MARCO Grand Rounds for July 1, 2007

From Warren, KD4GUA:

Field Day, last weekend--we will resume the educational portion of MARCO with a discussion of an article in Family Practice Recertificaiton, June 2007, page 45 titled, " DRUGS YOU MIGHT STOP: A PRACTICAL APPROACH TO MEDICATiON DEBRIDEMENT."

My 756 radio took 8 days to travel to ICOM in Seattle and will be out for about three weeks. I will probably be using Bill KC9CS's rig Sunday. He has a great antenna and should get out a handy signal. Hope everyone is having a grand early summer.

No Grand Rounds on June 24!

There will not be a formal net this Sunday since it is FIELD DAY and all of us should be out in the field. However, tune in 14.307 for a VOX POX voice of the people conversation.

Unfortunately, my radio is on the way to the State of Washington. My ICOM 756 froze on 14.307 and unable to reset so they advised my sending it in. Should be back by the following Sunday.

Danny is in Hawaii and brought his radio gear with him so he may be on for the CW and SSB.

Warren KD4gua.

Dioxin and Microwave Ovens

There has been an email making the rounds warning people not to use dishes or plastic wrap in a microwave oven, or to freeze liquids in plastic containers. The purported risk is increased cancer risk due to contamination with dioxin. The email quotes a Dr. Edward Fujimoto from Castle Hospital, and also attributes the warning to experts at "John Hopkins [sic].

The appearance of the message on the MARCO-list motivated Bob, K4RLC to search the literature:

As I mentioned before, I checked the report from an unnamed cancer specialist at Johns Hopkins on Snopes.com, a website which reviews such urban myths. Like most, there may be an element of truth, but placed in mythic proportions.
But, you have to ask, which physician at Hopkins, in which edition of the newsletter, etc made this statement. Then, what is the concentration of dioxin in saran wrap, how does microwaving cause this change, in what concentration and at what level of toxicity (if any) to a human. It smacks of an urban myth.
I did a quick Lit review at NIH Natl Library on Medicine (PUB MED), and below are the first 20 hits out of 1400. The first article (abstract listed) notes that Alcohol is the second most likely "food contamination" for carcogenic potential!
The second article cites dioxin as a possible protectant against breast ca.
However, as I have learned, one study doesn't make science.
Anyway, until someone can cite a specific physician at Hopkins and a specific edition of their consumer newsletter, then this info is a myth. But, something worth watching.
Always the skeptic,
Bob K4RLC
At the beach today (Windy Hill, SC) trying to check in on cw

1: Abnet CC.
Carcinogenic food contaminants.
Cancer Invest. 2007 Apr-May;25(3):189-96.
PMID: 17530489 [PubMed - in process]
Nutritional Epidemiology Branch, Division of Cancer Epidemiology and Genetics. Rockville, Maryland. USA.
A large number of scientific studies and reviews have addressed the potential for dietary components to influence the risk of developing cancer. One topic of particular interest has been the impact of food contaminants. Two complementary programs, among others, have reviewed and synthesized information on the carcinogenic potential of food contaminants and judged the degree of evidence linking different food contaminants to the risk of cancer in humans. These programs, the International Agency for Research on Cancer's IARC Monographs on the Evaluation of Carcinogenic Risks to Humans and the US National Toxicology Program's Report of Carcinogens have reviewed hundreds of chemicals, mixtures, and natural products and then graded the cancer risk posed to humans. Contaminants with the highest level of evidence include aflatoxin, alcoholic beverages, 2,3,7,8-tetracholordibenzo-p-dioxin. Agents with a moderate level of evidence include acetaldehyde, polycyclic aromatic hydrocarbons, some nitrosamines, and yerba mate. Agents with a low level of evidence include bracken fern, fumonsin B(1), ochratoxin, and others. This review presents a summary of the evidence for the carcinogenicity of these and other agents and the ranks provided by two important assessment programs.
PMID: 17530489 [PubMed - in process]

