Comparación entre las calculadoras de riesgo del European Randomized Study for Screening of Prostate Cancer (ERSPC) y Prostate Biopsy Collaborative Group (PBCG): predicción del riesgo de cáncer de próstata clínicamente significativo en una cohorte de pacientes de Argentina / Comparison between the European Randomized Study for Screening of Prostate Cancer (ERSPC) and Prostate Biopsy Collaborative Group (PBCG) risk calculators: Prediction of clinically significant prostate cancer risk in a cohort of patients from Argentina

Objetivo Comparar el desempeño de las calculadoras de riesgo del European Randomised Study for Screening of Prostate Cancer (ERSPC-RC) y el Prostate Biopsy Collaborative Group (PBCG-RC) en predecir el riesgo de presentar cáncer de próstata clínicamente significativo. Material y métodos Retrospectivamente, se identificó a los pacientes que fueron sometidos a biopsia prostática en el Sanatorio Allende Cerro, Ciudad de Córdoba, Argentina, desde enero de 2018 a diciembre de 2021. Se calculó la probabilidad de tener cáncer de próstata con las dos calculadoras por separado y luego se compararon los resultados para establecer cuál de las dos tuvo mejor desempeño. Para esto, se analizaron áreas bajo la curva (ABC). Resultados Se incluyeron 250 pacientes, 140 (56%) presentaron cáncer de próstata, de los cuales 92 (36,8%) tuvieron cáncer de próstata clínicamente significativo (Score de Gleason ≥7). Los pacientes que presentaron cáncer tenían mayor edad, mayor valor de antígeno prostático específico (PSA) y menor tamaño prostático. El ABC para predecir la probabilidad de tener cáncer de próstata clínicamente significativo fue de 0,79 y 0,73 para PBCG-RC y ERSPC-RC, respectivamente (p=0,0084). Conclusión En esta cohorte de pacientes, ambas calculadoras de riesgo de cáncer de próstata mostraron un buen desempeño para predecir el riesgo de cáncer de próstata clínicamente significativo, si bien el PBCG-RC mostró mejor exactitud. (AU)

Objective To compare the performance of the risk calculators of the European Randomized Study for Screening of Prostate Cancer (ERSPC) and the Prostate Biopsy Collaborative Group (PBCG) in predicting the risk of presenting clinically significant prostate cancer. Material and methods Retrospectively, patients who underwent prostate biopsy at Sanatorio Allende Cerro, Ciudad de Córdoba, Argentina, were identified from January 2018 to December 2021. The probability of having prostate cancer was calculated with the two calculators separately and then the results were compared to establish which of the two performed better. For this, areas under the curve (AUC) were analyzed. Results 250 patients were included, 140 (56%) presented prostate cancer, of which 92 (65.71%) had clinically significant prostate cancer (Gleason score ≥7). The patients who presented cancer were older, had a higher prostate-specific antigen (PSA) value, and had a smaller prostate size. The AUC to predict the probability of having clinically significant prostate cancer was 0.79 and 0.73 for PBCG-RC and ERSPC-RC respectively (p=0.0084). Conclusion In this cohort of patients, both prostate cancer risk calculators performed well in predicting clinically significant prostate cancer risk, although the PBCG-RC showed better accuracy. (AU)

Comparison between the European Randomized Study for Screening of Prostate Cancer (ERSPC) and Prostate Biopsy Collaborative Group (PBCG) risk calculators: Prediction of clinically significant Prostate Cancer risk in a cohort of patients from Argentina.

OBJECTIVE: To compare the performance of the risk calculators of the European Randomized Study for Screening of Prostate Cancer (ERSPC) and the Prostate Biopsy Collaborative Group (PBCG) in predicting the risk of presenting clinically significant prostate cancer. MATERIAL AND METHODS: Retrospectively, patients who underwent prostate biopsy at Sanatorio Allende Cerro, Ciudad de Córdoba, Argentina, were identified from January 2018 to December 2021. The probability of having prostate cancer was calculated with the two calculators separately and then the results were compared to establish which of the two performed better. For this, areas under the curve (AUC) were analyzed. RESULTS: 250 patients were included, 140 (56%) presented prostate cancer, of which 92 (65.71%) had clinically significant prostate cancer (Gleason score ≥7). The patients who presented cancer were older, had a higher prostate-specific antigen (PSA) value, and had a smaller prostate size. The AUC to predict the probability of having clinically significant prostate cancer was 0.79 and 0.73 for PBCG-RC and ERSPC-RC respectively (P=0.0084). CONCLUSION: In this cohort of patients, both prostate cancer risk calculators performed well in predicting clinically significant prostate cancer risk, although the PBCG-RC showed better accuracy.

