1 15 2 https://www.nal.usda.gov/exhibits/speccoll/files/original/c4613794beda86f8273ee8df4a9ed60b.pdf 5cad10780c14406b5f5c1e8bfca91f53 PDF Text Text Item ID Number 01532 Author Lee L ndon ' y Corporate Author Report/Article TltlB TCDD (2,3,7,8-tetrachlorodibenzo-p-dioxin) in Body Fat of Vietnam Veterans and Others (Draft) Journal/Book Title Year 000 ° Month/Day Color n Number of Imaoos 14 Descrlpton Notes Wednesday, June 06, 2001 Page 1633 of 1688 �VETERANS ADMINISTRATION REFERENCE SLIP INITIALS-DATE TO (Name or title-Mail routing symbol) ULCA^-v^>, L ^0-+~*~~c Q da. 4. S. REASON FOR REFERENCE j ("IAS REQUESTED IffifOR YOUR FILES 1 1 NOTE AND RETURN 1 1 (INFORMATION | | PER CONVERSATION 1 (NECESSARY ACT'ON | | SIGNATURE (COMMENTS LJ CONCURRENCE REMARKS M^-tr-Vvv-tA^^--, 44- 1. VA FORM AUG 1976 TEL. EXT. EXISTING STOCKS 6'F VA FORM 3230, O.CT 1956, WILL BE USED. AU.S.GPO: 1978—252-623 �TCDD (2,3,7,8-tetrachlorcKiLbenzo-p-dioxin) in Body Fat of Vietnam Veterans and Others -^y Authors * Lyndon E. Lee, M.D. , Philip Donahue, M.D. , Herbert B. Greenlee, M.D. , Carlos R» Mota, M.D. , William Schumer,M.D. , and Paul A, Thomas, Jr., M.D. Veterans Administration Medical Centers; Washington, D.C.; West Side, Chicago, II; Hines II; Lincoln, NE; West Side, Chicago, IL; and North Side, Chicago, IL. The past three years have seen a mounting concern over exposure to the defoliant 2,4,5-trichlorophenoxyacetic acid (2,4,5-T), an ingredient of Herbicide Orange used by the Uhited States Armed Forces in Vietnam from 1965 to 1971. At least some lots of 2,4,5-T contained a contaminant, 11 2,3,7,8-tetrachlorodibenzo-p-dioxin, also called TCDD or simply "dioxin . This substance is highly toxic to animals (1,2) and has been claimed to produce chronic and delayed adverse effects among American veterans who served in Vietnam. - , * TCDD accumulates preferentially._in""the body fat of experimental animals (3) and man ( 4 ) . It has been jbos tula ted to remain in adipose tissue for years and to threaten damage ;if .released by reduction in the amount of that tissue (5). /" Analytic methods to identify and measure TCDD have improved in recent years, enabling the Veterans Administration to investigate whether TCDD can be detected in the body fat of veterans who were presumably exposed to Herbicide Orange and in the fat of other veterans without known exposure to the herbicide. Three Air Force officers with more recent and better reported exposure to TCDD were tested as well. Twenty veterans who believe that they were exposed to Herbicide Orange in Vietnam volunteered to have 10 to 30 grams of fat removed from their abdominal walls. Another ten veterans without known contact agreed to have a similar specimen of subcutaneous fat removed during an otherwise necessary abdominal operation. Three Air Force officers who volunteered for biopsy had been intimately involved with the destruction of Herbicide Orange, two years earlier, had had other frequent contacts with the herbicide, and had used TCDD in the laboratory. The biopsies were conducted with care to avoid contamination by products containing TCDD. The specimens were collected in glass containers previously rinsed with acetone and refrigerated until use. vx-; The methods of extraction and of gas chroma tography - mass spectrography have been described by Gross (6). Ten specimens of the thirty-three were assayed as well in a second laboratory using slightly different techniques. The assays in both were conducted without knowledge of which specimens came from exposed and which from non-exposed men. �Each of the twenty exposed volunteers provided information about his military service with details of his exposure to toxic substances in Vietnam or elsewhere. A medical history, physical examination, and routine clinical chemistry were obtained, although the values of the latter are not available in some instances. Service records were available%as well. The clinical data were reviewed, seeking correlations between them and the assay results. The details of military service in Vietnam from the volunteer's report and his service record were examined in order to evaluate his likely exposure to Herbicide Orange using the dates, location, and nature of his service. From what is known of the times and places of Herbicide Orange usage a rough estimate of the likelihood of exposure was possible. This evaluation was made without knowledge of the assay results. Results. The assay results are reported in Table I. Detailed tabulations of the results and comparisons with those from the second laboratory are given by Gross (6). It should be noted that where the assay is indicated as negative despite an apparently detectable amount of TCDD, the chemist was unable to identify the measured substance as TCDD. In such cases, contamination with small quantities of some other, unidentified substance is likely (6). One of the three Air Force officers with known exposure to TCDD had no identified TCDD in his fat. The unidentified substance in his case and the TCDD measured in the other two officers was never more than 3 parts per trillion above the limit of detection. Of the twenty veterans from Vietnam, seven (numbers 1,9,13,16,19,27 and 30) had no detectable TCDD with a limit of detection at 2 to 4 parts per trillion; another two (numbers 6 and 8) had detectible material that could not be validated as TCDD and one (number 14) could be considered equivocal because the measured value was so low as to be questionable. The ten remaining men had TCDD identified anct measured in amounts from 