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Mon Jan 29 15:32:02 GMT 2007

Hold on a bit.  I'm not certain the Xie paper is as optimistic or as
definitive as you claim.  Read beyond the abstract.  

Peds cases are up, the elderly are down, sure; but everyone in between
is simply untrendable.  At the same time, the subtype analysis in this
very population shows a significant increase in the proportion of acute
lymphocytic leukemia (ALL).  

ALL is typically thought of as a "pediatric" version of the disease
(accounting for about three-quarters of cases in kids).  In adults, it
has always been comparatively rare and notoriously difficult to survive.

As far as I know -- although it's been awhile since I looked -- the only
proven environmental risk factor for adult-onset ALL is radiation
exposure. 

Of course not all of the possible environmental permutations have been
studied, and we must admit that the environment has been pretty badly
permutated in the past several decades.  Further, the risk/benefit in
trauma patients (as opposed to total body scans marketed as birthday
gifts) favors finding occult injury.  But the take-home message here is
simple and beyond debate: scans are not harmless.

Pret Bjorn, RN
Bangor, ME USA

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of William Bromberg
Sent: Monday, January 29, 2007 9:21 AM
To: trauma-list at trauma.org
Subject: Re: ccml Sunday's Case - 4 days Later

Whenever I disagree with Dr Mattox I tend to wait out the feeling and
the urge usually passes. However the 1/2000 leukemia rate for CT scan
seems to me to be flawed on it's face. CT scanning started in the early
80's and by mid 80's was common. We now have 20-25  year follow up and
the rates of leukemia overall are falling except in the youg pediatric
age group (
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dop
t=Abstract&list_uids=12712476
). Unless you postulate that the lag time b/w expsure and result has not
yet  been reached (reasonable ?) I find it hard to believe that the
exposure risk is that high. That is not to say that the risk is
non-existant, however.

William J. Bromberg
Savannah Surgical Group
912 350-7412

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ccml Sunday's Case - 4 days Later