Recovering traditional raw-milk Tetilla cheese flavour and sensory attributes by using Kocuria varians and Yarrowia lipolytica adjunct cultures.

The rationale of the present study was to evaluate the potential of microbial adjunct cultures including Kocuria varians and/or Yarrowia lipolytica strains in the recovery of the typical sensory profile of traditional (raw-milk) Tetilla cheese. Four batches of Tetilla cheese, a short ripened cows' milk cheese produced in Galicia (NW Spain), were made in duplicate from pasteurized milk inoculated with different microbial cultures. A control batch was manufactured by adding a mesophilic commercial D-starter only. The other three batches were made with the same starter after a cheese-milk pre-ripening step carried out with (i) an adjunct culture of K. varians, (ii) an adjunct culture of Y. lipolytica, or (iii) a combination of both adjunct cultures. The highest pH and water activity values, associated with softer textures were determined in the cheeses manufactured with the Y. lipolytica adjunct after 21days of ripening. The contents of the volatile compounds 3-methylbutanol, dimethyl disulfide and dimethyl trisulfide were higher in the cheeses made with only the K. varians adjunct than in the cheeses made with the only yeast adjunct and in the control cheeses. The contents of hexanoic and octanoic acids were highest in the cheeses made with the Y. lipolytica adjunct, and levels of ethyl hexanoate, ethyl octanoate and ethyl decanoate were higher in the cheeses made with only the yeast adjunct than in the other batches of cheese. The cheeses manufactured with both adjunct cultures were awarded the highest scores for flavour and overall sensory parameters (considering the standards of the traditional product) and were considered very similar to 'good quality' artisanal raw-milk cheeses. We conclude that use of selected Micrococcaceae and Y. lipolytica strains as adjunct cultures would differentiate the sensory properties and contribute to the quality and typicality of the short-ripened rennet-curd Galician Tetilla and Arzúa-Ulloa cheeses.

Characterization of yeasts isolated from artisanal short-ripened cows' cheeses produced in Galicia (NW Spain).

A total of 143 presumptive yeast isolates were obtained from the predominant microflora of 21 short-ripened starter-free raw cow's milk cheeses made in Galicia (NW Spain), and the following 68 isolates were identified by both genotyping and sequencing methods: Yarrowia lipolytica (21 isolates), Kluyveromyces lactis (18), Debaryomyces hansenii (11), Pichia guilliermondii (11), Pichia fermentans (4) and Saccharomyces cerevisiae (3). Of these, Y. lipolytica and K. lactis displayed the strongest extracellular proteolytic activity on skim milk agar, and none of the D. hansenii isolates showed any activity on this medium. Y. lipolytica also displayed the highest lipolytic activity on Tween 80 and on tributyrin. This species, which was characterized by production of butanoic acid, free fatty acid esters and sulfur compounds in pasteurized whole milk, was responsible for rancid and cheesy flavors. K. lactis mainly produced acetaldehyde, ethanol, branched chain aldehydes and alcohols, and acetic acid esters, which were responsible for alcoholic, fruity and acetic notes. The volatile profiles of D. hansenii were rather limited and characterized by high levels of methyl ketones. Most of the yeast isolates were described as tryptamine producers, although low concentrations of histamine were produced by five Y. lipolytica and two P. fermentans isolates. We conclude that selected Y. lipolytica strains could be used as adjunct cultures in the manufacture of Arzúa-Ulloa and Tetilla cheeses, and selected K. lactis strains could be used as co-starters in the manufacture of acid curd Cebreiro cheese, thus contributing to the sensory quality and typicality of the cheeses.

Chemical and biochemical study of industrially produced San Simón da Costa smoked semi-hard cow's milk cheeses: Effects of storage under vacuum and different modified atmospheres.

