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Environmental Medicine: Integrating a Missing Element into Medical Education (1995)
Institute of Medicine (IOM)

Page
401
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Environmental Medicine: Integrating a Missing Element into Medical Education
APPENDIX

*The Hantavirus Study Group includes M.Burkhart, N.Kalishman, R.Voorhees, J.Voorhees, M.Samuel, M.Tanuz, L.Hughes, S.Wictor, G.Oty, L.Nims, S.Castle, B.Bryt, and C.M.Sewell— New Mexico Department of Health; P.Reynolds and T.Brown— New Mexico Environment Department; L.Sands, K.Komatsu, C.Kioski, K.Fleming, J.Doll, C.Levy, T.M.Fink, P.Murphy, B.England, M.Smolinski, B.Erickson, W.Slanta, and G.Gellert —Arizona Department of Health Services; P.Schillam and R.E. Hoffman—Colorado Department of Health; S.Lanser and C.Nichols—Utah Department of Health; L.Hubbard-Pourier— Division of Health, Navaho Nation; J.Cheek, A.Craig, R.Haskins, B.Muneta, S.John, J.Kitzes, J.Hubbard, M.Carroll, R.Wood, C.North, P.Bohan, and N.Cobb—Indian Health Service; R.Zumwalt and P.McFeely—New Mexico Office of the Medical Investigator; H.Levy, G.Mertz, S.Young, K.Foucar, B.Hjelle, J.McLaughlin, S.Allen, and S.Simpson—University of New Mexico Hospital; T.Merlin—Lovelace Medical Center; and M.Schmidt, L.Simonsen, C.Vitek, C.Dalton, R.Helfand, P.Ettestadt, J.Tappero, A.Khan, L.Chapman, R.Pinner, K.Wachsmuth, A.Kaufmann, J.Wenger, and J.McDade—Centers for Disease Control and Prevention.

REFERENCES

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2. Haemorrhagic fever with renal syndrome; memorandum from a WHO meeting. Bull World Health Organ 1993;61:269–75.

3. McKee KT Jr, MacDonald C, LeDuc JW, Peters CJ. Hemorrhagic fever with renal syndrome—a clinical perspective. Mil Med 1985;150:640– 7.

4. Lee HW, Lee PW, Johnson KM. Isolation of the etiologic agent of Korean Hemorrhagic fever. J Infect Dis 1978;137:298–308.

5. Lee HW. Korean hemorrhagic fever. Prog Med Virol 1982;28:96–113.

6. Antoniadis A, Le Duc JW, Daniel-Alexiou S. Clinical and epidemiological aspects of hemorrhagic fever with renal syndrome (HFRS) in Greece. Eur J Epidemiol 1987;3:295–301.

7. Gligic A, Dimkovic N, Xiao SY, et al. Belgrade virus: a new hantavirus causing severe hemorrhagic fever with renal syndrome in Yugoslavia. J Infect Dis 1992;166:113–20.

8. Giles RB, Sheedy JA, Ekman CN, et al. The sequelae of epidemic hemorrhagic fever: with a note on causes of death. Am J Med 1954;16:629– 38.

9. Tsai TF, Bauer SP, Sasso DR, et al. Serological and virological evidence of a Hantaan virus-related enzootic in the United States. J Infect Dis 1985; 152:126–36.

10. LeDuc JW, Smith GA, Johnson KM. Hantaan-like viruses from domestic rats captured in the United States. Am J Trop Med Hyg 1984;33:992–8.

11. Nichol ST, Spiropoulou CF, Morzunov S, et al. Genetic identification of a hantavirus associated with an outbreak of acute respiratory illness. Science 1993;262:914–7.

12. Bruno P, Hassell LH, Brown J, Tanner W, Lau A. The protean manifestations of hemorrhagic fever with renal syndrome: a retrospective review of 26 cases from Korea. Ann Intern Med 1990;113:385–91.

13. Sheedy JA, Froeb HF, Batson HA, et al. The clinical course of epidemic hemorrhagic fever. Am J Med 1954;16:619–28.

14. Johnson K. Hantaviruses. In: Evans AS, ed. Viral infections of humans: epidemiology and control. 3rd ed. New York: Plenum Press, 1989:341–50.

15. Earle DP. Analysis of sequential physiologic derangements in epidemic hemorrhagic fever: with a commentary on management. Am J Med 1954;16:690–709.

