1/127. An alleged poisoning with methanol and formaldehyde.It was alleged that a defendant added an unspecified amount of undyed formalin solution, containing formaldehyde and methanol, to the victim's bottle of ice and drinking water. The medical report indicated that except for a slight elevation of total creatine kinase, all other chemistry profiles were within normal ranges. The elevation of creatine kinase suggested muscle injury and inflammation; however, the significance of this elevation was not clear. Toxicological evaluations were made by conducting risk assessments. Based upon the medical report and risk assessments, the following conclusions were made: The calculated exposure doses of methanol and formaldehyde were too low to cause appreciable adverse effects; however, formaldehyde may have irritated the gastrointestinal tract causing smooth muscle and mucosal inflammation. The doses of methanol and formaldehyde were too low to cause death. The exposure scenario (a single oral exposure to formaldehyde) would not likely increase the cancer risk in the victim. The risk assessments provided resulted in a reduction in charge from attempted murder to felony.- - - - - - - - - - ranking = 1keywords = cancer, muscle (Clic here for more details about this article) |
2/127. asbestosis and small cell lung cancer in a clutch refabricator.OBJECTIVES: To present a case of asbestosis and small cell lung cancer caused by asbestos in a clutch refabricator. methods: Exposed surfaces of used clutches similar to those refabricated in the worker's workplace were rinsed, and the filtrate analysed by analytical transmission electron microscopy. Tissue samples were also analysed by this technique. RESULTS: Numerous chrysotile fibres of respirable dimensions and sufficient length to form ferruginous bodies (FBs) were detected from rinsed filtrates of the clutch. bronchoalveolar lavage fluid contained many FBs, characteristic of asbestos bodies. Necropsy lung tissue showed grade 4 asbestosis and a small cell carcinoma in the right pulmonary hilum. Tissue analysis by light and analytical electron microscopy showed tissue burdens of coated and uncoated asbestos fibres greatly exceeding reported environmental concentrations (3810 FBs/g dry weight and 2,080,000 structures > or = 0.5 micron/g dry weight respectively). 72% Of the cores were identified as chrysotile. CONCLUSIONS: Clutch refabrication may lead to exposure to asbestos of sufficient magnitude to cause asbestosis and lung cancer.- - - - - - - - - - ranking = 4.5112456403887keywords = cancer (Clic here for more details about this article) |
3/127. tobacco and public health.OBJECTIVES: An interactive program for physicians and surgeons was used to focus their attention on current issues of lung cancer in the united states. The issues examined were the risks for the development of lung cancer in smokers, spouses of smokers, recipients of second-hand or sidestream smoke, and the appropriate workup and treatment of patients with lung cancer. DESIGN: Case presentation with interactive questions and answers. patients: Six patients are presented whose cases demonstrate issues that are relevant and timely to the practice of thoracic surgery and oncology Interventions: Treatment for the five case presentations is used for interactive teaching purposes. CONCLUSIONS: Lung cancer is epidemic in the united states, particularly among women at the present time. Physician awareness of the environmental and other factors contributing to the disease should stay current with the population variables that we are seeing in clinical practice.- - - - - - - - - - ranking = 3.0074970935925keywords = cancer (Clic here for more details about this article) |
4/127. liver angiosarcoma and hemangiopericytoma after occupational exposure to vinyl chloride monomer.Various malignant tumors of the liver, especially liver angiosarcoma, have been described after occupational exposure to vinyl chloride monomer. We present the case records and pathologic findings of two plastic industry workers who had been exposed to high concentrations of vinyl chloride. These workers developed hepatic neoplasms, angiosarcoma, or hemangiopericytoma. We discuss the histogenesis of these tumors; the common vascular origin and the mutual transformation of these two tumors suggest that the hemangiopericytoma may also have developed during occupational exposure to high concentrations of vinyl chloride monomer.- - - - - - - - - - ranking = 0.0078262262711853keywords = neoplasm (Clic here for more details about this article) |