3 parts per trillion with a limit of detection ofc> 2 parts (number 11) to 96 or 100 parts per trillion with 10 parts limit of detection (number 26). Only one other (number 10) had a TCDD value greater than 7 parts per trillion above the limit of detection. ^ • ^ Of the 10 unexposed veterans, two (numbers 20 and 23) had TCDD identified in their fat; neither had nore than 6* parts per trillion above the limit of detection. Two other veterans (numbers 17 and 23) had values low encught to be considered equivocal and in five instances (number 5,7,21,31, and 33) the detected material was not validated as TCDD. The remaining veteran (number 18) had no detectible TCDD with a limit of detection of 4 parts per trillion. No specimen was submitted for the assigned number 22. Table II presents data relevant to the exposure in Vietnam to Herbicide Orange. Group A is composed of the three volunteers (numbers 10, 19, and 26) were judged to be most heavily exposed to the -defoliants. Their duties in Vietnam involved handling the chemicals at a tijne and under circumstances when few precautions were taken to avoid contact or 'ingestion. ^1'V �The five veterans comprising Group B are judged to have had relatively little likelihood of exposure to Herbicide Orange either because their location in Vietnam was removed from the areas sprayed (nunber 1, 15, and 34), because of the time of their Vietnam duty (numbers 13 and 28) or its short duration (nunber 1), and because of a questionable description of exposure (nunber 34). The remaining twelve Vietnam veterans appear to have had an intermediate likelihood of exposure, i.e. between that of Groups A and B and are not described in Table II. Arong the most heavily exposed men are the highest TCDD content in their body had none detected. Two of the lightly no detect ible TCDD but the other three the two (numbers 10 and 26) with fat but the other man (nunber 19) exposed men (numbers 1 and 13) had (numbers 15, 28 and 34) did have. Table III summarizes the clinical information regarding all twenty Vietnam veterans. Seven of them (numbers 9,13,15,26,27,29, and 30) reported some health problems beginning during a tour of duty in Vietnam. No two, however, reported the same symptoms which included probable numbness and tingling; tingling and swelling of the hands and feet with insomnia due to the pain; plantar warts; a rash on the legs with "jungle rot" and occasional diarrhea; apparently generalized itching; amoebic dysentery as well as pleurisy, weakness, and hypertension; and asthma with cough and an intermittent rash on the flexor surface of the arms. The remaining thirteen veterans reported no illness while in Vietnam although only one reported good health at all times. Among the nineteen veterans with medical complaints six (numbers 1,8,10,19,24, and 26) suffered from conditions difficult to relate to toxic agents, namely malignant astrocytoma; chronic ulcer after laceration of the hand; plantar warts and a "stomach condition" without radiographic or chemical evidence of disease; varicose veins; hemorrhoids, low back pain, and palpable liver with a history of heroin use; and pruritis ani and possible urticaria. Of the thirteen other veterans reporting difficulties five reported mental problems ranging from nervousness to schizophrenia and three had experienced difficulties of reproduction, namely, spontaneous abortion by the^rwfes of two (numbers 11 and 15) and congential heart disease in the h^f a third (number 16) . Three of the seven veterans j £%>orted difficulties while in Vietnam had no TCDD detected; the fo~CHr, -others had 5 to 96 parts per trillion. Of the six men whose medical cowplaints were difficult to relate to toxic substances, three had no TCDD and three had 5 to 96 parts per trillion. The category of five veterans with nental problems included two without detectable TCDD and three whose assays results were 5 to 13 parts per trillion. One of three veterans reporting reproductive problems had no detected TCDD and the other two had levels of 3 and 7 parts per trillion. The lack of relationship between detectable TCDD in the body fat and the usual clinical chemical findings can be illustrated by the fact that none of the men tested had abnormal values for total plasma protein, albumen, thronboplastin, creatinine, or uric acid. The aspartate amino transferase (SOOT) was slightly elevated (21IL/L or less) in three •7s V. •• .' ' V �veterans without detectable TCDD in their fat and in two with 6 and 35 per trillion. One veteran with an elevation of 48 iq/L and another with an increase of 190 IIJ/L of SCOT had no TCDD detected. Similar lack^ relationship between clinical chemistry and TCDD content is eviderf£, £oj each test* _._ y"':\^ Summary and Conclusions; As Gross (6) concluded, his method of gas ohroma'tography-mass spectrcmetry is capable of detectingvand measuring very small amounts of TCDD of human fat. The technique is, however, difficult and delicate in its present form. It also requires enough adipose tissue to necessitate surgical biopsy and this must be performed under conditions that avoid contaminating the tissue with TCDD fran extraneous sources. The data indicate that TCDD can be found in some persons who report exposure to Herbicide Orange and in others who were never in Vietnam and know of no contact with the herbicide. On the other hand, some veterans from Vietnam have no detectible TCDD and the same is true of veterans who were never in Vietnam. The low level of TCDD in two Air Force officers and its absence in another is of special interest since their exposure to TCDD is certain and more recent than that of the veterans. Information regarding pre- and post-service exposure to chemicals that contain TCDD is too inadequate to allow more than speculation on other sources of the material in the fat samples. TCDD has been found in a substances other than Herbicide Orange or the 2,4,5-T in that mixture (1). It is impossible', therefore, to be certain of the source of TCDD found in any ofi ' the map in this study. r •; > .j. v \ • i.