Acute myocardial infarction and renal failure following naphtha ingestion

We present a case of a non-Q wave myocardial infarction and acute renal failure following an ingestion of naphtha, a petroleum distillate composed primarily of hydrocarbons. The patient's renal, metabolic, and cardiac status improved over several days with aggressive volume replacement and bicarbonate therapy. Acute cardiotoxic effects of hydrocarbon exposure generally manifest as dysrhythmias, secondary to myocardial sensitization to circulating catecholamines, or, possibly, coronary vasospasm. Ischemia from associated hypotension or direct myocardial toxicity are other potential causes of naphtha-related cardiac injury.     

Primary glomerulonephritis and hydrocarbon exposure: a case-control study and literature review.

A case-control study was undertaken to investigate the possible role of chronic hydrocarbon exposure and tobacco and alcohol consumption in the causation of primary glomerulonephritis. Exposure to hydrocarbons and the consumption of tobacco and alcohol were assessed blindly by telephone interview and questionnaire in 55 patients with end-stage renal disease due to biopsy-proven primary glomerulonephritis in whom there had been no evidence of systemic disease. This was compared with 55 normal subjects matched for age, sex, social class and residential area and a comparable internal control group of 45 patients with end-stage renal disease secondary to systemic disease, diabetic nephropathy or chronic pyelonephritis. Hydrocarbon exposure scores derived from the results of the questionnaires were significantly higher (p < 0.001) in the patients with primary glomerulonephritis than in the normal subjects and the internal control group. Moreover, more detailed assessment of the type of hydrocarbon exposure showed significantly greater exposure of patients with glomerulonephritis to petroleum products (p < 0.001), greasing/degreasing agents (p < 0.01) and paints/glue (p < 0.05), and a resulting estimated relative risk of developing glomerulonephritis with each type of hydrocarbon exposure of 15.5, 5.3 and 2.0. Those patients with heavy hydrocarbon exposure (hydrocarbon score > 25,000) had a significantly higher serum creatinine at presentation than those with mild to moderate exposure, suggestive of more advanced renal disease. However, there was no significant difference in tobacco and alcohol consumption among subjects in different groups. We conclude that occupational exposure to hydrocarbon is likely to play a role in the pathogenesis of primary glomerulonephritis and that the risk of developing glomerulonephritis is greatest in those subjects exposed to petroleum products.     

Hydrocarbon toxicity: A review

Context. Clinical effects of hydrocarbon exposure have been reported since 1897. These substances are ubiquitous, and their exposures are common. The specific hydrocarbon and route of exposure will determine the clinical effect, and an understanding of this is helpful in the care of the hydrocarbon-exposed patient. Objective. To complete a comprehensive review of the literature on hydrocarbon toxicity and summarize the findings. Methods. Relevant literature was identified through searches of Medline (PubMed/OVID) and Cochrane Library databases (inclusive of years 1975–2013), as well as from multiple toxicology textbooks. Bibliographies of the identified articles were also reviewed. Search terms included combinations of the following: hydrocarbons, inhalants, encephalopathy, coma, cognitive deficits, inhalant abuse, huffing, sudden sniffing death, toluene, renal tubular acidosis, metabolic acidosis, arrhythmia, dermatitis, and aspiration pneumonitis. All pertinent clinical trials, observational studies, and case reports relevant to hydrocarbon exposure and published in English were reviewed. Chronic, occupational hydrocarbon toxicity was not included. Results. Exposure to hydrocarbons occurs through one of the following routes: inhalation, ingestion with or without aspiration, or dermal exposure. Inhalational abuse is associated with central nervous system depression, metabolic acidosis, and arrhythmia. The exact mechanism of the CNS depression is unknown, but experimental evidence suggests effects on NMDA, dopamine, and GABA receptors. Chronic toluene inhalation causes a non-anion gap metabolic acidosis associated with hypokalemia. Halogenated hydrocarbon abuse can cause a fatal malignant arrhythmia, termed “sudden sniffing death”. Individuals who regularly abuse hydrocarbons are more likely to be polysubstance users, exhibit criminal or violent behavior, and develop memory and other cognitive deficits. Heavy, long-term use results in cerebellar dysfunction, encephalopathy, weakness, and dementia. Neuroimaging may demonstrate leukoencephalopathy in these cases. Acute exposures improve with cessation of exposure. Electrolyte and fluid replacement will improve metabolic acidosis. Arrhythmias are precipitated via catecholamine surge, and beta blockers are presumed protective. Aspiration of hydrocarbons causes a potentially fatal pneumonitis. Symptoms may include cough, wheezing respiratory distress, and hypoxia. Bilateral interstitial infiltrates may be delayed for several hours after the development of pneumonitis. Treatment consists of supportive care, supplemental oxygen, and may require intubation and admission to an intensive care unit in severe cases. Unfortunately, aspiration pneumonitis remains a leading cause of poisoning mortality in children. Dermal exposure can cause dermatitis, chemical burns, and defatting injury. Oral exposure can cause local irritation as well as vomiting, diarrhea, and abdominal pain. Conclusion. Acute hydrocarbon exposure can result in a wide array of pathology, such as encephalopathy, pneumonitis, arrhythmia, acidosis, and dermatitis. Intentional inhalational and accidental ingestion exposures with aspiration lead to the greatest morbidity and mortality.     

