Treatment of Arsenic-Induced Bowen's Disease With Topical 5-Fluorouracil

Here, we present a case of arsenic-induced Bowen's disease treated with a regimen consisting of topical 5-fluouracil and oral nicotinamide. The use of this therapy modality resulted in near complete resolution of all of the patient's lesions except for those on her palms, soles, and scalp. Excellent wound care and treatment adherence were major factors contributing to the success of this treatment option. Our results ultimately provide an alternative approach to treating multiple arsenical keratoses in patients who are limited to a drug plan involving 5-FU and oral nicotinamide and who are able to be rigorously compliant with application of medication and wound care. J Drugs Dermatol. 2019;18(5):477-479.

The effect of seasonal and human pressure on macrobenthic fauna in the Caroni Swamp Ramsar Site, Trinidad and Tobago / Efecto de la presión estacional y humana en la fauna macrobentónica del sitio Ramsar pantano Caroní, Trinidad y Tobago

Abstract Human pressures have placed many tropical estuaries in developing countries under increased levels of stress. The Caroni Swamp Ramsar Site, the largest mangrove swamp along the west coast of Trinidad, has been subjected to high levels of anthropogenic impacts including hydrological alteration and pollution from land-based sources since the 1920's. While most of these impacts have been well documented, limited information exists on the macrobenthic communities in the swamp. This study addresses the paucity of information. The macrobenthic fauna in the main waterways of Caroni Swamp was sampled at 12 locations using a Van Veen 0.025 m2 grab, once in the dry (April) and wet (August) season of 2015 with a total of 144 samples. The samples were sorted, counted and species were identified to the lowest possible taxonomic level. A total of 55 taxa were identified with polychaetes being the most abundant taxa. The ecological status of the macrobenthos was assessed using AZTI's Marine Biotic Index (AMBI) and the multivariate-AMBI (M-AMBI). Physicochemical parameters were measured with a YSI multiparameter metre. Chemical analyses were also conducted on nitrates, nitrites, ammonia and reactive phosphates using standard methods. Overall, AMBI characterised the Caroni Swamp as "slightly disturbed" with a macrobenthic community of "poor" ecological status according to M-AMBI. Generally, the quality of the environment improves from the dry season to the wet season. However, seasonal variations in AMBI and M-AMBI were found to be site specific as some showed improvement in ecological status and macrozoobenthos quality while others showed degradation from the dry season to the wet season. The stations to the North of the swamp showed improvement from the dry season to the wet season while the opposite was observed in the more Southern stations. One notable characteristic of the swamp was the high levels of pollutants, particularly ammonia, recorded in one of its major waterways, the Caroni River. This is in contrast to the other waterways within the swamp which experience much lower levels of pollutant input from land-based sources. The assessment of the Caroni Swamp using AMBI and M-AMBI may be useful for informing management strategies to conserve the wetland and improve environmental quality. Rev. Biol. Trop. 66(3): 1101-1117. Epub 2018 September 01.

