Baron & Budd, P.C. is one of the largest plaintiffs’ law firms in the country. The firm focuses on individuals, municipalities, and entities harmed by environmental toxins, fraud or disregard for safety  and remains active in cases involving pharmaceutical litigation, financial fraud, Chinese Drywall, and California Proposition 65.
Baron and Budd Protecting What's Right PDF generated using the open source mwlib toolkit. See http://code.pediapress.com/ for more information. PDF generated at: Tue, 28 Jun 2011 06:43:19 UTC Contents Articles Baron & Budd, P.C. 1 Fred Baron 3 Mesothelioma 7 References Article Sources and Contributors 22 Image Sources, Licenses and Contributors 23 Article Licenses License 24 Baron & Budd, P.C. 1 Baron & Budd, P.C. Baron & Budd, P.C. Industry Law Founded 1977 Headquarters 3102 Oak Lawn Venue, Suite 1100, Dallas, Texas, U.S. Number of 5 locations Area served Main office in Dallas, Texas. Other offices in Austin, Texas; Los Angeles, California; Miami, Florida; and Baton Rouge, Louisiana Key people Russell Budd, President and Managing Shareholder Services Mesothelioma and asbestos, water contamination, online scams, Qui Tam/False Claims Act, Chinese Drywall, dangerous drugs and medical devices, commercial litigation, FCPA/Whistleblower, securities fraud Employees 260 Website  Baron & Budd Baron & Budd, P.C. is one of the largest plaintiffs’ law firms in the country. The firm focuses on individuals, municipalities, and entities harmed by environmental toxins, fraud or disregard for safety  and remains active in cases involving pharmaceutical litigation, financial fraud, Chinese Drywall, and California Proposition 65. History Baron & Budd began its practice in 1977. The firm’s first major case involved a lead smelter adjacent to one of Dallas’ largest public housing projects. Baron & Budd represented more than 200 families in a lawsuit that eventually closed the smelter and provided sizable damage awards for court-supervised trusts benefiting 445 children. Mesothelioma Baron & Budd was one of the first law firms in the nation to successfully try a mesothelioma case. Baron & Budd eventually took its defense of mesothelioma victims to the Supreme Court, battling asbestos companies and, in some cases, other plaintiffs’ firms that wanted to turn all asbestos cases into class action lawsuits. Asbestos When a Halliburton subsidiary filed for bankruptcy reorganization in the late '90s, Baron & Budd stepped in to protect the rights of the firm’s asbestos victims. Russell Budd, the firm’s managing shareholder, negotiated with Halliburton and became the chief architect in establishing a trust fund that would protect current and future asbestos victims throughout the United States. The agreement reached between Halliburton and Baron & Budd created the largest asbestos trust fund of its kind anywhere in the world. Baron & Budd, P.C. 2 Water Contamination In 1985, Baron & Budd filed suit on behalf of more than 1,600 Tucson-area residents against an aircraft manufacturer, the City of Tucson, and the Tucson Airport Authority over trichloroethylene (TCE) contamination of the community’s groundwater. Throughout the ensuing 21-year legal battle that Baron & Budd ultimately won, the law firm helped to define Arizona law on pollution coverage. The case is widely considered as among the most important in U.S. history involving personal injuries caused by water pollution. In 2003, Baron & Budd represented the City of Santa Monica in a landmark MTBE contamination settlement with the major oil companies. MTBE contaminated five of Santa Monica’s 11 wells, forcing the city to begin importing water in 1996 for $3 million a year. In 2008, Baron & Budd played a lead role in negotiations with major oil companies that had contaminated drinking water through the use of MTBE as a gasoline additive. Baron & Budd’s efforts resulted in a landmark settlement, requiring the oil companies to pay a substantial cash settlement, nearly $1.5 billion, to 153 public water providers in 17 states, as well as a number of private well owners. In 2010, Scott Summy, the head of Baron & Budd’s water contamination team, was one of four attorneys nationwide chosen to serve on the Plaintiffs’ Executive Committee for the Gulf Oil Spill Multi-District Litigation (MDL) and as a member of the Plaintiffs’ Steering Committee (PSC). In August 2010, environmental attorney and Baron & Budd shareholder Burton LeBlanc of Baton Rouge, Louisiana, and Baron & Budd were retained by the state of Louisiana to provide counsel to the state’s designated trustees in connection with issues related to the Deepwater Horizon explosion and the resulting oil spill. Chinese Drywall In 2011, Baron & Budd, along with co-counsel, represented the first Chinese Drywall client to be remediated by the Chinese Sheetrock manufacturer Knauf. External links • Website of Baron & Budd  References  http:/ / baronandbudd. com  The History of Baron & Budd (http:/ / baronandbudd. com)  , Baron & Budd, P.C. Wins $9 Million Mesothelioma Cancer Verdict Against Dow Chemical (http:/ / www. marketwatch. com/ story/ baron-budd-pc-wins-9-million-mesothelioma-cancer-verdict-against-dow-chemical-2011-03-17) Business Wire, March 7, 2011. Accessed April 7, 2011.  Jonathan Glater, The Path Taken By Halliburton To Reach a Deal In Asbestos Suits (http:/ / www. nytimes. com/ 2002/ 12/ 31/ business/ the-path-taken-by-halliburton-to-reach-a-deal-in-asbestos-suits. html?src=pm), The New York Times, December 31, 2002. Accessed February 15, 2007.  "Tucson-Area Water Contamination Victims Triumph in Arizona Appeals Court Ruling Against Insurer" (http:/ / www. claimsjournal. com/ news/ west/ 2004/ 10/ 01/ 46444. htm), Claims Journal, October 1, 2004. Accessed February 15, 2007.  Associated Press, "Most oil companies in MTBE lawsuits settle" (http:/ / www. msnbc. msn. com/ id/ 24541226/ ns/ us_news-environment), MSNBC, May 9, 2008. Accessed April 5, 2011.  Marilyn Tennisen, "Texas attorneys appointed to plaintiff steering committee for BP MDL cases" (http:/ / www. setexasrecord. com/ news/ 230367-texas-attorneys-appointed-to-plaintiff-steering-committee-for-bp-mdl-cases),Southeast Texas Record, October 13, 2011. Accessed April 6, 2011.  "Environmental Attorney Burton LeBlanc of Baron & Budd, P.C. Hired by Louisiana Office of Coastal Protection and Restoration" (http:/ / www. businesswire. com/ news/ home/ 20100813005906/ en/ Environmental-Attorney-Burton-LeBlanc-Baron-Budd-P. C) MSNBC, August 13, 2010. Accessed April 5, 2011  , "Baron & Budd enter Chinese drywall fray" (http:/ / www. bizjournals. com/ dallas/ stories/ 2009/ 05/ 04/ daily21. html), Dallas Business Journal, May 5, 2009. Accessed April 6, 2011.  http:/ / baronandbudd. com/ Fred Baron 3 Fred Baron Fred Baron Fred Baron in 2008 Born Frederick Martin BaronJune 20, 1947Cedar Rapids, Iowa Died October 30, 2008 (aged 61)Dallas, Texas, USA Nationality American Occupation Lawyer Frederick Martin Baron (June 20, 1947 – October 30, 2008 ) was a trial lawyer best known for representing plaintiffs claiming toxic and chemical exposure. He was also an active figure in politics as a fund-raiser for the Democratic Party. Biography Legal career Baron was one of the founders of Baron & Budd, P.C., a Dallas, Texas law firm and a former president of the Association of Trial Lawyers of America. Fred Baron sold his interest in Baron & Budd and retired from the firm in December 2002. His former firm has become one of the largest firms in the country representing victims of toxic and chemical exposure particularly claims of asbestos exposure. As a young lawyer in 1975, Baron became a pioneer in the application of strict liability causes of action in asbestos litigation using the then-recently adopted Restatement Second of Torts Section 402a. He represented workers and widows of deceased workers at Pittsburg Corning's Tyler, Texas plant. Fred Baron inspired a generation of lawyers to continue to represent asbestos workers