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Aluminum is a neurotoxic element that enters the human body due to its widespread usage in daily life. It has the potential to affect the neurological development of the fetus and infant adversely. This study aimed to evaluate the relationship between maternal and umbilical cord serum aluminum level and infant neurodevelopment. Over a period of March 2018 to September 2019, we conducted a prospective cohort study; 173 Mother-new-born pairs were enrolled. Aluminum levels were measured using Inductively Coupled Plasma Optical Emission Spectrometry (ICP-OES). The correlation with Bayley Scales of Infant Development (BSID) -3rd edition score and maternal and cord serum aluminum were assessed via linear regression model. The mean concentration of maternal and cord serum aluminum was 2.58 ± 1.14 µg/dL and 1.44 ± 0.62 µg/dL, respectively. There was a significant correlation in aluminum level between maternal and umbilical cord serum (Pearson’s r = 0.591, p

Despite reported evidence on the relationship between higher serum aluminum levels and poor outcomes in patients on chronic hemodialysis (CHD), the acceptable cutoff value of serum aluminum for mortality remains unclear. A retrospective observational cohort study with 636 Taiwanese patients on CHD was conducted to investigate the impact of serum aluminum levels on mortality. The predictors were bivariate serum aluminum level (

Even though aluminum is not considered to be a heavy metal like lead, it can be toxic in excessive amounts and even in small amounts if it is deposited in the brain. Many of the symptoms of aluminum toxicity mimic those of Alzheimer’s disease and osteoporosis. Colic, rickets, gastrointestinal problems, interference with the metabolism of calcium, extreme nervousness, anemia, headaches, decreased liver and kidney function, memory loss, speech problems, softening of the bones, and aching muscles can all be caused by aluminum toxicity. This study included 40 workers in an aluminum factory in 6th October District in Egypt with mean aluminum concentration in the different departments in the factory was within permissible exposure level "PEL". Data were collected through a previously prepared questionnaire which consists of three parts. The first part was concerned with demographic data such as age and nationality. The second part was concerned with occupational data such as working hours, working years, smoking, and diseases. The third part concerned with knowledge, attitude and practice about aluminum hazards. The studied workers have reported the exposure to aluminum inside workplace during polishing and during smelting (85 % and 82.5 % respectively). However, majority of workers also reported an extra workplace exposure to aluminum with most of them in form of using alum. Utensils followed by use of food additives containing aluminum (72.5 % and 70 % respectively). By implementing the intervention study through the comprehensive health education program to workers in the factory, there was a statistically significant reduction in the mean serum aluminum before and after intervention (13.95 and 13.75 up/dl respectively) (P

Context.— Annual monitoring with serum aluminum measurements is recommended for dialysis patients who are susceptible to toxic accumulation from contaminated dialysis fluid or from ingestion of aluminum-containing medications. Objective.— To evaluate long-term trends in serum aluminum concentrations and frequency of chronic toxicity. Design.— A retrospective observational study was conducted by analyzing serum aluminum results obtained from the Veterans Affairs corporate data warehouse. Serum aluminum concentrations of 60 μg/L or greater were considered false positives and not indicative of chronic toxicity if another specimen retested within 45 days had a concentration below 20 μg/L. Results.— A total of 45 480 serum aluminum results involving 14 919 patients and 119 Veteran Affairs facilities during a 16-year period ending in October 2016 were evaluated. The percentage of elevated (≥20 μg/L) serum aluminum results declined from 31.5% in 2000 to 2.0% in 2015. Average testing intervals changed from every 159 days in 2000 to every 238 days in 2015. Of 529 patients with serum aluminum concentrations of 60 μg/L or greater, 216 (40.8%) were retested within 45 days (average = 21 days); of these, 83 (38.4%) had concentrations below 20 μg/L after repeated measurements. Retesting rates increased with higher initial serum aluminum concentrations. Conclusions.— Aluminum toxicity, as assessed by serum levels, has substantially declined over time and is now rare. Many serum aluminum concentrations in the toxic range were not confirmed after retesting. Patients with toxic serum aluminum concentrations should be retested with another specimen before undergoing treatment or investigating sources of exposure to verify abnormal results.

Aim: To develop and validate an inductively coupled plasma–mass spectrometry method for quantitative bioanalysis of aluminum (Al) in monkey serum in support of a GLP TOX study with alhydrogel-formulated drug candidate. Methods & results: The method was linear over a dynamic range of 10–1000 ng/ml using a 50-μl sample volume. The intra-/inter-run precision (%CV) of the quality control sample results were ≤7.9% (CV) and the accuracy (%bias) within ±11.0% across all quality control concentrations evaluated. Other validation parameters, including stability under various conditions, extraction recovery and matrix effect, all met the acceptance criteria. Conclusion: The validated method was successfully implemented for the quantitative analysis of Al in monkey serum to assess the systemic exposure to Al.