- "" Because.of the difficulty and limited availability of the assay techniques, the necessity for securing relatively large fat samples, and the uncertainty of the source of the TCDD detected, the method described here does not seem a satisfactory routine test for exposure to Herbicide Orange nor acceptable evidence of contact with that specific defoliant nor of the absence of such contact. It will provide a research tool under proper conditions and for specific purposes, e.g. the study of the rate of disappearance of TCDD after known exposure. It should be noted that the amounts of TCDD measured in the fat are very small, not exceeding 100 parts per trillion. Since the substance is more concentrated in fat than in other tissues, the total body concentration is even less. �References: (1) Young, A.L., J.A. Calcagni, C.E. Thalkan, and 3.W. Tremblay. The Toxicology, Environmental Fate and Human Risk of Herbicide Orange and its Associated DioxLn. UEAF OEHL Technical Report TR-78-92. 1978, (2) Cattabeni, F., A. Cavallaro, and^G. Galli. Dioxin. Technical and Chemical Aspects. Vol. 1 Monogr^^ of the Giovanni lorenzini Foundation. New York. 1978t^YJ ^ ,-'•»» t syjExT^ Gasiewicz, T.A. and RrA^^skl. 1978. Tissue distribution and excretion of 2,3,7,8*(t^trachlorodibenzo-p-dioxin (TCDD) and effects upon clinical parameters in the guinea pig. Fed. Proc. 37(3):501. (3) (4) Reggiani, G. 1978. The estimation of the TCDD toxic potential in the light of the Seveso accident. Presented at the 20th Congress of the European Society of Toxicology, West Berlin. (5) Commoner, B. 1978. Interview on "Agent Orange: Vietnam's Deadly Fog", WBBM-TV, Chicago" (6) Gross, M.L. 1980. Trace analysis of tetrachlorodibenzo-p-dioxin (TCDD) in human adipose in publication. �Table I. 1CDD in Hunan Fat Samples (after Gross (6)) Veterans with Military Service in Vietnam Subject TCDD Presence 1 Neg. b 6 Neg. b 8 Neg. b 9 TCDD Concentration3 (parts per trillion) n/z 392:n/z 328 n/z 322 Meg.6 ^jp* 11 nd (5) 5 (3) 5 (^X nd (12) nd (3) nd (4) ^£\12 ^ Pos. 10 nd (11) C 23 4 < > ^4 *-.(\£ -d 2 2 nd 1 21 17 2 1 P^KN^' 3 (2) Fos. 9 (3) 13 Neg. nd (2) nd (2) 14 Doubtful 4 (3) 4 12 ' 13 15 Pos. 7 (4) 8 16 Neg. nd (4) nd (8) - 19 Neg. nd (15) nd (3) 24 x^ >^ Pos. 25 26 5 4 5 ((3)) 3 Pos. 12 (4) 10 (3) 11 Pos. 63(6) 96 (10) t3$ ^i,J ^%V - 100 �27 Neg. nd (11) nd (6) 28 R>s. 8 (6) 7 (5) 29 R>s. nd nd (6) 13 (5) 3 8 jtfr Neg. 30 R>s. 34 9 (4) nd (3) J <IJ4K '<%P^ nd (5) Air Force Officers 2 IbB. 5 (2) 4 3 Neg.b 4 (1) 2 4 R>S. 6 (6) .,^k 4 Veterans with Military Service Ou ts i de^ie't ftain 5 Neg.b 9 (5) 4 (4) 6 5 7 Neg.e 3 (2) 2 nd 3 (3) 4 (3) 2 3 17 /.-.^Doubtful 18 „.<;•;> Neg. nd (4) - 20 V" Rxs. 5 (4) 5 21 Neg.e 6 (3) 2 23 R)S. 6 (3) 8 (2) 8 31 Neg.e 4 (2) - 32 toubtful nd (5) 4 (4) 5 7 (6) 14 (7) 5 33 Negf �a. n/z 322: m/z: 328" is value calculated from relative signafi^JiJtensities at two mass spectrcphotoneter channels. "m/£ 322" is vefJu^from absolute intensity of that channel. >«MJ;VV ^&~~^^ \^,' b. Cannot be consic3ered positive because of poor validation (substance detected probably not TCDD) and contaminant removed on repeat analysis. c. "nd" means "not detect^y.^ of TCDD. <£/*C Value in parentheses is limit of detection teV d. e. Dash indicateaW5\assay performed. ^L!V positive because of poor validation (substance Cannot be considered detected probably not TCDD). f. "Doubtful" indicates that result wxild be considered positive at 2.5:1 signal: noise ratio negative at 3:1 ratio. �Table III. Immediate Non- Service Civilian Symptoms Exposures Occupation ' Well Maintenance Chlorine; Chemo- Hone given therapy, radion disability ation SUMMARY OF CLINICAL INFORMATION Intermediate Health Lt. temperoparietal tumor; "kidney condition" Current Positive Findin<js None SUBJ: 1 *. Age 31 6 31 Machine Keeper Radiation tonsils 1950 None given Acoustic j^nkr, 8 30 Constructionunemployed tone - ETOH, cocaine, marl huana use None given Ma*reported difficulty Ulcer-after cut 2-3 mon. 9 30 Student None ? Numbness & tingling Rhinitis, "back condition" - 1969 Numbness, tingling Hostile - abdominal fatigability, fever- tenderness, pharynx yrs. "Psychiatric & edema sexual problems" tone 10 30 Steel mill crane None operator; studen None given Back pain, Chr. otitis media, plantar wart "Stomach condition" Plantar wart 11 32 Student; ConNone struction worker None given Wife aborted at 3-4 mon - 2 1/2 years ago Intermittent chest None pain & dyspnea - 2 yr Urinary frequency 2 yrs., Infertility .*!