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Individuals with multiple chemical sensitivity (MCS) report decreased attention/concentration, memory loss, disorientation, confusion, fatigue, depression, irritability, decreased libido, sleep disturbances, headaches, and weakness. These neurobehavioral symptoms represent possible alterations in the central nervous system (CNS). The evaluation of neurobehavioral functioning using neuropsychological techniques provides an indirect method for determining the integrity of the CNS. However, caution must be used in interpreting neuropsychological test results, since this technique is extremely sensitive but is not specific. Clinically significant aberrant test performance may be noted after chemical exposure as well as with other diseases of the CNS. In addition, neuropsychiatric conditions such as anxiety and depression are often manifested as cognitive difficulties that are similar in pattern to the cognitive dysfunction caused by toxic chemicals. Herein, limitations and cautions in the interpretations of neuropsychological test results are discussed.
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PMID:Neuropsychological evaluation for detecting alterations in the central nervous system after chemical exposure. 892 55

Toxicology has two goals. The first is to identify and characterize the adverse effects that can be produced in biological systems by exposure to chemicals and the second is to use this information to predict the type and severity of responses in other species and exposure situations. The tools that the toxicologist uses to detect and describe the adverse effects of chemical exposure include the traditional acute, subchronic, and chronic studies in animals plus a variety of special studies designed to demonstrate specific organ damage, reproductive and teratogenic effects, neurotoxicity, immunotoxicity, genotoxicity, and other responses. These are often supplemented with studies of the kinetics and the mechanism of action and more recently with studies designed to elucidate the molecular basis for cancer and other effects. Theses studies together with the information on exposure provide the basis for subsequent toxicologic predictions. Although general effects such as weight loss and mortality are included in toxicity protocols, most of the toxicology tests are related to specific end-organ toxicity or to mechanism or behavioral studies. We do not have animal protocols to study individually the subjective symptoms described for multiple chemical sensitivity, such as depression, fatigue, headache, and memory loss, and our tests lack sufficient specificity to evaluate a syndrome which is composed primarily of such symptoms. Since all chemicals can produce adverse effects under some conditions of exposure, toxicologic predictions are most useful when they specify both the type of adverse effect anticipated and the dose required to produce the effect. Multiple chemical sensitivity does not appear to consistently involve specific chemicals or specific adverse effects and the effects observed are reported to lack evidence of a threshold and to occur at extremely low levels. It is difficult to include these parameters in any reasonable toxicologic prediction relating cause and response in multiple chemical sensitivity or similar conditions.
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PMID:Specificity and dosimetry of toxicologic responses. 892 57

Disinfectant surveys from responding members of the American Society of Postanesthesia Nurses were divided into two groups based on whether or not they considered themselves to be exposed to disinfectants in their work environment. Their survey responses were then compared with those obtained previously from members of the Society of Gastroenterology Nurses and Associates, Inc., who were regularly exposed to 2% alkaline glutaraldehyde in the work setting. There were significant differences among the groups in the percentage of respondents who reported having headaches, eye irritations, respiratory problems, shortness of breath, rashes, memory loss, mood swings, and fatigue. These findings support the association of these complaints with 2% alkaline glutaraldehyde exposure. In contrast, there were no significant differences among the groups in the percentage of respondents who reported having asthma, rhinitis, chest pain, nausea, diarrhea, muscle/joint pain, visual disturbances, or dermatitis.
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PMID:Society of Gastroenterology Nurses and Associates, Inc. (SGNA) Endoscopic Disinfectant Survey results compared with control group. 902 1

A 65-year-old man presented with an episode of loss of consciousness associated with a fever and headache. His history was significant for 1 year of short-term memory loss. Computed tomographic scanning showed a third ventricular mass that was ultimately resected and pathologically confirmed as a colloid cyst. The patient's postoperative course was complicated by a dense left hemiparesis. A brief discussion of colloid cysts of the third ventricle is presented.
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PMID:Third ventricle colloid cyst. 911 14

