Quantitation of fetomaternal haemorrhage and F cells in unusual maternal blood samples by flow cytometry using anti-D and anti-HbF.

BACKGROUND: Fetomaternal haemorrhage (FMH) assessment by the Kleihauer-Betke test (KBT) is rapid but semi-quantitative and liable to false positive results. OBJECTIVES: To compare FMH estimated by KBT with flow cytometry (FC) quantitation for 37 patients with massive FMH, obstetric risk factors or technical problems. METHODS: Maternal blood was sent for analysis by FC after KBT. A variety of reagents including anti-haemoglobin F (HbF), anti-D and combined anti-HbF/anti-carbonic anhydrase (CA) were used. RESULTS: Eight cases of massive FMH (>100 mL fetal cells) causing fetal death or severe neonatal anaemia in late gestation were confirmed by FC. Anti-HbF FC identified maternal F cells and fetal cells. In some cases these red cell populations merged but they could be differentiated by anti-CA, labelling F cells only. Using KBT, false positive FMH results were obtained for 12 patients, who had strongly stained cells that were then shown by FC to be maternal F cells. All these patients had increased F cells (>5% of total red cells) whereas only 16% of patients with FMH and 22% of donors had elevated F cells. In contrast, anti-D FC was simple and rapid, quantitating D-positive FMH in all 15 D-negative patients except one with massive FMH of weak D fetal cells. Leucocytes in four samples bound anti-D, variably, giving erroneously high FMH, but they could be eliminated from FC analysis using combined anti-D/anti-CD45. CONCLUSION: FMH quantitation using anti-D by FC is suitable for the majority of maternal samples and could enable accurate targeted dosing of anti-D prophylaxis.

Testing clients' knowledge about chemical dependency: a method for assessing clients' progress in treatment and program evaluation.

A multiple-choice test was developed to assess clients receiving treatment for chemical dependency. Responses of 27 men and 20 women in treatment were examined for their progress. Discussion of program development and evaluation made use of these data.

Validity issues in using the Millon-II with substance abusers.

This study addressed the use of the Millon Clinical Multiaxial Inventory-II (Millon-II) in assessing 73 substance abusers. The influence of neuropsychological functioning on personality functioning is discussed and evaluated. Reported history of substance abuse did not significantly relate to measures of neuropsychological or personality functioning. Of the sample, 16.9% produced invalid Million-II scores; invalidity was not significantly related to demographic characteristics or history of substance abuse. Millon-II profile validity was related to verbal and perceptual-motor functioning. Some neuropsychological variables significantly predicted Millon-II scale scores but with little consistency.

Cattle lice (Anoplura, Mallophaga) in New York: seasonal population changes, effects of housing type on infestations of calves, and sampling efficiency.

A year-long survey was made of commercial dairy herds in New York for cattle lice (Anoplura and Mallophaga). All herds were infested with lice. The cattle bitting louse, Bovicola bovis (L.), accounted for about 90% of the observed infestations; infestations of mature animals were most common during the winter months, especially March (26% infested); and infestation rates of calves were high (30-45%) from January through June. Cows that were housed in stanchion barns were about twice as likely to be infested (24.7%) as were those in free stalls (11.1%). Calves housed in individual outdoor hutches had substantially lower infestation rates (4.5%) than calves maintained inside barns in collective stalls and pens (46.0%).

Gram-negative bacterial pyomyositis: unique case and review.

Bacterial pyomyositis in tropical or temperate climates is usually associated with gram-positive organisms, and Staphylococcus aureus has been recovered most often. In contrast, skeletal muscle infection due to aerobic gram-negative bacteria is an acknowledged rarity, even in tropical areas. A literature review revealed only five organisms implicated in gram-negative pyomyositis in the United States; to this list, we add a unique case of pyomyositis caused by Serratia marcescens that occurred in a patient with multiple myeloma. Although the data are limited, it appears that lower leg muscles are more likely to be involved and that clinical cure is often achieved following appropriate drainage and antibiotic therapy.