Proficiency testing schemes monitor laboratory performance and provide a stimulus for improvement in accuracy. Where several schemes operate in the same analytical sector, there are risks that assessments of performance may be in conflict. Performance assessment for the determination of trace elements such as aluminum in serum is particularly important due to the high risk of contamination and therefore erroneous results. The objectives of this work were (1) to compare several mathematical models to establish a predefined standard deviation for proficiency assessment and (2) to evaluate the influence of instrumental methods and proficiency testing scheme on the assessment of performance for serum aluminum measurements. For this purpose, three samples were sent to the participants of four proficiency testing schemes. Assigned values were calculated according to algorithm A according to ISO 13528 and standard deviation for proficiency assessment according to three methods based on individual variability, state of the art or previous proficiency testing results. The method based on individual variability produced a more stringent standard deviation compared to analytical imprecision based on the state of the art. The instrumental methods gave similar results, whereas significant differences were observed between the four proficiency testing schemes indicating that harmonization of the standard deviation for proficiency assessment fails to allow transferability from one proficiency testing scheme to another and that additional factor(s) contribute to variability in performance assessment.

The cardiothoracic ratio (CTR) and serum aluminum levels are both associated with mortality in hemodialysis patients. However, limited data regarding the association between serum aluminum levels and the CTR have been published to date. Therefore, we aimed to elucidate this association in patients on chronic hemodialysis (CHD). We investigated the association between the serum aluminum level and the CTR in CHD in a retrospective cross-sectional study of 547 Taiwanese patients on CHD. The mean age of patients was 62.5±13.2 years, with a mean hemodialysis time of 7.1±5.2 years. Among the patients, 36.9% were diabetic and 47.9% were male. After natural logarithmic transformation (ln(aluminum)), the serum aluminum level exhibited an independent and linear relationship with the CTR (β: 1.40, 95% confidence interval (CI), 0.6-2.2). A high serum aluminum level (≥6 ng/dL) was significantly associated with a CTR >0.5 in the crude analysis (odds ratio (OR): 2.15, 95% CI, 1.52-3.04) and remained significant after multivariable adjustment (OR: 2.45, 95% CI, 1.63-3.67). Moreover, the ln(aluminum) value was significantly associated with a CTR >0.5 (OR: 1.71, 95%CI, 1.28-2.29) in multivariable analysis, indicating a dose effect of aluminum on cardiomegaly. In conclusion, the serum aluminum level was independently associated with cardiac remodeling (elevated CTR) in patients on CHD.

Background: An enormous, alarming, and unexplained increase in the prevalence of autism is being reported, on an almost daily basis everywhere. Exposure to certain neurodevelopmental toxins, may increase the risk of autism spectrum disorders (ASD), autism, and attention-deficit hyperactivity disorder. Heavy metals including lead, aluminum and ethylmercury interrupt growth factor signaling, delaying neurodevelopmental growth of infants and children. Aim of the work: studying the state of some heavy metal overload and trace elements among children with autisticfeatures. Subjects and Methodology: children diagnosed as having autistic features were recruited from pediatric psychiatric clinic at Kasr Al Aini and National Research center. A total of 64 cases and 30 matched children as referent group, were involved in our cross sectional study. Measuring levels of heavy metals including RBCs lead, urinary mercury, serum aluminum, and zinc was performed using the atomic absorption spectrophotometer. Results and discussion: Abnormal high levels of lead, mercury and aluminum, low level of zinc, were detected in the autistic featured group. The measured levels of heavy metals and trace elements were statistically significantly different when compare with that in referent group. Conclusion and recommendation: The level of heavy metals should be monitored in every case diagnosed as having autistic features. We recommend early intervention for preventing long term disability. A full management protocol including early diagnosis, behavioral, speech therapy, chelation and replacement therapy should be developed.

Aluminum (Al) is an ingredient of a variety of foodstuffs and medications as well as of domestic water supplies. The patients with chronic kidney disease (CKD) are more susceptible to bone toxicity of Al. The aim of the study was to investigate the interactions between serum Al, parathyroid hormone (PTH) and active vitamin-D in CKD.A total of 10 pediatric patients with CKD and 20 healthy controls were enrolled in study. The blood calcium, aluminum, PTH, alkaline phosphatase and phosphorus were evaluated at onset and following a regimen of oral 1,25 dihydroxycholecalciferol (1,25 DHC) for 4 weeks.Although median values of PTH, calcium, phosphorus and alkaline phosphatase did not differ (P0.05) after calcitriol administration, the aluminum levels (median: 27.2 ng/ml, range: 11.3-175) declined significantly (median: 3.8 ng/ml, range: 0.64-11.9) after a regimen of oral 1,25 DHC for 4 weeks in all participants (P0.05). The median levels of aluminum after 1,25 DHC did not show statistically significant difference with median aluminum levels of healthy controls (median: 2.5 ng/ml, range: 0.2-33.2) (P0.05).Calcitriol may lead to decline in serum Al levels in CKD patients.

We investigated effects of multivitamin/mineral supplementation on element levels in serum and follicular fluid of women undergoing IVF. We used three groups in this study. The first group was used as an age-matched and nonpregnant control (n = 13). Group 2 (n = 30) constituted the IVF group and women in the third group who were undergoing IVF also received a multivitamin/mineral tablet daily for 45 days. Follicular fluid and serum selenium and zinc levels and follicular fluid copper levels were lower in IVF patients than in controls although follicular fluid aluminum and iron levels were higher in IVF patients than in controls. However, follicular fluid and serum aluminum, copper, zinc and selenium levels, and serum magnesium levels were higher in the multivitamin/mineral group than in the IVF group although follicular fluid iron levels were lower in the multivitamin/mineral group than in the IVF group. In conclusion, we observed that copper, zinc, and selenium in serum and follicular fluid decreased in women undergoing IVF. Multivitamin/mineral supplementation in serum and follicular fluid of women undergoing IVF normalized the trace element levels.

