Intraperitoneal Elemental Mercury Exposure from a Mercury-Weighted Bougie

INTRODUCTION: Significant exposure to elemental mercury can occur if a mercury-weighted medical device is damaged during use. We report a case of an elemental mercury spill into the peritoneum of a patient undergoing laparoscopic gastric bypass surgery. CASE REPORT: A 64-year-old man with multiple comorbidities underwent an elective Roux-en-Y gastric bypass procedure for the treatment of morbid obesity. A mercury-weighted esophageal bougie was inadvertently used during construction of the anastomosis. A suture placed through the distal tip of the device caused elemental mercury to leak into the peritoneum. Two days later, the patient underwent another surgical procedure for removal of the mercury. Intermittent air measurements taken from the laparoscope exhaust showed a peak intraperitoneal mercury concentration of 98,169 ng/m(3). Blood mercury levels peaked at 146 μg/L on day 22 after the exposure, and urine mercury concentrations peaked on day 43 at 227 μg/L. The patient had no evidence of acute toxicity, but he was found to have proteinuria on follow-up evaluation. DISCUSSION: Patients can be exposed inadvertently to toxic amounts of elemental mercury when the integrity of medical devices is compromised. We encourage hospitals to discontinue the use of devices that contain mercury. Effective alternatives that do not pose exposure risks to patients or health care workers are readily available

Inorganic arsenic and human prostate cancer Arsênico inorgânico e câncer de próstata humano

We critically evaluated the etiologic role of inorganic arsenic in human prostate cancer. We assessed data from relevant epidemiologic studies concerning environmental inorganic arsenic exposure. Whole animal studies were evaluated as were in vitro model systems of inorganic arsenic carcinogenesis in the prostate. Multiple studies in humans reveal an association between environmental inorganic arsenic exposure and prostate cancer mortality or incidence. Many of these human studies provide clear evidence of a dose-response relationship. Relevant whole animal models showing a relationship between inorganic arsenic and prostate cancer are not available. However, cellular model systems indicate arsenic can induce malignant transformation of human prostate epithelial cells in vitro. Arsenic also appears to impact prostate cancer cell progression by precipitating events leading to androgen independence in vitro. Available evidence in human populations and human cells in vitro indicates that the prostate is a target for inorganic arsenic carcinogenesis. A role for this common environmental contaminant in human prostate cancer initiation and/or progression would be very important.<br>Realizamos uma avaliação crítica do papel etiológico do arsênico inorgânico no câncer de próstata humano. Avaliamos dados de estudos epidemiológicos relevantes referentes à exposição ao arsênico inorgânico ambiental. Foram avaliados estudos com animais completos, bem como sistemas de modelo in vitro de carcinogênese decorrente de arsênico inorgânico na próstata. Estudos múltiplos em seres humanos revelaram uma associação entre exposição ao arsênico inorgânico ambiental e mortalidade por ou incidência de câncer de próstata. Muitos desses estudos em seres humanos oferecem indícios claros de uma relação dose-resposta. Não se encontram disponíveis modelos animais completos relevantes que mostrem uma relação entre arsênico inorgânico e câncer de próstata. Contudo, os sistemas de modelos celulares indicam que o arsênico é capaz de levar a transformações malignas de células epiteliais da próstata humana in vitro. Aparentemente, o arsênico também tem um impacto na progressão do câncer de próstata ao precipitar eventos que levam à independência de andrógeno in vitro. Os indícios disponíveis em populações humanas e células humanas in vitro indicam que a próstata é alvo da carcinogênese de arsênico inorgânico. Um papel para esse contaminante ambiental comum na iniciação e/ou progressão do câncer de próstata humano seria de suma importância