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A clinicopathologic study of ameloblastoma.

One hundred four ameloblastomas, 97 in the mandible, five in the maxilla, and two in peripheral locations, were studied. A consistent correlation between the age of the patient and the radiographic or histologic type of mandibular ameloblastoma was observed. There was a tendency for ameloblastomas of the follicular type to show a multilocular or soap bubble appearance and for those of the plexiform type to show a unilocular appearance. Recurrent ameloblastomas had a predominantly multilocular appearance. Histologically, the ameloblastomas in the maxilla were of the follicular type.

Adolescent↗

In vivo percutaneous absorption of acetochlor in the rhesus monkey: dose-response and exposure risk assessment.

Percutaneous absorption of three topical dose levels of [14C]acetochlor in the rhesus monkey were determined for exposure risk assessment. The topical doses were 30.7, 0.43 and 0.03 mg acetochlor in 40 microliters commercial formulation and aqueous dilutions thereof, spread over 10 cm3 skin surface area (lower abdominal). The dosing area was not covered. The skin application time was 24 hr. The dosed skin surface area was washed with 50% soap (Ivory Liquid) and water at the end of the 24-hr dosing period. An intravenous dose of 0.43 mg was also administered to determine the excretory kinetics of acetochlor in the rhesus monkey. The same four monkeys were used for all dose administrations. Bioavailability was determined by radioactivity disposition in blood, urine and faeces. Percutaneous absorption was 23.1 +/- 8.7, 17.3 +/- 5.9 and 4.9 +/- 1.4% for 0.03, 0.43 and 30.7 mg doses, respectively. Assuming a constant state of absorption, the hourly exposure flux (microgram/cm2/hr) was 0.03 +/- 0.01 for the 0.03 mg dose (3 micrograms/cm2). Increasing the dose approximately 15-fold to 0.43 mg (43 micrograms/cm2) resulted in a 10-fold increase in flux to 0.3 microgram/cm2/hr. Increasing the dose a further 70-fold to 30.7 mg (3070 micrograms/cm2) resulted in only another 21-fold increase in flux (6.3 +/- 1.8 micrograms/cm2/hr). Thus, the efficiency of absorption (%) decreased with increased topical dose, but the amount (mass/flux) of acetochlor absorbed always increased with increased dose. Plasma levels of topical acetochlor at the high dose were detectable at 1 hr and continued at a relatively steady level through the 24-hr dosing period. After the skin surface wash (24 hr) plasma levels decreased but were still detectable at the last 168-hr sampling period. Acetochlor, recently EPA approved as an herbicide for corn crops, is carcinogenic; however, farmers will use half as much acetochlor/acre as other herbicides. The percutaneous absorption of acetochlor is equal to that of alachlor. Therefore, human exposure based on one-half usage suggests that human risk assessment should be one-half all other factors being equal.

Administration, Topical↗

Dermal penetration of 4"-(epi-methylamino)-4"-deoxyavermectin B1a benzoate in the rhesus monkey.

The dermal absorption of the experimental avermectin insecticide emamectin benzoate was studied in the Rhesus monkey. Dermal absorption was calculated by comparing radioactivity levels in excreta following dermal application of the compound with those following administration of an equivalent intravenous dose. After i.v. administration of 300 micrograms [3H]MAB1a (prepared as a 1:1 solution of propylene glycol:saline) to three monkeys, plasma levels decreased biphasically with a rapid decline in radioactivity during the first 15 min followed by a slower decline to background. By 7 days post-dose, approximately 90% and 5% of the administered radioactivity was recovered in the faeces and urine, respectively. After a washout period, 300 micrograms [3H]MAB1a (dissolved in emulsifiable concentrate) was applied topically to the shaved forearm of the same monkeys. Following a 10-hr exposure period, approximately 90% of the radioactivity was recovered in a soap and water wash of the exposed forearms. Although plasma radioactivity levels generally remained below background levels, approximately 1.5% of the applied dose was recovered in the excreta. Dermal absorption of [3H]emamectin benzoate was calculated as 1.6%. The low dermal penetration of emamectin benzoate indicates that minimal actual exposure of agricultural workers to this compound will occur.

Administration, Cutaneous↗

Predictive exposure modelling--a case study with a detergent surfactant.

