[Cyanide, in And Then There Were None, Sparkling Cyanide]

And Then There Were None and Sparkling Cyanide, two of Agatha Christie's famous novels describe potassium cyanide-induced deaths. Cyanide, a tasteless, odorless, strongly alkaline poison is a powerful gastrointestinal irritant, following oral ingestion. It reacts with hydrochloric acid in the gastric juice to produce hydrogen cyanide gas, which is absorbed and inhibits the mitochondrial electron transfer system and consequently suppresses adenosine triphosphate (ATP) production. Therefore, the central nervous system, which consumes a large amount of ATP, is first affected and symptoms of poisoning manifest as dizziness, disorientation, coma, and convulsions. The orally lethal dose is approximately 300 mg.

Can excreted thiocyanate be used to detect cyanide exposure in live reef fish?

Cyanide fishing, where a solution of sodium or potassium cyanide is used to stun reef fish for easy capture for the marine aquarium and live fish food trades, continues to be pervasive despite being illegal in many countries and destructive to coral reef ecosystems. Currently, there is no easy, reliable and universally accepted method to detect if a fish has been exposed to cyanide during the capture process. A promising non-invasive technique for detecting thiocyanate ions, the metabolic byproduct excreted by exposed fish, has been reported in the literature. In an effort to validate this method, four cyanide exposure studies on Amphiprion ocellaris (common clownfish) were carried out over three years. Fish were either exposed to the same (25 ppm) or twice the concentration (50 ppm) as the previsouly published method. Over 100 water samples of fish exposed to cyanide were analyzed by reverse phase HPLC with a C₃₀ column treated with polyethylene glycol and UV detector operating at 220 nm. No thiocyanate was detected beyond the analytical standards and positive controls prepared in seawater. As an alternate means of detecting thiocyanate, water samples and thiocyanate standards from these exposures were derivatized with monobromobimane (MBB) for LC-MS/MS analysis. Thiocyanate was detected in standards with concentrations as low as 0.6 μg/L and quantified to 1 μg/L, but thiocyanate could not be detected in any of the water samples from fish exposed to cyanide with this method either, confirming the HPLC results. Further, we calculated both the mass balance of thiocyanate and the resultant plausible dosage of cyanide from the data reported in the previously published method. These calculations, along with the known lethal dosage of cyanide, further suggests that the detection of thiocyanate in aquarium water is not a viable method for assessing fish exposure to cyanide.

Methylene blue counteracts cyanide cardiotoxicity: cellular mechanisms

In adult left ventricular mouse myocytes, exposure to sodium cyanide (NaCN) in the presence of glucose dose-dependently reduced contraction amplitude, with ~80% of maximal inhibitory effect attained at 100 µM. NaCN (100 µM) exposure for 10 min significantly decreased contraction and intracellular Ca2+ concentration ([Ca2+]i) transient amplitudes, systolic but not diastolic [Ca2+]i, and maximal L-type Ca2+ current ( ICa) amplitude, indicating acute alteration of [Ca2+]i homeostasis largely accounted for the observed excitation-contraction abnormalities. In addition, NaCN depolarized resting membrane potential ( Em), reduced action potential (AP) amplitude, prolonged AP duration at 50% (APD50) and 90% repolarization (APD90), and suppressed depolarization-activated K+ currents but had no effect on Na+-Ca2+ exchange current ( INaCa). NaCN did not affect cellular adenosine triphosphate levels but depolarized mitochondrial membrane potential (ΔΨm) and increased superoxide (O2·-) levels. Methylene blue (MB; 20 µg/ml) added 3 min after NaCN restored contraction and [Ca2+]i transient amplitudes, systolic [Ca2+]i, Em, AP amplitude, APD50, APD90, ICa, depolarization-activated K+ currents, ΔΨm, and O2·- levels toward normal. We conclude that MB reversed NaCN-induced cardiotoxicity by preserving intracellular Ca2+ homeostasis and excitation-contraction coupling ( ICa), minimizing risks of arrhythmias ( Em, AP configuration, and depolarization-activated K+ currents), and reducing O2·- levels. NEW & NOTEWORTHY Cyanide poisoning due to industrial exposure, smoke inhalation, and bioterrorism manifests as cardiogenic shock and requires rapidly effective antidote. In the early stage of cyanide exposure, adenosine triphosphate levels are normal but myocyte contractility is reduced, largely due to alterations in Ca2+ homeostasis because of changes in oxidation-reduction environment of ion channels. Methylene blue, a drug approved by the U.S. Food and Drug Administration, ameliorates cyanide toxicity by normalizing oxidation-reduction state and Ca2+ channel function.