and persons with asbestos exposure, which continues to be cited by lawyers for plaintiffs as the leading causes of occupational injury in the United States. One academic estimated that Baron & Budd, along with Ness Motley, was one of two firms responsible for half of the hundreds of thousands of asbestos litigation claimants in the country. Baron convinced the United States Supreme Court to de-certify nationwide asbestos class action settlements involving future claims of people who are not yet ill, but who may later develop asbestos-related illnesses. The decertification addressed the problem that asbestos-related illnesses like mesothelioma (a fatal cancer of the lining of the lung), have a latency period of 20–40 years from the date of exposure. In 1985, Baron reached a $20 million (some argue $45 million after payments with interest are included over a 30 year period) agreement with RSR Corporation for one of the largest community lead contamination cases ever. In the mainly impoverished and minority community of West Dallas, he represented 370 children and some 40 property owners. Most clients resided in the West Dallas public housing complex that was located directly in the path of the prevailing southerly winds that had blown lead particles released in the air by RSR Corp. into the lives of the Fred Baron 4 children in the neighborhood. The case did not however make it all the way through the court systems. The actual agreement came in an out-of-court settlement with Baron and RSR Corp. The children benefiting from Barons work receive interest included periodical payments over a 30 year period. Political career Baron was an active figure in politics as a prominent fund-raiser for the Democratic Party and fellow trial lawyer, Sen. John Edwards. Baron was the finance chair of Edwards's 2004 presidential campaign before co-chairing the Kerry Victory '04 committee, a joint effort of the Democratic National Committee and the Presidential campaign of John Kerry. Baron gave $1.7 million to the Texas Democratic Trust in the last two years and is also heavily involved in Edwards's 2008 presidential campaign, moving to North Carolina to head up fundraising, and renting Edwards his Hawker 800 private jet. In total, the Edwards campaign paid Baron nearly 1.1 million dollars for this service. Baron joked about the prominence he and other trial lawyers have in the Democratic Party. In a July 2002 speech, he noted a Wall Street Journal editorial that said that "the plaintiffs bar is all but running the Senate." Baron pointed to the editorial and said, "Now I really, strongly disagree with that. Particularly the 'all but.'" Baron indicated on August 8, 2008, two months before his death at age 61, that he had given monetary assistance to the woman John Edwards had an affair with, Rielle Hunter. He claims he paid her directly, not using campaign money. Asbestos litigation tactics Baron & Budd have been criticized by attorneys for both plaintiffs and defendants for their role in asbestos litigation in aggressively seeking payment for plaintiffs who have suffered no injury; as a result, many defendants have been bankrupted and seriously injured plaintiffs have been unable to recover. The Baron & Budd asbestos memo is alleged to have been a subornation of perjury and a cover-up. It is cited by United States civil justice reformers and politicians as an example of ethical problems in the plaintiffs' bar and asbestos litigation. Baron and some academics argue that the memo was the act of a single paralegal, and that it was within the bounds of "zealous representation." However, the Dallas Observer conducted an investigation of the memo, and found that "a number of former Baron & Budd employees say that the information and techniques contained in the memo are widely used, even taught to employees" and that the "memo was not truly an aberration, but a written example of how the product-identification staff works at Baron & Budd."   In 2002, Baron left Baron & Budd along with his wife, Lisa Blue. Baron sued his former firm for breach of contract; Baron & Budd counterclaimed alleging that Baron and Blue breached contractual, fiduciary and legal obligations to the firm by failing to receive prior consent from Baron & Budd for plans to form a new firm. Baron lived in the Preston Hollow neighborhood of north Dallas. Awards and honors • Fred Baron has been honored as a lawyer who helped shape Texas law during the 20th century in Legal Legends: A Century of Texas Law and Lawyering. • Named as one of the nation's top plaintiff's lawyers by Forbes magazine (2001). • Named one of Dallas' top lawyers by D Magazine (May 2001 and May 2005). • In 2001, The University of Texas School of Law endowed a chair in his name. • Past president of the Association of Trial Lawyers of America (ATLA); • A member of the Board of Governors of ATLA, as Chairman of the Public Affairs Committee on the Board of Governors, and Chairman of its Section on Toxic, Environmental and Pharmaceutical Torts; • Past president of Trial Lawyers for Public Justice; • A member of the Board of Directors of The American Constitution Society; Fred Baron 5 • A member of the American Law Institute, serving on the Products Liability sub-committee; • Vice-Chairman of the Toxic and Hazardous Substances and Environmental Law Subcommittee for the American Bar Association; • Member of the American Board of Trial Advocates; • Life Fellow of the Texas Bar Foundation and Dallas Bar Foundation; • Former member of the Board of Advisors to the Toxic Law Reporter (B.N.A.); • Former Trustee for the Civil Justice Foundation; • Member of the Advisory Board of Texas Citizen Action; • Director of the Texas Law Review Association; • Director of the Irving Selikoff Foundation (Charitable Trust); • Trustee of the Manville Victims Special Trust (Charitable Trust); • Trustee of the Democratic National Committee; • On the Texas Advisory Board of the Environmental Defense Fund. References  Article about death (http:/ / www. dallasnews. com/ sharedcontent/ dws/ news/ localnews/ stories/ 103108dnmetbaron. 164c3b4a4. html)  Association of Trial Lawyers of America (http:/ / www. utexas. edu/ law/ depts/ alumni/ trustees/ baron. html)  "Outrageous Misconduct: The Asbestos Industry on Trial", Paul Brodeur, 1985, Pantheon Books, NY  Samuel Issacharoff, ‘‘Shocked’’: Mass Torts and Aggregate Asbestos Litigation After Amchem and Ortiz, 80 Tex. L. Rev. 1925, 1930 (2002).  Amchem Products, Inc. et al., v. George Windsor et al. (http:/ / www. law. cornell. edu/ supct/ html/ 96-270. ZO. html)  "Attorneys" (http:/ / baronandbudd. com/ about/ attorneys/ ). Private Firm. . Retrieved 2010-04-26.  Democratic effort helped by lawyer's $1.7 million (http:/ / www. tpj. org/ page_view. jsp?pageid=1100& pf=1), Austin American-Statesman, 12 Nov. 2006  "2008 Candidates Rely on Private Jets to Get Around" (http:/ / www. foxnews. com/ story/ 0,2933,268942,00. html). Fox News/Associated Press. 2007-04-27. . Retrieved 2008-06-03.  "John Edwards Expenditure Data" (http:/ / www. fec. gov/ DisclosureSearch/ MapAppDownload. do?cand_id=P40002347& cand_nm_title=Edwards, John& tranType=expendDetail). . Retrieved 2008-08-10.  John Fund, "Have You Registered to Sue?" (http:/ / www. opinionjournal. com/ diary/ ?id=110002581), Wall Street Journal, 6 Nov. 2002  http:/ / www. chron. com/ disp/ story. mpl/ metropolitan/ 5933053. html  Thomas Korosec, "Enough to Make You Sick" (http:/ / www. dallasobserver. com/ 2002-09-26/ news/ enough-to-make-you-sick/ full), Dallas Observer, 26 Sep 2002  Lester Brickman, "On the Theory Class’s Theories of Asbestos Litigation: The Disconnect Between Scholarship and Reality" (http:/ / papers. ssrn. com/ sol3/ papers. cfm?abstract_id=490682), 31 Pepperdine L. Rev. 33 (2004).  Walter Olson, "Thanks for the Memories" (http:/ / www. overlawyered. com/ articles/ olson/ memories. html), Reason (June 1998)  Additional View of Senator Kyl, Senate Report No. 108-118 (http:/ / frwebgate. access. gpo. gov/ cgi-bin/ getdoc. cgi?dbname=108_cong_reports& docid=f:sr118. 