based dairy farms.

Life-cycle assessment (LCA) is the preferred methodology to assess carbon footprint per unit of milk. The objective of this case study was to apply an LCA method to compare carbon footprints of high-performance confinement and grass-based dairy farms. Physical performance data from research herds were used to quantify carbon footprints of a high-performance Irish grass-based dairy system and a top-performing United Kingdom (UK) confinement dairy system. For the US confinement dairy system, data from the top 5% of herds of a national database were used. Life-cycle assessment was applied using the same dairy farm greenhouse gas (GHG) model for all dairy systems. The model estimated all on- and off-farm GHG sources associated with dairy production until milk is sold from the farm in kilograms of carbon dioxide equivalents (CO2-eq) and allocated emissions between milk and meat. The carbon footprint of milk was calculated by expressing GHG emissions attributed to milk per tonne of energy-corrected milk (ECM). The comparison showed that when GHG emissions were only attributed to milk, the carbon footprint of milk from the Irish grass-based system (837 kg of CO2-eq/t of ECM) was 5% lower than the UK confinement system (884 kg of CO2-eq/t of ECM) and 7% lower than the US confinement system (898 kg of CO2-eq/t of ECM). However, without grassland carbon sequestration, the grass-based and confinement dairy systems had similar carbon footprints per tonne of ECM. Emission algorithms and allocation of GHG emissions between milk and meat also affected the relative difference and order of dairy system carbon footprints. For instance, depending on the method chosen to allocate emissions between milk and meat, the relative difference between the carbon footprints of grass-based and confinement dairy systems varied by 3 to 22%. This indicates that further harmonization of several aspects of the LCA methodology is required to compare carbon footprints of contrasting dairy systems. In comparison to recent reports that assess the carbon footprint of milk from average Irish, UK, and US dairy systems, this case study indicates that top-performing herds of the respective nations have carbon footprints 27 to 32% lower than average dairy systems. Although differences between studies are partly explained by methodological inconsistency, the comparison suggests that potential exists to reduce the carbon footprint of milk in each of the nations by implementing practices that improve productivity.

An environmental, economic, and social assessment of improving cattle finishing weight or average daily gain within U.S. beef production.

The objective of this study was to assess environmental impact, economic viability, and social acceptability of 3 beef production systems with differing levels of efficiency. A deterministic model of U.S. beef production was used to predict the number of animals required to produce 1 × 10(9) kg HCW beef. Three production treatments were compared, 1 representing average U.S. production (control), 1 with a 15% increase in ADG, and 1 with a 15% increase in finishing weight (FW). For each treatment, various socioeconomic scenarios were compared to account for uncertainty in producer and consumer behavior. Environmental impact metrics included feed consumption, land use, water use, greenhouse gas emissions (GHGe), and N and P excretion. Feed cost, animal purchase cost, animal sales revenue, and income over costs (IOVC) were used as metrics of economic viability. Willingness to pay (WTP) was used to identify improvements or reductions in social acceptability. When ADG improved, feedstuff consumption, land use, and water use decreased by 6.4%, 3.2%, and 12.3%, respectively, compared with the control. Carbon footprint decreased 11.7% and N and P excretion were reduced by 4% and 13.8%, respectively. When FW improved, decreases were seen in feedstuff consumption (12.1%), water use (9.2%). and land use (15.5%); total GHGe decreased 14.7%; and N and P excretion decreased by 10.1% and 17.2%, compared with the control. Changes in IOVC were dependent on socioeconomic scenario. When the ADG scenario was compared with the control, changes in sector profitability ranged from 51 to 117% (cow-calf), -38 to 157% (stocker), and 37 to 134% (feedlot). When improved FW was compared, changes in cow-calf profit ranged from 67% to 143%, stocker profit ranged from -41% to 155% and feedlot profit ranged from 37% to 136%. When WTP was based on marketing beef being more efficiently produced, WTP improved by 10%; thus, social acceptability increased. When marketing was based on production efficiency and consumer knowledge of growth-enhancing technology use, WTP decreased by 12%-leading to a decrease in social acceptability. Results demonstrated that improved efficiency also improved environmental impact, but impacts on economic viability and social acceptability are highly dependent on consumer and producer behavioral responses to efficiency improvements.

