Chest

About the journal

Publisher: Elsevier
Published: 1970 to the present, United States
Language: English
ISSN: 0012-3692 (print), 1931-3543 (electronic)
Continues: Diseases of the Chest
Its record in the NLM Catalog

2020s

Incidence of Discordant Pleural Fluid Exudates and Diagnostic Patterns: A Retrospective Cohort Study. D.N. Addala, R. Mercer, A. Sundaralingam, et al. 2025;168(6):1517-1527. PubMed · Publisher · Free full text

Abstract

Background: Light's criteria use pleural fluid protein and lactate dehydrogenase (LDH) to differentiate pleural effusions as exudative or transudative. In a subset of exudative pleural effusions, discordance occurs between LDH and protein (ie, protein high, LDH low, or vice versa).

Research Question: What incidence and diagnostic profile are associated with discordant pleural fluid biochemistry?

Study Design And Methods: We conducted a retrospective analysis of 995 pleural fluid samples between 2015 and 2017 from a UK tertiary center. Exudates were subdivided into concordant or discordant, with low protein defined as < 30 g/L and low LDH as < 170 IU/L. Demographic characteristics and diagnostic patterns were assessed in both groups. A χ2 test and ORs (± 95% CI) were calculated for each diagnosis between discordant and concordant pleural effusions, and adjusted ORs were calculated by using multivariable logistic regression.

Results: In 715 exudative pleural fluid samples, 229 (32%) were discordant. Eighty-five (37%) of these displayed low protein, with high LDH, and 144 (63%) displayed low LDH with high protein. The median age was higher in the discordant group than in the concordant group (75 years vs 70 years; P = .01). The proportion of patients with the following diagnoses were significantly higher in the discordant group compared with the concordant group: fluid overload (10% [24 of 229] discordant vs 2% [10 of 486] concordant; P < .0001), benign asbestos-related pleural effusion (14% [33 of 229] vs 9% [44 of 486]; P = .031), and ICU-associated effusion (9% [20 of 229] vs 3% [15 of 486]; P = .001). The following were less frequent in the discordant group: pleural infection (6% [14 of 229] vs 16% [79 of 486]; P < .0001) and malignant pleural effusion (34% [77 of 229] vs 42% [206 of 486]; P = .025). These patterns were maintained when adjusting for age and sex.

Interpretation: Our results indicate that discordant pleural effusions are common and represent a biologically distinct entity with different diagnostic patterns compared with concordant effusions. Clinicians should assess for discordance early and tailor investigations accordingly.

Copyright © 2025 The Author(s). Published by Elsevier Inc. All rights reserved.
Pleural Effusion Caused by an Unusual Mass in the Right Hemithorax. M. Bluhm, B. Atmeh, S. Boehm, et al. 2024;165(5):e151-e155. Case report PubMed · Publisher

Abstract

An 80-year-old woman presented with complaints of weakness and dizziness. She had a medical history of subacute cerebral ischemia, vertigo, hypertension, and thalassemia minor. The patient was born and raised in Turkey and has lived in Switzerland for 50 years. Her sister died of a mesothelioma caused by asbestos exposure at the age of 60 years but had lived in Turkey until her death. The patient had neither a history of TB nor B symptoms. She has never smoked.

Copyright © 2024 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.
Pleural Plaques and the Role of Exposure to Mineral Particles in the Asbestos Post-exposure Survey. C. Paris, I. Thaon, F. Laurent, et al. 2023;164(1):149-158. PubMed · Publisher

Abstract

Background: Previous studies have inconsistently reported associations between refractory ceramic fibers (RCFs) or mineral wool fibers (MWFs) and the presence of pleural plaques. All these studies were based on chest radiographs, known to be associated with a poor sensitivity for the diagnosis of pleural plaques.

Research Question: Does the risk of pleural plaques increase with cumulative exposure to RCFs, MWFs, and silica? If the risk does increase, do these dose-response relationships depend on the co-exposure to asbestos or, conversely, are the dose-response relationships for asbestos modified by co-exposure to RCFs, MWFs, and silica?

Study Design And Methods: Volunteer workers were invited to participate in a CT scan screening program for asbestos-related diseases in France. Asbestos exposure was assessed by industrial hygienists, and exposure to RCFs, MWFs, and silica was determined by using job-exposure matrices. A cumulative exposure index (CEI) was then calculated for each subject and separately for each of the four mineral particle exposures. All available CT scans were submitted to randomized double reading by a panel of radiologists.

Results: In this cohort of 5,457 subjects, significant dose-response relationships were determined after adjustment for asbestos exposure between CEI to RCF or MWF and the risk of PPs (ORs of 1.29 [95% CI, 1.00-1.67] and 1.84 [95% CI, 1.49-2.27] for the highest CEI quartile, respectively). Significant interactions were found between asbestos on one hand and MWF or RCF on the other.

Interpretation: This study suggests the existence of a significant association between exposure to RCFs and MWFs and the presence of pleural plaques in a large population previously exposed to asbestos and screened by using CT scans.

Copyright © 2023. Published by Elsevier Inc.
A 73-Year-Old Woman With Progressive Shortness of Breath and Right-Sided Hemithorax Opacity. G.S. Wong, N. Searcy, C. Louis, et al. 2022;161(4):e203-e207. Case report PubMed · Publisher

Abstract

A 73-year-old frail woman presented with 3 months of progressively worsening exertional dyspnea, mild cough with white mucus, voice changes, and few episodes of dysphagia. She denied weight loss, night sweats, chest pain, or hemoptysis. Medical history was significant for hypertension, remote 30 years of tobacco use, and regular alcohol use. She had neither asbestos nor occupational exposure. She had no family history of malignancy.

Copyright © 2021 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.
Epidemiology of Adult Pleural Disease in the United States. S.R. Mummadi, J.K. Stoller, R. Lopez, et al. 2021;160(4):1534-1551. PubMed · Publisher

Abstract

Background: Comprehensive US epidemiologic data for adult pleural disease are not available.

Research Question: What are the epidemiologic measures related to adult pleural disease in the United States?

Study Design And Methods: Retrospective cohort study using Healthcare Utilization Project databases (2007-2016). Adults (≥ 18 years of age) with malignant pleural mesothelioma, malignant pleural effusion, nonmalignant pleural effusion, empyema, primary and secondary spontaneous pneumothorax, iatrogenic pneumothorax, and pleural TB were studied.

Results: In 2016, ED treat-and-discharge (T&D) visits totaled 42,215, accounting for charges of $286.7 million. In 2016, a total of 361,270 hospitalizations occurred, resulting in national costs of $10.1 billion. A total of 64,174 readmissions contributed $1.16 billion in additional national costs. Nonmalignant pleural effusion constituted 85.5% of ED T&D visits, 63.5% of hospitalizations, and 66.3% of 30-day readmissions. Contemporary sex distribution (male to female ratio) in primary spontaneous pneumothorax (2.1:1) differs from older estimates (6.2:1). Decadal analyses of annual hospitalization rates/100,000 adult population (2007 vs 2016) showed a significant (P < .001) decrease for malignant pleural mesothelioma (1.3 vs 1.09, respectively), malignant pleural effusion (33.4 vs 31.9, respectively), iatrogenic pneumothorax (17.9 vs 13.9, respectively), and pleural TB (0.20 vs 0.09, respectively) and an increase for empyema (8.1 vs 11.1, respectively) and nonmalignant pleural effusion (78.1 vs 100.1, respectively). Empyema hospitalizations have high costs per case ($38,591) and length of stay (13.8 days). The mean proportion of readmissions attributed to a pleural cause varied widely: malignant pleural mesothelioma, 49%; malignant pleural effusion, 45%; nonmalignant pleural effusion, 31%; empyema, 27%; primary spontaneous pneumothorax, 27%; secondary spontaneous pneumothorax, 27%; and iatrogenic pneumothorax, 20%. Secondary spontaneous pneumothorax had the shortest time to readmission in 2016 (10.3 days, 95% CI, 8.8-11.8 days).

Interpretation: Significant epidemiologic trends and changes in various pleural diseases were observed. The analysis identifies multiple opportunities for improvement in management of pleural diseases.

Copyright © 2021 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.
Persistent Dyspnea in a 74-Year-Old Man With Normal Spirometry and Lung Volumes. W.H. Chong, B. Saha, B. Shkolnik. 2021;159(5):e303-e307. Case report PubMed · Publisher

Abstract

A 74-year-old man was referred to a pulmonologist for evaluation of a 1-year history of nonproductive cough and progressive exertional dyspnea. He was initially evaluated by his primary care physician, where he had spirometry that was negative for any obstructive or restrictive lung disease. An echocardiogram showed a normal left ventricular ejection fraction, with no wall motion abnormality or valvular heart disease. He had an outpatient chest radiograph performed (Fig 1), and he was subsequently treated empirically for a COPD exacerbation with 5 days of oral prednisone and azithromycin. He was eventually referred to a pulmonologist because of a lack of clinical improvement. On seeing his pulmonary physician, he described the same exertional dyspnea and a nonproductive cough. A review of systems was negative for fever, chills, wheezing, angina, arthralgia, myalgia, rash, or leg swelling. He denied any medical illness and was not taking any medications. He was currently retired and had worked as a cashier his entire adult life. He had no occupational exposure to asbestos, coal dust, beryllium, silica dust, or dust from hard metal objects, such as cobalt. However, he had smoked approximately 1 to 2 packs of cigarettes per day and had done so for the past 50 years. His vital signs were unremarkable, aside from an oxygen saturation of 94% on room air. His physical examination revealed bibasilar "velcro-like" inspiratory crackles on lung examination. There was no digital clubbing, nor was there peripheral edema in his lower extremities. He had no muscle tenderness and demonstrated normal muscle strength against resistance.

Copyright © 2020 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.
Personalized Prognostication in Malignant Pleural Effusion: The Next Step?. D.N. Addala, N.M. Rahman, F. Maldonado. 2021;160(3):805-806. Editorial · Comment PubMed · Publisher
The Association Between Pleural Fluid Exposure and Survival in Pleural Mesothelioma. R. Asciak, N.I. Kanellakis, A. Bibby, et al. 2021;160(5):1925-1933. PubMed · Publisher

Abstract

Background: Most patients with malignant pleural mesothelioma (MPM) seek treatment with malignant pleural effusion (MPE). In vitro evidence suggests that MPE may not be a simple bystander of malignancy, but rather potentially has biological properties that improve cancer cell survival and promote cancer progression. If this is the case, MPE management may need to shift from current symptomatic strategies to aggressive fluid removal to impact survival.

Research Question: Is there an association between pleural fluid exposure and survival in MPM?

Study Design And Methods: Data from 761 patients who received a diagnosis of MPM between 2008 and 2018 were collected from patient medical records in three UK pleural units. Data included factors previously identified as influencing prognosis in MPM. Medical imaging was reviewed for presence, size, and duration of pleural effusion. Time-dependent covariate analysis of pleural fluid exposure and survival (model included weight loss, serum albumin, hemoglobin, MPM subtype, performance status, chemotherapy, and age) and multivariate Cox regression analysis of pleurodesis and survival were conducted.

Results: Median overall survival was 278 days (interquartile range, 127-505 days; 95% CI, 253-301 days). Pleural fluid exposure duration showed no association with survival (hazard ratio, 1.0; 95% CI, 1.0-1.0). Median survival was 473, 378, and 258 days with complete, partial, and no pleurodesis (P = .008).

Interpretation: Pleurodesis success seems to be associated with improved survival; however, it is unclear whether duration of MPM exposure to pleural fluid is associated with survival within the limitations of this retrospective study. Future prospective studies are required to assess this potentially important mechanism.

Copyright © 2021 The Author(s). Published by Elsevier Inc. All rights reserved.

2010s

A 65-Year-Old Man with Pulmonary Opacities and Worsening Cough. W. Pidcock, F. Chau-Etchapare, S. Murin. 2019;156(6):e117-e120. Case report PubMed · Publisher

Abstract

A 65-year-old man was referred for evaluation of several years of chest congestion and cough productive of yellow sputum as well as recently noted abnormalities on chest imaging. He denied dyspnea, weight loss, fevers, chills, or hemoptysis. He had no history of systemic illness, pneumonia, other respiratory illness, gastroesophageal reflux, or sinusitis. He had a remote smoking history. He worked as a railroad conductor and had occupational exposure to asbestos, as well as to other uncharacterized dusts and fumes. The patient spent most of his life in Washington and California and regularly traveled through the California Central Valley. Other travel history included trips to Southeast Asia, Iceland, and Europe in the remote past. The patient had one dog but no exposure to other animals. His only medication was loratadine, taken daily for allergic rhinitis. He applied petroleum jelly to his nares nightly to moisturize his nasal passages.

Copyright © 2019. Published by Elsevier Inc.
A Man in His 20s With Cough, Unilateral Pleural Effusion, and Nodular Pleural Thickening. M.A. Sonnick, S. Weisman, A.C. Borczuk, et al. 2019;156(6):e121-e126. Case report PubMed · Publisher

Abstract

A man in his 20s presented to the ED after several months of progressive dyspnea, dry cough, and night sweats. He had no chest pain, fevers, weight loss, or sick contacts. He was previously healthy and took no medications. Social history was notable for 5 pack-years of tobacco use. The patient was sexually active with male partners and had a recent partner infected with human T-lymphotropic virus. The patient worked in set design and window installations, and wore a respirator when working around solvents and resins. From ages 2 to 7 years, he frequently visited buildings at his parents' workplace that were undergoing asbestos abatement. From ages 7 to 24 years, he frequently visited pottery studios where talc-containing products were used. He frequently visited northern Massachusetts, and infections with Borrelia burgdorferi and Bartonella henselae were common in family members. His stepfather had recently been infected with Anaplasma. There was no family history of cancer.

Copyright © 2019 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.
Confocal Laser Endomicroscopy as a Guidance Tool for Pleural Biopsies in Malignant Pleural Mesothelioma. L. Wijmans, P. Baas, T.E. Sieburgh, et al. 2019;156(4):754-763. PubMed · Publisher

Abstract

Background: Pleural biopsies in patients with suspected malignant pleural mesothelioma (MPM) are often inconclusive resulting in repeat diagnostic procedures. Confocal laser endomicroscopy (CLE) enables real-time imaging on a cellular level. We investigated pleural CLE imaging as a biopsy guidance technique to distinguish malignant from benign pleural disease.

Methods: Prospective, multicenter study in patients with (suspected) MPM based on PET-CT imaging who were scheduled for pleural biopsies. Patients received 2.5 mL fluorescein intravenously preceding the procedure. In vivo through-the-needle CLE imaging of the pleura and ex vivo CLE imaging of the biopsies were correlated with histology. CLE characteristics for various pleural entities were identified, and their interpretability was tested by CLE video scoring by multiple blinded raters.

Results: CLE imaging was successfully obtained in 19 of 20 diagnostic pleural biopsy procedures (thoracoscopy: n = 4, surgical excision: n = 3, CT scan: n = 3, ultrasound: n = 9, esophageal ultrasound guided: n = 1) in 15 patients. CLE videos (n = 89) and corresponding pleural biopsies (n = 105) were obtained. No study-related adverse events occurred. Tumor deposits of MPM were distinguished from areas with pleural fibrosis based on CLE imaging and recognized by raters (n = 3) (interobserver agreement, 0.56; 95% CI, 0.49-0.64).

Conclusions: CLE imaging was feasible and safe regardless of the biopsy method. Real-time visualization of pleural abnormalities in epithelial and sarcomatoid MPM could be distinguished from pleural fibrosis. Therefore, CLE has potential as a guidance biopsy tool to reduce the current substantial rate of repeat biopsy procedures by identification of areas with malignant cells in vivo (smart needle).

Trial Registry: ClinicalTrials.gov; No.: NCT02689050; URL: www.clinicaltrials.gov.

Copyright © 2019. Published by Elsevier Inc.
Shining Light on Pleural Biopsy in Mesothelioma: Is It Time to Get "Smart"?. E.O. Bedawi, N.M. Rahman. 2019;156(4):643-644. Editorial · Comment PubMed · Publisher
An 80-Year-Old Man With Asbestos Exposure Presenting With Respiratory Distress. A. Aron, A.E. Urban, J.A. Lanfranco, et al. 2017;152(2):e25-e28. Case report PubMed · Publisher
Dendritic Cells in Human Lung Disease: Recent Advances. J.W. Upham, Y. Xi. 2017;151(3):668-673. Review PubMed · Publisher

Abstract

Dendritic cells (DCs) are potent antigen-presenting cells. Because of their particular ability to initiate and regulate cell mediated and humoral immune responses, there is considerable interest in the role that DCs play in the pathogenesis of various lung diseases, especially those in which there is an excessive immune response to specific antigens (as in asthma) or a deficient immune response (as in lung cancer). A number of DC subpopulations have been defined in the lungs, including myeloid or conventional DCs that initiate T-cell immunity and antibody production and plasmacytoid DCs that have an important role in antiviral immunity and immune tolerance. Although an extensive body of literature has documented the role that DCs play in experimental models of lung disease, this review will highlight recent advances in our understanding of DC function in human disease, including asthma, COPD, antimicrobial immunity, and lung cancer. The future is likely to see new approaches whereby antigens and small molecules are targeted to receptors on particular DC subpopulations in order to modify pulmonary immune responses.

Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.
Malignant Mesothelioma Biomarkers: From Discovery to Use in Clinical Practice for Diagnosis, Monitoring, Screening, and Treatment. J. Creaney, B.W.S. Robinson. 2017;152(1):143-149. Review PubMed · Publisher

Abstract

Malignant pleural mesothelioma is a highly aggressive tumor associated with asbestos exposure. There are few effective treatment options for mesothelioma, and patients have a very poor prognosis with a median survival of < 12 months from diagnosis. Biomarkers have been proposed as a cost-effective means of cancer management, and the search for a mesothelioma biomarker has been ongoing for the last 30 years. Many traditional soluble (glyco)protein biomarkers have been evaluated over this time, and an ever-increasing list of new biomarkers, including messenger RNA, DNA, microRNA, and antibodies, is being reported from biomarker discovery projects. To date, soluble mesothelin is the only tumor biomarker to receive US Food and Drug Administration approval for clinical use in mesothelioma. Mesothelin is a glycoprotein normally expressed on the surface of mesothelial cells, and in the cancerous state it can be present in circulation. Mesothelin has a limited expression on normal, nonmalignant tissue and is thus an attractive therapeutic target for mesothelin-positive tumors. In this review we will focus on the discovery and clinical usages of mesothelin and provide an update on other mesothelioma biomarkers and show how such biomarker studies might impact on the management of this deadly tumor in the future.

Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.
Longitudinal Measurement of Pleural Fluid Biochemistry and Cytokines in Malignant Pleural Effusions. R. Thomas, H.M. Cheah, J. Creaney, et al. 2016;149(6):1494-500. PubMed · Publisher

Abstract

Background: Malignant pleural effusion (MPE) is common. Existing literature on pleural fluid compositions is restricted to cross-sectional sampling with little information on longitudinal changes of fluid biochemistry and cytokines with disease progression. Indwelling pleural catheters provide the unique opportunity for repeated sampling and longitudinal evaluation of MPE, which may provide insight into tumor pathobiology.

Methods: We collected 638 MPE samples from 103 patients managed with indwelling pleural catheters over 95 days (median, range 0-735 days) and analyzed them for protein, pH, lactate dehydrogenase, and glucose levels. Peripheral blood was quantified for hematocrit, platelets, leukocytes, protein, and albumin. Cytokine levels (monocyte chemotactic protein [MCP]-1; vascular endothelial growth factor; interleukin-6, -8, and -10; tumor necrosis factor-α; and interferon-gamma) were determined in 298 samples from 35 patients with mesothelioma. Longitudinal changes of all parameters were analyzed using a linear mixed model.

Results: Significant decreases were observed over time in pleural fluid protein by 8 g/L per 100 days (SE, 1.32; P < .0001) and pH (0.04/100 days; SE, 0.02; P = .0203), accompanied by a nonsignificant rise in lactate dehydrogenase. The ratio of pleural fluid to serum protein decreased by 0.06/100 days (SE, 0.02; P = .04). MPEs from mesothelioma (n = 63) had lower pleural fluid glucose (P = .0104) at baseline and a faster rate of decline in glucose (P = .0423) when compared with non-mesothelioma effusions (n = 38). A progressive rise in mesothelioma pleural fluid concentration of [log] MCP-1 ([log] 0.37 pg/mL per 100 days; SE, 0.13; P = .0046), but not of other cytokines, was observed.

Conclusions: MPE fluids become less exudative and more acidic over the disease course. The rise in MCP-1 levels suggests a pathobiological role in MPE.

Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.
A man with pleural effusion and ascites. A. Li, L. Poon, K.L. Khoo, et al. 2015;147(6):e208-e214. Case report PubMed · Publisher

Abstract

A male lifelong nonsmoker aged 58 years with no prior asbestos exposure complained of gradual worsening breathlessness over 3 months. This was associated with abdominal and leg swelling and a 2-kg weight loss. He had no fever, night sweats, hemoptysis, joint pain, rash, abdominal pain, chest pain, or orthopnea. The patient had no recent travel or contact with pulmonary TB. He had stage I left-side testicular seminoma treated with left-sided radical orchidectomy 10 years previous and recently received a diagnosis of Child's B alcoholic liver cirrhosis. His hepatitis B and C screen result was normal.
Accuracy of fluorodeoxyglucose-PET imaging for differentiating benign from malignant pleural effusions: a meta-analysis. J.M. Porcel, P. Hernández, M. Martínez-Alonso, et al. 2015;147(2):502-512. Meta-analysis PubMed · Publisher

Abstract

Background: The role of fluorodeoxyglucose (FDG)-PET imaging for diagnosing malignant pleural effusions is not well defined. The aim of this study was to summarize the evidence for its use in ruling in or out the malignant origin of a pleural effusion or thickening.

Methods: A meta-analysis was conducted of diagnostic accuracy studies published in the Cochrane Library, PubMed, and Embase (inception to June 2013) without language restrictions. Two investigators selected studies that had evaluated the performance of FDG-PET imaging in patients with pleural effusions or thickening, using pleural cytopathology or histopathology as the reference standard for malignancy. Subgroup analyses were conducted according to FDG-PET imaging interpretation (qualitative or semiquantitative), PET imaging equipment (PET vs integrated PET-CT imaging), and/or target population (known lung cancer or malignant pleural mesothelioma). Study quality was assessed using Quality Assessment of Diagnostic Accuracy Studies-2. We used a bivariate random-effects model for the analysis and pooling of diagnostic performance measures across studies.

