Cancer mortality patterns among women who served in the military: the Vietnam experience

In response to concerns of women veterans regarding the long-term health effects of military service in Vietnam, the Department of Veterans Affairs has been conducting a retrospective cohort mortality study of women Vietnam veterans. Military records were used to identify approximately 4600 women who served in Vietnam between July 4, 1965, and March 28, 1973, and a comparison cohort of nearly 5300 women who served during the same time frame but not in Southeast Asia or the Pacific theater. Current data include vital status determinations as of December 31, 1991, with a total of 532 deaths and an average follow-up of just over 20 years for both groups. Both the Vietnam and non-Vietnam women cohorts had a significant deficit of deaths from all causes compared to women in the US population. The two cohorts showed no difference in total mortality or in deaths from all cancers. A significant excess risk of pancreatic cancer was observed among Vietnam nurses compared to either non-Vietnam nurses (relative risk = 5.74) or women in the US population (standardized mortality ratio (SMR) = 2.78). Vietnam nurses also had an elevated risk of dying from cancer of the uterine corpus. Non-Vietnam nurses had a higher lung cancer mortality rate than women in the general population (SMR = 1.55) or nurses who served in Vietnam. Observed deficits of deaths from all causes and circulatory system diseases generally confirm a healthy selection bias for entry into and retention in the military that has been observed among men serving in the Armed Forces.

Posttraumatic stress disorder and the risk of traumatic deaths among Vietnam veterans

Vietnam veterans have been reported to be at increased risk for posttraumatic stress disorder (PTSD) and deaths due to traumatic causes after service in the Vietnam War. This study evaluated whether an association exists between PTSD and traumatic deaths among Vietnam veterans. Mortality risk of 4,247 Vietnam veterans from the Agent Orange Registry (AOR) with a diagnosis of PTSD relative to that of 12,010 Vietnam veterans from the AOR with no diagnosis of PTSD was calculated using the Cox proportional hazards model. Mortality experience of both groups was also compared with U.S. males. The PTSD veterans were more likely than the non-PTSD veterans to die from suicide (relative risk = 3.97, 95% confidence interval [CI] = 2.20-7.03) and from accidental poisoning (relative risk = 2.89, CI = 1.03-8.12). The standardized mortality ratio for suicides was 6.74 (CI = 4.4-9.87) among PTSD veterans and 1.67 (CI = 1.05-2.53) among non-PTSD veterans. Among Vietnam veterans on the AOR, PTSD is associated with a significant increased risk for suicide and accidental poisoning.

Ophthalmodynamometry and corticosteroids in central retinal vein occlusion

PURPOSE

This is the first report of the monitoring of the clinical progress of a central retinal vein occlusion by measuring the retinal venous collapse pressure using ophthalmodynamometry.

METHOD

A 38-year-old woman with a nonischaemic central retinal vein occlusion received systemic prednisone. The dose of prednisone was increased and decreased both abruptly and gradually. The response was monitored by weekly measurements of visual acuity, retinal appearance and retinal venous collapse pressure. The retinal appearance was assessed by comparison of repeated stereo colour photographs and fluorescein angiographs. Retinal venous collapse pressure was estimated by taking the mean of four or more ophthalmodynamometric measurements.

RESULTS

An inverse relationship between the ophthalmodynamometric retinal venous collapse pressure and systemic prednisone dosage was observed. The visual acuity and retinal appearance remained unchanged throughout the follow-up.

CONCLUSIONS

Ophthalmodynamometry in this case was a useful method of quantitatively monitoring the response of central retinal vein occlusion to systemic prednisone. The response would not have been detected if only visual acuity and retinal appearance were used to monitor the progress.

The effects of mustard gas, ionizing radiation, herbicides, trauma, and oil smoke on US military personnel: the results of veteran studies

