Metal deposition in post-surgical granulomas of the urinary tract

Fourteen cases of post-surgical granulomatous inflammation of the urinary tract were studied to investigate the possible deposition in the tissues of metals derived from the diathermy instruments used. The granulomas showed central necrosis, palisaded histiocytes and giant cells. On electronmicroscopy both amorphous material and electrondense particles were seen in the granulomas. The former appeared to be necrotic tissue. The particles were metallic in nature. Energy dispersive analysis of X-rays showed the presence of tungsten, iron, copper, nickel, chromium, zinc and vanadium. Tungsten particles were always pure. Other single particles contained two or more of the remaining elements, indicating the presence of alloy metals. Analysis of the diathermy instruments showed the cutting loops to be pure tungsten and the 'rollerballs' to be nickel silver containing copper, zinc, nickel, manganese and iron. Both the loops and balls are supported on stainless steel wires containing iron, chromium, nickel, manganese, molybdenum, copper and vanadium. It is proposed that metallic fragments from the instruments were deposited in the tissues during the surgical procedures and elicited an immunological reaction with granuloma formation. Tungsten is probably inert but nickel, chromium, copper and zinc are immunogenic. Under certain circumstances both nickel and chromium may also be carcinogenic.

Metals and the skin

Certain metals, and many metal-based compounds, are inherently toxic, and their presence in occupational and environmental settings raises appropriate questions concerning human exposure. Contact of these materials with the skin represents an important route of exposure, which is not well characterized. The purpose of this review, therefore, is to assemble the available, useful information pertinent to risk assessment following dermal contact. Specifically, we summarize here: (1) data relevant to the qualitative and (where possible) quantitative evaluation of metal compound permeation through the skin; (2) the role of each metal in metabolism, particularly with respect to the skin, and the potentially toxic effects that may result from dermal contact; and (3) the immunological characteristics (including allergenicity) of the metals and their derivatives. In total, information on 31 metals has been reviewed. It is clear that many diverse factors determine the ability of metal-based species to permeate biological membranes, not all of which have been fully defined. Therefore, considerably more experimentation, targeted at the development of high-quality transport data, will be required before the specification of practically useful structure-activity relationships are possible.

[Computerized data base for recording information on patients with hypersensitivity to metals]

The authors describe a computer analysable etiological card used for registration of data of Ni hypersensitive patients' with oral symptoms. The collection and evaluation of the data related to the pathological changes and predisposing factors can be useful in prevention of development of hypersensitivity or clinical symptoms of hypersensitivity in cases belonging to this risk group.

Effect of the metal in the reaction between metallothionein and antimetallothionein antibody

1. An antimetallothionein antibody, raised against Cd-carrying metallothionein, was applied in Western blotting of metallothionein. 2. Treatment of the electroblotted nitrocellulose sheets with metals belonging to the periodic system transition groups Ib and IIb, or with Pb, Ni or Cr, considerably enhanced binding of anti-metallothionein. A similar effect was found when the electroblotted sheets were treated with the strong alkylator N-ethylmaleimide. 3. It seems that the binding of metal to metallothionein modifies the configuration of the antibody binding sites by the formation of metal thiolate complexes. 4. Metal treatment of the nitrocellulose sheets after electroblotting, but before application of the primary antibody, offers a convenient method for use in Western blotting to significantly potentiate the reaction between metallothionein and the antimetallothionein antibody.

Localization of membrane-associated (NiFe) and (NiFeSe) hydrogenases of Desulfovibrio vulgaris using immunoelectron microscopic procedures

The intracellular location of membrane-associated (NiFe) and (NiFeSe) hydrogenases of Desulfovibrio vulgaris was determined using pre-embedding and post-embedding immunoelectron microscopic procedures. Polyclonal antisera directed against the purified (NiFe) and (NiFeSe) hydrogenases were raised in rabbits. One-day-old cultures of D. vulgaris, grown on a lactate/sulfate medium, were used for all experiments in these studies. For post-embedding labeling studies cells were fixed with 0.2% glutaraldehyde and 0.3% formaldehyde, dehydrated with methanol, and embedded in the low-temperature resin Lowicryl K4M. Our post-embedding studies using antibody-gold or protein-A-gold as electron-dense markers revealed the location of the two hydrogenases exclusively at the cell periphery; the precise membrane location was then demonstrated by pre-embedding labeling. Spheroplasts were incubated with the polyclonal antisera against (NiFe) and (NiFeSe) hydrogenase followed by ferritin-linked secondary antibodies prior to embedding and sectioning. The observed labeling pattern unequivocally revealed that the antigenic reactive sites of the (NiFe) hydrogenase are located in the near vicinity of the cytoplasmic membrane facing into the periplasmic space, whereas the (NiFeSe) hydrogenase is associated with the cytoplasmic side of the cytoplasmic membrane.

Exercise-induced anaphylaxis: improvement after removal of amalgam in dental caries

We present a case of exercise-induced anaphylaxis with improvement following the removal of dental amalgam. Although her symptoms were unresponsive to various kinds of therapy until removal of the amalgam, her symptoms related to exercise improved remarkably after the removal. The increase in plasma histamine levels for exercise provocation test also improved. This suggests that sensitivity to metals might cause exercise-induced asthma in some patients.