Environmental exposure estimations are generally based on a knowledge of how and in what quantity a substance enters the environment and how it may subsequently be distributed and transformed. Once present within the environment, biota (including man) may be exposed. This paper outlines the tools commonly used to estimate environmental exposure to ingredients from detergents and other household products. Such products are typically manufactured in large quantities, used by many people, and disposed of after household use into the environment via the sewer. The vast majority of this waste stream is treated via domestic wastewater treatment plants (WWTPs) as documented in the sewage treatment Directive 91/275/EEC. WWTPs significantly reduce the load of chemical substances to the receiving surface waters, and have become an intrinsic part of exposure and risk assessment of household chemicals. WWTP models are generally first-order (e.g. SIMPLETREAT, WWTREAT) or mixed-order (e.g. Monod) kinetics and can exhibit, potentially, very distinct dependencies on the influent concentration. Thus, the correct representation of xenobiotic behaviour in a WWTP and modeling of their fate has a significant impact on exposure assessment. The Environmental Risk Assessment Steering Committee (ERASM) of the Association Internationale de la Savonnerie et la Détergence, et des Produits d'Entretiens (AISE) and the Comité Européen de Agents de Surface et Intermédiares Organiques (CESIO) has commissioned a joint industry Task Force of the Association to develop and apply specific methodology for the environmental monitoring of surfactants, and verification of fate models. The monitoring programmes have been designed to (1) establish the fate, distribution and concentrations of the major surfactants used in detergents-linear alkylbenzene sulfonate (LAS), alcohol ethoxylates (AE), alcohol ethoxylated sulfates (AES) and soap in relevant environmental compartments and (2) to provide the necessary data for checking the applicability of mathematical models to predict their fate and concentrations in these environmental compartments. The case study detailed here, specifically focuses on the refinement of the LAS exposure assessment for surface waters in The Netherlands.

Animals↗

[Compliance with the "recommendations SEPAR" on spirometry].

The objective of this study was to assess Spanish performance of spirometry and to determine the extent to which practice is in accordance with the 1985 SEPAR recommendations. To that end we formulated a questionnaire with 31 items in two sections, 10 covering basic aspects of compliance with necessary techniques and 21 general questions. The questionnaire was sent to all SEPAR members. One hundred eight responses were received. The results show that the typical spirometric measurement was forced expiration without a bronchodilator test by way of a pneumotacograph, with simultaneous representation of the flow/volume curve. Calibration, when performed, is done daily with a 3 1 syringe and atmospheric data are checked. Spirometric measurements are usually obtained by a registered nurse, who also collects anthropometric data directly from the patient. The patient is usually seated with the nose occluded. At least three and at most eight satisfactory readings are obtained. The criteria for starting and ending the maneuver and the reference values used are those recommended by SEPAR. The equipment is washed weekly with soap and water; calibrations and equipment incidences are not recorded. The level of compliance with 1985 SEPAR norms for forced spirometry is adequate with respect to some technical equipment questions but deficient on basic procedure and quality control.

Data Collection↗

[Fiberoptic bronchoscope disinfection with glutaraldehyde phenolate in 1:8 solution].

We evaluated the efficacy of phenolated glutaraldehyde in a 1:8 solution for the disinfection of bronchofibroscopes that were highly contaminated with Serratia marcescens and Pseudomonas aeruginosa. An Olympus BF-P10 bronchofibroscope was contaminated with artificial samples containing one of the aforementioned microorganisms in concentrations nearing 10(8) colony forming units per milliliter (cfu/ml). The instruments were then washed with soap and water and submerged in a 1:8 solution of phenolated glutaraldehyde. Samples were taken for culturing after contamination, after washing, and after 10, 15 and 30 min in the disinfectant solution. The level of cfu/ml in the cultures was measured and the definition of failure-to-disinfect was a finding of > or = 1 cfu/ml after each experimental procedure. Twenty procedures, 10 for each microorganism, were carried out. Washing of the bronchofibroscope afforded significant elimination of microorganisms and no colony growth was observed in cultures after 10 min submersion in phenolated glutaraldehyde. We conclude that immersion in a 1:8 solution of phenolated glutaraldehyde after careful washing is a valid way to disinfect bronchofibroscopes that are highly contaminated with S. marcescens and P. aeruginosa.

Bronchoscopes↗

Intrabony ameloblastoma of the jaws. An analysis of 147 Thai patients.

In this study, 147 cases of intrabony ameloblastoma from the files of our departments were reviewed. Clinical findings showed an average age of 31.6 years and a sex ratio of 1.1:1. The average duration of the tumour was 2.7 years. The majority of the tumours, 93.9%, occurred in the mandible with 36.1% of the cases found in the molar area. Radiographically, 62.7% of the lesions were polycystic. Histopathologically, 49.0% had a follicular pattern. There seems to be no direct correlation between the histologic patterns and the radiographic appearances of the tumors but there is a slight indication that both monocystic and polycystic types tend to have the plexiform pattern, while the soap-bubble type tends to have the follicular pattern.

