1593
and sex for whom there are some indications of mental impairment
(controls). Our preliminary results are consistent with those of Martyn et all and Neri and Hewitt-namely, people living in areas where the aluminium water concentration is low slightly more often show no signs of mental impairment, although the difference is not significant (table). Differences between cases and controls disappear if the analyses are based on the concentrations in water before treatment (data not shown); this suggests that the water treatment, usually with aluminium compound, separates the population into groups that are more or less affected by mental impairment. However, our main point is that there is also a strong association between water fluoride concentration and absence of dementia (table). The data suggest that men living in areas where drinking water aluminium concentrations are high and fluoride concentrations are low are about three times more likely to have some form of mental impairment, compared with those living in areas where aluminium concentrations are relatively low and fluoride concentrations high (odds ratios of 1.00 and 0-37,
respectively). Program in Gerontology, University of Waterloo, Waterloo, Ontario N2L 3G1, Canada
WILLIAM F. FORBES LYNDA M. HAYWARD NAMRITA AGWANI
1. Martyn CN, Barker DJP, Osmond C, Harns EC, Edwardson JA, Lacey RF. Geographical relation between Alzheimer’s disease and aluminium in drinking water Lancet 1989; i: 59-62.
Effect of Soviet industry on blood cadmium in Finns SIR,-Heavy metal fallout from smelters in the Kola Peninsula, USSR, has caused significant pollution in northern Finland, which has been further increased by the mobilisation of heavy metals from the soil as a consequence of acidification.’ One pollutant emitted from non-ferrous ores is cadmium, which is deposited on lichens, the principal food of reindeer, and is thereby enriched in the food chain. Human exposure to cadmium in Finland has remained unclear, however. We measured blood cadmium in 230 male reindeer herders (mean age 43,31 % smokers) in four areas of northern Finland. By graphite furnace atomic absorption spectrometry, concentrations averaged 10 nmol/1 (range 1-330) and increased from south-west to north-east (figure, site of smelter shown). A logistic regression analysis, allowing for smoking and age, showed geographical area to be a significant factor (p < 0-01). The health-based upper limit for blood cadmium (45 nmol/1)z was exceeded in 4-8% of men (11/230)
Mean concentrations (nmol/I) of cadmium in the blood of reindeer herders in four areas of northern Finland.
and in 10% of those living in the north-eastern area (6/62). The critical limit for renal damage (90 nmol/1)Z was exceeded by 3 men, 2 of them in the north-east. Blood cadmium was twice as high in men who ate reindeer meat at least twice a week than in those who did so less often.
Although environmental pollution from the Kola Peninsula is well-known,’ there has been some uncertainty about its health effects. It now seems that human exposure to cadmium is increased in the extreme north-east of Finland, and this should be taken into account in current efforts to reduce the emissions, which have so far proved unsuccessful. Department of Public Health Science, Univeristy of Oulu, SF-90220 Oulu, Finland
SIMO NÄYÄ HEIKKI KORPELA
Oulu Regional Institute of Occupational Health
LAURI PYY JUHANI HASSI
1.
Kauppi P, Anttila P, Kenttamies K, eds. Acidifcation in Finland: Finnish acidification
research programme HAPRO 1985-1990. Berlin: Springer, 1990. 2. World Health Organisation. Recommended health-based limits in exposure to heavy metals. Tech Rep Ser WHO 1980; no 647.