108. pdf) at pp. 81-184 (21 Jul. 2003) (reprinting memo in full).  W. William Hodes, The Professional Duty To Horseshed Witnesses—Zealously, Within The Bounds Of the Law, 30 TEX. TECH L. REV. 1343 (1999). See also Charles Silver, Preliminary Thoughts on the Economics of Witness Preparation, 30 TEX. TECH L. REV. 1383, 1398-1401 (1999)(discussing forces affecting the preparation of witnesses in civil cases, including mass tort lawsuits).  Julie Lyons, Patrick Williams, Thomas Korosec, and Christine Biederman, "Toxic Justice" (http:/ / www. dallasobserver. com/ 1998-08-13/ news/ toxic-justice/ ), 13 Aug. 1998  Thomas Korosec, "Homefryin' with Fred Baron" (http:/ / www. dallasobserver. com/ 2001-03-29/ news/ homefryin-with-fred-baron/ ), Dallas Observer, 29 March 2001  Julie Lyons, The Control Freak (http:/ / www. dallasobserver. com/ issues/ 1998-08-13/ columns. html), Dallas Observer, 13 Aug. 1998.  Brenda Sapino Jeffreys, Baron & Budd Alleges Ex-Shareholders Breached Duties by Planning Vioxx Venture With Lanier (http:/ / www. law. com/ jsp/ article. jsp?id=1165582058489), Texas Lawyer, 11 Dec 2006  Texas Lawyer commemorative publication, June 2000  Mary Ann Thomas and Ramesh Santanam 2002. "Lawsuit against ARCO, BWXT rolls on". Valley News Dispatch. (http:/ / www. pittsburghlive. com/ x/ pittsburghtrib/ s_88352. html)  "Chair established to honor Frederick M. Baron, '71" (2001) (http:/ / www. utexas. edu/ law/ news/ 2001/ chair_baron. html) Fred Baron 6 External links • Columbia Journalism Review "Baring Baron." (http://www.cjrdaily.org/politics/baring_baron.php) • San Antonio Express News column - "City climbs into legal/lucre bed with Democratic trial lawyers" (http:// www.mysanantonio.com/news/columnists/rstinson/stories/MYSA052106.3A.rstinson.74d1abd.html) Mesothelioma 7 Mesothelioma Mesothelioma Classification and external resources Left sided mesothelioma with mediastinal node enlargement : CT scan. ICD-10  C45. ICD-9  163 ICD-O:  M9050/3 -9055 OMIM  156240 DiseasesDB  8074 MedlinePlus  000115 eMedicine  med/1457 MeSH  D008654 Mesothelioma, more precisely malignant mesothelioma, is a rare form of cancer that develops from the protective lining that covers many of the body's internal organs, the mesothelium. It is usually caused by exposure to asbestos. Its most common site is the pleura (outer lining of the lungs and internal chest wall), but it may also occur in the peritoneum (the lining of the abdominal cavity), the pericardium (a sac that surrounds the heart), or the tunica vaginalis (a sac that surrounds the testis). Most people who develop mesothelioma have worked on jobs where they inhaled asbestos and glass particles, or they have been exposed to asbestos dust and fiber in other ways. It has also been suggested that washing the clothes of a family member who worked with asbestos or glass can put a person at risk for developing mesothelioma. Unlike lung cancer, there is no association between mesothelioma and smoking, but smoking greatly increases the risk of other asbestos-induced cancers. Those who have been exposed to asbestos have collected damages for asbestos-related disease, including mesothelioma. Compensation via asbestos funds or lawsuits is an important issue in law practices regarding mesothelioma (see asbestos and the law). The symptoms of mesothelioma include shortness of breath due to pleural effusion (fluid between the lung and the chest wall) or chest wall pain, and general symptoms such as weight loss. The diagnosis may be suspected with chest Mesothelioma 8 X-ray and CT scan, and is confirmed with a biopsy (tissue sample) and microscopic examination. A thoracoscopy (inserting a tube with a camera into the chest) can be used to take biopsies. It allows the introduction of substances such as talc to obliterate the pleural space (called pleurodesis), which prevents more fluid from accumulating and pressing on the lung. Despite treatment with chemotherapy, radiation therapy or sometimes surgery, the disease carries a poor prognosis. Research about screening tests for the early detection of mesothelioma is ongoing. Signs and symptoms Symptoms or signs of mesothelioma may not appear until 20 to 50 years (or more) after exposure to asbestos. Shortness of breath, cough, and pain in the chest due to an accumulation of fluid in the pleural space (pleural effusion) are often symptoms of pleural mesothelioma. Symptoms of peritoneal mesothelioma include weight loss and cachexia, abdominal swelling and pain due to ascites (a buildup of fluid in the abdominal cavity). Other symptoms of Peritoneal Mesothelioma may include bowel obstruction, blood clotting abnormalities, anemia, and fever. If the cancer has spread beyond the mesothelium to other parts of the body, symptoms may include pain, trouble swallowing, or swelling of the neck or face. These symptoms may be caused by mesothelioma or by other, less serious conditions. Mesothelioma that affects the pleura can cause these signs and symptoms: • Chest wall pain • Pleural effusion, or fluid surrounding the lung • Shortness of breath • Fatigue or anemia • Wheezing, hoarseness, or cough • Blood in the sputum (fluid) coughed up (hemoptysis) In severe cases, the person may have many tumor masses. The individual may develop a pneumothorax, or collapse of the lung. The disease may metastasize, or spread, to other parts of the body. Tumors that affect the abdominal cavity often do not cause symptoms until they are at a late stage. Symptoms include: • Abdominal pain • Ascites, or an abnormal buildup of fluid in the abdomen • A mass in the abdomen • Problems with bowel function • Weight loss In severe cases of the disease, the following signs and symptoms may be present: • Blood clots in the veins, which may cause thrombophlebitis • Disseminated intravascular coagulation, a disorder causing severe bleeding in many body organs • Jaundice, or yellowing of the eyes and skin • Low blood sugar level • Pleural effusion • Pulmonary emboli, or blood clots in the arteries of the lungs • Severe ascites A mesothelioma does not usually spread to the bone, brain, or adrenal glands. Pleural tumors are usually found only on one side of the lungs. Mesothelioma 9 Cause Working with asbestos is the major risk factor for mesothelioma. In the United States, asbestos is the major cause of malignant mesothelioma and has been considered "indisputably" associated with the development of mesothelioma. Indeed, the relationship between asbestos and mesothelioma is so strong that many consider mesothelioma a “signal” or “sentinel” tumor.    A history of asbestos exposure exists in most cases. However, mesothelioma has been reported in some individuals without any known exposure to asbestos. In rare cases, mesothelioma has also been associated with irradiation, intrapleural thorium dioxide (Thorotrast), and inhalation of other fibrous silicates, such as erionite. Some studies suggest that simian virus 40 (SV40) may act as a cofactor in the development of mesothelioma. Asbestos was known in antiquity, but it was not mined and widely used commercially until the late 19th century. Its use greatly increased during World War II. Since the early 1940s, millions of American workers have been exposed to asbestos dust. Initially, the risks associated with asbestos exposure were not publicly known. However, an increased risk of developing mesothelioma was later found among shipyard workers, people who work in asbestos mines and mills, producers of asbestos products, workers in the heating and construction industries, and other tradespeople. Today, the official position of the U.S. Occupational Safety and Health Administration (OSHA) and the U.S. EPA is that protections and "permissible exposure limits" required by U.S. regulations, while adequate to prevent most asbestos-related non-malignant disease, they are not adequate to prevent or protect against asbestos-related cancers such as mesothelioma. Likewise, the British Government's Health and Safety Executive (HSE) states formally that any threshold for mesothelioma must be at a very low level and it is widely agreed that if any such threshold does exist at all, then it cannot currently be quantified. For practical purposes, therefore, HSE assumes that no such "safe" threshold exists. Others have noted as well that there is no evidence of a threshold level below which there is no risk of mesothelioma. There appears to be a linear, dose-response relationship, with increasing dose producing increasing disease. Nevertheless, mesothelioma may be related to brief, low level or indirect exposures to asbestos. The dose necessary for effect appears to be lower for asbestos-induced mesothelioma than for pulmonary asbestosis or lung cancer. Again, there is no known safe level of exposure to asbestos as it relates to increased risk of mesothelioma. The duration of exposure to asbestos causing mesothelioma can be short. For example, cases of mesothelioma have been documented with only 1–3 months of exposure.  