INTRODUCTION The determination of toxic elements in the biological samples of human beings is an important clinical procedure. This study was performed to investigate the prevalence of abnormal blood contents of 2 trace elements (TEs), aluminum (Al),and lead (Pb) in hemodialysis (HD) patients and to analyze their relationship with the medications, such as CaCO(3), Ca acetate, 1,25-dihydroxy vit. D(3), and erythropoietin (EPO), as well as hematocrit level. MATERIAL AND METHODS We included 43 patients on maintenance HD and they had continued the previously mentioned medications for at least 3 months. None of the patients were on Al containing phosphate binding agents. RESULTS Serum aluminum and lead levels were significantly increased than in the healthy controls, but levels of both of them were far below toxic values. Male patients had higher mean levels of lead than did females. A strong positive correlation was found between serum Al and serum Pb levels among patients (r = 0.075, p = 0.0001).The serum level of Pb was positively correlated with the serum albumin in HD patients (r = 0.45, p = 0.03). Both serum aluminium and lead levels positively correlated with the EPO dose taken by the patients (r = 0.77, p = 0.0001 and r = 0.67, p = 0.0001 respectively). CONCLUSIONS The blood level of trace metals of these HD patients was not related to their medications except for the EPO dose. However, caution must be exercised in interpreting this result as dose and duration of medication may play an important role. Al and Pb over load may be considered from the causes of inadequate response to epoetin therapy.

Excessive exposure to aluminum (Al) can produce serious health consequences in people with impaired renal function, especially those undergoing hemodialysis. Al can accumulate in the brain and in bone, causing dialysis-related encephalopathy and renal osteodystrophy. Thus, dialysis patients are routinely monitored for Al overload, through measurement of their serum Al. Electrothermal atomic absorption spectrometry (ETAAS) is widely used for serum Al determination. Here, we assess the analytical performances of three ETAAS instruments, equipped with different background correction systems and heating arrangements, for the determination of serum Al. Specifically, we compare (1) a Perkin Elmer (PE) Model 3110 AAS, equipped with a longitudinally (end) heated graphite atomizer (HGA) and continuum-source (deuterium) background correction, with (2) a PE Model 4100ZL AAS equipped with a transversely heated graphite atomizer (THGA) and longitudinal Zeeman background correction, and (3) a PE Model Z5100 AAS equipped with a HGA and transverse Zeeman background correction. We were able to transfer the method for serum Al previously established for the Z5100 and 4100ZL instruments to the 3110, with only minor modifications. As with the Zeeman instruments, matrix-matched calibration was not required for the 3110 and, thus, aqueous calibration standards were used. However, the 309.3-nm line was chosen for analysis on the 3110 due to failure of the continuum background correction system at the 396.2-nm line. A small, seemingly insignificant overcorrection error was observed in the background channel on the 3110 instrument at the 309.3-nm line. On the 4100ZL, signal oscillation was observed in the atomization profile. The sensitivity, or characteristic mass ( m 0 ), for Al at the 309.3-nm line on the 3110 AAS was found to be 12.1 ± 0.6 pg, compared to 16.1 ± 0.7 pg for the Z5100, and 23.3 ± 1.3 pg for the 4100ZL at the 396.2-nm line. However, the instrumental detection limits (3 SD) for Al were very similar: 3.0, 3.2, and 4.1 μg L − 1 for the Z5100, 4100ZL, and 3110, respectively. Serum Al method detection limits (3 SD) were 9.8, 6.9, and 7.3 μg L − 1 , respectively. Accuracy was assessed using archived serum (and plasma) reference materials from various external quality assessment schemes (EQAS). Values found with all three instruments were within the acceptable EQAS ranges. The data indicate that relatively modest ETAAS instrumentation equipped with continuum background correction is adequate for routine serum Al monitoring.

Renal osteodystrophy in hemodialyzed patients with DM-HD shows different features from that in non-DM,HD. Two studies were done. One was a comparison of BMD in 30 non-DM,HD patients and 30 DM-HD patients. The second was a comparison of possible factors affecting calcium metabolism in the higher and lower BMD groups (n = 20/21) in the DM-HD patients. BMD was measured by dual-energy X-ray absorptiometry (DEXA; Hologic QDR 1,000/W) in the third lumbar vertebra (L3), head, pelvis, and whole body. The BMDs of the DM-HD group were lower in these areas and whole body than that in the non-DM,HD group. A significant difference was found in the head BMD (p less than 0.05). In the second study, factors which may contribute to the differences in BMD were compared in the DM-HD patients divided into higher and lower BMD of the head. The group with higher head BMD had a value 110% of the mean value or more. Clinical and biochemical test results (age, the time since the first dialysis, body weight, the degree of obesity, height, serum calcium, serum phosphate, serum aluminum, serum c-PTH level and the dose of 1 alpha-OH-D3) were compared. The degree of obesity of the patients with higher BMD was significantly larger than that with lower BMD (p less than 0.005).