Results: Fourteen non-high risk of bias studies, comprising 407 patients with malignant and 232 with benign pleural conditions, met the inclusion criteria. Semiquantitative PET imaging readings had a significantly lower sensitivity for diagnosing malignant effusions than visual assessments (82% vs 91%; P = .026). The pooled test characteristics of integrated PET-CT imaging systems using semiquantitative interpretations for identifying malignant effusions were: sensitivity, 81%; specificity, 74%; positive likelihood ratio (LR), 3.22; negative LR, 0.26; and area under the curve, 0.838. Resultant data were heterogeneous, and spectrum bias should be considered when appraising FDG-PET imaging operating characteristics.

Conclusions: The moderate accuracy of PET-CT imaging using semiquantitative readings precludes its routine recommendation for discriminating malignant from benign pleural effusions.
Intrapleural Fibrinolysis for the Treatment of Indwelling Pleural Catheter-Related Symptomatic Loculations: A Multicenter Observational Study. R. Thomas, F. Piccolo, D. Miller, et al. 2015;148(3):746-751. PubMed · Publisher

Abstract

Background: Indwelling pleural catheters (IPCs) are an effective option in the management of malignant pleural effusion. Up to 14% of patients with IPCs develop symptomatic pleural loculations causing ineffective fluid drainage and breathlessness. To our knowledge, this is the first study to describe intrapleural fibrinolytic therapy for IPC-related symptomatic loculations.

Methods: All patients who received intrapleural fibrinolytic therapy for symptomatic loculations between January 1, 2002, and June 30, 2014, in four established IPC centers were retrospectively included. Patient outcomes, treatment effectiveness, and adverse events were recorded.

Results: Sixty-six patients (mean age, 64.7 ± 14.2 years; 52% women) were included. Lung cancer (31.3%) and malignant pleural mesothelioma (20.3%) were the most common malignancies. Fibrinolytic instillation was performed in outpatient (61%) and inpatient settings. Tissue-plasminogen activator (n = 52), urokinase (n = 12), and streptokinase (n = 2) were used. The majority (69.7%) received only one fibrinolytic dose (range, one to six). Pleural fluid drainage increased in 93% of patients, and dyspnea improved in 83% following therapy. The median cumulative pleural fluid volume drained at 24 h posttreatment was 500 mL (interquartile range 300-1,034 mL). The area of opacity caused by pleural effusion on chest radiograph decreased from (mean, SD) 52% (14%) to 31% (21%) of the hemithorax (n = 13; P = .001). There were two cases of nonfatal pleural bleed (3%).

Conclusions: Intrapleural fibrinolytic therapy can improve pleural fluid drainage and symptoms in selected patients with IPC and symptomatic loculation, but it carries a small risk of pleural bleeding. There is significant heterogeneity in its use currently, and further studies are needed to determine patient selection and optimal dosing regimen and to define its safety profile.
Predictors of clinical use of pleurodesis and/or indwelling pleural catheter therapy for malignant pleural effusion. E.T.H. Fysh, S. Bielsa, C.A. Budgeon, et al. 2015;147(6):1629-1634. PubMed · Publisher

Abstract

Background: The clinical course of patients with malignant pleural effusions (MPEs) varies. The decision to undertake "definitive therapy" (pleurodesis, indwelling pleural catheter [IPC], or both) for MPEs is decided on a case-by-case basis. Identifying factors that predict definitive therapy may help guide early initiation of treatment. The aim of the study was to identify clinical, laboratory, and radiologic predictors associated with clinicians' prescription of definitive therapy for patients with MPE.

Methods: A multicenter, observational study was conducted over 55 months involving tertiary centers in Perth, Western Australia, Australia, and Lleida, Spain. Demographic, clinical, radiologic, biochemical, and histologic data and the treatments received were recorded. Logistic regression was performed to determine the variables useful for predicting definitive therapy.

Results: Data of 540 patients (365 from Perth and 184 from Lleida) were analyzed; 537 fulfilled the criteria of an MPE. Definitive therapy was used in 288 patients (53.6%): 199 received a pleurodesis and 89 an IPC. Univariate analysis of the combined cohort revealed that definitive therapy was more likely if the effusion has low pH, either as a continuous variable (OR, 30.30; P < .01) or with a pH cutoff of < 7.2 (OR, 2.09; P = .03); was large (> 50% of hemithorax) (OR, 2.75; P < .01); or was associated with mesothelioma (OR, 1.83; P < .01). Following multivariate analysis, low pleural pH (OR, 37.04; P < .01), large effusions (OR, 3.31; P < .01), and increasing age (OR 1.02, P = .01) were associated with the use of definitive therapy.

Conclusions: Patients with MPE with an effusion of low pleural fluid pH and large size on radiographs at first presentation are more likely to be treated with pleurodesis and/or IPC.
Survival in Patients With Malignant Pleural Effusions Who Developed Pleural Infection: A Retrospective Case Review From Six UK Centers. A.C. Bibby, A.O. Clive, G.C. Slade, et al. 2015;148(1):235-241. PubMed · Publisher

Abstract

Objective: Malignant pleural effusion (MPE) incidence is increasing, and prognosis remains poor. Indwelling pleural catheters (IPCs) relieve symptoms but increase the risk of pleural infection. We reviewed cases of pleural infection in patients with IPCs for MPE from six UK centers between January 1, 2005, and January 31, 2014.

Methods: Survival in patients with pleural infection was compared with 788 patients with MPE (known as the LENT [pleural fluid lactate dehydrogenase, Eastern Cooperative Oncology Group performance status, serum neutrophil to lymphocyte ratio, and tumor type] cohort) and with national statistics.

Results: Of 672 IPCs inserted, 25 (3.7%) became infected. Most patients (20 of 25) had mesothelioma or lung cancer. Median survival in the pleural infection cohort appeared longer than in the LENT cohort, although this result did not achieve significance (386 days vs 132 days; hazard ratio, 0.67; P = .07). Median survival with mesothelioma and pleural infection was twice as long as national estimates for mesothelioma survival (753 days vs < 365 days) and double the median survival of patients with mesothelioma in the LENT cohort (339 days; 95% CI, nonoverlapping). Survival with lung and breast cancer did not differ significantly between the groups. Sixty-one percent of patients experienced early infection. There was no survival difference between patients with early and late infection (P = .6).

Conclusions: This small series of patients with IPCs for MPE suggests pleural infection may be associated with longer survival, particularly in patients with mesothelioma. Results did not achieve significance, and a larger study is needed to explore this relationship further and investigate whether the local immune response, triggered by infection, is able to modulate mesothelioma progression.
Ultrasound-guided medical thoracoscopy in the absence of pleural effusion. G. Marchetti, A. Valsecchi, D. Indellicati, et al. 2015;147(4):1008-1012. PubMed · Publisher

Abstract

Background: Medical thoracoscopy (MT) is a diagnostic and therapeutic procedure that permits the study of the pleural space. The presence of pleural adhesions is the most important contraindication to performing MT. Lesions of the pleura in absence of pleural effusion are usually studied in video-assisted thoracoscopic surgery (VATS) with preoperative ultrasound evaluation. No data are available about ultrasound-guided MT in the absence of pleural effusion.

Methods: From January 2007 to June 2013, 622 consecutive MTs were performed under ultrasound guidance without inducing a pneumothorax. A retrospective cohort of 29 patients affected by pleural diseases without fluid was reviewed. The fifth or sixth intercostal spaces along the midaxillary line with a good echographic "sliding sign" and normal appearance of the pleural line were chosen as the entry site. The pleural cavity was explored, and biopsies were performed.

Results: The mean age of the patient cohort was 62.8 years; there were 20 male patients and nine female patients. Pleural adherences were avoided, and adequate number of pleural biopsies were performed. No parenchymal lung injuries, bleeding, or hematoma occurred. Seventeen patients had a completely free pleural cavity, four patients had a single pleural adhesion, and eight had multiple pleural adhesions; in all cases, however, endoscopic exploration was possible and biopsy specimens were adequate. The most frequent histopathologic diagnosis was malignant pleural mesothelioma.

Conclusions: We have shown that thoracic ultrasound accurately identifies intrathoracic adhesions and, in experienced hands, can guide MT access, replacing the VATS approach, even in the complete absence of pleural effusion.
A 70-year-old woman with dyspnea and chest pain. A. Ganesh, M. Flores, I. Oliva, et al. 2014;146(1):e14-e18. Case report PubMed · Publisher
Advantages of thoracic ultrasound-guided fine-needle aspiration biopsy in lung cancer and mesothelioma. M. Sperandeo, L. Dimitri, C. Pirri, et al. 2014;146(5):e178-e179. Letter · Comment PubMed · Publisher

Summary

In this letter, written in response to a study by Hallifax et al on physician-based ultrasound-guided pleural biopsy, the authors, based in Italy, described their use of thoracic ultrasound (TUS) and TUS-guided fine-needle aspiration biopsy (FNAB) as a primary intervention procedure, rather than waiting for thoracoscopy to fail, in patients with malignant pleural mesothelioma (MPM) or lung cancer (LC). They reassessed TUS imaging, diagnostic yield and complications using the records of 133 patients with MPM and 801 patients with LC. TUS-guided FNAB was performed in 55 of the MPM patients and in all 801 LC patients (2008-2013), using 20-gauge needles and ultrasound transducers with a central hole for needle passage. Specimens were 1.0-2.5 cm long. The procedure was repeated in 20 patients because of insufficient sampling. Four patients had a partial, self-limited pneumothorax, and no severe complication was observed. TUS signs seen in histologically confirmed MPM were irregular thickening of the pleural line and associated micronodules (5-10 mm). A lower percentage showed plaque nodulations (5-10 mm), all with slight or relevant pleural effusion. The authors reported that CT and TUS findings agreed more closely in MPM than in LC, probably because of the tumour's pleural-subpleural position. They concluded that CT remains the primary imaging method, but TUS is a valuable complementary imaging method and the primary diagnostic intervention procedure. They added that it could contribute to noninvasive screening of people with environmental and occupational risk for MPM and LC.

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Catheter tract metastasis associated with indwelling pleural catheters. R. Thomas, C.A. Budgeon, Y.J. Kuok, et al. 2014;146(3):557-562. PubMed · Publisher

Abstract

Background: Indwelling pleural catheters (IPCs) are commonly used to manage malignant effusions. Tumor spread along the catheter tract remains a clinical concern for which limited data exist. We report the largest series of IPC-related catheter tract metastases (CTMs) to date, to our knowledge.

Methods: This is a single-center, retrospective review of IPCs inserted over a 44-month period. CTM was defined as a new, solid chest wall lesion over the IPC insertion site and/or the tunneled subcutaneous tract that was clinically compatible with a malignant tract metastasis.

Results: One hundred ten IPCs were placed in 107 patients (76.6% men; 60% with mesothelioma). CTM developed in 11 cases (10%): nine with malignant pleural mesothelioma and two with metastatic adenocarcinoma. CTM often developed late (median, 280 days; range, 56-693) post-IPC insertion. Seven cases had chest wall pain, and six received palliative radiotherapy to the CTM. Radiotherapy was well tolerated, with no major complications and causing no damage to the catheters. Longer interval after IPC insertion was the sole significant risk factor for development of CTM (OR, 2.495; 95% CI, 1.247-4.993; P = .0098) in the multivariate analyses.

Conclusions: IPC-related CTM is uncommon but can complicate both mesothelioma and metastatic carcinomas. The duration of interval after IPC insertion is the key risk factor identified for development of CTM. Symptoms are generally mild and respond well to radiotherapy, which can be administered safely without removal of the catheter.
Chest CT scan screening for lung cancer in asbestos occupational exposure: a systematic review and meta-analysis. M. Ollier, A. Chamoux, G. Naughton, et al. 2014;145(6):1339-1346. Meta-analysis · Systematic review PubMed · Publisher

Abstract

Objective: Lung cancer is the most frequent malignant asbestos-related pathology and remains the most fatal cancer of industrialized countries. In heavy smokers, early detection of lung cancer with chest CT scan leads to a 20% mortality reduction. However, the use of CT scan screening for early detection of lung cancer in asbestos-exposed workers requires further investigation. This study aimed to determine whether CT scan screening in asbestos-exposed workers is effective in detecting asymptomatic lung cancer using a systematic review and meta-analysis.

Methods: We reviewed all cohort studies involving chest CT scan screening in former asbestos-exposed workers. The search strategy used the following keywords: "asbestos," "lung cancer," "screening," and "occupation*" or "work." Databases were PubMed, Cochrane Library, Science Direct, and Embase.

Results: Seven studies matched our inclusion criteria. Baseline screening detected 49 asymptomatic lung cancers among 5,074 asbestos-exposed workers. Of the 49 reported lung cancers, at least 18 were in the earliest stage (stage I), accessible to complete removal surgery. The prevalence of all lung cancers detected by CT scan screening in asbestos-exposed workers was 1.1% (95% CI, 0.6%-1.8%).

Conclusions: CT scan screening in asbestos-exposed workers is effective in detecting asymptomatic lung cancer. Detection of lung cancer in asbestos-exposed workers using CT scanning is at least equal to the prevalence in heavy smokers (1%; 95% CI, 0.09%-1.1%) and also shared a similar proportion of stage I diagnoses. Screening asbestos-exposed workers could reduce mortality in proportions previously observed among heavy smokers and, thus, should not be neglected, particularly for individuals combining both exposures.
CT scan procedure for lung cancer screening in asbestos-exposed workers. M. Ollier, J.M. Garcier, G. Naughton, et al. 2014;146(2):e76-e77. Letter · Comment PubMed · Publisher
Feasibility and safety of outpatient medical thoracoscopy at a large tertiary medical center: a collaborative medical-surgical initiative. Z.S. DePew, D. Wigle, J.J. Mullon, et al. 2014;146(2):398-405. PubMed · Publisher

Abstract

Background: Medical thoracoscopy (MT) is performed by relatively few pulmonologists in the United States. Recognizing that an outpatient minimally invasive procedure such as MT could provide a suitable alternative to hospitalization and surgery in patients with undiagnosed exudative pleural effusions, we initiated the Mayo Clinic outpatient MT program and herein report preliminary data on safety, feasibility, and outcomes.

Methods: All consecutive patients referred for outpatient MT from October 2011 to August 2013 were included in this study. Demographic, radiographic, procedural, and histologic data were recorded prospectively and subsequently analyzed.

Results: Outpatient MT was performed on 51 patients, with the most common indication being an undiagnosed lymphocytic exudative effusion in 86.3% of the cohort. Endoscopic findings included diffuse parietal pleural inflammation in 26 patients (51%), parietal pleural studding in 19 patients (37.3%), a normal examination in three patients (5.9%), diffuse parietal pleural thickening in two patients (3.9%), and a diaphragmatic defect in one patient (2%). Pleural malignancy was the most common histologic diagnosis in 24 patients (47.1%) and composed predominantly of mesothelioma in 14 (27.5%). Nonspecific pleuritis was the second most frequent diagnosis in 23 patients (45.1%). There were very few complications, with no significant cases of hemodynamic or respiratory compromise and no deaths.

Conclusions: Outpatient MT can be integrated successfully into a busy tertiary referral medical center through the combined efforts of interventional pulmonologists and thoracic surgeons. Outpatient MT may provide patients with a more convenient alternative to an inpatient surgical approach in the diagnosis of undiagnosed exudative pleural effusions while maintaining a high diagnostic yield and excellent safety.
Physician-based ultrasound-guided biopsy for diagnosing pleural disease. R.J. Hallifax, J.P. Corcoran, A. Ahmed, et al. 2014;146(4):1001-1006. PubMed · Publisher

Abstract

Background: Definitive diagnosis of pleural disease (particularly malignancy) depends upon histologic proof obtained via pleural biopsy or positive pleural fluid cytology. Image-guided sampling is now standard practice. Local anesthetic thoracoscopy has a high diagnostic yield for malignant and nonmalignant disease, but is not always possible in frail patients, if pleural fluid is heavily loculated, or where the lung is adherent to the chest wall. Such cases can be converted during the same procedure as attempted thoracoscopy to cutting-needle biopsy. This study aimed to determine the diagnostic yield of a physician-led service in both planned biopsies and cases of failed thoracoscopy.

Methods: This study was a retrospective review of all ultrasound-guided, cutting-needle biopsies performed at the Oxford Centre for Respiratory Medicine between January 2010 and July 2013. Histologic results were assessed for the yield of pleural tissue, final diagnosis, and clinical follow-up in nonmalignant cases.

Results: Fifty ultrasound-guided biopsies were undertaken. Overall, 47 (94.0%) successfully obtained sufficient tissue for histologic diagnosis. Of the 50 biopsy procedures, 13 were conducted after failed thoracoscopy (5.2% of 252 attempted thoracoscopies over the same time period); of these 13, 11 (84.6%) obtained sufficient tissue. Thirteen of 50 biopsy specimens (26.0%) demonstrated pleural malignancy on histology (despite previous negative pleural fluid cytology), while 34 specimens (68.0%) were diagnosed as benign. Of the benign cases, 10 were pleural TB, two were sarcoidosis, and 22 were benign pleural thickening. There was one "false negative" of mesothelioma (median follow-up, 16 months).

Conclusions: Within this population, physician-based, ultrasound-guided, cutting-needle pleural biopsy obtained pleural tissue successfully in a high proportion of cases, including those of failed thoracoscopy.
Pleural plaques and their effect on lung function in Libby vermiculite miners. K.A. Clark, J.J. Flynn, J.E. Goodman, et al. 2014;146(3):786-794. PubMed · Publisher

Abstract

Background: Multiple studies have investigated the relationship between asbestos-related pleural plaques (PPs) and lung function, with disparate and inconsistent results. Most use chest radiographs to identify PPs and simple spirometry to measure lung function. High-resolution CT (HRCT) scanning improves the accuracy of PP identification. Complete pulmonary function tests (PFTs), including spirometry, lung volumes, and diffusing capacity of the lung for carbon monoxide, provide a more definitive assessment of lung function. The goal of this study was to determine, using HRCT scanning and complete PFTs, the effect of PPs on lung function in Libby vermiculite miners.

Methods: The results of HRCT scanning and complete PFTs performed between January 2000 and August 2012 were obtained from the medical records of 166 Libby vermiculite miners. Multivariate regression analyses with Tukey multivariate adjustment were used to assess statistical associations between the presence of PPs and lung function. Adjustments were made for age, BMI, smoking history, duration of employment, and years since last occupational asbestos exposure.

Results: Nearly 90% of miners (n = 149) had evidence of PPs on HRCT scan. No significant differences in spirometry results, lung volumes, or diffusing capacity of the lung for carbon monoxide were found between miners with PPs alone and miners with normal HRCT scans. Miners with both interstitial fibrosis and the presence of PPs had a significantly decreased total lung capacity in comparison with miners with normal HRCT scans (P = .02). Age, cumulative smoking history, and BMI were significant covariates that contributed to abnormal lung function.

Conclusions: Asbestos-related PPs alone have no significant effect on lung function in Libby vermiculite miners.
Response. R. Thomas, Y.C.G. Lee. 2014;146(3):e111-e112. Letter · Comment PubMed · Publisher
Spinal cord ischemia resulting in paraplegia following extrapleural pneumonectomy. K. Ural, K. Jakob, S. Lato, et al. 2014;146(2):e38-e40. Case report PubMed · Publisher

Abstract

A patient undergoing radical extrapleural pneumonectomy for epithelioid malignant mesothelioma developed acute paraplegia postoperatively related to long-segment spinal cord ischemia. The usual area of concern for this complication is the T9 to T12 area where the artery of Adamkiewicz is most likely to originate. In this patient, there was ligation of only upper thoracic, ipsilateral segmental arteries from the T3 to T6 level, yet he still developed paraplegia. Our hypothesis is variant mid-thoracic vascular anatomy. Previously unreported, to our knowledge, this should be understood as a rare complication of this surgery.
To seed or not to seed: the open question of mesothelioma intervention tract metastases. L. Bertolaccini, A. Viti, A. Terzi. 2014;146(3):e111. Letter · Comment PubMed · Publisher

Summary

This letter to the editor commented on a study by Thomas et al., published in the same issue of CHEST, of catheter tract metastasis (CTM) after insertion of indwelling pleural catheters (IPCs). The authors noted that tract seeding is a common complication of diagnostic and therapeutic procedures for mesothelioma pleural effusion, but that there are few reports of CTM after IPC insertion. They cited a pooled systematic review of 10 studies involving 1,093 patients, in which nine patients (0.8%) had catheter tract seeding. In their own earlier study, they had found no cases of CTM in 13 of 90 patients with mesothelioma pleural effusions treated with IPC placement. They said the available literature lacks information on histologic subtype, disease stage, and treatment or diagnostic procedure. They summarized Thomas et al.: IPCs were placed mainly for mesothelioma-related effusion (60%), 10% of patients developed CTM (nine of the 11 with tract seeding had mesothelioma), and of the patients referred for radiotherapy, six completed it and four had a clinical response. The authors stated that the benefit of prophylactic tract irradiation in mesothelioma remains controversial. The two randomized trials were small and underpowered, and such irradiation has not been tested in patients with IPCs. They concluded that it will need to be tested in this group.

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Diagnostic surgical pathology in lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. A.M. Schwartz, M.K. Rezaei. 2013;143(5 Suppl):e251S-e262S. Guideline PubMed · Publisher

Abstract

Background: This article provides evidence-based background and recommendations for the development of American College of Chest Physicians guidelines for the diagnosis and management of lung cancer. Specific population, intervention, comparison, and outcome questions were addressed to arrive at consensus recommendations.

Methods: A systematic search of the medical and scientific literature using MEDLINE and PubMed was performed for the years 1990 to 2011 and limited to literature on humans and articles written in English. Our approach to examining the evidence and formulating recommendations is described in the "Methodology for Lung Cancer Evidence Review and Guideline Development: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (2nd Edition)" and updated in "Methodology for Development of Guidelines for Lung Cancer: Diagnosis and Management of Lung Cancer, 3rd ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines."