Mycosis fungoides and occupational exposures. Is there an association?

In a case-control study, the author and coinvestigators found no positive association between occupational or chemical exposures and the risk of mycosis fungoides. Thus, there was no support for the hypothesis that chronic antigenic stimulation is an etiologic factor in this disease.

[Electric current around dental metals as a factor producing allergenic metal ions in the oral cavity]

Allergy to dental metal alloys has been reported to occasionally cause dermatitis, stomatitis, lichen planus and pustulosis palmaris et plantaris. According to Faraday's law of electrolysis, when electric current flows into an anode, cationic metal ions dissolve in parallel with the amount of the electric current. Therefore, when patients hypersensitive to metals have suffered from the above mentioned persistent dermatoses, measurement of voltages and electric currents around the dental alloys of the patient's oral cavities was deemed necessary, in order to investigate whether or not such dental metals have been supplied causative metal ions to the patients. For the investigation of electrochemical dissolution of metal ions; firstly, voltages and electric currents between the mucous membrane and standard dental alloy tips placed in the oral cavities of each 15 healthy volunteers and patients were measured. Secondly, the same study was performed with the mucous membrane and actually installed dental metals with 158 patients who showed positive reactions to dental metal series patch test allergens composed of 19 reagents. The results were as follows: 1) Voltages between the mucous membranes and standard metal plates placed in the oral cavities varied depending on the composition of the dental metal. 2) The above-mentioned voltages changed when various food were present in the oral cavity. 3) With the dental metals actually present in the metal-hypersensitive patient's oral cavities, the voltages between the adjacent mucous membrane and dental metals varied greatly, depending on the individual patient rather than on the types of metal. Certain alloys acted as cathodes with some patients, but as anodes with others. 4) Amalgam and silver alloys showed higher voltages and more electric current with the smaller ranges of variation than other kinds of alloys. Both of these alloys tended to act as anodes, therefore, the electrochemical dissolution of metal ions was expected to be higher than with other metals. 5) The voltages and electric currents were often higher between mucous membrane and metals than between metals. These findings indicate that the patient's own mucous membrane acts as cathode for the electrochemical dissolution rather than the dental metals. 6) Measuring the voltage and electric current in the patient's oral cavities is technically easy, and is considered to be valuable since the tendancy of electrochemical dissolution of metal ions from the dental metals is clearly demonstrated.

[Contact allergies of the oral mucosa]

Patch tests were performed on 132 patients suspected of allergic sensitivity to dentures. Of these, 98 reacted positively to at least one substance. While only 4 patients showed positive reactions to methyl methacrylate, 42 (31,8%) had positive tests with the catalyst benzoyl peroxide, 4 and 5 patients, respectively, were positive to 4 different inhibitors, 7 patients reacted positively to various softeners and 3 to the reducing agent hydrazine sulfate. 43 positive reactions occurred on the commercial products, of these 39,5% on the liquid monomer, 23,2% on the polymer in powder form and 37,2% on the polymer in lamellar form. Among the 132 patients, 111 positive tests on metal allergens could be observed. Cadmium-, copper- and nickel-salts accounted for one half of all reactions. The sensitivity index of cadmium was 18,2% and of copper 13,6%, which indicates a high allergen exposition. Nickel, chrome and cobalt allergies were registered in 9,9; 8,3 and 6,1% of the patients, respectively, what is only slightly below the sensitivity indices of our standard test results in Würzburg.

Occupational asthma from nickel sensitivity: I. Human serum albumin in the antigenic determinant

Occupational asthma from nickel sensitivity was confirmed in a male worker (SB) by allergy skin tests and inhalational challenge. In an ammonium sulphate coprecipitation test 63Ni was selectively precipitated from SB plasma indicating antibody with nickel related specificity. Preincubation of 63Ni with human serum albumin (HSA) increased the specificity of the coprecipitation test. Blocking experiments with nickel and copper(II) salts effectively inhibited the binding of 63Ni to antibody of SB plasma but did not affect control tests or that for antibodies to an unrelated antigen, ampicillin. Co2+ slightly inhibited the binding of 63Ni, while Zn2+ and Mn2+ failed to inhibit. This deactivation pattern corresponds to the known sequence of binding of these metals to the primary copper binding site of HSA. It is concluded that the antigenic determinant depends on the combination of Ni2+ with HSA at this specific copper/nickel plasma transport site.

Occupational asthma from nickel sensitivity: II. Factors influencing the interaction of Ni2+, HSA, and serum antibodies with nickel related specificity

Serum from an individual with occupational asthma from nickel sulphate inhalation was shown by ammonium sulphate (Farr) and anti-IgG coprecipitation tests to contain antibodies which bind 63Ni2+. This binding was absent from 30 control sera. Ligand competition studies with serum and plasma from the propositus and controls are described, and include serial additions of HSA, L-histidine, EDTA, and the tripeptide gly-gly-L-his. The results, like those from metal ion blocking experiments, clearly showed that the formation of the reactive antigenic determinant depends on the selective binding of Ni2+ at the native Cu2+/Ni2+ transport site of HSA. Corroborating evidence is derived from the similar dependence on pH of the Ni2+-HSA formation and the ammonium sulphate 63Ni2+ coprecipitation reactions.

