Document NeMZjKn0v4R1V3mgZeQ7zy8bD

"M vv.!#' s!io<;6oois I I inhibition toot m negative for eehineeoc- nematode, Adolph et al'* hare indi mg/kg/day (five weeka of treat (aoit, eyitieerecite, and tosnpleemoaia. cated that serologic tests for fibrin- ment). Chills, nausea, and malaise Hefflagghttinetion inhibition and Ifoetto sis (hemagglutination and bentonite were complaints during the final Utkxt teU for fiUri^i* vert done on the poMibiltty that the hemoptysis and eonino philia (Loffier syndrome) might be plained Positive result* wore reportedhemagglutination titer, IrTOO-WO: floenita* tion, 15. The aeeond (1200) and third (1400) hemagglutination titm were pwi- flocculation) were oseful in arming at a clinical diagnosis of filariasts. On the basis of presumptive diagnosis, a therapeutic trial was undertaken with the use of diethytcarbamasine citrate, (2 mg/kg/day for one week). week of therapy. The patient had no farther he moptysis. Chest x-ray film was nor mal four months after treatment. The peripheral blood no longer showed in creased eosinophils. There have been tire. Identification of microfilaremia in the The dose was increased over three oo tocuirences of the patient's com patient's Mood or in the Mood of her pet weeks to 18 mg/kg/day. plaints of hemoptysis. There has been dor was not made. A presumptive diag Follow-up examination after three no eosinophflia daring the nine years nosis of infestation with Dirofiiona '** weeks of therapy showed no un of follow-up. milit was made. toward effects and no signs of menin Comment Despite the absence of microfilaria geal irritation. Diethylcarbamasine citrate therapy was discontinued af The beaaggtutlaatoa laMWtoe end fioceut*. ttat tmu vert performed it tbe Pubtfe Health in the blood or demonstration of a ter two weeks at the dosage of 18 tevfat CoeiMaksfeU DfaatK Center, Attest*. 1. PWllip* JH: Studio* ef the tranrmiwlon of dua to DirlUar*. S BmglJ Mti 278432433. 10. Atejouasioe T. at al: Caeephaltu pair en- tXr^fHnria in Memehuertta. Am J Hyg IMS. toeardit* ftbrobtestiqoe d'origtM filarientw. 9:UH9,1?M. 6. Lewi* JF. Willlama RW, Tirwlcy ft Ptlno- Reed before tbe Sodetd Fraaqats da Newologte, Beaver PC. Orihel TC:, Hunan infection with Merle* ef enimile In th* United Stetee. Am J Trop MtH Hug 14 I01M0W. [9*-'.. nary coin terion due to Dit tfiUrio taiariha ArtA Serf 9St>0, IMS 7. Goodman ML. Gore J: Puhwonary htfeiet Nav 5,1969. 1L fbrriaea 18. Tbampaaw JR: Oir*U+ riaait in gatktUn af *WiMel and keimintkit t 3. Hamm>n EG. Thompeon JH DimAleriuti aeondary to Dinfilaria lame ArrA Intern Met iirfaetien. KarriaWRejaa (ed). Baltimore, Wtt* ef human lung. Am J Clin Pntkei 43:224-234, * 113:702-705, 1W4. Hama aad WUkiiw Co. 1971. IMS. 4. Tuaaon RA, Firestone F. Blauttein AU: Hu S. Donohufh DL: Tropical eeeinophilia: Aa ettologie inquiry. S Engl J Med 250:1357-1354. IX Adolph PE. Kagan JG. KcQnay RM: Dia* neefe aad treatment of AcntAaduilamema per. man pulmonary dirtl*na*i* manifeeting aa a "coin" leaion. JAMA 199:4546. 1967. 1963. 9. Pande RS: Filarial eneeptaHtte. J Ame riaiu Steriaate. An J Treg M* Hyy ltfMB, 1M2. 6. Spaar HC. at al: Solitary pulmonary laaien ffcyririeii* India. 1046M71,1M2. l Asbestos-Like Fibers in Duluth Water Supply Relation to Cancer Mortality Thomas J. Masson. PhD: Frank W. MeKay; Robert W. Miller. MO r Asbestos-like fibers In industrial waste first entered the water suppfy ef wall, lungs, brain, omentum, and Duluth in 1955. In the next 14 years, no carefnogenie effect wee eppsrent In other organa.