Results: Pathologic examination results of lung cancers should be recorded in a synoptic form to include important prognostic features of histologic type, tumor size and location, involvement of visceral pleura, extension to regional and distant lymph nodes, and metastatic spread to visceral organs and bone to increase completeness of recording. It is important for the surgical pathologist to make distinctions between malignant mesothelioma and pleural adenocarcinomas, small cell and non-small cell carcinomas, adenocarcinomas and squamous cell carcinomas, and primary and metastatic carcinomas of the lung. In challenging cases of pathologic differential diagnosis, additional studies may enable the separation of distinct tumor types.

Conclusions: Pathologic assessment of lung cancers is a crucial component for the diagnosis, management, and prognosis of lung cancer, making the pathologist a critical member of the clinical and management team. Selective diagnostic techniques, including limited designed immunohistochemical panels, and decision analysis will increase diagnostic accuracy.
Does miR-1 play a role in malignant pleural mesothelioma development and progression?. C.M. Wright, M.B. Kirschner, N. van Zandwijk, et al. 2013;144(6):1971. Letter · Comment PubMed · Publisher
High risk of malignant mesothelioma and pleural plaques in subjects born close to ophiolites. M. Bayram, I. Dongel, N.D. Bakan, et al. 2013;143(1):164-171. PubMed · Publisher

Abstract

Background: Ophiolites, a special sequence of geologic rock units, are known sources of naturally occurring asbestos. The aim of this study was to test whether the occurrence of malignant mesothelioma (MM) or pleural plaques (PPs) in the province of Sivas, Turkey, is determined by the proximity of the patient's birthplace to ophiolites and, if so, to establish the magnitude of the risk.

Methods: The birthplaces of patients with MM or PPs (cases) and patients with prostate or breast cancer (control subjects), diagnosed between 2000 and 2010 and identified through a mandatory cancer registry or from hospital records (PPs), were located on a geologic map, and the nearest distance to ophiolites was measured. The relation of MM or PPs with distance to ophiolites was analyzed by logistic regression. Samples of soil and house plaster were determined by x-ray diffraction.

Results: Patients with MM (n = 100) or PPs (n = 133) were born significantly nearer to ophiolites (median distance, 4.5 km for men, 0 km for women) than were patients with prostate cancer (n = 161) or breast cancer (n = 139) (median distance, 20 km for both). ORs were 1.6 (men) ( P < .001) and 2.0 (women) ( P < .001) for every 5-km decrease in the distance of birthplace to ophiolites for MM, compared with prostate and breast cancer, respectively.

Conclusion: In this area without substantial industrial asbestos use, there is an association between the occurrence of mesothelioma (and of PPs) and the proximity of the subject's birthplace to ophiolites.
miR-1 induces growth arrest and apoptosis in malignant mesothelioma. Y. Xu, M. Zheng, R.E. Merritt, et al. 2013;144(5):1632-1643. PubMed · Publisher · Free full text

Abstract

Background: We investigated microRNA expression profiles of malignant pleural mesothelioma (MPM) specimens to identify novel microRNA that are potentially involved in the oncogenic transformation of human pleural cells.

Methods: microRNA microarray transcriptional profiling studies of 25 MPM primary tumors were performed. We used normal pleural tissue from an unmatched patient cohort as normal comparators. To confirm microarray data, we used real-time quantitative polymerase chain reaction. Representative cell lines H513 and H2052 were used in functional analyses of miR-1.

Results: In addition to several novel MPM-associated microRNAs, we observed that the expression level of miR-1 was significantly lower in tumors as compared with normal pleural specimens. Subsequently, pre-miR of miR-1 was introduced into MPM cell lines to overexpress this microRNA. Phenotypic changes of these altered cells were assayed. The cellular proliferation rate was significantly inhibited after overexpression of miR-1. Early and late apoptosis was increased markedly in miR-1-transfected cell lines. Taken together, these data suggested that overexpression of miR-1 induced apoptosis in these MPM cell lines, acting as a tumor suppressor. We confirmed our observations by assessing in the transduced MPM cells cell cycle-related, proapoptotic, and antiapoptotic genes, which all showed coordinated, significant changes characteristic of the apoptotic phenotype.

Conclusions: Further investigation and validation of our microRNA database of MPM may elucidate previously unrecognized molecular pathways and/or mechanisms by identifying novel microRNAs that are involved in malignant transformation. Our study has now found miR-1 to be one of these MPM-associated microRNAs, with potential pathogenic and therapeutic significance.
Response. Y. Xu, M. Zheng, A. Khuong, et al. 2013;144(6):1971-1972. Letter · Comment PubMed · Publisher
Immunohistochemistry: applications to the evaluation of lung and pleural neoplasms: part 2. H. Mani, D.S. Zander. 2012;142(5):1324-1333. PubMed · Publisher

Abstract

Immunohistochemistry has come to occupy a key position among the armamentarium of tools pathologists apply to the evaluation of lung and pleural neoplasms. This technique uses antibodies that bind to specific antigens, usually proteins, enabling microscopic detection of the antigens. Over the last several decades, an impressive array of antibodies has become commercially available, and many of these antibodies have become integrated into the routine practice of pathology. Evaluation of tissue or cytology samples with these antibodies can facilitate determination of tumor type and site of origin. Comments citing results of immunohistochemical staining with these antibodies frequently appear in pathology reports and may be difficult to translate for those less familiar with the technique. This review presents, in two parts, common diagnostic applications of immunohistochemistry with information about strategies taken for frequently encountered differential diagnostic scenarios. This article is the second of the two parts and focuses on immunohistochemical approaches to differentiating primary pulmonary from metastatic adenocarcinomas, mesotheliomas from carcinomas, and various types of spindle cell neoplasms. Potential future directions involving therapeutic and prognostic biomarkers are also discussed.
Postmortem findings of malignant pleural mesothelioma: a two-center study of 318 patients. R.S. Finn, F.J.H. Brims, A. Gandhi, et al. 2012;142(5):1267-1273. PubMed · Publisher

Abstract

Background: Malignant pleural mesothelioma (MPM) is an incurable cancer with a rising incidence. MPM is often perceived as a locally invasive cancer, and the exact cause of death is poorly understood.This two-center study describes the anatomic features of patients with MPM at postmortem.

Methods: The Western Australia Mesothelioma Registry (Australia) and Coroner’s Office reports from the Avon region (England) were interrogated for the postmortem records of confirmed mesothelioma cases.

Results: Postmortem records of 318 patients with pleural mesothelioma (169 from Western Australia and 149 from Avon) were identified. Most patients (91.5%) were men (mean age, 68.4 ± 11.5 years), and MPM was right-sided in 55.3%. Extrapleural dissemination of tumor was found in 87.7% of cases and lymph node involvement in 53.3%. Tumor dissemination in extra thoracicsites was common (55.4% of patients), and almost all organs were involved, including liver(31.9%), spleen (10.8%), thyroid (6.9%), and the brain (3.0%). Pulmonary emboli were found in 6% of cases and considered as directly contributing to death in 13 patients (4.1%). The precise cause of death could only be determined in 63 (19.8%) cases even after postmortem. The BMI was significantly lower in cases that had no identifiable anatomic cause of death at postmortem(18.8 ± 4.3 vs 21.0 ± 4.7, P = .034).

Conclusions: In this largest, to our knowledge, postmortem series on MPM, extrathoracic dissemination of mesothelioma was common and often under recognized. No anatomic cause of death was identified in the majority of patients even at autopsy, raising the possibility of physiologic and metabolic causes of death.
The effect of clinical covariates on the diagnostic and prognostic value of soluble mesothelin and megakaryocyte potentiating factor. K. Hollevoet, K. Nackaerts, O. Thas, et al. 2012;141(2):477-484. PubMed · Publisher

Abstract

Background: Soluble mesothelin (SM) and megakaryocyte potentiating factor (MPF) are serum biomarkers of mesothelioma. This study examined the effect of clinical covariates on biomarkers levels and their diagnostic and prognostic value.

Methods: Five hundred ninety-four participants were enrolled in a multicenter study, including 106 patients with mesothelioma and 488 control subjects. Multiple linear regression analyses were used to identify which covariates were independently associated with SM and MPF levels. The effect of these covariates on the diagnostic accuracy was evaluated with receiver operating characteristics curve analysis. In patients with mesothelioma, survival analysis was performed with Cox regression.

Results: SM and MPF levels were independently associated with age, glomerular filtration rate (GFR), and BMI in control subjects and with GFR and tumor stage in patients with mesothelioma. The diagnostic accuracy of SM and MPF was significantly affected by the distribution of these covariates in the study population. The patients with mesothelioma were best discriminated from the control subjects with either the youngest age, the highest GFR, or the largest BMI. Furthermore, the control subjects were significantly better differentiated from stage II to IV than from stage I mesothelioma. MPF, not SM, was an independent negative prognostic factor, but only if adjusted for the biomarker-associated covariates.

Conclusions: SM and MPF levels were affected by the same clinical covariates, which also had a significant impact on their diagnostic and prognostic value. To improve the interpretation of biomarker results, age, GFR, and BMI should be routinely recorded. Approaches to account for these covariates require further validation, as does the prognostic value of SM and MPF.
Fluorescence in situ hybridization in the definitive diagnosis of malignant mesothelioma in effusion cytology. S. Savic, N. Franco, B. Grilli, et al. 2010;138(1):137-44. PubMed · Publisher

Abstract

Background: Distinction of malignant mesothelioma (MM) from reactive mesothelial cells (RM) in effusions is notoriously difficult. The aim of our study was to test chromosomal aberrations detected by fluorescence in situ hybridization (FISH) in the diagnosis of MM in effusion cytology and to explore the potential role of p16, p14, and p15 gene methylation as an alternative mechanism of tumor suppressor gene inactivation.

Methods: Fifty-two effusions of biopsy-proven MM and 28 benign effusions were retrospectively analyzed by multitarget FISH assay for aberrations of chromosomes 3, 7, 17, and 9p21. In case of a negative result, the corresponding MM biopsy specimen was analyzed. Methylation-specific polymerase chain reaction (MSP) for p16, p14, and p15 was performed on FISH-negative MM biopsy specimens.

Results: Seventy-nine percent of effusions with biopsy-proven MM had chromosomal aberrations, with loss of 9p21 as the most common finding. All benign effusions were FISH negative. Sensitivity, specificity, and positive and negative predictive values for detection of MM by FISH were 79%, 100%, 100%, and 72%, respectively. Six of nine FISH-negative effusions with biopsy-proven MM were also FISH negative in the MM biopsy specimens. Four of five FISH-negative biopsy specimens showed promoter methylation in p16 and p14 as compared with one of 12 benign controls.

Conclusions: FISH is a sensitive and highly specific method for the definitive diagnosis of MM in effusion cytology. In the subset of FISH-negative MM, tumor suppressor genes on the chromosomal region 9p21 are often inactivated by promoter methylation.
Medical thoracoscopy vs CT scan-guided Abrams pleural needle biopsy for diagnosis of patients with pleural effusions: a randomized, controlled trial. M. Metintas, G. Ak, E. Dundar, et al. 2010;137(6):1362-8. Randomized trial PubMed · Publisher

Abstract

Background: In cases of pleural effusion, tissue samples can be obtained through Abrams needle pleural biopsy (ANPB), thoracoscopy, or cutting-needle pleural biopsy under the guidance of CT scan (CT-CNPB) for histopathologic analysis. This study aimed to compare the diagnostic efficiency and reliability of ANPB under CT scan guidance (CT-ANPB) with that of medical thoracoscopy in patients with pleural effusion.

Methods: Between January 2006 and January 2008, 124 patients with exudative pleural effusion that could not be diagnosed by cytologic analysis were included in the study. All patients were randomized after the CT scan was performed. Patients either underwent CT-ANPB or thoracoscopy. The two groups were compared in terms of diagnostic sensitivity and complications associated with the methods used.

Results: Of the 124 patients, malignant mesothelioma was diagnosed in 33, metastatic pleural disease in 47, benign pleural disease in 42, and two were of indeterminate origin. In the CT-ANPB group, the diagnostic sensitivity was 87.5%, as compared with 94.1% in the thoracoscopy group; the difference was not statistically significant (P = .252). No difference was identified between the sensitivities of the two methods based on the cause, the CT scan findings, and the degree of pleural thickening. Complication rates were low and acceptable.

Conclusion: We recommend the use of CT-ANPB as the primary method of diagnosis in patients with pleural thickening or lesions observed by CT scan. In patients with only pleural fluid appearance on CT scan and in those who may have benign pleural pathologies other than TB, the primary method of diagnosis should be medical thoracoscopy.

Trial Registration: clinicaltrials.gov; Identifier: NCT00720954.
Solitary fibrous tumors of the pleura: an estimation of population incidence. T. Thorgeirsson, H.J. Isaksson, H. Hardardottir, et al. 2010;137(4):1005-6. Letter PubMed · Publisher

Summary

In this letter, the authors estimated the population incidence of solitary fibrous tumors of the pleura (SFTPs). These are localized pleural tumors, most of which are benign, and the authors stated that an age-standardized incidence rate for them had not previously been reported. All patients diagnosed with histologically proven SFTP in Iceland from 1984 to 2007 were identified through a centralized pathology registry. Age-standardized incidence rates (world standard population) were calculated. For comparison, information on mesothelioma was obtained from the population-based Icelandic Cancer Registry. Eleven patients were diagnosed with SFTP (mean age 60 years; eight women), compared with 35 with mesothelioma (mean age 68 years; four women). The age-standardized incidence rates were 1.4 per million (95% CI, 0.54-2.2) for SFTP and 4.0 per million (95% CI, 2.6-5.4) for mesothelioma. All SFTPs had benign histology. Three cases were symptomatic and eight were detected incidentally. Apart from one case diagnosed at autopsy, all patients underwent complete surgical resection. Average tumor diameter was 6.5 cm (range, 1.3-20 cm). Eight tumors arose from the visceral pleura and three from the parietal pleura. At a median follow-up of 70 months there had been no recurrence or disease-related death. The authors concluded that this was, to their knowledge, the first age-standardized population incidence for SFTP. They suggested the Icelandic rate is possibly in the higher range, because easy access to chest imaging makes incidental detection more likely.

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In plain English

This short research letter from Iceland used nationwide registries to estimate how often solitary fibrous tumors of the pleura (SFTP), mostly benign tumors of the lining around the lungs, are diagnosed. The authors found every patient with a tissue-confirmed SFTP in Iceland from 1984 to 2007 through a central pathology registry. For comparison, they took mesothelioma cases from the Icelandic Cancer Registry. Eleven patients had SFTP (mean age 60; eight women) and 35 had mesothelioma (mean age 68; four women). The age-standardized rates were 1.4 per million for SFTP (95% CI 0.54 to 2.2) and 4.0 per million for mesothelioma (95% CI 2.6 to 5.4). All 11 SFTPs were benign. Eight were found by chance and three patients had symptoms. All but one were completely removed by surgery; that one was found at autopsy. At a median follow-up of 70 months there was no recurrence or disease-related death. The authors noted the small number of patients. Because many tumors are found by chance on chest imaging, they said Iceland's rate is possibly in the higher range. The letter did not examine asbestos exposure.

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2000s

American College of Chest Physicians consensus statement on the respiratory health effects of asbestos. Results of a Delphi study. D.E. Banks, R. Shi, J. McLarty, et al. 2009;135(6):1619-1627. Consensus statement PubMed · Publisher

Abstract

Background: The diagnosis of and criteria for the evaluation of asbestos-related disease impairment remains controversial after decades of research. Assessing agreement among experts who study pneumoconiosis, and diagnose and treat patients with asbestos-related respiratory conditions may be the first step in clarifying clinical and forensic/administrative issues associated with asbestos-related pulmonary conditions.

Methods: We conducted a Delphi study, an iterative method of obtaining consensus among a group of experts. An expert panel was identified using an objective, nonbiased algorithm, based on the number of asbestos-related disease publications authored during the preceding 10-year period. Identified experts were invited to participate by accessing an Internet site. Each expert was presented statements developed by the authors regarding the diagnosis or treatment of asbestos-related disease; experts then ranked their degree of agreement or disagreement utilizing an 11-level modified Likert scale for each statement. Each expert was asked to justify their selection and to suggest references in support of their opinion. The Wilcoxon signed rank test and the interquartile range were used to define "consensus." The results of the collective Likert rankings, deidentified comments, and suggested references as well as the initial consensus results were then provided to the participating experts. Each panel member then ranked their extent of agreement with a modified statement for which consensus was not achieved. The process was repeated three times.

Results: Consensus was achieved on all but 9 of 32 statements.

Conclusions: Consensus was not achieved for nine statements. These statements may be topics for future research.
Malignant pleural mesothelioma: an update on biomarkers and treatment. M. Ray, H.L. Kindler. 2009;136(3):888-896. Review PubMed · Publisher

Abstract

Although the insulating properties of asbestos have been known for millennia, the link between asbestos exposure and mesothelioma was not recognized until 1960, when it was first described in South African asbestos miners. The incidence of mesothelioma parallels asbestos usage with a latency of 20 to 40+ years; thus, patient numbers are declining in the United States but rising in the developing world. Radiation, genetics, and possibly simian virus 40 are less common causes. Diagnosis can be challenging, since the results of pleural fluid cytology testing are often negative despite repeated sampling. No staging system adequately predicts prognosis in the unresected patient. Newly described biomarkers, including soluble mesothelin-related peptide, megakaryocyte potentiation factor, and osteopontin, may predict which asbestos-exposed individuals will develop mesothelioma, and may prove useful in assessing response to treatment. Since surgery cannot eradicate all residual microscopic disease, a multimodality approach is encouraged. Metaanalysis suggests that pleurectomy/decortication may achieve outcomes similar to those of extrapleural penumonectomy. The standard first-line chemotherapy for unresectable disease is pemetrexed plus cisplatin. This combination improves response, survival, time to progression, pulmonary function, and disease-related symptoms. Carboplatin is often substituted, with similar results. Other active agents include raltitrexed, gemcitabine, and vinorelbine. Novel agents in clinical trials include inhibitors of the epidermal growth factor receptor, vascular endothelial growth factor, mesothelin, and histone deacetylases. Although disappointing results of early trials did not confirm promising preclinical data, recent studies have suggested that some novel agents may be effective. As we learn more about mesothelioma biology, molecularly targeted agents may become treatment options.
Age and sex differences in malignant mesothelioma after residential exposure to blue asbestos (crocidolite). A. Reid, G. Berry, N. de Klerk, et al. 2007;131(2):376-82. PubMed · Publisher

Abstract

Background: Blue asbestos was mined and milled at Wittenoom, Western Australia, from 1943 until 1966. Various public records were used to establish a cohort of residents of the nearby township. Mine tailings were distributed throughout the town.

Aims: To report the incident number of malignant mesotheliomas that have occurred in residents of the town who did not work at the mine or mill; and to determine if female subjects are more susceptible to asbestos exposure than male subjects, and if children are more susceptible than adults.

Subjects And Methods: A total of 4,768 residents of the town of Wittenoom have been followed up in cancer and death registries.

Results: There were 67 cases of mesothelioma, and 64 deaths with mesothelioma to the end of 2002. The mortality rate with mesothelioma increased with increasing residence duration, time since first exposure, and estimated cumulative exposure. The mesothelioma mortality rate was consistently lower for female subjects when compared with male subjects, but the dose-response curve was steeper for female subjects. The rate was lower in those first exposed as children compared with those first exposed at > or = 15 years of age. The dose-response slope for asbestos exposure and mortality from mesothelioma was not different between those who were first exposed as children than those who were first exposed at > or = 15 years of age.

Conclusions: Former residents of a crocidolite mining town have a high rate of mesothelioma. The rate is higher in male subjects and those > or = 15 years of age at first exposure, but women have a steeper dose-response curve.
Change in prevalence of asbestos-related disease among sheet metal workers 1986 to 2004. L.S. Welch, E. Haile, J. Dement, et al. 2007;131(3):863-869. PubMed · Publisher

Abstract

In 1985, the Sheet Metal Workers International Association and the Sheet Metal and Air Conditioning National Association formed The Sheet Metal Occupational Health Institute Trust to examine the health hazards of the sheet metal industry in the United States and Canada. Between 1986 and 2004, 18,211 individuals were examined. The mean age of this cohort was 57.9 years, and the participants had worked for a mean (+/- SD) duration of 32.9 +/- 6 years in the sheet metal trade. Twenty-three percent of participants were current smokers, 49% were former smokers, and 28% were never-smokers. A total of 9.6% of participants (1,745 participants) had findings that were consistent with parenchymal disease (International Labor Organization [ILO] score, >/= 1/0); 60% of those with an ILO score >/= 1/0 were classified as 1/0, 34% as 1/1 to 1/2, and 6% as >/= 2/1. A total of 21% of participants (3,827 participants) had pleural scarring. There was a lower prevalence of nonmalignant asbestos-related disease among those who began to work after 1970, when compared to workers who began to work before 1949; those who began to work between 1950 and 1969 had a prevalence between the other two groups. The strongest predictor of both parenchymal and pleural disease on a chest radiograph was the calendar year in which the worker began sheet metal work; work in a shipyard was also an important risk. The results of this study suggest that the efforts to reduce asbestos exposure in the 1980s through strengthened Occupational Safety and Health Administration regulation have had a positive public health impact.
Combined CA125 and mesothelin levels for the diagnosis of malignant mesothelioma. J. Creaney, I. van Bruggen, M. Hof, et al. 2007;132(4):1239-46. PubMed · Publisher

Abstract

Background: Malignant mesothelioma is an aggressive, uniformly fatal tumor. Serum markers would be useful for the diagnosis of this disease. One potential marker is mesothelin. The purpose of this study was to study the mesothelin biomarker in a large patient cohort and to determine if another biomarker, CA125, improves on the sensitivity of mesothelin in the diagnosis of mesothelioma.

Methods: Serum levels of mesothelin and CA125 were determined by commercially available assays in 117 samples obtained at diagnosis from patients with pleural malignant mesothelioma, 33 healthy, asbestos-exposed individuals, 53 patients with asbestos-related lung or pleural disease, and 30 patients presenting with benign pleural effusions. Cross-validated sensitivities were determined, and receiver operator characteristic curves were generated to compare the diagnostic accuracy of the biomarkers.

