Diagnosing metal fume fever--an integrated approach.

BACKGROUND: Exposure to high concentrations of zinc oxide fume can cause metal fume fever (MFF). Two cases occurring following the oxy-acetylene cutting of galvanized steel frames are reported. AIMS: To show that integrated working is valuable as secondary health care staff may not be familiar with MFF. METHODS: Site visits by Her Majesty's Medical, Health and Safety (H&S) and Specialist Occupational Hygiene Inspectors to gather information and cooperation with occupational health, primary and secondary health care staff to diagnose MFF. RESULTS: Poor exposure control caused metal fume inhalation in these cases. Multidisciplinary working established diagnosis, causation and compliance with H&S legislation. CONCLUSIONS: Risk assessments are required to identify health risks and to determine required exposure control measures. Failure to do this resulted in an unusual case of MFF leading to hospital admission. Diagnosis can be delayed if a full occupational history is not taken. Successful investigation of such cases benefits from collaborative working.

Upregulation of H+-ATPase in the distal nephron during potassium depletion: structural and functional evidence.

In the present study, we have investigated the effects of dietary potassium depletion on the activity and distribution of the H+-ATPase in the distal nephron of the Sprague-Dawley rat. H+-ATPase activity was assessed from the change in transepithelial potential difference (Vte) in response to bafilomycin A1 during perfusion of the late distal tubule in vivo, with solutions containing inhibitors of known ion channels. Bafilomycin A1 caused a negative deflection in Vte in control animals, an effect that was significantly enhanced during potassium depletion (P < 0.01). The distribution of H+-ATPase within the population of intercalated cells was assessed using a specific monoclonal antibody (E11). Hypokalemia was associated with a highly significant redistribution of the staining pattern (P < 0. 001), with an increase in the percentage of cells displaying immunoreactivity in the apical membrane. These results indicate that dietary potassium depletion increases electrogenic H+-ATPase activity in the rat distal tubule; this may be associated with increased insertion of pumps into the apical membrane.

Yields of muscle from myogenic cells implanted into young and old mdx hosts.

Implantation of normal muscle precursor cells (mpc) for treatment for inherited myopathies such as Duchenne muscular dystrophy is in clear need of improvement to become practicable, but few variables have been studied comparatively. Here, we report the first quantitative estimate of the effectiveness of implanting mpc into preirradiated muscles of young and old mice and into preirradiated and nonirradiated old muscles. Estimates were made of the amount of muscle formed by injection of 5 x 10(5) cells dissociated from neonatal normal mouse muscle into tibialis anterior muscles of the dystrophin-deficient mdx mouse. We show that normal mpc are incorporated slightly more efficiently into muscles of young than old host mice, to form some 10 mg of dystrophin-positive fibers. In older muscles, prior irradiation has little effect on the total yield of new muscle.

Ovarian torsion: an unusual cause of bilateral pelvic calcifications.

Ovarian calcification in children is rare, usually unilateral, and in most cases implies tumor involvement. A case of bilateral ovarian torsion with calcification that might mimic neoplasm is presented along with a literature review.

Alterations in protein kinase activity following exposure of cultured human lymphocytes to modulated microwave fields.

Cultures of human tonsil lymphocytes were exposed in a Crawford cell to a 450-MHz field (peak envelope intensity 1.0 mW/cm2), sinusoidally amplitude modulated (depth 80%) at frequencies between 3 and 100 Hz for periods up to 60 min. The Crawford cell was housed in a temperature-controlled chamber (35 degrees C) and control cultures were placed in the same chamber. Activity of cAMP-dependent protein kinase relative to controls remained unaltered by fields modulated at 16 or 60 Hz with exposures of 15, 30, and 60 min. By contrast, total non-cAMP-dependent kinase activity fell to less than 50% of unexposed control levels after 15 and 30 min exposures, but, despite continuing field exposure, returned to control or preexposure levels by 45 and 60 min. A smaller reduction (20-25%) also occurred with 60-Hz modulation and was also restricted to exposure durations of 15 and 30 min. CW 450-MHz fields were without effect. Reduced enzyme activity occurred with 16-, 40-, and 60-Hz modulation frequencies, but not with 3-, 6-, 80-, or 100-Hz modulation. The specific identity of this kinase is unknown. This rapid but transient reduction in lymphocyte protein kinase activity restricted to modulation frequencies between 16 and 60 Hz and to less than 30 min exposure is consistent with "windowing" with respect to modulation frequency and exposure duration.

Clinical content of the WAMI community clerkship in family medicine.

Student experience with diagnostic encounters and clinical procedures was documented in the WAMI Program's Community Clerkship in Family Medicine from 1974 to 1978. This six-week senior clerkship was completed by 234 students and taught in six family practicees across the four-state WAMI (Washington, Alaska, Montana, Idaho) region. Students encountered a mean of 83 diagnostic problems and 22 procedures weekly. The average student saw 56 percent of the diagnoses common in family practic and performed 26 percent of the common procedures. The mean level of student responsibility (self-rated with 3 = independent management, 2 = assisted, and 1 = observed) was 2.7 for diagnostic encounters and 2.4 for procedures and increased over the four years. Despite the wide geographic separation and diversity of teaching sites, few differences were observed among the sites; this suggests that a community-based family medicine clerkship can be taught in a widely scattered network of rural teaching practices with uniformity of clinical content and educational quality.