Necrotizing Granulomas within the Periprosthetic Tissues of Cemented and Cementless Total Arthroplasties

Necrotizing granulomas were found in the pseudocapsule or interfacial membrane of two patients with an aseptically loosened cemented total hip arthroplasty and in one patient with an aseptically loosened cementless knee arthroplasty. The environs of the necrotizing granulomas disclosed prosthetic debris-induced foreign body granulomatous, chronic inflammatory and cicatrizing changes. Particulate breakdown products of polyethylene and finely dispersed metallic particles were present in the necrotic core, stroma and macrophages of the necrotizing granulomas. A review of the literature and the authors’ personal experience attests to the rarity of such granulomas in the periprosthetic tissues. Polyethylene being non-antigenic, it is suggested that an allergic-pathergic reaction to metallic ions released in loco from the prosthesis itself, from the deposited metallic wear particles or from both accounts for the development of the necrotizing granulomas.

Rates of conversion of sulfur dioxide to sulfate in a scrubbed power plant plume

The rate of conversion of SO2 to SO4(2-) was re-estimated from measurements made in the plume of the Cumberland power plant, located on the Cumberland River in north-central Tennessee, after installation of flue gas desulfurization (FGD) scrubbers for SO2 removal in 1994. The ratio of SO2 to NOy emissions into the plume has been reduced to approximately 0.1, compared with a prescrubber value of approximately 2. To determine whether the SO2 emissions reduction has correspondingly reduced plume-generated particulate SO4(2-) production, we have compared the rates of conversion before and after scrubber installation. The prescrubber estimates were developed from measurements made during the Tennessee Plume Study conducted in the late 1970s. The postscrubber estimates are based upon two series of research flights in the summers of 1998 and 1999. During two of these flights, the Cumberland plume did not mix with adjacent power plant plumes, enabling rate constants for conversion to be estimated from samples taken in the plume at three downwind distances. Dry deposition losses and the fact the fact that SO2 is no longer in large excess compared with SO4(2-) have been taken into account, and an upper limit for the conversion rate constant was re-estimated based on plume excess aerosol volume. The estimated upper limit values are 0.069 hr(-1) and 0.034 hr(-1) for the 1998 and 1999 data, respectively. The 1999 rate is comparable with earlier values for nonscrubbed plumes, and although the 1998 upper limit value is higher than expected, these estimates do not provide strong evidence for deviation from a linear relationship between SO2 emissions and SO4(2-) formation.

The evolution of particles in the plume from a large coal-fired boiler with flue gas desulfurization

Airborne measurements were made of gaseous and particulate species in the plume of a large coal-fired power plant after flue gas desulfurization (FGD) controls were installed. These measurements were compared with measurements made before the controls were installed. The light scattering and number and volume distributions of plume excess particles were determined by nephelometry and optical particle counting techniques. The plume impact based on optical techniques was much lower than that observed in earlier measurements. Indeed, plume excess volumes as a function of particle size were of the same magnitude as the variability of the background volume distribution. In situ excess plume scattering actually decreased with distance from the source, in contrast to pre-FGD conditions. The upper limit for the dry rate of SO2-to-SO4(2-) conversion was estimated from plume excess volume measurements to be about 4% hr-1. This is slightly greater than the upper limit, 3.5% hr-1, estimated by earlier researchers, but the same as that estimated using the present technique with the earlier data. The cross-plume profile of volume suggests SO2-to-SO4(2-) conversion is highest at the plume edges. The greatest benefit of SO2 reduction on plume excess volume and visibility appears to occur far down-wind of the source.

DOAS measurements of tropospheric bromine oxide in mid-latitudes

Episodes of elevated bromine oxide (BrO) concentration are known to occur at high latitudes in the Arctic boundary layer and to lead to catalytic destruction of ozone at those latitudes; these events have not been observed at lower latitudes. With the use of differential optical absorption spectroscopy (DOAS), locally high BrO concentrations were observed at mid-latitudes at the Dead Sea, Israel, during spring 1997. Mixing ratios peaked daily at around 80 parts per trillion around noon and were correlated with low boundary-layer ozone mixing ratios.

Status of intraoperative cytology in the diagnosis of epithelioid hemangioma

Whereas evaluation of the frozen section of a subcutaneous retro-auricular mass was equivocal, the correct diagnosis of epithelioid hemangioma could be suggested on examination of intraoperative cytological smears. It is proposed that in the absence of cytological cues of malignancy and in the presence of the proper clinical setting, the constellation of vascular structures, eosinophils, lymphocytes, and clusters of cuboidal cells with vacuoles in their abundant acidophilic cytoplasm is indicative of epithelioid hemangioma.

Acute neutrophilic myositis in Sweet's syndrome: late phase transformation into fibrosing myositis and panniculitis

Early in the course of myeloblastic leukemia a patient concurrently developed febrile neutrophilic dermatosis and sterile acute myositis. The dermatitis and myositis were unresponsive to antibiotic therapy but remitted within a few days of institution of steroid treatment. The patient died of myocardial infarction. At autopsy the dermis was normal. Previously effected muscles were scarred. The overlying fascia and subcutaneous septa were fibrotically thickened. In addition, segmental acute aortitis was detected. Acute myositis and aortitis may reflect further organ manifestations of the Sweet's reactivity pattern. It is proposed that Sweet's myositis and dermatitis may evolve into a fibrosing myositis and panniculitis.