Results: CA125 had a cross-validated sensitivity of 27% for mesothelioma patients at a specificity of 95% relative to asbestos-exposed individuals, or 50% relative to individuals with benign pleural effusions. Mesothelin had a cross-validated sensitivity of 52% for mesothelioma patients, at a sensitivity of 95% relative to individuals with benign lung or pleural disease. CA125 and mesothelin levels were discordant in > 50% of mesothelioma patients. Combining the data from the two biomarkers using a logistic regression model did not improve sensitivity for detecting mesothelioma above that of the mesothelin marker alone.

Conclusion: Combining mesothelin and CA125 data does not improve the sensitivity of mesothelioma diagnosis over mesothelin alone. The use of both markers potentially increases the number of patients who can be monitored.
Dyspnea with slow-growing mass of the left hemithorax. N. Patel, A. Bishay, M. Bakry, et al. 2007;131(3):904-908. Case report PubMed · Publisher

Abstract

We report a case of a 65-year-old male patient who presented with gradually worsening dyspnea over 2 years. History was significant for smoking and the absence of any hazardous occupational exposure. The clinical findings at presentation included absent breath sounds and stony dullness on the left side, with tracheal deviation contralaterally and clubbing. A chest roentgenogram showed a left-sided opacity occupying almost the entire left hemithorax. A subsequent CT scan of the chest revealed an intrathoracic, extrapulmonary lesion producing a mediastinal shift. Surgical resection of the mass was performed, and pathology, along with immunohistochemical studies positive for CD34 and negative for epithelial markers, confirmed the diagnosis of solitary fibrous tumor of the pleura (SFTP). SFTP is a rare neoplasm, and diagnosis is often difficult. Suspicion of SFTP should arise in the setting of a patient presenting with a paucity of symptoms (except in the case of an accompanying paraneoplastic syndrome), the absence of exposure to asbestos, and a large mass with sharp margins and encapsulation seen on a chest radiograph.
Environmental asbestos contamination: What are the risks?. V.L. Roggli. 2007;131(2):336-8. Comment · Editorial PubMed · Publisher

Summary

This editorial discussed the risks of environmental asbestos contamination. It responded to an expert panel convened by the Agency for Toxic Substances and Disease Registry and to a follow-up study by Reid et al, published in the same issue of CHEST, of residents of Wittenoom, Western Australia, where crocidolite (blue) asbestos was mined from 1943 to 1966. Mine and mill tailings had been used on roads, school playgrounds and yards. Among 4,768 residents who never worked in the mine or mill, there had been 67 mesotheliomas, 31 in women. Twenty-seven of these women reported laundering workers' clothing. Risk rose with duration of exposure, estimated dose and latency. Women had a steeper dose-response than men, which was just significant at the 0.05 level. There was no evidence of greater susceptibility in children. The author calculated that, assuming a background rate of one case per million person-years and a linear no-threshold dose response, Wittenoom blue asbestos would double background risk at 0.015 fiber/mL/yr. That is about 2 months at the OSHA limit of 0.1 fiber/mL. He noted that most asbestos used in the United States was chrysotile, which would require a dose several hundred times higher for similar risk. The youngest cases at Wittenoom (26 years), in Turkish erionite villages (26 years) and in the author's consultation files (28 years) led him to conclude that mesothelioma in people under 25 is unlikely to be asbestos-related. He recommended dust suppression and avoidance of exposure.

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Epidemiology of lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition). A.J. Alberg, J.G. Ford, J.M. Samet, et al. 2007;132(3 Suppl):29S-55S. Review PubMed · Publisher

Abstract

Background: The objective of this study was to summarize the published literature concerning the epidemiology of lung cancer.

Methods: A narrative review of published evidence was conducted, identifying and summarizing key reports that describe the occurrence of lung cancer in populations and factors that affect lung cancer risk.

Results: In the United States, lung cancer remains the leading cause of cancer death in both men and women, even though an extensive list of modifiable risk factors has long been identified. The predominant cause of lung cancer is exposure to tobacco smoke, with active smoking causing most cases but passive smoking also contributing to the lung cancer burden.

Conclusions: The reductions in smoking prevalence in men that occurred in the late 1960s through the 1980s will continue to drive lung cancer mortality rates downward in men during the first portion of this century, but rates in women have not yet begun to decrease. Fortunately, exposures to major occupational respiratory carcinogens have largely been controlled, but the population is still exposed to environmental causes of lung cancer, including radon, the second leading cause of lung cancer death.
Asbestos and the pleura: a review. D.W. Cugell, D.W. Kamp. 2004;125(3):1103-17. Review PubMed · Publisher

Summary

This review surveyed asbestos-related pleural disease: history and mineralogy, exposure and latency, benign pleural effusions, circumscribed plaques, diffuse pleural thickening, rounded atelectasis, mesothelioma, disease mechanisms and US public policy. The authors noted that US exposure limits fell from 5 fibers per cubic centimeter in 1971 to 0.1 in 1994, and that US asbestos use fell from 803,000 metric tons in 1973 to 16,000 tons in 1998. Even so, pleural abnormalities attributable to asbestos had been increasing. They described the radiologic features of plaques and the pitfalls in detecting them. They summarized conflicting studies on whether plaques impair lung function or raise cancer risk, and stated that the preponderance of the evidence indicated plaques do not increase cancer risk, though this was far from a universal view. They reported general agreement that diffuse pleural thickening can cause significant restrictive ventilatory impairment. For mesothelioma, they reviewed incidence, the greater likelihood of amphibole than chrysotile fibers producing the tumor, the controversial role of simian virus-40, diagnosis, histologic types and poor survival. Mechanisms discussed included reactive oxygen and nitrogen species, DNA damage and p53. The authors stated that low-level exposure in public buildings probably poses no hazard beyond that of breathing outdoor air. They said asbestos-containing materials in buildings should be left in place, covered or sealed, and examined periodically. They also described renewed efforts to base settlement of nonmalignant claims on objective disability assessment.

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Changing patterns in asbestos-induced lung disease. P. De Vuyst, P.A. Gevenois, A. Van Muylem, et al. 2004;126(3):999. Letter · Comment PubMed · Publisher
Changing patterns in asbestos-induced lung disease. J. Ohar, D.A. Sterling, E. Bleecker, et al. 2004;125(2):744-53. PubMed · Publisher

Abstract

Study Objectives: To determine patterns in asbestos-induced lung diseases found in older, less exposed workers.

Design: Review of a database evaluating lung function, smoking status, form of asbestos-induced lung disease, and radiograph abnormalities.

Setting: Outpatient clinic.

Participants: A total of 3383 asbestos-exposed workers referred for independent medical evaluation, including control subjects who lacked asbestos-specific radiograph abnormalities (n = 243), subjects with low International Labor Organization (ILO) scores (n = 2,685), high ILO scores (n = 312), bronchogenic cancer (n = 63), and mesothelioma (n = 80). Of these, 3,327 workers have specific smoking status information and 3,312 workers have lung volume measures.

Interventions: Chest radiographs were interpreted by a certified B-reader, and abnormalities were quantified according to the ILO scoring system. Spirometry and lung volume measurement were performed. Subjects completed a self-administered questionnaire that was reviewed at the time of examination. Control subjects were screened on two separate occasions at least 10 years apart to exclude subclinical or slowly progressive asbestos-induced lung disease.

Measurements And Results: The mean age of the population was 65.1 +/- 9.9 years, and the latency was 41.4 +/- 10.1 years (+/- SD). Most subjects (41.8%) had normal pulmonary function. Obstruction was the most common pulmonary function abnormality (25.4%), followed by restriction (19.3%) and a mixed pattern (6.0%). Most subjects (79.4%) had low ILO scores. Benign pleural abnormalities were the only findings in 54% of subjects with low ILO score. Subjects with high ILO scores were older, smoked more, and had a longer latency than subjects with low ILO scores and control subjects. Smokers were younger, had a shorter latency, and had paradoxically greater ILO scores than nonsmokers. Subjects with bronchogenic cancer and mesothelioma had longer latencies than control subjects and subjects with benign asbestos-induced lung disease.

Conclusions: Asbestos-induced lung disease today is characterized by low ILO scores, long latencies, greater disease magnitude in smokers, and a normal or obstructive pattern of pulmonary function abnormality. Spirometric evaluation in the absence of lung volume measurements caused misclassification that resulted in overestimation of the presence of a restrictive pattern of pulmonary function.
Clinical correlation of asbestos bodies in BAL fluid. P. Vathesatogkit, T.J. Harkin, D.J. Addrizzo-Harris, et al. 2004;126(3):966-71. PubMed · Publisher

Abstract

Background: Asbestos bodies (AB) in BAL cells are specific markers of asbestos exposure.

Methods: We retrospectively reviewed BAL cytocentrifuge slides of 30 utility workers with a history of asbestos exposure and 30 normal volunteers. BAL cytocentrifuge slides were blinded and scanned under 40 x light microscope.

Results: AB were found more frequently in subjects with a history of asbestos exposure compared to normal volunteers (10 of 30 subjects, 33%, vs 0 of 30 subjects). The mean number of AB seen in the AB-positive group was 2.7 per slide. Demographic data were comparable including age, gender, and smoking. Exposure histories were also similar: duration > 20 years, onset > 30 years ago, and time since last exposure > 7 years. More AB-positive patients reported respiratory symptoms (70% vs 26%, p < 0.05). High-resolution CT scans of AB-positive patients revealed a higher prevalence of parenchymal disease (70% vs 26%, p < 0.05). AB-positive subjects had reduced pulmonary function compared to AB-negative subjects: FVC (86% vs 97% predicted), FEV(1) (77% vs 92% predicted, p < 0.05), and diffusion capacity of the lung for carbon monoxide (76% vs 104% predicted, p < 0.01).

Conclusion: In individuals with a history of asbestos exposure, the presence of AB in BAL cells is associated with higher prevalence of parenchymal abnormalities, respiratory symptoms, and reduced pulmonary function.
Decreasing prevalence of pleural calcifications among Metsovites with nonoccupational asbestos exposure. C. Manda-Stachouli, Y. Dalavanga, G. Daskalopoulos, et al. 2004;126(2):617-21. PubMed · Publisher

Abstract

Study Objectives: Twenty years ago, we reported on a very high prevalence of pleural calcifications (PCs) and malignant mesothelioma among inhabitants of Metsovo, in northwestern Greece. It was shown that both abnormalities were related to asbestos exposure from a whitewash containing tremolite. The fading use of this material has resulted in a decreased incidence of mesothelioma (one third of the original incidence). The aim of the present study was to examine whether PCs among Metsovites has followed a similar trend.

Design: Retrospective study.

Settings: University Hospital of Ioannina, a tertiary teaching hospital, "G. Hadjikosta" Hospital, a tertiary hospital in Ioannina, and Metsovo Health Center, a primary care center in the town of Metsovo.

Patients: Chest roentgenograms of 307 Metsovites, obtained between from 1998 to 2002 were examined. The prevalence of PCs was compared to the one noted 20 years ago.

Results: A significantly lower prevalence of calcifications was observed now among younger Metsovites (< 60 years of age). In both studies, there was an increasing rate of PC with age.

Conclusions: The findings of the present study strengthen the incrimination of the whitewash containing tremolite in the development of PCs in Metsovites. The withdrawal of its use in the area has resulted in a null prevalence of PCs in individuals < 40 years old.
Development of lung tumors in mutant p53-expressing mice after inhalation exposure to asbestos. G.F. Morris, A.R. Notwick, O. David, et al. 2004;125(5 Suppl):85S-6S. PubMed · Publisher

Summary

This brief conference report, from Tulane University Medical Center in New Orleans, described an experiment in mice on whether the tumor suppressor protein p53 protects against lung tumors caused by asbestos. The authors noted that the p53 gene is commonly mutated in human lung cancers but rarely in mouse lung tumors induced by carcinogen exposures. They had previously produced transgenic mice (SPC-DNp53 mice) that express a dominant-negative form of p53 specifically in the lung epithelium, using the human surfactant protein C promoter. Unexposed mice of this strain developed lung tumors at a low incidence and with delayed onset. The authors cited evidence that inhaled asbestos activates p53 expression at sites of fiber deposition and that asbestos exposure increases the risk of lung cancer about fivefold. They proposed that the p53-mediated response to asbestos protects against lung tumors. Transgenic mice and nontransgenic littermates were exposed at the same time to a single 5-hour aerosol of asbestos. The transgenic mice had a significantly higher incidence of lung tumors than their nontransgenic littermates. The report did not give the number of animals, the type of asbestos, the exposure concentration, or tumor counts. The authors concluded that compromised p53 function in the lung epithelium cooperates with asbestos in lung tumorigenesis.

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Failure to prove asbestos exposure produces obstructive lung disease. D.D. Smith. 2004;126(3):1000. Comment · Letter PubMed · Publisher
Summary

In this letter to the editor, Smith commented on a study by Ohar and colleagues (Chest, February 2004). That study had analyzed relationships among asbestos exposure, cigarette smoking, lung function and chest radiograph abnormalities in 3,383 patients referred mainly by plaintiff attorneys and trade union members. He noted that the study had reported clinically significant airflow obstruction as well as restrictive changes, attributed to a synergistic effect of smoking and asbestos exposure.

He pointed to what he described as contradictions. First, 73% of patients with mixed restrictive/obstructive findings had a normal total lung capacity, yet the authors later stated that 83% of smokers and 71% of nonsmokers with obstruction and a reduced FVC had hyperinflation. Second, a figure gave a value of 5,381 (16.0%), although 16% of 3,312 is 530.

He questioned the statistical method used to compare FEV1/FVC ratios in nonsmokers with high versus low ILO scores (72.8% vs 76.2%), citing Rothman and Greenland. He also raised these points:
- Diffusing capacity results were not presented.
- The cause of restriction (diffuse pleural disease vs asbestosis) was not given.
- Total lung capacity should have been used for clinical correlations.
- ILO scoring is prone to error.
- Patients referred largely by plaintiff attorneys may exaggerate asbestos exposure and minimize smoking.
- The bibliography was selective.
He concluded that the article failed to prove that asbestos exposure produces obstructive lung disease.

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Increased urinary 8-isoprostaglandin F(2)alpha is associated with lower plasma selenium levels and lower vegetable and fruit intake in an asbestos-exposed cohort at risk for lung cancer. E.B. Gottschall, P. Wolfe, A.D. Haegele, et al. 2004;125(5 Suppl):83S. PubMed · Publisher

Summary

Oxidative damage is thought to be one way asbestos causes lung diseases, including lung cancer. The authors had previously found that urinary 8-isoprostaglandin F2alpha (8-EPG), a product of lipid peroxidation, was positively associated with years of asbestos exposure and with smoking in an asbestos-exposed cohort. In this study they examined whether fruit and vegetable intake and plasma selenium levels influenced urinary 8-EPG in the same population. Seventy-nine asbestos-exposed construction trades workers completed a validated seven-item food frequency questionnaire on daily fruit and vegetable intake. An administered questionnaire recorded age, smoking status and asbestos exposure. Urinary 8-EPG was measured by enzyme-linked immunosorbent assay after solid phase extraction, and plasma selenium by a fluorometric method. Urinary 8-EPG was inversely associated with both daily fruit and vegetable intake and plasma selenium. These associations remained significant after adjustment for age, current smoking and duration of asbestos exposure. Smoking status interacted strongly with fruit and vegetable intake. The standardized regression coefficients differed markedly: 0.67 (p 0.01) in 16 current smokers and 0.23 (p 0.06) in 63 former or never-smokers. The signs and comparison symbols are not legible in the source text. The authors concluded that 8-EPG was significantly higher in asbestos-exposed workers reporting low fruit and vegetable intake, particularly smokers, and that low plasma selenium also predicted higher 8-EPG. They suggested implications for dietary modification and selenium supplementation in groups at risk for lung cancer.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.
Malignant pleural mesothelioma: update, current management, and newer therapeutic strategies. M. Pistolesi, J. Rusthoven. 2004;126(4):1318-29. Review PubMed · Publisher

Abstract

The diagnosis and management of malignant pleural mesothelioma are major challenges that often frustrate both patient and clinician alike. Occupational asbestos exposure to crocidolite or amosite forms of the fiber is the most important known risk factor in North America and Western Europe. Other mineral fibers such as erionite, a naturally occurring fibrous zeolite crystal, are associated with mesothelioma in volcanic tuffs of the Cappadocia region of central Anatolia in Turkey. In addition, other possible factors such as the presence of simian virus 40 and genetic susceptibility have been associated recently with the development of mesothelioma in animal models. These latter findings are increasing our understanding of this disease. In addition, the discovery of elevated levels of various markers such as folic acid receptor alpha, cyclooxygenase 2, and multidrug resistance proteins 1 and 2 in mesothelioma tissue have opened up new areas of potential diagnostic and therapeutic importance. However, traditional treatment modalities--surgery, radiotherapy, and chemotherapy--have evolved slowly, and few gains in therapeutic efficacy have occurred. Recently, however, continuing research efforts have led to novel treatment strategies that are changing the way clinicians view a disease that has traditionally been managed with almost universal therapeutic nihilism. This review explores our current knowledge of this disease and presents current and novel therapeutic strategies.
The clinical diagnosis of asbestosis in this century requires more than a chest radiograph. R.M. Ross. 2003;124(3):1120-8. Review PubMed · Publisher

Abstract

Asbestosis can cause significant impairment and even death. It is also a well-recognized risk factor for the development of lung cancer. However, asbestosis is usually diagnosed on clinical grounds without the aid of pathology. Many physicians and researchers believe that in asbestos-exposed individuals with adequate latency, chest radiographic findings that are compatible with asbestosis are sufficient for the diagnosis. In order to determine whether this approach is reasonable, the positive predictive value of the chest radiograph for the diagnosis of pathologic asbestosis must be determined. This requires information about the prevalence of asbestosis, and the sensitivity and specificity of the chest radiograph in its diagnosis. In this article, the sensitivity and specificity of the chest radiograph in diagnosing asbestosis is determined from a literature analysis. The prevalence of asbestosis among present-day cohorts, such as construction workers and petrochemical workers, is assessed based on the relative risk of lung cancer in patients with asbestosis and the overall relative risk of lung cancer in these occupationally asbestos-exposed cohorts. The results indicate a positive predictive value for abnormal chest radiograph findings alone to be significantly < 50%. Therefore, the chest radiograph is inadequate as the sole clinical tool to be used to diagnose asbestosis in these cohorts. However, when rales and a low diffusing capacity of the lung for carbon monoxide are also present, the diagnosis of asbestosis on clinical grounds can be made with reasonable confidence.
Tumor necrosis correlates with angiogenesis and is a predictor of poor prognosis in malignant mesothelioma. J.G. Edwards, D.E. Swinson, J.L. Jones, et al. 2003;124(5):1916-23. PubMed · Publisher

Abstract

Objectives: Malignant mesothelioma (MM) is a fatal tumor of increasing incidence related to asbestos exposure. Microscopic tumor necrosis (TN) is a poor prognostic factor in solid tumors, but it has not been characterized in MM. We wished to evaluate the incidence of TN in MM and its correlations with clinicopathologic factors, angiogenesis, and survival.

Methods: TN was graded in 171 routine formalin-fixed, paraffin-embedded hematoxylin-eosin-stained tumor sections by two independent observers. Angiogenesis was assessed by the microvessel count (MVC) of CD34 immunostained sections. TN was correlated with survival by Kaplan-Meier and log-rank analysis, and stepwise, multivariate Cox models were used to compare TN with angiogenesis and established prognostic factors and prognostic scoring systems.

Results: TN was identified in 39 cases (22.8%) and correlated with low hemoglobin (p = 0.01), thrombocytosis (p = 0.04), and high MVC (p = 0.02). TN was a poor prognostic factor in univariate analysis (p = 0.008). Patients with TN had a median survival of 5.3 months vs 8.3 months in negative cases. Independent indicators of poor prognosis in multivariate analysis were nonepithelioid cell type (p = 0.0001), performance status > 0 (p = 0.007), and increasing MVC (p = 0.004) but not TN. TN contributed independently to the European Organisation for Research and Treatment of Cancer (EORTC) [p = 0.03] and to the Cancer and Leukemia Group B (CALGB) [p = 0.03] prognostic groups in respective multivariate Cox analyses.

Conclusions: TN correlates with angiogenesis and is a poor prognostic factor in MM. TN contributes to the EORTC and CALGB prognostic scoring systems.
Additional proteins in BAL fluid of Metsovites environmentally exposed to asbestos: more evidence of "protection" against neoplasia?. V. Galani, S. Constantopoulos, C. Manda-Stachouli, et al. 2002;121(1):273-8. PubMed · Publisher

Abstract

Introduction: Inhabitants of Metsovo in northwest Greece have been exposed to asbestos from use of a tremolite-containing whitewash ("luto" soil). As a result, they have increased incidence of malignant pleural mesothelioma and pleural calcifications (PCs). However, subjects with calcifications have a much lower incidence of mesothelioma than those without. A previous study of the two groups with BAL revealed higher proportional lymphocytosis among subjects with calcifications. We suggested that BAL lymphocytosis may be somehow correlated with "protection" against neoplasia.

Methods: The present report is a study of the liquid phase of BAL in the two groups. BAL specimens of 43 Metsovites (13 subjects with PCs and 30 subjects without PCs) and two control groups were examined. We measured total protein, albumin, IgG, IgA, and interleukin-6. Proteins were analyzed with sodium dodecyl sulfate-polyacrylamide gel electrophoresis and two-dimensional electrophoresis and further characterized using an appropriate computer program.

Results: The most interesting finding was the presence of two additional protein spots corresponding to the electrophoretic site of Ig heavy chain and C(4) component of complement. The two proteins were present in all Metsovites with PCs but in none without PCs and also in none of the control groups.

Conclusion: This study further separates two groups of Metsovites with different reaction to asbestos, possibly as a result of different activation of alveolar macrophages. This difference leads the first group to the formation of PCs, BAL fluid lymphocytosis, and relative "protection" against malignancy, and the second group to no calcifications, no lymphocytosis, but also no protection against malignancy.
Airway wall remodeling induced by occupational mineral dusts and air pollutant particles. A. Churg, J.L. Wright. 2002;122(6 Suppl):306S-309S. PubMed · Publisher

Abstract

Objectives: COPD has been reported in workers exposed to particulates, and there is increasing evidence that high levels of ambient particulate pollutants may also be associated with COPD. The studies here investigate the hypothesis that particulates, including air pollution particles, can induce airway wall fibrosis, a process that can lead to COPD.