* ^ Headaches - 1 1/2 yrs Thyroid nodule, facial Acoustic neurFacial pain oma- 1979, N. changes thyroid nodule1976 12 Technical rep- None resentative for Clinical instru. Company 30 None given Current Symptoms None Butterfly facial None jg rash after r'TCH or ; anxiety - before Vietnam as weLU*Jf Diagnoses '•iliynant astrocytoma 1976 None None • Butterfly rash on face & forehead i [ i i ( i "i Ulcer - L index finger Chronic ulceration i " Comments ! ! �SUMMARY OF CLINICAL INFORMATION Civilian Occupation Ag. Immediate Symptoms Non-Service j Exposures Intermediate Health Current Symptoms Jumpy, small non-tendei none axillary nodes Construction Prominent hila, disc atelectasis : I 32 Mastectomy for bynecomastia - 197 200X swollen lids & red conjunctiva; nervousness, tingling of fingers & toes * "several years". periodic weakness 4 *&i ^^^> Farm chemicals; None Qiysft^fc 'Kidney stone-1975; Chestpain; forehead photographic; v*»* Pleurisy & pneumon a cyst; lipoma, mole, 2 wks; PPD pos.lawn fertilizer hernia >$x 1969; blood in stools Diagnoses School Teacher 1 (TP4 in service Plantar warts 'Heroin for 3 yr 1 4 yr. ago 29 <$^T<> 33 1/5 Current Positive Findings Machine repair- Cleaning agents Rash on legs; occasional heavy ETOH man diarrhea; jungle rot of ' toe-nails & groin Nervousness- late Recurrent extremity 1972; wife aborted well ing- 10 yrs. , IX between 1969 & "nerves", rash 1975; "nervous &f breakdown"- 1972 Comments i Sarcoidosis, inguinal herni; lipoma cyst Pigmented areas on It. Schizophrenia. thigh and lower legs skin rash, cnychomycosls .v> . ^^ \ rtf^^ YM) 'a* 1 35 Piper fitter None None given Son-congenital heart dis. 1971 Dry cough- 3 wks. , foot problems-since service Lt. great toe contract none ure; tenia pectis 51 Machinist (?) None None given No Statement Painful leg edema Varicose veins 33 Tailor 34 Auto Mechanic Varicose veins Painful knee & Groin pain - few yrs. Hemorrhoids; Palpable hernia [liver leg swelling after low back pain exercl se i None. HeroinNone given until 3 yr. ago • * 1 Insecticides • Pain, swelling left IBP 150/100; arthoscopy Recurrent dry icholecystectomy. tenia patches on back & | knee-post-traumatic iversicolor shoulders; peptic i ulcer j None given i : • i i i Arthritis. chronic cholecystitis, fattj liver, HBP, �SUMMARY OF CLINICAL INFORMATION Civilian Occupation Ag. SUBJ: 33 26 Non-Service Exposures None given None Artist Immediate Symptoms i Intermediate Health Current Symptoms Crampy abdominal pain-4 yr. ago; allergy to fish & IVP dye Severe rectal itch-3 yr; generalized skin itch occasionally since 1968 Current Positive Findings Diagnoses Perianal excoriated lesion * Pruritis ani, Possible urticaria <*t 27 32 None given i , . None w^ •$& 3 ItenjKjbur tingl- Still fingers & toe Reynaud -like reaction Stiff fingers & toes. none iipgVK swelling Hematemesis; back (& weakness of bilateral limp of hands & feet pain | extremities 1 insomnia from pain 28 33 MAS (VA) None None given 29 30 Carpenter None None given None None Given • Oil Tank leader Fireman 34 37 Carpenter } 1 i j None rimary light oils-benzene, toluene, etc. • -, 30 None Amoebic dysentery; Early morning weakness None pluerisy 2 mon in normal by evening BP 158/90 Vietnan; "weak" before discharge; HBP at discharge; Crampy abd. pain1976' "Poly cystic •kidney" a *'^ Repeated cough, ^Nervousness ^ •Intermittent pruritic Expiratory rhonchi asthma worse (t* «TV: r.ash'on flexor surface evac. hos) j \ of arms-since Vietnam W 1 30 None None Duodenitis None ¥•*" (Multiple, general iz Chr. anxiety, dyspnea Abdominal nodules blurred vision; palpit (lipomata ?) ;ed lipomata i ations; chest pain, stomach pain; facial flushing, infraorbital "water blisters" 1 eac week, HBP None •8 Ccnrnen Q. �•^ SUMMARY OF CLINICAL INFORMATION - SUBJ: 2 Civilian Occupation * Non-Service Exposures Intermediate Health Immediate Symptoms Current Positive Findings Current Symptoms 36 Farm d e f oliants None None None Mass ( ? ) 36 3 USAF USAF Laborat . insecticides None B r o n c h i e c t a s is , None None 39 USAF K^fc^. Organo-phosphatea , industrial V-"v HCOs 5 34 Unemployed No record 1 40 Unemployed No record 17 31 JNot r e p o r t e d Gasoline & i automot ive chemicals 18 51 20 Mot recorded 48 21 lot recorded federal Employee 43 Not given Not given • •, None leftaxill allergy NCC a r e t h r l t l s , r t n a l stone , spastic colon None O c c a s i o n a l p e r l o r - None bital acne-3yrs.t None m o l e - l i k e lesions of a r m , g r o i n , penla Not applicable None given None g i v e n ^•^\ Nolffc-^ jttven Not applicable .• *'l ;'• "' None given Not a p p l i - v P e l v i c cable 1 s * Not a p p l cable Not a p p l i cable f r a c t i o n s Acute low back pain. Infertility (past pelvic fracture) l U B P , a l l e r g y to idyes i Rt . i n g u i n a l hernia Hernia R e c t a l adenacarclnoma Rt . v a r i c o s e vv . ; Rt . leg a t r o p h y ; Lumbar spabraA i• -* - ^ \ \ ^ \ Epigastric her i> la, a c u t e leraboscral sprain Ca lc_ui~u I6»,»r t . kLrfney i-,f I n t e r m i t t e n t dematurla-9mon . Kt. renal ca l e u 1 us Hypertension '* • ["Back problems" Severe a b d o m i n a l & S l i d i n g l l a t a l ;gout-12 y r s . ago b a c k p a i n hernia; ureteral U r e t e r o l 1th l a s t s ; Hypertension Not a p p l i cable i K n o w n non-f unc t l o n f N o n e ing kidney Not r e c o r d e d Rt . , nonf unc t t o n i n g , mul t i c y r t i c kidney I . . 1 . Comments penlc t llln < *\ 4 Diagnoses I : i Ureterolithotomy UreteroHthotomy Nephoectomy �GO a,' SUMMARY OF CLINICAL INFORMATION SUBJ: Civilian Occupation Agi 23 31 31 27 Non- Service Exposures i Foreman meat cutter None given Intermediate Health Immediate Symptoms i Diagnoses Comments Not applicable Duodenal ulcer. Exigastric pain, ( Obesity bronchial asthm vomiting-tl/2 yr Not applicable Automobile acci Hipvpain dent with right '•*&'. hip injury <?