[Sensitization to metals in children]

Patch tests with Nickel sulphate, cobalt chloride, bichromate and mercury, were performed in 100 randomized children. Twenty children reacted with allergic positive responses 11 were positive to mercury. Nine to Nickel sulphate. The youngest was a girl of eight months of age, allergic to nickel sulphate and suffering contact dermatitis in the ear lobes, produced by the ear rings that she had brought from her first week of life. Mercury has been the strongest metal in the infancy examined. Biggest incidence of responses are in kids between six and eight years old.

Effect of metal allergens on the DNA synthesis of unsensitized guinea pig lymphoid cells cultured in vitro

The metal allergens cobalt chloride, mercuric chloride, nickel sulfate and potassium dichromate were tested regarding their effect on the DNA synthesis of lymphoid cells from unsensitized guinea pigs. At certain concentrations in the range of 10(-8) to 10(-6) M, all tested metal compounds stimulated the DNA synthesis of both thymocytes and peripheral lymphocytes after 48 h of culture. The most consistent stimulation with all tested metal allergens was obtained with spleen cells. Thymocytes and spleen cells were stimulated even when the small fraction of adherent cells was eliminated. Mercuric chloride and potassium dichromate were found to be inhibiting at 10(-6) to 10(-4) M, while cobalt chloride and nickel sulfate were less toxic and inhibiting at 10(-4) to 10(-3) M. At 5 h of culture the lowest inhibitory concentration of potassium dichromate was found to be about 100-fold lower than that of nickel sulfate, which may be of practical interest for the choice of concentrations used in human patch test. The lowest concentrations of mercuric chloride and potassium dichromate which at 5 h were inhibitory, were stimulating at 48 h. The presence of serum seemed to have a protective and modifying role regarding the effect of the various metal compounds on the DNA synthesis.

The response to the intramuscular implantation of pure metals

Discs of five high-purity metals, cobalt, nickel, copper, aluminium and lead have been implanted intramuscularly in rats and the response observed histologically for period up to 52 weeks. A reproducible but different response was observed with each metal. Whenever corrosion occurred, as with copper, nickel and some cobalt specimens, the implants became loose. In the absence of corrosion, the implants were firmly held within a more confined capsule. A minimal response was seen with lead, implying normally toxic metals do elicit an immune response whilst some, especially copper and nickel appear to render the host more susceptible to disease. The implants appear to have a profound effect on the immediate vasculature, are able to cause a prolonged polymorphonuclear response in the same way as bacteria, are associated with varying amounts of haemosiderin laden macrophages but not with giant cells. The animals appear to be able to deal with bacteria introduced at surgery without hindrance from the metal.

Enhancement of allergic encephalomyelitis by particulate adjuvants inoculated long before antigen

Carbonyl iron and several other particulate materials have been reported to enhance the development of experimental allergic encephalomyelitis when injected with neural antigen. In the present work, silicon and silica powders have been added to the list of particulate adjuvants. In addition, several particulate materials, but not carbonyl iron, were effective adjuvants when inoculated four weeks or even six months before the neural antigen. It was necessary for adjuvant and antigen to be injected in the same region, but both intraperitoneal and subcutaneous routes were effective. The long-lasting adjuvanticity of certain particulates in the tissues is probably related to their bland and unabsorbable nature. The reasons for restrictions in the range of adjuvants and antigens that are effective in this system and the possibility of a similar occurrence in nature remain to be investigated.

[The implication of trace metals in household products in the causation of contact dermatitis (author's transl)]

The 6 most common fluid and powder detergent brands in use in Austria were analyzed as to their nickel and chromium content. The analysis was carried out by means of atomic absorption spectroscopy. 1. The above-mentioned metals were found to be present in each of the products analysed. On average, the fluid detergents contained ten times less nickel and chromium than the powders. 2. Repeated investigations revealed a considerable variation in metal ion content in different batches of the same detergent. Thus, presumably the raw products already contain nickel and chromium and it is unlikely that these ions get into the products during the manufacturing process. 3. In the appropriately diluted detergent powder solutions, as recommended by the producer, the content of nickel was found to lie between 0.4 ppm and 0.717 ppm and the chromium content ranged from 0.733 to 0.917 ppm. Since powder detergents also contain complex-producing agents, it can be assumed that these concentrations of metal ions do not suffice for sensitization. In the fluid detergents the nickel and chromium contents were found to be below the safety limit for the elicitation of an excematous reaction.

[Allergic reactions of the mouth mucosa in patients wearing dental prostheses]

Due to the increase in the frequency of allergic disorders it is necessary also to consider allergic reactions in the case of unspecific lesions in the oral region. Intolerance of drugs, resins, and metals can be demonstrated by elimination and exposure tests, but also by epicutaneous tests. Diagnostic measures and therapy vary with the type of allergy in each case.