Effect of linoleic acid and dietary vitamin E supplementation on sustained conjugated linoleic acid production in milk fat from dairy cows.

Conjugated linoleic acid (CLA; cis-9,trans-11 18:2), a bioactive fatty acid (FA) found in milk and dairy products, has potential human health benefits due to its anticarcinogenic and antiatherogenic properties. Conjugated linoleic acid concentrations in milk fat can be markedly increased by dietary manipulation; however, high levels of CLA are difficult to sustain as rumen biohydrogenation shifts and milk fat depression (MFD) is often induced. Our objective was to feed a typical Northeastern corn-based diet and investigate whether vitamin E and soybean oil supplementation would sustain an enhanced milk fat CLA content while avoiding MFD. Holstein cows (n=48) were assigned to a completely randomized block design with repeated measures for 28 d and received 1 of 4 dietary treatments: (1) control (CON), (2) 10,000 IU of vitamin E/d (VE), (3) 2.5% soybean oil (SO), and (4) 2.5% soybean oil plus 10,000 IU of vitamin E/d (SO-VE). A 2-wk pretreatment control diet served as the covariate. Milk fat percentage was reduced by both high-oil diets (3.53, 3.56, 2.94, and 2.92% for CON, VE, SO, and SO-VE), whereas milk yield increased significantly for the SO-VE diet only, thus partially mitigating MFD by oil feeding. Milk protein percentage was higher for cows fed the SO diet (3.04, 3.05, 3.28, and 3.03% for CON, VE, SO, and SO-VE), implying that nutrient partitioning or ruminal supply of microbial protein was altered in response to the reduction in milk fat. Milk fat concentration of CLA more than doubled in cows fed the diets supplemented with soybean oil, with concurrent increases in trans-10 18:1 and trans-11 18:1 FA. Moreover, milk fat from cows fed the 2 soybean oil diets had 39.1% less de novo synthesized FA and 33.8% more long-chain preformed FA, and vitamin E had no effect on milk fat composition. Overall, dietary supplements of soybean oil caused a reduction in milk fat percentage and a shift in FA composition characteristic of MFD. Supplementing diets with vitamin E did not overcome the oil-induced reduction in milk fat percentage or changes in FA profile, but partially mitigated the reduction in fat yield by increasing milk yield.

The environmental and economic impact of removing growth-enhancing technologies from U.S. beef production.

The objective of this study was to quantify the environmental and economic impact of withdrawing growth-enhancing technologies (GET) from the U.S. beef production system. A deterministic model based on the metabolism and nutrient requirements of the beef population was used to quantify resource inputs and waste outputs per 454 × 10(6) kg of beef. Two production systems were compared: one using GET (steroid implants, in-feed ionophores, in-feed hormones, and beta-adrenergic agonists) where approved by FDA at current adoption rates and the other without GET use. Both systems were modeled using characteristic management practices, population dynamics, and production data from U.S. beef systems. The economic impact and global trade and carbon implications of GET withdrawal were calculated based on feed savings. Withdrawing GET from U.S. beef production reduced productivity (growth rate and slaughter weight) and increased the population size required to produce 454 × 10(6) kg beef by 385 × 10(3) animals. Feedstuff and land use were increased by 2,830 × 10(3) t and 265 × 10(3) ha, respectively, by GET withdrawal, with 20,139 × 10(6) more liters of water being required to maintain beef production. Manure output increased by 1,799 × 10(3) t as a result of GET withdrawal, with an increase in carbon emissions of 714,515 t/454 × 10(6) kg beef. The projected increased costs of U.S. beef produced without GET resulted in the effective implementation of an 8.2% tax on beef production, leading to reduced global trade and competitiveness. To compensate for the increase in U.S. beef prices and maintain beef supply, it would be necessary to increase beef production in other global regions, with a projected increase in carbon emissions from deforestation, particularly in Brazil. Withdrawing GET from U.S. beef production would reduce both the economic and environmental sustainability of the industry.

Bioethics Symposium: The ethical food movement: What does it mean for the role of science and scientists in current debates about animal agriculture?