People who work with asbestos wear personal protective equipment to lower their risk of exposure. Latency, the time from first exposure to manifestation of disease, is prolonged in the case of mesothelioma. It is virtually never less than fifteen years and peaks at 30–40 years. In a review of occupationally related mesothelioma cases, the median latency was 32 years. Based upon the data from Peto et al., the risk of mesothelioma appears to increase to the third or fourth power from first exposure. Environmental exposures Incidence of mesothelioma had been found to be higher in populations living near naturally occurring asbestos. For example, in central Cappadocia, Turkey, mesothelioma was causing 50% of all deaths in three small villages — Tuzköy, Karain and Sarıhıdır. Initially, this was attributed to erionite, a zeolite mineral with similar properties to asbestos, however, recently, detailed epidemiological investigation showed that erionite causes mesothelioma mostly in families with a genetic predisposition.  The documented presence of asbestos fibers in water supplies and food products has fostered concerns about the possible impact of long-term and, as yet, unknown exposure of the general population to these fibers. Mesothelioma 10 Occupational Exposure to asbestos fibers has been recognized as an occupational health hazard since the early 20th century. Numerous epidemiological studies have associated occupational exposure to asbestos with the development of pleural plaques, diffuse pleural thickening, asbestosis, carcinoma of the lung and larynx, gastrointestinal tumors, and diffuse malignant mesothelioma of the pleura and peritoneum. Asbestos has been widely used in many industrial products, including cement, brake linings, gaskets, roof shingles, flooring products, textiles, and insulation. Commercial asbestos mining at Wittenoom, Western Australia, occurred between 1945 and 1966. A cohort study of miners employed at the mine reported that while no deaths occurred within the first 10 years after crocidolite exposure, 85 deaths attributable to mesothelioma had occurred by 1985. By 1994, 539 reported deaths due to mesothelioma had been reported in Western Australia. Paraoccupational secondary exposure Family members and others living with asbestos workers have an increased risk of developing mesothelioma, and possibly other asbestos related diseases.  This risk may be the result of exposure to asbestos dust brought home on the clothing and hair of asbestos workers. To reduce the chance of exposing family members to asbestos fibres, asbestos workers are usually required to shower and change their clothing before leaving the workplace. Asbestos in buildings Many building materials used in both public and domestic premises prior to the banning of asbestos may contain asbestos. Those performing renovation works or DIY activities may expose themselves to asbestos dust. In the UK use of Chrysotile asbestos was banned at the end of 1999. Brown and blue asbestos was banned in the UK around 1985. Buildings built or renovated prior to these dates may contain asbestos materials. Diagnosis Diagnosing mesothelioma is often difficult, because the symptoms are similar to those of a number of other conditions. Diagnosis begins with a review of the patient's medical history. A history of exposure to asbestos may increase clinical suspicion for mesothelioma. A physical examination is performed, followed by chest X-ray and often lung function tests. The X-ray may reveal pleural thickening commonly seen after asbestos exposure and increases suspicion of mesothelioma. A CT (or CAT) scan or an MRI is usually performed. If a large amount of fluid is present, abnormal cells may be detected by cytopathology if this fluid is aspirated with a syringe. For pleural fluid, this is done by thoracentesis or tube thoracostomy (chest tube); for ascites, with CXR demonstrating a mesothelioma paracentesis or ascitic drain; and for pericardial effusion with pericardiocentesis. While absence of malignant cells on cytology does not completely exclude mesothelioma, it makes it much more unlikely, especially if an alternative diagnosis can be made (e.g. tuberculosis, heart failure). Unfortunately, the diagnosis of malignant mesothelioma by cytology alone is difficult, even with expert pathologists. Generally, a biopsy is needed to confirm a diagnosis of malignant mesothelioma. A doctor removes a sample of tissue for examination Mesothelioma 11 under a microscope by a pathologist. A biopsy may be done in different ways, depending on where the abnormal area is located. If the cancer is in the chest, the doctor may perform a thoracoscopy. In this procedure, the doctor makes a small cut through the chest wall and puts a thin, lighted tube called a thoracoscope into the chest between two ribs. Thoracoscopy allows the doctor to look inside the chest and obtain tissue samples. Alternatively, the chest surgeon might directly open the chest (thoracotomy). If the cancer is in the abdomen, the doctor may perform a laparoscopy. To obtain tissue for examination, the doctor makes a small incision in the abdomen and inserts a special instrument into the abdominal cavity. If these procedures do not yield enough tissue, more extensive diagnostic surgery may be necessary. Immunohistochemical studies play an important role for the CT scan of a patient with mesothelioma, coronal pathologist in differentiating malignant mesothelioma from neoplastic section (the section follows the plane that divides the body in a front and a back half). The mimics. There are numerous tests and panels available. No single test mesothelioma is indicated by yellow arrows, the is perfect for distinguishing mesothelioma from carcinoma or even central pleural effusion (fluid collection) is benign versus malignant. marked with a yellow star. Red numbers: (1) right lung, (2) spine, (3) left lung, (4) ribs, (5) descending part of the aorta, (6) spleen, (7) left kidney, (8) right kidney, (9) liver. Micrograph of a pleural fluid cytopathology specimen showing mesothelioma. Micrographs showing mesothelioma in a core biopsy. Mesothelioma 12 Image of Metastatic mesothelioma Typical immunohistochemistry results Positive Negative EMA (epithelial membrane antigen) in a membranous distribution CEA (carcinoembryonic antigen) WT1 (Wilms' tumour 1) B72.3 Calretinin MOC-3 1 Mesothelin-1 CD15 Cytokeratin 5/6 Ber-EP4 HBME-1 (human mesothelial cell 1) TTF-1 (thyroid transcription factor-1) There are three histological types of malignant mesothelioma: (1) Epithelioid; (2) Sarcomatoid; and (3) Biphasic (Mixed). Epithelioid comprises about 50-60% of malignant mesothelioma cases and generally holds a better prognosis than the Sarcomatoid or Biphasic subtypes. Staging Staging of mesothelioma is based on the recommendation by the International Mesothelioma Interest Group. TNM classification of the primary tumor, lymph node involvement, and distant metastasis is performed. Mesothelioma is staged Ia–IV (one-A to four) based on the TNM status.  