1/7. Palliative physicians persuade procurators fiscal.mesothelioma caused by occupational exposure to asbestos is well recognized and sufferers who have been employed in a prescribed occupation can claim compensation. Stringent criteria must be fulfilled in order to establish the link between occupational exposure and mesothelioma, and to this end the procurator fiscal is involved after the patient's death, both to elucidate the individual situation and 'for the common good'. Problems were experienced locally by the use of uniformed police officers, as the appointed Crown agents, as interviewers of recently bereaved relatives, irrespective of the degree of tact and sensitivity shown. The likelihood of an autopsy was also distressing. It is important to recognize the role of the procurator fiscal and to ensure that workers' compensation procedures exist and are followed. However, in order to minimize grief and distress to relatives, discussion took place with the local procurator fiscal. He was appreciative of the issues raised and practice has now changed substantially. In particular, police officers are no longer required to interview relatives either for the purpose of identification or to ascertain the deceased's occupational history. A pro forma has been produced and agreed locally to obviate the need for medical staff to be interviewed by police officers. Following subsequent discussion with the Crown Office our local arrangements have been incorporated in Crown Office guidance for national use.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/7. Sudden death caused by benign tumor of the atrioventricular node.Histologic study of the conduction system of the heart of a 16-year-old girl who died suddenly demonstrated a benign mesothelioma of the AV node, with almost complete replacement of the structure by the tumor. Teh past history was unremarkable, except for few syncopal episodes at 9 and 11 years of age and during pregnancy. Immediately postpartum, she developed a 2:1 AV block and intermittent complete AV block. Six weeks later, during diagnostic work-up in the cardiac catheterization laboratory, she died suddenly. Electrophysiological studies during this work-up disclosed complete AV dissociation, with normal QRS complexes. The block was proximal to the His-bundle recording site, with a normal H-V interval. Occasional syncopal attacks in young adults should alert the physician to the possibility of this diagnosis and lead to pacemaker insertion.- - - - - - - - - - ranking = 0.25keywords = physician (Clic here for more details about this article) |
3/7. The debate on elder abuse for undertreated pain.Presented is a review of the pain management provided to an elderly male patient dying of mesothelioma in an acute care hospital and, subsequently, in a nursing home. Discussed are the medico-legal aspects of the case, including the patient's survivors' efforts to hold the treating physicians, hospital, and nursing home accountable for inadequate pain management through complaints submitted to the state medical board, the state department of health services, and the Center for medicaid/medicare Services, and in state court.- - - - - - - - - - ranking = 0.25keywords = physician (Clic here for more details about this article) |
4/7. Benign cystic mesothelioma of the peritoneum: report of a case.A 36-year-old multiparous woman presented with the chief complaint of mass and fullness over the lower abdomen for the previous 3 months. Abdominal ultrasound revealed a uniloculated, thin-walled cyst attached to the peritoneal surface of the right lower abdomen. The cyst was surgically excised and confirmed to be cystic mesothelioma of the peritoneum by histopathologic and immunohistochemical studies. Benign cystic mesothelioma is an extremely rare intraperitoneal tumor. Although its etiology remains unclear, one distinctive clinicopathologic feature is a symptomatic abdominal mass in young females. The presence of a thin-walled cyst attached to the peritoneum on ultrasound should alert physicians to the possibility of this disease. The treatment of choice is complete resection and reexcision may be required due to a preponderance for local recurrence. Regular postoperative ultrasound follow-up is recommended to check for possible recurrence.- - - - - - - - - - ranking = 0.25keywords = physician (Clic here for more details about this article) |
5/7. Sarcomatous tumor of the chest wall with osteochondroid differentiation. Evidence of mesothelial origin.We describe a case of sarcomatous tumor of the chest wall with differentiation toward bone and cartilage that was observed in an asbestos-exposed worker. Although the mesothelial nature of the tumor was at first considered, it was not proven. Later, the tumor was shown to be a mesothelioma using a panel of pertinent antibodies that included a recently described anti-mesothelial cell marker. In addition, asbestos bodies were found in association with the sarcoma cells. Our findings indicate that whenever physicians encounter any type of primary sarcomatoid tumor involving serous membranes, the possibility of malignant mesothelioma should be regarded a priori.- - - - - - - - - - ranking = 0.25keywords = physician (Clic here for more details about this article) |
6/7. Occupational cancer: clinical interpretation and application of scientific evidence.Maintaining an awareness that workplace factors may contribute to occupational cancer is one of the most formidable obstacles in early clinical recognition. This early recognition provides an opportunity for a practicing physician to make an important contribution to new knowledge in the field. Another important reason for the physician to have a high index of suspicion of cancers being related to workplace exposures has to do with compensation benefits which may accrue to the injured worker. The physician's role in the compensation system is critical both in providing medical opinion, which is material to the final decision, and because in many states it is the physician who starts the time clock for the statute of limitations. Three case examples are used to illustrate the importance of clinical recognition by an alert physician: 1) mesothelioma and labor; 2) lung cancer in a plumber who smokes and one who does not smoke; 3) leukemia in a rubber industry worker. Given the inherent preventable nature of occupational cancers, it is hoped that society will assist in searching for these important links.- - - - - - - - - - ranking = 1.25keywords = physician (Clic here for more details about this article) |
7/7. Asbestos-related x-ray changes in foundry workers.michigan has a statewide mandatory occupational disease reporting system. As part of that system, reports are received from hospital, physicians, death certificates, the worker's compensation bureau, and company medical departments. Based on this reporting, the State of michigan has a special emphasis program for the surveillance of silicosis, a known disease outcome among foundry workers. From 1985-1996, 115 cases reported to the State Surveillance System as silicosis, pneumoconiosis not specified, or pulmonary fibrosis were reclassified as having asbestos related x-ray changes after a B-reader interpretation of each case's chest x-ray. During this same period there were an additional 697 reports confirmed as silicosis and 6,724 cases reported to the surveillance system as asbestosis. Among the 115 reports reclassified as having asbestos-related x-ray changes without evidence of silicosis-related x-ray changes, 54 had worked in foundries. Only 7 (14.8%) of these individuals had their primary work in maintenance in the foundry; 40 (85.1%) had their primary foundry work in a production job; and for 10 individuals the occupation was not known. Asbestos has been used in foundries on pipe laggings, boiler coverings, as insulation in fan housings, in gloves, aprons and curtains, as insulation in cupolas, and in ladles and insulation in sand molds. Clinicians caring for foundry workers need to be aware that asbestos-related x-ray changes are not uncommon in this population and asbestos exposure should be considered as one of the carcinogens contributing to the known increased risk of lung cancer among foundry workers.- - - - - - - - - - ranking = 0.25keywords = physician (Clic here for more details about this article) |