A pilot study of blood lead levels and neurobehavioral function in children living in Chennai, India

The relationship between blood lead level and neurodevelopment was assessed in a pilot cross-sectional study of 74 4-14-year-old children in Chennai, India. Mean blood lead level was 11.1 microg/dL (2.5-38.3). The Binet-Kamath IQ test and the Wide Range Assessment of Visual Motor Activity (WRAVMA) were administered to 58 children. Teachers completed the Connor's Behavioral Rating Scale. Excluding two outliers, IQ and WRAVMA composite scores were inversely related to blood lead level, with an effect size of approximately 6 points decline for a 10-microg/dL increase in blood lead. Children in the highest and lowest blood lead quartiles had mean IQs of 95.6+/-13.3 and 102.0+/-22.5, respectively. Behavior ratings were not associated with blood lead level. Lead exposure is a significant problem among Indian children, with many having blood lead levels associated with increased neurodevelopmental risk.     

Lymph node metastasis in an animal model: effect of piecemeal laser surgical resection

BACKGROUND AND OBJECTIVES: Endoscopic laser surgical resection of advanced squamous cell carcinoma (SCC) often requires division of the tumor into several pieces. It is unknown if this approach influences the incidence of regional and distant metastases. STUDY DESIGN/MATERIALS AND METHODS: In 143 rabbits VX2 SCC was induced. Eight days later the tumor was resected by two different methods. In the first group en bloc cold steel resection was performed. In the second group piecemeal laser resection was performed. On the 51th day the animals were sacrificed and examined for lymph node and distant metastases. RESULTS: After piecemeal laser resection 47.7% of the animals had lymph node metastases compared to 24.6% after en bloc resection (P = 0.01). The incidence of distant metastases did not differ for the two groups. CONCLUSIONS: In our model narrow margin piecemeal laser resection was associated with a higher incidence of metastases compared to wide en bloc surgical resection. The exact mechanism responsible for this increase is unclear.     

Contractile effect of prolactin on guinea pig isolated ileum

Prolactin (PRL) at high concentrations contracted the guinea pig isolated ileum. The maximum response elicited by PRL was 44% of that of histamine-induced responses. There was no significant difference in potency between PRL preparations obtained from two different sources. PRL responses were nullified by denaturation or proteolytic digestion of the hormone. The contractile response was antagonised by atropine and potentiated by neostigmine, but unaffected by the prostaglandin antagonist SC-19220. The pA2 values of atropine against PRL and ACh were similar. Preincubation with morphine, which inhibits ACh release, produced slight inhibition of PRL-evoked contractions. Even high concentrations of PRL failed to produce any response in neostigmine-treated frog rectus muscle preparations. This suggests that PRL may produce contractions through a cholinergic mechanism involving muscarinic receptors. Enhanced gut motility reported earlier for hyperprolactinemic states may be attributed to this cholinomimetic effect of PRL on the intestinal tract.     

A primary care perspective of posttraumatic stress disorder for the Department of Veterans Affairs

Posttraumatic stress disorder (PTSD) is a major mental disorder associated with significant morbidity, psychosocial impairment, and disability. The diagnosis of PTSD can be missed in a primary care setting, as patients frequently present with somatic complaints or depression and are often reluctant to discuss their traumatic experiences. As recent studies of veterans returning from the Gulf War and the Iraqi War suggest high rates of PTSD, the U.S. Department of Veterans Affairs (VA) Hospitals are gearing up to face this challenge. It is important to screen these veterans for symptoms of PTSD and make an appropriate referral if required. In this article, we attempt to review PTSD with a special focus on the VA population. In addition to discussing the epidemiology, diagnosis, and treatment options for PTSD, we also suggest screening questions for both combat-related and military sexual trauma-related PTSD.     

Neurolisteriosis causing hydrocephalus, trapped fourth ventricle, hindbrain herniation and syringomyelia

Central nervous system infection by Listeria monocytogenes is relatively uncommon, but is known to be highly morbid and fatal. We describe a case of listeria meningoencephalitis, wherein the acute episode was followed by a hitherto unreported conglomeration of severe and progressive neurological sequelae, in the form of supratentorial hydrocephalus, aqueduct block, trapped fourth ventricle, hindbrain herniation and syringomyelia. Pertinent literature is reviewed and the pathogenesis of the observed sequelae is explored.     

Duodenal somatostatinoma associated with Von Recklinghausen's disease

Somatostatinomas are rare, malignant, somatostatin-producing neuroendocrine tumors with a prevalence of one in 40 million. The coincidence of Von Recklinghausens disease and duodenal somatostatinoma has been known since 1982. We report the case of a 57-year-old female patient with Von Recklinghausens disease and a tumor of the pancreatic head that was diagnosed due to painless icterus. Histopathological examination after pylorus-preserving pancreatoduodenectomy revealed the existence of a duodenal somatostatinoma with lymph node metastases. Characteristics of the association of von Recklinghausens disease and somatostatinoma, and therapy and prognosis will be discussed. In patients with Von Recklinghausens disease and an ampullary tumor, a somatostatinoma should be considered. In contrast to its pancreatic counterparts, duodenal somatostatinoma is frequently associated with Von Recklinghausens disease, often contains psammoma bodies, is rarely associated with a recognizable somatostatin syndrome, and is hardly ever associated with demonstrable metastases at the time of diagnosis. Small tumors arising in the duodenum may be treated with local excision, whereas larger tumors should be treated by total excision, which may entail a partial pancreatoduodenectomy.     

Exposure assessment for respirable particulates associated with household fuel use in rural districts of Andhra Pradesh, India

Indoor air pollution associated with combustion of solid fuels seems to be a major contributor to the national burden of disease in India, but relatively few quantitative exposure assessment studies are available. This study quantified the daily average concentrations of respirable particulates (50% cut-off at 4 microm) in 412 rural homes selected through stratified random sampling from three districts of Andhra Pradesh, India and recorded time activity data from 1400 individuals to reconstruct 24-h average exposures. The mean 24-h average concentrations ranged from 73 to 732 microg/m(3) in gas- versus solid fuel-using households, respectively. Concentrations were significantly correlated with fuel type, kitchen type, and fuel quantity. The mean 24-h average exposures ranged from 80 to 573 microg/m(3). Among solid fuel users, the mean 24-h average exposures were the highest for women cooks and were significantly different from men and children. Among women, exposures were the highest in the age group of 15-40 years (most likely to be involved in cooking or helping in cooking), while among men, exposures were highest in the age group of 65-80 years (most likely to be indoors). The data are being used to develop a model to predict quantitative categories of population exposure based on survey information on housing and fuel characteristics. This would facilitate the development of a regional exposure database and enable better estimation of health risks.