EPIDEMIOLOGY Selected Reviews from the Literature Short-Term Asbestos Work Exposure and Long-Term Observation . H . Seidman, I . 1 . Selikoff, and E . C . Hammond . Proc NYAcadSci Dept . of Epidemiology and Statistics, American Cancer Society, New York, NY 10017 . Thomas A . Lincoln, M .D. Department Editor LITERATURE REVIEWERS Clinical Toxicology Industrial Hygiene Controls Griffilh Quinby, M .D Newell E . Bolton New York, N.Y . Wenatcnee, Wash . C . L. Cheever Argonne. III . Dermatology E . E . Campbell Los Atamos, N .M . James S . Taylor, M .D . Cleveland, Ohio Donaki R . Lynam, Ph.D, New York, N .Y . Robert M . Adams, M .D . Palo Alto, Calif. James B . Lucas, M .D . Cinoinnati, Ohio Internal Medicine Henry R . Herbert, M .D. Baltimore, Md . Energy Technology T . A . Lincoln . M .D . New York, N .Y . Philip A . Fuqua, M .D . Richland, Wash . George A . Poda, M .D . Aiken, S.C . Mental Health David Robbins, M .D . Chappaqua, N .Y . Epidemiology Noise and Hearing Philip E . Enterline . Ph .D . Pittsburgh, Pa. W . Dixon Ward, Ph .D . Minneapolis, Minn, John L . Fletoher, Ph .D . Memphis, Tenn . Ergonomics and Work Physiology E . R . Tichauer, Sc.D ., P .E . (Old) Alexander Cohen, Ph .D . Cincinnali, Ohio New York, N .Y . Suzanne H . Rodgers. Ph,D. Rochester, N .Y . Surgery . Experimental Toxicology Francis J . Kelly, M .D . Amarillo, Tex . Robert E . Eckardt, M .D . Scottsdale, Ariz . Austin E . Givens, M .D . Antioch, Calit M . P . Hodge Linden . N .J . Dudley Briggs . M .D. Columbus, Ohio There is considerable animal evidence which indicates that the time required for the development of ali nancies followin ex osure to a Carcinogen is irectly re ated to the maemtu eot e ose receivEd Support for this notion in humans, however, is somewhat limited. This is a report on the development of malignancies in 820 men exposed for varying periods (doses) to high airborne concentrations of amosite asbestos in the years 1941-1948 . For men exposed for a year or more in this interval a definite excess in cancer was observed after 15 years; whereas, for men exposed only 1-6 months, an excess did not appear until after 25 years . The authors point out that this has important implications for the control of cancer, since if it is not possible to completely avoid exposure to a carcinogenic agent, at least reducing exposure can delay occurrence of adverse effects . They also note, as have others, that for asbestos there is a definite dose response relationship and that lowering exposures decreases the frequenP .E . cy of cancer . Asbestos Expowre, Cigarette Smoking and Death Rates. E . C . Hammond, I . 1 . Selikoff, and H . Siedman . Proc NYAcad Sci Dept of Epidemiology and Statistics, American Cancer Society, New York, NY 10017 . There has been some confusion as to whether an asbestos worker who does not smoke cigarettes is at increased risk of lung cancer. This study shows clearly that on a relative basis, th~e r'nonr smokin a ers is no diferent from tha r ck nt hunoxa ..cer in asbestos workers who smoke In 1966, smoking histories were obtained on nearly all of a group of 17,800 male asbestos insulators in the United States and Canada. These workers were then followed for deaths occurring through 1976 . The age-standardized lung cancer death 190 . a a tl 3 . ~(q cr (4 I ~ 1 La ~G t R eu 7-:n l`-~'~~.~zL"*o-Q 1 te~ ~- R U Selected Reviews from the Literature EPIDEMIOLOGY Thomas A . Lincoln, M .D . Department Editor and Slatistics, American Cancer Society, Shor4Term Asbestos Work Exposure and Long•Term Observation . H . Seid• man, I . ) . Selikoff, and E . C . Hammond . Proc NYAcadSci Dept . of Epidemiology New York. NY 10017 . There is considerable animal evidence which indicates that the time re uired for the develo ment of LITERATURE REVIEWERS ali nancies fo owin ex osure o a arcinogen is irectl lated ta the Clinical Toxicology Industrial Hygiene Controls Griffith Quinby, M .D . Wenatchee, Wash. Newell E. Bolton New York. N .Y. C . L. Cheever Argonne, lit ma¢nrtu e o t e ose received Support for this notion in humans, however, is somewhat limited . This is a report on the development of malignancies in 820 men exposed for varying periods (doses) to high air- borne