Contemporary animal agriculture is increasingly criticized on ethical grounds. Consequently, current policy and legislative discussions have become highly controversial as decision makers attempt to reconcile concerns about the impacts of animal production on animal welfare, the environment, and on the efficacy of antibiotics required to ensure human health with demands for abundant, affordable, safe food. Clearly, the broad implications for US animal agriculture of what appears to be a burgeoning movement relative to ethical food production must be understood by animal agriculture stakeholders. The potential effects of such developments on animal agricultural practices, corporate marketing strategies, and public perceptions of the ethics of animal production must also be clarified. To that end, it is essential to acknowledge that people's beliefs about which food production practices are appropriate are tied to diverse, latent value systems. Thus, relying solely on scientific information as a means to resolve current debates about animal agriculture is unlikely to be effective. The problem is compounded when scientific information is used inappropriately or strategically to advance a political agenda. Examples of the interface between science and ethics in regards to addressing currently contentious aspects of food animal production (animal welfare, antimicrobial use, and impacts of animal production practices on the environment) are reviewed. The roles of scientists and science in public debates about animal agricultural practices are also examined. It is suggested that scientists have a duty to contribute to the development of sound policy by providing clear and objectively presented information, by clarifying misinterpretations of science, and by recognizing the differences between presenting data vs. promoting their own value judgments in regard to how and which data should be used to establish policy. Finally, the role of the media in shaping public opinions on key issues pertaining to animal agriculture is also discussed.

Intramammary infections and teat canal colonization with coagulase-negative staphylococci after postmilking teat disinfection: species-specific responses.

Coagulase-negative staphylococci (CNS) are the most common pathogens associated with intramammary infections (IMI) in dairy cows. We hypothesized that postmilking teat disinfection would reduce microbial colonization of the teat canal and thus reduce the prevalence of IMI caused by certain CNS species. The efficacy of iodine postmilking teat dip was tested against CNS colonization of the teat canal, and incidence of IMI was measured. Using an udder-half model, 43 Holstein cows at the Washington State University Dairy were enrolled in the trial; postmilking teat dip was applied to one udder-half, treatment (TX), and the remaining half was an undipped control (CX). Teat canal swabbing and mammary quarter milk samples were taken in duplicate once a week for 16 wk for microbial culture. Isolates from agar cultures were presumptively identified as CNS and then speciated using PCR-RFLP and agarose gel electrophoresis. Colonization of the teat canal and IMI by CNS were assessed. Thirty CNS IMI were diagnosed and the number of new IMI in CX quarters (21) was significantly greater than that in TX mammary quarters (9). The majority of CNS IMI were caused by Staphylococcus chromogenes (30%) and Staphylococcus xylosus (40%), and the latter were appreciably reduced by teat dip. Except for S. xylosus, an association was observed between teat canal colonization and IMI by all CNS species in this study, in which the majority of IMI were preceded by teat canal colonization. The total number of CNS IMI was greater for CX group cows compared with TX group cows. However, the effect of disinfection on IMI did not appear to be the same for all CNS species.

A comparison of the environmental impact of Jersey compared with Holstein milk for cheese production.

The objective of this study was to compare the environmental impact of Jersey or Holstein milk production sufficient to yield 500,000 t of cheese (equivalent cheese yield) both with and without recombinant bovine somatotropin use. The deterministic model used 2009 DairyMetrics (Dairy Records Management Systems, Raleigh, NC) population data for milk yield and composition (Jersey: 20.9 kg/d, 4.8% fat, 3.7% protein; Holstein: 29.1 kg/d, 3.8% fat, 3.1% protein), age at first calving, calving interval, and culling rate. Each population contained lactating and dry cows, bulls, and herd replacements for which rations were formulated according to DairyPro (Agricultural Modeling and Training Systems, Cornell, Ithaca, NY) at breed-appropriate body weights (BW), with mature cows weighing 454 kg (Jersey) or 680 kg (Holstein). Resource inputs included feedstuffs, water, land, fertilizers, and fossil fuels. Waste outputs included manure and greenhouse gas emissions. Cheese yield (kg) was calculated according to the Van Slyke equation. A yield of 500,000 t of cheese required 4.94 billion kg of Holstein milk compared with 3.99 billion kg of Jersey milk-a direct consequence of differences in milk nutrient density (fat and protein contents) between the 2 populations. The reduced daily milk yield of Jersey cows increased the population size required to supply sufficient milk for the required cheese yield, but the differential in BW between the Jersey and Holstein breeds reduced the body mass of the Jersey population by 125×10(3) t. Consequently, the population energy requirement was reduced by 7,177×10(6) MJ, water use by 252×10(9) L, and cropland use by 97.5×10(3) ha per 500,000 t of cheese yield. Nitrogen and phosphorus excretion were reduced by 17,234 and 1,492 t, respectively, through the use of Jersey milk to yield 500,000 t of Cheddar cheese. The carbon footprint was reduced by 1,662×10(3) t of CO(2)-equivalents per 500,000 t of cheese in Jersey cows compared with Holsteins. Use of recombinant bovine somatotropin reduced resource use and waste output in supplemented populations, with decreases in carbon footprint equivalent to 10.0% (Jersey) and 7.5% (Holstein) compared with nonsupplemented populations. The interaction between milk nutrient density and BW demonstrated by the Jersey population overcame the reduced daily milk yield, thus reducing resource use and environmental impact. This reduction was achieved through 2 mechanisms: diluting population maintenance overhead through improved milk nutrient density and reducing maintenance overhead through a reduction in productive and nonproductive body mass within the population.