Screening There is no universally agreed protocol for screening people who have been exposed to asbestos. Screening tests might diagnose mesothelioma earlier than conventional methods thus improving the survival prospects for patients. The serum osteopontin level might be useful in screening asbestos-exposed people for mesothelioma. The level of soluble mesothelin-related protein is elevated in the serum of about 75% of patients at diagnosis and it has been suggested that it may be useful for screening. Doctors have begun testing the Mesomark assay which measures levels of soluble mesothelin-related proteins (SMRPs) released by diseased mesothelioma cells. Mesothelioma 13 Pathophysiology The mesothelium consists of a single layer of flattened to cuboidal cells forming the epithelial lining of the serous cavities of the body including the peritoneal, pericardial and pleural cavities. Deposition of asbestos fibers in the parenchyma of the lung may result in the penetration of the visceral pleura from where the fiber can then be carried to the pleural surface, thus leading to the development of malignant mesothelial plaques. The processes leading to the development of peritoneal mesothelioma remain unresolved, although it has been proposed that asbestos fibers from the lung are transported Diffuse pleural mesothelioma with extensive to the abdomen and associated organs via the lymphatic system. involvement of the pericardium. Additionally, asbestos fibers may be deposited in the gut after ingestion of sputum contaminated with asbestos fibers. Pleural contamination with asbestos or other mineral fibers has been shown to cause cancer. Long thin asbestos fibers (blue asbestos, amphibole fibers) are more potent carcinogens than "feathery fibers" (chrysotile or white asbestos fibers). However, there is now evidence that smaller particles may be more dangerous than the larger fibers. They remain suspended in the air where they can be inhaled, and may penetrate more easily and deeper into the lungs. "We probably will find out a lot more about the health aspects of asbestos from [the World Trade Center attack], unfortunately," said Dr. Alan Fein, chief of pulmonary and critical-care medicine at North Shore-Long Island Jewish Health System. Dr. Fein has treated several patients for "World Trade Center syndrome" or respiratory ailments from brief exposures of only a day or two near the collapsed buildings. Mesothelioma development in rats has been demonstrated following intra-pleural inoculation of phosphorylated chrysotile fibers. It has been suggested that in humans, transport of fibers to the pleura is critical to the pathogenesis of mesothelioma. This is supported by the observed recruitment of significant numbers of macrophages and other cells of the immune system to localized lesions of accumulated asbestos fibers in the pleural and peritoneal cavities of rats. These lesions continued to attract and accumulate macrophages as the disease progressed, and cellular changes within the lesion culminated in a morphologically malignant tumor. Experimental evidence suggests that asbestos acts as a complete carcinogen with the development of mesothelioma occurring in sequential stages of initiation and promotion. The molecular mechanisms underlying the malignant transformation of normal mesothelial cells by asbestos fibers remain unclear despite the demonstration of its oncogenic capabilities (see next-but-one paragraph). However, complete in vitro transformation of normal human mesothelial cells to malignant phenotype following exposure to asbestos fibers has not yet been achieved. In general, asbestos fibers are thought to act through direct physical interactions with the cells of the mesothelium in conjunction with indirect effects following interaction with inflammatory cells such as macrophages. Analysis of the interactions between asbestos fibers and DNA has shown that phagocytosed fibers are able to make contact with chromosomes, often adhering to the chromatin fibers or becoming entangled within the chromosome. This contact between the asbestos fiber and the chromosomes or structural proteins of the spindle apparatus can induce complex abnormalities. The most common abnormality is monosomy of chromosome 22. Other frequent abnormalities include structural rearrangement of 1p, 3p, 9p and 6q chromosome arms. Common gene abnormalities in mesothelioma cell lines include deletion of the tumor suppressor genes: • Neurofibromatosis type 2 at 22q12 • P16INK4A • P14ARF Asbestos has also been shown to mediate the entry of foreign DNA into target cells. Incorporation of this foreign DNA may lead to mutations and oncogenesis by several possible mechanisms: Mesothelioma 14 • Inactivation of tumor suppressor genes • Activation of oncogenes • Activation of proto-oncogenes due to incorporation of foreign DNA containing a promoter region • Activation of DNA repair enzymes, which may be prone to error • Activation of telomerase • Prevention of apoptosis Asbestos fibers have been shown to alter the function and secretory properties of macrophages, ultimately creating conditions which favour the development of mesothelioma. Following asbestos phagocytosis, macrophages generate increased amounts of hydroxyl radicals, which are normal by-products of cellular anaerobic metabolism. However, these free radicals are also known clastogenic and membrane-active agents thought to promote asbestos carcinogenicity. These oxidants can participate in the oncogenic process by directly and indirectly interacting with DNA, modifying membrane-associated cellular events, including oncogene activation and perturbation of cellular antioxidant defences. Asbestos also may possess immunosuppressive properties. For example, chrysotile fibres have been shown to depress the in vitro proliferation of phytohemagglutinin-stimulated peripheral blood lymphocytes, suppress natural killer cell lysis and significantly reduce lymphokine-activated killer cell viability and recovery. Furthermore, genetic alterations in asbestos-activated macrophages may result in the release of potent mesothelial cell mitogens such as platelet-derived growth factor (PDGF) and transforming growth factor-β (TGF-β) which in turn, may induce the chronic stimulation and proliferation of mesothelial cells after injury by asbestos fibres. Treatment The prognosis for malignant mesothelioma remains disappointing, although there have been some modest improvements in prognosis from newer chemotherapies and multimodality treatments. Treatment of malignant mesothelioma at earlier stages has a better prognosis, but cures are exceedingly rare. Clinical behavior of the malignancy is affected by several factors including the continuous mesothelial surface of the pleural cavity which favors local metastasis via exfoliated cells, invasion to underlying tissue and other organs within the pleural cavity, and the extremely long latency period between asbestos exposure and development of the disease. The histological subtype and the patient's age and health status also help predict prognosis. The epithelioid histology responds better to treatment and has a survival advantage over sarcomatoid histology. Surgery Surgery, by itself, has proved disappointing. In one large series, the median survival with surgery (including extrapleural pneumonectomy) was only 11.7 months. However, research indicates varied success when used in combination with radiation and chemotherapy (Duke, 2008). (For more information on multimodality therapy with surgery, see below). A pleurectomy/decortication is the most common surgery, in which the lining of the chest is removed. Less common is an extrapleural pneumonectomy (EPP), in which the lung, lining of the inside of the chest, the hemi-diaphragm and