[The reliability of conclusions based on hair mineral analysis in individual diagnostic]. / Zur Aussagekraft von Haarmineral- Analysen in der individuellen klinischen Diagnostik.

The advantages of ubtaining samples for hair mineral analysis (HMA) as well as the possibility to measure former exposures and in addition to carry out segment analysis make it desirable to work with HMA in order to find a diagnosis. The laboratories which offer HMA differ distinctly in their procedure of analysis and quality control. HMA is generally not usable for individual diagnostic with two exceptions (arsenic and methylmercury) because of the large number of factors of individual and environmental influences and sources of error of the method of analysis. HMA can be used for cadmium, lead, and zinc in order to compare a single person with a larger population. Further research into the relationship of content of elements in hair and other tissues of the body is desirable.

Herbicide use on railway tracks for safety reasons in Germany?

A short overview on the occurrence of herbicides in groundwater and drinking water located in the vicinity of railway tracks in Germany is presented. The study has been conducted using the experience of various water supply companies and includes a literature research on the subject. It has been documented that in Germany only 1% of the total area treated with pesticides was under management of the former Deutsche Bundesbahn before 1990. The specific amount applied on the railway tracks was, however, a factor of 6 higher than that used in agriculture, although it must be borne in mind that the retaining capacity of railway tracks for pesticides is much lower. The herbicides applied ranged from 2,4-D and 2,4,5-T, triazine derivatives, e.g. atrazine and urea derivatives such as diuron. Traces of almost all of the herbicides applied could be detected in samples of groundwater and drinking water in the vicinity of railway tracks. Since 1997 only glyphosate has been used.

Presence of bleomycin-detectable free iron in the alveolar system of preterm infants.

Chronic lung disease (CLD) is a major cause of long term morbidity in preterm infants. Reactive oxygen species (ROS) play an important role in the pathogenesis of CLD. We show that a high percentage (63 to 83%) of the investigated bronchoalveolar secretions (BAS) of neonates contain bleomycin-detectable free iron concentrations (0. 04-0.124 nmol/micrograms SC, median range). Beside the presence of redox-active iron several iron-binding proteins like transferrin, ferritin and lactoferrin were determined in BAS. Comparison of protein distribution within the first three days of life showed slight differences between the group of preterm infants who developed CLD and the neonates who recovered from RDS. Because of the existence of free iron we suggest a higher risk of hydroxyl radical formation in the alveolar space. In an artificial system with addition of iron and hydrogen peroxide we were able to demonstrate OH-radical production in BAS by electron paramagnetic resonance (EPR). OH-radical formation by H2O2 and iron in buffer solution was slightly enhanced in the presence of BAS, indicating the absence of OH-radical-scavengers in BAS.

Selenium status in fibromyalgia.

Fibromyalgia (FM) is a chronic musculoskeletal pain syndrome of unknown etiology. The serum concentration of selenium (Se) was measured in 68 consecutive patients (nine male, mean age: 47 years; 59 female, mean age 49 years) with FM. The age- and sex-matched control group included 97 female healthy blood donors (mean age 46 years). The method is based on high-performance liquid chromatography (HPLC) involving detection of the fluorescent diaminonaphthalene (DAN) derivate of selenite. There was a statistical significant difference (P < 0.05) in serum Se between control (median 77 microg/l; range: 50-118 microg/l) and patients (median 71 microg/l; range: 39-154 microg/l) groups in the region of Tübingen, Germany.

Mercury concentrations in fetuses with malformations.

The total mercury concentrations in placenta, kidney and liver of 59 fetuses with malformations were detected and measured by cold-vapour atomic absorption spectrometry. Median values were 13 micrograms/kg for placenta, 20 micrograms/kg for kidney and 31 micrograms/kg for liver, based on the use of paraffin-embedded tissue (pt), which generally leads to values of concentration double those obtained on a wet weight basis. The tissue concentrations presented here are in the same range as results from other studies. Measurements in a control group of 56 fetuses without malformations from the same geographical region were also carried out. These demonstrated a median value of the liver-Hg-burden of 27 micrograms/kg (pt). The higher liver concentrations of the fetuses with malformations could be explained by growth retardation, leading to seemingly higher tissue concentrations of mercury. Regarding the results according to the organs affected by malformations, no abnormally high Hg-concentrations in the liver of any group were detected. Summing up, our investigations show no evidence of mercury implication in these malformations, and it was finally concluded that the mercury burden of the population in this region would not lead to organ malformations in the developing fetus.

