Fractional epidermal grafting in combination with laser therapy as a novel approach in treating radiation dermatitis.

Radiation injury to the skin is a major source of dysfunction, disfigurement, and complications for thousands of patients undergoing adjunctive treatment for internal cancers. Despite the great potential for affecting quality of life, radiation injury has received little attention from dermatologists and is primarily being managed by radiation oncologists. During our volunteer work in Vietnam, we encountered numerous children with significant scarring and depigmentation of skin from the outdated use of radioactive phosphorus P32 in the treatment of hemangiomas. This dangerous practice has left thousands of children with significant fibrosis and disfigurement. Currently, there is no treatment for radiation dermatitis. Here, we report a case series using the combination of laser treatment, including pulsed-dye laser, fractional CO2 laser, and epidermal grafting to improve the appearance and function of the radiation scars in these young patients. We hope that by improving the appearance and function of these scars, we can improve the quality of life for these young patients and potentially open up a new avenue of treatment for cancer patients affected with chronic radiation dermatitis, potentially improving their range of motion, cosmesis, and reducing their risk of secondary skin malignancies.

Cyanotoxin mixtures and taste-and-odor compounds in cyanobacterial blooms from the Midwestern United States.

The mixtures of toxins and taste-and-odor compounds present during cyanobacterial blooms are not well characterized and of particular concern when evaluating potential human health risks. Cyanobacterial blooms were sampled in twenty-three Midwestern United States lakes and analyzed for community composition, thirteen cyanotoxins by liquid chromatography/mass spectrometry and immunoassay, and two taste-and-odor compounds by gas chromatography/mass spectrometry. Aphanizomenon, Cylindrospermopsis and/or Microcystis were dominant in most (96%) blooms, but community composition was not strongly correlated with toxin and taste-and-odor occurrence. Microcystins occurred in all blooms. Total microcystin concentrations measured by liquid chromatography/mass spectrometry and immunoassay were linearly related (r(s) = 0.76, p < 0.01) and LC/MS/MS concentrations were lower than or similar to ELISA in most (85%) samples. Geosmin (87%), 2-methylisoborneol (39%), anatoxin-a (30%), saxitoxins (17%), cylindrospermopsins (9%), and nodularin-R (9%) also were present in these blooms. Multiple classes of cyanotoxins occurred in 48% of blooms and 95% had multiple microcystin variants. Toxins and taste-and-odor compounds frequently co-occurred (91% of blooms), indicating odor may serve as a warning that cyanotoxins likely are present. However, toxins occurred more frequently than taste-and-odor compounds, so odor alone does not provide sufficient warning to ensure human-health protection.

Fatalities Due to Failure of Continuous Subcutaneous Insulin Infusion Devices: A Report of Six Cases.

Diabetes mellitus type 1 and type 2 are diseases characterized by impaired regulation of blood glucose due to decreased insulin production and insulin resistance, respectively. Management of diabetes mellitus often requires injection of exogenous insulin. Continuous subcutaneous insulin infusion (CSII or insulin pump) is a diabetes treatment modality utilizing a device to aid in regulation of glycemic control. Malfunctions in device components can have rare fatal consequences. Described in this report are six fatalities due to one such malfunction, the failure of plastic cannulas of CSII devices to penetrate the skin and deliver insulin, resulting in fatal diabetic ketoacidosis (DKA). The cases derive from four different death investigation systems. For each case, scene and autopsy findings are presented, as well as selected toxicology and histology findings. These cases illustrate the importance of careful examination of CSII devices in death investigations and introduce a discussion on discrepant manner of death classifications.

The legacy of leaded gasoline in bottom sediment of small rural reservoirs.

The historical and ongoing lead (Pb) contamination caused by the 20th-century use of leaded gasoline was investigated by an analysis of bottom sediment in eight small rural reservoirs in eastern Kansas, USA. For the reservoirs that were completed before or during the period of maximum Pb emissions from vehicles (i.e., the 1940s through the early 1980s) and that had a major highway in the basin, increased Pb concentrations reflected the pattern of historical leaded gasoline use. For at least some of these reservoirs, residual Pb is still being delivered from the basins. There was no evidence of increased Pb deposition for the reservoirs completed after the period of peak Pb emissions and (or) located in relatively remote areas with little or no highway traffic. Results indicated that several factors affected the magnitude and variability of Pb concentrations in reservoir sediment including traffic volume, reservoir age, and basin size. The increased Pb concentrations at four reservoirs exceeded the U.S. Environmental Protection Agency threshold-effects level (30.2 mg kg(-1)) and frequently exceeded a consensus-based threshold-effects concentration (35.8 mg kg(-1)) for possible adverse biological effects. For two reservoirs it was estimated that it will take at least 20 to 70 yr for Pb in the newly deposited sediment to return to baseline (pre-1920s) concentrations (30 mg kg(-1)) following the phase out of leaded gasoline. The buried sediment with elevated Pb concentrations may pose a future environmental concern if the reservoirs are dredged, the dams are removed, or the dams fail.