Automated scanning electron microscopy and x-ray microanalysis for in situ quantification of gadolinium deposits in skin

Gadolinium (Gd) has been identified as a possible causative agent of an emerging cutaneous and systemic fibrosing disorder, nephrogenic systemic fibrosis (NSF), which can cause serious disability and even death. To date, there are only two known associations with this disorder--renal insufficiency and Gd enhanced magnetic resonance imaging (MRI). We developed an automated quantitative scanning electron microscopy (SEM) and Energy dispersive x-ray spectroscopy (EDS) method for Gd in tissue of NSF patients. Freshly cut paraffin block surfaces examined using the variable pressure mode under standardized conditions and random search of the tissue area allow in situ detection and semiquantitative morphometric (volumetric) analysis of insoluble higher atomic number features using backscattered electron imaging. We detected Gd ranging from 1 to 2270 cps/mm2 in 57 cutaneous biopsies of NSF. Gd was associated with P, Ca, and usually Na in tissue deposits. Our method reproducibly determines the elemental composition, relative concentration, and spatial distribution of detected features within the tissue. However, we cannot detect features below our spatial resolution, nor concentrations below the detection limit of our SEM/EDS system. The findings confirm transmetallation and release of toxic Gd ions in NSF and allow dose-response analysis at the histologic level.

Gadolinium deposition in nephrogenic fibrosing dermopathy

There is growing recognition of the association between the use of gadolinium-containing radiocontrast agents for magnetic resonance imaging and the serious dermal and systemic disease nephrogenic fibrosing dermopathy/nephrogenic systemic fibrosis (NFD/NSF). The pathogenesis of this entity remains unclear; however, our recent observations suggest a likely mechanism for the initial dermal manifestations of this gadolinium toxicity.

Issues in design and implementation in an urban birth cohort study: the Syracuse AUDIT project

The Syracuse AUDIT (Assessment of Urban Dwellings for Indoor Toxics) project is a birth cohort study of wheezing in the first year of life in a low-income urban setting. Such studies are important because of the documented serious risks to children's health and the lack of attention and published work on asthma development and intervention in communities of this size. We studied 103 infants of mothers with asthma, living predominantly in inner-city households. Our study combines measurements of a large panel of indoor environmental agents, in-home infant assessments, and review of all prenatal and postnatal medical records through the first year of life. We found multiple environmental pollution sources and potential health risks in study homes including high infant exposure to tobacco smoke. The prevalence of maternal smoking during pregnancy was 54%; postnatal environmental tobacco smoke (ETS) exposure was nearly 90%. The majority (73%) of homes showed signs of dampness. Participants' lives were complicated by poverty, unemployment and single-parenthood. Thirty-three percent of fathers were not involved with their children, and 62% of subjects moved at least once during the study period. These socioeconomic issues had an impact on project implementation and led to modification of study eligibility criteria. Extensive outreach, follow up, and relationship-building were required in order to recruit and retain families and resulted in considerable work overload for study staff. Our experiences implementing the project will inform further studies on this and other similar populations. Future reports on this cohort will address the role of multiple environmental variables and their effects on wheezing outcome during the first year of life.

Secondary ion mass spectroscopy demonstrates retention of beryllium in chronic beryllium disease granulomas

OBJECTIVE

We hypothesized that beryllium (Be) might persist in lung granulomas in patients with chronic beryllium disease (CBD).

METHODS

A total of 33 Be-exposed ceramics workers underwent transbronchial biopsy. They were classified based on histopathology and Be-lymphocyte proliferation test as CBD or other categories. Lung tissue sections were analyzed using secondary ion mass spectroscopy.

RESULTS

Be was detected in the lungs of all Be-exposed groups. Be levels were increased within the granulomas of patients with CBD compared with the Be levels outside granulomas. Notably, Be was detectable in the lungs of CBD patients who had ceased exposure to Be an average of 9 years previously.

CONCLUSIONS

Be was detected in the lungs of all Be-exposed subjects, with the highest levels of persistent Be inside CBD lung granulomas. Be antigen persistence may help explain the chronicity of this granulomatous disorder.

Inorganic dust exposure causes pulmonary fibrosis in smokers: analysis using light microscopy, scanning electron microscopy, and energy dispersive X-ray spectroscopy

Smoking is alleged to cause pulmonary fibrosis, but the role of inorganic dust particulates has not been adequately examined. The authors hypothesize that inorganic dust exposure is an independent risk factor for the development of fibrosis in smokers. They studied a prospective series of 34 subjects with open lung biopsies, 18 of whom had adequate lung parenchyma for evaluation. They also examined the relationships between smoking (pack-years), respiratory bronchiolitis (RB), inorganic dusts, and interstitial fibrosis. They graded RB, fibrosis, and particulate dust by means of light microscopy. They performed a semiquantitative analysis of dust burden by using scanning electron microscopy with energy-dispersive X-ray spectroscopy. A logistic regression analysis demonstrated a significant association between smoking and RB (p = .03), but not between smoking and fibrosis or between RB and fibrosis. Fibrosis was significantly associated with silica (p = .004) and titanium (p = .0006) concentrations. The results support the authors' hypothesis.