* the patterns ef cancer mortality among persona ef all ages, nor among chil To determine if tbe fibers present dren. The period of observation fa short relative to the latent period for occu in tbe drinking water of Duluth were pationally induced carcinogenesis from asbestos. related to cancer mortality, we have (JAMA 228:1019-1020,1974) studied data abstracted from death certificates for all persons who died of HIGH concentrations of ashestoe-like waste from taconite ore, which has cancer in the United States, from fibers have been reported recently in been emptied into Lake Superior 1950 to 1969. the drinking-water supplies of Du- since 1955.' * This pollution has caused hith, Minn, and other communities on concern because occupational expo* Mhods t the shores of Lake Superior. Officials sures to asbestos are known to induce The data were \ ade available to us of the Environmental Protection . mesothelioma of the pleura and perl- by the National Center for Health Agency stated that these fibers prob- toneum, as well as cancer of theJung, Statistics. We have tabulated the ably came from mine-tailings or mill- esophagus, and stomach, after a la- numbers of deaths ascribed to cancer - -, - tent period usually of 20 to 40 years.1 among whites, according to age, sex, From mo epttomioiegy fetneti. National Can- - Asbestos fed.experimentally toraU and ffy-e-year intervals, as well ss the eor motihrto. Bvtfwtto. Mp ^^\pasaed->tjiiii|th the gastric and age-adjusted cancer death rates for MmoAM CaneW Hwtmit*. aimotdfc'iSicPaoow'1 intestinalmucosa into the';blo6d- Dulutft;(1960 population, 105,759), for lOr. MMav stream. Fibers were lodged-in gut comparison with data for the state JAMA. May 20. 7974 Vol 228. No 8 DOU 03082 Asfasstos in Water Supply Meson et al 101S u I Stot With RWt Ratio* Significantly Oiffertnt From Unfty In at Uaat On* Five-Year Interval States and Canada in the 1967 to 1971 period, there were 2$ deaths from cancer of the colon or rectum as com White Mi White Winn pared with 17.5 expected, not a very Ho (ICD)* 1t 1995 I960- mo its*. 1955- 1969- teSS1954 1959 1904 tet* 1954 1999 1994 1989 targe excess." An important feature of this study was that cancer of the Eaophogua (ISO) Statot County* Stomach (151) State County Uteo intestine, oxelwdlno roetum M53T tato County Rectum (154) State County Total dlooattvo tract (1S(MM) State . County 14* 2261 *2Off 120 120 0271 0.10* 0.10 1.04 1.79 128 125 1.79 0.06* 0.061 0.14 (16)9 (23) (25) (14) (6) (2) (3) (6) 1.14 1-581 120 1A81 0.99 129 120 1.17 1.13 1.6111 12? 12711 1.04 122 1.778 1.41 (90) (101) (70) (81) (38) (34) (43) (30) 1.04 129 0*6 023 029* 128 1.04 1.18 099 121 0.87 0.73 0.521 0.96 1.02 1.10 (47) (60) (47) (45) (27) (54) (53) (67) 1.23 126 1.801 1.60 0.96 1.17 120 127* 1.3? 1.10 1.631 1.681 0.66 1.07 1.16 1.94!! (31) (30) (40) (34) (13) (18) (17) (25) 1.10 i.4sn 1201 1.11 1,441 1251 (184) (214) (182) 12* 0.79 116 0.78 (154) (04) 1.08 1.18 1208 0.99 122 128* (108) (118) (128) upper gastrointestinal tract showed far greater excesses than were ob served for cancer of the colon or rec tum. There were 13 deaths from can cer of the esophagus vs 3.2 expected and 16 from cancer of the stomach vs 6.6 expected. Thus, in Duluth, one would expect a greater extra* of can cer in the esophagus and stomach than in the rectum, but this did not occur It appears that the high rate of cancer of the colon in the 1965 to 1969 period in Duluth was observed by chance. To determine if young people were especially susceptible to the carcino genicity of asbestos in the drinking Biliary pstsagei water of Duluth, we examined cancer and (Ivor (.155.1S6A) State County 0.63 1.12 1.45 1.14 0.04 1.62 0.74 0.68 0.60 1.08 1.19 1.11 0.94 1.94* 0.84 0.79 (9) (16) (20) (14) (19) (32) (15) (12) mortality data for persons who died before 20 years of age, during the pe riod of 1950 through 1969. Through Parcraaa f157) State County 120 1.43 129 1.40 0.96 12011 0.71 1.41 1.18 1.16 1.34 1.35 1.00 2.121 0.68 1.43 (35) (38) .