Negative radioisotope bone scan in a patient with a fractured neck of femur

Radioisotope bone scanning is a sensitive and specific method of detecting occult fractures of the femoral neck but may occasionally give false negative results. It would appear that patients with renal failure are more likely to have a false negative test and this is probably related to avascularity of the femoral head.

Chronic neurological sequelae to organophosphate pesticide poisoning

OBJECTIVES

This work was undertaken to determine whether there are any chronic neurological sequelae to acute organophosphate pesticide poisoning.

METHODS

California surveillance data were used in a study of neurological function among 128 men poisoned by organophosphate pesticides in California from 1982 to 1990 and 90 referents. Tests included a neurological physical examination, 5 nerve conduction tests, 2 vibrotactile sensitivity tests, 10 neurobehavioral tests, and 1 postural sway test.

RESULTS

After correcting for confounding, the poisoned group performed significantly worse than the referent group on two neurobehavioral tests (sustained visual attention and mood scales). When the data were restricted to men with documented cholinesterase inhibition (n = 83) or to men who had been hospitalized (n = 36), the poisoned subjects also showed significantly worse vibrotactile sensitivity of finger and toe. Significant trends of increased impairment were found with increased days of disability on a wide spectrum of tests of both central and peripheral nerve function.

CONCLUSIONS

While these findings are limited by low response rates and by small sample sizes for specific pesticides, this study was based on a large surveillance database and is the largest study to date of the chronic effects of organophosphate pesticide poisoning. The evidence of some long-term effects of poisoning is consistent with two prior studies.

Superantigenic staphylococcal exotoxins induce T-cell proliferation in the presence of Langerhans cells or class II-bearing keratinocytes and stimulate keratinocytes to produce T-cell-activating cytokines

Several staphylococcal toxins are among a growing number of immunostimulatory molecules called "superantigens" because of their ability, when presented by appropriate major histocompatibility complex class II+ accessory cells, to activate essentially all T cells bearing particular T-cell receptor V beta gene segments. We have examined the ability of murine epidermal Langerhans cells and/or keratinocytes to act as accessory cells in the T-cell response to the superantigens staphylococcal enterotoxin B and exfoliative toxin, also known as epidermolysin. Purified murine splenic T cells were stimulated with staphylococcal enterotoxin B or exfoliative toxin in the presence of Langerhans cells--enriched epidermal cells from normal mice or epidermal cells isolated from mice pretreated with recombinant interferon-gamma, a procedure that induces the expression of major histocompatibility complex class II molecules on keratinocytes. The data show that both Langerhans cells and class II-bearing keratinocytes can act as accessory cells in the T-cell response to staphylococcal enterotoxin B and exfoliative toxin. We also observed that both human and murine keratinocytes cultured in the presence of staphylococcal enterotoxin B or exfoliative toxin produce increased amounts of cytokine(s) capable of stimulating thymocytes and D10 cells, and that this toxin activity is independent of the level of expression of class II on keratinocytes. Studies by enzyme-linked immunosorbent assay showed that staphylococcal enterotoxin B stimulates keratinocytes to produce tumor necrosis factor-alpha but not interleukin-1, suggesting tumor necrosis factor-alpha and perhaps other cytokines are responsible for the T-cell proliferative activity. These results demonstrate that two distinct epidermal constituents (i.e. Langerhans cells and keratinocytes) can serve as accessory cells in the responses of T cells to superantigenic bacterial toxins. It is possible that such toxins contribute to the pathogenesis of a variety of skin diseases by either locally activating T cells bearing particular V beta genes and/or enhancing keratinocyte production of immunomodulatory cytokines.

Contact urticaria and anaphylaxis to the fungicide chlorothalonil

Chlorothalonil, a common fungicide used for agricultural and horticultural purposes is capable of eliciting contact urticaria. In our patient, an anaphylactoid reaction resulted from intact skin contact to diluted chlorothalonil (0.01 percent aqueous). Our patient also experienced immediate respiratory reactions such as a tight chest and throat after entering the nursery greenhouse, without direct skin contact with chlorothalonil.

Kinematic analysis of human walking gait using digital image processing

A system using digital image processing techniques for kinematic analysis of human gait has been developed. The system is cheap, easy to use, automated and provides useful detailed quantitative information to the medical profession. Passive markers comprising black annuli on white card are placed on the anatomical landmarks of the subject. Digital images at the standard television rate of 25 per second are acquired of the subject walking past a white background. The images are obtained, stored and processed using standard commercially available hardware, i.e. video camera, video recorder, digital framestore and an IBM PC. Using a single-threshold grey level, all the images are thresholded to produce binary images. An automatic routine then uses a set of pattern recognition algorithms to locate accurately and consistently the markers in each image. The positions of the markers are analysed to determine to which anatomical landmark they correspond, and thus a stick diagram for each image is obtained. There is also a facility where the positions of the markers may be entered manually and errors corrected. The results may be presented in a variety of ways: stick diagram animation, sagittal displacement graphs, flexion diagrams and gait parameters.

