Los acúfenos de Miguel Ángel y su relación con la toxicología / Miguel Ángel's tinnitus and its relation to toxicology

Resumen El Plomo ha tenido una estrecha relación con el mundo artístico pictórico a través de los pigmentos utilizados por los artistas durante milenios. El íntimo contacto con sustancias químicas potencialmente peligrosas para la salud, casi siempre sin medidas de higiene y seguridad laboral, ha desarrollado en muchos casos, enfermedades laborales en estos artistas, a veces sospechadas y en otros casos, más que confirmadas. En el presente trabajo se analiza la historia de vida laboral de Miguel Angel Buonarroti, de quien se tiene registro suficiente como para establecer un nexo causal con exposición laboral al Plomo.

Abstract Lead has shown a close relationship with the fine arts'world through the pigments used by artists for thousand of years. Close contact with potentially dangerous chemical substances for health, almost always without occupational hygiene and safety measures, has produced, in many cases, occupational illnesses in these artists, sometimes suspected and in other cases, more than confirmed. In the present work, the history of Miguel Angel Buonarroti's working life is analyzed, since there is sufficient record to establish a causal link with occupational exposure to Lead.

Lead-induced effects on learning/memory and fear/anxiety are correlated with disturbances in specific cholinesterase isoform activity and redox imbalance in adult brain.

The aim of the present study was to investigate whether the underlying mechanism of lead (Pb)-induced effects on learning/memory and fear/anxiety behavior involves changes either on AChE G4 (most abundant in brain) or on G1 isoform activity, and/or to a putative local disruption of oxidant/antioxidant balance. Adult male mice were randomly divided into two groups (18 animals/group): a vehicle group [500ppm (mg/L) CH3COONa/day for 4weeks in their drinking water] and a Pb-treated group [500ppm Pb(CH3COO)2/day for 4weeks in their drinking water]. At the end of the treatment period, mice were subjected to the behavioral tasks. Learning/memory was tested by step-through passive avoidance test, whereas fear/anxiety was studied using the elevated plus-maze and thigmotaxis tests. Pb levels in mice brain were determined using atomic absorption spectrometry. AChE activity was determined colorimetrically, and GSH and MDA levels fluorometrically in whole brain minus cerebellum, cerebral cortex, midbrain, hippocampus, striatum and cerebellum. The possible correlations between learning/memory or fear/anxiety behavior with the AChE activity and/or the lipid peroxidation levels and GSH content were also examined. Pb consumption caused significant deficits on mice learning/memory ability and increased anxiety. The consumption of the Pb solution inhibited the activity of the two AChE isoforms in all brain regions tested. Moreover, Pb exposure increased lipid peroxidation and decreased GSH levels in all brain regions examined. Spearman correlation analysis revealed that the coefficients between the particular behaviors, AChE activity and redox balance were brain region- and AChE isoform-specific.

Adult lead encephalopathy.

The neurotoxicity of lead to the adult brain is less well-known than that seen in children. It may present as acute severe encephalopathy or as chronic cognitive and behavioural symptoms, either in isolation or with systemic features of lead intoxication. Magnetic resonance imaging findings in lead encephalopathy vary. The pathogenesis of lead encephalopathy and its effects on cognition both during development and in the adult are discussed. That encephalopathic symptoms do not correlate with blood lead levels and that they may persist after chelation are highlighted. As an illustration, we describe a patient with chronic cumulative lead intoxication, who presented with peripheral neuropathy, anaemia, and a 'lead line' on the gingiva. She had cognitive dysfunction with extensive subcortical and cerebellar white matter lesions on magnetic resonance imaging. An area of restricted diffusion in both frontal regions is likely to be due to active ongoing demyelinating at the 'leading edge' of the lesion. Although systemic features and the peripheral neuropathy improved with chelation, the encephalopathy showed only marginal change, with later appearance of a symmetric akinetic-rigid state.

