1/13. An unusual cause of recurrent abdominal pain.abdominal pain is a common complaint with diverse etiologies. We describe an unusual case of recurrent abdominal pain in an adult due to lead poisoning, a condition usually associated with childhood. A previously healthy 42-yr-old man presented with 2 days of severe crampy abdominal pain and a 1-month history of constipation. physical examination was remarkable for diffuse abdominal pain but peritoneal signs were not present. blood tests were remarkable for hematocrit of 33 and mean cell volume of 78, with ovalocytes and basophilic stippling on blood smear. Abdominal x-ray showed stool throughout the colon and a nonspecific bowel gas pattern. The patient was treated with intravenous fluids and enemas, and his symptoms resolved within 2 days. Repeat history taking revealed he had been stripping paint from an old Victorian house in the preceding few months. He was discharged after a blood lead level was obtained. Before his clinic appointment he was readmitted 2 days later with recurrent abdominal pain. His blood lead level was elevated at 110 microg/dl (toxic range). After consultation with the occupational health and safety Administration and local poison control service, he was treated with intravenous calcium edetate disodium and intramuscular dimercaprol. He was asymptomatic at discharge, with a level of 56 microg/dl. Two weeks later, a repeat level was elevated at 72 microg/dl, for which he received a 3-wk course of oral dimercaptosuccimer. Subsequent levels were unremarkable, and the patient remains asymptomatic. abdominal pain secondary to lead poisoning in adults is uncommon. This case highlights the importance of taking a detailed occupational history and appropriately using "routine" blood tests to diagnose a rare condition that presented with a common complaint.- - - - - - - - - - ranking = 1keywords = basophil (Clic here for more details about this article) |
2/13. Occupational asthma and rhinitis caused by multiple herbal agents in a pharmacist.BACKGROUND: Herb agents have been widely used for centuries in the Orient and they have been cultivated throughout asia. There have been a few cases of occupational allergy caused by herb materials. We report a case of occupational asthma and rhinitis caused by six herb materials in a pharmacist working at a pharmacy. OBJECTIVE: We sought the role of immediate hypersensitivity in herbal agent-induced asthma in a pharmacist. methods AND RESULTS: The patient had strong positive responses on skin prick test to extracts of six herb materials: Chunkung (Cnidii rhizoma), Banha (pinellia ternata), Sanyak (dioscorea radix), Kangwhal (Ostericum koreanum), Danggui (angelica radix), and Kunkang (Zingiberis rhizoma). Bronchoprovocation tests showed an early asthmatic response to Danggui extract. serum specific IgE antibodies to Chunkung, Banha, and Sanyak were detected by ELISA with no specific IgE bindings to Kangwhal, Danggui, and Kunkang extracts. Twelve percent sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) and IgE immunoblotting revealed one IgE binding component (60 kD) within Chunkung extract, two (10, 25 kD) in Banha, and four (33, 34, 65, 98 kD) in Sanyak. Basophil histamine release test revealed that Danggui extract could release a greater amount of histamine from basophils in the patient than in a healthy control. CONCLUSIONS: Chunkung, Banha, and Sanyak may induce IgE-mediated bronchoconstriction in an exposed worker, and Danggui can cause bronchoconstriction by direct histamine-releasing effect from mast cells in a sensitized patient.- - - - - - - - - - ranking = 1keywords = basophil (Clic here for more details about this article) |
3/13. The interpretation of zinc protoporphyrin changes in lead intoxication: a case report and review of the literature.BACKGROUND: zinc protoporphyrin (ZPP) has been used both as a screening and diagnostic test for overexposure to lead for nearly 30 years, although limitations for both purposes are recognized. methods: We present longitudinal findings for ZPP and whole-blood lead in a man with two episodes of acute lead intoxication and review the literature on the use of ZPP. RESULTS AND CONCLUSIONS: ZPP elevations in both chronic and acute exposure settings lag behind elevations in whole-blood lead by approximately 8-12 weeks. Therefore, ZPP measurement, in conjunction with whole-blood lead determination, has clinical