Adolescent↗

Evidence for various calcium sites in human hair shaft revealed by sub-micrometer X-ray fluorescence.

New information about calcium status in human scalp hair shaft, deduced from X-ray micro-fluorescence imaging, including its distribution over the hair section, the existence of one or several binding-types and its variation between people, is presented. The existence of two different calcium types is inferred. The first one corresponds to atoms (or ions) easily removable by hydrochloric acid, located in the cortex (granules), in the cuticle zone and also in the core of the medulla, which can reasonably be identified as calcium soaps. The second type consists of non-easily removable calcium atoms (or ions) that are located in the medulla wall, probably also in the cuticle, and rather uniformly in the cortex; these calcium atoms may be involved in Ca(2+)-binding proteins, and their concentration is fairly constant from one subject to another. In addition to its nonuniform distribution across the hair section, the second striking feature of the first type calcium content is its high variability from one subject to another, by up to a factor 10. We expect this information to be useful for analyzing in more detail the relationship between hair calcium and environmental and medical factors.

Calcium↗

Abuse of silver-nitrate solution for planing periorbital folds.

When using a Hollensteinstift to treat periorbital folds a 28-year-old female patient perceived a chemical burn of the lower lids and the periorbital regions. The initial treatment was frequent washing with soap solution and topical panthenol ointment. This unusual case is demonstrated to show the risks of improper use of silver-nitrate solution and to discuss therapeutic options.

Adult↗

Gasoline contact burns.

In the past four years, four cases of gasoline contact burns have been treated at the Detroit General Hospital Emergency Department. Signs are erythema and blister formation within 24 hours. Treatment is removal of contaminated clothing and washing the surface with soap and water plus open exposure of the wounds. Renal failure is not caused by skin absorption but may develop following inhalation.

Accidents, Traffic↗

Human bites of the hand: twenty years of experience.

A retrospective study of the records of 20 years of experience with injuries from human bites reviewed the results of treatment of 42 patients during the first 10 years and 94 in the second 10 years. In the later series there was less delay in the treatment due to better education of primary physicians as well as of patients. There were fewer complications also. A prospective study of 38 patients, whose treatment consisted of soap and water cleansing, thorough exploration and debridement, hospitalization for at least 48 hours, and administration of antibiotics, showed this treatment resulted in a reduction of the incidence of amputation and stiff fingers despite the fact that 61% of the patients still delayed seeking treatment.

Adolescent↗

Acute hepatotoxicity of the polycyclic musk 7-acetyl-1,1,3,4,4,6-hexamethyl-1,2,3,4-tetrahydronaphtaline (AHTN).

Synthetic musks are present in fine fragrances, cosmetics, soaps and laundry detergents. One of the most important synthetic musks is 7-acetyl-1,1,3,4,4,6-hexamethyl-1,2,3,4-tetrahydro-naphthaline+ ++ (AHTN; annual production: about 1500 metric tons). An increasing number of studies show that AHTN accumulates in surface water and fish and can be detected in human adipose tissue, as well in human milk. In the present report it is shown that a single high dose of AHTN leads to acute hepatic damage in rats, characterized by single cell necrosis, inflammation, swelling of liver parenchymal cells, and the presence of cytoplasmic condensations in the hepatocytes, while at the ultrastructural level disorganization of the rough endoplasmic reticulum and mitochondria as well as focal cytolysis is evident. Furthermore, evidence is presented that AHTN is not genotoxic, does not induce peroxisome proliferation, and does not lead to the induction of drug-metabolizing enzymes as phenobarbital and 3-methylcholanthrene do.

Animals↗

Gas chromatographic method using electron-capture detection for the determination of musk xylene in human blood samples. Biological monitoring of the general population.