Two batches of smoked, semi-hard (ripened for 45 d) San Simón da Costa cow's milk cheeses with Protected Designation of Origin were used to investigate the chemical, biochemical, and sensorial parameters that may be affected by modified-atmosphere packaging. Cheeses were packaged for 45 d as follows: vacuum packaging, packaging in 100% N(2), packaging in a gas mixture of 20% CO(2)/80% N(2), and packaging in a gas mixture of 50% CO(2)/50% N(2). The San Simón da Costa cheeses were characterized by high contents of lactic, oxalic, and citric organic acids. The main free amino acids found were isoleucine, phenylalanine, serine, valine, lysine, and glutamic acid, and the most abundant volatile compounds included ethanol, diacetyl, 2-butanol, isopropyl alcohol, furfural, acetaldehyde, 2-butanone, acetone, and 2-methylfuran. Modified atmospheres appeared to alter the ripening processes by affecting lipolysis, as indicated by the lower concentrations of butyric and propionic acids compared with control cheeses. In addition, modified-atmosphere packaging altered the proteolysis processes, yielding higher amounts of branched-chain alcohols. The results revealed that storage under modified atmosphere contributes to the accumulation of several compounds probably derived from smoke, including aldehydes such as 2-furancarboxaldehyde (furfural), alcohols such as 2-methoxyphenol (guaiacol), ketones such as 2-cyclopenten-1-one, and esters such as methyl furancarboxylate, which were negatively correlated with flavor. Vacuum packaging was the most useful technique in terms of preserving the sensory quality of San Simón da Costa Protected Designation of Origin cheeses. Considering the current demands for packaged portions of food at the distribution and retail levels and the potential health risks associated with some smoke-derived compounds usually present in some smoked foods, the results obtained in this study may be of special interest to the cheese industry.

Antibiotic resistance in lactic acid bacteria and Micrococcaceae/Staphylococcaceae isolates from artisanal raw milk cheeses, and potential implications on cheese making.

Antibiotic susceptibility against 19 antimicrobial agents was evaluated in isolates of the genera Lactococcus (46 isolates), Leuconostoc (22), Lactobacillus (19), Staphylococcus (8), Enterococcus (7), and Microccoccus/Kocuria (5) obtained from the predominant microflora of nonrecent and recent types of artisanal raw cow's milk cheeses. Beta-lactams showed broad activity against all genera, although leuconostocs and lactobacilli were highly resistant to oxacillin (80% to 95.5%). Resistance to aminoglycosides was frequent for lactococci and enterococci (particularly for streptomycin), whereas lower rates of resistance were detected for lactobacilli and leuconostocs. Technologically interesting traits for the food industry were distributed among isolates that showed different degrees of resistance to common antibiotics. However, isolates showing resistance to less than 2 antibiotics were mainly those with properties of greatest technological interest (acidifying activity, proteolytic/lipolytic activities, or diacetyl production).

Microscopic pulmonary embolisation of an indwelling central venous catheter with granulomatous inflammatory response.

Indwelling catheters can disintegrate into tiny fragments and embolise. Once the fragments are detected radiographically, they can be removed using vascular intervention techniques. Rarely, indwelling catheters dwindle into inextricable pieces that embolise into minute pulmonary vessels and lymphatics, causing granulomatous changes microscopically. The present study reports a 54-yr-old female who had received several indwelling central lines during several abdominal surgeries over a 5-yr period. The patient developed a noncaseating granulomatous skin lesion followed by exertional dyspnoea a few months later. Chest radiographs and computed tomography showed diffuse interstitial infiltrates. Open lung biopsy showed two types of granulomas: 1) peri-lymphangitic and peri-bronchiolar non-necrotising granulomas consistent with sarcoidosis; and 2) distinct foreign body granulomas. In some of the foreign body granulomas, confocal Raman spectroscopy identified the presence of bisphenol-A-polycarbonate, a polymer commonly used in biomedical devices. The patient improved following treatment with prednisone followed by methotrexate. The present case illustrates an interesting combination of two causes of granulomatous disease, the importance of examining all biopsy specimens from sarcoidosis patients for foreign particles and the rare occurrence of microscopic embolisation of catheter fragments to the lung with foreign-body giant cell reaction to them.

Health effects of natural dust: role of trace elements and compounds.