utility in cases of substantial overexposure by providing information on how long an individual may have been overexposed to lead. A guide to the interpretation of various combinations of whole-blood lead and ZPP results is provided. However, while ZPP levels do correlate with whole-blood lead measurements in aggregate, the considerable individual variability of ZPP measurements, poor sensitivity at lower ranges of lead exposure, poor specificity and delayed changes in unstable exposure conditions indicate that this test contributes little to screening programs. Finally, our results confirm that basophilic stippling is seen in acute as well as chronic lead intoxication, and may provide the first indication of lead intoxication.- - - - - - - - - - ranking = 1keywords = basophil (Clic here for more details about this article) |
4/13. Baker's asthma with a predominant clinical response to rye flour.BACKGROUND: Relatively little attention has been paid to rye flour as opposed to wheat flour in clinical and epidemiological research into Baker's asthma. methods: This report describes the investigation of a baker with asthma who reported a workplace response to rye flour and none to wheat flour, despite co-reactivity to both wheat and rye antigen. RESULTS: Skin prick tests, RASTs and basophil stimulation tests were positive for both wheat and rye antigen, but quantitatively greater for rye than wheat. Bronchial challenge elicited a much greater response to the rye-wheat flour mix used in the bakery than to 100% wheat flour. CONCLUSIONS: The greater clinical response to rye than to wheat may be immunologically mediated, but could also be due to physical characteristics of rye flour such as greater dose of inhaled airborne particles or an irritative effect. This information may be useful for medical management and occupational hygiene control, and should stimulate further research into rye flour in Baker's asthma.- - - - - - - - - - ranking = 1keywords = basophil (Clic here for more details about this article) |
5/13. Occupational asthma caused by cobalt chloride in a diamond polisher after cessation of occupational exposure: a case report.OBJECTIVES: The inspiration of cobalt containing dust leads to various respiratory symptoms, including asthma and interstitial lung disease. Occupational asthma caused by cobalt chloride has been diagnosed in a 35-year-old patient, who worked as a diamond polishing disc former. The patient presented a 2-year history of dyspnea, cough and symptoms of rhinitis. MATERIALS AND methods: The patient underwent a medical history interview, skin prick tests with common and occupational allergens (cobalt and nickel chloride), and pulmonary function testing both before and after the nasal provocation with 0.05% cobalt chloride. Additionally, the authors analyzed morphological and biochemical changes before and after the specific nasal challenge test. cell proliferation analysis was also carried out. RESULTS: Skin prick tests (SPTs) with common environmental allergens were found to be negative, while SPTs with cobalt chloride were positive for all applied solutions. The provocation with cobalt chloride caused a significant increase in the proportion of eosinophils, basophils and albumin during the late allergic reaction. The positive lymphocyte transformation caused by cobalt was also observed. CONCLUSIONS: cobalt salts may induce occupational asthma. The mechanism of this asthma may be IgE-mediated. The cobalt-sensitized lymphocytes may play an important role in this disease.- - - - - - - - - - ranking = 1keywords = basophil (Clic here for more details about this article) |
6/13. Coriander anaphylaxis in a spice grinder with undetected occupational allergy.BACKGROUND: anaphylaxis after ingestion of spices as a result from occupational sensitization remains anecdotal. We describe a patient, working in a spice factory, with anaphylaxis from coriander in a meal. He also demonstrated urticaria, angio-edema, rhinoconjunctivitis and bronchospasm during handling coriander and fenugreek. OBJECTIVE: To determine the mechanism of the anaphylactic reaction and to evaluate cross-reactivity between both botanically unrelated spices. methods: Investigations comprised quantification of total and specific IgE by Immuno-CAP FEIA, skin testing, basophil activation experiments by flow-assisted determination of CD63 expression in the patient and 3 healthy controls. Immuno-CAP inhibition experiments were applied to investigate cross-reactivity. RESULTS: Specific IgE, skin tests and basophil activation tests were clearly positive in the patient, whereas they remained negative in controls. No cross-reactivity between fenugreek and coriander was demonstrable by inhibition experiments. CONCLUSIONS: The clinical manifestations in temporal relationship to ingestion of coriander and handling of coriander and/or fenugreek, the positive specific IgE results, skin tests and basophil activation assays support the diagnosis of allergy to both spices. history suggests sensitization by occupational exposure.