Glycosylated hemoglobin in relation to rapid fluctuations in blood glucose in children with insulin-dependent diabetes: a comparison of methods with and without prior dialysis.

To evaluate the importance of dialysis in the determination of glycosylated hemoglobin (HbA1), we studied blood glucose and HbA1 in 38 insulin-dependent diabetic children during a morning fast and again 6 h postprandially. We used two methods to determine glycosylated hemoglobin: (1) the conventional macrocolumn method of Trivelli, which uses dialyzed hemolysate and (2) a commercially available microcolumn procedure, Isolab's Fast Hemoglobin Test System, which uses undialyzed blood samples. When the 6-h changes were assessed, the mean blood glucose had increased from 11.6 to 16.3 mmol/L (P less than 0.001). HbA1, determined by the microcolumn procedure simultaneously increased from 12.6% to 13.4% (P less than 0.001), and the increment in HbA1 correlated significantly with the increment in blood glucose (r = 0.62, P less than 0.001). HbA1 determined by the macrocolumn method increased slightly from 13.1% to 13.4% (P less than 0.01), and no correlation was present between the increment in blood glucose and HbA1 (r = -0.02, NS). When the microcolumn procedure was modified by employing dialyzed hemolysate, this method became unaffected by acute blood glucose variations. Therefore, dialysis in sample preparation appears to be important in minimizing the effect of acute changes in blood glucose on the level of glycohemoglobin. Methods in which dialyzed hemolysates are used may be more useful as an index of long-term glucose control.

Three weeks' exposure of rats to dearomatized white spirit modifies indices of oxidative stress in brain, kidney, and liver.

The present study was undertaken in order to investigate whether dearomatized white spirit induces indices of oxidative stress in subcellular fractions of hemisphere, hippocampus, kidney and liver tissue of rats exposed to 0, 400 and 800 ppm 6 hr/day, 7 days a week for 3 weeks. The results show that white spirit is a strong in vivo inducer of oxidative stress in subcellular fractions of brain, kidney and liver. In the liver there was a statistically significant increase in the rate of reactive oxygen species (ROS) generation and a decrease in glutamine synthetase activity. In the kidney there was a statistically significant decrease in the rate of ROS generation. In the hemisphere there was a statistically significant increase in the level of reduced glutathione. In the hippocampus there was a statistically significant increase in the rate of ROS generation. However, in vitro addition of dearomatized white spirit had no effect on the rate of cerebrocortical P2 fraction ROS generation. The results suggest that cumulative oxidative damage may be an underlying mechanism of dearomatized white spirit-induced neurotoxicity and that various regions of the brain may respond differently.

Neuronal loss in hippocampus in rats exposed to toluene.

Both clinical and epidemiological studies of the effects of exposure to toluene have shown that long-term exposure may result in chronic toxic encephalopathy, where one of the major symptoms is memory deficits. We have attempted to identify the structural basis of the toxic effects of toluene in the hippocampus, a region of the brain known to be involved in learning and memory processes and well suited for stereological analysis. Rats were exposed to 1500 ppm of toluene, six hours per day, five days per week for six months. This was followed by a four-month-period without exposure prior to sacrifice. The total number of neurons in each of the five subdivisions of hippocampus of six exposed and six control rats was estimated with the optical fractionator. A statistically significant neuron loss of 16% was found in regio inferior (CA3 and CA2) of the exposed rats.

Effect on the content of n-acetylaspartate, total creatine, choline containing compounds, and lactate in the hippocampus of rats exposed to aromatic white spirit for three weeks measured by NMR spectroscopy.

