Residential deleading: effects on the blood lead levels of lead-poisoned children

Acute elevations of venous blood lead levels (PbB) are periodically reported in children with chronic lead poisoning, during deleading of their houses. To evaluate this phenomenon 114 preschool children who entered the Massachusetts Childhood Lead Poisoning Prevention Program case management system during 1984 and 1985 were retrospectively studied. PbB increased from a mean (+/- SE) of 1.76 +/- 0.03 mumol/L (36.4 +/- 0.6 micrograms/dL) prior to deleading to 2.03 +/- 0.07 mumol/L (42.1 +/- 1.5 micrograms/dL) during deleading (P less than .001). Among 41 subjects for whom deleading was done by dry scraping and sanding, the mean mid-deleading PbB was higher than the pre-deleading PbB by 0.44 +/- 0.12 mumol/L (9.1 +/- 2.4 micrograms/dL). However, when deleading was done by covering or replacement of painted surfaces in the residences of 12 subjects, mid-deleading PbB decreased 0.11 +/- 0.12 mumol/L (2.25 +/- 2.4 micrograms/dL) (P less than .005). In a subset of 59 subjects who had no chelation therapy and were available for follow-up 250 +/- 14 days after completion of deleading, PbB had decreased from 1.72 +/- 0.04 mumol/L (35.7 +/- 0.9 micrograms/dL) to 1.24 +/- 0.04 mumol/L (25.5 +/- 0.9 micrograms/dL) (P less than .001). The long-term effect of deleading is a significant reduction in PbB. However, deleading resulted in a significant, albeit transient, increase in PbB.

Neuropathologic findings in three cases of profound hypoglycemia

Three clinical cases of profound hypoglycemia are described with survival periods ranging from 2 1/2 months to 6 years. Although prolonged clinical coma was present in all cases, only subtle evidence of neuronal loss was found. The value of immunohistochemical examination of the grey and white matter of the telencephalon in detecting evidence of neuronal loss in such cases is demonstrated. Infarcts were uniformly absent, as would be expected from the lack of cerebral acidosis in hypoglycemia. In addition to the usual absence of infarction, the pathologic findings in hypoglycemia distinguish themselves from hypoxic/ischemic encephalopathy in that the cerebellum is regularly spared, and that there is sometimes a characteristic involvement of the dentate gyrus, a structure relatively resistant to hypoxic/ischemic damage.

Fatal hepatitis associated with diclofenac

Non-steroidal anti-inflammatory agents (NSAIDS) are a well recognised cause of hepatotoxicity. Diclofenac, a relatively new NSAID, was first introduced into the UK in 1979. Five cases of hepatitis have recently been reported, principally in the French literature. We report the first fulminant case of hepatitis in the English literature in a patient taking diclofenac and indomethacin.