2: Hsu EL, Yoon D, Choi HH, Wang F, Taylor RT, Chen N, Zhang R, Hankinson O.
A Proposed Mechanism for the Protective Effect of Dioxin Against Breast Cancer:
MECHANISM FOR CANCER PROTECTION BY DIOXIN.
Toxicol Sci. 2007 May 21; [Epub ahead of print]
PMID: 17517823 [PubMed - as supplied by publisher]
Molecular Toxicology Interdepartmental Doctoral Program, School of Public Health.
Although it is causative for many types of cancers, experimental and epidemiological evidence suggest that 2,3,7,8-tetrachlorodibenzo-p-dioxin (dioxin) may in fact protect against breast cancer. The mechanism(s) for this protection remain unclear. In an attempt to further elucidate this mechanism, we performed a microarray experiment to identify genes that were modulated upon dioxin treatment. We found that dioxin down-regulated the mRNAs for the G-protein coupled receptor, CXCR4, as well as its unique chemokine ligand, CXCL12, in MCF-7 breast cancer cells. We demonstrated that the corresponding proteins are also down-regulated by dioxin. The interaction between CXCR4 and CXCL12 plays a central role in the metastasis of breast cancer, as disruption of the CXCL12/CXCR4 axis has been shown to limit the metastasis of breast cancer cells to the lung in mice. Utilizing an in vitro chemotaxis assay, we demonstrate that dioxin specifically inhibits the migration of MCF-7 cells towards CXCL12. We also show that dioxin reduces CXCR4 under hypoxia and CXCL12 under estradiol-induced conditions in MCF-7 cells. Finally, as the CXCR4/CXCL12 axis is implicated in the progression of numerous types of cancer, we identified several other cancer cell lines in which dioxin modulates CXCR4 and CXCL12 levels. We therefore propose that one mechanism whereby dioxin may protect against breast cancer is via down-regulation of CXCR4 and CXCL12, thereby inhibiting progression of the disease. Further, other non-toxic ligands for the AHR (Selective Aryl Hydrocarbon Receptor Modulators) may exert their protective effects by a similar mechanism.
PMID: 17517823 [PubMed - as supplied by publisher]

3: Hensley AR, Scott A, Rosenfeld PE, Clark JJ.
Attic dust and human blood samples collected near a former wood treatment
facility.
Environ Res. 2007 May 19; [Epub ahead of print]
PMID: 17517389 [PubMed - as supplied by publisher]

4: Brody JG, Moysich KB, Humblet O, Attfield KR, Beehler GP, Rudel RA.
Environmental pollutants and breast cancer: epidemiologic studies.
Cancer. 2007 May 14;109(S12):2667-2711 [Epub ahead of print]
PMID: 17503436 [PubMed - as supplied by publisher]

5: Burchiel SW, Thompson TA, Lauer FT, Oprea TI.
Activation of dioxin response element (DRE)-associated genes by benzo(a)pyrene
3,6-quinone and benzo(a)pyrene 1,6-quinone in MCF-10A human mammary epithelial
cells.
Toxicol Appl Pharmacol. 2007 Jun 1;221(2):203-14. Epub 2007 Mar 13.
PMID: 17466351 [PubMed - in process]

6: Eskenazi B, Warner M, Samuels S, Young J, Gerthoux PM, Needham L, Patterson D,
Olive D, Gavoni N, Vercellini P, Mocarelli P.
Serum Dioxin Concentrations and Risk of Uterine Leiomyoma in the Seveso Women's
Health Study.
Am J Epidemiol. 2007 Jul 1;166(1):79-87. Epub 2007 Apr 18.
PMID: 17443023 [PubMed - in process]

7: Warner M, Eskenazi B, Olive DL, Samuels S, Quick-Miles S, Vercellini P,
Gerthoux PM, Needham L, Patterson DG, Mocarelli P.
Serum dioxin concentrations and quality of ovarian function in women of Seveso.
Environ Health Perspect. 2007 Mar;115(3):336-40. Epub 2006 Dec 20.
PMID: 17431480 [PubMed - indexed for MEDLINE]

8: Cheng Y, Chang LW, Cheng LC, Tsai MH, Lin P.
4-Methoxyestradiol-induced oxidative injuries in human lung epithelial cells.
Toxicol Appl Pharmacol. 2007 May 1;220(3):271-7. Epub 2007 Feb 14.
PMID: 17397890 [PubMed - in process]

9: Gavva NR, Bannon AW, Surapaneni S, Hovland DN Jr, Lehto SG, Gore A, Juan T,
Deng H, Han B, Klionsky L, Kuang R, Le A, Tamir R, Wang J, Youngblood B, Zhu D,
Norman MH, Magal E, Treanor JJ, Louis JC.
The vanilloid receptor TRPV1 is tonically activated in vivo and involved in body
temperature regulation.
J Neurosci. 2007 Mar 28;27(13):3366-74.
PMID: 17392452 [PubMed - indexed for MEDLINE]