Design: Rat tracheal explants were exposed to various occupationally encountered dusts, air pollution particles, and model air pollution particles. In some experiments, iron was loaded onto the particle surface. Gene expression and nuclear factor (NF)-kappaB activation were measured after 7 days of air culture. Adhesion to and uptake of dusts by the tracheal epithelium were also evaluated.

Results: Known fibrogenic dusts such as amosite asbestos produced increased gene expression of procollagen, transforming growth factor-beta, and platelet-derived growth factor, and increased hydroxyproline in the explants, and the addition of iron increased these effects. The addition of iron also converted nonfibrogenic TiO2 into a fibrogenic dust. Dusts with surface complexed iron activated NF-kappaB via an oxidant mechanism. However, an ultrafine TiO2 with very low iron was also fibrogenic. In separate experiments, exogenous tumor necrosis factor-alpha increased dust adhesion to, and exogenous ozone increased dust uptake by, tracheal epithelial cells.

Conclusions: Mineral dusts can directly induce fibrosis in the airway wall. Exogenous inflammatory cells and exogenous agents are not required, but they probably exaggerate the fibrogenic effects. An iron-mediated oxidant mechanism underlies the fibrogenic effects of some, but not all, of these dusts. Particle-induced airway wall fibrosis may lead to COPD.
Cytoreductive surgery and intraoperative hyperthermic intrathoracic chemotherapy in patients with malignant pleural mesothelioma or pleural metastases of thymoma. E. de Bree, S. van Ruth, P. Baas, et al. 2002;121(2):480-7. PubMed · Publisher

Abstract

Study Objectives: No established curative treatment is available for pleural thymoma metastases and malignant pleural mesothelioma (MPM). Recently, peritoneal malignancies have been treated by cytoreductive surgery and intraoperative hyperthermic intracavitary perfusion chemotherapy (HIPEC). We investigated the feasibility and safety of this multimodality treatment in the thoracic cavity.

Design: Patients with pleural thymoma metastases or early-stage MPM were enrolled in a feasibility study. Morbidity, recurrence, and survival rates were recorded.

Setting: The Netherlands Cancer Institute.

Patients: Three patients with pleural thymoma metastases and 11 patients with pleural mesothelioma were treated.

Interventions: Cytoreductive surgery and intraoperative hyperthermic intrathoracic perfusion chemotherapy (HITHOC) with cisplatin and adriamycin were performed. The mesothelioma patients received adjuvant radiotherapy on the thoracotomy wound and drainage tracts.

Measurements And Results: Morbidity and mortality rates were 47% and 0%, respectively. Reoperation was necessary in four cases. Severe chemotherapy-related complications were not observed. A solitary mediastinal and a contralateral pleural thymoma recurrence were successfully treated by radiotherapy and a contralateral HITHOC procedure. All thymoma patients were alive and free of disease after a mean follow-up period of 18 months. After a mean follow-up period of 7.4 months, nine mesothelioma patients are alive. Two mesothelioma patients died of contralateral pleural and peritoneal recurrent disease, while one patient is alive with locoregional recurrence.

Conclusions: Cytoreductive surgery and HITHOC with cisplatin and adriamycin is feasible in patients with pleural thymoma metastases and early-stage MPM, and is associated with acceptable morbidity rates. Early data on locoregional disease control are encouraging, and a phase II study will be conducted.
Diagnostic value of medical thoracoscopy in pleural disease: a 6-year retrospective study. F.X. Blanc, K. Atassi, J. Bignon, et al. 2002;121(5):1677-83. PubMed · Publisher

Abstract

Study Objectives: Unlike thoracocentesis and closed pleural biopsy (CPB), medical thoracoscopy permits biopsy with direct visualization. In a 6-year retrospective study of patients having undergone at least one medical thoracoscopy, we analyzed the diagnostic yield of thoracoscopy and its value in the management of pleural disease.

Setting/Patients: From January 1, 1989, to December 31, 1994, 168 medical thoracoscopies were performed on 154 patients (123 men; mean age +/- SE, 61 +/- 1 years), of which 149 were diagnostic and 19 were indicated for therapeutic assessment in malignant mesothelioma (MM). Prior to thoracoscopy, at least one CPB had been performed in 120 of 149 cases, yielding a diagnosis in 96 cases.

Results: Thoracoscopy challenged the CPB-based diagnosis in 43 of 96 cases. In 66 cases of nonspecific inflammation diagnosed by CPB, thoracoscopy revealed MM in 16 cases, adenocarcinoma in 10 cases, undetermined carcinoma in 3 cases, and pleural tuberculosis in 3 cases. In 18 cases in which the CPB diagnosis was MM, thoracoscopy, performed for precise staging, challenged the diagnosis in 4 cases. In 12 cases of carcinoma diagnosed by CPB, thoracoscopy specified the histologic type in 7 cases. Thoracoscopic diagnoses were found to be erroneous in 10 of 149 cases, mainly owing to pleural adhesions that limited access to the pleural cavity. There was one thoracoscopy-related death, one case of sepsis, and six cases of empyema.

Conclusions: Medical thoracoscopy appears to be efficient and relatively safe in the management of pleural disease. Pleural adhesions can lower its diagnostic value.
Identifying fibrosis susceptibility genes in two strains of inbred mice. A.R. Brody, G.S. Warshamana, J.Y. Liu, et al. 2002;121(3 Suppl):31S. PubMed
Malignant mesothelioma due to environmental exposure to asbestos: follow-up of a Turkish cohort living in a rural area. S. Metintas, M. Metintas, I. Ucgun, et al. 2002;122(6):2224-9. PubMed · Publisher

Abstract

Study Objectives: This study examines the incidence of malignant pleural mesothelioma (MPM) in a rural population of Turkey with environmental exposure to asbestos-contaminated soil mixtures (white soil).

Design: A field-based epidemiologic study.

Setting And Subjects: A cohort of villagers (the "Eskisehir" cohort) from 11 villages around Eskisehir in central Anatolia, who had been environmentally exposed to asbestos due to the use of white soil.

Measurements: The mineral content and asbestos contamination of the white soil used in these villages was determined, as well as airborne fiber concentrations. Cohort members' details of age, sex, ambient exposure data, duration of residence in the villages, and hospital records, including pathologic diagnosis, were recorded.

Results: The Eskisehir cohort consisted of 1,886 villagers. During the observation time, 377 deaths occurred and 24 MPM cases were diagnosed. Average annual mesothelioma incidence rates were 114.8/100,000 for men and 159.8/100,000 for women.

Conclusions: These data indicate that the risk of mesothelioma is 88.3 times greater in men and 799 times greater in women, respectively, in comparison to world background incidence rates.
Women and mesothelioma. D.D. Smith. 2002;122(6):1885-6. Comment · Editorial PubMed · Publisher

Summary

In this editorial, the author commented on a study by Metintas and coworkers, published in the same issue of CHEST, which compared women and men for malignant pleural mesothelioma (MPM) caused by environmental amphibole asbestos exposure in Turkey. That study reported a higher risk for women than men (159.8 vs 114.8 per 100,000). An earlier study of erionite exposure in Karain Village, Turkey, had also shown a female predominance (440.9 vs 298.1 per 100,000). North American, Australian and European cohorts, by contrast, had shown a much lower risk for women. The author discussed possible explanations. One was higher exposure among women, for example from whitewashing homes and time spent at home, although Metintas and coworkers found no significant difference in exposure between the sexes. Others were the underrepresentation of women in occupational cohorts and physiologic factors such as breathing pattern, lung volume and body size affecting fiber deposition. He also discussed peritoneal mesothelioma in women and its past confusion with ovarian serous carcinoma, which he said is not a significant problem with current techniques. He described a British review of 177 cases in women, 98% with elevated amphibole fiber burden, as reflecting selection bias. He noted the 59.2-year latency, which was the same for both sexes, and evidence that latency increases with lower exposures. He suggested that longer life expectancy may reveal more mesotheliomas from low-dose amphibole exposure. He described the roles of SV40 and genetic factors as uncertain.

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Enhancement of fibrogenesis by the p53 tumor suppressor protein in asbestos-exposed rodents. A. Nelson, T. Mendoza, G.W. Hoyle, et al. 2001;120(1 Suppl):33S-34S. PubMed · Publisher

Summary

This conference report from Tulane University Medical Center, New Orleans, examined whether the p53 tumor suppressor protein contributes to lung scarring (fibrogenesis) caused by inhaled asbestos. The authors noted that p53 activates transforming growth factor-alpha (TGF-a), an inducer of fibrosis, and its receptor, epidermal growth factor receptor (EGF-R). They used transgenic mice with reduced p53 function (SPC-DNp53) or enhanced p53 function (SPC-wtp53) in the lung epithelium, and compared them with nontransgenic littermates exposed at the same time. In the first experiment, SPC-DNp53 and control mice from three separate exposures inhaled an asbestos aerosol for 5 hours and were killed 2 or 3 days later. Three observers who did not know which sample was which scored lung damage. Histopathologic scores appeared lower in the SPC-DNp53 mice. Bromodeoxyuridine incorporation, a marker of cell proliferation, was also reduced in the terminal bronchioles and bronchiolar-alveolar duct bifurcations. In the second experiment, SPC-wtp53 and control mice were exposed for 5 hours on 3 consecutive days and killed one week later. The transgenic mice showed more severe fibrogenesis. The report did not give the numbers of animals. The authors concluded that the results were consistent with their view that p53 activation intensifies the fibrogenic response to inhaled asbestos. They added that preliminary messenger RNA analyses suggested that a p53-induced TGF-a–EGF-R loop in the lung epithelium accounts in part for this response.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.
Percutaneous image-guided cutting needle biopsy of the pleura in the diagnosis of malignant mesothelioma. R.F. Adams, W. Gray, R.J. Davies, et al. 2001;120(6):1798-802. PubMed · Publisher

Abstract

Study Objectives: Pleural fluid cytology and non-image-guided Abrams or Cope biopsies have sensitivities of approximately 30% for detecting malignant mesothelioma, and thoracoscopic biopsy has a sensitivity of approximately 90%. The difference between these two probably relates to obtaining adequate tissue. The use of immunohistochemical stains allows a firm diagnosis to be made from relatively small samples. This study explores whether percutaneous image-guided cutting needle biopsy (CNB) combined with immunohistochemistry is accurate in diagnosing pleural thickening due to mesothelioma.

Design: Retrospective review of image-guided CNB of pleural thickening performed on consecutive patients over 7 years by a single radiologist.

Setting: Teaching hospital chest radiology department.

Patients: Twenty-one adult patients with a final diagnosis of malignant mesothelioma were identified from 53 consecutive patients who underwent percutaneous image-guided CNB. All 21 patients had pleural thickening identified on contrast-enhanced CT, and all had a final histologic diagnosis of mesothelioma confirmed by postmortem examination or thoracoscopy.

Interventions: Fourteen-gauge and 18-gauge cutting needles were used. Biopsy guidance was by ultrasound in 6 patients and by CT in 15 patients.

Measurements And Results: A correct histologic diagnosis of malignant mesothelioma was made by CNB in 18 patients (86% sensitivity and 100% specificity). Complications included one chest wall hematoma and a small hemoptysis. Four patients with a pleural thickness of < or = 5 mm underwent biopsy, and all specimens were diagnostic for mesothelioma.

Conclusions: Image-guided percutaneous CNB of pleural thickening is a safe procedure, with 86% sensitivity for detecting malignant mesothelioma. Pleural thickening of < or = 5 mm may be successfully sampled.
Primary intrathoracic malignant effusion: a descriptive study. P. Ang, E.H. Tan, S.S. Leong, et al. 2001;120(1):50-4. PubMed · Publisher

Abstract

Background: Patients who present with malignant pleural/malignant effusion without a definite primary site are not well described in the medical literature. In the course of our clinical practice, we have observed certain traits that are peculiar to patients with such a presentation. We have applied the term primary intrathoracic malignant effusion (PIME) to describe this condition.

Study Objectives: Patients must fulfill the following criteria before a diagnosis of PIME can be made: clinical presentation dominated by pleural/pericardial effusion; histologic proof of malignancy obtained from the pleura and/or pericardium; no definite primary site in the lungs or elsewhere from CT scan of the chest, chest radiograph, or physical and endoscopic examination; no history of malignancy; and no history of asbestos exposure. Exposure to environmental tobacco smoke (ETS) among the nonsmokers was examined in a case-control setting.

Methods: We conducted a retrospective search of our database of patients who were referred to the Department of Medical Oncology with a diagnosis of pleural/pericardial effusion from January 1993 to January 2000.

Results: Seventy-one of 200 patients from our database met the criteria. A significant majority of the patients were women (65%) and nonsmokers (72%). All patients had adenocarcinoma shown on biopsy. The majority of patients (63%) had disease localized to the intrathoracic serosal surfaces; the rest had distant metastases involving the lung (50%), bone (27%), liver (19%), brain (8%), and skin (4%). Six patients had two or more sites of distant metastases. There was a significant association with ETS exposure when compared to a control group comprised of patients with colonic cancer, matched for sex and age. The median survival was 10 months for patients with disease localized to the pleura/pericardium and 7 months for those with distant metastases. Thirty-eight patients (54%) received chemotherapy. All had platinum-based chemotherapy, except for three patients. The median survival for patients treated or not treated with chemotherapy was 12 months and 5 months, respectively. This difference in survival was statistically significant (p = 0.003).

Conclusions: PIME should be viewed as a distinct entity. Its etiology remains largely unknown, although exposure to environmental tobacco smoke may play a part. Platinum-based chemotherapy may have a positive biological effect on this disease. More studies are required to elucidate the epidemiology, possible etiologic factors, and treatment options for this group of patients.
Asbestos in extrapulmonary sites: omentum and mesentery. R.F. Dodson, M.F. O'Sullivan, J. Huang, et al. 2000;117(2):486-93. PubMed · Publisher

Abstract

Study Objectives: Asbestos fibers have not been reported in tissues from the peritoneal cavity. Therefore, omentum, mesentery, and lung tissues from 20 individuals in whom mesothelioma was diagnosed were analyzed for asbestos bodies and asbestos fibers.

Design: Tissue was digested and prepared filters were analyzed by light microscopy and analytical transmission electron microscopy.

Results: Asbestos bodies were found in the lungs of 18 individuals, mesentery samples from 5, and omentum samples from 2. Uncoated asbestos fibers were found in lungs of 19 patients, 17 of whom had fibers in at least one extrapulmonary site. The most common asbestos in the omentum and mesentery was amosite. Several features of asbestos found in lung influenced the likelihood of amphibole fibers being found in the omentum or mesentery. Lung features included total amphibole fiber burden, length, aspect ratio, and ferruginous body burden. An increased total ferruginous body burden was strongly associated with increased likelihood of detecting amphiboles in the omentum (p < 0. 05).

Conclusion: Asbestos fibers reach areas in the peritoneal cavity where some mesotheliomas develop. This study suggests their presence can be predicted based on concentrations and characteristics of fiber burdens in lung tissue.

1990s

Asbestos exposure, asbestosis, and lung cancer. D.E. Banks, M.L. Wang, J.E. Parker. 1999;115(2):320-2. Comment · Editorial PubMed · Publisher

Summary

This editorial commented on a review by Weiss, published in the same issue of Chest, of 39 English-language reports of cohorts exposed to asbestos. The review addressed whether excess lung cancer in asbestos-exposed workers is caused by asbestosis (the "Browne hypothesis") or by asbestos exposure itself. The authors summarized early evidence. A 1949 report found lung cancer in 35 of 235 (13.2%) autopsied deaths where asbestosis was identified. A 1955 cohort study found lung cancer in 18 of 105 deaths, 15 of them in association with asbestosis. The authors argued that the seven cohorts Weiss used as a comparison group, which showed neither asbestosis nor excess lung cancer (mean relative risk 1.00), had weaknesses: small numbers of deaths, low exposures, high worker turnover, or selection of subcohorts with shorter exposure. They cited studies linking pleural plaques and chest radiograph abnormalities other than small opacities to raised lung cancer risk. Among people with pleural plaques independent of asbestosis, the lung cancer SMR was 1.4. They stated that one of Weiss's relative risk calculations appeared to be in error. They also cited expert estimates that lung cancer risk roughly doubles at a cumulative exposure of 25 fiber-years, a level at which asbestosis may or may not be present. The authors concluded that asbestosis indicates high exposure and adds risk. However, they judged the hypothesis that excess lung cancer occurs only among those with asbestosis insufficient to explain the heightened risk.

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Asbestosis: a marker for the increased risk of lung cancer among workers exposed to asbestos. W. Weiss. 1999;115(2):536-49. Review PubMed · Publisher

Abstract

This review examines the hypothesis that excess lung cancer risk in worker cohorts exposed to asbestos occurs only among those with asbestosis. The adequately designed studies in the literature support this hypothesis. The summary relative risk for lung cancer was 1.00 in seven cohorts with no deaths from asbestosis. In addition, there is a high correlation between asbestosis rates and lung cancer rates in 38 cohorts in contrast to a poor correlation between cumulative exposure data and lung cancer relative risks in eight cohorts with adequate data. The evidence indicates that asbestosis is a much better predictor of excess lung cancer risk than measures of exposure and serves as a marker for attributable cases.
Assessment of hazardous dust exposure by BAL and induced sputum. E. Fireman, J. Greif, Y. Schwarz, et al. 1999;115(6):1720-8. PubMed · Publisher

Abstract

Objectives: BAL, an important tool in assessing occupational lung diseases, is unsuitable for screening programs, exposure evaluation, or monitoring hazardous dust because it is an invasive technique. The results of induced sputum (IS) analysis were compared with BAL and evaluated as a possible alternative.

Methods: We compared BAL with IS analysis of 5 workers exposed to asbestos and 14 exposed to silica and hard metals. Pulmonary function tests and BAL were performed by conventional methods. IS induction was performed after a 20-min inhalation of 3.5% saline solution with an ultrasonic nebulizer. Giemsa-stained cytopreparations were differentially counted. T-lymphocyte subsets were analyzed by flow-activated cell sorter, and messenger RNA (mRNA) was transcribed by reverse transcriptase-polymerase chain reaction. Mineralogic particles were analyzed by scanning electron microscopy and polarizing light microscopy and quantified by an analyzer.

Results: The percentage of neutrophils was significantly lower in BAL fluid than in IS specimens, whereas no differences were found in the percentage of lymphocytes and subsets profile. Asbestos fibers were found in BAL but not in IS samples from workers exposed to asbestos. Polarizing particles were found in both samples. Similar mineral elements were found in qualitative analysis by scanning electron microscopy. Quantitative studies showed similar size distribution with a small shift toward larger particles in sputum; mRNA showed the same cytokine profile.

Conclusions: A comparison of BAL and IS specimens in the evaluation of the study population yielded similar quantitative and qualitative results. Further research is needed to evaluate the hypothesis that IS, being a noninvasive technique, may be useful in monitoring exposed workers.
Emerging translational therapies for mesothelioma. H.I. Pass, B.W. Robinson, J.R. Testa, et al. 1999;116(6 Suppl):455S-460S. Review PubMed · Publisher

Abstract

Malignant pleural mesothelioma remains a therapeutic and diagnostic problem. Translational mechanisms for treatment of the disease are emerging from newly learned characteristics of the tumor on a molecular, cellular, and extracellular basis. Although slow to reach the clinical arena, these potential strategies do show proof of principle in the in vitro and in vivo settings, and some, including adenoviral molecular chemotherapy, have completed phase I testing. This review describes the rationale and status of these newer treatment ideas.
Simian virus 40 is present in most United States human mesotheliomas, but it is rarely present in non-Hodgkin's lymphoma. P. Rizzo, M. Carbone, S.G. Fisher, et al. 1999;116(6 Suppl):470S-473S. PubMed · Publisher

Abstract

Simian virus 40 (SV40) causes mesotheliomas, osteosarcomas, ependymomas, choroid plexus tumors, and lymphomas in hamsters. In humans, SV40 has been detected in tumors of the first four types. Using the polymerase chain reaction (PCR), we tested 29 non-Hodgkin's lymphomas (intermediate and high-grade), 25 posttransplant lymphoproliferative disorders, and 5 AIDS lymphomas for SV40 DNA. PCR analysis revealed that 3 of 29 lymphomas, 6 of 25 posttransplant lymphoproliferative disorders, and 2 of 5 AIDS lymphomas contained SV40 sequences corresponding to the retinoblastoma (RB)-pocket binding domain of SV40 tumor antigen (Tag). However, among positive samples, only one posttransplant lymphoproliferative disorder and one AIDS lymphoma contained the SV40 regulatory region, which suggest a higher viral load in these patients. In parallel experiments, 8 of 12 mesotheliomas tested positive for SV40 for both the RB-pocket binding domain of Tag and the SV40 regulatory region. These data confirm the presence of SV40 in most United States mesotheliomas and indicate that in human non-Hodgkin's lymphomas, the prevalence of SV40 is low.
A 77-year-old man with progressive dyspnea on exertion. J.G. Weg. 1998;113(2):521-2. Case report PubMed · Publisher
Absence of left-sided predominance in asbestos-related pleural plaques: a CT study. J.C. Gallego. 1998;113(4):1034-6. PubMed · Publisher

Abstract

Study Objectives: Differences between the number and areas of pleural plaques in every hemithorax could not be expected a priori. However, previous studies based on chest radiographs reported an unexplained left-sided predominance. In this paper, a comparison of summed surfaces and location of plaques calculated from CT studies was performed.

Patients And Methods: Thoracic CT scans from 40 adults with asbestos exposure and pleural plaques were analyzed. The surface area of every plaque was calculated, and summed areas were recorded separately for every hemithorax. The statistical analysis was performed with t-tests for paired samples. Emphasis was placed on measurement differences.

Measurements And Results: The results show lack of significant predominance for any hemithorax. A total of 668 plaques (352 right and 316 left) were measured, with an average area (+/-SD) of 47.81+/-47.72 cm2 for the right plaques and 45.34+/-67.32 cm2 for the left. The mean of differences (left minus right areas) was -2.56+/-53.68 and slightly statistically different from zero (p=0.652).

