The thymus gland in elderly patients with myasthenia gravis.

This study was undertaken to determine the amount and histologic appearance of the persistent thymic tissue removed post mortem from 20 patients over 60 years of age with myasthenia gravis. One patient died several days after thymectomy. No recognizable thymic tissue on gross examination was seen in any patient. On microscopic examination, 11 patients had no thymic tissue. The other nine patients, including the one with thymectomy, all showed marked involution of the thymus. No germinal centers were seen. The thymus glands of two additional patients, still alive after thymectomy at ages 62 and 70, showed similar findings. Marked involution of the thymus also was found in each of six elderly controls. Thymectomy is not likely to be effective treatment of the elderly myasthenic patient.

Thymoma: a continuing survey at the Massachusetts General Hospital.

An analysis is presented of the treatment of 103 patients with thymoma, 56 with myasthenia gravis and 47 without. In a 1966 report on the first 63 patients, it was stated that the presence of myasthenia and the finding of local tumor invasion at operation were ominous prognostic indicators. The augmented series suggests that myasthenia no longer carries this stigma, possibly because of improved methods in its management in patients who have undergone operation.

Limited surgical excision as the basis of a comprehensive therapy for cancer of the breast.

A comprehensive program of therapy has evolved with collaborating roles for surgery, pathology, radiotherapy, and chemotherapy. Our experience includes 131 patients with breast cancer treated at the Massachusetts General Hospital since 1956 by limited excision of the cancer. The tumors of 10 patients were noninvasive or sluggishly so; the patients received no further therapy. Because of the invasive character of their tumor, 121 patients received heavy postoperative irradiation. In 12 of these 121, the irradiation has been followed by immediate and prolonged chemotherapy. It is too soon to judge the effect of the chemotherapy, but survival rates of those treated by limited excision and primary irradiation compare favorably with those of patients treated by radical mastectomy.

Heroism in occupational health.

The author reports on an informative and confrontational discussion at the Indian Association of Occupational Health conference in New Delhi in February 2001. The president of the association, Dr. T. K. Joshi, took a strong and principled stand against the asbestos industry and many of his colleagues in maintaining his position that the use of asbestos should be banned in India.

The export of hazardous factories to developing nations.

The export of hazardous industrial plants to developing nations is examined for a number of industries. As hazardous and polluting industries come under increasing regulation in industrial nations, some of the affected processes are exported, without improvements to make them less hazardous, to nonregulating countries where cheap and uninformed labor is abundant. "Runaway shops" then market their products in industrial nations with the competitive advantage of not having had to comply with costly workplace and pollution-control regulations. The international trade impacts of hazard export include: export of jobs from regulating to nonregulating countries; shift of international balance of payments in favor of nonregulating countries; export of mortal health hazards and environmental destruction to workers and communities in nonregulating nations, in order to produce goods for consumption by the regulating countries; weakened competitive position of reputable manufacturers who incur control costs and complete in domestic and would markets against less scrupulous companies; prolonged widespread use of discredited, extremely hazardous technologies, arising from the continuing "subsidy" of certain industries by workers and communities exposed to uncontrolled, well-recognized, mortal health hazards; and aggravated international relations resulting from developing nations' awareness and concern over becoming dumping grounds for hazard export from industrial nations.

Controversies at international organizations over asbestos industry influence.

International scientific organizations have been subject to repeated efforts by Canadian government officials and representatives of the asbestos industry to issue reports that would be favorable to the industry on questions of asbestos use and public health implications. In recent years these efforts have been met with international opposition from scientists, governments, unions, and environmental groups, and a pattern of improprieties, often involving the same individuals and tactics, has emerged. This has been a serious threat to scientific objectivity at the most respected international scientific bodies in the world. The manipulation of these international organizations takes on unprecedented significance in this age of the World Trade Organization.

International mobility of hazardous products, industries, and wastes.

The export of hazards to developing countries, frequently associated with the transfer of technology, is an increasing public health problem. It may arise from the export of hazardous products and wastes, or from the transfer of hazardous industries in the absence of appropriate safeguards. Multinational corporations bear a major responsibility for having lower standards of health protection in manufacturing and marketing in the developing countries than in home-country operations. These firms are coming under growing international pressure from concerned citizens, unions, environmental groups, national governments and international organizations, religious groups, the media, and public health professionals.

Impending proliferation of asbestos.

The international asbestos industry is under considerable pressure in some countries to control dust exposures in the workplace and restrict pollution. In addition, major firms in the United States face mounting compensation costs for past failures to protect asbestos workers. At the same time, however, the asbestos industry is expanding in developing nations, largely on the strength of sales of asbestos-cement construction materials. This report describes problems encountered with the use of asbestos-cement in schools and low-income housing in Puerto Rico, resulting in the condemnation of these buildings and the relocation of over 1,000 families at public expense. The manufacturer of the asbestos-cement panels, a Colombian affiliate of the European-based multinational Eternit, escaped all liability. The issue is presented as a needless, expanding threat to public health worldwide. Safe, economic alternatives exist, such as the use in some cases of crop waste fibers in place of asbestos as a cement binder. There have also been major advances in the commercialization of asbestos-free brake and clutch friction products.