Legionella is a frequent etiologic agent in the development of both nosocomial and community acquired pneumonias. Involvement of the nervous system is common in Legionella infections. We present a case of Legionnaires' disease which illustrates distinctive neurologic findings including delirium and cerebellar dysfunction. Furthermore, this paper reviews the neurological and psychiatric features of 609 Legionella infected patients with involvement of the nervous system. The most common signs were disorientation (58%), headache (52.4%), and somnolence (39.7%). Less frequent or rare were: cerebellar dysfunction (11.2%), hallucinations (8.4%), agitation or stupor (4.1%), affective disorders (3.1%), peripheral neuropathy (2.8%), pyramidal disturbances (2.1%), memory loss (1.6%), seizures (1.5%), cranial nerve palsies (1.5%), incontinence (0.7%), and extrapyramidal disturbances (0.3%). Cranial CT scans, cerebrospinal fluid findings, and nerve and muscle biopsies were usually unremarkable. Neuropathologic examinations failed to demonstrate specific characteristics. Hyponatremia and serum CPK level elevation were present in up to 89% and 50% of patients, respectively. Prognosis of disturbances of the nervous system was mainly good. We conclude that in the presence of definite neurological findings, pulmonary infection, hyponatremia, and CPK elevation Legionella infection should be considered.
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PMID:[Neurologic and psychiatric symptoms of legionella infection. Case report and overview of the clinical spectrum]. 927 65

Dentistry uses a variety of different polymer materials. Dental polymer materials are based on methacrylate, its polymer, and polyelectrolytes. The setting of restorative materials and adhesives is initiated chemically by mixing two components or by light. In both cases, polymerisation is incomplete and monomers, not reacted, release. Studies have documented that monomers may cause a wide range of adverse health effects such as irritation to skin, eyes or mucous membranes, allergic dermatitis, asthma, parenthesise in the fingers, and disturbances from central nervous system such as; headache, pain in the extremities, nausea, loss of appetite, fatigue, sleep disturbances, irritability, loss of memory and changes in blood parameters. Dental personnel are occupationally exposed when handling the non reacted monomers. The use of gloves do not give enough protection as monomers, released from the material, easily penetrate all gloves used in dentistry. Face masks do not prevent inhalation of monomers. Ordinary glasses do not protect the eyes against vapor from monomers. The result from this study demonstrate the need for the development of ergonomic procedures and practices for safe handling of such materials in dental clinics.
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PMID:Use of polymer materials in dental clinics, case study. 941 12

Patients with exposure to Pfiesteria toxin have developed an illness, Pfiesteria-human illness syndrome, characterized by skin lesions, headache, myalgias, conjunctival irritation, bronchospasm, abdominal pain, secretory diarrhea, recent memory loss, and difficulties with number sequencing. Not all patients demonstrated all features of the syndrome. The natural history of Pfiesteria-human illness syndrome shows that most patients' symptoms improve without treatment. This article reports the improvement of symptoms that had persisted for over one month in five patients, which the author attributes to treatment with cholestyramine. These patients were self-referred to the Pocomoke River Rash and Associated Illness Center, a clinic that opened on August 6, 1997, in response to the need for a central facility for diagnosis of human illness acquired from Pfiesteria. Until the Pfiesteria toxin(s) is isolated and characterized, and laboratory diagnostic tests are available, physicians must be able to recognize Pfiesteria-human illness syndrome and intervene when symptoms, particularly memory loss and diarrhea, cause significant impairment in daily activities. There are no precedents for the treatment of Pfiesteria or any dinoflagellate toxin-related human illness reported in the literature. The successful use of cholestyramine reported here may provide a model for understanding dinoflagellate toxin physiology in the human body. This paper reports an uncontrolled observational study. When identification of the toxin is completed, a basis for properly controlled studies will be available.
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PMID:Treatment of persistent Pfiesteria-human illness syndrome. 952 12