the pericardium are removed. Radiation For patients with localized disease, and who can tolerate a radical surgery, radiation is often given post-operatively as a consolidative treatment. The entire hemi-thorax is treated with radiation therapy, often given simultaneously with chemotherapy. Delivering radiation and chemotherapy after a radical surgery has led to extended life expectancy in selected patient populations with some patients surviving more than 5 years. As part of a curative approach to mesothelioma, radiotherapy is also commonly applied to the sites of chest drain insertion, in order to prevent growth of the tumor along the track in the chest wall. Mesothelioma 15 Although mesothelioma is generally resistant to curative treatment with radiotherapy alone, palliative treatment regimens are sometimes used to relieve symptoms arising from tumor growth, such as obstruction of a major blood vessel. Radiation therapy when given alone with curative intent has never been shown to improve survival from mesothelioma. The necessary radiation dose to treat mesothelioma that has not been surgically removed would be very toxic. Chemotherapy Chemotherapy is the only treatment for mesothelioma that has been proven to improve survival in randomised and controlled trials. The landmark study published in 2003 by Vogelzang and colleagues compared cisplatin chemotherapy alone with a combination of cisplatin and pemetrexed (brand name Alimta) chemotherapy in patients who had not received chemotherapy for malignant pleural mesothelioma previously and were not candidates for more aggressive "curative" surgery. This trial was the first to report a survival advantage from chemotherapy in malignant pleural mesothelioma, showing a statistically significant improvement in median survival from 10 months in the patients treated with cisplatin alone to 13.3 months in the group of patients treated with cisplatin in the combination with pemetrexed and who also received supplementation with folate and vitamin B12. Vitamin supplementation was given to most patients in the trial and pemetrexed related side effects were significantly less in patients receiving pemetrexed when they also received daily oral folate 500mcg and intramuscular vitamin B12 1000mcg every 9 weeks compared with patients receiving pemetrexed without vitamin supplementation. The objective response rate increased from 20% in the cisplatin group to 46% in the combination pemetrexed group. Some side effects such as nausea and vomiting, stomatitis, and diarrhoea were more common in the combination pemetrexed group but only affected a minority of patients and overall the combination of pemetrexed and cisplatin was well tolerated when patients received vitamin supplementation; both quality of life and lung function tests improved in the combination pemetrexed group. In February 2004, the United States Food and Drug Administration approved pemetrexed for treatment of malignant pleural mesothelioma. However, there are still unanswered questions about the optimal use of chemotherapy, including when to start treatment, and the optimal number of cycles to give. Cisplatin in combination with raltitrexed has shown an improvement in survival similar to that reported for pemetrexed in combination with cisplatin, but raltitrexed is no longer commercially available for this indication. For patients unable to tolerate pemetrexed, cisplatin in combination with gemcitabine or vinorelbine is an alternative, or vinorelbine on its own, although a survival benefit has not been shown for these drugs. For patients in whom cisplatin cannot be used, carboplatin can be substituted but non-randomised data have shown lower response rates and high rates of haematological toxicity for carboplatin-based combinations, albeit with similar survival figures to patients receiving cisplatin. In January 2009, the United States FDA approved using conventional therapies such as surgery in combination with radiation and or chemotherapy on stage I or II Mesothelioma after research conducted by a nationwide study by Duke University concluded an almost 50 point increase in remission rates. Immunotherapy Treatment regimens involving immunotherapy have yielded variable results. For example, intrapleural inoculation of Bacillus Calmette-Guérin (BCG) in an attempt to boost the immune response, was found to be of no benefit to the patient (while it may benefit patients with bladder cancer). Mesothelioma cells proved susceptible to in vitro lysis by LAK cells following activation by interleukin-2 (IL-2), but patients undergoing this particular therapy experienced major side effects. Indeed, this trial was suspended in view of the unacceptably high levels of IL-2 toxicity and the severity of side effects such as fever and cachexia. Nonetheless, other trials involving interferon alpha have proved more encouraging with 20% of patients experiencing a greater than 50% reduction in tumor mass combined with minimal side effects. Mesothelioma 16 Heated Intraoperative Intraperitoneal Chemotherapy A procedure known as heated intraoperative intraperitoneal chemotherapy was developed by Paul Sugarbaker at the Washington Cancer Institute. The surgeon removes as much of the tumor as possible followed by the direct administration of a chemotherapy agent, heated to between 40 and 48°C, in the abdomen. The fluid is perfused for 60 to 120 minutes and then drained. This technique permits the administration of high concentrations of selected drugs into the abdominal and pelvic surfaces. Heating the chemotherapy treatment increases the penetration of the drugs into tissues. Also, heating itself damages the malignant cells more than the normal cells. This technique is also used in patients with malignant pleural mesothelioma. Multimodality Therapy All of the standard approaches to treating solid tumors—radiation, chemotherapy, and surgery—have been investigated in patients with malignant pleural mesothelioma. Although surgery, by itself, is not very effective, surgery combined with adjuvant chemotherapy and radiation (trimodality therapy) has produced significant survival extension (3–14 years) among patients with favorable prognostic factors. However, other large series of examining multimodality treatment have only demonstrated modest improvement in survival (median survival 14.5 months and only 29.6% surviving 2 years). Reducing the bulk of the tumor with cytoreductive surgery is key to extending survival. Two surgeries have been developed: extrapleural pneumonectomy and pleurectomy/decortication. The indications for performing these operations are unique. The choice of operation depends on the size of the patient's tumor. This is an important consideration because tumor volume has been identified as a prognostic factor in mesothelioma. Pleurectomy/decortication spares the underlying lung and is performed in patients with early stage disease when the intention is to remove all gross visible tumor (macroscopic complete resection), not simply palliation. Extrapleural pneumonectomy is a more extensive operation that involves resection of the parietal and visceral pleurae, underlying lung, ipsilateral diaphragm, and ipsilateral pericardium. This operation is indicated for a subset of patients with more advanced tumors, who can tolerate a pneumonectomy. Epidemiology Although reported incidence rates have increased in the past 20 years, mesothelioma is still a relatively rare cancer. The incidence rate varies from one country to another, from a low rate of less than 1 per 1,000,000 in Tunisia and Morocco, to the highest rate in Britain, Australia and Belgium: 30 per 1,000,000 per year. For comparison, populations with high levels of smoking can have a lung cancer incidence of over 1,000 per 1,000,000. Incidence of malignant mesothelioma currently ranges from about 7 to 40 per 1,000,000 in industrialized Western nations, depending on the amount of asbestos exposure of the populations during