Occurrence of polychlorinated terphenyls (PCTs) in indoor particulate matter.

In the course of a routine investigation concerned with polychlorinated biphenyl (PCB) contamination of dust collected in classrooms of a junior high school, a group of electron capture detector (ECD)-sensitive compounds with high boiling points were found in addition to PCBs. Using gas chromatographic-mass spectrometric techniques, these compounds were identified as polychlorinated terphenyls (PCTs). Additional measurements indicated that the PCTs were present only in particulate matter collected from the tops of fluorescent light frames but not in air samples obtained concomitantly in the classrooms. Attempts to identify the PCT emission source were unsuccessful. A survey of the literature revealed that PCTs are ubiquitously distributed environmental contaminants, although no data on their indoor occurrence have been reported to date. In view of the toxic effects of PCTs, which seem to be as important as those of PCBs, further attention should be given to the possible presence of PCTs in indoor environments.

Mercury in urine and ejaculate in husbands of barren couples.

Mercury concentrations in morning urine and ejaculate were detected in 80 husbands of women presenting for infertility treatment. Additionally, the number of their dental amalgam fillings was documented. A routine spermiogram was performed, from which a numerical "fertility index" was calculated. Urinary mercury concentrations were in the range of non-exposed populations, only minute Hg concentrations were determined in ejaculate, 75% of the semen sample concentrations were under the detection limit of 5 micrograms/l. In comparison, 7 proven fertile workers with occupational mercury exposure had elevated levels of mercury in their ejaculates (range 10-65 micrograms/l). No positive correlation could be established between subject mercury concentrations in urine or ejaculate and the quality of their semen, expressed as fertility index. Equally, no such correlation could be established between the fertility index and the number of their dental amalgam fillings. From these preliminary data no evidence can be derived for the alleged relation between the mercury burden from dental amalgam fillings and male fertility disorders.

Pentachlorophenol in the indoor environment: evidence for a correlation between pentachlorophenol in passively deposited suspended particulate and in urine of exposed persons.

Analysis of passively deposited suspended particulate (PDSP) proved to be a reliable and easily applicable method for the investigation of pentachlorophenol (PCP) exposure from indoor air. PDSP was analyzed after manual collection of samples in 78 rooms with wooden paneling, where earlier treatment with wood preservatives was suspected. Pentachlorophenol was quantitatively determined by gas chromatography with an electron capture detector following derivatization with acetic anhydride. For biological monitoring of PCP, morning urine specimens were collected from 135 persons living in the rooms investigated. After acidic hydrolysis, these samples were analyzed for PCP. The urine samples from 9% of the test-persons exceeded a PCP level of 10 micrograms/g creatinine. From this urine level, a corresponding PCP level of approximately 40 micrograms/g in PDSP could be calculated. These results show that there is still a considerable risk of exposure to PCP, even after a long period following treatment of wood with PCP-containing preservatives.

Demonstration of mercury in the human brain and other organs 17 years after metallic mercury exposure.

A male subject became exposed to metallic mercury vapor at work in 1973. He excreted 1,850 mg Hg/l urine initially. Controls of urine mercury excretion after D-penicillamine administration led to the assumption of a total body clearance of mercury latest since 1976. Subsequently he developed an organic psychosyndrome without detectable signs of classical mercurialism. He never returned to work again and died of lung cancer in 1990. In different organs (brain, kidney, and lung) which were sampled at autopsy elevated levels of mercury were documented by atomic absorption analysis. Histological examination of the tissue by the Danscher and Schroder method, which is specific for mercury, showed a highly positive staining in the majority of nerve cells and cells of other organs. Ultrastructurally mercury could be demonstrated by elemental x-ray analysis within lipofuscin deposits. The lipofuscin content was increased in the mercury positive nerve cells as demonstrated by a strong positive autofluorescence.

