Elevated cytotoxicity in combat veterans with long-term post-traumatic stress disorder: preliminary observations.

Resting immune [WBC and differential cell counts lymphocyte phenotyping (CD2, CD4, CD8, CD16, CD20, and CD56), and NK activity] and endocrine (cortisol, prolactin, growth hormone, and DHEA-SO4) parameters were measured in 10 male, Vietnam combat veterans diagnosed with long-term post-traumatic stress disorder (PTSD) and 9 control Vietnam combat veterans without a PTSD diagnosis but with a comparable history of alcohol abuse. Subjects completed a battery of psychological questionnaires. We report on preliminary observations of the relationship between PTSD and physiological and psychological parameters. With some important exceptions, PTSD patients did not differ from the age-matched control group with regard to hormone levels or lymphocyte phenotypes. However, NK activity was higher in the PTSD population than in the controls. Beck, Mississippi, and Combat Exposure scores were significantly elevated in the PTSD population. In contrast to previous observations in depressed populations, depression (indicated by elevated Beck scores), comorbid with PTSD, was associated with increased natural cytotoxicity.

A case-control study of persons with elevated blood levels of dieldrin.

Twenty-seven pesticide workers with elevated blood levels of dieldrin (greater than or equal to 15 ppb) were involved in a case-control study which included history and physical examination, comprehensive neurological evaluation, laboratory tests, and psychological and psychomotor testing. No clinically important differences were found on history, physical, specialized neurological tests, or laboratory examination. The exposed group showed a statistically significant difference in five out of 58 psychological (P) and psychomotor (PM) tests--at least three would be expected by chance (p less than or equal to .05). In only one of these tests was there any significant correlation with dieldrin levels. Even though the exposed group had worse scores than the control group in 47 of 58 P--PM tests, such scores were, with a few exceptions, in the normal range of values. Elevated blood levels of dieldrin encountered in this study do not appear to have any chronic deleterious effects on health, as measured by conventional medical work-up and extensive central nervous system testing.

Follow-up on the problem of increased incidence of thyroid carcinoma from the effects of childhood irradiation.

There has been widespread concern in both the medical and lay community on how to deal with the problem of the increased incidence of thyroid cancer in patients irradiated in the head and neck during childhood, including the difficult question of whether all of these patients should be recalled and screened. Such an approach is not deemed logistically feasible and the desired benefits of the program which hinge on treatment through early detection are nullified by the protracted nature of the disease. The iatrogenic nature of the problem has raised ethical questions concerning professional duty and responsibility. The principle of "similar treatment for similar cases" seems fairest and most justifiable in pursuit of the goal of equal access to health care. The most effective plan appears to be a carefully devised public education campaign. Informing practicing physicians not already aware of the problem should be an important part of this effort. The responsibility for seeking treatment would be left to the patient who would see his personal physician or be recommended to a previously designated physician in his area.