Acrolein environmental levels and potential for human exposure.

This article provides environmental information on acrolein including environmental fate, potential for human exposure, analytical methods, and a listing of regulations and advisories. Acrolein may be released to the environment in emissions and effluents from its manufacturing and use facilities, in emissions from combustion processes (including cigarette smoking and combustion of petrochemical fuels), from direct application to water and waste water as a slimicide and aquatic herbicide, as a photooxidation product of various hydrocarbon pollutants found in air (including propylene and 1,3-butadiene), and from land disposal of some organic waste materials. Acrolein is a reactive compound and is unstable in the environment. The general population may be exposed to acrolein through inhalation of contaminated air and through ingestion of certain foods. Important sources of acrolein exposure are via inhalation of tobacco smoke and environmental tobacco smoke and via the overheating of fats contained in all living matter. There is potential for exposure to acrolein in many occupational settings as the result of its varied uses and its formation during the combustion and pyrolysis of materials such as wood, petrochemical fuels, and plastics.

Acrolein health effects.

Acrolein is a chemical used as an intermediate reactive aldehyde in chemical industry. It is used for synthesis of many organic substances, methionine production, and methyl chloride refrigerant. The general population is exposed to acrolein via smoking, second-hand smoke, exposure to wood and plastic smoke. Firefighters and population living or working in areas with heavy automotive traffic may expose to higher level of acrolein via inhalation of smoke or automotive exhaust. Degradation of acrolein in all environmental media occurs rapidly, therefore, environmental accumulation is not expected. Acrolein degrade in 6A days when applied to surface water, and it has not been found as a contaminant in municipal drinking water. Acrolein vapor may cause eye, nasal and respiratory tract irritations in low level exposure. A decrease in breathing rate was reported by volunteers acutely exposed to 0.3A ppm of acrolein. At similar level, mild nasal epithelial dysplasia, necrosis, and focal basal cell metaplasia have been observed in rats. The acrolein effects on gastrointestinal mucosa in the animals include epithelial hyperplasia, ulceration, and hemorrhage. The severity of the effects is dose dependent. Acrolein induces the respiratory, ocular, and gastrointestinal irritations by inducing the release of peptides in nerve terminals innervating these systems. Levels of acrolein between 22 and 249 ppm for 10 min induced a dose-related decrease in substance P (a short-chain polypeptide that functions as a neurotransmitter or neuromodulator).

Surveillance for asthma--United States, 1960-1995.

PROBLEM/CONDITION: Asthma is one of the most common chronic diseases in the United States, and it has increased in importance during the preceding 20 years. Despite its importance, no comprehensive surveillance system has been established that measures asthma trends at the state or local level. REPORTING PERIOD: This report summarizes and reviews national data for specific end-points: self-reported asthma prevalence (1980-1994), asthma office visits (1975-1995), asthma emergency room visits (1992-1995), asthma hospitalizations (1979-1994), and asthma deaths (1960-1995). DESCRIPTION OF SYSTEM: The National Center for Health Statistics (NCHS) annually conducts the National Health Interview Survey, which asks about self-reported asthma in a subset of the sample. NCHS collects physician office visit data with the National Ambulatory Medical Care Survey, emergency room visit data with the National Hospital Ambulatory Medical Care Survey, and hospitalization data with the National Hospital Discharge Survey. NCHS also collects mortality data annually from each state and produces computerized files from these data. We used these datasets to determine self-reported asthma prevalence, asthma office visits, asthma emergency room visits, asthma hospitalizations, and asthma deaths nationwide and in four geographic regions of the United States (i.e., Northeast, Midwest, South, and West). RESULTS: We found an increase in self-reported asthma prevalence rates and asthma death rates in recent years both nationally and regionally. Asthma hospitalization rates have increased in some regions and decreased in others. At the state level, only death data are available for asthma; death rates varied substantially among states within the same region. INTERPRETATION: Both asthma prevalence rates and asthma death rates are increasing nationally. Available surveillance information are inadequate for fully assessing asthma trends at the state or local level. Implementation of better state and local surveillance can increase understanding of this disease and contribute to more effective treatment and prevention strategies.

Comparison of changes in cardiac structure after treatment in secondary hypertension.