Resumen Los estuarios tropicales de países en desarrollo han experimentado un aumento en los niveles de estrés debido a la presión humana. El sitio Ramsar pantano Caroní, el manglar más grande de la costa oeste de Trinidad, ha estado sujeto a altos niveles de impacto antropogénico, incluyendo alteraciones hidrológicas y contaminación de fuentes terrestres desde la década de 1920. Aunque la mayoría de estos impactos han sido bien documentados, existe información limitada sobre las comunidades macrobentónicas en el pantano. Este estudio aborda esta escasez de información. Se muestreó la fauna macrobentónica en el canal principal del pantano Caroní en 12 localidades utilizando una draga Van Veen de 0.025 m2, una vez durante la época seca (Abril) y la época lluviosa (Agosto) 2015, con un total de 144 muestras. Las muestras fueron ordenadas, contadas y las especies se identificaron al menor nivel taxonómico posible. Se identificaron un total de 55 taxa, siendo los poliquetos el taxa más abundante. El estatus ecológico del macrobentos se evaluó utilizando el Índice Marino Biótico de AZTI (AMBI) y el AMBI-multivariado (M-AMBI). Los parámetros fisicoquímicos se midieron con un multiparámetro YSI. Los análisis químicos también se realizaron para nitratos, nitritos, amonio y fostatos activos utilizando métodos estándar. En conjunto, el índice AMBI caracterizó el pantano Caroní como "levemente alterado" con una comunidad macrobentónica de categoría "pobre" de acuerdo al M-AMBI. Generalmente, la calidad de los ambientes incrementa desde la época seca hasta la época lluviosa. Sin embargo, las variaciones estacionales en los índices AMBI y M-AMBI fueron específicas a la localidad, mostrando algunas un incremento en el estatus ecológico y calidad del macrozoobentos, mientras que otros mostraron una degradación de la época seca a la época lluviosa. Las estaciones al norte del pantano mostraron una mejora de la época seca a la época lluviosa, mientras que se presentó lo contrario en las estaciones más al sur. Una característica notable del pantano fueron los altos niveles de contaminantes, particularmente amonio, registrado en uno de los canales principales del río Caroní. Esto contrasta con los otros canales del pantano que experimentan niveles menores de aporte de contaminantes de fuentes terrestres. La evaluación del pantano Caroní utilizando los índíces AMBI y M-AMBI puede ser una base útil de información para las estrategias de manejo y conservación del humedal y mejorar su calidad ambiental.

Distribution and phytotoxicity of soil labile aluminum fractions and aluminum species in soil water extracts and their effects on tall fescue.

Soil acidification can alter the biogeochemistry of ecosystems and adversely affect biota; however, there are still many debates about the toxicity of aluminum (Al) fractions and Al species in soil:water extracts to plants. In this study, five crude soils with different pH values (4.92-8.51) were collected, seeded with tall fescue and grown in rhizosphere boxes for 120 days. Then, soil properties, labile Al fractions and Al species in soil:water extracts were determined, and their toxicities to plants were analyzed. Our study showed that a stable exchangeable Al fraction (ExAl) pool exists and is supplied by other labile Al fractions. Dissolution of Al from adsorbed hydroxyl-Al fraction (HyAl) and organic-Al fraction (OrAl) may play important roles in soil Al toxicity, as HyAl and OrAl account for major parts of soil labile Al. Additionally, Al3+ and mononuclear hydroxyl-Al species in soil:water extracts have few effects to plants. Nevertheless, high negative correlations were found between Al-F- complexes and tall fescue biomass, indicating their toxicity in the natural soil environment. Thus, in many cases, Al3+ toxicity should not be emphasized because of its lower activity in soil water extracts. Moreover, toxicities of AlF3(aq) and AlF4- to plants should be emphasized, because they have been confirmed in soil water extracts in this study.

Research on Hygiene Based on Fieldwork and Experimental Studies.

Several experimental studies on hygiene have recently been performed and fieldwork studies are also important and essential tools. However, the implementation of experimental studies is insufficient compared with that of fieldwork studies on hygiene. Here, we show our well-balanced implementation of both fieldwork and experimental studies of toxic-element-mediated diseases including skin cancer and hearing loss. Since the pollution of drinking well water by toxic elements induces various diseases including skin cancer, we performed both fieldwork and experimental studies to determine the levels of toxic elements and the mechanisms behind the development of toxic-element-related diseases and to develop a novel remediation system. Our fieldwork studies in several countries including Bangladesh, Vietnam and Malaysia demonstrated that drinking well water was polluted with high concentrations of several toxic elements including arsenic, barium, iron and manganese. Our experimental studies using the data from our fieldwork studies demonstrated that these toxic elements caused skin cancer and hearing loss. Further experimental studies resulted in the development of a novel remediation system that adsorbs toxic elements from polluted drinking water. A well-balanced implementation of both fieldwork and experimental studies is important for the prediction, prevention and therapy of toxic-element-mediated diseases.

