JSTOR is a not-for-profit service that helps scholars, researchers, and students discover, use, and build upon a wide range of content in a trusted digital archive. We use information technology and tools to increase productivity and facilitate new forms of scholarship. For more information about JSTOR, please contact support@jstor.org.. The National Institute of Environmental Health Sciences (NIEHS) andBrogan & Partners are collaborating with JSTOR to digitize, preserve and extend access to Environmental Health Perspectives.

Millions of women of cild-bearing age have substantial bone lead stores due to lead exposure as children. Dietary calcium ingested simultaneously with lead eposure can reduce lead absorption and accumulaton. However, the efects of dietary calcium on previously accumulted maternal lead stores and transfer to the fetus have not been investigatedL We studied the effects oflead exposure of female rats at an early age on fetal development during a subsequent pregancy. We gave 5-weekold female Sprague-Dawley rats lead as the acetate in their ddnking water for 5 weeks; controls received equimolar sodium acetate. This was followed by a 1-month period without lead exposure before mating. We randomly assigned prewant rats (n = 39) to diets with a deficient (0.1%) or normal (0.5%) calcium content during pregnancy. A total of 345 pups were delivered alive. Leadexposed dams and their pups had significantly higher blood lead concentrations than controls, but the concentrations were in the range of those found in many pregnant women. Pups bom to dams fd the calcium-deficient diet during pregnancy had higher blood and organ lead concentrations than pups born to dams fed the 0.5% calcium diet. Pups bom to lead-exposed dams had sigificant- controls were simultaneously given equimolar sodium acetate in the drinking water. A 5-week period of lead exposure was followed by a 4-week period without lead exposure. During these periods before mating, the rats consumed diets containing 0.5% calcium. At this time, the rats were 14 weeks of age. The female rats were then mated with 14-weekold male SD rats, with 1 male and 3 females caged together. Of the 76 female rats, 39 (51.3%) were impregnated. Lead-exposed and nonexposed pregnant rats were then randomly assigned to either normal (0.5%) or low (0.1%) calcium diets during pregnancy. Nonpregnant animals were also randomly assigned to one of the calcium diets. We used a stratified design based on the blood lead concentration at the time of random assignment. This ensured comparable initial blood lead concentrations in the two lead-exposed treatment groups that were fed either 0.1% or 0.5% calcium. During pregnancy, dam body weights were measured twice each week. In addition, blood samples (150 pL) were drawn from a tail vein once each week.

No abstract

Ischemic vascular ulcerations of the upper extremities are an uncommon and frequently painful condition most often associated with scleroderma and small vessel inflammatory diseases. Digital amputation has been advocated as primary therapy because of the poor outcome with medical care. Intermittent pneumatic compression (IPC) pump therapy can improve ulcer healing in lower extremity ischemic ulcerations; however, the value of this treatment in upper extremity ischemic ulcerations is not known. This observational pilot study consisted of a consecutive series of 26 patients with 27 upper extremity ischemic vascular ulcers seen at the Mayo Gonda Vascular Center from 1996 to 2003. Inclusion criteria were documented index of ulcer size and follow-up ulcer size and use of the IPC pump as adjunctive wound treatment. Twenty-six of 27 ulcers (96%) healed with the use of the IPC pump. Mean baseline ulcer size was 1.0 cm2 (SD=0.3 cm2) and scleroderma was the underlying disease in 65% (17/26) of cases. Laser Doppler blood flow in the affected digit was 7 flux units (normal greater than 100). The mean ulcer duration before IPC treatment was 31 weeks. The average pump use was 5 hours per day. The mean time to wound healing was 25 weeks. Twenty-five of 26 patients reported an improvement in wound pain with pump use. Intensive IPC pump use is feasible and associated with a high rate of healing in upper extremity ischemic ulcers. A prospective, randomized, sham-controlled study of IPC is needed to determine whether IPC treatment improves wound healing compared to standard medical care.

A 29-year-old generally healthy male was in his usual state of health until May 2000, when he developed a spontaneous left leg deep vein thrombosis. This was followed by several months of progressively worsening weight gain (80 lb=36.3 kg), fatigue, dyspnea on exertion, orthopnea, lower extremity edema, and intermittent abdominal pain that was occasionally severe. H e also had developed many tender 'lumps' on his legs that resolved over 2 months. H is primary physician suggested that these were likely supercial thrombophlebitis. He was referred to a regional medical center, where further evaluation was undertaken. A chest X-ray showed cardiomegaly. An echocardiogram demonstrated a globally reduced ejection fraction of 40%. A coronary angiogram was interpreted as 'essentially normal'. H is creatinine was 1.9 mg=dl and his aspartate amino transferase and alkaline phosphatase were mildly elevated. Serum ferritin, ceruloplasmin, and serum and urine protein electrophoresis were normal and Lyme serology was negative. The patient was treated with an angiotensin-converting enzyme inhibitor and furosemide for presumed congestive heart failure. Computed tomography of the abdomen was performed because of persistent and unexplained abdominal pain. It revealed a 5-cm Type III thoracoabdominal aneurysm (Figure 1), but was otherwise unremarkable. At this point, the patient was referred to a tertiary medical center for further evaluation and management.The patient had no history of coronary artery disease. He denied diabetes, hypertension, hyperlipidemia, or family history of coronary artery disease. He was an active smoker (half a pack per day for 12 years). His medications included: lisinopril 20 mg daily, furosemide 80 mg daily, omeprazole 20 mg daily, trazodone 50 mg as needed for sleep, and lorazepam 5 mg as needed for anxiety. His allergies included penicillin and sulfa drugs, which caused rashes. His past medical history was signi cant for persistent neonatal jaundice during infancy. A liver biopsy at that time revealed 'non-speci c hepatitis and possible intrahepatic biliary atresia'. The jaundice resolved spontaneously and the patient's liver function had been unremarkable since that time. The patient also had a large atrial septal defect that was repaired at age 3 years without complications.The patient's father died at 40 years old of pulmonary embolism in the setting of esophageal cancer. H is mother had an immunogobulin (Ig) A de ciency and a history of H ashimoto's thyroiditis, but was otherwise healthy. The patient was single. H e did not drink alcohol or use illicit drugs. He had worked for a number of years as a farm laborer, but was currently working as a nursing assistant in a mental health facility.On systems review, he reported prior evaluation for a slightly unusual body habitus with central obesity and long limbs. Previous genetic and hormonal studies attempting to explain his morphology had been negative. He had chronic intermittent skin rashes described as pustular lesions that resembled chickenpox. The...