Biomedical subjects
P Landrigan
Publications and source records attributed to P Landrigan.
The mortality of lead smelter workers: an update.
OBJECTIVES: Mortality studies of lead workers have shown excesses of nonmalignant renal disease and cerebrovascular disease. Animal studies and one human study have shown excess kidney cancer. We have updated a mortality study of male lead smelter workers (n = 1990). METHODS: An analysis was conducted using standard life table techniques. The updated analysis added 11 years of follow-up and 363 new deaths. RESULTS: The original study had found elevated but nonsignificant risks for kidney cancer, stroke, and nonmalignant renal disease, probably attributable to lead exposure. Deaths from accidents and nonmalignant respiratory disease were significantly elevated, but probably not as a result of lead exposure. In the updated study, no new deaths from nonmalignant renal disease occurred (9 observed, standardized mortality ratio = 1.21). Three more deaths from kidney cancer were observed, yielding a standardized mortality ratio of 1.93 (9 observed, 95% CI = 0.88, 3.67), which increased for those who had worked in areas with the highest lead exposure (8 observed, standardized mortality ratio = 2.39, 95% CI = 1.03, 4.71). Cerebrovascular disease remained elevated for those with more than 20 years of exposure (26 observed, standardized mortality ratio = 1.41, 95% CI = 0.92, 2.07). CONCLUSIONS: This cohort with high lead exposure showed a diminishing excess of death from nonmalignant renal disease, a continued excess from kidney cancer, and an excess of cerebrovascular disease only in those with longest exposure to lead.
[Current problems of epidemiology and toxicology of the occupational action of lead (review of the literature)].
The focus of current research on industrial lead toxicity is on the definition of dose-response relationships, particularly++ at low levels of exposure. Major interest surrounds the development of biochemical and physiologic markers of subclinical toxicity. Need exists to better delineate the toxicity of lead on the peripheral and central nervous system the kidneys, the cardiovascular system and the reproductive organs. To obtain more accurate information on cumulative individual exposure to lead, future research on lead toxicity will increasingly utilize X-ray fluorescence (XRF) analysis for determination of the lead content in bone.
The magnitude of the occupational disease problem: an investigation in New York State.
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The hazards of benign(?) neglect of elevated blood lead levels.
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Anaesthetic management for oophorectomy in pulmonary lymphangiomyomatosis.
Pulmonary lymphangiomyomatosis is an idiopathic disease, resulting in severe respiratory impairment. Bilateral oophorectomy has led to objective and subjective amelioration of the pulmonary pathology. In the anaesthetic management of such a patient, careful attention must be paid to pulmonary and systemic haemodynamics, and gas exchange. We describe the successful anaesthetic management of a 34-year-old female, using epidural anaesthesia, and pulmonary artery catheterization. Although the intraoperative and immediate postoperative courses were heralded by marked cardiorespiratory stability, refractory respiratory failure developed, and she died five months after surgery.
Use of court records for supplementing occupational disease surveillance.
To conduct surveillance of occupationally related health events, the New Hampshire Division of Public Health Services analyzes death certificates and workers' compensation claims. In an effort to bolster these limited data sources, a previously unrecognized data-set comprised of court records was explored. Court records obtained from the Federal District Court proved to be a readily accessible and detailed source of information for identifying suspected cases of asbestos-related disease and potential sources of asbestos exposure.
A study of the effects of systemic administration of adrenal glucocorticoids in an experimental model of hypersensitivity pneumonitis.
To study the effects of steroids on the pulmonary lesions in experimental hypersensitivity pneumonitis, rabbits were sensitized to ovalbumin (OA) by injections of OA into footpads and 3 weeks later they were subjected to two successive aerosol challenges with OA at an interval of 48 hr. Injections of hydrocortisone sodium succinate 10 mg twice daily (but not at the reduced dosage of 5 mg twice daily) or methyprenisolone acetate 5 mg twice daily beginning 30 min before the first challenge and continued to the time of killing reduced the extent and intensity of vasculitis in both the treated groups and showed less alveolar septal thickening in the hydrocortisone treated group and less alveolar consolidation in the methylprednisolone treated group compared to the pulmonary lesions in the rabbits which were sensitized and then subjected to OA aerosol challenges, but received no treatment. In view of the observation that even in a steroid sensitive species like the rabbit, extensive pulmonary changes like alveolar consolidation, septal thickening and vasculitis persisted in spite of treatment with relatively large doses of these steroids, it was felt that in human hypersensitivity pneumonitis steroids might only suppress the warning symptoms without substantially affecting the progress of the pulmonary lesions.
A study of lung-specific, cell-mediated immunity in chronic pulmonary diseases.
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Cryptogenic fibrosing alveolitis.
Clinical, radiographic, and histologic data, together with pulmonary function features, in eleven patients with cryptogenic fibrosing alveolitis, are described in the following study. All these patients presented with a history of exertional dyspnea. Eight of the eleven had radiographic evidence of pleural involvement as manifested by blunting of one or both costophrenic angles. A restrictive defect was present in eight patients, all of whom had x-ray changes showing diffuse involvement. One of the patients presented showed marked improvement in all parameters including a repeat lung biopsy. Immunofluorescent studies of the lung biopsies from six patients revealed no evidence of immunologic damage. Based upon the histologic pattern of pulmonary reaction in the biopsies and the intervals between the onset of symptoms and the time of biopsy, a tenative scheme of temporal evolution of this disease is presented. Lung injury may lead either directly to diffuse interstitial pulmonary fibrosis (DIPF) or lungs may react to injury by an initial alveolar, mural or mixed pattern, all of which might ultimately progress to DIPF. An initial alveolar or mural pattern might change to a mixed pattern.
Immunopathological studies in patients with farmer's lung.
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Localization of immunoglobulin and complement in pulmonary sarcoid granulomas.
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A comparison of the antipyretic effect of acetaminophen and aspirin. Another approach to poison prevention.
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