The environmental impact of beef production in the United States: 1977 compared with 2007.

Consumers often perceive that the modern beef production system has an environmental impact far greater than that of historical systems, with improved efficiency being achieved at the expense of greenhouse gas emissions. The objective of this study was to compare the environmental impact of modern (2007) US beef production with production practices characteristic of the US beef system in 1977. A deterministic model based on the metabolism and nutrient requirements of the beef population was used to quantify resource inputs and waste outputs per billion kilograms of beef. Both the modern and historical production systems were modeled using characteristic management practices, population dynamics, and production data from US beef systems. Modern beef production requires considerably fewer resources than the equivalent system in 1977, with 69.9% of animals, 81.4% of feedstuffs, 87.9% of the water, and only 67.0% of the land required to produce 1 billion kg of beef. Waste outputs were similarly reduced, with modern beef systems producing 81.9% of the manure, 82.3% CH(4), and 88.0% N(2)O per billion kilograms of beef compared with production systems in 1977. The C footprint per billion kilograms of beef produced in 2007 was reduced by 16.3% compared with equivalent beef production in 1977. As the US population increases, it is crucial to continue the improvements in efficiency demonstrated over the past 30 yr to supply the market demand for safe, affordable beef while reducing resource use and mitigating environmental impact.

Esme Hadfield (1921-92) and the Wycombe woodworkers.

This paper reflects on the life and work of Esme Hadfield, an otolaryngologist based at Wycombe General Hospital and, in particular, on her discovery of the link between adenocarcinoma of the paranasal sinuses and wood dust exposure from those in the furniture industry. The paper also explores the woodworking industry that forms the backdrop to her discovery.

The environmental impact of dairy production: 1944 compared with 2007.

A common perception is that pasture-based, low-input dairy systems characteristic of the 1940s were more conducive to environmental stewardship than modern milk production systems. The objective of this study was to compare the environmental impact of modern (2007) US dairy production with historical production practices as exemplified by the US dairy system in 1944. A deterministic model based on the metabolism and nutrient requirements of the dairy herd was used to estimate resource inputs and waste outputs per billion kg of milk. Both the modern and historical production systems were modeled using characteristic management practices, herd population dynamics, and production data from US dairy farms. Modern dairy practices require considerably fewer resources than dairying in 1944 with 21% of animals, 23% of feedstuffs, 35% of the water, and only 10% of the land required to produce the same 1 billion kg of milk. Waste outputs were similarly reduced, with modern dairy systems producing 24% of the manure, 43% of CH(4), and 56% of N(2)O per billion kg of milk compared with equivalent milk from historical dairying. The carbon footprint per billion kilograms of milk produced in 2007 was 37% of equivalent milk production in 1944. To fulfill the increasing requirements of the US population for dairy products, it is essential to adopt management practices and technologies that improve productive efficiency, allowing milk production to be increased while reducing resource use and mitigating environmental impact.

Is surgical debridement and topical 5 fluorouracil the optimum treatment for woodworkers' adenocarcinoma of the ethmoid sinuses? A case-controlled study of a 20-year experience.