Diseases Associated With Exposure to Contaminants in the Water Supply at Camp Lejeune. Final rule.

The Department of Veterans Affairs (VA) amends its adjudication regulations regarding presumptive service connection, adding certain diseases associated with contaminants present in the base water supply at U.S. Marine Corps Base Camp Lejeune (Camp Lejeune), North Carolina, from August 1, 1953, to December 31, 1987. This final rule establishes that veterans, former reservists, and former National Guard members, who served at Camp Lejeune for no less than 30 days (consecutive or nonconsecutive) during this period, and who have been diagnosed with any of eight associated diseases, are presumed to have incurred or aggravated the disease in service for purposes of entitlement to VA benefits. In addition, this final rule establishes a presumption that these individuals were disabled during the relevant period of service for purposes of establishing active military service for benefits purposes. Under this presumption, affected former reservists and National Guard members have veteran status for purposes of entitlement to some VA benefits. This amendment implements a decision by the Secretary of Veterans Affairs that service connection on a presumptive basis is warranted for claimants who served at Camp Lejeune during the relevant period and for the requisite amount of time and later develop certain diseases.

Effects of indoor swimming pools on the nasal cytology of pool workers.

OBJECTIVE: We aimed to evaluate the relationship between swimming pool pollutants and allergic rhinitis in swimming pool workers. MATERIALS AND METHODS: Twenty-seven indoor pool workers (group 1) and 49 control subjects (group 2) were enrolled in the study. A skin prick test was performed and a nasal smear was obtained from each subject to evaluate rhinitis. RESULTS: When the groups were compared in terms of epithelial cells, group 1 had significantly more epithelial cells than group 2. When the groups were compared with regard to eosinophils, group 1 had significantly more eosinophils than group 2. The skin prick test results for both groups were not significantly different. CONCLUSION: Indoor pool workers showed severe symptoms of rhinitis and eosinophilic nasal cytology, likely due to chlorine. Nasal cytology is an easy-to-administer diagnostic test and can be used to follow up rhinitis in indoor pool workers, along with nasal endoscopy, a detailed clinical history and a skin prick test.

Expression of 8-OHdG in Zosterisessor ophiocephalus from the Venetian lagoon, Italy.

The aim of the present work was to evaluate the expression of 8-OHdG (8-hydroxydeoxyguanosine) in the benthic fish Zosterisessor ophiocephalus collected in two differently polluted sites of the Venetian lagoon (Porto Marghera and Caroman). We compared our data on 8-OHdG with those of CYP1A (Cytochrome P450, family 1, subfamily A, polypeptide 1), which is a well known biomarker for detoxification of contaminants. Immunohistochemistry with an antibody to 8-OHdG showed immunopositivity in nuclei of hepatocytes as well as in melanomacrophage centres of spleen and kidney, whereas an anti-CYP1A antibody exhibited positive immunostaining in the liver, kidney and ovary. The liver of males showed higher expression of both proteins than females. In animals from Porto Marghera site, the enzymatic assay for 8-OHdG exhibited higher levels in liver of males than in females. Western Blot analysis using the antibody anti-CYP1A recognized the presence of a band of about 60 kDa in the liver of males and females. Males exhibited a strong band, whereas in females the band showed a lower intensity. By using Real-Time PCR, the mRNA expression of CYP1A did not show any differences between males and females from each site, but it was at borderline significance level. Comparing the two sites, mRNA expression of CYP1A was significantly higher in the liver of both males and females from Porto Marghera than that of Caroman. The present data suggest that pollutants are bio-available as demonstrated by our biomarker analyses and may have a harmful effect on aquatic organisms such as Z. ophiocephalus. We report that the highest levels of hepatic 8-OHdG and CYP1A expression were detected in males, showing clear gender specificity.

Health risk assessment of volatile organic compounds in a high risk group surrounding Map Ta Phut industrial estate, Rayong Province.

