Because of potential exposure both in the workplace and from ambient air, the known carcinogen 1,3-butadiene (BD) is considered a priority hazardous air pollutant. BD and its 2-methyl analog, isoprene (ISO), are chemically similar but have very different toxicities, with ISO showing no significant carcinogenesis. Once released into the atmosphere, reactions with species induced by sunlight and nitrogen oxides convert BD and ISO into several photochemical reaction products. In this study, we determined the relative toxicity and inflammatory gene expression induced by exposure of A549 cells to BD, ISO, and their photochemical degradation products in the presence of nitric oxide. Gas chromatography and mass spectrometry analyses indicate the initial and major photochemical products produced during these experiments for BD are acrolein, acetaldehyde, and formaldehyde, and products for ISO are methacrolein, methyl vinyl ketone, and formaldehyde; both formed < 200 ppb of ozone. After exposure the cells were examined for cytotoxicity and interleukin-8 (IL-8) gene expression, as a marker for inflammation. These results indicate that although BD and ISO alone caused similar cytotoxicity and IL-8 responses compared with the air control, their photochemical products significantly enhanced cytotoxicity and IL-8 gene expression. This suggests that once ISO and BD are released into the environment, reactions occurring in the atmosphere transform these hydrocarbons into products that induce potentially greater adverse health effects than the emitted hydrocarbons by themselves. In addition, the data suggest that based on the carbon concentration or per carbon basis, biogenic ISO transforms into products with proinflammatory potential similar to that of BD products.

Complex urban air mixtures that realistically mimic urban smog can be generated for investigating adverse health effects. "Smog chambers" have been used for over 30 yr to conduct experiments for developing and testing photochemical models that predict ambient ozone (O(3)) concentrations and aerosol chemistry. These chambers were used to generate photochemical and nonirradiated systems, which were interfaced with an in vitro exposure system to compare the inflammatory effects of complex air pollutant mixtures with and without sunlight-driven chemistry. These are preliminary experiments in a new project to study the health effects of particulate matter and associated gaseous copollutants. Briefly, two matched outdoor chambers capable of using real sunlight were utilized to generate two test atmospheres for simultaneous exposures to cultured lung cells. One chamber was used to produce a photochemically active system, which ran from sunrise to sunset, producing O(3) and the associated secondary products. A few hours after sunset, NO was added to titrate and remove completely the O(3), forming NO(2). In the second chamber, an equal amount of NO(2) and the same amount of the 55-component hydrocarbon mixture used to setup the photochemical system in the first side were injected. A549 cells, from an alveolar type II-like cell line grown on membranous support, were exposed to the photochemical mixture or the "original" NO(2)/hydrocarbon mixture for 5 h and analyzed for inflammatory response (IL-8 mRNA levels) 4 h postexposure. In addition, a variation of this experiment was conducted to compare the photochemical system producing O(3) and NO(2), with a simple mixture of only the O(3) and NO(2). Our data suggest that the photochemically altered mixtures that produced secondary products induced about two- to threefold more IL-8 mRNA than the mixture of NO(2) and hydrocarbons or O(3). These results indicate that secondary products generated through the photochemical reactions of NO(x) and hydrocarbons may significantly contribute to the inflammatory responses induced by exposure to urban smog. From previous experience with relevant experiments, we know that many of these gaseous organic products would contribute to the formation of significant secondary organic particle mass in the presence of seed particles (including road dust or combustion products). In the absence of such particles, these gaseous products remained mostly as gases. These experiments show that photochemically produced gaseous products do influence the toxic responses of the cells in the absence of particles.

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We studied all patients referred to the orthoptic department with binocular diplopia following cataract surgery between January 1991 and June 1993. Persistence of diplopia for a minimum of 3 months after cataract surgery was required for inclusion in the study. Eighty-one patients (2% of all patients who underwent cataract surgery during this time) satisfied the entry criteria. The patients fell into two groups: non-traumatic and traumatic cataracts. Horizontal deviations were seen in 24 patients. Vertical deviations were seen in 8 patients and a combined horizontal and vertical deviation was seen in 49 patients. Fresnel prisms were used to manage the diplopia in 58 patients. Of these, 48 patients in the non-traumatic group regained binocular single vision with this prism while 10 in the traumatic group benefited. Mechanical and sensory causes are discussed.

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