OBJECTIVES: Woodworkers' adenocarcinoma of the ethmoid sinuses is an extremely rare occupational malignancy with a locally aggressive course. Treatment with surgical exenteration and topical 5 fluorouracil (5FU) packs has become standard treatment over the last 10 years in this ENT unit. This study presents level 2 evidence that 5FU provides improved survival over previous management with primary radiotherapy and salvage craniofacial resection. DESIGN: Retrospective case series with historical control group. SETTING: District General Hospital. PARTICIPANTS: The records of 31 consecutive patients with the disease were analysed. Five patients died prior to treatment. One patient was treated with surgery alone and therefore excluded. Twenty-five patients were included in the analysis. Fourteen were treated with primary radiotherapy and 11 with surgery and topical 5FU. OUTCOME MEASURES: Disease free survival was measured using Kaplan-Meier survival analysis. RESULTS: Five-year disease free survival improved from 50% with primary radiotherapy to 86% with surgery and 5FU. This improvement is statistically significant (P = 0.03). CONCLUSION: Topical 5FU treatment improves survival of Woodworker's adenocarcinoma of the ethmoid sinuses. This finding may be useful in the treatment of other locally aggressive sinonasal malignancies.

A novel HLA-C locus allele with codon 54 deletion, Cw*0346.

This report describes the discovery and characterization of the novel Cw*0346 allele.

A novel HLA-Cw*05 allele, Cw*0517.

This report describes the discovery and characterization of the HLA-Cw*0517 allele.

The effect of fish oil supplementation of pregnant and lactating ewes on milk production and lamb performance.

Supplementation of pregnant ewes with long-chain n-3 polyunsaturated fatty acids (PUFA) demonstrably improves indicators of neonatal lamb vigour, potentially improving the number of lambs reared per ewe. The present study investigated the effect of supplementing ewes with fish oil and vitamin E (α-tocopherol acetate) throughout both pregnancy and lactation on the performance of lactating ewes and sucking lambs. Forty-eight ewes were supplemented with one of four concentrates containing either Megalac or fish oil plus a basal (50 mg/kg) or supranutritional (500 mg/kg) concentration of vitamin E from 6 weeks pre-partum until 4 weeks post partum in a two-by-two factorial randomised-block design. All concentrates were formulated to contain approximately 60 g/kg supplemental fatty acids. Ewes were housed, penned on sawdust and offered straw ad libitum. Blood samples were taken from ewes and lambs at intervals throughout the experiment and milk samples were obtained at 21 days into lactation. There was no notable effect of dietary vitamin E concentration upon ewe or lamb performance. Ewe dry-matter (DM) intake and yield were unaffected by dietary treatment, although ewes fed fish oil lost less weight during lactation (-1.88 kg compared with -3.97 kg for Megalac-supplemented ewes; P < 0.01). Milk fat concentrations (67.3 g/kg compared with 91.8 g/kg; P < 0.01) and yields (6.65 g/h v. 9.26 g/h; P < 0.01) were reduced in ewes fed fish oil and these decreases were associated with lower litter-growth rates (0.49 g/day compared with 0.54 g/day; P < 0.05). Milk protein yield was increased by fish oil supplementation (3.82 g/h) compared with Megalac supplementation (3.28 g/h; P < 0.05); moreover, there was an interaction between fat source and vitamin E concentration in that both protein concentration and yield were significantly lower in milk from ewes fed treatment with Megalac + basal vitamin E (MB) compared with the other three treatments. Fish oil supplementation increased the concentrations of C18:1 trans-, cis-9, trans-11 conjugated linoleic acid (CLA), C20:5 (n-3) and C22:6 (n-3) within ewe plasma, milk and lamb plasma. The mechanisms by which fish oil supplementation affects milk composition warrants further investigation.

Mucous membrane pemphigoid: nasal and laryngeal manifestations.