OBJECTIVE: The health risks of a high-risk group, surrounding Map Ta Phut industrial estate, Rayong, which may be exposed to VOCs through inhalation of contaminated air and dermal contact of contaminated water were assessed. MATERIAL AND METHOD: The health risk was assessed for 19 subjects categorized as children, adult and elderly from Ban plong and Nongfab communities following the US Environmental Protection Agency (EPA) method. The VOC concentrations in ambient air and ground water were monitored by Pollution Control Department (PCD), Ministry of Natural Resources and Environment to represent average VOC exposure of subjects. RESULTS: The lifetime cancer risk of VOCs exposure from inhalation and dermal contact with ground water were 1.32 x 10(-7)-5.21 x 10(6) for elderly 1.18 x 10(-7)-6.20 x 10(-6)for adult and 8.93 x 10(-7)-5.93 x 10(-6) for children. For non-cancer risk, the hazard index was 0.44 for elderly, 0.38-0.42 for adult and 0.55 for children. CONCLUSION: The lifetime cancer risk of the high-risk group living near Map Ta Phut industrial estate was in acceptable range for elderly, adult and children. For non-cancer risk, it is also acceptable.

Comparing predicted against measured steroid estrogen concentrations and the associated risk in two United Kingdom river catchments.

Predicted concentrations of estrone, 17ß-estradiol, and 17α-ethinylestradiol generated from a geographical information systems-based model (LF2000-WQX) have previously been used to assess the risk of causing intersex in male fish in the rivers of England and Wales, United Kingdom. Few measured data of sufficient quality and spatial extent have been available to verify this risk assessment. New measured data have been collected from sewage treatment plant effluents and the receiving waters upstream and downstream of these discharges from the Erewash River and the Avon River systems in England. The model results for these rivers were in good agreement with the measured values in terms of estradiol equivalents. Critically, the risk assessment based on the measured data gave a risk assessment nearly identical to that derived from the modeled results. For individual estrogens, 17α-ethinylestradiol was modeled best and estrone worst. Poor simulations reflected poor estimates of the effluent concentrations, which were more variable from day to day and between works of nominally similar type than is assumed in the model. In support of this, model results for the Erewash River, calculated using observed effluent concentrations, were in excellent agreement with the measured data. The model has proved to be adequate in predicting overall estrogenic potency, and therefore risk, along these rivers; however, improvements are possible, particularly in predicting STP removal efficiency and therefore effluent concentrations.

Photodynamic inactivation of microbial pathogens: disinfection of water and prevention of water-borne diseases.

Porphyrins have been shown to act as very efficient photosensitizing agents against a broad number of microbial pathogens, including bacteria, fungi, and protozoa. This property has promising applications at a clinical level for the treatment of infectious diseases by photodynamic therapy. Moreover, this technique is also being used to address environmental problems of high significance, such as the decontamination of wastewaters, the disinfection of fish-farming tanks, the protection of animal species (e.g., amphibians and reptiles) that are endangered by pathogens whose life cycle takes place largely in aqueous media, and the control of populations of noxious insects. Such diversified applications take advantage of the availability of a truly large number of porphyrin derivatives with chemical structures that can be tailored to comply with the physical and chemical properties as well as the biological features of several milieus. In addition, the property typical of porphyrins to absorb essentially all of the wavelengths in the sun emission spectrum allows the promotion of processes largely based on natural resources with significant energy savings and low impact on ecosystems.

Prevention of hepatocellular carcinoma in nonviral-related liver diseases.

Although chronic infection with hepatitis B virus and/or hepatitis C virus are the most important risk factors for hepatocellular carcinoma (HCC) worldwide, other causes of cirrhosis can also lead to HCC. Given the high prevalence of alcoholism and the worldwide obesity epidemic, the relevant importance of nonviral liver disease-related HCC is expected to increase in the future. Some evidence supports mechanistic interactions between host or environmental factors and chronic viral hepatitis in the development of HCC. For example, food- and water-borne carcinogens have contributed to unusually high rates of HCC in parts of China and sub-Saharan Africa. With some of these conditions, appropriate public health measures to reduce the population's exposure to known etiologic agents, or early therapeutic intervention for 'at-risk' individuals before development of cirrhosis (e.g. hereditary hemochromatosis) can prevent HCC. Community-based programs to discourage and deal with excessive alcohol intake, to promote tobacco smoking awareness, to avoid exposure to aflatoxin and other food toxins, and measures to reduce the pandemic of obesity and diabetes are vital for effective interruption of the rising tide of HCC from nonviral liver disease.