Evaluation of biochemical effects of Casuarina equisetifolia extract on gentamicin-induced nephrotoxicity and oxidative stress in rats. Phytochemical analysis

Nephrotoxicity is defined as renal dysfunction that arises as result of exposure to external agents such as drugs and environmental chemicals. The present work was undertaken to carry out the phytochemical study and nephroprotective activity of methanolic extract of Casuarina equisetifolia leaves in gentamicin-induced nephrotoxicity in Wistar rats. Flavonoids and phenolic acids were identified and quantified using high performance liquid chromatography. Subcutaneous injection of rats with gentamicin (80 mg/kg body weight/day) for six consecutive days induced marked acute renal toxicity, manifested by a significant increase in serum urea, creatinine and uric acid levels, along with a significant depletion of serum potassium level, compared to normal controls. Also oxidative stress was noticed in renal tissue as evidenced by a significant decrease in glutathione level, superoxide dismutase, glutathione-S-transferase activities, also a significant increase in malondialdehyde and nitric oxide levels when compared to control group. Administration of plant extract at a dose of 300 mg/kg once daily for 4 weeks restored normal renal functions and attenuated oxidative stress. In conclusion, Casuarina equisetifolia leaves extract ameliorates gentamicin-induced nephrotoxicity and oxidative damage by scavenging oxygen free radicals, decreasing lipid peroxidation and improving intracellular antioxidant defense, thus extract may be used as nephroprotective agent.     

A long-term surveillance of occupational health hazards faced by cadmium workers

The decrease or damage of renal tubular functions by cadmium (Cd) exposure is designated as the critical effect on human body. When the Cd workers suffer from tubular damage, it is matter of concern whether the damage is reversible or irreversible. In this study, chronic influences of long-term exposure to Cd dust or fumes in the working environment were clarified. Besides the survey on Cd contents in work environment and production amounts of Cd pigments in the factory, the changes of Cd concentration in blood and urine, beta 2-microglobulin (beta 2MG) in serum and urine, C beta 2-MG/Ccr, the rate of tubular reabsorption of phosphorus (% TRP) and other laboratory examinations in 7 Cd pigment workers were observed for the past 15 years. In almost workers, the changes of Cd concentrations in blood and urine, beta 2MG in urine, and C beta 2MG/Ccr basically paralleled those of Cd concentrations in working environment. In some workers the fluctuations of beta 2MG in urine, C beta 2MG/Ccr and %TRP did not paralleled those of environmental Cd concentration and they were very variable. From the results obtained, it is stressed that the long-term follow-up studies on environmental Cd concentrations and analysis of biological indicators are necessary to determine the degree of the renal tubular dysfunction by Cd.     