A forty-three-year follow-up of a vitallium scaphoid arthroplasty

Over the years various treatment options for scaphoid nonunions have been proposed. We present as a historical note the long-term follow-up of one such treatment, the insertion of a vitallium scaphoid.

An epidemic of dermatitis at a large construction site

During 6 months in 1986, an epidemic of dermatitis occurred among more than 5600 workers at a single large construction site in the United States. To identify its cause, we used the monthly nurses' log of visits to the medical facility to characterize the outbreak by person, place, and time. Follow-up studies included a survey of carpenters and skin testing of laboratory animals. Workers were more than twice as likely to visit the medical facility for a skin-related complaint in 1986 compared with 1985 (relative rate [RR] = 2.6, 95% confidence interval [CI] 2.2-3.2). Carpenters experienced the greatest increased risk (RR = 9.7, 95% CI 5.5-17.3). We found a strong association between dermatitis and handling of fire-retardant lumber and plywood. Carpenters working only with fire-retardant lumber had a rate of dermatitis 4 times that of carpenters who worked exclusively with untreated wood (RR = 3.6, 95% CI 1.5-8.6). Carpenters who occasionally worked with fire-retardant lumber and plywood were at moderate risk (RR = 2.18, 95% CI 0.7-6.7). Although laboratory tests showed that phosphate compounds could be leached with water from the fire-retardant wood, an extract of these phosphates did not irritate the skin of laboratory animals. We concluded the epidemic was a result of handling fire-retardant lumber but could not identify the specific chemical agent. In view of the observed association, construction workers should be advised to handle this material with caution, especially in high temperature and humidity.

Cell membrane DNA: a new target for psoralen photoadduct formation

The effects of 8-methoxypsoralen plus long wavelength ultraviolet radiation on cell membrane DNA were examined. Treatment of human lymphocytes with 100 ng/ml 8-methoxypsoralen and 5 J/cm2 UVA led to the formation of 7.1 +/- 3.8 photoadducts per million bases. A monoclonal antibody, specific for 8-methoxypsoralen 4',5'-monoadducts, was used to detect photoadducts in the cell membrane DNA of human lymphocytes and three lymphoblastoid cell lines. Treatment of lymphocytes with 8-MOP and UVA reduced the lymphocyte DNA binding capacity by 56%. Cell membranes of normal lymphocytes were shown to contain three high affinity DNA binding proteins of 28, 59, and 79 kDa, respectively.

Evaluation of consumer uses of first aid recommendations on pesticide labels

In order to evaluate consumer uses of first-aid recommendations on pesticide labels and the appropriateness of current label first-aid statements, callers to the University of California, Davis Regional Poison Control Center (RPCC) reporting pesticide exposures were questioned during the period from August 27 to September 30, 1987. Of 2,650 calls received by the RPCC during the study period, 160 (6.0%) of the calls related to pesticides. Eighty-nine (55.6%) of the callers in these cases participated in our label evaluation survey. Only 47 (53%) of the survey participants reported having a product container or label available at the time they called the RPCC. Of 15 participants identifying themselves as physicians or nurses inquiring about exposures to patients, only 1 (7%) reported having access to a product label, compared to 46 (63%) of 74 other callers, a difference in proportion which was highly significant (p less than 0.001). All calls received relating to pesticides were reviewed in order to identify product labels from the registration file at the California Department of Food and Agriculture (CDFA). Of the 160 calls received, 133 contained information sufficient to allow for identification of the product involved and an understanding of the exposure event. Label first-aid information in these cases was appropriate to the circumstances of exposure in 63 (47%) of these cases, completely or partially incorrect in 20 (12%), and missing from the label in the remaining 50 (37%) of the cases. Inappropriate first-aid advice was limited to cases involving ingestion while missing first-aid advice was common for all routes of exposure.(ABSTRACT TRUNCATED AT 250 WORDS)

Axial bone density in rheumatoid arthritis: comparison of dual-energy projection radiography and dual-photon absorptiometry