(44) (44) (16) (38) (17) (35) the use of Hennepin County and state data, risk ratios were calculated for leukemia (ICD 204), cancer of the ner lung (162. 163) vous system (ICD 193). and all other Stato County All malignant 1.15 1.S8H 125 1.491 0.76 0.90 1.18 1.14 1.25 0.99 (60) (103) (109) (150) (9) 1.78 t .63 (23) 1.39 120 (22) 12T 1.15 (29) cancers. So significant excesses were found. The delayed effects of asbestos in GO nooplaama (140-205) drinking water arc unknown, and the Stato County 1.11 12811 1.101 1.01 1.261 1.C0 (519) (654) (594) 1291 0.93 1.181 0.88 (646) (377) 128" 1.10 1221 1.10 (525) (465) 120* 1,17* (527) extent to which asbestos has accumu lated in the water with the passage of * International Claaalfieation of Dtaeaaea for World Haalth Organization mimb*r. tStato of Mlnnoaota. time has not yet been reported. A longer period of follow-up than was tHannapln County, Mlnnasota. possible in this study will be neces fNumbor of daatha In Duluth. I Iftlak ratio dlffara algnifieantly from 12 (P<21). sary before one can conclude that there is no cancer hazard related to C of Minnesota and Hennepin County, sex are given in the Table. If the as the drinking water supplies of Duluth which includes Minneapolis (1960 pop bestos fibers had induced cancer at a and neighboring communities. ulations, 3^371,603 and 825,986, re particular site, one would expect the spectively). The number of deaths mortality rates for that site to have from cancer and the age-adjusted death rates were examined for each cancer site, as coded according to the increased in males and females over time, especially in the moot recent five-year period studied (1965 to t. Finding* tf Faet CmeiwsioKM ef Law and Orderfit* Judgment. Rmrta Wain* Cemptnr. Minnesota Pottotte* Control Affvaey. Dse IS. imps. International Classification of Dis eases.' 1969). As shown in the Table, the only site that fell into this category was g Enrirmmmlal New*. Environmental Pr^ teetwn Agency. June 15,1973. t IARC Monograph* m the MmIwi *f Results cancer of the tectum. CareimgtHie Rink ttf Gemini* tn Man. Lyons. Frmace. International Agency for Research on For 21 cancer sites, risk ratios were Comment Cancer. 1973, *ol 1 po 17-47. 4. Pontefmn RD. Cunningham HM: Pene II calculated from age-adjusted mortal ity rates for Hennepin County and the state, and tested for. statistical The question,arises, is the excess of rectal cancer attributable to the fi bers, or is jt^e observation among tration of asbestos through the difesti*e tmet of rata Xatnrr 243372*153. 1971 5. Mannal ttf the International Stalintieal Cta**ifientinn tn'Dinmne*. Injnrirt, and Carnet of significance, assuming an underlying many, whichhy chance fits the pat- Death, mi 7. Reneva, World Health Organisation, !? I. Poisson distribution. The, risk ratios;. tem sought^yPthcr human esperi- A Hammond EC fed): Combined Clinical 1 (Dul'uth/tompansoh groupV.fo^ eighth !. epee./wi^pc^pationa! exposures, re Sttlf Conference held at the Clinical Center, Na i1 individuar #ites that tlifT*>rrii signifi vealed that among ,47.800 asbestos- tional Institutes nf Health by the Nation*! Instj* lute nf Kn*tn*nn*nisl MesliH ft. cantly faun unity fur1 either msullation workers in the United thsods. Nil. Ann Intern Med. u* he published. 10*0 JAMA. May 20. 1974 Vol 228 No 8 DOW 03083 Asbestos in Water Suooiy-Mason at si