Musk xylene (2,4,6-trinitro-1,3-dimethyl-5-tert.-butylbenzene, MX), a synthetic musk often used in different fragrances and soaps to substitute the natural musk, is a potential contaminant of humans. In this publication, a specific and sensitive detection method for the determination of musk xylene in human blood samples is described. The clean-up of the blood samples includes an extraction step followed by a solid-phase adsorption to separate MX from other plasma components. Separation and detection was carried out by capillary gas chromatography and an electron capture detector (GC-ECD). The results were verified using qualitative capillary gas chromatography and a mass selective detector with electron impact ionisation (GC-EI-MS). epsilon-Hexachlorocyclohexane (epsilon-HCH) is used as internal standard. The reliability of the GC-ECD method has been proved. The relative standard deviations of the within-series imprecision were 12.7% for samples with a concentration of 0.5 microg/l and 2.1% for samples with a concentration of 5.0 microg/l, whereas the relative standard deviations for the between-day imprecision were 14.9% (0.5 microg/l samples) and 3.4% (5.0 microg/l samples). The losses during sample treatment were between 10.1% and 17.8%. No interfering peaks were observed. The absolute detection limit was 0.1 microg/l plasma. A total of 72 human blood samples were analysed to determine the MX concentrations within the general population. In 66 of the 72 human blood samples, the MX concentrations ranged from 0.10 to 1.12 microg/l plasma for the described method. In six samples no MX was detected. The median concentration was 0.24+/-0.23 microg MX/l plasma. The 95 percentile was 0.79 microg/l. No correlation could be found between MX concentrations and smoking habit, broca index, age, sex as well as fish consumption habits. Nevertheless, the results demonstrate the exposure of the general population to MX.

Chromatography, Gas↗

Cultural categorization of febrile illnesses in correlation with herbal remedies used for treatment in Southwestern Nigeria.

The ethnographic study was conducted in two communities in Oyo State in Southwestern Nigeria. The study sites consisted of a rural and an urban local government area located in the tropical rain forest zone of Nigeria. The study was designed to obtain information on febrile illnesses and herbal remedies for treatment with the aim of identifying potential antimalarial drugs. The study revealed that fever is a general term for describing illnesses associated with elevated body temperature. The indigenous Yoruba ethnic population has categorized fever based on symptoms and causes. The present communication is the result of focus group discussion and semi-structured questionnaire administered to traditional healers, herb sellers, elders and mothers. This was on types of fevers, symptoms and causes of febrile illnesses. The investigation also included use of traditional herbs in the prevention and treatment of the illnesses in the two communities.A total of 514 respondents were interviewed. This was made up of 266 (51.8%) from Atiba local government area (LGA), an urban centre while 248 (48.2%) respondents were interviewed from Itesiwaju LGA, a rural community. The LGAs are located in Oyo State of Nigeria. The respondents proffered 12 types of febrile illnesses in a multiple response answering system in Yoruba language. The most common ones (direct translation into English) were: yellow fever (39.1%), typhoid (34.8%), ordinary (28.8%), rainy season (20.8%) and headache (10.5%) fevers, respectively. Perceived causes of each of the febrile illnesses included stress, mosquito bites, unclean water, rains and over exposure to the sun. Methods of fever prevention were mainly with the use of herbal decoctions, powdered herbs, orthodox medications and maintenance of proper hygiene. Of a total of 112 different herbal remedies used in the treatment of the febrile illnesses compiled from the study, 25 recipes are presented. Recipes consisted of 2-7 ingredients. Oral decoctions (84%), oral powders (63%), use as soaps and creams (40%) in a multiple response system, were the most prevalent routes of administration of prepared herbs used in the treatment of the fevers. Boiling in water or alcohol was the most common method used in the preparation of the remedies. The four most frequently mentioned (multiple response system) plants in the Southwest ethnobotany for fevers were Azadirachta indica (87.5%), Mangifera indica (75.0%), Morinda lucida (68.8%) and Citrus medica (68.8%).

Adolescent↗

Body models in forensic ballistics: reconstruction of a gunshot injury to the chest by bullet fragmentation after shooting through a finger.

Forensic science uses substitutes to reconstruct injury patterns in order to answer questions regarding the dynamic formation of unusual injuries. Using a case study, an experimental simulation of a finger was designed, for the first time with a combination of hard wood and glycerin soap. With this model as an intermediate target simulation, it was possible not only to demonstrate the "bullet-body (finger) interaction", but also to recreate the wound pattern found in the victim. This case demonstrates that by using ballistic models and body-part substitutes, gunshot cases can be reproduced simply and economically, without coming into conflict with ethical guidelines.

Finger Injuries↗

Morphometric study of the medial aspect of the human maxillary sinus with special reference to the nasal fontanelle.