Aluminum levels of serum and red blood cell (RBC) were determined by instrumental neutron activation analysis (INAA) in 15 patients undergoing long-term haemodialysis. In the sample, aluminum was bombarded with thermal neutrons due to 27Al(n,γ)28Al and was determined by measuring 1779 keV gamma-ray of 28Al (T 1/2 = 2.24 min) with a HPGe detector. Phosphorus, causing an important interference by the fast neutron reaction, 31P(n,α)28Al, was determined by the photometric method to correct the net-area under the 28Al gamma-peak. The one-sample Kolmogorov-Smirnov test was used to control the normality distribution of the aluminum levels in serum and RBC. The results obtained were found to be in agreement with the serum aluminum determination performed by electrothermal atomic absorption spectrophotometry. The statistical results show a correlation between the aluminum levels of serum and RBC.

Background: The different scoring methods used by eight European External Quality Assessment Schemes (EQASs) for occupational and environmental laboratory medicine were compared to develop suitable quality specifications as a step toward harmonization. Methods: Real results for blood lead and serum aluminum assays, reported by participants in Italian and United Kingdom EQASs, were evaluated according to individual scheme scoring criteria. The same results were then used to produce z scores using scheme-based between-laboratory SDs as the estimate of variability to determine whether simple performance-derived quality specifications produced better agreement among schemes. Results: The schemes gave conflicting assessments of participants’ performance, and participants judged to be successful by one scheme could be defined as performing inadequately by another. An approach proposed by Kenny et al. (Scand J Clin Lab Invest 1999;59:585), which uses clinical inputs to set targets for analytical imprecision, bias, and total error allowable, was then used to elaborate quality specifications. Conclusions: We suggest that the CLIA ′88 recommendations for blood lead (± 40 μg/L or ± 10% of the target concentration, whichever is the greater) could be used as a quality specification, although a revision to ± 30 μg/L or ± 10% is recommended. For serum aluminum, a suitable quality specification of ± 5 μg/L or ± 20% of the target concentration, whichever is the greater, is suggested. These specifications may be used to compare laboratory performance across schemes.

To assess the effect of concomitant iron and aluminum loads on bone aluminum accumulation and on the response to the deferoxamine test in rats with the same aluminum surcharge, Wistar rats with chronic renal failure were divided into three groups: iron-overloaded rats (N = 6) (intraperitoneal iron); iron-depleted rats (N = 6) (blood withdrawal two to three times per week); control rats (N = 4) (no manipulation). All groups received intraperitoneal aluminum simultaneously. After 6 wk, a deferoxamine challenge test was performed. Thereafter, bone aluminum and iron were measured. The iron-overloaded rats showed higher bone iron content (iron overloaded: 147.7+/-55.4 microg/g; iron depleted: 7.9+/-1.0, and controls 13.3+/-9.9 microg/g, p0.010) and lower bone aluminum content (iron overloaded: 14.2+/-4.0 microg/g; iron depleted: 70.9+/-35.1 microg/g; controls: 72.7+/-28.3 microg/g p0.005). No differences were found between the iron-depleted and control rats. After the deferoxamine infusion, the iron-depleted rats tended to have higher serum aluminum increments (p = NS) and higher urinary aluminum excretion (p0.012, p0.020) than control rats despite similar amounts of aluminum in bone of the two groups. Aluminum bone accumulation was minor if iron and aluminum loads were given concomitantly. The iron depletion influenced the results of the deferoxamine challenge test in rats with similar bone aluminum burden.

血液透析患者の高いアルミニウム値と脳症、骨症との関係は知られている。新潟県立中央病院(上越市)で血液透析を受けている患者76人に対して、血清アルミニウム値を調べたところ、 14名(18%)にアルミニウム高値者が存在した。そこで、患者が日常生活においてアルミニウムを取り込む原因となるものについて調査を行った。その結果、アルミニウム高値患者は透析年数が15年以上の患者と、アルミニウム化合物を含む市販薬(バファリン、太田胃酸、熊の胆等)の服用者に見られた。また高値患者の1人は、アルミニウムが多く含まれていたウ-ロン茶を飲用していた。日常飲用している水道水にもアルミニウムが含まれるが、その含有量は浄水場によって異なり、城山浄水場からの水道水が高値を示した。さらに、古いアルミニウム製品からアルミニウムが多く溶出することも分かった。, It is known that hemo-dialysis patients have a high content of aluminum in their serum and this has a close relation to encephalopathy and osteodystrophy. We determined aluminum content in the serum of 76 hemodialysis patients in Niigata Prefectural Center Hospital (in Joetsu City). The aluminum content in the serum of 14 (18%) patients was significantly higher than that of normal subjects. We then researched the causes of the patient-s higher aluminum levels. The result showed that patients who had taken hemodialysis for more than 15 years tended to have a higher contend of aluminum in their serum. Another result showed that the patients who had taken certain medicines containing aluminum (Bafferin, Otaisan, Kumanoi etc.) also had a higher level of aluminum in their serum. We also found out that a patient who had high aluminum in his serum had drunk oolong tea. In addition to these results we have to mention that the water from the filtration plant SIROYAMA proves to contain higher aluminum than other plants. We also found out that the water in the old aluminum kettles and pans contains a higher level of aluminum.

