Intraoperative photodynamic therapy after pleuropneumonectomy for malignant pleural mesothelioma.

and its placement in the section on occupational and environmental lung disease is misleading. Moreover, nowhere in the article is there specific reference to the fact that it deals only with acute exposures. By conservative estimates, there are at least 8,000 deaths annually in the United States caused by occupational asbestos exposure, almost all of which qualify as being caused by " fatal, work-related inhalation of harmful substances. " As one who has represented these victims for Ͼ 25 years and who continues to focus on both the litigation and legislative contexts in which our society must deal with occupational lung disease, I am concerned when a journal as prestigious as yours even inadvertently creates the opportunity for miscitation and inappropriate minimization of the real occupational disease problems still facing our society. Perhaps an appropriate qualification is in order. I would also suggest a little more attention to the " trappings " surrounding even the most useful of articles. Mr. Kazan is right when interpreting that our article 1 in the March 2002 issue of CHEST deals only with acute exposures. However, we do not think that any misunderstanding could arise from the reading of the article, as we clearly state throughout the abstract and the article that we focus on occupational injuries. There is a consensus in the medical and epidemiologic community about what constitutes an injury. It might be useful, however, to report here the definition provided by the US Bureau of Labor Statistics: " An injury is defined as any intentional or unintentional wound or damage to the body resulting from acute exposure to energy, such as heat, electricity, or kinetic energy from a crash, or from the absence of such essentials as heat or oxygen caused by a specific event, incident, or series of events within a single workday or shift. " This definition is available to anyone at the Web page of the Census of Fatal Occupational Injuries, our referenced source of data. 2 We read with great interest the article by Schouwink et al (October 2001) 1 about intraoperative photodynamic therapy after pleuropneumonectomy for the treatment of patients with pleural mesothelioma. In the series by Sugarbaker et al, 2 pleuropneumonectomy has a low postoperative mortality rate (3.8%) and relatively satisfying long-term results. Their technique involves opening the pericar-dial cavity and resecting the diaphragm while preserving the peritoneum. However, mesothelioma is one of the most …