Amygdalin, quackery or cure?

BACKGROUND

The cyanogenic diglucoside, amygdalin, has gained high popularity among cancer patients together with, or in place of, conventional therapy. Still, evidence based research on amygdalin is sparse and its benefit controversial.

PURPOSE

Since so many cancer patients consume amygdalin, and many clinicians administer it without clear knowledge of its mode of action, current knowledge has been summarized and the pros and cons of its use weighed.

METHODS

A retrospective analysis was conducted for amygdalin relevant reports using the PubMed database with the main search term "Amygdalin" or "laetrile", at times combined with "cancer", "patient", "cyanide" or "toxic". We did not exclude any "unwanted" articles. Additionally, internet sources authorized by governmental or national institutions have also been included.

SECTIONS

Individual chapters summarize pharmacokinetics, preclinical and clinical studies and toxicity.

CONCLUSION

No convincing evidence showing that amygdalin induces rapid, distinct tumor regression in cancer patients, particularly in those with late-stage disease, is apparent. However, there is also no evidence that purified amygdalin, administered in "therapeutic" dosage, causes toxicity. Multiple aspects of amygdalin administration have not yet been adequately explored, making further investigation necessary to evaluate its actual therapeutic potential.

Determinants of cognitive performance in children relying on cyanogenic cassava as staple food

While risk factors for konzo are known, determinants of cognitive impairment in konzo-affected children remain unknown. We anchored cognitive performance (KABC-II scores) to serum levels of free-thyroxine (free-T4), thyroid-stimulating hormone (TSH), albumin, and motor proficiency (BOT-2 scores) in 40 children including 21 with konzo (median age: 9 years) and 19 without konzo (median age: 8 years). A multiple regression model was used to determine variables associated with changes in KABC-II scores. Age (β: -0.818, 95% CI: -1.48, -0.152) (p = 0.018), gender (β: -5.72; 95% CI: -9.87, -1.57 for females) (p = 0.009), BOT-2 score (β: 0.390; 95% CI: 0.113, 0.667) (p = 0.008), and free-T4 (β: 1.88; 95% CI: 0.009, 3.74) (p = 0.049) explained 61.1 % of variation in KABC-II scores. Subclinical hypothyroidism was not associated with poor cognition. A crude association was found between serum albumin and KABC-II scores (β: 1.26; 95 % CI: 0.136, 2.39) (p = 0.029). On spot urinary thiocyanate reached 688 μmol/l in children without konzo and 1,032 μmol/L in those with konzo. Female gender and low serum albumin are risk factors common to cognitive and proportionally associated motor deficits in children exposed to cassava cyanogens. The two types of deficits may share common mechanisms.

[Alternative means of drug therapy in cancer: letril]

Letril (amygdaline) is one of drugs of alternative therapy for cancer that is used over three decades and relates to cyanogenic glycosides received from kernels of various fruits (almonds, apricots, peaches, etc. The basis of suggestion of letril as antitumor agent is hypotheses about selective fermentative splitting of amygdaline in tumor cells with developing of cyanide that should cause to apoptosis as a result of aerobic glycolysis suppression. None of these assumptions found their experimental confirmation. In clinical trials there was established inefficiency of letril with a very high probability to develop severe cyanide intoxication. Despite obtained scientific data and absence of permission from the supervising institutions (FDA) letril is still advertised, produced and distributed as anti-tumor drug.

Cardiopulmonary Bypass, Hemolysis, and Nitroprusside-Induced Cyanide Production

BACKGROUND

Cyanide toxicity is a complication of sodium nitroprusside administration. Cardiac surgery may increase the risk of cyanide toxicity, because hemolysis during cardiopulmonary bypass (CPB) may catalyze the release of free cyanide from sodium nitroprusside.

METHODS

We obtained serial blood specimens from 25 cardiac surgical patients during CPB. Plasma specimens were analyzed for free hemoglobin concentration and ability to generate free cyanide anion upon exposure to sodium nitroprusside.

