Document gkgVbxqBq5QXLYL6YX82BoKG

exhibit DUP-2200 `OditcrlaU ION# TUM IINIflT OS WVVHQ UP A CAM iipotr o chimpanziis an riincuut MMINIZATION. TOO The purpose ot this editorial n to encourage young physicians :o writ* cut report etrly in their carter, and remain current with tht Uterature in that area. As the yean (o by, one will be tbit to obttrvt tht many development that occur. Let me give you my example: In 1955, tht first year that I practiced internal mediant in Wilmington, l evaluated a 20.yearaid woman with primary amenorrhea. Her work up revealed e one-centimeter vagina with the uterus and ovariee not palpable. Tbeee findings were confirmed by the gynecology contultant. Dr. Seta Stem. Femily history revealed her two sib lings tlso had primary amenorrhea. One of thate wei examined by the surgicei consultant. Dr. Dea Preston, end similer physical findings wan noted. The other sibling refund examination. Scnndipitouily, my patient developed acuta appendicitis. Dr. Preston confirmed the physscsl flndinp u surgery and did a btopey ot the goaadat area which revealed femindadoa, a special form ot male paatidohartBaphrodititai (female pkeaocype, temele peycSsoaezuai ortaataaion, tenet* mala 46XY, gonadal mala). Dr. Stem and I wroaa ap oar patient m a teas report in the iVese Inland Jomtl of Mmlidnt in 1954.* Over the seat 25 yean I kept track ot the literature on thlt subject. To follow dm vetopraeata ia this ana waa mow rewatdlag and exciting, [a IM5 a book, Ttttknltr /embdzoilon, waa pwbUatsad whlcSi artad to pull this ma terial together.' The SUM emphasised the an drogen IneeasMivicy la a 1977 CPC* The circle seatsad ootapiaee whan I recently read t reference ia Clinical Basesreh Sepeamber 1910; testicular frainixadoa haa now been describad ia cfeaapaaaaat tor tho tint doe.' I cam picture Jana GocdalTi Crastratioa ia described la bar book, /a tht Sktiaw ot Man.' Sha may we* DlL MtO JlL. Max 19*1--Voc 53, N'O 3 have been trying to understand dtis .air gumg. mystifying syndrome in a chimpanzee, as t had 'license attempted to understand .t 25 years ago an the wards ot (he old Ddawere Hospital. Wu.ua* 1. Vakdexvort, M.D. tarxaincis :. 3 OH. V*n4*rvtft WJ, Twtfcttir 'tamiium ia * wgn **'**"' mm* * a M. N Caii / Mr*. RH. W* V. Olpu* W/' Thanaaih/ 3*rtngQgbl. ttUar Cfcarte* C Ca . HL 1 ifriwi. n tad* ,Jl*>imH.**;mnm,ismw+,ril S***C Cut w ASMSTOI HUTtO OOSAfl ' - The effect ot ubestns exposure on health has been and temaiis a popular topic In the ley press and medical Utenons. Drinking water, heir dry ers and home humidifiers have been suspected ot brfnglag aabanoa Into the environment. Public awartaces is high regarding the problem ot ubastoa la school buildings Asbestos tufstid disease also coBcarae those involved with workman's eonspetsadoa and oagoing litigation. Current coneepta and contmveniee have been reviewed at e recant workshop* tad International meeting.* Gsariy, ubmtct expoauiu ha* been maximal in the workplans. la Delaware and neighboring states IMS has oocanad to tha gieitest degree in the shipbaQdlsg tad chemical industries. I once span* six aoath* a* a laborer I* a nearby ibipyud wberu fine Sakea of ubettoe continually showed on tbs decks tad worksrs below. Can can la tbs gastrtilniaad.eai tract and larynx, and peritoneal mesotheliomas have been linked to sabsttoa exposal*. Mast asbestos related disease is found ia the cheat, howarir. The most frequent asaaifattatioa of asbisos dis ease In tha praeanci of plaunt thickening or pleu ral plaques which us usually ta iaadeotai rtdiograpMa fiadtag is ia asymptomatic person. Obliqu views ot tht cheat show the** changes more 165 DUP 0934444 DU 036792 Editorials clearly. Lung function retting :i usually normal unlea* die plaques in ezremive and duck, or thrt J other ccncomitint duets*. Calcification at these plaquei eta occur, accounting (or tht chiracierisnc linear calcification occasionally seea tiong die diaphragmatic lurfae*. Bentgn pleurii effusion is to unusual but es tablished tssocisnoa of ubestoi rented disease. Thee* ptutatt may 0* asymptomatic or may pralent with cheat discomfort and dyspnea. The effusion is an exudate and may be oioody. It may rasoivt spontaatousiy, only to recur. Cyto logic studies art negative. Tht pleural surfaces show to acuve exudative process. Because there arc no specific diagnostic characteristics, the diag nosis is one of exclusion. Asbcstosts is a pneumoconiosis characttrixtd by diffuse intenddei Sbrosis ot the lung and of the visceral pltura. Dyspnea with exartioa ii th common complaint. Basilar Inspiratory ertpitadona are usually present; clubbing is a lest fre quent sign. Fine reticular changes and small ir regular opacities ia the lower lung zones era early radiographic findings. A tsatrictio* of lung vo*urns, particularly vital capaeity, a decrease ia diffusing capacity, and artenil hypoxemia with exercise an charactansec pulaontry function abnormalities. The diagnosis of ashesteen is estab lished when a history of exponn, together with appropriate clinics! and Laboratory ffndiap are present. The term "asbestosis ihouid be it. red us this lung perenchymel fibrotic process. Pleural mesothelioma it a rxrt malignant neo plasm originating from mesothetiai ceils. Its as sociation with asbestos exposure is wed mown. The miervei between inihel exposure end diag nosis is tong and may approach WO years. There is oo effect!va therapy and most patients are dead within on* year after diagnosis. The ciuncai features o< this unusual enucy have recently been reviewed.* Lung carcinoma it strongly associated with cigarette smoking. Asbestos has bees .mplicated aa a co-carcinogen in ageretze smokers; a lycre gime effect between the two in the etiology of lung caacer is acknowledged. Current ttudies also indicate that even ia the absence of ctgaretre trucking, aabeetoa probably increases the nik of lung cancer. A large number of person have been exposed to tibeatoa la the workplace. Although the level of axposois has dropped markedly in recent years, and ta many instances aabeetoa has bean replaced by othar matanala, once exposed to asbestos mdlviduak reauia at risk of developing asbestos reietad diiaeea All physicians, from obetetnaans to ophthalmologies, eaa anutipats coouauing inquiries concerning asbestos. Joaara P. Kunm, fa., VLD. 166 Dil Mis fax.. Max 19tl--Vol 53, So 3 DU* 093***5 DU 036793