16. Lukes RJ. The pathology of thirty-nine fatal cases of epidemic hemorrhagic fever. Am J Med 1954;16:639–50.

17. Petty TL. Adult respiratory distress syndrome: definition and historical perspective. Clin Chest Med 1982;3:3–7.

18. Pepe PE, Potkin RT, Reus DH, Hudson LD, Carrico CJ. Clinical predictors of the adult respiratory distress syndrome. Am J Surg 1982;144:124–30.

19. Simon RH, Ward PA. Adult respiratory distress syndrome. In: Gallin JI, Goldstein IM, Snyderman R, eds. Inflammation: basic principles and clinical correlates. 2nd ed. New York: Raven Press, 1992:999–1016.

20. Rinaldo JE, Rogers RM. Adult respiratory-distress syndrome: changing concepts of lung injury and repair. N Engl J Med 1982;306:900–9.

21. Gajdusek DC. Virus hemorrhagic fevers: special reference to hemorrhagic fever with renal syndrome (epidemic hemorrhagic fever). J Pediatr 1962;60: 841–57.

22. Lee HW. Hemorrhagic fever with renal syndrome in Korea. Rev Infect Dis 1989;11:Suppl 4:S864–S876.

23. Lee M, Kim BK, Kim S, et al. Coagulopathy in hemorrhagic fever with renal syndrome (Korean hemorrhagic fever). Rev Infect Dis 1989;11:Suppl 4:S877–S883.

24. St John RC, Dorinsky PM. Immunologic therapy for ARDS, septic shock, and multiple-organ failure. Chest 1993;103:932–43.

25. Obukhova GG. Kinen system components and blood serum proteinase inhibitors in hemorrhagic fever with renal syndrome. Vopr Med Khim 1980;26:118–20. (In Russian.)

26. Yang CW, Bang BK. Changes of serum levels of tumor necrosis factor-alpha in patients with hemorrhagic fever with renal syndrome. J Cathol Med Coll 1992;45:819–30. (In Korean.)

27. Huggins J, Hsiang C, Cosgriff T, et al. Prospective, double-blind, concurrent, placebo-controlled clinical trial of intravenous ribavirin therapy of hemorrhagic fever with renal syndrome. J Infect Dis 1991;164:1119–27.

28. Childs JE, Korch GW, Glass GE, LeDuc JW, Shah KV. Epizootiology of Hantavirus infections in Baltimore: isolation of a virus from Norway rats, and characteristics of infected rat populations. Am J Epidemiol 1987;126: 55–68.

29. Lee PW, Amyx HL, Yanagihara R, Gajdusek DC, Goldgaber D, Gibbs CJ Jr. Partial characterization of Prospect Hill virus isolated from meadow voles in the United States. J Infect Dis 1985;152:826–9.

30. Tsai TF, Bauer SP, Sasso DR, et al. Preliminary evidence that Hantaan or a closely related virus is enzootic in domestic rodents. N Engl J Med 1992;307:623–4.

31. Yanagihara R, Gajdusek DC, Gibbs CJ Jr, Traub R. Prospect Hill virus: serologic evidence for infection in mammalogists. N Engl J Med 1984;310: 1325–6.

32. Yanagihara R. Hantavirus infection in the United States; epizootiology and epidemiology. Rev Infect Dis 1990;12:449–57.

33. Update: outbreak of hantavirus infection—southwestern United States, 1993. MMWR Morb Mortal Wkly Rep 1993;42:441–3.

34. Hantavirus pulmonary syndrome—United States, 1993. MMWR Morb Mortal Wkly Rep 1994;43:45–8.

35. Hantavirus infection—southwestern United States: interim recommendations for risk reduction. MMWR Morb Mortal Wkly Rep 1993;42(RR-11):1–13.

