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PubMedDate not supplied

The surgical management of benign and malignant thyroid neoplasms in Marshall Islanders exposed to hydrogen bomb fallout.

On March 1, 1954, a serious fallout accident occurred during the United States atomic testing program at Bikini in the Trust Territory of the Pacific Islands. Following the detonation of a large thermonuclear device (known as Bravo) an unexpected shift in winds resulted in deposition of radioactive debris on several inhabited atolls in the Marshall Islands. During the early post-detonation period military, sea, and air surveys traced the hottest portion of the parabolic cloud as it drifted in an ever widening pattern of diminishing concentration eastward and southeast of Bikini. The center of the cloud passed North of the Rongelap Atoll, which was the nearest inhabited atoll. This report concerns the development of thyroid lesions, the special circumstances encountered during thyroid surgery, and the results of the surgical management of benign and malignant lesions that were subsequently encountered in this population.

Adenoma↗
PubMed2003

Shifting priorities at the Department of Energy's bomb factories: protecting human and ecological health.

More than 50 years of research, development, manufacture, and testing of nuclear weapons at Department of Energy (DOE) sites has left a legacy of on-site contamination that often spreads to surrounding areas. Despite substantial cleanup budgets in the last decade, the DOE's top-to-bottom review team concluded that relatively little actual cleanup has been accomplished, although milestones have been met and work packages completed. Rather than solely use regulatory constraints to direct cleanup, many people have suggested that human and ecological health should guide long-term stewardship goals of DOE-managed sites. The main questions are how ecological and human health considerations should be applied in deciding the extent of cleanup that contaminated sites should receive and how near-term and longer run considerations of costs and benefits should be balanced as cleanup decisions are made. One effort to protect ecological integrity is the designation of the largest sites as National Environmental Research Parks (NERPs). Recently, the Competitive Enterprise Institute (CEI) suggested isolating and conserving DOE sites as a policy priority because of their rich ecological diversity. A more effective long-term stewardship approach for former nuclear weapons complex sites may emerge if the guiding principles are to (1) reduce risks to human and ecological health, (2) protect cultural traditions, and (3) lower short- and long-term cleanup and remediation costs. A "net benefits" perspective that takes both near- and longer-term costs and consequences into account can help illuminate the trade-offs between expensive cleanup in the near term and the need to assure long-term protection of human health, cultural values, and high levels of biodiversity and ecological integrity that currently exist at many DOE sites.

Decision Making↗
PubMed2006

[Age-related macular degeneration: a socioeconomic time bomb in our aging society].

BACKGROUND: More than 50% of all Europeans over 65 years of age have alterations to the fundus that should give rise to the suspicion of incipient age-related macular degeneration (AMD). Demographic changes in the German population and the longer life expectancy now are causing a rapid increase in the absolute number of AMD patients. On the one hand, new treatment options are causing an increase in treatment costs; on the other, social costs are also rising because patients are often left with some sight impairment. The authors attempt to forecast prevalence and incidence on the basis of the epidemiological data known for Germany and, using model calculations, to highlight trends that illustrate the increasing socioeconomic significance of this disease. RESULTS: Forecasts show that the number of patients with advanced AMD will increase from 710,000 at present to over a million by 2020. In the same period, the number of patients with neovascular AMD will increase from 485,000 to 700,000. There are currently 50,000 new cases of neovascular AMD every year in Germany, and it has only just become possible to treat these with the new anti-VEGF drugs. The new treatment options will cause additional annual costs of 1.1-2.9 billion euro for Germany alone. CONCLUSION: The new treatment options for AMD will lead to a pronounced reduction in the number of visually impaired and blind people. However, this progress cannot be achieved without the financial resources dedicated to ophthalmology being approximately doubled.

Age Factors↗