• V* :Limit movement, rt. Traumatic Kip fussion nip. Abscess mandi- dislocation ble rt. hip; ostionicrosis; anemia £ Sheet-m^Sl None , drug J ma ch i nfe ' a{4e r- abuse Current Positive Findings Current Symptoms ator ^i^ Hiatus her- Nissen nia & fundoreflex iso- olication phagitis, asthma -33 43 Retired AF and Marine None Not applicable Dermatitis .left Sinus headaches, foot; arthritis tics chest 6 left arm pains, dyspenia 6-7yrs Bilat, direct in guinal hernia Hemorrhoids Left inguin Herniorrhapty ~ "~iernia '.33 42 Manager-auto repairs None given Not applicable None given None given Cholelithia- Cholecystec tomy sis None given . i , . • j i i i 1 • \ i i ! � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Alvin L. Young Collection on Agent Orange Description An account of the resource <p style="margin-top: -1em; line-height: 1.2em;">The Alvin L. Young Collection on Agent Orange comprises 120 linear feet and spans the late 1800s to 2005; however, the bulk of the coverage is from the 1960s to the 1980s and there are many undated items. The collection was donated to Special Collections of the National Agricultural Library in 1985 by Dr. Alvin L. Young (1942- ). Dr. Young developed the collection as he conducted extensive research on the military defoliant Agent Orange. The collection is in good condition and includes letters, memoranda, books, reports, press releases, journal and newspaper clippings, field logs and notebooks, newsletters, maps, booklets and pamphlets, photographs, memorabilia, and audiotapes of an interview with Dr. Young.</p> <p>For more about this collection, <a href="/exhibits/speccoll/exhibits/show/alvin-l--young-collection-on-a">view the Agent Orange Exhibit.</a></p> Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Box The box containing the original item. 060 Folder The folder containing the original item. 1632 Series The series number of the original item. Series III Subseries III Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Creator An entity primarily responsible for making the resource Lee, Lyndon E. Philip Donahue Herbert B. Greenlee Carlos R. Mota William Schumer Paul A. Thomas Title A name given to the resource TCDD (2,3,7,8-tetrachlorodibenzo-p-dioxin) in Body Fat of Vietnam Veterans and Others (Draft) Subject The topic of the resource VA Dioxin Fat Assay Study ao_seriesIII https://www.nal.usda.gov/exhibits/speccoll/files/original/82d2cf1780e15a03c570f2d75f569c25.pdf f0907c4d71a4360bd86c0b8f4b1701ff PDF Text Text Item ID Number °1491 Author Lee, Lyndon E. Corporate Author RBDOrt/ArtlClO TltlO Typescript: 2,3,7,8-Tetrachlorodibenzo-p-dioxin (TCDD) in Body Fat of Vietnam Veterans and Other Men Journal/Book Title Year 000 ° Month/Day Color Number oflmaoos n is Descripton Notes Tuesday, May 15, 2001 Page 1491 of 1514 �2,3,7,8-Tetrachlorodibenzo-p-dioxin (TCDD) in Body Fat of Vietnam Veterans and Other Men Lyndon E. Lee, M.D., Philip Donahue, M.D., Herbert B. Greenlee, M.D., Carlos R. MDta, M.D., William Schumer, M.D., Paul A. Thomas, Jr., M.D., and Lawrence B. Hobson, M.D., Ph.D. Veterans Administration Medical Centers: Washington, D.C.; West Side, Chicago, IL; Hines, IL; Lincoln, NE; West Side, Chicago, IL; forth Side, Chicago, IL; and Veterans Administration Central Office, Washington, D.C. Summary: TCDD in surgical biopsy specimens of fat from twenty veterans (A) reporting Agent Orange exposure in Vietnam, ten veterans (B) without Vietnam experience and (C) three Air Force officers recently exposed to Agent Orange and TCDD. In A 10/20, in B 2/10, and in C 2/3 men had detectable TCDD. The highest concentrations (in A) were 99 and 35 ppt.; none others exceed 12 ppt. Gas chromatography - mass spectrometry currently cannot prove Agent Orange exposure. The past three years have seen mounting concern over exposure to the defoliant 2,4,5-trichlorophenoxyacetic acid (2,3,5-T), an ingredient of Agent Orange used by the United States Armed Forces in Vietnam from 1965 to 1971. Some lots of 2,4,5-T contained small amounts of a contaminant, 2,3,7,8-tetrachlorodibenzo-p-dioxin, also called TCDD or "dioxin". TCDD is highly toxic to animals (1) and has been claimed to produce chronic and delayed adverse effects among American veterans who served in Vietnam. TCDD accumulates preferentially in the body fat of experimental animals (2) and man (3). It has been postulated that the compound remains in adipose tissue for years and damages the individual who subsequently �-2- loses fat and mobilizes the substance (4). TCDD has a half-life of 30 days in the fat of rats (5) and guinea pigs (7) and 105 to 125 days in the adipose tissue of cows ( ) No one has investigated the possibility that 7. TCDD remains more than eight years in the fat of veterans who served in Vietnam that long ago. Analytic methods for identifying and measuring TCDD have been improved in recent years so that it is possible to assay fat for quantities as small as a few parts per trillion, i.e. a few pioograms per gram or little more than 0.000000000001 gram of TCDD per gram of tissue (8). Because results viere uncertain and the method complicated and difficult, a pilot trial seemed more appropriate than a full-scale study to determine whether the assay discriminates between veterans who were exposed to Agent Orange a decade or so earlier and men who were not. The study might also indicate whether specific symptoms were associated with detectible TCDD in an individual's body fat. Subjects: Three groups of men served as subjects and all signed informed consents for biopsies. The smallest group of three Air Force officers had handled Agent Orange in field tests or in disposal operations and had worked with the herbicide and TCDD in a laboratory. All three reported repeated contact with the chemicals and all had been exposed within the prior