Volatile substances of abuse

Substances that are inhaled for the purpose of recreational self-intoxication include aliphatic hydrocarbons, alkyl halides, alkyl nitrites, aromatic hydrocarbons, ethers, and ketones. All have the ability to cause asphyxia, arrhythmias, cardiovascular depression, neurologic dysfunction, and mucosal, pulmonary, and skin irritation following acute exposure and permanent neurologic damage with chronic exposure. The acute effects of alkyl halides and alkyl nitrites also include carbon monoxide poisoning and hepatorenal toxicity, and methemoglobinemia, respectively. Chronic exposure to aromatic hydrocarbons and ketones can result in liver, kidney, and bone marrow injury; myopathy, rhabdomyolysis, metabolic acidosis, and electrolyte abnormalities are further complications of chronic aromatic hydrocarbon inhalation.     

Hydrocarbon exposure may cause glomerulonephritis and worsen renal function: evidence based on Hill's criteria for causality

Many observational and experimental studies point to hydrocarbon exposure as an important pathogenic factor in glomerulonephritis. The findings have made little impact on current concepts and patient care, possibly because the hypothesis of a direct causal effect of the exposure and the hypothesis that the exposure worsens renal function have not been considered separately. This review examines these two hypotheses using Hill's criteria for causality. The results from 14 cross-sectional, 18 case-control studies, two cohort studies, 15 experiments on laboratory animals and two on human beings together with many case reports satisfy all but one of Hill's criteria for both hypotheses. Of particular importance is the finding in the case-control and follow-up studies of an association between degree of exposure and stage of renal disease, and an inverse association between degree of exposure and renal function, indicating that the most important effect of hydrocarbon exposure is its effect on renal function. End-stage renal failure may be preventable in many patients with glomerulonephritis provided a possible exposure to toxic chemicals is discontinued.     

Factors associated with renal cortical echogenicity

We studied the causes of renal cortical echogenicity (RCE). Its bilateral average value (AvRCE) and the left renal cortex/spleen echo ratios (RCSplE) were determined among 22 workers exposed to industrial solvents and 19 controls. Men had a higher AvRCE than women (p = 0.006). Current exposure to solvents increased AvRCE (p = 0.024), as did any exposure to aliphatic solvents (p < 0.001). AvRCE had a significant negative correlation with liver transaminases AST, ALT and GGT and with serum triglycerides. RCSplE correlated positively with AST, ALT and GGT, with total serum cholesterol and with diastolic blood pressure. Besides renal structural changes, RCE may be influenced by renal flow effects and the presence of macromolecules in renal vessels and tubular systems. Incidentally-found altered RCE may warrant the workout of occupational exposure history and general medical investigation if no kidney disease is known to exist.     

大鼠肾脏经90 dB或130 dB次声作用后其超微结构的改变

目的探讨大鼠肾脏组织经相同频率(8Hz)，不同声压级水平(90dB及130dB)的次声作用后，其细胞超微结构损伤的特点及意义。方法将雄性SD大鼠78只，随机分为对照组(6只)、实验A组(次声声压级为90dB)及实验B组(次声声压级为130dB)，实验A、B组又根据次声作用时间(1，7，14，21，28和35d)各分为6个亚组，每个亚组有6只大鼠。各组大鼠每天分别在相应声压级水平的8Hz次声环境中暴露1次，每次2h。各组动物待实验结束后处死，取其左、右侧肾组织用戊二醛及锇酸固定，置于透射电镜下观察其超微结构的变化。结果经130dB次声作用1d后，大鼠肾小管上皮细胞间隙略增宽，有轻度线粒体肿胀，而90dB次声作用相同时间后，未见大鼠肾小管上皮细胞超微结构发生明显损伤，仅见肾小球毛细血管充血；经130dB次声作用14d后，大鼠部分肾小管上皮细胞发生坏死、脱落等病理改变，90dB次声作用相同时间后，可见肾小管上皮细胞溶酶体增生；经130dB次声作用21d后，大鼠肾小管上皮细胞线粒体明显被破坏，管腔内可见红细胞，肾球囊基膜出现复层化，90dB次声作用相同时间后，肾小管上皮细胞间隙扩大，间质血管扩张、充血，肾小管受压扭曲；当90dB、130dB次声分别作用28d及35d时，此时大鼠肾脏损伤程度有逐渐减轻的趋势。结论次声对大鼠多次作用后，可导致其肾脏发生直接的、广泛的、无组织特异性的损伤；当次声作用28d或更长时间后，大鼠肾脏组织各种细胞对次声的损伤作用具有一定的适应性。     