The usefulness of dual-energy projection radiography (DEPR) in the evaluation of rheumatoid arthritis was compared with that of dual-photon absorptiometry (DPA). Bone density measurements of the lumbar spine and the proximal femur were obtained with DPA in 75 patients (45 women and 30 men). For comparison, the bone density of the lumbar spine was measured with DEPR in a subset of 52 patients (33 women and 19 men). High correlation was documented between DEPR and DPA measurements of the lumbar spine. No significant relationship between bone density and age was observed, in contrast to the known relationship in healthy subjects regardless of sex, site of measurement, or measurement technique. Bone density values in the spine and the proximal femur were significantly reduced for both sexes as compared with matched normative data. Interlevel variation in lumbar vertebral density as measured with DEPR was not significantly different in patients with rheumatoid arthritis as compared with control subjects. Significant correlation between bone density determination and body weight, as well as duration of menopause, was noted, whereas duration of disease, functional status, and cumulative corticosteroid dose were not predictive. Rheumatoid arthritis did not appear to influence the relationship between DEPR and DPA measurements of the spine, and neither method nor site of measurement exhibited a consistent advantage in discriminating patients with rheumatoid arthritis from healthy control subjects.

Secretory breast carcinoma in a man

A 23-year-old man who presented clinically with unilateral gynecomastia was found to have secretory breast carcinoma. The patient is free of disease 4 years following a modified radical mastectomy. The indolent biological potential of this rare variant of primary mammary carcinoma is evidenced by the long clinical history of a breast mass in this patient and the absence of axillary lymph node metastases. Although secretory carcinoma occurs both in children and adults, most examples have been reported in female patients.

Essential skills for baccalaureate graduates: perspectives of education and service

What psychomotor tasks should baccalaureate graduates be able to perform when they arrive on the doorsteps of practice settings? This article describes a research study in which a representative sample of nursing educators and nursing service personnel provide their perceptions in regard to that question. The content offers a clear view of the expectations of both groups, emphasizes the need for dialogue on this topic between educational service, and raises important issues for nursing administrators regarding the role of staff development and the transition of new graduates to the work setting.

The clinical features of migraine as a manifestation of allergic disease

Patients with a clinical history of migraine were evaluated psychiatrically, and by electroencephalography. They were challenged with food antigens by skin-prick test, and abdominal symptoms were evaluated following oral ingestion of food allergens. A significant correlation was found between challenge with specific food allergens and the development of migraine headaches, the appearance of abdominal symptoms and the occurrence of positive skin reactions. Psychiatric abnormalities and EEG alterations were associated with the occurrence of headaches and allergic clinical features. It is suggested that the clinical features of migraine can be explained as a result of release of chemical mediators following antigen-antibody reactions in the brain and other tissues where specific antibodies are localized. The continuous ingestion of the responsible food allergens would account for the raised tissue concentrations of noradrenaline, histamine and other mediators to which the clinical features of migraine are attributed.

Cromolyn DSG effects in hyperkinetic and psychotic children with allergies

Preliminary findings of an open trial of cromolyn in hyperkinetic and psychotic children indicates that the medication is useful, safe and well tolerated. Further controlled studies are suggested to determine the efficacy and indications of cromolyn in child psychiatry. Positive findings could clarify the biochemical mechanisms of hyperkinesis.

Serum factors releasing serotonin from normal platelets: relation to the manifestations of systemic lupus erythematosus

In 13 patients with systemic lupus erythematosus, globulin fractions of sera from serial bleedings were assayed for the induction of serotonin release from normal platelets. Releasing activity appeared at some time in the sera of seven patients, five of whom had episodes of thrombocytopenia. Conversely, only one patient manifested thrombocytopenia without the occurrence of serotonin releasing activity at any time. In three patients with episodes of thrombocytopenia, increases in serotonin releasing activity temporally coincided with drops in platelet count. These data show that levels of circulating platelet serotonin releasing factor(s) vary in the course of systemic lupus erythematosus and these variations may be inversely related to the platelet count in particular patients.

Release of platelet constituents by monosodium urate crystals

The release of human platelet constituents by the etiologic agent of gout, the monosodium urate crystal, is described here. In suspensions of washed platelets, response to urate crystals proceeded in two phases: A secretory phase involved the rapid active release of serotonin, ATP, and ADP with little loss of lactic dehydrogenase or beta-glucuronidase. A lytic phase involved the slower loss of all platelet constituents. Both phases were inhibited by iodoacetate plus dinitrophenol, suggesting an energy requirement. In ultrastructural studies, lysis of washed platelets which appeared to contain crystals was seen. Urate crystals were also shown to induce serotonin release and platelet lysis in citrated platelet-rich plasma. Since urate crystals are deposited at a variety of sites, urate crystal-platelet interaction in vivo is a possibility. Such interactions, leading to release of platelet constituents, might contribute to gouty inflammation or to enhanced atherogenesis.