[Study on the significance of mercury accumulation in the brain from dental amalgam fillings through direct mouth-nose-brain transport]. / Untersuchung zur Bedeutung einer cerebralen Quecksilberbelastung aus Amalgamfüllungen durch direkten Mund- und Nase- Hirn-Transport.

The transport of mercury (Hg) from the oro-nasal to the cranial cavity via a direct route was investigated. In 55 deceased persons, Hg concentrations were measured in the olfactory bulb and the trigeminal ganglion, and the number of dental amalgam fillings was assessed. For the purpose of comparison, Hg concentrations were also determined in the occipital lobe cortex, the pituitary gland and the kidney cortex. Quantitative Hg analysis was performed by cold vapor atomic absorption spectroscopy after acid digestion using high pressure microwave treatment. In the olfactory bulb (geom. mean 17.4 micrograms/kg w. w.), the Hg concentration was significantly higher than in the occipital lobe cortex (geom. mean 9.2 micrograms/kg w. w.) (p < 0.0001). No significant difference was found between the Hg concentration in the trigeminal ganglion (geom. mean 12 micrograms/kg w. w.) and the occipital lobe cortex (alpha = 0.005; p = 0.0342). Regression analysis did not reveal a statistically significant correlation between the number of dental amalgam fillings and the Hg content in the olfactory bulb and the trigeminal ganglion, respectively (alpha = 0.01). Therefore, these results do not support the hypothesis of a significant flow o Hg from dental amalgam fillings to the cranial cavity by a direct oro-nasal route. In contrast, a statistically significant correlation exists between the number of dental amalgam fillings and the Hg concentration in the kidney cortex (r2 = 0.317; p < 0.0001), and, to a lesser extent, the Hg concentration in the occipital lobe cortex (r2 = 0.17; p = 0.0016). The highest Hg concentrations (geom. mean 93.1 micrograms/kg w. w.) were detected in the kidney cortex, followed by the pituitary gland (geom. mean 30.0 micrograms/kg w. w.). In this study, Hg concentration in the pituitary gland did not correlate with the number of dental amalgam fillings.

Cadmium concentration in the renal cortex of kidney tumor patients and controls.

In this pilot study the concentration of cadmium was determined quantitatively in samples of renal cortex of 22 kidney cancer patients and 19 controls. Data on the three main sources of exposure to cadmium-diet, cigarette smoking and occupation-were obtained through interviews. No significant difference in Cd concentration between the tumor samples and the controls could be found. The mean Cd concentration was 50.9 +/- 25 mg/kg dry weight for cancer patients and 55.2 +/- 50 mg/kg for controls. Further, it was established that the age-dependent relationship for cadmium in the cortex was not valid for smokers.

[Exacerbation of pustular psoriasis in mercury poisoning]. / Exazerbation einer Psoriasis pustulosa bei Quecksilber-Intoxikation.

A patient suffering from long-standing pustular psoriasis of the palms was treated for 3 weeks with a mercury-containing drug. Exacerbation into generalized pustular psoriasis developed. Mercury levels in blood and urine were increased. After withdrawal of the mercury preparation, therapy with DMPA (2,3-Dimercapto-1-propane-sulfonic acid), a mercury antidote, was initiated, together with short-term treatment with aromatic retinoids and PUVA. Within a few days mercury levels decreased significantly and the skin lesions practically disappeared.

Risk estimation of mercury intake from different sources.

Biological monitoring of mercury (Hg) in blood, urine and hair was performed in volunteers with amalgam fillings, in subjects who consumed fish and in Hg-exposed workers. It was found that both amalgam fillings and the consumption of fish burden the organism with Hg in the same order of magnitude. The Hg concentrations in urine in the occupationally exposed group were higher by a factor of about 100 compared to the group with amalgam fillings. No pathological changes were found in the exposed workers. It seems safe to conclude that no health-related problems from Hg are to be expected from amalgam fillings.