[Anaplastic seminoma of the testis]

Between 1968-1988, 9 patients with Stage I anaplastic seminoma were registered at this oncology center, representing 11% of 83 with testicular seminoma referred for treatment and follow-up. They ranged in age from 33-50, with a mean of 41. In all orchiectomy was performed and 8 of them received postoperative radiotherapy. After a mean of 60 months, 7 were alive with no evidence of disease, 1 had no evidence of disease and was lost to follow-up 152 months following radiotherapy, and 1 had died of metastatic disease. One of the survivors developed widespread metastatic disease but was saved by chemotherapy and is now alive and well. It is suggested that decision as to treatment of anaplastic seminoma should be based mainly on the extent of the disease, rather than the degree of differentiation.

Deterioration of Jerusalem limestone from air pollutants; field observations and laboratory simulation

Samples of Jerusalem limestones were exposed to high levels of common air pollutants (SO2, NO) in the presence and absence of hydrocarbon, water vapor and ultra-violet light. After exposure, the outer layers were shaved off and analyzed for sulfate and nitrate. The results revealed that even after one day of exposure significant concentrations of CaSO4 and Ca(NO3)2 could be detected in the external 40 μm layers. Sulfate formation was found to relate very strongly to relative humidity with nearly undetectable production at humidities below 10%. Nitrate formation was found to relate to UV light and to a limited extent to the presence of hydrocarbon but was unchanged at different humidities. Surface samples were taken from different sites of the old city wall and were also analyzed for the same substances. The data showed that the concentrations of especially CaSO4, and to a limited extend Ca(NO3)2, measured at various points along the city walls were higher than the expected values extrapolated from laboratory simulations. The elevated pollution content may be explained in part due to the deposition of transported ions, especially sulfate, onto the stone surface. It was concluded that although air pollution may not cause any structural damage in the foreseeable future it definitely deteriorates the fine details of the ancient monument.

Comparison of air quality data obtained from roof top, sidewalk and suburban areas

A comparison of air quality data obtained at a downtown roof top location, a surburban area, a main road curbside and adjacent to a major highway was conducted. The results of this study revealed that a reasonably good correlation between daily average concentrations at these locations can be established. For primary pollutants it was found that within the immediate release zone their average concentration is 3.5 to 4.0 times higher than at a close location but at roof top level. Total suspended particulate (TSP) concentration was found to increase by about 80%, and O3 is reduced by about 25%. No significant difference was obtained between daily averages obtained at the city center location and the suburb site 5 km away.

Sources of parathion exposures for Israeli aerial spray workers, 1977

Exposure of Israeli agricultural spray pilots and ground crews to parathion was studied. Measurements were made with personal samplers contianing wet midget impingers; samples were analyzed by gas chromatography. Cockpit air exposure levels during 11-21-minute sampling periods for 12 flights ranged from nearly 0 to 430 microgram/m3. During sampling periods of 30 minutes to 4 hours the threshold limit value (TLV) of 100 microgram/m3 was exceeded in 2 of 19 instances. In seven measurements of ground crew exposures, TLV was not exceeded. Air washing with parathion resulted in airborne contamination of the ground level area at more than three times the TLV. Skin exposure data suggested that this route of exposure was significant for ground crew workers but not for pilots. Calculations based on the present data and standard absorption formula suggested that total daily intake for ground crew, but not for pilots, exceeded the Accepted Daily Intake (ADI) of 5 microgram/kg body weight. Sources of exposure and contamination for ground crew and pilots were identified. Recommended environmental control measures for parathion exposure should include cockpit air filtration, modification in flight patterns, paving landing areas, installation of hosing and drainage, NaOH neutralization point, and separate loading and unloading sites. Personal control measures were suggested as a supplement.

Plasma ACTH and cortisol responses to TRF, vasopressin or hypoglycemia in cushing's disease and nelson's syndrome

The response of plasma ACTH and/or cortisol concentrations to thyrotropin-releasing-factor (TRF), vasopressin, and insulin administration was determined in 5 patients with Nelson's syndrome and 12 patients with untreated Cushing's disease. TRF administration was associated with a mean increment of 267 pg/ml in plasma ACTH concentrations in patients with Nelson's syndrome, and of 42 pg/ml in patients with Cushing's disease. The increment in plasma cortisol concentrations in the latter group was 12 mug%. No ACTH or cortisol response was observed in normal subjects. Patients with Cushing's disease or Nelson's syndrome exhibited significantly greater increments in plasma ACTH concentrations in response to vasopressin administration (P less than .05, P less than .02 respectively) than did normal subjects; the increment in cortisol concentration was also greater, (P less than .05), in patients with Cushing's disease than in normal subjects. No significant difference was present between patients with Cushing's disease and Nelson's syndrome with regard to the magnitude of the ACTH response to vasopressin administration. In contrast, the increment in plasma cortisol and plasma ACTH concentrations following insulin induced hypoglycemia was significantly less in patients with Cushing's disease than seen in normal subjects, (P less than .001, P less than .05 respectively); while this stimulus was associated with a significantly greater increment in plasma ACTH concentrations in patients with Nelson's syndrome as compared to that seen in normal subjects, (P less than .01) and in patients with Cushing's disease (P less than .01). These findings indicate that pituitary function in patients with Nelson's syndrome is not autonomous and suggest the possibility that altered central nervous regulatory mechanism might play a role in the etiology of the pituitary tumors which are frequently associated with this syndrome. The TRF induced rise in plasm cortisol and ACTH concentrations in patients with Cushing's disease and Nelson's syndrome suggests the possibility of altered hypothalamic or pituitary receptors in such patients.

Effectiveness of cyproheptadine in decreasing plasma ACTH concentrations in Nelson's syndrome

Cyproheptadine (24 mg q.d.) was administered to four patients with Nelson's Syndrome for a 3-5 month period. This resulted in a significant reduction in plasma ACTH and prolactin concentrations in 3 of these subjects. A rise in plasma ACTH concentrations occurred following discontinuance of medication in one patient. The results suggest that pituitary ACTH secretion in some patients with Nelson's Syndrome is under Central Nervous System control.