Several epidemiological studies of workers occupationally exposed to white spirit show that neuropsychiatric disorders are a frequent cause of early disability pension in this population compared with non-exposed controls. In the rat, we have demonstrated that exposure to different kinds of white spirit induces changes in neurotransmitter concentrations, indices of oxidative stress, and electrophysiological parameters. Others have confirmed that acute behavioural effects can be induced by short-term high-level exposure. With NMR spectroscopy technique it is possible to study neurochemical parameters in vivo, and to examine the same subjects repeatedly over time. NMR spectroscopy was used to study the effects of organic solvents in rats. Rats were exposed to 0, 400 ppm, or 800 ppm of aromatic white spirit 6 hr/day, 7 days/week for 3 weeks. During the first week, the rats showed signs of irritation of mucous membranes, and appeared to be sedated. Both types of effect gradually diminished during the second week. The rats were examined by single volume of interest (VOI) NMR spectroscopy. N-acetylaspartate, creatinine and phosphocreatinine, and choline containing compounds were measured in the hippocampus and surrounding regions. The concentration of N-acetylaspartate for the three groups was found to be in the range of 8.2-8.5 mM with a standard deviation of 0.6-0.9. There was no difference between the three groups. In a previous study no change in the number of astrocytes in hippocampus was found following exposure to white spirit for six months. Since N-acetylaspartate is thought to be a marker for neurons, the results of these two studies indicate that white spirit does not produce a marked neuronal loss. However, it was not possible to show effect of trimethyltin. In this study trimethyltin was used as a "positive control'. The NMR technique can be applied to the rat, and it is possible to obtain reasonable signal-to-noise ratios.

Toxicity of the styrene metabolite, phenylglyoxylic acid, in rats after three months' oral dosing.

Male Wistar rats were dosed with 0, 1250, 3750 or 5000 mg/l of phenylglyoxylic acid (PGA) (CAS no. 611-73-4) in the drinking water ad libitum for 3 months. During the entire treatment period, there were no gross signs of toxicity related to PGA. No changes in neurobehavior were found after using a functional observational battery or radial arm maze. An increased relative kidney weight was seen in the highest dose-group (Controls: 0.504 +/- 0.031 g/100 g b.wt.; 5000 mg PGA/l: 0.579 +/- 0.033 g/100 g b.wt.; p<0.01). No other organ weights were affected. Histopathology revealed no change in kidney structure. No changes in clinical biochemistry. In the highest dose-group three animals out of ten showed reduction in peripheral nerve myelin sheath thickness. No such changes were seen in the control group. The study revealed no changes in auditory brain stem response but minor changes in electroretinography. The noradrenaline (NA) concentration decreased in pons and thalamus whereas it increased in medulla oblongata and whole brain. The dopamine (DA) concentration increased in cerebellum, hippocampus, pons, and whole brain. The most marked DA increase was seen in hippocampus (Controls: 0.56 +/- 0.10 nmol/g tissue; 5000 mg/l: 1.04 +/- 0.11 nmol/g tissue; p<0.001). The 5-hydroxytryptamine (5-HT) concentration decreased in cerebellum, cerebral cortex, hippocampus, and medulla oblongata, whereas it increased in thalamus. The yield of synaptosomal protein, synaptosomal NA, DA, and 5-HT concentrations, and DA uptake rate were not affected. When dosed males were mated with naive females, there were no differences between groups in the pregnancy rate, number of corpora luteae, implantations, live or dead fetuses, resorptions, preimplantation loss, or postimplantation loss. It is concluded that a part of the effects on kidney, peripheral nerves, and vision, which have previously been reported after exposure to styrene, might be induced by the styrene metabolite, PGA. If PGA has ototoxic effects in rats, the dosing in the present study is not sufficient to induce the necessary ototoxic concentration in blood. Alternatively, the ototoxicity of styrene, like toluene, may be caused the parent compound itself and not by a metabolite like PGA.

The IPCS Collaborative Study on Neurobehavioral Screening Methods: III. Results of proficiency studies. Steering Group.

The goal of the IPCS Collaborative Study on Neurobehavioral Screening Methods was to determine the intra- and inter-laboratory reliability of a functional observational battery (FOB) and an automated assessment of motor activity in eight laboratories world-wide. The first phase of the Collaborative Study involved training the participants: evidence of training was then evaluated using positive-control compounds. The positive-control studies required the laboratories to identify, using the FOB, specific neurotoxic syndromes produced by acute exposure to p,p'-DDT, parathion, and by short-term repeated dosing with acrylamide. For the sake of expediency, only one dose of each chemical was used instead of collecting dose-response data. Motor activity test chambers were not of uniform design. The laboratories were therefore required to demonstrate adequate sensitivity by the ability to detect statistically-significant activity increases and decreases produced by triadimefon and chlorpromazine, respectively, following acute administration of a range of doses. The resulting FOB and motor activity data showed variability in the magnitude of effects obtained: some of these differences were attributed to miscommunications, difficulties with the techniques or protocol, or the limitations of having only one dose. All laboratories, however, successfully met the criteria set forth by the Study Steering Committee.