This article reviews the health effects of trace elements carried in natural dusts of geologic or geochemical origin. The sources of these dusts are diverse, including volcanoes, dust storms, long-range transport of desert dust, and displacement through natural processes such as landslides and earthquakes. The primary focus is dust exposures affecting communities rather than occupational groups (which have been comprehensively explored in other publications). The principal elements and compounds reviewed are trace metals (including As, Hg, Cd, and Fe), radioactive elements, fluoride, silicates, natural asbestiform compounds, and alkali salts. The pathways by which such agents affect human populations are explored, including carriage through water, air, soil, and the food chain. The mechanisms of biotoxicity and the acute and chronic consequences on health associated with these elements are described. The discussion explores problems inferring risk and disease causation from natural dust exposures using standard epidemiological indicators, particularly for chronic outcomes, and will argue for the importance of the ecological perspective in assessing pathogenesis. The authors stress the global scale of the problem, which remains underevaluated and underreported in terms of health implications.

Effect of wild strains of Lactococcus lactis on the volatile profile and the sensory characteristics of ewes' raw milk cheese.

The production of volatile compounds by wild strains of Lactococcus lactis used as starter cultures and their effect on the sensory characteristics of ewes' raw milk cheese were investigated. Sixteen vats of cheese were manufactured and ripened for 120 d in two experiments, each of them duplicated. In the first experiment, milk was inoculated with different ratios of four wild Lactococcus lactis strains, two producing and two not producing branched-chain volatile compounds, and in the second experiment with different ratios of a commercial starter culture and the two strains producing branched-chain volatile compounds. Cheese pH, proteolysis, and aminopeptidase activity increased when the strains producing branched-chain volatile compounds were inoculated at a higher rate. Fifty volatile compounds were identified in cheeses using a purge and trap system coupled to a gas chromatography-mass spectrometry apparatus. The relative abundances of 30 volatile compounds (8 alcohols, 5 aldehydes, 3 ketones, 12 esters, 1 sulfur compound, and 1 benzenic compound) were influenced by starter culture composition. 2-Methylpropanol, 3-methylbutanol, isobutyl acetate, isoamyl acetate, ethyl butyrate, isobutyl butyrate, and isoamyl butyrate were always more abundant in the cheeses made with a higher level of L. lactis strains producing branched-chain volatile compounds. Flavor intensity was enhanced by a high level of L. lactis strains producing branched-chain volatile compounds in the first experiment, in which four wild L. lactis strains were used as starter culture, but not in the second experiment, in which a combination of two wild L. lactis strains and the commercial starter culture were used. Flavor quality, as judged by trained panelists, was impaired in both experiments by a high level of L. lactis strains producing branched-chain volatile compounds.

Hemochromatosis (HFE) gene sequence analysis of formalin-fixed, paraffin-embedded liver biopsy specimens.

BACKGROUND: Hereditary hemochromatosis (HH) is a common disease predominantly characterized by mutations of the HFE gene. METHODS AND RESULTS: We investigated the utility of HFE gene sequence analysis in the diagnosis of HH in 61 prospectively accrued formalin-fixed, paraffin-embedded liver biopsy specimens with clinical or histologic features suggestive of HH. Mutations in codons 63 or 282 of the HFE gene were identified by direct sequencing; in 21 of these samples, quantitative hepatic iron testing was also performed. Changes characteristic of HH were present in 16 (26%) of the cases, and 54% of the cases showed HFE gene mutations. The most common alteration was homozygous mutation of codon 282 (11 cases, 18%), followed by the combined 63 + 282 heterozygous mutation (3 cases, 5%). Two cases (3%) showed biallelic mutation of codon 63. The other 28 cases (46%) showed no sequence abnormalities. Weak iron staining did not exclude HH; intense staining did not reliably predict HH. CONCLUSION: When HH is clinically and/or histologically suspected, HFE gene sequencing of formalin-fixed, paraffin-embedded liver biopsy specimens is a rapid and cost-effective approach to genotypic diagnosis of HH.

Effects of Lactobacillus strains on the ripening and organoleptic characteristics of Arzúa-Ulloa cheese.

