An outbreak of poisoning, characterized clinically by hyperpigmentation and a chloracne-like eruption. broke out in mid-Taiwan in Feburary 1979. Probably over a thousand persons were affected. The source of poisoning was found to be a specific brand of rice bran oil which was contaminated accidentally with polychlorinated biphenyls (PCB). PCB was detected from suspected oil samples in concentrations of 40 to 106 ppm. The blood PCB levels were 70 to 460 ppb in some patients. The amount of oil consumed by the individual patients was approximately one liter per month.A total of 358 cases of suspected rice bran oil poisoning was seen in the special clinics of Provincial Taichung Hospital and National Taiwan University Hospital. There were 171 males and 187 females. aged between 7 days and 78 years. Half of the patients were aged 11 to 30 years. One hundred and twenty-three patients were from families and the rest were groups from Hwei-Ming Blind School. factories. and temples.In general. the age distribution of the patients. the symptomatology. the skin pathology and the way the poisoning occurred, were similar to those of Yusho patients. However. differences were noted in some clinical signs, namely a higher incidence of hyperpigmentation and a lower incidence of acneform eruption in our series when compared with Goto's series. It is speculated that this may be partly due to different isomers or concentrations of PCB in the blood and tissues.
This paper describes in detail the dermatological, medical, and laboratory findings of patients poisoned with PCBs and related compounds in Taiwan. Together with their symptoms, their skin lesions as well as their hematological, immunological, and other clinical features are explained. A grading of their clinical severity was tried, and its possible association with PCB concentrations in their blood was examined but could not be demonstrated. Various treatments have been applied but without notable success. Even so, a follow-up study of patients one year later showed that about 38% of patients were somewhat clinically improved, while 54% were not altered.
benign or not?Monoclonal gammopathy of uncertain significance (MGUS) may be found in up to 3% of people over 70 years of age.' It is usually defined as the presence of up to 30 g/L of a monoclonal (or M-protein) with no Bence-Jones proteinuria and less than 5% of plasma cells on bone marrow examination. There is usually no evidence of significant anaemia, hypercalcaemia, renal insufficiency, osteolytic lesions on a skeletal survey or decreased polyclonal immunoglobulins.We present the case of a 7 1 -year-old man who was diagnosed with MGUS in 1989 and was found to have two IgG kappa paraprotein peaks (6 g/L and 2 g/L) on serum electrophoresis. Bone marrow examination revealed less than 5% plasma cells. No specific therapy was instituted and he was then followed up at regular intervals. Other significant past history included polymyalgia rheumatica in 1993 for which he was successfully treated with prednisolone over the next three years.In January 1995, aged 78, he presented with severe left shoulder pain and rigors. At the time he was taking 10 mg/d of prednisolone. On admission, he was febrile with a temperature of 39°C and had marked reduction in left shoulder range of movement. Two aspirations of his left shoulder were 'dry'. However, blood cultures grew Haemophilus injluenzae. Chest X-ray examination was unremarkable and X-ray of the left shoulder showed degenerative changes only. A diagnosis of H. injluenzae septicaemia and septic arthritis was made and he was successfully treated with two weeks of oral ciprofloxacin.He presented again in November 1997 with a fever of 38.6"CJ 'collapse' and severe left shoulder pain. Prednisolone had been ceased 12 months earlier. Streptococcus pneumoniae was grown from both a leftshoulder aspirate and blood cultures. A diagnosis of pneumococcal septic arthritis was made and he was successfully treated with intravenous penicillin for ten days followed by two months of oral amoxicillin.In February 1998 he presented again with cellulitis of his left foot after minor trauma. The amoxicillin had been ceased eight days previously. No organism was isolated on this occasion despite a series of blood cultures. There was no evidence of osteomyelitis on radio-labelled Technetium bone scan. He was successfully treated with intravenous flucloxacillin for one week followed by four weeks of oral amoxicillin.During this admission, reassessment of his MGUS was performed. Serial paraprotein and immunoglobulin levels dating from the time of the initial diagnosis of MGUS are given in Table 1.
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