5/127. Invading basal cell carcinoma of the jaw: an under-evaluated complex entity.Basal cell carcinoma (BCC) is a locally invasive neoplasm, rarely metastatic, yet capable of significant local destruction and disfigurement. Invasion into the bone is uncommon and only a few cases of invasion into facial bones, but never to the mandible or maxilla, have been described. We report three patients with BCC lesions invading their jaws, as a consequence of which either their mandible or maxilla had to be partially resected. This resulted in facial mutilation which required comprehensive multi-disciplinary therapy to restore function and esthetics. Such therapy requires a combination of modalities offered by both plastic and maxillofacial surgeons, as well as oral and dental rehabilitators.- - - - - - - - - - ranking = 0.0078262262711853keywords = neoplasm (Clic here for more details about this article) |
6/127. Lung cancer in a nonsmoking underground uranium miner.Working in mines is associated with acute and chronic occupational disorders. Most of the uranium mining in the united states took place in the Four Corners region of the Southwest (arizona, colorado, new mexico, and utah) and on Native American lands. Although the uranium industry collapsed in the late 1980s, the industry employed several thousand individuals who continue to be at increased risk for developing lung cancers. We present the case of a 72-year-old Navajo male who worked for 17 years as an underground uranium miner and who developed lung cancer 22 years after leaving the industry. His total occupational exposure to radon progeny was estimated at 506 working level months. The miner was a life-long nonsmoker and had no other significant occupational or environmental exposures. On the chest X-ray taken at admission into the hospital, a right lower lung zone infiltrate was detected. The patient was treated for community-acquired pneumonia and developed respiratory failure requiring mechanical ventilation. Respiratory failure worsened and the patient died 19 days after presenting. On autopsy, a 2.5 cm squamous cell carcinoma of the right lung arising from the lower lobe bronchus, a right broncho-esophageal fistula, and a right lower lung abscess were found. Malignant respiratory disease in uranium miners may be from several occupational exposures; for example, radon decay products, silica, and possibly diesel exhaust are respiratory carcinogens that were commonly encountered. In response to a growing number of affected uranium miners, the Radiation Exposure Compensation Act (RECA) was passed by the U.S. Congress in 1990 to make partial restitution to individuals harmed by radiation exposure resulting from underground uranium mining and above-ground nuclear tests in nevada.- - - - - - - - - - ranking = 4.5112456403887keywords = cancer (Clic here for more details about this article) |
7/127. amyotrophic lateral sclerosis in a battery-factory worker exposed to cadmium.A 44-year-old patient died from amyotrophic lateral sclerosis (ALS) after nine years of heavy exposure to cadmium (Cd) in a nickel cadmium (Ni-Cd) battery factory. Two years after starting work he and co-workers had experienced pruritus, loss of smell, nasal congestion, nosebleeds, cough, shortness of breath, severe headaches, bone pain, and proteinuria. Upper back pain and muscle weakness progressed to flaccid paralysis. EMG findings were consistent with motor neuron disease. Cd impairs the blood-brain barrier, reduces levels of brain copper-zinc (Cu-Zn) superoxide dismutase (SOD), and enhances excitoxicity of glutamate via up-regulation of glutamate dehydrogenase and down-regulation of glutamate uptake in glial cells. High levels of methallothionein, a sign of exposure to heavy metals, have been found in brain tissue of deceased ALS patients. The effects of Cd on enzyme systems that mediate neurotoxicity and motor neuron disease suggest a cause effect relationship between Cd and ALS in this worker.- - - - - - - - - - ranking = 0.12406286330094keywords = muscle (Clic here for more details about this article) |
8/127. Avoidance of radiation injuries from medical interventional procedures.Interventional radiology (fluoroscopically-guided) techniques are being used by an increasing number of clinicians not adequately trained in radiation safety or radiobiology. Many of these interventionists are not aware of the potential for injury from these procedures or the simple methods for decreasing their incidence. Many patients are not being counselled on the radiation risks, nor followed up when radiation doses from difficult procedures may lead to injury. Some patients are suffering radiation-induced skin injuries and younger patients may face an increased risk of future cancer. Interventionists are having their practice limited or suffering injury, and are exposing their staff to high doses.In some interventional procedures, skin doses to patients approach those experienced in some cancer radiotherapy fractions. Radiation-induced skin injuries are occurring in patients due to the use of inappropriate equipment and, more often, poor operational