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Eleven cases of hepatic disease, including seven cases of hepatic angiosarcoma, have been identified to date among men employed at one vinyl chloride polymerization plant. The earliest diagnosis was made in April 1964. The two most recent cases, both angiosarcoma, were diagnosed in February 1974 as a result of systematic medical screening for liver abnormalities among workers at the plant. Ages at diagnosis have ranged from 36 to 58 years for the seven patients with angiosarcoma and from 28 to 56 years for the four patients with nonmalignant disease; durations of employment before diagnosis have ranged from 12 to 28 years and from 5 to 29 years. All 11 persons had worked in close and continuous contact with various phases of the vinyl chloride polymerization process. Review of pathologic material suggests the presence in both tumor and nontumor cases of portal fibrosis and atypical sinusoidal lining cells. A direct causal relationship between exposure to vinyl chloride monomer and pathologic findings is postulated.(JAMA 230:59-63, 1974)

The compound 2,3,7,8-tetrachlorodibenzo-p-dioxin, commonly known as dioxin, was measured in the adipose tissue of 39 persons with a history of residential, recreational, or occupational exposure in Missouri and in 57 persons in a control group. All participants had detectable levels of 2,3,7,8-tetrachlorodibenzo-p-dioxin in their adipose tissue, but the exposed group had significantly higher levels. Levels of six of the exposed persons were more than five times greater than the level of the highest control. Measuring 2,3,7,8-tetrachlorodibenzo-p-dioxin in adipose tissue provides a much improved index of exposure, an important advance for research studies evaluating the possible health effects of this compound.(JAMA 1986;256:2683-2686)

Between 1970 and 1973, seven cases of acute nonlymphocytic leukemia were diagnosed in the village of Elmwood, Wis, and the surrounding area. The patients ranged in age from 14 to 97 years. Interpersonal relationships were noted among all patients in the group. This cluster of cases represents a greater than 20-fold increase in the expected incidence of this disease for this population. Morphologic similarities in the blast cells were seen in all cases.This cluster of cases may bear a relationship to bovine leukemia since the town was located in dairy farming country and because a number of the patients had either worked at or lived near the town creamery.(JAMA 232:1333-1336, 1975)

Thirty-five known deaths were caused by the landslide and lateral blast of the May 18 eruption of Mount St Helens and at least 23 persons are missing. In 18 of 23 cases that reached autopsy, asphyxiation from ash inhalation was the cause of death. A rapidly established hospital surveillance system detected increases in the number of emergency room (ER) visits and admissions for asthma and bronchitis in communities with the heaviest ashfall after the May 18 eruption and the eruptions on May 25 and June 12. There were also increases in the number of ER visits for ash-related eye complaints in some areas. Laboratory studies indicated that the May 18 ash was not acutely toxic, but the respirable portion contained 3% to 7% of crystalline free silica, a potential pneumoconiosis hazard to certain heavily exposed occupational groups. Continuing volcanic activity of Mount St Helens and future eruption of other volcanoes in the Cascade Range may pose a variety of health hazards, including blast, ashfalls, flooding, damage to public utilities, and possible psychosocial effects.(JAMA 1981;246:2585-2589)

To establish whether the syndrome of unexplained generalized lymphadenopathy in homosexual men was new and related epidemiologically to the acquired immune deficiency syndrome (AIDS), we reviewed 3,139 pathology reports of lymph node biopsies performed at seven hospitals in New York City during the years 1977 through 1981. Three hundred twenty-nine patients (10%) were categorized as having unexplained lymph node hyperplasia; a detailed medical record review of 30% of these patients revealed three, two, six, eight, and 16 cases of unexplained generalized lymphadenopathy in the five years studied, respectively. Of these 35 cases, 26 (74%) occurred in males aged 16 to 44. A record review of 68 additional male patients aged 16 to 44 years with unexplained lymph node hyperplasia in two of the hospitals showed a similar increase in cases of unexplained generalized lymphadenopathy during the five-year period. Twenty-one of 25 cases in males with known sexual orientation were homosexual or bisexual. The increase in the syndrome of unexplained generalized lymphadenopathy from 1978 to 1981 and the characteristics of the population affected are similar to those observed for AIDS.(JAMA 1984;251:242-246)