two years. The second and largest group of twenty volunteers was self-selected; each believed that he was exposed to Agent Orange in Vietnam prior to 1971 and all but one claimed health problems as a consequence. The exposure of these men was recorded as they reported; tours of duty in Vietnam and military classifications were obtained from service records. �-3- The third or control group of ten veterans contained volunteers with no Vietnam servie and no known exposure to Agent Orange or related chemicals. Their biopsies were obtained during otherwise necessary abdominal operations. Methods; Surgeons removed 10 to 30 grams of subcutaneous fat from the abdominal wall under local anesthesia in the case of the 23 "exposed" men. A similar specimen was removed during operation from each of the ten "unexposed" controls. Precautions were taken before during and after the procedure to avoid contamination by products, e.g., hexachlorophene, that could contain TCDD. Specimens were collected in glass containers previously rinsed with acetone and dried before use. All tissues were refrigerated during shipment to the assay laboratory. The methods of extraction, gas chromatography, and mass spectrometry are described by Gross (8) who performed the analyses. As he reports a second laboratory assayed 15 of the 23 specimens using a somewhat different technique; only Gross1 results are considered here in order to maintain uniformity of the method used for all volunteers. The assays in both laboratories were performed without knowledge of which specimens came from "exposed" and which from "unexposed" men. Each of the volunteers had a medical history, physical examination, and routine clinical chemistry. The clinical data were reviewed, seeking correlations between them and the assay results. The details of military service in Vietnam from the volunteer's report and his service record were examined to evaluate his exposure to Agent Orange using the dates, location, and nature of his service. From these a rough estimate of the likelihood of exposure was made without knowledge of the assay results. �-4- Results; The assay results are reported in Table I. Details and comparisons with those from the second laboratory are given by Gross (8). Where the assay is indicated as negative despite an apparently detectible amount of TCDD, the chemist was unable to confirm the identity as TCDD. One of the three Air Force officers with known exposure had no identified TCDD in his fat. The unidentified substance in his case and the TCDD measured in the other two officers was never more than 3 parts per trillion (3 picograms per gram) above the limit of detection. Of the twenty veterans from Vietnam, seven had no detectible TCDD with the limit of detection at 2 to 6 parts per trillion (ppt). toother two (numbers 6 and 8) had detectible material that could not be validated as TCDD and the results for two (numbers 11 and 14) were considered equivocal because the measured value was only questionably above the detection limit. Pour of the nine remaining Vietnam veterans had TCDD in amounts from 5 ppt to 7 ppt. Five men had TCDD in concentrations above those of the controls. One (number 26) had 63 to 99 ppt; another (number 10) had to 35 ppt. Of the ten "unexposed" veterans, two had TCDD identified in their fat; neither had more than 8 ppt. Two other veterans (numbers 17 and 32) had values low enough to be considered equivocal and in five instances the detected material was not validated as TCDD. The remaining veteran had no detectible TCDD. No specimen was submitted for the assigned number 22. Veterans were divided into three groups on the basis of exposure in Vietnam to Agent Orange. One contained the three volunteers (numbers 10 19 and 26) who were judged to be most heavily exposed. They included handling the defoliant amoung their duties in Vietnam. Five other veterans judged to have had little likelihood of exposure to Agent Orange �-5- either because their location was removed from the areas sprayed (numbers 1, 15 and 34), because the dates of their Vietnam duty (numbers 13 and 28) or its short duration (number 1) reduced the chances of exposure, or because the description of exposure was questionable (number 34). The remaining twelve Vietnam veterans appear to have had an intermediate likelihood of exposure, i.e. between that of the other groups. Among the most heavily exposed men, two (numbers 10 and 26) had the highest TCDD content in their body fat but the other man (number 19) had no identifiable TCDD. Two of the lightly exposed men (numbers 1 and 13) had no detectible TCDD but the other three did have. Six of the twelve men judged to have had intermediate exposure were ground combat troops; three had TCDD in their fat, three did not. Of the six other veterans, two had detectible TCDD and three did not; one with a doubtful level was a helicopter gunner who described some contact with Agent Orange. Table II summarizes the clinical information regarding all twenty Vietnam veterans. Seven of them (numbers 9, 13, 15, 26, 27, 29 and 30) reported some health problems beginning during a tour of duty in Vietnam. ND two, however, reported the same symptoms. The remaining thirteen veterans reported no illness in Vietnam although only one reported good health at all times. Among the nineteen veterans with current medical complaints, symptoms and diagnoses varied widely without any common pattern. Five had mental problems ranging from nervousness to schizophrenia (numbers 9, 13, 15, 30 and 34) and three had experienced