Cigarette smoking and drinking water source: correlation with clinical features and pathology of superficial bladder carcinoma.

OBJECTIVE: Water source and cigarette smoking are related to clinical characteristics and pathology of superficial transitional cell carcinoma of the bladder. METHODS: Tumor number, dimension, G-grade, T-stage, recurrences, cigarette smoking and water supply were recorded in patients harboring Ta-T1 G1-3 transitional cell carcinoma of the bladder. RESULTS: Of 577 patients, 61% had multiple and 36% recurrent tumors. Two hundred and forty-one patients (42%) were current smokers and 188 (33%) were former smokers. Bottled water was the only drinkable source for 249 (45%) patients, municipal water supply for 177 (32%), artesian wells for 38 (7%), spring water for 7 (1%) and mixed source for 89 (16%). By adopting a cut-off of 30 years of smoking, patients affected by recurrent tumors varied from 22 to 43% (p = 0.0001). T1 tumors were more frequent in patients drinking nonbottled water (p = 0.03). Nonbottled supply was more frequent in never smokers (p = 0.015) and could represent a weak risk factor not detectable in smokers. CONCLUSIONS: Cigarette smoking correlates with the number of recurrences. T1 tumors were statistically more frequent in patients taking nonbottled drinking water. Chlorinated water supply was more frequent among patients who did not present cigarette smoking as a risk factor.

Oral exposure to inorganic arsenic: evaluation of its carcinogenic and non-carcinogenic effects.

Inorganic arsenic, which is extensively metabolised in humans into even more toxic methylated arsenicals, is a potent carcinogen, causing tumours of the skin, lung, urinary bladder, and other organs. It also induces a number of non-cancer effects. Consumption of drinking water highly contaminated by arsenic causes serious health problems in some countries in southeastern Asia, and arsenic poses problems for drinking-water safety world-wide. Existing risk assessments are based on epidemiological studies from regions with high exposure concentrations (in the mg/L range). It is a matter of debate whether these findings are useful at predicting arsenic-induced effects at low concentrations. In recent years numerous epidemiological studies on cancer and non-cancer effects of inorganic arsenic have been published. This work aims at reviewing recent toxicological and epidemiological data on inorganic arsenic with emphasis on effects at low exposure concentrations. Information obtained from epidemiological studies is supplemented with mechanistic data from in vitro and in vivo studies. Various modes of action for arsenic carcinogenicity are discussed. The information gathered was used to evaluate the reliability of existing cancer-risk assessments and to improve current assessments of non-cancer health effects. A tolerable daily dose, based on epidemiological studies on arsenic-induced skin disorders, is presented.

Pathogenesis, clinical features and pathology of chronic arsenicosis.