Mucous membrane pemphigoid (MMP) is a sub-epithelial blistering disease that primarily involves mucosal surfaces but may also involve the skin. Clinically, it appears as vesiculobullous lesions of the oral cavity and eyes, but other tissues such as the nasopharyngeal and laryngeal mucosa can also be affected. Ultimately, scarring and airway stenosis may occur. The condition should be managed by a multidisciplinary team led by a dermatologist. Immunosuppressive therapy forms the mainstay of treatment, with surgery having both a diagnostic role and a use in the treatment of complications such as airway obstruction. There must be a low threshold of suspicion for laryngeal involvement in this group of patients, so that prompt action can be taken. Once laryngeal stenosis has occurred repeated endoscopic laser excision of scar tissue can be used to maintain an adequate airway. Adjuvant use of mitomycin-C can be used beneficially in the treatment of laryngeal complications of MMP.

External auditory canal pH in chronic otitis externa.

Several risk factors have been postulated to play a part in the progression of acute into chronic otitis externa, including changes towards alkalinity of the skin pH of the external auditory canal. These changes have been previously reported to occur in the acute stage, and their persistence may predispose to a chronic status of this condition. This prospective control study was designed to look at this possible relationship in more depth, by comparing the external auditory canal pH of individuals with chronic otitis externa, but with no current exacerbation, with an age-/sex-matched control group. Analysis of the data revealed a significantly higher external auditory canal pH in the chronic otitis externa group (P < 0.004) when compared with the controls, with no concomitant difference in body skin pH. Within this chronic otitis externa cohort, a statistically significant correlation was found between external auditory canal pH and the severity of the condition, as assessed using a multiparameter scoring system (r = 0.562; P < 0.02). Importantly, the pH was not related to the length of time since the last exacerbation. There was a significant age relationship present within our sample. Younger patients displayed more severe chronic otitis externa(r = -0.813; P < 0.001), with correspondingly higher external auditory canal pH values (r = -0.550; P < 0.02). The results suggest that alkaline ear canal skin is a local risk factor for the progression into chronic otitis externa, occurring, in this study, with greater severity in younger individuals.

Adenocarcinoma of the ethmoid sinuses: a case of two primary tumours.

The authors present a case report of a retired furniture worker who initially presented with a mucin-secreting adenocarcinoma of the right ethmoid sinus. He underwent surgical resection, leaving the nasal septum intact, and topical treatment with 5-fluorouracil. He remained disease free. Three years after his initial presentation he was found to have a left nasal polyp on routine examination. This subsequently proved to be a second primary adenocarcinoma. A review of the literature has not shown any other cases of a second primary adenocarcinoma of the ethmoid sinuses.

Transplantation of a fetus with paternal Thy-1(+)CD34(+)cells for chronic granulomatous disease.

A fetus diagnosed with X-linked chronic granulomatous disease was transplanted with Thy-1(+)CD34(+) cells of paternal origin. The transplant was performed at 14 weeks gestation by ultrasound guided injection into the peritoneal cavity. The fetus was delivered at 38 weeks gestation after an otherwise uneventful pregnancy. Umbilical cord blood was collected and used to determine the level of peripheral blood chimerism as well as levels of functional engrafted cells. Flow cytometry was used to detect donor leukocytes identified as HLA-A2(-)B7(+) cells, whereas recipient cells were identified as HLA-A2(+)B7(-) cells. No evidence of donor cell engraftment above a level of 0.01% was found. PCR was used to detect HLA-DRB1*15(+) donor cells among the recipient's HLA-DRB1*15(-) cells, but no engraftment was seen with a sensitivity of 1:1000. The presence of functional, donor-derived neutrophils was assessed by flow cytometry using two different fluorescent dyes that measure reactive oxygen species generated by the phagocyte NADPH oxidase. No evidence of paternal-derived functional neutrophils above a level of 0.15% was observed. Peripheral blood and bone marrow samples were collected at 6 months of age. Neither sample showed engraftment by HLA typing using both flow cytometry and PCR. Functional phagocytes were also not observed. Furthermore, no indication of immunological tolerance specific for the donor cells was indicated by a mixed lymphocyte reaction assay performed at 6 months of age. While there appears to be no engraftment of the donor stem cells, the transplant caused no harm to the fetus and the child was healthy at 6 months of age. Analyses of fetal tissues, obtained from elective abortions, revealed that CD3(+) T cells and CD56(+)CD3(-) NK cells are present in the liver at 8 weeks gestation and in the blood by 9 weeks gestation. The presence of these lymphocytes may contribute to the lack of donor cell engraftment in the human fetus.