Aluminum ranks as a potentially hazardous agent. Pathologic findings in different organs show that it can accumulate in brain, muscle, liver and bone. Therefore, we investigated whether patients with cementless total hip endoprostheses made out of titanium alloys containing aluminum are at risk. In order to determine the complete aluminum body loading in patients who have had their hip replacement for a long period of time (mean 58 months), we mobilized possible stores of aluminum with desferoxamine (DFO). Electrothermal atomic absorption spectroscopy was used to quantify the level of aluminum in serum and urine before and after DFO treatment. A serum aluminum value of 10 micrograms/l or less is internationally accepted as safe. The average serum aluminum level in this study was 14.2 micrograms/l, which is slightly above the limit, but clearly below those levels which can lead to disease (50 micrograms/l). No relevant storage of aluminum was found. This latter finding is more important since chronically elevated aluminum levels lead to cellular deposits, which affect the cellular biochemistry. The values before and after DFO mobilization did not differ substantially, indicating that aluminum in alloys for biomaterials can be regarded as safe as far as the risk of aluminum release in vivo is concerned. Histologic studies of bone from the bone-metal interface also showed no deposits of local aluminum release.

The present study examines the serum aluminum (Al) and daily urine Al excretion in 50 patients with chronic renal insufficiency (CRI) who are not taking any Al-containing agents. The influence of body iron stores and hematological indexes on the above parameters were also studied. Data on a group of 20 healthy subjects not taking any drugs were included for comparisons. The basal Al levels in CRI patients (10.5 +/- 9.7 micrograms/l) were significantly higher than those (3.8 +/- 2.4 micrograms/l) of the normal subjects. In addition, the renal Al clearance (2.98 +/- 0.35 ml/min) in CRI patients was significantly lower than that (4.93 +/- 0.21 ml/min) in normal subjects. Although all serum Al levels of our patients were within the nontoxic range (50 micrograms/l), the results of our study showed a negative correlation between serum Al and serum transferrin saturation (r = -0.40, p0.005) as well as serum iron (r = -0.406, p0.005). There was a negative correlation between daily urine Al excretion and serum ferritin levels (r = -0.305, p = 0.031). The study group is further divided into 2 subgroups, i.e. group A (ferritin100 micrograms/l) and group B (ferritin300 micrograms/l). The daily urine Al excretion in group A was higher than that in group B. In conclusion, our study first demonstrates that Al tends to be accumulated in patients with CRI, similar to Al in patients with hemodialysis, and the chronic low-level Al exposure in CRI patients may affect body iron status and metabolism, or iron status may play a role in Al absorption and excretion.(ABSTRACT TRUNCATED AT 250 WORDS)

The exact cause of Alzheimer's disease and the part played in it by aluminum is still speculative. We have studied serum aluminum in 356 healthy people, and we have observed that serum aluminum concentration is increased in aging people in relation to age. We suggest that this could be associated with an enhanced gastric permeability or by an increase in metal accumulation proportional to age. We have measured serum aluminum levels in patients with probable Alzheimer's disease, patients with other senile dementias, and age-matched group. Patients with probable Alzheimer's disease have statistically significant higher serum aluminum levels than patients with other types of senile dementias (alcoholic, vascular, multi-infart) and an age-matched control group. When we compare serum aluminum of patients with senile dementias from other causes with the age-matched control group, we do not find significant differences.

Some of the problems arising from the organization of quality assurance programs for the analysis of trace elements in blood are discussed. These include the preparation of suitable control materials by the organizing center and the elaboration of valuable strategies of sample distribution, treatment of data, and evaluation of results, which can be applied even to a small number of participants. The procedures used in the Italian quality assurance scheme for trace elements in blood are reported. Their reliability was partly confirmed by the results of some experiments carried out within the framework of the program. They dealt with the commutability of control and fresh samples in blood lead analysis, the analytical behavior of liquid compared to that of lyophilized control materials for serum aluminum determination, and the evaluation of laboratory performance in the analysis of “open” or “blind” duplicates.

The analytical performance of a group of Italian laboratories with regard to the determination of blood lead (BPb), blood cadmium (BCd), serum aluminum (SAl), serum copper (SCu), and serum zinc (SZn) was estimated from the results of quality assurance programs carried out in Italy between 1983 and 1990. Mean imprecision, mean inaccuracy, and percentage of acceptable results provided, according to preset limits, were adopted as indexes of performance. Positive trends were observed, over the course of the years, toward smaller bias and lower percentage of laboratories with poor performance. At present, taking into account results from all participants, mean absolute inaccuracy can be evaluated as 40 μg/liter (mean concentration: 440 μg/liter) for BPb, 0.55 μg/liter (mean concentration: 3.6 μg/liter) for BCd, and 13.4 μg/liter (mean concentration: 77 μg/liter) for SAl. At mean concentrations of 0.94 mg/liter of SCu and 1.08 mg/liter of SZn, mean absolute inaccuracies were 0.130 mg/liter and 0.162 mg/liter, respectively. The percentage of laboratories providing results within established limits for at least 80% of the examined samples is rather high for BCd (61.9%), SCu (43.8%), and BPb (41.2%). On the contrary, only 15.7% of laboratories achieved good performance in SZn analysis and none in SAl determination.