Proposed criteria for mixed-dust pneumoconiosis: Definition, descriptions, and guidelines for pathologic diagnosis and clinical correlation1 1The NIKKO-Symposium on Mixed-Dust Pneumoconiosis was held October 18–19, 1997, in Nikko, Tochigi, Japan, to develop diagnostic criteria for mixed-dust pneumoconiosis under the auspices of Labour Welfare Corporation, Tokyo, Japan. The Organizing Committee included Keizo Chiyotani, Koichi Honma, Yutaka Hosoda, and Hisao Shida, and participants included Zoltán Adamis, Eduardo Algranti, Toshiharu Fuyuki, Kiyonobu Kimura, Otha Linton, Michihito Mishina, Hiroshi Morikubo, Alvaro R. Osornio-Vargas, Yoshiaki Saitoh, Yasushi Shinohara, and Hiroshi Watanabe

We defined mixed-dust pneumoconiosis (MDP) pathologically as a pneumoconiosis showing dust macules or mixed-dust fibrotic nodules (MDF), with or without silicotic nodules (SN), in an individual with a history of exposure to mixed dust. We defined the latter arbitrarily as a mixture of crystalline silica and nonfibrous silicates. According to our definition of MDP, therefore, MDF should outnumber SN in the lung to make a pathologic diagnosis of MDP. In the absence of confirmation of exposure, mineralogic analyses can be used to support the pathologic diagnosis. The clinical diagnosis of MDP requires the exclusion of other well-defined pneumoconioses, including asbestosis, coal workers' pneumoconiosis, silicosis, hematite miners' pneumoconiosis, welders' pneumoconiosis, berylliosis, hard metal disease, silicate pneumoconiosis, diatomaceous earth pneumoconiosis, carborundum pneumoconiosis, and corundum pneumoconiosis. Typical occupations associated with the diagnosis of MDP include metal miners, quarry workers, foundry workers, pottery and ceramics workers, and stonemasons. Irregular opacities are the major radiographic findings in MDP (ILO 1980), in contrast to silicosis, in which small rounded opacities predominate. Clinical symptoms of MDP are nonspecific. MDP must be distinguished from a variety of nonoccupational interstitial pulmonary disorders.

Toxicologic and epidemiologic clues from the characterization of the 1952 London smog fine particulate matter in archival autopsy lung tissues

Exposure to atmospheric fine particulate matter (PM), even at low ambient concentrations, has clearly been linked to increases in mortality and morbidity. A 10- micro g m(-3) increase in PM10 (PM < 10 micro m) has been found to produce a 0.5% increase in daily mortality. The mechanism of action is a source of debate, although recent attention has focused on the cardiac effects of PM exposures. Likewise, several possible etiologic agents have been implicated, including ultrafine PM (PM <or= 100 nm), metals, and the acid components, yet the responsible constituent remains undetermined. During the catastrophic PM exposure episode in London in December 1952, some 4,000 excess deaths occurred at the height of the event. The extreme mortality during that episode and the preservation of archival autopsy tissues allow us the unique opportunity to report on the form and composition of December 1952 London PM in situ in tissues from persons known to have died from the smog exposure. Because absolute increases in mortality with current levels of PM in Western Europe and North America are low, analogous tissues are unlikely to be contemporaneously available. Taking a lung compartment (airway, airspace, interstitium, and lymph node) approach, we differentiated exposures contemporary with death from those of earlier origin. Electron microscopic analyses revealed the dominance of retained soot and a surfeit of other particle types. A variety of metal-bearing particle types were found in all compartments, but Pb, Zn, and SnZn types appeared the least biopersistent. The results support the acute toxicologic importance of ultrafine carbonaceous and metal PM.

Aluminum welding fume-induced pneumoconiosis

Chronic exposure to high concentrations of fumes during aluminum arc welding causes a severe pneumoconiosis characterized by diffuse pulmonary accumulation of aluminum metal and a corresponding reduction in lung function. Aluminum fume-induced pneumoconiosis is a rarely reported entity, of which the true incidence is unknown. We report the clinical, radiographic, microscopic, and microanalytic results of 2 coworkers, employed by the same aluminum shipbuilding facility, who died of complications from this disease. Scanning electron microscopy and energy dispersive x-ray analysis of the exogenous particle content in the lung tissue of these cases revealed the highest concentrations of aluminum particles (average of 9.26 billion aluminum particles per cm(3) of lung tissue) among the 812 similar analyses in our pneumoconiosis database. One patient had an original clinical diagnosis of sarcoidosis but no evidence of granulomatous inflammation.