Biochemical markers of basement membrane disturbances and occupational exposure to hydrocarbons and mixed solvents

To investigate possible mechanisms of hydrocarbon or solvent-inducedrenal damage, we studied three groups of healthy men employedin a UK manufacturing plant. Group 1 (n = 111) were occupationallyexposed to hydrocarbon-based paints, Group 2 (n = 100) wereoccupationally exposed to petroleum-based mineral oils, andGroup 3 (n = 92) had low background occupational exposure tohydrocarbons. Occupational atmospheric exposure levels for toluene,xylene, butanol and oil mist around the time of this study werewithin UK permissible limits. Group 4 (controls) were maleswith no known occupational hydrocarbon or solvent exposure (n= 108). Circulating laminin antibodies and the auto-antibodyimplicated in Goodpasture's syndrome (anti-GBM) were measured,as were serum laminin, a basement membrane turnover marker,and soluble E-selectin, an endothelial activation marker. Group1 had a significantly greater proportion of subjects with highlevels of both anti-laminin antibodies and soluble E-selectin;Group 2 had significantly more subjects with raised anti-GBMantibodies, laminin and soluble E-selectin. Mean levels of solubleE-selectin were increased in Groups 1 and 2. In a small butsignificant proportion of these workers exposed to hydrocarbons/mixedsolvents there are alterations both to basement membranes, resultingin autoantibody production, and to overlying vascular endothelialcells.     

Membranous nephropathy, hydrocarbon exposure and genetic variants of hydrocarbon detoxification

Modulation of biotransformation by genetic traits may be important in determining environmentally-induced nephrotoxicity. We conducted a case-control study to investigate the role of occupational hydrocarbon exposure, along with polymorphisms of the genes coding for N-acetyltransferase 2 (NAT2) and glutathione S-transferase mu (GSTmu), in the development of idiopathic membranous glomerulonephritis (IMGN). Patients (n=36) with biopsy-proven IMGN were matched with healthy controls for age, gender, and geographical area. Lifetime hydrocarbon exposure was assessed by a validated questionnaire. The polymorphisms of the NAT2 and GSTmu genes (GSTM1) were defined by use of a polymerase chain reaction on white-cell DNA from peripheral blood. Exposure to hydrocarbons was significantly greater in patients with IMGN than in controls (mean+/-SEM hydrocarbon exposure score 11 003+/-2955.7 vs. 4352+/-1418, p<0.02). NAT2 acetylator status was identical in patients and controls with 23 (63.9%) fast and 13 (36.1%) slow acetylators in each group. GSTmu was present in 15 (41.7%) patients and 16 (44.4%) controls. While occupational exposure to hydrocarbons remains a likely factor in its pathogenesis, further work is required to identify the genetic polymorphisms that modulate the risk of IMGN.     

Attitude and Knowledge of Physicians and Nurses About Ionizing Radiation

The purpose of this study was to describe physicians' and nurses' knowledge and attitude about the potential dangers of imaging tests. The study comprised 144 participants; 68 physicians, and 76 nurses. Over 70% of the physicians reported that to complete their diagnosis, they always sent patients for ionized testing. Most of the physicians and nurses indicated that they knew that these tests could cause cancer and genetic changes. Over 80% of the medical staff did not know the amount of environmental radiation that was equal to an x-ray test or computed tomography scan. Thirty percent of the respondents noted that they did not protect the patient's sensitive organs during radiation procedures. As for the physicians and nurses in the invasive unit, they did not follow precise instructions for self-protection from exposure to radiation while working. There is a necessity to follow up on quantity of exposure to x-ray and computed tomography scan radiation for all patients and to promote physicians' and nurses' knowledge about protection from exposure to radiation.     