Late effects of exposure to certain environmental hazards as a consequence of their active military service have become an issue of particular concern to veterans and the public at large. Approximately one out of four Americans is a veteran or a family member of a veteran. The US military develops and uses increasingly complex and sophisticated weaponry. As the military technology changes, so do the kinds of health issues to be addressed. The changing composition of military personnel, most notably the increasing number of women veterans and their expanding role into combat-related activities, will affect both the health issues to be addressed and the kind of health care to be provided. The emerging role of the military as peace-keepers in hostile but nonwar zones and as disaster-relief workers, endemic to the area and to psychological stressors unrelated to combat. The formation of a registry of military personnel exposed to potentially serious long-term health hazards would be highly advisable, whenever feasible. Such an exposure registry could serve as the basis for future medical surveillance and response to affected veterans and help avoid the kind of difficulty experienced in addressing health concerns of WWII veterans exposed to mustard gas and Vietnam veterans exposed to Agent Orange. Close cooperation between the Department of Veterans Affairs and the Department of Defense is essential in the identification of potential hazards and follow-up of affected individuals. Growing public awareness of potential occupational and environmental hazards, publicity surrounding such suspected health risks, and the limited scientific knowledge about low-level exposure to toxic substances may all lead to misunderstanding, unwarranted fear, and suspicion of government coverup. Establishment of an exposure registry of veterans may be seen as a government commitment to address the future effects of potential hazards.

Cerebral paragonimiasis in early active stage: CT and MR features

OBJECTIVE

Diagnosis of cerebral paragonimiasis in its early active stage is important because curative chemotherapy is possible. Accordingly, this study was undertaken to evaluate the CT and MR features of early active cerebral paragonimiasis.

MATERIALS AND METHODS

We retrospectively reviewed the CT scans (n = 29) and MR images (n = 7) of the brain in 20 patients between 7 and 59 years old who had cerebral paragonimiasis in the early active stage. The diagnosis was based on a positive antibody test by enzyme-linked immunosorbent assay (ELISA) for paragonimiasis in serum and CSF. The diagnosis was confirmed surgically in seven patients.

RESULTS

The most common and characteristic imaging finding was a conglomerate of ringlike enhancing lesions (grape-cluster appearance) with surrounding edema in one cerebral hemisphere in 11 patients (55%). Other nonspecific findings included a solitary ringlike lesion (n = 4) or irregular enhancing lesions (n = 2), localized hemorrhage with (n = 3) or without (n = 2) enhancing lesions, and a poorly defined non-hemorrhagic, nonenhancing lesion (n = 1).

CONCLUSION

CT and MR findings of clustered ring-enhancing lesions, seen in approximately half of the cases of early cerebral paragonimiasis, are suggestive of cerebral paragonimiasis.

Risk of testicular cancer associated with surrogate measures of Agent Orange exposure among Vietnam veterans on the Agent Orange Registry

A case-control analysis was undertaken to examine the association between various surrogate measures of Agent Orange exposure and testicular cancer among Vietnam veterans. Study subjects were selected from the Department of Veterans Affairs Agent Orange Registry. The case patients consisted of 97 veterans with a diagnosis of testicular cancer, and 311 veterans without any clinical diagnosis served as a comparison group. The surrogate measures were branch of service, type of duty, corps area, and location of the individual's unit in relation to recorded Agent Orange spray tracts. Only Navy veterans had a statistically significant increased risk of testicular cancer (odds ratio (OR) = 2.60; 95% confidence interval (CI), 1.08 to 6.24). Risk of testicular cancer was not significantly increased for ground troops (OR = 0.46; 95% CI, 0.25 to 0.86), for combat duty (OR = 0.91; 95% CI, 0.52 to 1.58), for service in the III Corps area (OR = 1.10; 95% CI, 0.66 to 1.84), and for being close to spray tracts within 90 days/8 km (OR = 0.99; 95% CI, 0.54 to 1.84) or 3 days/2 km (OR = 1.39; 95% CI, 0.50 to 3.80). The study results are not consistent with the hypothesis that Agent Orange may be a risk factor for testicular cancer among Vietnam veterans.

Spinal intramedullary granulocytic sarcoma: magnetic resonance imaging

A rare case of spinal intramedullary granulocytic sarcoma (GS) in a patient with acute myelogenous leukemia is described along with its magnetic resonance (MR) finding. The mass shows isointense signal on T1-weighted images, and slightly higher intensity on T2-weighted images. Contrast enhancement with gadolinium (Gd)-DTPA in this case differs from the other report in which the tumor was not enhanced. As MRI becomes the first choice in the evaluation of spinal tumors, high index of suspicion of GS with familiarity with its MR finding in leukemic patients may obviate the need for surgical intervention, since the tumor is sensitive to both radiation and chemotherapy.

