The risk of radiation-associated solid tumor development after BMT is likely to increase with longer follow-up. This underscores the importance of close monitoring of patients who undergo BMT.

No abstract

Smoking and a high intake of red meat are risk factors for colorectal tumors. These effects could be due to aromatic amine carcinogens. Individual susceptibility to aromatic amines has been related to acetylation phenotype, which plays a role in the bioactivation of arylamines. Polymorphisms in both N-acetyltransferase genes, NAT1 and NAT2, have been associated with an increased risk of colorectal tumors. We studied the NAT1*10 fast acetylator allele (1088 T-->A mutation) and distal adenomas in a sigmoidoscopy-based case-control study (441 cases, 484 controls). We found neither an increased adenoma prevalence in subjects homozygous or heterozygous for the NAT1*10 fast acetylator allele (odds ratio 1.04; 95% confidence interval 0.79-1.36), nor a gene-gene interaction between NA1 and NAT2 (P(interaction) = 0.59). Further NAT1 alleles must be considered for more conclusive results regarding the relevance of NAT1 activity to colorectal tumorigenesis.

The authors present a case of a 28-year-old woman on trimethoprim ⁄ sulfamethoxazole for 9 months, who presented to the emergency department with weakness, shortness of breath, and cyanosis. The patient's clinical course is outlined. A discussion of the potential etiologies, as well as the clinical management, is provided. RESIDENT CASE REPORTA 28-year-old female presented to the emergency department (ED) with a chief complaint of shortness of breath. The patient complained of a 3-week history of weakness and tiredness that she originally attributed to stress. She went on vacation 1 week prior to admission in Florida, and during this trip her husband noticed a blue tinge to her lips. She returned from Florida and was seen by her endocrinologist who also noticed her perioral cyanosis and noted a pulse oximetry reading of 84% on room air; she was sent to the ED for evaluation.In the ED, the patient reiterated her progressively worsening tiredness and weakness, stating that she would sleep for most of the day. Her medical history was significant for bladder rhabdomyosacroma diagnosed at the age of 2 years, a right nephrectomy, a ureteralileosigmoidostomy that causes a chronic metabolic acidosis, anemia, multiple bowel obstructions, and multiple urinary tract infections. Her medications included sodium bicarbonate, iron, and trimethoprim ⁄ sulfamethoxazole (TMP ⁄ SMX) for the past 9 months without any changes in dosage. She noted an allergy to prochlorperazine and silk tape. She denied tobacco, alcohol, or drug abuse.On physical exam the patient was awake, alert, responsive to questioning, and in no acute distress. Her heart rate was 75 beats ⁄ min, blood pressure was 123 ⁄ 85 mmHg, respiratory rate was 20 breaths ⁄ min., and oral temperature was 97.5°F. The oxygen saturation read 85% on room air and increased to 90% on a 100% oxygen nonrebreather mask.The patient was a thin, well-nourished female who appeared comfortable but displayed some conversational dyspnea. The head and neck examination was unremarkable. The chest was clear to auscultation. Cardiac examination revealed normal sinus rhythm without murmurs. The abdomen was soft and nontender, with an old midline scar from previous surgery. Cranial nerves II-XII were normal. Motor strength, sensation, and pulses in all extremities were normal. Examination of the skin revealed perioroal bluish discoloration. All of her distal fingertips were pale with a slight purplish discoloration to the nailbed.The initial electrocardiogram (ECG) was normal sinus rhythm and unremarkable, and the chest radiograph was normal, without evidence of pneumonia or pneumothorax. Initial laboratory studies showed normal complete blood count. The electrolytes revealed a bicarbonate of 13 but normal sodium, potassium chloride, blood urea nitrogen, and creatinine. A presumptive diagnosis of PE was entertained; however, due to the ª