Neurobehavioural tests were undertaken by 30 female workers exposed to toluene and matched controls with low occupational exposure to toluene. The environmental air levels (TWA) of toluene was 88 ppm for the exposed workers and 13 ppm for the controls. The toluene in blood concentrations for the exposed workers was 1-25 mgIl and for the controls 0-16 mg/l. Statistically significant differences between workers exposed to toluene and controls in neurobehavioural tests measuring manual dexterity (grooved peg board), visual scanning (trail making, visual reproduction, Benton visual retention, and digit symbol), and verbal memory (digit span) were observed. Further, the performance at each of these tests was related to time weighted average exposure concentrations of air toluene. The workers exposed to toluene had no clinical symptoms or signs. The question arises as-to whether these impairments in neurobehavioural tests are reversible or whether they could be a forerunner of more severe damage.

Elastic and collagen fibers confer recoil and tensile strength on the pulmonary vasculature, airways, alveolar walls, and pleura. These durable extracellular matrix components are primarily synthesized during lung development and growth, and are expressed at very low levels in healthy adult lung. However, reinitiation of elastin and collagen synthesis in diseases of adult lung, such as idiopathic pulmonary fibrosis, often leads to excessive or aberrant deposition of elastin and collagen which contribute to the pathophysiology of these diseases. We used an experimental model of postpneumonectomy lung growth to determine whether normal patterns of synthesis and deposition of these critical structural components can occur in the adult lung. Male Sprague-Dawley rats (250-300 grams) were subjected to left pneumonectomy and right lobectomy. The remaining lung tissue was harvested for analysis after 3, 7, or 14 days. Compensatory growth of the remaining right lung progressed throughout the time course. Total desmosine and hydroxyproline content increased in the postpneumonectomy lung, reflecting increased elastin and collagen accumulation, but both were normal in content per weight of lung tissue. Northern analysis demonstrated induction of tropoelastin and type I procollagen mRNA expression in lungs of pneumonectomy rats. In situ hybridization localized tropoelastin and type I procollagen mRNA expression to anatomical sites similar to those seen during lung development. These data indicate that the adult lung can reinitiate elastin and collagen production and deposit these extracellular matrix components in a normal pattern.

A large percentage (50%) of PCN cases performed after-hours could have been performed during daytime hours instead due to the absence of infection. This would be in line with the practices of some centers that consider an infected obstructed kidney as the only absolute indication for emergent decompression overnight. The study also demonstrates that the absence of a SIRS in a patient with urinary tract obstruction correlates well with a negative urine culture result from the nephrostomy specimen which has a high negative predictive value for excluding pyonephrosis.

Summary Hypodense MCA sign – Large‐vessel occlusion secondary to fat embolism post‐right hip hemiarthroplasty.