Impact of Renal Function on the Pharmacokinetics and Safety of Ceftolozane-Tazobactam

Ceftolozane-tazobactam is a novel antipseudomonal cephalosporin with a β-lactamase inhibitor. We investigated the pharmacokinetics (PK) and safety of ceftolozane-tazobactam in subjects with various degrees of renal function. In two phase I, open-label studies, a single dose of ceftolozane-tazobactam was administered as a 1-h intravenous infusion to 24 subjects with normal, mild, or moderate renal impairment (1,000/500 mg) and six subjects with severe renal impairment (500/250 mg). Six subjects with end-stage renal disease (ESRD) received two doses of ceftolozane-tazobactam (500/250 mg each), pre- and posthemodialysis (post-HD). PK parameters were determined by noncompartmental methods. Plasma exposure to ceftolozane-tazobactam increased as renal function declined with only slightly increased exposures in subjects with mild renal impairment; the median area under the concentration-time curve from time zero to infinity (AUC_0-∞) for ceftolozane and tazobactam increased 1.4- and 1.2-fold, respectively. In subjects with moderate renal impairment, the AUC_0-∞ increased 2.5- and 2.2-fold for ceftolozane and tazobactam, respectively. In subjects with severe renal impairment, the dose-normalized median AUC_0-∞ for ceftolozane and tazobactam increased 4.4- and 3.8-fold, respectively. In ESRD subjects, ceftolozane and tazobactam concentrations declined rapidly following the start of HD, with approximately 66 and 56% reductions in overall exposure based on the AUC_0-∞ before and after dialysis. Slight increases in exposure with mild renal impairment do not warrant a dose adjustment; however, subjects with moderate or severe renal impairment and those on HD require a decrease in the dose, a change in the frequency of administration, or both to achieve exposures within the established safety and efficacy margins of ceftolozane-tazobactam. Ceftolozane-tazobactam was well tolerated by all renal impairment groups.     

Cigarette smoking, coffee drinking, and ingestion of charcoal-broiled beef as potential modifiers of drug therapy and confounders of clinical trials

A pathway of research is described, leading from the finding of an inhibitory effect of 3-methylcholanthrene on the carcinogenicity of an aminoazo dye, to the induction of drug-metabolizing enzymes by 3-methylcholanthrene, benzo[a]pyrene, and other polycyclic aromatic hydrocarbons, to the demonstration of enhanced drug metabolism in cigarette smokers, coffee drinkers, and people who eat charcoal-broiled beef. The results of these studies indicate that cigarette smoking, coffee drinking, and the ingestion of charcoal-broiled beef (all resulting in exposure to polycyclic aromatic hydrocarbons) can influence the dosing regimen needed for proper drug therapy and are potential confounders of clinical trials with drugs metabolized by polycyclic aromatic hydrocarbon-inducible enzymes.     

Dialysis amyloidosis syndrome in patients aged over 55 years and undergoing a hemodialysis program

The clinical-and-biochemical signs of the dialysis amyloidosis syndrome were studied in two groups of patients with chronic renal insufficiency (CRI), who have been undergoing a multi-year renal-substitutive therapy (program-type hemodialysis). The first group comprised 77 adult patients (aged 18-40), the second group comprised 49 "elderly" patients (aged 55-73). Apart from the standard analyses, the dynamics of beta 2-microglobulin (beta 2-M) was studied in the blood of patients. Specific features in the development of the syndrome of dialysis amyloidosis were described; they correlated with the level of beta 2-M, with a duration of program-type hemodialysis, with the elderly age of patients, with variants of renal pathologies, and with an concomitant diabetes mellitus.     

Motivation and dissatisfaction factors in the nurse's work

Motivation and dissatisfaction factors in the work of nurses were researched and identified in the health institutions of the city of Aracaju, with emphasis in the remuneration and working conditions. The sample comprised 10% of the nurses allotted in each health unit researched. It was found that remuneration is not the main motivation in work, but it is the second most mentioned dissatisfaction factor, topped only by working conditions. Other factors that motivate nurses to stay in the job include the possibility of working in something they enjoy, the professional stability given by public positions, a commitment with the population and the importance of their service, among others.     

囊性肾肿瘤的超声表现

报告7例囊性肾肿瘤的超声表现,并探讨其病理基础改变.6例恶性囊性肾肿瘤中83.3%(5/6)超声表现为多房分隔,囊壁及房壁薄厚不均的囊性肿物,内充满陈旧性出血和/或坏死组织碎屑.     