10: Angerer J, Ewers U, Wilhelm M.
Human biomonitoring: state of the art.
Int J Hyg Environ Health. 2007 May;210(3-4):201-28. Epub 2007 Mar 21.
PMID: 17376741 [PubMed - in process]

11: Steenland K, Bartell S.
Caution in drawing conclusions from PBPK models based on sparse human data.
Risk Anal. 2007 Feb;27(1):7-8; author reply 9-10. No abstract available.
PMID: 17362395 [PubMed - indexed for MEDLINE]

12: National Toxicology Program.
NTP Toxicology and Carcinogenesis Studies of a Binary Mixture of
3,3',4,4',5-Pentachlorobiphenyl (PCB 126) (CAS No. 57465-28-8) and
2,3',4,4',5-Pentachlorobiphenyl (PCB 118) (CAS No. 31508-00-6) in Female Harlan
Sprague-Dawley Rats (Gavage Studies).
Natl Toxicol Program Tech Rep Ser. 2006 Nov;(531):1-218.
PMID: 17342196 [PubMed - in process]

13: National Toxicology Program.
NTP Toxicology and Carcinogenesis Studies of a Mixture of
2,3,7,8-Tetrachlorodibenzo-p-Dioxin (TCDD) (CAS No. 1746-01-6),
2,3,4,7,8-Pentachlorodibenzofuran (PeCDF) (CAS No. 57117-31-4), and
3,3',4,4',5-Pentachlorobiphenyl (PCB 126) (CAS No. 57465-28-8) in Female Harlan
Sprague-Dawley Rats (Gavage Studies).
Natl Toxicol Program Tech Rep Ser. 2006 Sep;(526):1-180.
PMID: 17342195 [PubMed - in process]

14: Read D, Wright C, Weinstein P, Borman B.
Cancer incidence and mortality in a New Zealand community potentially exposed to
2,3,7,8-tetrachlorodibenzo-p-dioxin from 2,4,5-trichlorophenoxyacetic acid
manufacture.
Aust N Z J Public Health. 2007 Feb;31(1):13-8.
PMID: 17333602 [PubMed - indexed for MEDLINE]

15: Thundiyil JG, Solomon GM, Miller MD.
Transgenerational exposures: persistent chemical pollutants in the environment
and breast milk.
Pediatr Clin North Am. 2007 Feb;54(1):81-101, ix. Review.
PMID: 17306685 [PubMed - indexed for MEDLINE]

16: Ruan Q, Gelhaus SL, Penning TM, Harvey RG, Blair IA.
Aldo-keto reductase- and cytochrome P450-dependent formation of
benzo[a]pyrene-derived DNA adducts in human bronchoalveolar cells.
Chem Res Toxicol. 2007 Mar;20(3):424-31. Epub 2007 Feb 13.
PMID: 17295519 [PubMed - indexed for MEDLINE]

17: Schmidt M, Ungvari J, Glode J, Dobner B, Langner A.
New 1,3-dioxolane and 1,3-dioxane derivatives as effective modulators to overcome
multidrug resistance.
Bioorg Med Chem. 2007 Mar 15;15(6):2283-97. Epub 2007 Jan 19.
PMID: 17276076 [PubMed - indexed for MEDLINE]

18: Gaudry J, Skiehar K.
Promoting environmentally responsible health care.
Can Nurse. 2007 Jan;103(1):22-6. Review.
PMID: 17269580 [PubMed - indexed for MEDLINE]

19: Bonzo JA, Belanger A, Tukey RH.
The role of chrysin and the ah receptor in induction of the human UGT1A1 gene in
vitro and in transgenic UGT1 mice.
Hepatology. 2007 Feb;45(2):349-60.
PMID: 17256720 [PubMed - indexed for MEDLINE]

20: Jiang Q, Hanari N, Miyake Y, Okazawa T, Lau RK, Chen K, Wyrzykowska B, So MK,
Yamashita N, Lam PK.
Health risk assessment for polychlorinated biphenyls, polychlorinated
dibenzo-p-dioxins and dibenzofurans, and polychlorinated naphthalenes in seafood
from Guangzhou and Zhoushan, China.
Environ Pollut. 2007 Jul;148(1):31-9. Epub 2007 Jan 24.

and:

Here's another  important abstract, just published this month, reviewing this
area. Note their analysis of dioxins below. Also, go to the Silent Spring website and you can get a full text of this article, which has full review of environmental toxins and ca. Vy good review article.