the past several decades. It has been estimated that incidence may have peaked at 15 per 1,000,000 in the United States in 2004. Incidence is expected to continue increasing in other parts of the world. Mesothelioma occurs more often in men than in women and risk increases with age, but this disease can appear in either men or women at any age. Approximately one fifth to one third of all mesotheliomas are peritoneal. Between 1940 and 1979, approximately 27.5 million people were occupationally exposed to asbestos in the United States. Between 1973 and 1984, the incidence of pleural mesothelioma among Caucasian males increased 300%. From 1980 to the late 1990s, the death rate from mesothelioma in the USA increased from 2,000 per year to 3,000, with men four times more likely to acquire it than women. These rates may not be accurate, since it is possible that many cases of mesothelioma are misdiagnosed as adenocarcinoma of the lung, which is difficult to differentiate from mesothelioma. Mesothelioma 17 Society and culture Notable cases Mesothelioma, though rare, has had a number of notable patients. • Malcolm McLaren, former manager of New York Dolls and Sex Pistols, died on 8 April 2010. • Billy Vaughn, American bandleader, died in 1991. • Hamilton Jordan, Chief of Staff for U.S. President Jimmy Carter and lifelong cancer activist, died in 2008. • Richard J. Herrnstein, psychologist and co-author of The Bell Curve, died in 1994. • Australian anti-racism activist Bob Bellear died in 2005. • British science fiction writer Michael G. Coney, responsible for nearly 100 works, also died in 2005. • American film and television actor Paul Gleason, perhaps best known for his portrayal of Principal Richard Vernon in the 1985 film The Breakfast Club, died in 2006. • Mickie Most, an English record producer, died of mesothelioma in 2003. • Paul Rudolph, American architect, died in 1997. • Bernie Banton, an Australian workers' rights activist, fought a long battle for compensation from James Hardie after he contracted mesothelioma after working for that company. He claimed James Hardie knew of the dangers of asbestos before he began work with the substance making insulation for power stations. Mesothelioma eventually took his life along with his brothers and hundreds of James Hardie workers. James Hardie made an undisclosed settlement with Banton only when his mesothelioma had reached its final stages and he was expected to have no more than 48 hours to live. Australian Prime Minister Kevin Rudd mentioned Banton's extended struggle in his acceptance speech after winning the 2007 Australian federal election. • Actor Steve McQueen was diagnosed with peritoneal mesothelioma on December 22, 1979. He was not offered surgery or chemotherapy because doctors felt the cancer was too advanced. McQueen subsequently sought alternative treatments at clinics in Mexico. He died of a heart attack on November 7, 1980, in Juárez, Mexico, following cancer surgery. He may have been exposed to asbestos while serving with the U.S. Marines as a young adult—asbestos was then commonly used to insulate ships' piping—or from its use as an insulating material in automobile racing suits (McQueen was an avid racing driver and fan). • United States Congressman Bruce Vento died of mesothelioma in 2000. The Bruce Vento Hopebuilder award is given yearly by his wife at the MARF Symposium to persons or organizations who have done the most to support mesothelioma research and advocacy. • Rock and roll musician and songwriter Warren Zevon, after a long period of untreated illness and pain, was diagnosed with inoperable mesothelioma in the fall of 2002. Refusing treatments that he believed might incapacitate him, Zevon focused his energies on recording his final album The Wind, including the song "Keep Me in Your Heart," which speaks of his failing breath. Zevon died at his home in Los Angeles, California, on September 7, 2003. • Christie Hennessy, the influential Irish singer-songwriter, died of mesothelioma in 2007, and had stridently refused to accept the prognosis in the weeks before his death. Hennessy's mesothelioma has been attributed to his younger years spent working on building sites in London.  • Bob Miner, one of the founders of Software Development Labs, the forerunner of Oracle Corporation, died of mesothelioma in 1994. • Scottish Labour MP John William MacDougall died of mesothelioma on August 13, 2008, after fighting the disease for two years. • Australian journalist and news presenter Peter Leonard of Canberra succumbed to the condition on September 23, 2008. Mesothelioma 18 • Terrence McCann, Olympic gold medalist and longtime Executive Director of Toastmasters, died of mesothelioma on June 7, 2006, at his home in Dana Point, California. • Merlin Olsen, Pro Football Hall of Famer and television actor, died on March 10, 2010, from mesothelioma that had been diagnosed in 2009. Notable people who have lived for some time with mesothelioma Although life expectancy with this disease is typically limited, there are notable survivors. In July 1982, Stephen Jay Gould was diagnosed with peritoneal mesothelioma. After his diagnosis, Gould wrote "The Median Isn't the Message" for Discover magazine, in which he argued that statistics such as median survival are just useful abstractions, not destiny. Gould lived for another 20 years, eventually succumbing to metastatic adenocarcinoma of the lung, not mesothelioma. Author Paul Kraus was diagnosed with peritoneal mesothelioma in July 1997. He was given a prognosis of less than a year to live and used a variety of complementary modalities. He continues to outlive his prognosis and wrote a book about his experience "Surviving Mesothelioma and Other Cancers: A Patient's Guide" in which he presented his philosophy about healing and the decision making that led him to use integrative medicine. Legal issues The first lawsuits against asbestos manufacturers were in 1929. Since then, many lawsuits have been filed against asbestos manufacturers and employers, for neglecting to implement safety measures after the links between asbestos, asbestosis, and mesothelioma became known (some reports seem to place this as early as 1898). The liability resulting from the sheer number of lawsuits and people affected has reached billions of dollars. The amounts and method of allocating compensation have been the source of many court cases, reaching up to the United States Supreme Court, and government attempts at resolution of existing and future cases. However, to date, the US Congress has not stepped in and there are no federal laws governing asbestos compensation. History The first lawsuit against asbestos manufacturers was brought in 1929. The parties settled that lawsuit, and as part of the agreement, the attorneys agreed not to pursue further cases. In 1960, an article published by Wagner et al. was seminal in establishing mesothelioma as a disease arising from exposure to asbestos. The article referred to over 30 case studies of people who had suffered from mesothelioma in South Africa. Some exposures were transient and some were mine workers. Prior to the use of advanced microscopy techniques, malignant mesothelioma was often diagnosed as a variant form of lung cancer. In 1962 McNulty reported the first diagnosed case of malignant mesothelioma in an Australian asbestos worker. The worker had worked in the mill at the asbestos mine in Wittenoom from 1948 to 1950. In the town of Wittenoom, asbestos-containing mine waste was used to cover schoolyards and playgrounds. In 1965 an article in the British Journal of Industrial Medicine established that people who lived in the neighbourhoods of asbestos factories and mines, but did not work in them, had contracted mesothelioma. Despite proof that the dust associated with asbestos mining and milling causes asbestos-related disease, mining began at Wittenoom in 1943 and continued until 1966. In 1974 the first public warnings of the dangers of blue asbestos were published in a cover story called "Is this Killer in Your Home?" in Australia's Bulletin magazine. In 1978 the Western Australian Government decided to phase out the town of Wittenoom, following the publication of a Health Dept. booklet, "The Health Hazard at Wittenoom", containing the results of air sampling and an appraisal of worldwide medical information. By 1979 the first writs for negligence related to Wittenoom were issued against CSR and its subsidiary ABA, and the Asbestos Diseases Society was formed to represent the Wittenoom victims. Mesothelioma 19 In Leeds, England the Armley asbestos disaster involved several court cases against Turner & Newall where local residents who contracted mesothelioma claimed compensation because of the asbestos pollution from the company's factory. One notable case was that of June Hancock, who contracted the disease in 1993 and died in 1997. References Sources • This article uses information from a public domain U.S. National Cancer Institute fact sheet . 