Insurance companies' attitude to psychiatric illness.
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Biomedical subjects
Publications and source records attributed to H A Anderson.
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Necrotizing sialometaplasia is a disease process which affects minor salivary glands. It may clinically and microscopically resemble squamous cell or mucoepidermoid carcinoma but is histologically benign. Thirteen patients with this process occurring on the hard palate have been reported in the past two years. We describe two cases in the nasal cavity and propose that compromise of the blood supply contributed to the occurrence of these lesions. This apparently benign lesion may represent nonspecific reaction of salivary and mucous glands to ischemic injury and must be distinguished from carcinoma.
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Isolated laryngeal lymphoma is a rare occurrence. We found a total of 14 previously reported cases. These plus ouradditional case are reviewed in order to make recommendations for diagnosis, therapy,a nd follow-up. Histologic classification and clinical staging of lymphomas have limited usefulness, because the tumor can change cell type during the clinical course of the disease. Once histologic proof of the tumor exists, adequate evaluation consists of physical examination to detect adenopathy elsewhere, bone marrow biopsy, urinalysis, blood uric acid levels, liver biopsy, and liver and kidney function tests. The search must continue in the chest by X-ray, the retroperitoneal nodes by lymphangiography and the abdomonal visera by contrast radiography. Radiation therapy is the best initial treatment for isolated laryngeal lymphoma. If the tumor does not respond to irradiation, then operation to remove the lesion is required. This tumor has a tendency to recur at distant sites many years later. As with all cancer patients life-long follow-up is required.
There are numerous studies using various agents to reduce posttonsillectomy morbidity. Due to lack of conclusive results a double-blind study using methylprednisolone acetate (Depo Medrol) was conducted. A total of 165 patients were randomly divided into two groups. Following tonsillectomy 2.5 ml of solution was injected into the base of each tonsillar fossa. The study group received 20 mg of deposteroid to each fossa while the control group got normal saline. The deposteroid reduced postoperative pain but did not significantly alter other factors contributing to morbidity such as difficulty in swallowing or resumption of a normal diet. The deposteroid appeared to have no effect on the rate of healing of the tonsillar fossa.
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Environmental contaminants can be stored in the mother's body or can be transiently present from current diet, occupational exposures or personal habits. These chemicals can be transferred prenatally to the developing fetus or postnatally from breast milk to the nursing infant. Exposures through breast milk can be substantial, especially when the mother has significant ongoing exposures or has accumulated an unusually high body burden of persistent chemicals. Several studies demonstrate that organochlorines (OCs) acquired from breast milk elevate a child's body burden for several years. The decline of persistent OC residues in Western countries suggests that these exposures through breast milk will also diminish. Heavy metals such as lead and mercury are also present in milk, but the pharmacokinetics are quite different from OCs. Less persistent environmental agents, including solvents, polycyclic aromatic hydrocarbons, certain pesticides, and nicotine, can also be detected in milk. There is little information on currently used pesticides and other more recently identified environmental agents for which exposures are common today. Epidemiologic research has established that pre- and postnatal exposures to environmental contaminants including lead and OCs are associated with developmental deficits in early childhood. Therefore, characterization of these contaminants in breast milk can add to our knowledge of potential environmental exposures among children.
A subgroup of workers from a secondary lead smelter was defined to include those with blood lead levels not exceeding 80 microgram/100 ml and with no past history of elevated blood lead. Central nervous system symptoms (tiredness, sleeplessness, irritability, headache) were reported by 55% of the group and muscle and joint pain by 39%. Zinc protoporphyrin (ZPP) levels were elevated in 71% of cases. Low hemoglobin levels (less than 14 gm/100 ml) were found in more than a third of the workers. While BUN and creatinine were mostly in the normal range, there was nevertheless a correlation between ZPP and both BUN and creatinine. Reduced nerve-conduction velocities were present in 25% of the group; this was not significantly different from findings in a control group. The data indicate that a blood level of 80 microgram/100 ml is an inappropriate biological guide in the prevention of lead disease.
Assessing the potential for human exposure and resultant health risk from applying dioxin-contaminated papermill sludge to agricultural and silvicultural lands in Central Wisconsin is a complex issue. This is an intricate problem with many facets to consider. Among the exposure and risk assumption issues discussed are application of dioxin and furan equivalency factors; acceptable daily intake levels; cancer risk levels; and exposure scenarios including food, air, dermal, and soil ingestion. The range of regulatory options run from banning any application of dioxin-contaminated sludge to establishing acceptable or tolerable contamination limits. A preliminary assessment of potential human exposure scenarios found a many thousand-fold range of risk.
Sport-caught fish consumption is the major source of polychlorinated biphenyls (PCBs) exposure for the general population. To assess this and 2,2'-bis-(p-chlorophenyl)-1,1-dichloroethylene (DDE) exposure, we surveyed 801 Wisconsin anglers for fishing and consumption habits and comprehension of and compliance with the Wisconsin fish consumption health advisory. The mean annual number of sport-caught fish meals was 18. Seventy-two percent of anglers were familiar with the health advisory and 57% had changed their fishing or fish consumption habits as a result of the advisory. The mean PCB serum congener sum level for 192 anglers was 2.2 micrograms/l (range = nondetectable to 27.1 micrograms/l); mean DDE was 6.3 micrograms/l (range = nondetectable to 40.0 micrograms/l). Statistically significant positive Spearman correlations were observed between sport-caught fish meals and PCB and DDE sera levels (R = .21 and .14, respectively) and between kilograms of fish caught and PCB sera levels (R = .25). These results demonstrate that anglers may provide a population for assessment of PCBs and DDE associated morbidity and mortality.