Seven batches of Arzúa-Ulloa, a short-ripened soft cow's milk cheese produced in Galicia (NW Spain), were prepared from pasteurized milk. Two control batches of cheese (CB) were made with an acid-aromatic starter containing Lactococcus lactis subsp. lactis and Lactococcus lactis subsp. lactis var. diacetylactis, isolated from raw-milk Arzúa-Ulloa cheeses. Five batches of cheese (LB) were made with the acid-aromatic starter plus one of five strains of mesophilic homofermentative Lactobacillus spp.: four of them isolated from raw-milk Arzúa-Ulloa cheese (characterized in previous works) and the remaining was a commercial Lactobacillus strain. Higher counts of mesophilic viable bacteria, lactic acid bacteria and citrate-fermenting bacteria were found on days 1 or 15 of ripening, while higher counts of lactobacilli were found on day 30 of ripening. On day 1 of ripening the highest diacetyl-acetoin content was noted in the CB, but after day 15 the diacetyl-acetoin content was similar or higher in three of the five LB. The mean degradation of beta-casein in CB was higher than in LB, while the degradation of alpha(s1)-casein was higher in LB. The mean contents of nitrogen-soluble fractions were slightly higher in the LB than in the CB. Volatile free fatty acid (VFFA) contents were, in general, greater in LB than in CB and maximum amounts were determined on day 15 of maturation. Sensorial analysis indicated a more acid taste was in LB, while bitter and astringent tastes were more intense in CB. A positive correlation was found between beta-casein degradation and bitter taste. Yogurt and butter aromas were more intense in CB and in two of the five LB. Firmness was lower in LB and a negative correlation was found between this parameter and alpha(s1)-casein degradation. Crumbliness showed a positive correlation with beta-casein degradation. The use of the Lactobacillus strains assessed in this study is recommended for Arzúa-Ulloa cheese manufacture, in order to enhance the desirable characteristics of this cheese variety, i.e., a soft texture due to alpha(s1)-casein proteolysis but without the bitter taste due to beta-casein degradation and a spicy and slightly rancid aroma and taste.

Ferrous sulfate toxicity: a review of autopsy findings.

Ferrous sulfate is the leading cause of accidental pediatric poisonings. Despite the requirement for child-resistant packaging for any oral iron product with 250 mg or more per container, the incidence has continued to increase. Although the clinical presentation of iron toxicity has been well described, pathologic findings in human tissue and correlation with clinical data are scant. We reviewed autopsies from the Armed Forces Institute of Pathology of 11 children who died from ferrous sulfate toxicity. Clinical data, morphologic changes, and iron levels in tissue were evaluated. The children's ages ranged from 11 to 36 mo. Prominent iron deposition in gastric and small intestinal mucosa was associated with necrosis, with some cases demonstrating prominent vascular iron deposition. The clinical courses were rapid and progressed from Stage I to Stage III. These observations were correlated with increased levels of iron in various tissues, as determined by analytical atomic absorption spectrophotometry. The morphologic and chemical analysis data provide information on the pathogenesis of ferrous sulfate poisoning; the vascular iron deposition may be related to subsequent hemorrhage. In the liver the periportal necrosis is probably a direct cytopathic effect of the highest levels of iron carried to these cells by the portal blood flow.

Andrew Jackson's exposure to mercury and lead: poisoned president?

Historians have suggested that US president Andrew Jackson (1767-1845) experienced lead and mercury poisoning following his therapeutic use of calomel (mercurous chloride) and sugar of lead (lead acetate). To evaluate these claims, we performed direct physical measurement of 2 samples of Jackson's hair (1 from 1815, 1 from 1839). Following pretreatment and acid digestion, mercury was measured using cold vapor generation techniques, while lead levels were measured by electrothermal atomic absorption spectrophotometry. Mercury levels of 6.0 and 5.6 ppm were obtained from the 1815 and 1839 hair specimens, respectively. Lead levels were significantly elevated in both the 1815 sample (mean lead level, 130.5 ppm) and the 1839 sample (mean lead level, 44 ppm). These results suggest that Jackson had mercury and lead exposure, the latter compatible with symptomatic plumbism in the 1815 sample. However, Jackson's death was probably not due to heavy metal poisoning.

Laser-Raman microprobe identification of inclusions in capsules associated with silicone gel breast implants.