Arsenicosis is a multisystem disorder, with virtually no system spared from its vicious claw; though its predominant manifestations are linked to cutaneous involvement. Cutaneous effects take the form of pigmentary changes, hyperkeratosis, and skin cancers (Bowen's disease, squamous cell carcinoma, and basal cell epithelioma). Peripheral vascular disease (blackfoot disease), hypertension, ischemic heart disease, noncirrhotic portal hypertension, hepatomegaly, peripheral neuropathy, respiratory and renal involvement, bad obstetrical outcome, hematological disturbances, and diabetes mellitus are among the other clinical features linked to arsenic toxicity. The effects are mediated principally by the trivalent form of arsenic (arsenite), which by its ability to bind with sulfhydryl groups present in various essential compounds leads to inactivation and derangement of body function. Though the toxicities are mostly linked to the trivalent state, arsenic is consumed mainly in its pentavalent form (arsenate), and reduction of arsenate to arsenite is mediated through glutathione. Body attempts to detoxify the agent via repeated oxidative methylation and reduction reaction, leading to the generation of methylated metabolites, which are excreted in the urine. Understandably the detoxification/bio-inactivation process is not a complete defense against the vicious metalloid, and it can cause chromosomal aberration, impairment of DNA repair process, alteration in the activity of tumor suppressor gene, etc., leading to genotoxicity and carcinogenicity. Arsenic causes apoptosis via free radical generation, and the cutaneous toxicity is linked to its effect on various cytokines (e.g., IL-8, TGF-beta, TNF-alpha, GM-CSF), growth factors, and transcription factors. Increased expression of cytokeratins, keratin-16 (marker for hyperproliferation) and keratin-8 and -18 (marker for less differentiated epithelial cells), can be related to the histopathological findings of hyperkeratosis and dysplastic cells in the arsenicosis skin lesion.

[German Environmental Survey for Children (GerES IV) in the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). First results]. / Kinder-Umwelt-Survey (KUS) im Rahmen des Kinder- und Jugendgesundheitssurveys (KiGGS). Erste Ergebnisse.

The German Environmental Survey for Children (GerES IV) is the environment-related module of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) of the Robert Koch Institute and the fourth GerES of the Federal Environment Agency. The main objective of GerESs is to analyse and document the extent, distribution and determinants of exposure to environmental pollutants of the German general population. GerES IV was performed from 2003 to 2006. A total of 1.790 children aged 3-14 years from 150 sampling locations participated in GerES IV. Samples of blood, urine, tap water, house dust and indoor air were analysed. Hearing tests, measurements of traffic noise and interviews to get exposure-related information were conducted. First results indicate a clear decrease of the exposure to arsenic, lead and mercury. Cotinine concentrations in urine can be used to classify the exposure of children to environmental tobacco smoke. The examination of the tap water used in the subjects' households indicates that in some households the guideline values of the German Drinking Water Ordinance were not always met. This is the case for nickel, copper and lead which are used as pipe material for domestic plumbing.

Does the evidence about health risks associated with nitrate ingestion warrant an increase of the nitrate standard for drinking water?

Several authors have suggested that it is safe to raise the health standard for nitrate in drinking water, and save money on measures associated with nitrate pollution of drinking water resources. The major argument has been that the epidemiologic evidence for acute and chronic health effects related to drinking water nitrate at concentrations near the health standard is inconclusive. With respect to the chronic effects, the argument was motivated by the absence of evidence for adverse health effects related to ingestion of nitrate from dietary sources. An interdisciplinary discussion of these arguments led to three important observations. First, there have been only a few well-designed epidemiologic studies that evaluated ingestion of nitrate in drinking water and risk of specific cancers or adverse reproductive outcomes among potentially susceptible subgroups likely to have elevated endogenous nitrosation. Positive associations have been observed for some but not all health outcomes evaluated. Second, the epidemiologic studies of cancer do not support an association between ingestion of dietary nitrate (vegetables) and an increased risk of cancer, because intake of dietary nitrate is associated with intake of antioxidants and other beneficial phytochemicals. Third, 2-3 % of the population in Western Europe and the US could be exposed to nitrate levels in drinking water exceeding the WHO standard of 50 mg/l nitrate, particularly those living in rural areas. The health losses due to this exposure cannot be estimated. Therefore, we conclude that it is not possible to weigh the costs and benefits from changing the nitrate standard for drinking water and groundwater resources by considering the potential consequences for human health and by considering the potential savings due to reduced costs for nitrate removal and prevention of nitrate pollution.

Major contributors to inorganic arsenic intake in southeastern Michigan.