Serum and bone aluminum concentrations were significantly higher in young rats fed pharmacological doses of aluminum for 29 d than in control rats that did not receive extra aluminum. The control rats had a serum aluminum level of 18 ± 3 (SE) ppb and a bone aluminum level of 19.1 ± 1.0 ppm; the aluminum-exposed rats had a serum aluminum level of 44 ± 7 ppm and a bone aluminum level of 27.2 ± 2.4 ppm. Rats fed a diet analogous to aluminum-contaminated foods had control levels of serum and bone aluminum. Increases of approximately 1 ppm (over the control level) in brain aluminum concentrations of both dosed groups of rats were not statistically significant. The aluminum intake correlated with serum and bone aluminum concentrations, and the serum aluminum concentrations correlated with the bone aluminum concentrations. However, the concentrations of brain aluminum did not correlate with either aluminum intake or serum aluminum levels.

The relationship between serum aluminum (Al), zinc (Zn), copper (Cu), and iron (Fe) and plasmapheresis (PP) treatment was examined. Three patients with rheumatoid arthritis, six with myasthenia gravis, and 6 with multiple sclerosis were studied. Serum Al, Zn, Cu, and Fe were measured before and after PP. Plasma was separated by first filtration; a second filtration separated the plasma components. Three liters of plasma were treated in each PP session. With each PP treatment, total protein (TP) removed was 20 +/- 5% and serum albumin removed was +/- 6%. Serum Al rose significantly (p less than 0.01 from 1.1 +/- 0.2 micrograms/dl pre-PP to 2.8 +/- 0.4 micrograms/dl post-PP. Serum Zn, Cu, and Fe decreased significantly (p less than 0.01) from 86.2 +/- 7.4 micrograms/dl, 126 +/- 18 micrograms/dl, and 108 +/- 14 micrograms/dl pre-PP to 58.4 +/- 10.2 micrograms/dl, 104 +/- 6 micrograms/dl, and 82 +/- 16 micrograms/dl post-PP, respectively. Two days after the end of the six-month PP treatment, serum Al levels rose significantly (p less than 0.01), from 1.1 +/- 0.2 micrograms/dl to 3.6 +/- 0.8 micrograms/dl. However, serum TP, serum albumin, and serum Zn, Cu, and Fe did not change significantly. It thus appears essential in PP treated patients, to remove Al from the blood to protect against aluminum intoxication.

OBJECTIVE: There is no information in the literature on the impact of crack smoking using crushed aluminum cans as makeshift pipes, a common form of crack use in Brazil. Since aluminum intake is associated with neurological damage, we measured serum aluminum levels in crack smokers. The objective of this study was to ascertain the levels of aluminum in crack users who smoke on makeshift aluminum pipes. METHOD: 71 female crack smokers, their mean age being 28.0 (± 7.7), provided information about their drug use, and had blood samples tested for serum aluminum level. RESULTS: 56 (79%) subjects smoked crack from crushed can pipes, while 15 (21%) smoked from other containers. Fifty-two (73.2%) out of the 71 subjects presented a serum aluminum level of 2 µg/l and 13 (18.3%) had a serum aluminum level of 6 µg/l cut-off point, which is above the reference value. When compared to non-drug users matched by their mean age and gender, they had similar median values and interquartile ranges for serum aluminum level [3 (2-4.6) for crack smokers; 2.9 (1.6-4.1) for controls], but with different means and standard deviations (4.7 ± 4.9 and 2.9 ± 1.7, respectively). DISCUSSION: Crack smokers have high serum aluminum level, but we are unsure of its complete association with aluminum cans. Further studies are needed. If such association is proven true in future research, further issues will be raised in dealing with this important disorder, including proper planning and evaluation of public health policies in this area. OBJETIVO: Não há informação na literatura sobre o impacto do uso de crack fumado em latas de alumínio utilizadas como cachimbos improvisados, uma forma comum de uso de crack no Brasil. Uma vez que a ingestão de alumínio está associada a dano neurológico, nós medimos alumínio sérico em usuários de crack. O objetivo deste estudo foi avaliar os níveis de alumínio em usuários de crack que fumam em cachimbos improvisados de lata de alumínio. MÉTODO: Setententa e uma usuárias de crack, com média de idade de 28,0 anos (± 7,7), forneceram informação sobre seu uso de drogas e tiveram amostras de seu sangue testadas para níveis séricos de alumínio. RESULTADOS: Cinqüenta e seis (79%) sujeitos fumaram crack usando cachimbos de lata e 15 (21%) fumaram em outros formatos. Cinqüenta e dois (73,2%) dos 71 sujeitos apresentaram níveis de alumínio sérico de 2 µg/l e 13 (18,3%) tinham níveis no ponto de corte 6 µg/l, o que está acima dos valores de referência. Quando comparados com não-usuários pareados por média de idade e do mesmo gênero, os sujeitos tiveram valores medianos e intervalos inter-quartil para níveis séricos similares [3 (2-4,6) para usuários de crack; 2,9 (1,6-4,1) para os controles], porém com médias e desvios-padrão diferentes (4,7 ± 4,9 e 2,9 ± 1,7, respectivamente). DISCUSSÃO: Usuários de crack apresentam altos níveis de alumínio sérico, mas não temos certeza disto estar associado completamente com as latas de alumínio. Mais estudos são necessários. Se tal associação se mostrar verdadeira em pesquisa no futuro, questões terão que ser debatidas a respeito deste problema, incluindo planejamento apropriado e avaliação das políticas públicas nesta área.