Raman spectroscopy (the analysis of scattered photons after excitation with a monochromatic light source) provides a nondestructive method for identifying organic and inorganic materials on the basis of the molecule's characteristic spectrum of vibrational frequencies. Although the technique has been predominantly applied in sciences other than pathology, the recent advent of high-quality microscope optics coupled to optical Raman spectrometers (a variation known as a Raman microprobe) rendered this technique amenable to applications in human pathology. In the Raman microprobe, a laser beam is focused on a spot approximately 1 microm in diameter on the surface of the sample, e.g., tissue, and the scattered light is collected and analyzed. In this investigation, we used the Raman microprobe for the identification of foreign materials in breast implant capsular tissues. The characteristic silicone group frequencies associated with the silicon-oxygen stretch, the silicone-carbon stretch, the silicon-methyl and the methyl carbon-hydrogen stretch frequencies were used to identify polydimethylsiloxane and to define chemical differences among the various other implant-related inclusions. All of the inclusions were positively identified in a series of 44 capsules from silicone gel-filled implants: polydimethylsiloxane was found in 44 of 44 capsules surrounding silicone gel-filled implants; polyurethane was seen in 4 of 4 capsules around polyurethane foam-coated gel-filled implants; 4 of 4 capsules enveloping Dacron patch gel-filled implants revealed Dacron; and talc was identified in 8 of these 44 capsules. Raman microspectroscopy provides a rapid, accurate, and sensitive method for identifying inclusions associated with silicone and other implant materials in tissue.

Effects of the addition of Enterococcus faecalis in Cebreiro cheese manufacture.

Ten batches of Cebreiro, a fresh or short-ripened acid-curd cheese, produced in the Galician mountains (NW Spain) were prepared from pasteurized milk inoculated with microorganisms isolated from raw-milk cheese. Two control batches were made with a Lactococcus lactis subsp. lactis starter; 8 batches were made with the lactococcal starter plus one of eight Enterococcus faecalis cultures: 4 E. faecalis var. liquefaciens (EFLB) and 4 E. faecalis var. faecalis (EFFB). Whey dry matter in the EFLB was notably higher than in the control batches and this was related to lower cheese yields. After over 15 days storage the highest counts of both aerobic bacteria and lactic acid bacteria were observed for the EFLB. The lower content in protein on dry matter was found in the EFLB. The beta-casein broke down to a greater extent in the EFLB than in the EFFB, the lowest values being obtained for the control batches. The higher level of hydrolysis of alphax1-casein and maximum peptide alpha(s1) - I/alpha(s1)-casein ratio were obtained for EFFB at day 15 of storage. In all the batches made with enterococci soluble nitrogen was higher than in the control batches, with the highest values in the EFLB. In all the batches made with enterococci, volatile free fatty acid, long-chain free fatty acids and diacetyl and acetoin contents at days 10 and 15 of storage were higher than in the control batches, the highest values being obtained for EFLB. Acetic acid in all batches accounted for the main proportion of the volatile free fatty acids. Butyric and caproic acids were not detected in the volatile free fatty acids fractions of the control batches, but both acids were detected in most of the batches made with enterococci. The more intense acid taste was found in the EFFB and control batches, the most bitter taste being found in the EFLB. Buttery, rancid and spicy flavors were more evident in the EFLB. The rancid and spicy flavors were positively correlated with the contents of volatile free fatty acids and long-chain free fatty acids. The cheeses of EFLB proved to be more crumbly than the EFFB, whereas the stickiness and deformability were higher in the EFFB. The batches with similar organoleptic characteristics to those of traditional cheese were the batch IV made with the less proteolytic strain of E. faecalis var. liquefaciens, and the batch VI made with a moderate lipolytic activity strain of E. faecalis var. faecalis.

Biologic response to passive dissolution of titanium craniofacial microplates.

The effect of anodization on passive dissolution of titanium was studied by measuring titanium levels in peritoneal leukocytes and tissues of laboratory animals with titanium plates implanted into the peritoneal cavity. Fifteen Sprague-Dawley rats were assigned randomly to three treatment groups of five animals. One group served as controls, the other two groups had an anodized or an unanodized implant placed in the left paracolic gutter. Peritoneal lavage samples and blood samples, organ tissues and tissue surrounding the implants, were removed for histologic examination and titanium levels. Titanium was not detected in any distant organs or in the peritoneal lavage fluid. The capsular tissues surrounding the implants contained titanium at levels ranging from 2610 to 16786 ng/g for unanodized plates, and 888-5933 ng/g for anodized plates. The titanium levels within the peritoneal leukocytes of animals with unanodized implants were significantly elevated (P = 0.01) over time, as compared with controls. The level of titanium in the peritoneal leukocytes of animals with anodized implants was not significantly elevated when compared with controls. Titanium levels in the trace range, as measured in the capsular tissues, are likely a result of corrosion. Surface treatment of titanium by anodization reduces passive dissolution.