Conclusions: Left-sided predominance of asbestos-related pleural plaques is not supported by this study.
Diagnosing malignant pleural mesothelioma. A.S. Teirstein. 1998;114(3):666-7. Editorial · Comment PubMed · Publisher
Factors predictive of survival among 337 patients with mesothelioma treated between 1984 and 1994 by the Cancer and Leukemia Group B. J.E. Herndon, M.R. Green, A.P. Chahinian, et al. 1998;113(3):723-31. PubMed · Publisher

Abstract

Purpose: To examine the individual and joint effect of various pretreatment clinical characteristics on the survival of patients with mesothelioma treated by the Cancer and Leukemia Group B (CALGB).

Patients And Methods: Between June 1984 and September 1994, 337 patients with malignant mesothelioma and no prior chemotherapy were accrued to seven phase II studies conducted by the CALGB which screened the efficacy of 10 treatment regimens or dose levels. The eligibility criteria for all studies were virtually identical. Patient characteristics include the following: age older than 60 years (63%); male (83%); performance status (PS) of 0 or 1 (81%); chest pain (60%); definite asbestos exposure (62%); >5% weight loss (41%); and pleural involvement (94%). Median survival time (MST) for the 10 treatment regimens ranged from 3.9 to 9.8 months (overall=7.2; 95% confidence interval [CI], 6.5 to 8.3), with 1-year survival between 14% and 50% (overall=27%; 95% CI, 23 to 33%).

Results: Cox survival models and exponential regression trees were used to examine the prognostic importance of pretreatment patient characteristics. Univariate analyses show that patients with poor Eastern Cooperative Oncology Group PS, chest pain, dyspnea, platelet count (PLT) >400,000/microL, weight loss, serum lactate dehydrogenase (LDH) level >500 IU/L, pleural involvement, low hemoglobin (HGB) level, high WBC count, and increasing age over 75 years have a worse prognosis. With decreasing risk ratio, multivariate Cox analyses showed that pleural involvement, LDH >500 IU/L, poor PS, chest pain, PLT >400,000/microL, nonepithelial histology, and increasing age older than 75 years jointly predict poor survival. PS was the most important prognostic split in the regression tree. Terminal nodes were amalgamated to form six distinct prognostic subgroups with MST (2-year survival) of 13.9 (38%) in 36 patients, 9.5 (21%) in 36 patients, 9.2 (10%) in 146 patients, 6.5 (3%) in 33 patients, 4.4 (0%) in 73 patients, and 1.4 (0%) in 13 patients (p<0.0001).

Conclusions: The subgroup with the best survival (MST=13.9 months) included patients with PS=0 and age younger than 49 years, and patients with PS=0, age of 49 years or older, and HGB > or =14.6. The worst survival (MST= 1.4 months) occurred for patients with PS= 1/2 and WBC > or =15.6/microL.
Medical thoracoscopic talc pleurodesis for chylothorax due to lymphoma: a case series. D.C. Mares, P.N. Mathur. 1998;114(3):731-5. PubMed · Publisher

Abstract

Study Objectives: Recurrent chylothorax as a complication of lymphoma has had unsatisfactory outcomes. Serial thoracentesis, tube thoracostomy, and pleurodesis via chest tube have been ineffective and compromise the nutritional and immune status of the patient. Medical thoracoscopic talc pleurodesis has been safe and effective in the treatment of some other varieties of recurrent pleural effusions. Our objective was to investigate the safety and efficacy of medical thoracoscopic talc pleurodesis in the palliation of chylothorax related to lymphoma.

Design: This is a report of 24 hemithoraces treated in 19 consecutive patients with lymphoma-related chylothorax, failing chemotherapy or radiation therapy. The average patient age was 55 years.

Interventions: Medical thoracoscopy was performed under local anesthesia and conscious sedation in a bronchoscopy suite. Sedation included midazolam (mean dose, 6 mg; range, 2-14 mg) with either meperidine (mean dose, 94 mg; range 25-140 mg), or morphine (mean dose, 18 mg; range 4-40 mg). Pleurodesis was performed with insufflation of sterile asbestos-free talc, (4-8 g). After pleurodesis, chest tubes were placed, with the mean duration of chest tube placement being 4 days, range 3 to 10 days.

Results: One patient died a few days after the procedure due to causes related to the primary disease process. Follow-up was for at least 90 days following the procedure. Patients were assessed at 30, 60, and 90 days following the procedure. At each of these endpoints, all patients remaining alive were without recurrence of pleural effusions, which was confirmed by chest radiography. Eight patients in the series died of the effects of their malignancy during the 90-day evaluation interval. Complications included medication reactions in two patients (8.3%) and ARDS in one patient (4.1%).

Conclusion: Many patients with lymphoma-related chylothorax are refractory to chemotherapy and/or radiation therapy. In this group, medical thoracoscopic talc pleurodesis has an acceptable complication rate and a 100% success rate in the prevention of recurrence of pleural effusions at 30, 60, and 90 days following the procedure.
Progression of asbestosis predicts lung cancer. P. Oksa, M. Klockars, A. Karjalainen, et al. 1998;113(6):1517-21. PubMed · Publisher

Abstract

Study Objectives: To explore whether the progression of asbestosis correlates with the risk of lung cancer among patients with asbestosis.

Design: A group of 85 asbestosis patients (78 men and 7 women) were radiographically followed up between 1979 and 1987. Two or three posteroanterior radiographs taken from each patient in 1978 to 1979, 1983 to 1984, and 1986 to 1987 were classified according to the International Labour Office 1980 classification and were used to divide the patients into progressors and nonprogressors. Follow-up for cancer was done automatically through the files of the Finnish Cancer Registry from the time of determination of the progression status to December 31, 1994. Predictors of lung cancer risk were studied with a logistic regression model, and the standardized incidence ratio (SIR) was calculated for lung cancer.

Results: Of the 24 male patients with progressive small opacity profusion, 11 (46%) developed lung cancer, as opposed to 5 (9%) of the 54 male patients without progression. The SIR for lung cancer was 37 (95% confidence interval, 18 to 66) for the progressors and 4.3 (1.4 to 9.9) for the nonprogressors. In both groups, all the lung cancer cases occurred among smokers or ex-smokers. None of the seven female patients showed progressive small opacity profusion. One of them developed lung cancer. In the logistic regression model including all 85 asbestosis patients, radiographic progression of small opacity profusion (p=0.0009) and current smoking (0.0021) were significant predictors of lung cancer morbidity.

Conclusions: Asbestosis patients with radiographic progression of small opacity profusion over a few years are at a higher risk of lung cancer than those with a less aggressive course of the disease. The progression of pulmonary fibrosis may be an independent risk factor that, in addition to smoking history and the intensity of asbestos exposure, could be used to estimate lung cancer risk.
The validity of radiographic estimation of total lung capacity in patients with respiratory disease. G.P. Pappas, C.A. Brodkin, L. Sheppard, et al. 1998;114(2):513-20. PubMed · Publisher

Abstract

Study Objective: To evaluate the validity of a state-of-the-art computerized planimetry technique for estimation of total lung capacity (TLC) from chest radiographs, when applied to patients with clinical lung disease receiving routine chest radiographs.

Design: Retrospective clinical survey.

Setting: An occupational medicine diagnostic clinic.

Patients: A convenience sample of 40 subjects with asbestos-related lung disease, 5 patients with nonasbestos-related restrictive defects, 15 subjects with occupational asthma, and 10 subjects with irritant tracheobronchitis.

Results: Estimation of TLC using state-of-the-art computerized algorithms demonstrated limited agreement with conventional measures of TLC when applied to patients with occupational lung disease receiving routine chest radiographs. The most pronounced differences occurred in patients with asbestos-related lung disease and restrictive defects, where the radiographic method of measurement significantly overestimated helium dilution TLC by 986 mL (r=0.73, p<0.001) and 1,135 mL (r=0.82, p<0.05), respectively. Good inspiratory effort was associated with significantly increased radiographic TLC relative to helium dilution TLC; however, radiographic features did not fully account for the observed differences between radiographic and helium dilution techniques.

Conclusions: Our findings suggest that this planimetric technique should not be used as a substitute for conventional measures of TLC in clinic populations receiving routine radiographs. The large diagnostic group specific mean differences observed between radiographic and conventional measures of TLC also suggest that this method is of limited utility in clinical evaluation of occupational lung disease.
Asbestos-related disorders. A realistic perspective. D.M. Rosenberg. 1997;111(5):1424-6. Comment PubMed · Publisher

Summary

In this "debate in print" commentary, the author argued that asbestos-related disorders should be diagnosed with greater specificity. He noted that asbestosis is dose-related, that workplace exposures had decreased, and that diagnostic criteria varied in specificity. He emphasized three criteria for asbestosis: exposure of significant intensity, duration and latency; documented fibrosis, for which high-resolution CT was sensitive but not specific; and exclusion of other causes of fibrosis. He considered histologic examination of lung tissue the gold standard and fiber burden analysis mainly a research tool. He cited 120,000 asbestos claims disposed of before 1995, an estimated 135,000 pending lawsuits, up to 250,000 future claims, and a projection of 131,200 asbestos-related cancer deaths for 1985 to 2009. NIOSH surveillance data reported 8,215 asbestosis-associated deaths and 10,557 malignant pleural mesothelioma deaths in the United States between 1968 and 1990. From these data and published proportions of deaths among certified asbestosis cases, he estimated about 41,000 cases of asbestosis (1,900 per year) and about 28,000 asbestos-related cancer deaths (1,300 per year) in that period. He concluded that actual mortality was far smaller than projections, and that far fewer people probably had asbestos-related disease than the number of claims implied. He also concluded that diagnoses based on only selected criteria were too uncertain for sound legal or policy judgments.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.
Brachytherapy for non-small cell lung cancer and selected neoplasms of the chest. A. Raben, B. Mychalczak. 1997;112(4 Suppl):276S-286S. Review PubMed · Publisher

Abstract

This article reviews the indications, techniques, and results of brachytherapy in the treatment of non-small cell lung cancer (NSCLC) and selected chest neoplasms. Various isotopes and techniques are used to place radioactive sources directly into a tumor, tumor bed, or the chest. Brachytherapy techniques can be tailored to the clinical situation and can be in the form of permanent interstitial volume or planar implants (radioactive sources permanently imbedded into the tumor or tumor bed) or in the form of temporary interstitial or endoluminal implants (where radioactive sources irradiate a tumor bed over a certain length of time and then are removed). These treatments can be delivered over a short interval (high-dose rate [HDR]) or over a more protracted time (low-dose rate). HDR treatments can be used intraoperatively to deliver a large dose of radiation to a determined target area with selective sparing of surrounding normal structures. Different methods of delivering HDR intraoperative radiation are under investigation. Most reports on brachytherapy for chest malignancies are retrospective and come from a few single institutions. Most of the published data relate to the treatment of NSCLC, but other intrathoracic malignancies, such as malignant pleural mesothelioma and malignant thymoma, have been treated with brachytherapy. To our knowledge, no major randomized trials accurately assess or confirm these retrospective studies yet, complicating the interpretation of these results. Nevertheless, brachytherapy is of value in selected situations and offers the clinician and the patient an innovative method of delivering conformal high-dose radiation to a defined target with preferential sparing of normal surrounding structures. With continued innovations in the development of radioactive isotopes, computerized treatment planning and targeting, and source delivery, brachytherapy should continue to offer an attractive alternative and complement to conventional treatment approaches, and may offer patients improved local control and survival.
Diagnosis of asbestosis. Primum non nocere. W.S. Beckett. 1997;111(5):1427-8. PubMed · Publisher
Innovative therapies for malignant pleural mesothelioma. J.R. Roberts. 1997;112(4 Suppl):269S-271S. Case report PubMed · Publisher

Abstract

Therapy for malignant pleural mesothelioma is in a transitional stage. Recent trials of multimodality therapy for this disease suggest that selected patient subgroups may benefit from extensive treatment. This report discusses new approaches to the treatment of malignant pleural mesothelioma. Two case reports are presented.
Surgically treated pneumothorax. Radiologic and pathologic findings. K.G. Jordan, J.S. Kwong, J. Flint, et al. 1997;111(2):280-5. PubMed · Publisher

Abstract

Objective: To compare the identifiable pulmonary abnormalities on preoperative chest radiographs and CT scans with the histologic findings in patients requiring surgical intervention for recurrent or persistent pneumothoraces.

Materials And Methods: Chest radiographs were reviewed retrospectively in 116 consecutive patients (aged 16 to 81 years) who had undergone thoracotomy for recurrent or persistent pneumothorax. CT scans were performed in 21 patients. Chest radiographs and CT scans were reviewed by two observers without knowledge of the histologic findings. All specimens were reviewed by a surgical pathologist.

Results: Seventy-nine (68%) patients had parenchymal abnormalities and five (4%) had pleural thickening evident on the radiograph. The most common radiographic abnormalities included apical bullae (n = 51), apical scarring (n = 17), and diffuse emphysema (n = 9). Twenty of 21 (95%) CT scans demonstrated either a parenchymal or a pleural abnormality. CT demonstrated emphysema in four patients with normal radiographs, as well as additional findings in six patients with abnormal radiographs. Histologically, 74 patients had focal irregular emphysema, 26 had distal acinar emphysema, six had mixed emphysema, four had isolated bullae or blebs, two had mesothelioma, and one each had the following: metastatic angiosarcoma, subpleural fibrosis, congenital cystic adenomatoid malformation, and tuberculous pleuritis with inactive interstitial fibrosis and honeycombing.

Conclusion: Most patients with surgically treated pneumothorax have emphysema or an isolated bulla. Although these findings may not be apparent on the radiograph and seen on CT, this probably does not affect patient management. In most cases of pneumothorax related to other causes, findings consistent with the diagnosis can be seen on the radiograph.
The role of cytologic evaluation of pleural fluid in the diagnosis of malignant mesothelioma. A.A. Renshaw, B.R. Dean, K.H. Antman, et al. 1997;111(1):106-9. PubMed · Publisher

Abstract

Study Objective: Treatment of malignant mesothelioma (MM) at an early stage results in increased survival. Cytologic examination of pleural effusions is one of the first diagnostic techniques attempted in these patients. The objective of this study was to define the role of cytologic examination of pleural fluid in facilitating early diagnosis.

Design: The medical records and cytologic slides of patients with pleural MM were reviewed.

Setting: Medical records were reviewed from two institutions: a large general hospital and a cancer hospital.

Patients: Twenty-nine patients ranging in age from 32 to 81 years (mean, 59 years) met the study criteria.

Interventions: All patients had at least one cytologic pleural fluid examination.

Measurements And Results: The median time from initial symptoms to the diagnosis of MM was 8 weeks for all patients. For patients with a positive or suspicious cytologic result, the median was 4 weeks, and in those with a negative cytologic result, it was 12 weeks. The overall sensitivity of cytologic examination for the diagnosis of MM was 32%. Cytogenetic analysis of pleural fluid had a sensitivity of 56%, and was positive in 1 case in which results of cytologic examination were negative. Patients in whom the time from presentation to diagnosis was greater than 1 year all had negative cytologic results followed by long periods without further workup, despite a history of exposure to asbestos.

Conclusions: A positive or suspicious cytologic result was associated with a decreased median time to diagnosis. Unfortunately, the sensitivity of cytologic examination for a diagnosis of MM was only 32%. Until better diagnostic techniques are developed, we recommend immediate pleural biopsy in patients in whom MM is suspected and cytologic evaluation of pleural fluid gives negative results.
Chrysotile asbestos induces PDGF-A chain-dependent proliferation in human and rat lung fibroblasts in vitro. J.A. Lasky, J.C. Bonner, B. Tonthat, et al. 1996;109(3 Suppl):26S-28S. PubMed · Publisher

Summary

This conference report asked whether chrysotile asbestos fibers can directly stimulate the growth of lung fibroblasts in the absence of other cell types and outside factors, and whether human lung fibroblasts respond as rat lung fibroblasts did in the authors' earlier work. Primary human lung fibroblasts were isolated from normal lung tissue removed during lobectomy or pneumonectomy for lung cancer. Cells from two donors were characterized by immunostaining. The isolates stained for vimentin but not for desmin, factor VIII or neurofilament protein. About 10% stained weakly for alpha-smooth muscle actin, so the isolates were judged to be about 90% fibroblasts and 10% myofibroblasts. Northern blot analysis showed that the human cells made PDGF-A chain mRNA. The cells also proliferated in response to recombinant PDGF-AA, which the authors took to show that they express the PDGF-alpha receptor. Quiescent rat and human fibroblasts were exposed for 3 days to sheared, sonicated, sterile chrysotile at 0.05 to 5 µg/cm2, and growth was measured with a colorimetric proliferation assay. Both rat and human fibroblasts proliferated in response to chrysotile. Asbestos was toxic to human fibroblasts at doses above 10 µg/cm2. In preliminary experiments, PDGF-A chain antisense oligomers blocked the asbestos-induced growth of human fibroblasts, while sense-strand controls did not. The authors concluded that asbestos is mitogenic for rat and human lung fibroblasts in vitro through a PDGF-A chain-dependent mechanism.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.
Clara cell protein (CC-16) and surfactant-associated protein A (SP-A) in asbestos-exposed workers. O. Lesur, A.M. Bernard, R.O. Bégin. 1996;109(2):467-74. PubMed · Publisher

Abstract

Asbestos-exposed workers (Asb) can sometimes develop lung impairments resembling idiopathic pulmonary fibrosis (IPF). Smoking is often a troubling confounder in the natural history of these lung diseases. Distal airspace epithelial cells, which are also altered in asbestosis, secrete Clara cell protein (CC-16, also designated CC-10) and surfactant-associated protein A (SP-A). By inhibiting phospholipase A2 (PLA2), CC-16 and SP-A are putative candidates for controlling lung inflammatory events. Both were measured with PLA2 activity in alveolar fluids (and sera for CC-16) of smoker and nonsmoker Asb and compared with smoking-matched normal subjects (N). CC-16 (in mg/L) was slightly increased in Asb and affected by smoking: nonsmoker Asb: 3.1 +/- 0.5 vs nonsmoker N: 1.9 +/- 0.2 (p < 0.05), smoker Asb: 1.7 +/- 0.3 vs smoker N: 0.6 +/- 0.1 (p < 0.05). SP-A (in microgram/mL) was enhanced in Asb but not affected by smoking: 5.4 +/- 1.5 in Asb vs 1.6 +/- 0.4 in N (p < 0.05), whereas SP-A to phosphorus ratio was increased in Asb but affected by smoking. CC-16 to albumin and CC-16 in serum to alveolar fluid ratios were altered by cigarette consumption in Asb (p < 0.05 vs N). Secretory PLA2 activity was slightly enhanced in Asb (p < 0.05 vs N). All data were similar between stages of disease. In summary, alveolar CC-16, SP-A, and secretory PLA2 activity were increased in Asb. Smoking affected several parameters. By this habit, Asb might reinforce lung profibrotic factors and increase their risk in developing lung alterations resembling IPF.
Evolution of idiopathic pleural effusion: a prospective, long-term follow-up study. J.S. Ferrer, X.G. Muñoz, R.M. Orriols, et al. 1996;109(6):1508-13. PubMed · Publisher

Abstract

Unlabelled: The management of idiopathic pleural effusion remains controversial. Because the long-term evolution of this entity is not well known, two different approaches, aggressive and conservative, have been proposed. We conducted a 10-year study of the evolution of idiopathic pleural effusion.

Methods: Between 1984 and 1994, we prospectively studied 40 consecutive patients (30 men and 10 women; mean [+/- SD] age, 53.8 +/- 19.4 years) with exudative pleural effusion undiagnosed after exhaustive evaluation. The pleural fluid adenosine deaminase level was below 43 IU/L in all; periodic chest radiographs and clinical evaluation were carried out in all patients for a mean of 62 months (range, 36 to 108 months). Further diagnostic procedures were performed whenever the effusion recurred or when indicated by the clinical picture.

Results: Effusions resolved in a mean time of 5.6 months (range, 7 days to 48 months). Five patients (12.5%) had one or more relapses of their pleural effusion, and in a further 5 (12.5%), the effusion persisted unchanged for more than 1 month. In 32 cases (80%), no potential cause of the effusion was detected. The diagnoses in the remaining eight cases were asbestos pleural effusion in three, pulmonary adenocarcinoma in one, mesothelioma in one, congestive heart failure in one, liver cirrhosis in one, and rheumatoid arthritis in one. Tuberculosis was not detected in any of the cases, although 19 patients initially had positive tuberculin tests.