Bob K4RLC

1: Cancer. 2007 Jun 15;109(S12):2667-2711.

Environmental pollutants and breast cancer: epidemiologic studies.

Brody JG, Moysich KB, Humblet O, Attfield KR, Beehler GP, Rudel RA.

Silent Spring Institute, Newton, Massachusetts.

Laboratory research has shown that numerous environmental pollutants cause
mammary gland tumors in animals; are hormonally active, specifically mimicking
estrogen, which is a breast cancer risk factor; or affect susceptibility of the
mammary gland to carcinogenesis. An assessment of epidemiologic research on these
pollutants identified in toxicologic studies can guide future research and
exposure reduction aimed at prevention. The PubMed database was searched for
relevant literature and systematic critical reviews were entered in a database
available at URL: www.silentspring.org/sciencereview and URL:
www.komen.org/environment (accessed April 10, 2007). Based on a relatively small
number of studies, the evidence to date generally supports an association between
breast cancer and polycyclic aromatic hydrocarbons (PAHs) and polychlorinated
biphenyls (PCBs) in conjunction with certain genetic polymorphisms involved in
carcinogen activation and steroid hormone metabolism. Evidence regarding dioxins
and organic solvents is sparse and methodologically limited but suggestive of an
association. Methodologic problems include inadequate exposure assessment, a lack
of access to highly exposed and unexposed populations, and a lack of preclinical
markers to identify associations that may be obscured by disease latency. Among
chemicals identified in toxicologic research as relevant to breast cancer, many
have not been investigated in humans. The development of better exposure
assessment methods is needed to fill this gap. In the interim, weaknesses in the
epidemiologic literature argue for greater reliance on toxicologic studies to
develop national policies to reduce chemical exposures that may be associated
with breast cancer. Substantial research progress in the last 5 years suggests
that the investigation of environmental pollutants will lead to strategies to
reduce breast cancer risk. Cancer 2007. (c) 2007 American Cancer Society.

PMID: 17503436 [Pubmed - as supplied by publisher]

Related Links

  Environmental pollutants, diet, physical activity, body size, and breast cancer:
where do we stand in research to identify opportunities for prevention? [Cancer.
2007] PMID:17503444

  Environmental pollutants and breast cancer. [Environ Health Perspect. 2003]
PMID:12826474

  Chemicals causing mammary gland tumors in animals signal new directions for
epidemiology, chemicals testing, and risk assessment for breast cancer
prevention. [Cancer. 2007] PMID:17503434

  Sources, pathways, and relative risks of contaminants in surface water and
groundwater: a perspective prepared for the Walkerton inquiry. [J Toxicol Environ
Health A. 2002] PMID:11809004

  Hormonal and environmental factors affecting cell proliferation and neoplasia
in the mammary gland. [Prog Clin Biol Res. 1996] PMID:8778798
PMID: 17254684 [PubMed - in process]

Danny, W4DAN then added a bit of levity to the proceedings:

Personally, I think K4RLC's comments and research should be taken more
seriously than the email forwarded and originated from an unknown source.

I suspect that the email is a hoax, for the simple reason that
the original sender requests everyone forward the email. Most emails that
request forwarding are usually hoaxes. The FW FW in the subject line is a
give away of a game that has been played ever since "someone" invented the
Internet. Another thing that makes me suspect that it is a deception is the
spelling of Johns Hopkins. The hoaxologist calls it it John Hopkins. Who is
(Dr.?) Edward Fujimoto? Sounds like a good Japanese family name to me.
Where in the world is Castle Hospital?

I must say 73 now and pop my microwave popcorn. I don't know what the paper
bag is made of, so I will pour the corn into an UNCOVERED corning ware bowl before
I pop it. I have tried metal containers in the past, but that created an electrical
storm in the microwave oven.

Please don't forward this email to 399 people. Someone may suspect that I am
hoping that it will make the circuit and rounds, eventually returning back to my mailbox.

Danny, W4DAN

Iron Lung Remembrances

Warren's talk about post-polio syndrome touched on the old iron-lung respirators.