occupational
Childhood infective dermatitis evolving into adult T-cell leukaemia after 17 years SIR,-We have reported an association between infective dermatitis and HTLV-I infection in Jamaican children, and we suggested that these patients may be at risk of adult T-cell leukaemia/lymphoma (ATL).1 We have done a retrospective search for medical records on additional cases at University Hospital, Kingston, and found a case of infective dermatitis diagnosed in 1970. Non-Hodgkin lymphoma with features typical of ATL developed 10 years later, and the patient died after a rapidly worsening illness. The patient had a 7-year history of face and scalp rash when first seen in the dermatology unit at age 10. Dr M. M. Walshe diagnosed infective dermatitis, the disease that she and Dr R. D. Sweet had previously described in Jamaican children.2,3 Therapy with a steroid/antibiotic ointment resulted in some improvement initially but the patient did not attend for further follow-up. 10 years later he was admitted to a medical ward with a widespread scaly macular rash, painful diffuse lymphadenopathy, hepatomegaly, and ascites. Laboratory investigations revealed a lymphocytosis of 175 x 109/1, with 83% abnormal (cleaved) lymphocytes; hypercalcaemia (286 jmol/1); and abnormal hepatic and renal function. Lymph node biopsy showed what was classified then as a diffuse large cleaved lymphocytic lymphoma, and neoplastic cleaved lymphocytes were also present in the dermis of the skin. Despite two courses of chemotherapy (CHOP) the patient’s condition worsened rapidly, with deteriorating hepatic and renal function and terminal shortness of breath with haemoptysis. Permission for necropsy was refused. The clinical and pathological features are strong evidence that the lymphoreticular malignancy in this case was ATL. Although serum could not at that time be tested for HTLV-I antibodies, the hypercalcaemia, lymphadenopathy, lymphocytosis with cleaved (polylobated) cells, skin involvement, and hepatomegaly are all typical of acute ATL.45Review of the lymph node and skin biopsies indicated that the morphological features were also compatible. The lymph node showed leukaemic infiltration by a pleomorphic, polymorphous lymphoma, with numerous large cerebrifonn lymphocytes, best classified these days as pleomorphic mediumsize cell type.6,7 The infiltrate in the skin was similarly pleomorphic and was deep dermal without epidermotropism. The giant cerebrifonn lymphocytes seen in the infiltrate are very characteristic of HTLV-I-positive tumours and are a fairly reliable index of virus positivity.8 Immunohistochemical studies on sections from stored paraffin blocks with the peroxidase anti-peroxidase (PAP) method showed aT-cell phenotype. It has been suggested that ATL is more likely to develop in those infected with the virus in childhood, after a long incubation period, contrast with the HTLV-1-associated tropical spastic paraparesis, which is thought to have a short incubation period.9 In
in
and sex for whom there are some indications of mental impairment
(controls). Our preliminary results are consistent with those of Martyn et all and Neri and Hewitt-namely, people living in areas where the aluminium water concentration is low slightly more often show no signs of mental impairment, although the difference is not significant (table). Differences between cases and controls disappear if the analyses are based on the concentrations in water before treatment (data not shown); this suggests that the water treatment, usually with aluminium compound, separates the population into groups that are more or less affected by mental impairment. However, our main point is that there is also a strong association between water fluoride concentration and absence of dementia (table). The data suggest that men living in areas where drinking water aluminium concentrations are high and fluoride concentrations are low are about three times more likely to have some form of mental impairment, compared with those living in areas where aluminium concentrations are relatively low and fluoride concentrations high (odds ratios of 1.00 and 0-37,
respectively). Program in Gerontology, University of Waterloo, Waterloo, Ontario N2L 3G1, Canada
WILLIAM F. FORBES LYNDA M. HAYWARD NAMRITA AGWANI
1. Martyn CN, Barker DJP, Osmond C, Harns EC, Edwardson JA, Lacey RF. Geographical relation between Alzheimer’s disease and aluminium in drinking water Lancet 1989; i: 59-62.
Effect of Soviet industry on blood cadmium in Finns SIR,-Heavy metal fallout from smelters in the Kola Peninsula, USSR, has caused significant pollution in northern Finland, which has been further increased by the mobilisation of heavy metals from the soil as a consequence of acidification.’ One pollutant emitted from non-ferrous ores is cadmium, which is deposited on lichens, the principal food of reindeer, and is thereby enriched in the food chain. Human exposure to cadmium in Finland has remained unclear, however. We measured blood cadmium in 230 male reindeer herders (mean age 43,31 % smokers) in four areas of northern Finland. By graphite furnace atomic absorption spectrometry, concentrations averaged 10 nmol/1 (range 1-330) and increased from south-west to north-east (figure, site of smelter shown). A logistic regression analysis, allowing for smoking and age, showed geographical area to be a significant factor (p < 0-01). The health-based upper limit for blood cadmium (45 nmol/1)z was exceeded in 4-8% of men (11/230)
Mean concentrations (nmol/I) of cadmium in the blood of reindeer herders in four areas of northern Finland.
and in 10% of those living in the north-eastern area (6/62). The critical limit for renal damage (90 nmol/1)Z was exceeded by 3 men, 2 of them in the north-east. Blood cadmium was twice as high in men who ate reindeer meat at least twice a week than in those who did so less often.
