Cirrhosis in patients with rheumatoid arthritis receiving low dose methotrexate.

We describe three patients with RA who developed cirrhosis while taking low dose methotrexate (MTX). This report includes a review of the risk factors for cirrhosis occurring in association with MTX. Two of these patients were part of a prospective study to quantify changes in pericellular and total collagen in 76 patients with RA receiving low dose pulse MTX, giving a point prevalence of cirrhosis of 2.63%.

Potential lung cancer risk from indoor radon exposure.

The contribution of radon daughter exposure to excess lung cancer in underground miners is universally accepted. These miners received exposures from tens to thousands of WLM in a relatively few years. Although the miners were also exposed to other noxious agents in mines, the appearance of the excess lung cancer mortality in several types of mines and the increase with increasing exposure provide convincing evidence of the role of radon as the carcinogen. It is conceivable that exposures to radon at an average concentration of one to two pCi/liter, the levels for a majority of homes, might not produce excess lung cancers. This would require that a lifetime exposure at low concentrations produce a different response from that of a few years at higher levels for the miners. This is unlikely but not impossible. The current environmental epidemiology is of varying quality. The better studies may give some answers in a few years. These studies are more likely to establish an upper limit of risk than to provide an exposure-response model. Present risk estimates cannot be used accurately in estimating the overall lung cancer risk to the US population, since there are no good data on average exposure and exposure distribution. For example, the number of homes above the EPA guideline of four pCi/liter may range from two million to 10 million. An estimate of the actual radon exposure in the US may be forthcoming from a planned EPA survey, but these data will not be available for a few years. In the conservative tradition of radiation protection, indoor radon exposures in homes are estimated to produce a number of excess lung cancers in the population. One estimate by the NCRP is about 10,000 deaths per year in the US, for an average annual estimated exposure of 0.2 WLM (about one pCi/liter). The National Academy of Sciences (BEIR IV) estimates 13,000 deaths for the same exposure, and the EPA's estimate is 5,000 to 20,000.

The 1986 and 1988 UNSCEAR (United Nations Scientific Committee on the Effects of Atomic Radiation) reports: findings and implications.

The United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR) has published a substantive series of reports concerning sources, effects, and risks of ionizing radiation. This article summarizes the highlights and conclusions from the most recent 1986 and 1988 reports. The present annual per person effective dose equivalent for the world's population is about 3 mSv. The majority of this (2.4 mSv) comes from natural background, and 0.4 to 1 mSv is from medical exposures. Other sources contribute less than 0.02 mSv annually. The worldwide collective effective dose equivalent annually is between 13 and 16 million person-Sv. The Committee assessed the collective effective dose equivalent to the population of the northern hemisphere from the reactor accident at Chernobyl and concluded that this is about 600,000 person-Sv. The Committee also reviewed risk estimates for radiation carcinogenesis which included the new Japanese dosimetry at Hiroshima and Nagasaki. These data indicate that risk coefficient estimates for high doses and high dose rate low-LET radiation in the Japanese population are approximately 3-10% Sv-1, depending on the projection model utilized. The Committee also indicated that, in calculation of such risks at low doses and low dose rates, a risk-reduction factor in the range of 2-10 may be considered.

Estimate of risk from environmental exposure to radon-222 and its decay products.

Consideration of the epidemiological evidence on radiogenic lung cancer in uranium miners and of the incidence of the disease generally leads to an upper estimate for the lifetime risk of 10(-4) cases per working level month for members of the general population.