Fatal asbestosis 50 years after brief high intensity exposure in a vermiculite expansion plant

The authors report the case of a 65-year-old accountant whose only asbestos exposure was during a summer job 50 years earlier in a California vermiculite expansion plant. Vermiculite is a silicate material that is useful in building and agriculture as a filler and insulating agent. He developed extensive fibrocalcific pleural plaques and end-stage pulmonary fibrosis, with rapidly progressive respiratory failure. Careful occupational and environmental history revealed no other source of asbestos exposure, and the initial clinical diagnosis was idiopathic pulmonary fibrosis; open lung biopsy shortly before his death confirmed asbestosis. Electron microscopic lung fiber burden analysis revealed over 8,000,000 asbestos fibers per gram dry lung, 68% of which were tremolite asbestos. Additional asbestiform fibers of composition not matching any of the standard asbestos varieties were also present at over 5,000,000 fibers per gram dry lung. Comparison analysis of a sample of Libby, Montana, vermiculite showed a similar mix of asbestiform fibers including tremolite asbestos. This case analysis raises several concerns: risks of vermiculite induced disease among former workers of the more than 200 expansion plants throughout the United States; health effects of brief but very high-intensity exposures to asbestos; and possible health effects in end-users of consumer products containing vermiculite.

Traumatic osmium tetroxide inoculation

Osmium tetroxide is a highly oxidizing, corrosive compound commonly found in electron microscopy laboratories. Although osmium tetroxide is known to cause rapid damage to organic tissue, its cutaneous effects have not been well studied. We report a case of traumatic inoculation from a broken vial of 4% osmium tetroxide. Electron microscopy and energy dispersive x-ray spectroscopy confirmed the presence of osmium in the tissue specimen. The lesion was treated by simple excision.

Mercury exposure and cutaneous disease

Human contact with mercury has been ongoing for centuries and was previously considered a legitimate means of treating different cutaneous and systemic conditions. Toxicity from this heavy metal may occur from exposure to elemental, inorganic, and organic forms of mercury. This article outlines the signs and symptoms of mercury poisoning and the different clinical conditions with assorted cutaneous findings.

Evaluation of workers exposed to dust containing hard metals and aluminum oxide

BACKGROUND

Fourteen worker exposed to hard metals and aluminum oxide were evaluated.

METHODS

Six heavily exposed workers underwent bronchoscopy and bronchoalveolar lavage, and five workers underwent transbronchial biopsy.

RESULTS

Microchemical analysis of transbronchial biopsies showed a high lung burden of exogenous particles, especially metal related to their hard metals exposure. Lung tissue and cellular changes, which were associated with exposure to hard metal and aluminum oxide, corresponded well with the microanalytic test results.

CONCLUSIONS

Three workers had at biopsy diffuse interstitial inflammatory changes: two of them were asymptomatic with normal chest X-ray films, and one had clinically evident disease with severe giant cell inflammation. Two other workers showed focal inflammation. The worker showing clinical disease and one asymptomatic worker with interstitial inflammatory changes had evaluated bronchoalveolar lavage fluid-eosinophilia counts. These two were father (with clinical disease) and son (asymptomatic).

Potato gun ocular injury

PURPOSE

This study aimed to identify a dangerous new weapon capable of causing damage to the ocular and periocular regions.

METHODS

The authors report two patients who had penetrating ocular injury in the past year because of homemade recreational potato guns.

RESULTS

In one 14-year-old boy, projectiles from the firing of a potato gun resulted in orbital and cranial injuries that were life threatening with widespread fractures, marked disruption of facial structures, a cerebrospinal fluid fistula requiring bifrontal surgical repair, and loss of one eye. In a separate accident with a different potato gun, a 14-year-old boy who was wearing glasses at the time of injury had a sight-threatening perforating corneal laceration.

CONCLUSION

Practitioners must be aware of the existence of these new, homemade unregulated devices. Information about the use and construction of these guns is widespread on the Internet, but no injuries resulting from these guns currently are documented in the medical literature.

Cirsoid arteriovenous malformation of kidney presenting as a mass suggestive of malignancy

This paper reports a rare case of cirsoid renal arteriovenous malformation (AVM) that showed radiological characteristics of a renal malignancy. Using only conventional procedures such as computerized tomography, the present case was misdiagnosed as a solid tumor mass and therefore radical nephrectomy was indicated. Angiographic analysis is expected to improve the accuracy of diagnosis of AVM, thus reducing the need to resort to invasive techniques.

Lead and other metals in play kit and craft items composed of vinyl and leather

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Silicate and metal dust in lungs of Greyhounds

OBJECTIVES

To determine whether the amount of opaque dust in lung specimens increases with age, the composition of that dust, and whether the composition is similar for Greyhounds and pet dogs.

DESIGN

Quantification of lung particulate dust burdens.

ANIMALS

192 Greyhounds and 5 pet dogs.

PROCEDURE

Lung specimens of 192 Greyhounds and 5 pet dogs were examined for dust accumulation, using light microscopy. Lung specimens from Greyhounds and the 5 pet dogs were analyzed, using scanning electron microscopy and energy dispersive x-ray spectroscopy to quantify the lung burden of inorganic particles.

RESULTS

Lung dust burden increased linearly with age. Pulmonary dust was composed of aluminum silicates, silica, and 18 metals. Silicate and metal particulate burdens were higher in Greyhounds than in the pet dogs. The 3 most common metals were iron, titanium, and chromium.

CONCLUSIONS AND CLINICAL RELEVANCE

Amount of opaque dust increased with age. The higher pulmonary dust burden in Greyhounds than in pet dogs suggests that environmental exposure is important.