RESULTS

Hemolysis based on plasma-free hemoglobin concentration increased over time during CPB at an average rate of 0.27 mg x dL(-1) x min(-1) (P < 0.001). The concentration of free cyanide generated by the addition of sodium nitroprusside to the plasma samples was directly related to the plasma-free hemoglobin concentration (P < 0.001).

CONCLUSION

CPB-associated hemolysis and free hemoglobin release accelerated the immediate release of free cyanide from sodium nitroprusside. These in vitro findings suggest that cardiac surgical patients may be at increased risk of cyanide toxicity in response to the perioperative administration of sodium nitroprusside.

Spectrofluorimetric determination of tranexamic acid in hydrogel patch formulations by derivatization with naphthalene-2,3-dicarboxaldehyde/cyanide

The aim of this research was to develop and validate a spectrofluorimetric method for determination of tranexamic acid in hydrogel patch formulations. Tranexamic acid (trans-4-aminomethylcyclohexanecarboxylic acid, trans-AMCHA) is an antifibrinolytic drug that recently gained attention as a skin-whitening agent due to its inhibitory effect on ultraviolet (UV)-induced pigmentation in vivo. Derivatization with naphthalene-2,3-dicarboxaldehyde (NDA) in the presence of cyanide ion (CN(-)) to produce a fluorescent 1-cyanobenz[f]isoindole (CBI) product (lambda(ex) = 420 nm, lambda(em) = 480 nm) is for the first time reported for the determination of tranexamic acid in hydrogel patch formulations. Other separation techniques were not used in the analysis of the CBI-fluorescent product as required in the previous studies. The developed method was proven to be precise and accurate with percent recoveries ranging between 98.0% and 101.8% at the concentration range of 8.4-84.0 microg/ml (R(2) > 0.999). The intra- and inter-day precisions as expressed by the relative standard deviations (RSD) were below 1.85%. Derivatization of tranexamic acid with NDA/CN(-) was completed within five minutes and was stable for at least 30 minutes. The method has been applied to the analysis of drug content and release profiles in tranexamic hydrogel patch formulations.

Phase I study and pharmacokinetic of CHS-828, a guanidino-containing compound, administered orally as a single dose every 3 weeks in solid tumours: an ECSG/EORTC study

CHS 828 is a new guanidino-containing drug. The aim of this study was to determine the maximum tolerated dose (MTD), the recommended dose and the toxicity of CHS 828. CHS 828 was given orally once every 3 weeks. The starting dose was 50 mg, which was escalated to 500 mg. A total of 107 courses was administered to 37 patients. At the 500-mg dose level, two of three patients experienced dose-limiting toxicities (DLT) (grade 3 mucositis and grade 4 thrombocytopenia), establishing this as the MTD. One of seven patients treated at 420 mg dose experienced DLT (grade 4 leucopenia, grade 4 mucositis and grade 4 diarrhoea), and this was considered the recommended dose for phase II studies. Vomiting, haematuria, leucopenia and thrombocytopenia were other significant toxicities. The pharmacokinetics of CHS 828 showed large variations both between and within patients. No objective responses were seen. A dose of 420 mg of CHS 828 administered every 3 weeks is the recommended dose, while 500 mg is the MTD.

High mortality of subjects with endemic ataxic polyneuropathy in Nigeria

BACKGROUND

Endemic ataxic polyneuropathy, a neurological syndrome that was thought to be benign, has been shown to persist in some communities in south-western Nigeria, where it was first described in the 1950s.

OBJECTIVES

This study was conducted to compare mortality of cases and controls, and to determine if mortality is related to exposure to cyanide from cassava foods.

MATERIAL AND METHODS

Cases of endemic ataxic polyneuropathy and two groups of controls, one group living in an endemic community and the other group living in a non-endemic community, were followed for 25 months. The outcome was death from medical causes.

RESULTS

A total of 5970 subjects, 204 cases and 5766 controls - 4000 controls in the endemic community and 1766 controls in the non-endemic community, were followed. A total of 153 subjects died, 24 cases, 115 controls in the endemic community, and 14 controls in the non-endemic community. Relative risks of death (95% CI), adjusted for age and gender, were 4.5 (2.3-8.9) for cases (P < 0.0001), but 2.6 (1.5-4.6) for controls living in the endemic community (P = 0.001).