Pharmacokinetics of telbivudine in subjects with various degrees of renal impairment

This study evaluates the effect of renal impairment on the pharmacokinetics of telbivudine. Thirty-six subjects were assigned, on the basis of creatinine clearance (CL(CR)), to 1 of 5 renal function groups with 6 to 8 subjects per group: normal renal function; mild, moderate, or severe renal impairment; or end-stage renal disease [ESRD] requiring hemodialysis. Subjects received a single oral dose of telbivudine at 600 mg (normal function and mild impairment), 400 mg (moderate impairment), or 200 mg (severe impairment and ESRD); plasma and/or urine samples were collected over a 48-h period for pharmacokinetic analyses. Telbivudine was well tolerated by all subjects. The pharmacokinetics of 600 mg of telbivudine were comparable for subjects with mild renal impairment and normal renal function. Likewise, for subjects with moderate to severe impairment, including ESRD, reduced doses from 200 to 400 mg produced plasma exposure similar to that for subjects with normal renal function. These results indicate that the pharmacokinetics of telbivudine were dependent on renal function, especially for subjects with moderate to severe renal impairment or ESRD. Apparent total plasma clearance, renal clearance (CL(R)), and urinary excretion of telbivudine decreased as renal function deteriorated. A linear relationship was established between CL(R) and CL(CR). In ESRD subjects, a routine 3.5- to 4-h hemodialysis session removed telbivudine from plasma at an extraction ratio of approximately 45%, representing a approximately 23% reduction in total exposure. These results suggest that while no adjustment of the telbivudine dose appears necessary for subjects with mild renal impairment, dose adjustment is warranted for those with moderate to severe renal impairment or ESRD in order to achieve optimal plasma exposure.     

数字化体层摄影在老年IVP中的应用价值

目的探讨数字化体层摄影在老年静脉肾盂造影应用中的价值。方法应用直线轨迹8^0／o．4s和数字化体层自动曝光三点技术：kV、mAs、ms，在透视检查后决定曝光条件即时抓摄泌尿系统的体层影像。结果26例老年病人造影检查中，有19例腹部准备不充分，通过体层摄影全部消除了重叠伪影的干扰，使肾脏正常组织和病变得到清晰的显示，肾脏：)己明显异常征象20例，肾结石3例，肾积水1例，肾盂癌1例，肾钙化1例。诊断符合率达100％，曝光剂量降低了83．75％。结论数字化体层摄影对提高老年IVP检查的诊断符合率和射线防护具有很高的价值，应该作为常规运用。     

Effects of rosiglitazone maleate when added to a sulfonylurea regimen in patients with type 2 diabetes mellitus and mild to moderate renal impairment: a post hoc analysis

BACKGROUND: Patients with type 2 diabetes mellitus (DM) and renal impairment whose disease is inadequately controlled on a sulfonylurea (SU) have limited oral combination treatment options. OBJECTIVE: This post hoc analysis assesses the efficacy and tolerability of the insulin sensitizer rosiglitazone maleate (RSG) when added to an SU treatment regimen in patients with type 2 DM with mild to moderate renal impairment that is inadequately controlled by SU monotherapy. METHODS: Data were pooled from 3 randomized, double-blind, placebo-controlled, parallel-group studies in which RSG or placebo was added to an SU (glibenclamide, gliclazide, or glipizide) treatment regimen for a period of 6 months. Patients were subcategorized as having mild to moderate renal impairment or normal renal function based on a baseline creatinine clearance rate of 30 to 80 mL/min or >80 mL/min, respectively, as estimated by the Cockcroft-Gault equation. RESULTS: The population studied comprised 824 patients, 62% men and 38% women, aged 32 to 81 years, of whom 301 had mild to moderate renal impairment and 523 had normal renal function. In patients with and without renal impairment, glycemia was improved in the SU + RSG-treated group compared with the SU + placebo-treated group. The observed treatment differences between the groups were -2.6 mmol/L for fasting plasma glucose and -1.1% for glycosylated hemoglobin (for both renally impaired and nonimpaired patients). For patients receiving SU + RSG, little difference in the safety profile was found between patients with and without renal impairment. CONCLUSION: RSG was effective and well tolerated when added to SU therapy in this population of patients with mild to moderate renal impairment.