Page
401
Front Matter (R1-R12)
Executive Summary (1-4)
1 Introduction (5-13)
2 Curriculum Content (14-21)
3 Implementation Strategies (22-43)
4 Changing Medical Education (44-51)
5 Concluding Remarks (52-53)
References (54-58)
Appendixes (59-60)
A: Taking an Exposure History (61-96)
B: Medical School Courses and Clerkships: Access Points for Integrating Environmental Medicine (97-120)
C: Case Studies in Environmental Medicine (121-138)
Case Study 1: Arsenic Toxicity (139-163)
Case Study 2: Seasonal Arsenic Exposure from Burning Chromium-Copper-Arsenate-Treated Wood (164-167)
Case Study 3: Asbestos Toxicity (168-188)
Case Study 4: Benzene Toxicity (189-207)
Case Study 5: Beryllium Toxicity (208-223)
Case Study 6: Cadmium Toxicity (224-243)
Case Study 7: Fetal Death Due to Nonlethal Maternal Carbon Monoxide Poisoning (244-248)
Case Study 8: Carbon Tetrachloride Toxicity (249-266)
Case Study 9: Chlordane Toxicity (267-288)
Case Study 10: Chronic Reactive Airway Disease Following Acute Chlorine Gas Exposure in an Asymptomatic Atopic Patient (289-290)
Case Study 11: Chromium Toxicity (291-311)
Case Study 12: Cyanide Toxicity (312-331)
Case Study 13: Dioxin Toxicity (332-348)
Case Study 14: Ethylene/Propylene Glycol Toxicity (349-371)
Case Study 15: Formalin Asthma in Hospital Staff (372-373)
Case Study 16: Gasoline Toxicity (374-394)
Case Study 17: Hantavirus Pulmonary Syndrome: A Clinical Description of 17 Patients with a Newly Recognized Disease (395-401)
Case Study 18: Lead Poisoning from Mobilization of Bone Stores During Thyrotoxicosis (402-409)
Case Study 19: Lead Toxicity (410-435)
Case Study 20: Legionaires' Disease: Description of an Epidemic of Pneumonia (436-444)
Case Study 21: Mercury in House Paint as a Cause of Acrodynia: Effect of Therapy with N-Acetyl-D, L-Penixillamine (445-449)
Case Study 22: Mercury Toxicity (450-472)
Case Study 23: Methanol Toxicity (473-492)
Case Study 24: Methylene Chloride Toxicity (493-511)
Case Study 25: Paint Remover Hazard (512-515)
Case Study 26: Fatal Outcome of Methemoglobinemia in an Infant (516-517)
Case Study 27: Nitrate/Nitrite Toxicity (518-537)
Case Study 28: An Outbreak of Nitrogen Dioxide-Induced Respiratory Illness Among Ice Hockey Players (538-541)
Case Study 29: Pentachlorophenol Toxicity (542-557)
Case Study 30: Aldicarb Poisoning: A Case Report with Prolonged Cholinesterase Inhibition and Improvement After Pralidoxime Therapy (558-561)
Case Study 31: Cholinesterase-Inhibiting Pesticide Toxicity (562-584)
Case Study 32: Infertility in Male Pesticide Workers (585-587)
Case Study 33: Pesticide Food Poisoning from Contaminated Watermelons in California, 1985 (588-595)
Case Study 34: Poisoning of an Urban Family Due to Misapplication of Household Organophosphate and Carbamate Pesticides (596-604)
Case Study 35: Polynuclear Aromatic Hydrocarbon (PAH) Toxicity (605-621)
Case Study 36: Polychlorinated Biphenyl (PCB) Toxicity (622-638)
Case Study 37: Ionizing Radiation (639-673)
Case Study 38: Radon Toxicity (674-694)
Case Study 39: Residential Radon Exposure and Lung Cancer in Sweden (695-700)
Case Study 40: Community Oubreaks of Asthma Associated with Inhalation of Soybean Dust (701-706)
Case Study 41: Tetrachloroethylene Toxicity (707-726)
Case Study 42: Toluene Toxicity (727-743)
Case Study 43: Occupational Asthma Due to Toluene Diisocyanate Among Velcro-like Tape Manufacturers (744-749)
Case Study 44: 1,1,1-Trichloroethane (750-766)
Case Study 45: Trimethyltin Encephalopathy (767-771)
Case Study 46: Trichloroethylene Toxicity (772-792)
Case Study 47: Vinyl Chloride Toxicity (793-811)
Case Study 48: Work-Related Disorders of the Neck and Upper Extremity (812-813)
Case Study 49: Contact Dermatitis in Surgeons from Methylmethacrylate Bone Cement (814-816)
Case Study 50: Skin Lesions and Environmental Exposures: Rash Decisions (817-861)
Case Study 51: Acoustic Trauma Caused by the Telephone: A Report of Two Cases (862-867)
Case Study 52: Behavioral and Audiologic Manifestations of Noise-Induced Hearing Loss (868-871)
Case Study 53: Reproductive and Developmental Hazards (872-892)
Case Study 54: Childhood Asthma and Indoor Enviromental Risk Factors (893-903)
Case Study 55: Populations at Risk From Particulate Air Pollution - United States, 1992 (904-908)
D: Resources: Agencies, Organizations, Services, REferences, and Tables of Environmental Health Hazards (909-970)
E: Committee and Staff Biographies (971-975)