CONCLUSION

This study shows that endemic ataxic polyneuropathy decreases survival. The finding of lower risk of death in the community with higher exposure to cyanide from cassava foods indicates that mortality of endemic ataxic polyneuropathy is not associated with exposure to cyanide from cassava foods.

[Endemic spastic paraperesis (konzo)]

Konzo is characterized by the abrupt onset of isolated and symmetric spastic paraparesis of the lower extremities which is permanent but nonprogressive. Epidemic outbreaks in subtropical and tropical regions are associated with drought-provoked agricultural and social crises rendering populations dependent on a diet of insufficiently processed bitter cassava. The shortcuts in processing allow large amounts of cyanogens to remain in the cassava consumed and hence there is a high dietary cyanide exposure. Mainly children and ill people, often malnourished (and with kwashiorkor), are not able to detoxify the cyanide sufficiently, consequently developing symptoms of upper motoneuron damage. Konzo generally seems not to be caused by ignorance concerning the correct processing of cassava, but predominantly directly and indirectly by poverty.

A Phase I study of CHS 828 in patients with solid tumor malignancy

CHS 828 is a cyanoguanidine, which has demonstrated potent antitumor activity in preclinical tumor models. The activity of CHS 828 in vitro showed only low to moderate correlation to other antineoplastic agents suggesting a unique mechanism of action. Ten females and 6 males (median age 58 years) with solid tumors refractory to standard therapy were included in this Phase I study. The study drug was administered to fasting patients as a single oral dose on days 1-5 of each treatment cycle. Patients received one to six cycles of treatment. The doses ranged from 30 mg to 200 mg (total dose within a cycle). Hematological toxicity was generally mild and dominated by transient thrombocytopenia and lymphocytopenia. Nonhematological toxicity most frequently consisted of nausea, vomiting, diarrhea, fatigue, and localized genital mucositis. The dose-limiting toxicities were thrombocytopenia, thrombosis, esophagitis, diarrhea, and constipation. The recommended Phase II dose of CHS 828 was 20 mg once daily for 5 days in cycles of 28 days duration. The extent of systemic exposure of CHS 828 across patients was approximately dose proportional. The time at which the highest drug concentration occurs was 2.2 +/- 1.3 h and half-life was 2.1 +/- 0.52 h (mean +/- SD). Large intra- and interindividual variation in dose level-adjusted maximum plasma concentration and the area under the curve from time 0 h to infinity were observed. There was an apparent inverse relationship between systemic exposure of CHS 828, and thrombocyte and lymphocyte nadir levels. No objective tumor responses were observed, and 7 patients showed stable disease after two courses of therapy.

Impact of metals on the environment due to technical accident at Aurul Baia Mare, Romania

The S.C. Aurul S.A. is a joint venture company owned by the Esmeralda from Australia and the "Remin" National Company of Precious and Non-ferrous Metals in Romania, established in 1992. The design concept was to transport the mining waste away from the city, while the gold and silver in the tailings could be recovered, using efficient and modern technology that was not available at the time the dam was established. On 30 January, 2000, at 22.00, the dam burst and released 100,000 cubic meters of tailing pulp, heavily contaminated with cyanide and cyanide complexes, especially with copper, into the Lapus and Somes tributaries of the river Tisa. The paper deals with the impact of metals on the environment associated with their presence in surface waters, river sediments and soils.

Guanidino-containing drugs in cancer chemotherapy: biochemical and clinical pharmacology

The pharmacology and clinical application of three guanidino-containing compounds are reviewed in this commentary with special focus on a new member of this group of drugs, CHS 828 [N-(6-(4-chlorophenoxy)hexyl)-N'-cyano-N"-4-pyridylguanidine]. m-Iodobenzylguanidine (MIBG) and methylglyoxal bis(guanylhydrazone) (MGBG) have been extensively studied, preclinically as well as clinically, and have established use as anticancer agents. MIBG has structural similarities to the neurotransmitter, norepinephrine, and MGBG is a structural analog of the natural polyamine spermidine. CHS 828 is a pyridyl cyanoguanidine newly recognized as having cytotoxic effects when screening antihypertensive compounds. Apart from having the guanidino groups in common, there are many differences between these drugs in both structure and their mechanisms of action. However, they all inhibit mitochondrial function, a seemingly unique feature among chemotherapeutic drugs. In vitro in various cell lines and primary cultures of patient tumor cells and in vivo in various tumor models, CHS 828 has cytotoxic properties unlike any of the standard cytotoxic drugs with which it has been compared. Among these are non-cross-resistance to standard drugs and pronounced activity in tumor models acknowledged to be highly drug-resistant. Similar to MIBG, CHS 828 induces an early increase in extracellular acidification, due to stimulation of the glycolytic flux. Furthermore, ATP levels decrease, and the syntheses of DNA and protein are shut off after approximately 30 hr of exposure, indicating active cell death. CHS 828 is now in early clinical trials, the results of which are eagerly awaited.

