Document DGr7ZO3qjjVx03dpR4aNMRZgN

DISCUSSION Although this study was undertaken initially in an attenpt to discover whether it would be feasible to determine the environmental factors responsible for the increase of malignant mesothelioma in the State of Connecticut, it has suffered from the lack of detail in available records. lab^o II ^nd III i-Huotsafea aae. cif the j* ft to likjor deficiencies in the data available for study, noaoly the low autopsy rate for the pleural mesotheliomata and the inadequacy of the eypc.a of ciooue. available and used for diagnostic purposes. It has been oiir experience that occupational histories are not routinely obtained his disease -, A ppear( d to i.nt -o- UCC 010112 Cogent on the significance of the findings or. the slide reviev. It is evident that until the physicians or hospitals investigating cases of 0Ouf>ttol * ot ^ malignancy annreciate the importance of environmental facts ` A' the etiology of ' these diseases, no attempt can be made to apportion the blame to any particular factor unless adequate histories are available containing complete information or. lifestyle, habits, hobbies, part-time activities and details of occupation anc industry. It is also essential,particularly in the case of a rare tumor which may present diagnostic difficulties,to obtain sufficient tissue for study before <UA it the final diagnosis is cade. VTnenever a tumor is found where * association ^exists between it anc a particular occupational or environmental factor, every attempt should be made to fully document all the ai.ire.ml facts and to subsequently verify the diagnosis by means of a full autopsy. Aooeo? UCC 010113 1 ' J'ur.ng the pa?: a ir:r 'f b- C -abiut;., how (". ct, v'u.r. " * *zn.\t t.v. a. jv ;rv e = : Vo s::_atnr ce-.eiopec a: the sue o' a pairing of ::m-. lte: o' iff - anc it. aoo.inv- localize: r,trues simp/tx infection in most instantes where ceatr has r.a mass r:>e kac ueer. trtatec iur chronic recurrir p s-,. novr...- of Uit knees with oexarieikasorie ir. ousages from 0.5 to 1.6 mg Cfciiy intermittently for iec years. During this period, the skit of her fore arms became extremely thin, and she tha: Lac occurrec or, rr.y upper ii; . resulted from, pulmonary canter c' a and had not heaiec for approximately j thoracic or peritonea! mesothelioma. one year. It was removed by a Mobs' I it is important to identify the tissue surgical procedure at a local universi alterations directly attributable to ty center, and a diagnosis of base- occupational contact with the respira- experienced eevera,' episodes of subcuta squamous cell carcinoma was made bie asbestos fiber. neous extravasation of blood. again. At that time, the dermatolo As we have counseled family survi Or the fount hospital day, she was gist performing tbe chemosurgery vors of such persons dying of asbesto- transported to the x-ray department, where i: was noted that she had two superficial tears in the skin of the left forearm with gaping margins Attempts were made to suture the skin edges togeth er. but the sutures tore througr tbe skin. Tbe tdges were held together with strips mentioned how unusual the lesion was, inasmuch as there were not supposed to be such things as basesquamous carcinomas Both wounds healed without any unusual event. After the first occurrence, 1 con sis or its related disease states, or both, to request a necropsy to lend substance to a worker's compensation claim, it is strongly suggested that aii physicians or house staff caring for such patients urge relatives to permit of ster.ie tare tacted Dr Herman Pinkus in Detroit, the examination These procedures Or. one other occasion curing her hospi and he stated that there were about a will not only aid the beneficiaries but tal scat, s.nti.ar lesions developed during dozen cases in the literature at that will also prove of worth to physicians the course of transport to anc from her time. I saw him at a meeting shortly in familiarizing them with the find bed for other diagnostic procedures These lesions failed to heaJ ouriDg her hospital stay, and gross evidence of infection was do: noted Comment--Transport by handling after the chemotherapy, and he com mented on the unusual nature of this condition occurring more than once, though be was more aware of its