Organochlorine pesticides and chlorinated hydrocarbon solvents in the blood of chemically sensitive patients [corrected]. A statistical comparison with therapeutic medication and natural hormones.

The blood levels of organochlorine pesticides and chlorinated hydrocarbon solvents were measured in 200 and 114 chemically sensitive patients respectively, and compared with blood concentrations of standard medication (non- chlorinated substances. Clonidine, Haloperidol) of comparable toxicity after therapeutically effective dosage, and with reference levels of highly potent chemicals in the blood such as hormones. It was shown that the average blood levels of the most toxic environmental pollutants are comparable with the therapeutic steady state average blood levels of medications which have similar toxicities in the animal model. In addition the toxicity levels of xenoestrogens are at least an order of magnitude higher than normal plasma estrogen or progesterone levels. These findings suggest the possibility of additive or synergistic effects of these chlorinated compounds and the aforementioned medications. Also, these findings suggest the possibility of hormone deregulation from exposure to the aforementioned toxic chlorinated compounds.

Neurotoxicity in single photon emission computed tomography brain scans of patients reporting chemical sensitivities.

The subset of patients reporting chemical sensitivity with neurocognitive complaints usually exhibits specific abnormalities of brain metabolism consistent with neurotoxicity, on imaging with single photon emission computed tomography (SPECT). These recurrent neurotoxic patterns are characterized by a mismatch in tracer uptake between early- and late-phase imaging, multiple hot and cold foci throughout the cortex, temporal asymmetry and increased tracer uptake into the soft tissues and, sometimes, the basal ganglia. Previous studies confirm these neurotoxic findings in patients with neurotoxic chemical exposures and breast implants. Affective processes such as depression do not, alone, show this pattern. These abnormalities in SPECT images correlate with documented neurocognitive impairment. Controlled challenges to ambient chemicals can induce profound neurotoxic changes seen on SPECT imaging in chemically sensitive patients. Detoxification treatment techniques frequently produce significant improvement on brain SPECT brain imaging in these patients. Neurotoxicity appears to be characteristic in many cases of chemical sensitivity.

The role of the T lymphocytic cell cycle and an autogenous lymphocytic factor in clinical medicine.

In this study 315 individuals (25 controls, 290 chemically sensitive immunocompromised patients) were investigated. Each patient had been on a standard therapy of avoidance of pollutants, nutritional supplementation, and injections of antigens for foods, and biological inhalants, but did not attain their immunological competence. Peripheral lymphocytes were collected and DNA histograms were constructed. The flow cytometer was used to evaluate the cell cycle, haematological, and other immunological profiles. From the other portion of the blood specimen, lymphocytes were propagated in vitro, harvested, and a lysate, termed the autogenous lymphocytic factor (ALF), was prepared. When treated with ALF, 88% of these individuals showed a significant (p < 0.001) clinical improvement which correlated with laboratory findings, involving regulation of abnormal cell cycles, increase in total lymphocytes and subsets T4, T8, (p < 0.05) and cell mediated immunity (CMI) response (p < 0.001). The ALF presumably acts as a biological response modifier. The cell cycle and ALF provide clinical tools for diagnosis and regulation of immunological incompetence.

Comparison of single photon emission computed tomography findings in cases of healthy adults and solvent-exposed adults.

Single photon emission computed tomography (SPECT) is a useful tool in measuring dynamic brain functioning. Its potential to reveal the physiological mechanisms of neurotoxicity has not been fully explored. In the present study, the SPECT findings for 25 healthy control subjects were compared to the findings for 25 mixed organic solvent exposure subjects. Specific physiological abnormalities related to regional cerebral blood flow activity (rCBF) were revealed. In the early phase of uptake, significantly decreased uptake was found in the mixed organic solvent group; in the late phase of uptake, a significant increase in uptake was found in specific regions of interest. The discovery of this abnormality in brain functioning may be a significant step toward the creation of a biological marker of neurotoxicity. Early detection of neurotoxicity is important in occupational medicine to prevent neurotoxic illnesses in working populations.

Mitogenic effects of mycotoxins on T4 lymphocytes.

Mycotoxins have compromising effects on varied biological systems, even when ingested at levels which do not evoke manifestations of clinical mycotoxicoses. No data have been previously found as to the therapeutic and mitogenic effects of mycotoxins. This was the objective of the present work. Human peripheral T4 lymphocytes were obtained by venipuncture, propagated in RPMI 1640 medium and challenged with varied concentrations of aflatoxins, B1, B2, G1, and G2. The cells were stained with propidium iodide and fluorescent isothiocyanate (FITC) and examined microfluorometrically. All the mycotoxins were significantly mitogenic on the basis of dose response. No adverse effects were observed when doses of 10, 50 and 100 micrograms were administered on a modest clinical basis to volunteers.

Single photon emission computed tomography of the brain in patients with chemical sensitivities.