Comparative effects of scopoletin and cyanide on rat brain, 1: histopathology

Four week old male Wistar rats were used to study the effects of scopoletin and cyanide on the histopathology of rat brain. The rats were divided into a control and three experimental groups (2-4) and fed rations containing 0.07 microg scopoletin/100 g, 0.07 microg scopoletin + 1.8 mg cyanide/100 g and 1.8 mg cyanide/100 g, respectively. These levels of scopoletin and cyanide corresponded to levels found in a processed cassava diet. The first group was fed the same ration as the others but without scopoletin and cyanide. The rats were fed these rations for twelve months. Rats from each group were sacrificed at the third, sixth, ninth and twelfth months; the relative brain weight of the rats (% of body weight) and histology of their brains were studied. The lipid peroxide levels of the rat brains were also studied at the twelfth month. The results showed that the relative brain weights of the rats fed scopoletin + cyanide were significantly (p<0.05) less than that of the control from the third month. There were no significant changes in the lipid peroxide levels of the rat brains in the various groups. Histological examination of the brains of the rats suggested that scopoletin is involved in the pathogenesis of the neuropathy seen in cassava consuming populations.

Maternal residential proximity to hazardous waste sites and risk for selected congenital malformations

Using data from two population-based case-control studies, we investigated whether maternal residential proximity to hazardous waste sites increased the risk for neural tube defects, conotruncal heart defects, and oral cleft defects in California. We obtained a residential history by interview for mothers of 507 neural tube defect cases (82.7% of eligible) and their 517 controls (84.6%); and 201 heart cases (84.4%), 439 cleft cases (82.2%), and their 455 controls (72.1%). We identified the locations of 764 inactive hazardous waste sites and systematically collected information on site-related contamination for the subset of 105 National Priority List sites. After controlling for several potential confounders, we found little or no increased risk for maternal residence in a census tract containing a site [odds ratio (OR) = 0.9, 95% confidence interval (CI) = 0.7-1.3 for neural tube defects; OR = 1.3, 95% CI = 0.8-2.1 for heart cases; OR = 1.2, 95% CI = 0.8-1.8 for clefts], but elevated risks for neural tube defects (OR = 2.1, 95% CI = 0.6-7.6) and heart defects (OR = 4.2, 95% CI = 0.7-26.5) for maternal residence within 1/4 mile of a National Priority List site. Furthermore, we observed elevated ORs (> or = 2.0) for neural tube defects and heart defects in association with maternal residence within 1 mile of National Priority List sites containing selected chemical contaminants. Among controls, only 0.6% and 4.4% lived within 1/4 mile and 1 mile of a National Priority List site, respectively, resulting in imprecision in risk estimation.

Evaluation of cyanide exposure and its effect on thyroid function of workers in a cable industry

A thyroid-hormone evaluation of workers dealing with cyanide compounds in an electroplating process of a cable industry was carried out. Serum thiocyanate (SCN) levels of 35 nonsmoking copper-ply employees were assayed by a ferric-chloride color test. The mean SCN concentration of these employees was 316 +/- 15 mumol/L, which was significantly (P < 0.01) higher than that of control subjects (90.8 +/- 9.02 mumol/L). Serum thyroxine (T4), triiodothyronine (T3), and thyroid-stimulating hormone (TSH) concentrations of exposed workers were compared with those of 35 control subjects. Cyanide exposure resulted in a decrease in T4 and T3 concentrations (P < 0.05) and an increase in TSH concentration (P < 0.05), compared with the control subjects. The serum T4 level was found to be negatively correlated (r = -0.363, P < 0.05), whereas the TSH level was positively correlated (r = 0.354, P < 0.05), with SCN concentration in the exposed group. The study suggests that occupational cyanide exposure in the industry impairs thyroid function.