OBJECTIVE: The purpose of this study was to clarify configurations of the nasal fontanelle (NF) from the morphometrical point of view, especially variations of its four margins (anterior, posterior, superior, and inferior), for clinical application. METHODS: We used 136 sides of hemi-sectioned heads that were obtained from 119 donated Japanese cadavers (66 men and 53 women with an average age of 77.6+/-12.0). After mucosal examination, the specimens were boiled with a small amount of powdered soap and treated with protease. The residual mucous membrane was then gently removed. These specimens were originally made for our previous study describing variations of the uncinate process (Isobe M, Murakami G, Kataura A. Variations of the uncinate process of the lateral nasal wall with clinical implications, Clin. Anat. 1998;11:295-303). Different series of measurements were conducted based on surgical approaches and angles of observation. RESULTS: The superior margin of the NF is difficult to identify because the ethmoidal infundibulum, which leads the anterior end of the margin upward, often interrupts the superior margin. Because the inferior and posterior margins are modified by thin paper-like bony structures and because the anterior margin is disturbed by variations of the lacrimal bone and/or the inferior turbinate, they are also difficult to identify. Knowing these variables, we evaluated the NF morphometrically. The NF was located 12.6+/-4.3 mm posterior to the anterior nasal spine and 6.6+/-2.2 mm anterior to the sphenopalatine foramen. The size of the NF was 17.9+/-3.2 mm (anteroposterior axis) x 11.5+/-3.0 mm (inferosuperior axis). The lowest orbital floor was located 10 mm below the superior margin of the anterior NF (-10 mm), and the distance was therefore measured as -3.7+/-2.4 mm on average. Viewed from the maxillary sinus, the location of the NF varied along the anteroposterior axis, whereas it was located consistently at the most superior portion of the medial aspect of the sinus wall. CONCLUSION: During endoscopic sinus surgery for tumor resection in the maxillary sinus, a large and primary window should be prepared in the posterior NF, including partial removal of the uncinate process. Preparation of an additional window in the inferior meatus is preferable to enlargement of the primary window. Approaching the anterior NF should be avoided, if possible, due to its complicated configuration as well as its proximity to the orbital floor.

Aged↗

[Evaluation of aseptic measures in the performance of epidural catheterization and perception of its risk of infection. Results of a survey in Languedoc-Roussillon].

OBJECTIVE: To assess the level of aseptic practice in epidural catheterization, to determine the perception of its infectious risk and the knowledge of epidural abscess symptoms. STUDY DESIGN: Cross-sectional regionwide retrospective survey. MATERIAL: Questionnaire sent after telephone call to 160 anaesthesiologists performing epidural anaesthesia in Languedoc-Roussillon. RESULTS: Replies were obtained from 96 anaesthesiologists working in 26 centres. Handwashing techniques were various: 53% onefolded with an antiseptic preparation, 38% twofolded and 9% used a simple soap; 41% did never wear a long-sleeved sterile surgical gown and only 53% wored simultaneously a cap; a surgical mask and a sterile gown; 4% of the Tuohy needles were reusable; 21% of the dressings permitted continuous inspection of the site of puncture; 12.5% admitted not to know epidural abcess symptoms and 30% ignored the most adapted radiological diagnostic means. CONCLUSIONS: Good aseptic practice in epidural catheterization should be clarified by a consensus conference. There is an obvious lack of knowledge concerning features of epidural abscess.

Anesthesia, Epidural↗

[Survey on the measures of asepsis taken by general practitioners].

UNLABELLED: CURRENT STATE OF THE QUESTION: Many legislative and administrative texts rule asepsis and prophylaxis in health care centres. The deontological code provides the guidelines for medical corps. OBJECTIVE: To identify the measures set-up to prevent the transmission of infections in general practitioners' consulting rooms and to compare them with the data in the literature. METHOD: A postal survey using a questionnaire was sent to a representative sample of 119 general practitioners in the Loire-Atlantique area in France. RESULTS: The response rate was of 69%. The majority of physicians declared that had a wash basin in the consulting room, 43% declared that they did not systematically wash their hands between 2 patients in their consulting rooms and 78% during home visits, 23% used an ordinary soap, 49% a hydro-alcoholic solution, and 62% wiped their hands with a cotton towel. Blood interventions were performed with gloves by more than 80% of the participants, complete decontamination procedures of the material were performed by 6%, but more than 80% used single use material. Although 45% believed they had changed their habits, 23% remained wary of any eventual recommendations and 43% made no comments. DISCUSSION: This survey method collects declarative data and remains limited with regard to information. In-depth analysis of the daily activity of the participants would be useful for an approach of performance criteria, in view of the fact that some consultations do not include any, or even partial, clinical examination. The investments required for the purchase of the material compatible with the specifications applicable to health care centres may appear excessive for their current activity. The generalisation of the use of single use material represents a great progress in the field of prevention. Comparison with similar earlier studies shows the good progress made and the improvement in quality. Nevertheless, studies using a strict methodology are necessary to establish guidelines to be applied in general medical practice. The drawing-up of Referentials requires great rigour and the participation of the practitioners in their development and organisation would lead to substantial benefits.

Asepsis↗