Although environmental pollution from the Kola Peninsula is well-known,’ there has been some uncertainty about its health effects. It now seems that human exposure to cadmium is increased in the extreme north-east of Finland, and this should be taken into account in current efforts to reduce the emissions, which have so far proved unsuccessful. Department of Public Health Science, Univeristy of Oulu, SF-90220 Oulu, Finland
SIMO NÄYÄ HEIKKI KORPELA
Oulu Regional Institute of Occupational Health
LAURI PYY JUHANI HASSI
1.
Kauppi P, Anttila P, Kenttamies K, eds. Acidifcation in Finland: Finnish acidification
research programme HAPRO 1985-1990. Berlin: Springer, 1990. 2. World Health Organisation. Recommended health-based limits in exposure to heavy metals. Tech Rep Ser WHO 1980; no 647.
occupational
Childhood infective dermatitis evolving into adult T-cell leukaemia after 17 years SIR,-We have reported an association between infective dermatitis and HTLV-I infection in Jamaican children, and we suggested that these patients may be at risk of adult T-cell leukaemia/lymphoma (ATL).1 We have done a retrospective search for medical records on additional cases at University Hospital, Kingston, and found a case of infective dermatitis diagnosed in 1970. Non-Hodgkin lymphoma with features typical of ATL developed 10 years later, and the patient died after a rapidly worsening illness. The patient had a 7-year history of face and scalp rash when first seen in the dermatology unit at age 10. Dr M. M. Walshe diagnosed infective dermatitis, the disease that she and Dr R. D. Sweet had previously described in Jamaican children.2,3 Therapy with a steroid/antibiotic ointment resulted in some improvement initially but the patient did not attend for further follow-up. 10 years later he was admitted to a medical ward with a widespread scaly macular rash, painful diffuse lymphadenopathy, hepatomegaly, and ascites. Laboratory investigations revealed a lymphocytosis of 175 x 109/1, with 83% abnormal (cleaved) lymphocytes; hypercalcaemia (286 jmol/1); and abnormal hepatic and renal function. Lymph node biopsy showed what was classified then as a diffuse large cleaved lymphocytic lymphoma, and neoplastic cleaved lymphocytes were also present in the dermis of the skin. Despite two courses of chemotherapy (CHOP) the patient’s condition worsened rapidly, with deteriorating hepatic and renal function and terminal shortness of breath with haemoptysis. Permission for necropsy was refused. The clinical and pathological features are strong evidence that the lymphoreticular malignancy in this case was ATL. Although serum could not at that time be tested for HTLV-I antibodies, the hypercalcaemia, lymphadenopathy, lymphocytosis with cleaved (polylobated) cells, skin involvement, and hepatomegaly are all typical of acute ATL.45Review of the lymph node and skin biopsies indicated that the morphological features were also compatible. The lymph node showed leukaemic infiltration by a pleomorphic, polymorphous lymphoma, with numerous large cerebrifonn lymphocytes, best classified these days as pleomorphic mediumsize cell type.6,7 The infiltrate in the skin was similarly pleomorphic and was deep dermal without epidermotropism. The giant cerebrifonn lymphocytes seen in the infiltrate are very characteristic of HTLV-I-positive tumours and are a fairly reliable index of virus positivity.8 Immunohistochemical studies on sections from stored paraffin blocks with the peroxidase anti-peroxidase (PAP) method showed aT-cell phenotype. It has been suggested that ATL is more likely to develop in those infected with the virus in childhood, after a long incubation period, contrast with the HTLV-1-associated tropical spastic paraparesis, which is thought to have a short incubation period.9 In
in
