Multiple system atrophy following chronic carbon disulfide exposure

Disulfiram-Mitigating Unintended Effects

Lyme disease caused by infection with a multitude of vector-borne organisms can sometimes be successfully treated in its very early stages. However, if diagnosis is delayed, this infection can become disseminated and, like another spirochetal infection syphilis, can affect multiple organ systems in the body, causing a wide variety of life-altering symptoms. Conventional antibiotic therapy may not be effective in eradicating the symptoms of the disease we know as Lyme disease. The recent literature has suggested that disulfiram (DSM) may be a potent drug in the armamentarium of physicians who treat chronic Lyme disease. The use of disulfiram in the treatment of Lyme disease started with a researcher who determined that DSM is bactericidal to spirochete. Encouraged by published case reports of apparent recovery from chronic Lyme disease, having prescribed DSM ourselves in the past for alcoholics who had a desire to stop drinking and prescribing it now for patients with chronic Lyme disease, we observed both predictable and potentially avoidable side effects not necessarily related to the ingestion of alcohol. We reviewed the published literature in PubMed and Google Scholar, using the following key words: Lyme Disease; Borrelia burgdorferi treatment; and disulfiram toxicity. This paper outlines the results of that research to help avoid some of the pitfalls inherent in this novel use of an old and established medication in the practice of clinical medicine.

Tremor secondary to neurotoxic exposure: mercury, lead, solvents, pesticides

Lead, mercury, solvents, and pesticide exposures are common in certain occupations and may cause nervous system dysfunction. Tremors may be the herald manifestation among a constellation of acute toxicity signs and symptoms. However, since tremors may also be the only sign on clinical presentation and since tremors also occur in other diseases, relating tremors to a specific occupational exposure can be challenging. Diagnosis of tremor etiology must be based on other findings on physical exam, laboratory results, and/or imaging. Discerning whether the tremor resulted from the occupational environment versus other etiologies requires knowledge of potential exposure sources, additional detail in history taking, and support of other health and industrial professionals. Reduction or removal from the exposure source remains the key first step in treating patients suffering from tremor that had resulted from occupational exposure toxicity.

Multiple system atrophy: genetic or epigenetic?

Multiple system atrophy (MSA) is a rare, late-onset and fatal neurodegenerative disease including multisystem neurodegeneration and the formation of α-synuclein containing oligodendroglial cytoplasmic inclusions (GCIs), which present the hallmark of the disease. MSA is considered to be a sporadic disease; however certain genetic aspects have been studied during the last years in order to shed light on the largely unknown etiology and pathogenesis of the disease. Epidemiological studies focused on the possible impact of environmental factors on MSA disease development. This article gives an overview on the findings from genetic and epigenetic studies on MSA and discusses the role of genetic or epigenetic factors in disease pathogenesis.

Nitric oxide mediated effects on reproductive toxicity caused by carbon disulfide in male rats

This study investigated nitric oxide (NO) mediation of carbon disulfide (CS(2)) toxicity that compromised male rat spermatogenesis and endocrine function. Rats were exposed to multiple levels of CS(2) concentration (0, 50, 250, 1250 mg/m(3)). A 1250 mg/m(3) CS(2)+sodium nitroprusside (SNP) group and a 1250 mg/m(3) CS(2)+NG-monomethyl-L-arginine (L-NMMA) group were established to explore the role of NO in mediating CS(2) toxicity. NO concentrations, NO synthase (NOS) activity, and sex hormone levels were measured, and sperm characteristics were observed and analyzed. Our data show that CS(2) exposure decreased: NOS activity; tissue NO concentrations; serum levels of gonadotropin-releasing hormones, luteinizing hormones, and testosterone; and sperm count and activity. In contrast, increased serum follicle-stimulating hormone concentrations and teratospermia were observed with CS(2) exposure. SNP reduced some of the toxic effects of CS(2), while L-NMMA treatment showed no effect. The results suggests that NO mediates compromised reproductive system function caused by CS(2) exposure.

Epidemiological evidence on multiple system atrophy

Multiple system atrophy (MSA), is a sporadic neurodegenerative disorder characterized clinically by any combination of parkinsonian, autonomic, cerebellar or pyramidal symptoms and signs. The frequence of disease is estimated for the incidence rate to 0.6 cases per 100.000 person-years, while the prevalence rate is included between 1.86 and 4.9 cases per 100.000 pop. A risk factor seems to be the occupational history of farming also if the occupational exposure to pesticides is not associated with MSA. Smoking is probably a protective factor in MSA as Parkinson's disease. MSA seems a sporadic disease also if recently a German family with two MSA cases has been reported. The polymorphism association studies support a role for inflammation-related genes in risk for MSA. The current epidemiological and clinical evidence suggests that likely the etiopathogenesis of MSA is complex, and that many genetic as well as environmental factors are involved. Unfortunately, the most of studies in MSA are lacking in a sample size estimate to test the hypothesis, then the scientific evidence is poor. Then, much larger numbers of cases and controls are necessary for these studies to reach sufficient power, but collecting such large numbers is feasible only in the framework of multicentric consortia.

Neurologic erectile dysfunction

Neurologic erectile dysfunction presents a diagnostic and treatment challenge to the internist and urologist. Multiple chronic disease modalities and traumatic etiologies exist. Education regarding these conditions and a detailed and thorough history and office work-up are the best resources for the clinician. Treatment can follow the model of proceeding from the least to most invasive procedure (process of care), taking into account patient and partner satisfaction. Because the psychology of grief and loss may enter into treatment of some neurologic conditions (e.g., erectile dysfunction after radical retropubic prostatectomy, spinal cord injury, or chronic diseases), a whole-patient approach encompassing psychotherapy is warranted.

Chemicals and gases

This article covers the major chemicals and gases that are considered to be of the most clinical relevance to the primary care provider. The reader is referred to other comprehensive textbooks of toxicology and occupational medicine for a complete discussion of the numerous additional products found in the workplace that may result in occupational exposure.