The IPCS Collaborative Study on Neurobehavioral Screening Methods: IV. Control data. Steering Group.

The goal of the International Programme on Chemical Safety (IPCS) Collaborative Study on Neurobehavioral Screening Methods was to determine the intra- and inter-laboratory reliability of a functional observational battery (FOB) and an automated assessment of motor activity in eight laboratories worldwide. The control data were crucial to the outcome of the studies in terms of sensitivity and reliability of the test measures, which in turn impact on the between-laboratory comparisons of chemical effects. In addition, analyses of control data can aid in determining endpoints that may require modification to improve their sensitivity and reliability. The control data from the eight laboratories were examined in terms of the following parameters: 1) control variability within studies for each laboratory; 2) within-laboratory replicability of control values across studies; 3) within-laboratory stability of control values over the course of testing for a given study; and 4) between-laboratory comparisons of parameters (1), (2), and (3). The analyses indicated considerable differences across endpoints, wherein some measures showed high variability and little replicability, while others were extremely reproducible. Generally, there were similar ranges of variability and replicability of control data across laboratories, although in some cases one or two laboratories were markedly different from the others. The physiological (weight, body temperature) and neuromuscular (grip strength, landing foot splay) endpoints exhibited the least variability, whereas the subjective assessments of reactivity varied the most. These data indicate a reasonable degree of comparability in the data generated in the participating laboratories.

The IPCS Collaborative Study on Neurobehavioral Screening Methods: V. Results of chemical testing. Steering Group.

The IPCS Collaborative Study on Neurobehavioral Screening Methods was undertaken to determine the intra- and inter-laboratory reliability of a functional observational battery (FOB) and an automated assessment of motor activity in eight laboratories world-wide. Following the training phase and the conduct of proficiency studies in all laboratories, participants proceeded to test the effects of seven chemicals in both single dose and four-week repeated dosing scenarios. The chemicals studied were acrylamide, bisacrylamide, p,p'-DDT, lead acetate, parathion, toluene, and triethyl tin. Participants received coded samples from a common source. In order to judge the general utility of these procedures in a diversity of testing situations, laboratories conducted the studies under their standard conditions, using their choice of rat strain and test equipment. Chemical does and time of peak effect for acute testing were determined by each laboratory: these parameters were quite similar for some chemicals, but varied greatly for others. The results of the chemical tests indicated that while there was some variability in the data on specific endpoints, all laboratories detected and characterized the effects of all but one of the known neurotoxicants. The one exception (toluene) was probably due to other factors (e.g., dose level, route of administration) rather than lack of sensitivity of the test methods. This study provides extensive data regarding the use of neurobehavioral screening methods over a range of laboratory conditions as well as the reliability, sensitivity, and robustness of the tests to detect neurotoxic potential of chemicals.

Three weeks' and six months' exposure to aromatic white spirit affect synaptosomal neurochemistry in rats.

The effects of 3 weeks' or 6 months' inhalation exposure of rats to aromatic white spirit 6 h/day, 5 days/week at 0, 400, or 800 ppm were studied. Synaptosomal neurochemistry was investigated as index of the in situ conditions in the presynaptic nerve terminal. In both studies, the relative and absolute yield of synaptosomal protein were significantly reduced in the two exposed groups. Both studies demonstrated increased synaptosomal noradrenaline (NA), dopamine (DA), and 5-hydroxytryptamine (5-HT) concentrations, high- affinity 5-HT uptake rate and uptake capacity. It is hypothesized that a reduced density and total number of synapses in situ may be functionally compensated by increased NA, DA, and 5-HT neurotransmitter release, or by increased activity of corresponding neurons. The increased synaptosomal 5-HT uptake rates and uptake capacities may explain the previously demonstrated increased global and regional neurotransmitter concentrations and the present finding of increased synaptosomal 5-HT concentrations. These changes are interpreted as an indication of toxic effect on the CNS function and are considered supportive of recent findings of electrophysiological changes and affected motor activity following 6 months' exposure to dearomatized white spirit followed by an exposure-free period.

Inhalation exposure to white spirit causes region-dependent alterations in the levels of glial fibrillary acidic protein.