difficulties of reproduction, namely, spontaneous abortion by the wives of �-6- two (numbers 11 and 15) and congenital heart disease in the son of a third (number 16). Pour of the seven veterans who reported difficulties while in Vietnam had no TCDD detected; the other three had 7 to 99 ppt. The five veterans with mental problems included three without detectible TCDD and three whose assays results were 5 to 7 ppt. One of three veterans reporting reproductive problems had no detected TCDD, one had a doubtful level, and one had 7 ppt. Detectible TCDD in the body fat could not be correlated with clinical chemical findings. Discussion; Gross (8) concluded that his assay is capable of detecting and measuring a few parts per trillion of TCDD in human fat. The present technique is, however, difficult and delicate and may not be free of error. The determinations require surgical biopsy, a minor operation, performed under conditions that avoid contamination with TCDD. TCDD has been found in substances other than 2,4,5-T (1). It and closely related chemicals could have been acquired by "exposed" and "unexposed" veterans from the civilian environment long after they left military service. There is no known source of TCDD, however, in the surroundings of a steel mill crane operator and student nor of an artist, the two men with the greatest concentrations of the compound. It is impossible to determine when, in what amounts, and from what source the subjects could have acquired TCDD. TCDD was found in some persons who report exposure to Agent Orange and in others who were never in Vietnam. On the other hand, some veterans from Vietnam had no detectible TCDD and the same is true of veterans who were never in Vietnam. The low level of TCDD in two Air Force officers and its absence in another is of special interest since their exposure to �TCDD is certain and more recent than that of the veterans. flnong the twenty Veitnam veterans there was no uniformity of symptoms, either immediately after exposure, at the time of biopsy, or during the intervening period. No one symptom or group of symptoms was common to veterans with detectible TCDD in their fat. The presence of TCDD did not mean ill health nor did its absence indicate good health. ND detailed statistical analysis was attempted of this small pilot series. The TCDD content in the fat was very small, not exceeding 100 ppt. Since TCDD accumulates in fat more than in other tissues, the average body concentration would be much lower. Even if all tissues contained 100 ppt., however, the concentration would be 0.1 microgram per kilogram of body weight, too far below the demonstrated toxic dose to threaten health. Conclusions; The present assay for TCDD in fat tissue does not offer a satisfactory routine test for exposure to Agent Orange, providing neither clear evidence of contact with that specific defoliant nor of absence of such contact. The assay technique is difficult and not readily available, fat samples must be obtained by surgical biopsy, and the source of any TCDD detected is uncertain. The current assay method does provide a research tool under proper conditions and for specific purposes, e.g., for determining the rate of disappearance of TCDD after known exposure. �-8- References; (1) Young, A.L., J.A. Calcagni, C.E. Thalkan, and J.W. Tremblay, The Toxicology, Environmental Fate and Human Risk of Herbicide Orange and its Associated Dioxin. USAF OEHL Technical Report TR-78-92(1978). (2) Gasiewicz, T.A. and R.A. Neal, Fed. Proc. 37(3):501(1978). (3) Reggiani, G., The estimation of the TCDD toxic potential in the light of the Seveso accident. Presented at the 20th Congress of the European Society of Toxicology, West Berlin (1978). (4) Commoner, B., Hosp. Pract. 13(6):56(1978). (5) Rose, J.Q., J.C. Ramsey, T.H. Vfentzler, R.A. Hummel and P.G. Gehring, Tox. and Appl. Pharmacology 36:209(1976). (6) Gasiewicz, T.A. and R.A. Neal, ibid. 51:329(1978). (^) Exposure, Toxicity and Risk Assessment of 2,4,5-T/TCDD. Element Associates Document prepared for Environmental Protection Agency Vol. 1, pages 1-36(1980). (8) Gross, M.L., J.O. Lay, P.A. Lyon, D. Lippstreu, N. Kangas, R.L. Harless, and A. E. Dupuy, Jr., In press (1981). �-9- Table I. TCDD in Human Fat Samples (after Gross (6)) Veterans with Military Service in Vietnam TCDD TCDD Cbncentration Subject Presence (parts per trillion) 1 Neg. 6 TCDD TCDD Cbncentration Subject Presence (parts per trillion) nd (5)b 28 Pos. 7 (5) Neg.a 5 (3) 29 Pos. 13 (5) 8 Nsg.a 5 (3) 30 Neg. nd (3) 9 Neg. nd (3) 34 Pos. 5 (3) 10 K>s. 12 (2) Air Force Officers 16 (4) 2 Pos. 5 (2) 35 (9) 3 Neg.a 4 (1) 23 (4) 4 Pos. 6 (2) 11 Dfl.c 3 (2) 12 POS. 9 (3) 5 Neg.a 4 (4) 13 Neg. nd (2) 7 Neg.d 3 (2) 14 Dfl. 4 (3) 17 Dfl. 4 (3) 15 Pos. 7 (4) 18 Neg. nd (4) 16 Neg. nd (4) 20 Pos. 5 (4) 19 Neg. nd (3) 21 Neg.d 6 (3) 24 Pos. 5 (3) 23 Pos. 8 (2) 25 Pos. 12 (4) 31 Neg.d 7 (4) 26 Pos. 63 (6) 32 Dfl. 4 (4) 99 (10) 33 Neg.d 14 (7) 27 Neg. nd (6) Veterans with Military Service Ouside Vietnam �-10- a. Cannot be considered positive (Pos.) because of poor validation (substance detected probably not TCDD) and contaminant removed on repeat analysis. b. "nd" means "not detectible". Value in parentheses is limit of detection of TCDD. c. "Doubtful" (Dfl.) indicates that result would be considered positive at 2.5:1 signal: noise ratio negative at 3:1 ratio. d. Cannot be considered positive because of poor validation (substance detected probably not TCDD). �TABLE II. SUMMARY OF CLINICAL INFORMATION SUBJ: 1 6 Non-Service Exposures Immediate Symptoms