concentrations of amosite asbestos in the years 1941-1948 . For Dermatology E . E. CampbeA Los Alamos. N .M . James S. Taytor, M .D . Cleveland . Ohio Donaid R . Lynam, Ph.D. New York. N .Y. Robert M. Adams . M .D. Pa!o Alto. Calif . months, an excess did not appear until after 25 years . The authors point out that this has important implications for the control of cancer, since James 8. Lucas . M .D . Cincinnati . Ohio Internal Medicine Henry R . Herbert, M .D . Baltimore . Md. Energy Technology George A . Poda, M .D . Aiken, S.C. Menial Health David Robbins, M .D. Chappaqus . N.Y. . , Epidemiology Noise and Hearlny Phaip E . Emernine . Ph .D . Pittsburgh. Pa . W . Daon Ward, Ph.D . Minneapolis, Minn. John L . Fletcher. Ph.D. Memphis, Tenn . Ergonomlcs and Work Physiology E . R. Tichauer, Sc.D ., P.E . (Old) if it is not possible to completely avoid exposure to a carcinogenic agent, at least reducing exposure can delay occurrence of adverse effects . They also note, as have others, that L A . tincom . M .D. New York . N.Y . Philip A. Fuque, M .D . Richland, Wash. men exposed for a year or more in this interval a definite excess in cancer was observed after '!5 yean ; whereas, for men exposed only 1-6 Alexander Cohen, Ph .D . Cincinnati, Ohio New York, N .Y . Suzanne H. Rodgers, Ph .D . Roohesler, N .Y . Surgery Experimental Toxicology Francis J. Kelly . M .D. Amarillo. Tex . Robert E . Eckardt . M.D. Scottsdale, Ariz. Austin E . GNens, M.D. Antioch, Calif . M . P . Hodge Linden, N .J . Dudby Brpqa M .D . Cotumbus. Ohlo for asbestos there is a definite doseresponse-reiationship and that lowering exposures decreases the frequency of cancer. P.E Asbestos Exposure, Cigarette Smoking and Death Rates. E . C . Hammond, I. f . Selikoff, and H . Siedman . Proc NYAcad Sci DepL of Epidemiology and Statistics, American Cancer Society, New York, NY 10017 . There has been some confusion as to whether an asbestos worker who 0 does not smoke cigarettes is at in- Iry creased risk of lung cancer. This O study shows clearly that on a relative 0 basis, thnon O smokin a 's . .DQ i O erent rom ~~ a as estos work rs who smoke . In x 1966, smoking histories were obtained on nearly all of a group of 17,8W male asbestos insulators in the F United States and Canada. These workers were then followed for . deaths .occuning through 1976. The age-standardized lung cancer death 190 .Ti ax~~ Mc.G-w;.a 0 3. piAQ-r91 ~ l`4d" r9co rate in nonsmoking asbestos insulators was 58 .4 per 100,000 as compared with an expected death rate of 11 .3 based on observations on nonsmokers among nearly 500,000 men enrolled in a long-term prospective epidemiological study being con- _ ducted by the American Cancer Society (ACS) . The age-standardized lung cancer death rate in asbestos insulators who smoked was 601 .6 as compared with an expected death rate based on the ACS study of 122 .6 . Thus, the relative risk for lung cancer in nonsmokers was 5 .1 while the relative risk in smokers was 4 .9 . The absolute increment in the death rate for nonsmokers was very small (58 .4-11 .3), however, compared with the absolute increment in smokers (601 .6-122 .6) . P.E, i Lung Cancer and Coal Workers' Pneurnoconiosis: A . Seaton . Br Med I p. 208, July, 1979 . Institute of Occupational Medicine, Edinburgh EH89JU, Britain . Some British studies have suggested that coal dust protects against lung cancer . This question has now been carefully investigated by Michael Jacobsen, a British statistician, and he concludes that there is no evidence of a protective effect of coal dust exposure . In a letter to the editor of the British Medical lournal he reports on a 16-year mortality follow-up of 16,628 coal miners. For men with category 2 or 3 simple pneumoconiosis or with PMF, mortality was low relative to that in men with no pneumoconiosis . However, he felt this was more likely to be due to the presence of pathology rather than as a nearly eight-fold excess in lung cancer when compared with nonsmoking coal miners which "make it abundantly clear that neither coal mining, as such, nor exposure to dust can be regarded as an effective protection from the disease." P.E .E. INTERNAL MEDICINE Trimethoprim-Sulfamethoxazole in the United