Difference in concentration of lead (Pb) in meat from pheasants killed using lead and iron (Fe) shotgun ammunition.

The use of lead shotgun ammunition for hunting has been banned in a few jurisdictions and habitats, principally to protect wild birds from poisoning by ingestion of spent lead shot. The EU and UK REACH processes have recently considered bans on lead ammunition throughout the European Union and United Kingdom, including assessments of possible health benefits from reduced human dietary exposure to lead from game meat. Comparisons of the mean lead concentrations in meat from gamebirds killed using lead and non­lead shotgun ammunition have not been published. We compared lead concentrations in meat from wild-shot pheasants from which lead shotgun pellets were recovered (n = 27) with those from which iron pellets were recovered (n = 20), having removed all pellets from the meat before analysis. The mean concentration of lead in meat from pheasants killed using lead shot was 2.10 mg/kg w.w., which is >20 times the European Union's maximum permitted level for the lead concentration in meat from domesticated animals. For pheasants killed using iron shot the mean was 0.07 mg/kg w.w., which is below the maximum permitted level.

A case of a testosterone-secreting oncocytic adrenocortical carcinoma.

Oncocytic neoplasms are most rarely found in the adrenal gland. They are usually benign and non-functioning. We present a case of a testosterone-secreting oncocytic adrenocortical carcinoma in a 19-year-old female who presented with acne, hirsutism and irregular menses. Clinical investigations revealed an elevated testosterone and DHEA-S and a 4×5 cm left adrenal mass. The tumour was successfully excised. The histology showed the tumour to be comprised of oncocytic cells with granular, eosinophilic cytoplasm, features consistent with an oncocytic carcinoma. This is the first case presented of a testosterone-secreting oncocytic adrenocortical carcinoma.

Cumulative sum (Cusum) analysis provides an objective measure of competency during training in endoscopic retrograde cholangio-pancreatography (ERCP).

BACKGROUND AND AIM: Endoscopic retrograde cholangio-pancreatography (ERCP) is a complex and technically challenging procedure with a risk of significant complications. Although recommendations exist as to how many ERCPs should be performed before a trainee is deemed competent they lack objective measures of outcome. Cumulative sum (Cusum) analysis allows continuous monitoring of a proceduralist's performance to ensure acceptable outcomes are being achieved. The aim of the present study was to assess a trainee's progress with ERCP using Cusum analysis. METHOD: A single trainee performed one supervised ERCP list per week between June 2005 and May 2008. Prospective data were collected and analysed by intention to treat using Cumulative failure charting and Cusum analysis. The binary outcome measure was successful cannulation in patients with a native sphincter. Acceptable and unacceptable cannulation failure rates were set at 20% and 35% respectively, with Type I and II error rates set at 0.10. RESULTS: A total of 290 ERCPs were performed. Successful cannulation was achieved in 168 of 238 (70.6%) patients with intact biliary sphincters. Although cumulative failure charting suggested the trainee had not yet achieved satisfactory performance, Cusum analysis with sequential probability ratio testing indicated that an acceptable outcome had been achieved for the last 179 consecutive ERCPs. CONCLUSION: Cusum analysis enables sensitive and continuous monitoring of a trainee's performance to objectively determine competency. Wider and systematic use may enable appropriate benchmarks to be identified and more objective assessment of a trainee's experience.