To investigate the role of aldosterone and the renin-angiotensin system in cardiac structure, we performed echocardiography in patients with secondary hypertension. The relation between blood pressure or hormonal influences and left ventricular hypertrophy has not been well established in secondary hypertension. Sixteen patients with primary aldosteronism and 11 with unilateral renovascular hypertension who had completely normalized blood pressure after operation or percutaneous transluminal angioplasty were evaluated by echocardiography before and after surgery or other interventional treatment. Blood pressure was not statistically different between the groups before treatment and was normalized after treatment in both groups. Left ventricular hypertrophy was mild in both groups before treatment, and its degree was not statistically different between the groups. At the end of the follow-up period, all parameters of primary aldosteronism and left ventricular mass index in patients with unilateral renovascular hypertension were significantly reduced. In patients with primary aldosteronism, changes in end-diastolic left ventricular internal dimension correlated positively with changes in left ventricular mass index (r=.58,P<.01). In patients with unilateral renovascular hypertension, changes in mean blood pressure and left ventricular mass index were significantly correlated (r=.77,P<.01). The expanded plasma volume induced by an excess of aldosterone and high blood pressure may play an important role in the increase of left ventricular mass in primary aldosteronism. In unilateral renovascular hypertension, high blood pressure mainly contributes significantly to increased left ventricular mass. Therefore, different factors may modulate the development of left ventricular hypertrophy in patients with secondary hypertension.

Idiopathic left innominate vein stenosis manifested following the creation of arteriovenous fistula in uremia.

A 48-year-old woman on maintenance hemodialysis was admitted with her left upper limb swollen and her left jugular vein dilated following the creation of an arteriovenous fistula on her left arm. The intracorporeal pressure during hemodialysis was found to be high. Venographic investigation showed severe stenosis of her left innominate vein accompanied by rich blood flow of the collaterals. Ligation of her fistula promptly reduced swelling of her left upper limb and dilatation of the left jugular vein. The exact cause of the stenosis could not be determined from venographic or computerized tomography findings. Idiopathic left innominate vein stenosis was diagnosed which we believe is the first case to be reported in a hemodialyzed patient.

Cisplatin, vindesine, pepleomycin and combined radiation therapy for inoperable esophageal carcinoma.

Sixteen inoperable esophageal cancer patients, including six over 80 years of age, were given combined chemoradiation therapy. The treatment consisted of radiation therapy (50-60 Gy for 6-7 wk on days 1 to 46) combined with cisplatin (50 mg/m2 i.v. on days 22 and 50), vindesine (3 mg/m2 i.v. on days 22 and 50) and pepleomycin (5 mg i.m. on days 23 to 27 and 51 to 55). The treatment was well-tolerated. The overall response rate was 56%, with three complete responses and six partial responses. For 10 patients with loco-regional disease (stage II-III), the response rate was 70%. The overall median survival was 7 mo and the survival rate was 31% at one year and 23% at two years. For loco-regional disease, the one and two-year survival rates were 40 and 27%, respectively, with a median survival of 8 mo. The protocol is worthy of being considered for treating inoperable, poor-risk esophageal cancer patients.

[The effectiveness of radiotherapy for Merkel cell carcinoma].

Merkel cell carcinoma is a high-grade malignant tumor of the skin that tends to extend locally and metastasize to regional lymph nodes. Surgical resection is the treatment of choice, and the effectiveness of radiotherapy for this disease has not yet been established. We report two cases of biopsy-proven Merkel cell carcinoma effectively treated with radiotherapy. Histopathological examination of the resected specimens after radiotherapy of 50 Gy and 38 Gy, respectively, using 6 approximately 15 MeV electrons showed no malignant cells in either case. No evidence of recurrence or metastasis has been noted in 11 to 21 months after radiotherapy. To our knowledge, no case of Merkel cell carcinoma in which complete cure was obtained by radiotherapy alone has been reported previously. It is considered that preoperative radiotherapy would contribute to the management of this locally invasive but radiosensitive tumor.

[Ultrasonography and CT of thyroglossal duct cysts].

A retrospective analysis of pathologically proved 7 cases of thyroglossal duct cysts was performed in an attempt to determine the characteristics of these lesions using both ultrasonography (US) and computed tomography (CT). US showed cystic mass with variable internal echoes or debris in 6 of 7 cases and internal septation in two. CT showed hypodense mass in all 4 cases of which attenuation value were higher than that of water, and rim-enhancement of the wall in one case. CT and US also showed calcification of the wall in one patient. To our knowledge, calcification of the wall of thyroglossal duct cyst was not reported previously. These findings described above may be due to complicated inflammation, and may enable to differentiate the thyroglossal duct cyst from the other neck masses.

[CT and sonographic diagnosis of retained surgical sponge].

Seven cases of pathologically proven retained surgical sponge were reviewed and classified into four types, depending on CT and US findings. Type I: CT shows a mass with tiny gas bubbles, and sonogram shows an echogenic area with strong posterior shadow. Type II: CT shows an irregular high density mass with no gas bubble, and sonogram shows an echogenic area with strong posterior shadow. Type III: CT shows a low density mass with irregular internal high density areas, and sonogram shows a cystic mass with zigzag internal components. Type IV: CT shows an elliptic high density mass with low density area internally. Judging from the experiment and operative findings, these patterns were decided by the number and status of the gauze, volume of the exudate and hematoma, and status of the granulation. The author concludes that these characteristic CT and US findings, together with a history of surgery, permit the correct diagnosis of retained surgical sponge.