Chemistry, toxicology, and human health risk of cyanide compounds in soils at former manufactured gas plant sites

Cyanide-containing wastes are commonly found in soils at former manufactured gas plant (MGP) sites, also known as town gas sites. The complex forms of cyanide are responsible for the blue-stained soils and rocks found at these sites. Most concentrations of cyanide at MGP sites are below 2000 ppm, although concentrations greater than 20,000 ppm have been observed. An understanding of the chemistry of the MGP cyanide-containing compounds, their fate, and transport as well as their toxicology is critical to accurately assessing potential human health risks from these compounds. In this paper, the authors demonstrate that the most prevalent types of cyanide compounds found at former MGP sites are the relatively nontoxic iron-complexed forms, such as ferric ferrocyanide, rather than the highly toxic free cyanide forms. Moreover, the chemical conditions at most former MGP sites limit the extent to which free cyanide may be released into air and water from complex cyanides. Using a screening analysis, the authors estimate potential risks from a multiroute exposure to complex and free cyanides in soil, air, and groundwater at former MGP sites and demonstrate that such risks are likely to be insignificant. Unfortunately, the lack of readily available measurement techniques to characterize cyanides in soil can result in erroneous conclusions about potential risks from cyanide compounds in soils at former MGP sites, particularly if health-based soil criteria for free cyanide (e.g., the Massachusetts Department of Environmental Protection criterion for free cyanide is 100 ppm (MA. DEP, 1995)) are applied. The authors recommend development of routine methods for field sampling and laboratory testing techniques to demonstrate that cyanides in soil at former MGP sites are predominated by iron-complexed species and that free cyanide is less than levels of concern.

Konzo in the Central African Republic

We identified a new focus of konzo, an upper motor neuron disease, in a part of western Central African Republic. Interviews and high serum levels of thiocyanate indicate that cyanide exposure from insufficiently processed cassava may cause konzo. Abrupt onset, nonprogressive course, and seronegativity to HTLV-I clearly differentiate konzo from HTLV-I-associated myelopathy in tropical countries.

Cyanide toxicity. Agency for Toxic Substances and Disease Registry

Cyanide is one of the most rapidly acting poisons. Cyanide poisoning is a hazard that may accompany enclosed-space fires, and its occurrence in persons with smoke-inhalation injuries may be underestimated. Acute cyanide exposure primarily causes central nervous system, cardiovascular and respiratory effects. Thyroid function abnormalities have been noted in persons chronically exposed to cyanide. Initial symptoms may be nonspecific. Death may occur in seconds after acute inhalation of hydrogen cyanide.

ATP synthase activity is required for fructose to protect cultured hepatocytes from the toxicity of cyanide

The contributions of the loss of the mitochondrial membrane potential (MMP) and a depletion of ATP to the genesis of lethal injury were evaluated in the killing of cultured hepatocytes by cyanide (CN). The glycolytic production of ATP from fructose (Fru) maintained the MMP and prevented the killing by CN. Inhibition of the mitochondrial ATP synthase by 0.1 micrograms/ml oligomycin (Oligo) reduced ATP stores at the same rate and to the same extent as did 1 mM CN. With Oligo there was no loss of the MMP, and the hepatocytes maintained viability over the 6 h during which CN killed all of the cells. Oligo had no effect on the rate of killing by CN. However, Oligo reversed the protective effect of Fru on CN-induced killing, a result that correlated with the loss of MMP but not with the depletion of ATP. Neither Fru nor Oligo affected the intracellular acidosis achieved with CN alone. Fru also prevented toxicity of the uncoupler carbonyl cyanide m-chlorophenylhydrazone (CCCP), a result that correlated with the preservation of MMP. Oligo potentiated the toxicity of CCCP. It is concluded that a functioning mitochondrial ATP synthase is required for the production of ATP from Fru to prevent the killing of hepatocytes by CN. The extent of killing correlated closely with changes in the MMP but not with changes in the content of ATP.