Transient absorption spectra and quenching of coumarin excited states by nucleic acid bases

Triplet-triplet absorption spectra of coumarin show different profiles and maxima in ethanol from those in water, which are very similar to those reported in benzene. Long-lived transient species other than triplet states were generated as initial photoproducts between coumarins and nucleic acid bases. The excited singlet and triplet states of coumarins were quenched by nucleic acid bases. Adenine base quenched the excited singlet state of coumarins more efficiently than thymine base. However, photocycloadducts of furocoumarins are formed predominantly with thymine, and not with adenine. Moreover, it is reported that the poly[dA-dT].poly[dA-dT] sequence region is the most favourable site for the photocycloaddition reaction of furocoumarins. The results imply that adenine contributes to singlet-state photocycloaddition reaction of furocoumarins with thymine, probably through an adenine-furocoumarin-thymine termolecular interaction.

Posttraumatic stress disorder among Vietnam veterans on the Agent Orange Registry. A case-control analysis

Some of the readjustment problems of Vietnam veterans have been attributed to posttraumatic stress disorder (PTSD). This case-control study compared demographic and military characteristics of 374 Vietnam veterans who had PTSD with 373 healthy Vietnam veterans. Veterans were chosen from the Agent Orange Registry, a Department of Veterans Affairs computerized database of approximately 200,000 Vietnam veterans who volunteered for a physical examination. Case patients and control subjects were frequently-matched by age, year of Registry examination, and race. Crude odds ratios (OR) were used to evaluate the risk of PTSD associated with certain characteristics of Vietnam service, as there was no apparent confounding by other military factors. Being wounded in Vietnam (OR, 2.33; 95% confidence interval (CI), 1.49-3.65) and having a combat job in Vietnam (OR, 1.54; 95% CI, 1.15-2.06) were the only risk factors for PTSD. Those who had noncombat jobs but were wounded had the highest risk of PTSD (OR, 3.56; 95% CI, 1.26-10.06).

Mortality among women Vietnam veterans, 1973-1987

A retrospective cohort mortality study was conducted to examine health effects of US military service in Vietnam on women veterans who served there between July 4, 1965 and March 28, 1973. About 4,600 women Vietnam veterans and 5,300 women veterans who had never served in Vietnam were identified from military records and followed for vital status on December 31, 1987. Mortality rates for all causes of death combined and for all cancers among Vietnam veterans were similar to those among non-Vietnam veterans (relative risk (RR) = 0.93). There was a slight excess of mortality from external causes among women Vietnam veterans compared with non-Vietnam veterans (RR = 1.33), primarily due to an excess of motor vehicle accidents (RR = 3.19). Suicide rates were nearly the same in both cohorts (RR = 0.96). Vietnam veterans had twofold increases in mortality from cancers of the pancreas and uterine corpus compared with non-Vietnam veterans. Women Vietnam veterans and non-Vietnam veterans had lower-than-expected mortality from all causes of death combined (standardized mortality ratio (SMR) = 0.82 and 0.88, respectively), based on rates for US women, due to significant deficits of deaths from circulatory diseases. Compared with rates for US women, mortality from cancers of the pancreas (five deaths, SMR = 3.27) and uterine corpus (four deaths, SMR = 4.05) was significantly elevated among Vietnam veteran nurses.

Non-Hodgkin's lymphoma among Vietnam veterans

In light of findings suggesting an increase in the risk for non-Hodgkin's lymphoma among men exposed to phenoxyherbicides and concerns among veterans over Agent Orange exposure, a hospital-based case-control study was undertaken to examine the association between military service in Vietnam and non-Hodgkin's lymphoma. The cases consisted of 201 Vietnam-era veteran patients who were treated in one of 172 Department of Veterans Affairs hospitals from 1969 through 1985 with a diagnosis of non-Hodgkin's lymphoma. 358 Vietnam-era veteran patients with a diagnosis other than malignant lymphoma served as a comparison group. Military service information was obtained from a review of the veteran's military personnel records. Service in Vietnam did not increase the risk of non-Hodgkin's lymphoma either in general (branch adjusted odds ratio = 1.03, 95% confidence interval = 0.70-1.50) or with increased latency period as defined as the duration in years from first service in Vietnam to hospital discharge. Surrogate measures of potential Agent Orange exposure such as service in a specific military branch, in a certain region within Vietnam, or in a combat role as determined by military occupational speciality were not associated with any increased risk of non-Hodgkin's lymphoma.