Accurate estimates of inorganic arsenic intake are critical for evaluating potential health risks. Intake estimates have not been critically examined in regions of the United States where people are at risk from arsenic concentrations in drinking water exceeding the maximum contaminant limit of 10 microg/l. In southeastern Michigan, approximately 8% of the population is exposed to arsenic in drinking water >10 microg/l. Four hundred and forty participants of a control group in this region, frequency matched to cases in a population-based bladder cancer case-control study, answered a questionnaire about water and food consumption and smoking history. Water samples were collected from participants' current residences and analyzed for arsenic. Water arsenic data were combined with questionnaire data and published data of inorganic arsenic concentrations in select foods and cigarettes to examine the influence of arsenic in water at home, at work, and at other places, as well as inorganic arsenic intake from food and cigarettes. Monte Carlo simulations and analyses of individual-level intake estimates were conducted to quantify the variability attributed to different parameters in this primarily elderly white male population of southeastern Michigan. The 95th percentile of total inorganic arsenic intake ranges from 11 to 24 microg/day, depending on the intake metric selected. Results indicate that arsenic in home drinking water is the largest source of inorganic arsenic, accounting for 55.1% of the variance in the intake estimates. Food intake explains 37.3% of the variance, with rice being the largest contributor. In the upper decile of intake, consumption of plain water and beverages made with water at home, and ingestion of arsenic in water at work, also contribute to intake estimates. Water used for cooking and arsenic from smoking, however, only minimally alter the intake estimates. This is due to a relatively small volume of water absorbed into cooked foods and low concentrations of arsenic in cigarettes. Results from this study will assist investigators in better characterizing exposure to inorganic arsenic.

Carcinomatosis múltiple de localización bucal en un paciente de zona de hidroarsenicismo crónico regional endémico (HACRE) / Oral multiple carcinomatosis in a patient from an area with endemic regional chronica hydroarsenicism (ERCH)

Antecedentes: La acción nociva del arsénico (As) y sus compuestos sobre el organismo humano es múltiple, afectando procesos biológicos de gran importancia. En extensas zonas de la República Argentina se consume agua de pozo contaminada con As, lo que produce una enfermedad denominada"Hidroarsenicismo Crónico Regional Endémico (HACRE), en cuyo cuadro clínico se han observado pacientes con múltiples lesiones carcinomatosas de la piel. coexistentes o sucesivas en largos periodos de tiempo. Objetivo: presentar el caso clínico de una paciente residente en la zona arsenical de la Provincia de Córdoba con lesiones carcinomatosas orales. Materiales y Métodos: Se realizó Historia Clínica, iconografía, eliminación quirúrgica de lesiones de labio, estudios anatomopatológicos de los especimenes obtenidos y control evolutivo. Resultados: Por los datos obtenidos de la Historia Clínica, y por el seguimiento realizado, se pudo comprobar la existencia de múltiples y sucesivas lesiones carcinomatosas en la mucosa bucal. Conclusión: Del estudio de este caso se concluye que el AS presente en el agua de bebida en cantidades superiores a las aceptadas por la Organización Mundial de la Salud (0,05 ppm), puede producir, al igual que en la piel, múltiples lesiones carcinomatosas en la mucosa oral.

Background: Arsenic (As) and its compounds may cause multiple harmful effects on the human rganism, interfering with biological processes of vital importance. It is known that the inhabitants of vast areas of the Argentine Republic drink well water contaminated with AS, which results in a disease known as Endemic Regional Chronic Hydroarsenicism (ERCH). It has been observed that these patients present a clinical picture characterized by multiple carcinomatous skin lesions which occur concurrently or successively along long periods of time. Purpose: To present the clinical case of a female patient from the arsenical area of Cordoba Province, who had multiple carcinomatous oral lesions. Materials and method: The patient's history was written and iconographies, surgical excision of the lip lesions, pathological studies of the samples, and evolution observations were done. Results: Based on both the patient’s history and follow-upstudies, it was possible to preve the presence of multiple successive carcinomatous lesions in the oral mucose. Conclusion: it is conclude that drinking water containing more AS than the quantity accepted by the WHO (0,05 ppm) can cause multiples carcinomatous lesions on the oral mucosa as on the skin.