- - - - - - - - - - ranking = 3keywords = basophil (Clic here for more details about this article) |
7/13. Bronchial asthma due to cannabis sativa seed.A 51-year-old man with asthmatic attacks due to cannabis sativa seed inhalation was studied. Specific IgE against this seed was demonstrated by in vivo (skin and bronchial challenge tests) and in vitro methods (reverse enzyme immunoassay and histamine release from basophils), suggesting a Type I immunologic reaction.- - - - - - - - - - ranking = 1keywords = basophil (Clic here for more details about this article) |
8/13. lead poisoning: clinical, biochemical, and haematological aspects of a recent outbreak.The clinical, biochemical, and haematological aspects of a recent outbreak of lead poisoning, in which exposure was related to the oxyacetylene cutting of red lead painted ironwork, were investigated. Initial suspicion was raised when a blood film showed punctate basophilia which remains a simple and useful method of picking up lead toxicity. Estimations of blood lead concentration and conventional laboratory data confirmed the diagnosis. Although there was prominent punctate basophilia, spectrophotometric analysis showed only negligible accumulation of pyrimidine-5'-nucleotides despite severe suppression of pyrimidine-5'-nucleotidase activity. The pattern of the red cell glycolytic intermediates, investigated for the first time, suggested that lead may also affect glycolysis at the hexokinase step. Once the diagnosis was made intravenous chelation treatment was begun with a rapid improvement in symptoms. Long term follow up is required to assess any sequelae of intoxication. These cases emphasise the classic features of lead poisoning, and despite the currently available diagnostic tests, lead intoxication may still go unrecognised unless a thorough occupational history is taken.- - - - - - - - - - ranking = 2keywords = basophil (Clic here for more details about this article) |
9/13. Acute systemic reactions to carbonless copy paper associated with histamine release.We report two cases of recurrent episodes of hoarseness, cough, flushing, pruritus, and rash occurring within 30 minutes of topical exposure to carbonless copy paper. Provocative challenges revealed that alkylphenol novolac resin was the ingredient responsible. Video endoscopy of the larynx was performed and plasma histamine levels were obtained prior to and 30 minutes after cutaneous challenge of a patient with alkylphenol novolac resin. We documented marked laryngeal edema and a sixfold increase in plasma histamine levels after challenge. We conclude that topical exposure to carbonless copy paper may cause mast cell/basophil-mediated acute systemic and potentially life-threatening reactions in susceptible patients.- - - - - - - - - - ranking = 1keywords = basophil (Clic here for more details about this article) |
10/13. A ceramic glazer presenting with extremely high lead levels.A case of lead poisoning in a ceramic glazer is reported. The patient had an extremely high level of blood lead at 29.5 mumol/l, and many of the laboratory features of lead toxicity: normocytic anaemia with marked basophilic stippling, abnormal blood and urinary porphyrins, and elevated liver enzymes. Surprisingly, the patient had no electromyographic evidence of neurologic involvement. The patient was treated with intravenous EDTA-calcium followed by oral penicillamine. Urinary porphyrin and porphyrin precursor excretion followed an interesting pattern, correlating with the chelator used. This patient illustrates that extremely high blood lead level can be achieved through the oral route in an adult.- - - - - - - - - - ranking = 1keywords = basophil (Clic here for more details about this article) |
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