Conclusions: Most idiopathic pleural effusions follow a benign course. Our results support conservative treatment of patients with idiopathic pleural effusion. Antituberculous treatment does not appear to he warranted, regardless of tuberculin test results, if the pleural fluid adenosine deaminase level is not elevated.
Expression of genes coding for growth factors in experimental pneumoconiosis. G.F. Morris, J.Y. Liu, W.H. Lei, et al. 1996;109(3 Suppl):45S-49S. Review PubMed · Publisher
Longitudinal pattern of reported respiratory symptoms and accelerated ventilatory loss in asbestos-exposed workers. C.A. Brodkin, S. Barnhart, H. Checkoway, et al. 1996;109(1):120-6. Randomized trial PubMed · Publisher

Abstract

Studies investigating the relation between respiratory symptoms and change in ventilatory function have been limited by use of reported symptoms at a single point in time. To assess the relation between the longitudinal pattern of reported cough, phlegm, wheeze, and dyspnea and ventilatory loss, we prospectively investigated changes in FVC and FEV1 associated with development, resolution, or persistence of these symptoms over a 3- to 5-year period in 446 asbestos-exposed workers. Longitudinally reported symptoms changed frequently, with 52 to 61% of subjects reporting a specific symptom noting resolution or development of that symptom during follow-up. Initially reported symptoms were not predictive of accelerated loss of FVC or FEV1. In contrast, development of any new respiratory symptom, and to a lesser extent persistence of symptoms during follow-up, were associated with significantly greater ventilatory losses compared with asymptomatic individuals, ranging from 28 mL/yr in FEV1 for newly developed dyspnea, to 67 mL/yr in FVC for developed wheeze (p < 0.01). We conclude that development or persistence of respiratory symptoms over time, rather than the presence of symptoms per se, is predictive of future ventilatory loss. Recognition of interval changes in symptom reporting during surveillance of asbestos-exposed workers may effectively identify groups at risk for progressive ventilatory impairment.
The molecular epidemiology of oncoproteins. Serum p53 protein in patients with asbestosis. K. Hemminki, R. Partanen, H. Koskinen, et al. 1996;109(3 Suppl):22S-26S. PubMed · Publisher

Summary

The authors examined whether serum levels of p53 protein, a tumor suppressor gene product that accumulates in many cancers, were raised in patients with asbestosis who developed cancer. They studied a previously described cohort of 111 patients with compensable asbestosis followed at the Institute of Occupational Health in Helsinki, Finland, from 1978 to 1987. Serum samples were collected periodically between 1981 and 1987 and stored frozen. By fall 1994, the Finnish Cancer Registry showed that 38 patients had developed malignant tumors: 27 lung cancers, 3 malignant pleural mesotheliomas and 8 other cancers. Single serum samples from nine normal control subjects were also available. Samples were tested with two ELISAs, one pantropic and one mutant-specific. A value above 200 pg/mL was defined as positive. With the pantropic assay, 2 of 27 lung cancer cases (7%) were positive, compared with 0 of 3 mesotheliomas, 1 of 73 noncancer asbestosis patients (1%) and 0 of 8 normal controls. With the mutant assay, 5 of 27 lung cancer cases (19%) were positive, compared with 0 of 3, 2 of 36 (6%) and 1 of 9 (11%). These differences were not statistically significant (p>0.05). The two assays correlated (R=0.67, p<0.001). Some cases were positive years before diagnosis; one adenocarcinoma case was positive up to 7 years before. The authors concluded that further study is needed to show whether elevated serum p53 predicts cancer.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.
Airways obstruction from asbestos exposure and asbestosis revisited. K.H. Kilburn, R.H. Warshaw. 1995;107(6):1730-1. Comment PubMed · Publisher

Summary

In this 'Debate in Print' commentary, the authors answered criticisms by Jones and colleagues (published in the same issue) of their earlier study of airways obstruction in 8,720 asbestos-exposed workers. They restated that asbestosis first appears as air trapping (increased RV/TLC) and small airways obstruction (reduced FEF25-75 and FEF75-85), and that these functional signs come before irregular opacities on chest x-rays. They said these findings had been repeated in over 8,000 more workers. They defended comparing the workers with a Michigan population free of asbestos exposure. On self-selection bias, they noted that 42% of those contacted in the Michigan population were examined, compared with 70% of eligible asbestos-exposed workers. They defended having one reader classify the x-rays using International Labour Organization criteria, noting that Dr. Robert Fraser read 500 films from each of two sites with average profusion readings slightly higher. They argued that judging groups as normal because values exceeded 80% of predicted was not valid. They reported that nonsmoking exposed workers with asbestosis (n=426) and without it (n=1,752) differed significantly from Morris and Miller predicted values. Among 2,483 never-smoking construction and metal trades workers (250 with asbestosis), FVC and FEV1 fell and FET25-75 lengthened as radiographic profusion increased (analysis of variance p=0.0005). They concluded that small airways obstruction is the main physiologic defect in asbestosis, occurs even without smoking, and that years of asbestos exposure is the key factor.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.
Asbestos-related rounded atelectasis. Radiologic and mineralogic data in 23 cases. C. Voisin, F. Fisekci, S. Voisin-Saltiel, et al. 1995;107(2):477-81. PubMed · Publisher

Abstract

A retrospective study was conducted in 23 subjects with previous occupational exposure to asbestos and exhibiting rounded atelectasis (RA) on high-resolution computed tomography scan (HRCT scan) to evaluate the retention of asbestos bodies (ABs) using light microscopy in the bronchoalveolar lavage (BAL) fluid or lung parenchyma in such patients. A total of 31 RAs were identified, usually located in the lower (25 RAs) and posterior (23 RAs) parts of the lung. Pleural thickening in contact with the RA was observed in 27 RAs and parenchymal bands were detected in 15 cases. Twelve of the 20 patients who underwent BAL or surgery exhibited significant retention of ABs in BAL fluid or lung tissue. Moreover, a significant retention of ABs was observed in five of nine patients with a history of asbestos exposure but no diffuse pleural thickening on chest radiograph or interstitial opacities on HRCT scan. Patients with RAs and coexisting diffuse pleural thickening and/or interstitial fibrosis should be considered at a higher risk for lung cancer in comparison to patients with isolated circumscribed pleural plaques based on increased AB counts. By contrast, the excess risk of lung cancer is more questionable in patients with only RAs and circumscribed pleural plaques as they may have AB counts either above or below that associated with pleural plaques alone. This emphasizes the need for further follow-up studies to define criteria indicating the need for thoracotomy in these subjects.
Chemoprevention of lung cancer. S.E. Benner, S.M. Lippman, W.K. Hong. 1995;107(6 Suppl):316S-321S. Review PubMed · Publisher

Abstract

Treatment of lung cancer remains frustrating. Most patients with lung cancer are not candidates for curative therapy, and new therapies have not made a substantial impact on survival. Consequently, some clinical investigators have focused their efforts on developing prevention strategies. Chemoprevention, the administration of agents to block or reverse carcinogenesis, is being investigated in ongoing trials. Studies of chemoprevention in lung cancer have included trials to reverse premalignant lesions such as sputum atypia or squamous metaplasia of the bronchial epithelium. Clinical trials of lung cancer prevention have often studied groups of participants with tobacco or asbestos exposure. Other clinical trials are being conducted among patients who have been treated for an early-stage lung cancer. As the result of diffuse epithelial injury, these patients are at very high risk for developing second primary tumors, predominantly in the lungs and upper aerodigestive tract. It is our hope that these studies may establish a new strategy for preventing lung cancer.
Current approach to malignant mesothelioma of the pleura. J. Aisner. 1995;107(6 Suppl):332S-344S. Review PubMed · Publisher

Abstract

Malignant mesothelioma of the pleura occurs primarily in individuals who were exposed to asbestos either in the workplace or home. The incidence of malignant mesothelioma is rising and, reflective of the malignancy's long latency period, is expected to continue to increase into the next century. Current treatment measures, including surgery, radiation therapy, chemotherapy, intrapleural therapy, and combined-modality therapies, have had varying impacts on survival. This paper explores current trends in the treatment of malignant pleural mesothelioma.
Emphysema in silica- and asbestos-exposed workers seeking compensation. A CT scan study. R. Bégin, R. Filion, G. Ostiguy. 1995;108(3):647-55. PubMed · Publisher

Abstract

It has been established that coal pneumoconiosis and confluent silicosis are associated with emphysematous changes in the lungs. In the present study, we addressed the concept of emphysema in simple silicosis and asbestosis and in workers exposed to these minerals without the pneumoconiosis. The study was done on 207 consecutive workers evaluated for possible pneumoconiosis at Québec Workman Compensation Board, who had a radiographic reading of pneumoconiosis in the category 0 or 1 of the ILO scale, and in 5 control subjects. Emphysema was detected, typed, and graded on high-resolution CT scans by three independent experienced readers. Age, work experience and industry, smoking habits, and pulmonary function test results were analyzed for possible associations. The subjects were 59 +/- 1 years of age and had mineral dust exposure averaging 26 +/- 1 years; 31 were lifetime nonsmokers and the others were either ex- or current smokers. Ninety-six workers were from primary and 111 from secondary industries and did not differ in any parameter. The CT scan readings for emphysema yielded a 63% complete agreement. In lifetime non-smokers, emphysema was seen in 1 of 20 subjects without pneumoconiosis but in 8 of 11 patients with pneumoconioses. In smokers without pneumoconioses, emphysema was present in 55% of patients with silica exposure, but 29% of patients with asbestos exposure but comparable smoking (p = 0.04). Emphysema type was equally distributed among the groups except for more paracicatricial type in confluent silicosis. Regression analyses documented that age, smoking, exposure type, and presence of pneumoconiosis were significant contribution factors. In the workers without pneumoconiosis, age, smoking, and exposure type (silica) were significant. Emphysema related best with FEV1/FVC ratio, MMEF, and DCO reductions. The prevalence of abnormality of FEV1/FVC ratio was two to five times normal and that of reduced DCO two times normal. We conclude that, in our population, there was a significant excess of CT scan emphysema, associated with lung dysfunction, in those with pneumoconioses and in smokers with silica exposure. In the absence of smoking, it took a patient with pneumoconiosis to have emphysema. These changes contributed to the lung function impairment of these subjects with ILO category 0 or 1 pneumoconioses.
More on thoracic neoplasms related to Lucite sphere plombage. C. Ibarra-Perez, J. Kelly-Garcia. 1995;107(2):581-2. Letter PubMed · Publisher
Review of the Kilburn and Warshaw Chest article--airways obstruction from asbestos exposure. R.N. Jones, H.W. Glindmeyer, H. Weill. 1995;107(6):1727-9. Comment PubMed · Publisher

Summary

This commentary, part of a debate in print, critiqued a 1994 Chest article by Kilburn and Warshaw, which concluded that "Asbestos exposure causes airway obstruction and asbestosis increases it." The original study compared 8,720 self-selected asbestos-exposed construction and shipyard workers with a reference group drawn from a Michigan population sample. The critics argued that this reference group had been studied in the early 1980s by other investigators for a different purpose and was not comparable in age and smoking history. They noted that a single reader interpreted all chest radiographs knowing each worker's exposure and health status, and gave his reading in the worker's presence. The prediction and smoking-adjustment equations used came from younger, health-screened subjects. The critics said these would underestimate smoking effects in older smokers, whose mean ages were 58 and 63 years. Reanalysing the published group means with the Morris et al equations, the critics found generally normal values in never smokers. Ratios of forced expiratory volume in 1 second (FEV1) to forced vital capacity (FVC) in the asbestos-exposed and asbestosis groups exceeded those of the reference group. The ratio of residual volume to total lung capacity (RV/TLC) in current smokers was 34.1% in nonexposed and 47.9% in exposed men. Expressed as percent predicted, the values were 105.6 and 108.6. The authors concluded that the original paper failed to demonstrate its claimed differences and instead supported the conclusion that asbestos does not cause significant obstruction.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.
Sterilization of talc for pleurodesis. Available techniques, efficacy, and cost analysis. L. Kennedy, L.M. Vaughan, L.L. Steed, et al. 1995;107(4):1032-4. PubMed · Publisher

Abstract

Although talc has been used as a pleurodesis agent since 1935, a sterilization protocol has not been established. We obtained USP asbestos-free talc from six different suppliers and sterilized each using dry heat, gamma irradiation, and ethylene oxide gas. Aerobic, anaerobic, and fungal cultures were obtained prior to sterilization, and 1, 30, and 90 days after sterilization. Bacillus species were cultured from all six unsterilized specimens and coagulase-negative Staphylococcus grew from two unsterilized specimens. No growth of organisms was found following any method of sterilization. The cost of sterilization per 5-g packet of talc was $4.74, $7.85, and $16.25 for heat, ethylene oxide, and gamma irradiation, respectively. In conclusion, untreated talc is not sterile. Sterilization by prolonged dry heat exposure, ethylene oxide gas, and gamma irradiation are all effective, with dry heat being the least expensive.
Talc slurry pleurodesis. Pleural fluid and histologic analysis. L. Kennedy, R.A. Harley, S.A. Sahn, et al. 1995;107(6):1707-12. PubMed · Publisher

Abstract

Although talc slurry pleurodesis is effective for control of malignant pleural effusions and recurrent pneumothorax, the mechanisms of pleurodesis remain incompletely defined. We instilled 70 mg/kg of sterile asbestos-free talc slurry into the pleural space of New Zealand white rabbits and studied the inflammatory response at 1, 2, 3, 7, 15, 30, 60, 90, and 120 days by observing pleural fluid and histologic characteristics. Talc slurry caused mesothelial denudement and an exudative neurotrophilic pleural effusion that resolved after 48 h. A transient mononuclear vasculitis was seen within the lung at 1, 2, and 3 days after instillation. Pleural adhesions were minimal and did not increase in number over time. Talc was found outside of the pleural space in mediastinal lymph nodes (4 of 23 animals examined), kidney (1 of 6), and spleen (4 of 10). The predominant cause of pleurodesis with talc slurry instillation is an acute pleural injury similar to the tetracycline class agents.
Airways obstruction from asbestos exposure. Effects of asbestosis and smoking. K.H. Kilburn, R.H. Warshaw. 1994;106(4):1061-70. PubMed · Publisher

Abstract

Objective: To define the apparent steps in developing airways obstruction vs restrictive lung disease in men exposed to asbestos for more than 20 years who had never smoked vs cigarette smokers.

Design: Physiologic signs of asbestosis were studied in cross-sectional age-matched groups of never, current, and ex-cigarette smoking workers.

Setting And Participants: The study included 8,720 asbestos-exposed construction and shipyard workers in the United States.

Measurements: FVC, FEV1, FEF25-75, and FEF75-85 were measured by spirometry and total lung capacity (TLC) by planimetry of standard chest radiographs and adjusted for height, age, and duration of cigarette smoking and expressed as percentage of predicted. TLC minus FVC yielded RV. We compared means and mean residuals (measurement minus group mean) expiratory flows and lung volumes in 1,146 men with pulmonary asbestosis age matched to 1,146 without asbestosis who had similar durations of asbestos exposure and to 370 men without asbestos exposure. Next, flows and volumes were regressed against the International Labour Office (ILO) profusion scale of irregular opacities on chest radiographs (PIO) and the duration of asbestos exposure for 1,777 never smokers (NS), 4,550 current smokers, and 2,393 ex-smokers.

Results: Asbestos exposure in NS men decreased expiratory flows and increased TLCs compared with unexposed NS men. Further reductions in flows and FVC and increases RV/TLC with radiographic asbestosis were not statistically significant. As the PIO increased from 1/1 to 3/3, obstruction and air trapping increased significantly but TLC did not.

Conclusions: Asbestos exposure reduced flows and produced air trapping after 20 years in workers who never smoked. Smoking increased these abnormalities.
Asbestos-induced pleural fibrosis and impaired exercise physiology. J.F. Shih, J.S. Wilson, A. Broderick, et al. 1994;105(5):1370-6. PubMed · Publisher

Abstract

To further assess the clinical significance of asbestos-induced pleural fibrosis, we performed cardiopulmonary exercise testing in 90 subjects who were exposed to asbestos. Of the 82 subjects without an abnormal resperate exercise, 35 had normal pleura, 33 had circumscribed pleural plaques, and 14 had diffuse pleural thickening. Interstitial fibrosis (International Labor Organization [ILO]. > or = 1/10) was present in 14 of 35 subjects with normal pleura, 13 of 33 subjects with circumscribed pleural plaques, and 2 of 14 subjects with diffuse pleural thickening. Although pleural fibrosis did not appear to be related to impaired respiratory function with exercise in our entire cohort, this finding was confounded by a higher proportion of interstitial fibrosis in subjects with normal pleura. In fact, among study subjects without asbestosis, significant decreases in gas exchange (higher VD/VT and increased alveolar-arterial oxygen pressure difference) were observed at maximal exercise among subjects with pleural fibrosis. Interestingly, neither a higher respiratory rate nor a lower VT/FVC ratio was observed among those with pleural fibrosis, suggesting that the mechanical effects of pleural fibrosis on the chest wall do not explain the increased VD/VT. Using multivariate analyses to control for potential confounders, regression models showed that pleural plaques (p = 0.04) and diffuse pleural thickening (p = 0.03) were independently associated with significant increases in dead space ventilation (VD/VT) with maximal exercise. These findings indicate that asbestos-induced pleural fibrosis is independently associated with decrements in gas exchange with maximal exercise and suggest that interstitial lung disease, not detected on the routine chest x-ray film, may be responsible for this abnormal response to exercise.
Asbestos-related pleural plaques and lung cancer. M. Nurminen, A. Tossavainen. 1994;106(2):648-9. Comment · Letter PubMed · Publisher
Development of a disposable spray canister for talc pleurodesis. A preliminary report. H.G. Colt, J.F. Dumon. 1994;106(6):1776-80. PubMed · Publisher

Abstract

Talc pleurodesis has been used for more than 50 years in both the United States and in Europe, and it has proven to be safe and effective in patients with malignant pleural effusions as well as recurrent pneumothorax. In this preliminary report, we describe a disposable, single-use spray canister that allows intrapleural administration of sterile, asbestos-free Luzenac talc, thus facilitating thoracoscopic talc insufflation for pleurodesis, particularly in patients with recurrent malignant effusions. The talc is delivered ready to use, administered via a hollow plastic delivery catheter that can be inserted through the pleural trocars used during thoracoscopy. Use of this spray canister allows practitioners to avoid complex handling and sterilization procedures required for bulk talc powder.
Environmental airborne tremolite asbestos pollution and pleural plaques in Afghanistan. C. Voisin, I. Marin, P. Brochard, et al. 1994;106(3):974-6. Case report · Review PubMed · Publisher

Abstract

A 51-year-old man underwent pleuroscopy for radiologic pleural abnormalities. Pathologic examination of pleural and lung biopsy specimens concluded on hyalinized pleural plaques associated with mild asbestosis. Transmission electron microscopy analysis showed significant retention of tremolite asbestos fibers. The absence of any occupational exposure to asbestos and the existence of geologic deposits of tremolite in the Kabul area of Afghanistan suggest an environmental exposure during the patient's childhood spent in this region.
Environmental asbestosis complicated by lung cancer. P. De Vuyst, P. Dumortier, D. Jacobovitz, et al. 1994;105(5):1593-5. Case report PubMed · Publisher

Abstract

Diagnosis of asbestosis and bronchiolo-alveolar carcinoma was made in a 55-year-old Turkish woman who was a nonsmoker. She originated from and was living in an area with a high prevalence of environmental diseases attributed to tremolite asbestos. Mineralogic analysis of lung tissue revealed very high concentrations of asbestos bodies (1.64 x 10(6)/g of dry tissue) and tremolite fibers (173.7 x 10(6) of dry tissue). This case illustrates the following points: (1) In some areas, environmental exposure can lead to cumulated fiber retention comparable to occupational exposure and thus can represent a risk for lung fibrosis (asbestosis). (2) Lung cancer as a complication of environmental asbestosis also should be considered as a potential environmental disease.
Exercise impairment in asbestos-induced pleural fibrosis. Is it really just interstitial fibrosis?. E.T. Mannix, W.J. Martin. 1994;105(5):1312-3. Comment · Editorial PubMed · Publisher
Intrapleural talc for the prevention of recurrent pneumothorax. J.R. Milanez, F.S. Vargas, L.T. Filomeno, et al. 1994;106(4):1162-5. PubMed · Publisher

Abstract

The ipsilateral recurrence rate after the first spontaneous pneumothorax treated with tube thoracostomy is reported to be between 23 percent and 52 percent. The incidence of recurrence after the first recurrence is substantially higher. Chemical pleurodesis has been attempted to decrease the recurrence rate. Tetracycline has been widely utilized, but parenteral tetracycline is no longer available. Therefore, alternative sclerosing agents have been used. Talc has been demonstrated to be effective in preventing recurrences and it has minimal long-term effects. This prospective study was designed to determine the efficacy of talc pleurodesis in patients with recurrent spontaneous pneumothorax. Eighteen patients admitted between May 1985 and March 1993 to the Department of Thoracic Surgery underwent thoracoscopy and were treated by tube thoracostomy with chemical pleurodesis. All the patients had had at least two pneumothoraces and six had had at least six pneumothoraces. Sterile asbestos-free talc, 2g, was aerosolized throughout the pleural surface. One or two chest tubes were inserted, left clamped for 2 h, and unclamped after this time. The tubes were removed when no air had escaped for 24 h. Only one (5.6 percent) patient had recurrence of the pneumothorax, and a second insufflation of talc resulted in no new recurrence after a follow-up of 10 months. The remaining 94.4 percent did not have recurrence of pneumothorax within an observation period of 38.5 +/- 28.1 months. The follow-up was more than 2 years for 66.7 percent with no recurrence and was more than 5 years for 33.3 percent. We conclude from these observations that the insufflation of 2 g of talc into the pleural space is a safe effective treatment for control of recurrent spontaneous pneumothorax.
Localized pleural mesothelioma. The clinical spectrum. L.A. Robinson, R.B. Reilly. 1994;106(5):1611-5. Case report · Review PubMed · Publisher

Abstract

Localized pleural mesotheliomas are rare tumors that have a variety of clinical presentations, from an asymptomatic solitary nodule to a massive, highly symptomatic neoplasm filling most of the pleural cavity. Two cases are reported which show the clinical spectrum of the more common benign variant. The clinical differentiation between the benign tumor as well as the less frequent malignant neoplasms of localized mesotheliomas has been disappointing. Complete surgical resection is the preferred treatment for both types and is usually curative with the benign mesothelioma.
Miliary mesothelioma. M. Huncharek. 1994;106(2):605-6. Case report PubMed · Publisher

Abstract

Metastases in pleural mesothelioma usually occur late in the disease process. Diffuse involvement of the lung parenchyma is rare. A patient with miliary pulmonary parenchymal involvement with malignant mesothelioma is described. To our knowledge, this represents the first such case reported.
Pleural plaques and risk for bronchial carcinoma and mesothelioma. A prospective study. G. Hillerdal. 1994;105(1):144-50. PubMed · Publisher

Abstract

From the general population in the county of Uppsala, Sweden, 1,596 men with pleural plaques fulfilling strict radiologic criteria were identified from 1963 until June 1985. The men have been followed prospectively for 16,369 person-years. The number of mesotheliomas and bronchial carcinomas was compared with the age- and year-specific expected incidence from the official cancer registry of Sweden. Fifty bronchial carcinomas occurred, while 32.1 were expected after correction for smoking habits, a difference which was statistically significant. Patients with radiologic asbestosis were overrepresented among those with bronchial carcinoma. The risk for patients with pleural plaques without asbestosis was increased 1.4 times, which was statistically significant. There were 9 mesotheliomas, while only 0.8 were expected. The mean latency time from first exposure to diagnosis of bronchial cancer was 44.1 years and for mesothelioma was 48.1 years. Thus, pleural plaques on the chest roentgenogram indicate significant exposure to asbestos, with an increased risk for mesothelioma and possibly also for bronchial carcinoma. Any person found to have plaques on chest roentgenogram should be informed of them and should be persuaded to stop smoking.
Round atelectasis as a complication of Legionnella pneumonia. R. Kuno, D.J. Bower, S.M. Aguayo. 1994;106(2):607-8. Case report PubMed · Publisher