occurrence than he had h*en before ings characterizing a greatly under diagnosed job-generated disease. Furthermore, such postmortem data will aid in our knowing what actually happens to a worker under of the forearms, even though careful There is an embarrassing situation certain conditions of exposure and ly done, resulted in serious, poorly about this personally, aDd tha: is that I will help to rectify the inaccurate healing tears of the skiD in this overweight, weak woman. Even though extra care was taken after the initial episode, there was recurrence. Ir. this case there w2s no complaint or dissatisfaction expressed by the pa tient or the family, but such episodes have the potential for risk of com pensable injury. Certainly there have beer, allegations of hospitai-based I am a dermatologist. I conclusions drawn from the current There were no other forms of ther I underreporting of occupationally as- apy used on these lesions with either J sociated disease. surgery, antibiotics, or photodynamic ! .*** Fr.lC* inactivation, nor am 1 a smoker. 1 I O' &C*Ut *'***' C-0ii!O*Tlia have had an occasional localized i | Scnoo p' MpOicjit* to* <knp*N*a herpes simplex infection during the I past 20 years. ! Safety of Ipecac Syrup L GaCaT, Ml Alison Utoiso' Group SC Tv i\t Eiiior.--On behalf of the injury with lesser justification. Crwcapc American Association of Poison Cen h would be prudent for physicians tro! Centers. 1 am concerned about hospitalizing patients who have been The Autopsy the titling of a recent JAMA article, I receiving steroid therapy to place a and Asbestos Exposure warning note on the chart advising "Death Resulting From Ipecac Syrup Poisoning" (243:1927, 29S0). I am wor hospital personnel to use extreme To th* Editor.--In the article entitled ried tha: the index skimmer or scan care when bathing, assisting, or "The Autopsy Past, Present, and ner--particularly if he is of the older I transporting such patients. T Future" by Anderson and co-workers school reared in aD era of gastric MD (242:]05. 19~9i. the fall in the rate of lavage for management of poison tjZftnmy Calri autopsies is decried, and several ings--may inadvertently conclude cogent reasons are presented for a that the typical emetic dose of syrup Carcinoma at the Site of Herpes Simplex Infection return to the previous high number of sucb examinations, a goal formerly pursued by dedicated house ofheers. of ipecac was responsible. In reality, the dose was three to four bottles per day for three months--thus repre Tv ti,< Editor -- The Journal recently One additional need for postmor senting a long-term poisoning. published a letter er.titled "Carcino tem review-s has been given emphasis As noted by the authors, syrup of ma at the Site of Herpes Simplex id recent years by the epidemiologic ipecac as an emetic agent has a Infection" (243.2296, 1980). My letter and clinical information gathered in remarkable safety record; its current is to note further the occurrence of connection with the asbestos-related availability over-the-counter and in such a situation. 1 personally had disease. Because workers are now the home permits an enormous saving basosquamous carcinoma develop on beginning to present radiological and of needless visits to emergency rooms two occasions. The first occurrence altered physiological evidence of the for the treatment of accidental inges was approximately five or six years effects of the inhalation of free asbes tions 1 think that it would be unfor ago at the site of a vaccination for tos fiber, years to decades after initial tunate indeed were the inference small pox that I had received for work exposure, a problem in work drawn that single emetic doses were traveling. After the vaccination site er's compensation adjudication has risky. did not heal for one year, I became arisen. The changes elicited through suspicious and had it excised at the clinical study, although present, most WlliAmO MD Ch.io ** Ortboprfl'C Hrspftai loc al university hospital. I was ap proximately 55 years old at that tune. often do not have accompanying symptoms. c-c yet, nor have they caused any disability, as yet There Oct 10. 1930 --Vol 244, No. 15 anC Mt-flicai C*ni#i Amensar AtiotuKor e' Poison Control Cantors S*attr A 00608 Letters 1675 UCC 010114 i I i Il !