Enhanced expression of glial fibrillary acidic protein (GFAP) is known to be associated with toxicant-induced gliosis, a homotypic response of the central nervous system to neural injury. A variety of neurochemical and neurophysiological effects have been observed in experimental animals exposed to white spirit, but a linkage of such effects to neural damage has not been established. Here we evaluated the regional levels of GFAP to assess potential sites of CNS damage in the rat, following exposure to dearomatized and aromatic white spirit. Samples from rats exposed to dearomatized white spirit were assayed for GFAP levels in the United States and Denmark. The results were remarkably similar between countries. Small region-dependent increases and decreases in GFAP were observed with the cerebellum showing the most consistent effects (increases). In contrast, samples from rats exposed to aromatic white spirit showed large (as much as 150% of control) increases in regional levels of GFAP; again, the cerebellum showed the most consistent effects. The data are indicative of an aromatic white-spirit-induced astrogliosis in several regions of the rat CNS and suggest that chronic exposure to this solvent may be associated with underlying neural damage.

Dearomatized white spirit inhalation exposure causes long-lasting neurophysiological changes in rats.

Exposure for 6 h per day, 5 days per week, during a period of 6 months to the organic solvent dearomatized white spirit (0, 400, and 800 ppm) was studied in rats that were 3 months old when the repeated exposure was initiated. After an exposure-free period of 2-6 months duration, neurophysiological, neurobehavioral, and macroscopic pathologic examinations were performed. The study revealed exposure-related changes in sensory evoked potentials and a decrease in motor activity during dark (no light) periods but no white spirit-induced changes in learning and memory functions. The measurements of the flash evoked potential (FEP), somatosensory evoked potential (SEP), and auditory brain stem response (ABR) all demonstrated dose-dependent increases of the amplitudes of the early latency peaks of the sensory evoked potentials (EPs). Furthermore, an increase of the dose showed that the measurements of FEP and SEP revealed changes in the later-latency peaks, which reflect the more associative aspects of sensory processing. The results demonstrated that 6 months of exposure to dearomatized white spirit induced long-lasting and possible irreversible effects in the nervous system of the rat.

Repeated dose 28-day oral toxicity study in Wistar rats with a mixture of five pesticides often found as residues in food: alphacypermethrin, bromopropylate, carbendazim, chlorpyrifos and mancozeb.

Six dose groups of 8 male and female rats respectively received a daily dose equivalent to 0, 0.15, 0.006, 0.03, 0.15 or 0.3 mg/kg b.w./day chlorpyrifos (groups 1-6) and the last four dose groups (groups 3-6) received in addition daily doses equivalent to 18 mg/kg b.w./day alphacypermethrin, 30 mg/kg b.w./day bromopropylate, 45 mg/kg b.w./day carbendazim and 12.5 mg/kg b.w./day mancozeb for 28 days. Plasma acetylcholinesterase was significantly decreased in the groups 2, 5 and 6 males. Total white blood cell count was significantly lower in females of group 6. Total red blood cell count, haematocrite and haemoglobin concentration was significantly reduced in both male and female rats of groups 5 and 6. Relative liver weight was significantly increased in groups 3-6 male and female rats. Absolute thyroid gland weight was significantly increased in groups 3, 5 and 6 male rats and of groups 3-6 female rats, and relative thyroid gland weight was significantly increased in groups 2-6 male rats and of groups 3-6 female rats. Absolute thymus weight of groups 3-6 male and female rats and relative thymus weight of groups 3-6 male rats and groups 3 and 4 female rats was significantly decreased. A mild degree of centrilobular cell hypertrophy of the liver was seen in all male rats and of three female rats of group 6. In the thyroid gland follicular cell hypertrophy was present in one female in the control group and in six females and seven males of group 6. It was concluded that inhibition of acetylcholinesterase activity in plasma and brain by chlorpyrifos was not enhanced by co-administration of the other four pesticides. Effects were seen in liver, thyroid, thymus and blood in the combination groups. However, identification of the pesticide(s) responsible for these changes would require further studies of the individually pesticides as well as various combinations of the pesticides.

[CT in children with epilepsy. The value of cerebral CT in children with epilepsy]. / CT hos børn med epilepsi. Vaerdien af cerebral CT hos børn med epilepsi.

In a retrospective material of 66 children with epilepsy, computed tomographic scanning had been undertaken in 30 cases. Abnormal computed tomographic findings were observed in five children in the form of cerebral tumour or sequelae of head injuries or perinatal asphyxia. All five children had focal EEG changes but none of these as the only positive finding. The investigation had therapeutic consequences in one case only, viz the case where computed tomographic scanning confirmed the clinical suspicion of tumour. The value of computed tomographic scanning in children with epilepsy is discussed, particularly in children with focal EEG changes.