Mortality among Vietnam veterans: with methodological considerations

The Department of Veterans Affairs previously conducted a proportionate mortality study of Army and Marine Vietnam-era veterans who died during 1965 through 1982. In the present study, 11,325 veterans who died during 1982 through 1984 and 50,743 veterans from the previous analysis made up the final sample of 62,068 veterans. When compared with all non-Vietnam veterans, Army Vietnam veterans had statistically significant excesses of deaths from external causes (proportionate mortality ratio [PMR] = 1.03), laryngeal cancer (PMR = 1.53), and lung cancer (PMR = 1.08). Marine Vietnam veterans had a significantly elevated PMR for external causes (PMR = 1.06) with a significant excess of homicide deaths (PMR = 1.16) when compared to all non-Vietnam veterans. The elevated PMRs for lung cancer and non-Hodgkin's lymphoma among Marine Vietnam veterans reported in the earlier VA study persisted when compared with Marine non-Vietnam veterans. However, it was found that these elevations probably were due to a deficit among the Marine non-Vietnam veterans rather than an excess among Marine Vietnam veterans.

Simple enzyme immunoassay for the simultaneous measurement of whole choriogonadotropin molecules and free beta-subunits in sera of women with abnormal pregnancies or tumors of the reproductive system

A multiple enzyme immunoassay (multi-EIA) was developed to quantify whole-molecule human choriogonadotropin (w-hCG) and free hCG beta-subunits (hCG-beta) simultaneously. A clone of a specific monoclonal antibody was coupled to solid phase; two other clones of different monoclonal antibodies were conjugated to horseradish peroxidase (HRP; EC 1.11.1.7) and alkaline phosphatase (AP; EC 3.1.3.1), respectively. These two enzyme conjugates were mixed together to measure w-hCG or hCG-beta, depending on the selection of the enzyme substrate. To measure w-hCG and hCG-beta simultaneously, both enzyme substrates were used with the blended enzyme conjugates. The assay is simple and reproducible, and can be completed within 2 h with high specificity and sensitivity. We measured w-hCG and hCG-beta in the sera of women with abnormal pregnancies and in patients with tumors of the reproductive system, and observed different hCG-beta/w-hCG ratios in patients with various types of trophoblastic tumors.

Simple enzyme immunoassay for the simultaneous measurement of whole choriogonadotropin molecules and free beta-subunits in sera of women with abnormal pregnancies or tumors of the reproductive system

A multiple enzyme immunoassay (multi-EIA) was developed to quantify whole-molecule human choriogonadotropin (w-hCG) and free hCG beta-subunits (hCG-beta) simultaneously. A clone of a specific monoclonal antibody was coupled to solid phase; two other clones of different monoclonal antibodies were conjugated to horseradish peroxidase (HRP; EC 1.11.1.7) and alkaline phosphatase (AP; EC 3.1.3.1), respectively. These two enzyme conjugates were mixed together to measure w-hCG or hCG-beta, depending on the selection of the enzyme substrate. To measure w-hCG and hCG-beta simultaneously, both enzyme substrates were used with the blended enzyme conjugates. The assay is simple and reproducible, and can be completed within 2 h with high specificity and sensitivity. We measured w-hCG and hCG-beta in the sera of women with abnormal pregnancies and in patients with tumors of the reproductive system, and observed different hCG-beta/w-hCG ratios in patients with various types of trophoblastic tumors.

Dioxins and dibenzofurans in adipose tissue of US Vietnam veterans and controls

The primary reason for concern about the adverse effects of exposure to Agent Orange is attributable to its toxic contaminant, 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) or dioxin. We studied adipose tissues from 36 Vietnam veterans, a similar group of 79 non-Vietnam veterans, and 80 civilians; the tissue specimens were selected from the 8,000 archived tissues collected from the non-institutionalized general population by the US Environmental Protection Agency. The geometric mean (+/- standard deviation) dioxin levels in adipose tissue for Vietnam veterans, non-Vietnam veterans, and civilian controls were 11.7 (+/- 1.7), 10.9 (+/- 1.7), and 12.4 (+/- 1.9) parts per trillion on a lipid weight basis, respectively. The mean levels for these groups were not significantly different from each other with or without adjustment for age of individuals, body mass index, and specimen collection year. In addition, none of the surrogate measures of Agent Orange exposure such as military branch, service within specific geographic region, military occupation, and troop location in relation to recorded Agent Orange spray was associated with the dioxin levels in adipose tissue of Vietnam veterans. Our results suggest that heavy exposure to Agent Orange or dioxin for most US troops was unlikely.