Chemical Health Effects Assessment Methodology for airborne contaminants.

Chemical Health Effects Assessment Methodology (CHEM) is a new procedure for assessing hazardous properties of airborne toxic contaminants. CHEM evaluates substances for four major health effect categories: carcinogenicity, mutagenicity, reproductive/developmental toxicity, and toxic effects other than the first three. Three elements are considered in the assessment: weight of evidence, potency, and severity of effect. This approach produces a profile of toxic properties of chemicals which preserves their unique multidimensional character and highlights data gaps.

A methodology for assessing mutagenic hazards of chemicals.

A comprehensive framework for identifying substances which represent a potential threat to public health due to mutagenicity and for relative ranking of their hazards has been developed. The methodology is designed to evaluate a range of genotoxic endpoints of potential significance to humans and is not merely a substitute for, or an adjunct to, the carcinogenicity assessment. A range of endpoints in both somatic and germ cells is considered. The biological test systems utilized here include humans and other mammals, bacteria, Drosophila, yeasts, molds, and plants. Bioassays conducted in vivo and in vitro, with and without metabolic activation, are included. Seventy-five different assays are considered, of which 73 are currently included in the Gene-Tox database. The tests are grouped into three categories on the basis of significance to humans, as well as sensitivity, specificity, validity, and reliability. Seven in vivo mammalian tests comprise Group I. The remaining 68 tests are divided between Groups II and III, in a decreasing order of significance and confidence in the tests. Tests with virtually identical endpoints and organisms are listed together. The system accomplishes two tasks: 1) organizes the data from short-term tests on chemicals, and 2) classifies chemicals into one of five hazard categories, designated by letters A to E, on the basis of that information. Classification into hazard categories depends on the overall strength of evidence that an agent may cause mutations in humans. Generally, score for each chemical is a function of the number and combination of results in each of the three groups of tests. Specifically, it is derived by weighing several variables: the number and type of endpoints measured, the number and type of species represented, the significance of positive and non-positive results, the relevance of specific tests for predicting effects in humans, the group classification (I, II or III) of each test result and the overall pattern presented. Assessment of data for one hundred chemicals shows a good representation of scores from A to E, with category E most commonly represented, followed by D and C.

A methodology for assessing developmental and reproductive hazards of chemicals.

A method to evaluate developmental and reproductive toxicity for a wide variety of chemicals has been developed. The assessment includes all effects on male and female reproductive function as well as effects in the developing embryo or fetus. Effects are evaluated using primary literature. Studies are classified as adequate, supportive or inadequate. Only adequate studies are used in further assessment. Reproductive and developmental toxicity of each chemical is assessed using both qualitative and quantitative information. Three elements are used to describe developmental toxicity of chemicals: Lowest Observed Effect Level (LOEL), weight-of-evidence classification and a Risk Ratio (RR). For reproductive toxicity only two elements are used, LOEL and weight-of-evidence. LOEL is defined as the lowest dose at which statistically significant effects are found. A risk ratio is calculated using the levels of the chemical producing acute maternal lethality (LD50 or LC50) to the levels producing developmental toxicity in the same animal species and route of administration. The risk ratio is used to indicate the extent to which the developing embryo or fetus is more susceptible than the dam to the toxic effects of a chemical. A toxicity score (A through E) is assigned to each chemical from a two- or three-dimensional matrix based on the elements of assessment. The score reflects the degree of hazard associated with each chemical. To date, 110 chemicals have been evaluated using this system. From the selected databases, 188 articles were reviewed. Of these, 103 (55%) were judged to be adequate, 23 (12%) provide supportive information, and 62 (33%) were inadequate and excluded from the assessment methodology. Scores for 47 chemical with some adequate data available show that high hazard substances (28 A and B) outnumber those associated with lower hazards (a total of 19 C, D and E). This may reflect a selection process for testing which favors substances suspected of causing adverse reproductive and developmental effects.

A methodology for assessing carcinogenic hazards of chemicals.