Intermediate Health Chlorine; chemotherapy; radiation None given*a' Temperoparietal Radiation tonsils 1950 None given Current Symptoms None tumor; "kidney condition" Acoustic tumor Findings and/or Diagnoses Malignant astrocytoma-1976 Headaches; facial pain Acoustic neuroma 1979; thyroid nodule 1976 8 Alcohol , None given No reported difficulty Ulcer after cut Numbness & tingling Rhinitis; "back condition" Numbness, tingling; cocaine, marihuana use 9 None fo) Chronic ulceration of finger Hostility; fatigability; fever; abdominal "psychiatric & sexual problems" 10 None None given Back pain; otitis tenderness pharyngeal edema "Stomach condition" Plantar wart Intermittent chest pain & dyspnea: urinary frequence infertility None None Butterfly rash on face & forehead media; wart 11 None None given Wife aborted at 3-4 months 12 None None given Butterfly facial rash after alcohol or anxiety as before Vietnam (a) "None" indicates that record states a negative reply (b) "None given" indicates that record indicates neither positive or negative reply �TABLE II. SUMMARY OF CLINICAL INFORMATION SUBJ: Non-Service Exposures Immediate Sjymptoms 13 Heroin for 3 yrs 4 yrs ago Plantar warts 14 Farm and photographic chemicals; lawn fertilizers 15 Intermediate Health Mastectomy for gynecomastia 1978 Findings and/or Diagnoses Current Symptoms Swollen lids & red conjunctiva; nervousness; tingling of fingers & toes; periodic weakness Jumpy; small non-tender axillary nodes None given*b' Kidney stone 1975; pleurisy & pneumonia; PPD pos. - 1969; blood in stools Chest pain; forehead cyst; lipoma; mole; hernia Sarcoidosis; inguinal hernia; lipoma; cyst Cleaning agents; heavy alcohol use Rash on Nervousness; wife legs; occa- aborted; "nervous breakdown" - 1972 sional diarrhea; "jungle rot" of toe-nails & groin Recurrent extermity swelling; "nerves"; rash Schizophrenia; cnychomycosis; pigmented areas on legs 16 None (a) None given Son-congen ital heart disease 1971 Dry cough; foot problems since service Lt. great toe contracture; tenia pectis 19 None None given No statement Painful leg edema veins Varicose veins 24 Heroin until 3 yrs ago None given Painful knee & leg swelling after exercise Groin pain; low back pain Hemorrhoids; palpable liver; hernia 25 Insecticides None given Recurrent dry patches on back & shoulders; peptic ulcer Pain, swelling left knee, post-traumatic Arthritis; chronic cholecystitis; fatty liver; hypertension; tenia versicolor (a) "None" indicates that record states a negative reply (b) "None given" indicates that record indicates neither positive or negative reply �TABLE II. SUMMARY OF CLINICAL 1OTOPMATION SUBJ; Non-Service Exposures Immediate Symptoms Intermediate Health Findings and/or Diagnoses Current Symptoms 26 None(a> None given^) Crampy abdominal pain; allergy to fish & IVP dye Severe rectal itch; occasional generalized skin itch Pruritis ani; possible urticaria 27 None Tingl ing, swelling of hands & feet; insomnia from pain Tingling of fingers & toes hematemesis; back pain Reynaud-like reaction; weakness of extremities Stiff fingers & toes bilateral limp 29 None None given Amoebic dysentery; Early morning weakpluerisy in ness, normal by Vietnam; "weak" evening before discharge; hypertension at discharge; crampy abdominal pain "Polycystic kidney" 30 Primary light oils, benzene toluene, etc. Cough, asthma made worse Nervousness 34 None None given Multiple, general- Chronic anxiety; ized lipomata dyspnea; blurred vision; palpitations; chest pain, stomach pain; facial flushing; infraorbital "water blisters"; hypertension Duodenitis; marginal hypertension Intermittent pruritic Expiratory rash on flexor sur- rhonchi face of arms Abdominal nodules (possible lipomata) (a) "None" indicates that record states a negative reply (b) "None given" indicates that record indicates neither positive or negative reply � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Alvin L. Young Collection on Agent Orange Description An account of the resource <p style="margin-top: -1em; line-height: 1.2em;">The Alvin L. Young Collection on Agent Orange comprises 120 linear feet and spans the late 1800s to 2005; however, the bulk of the coverage is from the 1960s to the 1980s and there are many undated items. The collection was donated to Special Collections of the National Agricultural Library in 1985 by Dr. Alvin L. Young (1942- ). Dr. Young developed the collection as he conducted extensive research on the military defoliant Agent Orange. The collection is in good condition and includes letters, memoranda, books, reports, press releases, journal and newspaper clippings, field logs and notebooks, newsletters, maps, booklets and pamphlets, photographs, memorabilia, and audiotapes of an interview with Dr. Young.</p> <p>For more about this collection, <a href="/exhibits/speccoll/exhibits/show/alvin-l--young-collection-on-a">view the Agent Orange Exhibit.</a></p> Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Box The box containing the original item. 056 Folder The folder containing the original item. 1491 Series The series number of the original item. Series III Subseries II Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Creator An entity primarily responsible for making the resource Lee, Lyndon E. Philip Donahue Herbert B. Greenlee Carlos R. Mota William Schumer Paul A. Thomas, Jr. Lawrence B. Hobson Title A name given to the resource Typescript: 2,3,7,8-Tetrachlorodibenzo-p-dioxin (TCDD) in Body Fat of Vietnam Veterans and Other Men Subject The topic of the resource adipose tissue testing ao_seriesIII