The effects of aluminum on the pulmonary function of aluminum workers were investigated in this study. Serum aluminum levels and spirometry were measured in 55 male workers and 30 male controls. The mean serum aluminum level of workers (72.7 +/- 9.9 ng/ml) was significantly high compared to that of controls, indicating aluminum toxicity. Spirometric parameters were significantly lower in workers than in controls and correlated negatively with both exposure time and serum aluminum levels. The impairment in pulmonary function may be due to exposure time and insufficient protection. (C) 1998 Wiley-Liss, Inc.

A woman on long-term chronic hemodialysis has developed persistent mild hypercalcemia. Her calcium supplement (phosphate binder) has been discontinued and aluminum binders started; calcitriol is not being given. Serum aluminum levels are very low as is intact PTH. Thyroid function is normal and phosphate levels slightly elevated. Dialysate calcium level was reduced several months ago to 1.25 mmollL. Physical exam, bone survey, bone scan, chest x-ray and mammography are negative. Is there anything related to dialysis that might explain this picture?

Aluminum was determined in serum samples obtained from 533 Saudi female pupils aged 6-8 years who attended primary public school in Riyadh City, Capital of Saudi Arabia. The aluminum mean value was 23.21 +/- 15.25 micrograms l(-1) in the range of 5.98-206.93 micrograms l(-1). Serum aluminum levels of pupils attending the Northern school area were higher than levels found in pupils from other school areas (Southern, Eastern and Central). Renal variables had no correlation with serum aluminum. On the other hand, a significant positive correlation was found between serum aluminium above 49.2 micrograms l(-1) and urea (r = 0.6, P < 0.002). Although 53% of the screened schools had aluminum in water above the European Union (EU) acceptable limit of 50 micrograms l(-1), there were no differences in aluminum in water between the four different school areas in Riyadh. Factors such as drinking water, diet and the use of aluminum utensils may have contributed to this result. As there is a bulk of literature which highlights the adverse developmental effects of aluminum on children and infants, it would be advantageous to establish regular aluminum monitoring.

The analytical performance of laboratories participating in the dialysis fluids and water aluminum program of the Guildford External Quality Assessment Scheme over the period 1986-1993 has been reviewed. For aluminum concentrations > 3.33 mumol/L in dialysis fluids, the between-laboratory CV has fallen from approximately 36% to 23%, whereas for specimens of water the reduction was from 36% to approximately 18%. Improvements at lower concentrations were less impressive. Performance of individual participants varied; only a few consistently provided accurate results. Many of the participants are able to measure serum aluminum well, so lack of expertise is not responsible for poor results. We suggest that matrix effects associated with different specimen types have a significant influence on performance and that due account is not always taken of these factors. Resolution of these problems would be aided by appropriate reference materials.

Aluminum concentration was measured in serum, whole blood, hair, and urine by neutron activation analysis. Seventy-six nondemented subjects were investigated. Not all assays were done on all subjects (e.g., serum aluminum on 76 subjects, whole blood aluminum on 42 subjects), but tissue aluminum concentrations were estimated on more than one occasion on 32 subjects. The mean +/- SD aluminum concentration in serum was 0.219 +/- 0.063 micrograms/ml (N = 76), in whole blood 0.368 +/- 0.091 micrograms/ml (N = 42), in urine 0.092 +/- 0.076 micrograms/ml (N = 42), and in hair 6.42 +/- 2.22 micrograms/g (N = 42). Using product moment correlation coefficient there was no significant correlation between age and tissue aluminum concentrations, nor between dietary intake of aluminum and tissue aluminum. The tissue aluminum concentrations were not stable over time even when dietary intake was constant. Tissue aluminum concentrations were measured in 14 patients after 7 days of dietary control and repeated approximately 6 weeks later, again after 7 days of dietary control. There was no significant correlation between the two estimations in any tissue measured. These results suggest that raised tissue aluminum concentrations reported in Alzheimer's disease are not an exaggeration of a normal ageing process, are not likely to be simply secondary to increased dietary aluminum intake, and that Alzheimer's disease does not represent the chronic toxic effect of moderately raised aluminum levels at the upper end of the normal distribution.

Aluminum loading in children with chronic renal failure. Kidney Int 1984;26:201. 9. Griswold WR, Reznik V, Mendoza SA, Trauner D, Alfrey AC. Accumulation of aluminum in a nondialyzed uremic child receiving aluminum hydroxide. Pediatrics 1983;71:56. 10. Slanina P, Frech W, Ekstrom LG, Loof L, Slorach S, Cedergren A. Dietary citric acid enhances absorption of aluminum in antacids. Clin Chem 1986;32:539. l l. Trompeter RS, Polinsky MS, Andreoli SP, Fennell RS. Neurologic complications of renal failure. Am J Kidney Dis 1986;4:318-23. 12. Roodhooft AM, van de Vyver FL, Haese CD, van Acker K J, Visser W J, de Broe ME. Aluminum accumulation in children on chronic dialysis: predictive value of serum aluminum levels and desferrioxamine infusion test. Clin Nephrol 1987;28: 125-9. 13. McCarthy JT, Milliner DS, Kurtz SB, Johnson W J, Moyer TP. Interpretation of serum aluminum values in dialysis patients. Am J Clin Pathol 1986;86:629-36. 14. Bene C, Manzler A, Bene D, Kranias G. Irreversible ocular toxicity from single "challenge" dose of deferoxamine. Clin Nephrol 1989;31:45-8. 15. Lawson M, Milla P J, Harper JI. Aluminum and infant formulae. Lancet 1989;1:614. 16. BirchalI JD, Chappell JS. Aluminum, chemical physiology, and Alzheimer's disease. Lancet 1988;2:1008.