[Mercury exposure by fish consumption in Rhine fishermen]. / Quecksilberbelastung durch Fischkonsum bei Rheinfischern.

In this study 149 test persons were included, which were divided in 2 groups: consumption of Rhine fish (n = 77) and control group which consumed no Rhine fish (n = 72), but eventually fish from other sources. The consumption of Rhine fish averaged 1290 g per month (range: 100-5250 g per month), in the control group the consumption of fish averaged 340 g per month (range: 0-4000 g per month). The monthly fish consumption for inhabitants of Baden-Württemberg is in the range of 300 to 400 g. From this it can be seen that the control group consumed fish in the range of the general population, whereas in the group with Rhine fish consumption the quantity of consumed fish was 4 fold. In the group with Rhine fish consumption the levels of mercury in blood were in the geometric mean (GM) 2.41 micrograms/l, arithmetic mean (AM) 3.43 micrograms/l (range: 0.5-17.8 micrograms/l); control group an estimated GM: 0.68 micrograms/l, AM of 0.90 micrograms/l (range: 0.2-3.2 micrograms/l). The corresponding levels in hair were in the group with Rhine fish consumption GM: 1060 micrograms/kg, AM: 1410 micrograms/kg (range: 190-7200 micrograms/kg) and in the control group: GM 520 micrograms/kg, AM: 610 micrograms/kg (range: 190-2710 micrograms/kg). From this data it can be concluded that the consumption of Rhine fish gives rise to higher levels of mercury in blood (GM: 3.5, AM: 3.8 fold) and hair (GM: 2.0, AM: 2.3 fold). In the Umwelt-Survey of the German Bundesgesundheitsamt for the general German population an estimated GM of 0.46 microgram/l and AM of 0.74 microgram/l for mercury levels in blood was reported. The corresponding mercury concentrations determined in the group with Rhine fish consumption were 5.2. and 4.6 fold higher. No significant differences of mercury levels in urine were seen in the 2 groups (Rhine fish consumption GM: 0.57 microgram/l, AM: 0.84 microgram/l, range: < 0.1-4.7 micrograms/l; control group GM: 0.40 micrograms/l, AM: 0.93 microgram/l, range: < 0.1-13.6 micrograms/l). In both groups no correlation was found between mercury in urine and mercury in blood or hair respectively. For biological monitoring of organic mercury derived from fish consumption the determination of mercury in blood and hair is suited. The excretion of mercury in urine does not reveal an exposition with mercury from fish consumption.

[Health hazards from metals in drinking water]. / Gesundheitsgefährdung durch Metalle im Trinkwasser.

Drinking water is essential for man and cannot be replaced. In the public discussion the quality of drinking water is often presented in a one-sided way. This has led to great sensitivity and insecurity with the result that the intake of drinking water is often regarded as deleterious to human health. In this presentation it is attempted to demonstrate by the example of six metals and semi-metals in which way these substances are transmitted into water, how much the consumption of drinking water contributes to the total uptake, and whether a health risk can be derived from this source.

[Biomonitoring for the evaluation of a mercury burden from amalgam fillings. Mercury determination in urine before and after oral doses of 2,3-dimercapto-1-propanesulfonic acid (DMPS) and in hair]. / Biomonitoring zur Beurteilung einer Quecksilberbelastung aus Amalgamfüllungen. Quecksilberbestimmung in Urin vor und nach oraler Gabe von 2,3-Dimercapto-1-propansulfonsäure (DMPS) und in Haaren.