Proportionate mortality among US Army Vietnam veterans who served in military region I

A proportionate mortality study was conducted to determine if the post-service mortality experience of 6,668 Army Vietnam veterans who served in Military Region I (I Corps) was different from that of 27,917 Army non-Vietnam veterans. These veterans served in the US military between 1965 and 1973 and had died as of December 31, 1984. Statistically significant excesses of deaths were observed for motor vehicle accidents and accidental poisonings, with accidental poisonings having the largest elevation. Suicides and deaths due to any other major disease categories including malignant neoplasms were no more frequent among the I Corps veterans than their counterparts.

Combat experience and postservice psychosocial status as predictors of suicide in Vietnam veterans

The authors examined potential risk factors for suicide among 38 Vietnam veterans using 46 Vietnam veterans who died from motor vehicle accidents as a comparison group. The veterans were selected from Los Angeles County Medical Examiner's file (1977-1982). Data for these veterans were obtained from military service records, the coroner's reports, and the psychological autopsy conducted with the decedents' family members. No military service factor was associated with suicide. The characteristics of Vietnam veteran suicide cases were not substantially different from non-Vietnam veteran suicide cases with respect to known demographic risk factors. The psychological profile of Vietnam veteran suicide cases are also similar to non-Vietnam veteran suicide cases in most instances. Symptoms related to posttraumatic stress disorder were observed more frequently among suicide cases than accident cases. However, suicides were not associated with specific combat experiences or military occupation. The extent of combat experience in Vietnam per se as measured in this study is not a good predictor of suicide death.

Mortality and morbidity among Army Chemical Corps Vietnam veterans: a preliminary report

Nearly 1,000 men serving in Army Chemical Corps units in Vietnam between 1965 and 1971 were responsible for the mixing and application of herbicides, riot control substances, and burning agents. Information on Vietnam service was obtained from military records of 94% of this cohort. Follow-up for vital status on December 31, 1987, was conducted using Department of Veterans Affairs (VA), military, National Death Index, U.S. Internal Revenue Service, and Social Security Administration records. Cause-specific observed numbers of deaths among the 894 men included in the study group were compared with the numbers expected based on rates for U.S. men, adjusting for race, age, and calendar period. Fifty-three deaths from all causes were observed during the study period, compared to 48.8 expected (SMR = 1.09). There were statistically significant excesses of digestive disease deaths (SMR = 2.98), primarily due to cirrhosis, and from motor vehicle accidents (SMR = 2.00). Two deaths were observed from leukemia (0.5 expected) and two from brain cancer (0.4 expected). A total of 257 of the study subjects had received VA inpatient care or Agent Orange registry medical examinations during the study period. Two of these subjects had confirmed diagnoses of Hodgkin's disease (expected = 0.7) and one of hairy cell leukemia. Because of the small study group size and the lack of specificity of information regarding their exposures, these results cannot be attributed to any single chemical agent.

Proportionate mortality study of US Army and US Marine Corps veterans of the Vietnam War

The patterns of mortality among 24,235 US Army and Marine Corps Vietnam veterans were compared with that of 26,685 non-Vietnam veterans using standardized proportional mortality ratios. The veterans were a random sample of deceased Vietnam-era veterans identified in a Veterans Administration computerized benefit file. Military service information was obtained from military personnel records, and cause of death information from death certificates. Statistically significant excess deaths were observed among Army Vietnam veterans for motor vehicle accidents, non-motor vehicle accidents, and accidental poisonings. Similar findings have been reported in other studies of Vietnam veterans. Suicides were not elevated among Vietnam veterans. The Marine Corps Vietnam veterans appeared to have an increased mortality from lung cancer and non-Hodgkin's lymphoma. Although exposure to several environmental factors may be speculated, this study did not investigate possible etiologic factors for these elevated malignancies.

Methods compared for determining glutathione peroxidase activity in blood

We compared four methods for determination of glutathione peroxidase (EC 1.11.1.9) activity, using blood samples from 52 healthy volunteers. Two methods depended on direct assay of the amount of glutathione remaining at specific time intervals; the two indirect methods involved measuring the rate of disappearance of NADPH. We assessed the precision and reproducibility of each method. One of the indirect assays proved to be far superior to the other methods. Results of each of the methods were correlated with one another. We present the normal reference intervals for glutathione peroxidase activity for all four methods.