A toxic shot from the hip.

A 26-year-old man developed a movement disorder characterised by bradyphrenia, bradykinesia, rigidity, tremor and dystonia, several years after having been shot by a gun in the hip. Laboratory investigations revealed anaemia and porphyria. The authors demonstrate that his neurological condition was a delayed manifestation of lead toxicity, caused by slow absorption of lead from persisting bullet fragments in the hip joint. Treatment with excision of the femoral head and debridement of the hip followed by a total hip, in combination with chelating therapy, led to a remarkable remission.

Cumulative lead dose and cognitive function in older adults.

BACKGROUND: The current population of older Americans has accumulated substantial lifetime lead doses, which raises concern about the possibility of adverse cognitive outcomes. We evaluated whether cumulative lead dose from environmental exposures is associated with cognitive function and decline, and whether such effects are persistent, reversible, or progressive. METHODS: We used longitudinal linear modeling to evaluate associations of tibia lead concentration with cognitive function and decline in sociodemographically diverse, community-dwelling adults aged 50-70 years who were randomly selected from neighborhoods in Baltimore. Six summary measures of cognitive function were created from standard tests in the following domains: language, processing speed, eye-hand coordination, executive functioning, verbal memory and learning, and visual memory. RESULTS: The mean (SD) tibia lead level was 18.8 (11.6) microg/g. In models adjusted for demographic characteristics, socioeconomic status (SES), and race/ethnicity, higher tibia lead was associated with a progressive decline in eye-hand coordination. Tibia lead was associated with persistently impaired cognitive function in all 6 domains, although these associations weakened after increasing covariate control. In fully adjusted stratified analysis among white persons, persistent effects were apparent in eye-hand coordination, executive functioning, and verbal memory and learning. CONCLUSIONS: The study presents the strongest evidence to date of the effects of cumulative lead dose on adult cognitive function independent of SES. The study population was relatively young and the average total duration of follow-up short (<30 months); these findings may represent the lower bound of the impact of cumulative lead dose on cognitive function of older adults.

Association of cumulative lead and neurocognitive function in an occupational cohort.

Lead is a neurotoxicant that accumulates in bone with a half life of 25-30 years. To evaluate the association of lead biomarkers and cognitive function, a cohort of exposed and nonexposed workers who had been previously assessed in 1982 was retested approximately 22 years later. For the current assessment, both blood lead and tibia bone lead levels were determined. In addition, cognitive function was tested with the Pittsburgh Occupational Exposures Test battery, which had previously been administered in 1982. In exposed workers, bone lead level predicted lower current cognitive performance and cognitive decline over 22 years. In those lead-exposed workers older than age 55, higher levels of bone lead predicted poorer cognitive scores, suggesting vulnerability for older workers with higher past lead exposure. Finally, there was no association with bone lead level and recency of exposure, suggesting that cumulative body burden is most likely responsible for the progressive cognitive decrement evidenced with vulnerability because of aging.

Goya's deafness.

Francisco Goya (1746-1828), a major Spanish artist, became profoundly deaf aged 46 years, following an acute illness. Despite this, his success continued and he eventually died aged 82 years. His illness is sketchily documented in letters written during his convalescence, describing headache, deafness, tinnitus, unsteadiness and visual disturbance with recovery (apart from deafness) over three months. There was a milder similar illness two years before, suggesting a relapsing condition. Vogt-Koyanagi-Harada syndrome, although previously accepted as Goya's diagnosis, is not supported by the limited evidence. Susac's syndrome or Cogan's syndrome, although both rare, are more likely explanations.