Dialysis using a low aluminum dialysate reduced serum aluminum levels in a study of 55 chronic hemodialysis patients. Serum aluminum concentrations, which are often dangerously elevated in chronic ren

The authors evaluated risk factors for hyperaluminemia and aluminum toxicity in 51 CAPD patients, who received aluminum-containing phosphate binders. Serum aluminum correlated with total intake of elemental aluminum after starting CAPD (p = 0.001), with aluminum intake in the previous six months (p = 0.001), with duration of CAPD (p = 0.003), and with serum phosphate (p = 0.05). Eight patients had elevated serum aluminum, but only one had clincial evidence of aluminum toxicity (he had been on hemodialysis with untreated water until he was changed to CAPD 30 months before the study). Although the incidence of clinical aluminum toxicity appears to be low, we conclude that the aluminum intake from aluminum-containing phosphate binders is a major factor in the evolution of hyperaluminemia and, potentially, aluminum toxicity in CAPD patients. We believe that alternative effective, phosphate binders are much needed.It has been shown that tissue accumulation of aluminum in brain, bone and blood in uremic patients causes encephalopathy (I. 2), osteomalacia (3, 4), and anemia (5, 6). Clinically aluminum toxicity has been observed mainly in hemodialysis patients (1–6), although it has been reported in few cases before dialysis (7–9) and in those on continuous ambulatory peritoneal dialysis (10. II). The major cause of aluminum toxicity during hemodialysis has been transfer of aluminum from untreated water in the dialysate (1–5); this mechanism has tended to obscure the contribution of other factors, such as diet and drugs. Peritoneal dialysate contains a low concentration of aluminum (less than 15 μg/L) and there is a net removal of aluminum in the dialysate in those with serum aluminum levels within the reference range for dialysed uremics (11–13). Serial aluminum levels in CAPD patients not receiving aluminum -containing phosphate binders (ACPB) showed no significant change during a two-year follow-up (12, 14); this suggests that aluminum removal in the dialysate compensates for the failure of the kidney to excrete absorbed dietary aluminum in end-stage renal disease. Since the combination of CAPD and diet appears to have minimal influence on serum aluminum, this study was done to identify those factors which determine serum aluminum levels in CAPD patients, receiving aluminum-containing phosphate binders.

Aluminum has been implicated in the etiology of the progressive dialytic encephalopathy. Data are presented on samples taken from patients on maintenance hemodialysis, during treatment. Aluminum was determined by electrothermal atomic absorption spectroscopy. Hemodialysis had no significant effect on serum aluminum concentrations, which ranged from 27 to 254 micrograms of Al per liter (1.00 to 9.42 mumol/L). Isolated ultrafiltration removed part of the serum aluminum, but most remained bound to a nonfiltrable component. These results are evaluated in the light of present knowledge concerning dialysis dementia.

The aluminum content of muscle, bone and brain was measured in control subjects and in uremic patients on dialysis who had been maintained on phosphate-binding aluminum gels. The mean muscle aluminum was 14.8 ppm, and the trabecular-bone aluminum 98.5 ppm in the patients on dialysis, as compared with 1.2 and 2.4 in control subjects (P less than 0.05). Brain gray-matter aluminum values in a group of uremic patients on dialysis who died of a neurologic syndrome of unknown cause were 25 ppm as compared with 6.5 ppm in a group of uremic patients on dialysis who died of other causes and 2.2 ppm in control subjects. The fact that brain gray-matter aluminum was higher in all patients with the dialysis-associated encephalopathy syndrome than any of the control subjects or other uremic patients on dialysis suggests that this syndrome may be due to aluminum in intoxication.

In vivo neutron activation analysis was used to examine the total body and partial body (hand) aluminum levels in patients with end-stage renal failure. Patients maintained on chronic hemodialysis had higher mean body burdens of aluminum than, did those clinically managed without dialysis. Approximately 70% of the patients examined indicated elevated levels of body or skeletal aluminum. A significant correlation was observed between the in vivo aluminum/calcium ratio obtained for the hand measurement and the increase in serum aluminum levels following a disferroxamine infusion test. The direct in vivo monitoring of hand Al/Ca values in patients may provide an alternate choice to bone biopsy for the detection of aluminum intoxication.

A 61-year-old male hemodialysis patient developed the syndrome of aluminum intoxication including bone pain, fractures, proximal myopathy, progressive anemia and expressive aphasia. Serum aluminum was 130 micrograms/l and rose to 445 micrograms/l after the administration of 2 grams of desferrioxamine. Bone biopsy of the iliac crest revealed severe osteomalacia, heavy staining for aluminum and a bone aluminum content of 229 mg/kg dry bone. Treatment with combined hemofiltration and desferrioxamine administration led to a marked clinical improvement and a repeat bone biopsy striking healing of the osteomalacia with a bone aluminum content of 11 mg/kg dry bone.