Mechanic's hand; is it a prodromic sign of disease relapse of anti-synthetase syndrome; a case report.

BACKGROUND: Anti-synthetase syndrome is the collection of myositis and/or interstitial lung disease with the presence of various antibodies directed against an aminoacyl transfer RNA synthetase. Anti Jo - 1 antibody is the commonest of these antibodies and its presence is characteristically associated with the dermatological manifestation of mechanic's hands. However, in the absence of other features, whether the presence of mechanic's hands could be considered as a prodromic sign of disease relapse is not proven. We would like to present a patient who developed mechanic's hands and subsequently went on to have recurrence in her myositis. CASE PRESENTATION: A 45-year-old female initially presented with a progressive proximal muscle weakness. Her muscle enzymes were elevated, EMG and biopsy were also in keeping with an inflammatory myositis. Subsequently she was found to have an interstitial lung disease with a non-specific interstitial pneumonitis pattern radiologically. Her anti Jo-1 was positive. However, she did not have any dermatological manifestations at the time. With immunosuppressive therapy she achieved remission which lasted for about 2 years. Then she developed fissuring and cracking of the palms and fingers suggestive of mechanic's hands without any muscle pain, weakness and elevation of muscle enzymes. A few months later she did develop muscle pain, weakness and elevation of muscle enzymes heralding a disease relapse. CONCLUSION: The presence of mechanic's hands without other features should be considered as a prodromic sign of disease relapse.

Hypovitaminosis D in dogs with spirocercosis.

BACKGROUND: Spirocercosis in dogs is characterized by esophageal nodules that can undergo neoplastic transformation. Hypovitaminosis D has been associated with neoplasia formation. We hypothesized hypovitaminosis D in neoplastic spirocercosis and that it could be a risk factor for neoplastic transformation. OBJECTIVE: To measure and compare vitamin D status, assessed by serum 25-hydroxyvitamin D [25(OH)D] concentrations in non-neoplastic (n = 25) and neoplastic (n = 26) spirocercosis client-owned dogs and healthy dogs (n = 24). ANIMALS: Twenty-five non-neoplastic dogs, 26 neoplastic dogs, and 24 healthy dogs. METHODS: Fifty-one dogs were randomly selected from 119 dogs diagnosed with spirocercosis presenting to our hospital, and further divided into non-neoplastic or neoplastic groups. Exclusion criteria included dogs less than 1 year old, with concurrent diseases, received corticosteroids, or treated prophylactically for spirocercosis. Serum 25(OH)D concentration was measured by high-performance liquid chromatography. Spirocercosis dogs' appetites were graded and compared. RESULTS: Serum 25(OH)D concentrations were significantly different among all groups (P < .001). 25-Hydroxyvitamin D concentrations were significantly lower in neoplastic group (median 30.7 nmol/L [range 14.7-62.2]) compared to non-neoplastic (median 52.7 nmol/L [range 19.1-129.7, P < .05]) and healthy groups (median 74.6 nmol/L [range 37.4-130.5, P < .005]). 25-hydroxyvitamin D concentrations were significantly lower in non-neoplastic spirocercosis dogs compared to healthy ones (P < .05). Neoplastic and non-neoplastic spirocercosis dogs had similar appetite scores (P = 1.0). 25-Hydroxyvitamin D concentrations were not significantly different between dogs with normal (P = .087) and abnormal (P = .125) appetites within neoplastic and non-neoplastic spirocercosis groups. CONCLUSIONS AND CLINICAL IMPORTANCE: Further studies are warranted to determine potential use of vitamin D treatment in spirocercosis and explore role of hypovitaminosis D in pathogenesis of malignant transformation.

Prediction of the health effects of polychlorinated biphenyls (PCBs) and their metabolites using quantitative structure-activity relationship (QSAR).