Assessment of carcinogenic hazards of substances involves evaluation and classification of qualitative and quantitative data, including the attendant uncertainty. Recently proposed EPA guidelines represent a significant step towards a uniform carcinogenic risk assessment procedure and its appropriate use. The Methodology for Assessing Carcinogenic Hazards of Chemicals proposed here shares common characteristics with the EPA guidelines but it also focuses on other aspects of carcinogen assessment, not addressed by the guidelines, such as: folding together quantitative and qualitative data into a combined hazard index; classification of limited, incomplete or flawed qualitative data; utilization of quantitative risk estimates based on weak qualitative evidence. The elements are used to assess carcinogenic hazards of chemicals, qualitative and quantitative. The qualitative assessment consists of stratification into one of five categories of weight-of-evidence, whereas quantitative assessment consists of stratification into one of four potency categories on the basis of carcinogenic unit risk estimate. Carcinogenic hazard index, codified in letters A to E, is derived from the quantitative and qualitative elements of assessment in a two-dimensional matrix. The matrix is designed so that weaker evidence for carcinogenicity requires a correspondingly higher unit risk value for a given score. Assessment of 100 chemicals using our methodology shows a good distribution of scores from A to E. Group B, which can be described as moderately hazardous, is most frequently represented. The methodology represents a mixture of two possible approaches to assessing hazards of carcinogens: one which gives the highest rank to those likely to produce the greatest risk, the other which ranks highest those most likely to produce cancer in humans. By using this combined approach, it is ensured that a chemical hazardous on either count is not missed. The methodology also makes maximum use of all available data without over-interpreting some highly uncertain procedures such as quantitative risk estimation or extrapolation of animal response to humans.

Nutrient content of milk and milk products: water soluble vitamins in baby milk formulae.

A study of the content of water soluble vitamins in the 12 baby milk formulae available in the UK in April 1983 showed that levels of vitamins in the individual brands were generally in excess of those declared by the manufacturer. For cows' milk based formulae the mean excess of vitamins over the declared level was 94%. Vitamin levels in prepared formulae averaged three times the minimum recommended level. The average level of B vitamins in prepared cows' milk based formulae was six times higher than in mature human milk. For the two soya based products, the levels of vitamins were generally in excess of the declared level and levels of vitamin B12, biotin and, in one sample, vitamin B6 were considerably in excess of those found in mature human milk.

New hope for identifying the unidentified. The National Crime Information Center unidentified person/missing person files.

The National Crime Information Center Unidentified Person/Missing Person Files offer computer comparison of descriptive data on unidentified dead and living persons with data entered on missing persons. Completion of a simple, but detailed standard form allows entry of descriptors of physical characteristics, fingerprint classification, dentition, anthropologic and x-ray findings, optic prescriptions, medical devices, surgical procedures, serology, jewelry, and clothes. Medical and law enforcement agencies collect the descriptive data on the unidentified; families and law enforcement agencies collect missing persons information. Entry for both is via law enforcement regional or state NCIC computer terminals. Continuous comparison and cross search of both files is initiated upon entry of either form.

The role of skin absorption as a route of exposure for volatile organic compounds (VOCs) in drinking water.

Assessments of drinking water safety rely on the assumption that ingestion represents the principal route of exposure. A review of the experimental literature revealed that skin penetration rates for solvents are remarkably high, and that the stratum corneum is a less effective barrier to penetration than traditionally assumed. Based on published skin absorption rates, we used Fick's law (Jos = Kop delta Cos) to determine permeability constants for selected compounds. We then calculated dose per kilogram for nine different exposure situations and compared this to the oral dose per kilogram. We found that skin absorption contributed from 29-91 per cent of the total dose, averaging 64 per cent. Dose per kilogram body weight ranged from .0002 mg/kg-.18 mg/kg, with an average of .03 mg/kg. In weak aqueous solutions, flux of the solute is directly proportional to concentration. Laboratory approaches differ markedly from environmental exposures and can underestimate absorption. We conclude that skin absorption of contaminants in drinking water has been underestimated and that ingestion may not constitute the sole or even primary route of exposure.