Randomized placebo-controlled trial of 2,3-dimercaptosuccinic acid in therapy of chronic arsenicosis due to drinking arsenic-contaminated subsoil water.

INTRODUCTION: Chronic arsenic toxicity producing various clinical manifestations is currently epidemic in West Bengal, India, Bangladesh, and other regions of the world. Animal studies have indicated that 2,3-dimercaptosuccinic acid can be used as an oral chelating agent. A prospective, double-blind, randomized controlled trial was carried out to evaluate the efficacy and safety of 2,3-dimercaptosuccinic acid for chronic arsenicosis due to drinking arsenic-contaminated (> or = 50 micrograms/L) subsoil water in West Bengal. METHOD: Twenty-one consecutive patients with chronic arsenicosis were individually randomized (random number; assignment made by individual not evaluating patients) into 2 groups: 11 patients (10 male, age 25.5 +/- 8 years) received 2,3-dimercaptosuccinic acid 1400 mg/d (1000 mg/m2) in the first week and 1050 mg/d (750 mg/m2) during the next 2 weeks with a repeat course 3 weeks later. The other 10 patients (all male, age 32.2 +/- 9.7 years) were given placebo capsules for the same schedule. The clinical features were evaluated by an objective scoring system before and after treatment. Routine investigations including liver function tests, arsenic concentrations in urine, hair, and nails, and skin biopsy evaluations were also completed. RESULTS: Though there was improvement in the clinical score of 2,3-dimercaptosuccinic acid-treated patients, similar improvement was observed in the placebo-treated group. There were no statistical differences in the clinical scores between the 2 groups at the beginning and at the end of treatment. Similarly, no differences were found for the other investigated parameters. CONCLUSION: Under the conditions of this study, 2,3-dimercaptosuccinic acid was not effective in producing any clinical or biochemical benefit or any histopathological improvement of skin lesions in patients with chronic arsenicosis.

Pathological and biophysical findings associated with silicone breast implants: a study of capsular tissues from 86 cases.

Breast implant capsular tissues from 86 cases were studied to characterize the relationship between capsular findings and the type of implant used. Tissues were examined by light microscopy, immunohistochemistry, scanning electron microscopy/energy dispersive x-ray analysis and Fourier transform infrared, and Raman microspectroscopy. Capsular pathology was influenced by the structure and composition of the implant. A pseudoepithelium at the inner capsular surface (synovial metaplasia) was noted with silicone gel-filled, saline-filled, and polyurethane-coated implants, and disproportionatelywith textured surface implants. Immunohistochemical studies of pseudoepithelium supported a macrophage/histiocyte cellular origin. Talc was identified intracellularly within macrophages in 42 cases. Capsular calcification was strongly associated with the presence of implant stabilization patch material. Infrared spectra were used to identify silicone, talc, Dacron, and two different types of polyurethane in capsular tissues. Micropapillary structures identified at the pseudoepithelial surface have, to the authors' knowledge, not been previously described.

Detection of titanium in human tissues after craniofacial surgery.

Generally, titanium fixation plates are not removed after osteosynthesis, because they have high biocompatability and high corrosion resistance characteristics. Experiments with laboratory animals, and limited studies of analyses of human tissues, have reported evidence of titanium release into local and distant tissues. This study summarizes our results of the analysis of soft tissues for titanium in four patients with titanium microfixation plates. Energy dispersive x-ray analysis, scanning electron microscopy, and electrothermal atomic absorption spectrophotometry were used to detect trace amounts of titanium in surrounding soft tissues. A single metal inclusion was detected by scanning electron microscopy and energy dispersive x-ray analysis in one patient, whereas, electrothermal atomic absorption spectrophotometry analyses revealed titanium present in three of four specimens in levels ranging from 7.92 to 31.8 micrograms/gm of dry tissue. Results from this study revealed trace amounts of titanium in tissues surrounding craniofacial plates. At the atomic level, electrothermal atomic absorption spectrophotometry appears to be a sensitive tool to quantitatively detect ultra-trace amounts of metal in human tissue.