Polychlorinated biphenyls (PCBs) are a group of 209 persistent environmental contaminants that are slightly different but structurally related. PCBs are known to induce a variety of health effects and often have been toxicologically tested as complex commercial mixtures (Aroclors) but environmental exposure occurs separately to a small number of specific congeners. Recently, the Third National Report on Human Exposures to Environmental Chemicals, an assessment of exposure data of the National Health and Nutrition Examination Survey (NHANES), identified 35 individual PCB congeners in the U.S. population. These types of findings necessitate the toxicity evaluation of individual congeners but adequate toxicity data for most individual PCB congeners are not available. Due to this, a quantitative structure-activity relationship (QSAR) approach was used to assess the potential mutagenesis and carcinogenesis of individual congeners and their possible metabolites. The predictions were analyzed to define the underlying generalizations between the parent PCBs, their metabolites, and some important toxicological endpoints. This analysis reveals that (1) mono and di-chlorinated PCBs and their metabolites can be potential mutagens; (2) PCB benzoquinone metabolites could be carcinogenic but the weight of evidence is poor. These results support the hypothesis that environmental exposure to some PCBs and/or their metabolites could produce mutagenicity and/or carcinogenicity. Hence, these data should be considered as priority toxicological testing data needs. As with all computational toxicology analytical findings, these conclusions must yield to empirical data as they become available.

Implications of chemical mixtures in public health practice.

The Agency for Toxic Substances and Disease Registry (ATSDR) is a federal public health agency that investigates and strives to prevent human health problems produced by exposure to toxic chemicals and their mixtures in the environment. Most human exposures involving toxic chemicals or mixtures are thought to originate from environmental and occupational sources; however, concurrent exposures are also likely from other sources, such as prescription and nonprescription drugs, indoor air pollutants, alcohol, and tobacco smoke. Thus, in evaluating the potential hazard following exposure to environmental mixtures, ATSDR not only considers the inherent joint toxicity of the mixture but also the influence of environmental, demographic, occupational, and lifestyle factors. To foster these goals, ATSDR has pursued a Mixtures Research and Assessment Program that consists of three component efforts: trend analysis, joint toxicity assessment, and experimental testing. Through trend analysis, ATSDR sets priorities for environmental mixtures of concern for which joint toxicity assessments are conducted as needed. If data are not available to conduct appropriate assessments, a research agenda is pursued through established extramural mechanisms. Ultimately, the data generated are used to support ATSDR's work at sites involving exposure to chemical mixtures. This pragmatic approach allows testable hypotheses or research needs to be identified and resolved and enhances our understanding of the mechanisms of joint toxicity. Several collaborative and cooperative efforts with national and international organizations such as the Toxicology and Nutrition Office, the Netherlands, and the Department of Energy are being pursued as part of these activities. ATSDR also develops guidance manuals to consistently and accurately apply current methodologies for the joint toxicity assessment of chemicals. Further, expert panels often are assembled to resolve outstanding scientific issues or obtain expert advice on pertinent issues. Recently, the need for studies on chemical mixtures has been proposed as one of the six priority areas the agency identified in its agenda for public health environmental research. This has been reinforced through the agency's close work with communities whose leaders have spoken passionately about their concern for information on exposures to chemical mixtures. The five other priority research areas the agency identified are exposure, susceptible populations, communities and tribal involvement, evaluation/surveillance of health effects, and health promotion/prevention.

Gene induction studies and toxicity of chemical mixtures.

As part of its mixtures program, the Agency for Toxic Substances and Disease Registry (ATSDR) supports in vitro and limited in vivo toxicity testing to further our understanding of the toxicity and health effects of chemical mixtures. There are increasing concerns that environmental chemicals adversely affect the health of humans and wildlife. These concerns have been augmented by the realization that exposure to chemicals often occurs to mixtures of these chemicals that may exhibit complex synergistic or antagonistic interactions. To address such concerns, we have conducted two studies with techniques that are being used increasingly in experimental toxicology. In the first study, six organochlorine pesticides (4,4 -DDT, 4,4 -DDD, 4,4 -DDE, aldrin, dieldrin, or endrin) were selected from the ATSDR Comprehensive Environmental Response, Compensation and Liability Act of 1980 (or Superfund) priority list and tested for their ability to modulate transcriptional activation of an estrogen-responsive reporter gene in transfected HeLa cells. In these assays, HeLa cells cotransfected with an expression vector encoding estrogen receptor and an estrogen-responsive chloramphenicol acetyltransferase (CAT) reporter plasmid were dosed with and without selected environmental chemicals either individually or in defined combinations. Estradiol consistently elicited 10- to 23-fold dose-dependent inductions in this assay. By contrast, all six of the organochlorine pesticides showed no detectable dose-related response when tested either individually or in binary combinations. Thus, these chemicals as binary mixtures do not exhibit any additional estrogenicity at the levels tested in these assays. In the second study, arsenic [As(V)], cadmium [Cd(II)], chromium [Cr(III, VI)], and lead [Pb(II)] were tested in a commercially developed assay system, CAT-Tox (L), to identify metal-responsive promoters and to determine whether the pattern of gene expression changed with a mixture of these metals. This assay employs a battery of recombinant HepG2 cell lines to test the transcriptional activation capacity of xenobiotics in any of 13 different signal-transduction pathways. Singly, As(V), Cd(II), Cr(III, VI), and Pb(II) produced complex induction profiles in these assays. However, no evidence of synergistic activity was detected with a mixture of Cd(II), Cr(III), and Pb(II). These results have shown metal activation of gene expression through several previously unreported signal-transduction pathways and thus suggest new directions for future studies into their biochemical mechanisms of toxicity. In conclusion, the (italic)in vitro(/italic) methods used in these studies provide insights into complex interactions that occur in cellular systems and could be used to identify biomarkers of exposure to other environmental chemical mixtures.