technique. Injuries to physicians and staff performing interventional procedures have also been observed. Acute radiation doses (to patients) may cause erythema at 2 Gy, cataract at 2 Gy, permanent epilation at 7 Gy, and delayed skin necrosis at 12 Gy. Protracted (occupational) exposures to the eye may cause cataract at 4 Gy if the dose is received in less than 3 months, at 5.5 Gy if received over a period exceeding 3 months.Practical actions to control dose to the patient and to the staff are listed. The absorbed dose to the patient in the area of skin that receives the maximum dose is of priority concern. Each local clinical protocol should include, for each type of interventional procedure, a statement on the cumulative skin doses and skin sites associated with the various parts of the procedure. Interventionists should be trained to use information on skin dose and on practical techniques to control dose. Maximum cumulative absorbed doses that appear to approach or exceed 1 Gy (for procedures that may be repeated) or 3 Gy (for any procedure) should be recorded in the patient record, and there should be a patient follow-up procedure for such cases. patients should be counselled if there is a significant risk of radiation-induced injury, and the patient's personal physician should be informed of the possibility of radiation effects. Training in radiological protection for patients and staff should be an integral part of the education for those using interventional techniques. All interventionists should audit and review the outcomes of their procedures for radiation injury. Risks and benefits, including radiation risks, should be taken into account when new interventional techniques are introduced.A concluding list of recommendations is given. Annexes list procedures, patient and staff doses, a sample local clinical protocol, dose quantities used, and a procurement checklist.- - - - - - - - - - ranking = 1.5037485467962keywords = cancer (Clic here for more details about this article) |
9/127. Peripheral neuropathy in chronic occupational inorganic lead exposure: a clinical and electrophysiological study.BACKGROUND AND OBJECTIVES: Traditionally the neuromuscular disorder associated with lead poisoning has been purely motor. This study assessed peripheral nerve function clinically and electrophysiologically in 46 patients with neuropathic features out of a total population of 151 workers with raised blood and/or urinary lead concentrations. RESULTS: Average duration of occupational exposure for the neuropathic group ranged from 8-47 years (mean 21.7). Their mean blood lead concentration (SD) was 63.9 (18.3) microg/dl (normal <40), urinary lead 8.6 (3.3) microg/dl (normal<5.0), urinary coproporphyrins 66.7 (38.4) microg/g creatinine (20-80), urinary aminolaevulinic acid 1.54 (0.39) mg/g creatinine (0.5-2.5). All 46 had distal paraesthesiae, pain, impaired pin prick sensation, diminished or absent ankle jerks, and autonomic vasomotor or sudomotor disturbances. Reduced vibration sensation and postural hypotension were present in all 20 studied. None of these 46 patients had motor abnormalities. Motor conduction velocity and compound muscle action potential amplitudes were normal, with marginally prolonged distal motor latencies. Sensory nerve action potential amplitudes lay at the lower end of the normal range, and the distal sensory latencies were prolonged. No direct correlation was found between the biochemical variables, and the clinical or electrophysiological data. CONCLUSIONS: One additional patient was seen with shorter term exposure to lead fumes with subacute development of colicky abdominal pain, severe limb weakness, and only minor sensory symptoms. Unlike the patients chronically exposed to lead, he had massively raised porphyrins (aminolaevulinic acid 21 mg/g creatinine, coproporphyrins 2102 microg/g creatinine). patients with unusually long term inorganic lead exposure showed mild sensory and autonomic neuropathic features rather than the motor neuropathy classically attributed to lead toxicity. It is proposed that the traditional motor syndrome associated with subacute lead poisoning is more likely to be a form of lead induced porphyria rather than a direct neurotoxic effect of lead.- - - - - - - - - - ranking = 0.12406286330094keywords = muscle (Clic here for more details about this article) |
10/127. Anterior interosseous nerve palsy after cardiopulmonary resuscitation in a resuscitator with undiagnosed muscle anomaly.IMPLICATIONS: We present a case of nerve palsy after cardiopulmonary resuscitation in a resuscitator with undiagnosed muscle anomaly. Effort-related nerve palsy may occur after prolonged performance of CPR.- - - - - - - - - - ranking = 0.6203143165047keywords = muscle (Clic here for more details about this article) |
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