Chemical sensitivities display a recurrent pattern on scintigraphic examinations of the brain. The pattern can include mismatching between early and late imaging, multiple hot and cold foci distributed throughout the cortex without regard to lobar distribution (salt and pepper pattern), temporal asymmetries, and sometimes increased activity in the basal ganglia. This study used Desert Shield/Desert Storm veterans who present with abnormal neurological and psychological symptoms as a model to exhibit abnormalities by brain scintigraphy. These are typical of those seen in patients with documented exposure to neurotoxic compounds who develop a clinical syndrome that has been termed "chemical sensitivity." Exposure to cocaine, alcohol, and other substances of abuse can result in abnormal scintigrams of the brain using tracers such as [technetium-99m]hexamethylpropyleneoxime. This study used techniques combining regional cerebral blood flow data with delayed distributional data after the intracellular conversion of the tracer into a hydrophilic molecule. In addition to delayed image abnormalities, a mismatch occurs in the regional activity between the two image sets of the veterans. This degree of mismatch was not seen in control subjects who were screened for avoidance of neurotoxic agents. Patterns identified from examinations performed on patients with known exposure to petroleum distillates, pesticides and other materials linked with neurotoxicity were identified in some veterans of the Desert Shield/Desert Storm operation. A single case of repeated examinations on a veteran showed a reversion of these patterns toward normal after therapy. This reversion followed independent assessments of clinical improvement.

Chemical sensitivity in physicians.

By the nature of their work environment, physicians may be exposed to potentially toxic substances that can trigger chemical sensitivity. Nineteen physicians with chemical sensitivity were evaluated at the Environmental Health Center - Dallas regarding: type of specialty, history of chemical exposure, symptoms produced, food and water tolerance, immune parameters and double-blind chemical inhalation challenge. Food and chemical sensitivities were demonstrated in these physicians by oral, intradermal and inhalation challenges. After treatment, fifteen of the nineteen physicians were able to resume medical practice. Potential sources of chemical exposure in medical environments are evaluated.

Confirmation of chemical sensitivity by means of double-blind inhalant challenge of toxic volatile chemicals.

Fifty chemically sensitive patients with vascular, asthmatic and arthritic signs, ranging in age from 21 to 61, were exposed to double-blind challenges of ambient doses of inhaled toxic chemicals in a specially designed booth in an Environmental Control Unit (ECU). Primary signs and symptoms were recorded before and after challenge with five chemicals and three placebos. Inhaled challenges included phenol (less than .0025 ppm), petroleum-derived ethyl alcohol (less than .5 ppm), formaldehyde (less than .2 ppm), chlorine (less than .3 ppm), and pesticide (2, 3,-D at less than .0034 ppm). Placebos were water or saline. A set on testing criteria were evaluated for maximizing the likelihood of well-defined, reproducible information from these ambient-dose double-blind challenges. For best results, these testing criteria include: Before testing, the patient must be housed in a chemically less polluted environment. The individual must have been de-adapted to food, air, and water pollutants by means of a water fat for three to four days. At the time of the challenge, the patient must be on food and water previously determined to be safe. An enclosed non-pulluted challenge booth must be used for these chemical exposures. Sign and symptom scores appropriate for that patient must be recorded, before and after challenge. Appropriate doses of the chemical in question (determined by air concentration and length of exposure) are necessary to investigate a particular problem. The conclusion of the study is that in these patients, chemical sensitivity clearly does exist (pulse rate differences between positive responses and placebo - p .001).(ABSTRACT TRUNCATED AT 250 WORDS)

Aliphatic hydrocarbon solvents in chemically sensitive patients.

The purpose of the present study was to see if chemically sensitive individuals had aliphatic hydrocarbon solvents as part of their total body load. This was done by measuring blood levels from 85 chemically sensitive patients. These were measured by a purging trap method with gas chromatography/mass spectrometry (GCC/MS) by the methods of Laseter. Thirteen patients had blood levels below the detection limit of less than 1 ppb and 72 were above the detection limit. An average of three solvents, out of seven measured, including n-pentane, 2,2-dimethylbutane, cyclopentane, 2-methylpentane, 3-methylpentane, n-hexane, n-heptane, was found in 85% of the patients' blood on the 1 to 299 ppb range. The means were as follows: n-pentane 14.7 ppb, 2,2-dimethylbutane 2.5 ppb, cyclopentane 9.0 ppb, 2-methylpentane 16.7 ppb, 3-methylpentane 28.0 ppb, n-heptane 5.5 ppb. The most frequently found of the above solvents was 2-methylpentane (found in 68.1% of the patients), 3-methylpentane (62.5%), n-hexane (61.1%), and pentane (40.3%).

Food and chemicals as environmental incitants.

Susceptibility to environmental incitants such as air, food and water components is becoming an increasingly recognized health problem. These sensitivities and reactions can induce a spectrum of symptoms affecting smooth muscle, mucous membranes and collagen in the respiratory, gastrointestinal, genitourinary and vascular systems. These reactions may be mistaken for hypochondriasis, but actually are due to reactions to foods and chemicals found in the patient's home and work environments. Careful clinical histories should alert the nurse and physician, who can confirm suspicions by eliminating and challenging the patient with potentially offending agents under controlled circumstances.