Neurodevelopmental effects: making the case for biologic plausibility.

It has been suggested that the most critical missing link between science and policy is causality; that is, the establishment of a definite cause-effect relationship between exposure and adverse health effects. As has been clearly demonstrated by the decades-long tobacco debate, causality is extremely difficult to establish with absolute certainty, particularly in the minds of scientists. Because of this, it has been suggested that a "weight of evidence" approach based on biologic plausibility should be used as a surrogate for causality when translating science into policy and public health practice. In the case of neurodevelopmental effects, the case for biologic plausibility is supported by scientific findings from three broad areas consisting of wildlife biology, toxicology, and epidemiology. A striking example of this is provided by research findings from the Great Lakes Basin, an area which has been the focus of significant scientific research for the last thirty years in these three broad areas. In this paper, we examine relevant findings from the Great Lakes Basin and elsewhere as they relate to establishing and supporting the biologic plausibility of neurodevelopmental effects associated with environmental exposures to persistent toxic substances.

Public health challenges posed by chemical mixtures.

Approximately 40 million people live within a 4-mile radius of waste sites that the Agency for Toxic Substances and Disease Registry (ATSDR) has assessed to date. Human populations living in the vicinity of such sites are often subjected to complex chemical exposures that may contribute to the total body burden of oxogenous chemicals. Apart from the contaminants found at waste sites, exposure may also include environmental, occupational, and personal agents. Concurrent exposure to chemicals such as welding fumes, indoor air pollutants, tobacco smoke, alcohol, and prescription and nonprescription drugs makes the health assessment of exposure to waste site chemicals a more complex task. Voluntary exposures such as these frequently entail exposures to relatively high chemical concentrations and can usually be well defined and quantified. Conversely, involuntary exposures from waste sites may be at low concentrations and hence difficult to characterize and quantify. Of the approximately 1450 waste sites evaluated by the ATSDR, 530 (37%) had either completed or potentially completed exposure pathways. Results of public health assessments conducted at 167 sites during 1993 to 1995 show that about 1.5 million people have been exposed to site-specific contaminants. At 10% or more of the sites that had either completed or potentially completed exposure pathways, 56 substances were identified. Of these, 19 are either known or anticipated human carcinogens, and 9 are associated with reproductive or endocrine-disrupting effects. In this paper we present important concerns regarding hazardous waste sites including the impact on human health, ecology, and quality of life. To address such human-health related issues, the ATSDR has established a mixtures program that consists of three components: trend analysis to identify combinations of chemicals of concern, experimental studies to identify data that would be useful in the development and implementation of predictive decision support methodologies, and development of assessment methodologies and guidance to provide health assessors with the tools to incorporate the evaluation of multiple-chemical exposure into site assessments.

Estimation of toxicity of chemical mixtures through modeling of chemical interactions.