[Differential diagnosis between nonhyperfunctioning adenoma and adrenal metastasis on adrenocortical scintigraphy].

Adrenocortical scintigraphy using I-131-adosterol was performed in six cases of nonhyperfunctioning adenoma incidentally discovered on CT scans and four cases of adrenal metastasis. In all six cases of nonhyperfunctioning adenoma, there was increased uptake of of the I-131-adosterol on the side of the adrenal mass discovered at CT. In three of four cases of adrenal metastasis, there was no uptake of the I-131-adosterol on the side of the mass detected at CT. Uptake was symmetrical in one case of adrenal metastasis. Adrenocortical scintigraphy is able to differentiate nonhyperfunctioning adenoma from adrenal metastasis in recognition of increased uptake of I-131-adosterol on the side of the adrenal mass discovered on CT scans.

[Application of a stent splint to protect intraoral organs from radiation injury in a 97-year-old patient with multiple oral cancers who survived to over 100 years old].

Radiation therapy had been used with increasing frequency in recent years in the management of oral cancers of advanced ages. In those cases we have to take good care to maintain the oral health of patients undergoing cancerocidal dose of radiation therapy. Using splints, as a tissue displacer, during radiation, we could treat a 99-year-old female patient without serious radiation sequelae, successfully she survived over 100 year-old. As she visited us at 97 year-old, the primary lesions located on the left upper lip, nose, upper and lower gums were diagnosed as multiple verrucous carcinoma histologically. Seventeen months after the first radiotherapy to the lip, nose and upper jaw, we planned again radiotherapy to the recurrent tumor of the lower gum. In order to eliminate and minimize side effects of the second irradiation for the contiguous intraoral organs, we devised a splint to exclude the tongue and upper gum apart from a radiation field. The splint, as tissue displacer, was made of heat-cured acrylic resin and divided into two pieces which were formed like full denture without artificial teeth. They were applied to the upper and lower jaws. The lower one had a large wing to exclude the tongue from irradiation field. After setting of the splint, she had been clenched slightly with an aid of chin cap. Then we could finish successfully the radiotherapy with 10 MV X-ray 40 Gy as scheduled without serious troubles.

CT of adrenal tumors: frequency and clinical significance of low-attenuation lesions.

The CT values of adrenal tumors were evaluated in 36 patients to determine the frequency and significance of negative CT values. Twenty-seven patients had adrenocortical adenomas (13 had primary aldosteronism, 12 had Cushing syndrome, and two had nonhyperfunctioning adenoma), one had adrenocortical carcinoma, and eight had pheochromocytomas. The CT values in primary aldosteronism (mean, 1.8 +/- 9.9 H) were lower than those in Cushing syndrome (27.6 +/- 12.0 H) and pheochromocytoma (35.9 +/- 9.8 H). Six adrenocortical adenomas had homogeneous, low CT attenuation, with CT values ranging from -20 to -0.4 H. Four of these had primary aldosteronism, one had Cushing syndrome, and one had nonhyperfunctioning adenoma. Our results suggest that adrenal tumors with homogeneous, slightly negative CT attenuation are likely to be adrenocortical adenomas, mainly primary aldosteronism and nonhyperfunctioning adenomas. This finding may be especially useful in diagnosing nonhyperfunctioning adenoma.

[A case of hepatoma treated successfully with a percutaneous intratumoral injection of CDDP-PC-lipiodol suspension].

Reported is a case that was treated successfully with a percutaneous intratumoral injection of a CDDP-PC-Lipiodol Suspension (CPLS) of the viable tumor cells of a hepatoma after arterial injection therapy. Although the size of the viable tumor cells remained almost unchanged, a marked reduction in the level of the plasma AFP (484 ng/ml-35 ng/ml) was obtained after the percutaneous injection. No major complication was encountered except for minimal vomiting and mild transient abnormalities of the liver functions.

[Long-term results of percutaneous transluminal angioplasty in patients with renovascular hypertension--a follow-up study on renal function and renal size].