[Neurocysticercosis. Severe neurocysticercosis in a child]. / Neurocysticerkose. Svoer neurocysticerkose hos et barn.

A case of neurocysticercosis with progressive severe neurological symptoms is described. The patient was a Turkish girl aged 4 1/2 years who had experienced intermittent neurological symptoms for two years. Rapid diagnosis and treatment with praziquantel and corticosteroid resulted in complete restitution.

[Toxic shock syndrome. A case of a child with burns]. / Toksisk shock syndrom. Et tilfoelde hos et barn med forbroending.

A case of the toxic shock syndrome (TSS) in a burnt (scalded) child is presented. TSS is a condition most frequently associated with menstruating women using tampons. In recent years, however, increased knowledge of the syndrome has led to an increase in the number of reported cases associated with other clinical situations. The non-menstrual cases are most frequently observed in young persons many of whom are children. TSS is due to infection with toxin-producing S. aureus. TSS-toxin-1 is apparently the most important among toxins. The fatality rate has been reported to be as high as 15%, so recognition of the syndrome and institution of the correct treatment are of utmost importance. By means of an easy and rapid test, it is possible to detect if the strain of S. aureus is TSST-1-producing. The test is now available and employs passive latex agglutination. The sensitivity and specificity are high and, if clinical signs of TSS are present, a positive test result will support the diagnosis in 94% of alle positive cases.

The applicability of the ADI (Acceptable Daily Intake) for food additives to infants and children.

Children are not little adults. Children may respond differently from adults because they are in a state of growth and development; or because of differences in toxicokinetics or toxicodynamics. Infants and children are often assumed to be more susceptible to toxic effects, but this generalization is founded on assumptions rather than on facts. Available data are mostly concerned with toxicity and therapeutic effects of pharmaceuticals, while the effects in children of industrial chemicals are less well documented. Childhood is characterized by growth and development. Toxicants may interfere with these processes, and therefore toxic exposure may have more serious consequences for children than for adults, irrespective of sensitivity. Immature physiological functions of the foetus and young child theoretically make these age groups more vulnerable to toxicants, at least up to 1 year of age. The existing data on effects of chemical exposure in children point in the direction that susceptibility depends on the substance and on the exposure situation. For a particular compound children may be more sensitive than adults, or they may be less sensitive. Further, the sensitivity of children to a particular substance varies greatly with age. It is necessary to view premature neonates, neonates, infants, and children of different ages as separate risk groups. The long-term studies used as the basis for establishing ADIs cover lifetime for laboratory animals. Methods which have special emphasis on reproductive cells, on the foetus, and on the immature organism are used. Taken together, these studies cover exposure during all life stages. However, some specific types of effects, and delayed effects of perinatal exposure are not always included in standard toxicity test protocols. Exposure may also differ between children and adults. The food intake of children is qualitatively and quantitatively different form that of adults, and the EU Scientific Committee for Food has recommended that intake assessment of children be considered separately from that of adults because patterns of consumption are different. The ADI should cover the entire population including children. Special considerations regarding the use of food additives do apply to infants below the age of 12 weeks, who depend entirely on infant formula for nutrition.

The 8p-syndrome.

A partial de novo deletion of 8p in a 10 1/2 month-old boy is described, the karyotype being 46,XY,del(8) (p21.3-qter:). Reduced birth weight, growth and psychomotor retardation, craniofacial dysmorphism with microcephaly and low set, deformed ears, stubby nose, wide set nipples, congenital heart defect and undescended testes were the main clinical findings. Death occurred at 2 1/2 years of age due to fulminant tracheo-bronchitis. Red cell glutathion reductase activity was normal. A review of previous cases with similar deletions outlines a definite clinical entity.

Atrophic, autoimmune thyroiditis in infancy. A case report.

Autoimmune thyroiditis in infancy is a very rare condition. Only 1 case has been reported previously. In the present patient an acquired primary hypothyroidism with high titers of thyroid microsomal antibodies was diagnosed at the age of 7 months. The patient died at 9 months of age in a sepsis-like condition. Autopsy revealed an atrophic thyroiditis. The more severe and complex clinical picture of autoimmune thyroiditis in infancy compared to that later in childhood is discussed.