The content of total and carcinogenic polycyclic aromatic hydrocarbons (PAHs) in Italian foods was measured. The highest levels of PAHs were found in pizza baked in wood-burning ovens and barbecued beef and pork. Relatively high levels were also found in beet greens and squash, apples and bread, fried beef, pork and rabbit, cured meats and chocolate. Conversely low levels were detected in potatoes and cooked fish, beverages and eggs. The daily intake of total and carcinogenic PAHs also was calculated by multiplying the average consumption of each food by its mean concentration of PAHs. Cereal and milk products, meat, vegetables and fruits were the highest contributors to total PAH intake, since these products are the most important dietary components in Italy. The calculated total dietary PAH intake was 3 micrograms/day per person. The calculated intake of carcinogenic PAHs was 1.4 microgram/day per person. The dietary intake of PAHs was high compared with the calculated respiratory intake (370 ng/day) owing to polluted city air in Italy. These results confirm that food is the major source of human exposure to PAHs, due in particular to the high consumption of contaminated cereal products.
Summary:Purpose: To describe an 11-year-old girl with symptomatic localization-related epilepsy and normal intelligence who developed reversible mental deterioration and pseudoatrophic brain changes while receiving valproate (VPA).Methods; Assessment of mental function using Wechsler Intelligence Scale for Children-I11 (WISC) and Raven's Progressive Matrices (PM), EEG recordings while awake and asleep, and brain magnetic resonance imaging (MRI), were performed at the beginning of VPA therapy, after 2 years and 8 months of treatment and following VPA discontinuation.Results: After 2 years and 6 months on VPA (G26 mg/kg/ day) the girl insidiously developed mental deterioration (loss of I8 IQ points and drop in age-adjusted PM score from the 95th to the 50th percentile) associated with MRI-documented pseudoatrophy of the brain. Onset of severe cognitive impairment coincided with serum VPA concentrations near 100 pglml. There were no other manifestations of drug toxicity or hyperammonemia. Background EEG activity was normal. Reduction of VPA dosage and subsequent discontinuation 4 months later resulted in disappearance of clinical symptoms with a 20-point improvement at IQ testing and recovery of previous PM score. Repeat MRI showed disappearance of pseudoatrophic changes.Conclusions: The striking cognitive improvement and reversal of pseudoatrophic brain changes following VPA discontinuation strongly suggest a drug-induced condition. Based on this and previous reports, the syndrome of VPA-associated mental deterioration and pseudoatrophy of the brain appears to encompass different but possibly related clinical entities, which include parkinsonism with cognitive deterioration, mental deterioration with signs of VPA-toxicity, and isolated mental deterioration, as seen in our patient. A drug-induced effect should be considered whenever cognitive deterioration and imaging findings of brain atrophy occur in VPA-treated patients. Key Words: Valproate-MRI-Brain pseudoatrophy-Mental deterioration.Valproate (VPA) is associated with fewer adverse neurological effects than other antiepileptic drugs ( 1). Severe neurological side effects such as VPA-induced encephalopathy with or without hyperammonemia (2,3), extrapyramidal disorders ( 4 3 , and reversible dementia (6-9) are rare. We report on an 1 I-year-old girl with nonsevere epilepsy, in whom mental deterioration with pseudoatrophy of the brain developed insidiously after 2 years on VPA. The condition was not associated with other signs of toxicity or hyperammonemia and was rapidly reversible upon VPA discontinuation. CASE REPORTThis I I-year-old girl was born with mild perinatal suffering (Apgar score 5-9) after a normal pregnancy. Developmental milestones were normal. At age 6 years Accepted June 6, 1997. Address correspondence and reprint requests to Dr. R. Guerrini at Institute of Child Neurology and Psychiatry, University of Pisa, Via dei Giacinti 2, 56018 Calambrone, Pisa, Italy.she experienced her first, sleep related, brief generalized clonic seizure. The electroen...
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