Cerebral energy metabolism in cyanide encephalopathy

This study documents the effects of an intracarotid artery injection of a lethal threshold amount of KCN (2.5 mg.kg-1) on the energy metabolism and histology of the rat brain. This dose of KCN resulted in a rapid abolition of electroencephalographic activity, which remained essentially absent for up to 3 h. Cerebral metabolite measurements 0.25 h after KCN infusion indicated a 52% reduction in cytochrome oxidase activity, a 600% increase in lactate, a 32% reduction in ATP, a 73% increase in ADP, and an 85% decrease in glycogen. Measurements of the above energy metabolites over the ensuing 7 days showed a return to control of all metabolites by 6-24 h. Corresponding to the normalization of energy metabolism was a return of EEG and conscious activity. Histological examination of cyanide-exposed animals revealed a paucity of change with only one animal at 0.5 h showing several dark neurons, two animals at 1 h with minor pallor of corpus callosum and caudate-putamen, and one animal at 48 h with a small hippocampal infarction. It is concluded that it may be impossible to produce a serious enough disruption of cerebral metabolism with KCN injection, to produce neuronal damage by purely "histotoxic" mechanisms.

Diabetes and cassava in Dominica

A study of 110 non-insulin dependent diabetics and 110 controls failed to find evidence that chronic consumption of cassava flour containing significant amounts of cyanide, predisposes to diabetes mellitus.

Hepatic disease associated with ground-glass inclusions in hepatocytes after cyanamide therapy

In a retrospective review of 2400 consecutive liver biopsy specimens, 60 cases with ground-glass hepatocytes were identified, 41 specimens gave a positive reaction to orcein stain and 19 a negative staining. These 19 specimens were obtained from chronic alcoholics who had been admitted to a detoxication program that used aversive drugs and who were hepatitis B surface antigen negative. The use of cyanamide (Colme), an inhibitor of aldehyde dehydrogenase could be documented in 11 instances. In addition to ground-glass hepatocytes, which were periodic acid-Schiff positive and had a periportal or paraseptal distribution, these liver specimens showed a variety of hepatic lesions: cirrhosis in five cases, portal and periportal inflammation in six, triaditis in five, portal fibrosis in two, and minimal changes in one. Patients with shorter courses of cyanamide were those who had less severe histologic lesions. In three patients who had a liver biopsy carried out before the cyanamide treatment ground-glass hepatocytes were not found. These data indicate that ground-glass hepatocytes that stain with periodic acid-Schiff may develop after cyanamide treatment. They are associated with structural hepatic damage of varied severity in patients submitted to a long-term treatment.

Vitamin B nutrition in the Nigerian tropical ataxic neuropathy

Assessment of nutritional status of vitamin B components by plasma or blood levels indicated riboflavin deficiency and possibly thiamine deficiency in Nigerian patients who suffered from tropical ataxic neuropathy and neurologically normal Nigerians who subsisted on predominant cassava diet. Serum levels of folate, niacin, pyridoxine and panthothenic acid were normal. Vitamin deficiencies probably are minor factors, if any, in the pathogenesis of tropical ataxic neuropathy in Nigerians.

Structural hepatic changes associated with cyanamide treatment: cholangiolar proliferation, fibrosis and cirrhosis

The authors present the clinical and histological findings in a series of 42 liver biopsies from 39 chronic alcoholics treated with cyanamide as aversion therapy. All biopsies displayed characteristic cytoplasmic inclusions in the liver-cells. Fibrosis and disruption of the parenchymal-connective tissue interface were observed in all cases. According to the severity and extension of fibrosis, three stages could be depicted: Stage I. Periportal activity cholangiolar type (ACT), which is defined by cholangiolar proliferation, fibroblastic activation and inflammatory infiltrate, which together cause a blurred appearance of the parenchymal-connective tissue junction. It is the elementary lesion and was observed alone in 26 biopsies. Stage II. Portal-to-portal linkage. It was observed in 10 biopsies, all of which also showed periportal ACT. Three of these came from patients with two biopsies in which transition from stage I (first biopsy) to stage II (second biopsy) was observed. Stage III. Nodular parenchymal regeneration, associated with changes observed in stage I and II. It was found in six patients. The histological picture resembles the biliary type of cirrhosis. There is a clear-cut correlation between the length of treatment and the stage of the hepatic lesion.

[Pathology in firemen]

Fire fighters' respiratory organs, circulatory system and muscular system are often exposed to considerable risks. In fact in addition to the most obvious external stress causes (heat, humidity, O2 decrement, CO2 increment, emotional stress) these workers use heavy equipments and carry people or things. Furthermore always present is the risk of poisoning by inhalation of toxic combustion gas of the fire atmosphere.