Follow-up of health status has been completed through 1979 for 3,072 (95.5%) of 3,217 nuclear test participants on military maneuvers during the 1957 nuclear test "Smoky." In these participants, 112 cases of cancer were diagnosed, compared with 117.5 cases expected. During the same follow-up period (1957 through 1979), 64 persons died of cancer, compared with an expected 64.3. Statistically significantly increased frequency of occurrence and mortality was found only for leukemia. The amount of cumulative gamma radiation exposure for 1957 ranged from 0 to 10,397 mrem as measured by individual personnel film badges. Although uncertainty remains about the exact amount of radiation exposure, the lack of a significant increase after 22 years in either the incidence of or the mortality from any other cancer and the apparent lack of a dose effect by unit lead to the consideration that the leukemia findings may be attributable either to chance, to factors other than radiation, or to some combination of risk factors possibly including radiation.(JAMA 1983;250:620-624)

A questionnaire survey was done in 152 Houston supermarkets to assess the prevalence of respiratory tract symptoms in meat wrappers exposed to the thermal decomposition fumes of polyvinyl chloride (PVC) film wrap and in two supermarket control groups (checkers and meat cutters). Meat wrappers had increased respiratory tract symptoms; 12% of meat wrappers who smoked (vs 6% and 2% of controls) and 5% of meat wrappers who did not smoke (vs 0% and 0% of controls) had multiple respiratory tract symptoms. It is probable that a large number of meat wrappers have mild symptoms with some progressing to more severe respiratory impairment or clinical asthma.(JAMA 235:915-917, 1976)

In Reply.—We agree that leukemia appears with a latent period between two and 20 years and that the latent period for solid cancers probably exceeds 15 years from the time of radiation exposure. Although we reported a statistically significant increase in the occurrence of leukemia in the Smoky participants, the latent period exceeds 15 years for 63.6% of the cases, as shown in the Table. Our article gives various reasons (including the peculiar latency picture) why the null hypothesis cannot be "convincingly rejected."With regard to the solid cancers, no statistically significant increase was found in the total or in the numbers for any single five-year period, but only one full five-year period and a two-year period have occurred since the minimum latent period of 15 years. Even the tentative and probably incomplete data for 1978 to 1982 (31 cases observed and 59 expected) do not support a dramatic

To the Editor.—The article by Drs Ottosson and Krantz1 and the accompanying editorial by Dr Frey2 concerning traffic fatalities were very revealing. We were disappointed, however, in the narrow sense in which the term prevention was used."Preventable" traffic fatalities were not defined. As used in the article and editorial, the term preventable fatalities refers only to the secondary prevention of fatalities (ie, preventing death through the treatment of injuries that have already occurred). The article implies that only minimal benefit can be expected from further advances in secondary prevention in systems apparently as far advanced as Sweden's.Primary prevention of traffic fatalities (ie, preventing the initial injury), however, is feasible to perhaps a large degree through the use of passive restraints and other means. In their article, Ottosson and Krantz demonstrate the need for primary prevention measures if we are to reduce significantly the toll of

To the Editor. —In a recent letter to the editor (237:1826, 1977) Jones and Weill suggest that their review of respiratory symptoms and lung function in supermarket employees does not support previous reports that related asthma to polyvinyl chloride (PVC) exposure.In an earlier study of respiratory illness in meat wrappers,1 we found that the highest incidence of respiratory symptoms and illness occurred in full-time meat wrappers who were exposed to PVC pyrolysis fumes while working with hotwire cutting machines. No work-related respiratory symptoms were seen in 17 of 145 meat wrappers who used mechanical film cutting machines; more frequent and more severe work-related respiratory symptoms were seen in full-time meat wrappers than in meat cutters who only occasionally wrapped meat. The study of Jones and Weill looked at employees who wrapped meat only intermittently and who usually did so with mechanical film cutters; it is perhaps not

In Reply.—We accept Dr Grossman's criticism that the fate of the 145 participants could markedly affect the outcome of the study but do not accept his implication that, because they could not be traced, they have all died. Some of the untraced 145 participants almost certainly have died and some of these of cancer, but how many?Of the 145, we knew the Social Security Account Number (SSAN) for 63. Evidence of death was not found after these were submitted to the Internal Revenue Service, Veterans Administration, and Social Security Death Registry. Those without an SSAN were checked through the Veterans Administration, National Personnel Records Center, Social Security Administration, and Federal Bureau of Investigation for either an SSAN or evidence of death. No other sources of data were available unless we had each name reviewed by each state for each of 22 years. Even if this had been done,