This study investigated blood mercury (B-Hg) levels and the auditory neuro-sensory status of children and adults in the remote Andean settlement of Nambija, Ecuador where Hg is used in the extensive gold mining operations. The mean B-Hg level in 75 Nambija (Study Area) inhabitants (36 children and 39 adults) was 17.5 micrograms/L (SD = 11.0) vs 3.0 micrograms/L (SD = 1.6) in a second group of 34 subjects (15 children and 19 adults) in a non-gold mining area (Reference Area), the difference being statistically significant (p < 0.0001). Neuro-otological examinations revealed 34 subjects (45%) with complaints of headaches and/or memory loss, 3 cases of severe neurological impairment and 4 cases of middle ear pathology. Audiological tests on 40 persons in the Study Area (21 children and 19 adults) showed hearing thresholds ranging from normal to mildly abnormal at 2, 3, 4, 6 and 8 kHz for children, and normal to severely abnormal for adults. Correlation coefficients showed a significant relationship between B-Hg level and hearing level in children at 3 kHz in the right ear, and at no frequency for adults. Auditory brainstem evoked responses (ABR) on subjects in the Study Area showed a significant correlation between B-Hg and the I-III interpeak latency on the right side. The results indicated that the study population of the Nambija gold mining area had abnormally elevated B-Hg levels, and may be at neurological risk from exposure to methylmercury (MeHg) from the consumption of contaminated food and possibly from elemental Hg vapors inhaled during amalgam burning in the gold extraction process.
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PMID:Blood mercury and auditory neuro-sensory responses in children and adults in the Nambija gold mining area of Ecuador. 955 55

We reported a case of adult-onset citrullinemia associated with hypertrigliceridemia and diabetes mellitus. A 24-year-old female was healthy until recently. She first felt intermittent headaches and nausea. Then she noticed memory loss and tiredness. Abnormal behavior such as getting lost on the way from her company sometimes occurred. She came to our hospital because these symptoms had been getting worse. Neurologically she had a very mild disturbed consciousness. An EEG recording showed diffuse slow wave with high amplitude. MR image of the brain showed hyper-intensity in globus pallidus with T1-weighted image. Plasma citrullin level was very high. Plasma ammonia and triglyceride showed a moderately high level. Using biopsied liver tissues, the enzymes of the urea cycle were analyzed. Argininosuccinate synthetase activity was extremely low. Because of clinical course and the result of liver biopsy, the patient was diagnosed as type 2 citrullinemia. A low protein diet was started, but intermittent nausea and consciousness disturbance did not improve. A partial liver transplantation was performed. The living donor was her father, a 50-year-old male, who had normal liver function. After the liver transplantation, all neurological signs soon disappeared. Plasma citrulline, ammonia and triglyceride normalized rapidly. An EEG recording became normal, and the hyper-intensity in globus pallidus with T1-weighted MR image disappeared two months after surgery. Liver transplantation should be planned as soon as possible in a type 2 citrullinemia patient.
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PMID:[Liver transplantation in type II citrullinemia]. 1065 68

Individuals with idiopathic environmental intolerance (IEI) report fatigue, headaches, weakness, malaise, decreased attention/concentration, memory loss, disorientation, confusion, and psychological disturbances. These neurobehavioral symptoms may be a sign of possible alterations in the central nervous system (CNS). The evaluation of neurobehavioral functioning using standardized testing provides a surrogate measure of integrity of the CNS. However, the interpretation of neuropsychological test results must be made cautiously since this technique is extremely sensitive, but not specific. Abnormal test results could be due to a neurological disorder, a medical disorder, or a neuropsychiatric disorder. Therefore, when evaluating patients who present with symptoms of IEI, abnormal neurobehavioral results should not be attributed routinely to environmental chemical exposure until other causes are systematically ruled out.
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PMID:Use of neuropsychological testing in idiopathic environmental testing. 1090 55


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