Preventable mortality in Missouri: excess deaths from nine chronic diseases, 1979-1991.

For the period 1979-1991, 54% of the 644,045 deaths in Missouri were attributed to nine chronic diseases--cancers of the breast, uterine cervix, lung, colon/rectum; coronary heart disease; stroke; diabetes; chronic obstructive pulmonary disease; hepatic diseases/cirrhosis. Elimination of risk factors and screening have been shown to reduce the mortality caused by these diseases. To evaluate the range in excess mortality in the state, we calculated excess mortality by county and correlated these rates with three sociodemographic variables. Based on these analyses, an estimated 100,000 deaths may have been prevented through prevention and early detection activities.

Medical evaluation of subjects with known body levels of 2,3,7,8-tetrachlorodibenzo-p-dioxin.

Forty-one persons with a history of 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) exposure and measured adipose tissue TCDD levels were evaluated for potential health effects. No pattern of clinical abnormalities emerged related to TCDD levels.

Cytologic evaluation of bronchoalveolar lavage specimens in immunosuppressed patients with suspected opportunistic infections.

The role of bronchoalveolar lavage cytology in the diagnostic evaluation of immunosuppressed patients with suspected opportunistic pulmonary infections was evaluated by comparing two groups of patients who underwent fiberoptic bronchoscopy. Bronchoalveolar lavage specimens were compared with other available diagnostic techniques, including bronchial washings, bronchial brushings, transbronchial lung biopsies and open lung biopsy. Prior to the initiation of a protocol for bronchoalveolar lavage, a specific etiology for the pulmonary infiltrate using the above combined modalities was identified in 23 of 47 cases, for an overall diagnostic rate of 49%. The combined bronchial washings and brushings (cytologic procedures) identified a specific etiology in 9 of 47 (19%) of the cases. There were ten cases in which a cytologically identifiable organism (Pneumocystis, virus or fungus) was not present in the bronchial washings and brushings and one missed case of malignancy, for a false-negative rate of 23%. With the addition of the lavage technique and better sampling of the distal airways, a specific etiology for the pulmonary infiltrate was identified in 32 of 48 (67%) of the cases. This is comparable to the values of 40% to 65% cited in the literature for diagnosis of infectious disease by open lung biopsy. The lavage cytologic procedure identified a specific etiology in 22 of 48 (46%) of the cases, and the false-negative rate was reduced to 6%. With the excellent sampling of the bronchoalveolar lavage and the improved cytology results, the need for transbronchial or open lung biopsy has been eliminated in immunosuppressed patients with suspected opportunistic pulmonary infections. This allows these patients to be studied on an outpatient basis.

Health effects of long-term exposure to 2,3,7,8-tetrachlorodibenzo-p-dioxin.

In 1971, sludge wastes contaminated with 2,3,7,8-tetrachlorodibenzo-p-dioxin were mixed with waste oil and sprayed on a dirt road at the Quail Run Mobile Home Park in Gray Summit, Mo. We performed a comprehensive examination of 154 exposed and 155 unexposed persons in the area. There were no consistent differences between the two groups on medical history, physical examination, serum and urinary chemistry studies, and neurologic tests. Results of liver function tests suggested possible subclinical effects. The exposed group had an increased frequency of anergy (11.8% vs 1.1%) and relative anergy (35.3% vs 11.8%). The exposed group also had non-statistically significant increased frequencies of abnormal T-cell subset test results (10.4% vs 6.8%), a T4/T8 ratio of less than 1.0 (8.1% vs 6.4%), and an abnormality in the functional T-cell test results (12.6% vs 8.5%). These findings suggest that long-term exposure to 2,3,7,8-tetrachlorodibenzo-p-dioxin is associated with depressed cell-mediated immunity, although the effects have not resulted in an excess of clinical illness in the exposed group. Further studies are indicated to elucidate the pathophysiology and clinical significance of these immunologic findings.