Bobby, KM5VU asked what the longest survival was in one of these devices. Later, he answered his own question on the Marco-list reflector:

RE Our discussion on grand rounds..( Warren really had a good discussion.)

As of 2003, the longest surviving iron lung patient was a man in England who was 64 in 2003 and got polio at age 17.

Most of the time, he used a more modern negative pressure ventilator at home. This device is actually only a little larger than his chest.

Until a few years ago, I had a patient who in an iron lung about 45 years, having gotten polio as a young child. His mother took care of him at their home for over 40 years. For some reason, he never got into the smaller device but was in one of the old noisy iron lungs that looked exactly like the pictures we see of polio wards in the early 60’s.

I went out to the house to see him every couple of months. His mother did a terrific job keeping him alive all those decades. Several articles mentioned that in recent years it has been hard to find spare parts for the old machines and the mother had similar problems. If he had a serious infection we would transport him and the iron lung to the hospital. I think that in the early 80’s his mom and dad had him come to the hospital so they could take a brief vacation….their only one in like 40 years.

He died of pneumonia.

Bobby, KM5VU

Jeff K6JW added this:

When I was in medical school at NYU in the late 60s, I did a summer fellowship in the NYU Institute of Rehabilitation Medicine, now named the Rusk Institute after its founder and leading proponent, Howard Rusk. I remember well that we had several patients there still in Drinker respirators (iron lungs) and at least one large store room packed with old Drinkers. Nearly 40 years later, I have no idea whether those respirators are still in storage somewhere or have been destroyed but, if anyone needs spare parts, the Rusk Institute is the most likely place to have them.

--JW, K6JW

Then Marilyn Currier shared her memories:

I worked as a teacher on the polio ward in Ann Arbor in the early 50s. It was quite an experience - iron lungs, the old chest respirators and swinging beds. I was not a nurse but even I learned to put on the chest respirators when a patient got tired of breathing on his own, and to look for signs of trouble and call a nurse. One of the patients was finally sent to a nursing home and he died soon after he got there - someone there left a vent open. I was on the ward when the news of the Salk vaccine was announced on the radio and there were many breathy cheers on that ward that day.

Marilyn Currier

MARCO Grand Rounds for June 17, 2007

From Warren, KD4GUA:

This Sunday we will briefly touch on the new "anti-fat" pill Alli which is the 1999 Orlistat which is now available over the counter.

THEN, we will dive into POST POLIO SYNDROME, something many of you never heard of--but read on--There is an estimated 1.6 million post polio victims still alive in the USA and 60% of them will develop POST POLIO SYNDROME. Many of these had what was called "abortive" or "non-paralytic" polio and some didn't know they even had it! What happens is the polio victim regains strength through exercising the remaining muscles which give them relief. However, with AGING the weakened muscles + time begin to give symptoms. Many of the multiple diseases of agiing are post-polio syndromes.

Example: I have a friend who was in an aircraft accident when he was 35....he suffered multiple lumbar fractures and knee fractures....he got better with exercise. BUT, when he hit 69, the damaged tissues began to go and go fast--his compensation buildup had now disappeared....this is what happens in Post Polio syndrome, the damaged anterior roots lose axons with time and BANG--where are we? Tune in -- should be a good one.


[Tune in to MARCO Grand Rounds on 14.307 KHz at 10AM EDT, Sundays]

MARCO Grand Rounds for June 10, 2007

From Warren, KD4GUA:

Last week Harry WB9EDP discussed the TB situation and the use of the rapid diagnostic molecular method called the Quantiferon TB test which is very sensitive which cuts down the potential diagnostic time for TB to a matter of days rather than weeks.

The timing of medications was the title but because HIV and TB require DOT (direct observed therapy) to be effective, meds must be given routinely or they don't work.

We also learned that MDR (multi-drug resistant)-TB is TB resistant to INH and RMP (rifampin) and that XDR-TB (extensively drug resistant TB) is resistant to any one of the the following: Kanamycin, Careomycin and Amikacin.

Remember, the 100 year old skin tests will tell you if the patient has been exposed to TB not that he has ACTIVE TB. Most people who grew up in the large cities have positive TB skin tests because of the exposure in crowded areas.

This Sunday we will continue the discussion...tune in 14.307, 10 a.m. eastern on Sunday.

PS: Sympathy to Bernie and Linda in El Paso for the loss of their little dog Pixie who was taken away in an auto accident.