The Agency for Toxic Substances and Disease Registry (ATSDR), in collaboration with the Dutch Organization for Applied Scientific Research (TNO) Nutrition and Food Research Institute, is conducting studies to evaluate the role of chemical interactions in the expression of toxicity from low-level exposure to combinations of chemicals. The goal of this collaborative effort is to use a weight-of-evidence (WOE) approach to estimate joint toxicity of some simple chemical mixtures and to compare the estimations with test results from animal toxicity studies. The WOE approach uses individual chemical dose-response assessments and algorithms that incorporate various assumptions regarding potential chemical interactions. Qualitative evaluations were prepared for binary combinations of chemicals for the effect of butyl hydroxyanisole on di(2-ethylhexyl)phthalate, the effect of stannous chloride on Cd chloride (CdCl2), and the effect of CdCl2 on loperamide. Analyses of these evaluations and their comparison with the conclusions of laboratory animal experiments indicate that the WOE approach can be used to estimate qualitatively the joint toxicity of such simple mixtures. To further test the utility of the WOE approach, qualitative and semiquantitative evaluations were prepared for two chemical mixtures--one with similarly acting halogenated aliphatics (trichloroethylene, tetrachloroethylene, hexachloro-1,3-butadiene[HCBD], and 1,1,2-trichloro-3,3,3-trifluoropropene [TCTFP]) and the other with dissimilarly acting nephrotoxic components (mercuric chloride, lysinolalanine, D-limonene, and HCBD). These two sets of data were used to estimate the overall toxicities of the mixtures using the WOE algorithm for the mixture. The comparison of the results of the estimated toxicity with experimentally determined toxicity of the mixture of similarly acting nephrotoxicants demonstrated that the WOE approach correctly adjusted for the observed interactions in experimental animal studies. However, this was not true for the mixture of dissimilarly acting nephrotoxicants. This could be attributed to the fact that WOE evaluations are based on dose additivity that postulates that all chemicals in a given mixture act in the same way--by the same mechanism--and differ only in their potencies. In these cases the WOE approach evaluations, based on consideration of common mechanisms for simple chemical mixtures, can lead to better estimates of joint toxicity of chemical mixtures than the default assumption of dose additivity. The results also show that the WOE evaluations should be target-organ specific because none of the models tested could approximate the observed responses in organs other than the target organs in the laboratory animal studies.

Health and environmental effects profile for pentachloronitrobenzene.

Pure pentachloronitrobenzene (PCNB) is a colorless crystalline solid (Worthing, 1983). The commercial product may have a light-yellow to cream color with a musty odor (Hartley and Kidd, 1983). It is practically insoluble in a number of organic solvents. The compound is reasonably stable but may undergo hydrolysis in a strong alkaline medium (Hartley and Kidd, 1983). In 1983, Olin Corp., Leland, MS, was the only manufacturer of PCNB in the United States (SRI, 1984; Hartley and Kidd, 1983). No data for U.S. production volume for this chemical are available, but recent production source data (USITC, 1985; SRI, 1985) suggest that this chemical is no longer commercially produced in the United States. The primary usage of PCNB is as a soil fungicide for a wide variety of crops and in seed treatment (Worthing, 1983; Hartley and Kidd, 1983). The fate of PCNB in water has not been comprehensively studied. Only qualitative data regarding fate and transport in water are available. The half-life of PCNB in the water phase was estimated to be 1.8 days. The two processes reported to be most responsible for the rapid decrease in PCNB concentration in water were volatilization and sorption to seston and biota, followed by sedimentation as detritus (Schauerte et al., 1982). Neither biodegradation nor photolysis appears to be a significant process for the loss of PCNB from water (Crosby and Hamadmad, 1971; Schauerte et al., 1982). The BCFs for PCNB in the golden orfe, Leucisens idus melanotus, and in rainbow trout, Salmo gairdneri, were reported to be 950-1130 and 260-590, respectively (Korte et al., 1978; Oliver and Niimi, 1985). It therefore appears that PCNB will moderately bioaccumulate in aquatic organisms. Pertinent data regarding the fate and transport of PCNB in air could not be located in the available literature as cited in the Appendix. Based on its physical properties and its behavior in other media, it would appear that PCNB will persist in the atmosphere because no known chemical/photochemical processes significantly degrade this chemical. Precipitation of particulate PCNB, especially of larger particle size and higher particle density, may remove some PCNB from the atmosphere. PCNB is persistent in soils. The two processes that are important in the loss of PCNB from soils are volatilization and biodegradation; biodegradation is more rapid in soils under anaerobic conditions than under aerobic conditions (Ko and Farley, 1969; Casley, 1968; Gile and Gillett, 1979; Cole and Metcalf, 1977).(ABSTRACT TRUNCATED AT 400 WORDS)