Goya y su sintomatología miccional de Burdeos, 1825 / Goya and his lower urinary tract symptoms in Bordeaux, 1825

El célebre pintor don Francisco de Goya y Lucientes (1746-1828) padeció a lo largo de su vida una o varias enfermedades cuya naturaleza no ha sido determinada con seguridad. Los episodios mórbidos, parcialmente documentados, correspondientes a los años 1792-1793, acontecidos en Sevilla y Cádiz; 1819, en Madrid, y 1825, en Burdeos, pudieran estar relacionados entre sí. En éste último, los signos y síntomas urológicos que el ilustre enfermó presentó sí han quedado acreditados. El objetivo del presente trabajo es proponer, recurriendo al material que no es otro que el «Diplomatario de Goya», con las cartas y documentos que hasta la fecha han sido coleccionados y dados a conocer, pretendiendo observar un método inductivo-deductivo en su estudio e interpretación e interrelacionando estas valiosas fuentes tanto con los conocimientos médicos de la época como los contemporáneos, particularmente en lo que a sus aspectos urológicos se refiere, y revisando la bibliografía disponible al respecto, con las naturales reservas de un pronunciamiento diagnóstico retrospectivo que por tanto, por sus inherentes características, no puede ser de total certidumbre, la hipótesis de la tabes dorsal neurosifilítica como responsable de los trastornos miccionales que se le presentaron en Burdeos en la primavera de 1825. Igualmente, y de manera complementaria, se incluye un breve repaso de algunas de las circunstancias y personajes que rodearon al artista en Francia para ayudar a incardinar y comprender mejor la personalidad de Goya, ya por entonces anciano y enfermo (AU)

The famous painter Francisco de Goya y Lucientes (1746-1828) suffered during his life one or several diseases, the nature of which has not been determined with certainty. The partially documented morbid episodes that happened during the years 1792-1793 in Seville and Cadiz, 1819 in Madrid, and 1825 in Bordeaux could be related. In the latter one, the urological signs and symptoms the distinguished patient presented have been demonstrated. The objective of this paper is to propose the hypothesis of neurosyphilis' dorsal tabes responsible for the voiding disorders he presented in Bordeaux in the spring of 1825, having as a resource Goya's «diplomatario», with the letters and documents that have been collected and made known to date, with the purpose of using an inductive-deductive method for their study and interpretation, setting an interrelation between these valuable sources with both the medical knowledge of the period and the current, particularly in urological features, and reviewing the available bibliography on that topic, with the natural reserve about giving a retrospective diagnosis which cannot be completely true due to its inherent characteristics. In the same way, and as a complement, we include a brief review of some circumstances and characters that surrounded the artist in France to help to incardinate and better understand the personality of Goya, already old and sick at that time (AU)

Autonomic dysfunction due to lead poisoning.

We present a case history of a 24 years old male who developed autonomic dysfunction, intestinal pseudo-obstruction and anemia due to lead poisoning. Concomitant recording of blood levels of lead and autonomic function showed a gradual decline in blood lead level (98.8 microg/dL at week 0, 56 microg/dL at week 6, and 40 microg/dL at week 52) and gradual improvement in autonomic functions. Decrease in blood lead levels with DMSA (Meso-2, 3-dimercaptosuccinic acid) therapy showed improvement in autonomic functions. At week 0, the patient had severe loss of autonomic tone and autonomic reactivity which improved at week 6. At the 52nd week, most of the autonomic parameters had normalized except for the persistence of mild loss of parasympathetic reactivity.

The relationship between blood lead levels and neurobehavioral test performance in NHANES III and related occupational studies.

