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Dust elemental levels can be expressed as concentrations (bulk samples) or surface loadings (wipe samples). Wipe sampling has not been widely adopted for elements other than lead (Pb). In this study, 433 wipe samples from 130 households in south west England – a region of widespread, natural and anthropogenic arsenic contamination linked with previous mining activities-were analysed to (i) quantify loadings of arsenic (As); (ii) assess the quality of wipe data using QA/QC criteria; (iii) estimate, using published ingestion rates, human exposure to As in dust using loadings and concentrations from 97 bulk samples and (iv) comparatively assess the performance of wipe and bulk sampling using associations with As biomonitoring data (urine, toenails and hair). Good QC performance was observed for wipes: strong agreement between field duplicates, non-detectable contamination of field blank wipes and good reference material recoveries. Arsenic loadings exceeded an existing urban background benchmark in 67 (52%) households. No exceedances of tolerable daily As intake were observed for adult exposure estimates but infant estimates exceeded for 1 household. Infant estimates calculated using bulk concentrations resulted in 4 (3%) exceedances. Neither wipe nor bulk As metrics were sufficiently better predictors of As in biospecimens. Sampling strategies, analytical protocols, exposure metrics and assessment criteria require refinement to validate dust sampling methodologies.

A consecutive series of 435 patients with breast cancer followed from six to thirty years is presented. Radical mastectomy was the surgical procedure of choice and our experience indicated that the degree of axillary nodal involvement is a most important guide in establishing prognosis in this disease. The majority of recurrences became evident within the first five postoperative years, the next most hazardous period for the patient being the half decade between the fifth and tenth years after initial therapy. A second independent malignancy developed in 37 of the 275 pateints who died, and it was the cause of death in 7.6 per cent of this group. Among the 160 patients still living to date a second independent malignancy has already developed in 10. Bilateral breast cancer was observed thirty-eight times in this entire series of 435 patients, an incidence of 8.7 per cent.

Ten pseudofractures and six complete fractures occurred in five patients with adult hypophosphatasia. The four pseudofractures that were treated non-operatively progressed to complete fracture. The six pseudofractures and six complete fractures that were treated by internal fixation united. New fractures occurred in four patients after the removal of the internal fixation. We recommend that complete fractures, symptomatic pseudofractures, and progressive asymptomatic pseudofractures in patients with adult hypophosphatasia be treated with load-sharing internal-fixation devices, such as rigid intramedullary nails. These should not be removed unless it is absolutely essential. If removal is necessary, however, they should be replaced, preferably during the same anesthetic session. In our opinion, the guidelines developed from this study may be applied reasonably to patients with osteomalacia from causes other than hypophosphatasia, especially if medical therapy has been unsuccessful.

THE COMPOUND hexachlorophene (2,2'-dihydroxy-3,5,6-3',5'6'-hexachlorodiphenyl-methane) frequently referred to as G-11 or AT-7 and incorporated into liquid soap, has been studied extensively as an effective bactericidal agent in reducing the numbers of bacterial flora of the human skin. The studies on liquid soaps by Traub and his co-workers 1 in 1944 and 1945, by Clark and others 2 in 1947 and by Price and his colleagues 3 in 1948 are informative and convincing. Seastone and Erickson 4 made valuable studies and in 1949 compared the liquid and bar soaps as vehicles for hexachlorophene in the surgical scrub. Nungester, Thirlby and Vial 5 in 1949 evaluated a bar soap containing this formula and concluded that a three minute scrub with such a soap was superior to the usual 10 minute surgical scrub. In spite of these excellent studies, it was difficult for our group at the University Hospital to accept this rather radical