The statistically significant correlation between mercury urine concentrations of 67 male volunteers aged 16 to 72 years (mean: 1.20 micrograms/l, range 0.1-5.0; 1.57 micrograms/24 h, range 0.1-7.8) and their amalgam filling index (r = 0.653; p < or = 0.0001) indicates that amalgam fillings burden the organism with mercury. Oral gavage of 300 mg DMPS (Dimaval) elevated mercury elimination in the urine by a factor of 9.2. The correlation between mercury elimination in the 24 h urine with and without DMPS is statistically highly significant (r = 0.89, p < or = 0.0001). This means that the information yield from mercury determination in urine is usually not improved by DMPS. For toxicological evaluation of mercury excretion in urine we propose to employ 1/20 of the BAT-level for inorganic mercury (200 micrograms/l). This approach is frequently used in setting MIK levels based on MAK levels. We refer to the resulting standard as BUT level (Biologischer Umweltstofftoleranzwert). The BUT level for inorganic mercury in urine is thus 10 micrograms/l. The mean determined in the cohort under investigation was ca. 10 times lower than the proposed threshold value. Therefore the present findings do not suggest a risk to health due to mercury in the volunteers examined here. Hair analysis of the same volunteers did not correlate with inorganic mercury burden from amalgam fillings. However, a weak correlation was found between hair mercury levels and fish consumption. Since fish are mainly a source of organic mercury, hair analysis may be useful for biological monitoring of this form of mercury.

Drinking water fluoridation and caries prophylaxis: with special consideration of the experience in the former East Germany.

Drinking water fluoridation for caries prophylaxis is not a means of primary prevention: i.e., avoidance of sugar and microorganisms in the oral cavity; but rather a means of secondary prevention: e.g., prevention of bacterial production of carboxylic acid from sugar, and therapy: e.g., enhancement of enamel resistance to demineralization by incorporation of fluoride in remineralization of the enamel surface. Currently available epidemiologic studies on the effects of drinking water fluoridation reveal: reduction of the incidence of caries, particularly in children no detrimental health effects; cosmetically undesirable dental fluorosis may occur, however. Nevertheless, introduction of drinking water fluoridation in Germany is not recommendable because of: the greater effectiveness of primary caries prevention, the acceptance of which is reduced, however, by drinking water fluoridation the at least equal prophylactic effect of fluoride via other routes, e.g. via toothpaste the narrow range between beneficial and detrimental dosage the avoidance of fluoride-enriched waste water the prerogative of minimal manipulation of drinking water content.

Tripotassium dicitrato bismuthate: absorption and urinary excretion of bismuth in patients with normal and impaired renal function.

We have investigated the absorption and urinary excretion of tripotassium dicitrato bismuthate during a treatment course of 4 weeks in 7 patients with normal renal function (creatinine clearance 115 +/- 29 ml/min; mean +/- S.D.), in 7 patients with impaired renal function (creatinine clearance = 34 +/- 19 ml/min) and in 4 dialysed patients. Following the first dose of tripotassium dicitrato bismuthate (216 mg bismuth b.d.), and after 2 and 4 weeks of treatment (dialysed patients received only 108 mg/b.d.), plasma and urine concentrations of bismuth were monitored for 2 and 24 h, respectively. After stopping therapy plasma and urine concentrations of bismuth were followed for 4 and 6 weeks, respectively. In all three groups of patients small amounts of bismuth (mean values 0.26 to 0.28% of dose) were rapidly (transient mean peak concentrations between 40 and 134 micrograms/L) reached within about 30 to 40 min, absorbed and plasma levels demonstrated a wide intra- and inter-individual variability. Absorption profiles were not altered during the treatment course; however, the trough plasma concentration of bismuth demonstrated an about 3- to 5-fold accumulation (correlated to creatinine clearance) from about 5 micrograms/L to 15 micrograms/L (normal renal function) or to 20-25 micrograms/L (impaired renal function). Pre-study bismuth levels could be detected within 2 to 4 weeks after stopping therapy in all subjects whereas urinary concentrations were still elevated 6 weeks after the course of treatment. Our results indicate that tripotassium dicitrato bismuthate is absorbed in very low amounts during standard therapy. However, dependent on renal function, accumulation to non-toxic levels does occur during a course of treatment. It appears prudent to halve tripotassium dicitrato bismuthate dosage in patients with severe renal insufficiency (creatinine clearance less than or equal to 20 ml/min) to avoid any possible toxic risks. In such patients monitoring of the plasma bismuth concentration might be helpful, especially if longer or repeated treatment is anticipated.