OBJECTIVES: The goals of this study were two-fold: (1) to assess the relationship between blood lead levels and neurobehavioral test performance in a nationally sample of adults from the third National Health and Nutrition Evaluation Survey and (2) to analyze the results from previously published studies of occupational lead exposure that used the same neurobehavioral tests as those included in the survey. METHODS: Regression models were used to test and estimate the relationships between measurements of blood lead and performance on a simple reaction time, a symbol-digit substitution, and a serial digit learning test in adults aged 20-59 years who participated the survey. Mixed models were used to analyze the data from the occupational studies. RESULTS: The blood lead levels of those participating in the survey ranged from 0.7 to 41.8 microg/dl. The estimated geometric mean was 2.51 microg/dl, and the estimated arithmetic mean was 3.30 microg/dl. In the survey, no statistically significant relationships were found between blood lead concentration and performance on the three neurobehavioral tests when adjusted for covariates. In the occupational studies, the groups exposed to lead consistently performed worse than control groups on the simple reaction time and digit-symbol substitution tests. CONCLUSIONS: The results from the survey and the occupational studies do not provide evidence for impairment of neurobehavioral test performance at levels below 25 microg/dl, the concentration that the Centers for Disease Control and Prevention define as elevated in adults. The average blood lead level of the exposed groups in the occupational studies was 41.07 microg/dl, less than 50 microg/dl, the minimum concentration that the Occupational Safety and Health Administration requires for medical removal from the workplace. Given the evidence of impaired neurobehavioral performance in these groups, the 50 microg/dl limit should be reevaluated.

[Late sequelae of tetraethyl lead poisoning]. / Odlegle nastepstwa zatrucia czteroetylkiem olowiu.

In our previous study a tetraethyl lead poisoning due to a rural environmental exposure of four family members was described. A differently intensified OUN dysfunction dominated clinical picture. Cognition status and degree of OUN dysfunction was monitored using generally accepted neurobehavioral test battery. The tests applied were fitted individually to each poisoned family member in accordance to current intensification of symptoms. Basing on the neurobehavioral performance results a consecutive imagine techniques were introduced to full CNS evaluation of intoxicated patients. Results of neuropsychological monitoring in 12 months period were compared to brain CT, SPET 99mTc-ECD used to evaluation of regional brain perfusion disturbances, MRI and MRS and presented in the study.

Lead poisoning.

Understanding of lead toxicity has advanced substantially over the past three decades, and focus has shifted from high-dose effects in clinically symptomatic individuals to the consequences of exposure at lower doses that cause no symptoms, particularly in children and fetuses. The availability of more sensitive analytic methods has made it possible to measure lead at much lower concentrations. This advance, along with more refined epidemiological techniques and better outcome measures, has lowered the least observable effect level until it approaches zero. As a consequence, the segment of the population who are diagnosed with exposure to toxic levels has expanded. At the same time, environmental efforts, most importantly the removal of lead from gasoline, have dramatically reduced the amount of lead in the biosphere. The remaining major source of lead is older housing stock. Although the cost of lead paint abatement is measured in billions of dollars, the monetized benefits of such a Herculean task have been shown to far outweigh the costs.

Saturnismo: reporte de dos casos y revisión de la literatura / Saturnismo: report of two cases and review of the literature

Se discuten 2 casos de intoxicación crónica por plomo; el primero es un paciente masculino de 29 años de edad, cauchero y con proyectil alojado en el tobillo derecho desde hace 5 años, quien inició enfermedad 15 meses previo a su hospitalización caracterizada por dolor abdominal difuso, hiporexia y pérdida de peso, posteriormente estreñimiento, debilidad muscular generalizada y como hallazgos relevantes de laboratorio anemia y plumbemia de 106 µg por ciento; y el segundo caso, es un paciente masculino de 31 años de edad, tornero y con proyectil alojado en la cabeza femoral derecha desde hace 5 años quien presentó dolor abdominal difuso, hiporexia, pérdida de peso y estreñimiento de 2 meses de evolución con desarrollo posterior de temblor distal, disfonía y debilidad muscular generalizada presentando paraclínicamente, anemia y plumbemia de 88,5 µg por ciento. En ambos casos se inició tratamiento con D-penicilamina, en ausencia de otro agente quelante en el país y la necesidad de terapia continua hasta lograr la extracción de la fuente endógena de plomo (proyectil), evidenciándose respuesta clínica y paraclínica favorables a las 4 semanas de tratamiento sin toxicidad medicamentosa