States. G . P . Wormser, et al. Ann Int Med 91 :420-429, 1979 . Dept . of Medicine, Mount Sinai School of Medicine, New York, N .Y . This antimicrobial agent is com- posed of a fixed combination of diaminopyrimidine and a sulfonamide. It was introduced into the United States approximately five years ago, and is marketed under the trade name of "Bactrim and Septra ." The FDA has approved its use in four situations : chronic urinary tract infection due to sensitive organisms ; otitis media caused by susceptible strains of Haemophilus influenzae or Streptococcus pneumoniae ; shigellosis; and proven Pneumocystis carinii pneumonia . This paper describes the mechanisms of actions, pharmacology, spectrum of activity, nonapproved possible clinical indications such as prostatitis, venereal diseases, enteric (typhoid fever) and enteric infection, meningitis, bacte ;emia and endocarditis, pulmonary infections, nocardiosis, and miscellaneous infections . It also describes the dose and administration, the adverse drug interactions, and toxicity. This excellent review should be part of the library for all occupational physicians who are involved in patient care . - H.R.H. Acute Leukemia : Biology and Treatment. M. G . Cline . Ann Int Med 91 :758-773, 1979 . Dept. of Medicine, UCLA School of Medicine, Los Angeles, Calif. This excellent panel discussion directs itself to a pathogenesis of the various acute and chronic categories of leukemia . It is an excellent reference for current methodologies of therapy and presents an interesting section on frontiers of leukemic research . The bibliography is exten• sive and should be of particular interest to occupational physicians who are dealing not only with patients who have leukemia in the work force, but are concerned about the etiology of these diseases . - H.R .H. Inherited Elevation of Alkaline Phosphatase Activity in the Absence of Disease. 1 . W . W ilson. N Eng / Med 301 :983,1979. Lynchburg Endocrinology and Rheumatology Clinic, 200 Tate Springs Rd ., Lynchburg, VA 24501 . This is a case presentation of a young man who had markedly elevated alkaline phosphatase with- out apparent underlying disorder. The unexpected finding of elevated phosphatase in the patient's father promoted an investigation of other family members . The family demonstrated benign familial elevations of alkaline phosphatase and a pattern suggestive of autosomal-dominant inheritance. This article is of particular interest to occupational physicians participating in screening programs where there is suspicion of alkaline phosphatase elevation due to toxic exposure . H .R .H . Opportunistic Lung Infection Due to "Pittsburgh Pneumonia Agent ." R. L . Myerowitz, et al . N Eng I Med 301 :953, 1979. Dept. of Pathology, PresbyterianUniversity Hospital, DeSoto at O'Hara St ., Pittsburgh, PA 15213 . Eight immunosuppressed patients had pneumonia due to Pittsburgh pneumonia agent (PPA), a gram-negative, weakly acid-fast bacterium cultivatable only in embryonated eggs and guinea pigs and distinct from Legionella pneumophila . The diagnosis was established by isolation of the agent from lung or visualization of the organism in lung tissue . The clinical presentations, radiographic abnormalities and pathology were not specific . The most consistent feature associated with the disease was the recent institution of daily high-dose corticosteroid therapy in all patients . Five of the eight patients died despite broadspectrum antibiotic and antituberculous therapy. Antimicrobial activity against PPA was demonstrated for sulfamethoxazole combined with trimethoprim, for rifampin and for erythromycin with egg-protection assay . Serologic studies with an indirect fluorescent-antibody technic suggested that serocohversion or high titers may be a sensitive test for PPA disease . PPA appears to be a newly recognized cause of life-threatening bacterial pneumonia in immunosuppressed patients. (Authors' abstract) NOISE AND HEARING A Real-World Assessment of Noise Exposure. T, R . Schori and E . A . McCatha. Sound vibration 12 :2430, 1978 . University of Dayton, Dayton, Ohio . Noise exposures of 50 persons Journal ot Occupational Medicine/Vol . 22, No . 3/March 1980 191 THKP 0000951