Twenty patients with renovascular hypertension were followed for at least 1 year (mean 3.3 years) after successful percutaneous transluminal angioplasty (PTA). Renal arteries were patent in 13 (65%) patients and were re-stenosed in 7 (35%). In 12 patients with unilaterally stenosed renal artery which were patent at the end of the follow up period, 6 patients were normotensive, the other 6 patients had less degree of hypertension. Determinations of renal vein renin were only of limited prognostic value. Renal blood flow pattern by doppler echography improved after PTA in the 12 patients. Radioisotope renogram showed tendency of improved Tmax ratio (stenotic kidney/nonstenotic kidney) from 1.5 +/- 0.8 to 1.0 +/- 0.2 (mean +/- SD, p less than 0.1). Serum creatinine levels decreased significantly from 1.2 +/- 0.5 mg/dl to 1.0 +/- 0.2 mg/dl (p less than 0.05) and creatinine clearance increased from 72.1 +/- 18.5 ml/min to 99.6 +/- 31.7 ml/min (p less than 0.02). The size of the stenosed kidneys increased from 11.2 +/- 0.7 cm to 12.0 +/- 0.8 cm (p less than 0.01), while the size of the contralateral kidneys did not change. These results indicate that PTA has favorable long-term effects on blood pressure and renal function with restoration of renal size in cases with patent renal arteries after this procedure.

Left ventricular structural characteristics in unilateral renovascular hypertension and primary aldosteronism.

To assess the importance of the renin-angiotensin system and plasma volume as determinants of hypertensive left ventricular hypertrophy and its anatomy, patients with unilateral renovascular hypertension and primary aldosteronism were studied by echocardiography. Blood pressure, age and sex were matched as closely as possible. The 19 patients with unilateral renovascular hypertension and the 19 patients with primary aldosteronism were similar in age, sex and blood pressure (168 +/- 19/97 +/- 11 and 163 +/- 17/99 +/- 10 mm Hg, respectively), but plasma volume was increased in the patients with primary aldosteronism. Interventricular septal thickness, left ventricular posterior wall thickness, left ventricular mass index and relative wall thickness did not differ between the 2 groups of patients. There was a significant correlation between the level of systolic blood pressure and either left ventricular mass index (r = 0.34, p less than 0.05) or relative wall thickness (r = 0.58, p less than 0.001) in both groups of patients. Left ventricular end-diastolic dimension index was increased in the patients with primary aldosteronism compared with those with unilateral renovascular hypertension (3.2 +/- 0.4 vs 2.9 +/- 0.3 cm/m2, p less than 0.02). When confined to the patients with systolic pressure greater than or equal to 150 mm Hg, relative wall thickness was significantly increased in the patients with unilateral renovascular hypertension. Patients with primary aldosteronism and unilateral renovascular hypertension of similar blood pressure levels, age and sex have almost identical degrees of left ventricular hypertrophy and anatomy. In contrast, the patients with primary oldosteronism had increased left ventricular dimension index.(ABSTRACT TRUNCATED AT 250 WORDS)

Computed tomography in amyloid goiter.

Two cases of amyloid goiter showed diffuse decreased density of enlarged thyroid on CT. The diffuse decreased density of amyloid goiter on CT is thought to represent large amount of adipose tissue often found in amyloid goiter. When diffuse decreased density of the enlarged thyroid is recognized on CT, amyloid goiter should enter into differential diagnosis.

[Postoperative radiotherapy with the electron beam in breast cancer].

The usefulness of postoperative radiotherapy for breast cancer was investigated in 152 patients. A dose of 50 Gy was given to the axillar, supraclavicular and internal mammary lymphnode areas using a 12 MeV electron and to the chest wall using a 6 MeV electron. The five and 10-year survival rates were 79.1% and 50.8%, respectively. The five-year survival rates according to the TNM staging were 100% for stage I, 78.4% for stage II, 58.8% for stage III and 0% for stage IV. The local recurrence rate was 8.8%, the metastasis rate was 33.1% and the recurrence rate in the ipsilateral supraclavicular regions previously treated by prophylactic irradiation was 2.6%, while it was 8.9% in the ipsilateral chest wall.

The role of chloride ion on the photoreactivation of the oxygen-evolving center of tris-washed, 2,6-dichlorophenol indophenol-treated grana.

Chloride ion is found to be an essential factor in photoreactivation of the oxygen-evolving center. Tris-washed, 2,6-dichlorophenol indophenol-treated grana are low in both Mn content and oxygen-evolving activity. These grana can restore high oxygen-evolving activity, however, by incorporating Mn2+ ion under weak light in the presence of chloride and calcium ions with dithiothreitol. This restoration is called photoreactivation. When chloride ion is omitted from the medium for the photoreactivation, the recovery of oxygen-evolving activity is inhibited. Other anions, such as bromide and nitrate anions, could also mediate the reactivation; but, anions of weak acids or polyvalent strong acids were not effective. Chloride ion is also required in the light-induced H+ and Mn2+ uptake of these grana, which are essential partial reactions for the reactivation. It is therefore concluded that chloride ion plays an important role in the photoreactivation.