Clearing of toxic volatile hydrocarbons from humans.

In this study, different modes of therapy for the removal of toxic chemicals from the human body have been assessed and compared. This consisted of: 1) thirteen inpatients in an environmentally controlled area in a hospital, 2) fourty-one outpatients with home environmental control and work area change, and 3) fifteen outpatients in a physical therapy/sauna program with a good environmental control. Attention to manipulation of food, food contaminants, water and air pollution as well as nutritional therapy was important in all groups. Each modality seemed efficacious in++ its own right; 100% inpatients, 80% sauna/physical therapy patients, and 70% outpatients improved their signs and symptoms. Inpatient therapy in a finally controlled environment was far superior to the other two modalities in clearing of symptoms, as well as in clearing of organic chemicals. Outpatient and sauna/physical therapy are efficacious for less ill patients.

[A pupillographical study on the presence of organochlorine pesticides in autonomic nerve disturbance].

It is well known that the effect of organophosphate pesticides on the autonomic nervous system is a cholinergic reaction. However no study has been done assessing the effect of organochlorine pesticides on the autonomic nervous system. We evaluated the autonomic nerve function using open-loop pupillography in 20 patients who had exposure to the organochlorine pesticides. Significant differences were seen in pupil area (p less than .006), velocity of both constriction and dilatation (p less than .001), and dilatation time (p less than .02), when compared with 18 normal subjects. Autonomic nerve disturbances were detected in eighteen of 20 patients (90%) by evaluating the pupillary light reflex in each patient. Sympathetic nerve inhibition i.e. sympatholytic pattern, was recognized in ten of 18 patients (55%). Four patients with sympatholytic pattern had a disturbance not only in the sympathetic nerve, but also parasympathetic nerve involvement suggesting pandysautonomia. The residue blood level of the organochlorine pesticides was examined in each patient. A high frequency of the DDE was recognized (85%). It was concluded that the toxicity of the organochlorine pesticide on the autonomic nerve appear as an inhibitory effect on pupil light reflex.

Food and chemicals as environmental incitants.

Susceptibility to environmental incitants such as air, food and water components is becoming an increasingly recognized health problem. These sensitivities and reactions can induce a spectrum of symptoms affecting smooth muscle, mucous membranes and collagen in the respiratory, gastrointestinal, genitourinary and vascular systems. These reactions may be mistaken for hypochondriasis, but actually are due to reactions to foods and chemicals found in the patient's home and work environments. Careful clinical histories should alert the nurse and physician, who can confirm suspicions by eliminating and challenging the patient with potentially offending agents under controlled circumstances.

Elimination of oral food challenge reaction by injection of food extracts. A double-blind evaluation.

Twenty subjects underwent a double-blind evaluation by analyzing six variables to determine if subcutaneous injection of the food extract neutralizing dose would protect subjects from reactions. Twelve subjects had four of the six variables neutralized 60% of the time following the food antigen neutralizing dose. The placebo trials neutralized four of six variables 15% of the time. The sign/symptom results show statistical significance favoring food extract neutralization over placebo. The remaining eight subjects had at least two of the six variables neutralized by the food extract up to 85% of the time. It appears that the phenomenon of subcutaneous food neutralization can be scientifically endorsed for clinical use in the treatment of food reactions.

Recurrent environmentally triggered thrombophlebitis: a five-year follow-up.

Twenty disabled patients with recurrent intractable nontraumatic phlebitis were studied. The patients were divided into two groups and matched for age and severity. The control group was continued on their standard anticoagulant regime, bed rest and support hose. The other group was placed in an especially designed Environmental Control Unit (ECU) where all air, food and water could be controlled. These patients were taken off all medication and not fed until the leg pain and swelling disappeared, which was four to seven days. The patients then showed specific sensitivities to foods and ambient subthreshold doses of inhaled chemicals such as formaldehyde less than 0.2 ppm, phenol less than 0.0024 ppm, chlorine less than 0.33 ppm, petroleum alcohol less than 0.5 ppm and pesticide (2,4 DNP) less than 0.0134 ppm under controlled double-blind challenges. Eight out of 10 patients had their phlebitis reproduced in this manner. When in the symptom-free state, these patients were required to ride an exercycle at 150 kpm for one mile daily to demonstrate absence of phlebitis (none could walk across the room prior to examination). The five-year follow-up in the group showed two 48-hour episodes of phlebitis cleared by home bed rest and food abstenance. In contrast, the control group had more than 60 episodes of phlebitis at home and 41 episodes in the hospital. Medical costs in these comparable groups showed a differential of $20 per patient in the Environmental Control Unit treatment versus more than $20,000 per patient in the control group over the five-year follow-up.