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PMID 13782506. Mesothelioma 21  Alastair J Moore, Robert J Parker, John Wiggins (2008). "Malignant mesothelioma". Orphanet Journal of Rare Diseases 3 (34): 1750–1172. doi:10.1186/1750-1172-3-34. PMC 2652430. PMID 19099560.  McNulty JC (December 1962). "Malignant pleural mesothelioma in an asbestos worker". Med J Aust 49 (2): 953–4. PMID 13932248.  "June Hancock Research Fund" (http:/ / www. junehancockfund. org/ ). . Retrieved 2010-03-01.  http:/ / www. cancer. gov/ cancertopics/ factsheet/ Sites-Types/ mesothelioma External links • ATSDR - Case Studies in Environmental Medicine: Asbestos Toxicity (http://www.atsdr.cdc.gov/csem/ asbestos/) U.S. Department of Health and Human Service (public domain) • Mesothelioma: Questions and Answers (http://www.cancer.gov/cancertopics/factsheet/Sites-Types/ mesothelioma) from the U.S. National Cancer Institute • Cancer.gov: Malignant Mesothelioma (http://www.cancer.gov/cancertopics/types/malignantmesothelioma) from the U.S. National Cancer Institute • Mesothelioma (http://www.cancer.org/docroot/CRI/CRI_2_3x.asp?dt=29) from the American Cancer Society • Malignant Mesothelioma (http://www.cancer.org/downloads/PUB/DOCS/SECTION28/89.pdf) review article from the American Cancer Society • Medlineplus: Mesothelioma (http://www.nlm.nih.gov/medlineplus/mesothelioma.html) from MEDLINE, part of the United States National Library of Medicine • Worksafe, Western Australia (http://www.safetyline.wa.gov.au/institute/level2/course21/lecture95/l95_04. asp), from Western Australia's Department of Consumer and Employment Protection • US Nat'l Institute for Occupational Safety and Health (http://www.cdc.gov/niosh/topics/asbestos/), from the Centers for Disease Control • Australian Mesothelioma Register (http://www.ascc.gov.au/ascc/AboutUs/Publications/StatReports/ AustralianMesotheliomaRegister.htm) • What is Mesothelioma? (http://www.curemeso.org/site/c.kkLUJ7MPKtH/b.4023387/k.6580/ What_is_Mesothelioma.htm) Research and advocacy from the Mesothelioma Applied Research Foundation • Radiology of mesotheliomas, with additional examples (http://radiopaedia.org/articles/mesothelioma) from Radiopaedia.org (http://radiopaedia.org/) Article Sources and Contributors 22 Article Sources and Contributors Baron & Budd, P.C. Source: http://en.wikipedia.org/w/index.php?oldid=435933392 Contributors: Bearcat, Katharineamy, Tbhotch, Vegas949, 2 anonymous edits Fred Baron Source: http://en.wikipedia.org/w/index.php?oldid=432523889 Contributors: BlushDiamonds, Buellering, Cosprings, Crusio, Droliver, Dugwiki, Ebpierce, EchetusXe, Evb-wiki, Floral park, Folksong, Gfwesq, Hopwas2007, Huntster, Ironholds, JPG-GR, JamesMLane, Jance, Jareha, Jgwlaw, John Edwards in a douche, Karwall, Kelly, LarryBH, LukeTheSpook, Mboverload, Merope, Pearle, Rich Farmbrough, Rjwilmsi, Robina Fox, RogDel, Scm83x, Sigma 7, Silentspring65, Springeragh, Stephen e nelson, SuzanneKn, THF, TYelliot, Theking17825, Timecarter, WWGB, Will Beback, Wizardman, Wrparker65, 45 anonymous edits Mesothelioma Source: http://en.wikipedia.org/w/index.php?oldid=436487060 Contributors: A. B., AAAAA, ACupOfCoffee, Acroterion, Adacus12, Adamoppe, Adavidw, Agutie, Ahoerstemeier, Ahsansaeedsunny, Alan68, Alansohn, Alchemist Jack, Alexius08, Alikhalid1, Alteripse, Amongarmed, Andrew73, Andrewphelps, Anghe20, Aorxp, Apollo, Applecart11, Arcadian, Arizonaland, Armageddon Expert, Armhas, Aroseland, Asbestosdotnet, Axl, Aymerkez, Babyangel381, Barneca, Belsavis, Billyg, Birdmaru, Blainegamez, Bobo192, Borisbcs, Borow1, Boston2austin, BradBeattie, Brody34, Bsacimano, Bucinka, CWii, Callofduty007, Camembert, Cancercenter, Cancerhelp, Canderson7, Carabera, Carax, Ccbelland, Cckkab, Cdc, Cellcom, Celticsapien, Chris 73, Chrislk02, Chrissy385, Christian List, Christian75, ChristianH, Christopher Parham, Cirt, CleoSrivastava, Clicketyclack, CloudNine, Coemgenus, Cometstyles, Comrade Graham, Corpx, Countincr, Courtrye, Creck01, Crowsbridge, Cshay, Cshine41, Cultofpj, DVD R W, Ddnile, Dean in tx, Dekisugi, Deli nk, Delirium, Delldot, Diberri, Dina, Discospinster, Dl2000, Donreed, 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Rlee1185, Robertolyra, Rodhullandemu, Rooomkaweb, Rostau989, Rror, Ruslik0, Sam Hocevar, Samsys, Sasooow, Sasquatch35, Sassf, Scanar, ScepterMT, Schuym1, Sciurinæ, ScottW, Sfmammamia, Shawnbright, Shawnhath, Shub iitkgp, Sidney, Silverchemist, Simorny, Skarebo, Slakr, Slawojarek, Smawa, Snarkosis, Solipsist, Someone else, Somopehel, Spiffy sperry, Splacez, Spraif, Ssimo02, Stalfur, StaticGull, Steve802, Stevenfruitsmaak, Suran.c, Swatjester, THF, Tatihuni, Tbattaglia, Tbhotch, Tegiap, Tenro1, That Guy, From That Show!, The Anome, The Thing That Should Not Be, The undertow, TheNeutroniumAlchemist, TheNoise, Thingyamabob, Tinaiyi, Tlpoole, Tnxman307, Tregoweth, Tristanb, Trusilver, Ttilleman, Unifiedac, Ursa Gamma, Varlaam, Versageek, Victor Chmara, Victoryads, Wasif121, Web499, Webstergraphix, WildHorses325, Wildlovepad, Woohookitty, Worksafe, Wouterstomp, Wozney85, Xavexgoem, Yuckfoo, Zac3118, Zarius, Zeichick, ZimZalaBim, Zippy, Zntrip, Zzuuzz, 239 ,55דודanonymous edits Image Sources, Licenses and Contributors 23 Image Sources, Licenses and Contributors File:Fred Baron.jpg Source: http://en.wikipedia.org/w/index.php?title=File:Fred_Baron.jpg License: Creative Commons Attribution 2.0 Contributors: derivative work: Kelly (talk) Fred_and_Andrew_Baron.jpg: Andrew Baron File:MesotheliomaCT.jpg Source: http://en.wikipedia.org/w/index.php?title=File:MesotheliomaCT.jpg License: Creative Commons Attribution-Sharealike 3.0 Contributors: Frank Gaillard File:MesotheliomaCXR.png Source: http://en.wikipedia.org/w/index.php?title=File:MesotheliomaCXR.png License: Creative Commons Attribution-Sharealike 3.0 Contributors: User:Jmh649 Image:Tumor Mesothelioma2 legend.jpg Source: http://en.wikipedia.org/w/index.php?title=File:Tumor_Mesothelioma2_legend.jpg License: Creative Commons Attribution-Share Alike Contributors: Stevenfruitsmaak Image:Mesothelioma cytology 1.jpg Source: http://en.wikipedia.org/w/index.php?title=File:Mesothelioma_cytology_1.jpg License: Creative Commons Attribution-Sharealike 3.0 Contributors: Nephron File:Mesothelioma.PNG Source: http://en.wikipedia.org/w/index.php?title=File:Mesothelioma.PNG License: Public Domain Contributors: Robertolyra File:Metastatic-mesothelioma.jpeg Source: http://en.wikipedia.org/w/index.php?title=File:Metastatic-mesothelioma.jpeg License: Creative Commons Attribution-Sharealike 3.0 Contributors: User:Cellcom Image:Diffuse pleural mesothelioma.jpg Source: http://en.wikipedia.org/w/index.php?title=File:Diffuse_pleural_mesothelioma.jpg License: Public Domain Contributors: The Armed Forces Institute of Pathology (AFIP) License 24 License Creative Commons Attribution-Share Alike 3.0 Unported http:/ / creativecommons. org/ licenses/ by-sa/ 3. 0/
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