Abstract

Round atelectasis is a rare lung pseudotumor that is most commonly associated with asbestos-related pleural disease but can result from a variety of chronic pleural diseases. We describe a patient who developed round atelectasis over a period of only several months following an acute pleuropulmonary illness caused by Legionnella pneumophila.
Spirometric impairments in long-term insulators. Relationships to duration of exposure, smoking, and radiographic abnormalities. A. Miller, R. Lilis, J. Godbold, et al. 1994;105(1):175-82. PubMed · Publisher

Abstract

A study of 2,611 long-term asbestos insulators was well suited to provide information on (1) the prevalence of spirometric impairments in a large, well-defined population and (2) the effects of cigarette smoking, radiographic abnormalities, and duration from onset of exposure on pulmonary function. Prevalences are reported by a mutually exclusive classification of impairments (normal, restrictive, obstructive, small airways, and combined) as well as by abnormality of specific spirometric tests (FVC, FEV1/FVC, and midexpiratory time). Only 3 percent of nonsmokers (NS) had obstruction and 6 percent a decreased FEV1/FVC. Frequency of restriction did not vary by smoking history; it was 31 percent in NS and current smokers (CS) and 34 percent in ex-smokers (XS). Obstruction (present in 17 percent) and combined impairment (in 18 percent) were most common in CS. The FEV1/FVC was decreased in 35 percent of CS and 18 percent of XS. The FVC was decreased in 49 percent of CS, 44 percent of XS, and 33 percent of NS. Normal spirometry was most common when the radiograph was normal (almost half the workers with normal radiographs had normal spirometry). Nevertheless, FVC was reduced in 27 percent of those with normal radiographs and a normal radiograph was seen in 11 percent of workers with restriction. Restrictive and combined impairments were most frequent when both parenchyma and pleura were abnormal. Restriction was more frequent in isolated pleural disease (seen in 34 percent such subjects) than in isolated parenchymal disease (22 percent). The contribution of pleural fibrosis to reduced FVC and of asbestos exposure and smoking both to reduced FVC and to reduced FEV1/FVC was confirmed by regression analysis. That reduced FVC and reduced FEV1/FVC are both more frequent in insulators who have smoked (compared with NS insulators or smokers in the general population) suggests an interaction between asbestos and smoking in producing both these physiologic abnormalities.
AIDS and malignant mesothelioma--is there a connection?. C.A. Behling, P.L. Wolf, P. Haghighi. 1993;103(4):1268-9. Case report PubMed · Publisher

Abstract

A 35-year-old male homosexual, a former intravenous drug abuser, was found to be human immunodeficiency virus (HIV) positive in 1984. He developed AIDS in 1987 and began treatment with zidovudine in 1989. One year later he developed left apical pleural blebs, a pneumothorax and an exudative pleural effusion. A malignant mesothelioma developed at the pleural blebs in the left apex. He was treated with adriamycin but rapid progression of the malignancy occurred and he died three months later. At autopsy, a malignant mesothelioma, causing respiratory failure and death, was found. The patient had no exposure to asbestos and asbestosis was not present at autopsy. We postulate that the development of malignant mesothelioma was probably related to HIV immune suppression or HIV and/or cytomegalovirus or zidovudine and is a complication of AIDS similar to the development of other malignant neoplasms in patients with AIDS.
Asbestos-related pleural plaques and lung cancer. W. Weiss. 1993;103(6):1854-9. Review PubMed · Publisher

Abstract

The English-language literature was reviewed to evaluate a possible relationship between asbestos-related pleural plaques and lung cancer in the absence of parenchymal asbestosis. There were six cohort studies in which the comparison group was limited to unexposed persons or the general population, four lung cancer case-control studies, and three autopsy studies. Of the 13 investigations, only 3 supported the hypothesis that lung cancer risk is elevated among persons with pleural plaques over the risk in unexposed people: 2 cohort studies from the same city in England with much the same data and 1 case-control study. These three studies had the most defects in design. The other ten studies failed to confirm the hypothesis. Thus, the weight of the evidence favors the conclusion that persons with asbestos-related pleural plaques do not have an increased risk of lung cancer in the absence of parenchymal asbestosis.
Cardiorespiratory responses to incremental exercise in patients with asbestos-related pleural thickening and normal or slightly abnormal lung function. A. Miller, A. Bhuptani, M.F. Sloane, et al. 1993;103(4):1045-50. PubMed · Publisher

Abstract

An increasing number of patients with asbestos exposure are being identified with pleural thickening (PT) alone, with little or no impairment in standard tests of lung function despite their frequent complaint of dyspnea. We have employed incremental cardiorespiratory exercise testing to evaluate the types and mechanisms of impairment in 23 such patients. All had normal lung fields on radiographic examinations and normal (group 1, n = 12) or minimally reduced (group 2A slight restriction, n = 5, group 2B, slight obstruction, n = 6), lung function. Excessive ventilation was common in all groups, but especially in group 2B. Abnormal dead space ventilation (VD/VT) was more frequent in groups 2A (4/5) and 2B (4/6) than in group 1 (3/12). It was associated with O2 desaturation in three patients in groups 2A and B. Cardiovascular abnormalities were rare (1/23). Excessive ventilation and dead space provide a basis for the symptom of dyspnea in these patients.
Intrapleural recombinant IL-2 in passive immunotherapy for malignant pleural effusion. P. Astoul, J.R. Viallat, J.C. Laurent, et al. 1993;103(1):209-13. PubMed · Publisher

Abstract

The purpose of this phase 1 study was to determine the toxicity and effectiveness of recombinant interleukin-2 (RU 49637 Roussel Uclaf-France) administered by continuous pleural infusion for 5 days to patients with different histologic subtypes of pleural cancer. Incremental doses of rIL-2 from 3 x 10(6) to 24 x 10(6) were given via a thin catheter inserted into the homolateral pleural cavity. Patients were evaluated before treatment and 36 days after treatment by computed tomography scan and thoracoscopy with biopsy. Twenty-two patients with malignant pleural effusion (15 malignant pleural mesotheliomas, 6 adenocarcinomas, 1 squamous cell carcinoma) were treated. The maximum tolerated dose (MTD) of rIL-2, defined as the dose that produced grade 3 or greater toxic reactions in 50 percent of the patients, was 24 x 10(6) IU/m2/d. Although some side effects were encountered at any dose, tolerance was acceptable. The main side effect was fluid retention (8 of 22) which never exceeded 10 percent of body weight. Responses were achieved in 10 out of 22 patients with 1 complete remission (mesothelioma) and 9 partial remissions (3 adenocarcinomas and 6 malignant pleural mesotheliomas). Based on these results, we recommend that phase 2 studies using rIL-2 at a dose of 21 x 10(6) IU/m2/d via the intrapleural route be undertaken.
Localized inflammatory pulmonary disease in subjects occupationally exposed to asbestos. S.P. Hammar, K.O. Hallman. 1993;103(6):1792-9. PubMed · Publisher

Abstract

In reviewing pathology materials from patients occupationally exposed to asbestos, we identified eight patients with either localized nodules in their lung or unusual pathologic changes. The chest radiographs of six patients showed isolated parenchymal nodules thought to represent primary neoplasms. In three cases, pathologic examination of these nodules showed intraluminal fibrosis and inflammation of the distal airways, a pattern of change frequently referred to as "bronchiolitis obliterans organizing pneumonitis." In each instance, asbestos bodies were present in association with the fibroinflammatory tissue. In one case, the nodule showed a desquamative interstitial pneumonitis type pattern, and asbestos bodies were present admixed with the alveolar macrophages and occasionally within their cytoplasm. In one case, the nodule was composed of nonspecific inflammation and fibrosis with focal bronchiolitis obliterans and frequent asbestos bodies scattered throughout the area of inflammation and fibrosis, and in another case, necrotizing inflammation association with Aspergillus fungal organisms was identified. Granulomatous inflammation was the dominant pulmonary pathologic change in one patient, and the other patient's lung biopsy specimen showed a diffuse lymphocyte-plasma cell interstitial pneumonitis. The cases reported suggest that asbestos may cause localized lesions in the lung that clinically and radiographically are misinterpreted as cancer and that pathologically show inflammation and fibrosis of the distal airways. In addition, our observations suggest that asbestos may cause granulomatous inflammation, a desquamative interstitial type pneumonitis, and a lymphocytic interstitial pneumonitis type pattern. Our conclusions that asbestos may cause these pathologic changes are supported by case reports in the clinical and pathologic literature, clinicopathologic studies, and by experimental studies.
Natural history and epidemiology of malignant mesothelioma. K.H. Antman. 1993;103(4 Suppl):373S-376S. Review PubMed · Publisher

Abstract

Asbestos exposure constitutes the primary cause of pleural and peritoneal mesothelioma in humans. Risk relates to the duration and intensity of exposure. Thus, those exposed at younger ages are at higher lifetime risk. Families of asbestos workers exposed to asbestos on hair and clothing as well as to asbestos items brought home from the workplace are also at risk, as are employees working in the same vicinity as asbestos workers. The public health significance of exposure from asbestos in public and private buildings remains controversial. Malignant mesothelioma is difficult to diagnose and carries a poor prognosis. Chemotherapy with single or multiple agents has thus far been disappointing, but doxorubicin and cisplatin or mitomycin and cisplatin are probably most active with response rates in measurable disease of 25%. Palliative radiotherapy is also problematic since differences between tumor cytotoxicity and pulmonary tolerance are small and radiation pneumonitis may significantly impair quality of life.
Pleural determinants of restrictive lung function and respiratory symptoms in an asbestos-exposed population. P.H. Wright. 1993;104(4):1314-5. Comment · Letter PubMed · Publisher
Pleurectomy/decortication and adjuvant therapy for malignant mesothelioma. V.W. Rusch. 1993;103(4 Suppl):382S-384S. PubMed · Publisher

Abstract

Malignant mesothelioma is an uncommon and usually fatal cancer, for which there is no standard treatment. However, surgical resection remains the mainstay of treatment because of the inability to treat the entire hemithorax effectively with radiation and the lack of effective chemotherapy drugs. Extrapleural pneumonectomy is the only technically feasible operation for patients who have bulky local tumor and chronic entrapment of the lung, but pleurectomy/decortication is associated with a lower operative morbidity and mortality, and seems to lead to an equally good survival in patients who have early-stage disease. Because of the high risk of local recurrence after surgical resection by either extrapleural pneumonectomy or pleurectomy/decortication, efforts have been directed at developing effective adjuvant treatment. Radiation given postoperatively after pleurectomy/decortication has led to a minimal improvement in survival and to significant side effects. Adjuvant chemotherapy is considered investigational but is currently being evaluated in a clinical trial using high-dose intrapleural and systemic chemotherapy after pleurectomy/decortication. Additional well-designed prospective trials are needed to alter the dismal outcome of this disease.
Relative release of interleukin-1 beta and interleukin-1 receptor antagonist by alveolar macrophages. A study in asbestos-induced lung disease, sarcoidosis, and idiopathic pulmonary fibrosis. J.N. Kline, D.A. Schwartz, M.M. Monick, et al. 1993;104(1):47-53. PubMed · Publisher

Abstract

We examined the influence of untreated interstitial lung disease (ILD) on the in vitro release of interleukin-1 beta (IL-1 beta) and interleukin-1 receptor antagonist (IL-Ira) from alveolar macrophages (AM); AM were harvested from normal volunteers, ILD patients, and patients with asbestos-related pleural disease but no ILD. AM were cultured for 24 h and assays for IL-1 beta and IL-1ra were done using sensitive and specific enzyme-linked immunosorbent assay. A greater amount of IL-1 beta was detected in AM supernatants from asbestosis, sarcoidosis, and IPF patients than in those from normal subjects. The IL-1 beta:IL-1ra ratio (IL-1 beta activity index [IL-1AI]) was significantly lower in supernatants of normal macrophages compared with macrophage supernatants from individuals with ILD. The IL-1AI correlated with bronchoalveolar lavage cellularity, a marker of disease activity. Current smoking was associated with lower IL-1 beta and IL-1ra release in ILD. The IL-1AI is a convenient method for comparison of IL-1 beta activity between patient populations.
Round atelectasis and Metsovo lung. S.A. Papiris, M.A. Maniati, K. Sakellariou, et al. 1993;103(6):1759-62. PubMed · Publisher

Abstract

Round (helical) atelectasis is one of the benign sequelae of occupational asbestos exposure. Environmental asbestos exposure does not differ from occupational in its pleural manifestations, but to our knowledge, round atelectasis has not been reported yet. In the present study, we present the clinical and radiologic findings of five individuals with round atelectasis. They were all born in the Metsovo area, northwest Greece, where environmental exposure to asbestos (tremolite) has been documented. All five had negative evaluation for malignancy. In addition, they have been followed up for one to four years and four of them are in good health, thus confirming round atelectasis as a benign, nonpremalignant condition. The fifth patient died of malignant pleural mesothelioma two years later, while the previously detected round atelectasis remained unchanged. We therefore consider that his mesothelioma was not related to the round atelectasis, although both were certainly related to the same environmental asbestos exposure.
The attribution of lung cancer to asbestos. W. Weiss. 1993;103(2):654-5. Comment · Letter PubMed · Publisher
The epidemiology of lung cancer. J.M. Samet. 1993;103(1 Suppl):20S-29S. Review PubMed · Publisher

Abstract

Lung cancer rates and mortality have risen in epidemic proportions in the United States and other industrialized nations during the 20th century. Case-control and cohort studies performed in the 1950s and 1960s firmly established cigarette smoking as the single greatest risk factor for lung cancer. In the United States, overall lung cancer mortality rates in men and women rose progressively from the 1950s. Fortunately, lung cancer incidence and mortality are now declining in middle-aged men. Smoking has significantly increased lung cancer rates among women and is on the rise in developing countries. Environmental agents found in the home and workplace, including radon and asbestos, have also been shown to increase lung cancer risk in both smokers and nonsmokers. Government regulations have helped curtail quantities of these and other atmospheric carcinogens. Efforts to reduce lung cancer risk must be continued and their scope expanded in order to have a global impact on the incidence and mortality of this fatal malignancy.
The relationship between HLA-A, B, DQ, and DR antigens and asbestos-induced lung disease. J.F. Shih, G.W. Hunninghake, N.E. Goeken, et al. 1993;104(1):26-31. PubMed · Publisher

Abstract

To evaluate the relationship between human leukocyte antigen (HLA) and both asbestos-induced pulmonary fibrosis and pleural fibrosis, we obtained HLA-A, B, C, DQ, and DR phenotypes in 42 long-term asbestos-exposed workers. Among these exposed workers, 15 had asbestosis (ILO > or = 1/0) on the chest radiograph and 18 had asbestos-induced pleural fibrosis. We found that there was an increased percentage of HLA-A29, HLA-B44, and HLA-Bw4 in the subjects with asbestosis. In addition, we observed a marginally positive relationship between HLA-A29 and the severity of pulmonary fibrosis. Similarly, there was a higher prevalence of HLA-DRw53 and DQ2 in the subjects with asbestos-induced pleural fibrosis. The presence of HLA-DQ2 was significantly related to the extent and type of asbestos-induced pleural fibrosis while HLA-DRw53 was not consistently related to the type or extent of pleural disease. Importantly, we observed that HLA-A29, HLA-B44, HLA-Bw4, HLA-DRw53, and HLA-DQ2 do not have a significantly shorter duration or latency of asbestos exposure. Moreover, none of the HLA haplotypes (A29, B44, Bw4, DRw53, and DQ2) that we found to be associated with radiographic manifestations of asbestos-induced lung disease were associated with the physiologic abnormalities that have been traditionally associated with asbestos-induced lung disease. The only exception was an isolated decrease in the residual volume associated with the presence of HLA-A29. These results suggest that the HLA-A29 phenotype may be associated with the development of asbestosis and the HLA-DQ2 phenotype may be associated with the development of asbestos-induced pleural fibrosis. However, these associations are not particularly strong, physiologic correlation is lacking, and previous studies do not support our findings.
Association between acute inflammatory cells in lavage fluid and bronchial metaplasia. W.W. Merrill, M.R. Cullen, D. Carter, et al. 1992;102(3):688-93. PubMed · Publisher

Abstract

In epidemiologic studies, airway disease and parenchymal injury are known morbid outcomes of occupational exposure to asbestos. However, the relationship of inflammatory events considered to be responsible for parenchymal injury to the subsequent development of airway injury is unknown. To assess this we performed bronchoalveolar lavage (BAL) and airway biopsies on a population of subjects with exposure to asbestos in the workplace. As an index of airway injury, we employed histologic metaplasia seen in mucosal biopsy specimens. Lung BAL fluid was analyzed for two potentially relevant protein markers and for inflammatory cells recovered from the lower respiratory tract. We related metaplasia to demographic features of this study population (eg, smoking history and asbestos exposure data) and also to the protein and cellular markers recovered by BAL. We studied 50 workers and detected keratinizing metaplasia in 15 and varying lesser abnormalities in the other 28. Cigarette smoking was not associated with the presence of metaplasia (p less than 0.2). Smoking status was associated with an increase in BAL cells (p less than 0.02); however, neither the percent nor concentration of acute inflammatory cells was significantly increased. Acute inflammatory cells (percent and cells per milliliter of BAL fluid) were significantly increased among the subjects with severe metaplasia compared with other study subjects. This increase was true of both neutrophils and eosinophils and the sum of these two (p less than 0.02). Stratification of subjects by smoking status demonstrated a persistent association of inflammatory cells with metaplasia. By logistic regression analysis, polymorphonuclear leukocytes per milliliter and eosinophils per milliliter were significantly related to the presence of metaplasia in two independent models (odds ratios, 9.9 and 7.6, respectively). Cigarette smoking and other demographic or BAL variables were not significantly associated with metaplasia in these models.
Association between neutrophil concentration in bronchoalveolar lavage fluid and recent losses in diffusing capacity in men formerly exposed to asbestos. M.R. Cullen, W.W. Merrill. 1992;102(3):682-7. PubMed · Publisher

Abstract

It has been observed widely that some individuals exposed to asbestos will experience continued losses of lung function after asbestos exposure ceases. Unfortunately, there are few data on factors that determine clinical course, limiting the clinician's ability to determine prognosis in an individual case and restricting the possibility for testing or targeting any potential intervention to alter the course among the millions at risk. In an attempt to address this question, we studied a volunteer population of 50 such men from among a stable, heterogeneous population of asbestos-exposed workers who had been continuously followed in our occupational medicine clinics for up to 12 years (mean, 6.3 years); most had some clinical or roentgenographic sign of asbestos effect, pleural or parenchymal. Each subject was reexamined clinically, functionally, and roentgenographically. Asbestos and tobacco exposure histories were carefully reviewed with the subjects and quantified based on these reports and available data regarding the various work environments from which they came. Subsequently, each underwent a bronchoalveolar lavage to assess cellularity and levels of various proteins. The levels of risk factors, clinical findings, and biologic parameters from lavage were examined for their relationship to serial changes in lung function during the period over which they had been previously followed. Results of the study demonstrate that serial changes in lung function were not closely related to level or length of prior exposure, smoking behavior, chest roentgenographic findings, or lung volumes. Progressive loss of diffusing capacity for carbon monoxide (Dco) was significantly associated with two factors: level of neutrophil concentration in lavage fluid (0.043 +/- 0.016 ml/min/mm Hg/yr drop for each 0.1 x 10(4) neutrophils per milliliter, p = 0.02) and the level of Dco itself (0.17 +/- 0.07 ml/min/mm Hg/yr drop for each 10 percent decrease in percent Dco predicted, p = 0.01). The relationship with neutrophil concentration was statistically independent of the association with Dco itself and stronger; it persisted when loss of Dco was adjusted for baseline value. Lung volume changes were not associated with any predictor variables, alone or in combination. We conclude that the presence of neutrophils in bronchoalveolar lavage fluid is associated with recent disease progression that may have implications in studies of the mechanisms of asbestos-associated disease and in clinical treatment of patients at risk.
Cancer due to asbestos exposure. T. Kishimoto. 1992;101(1):58-63. PubMed · Publisher

Abstract

To determine the relationship between malignancies and asbestos exposure, the number of asbestos bodies in wet lung tissue was counted by light microscopy according to the modified method of Smith and Naylor, and occupational histories were examined. The results revealed that 17 (89 percent) of 19 malignant mesotheliomas, 39 (38 percent) of 104 lung cancers, 23 (37 percent) of 62 gastric cancers, and 13 (28 percent) of 45 colon cancers were shown to be cases with asbestos exposure. These values were significantly higher than those of noncancerous cases (200 cases). It is of interest that five out of ten cases of leukemia were related to asbestos exposure. Nearly all multiple cancers including lung and gastric cancer in this study were also cases with asbestos exposure. Additional research should be conducted on the carcinogenicity of asbestos for multiple cancers.
Lymphocyte-macrophage alveolitis in nonsmoking individuals occupationally exposed to asbestos. W.N. Rom, W.D. Travis. 1992;101(3):779-86. Case report PubMed · Publisher

Abstract

A disordered immunologic activity has been observed in humans and animal models of asbestosis and silicosis. To characterize the lung immunologic response following long-term occupational exposure to asbestos, bronchoalveolar lavage (BAL) was performed on 28 nonsmoking individuals. Increased BAL lymphocytes were observed in one third. Lung lymphocytes were predominantly of the CD4+ helper-inducer subtype with increased CD4+/CD8+ ratio and increased surface expression of DR antigen consistent with the activation phenotype. Histologic evaluation of lung tissue from two individuals with lymphocytic-macrophage alveolitis and asbestos exposure revealed an infiltration of alveolar walls with chronic inflammatory mononuclear cells (lymphocytes). Interferon gamma was spontaneously released by BAL cells from 19 (76 percent) of 25 of the individuals with asbestos exposure and only one of ten normal controls. The release of interferon gamma by BAL cells could be further stimulated with concanavalin A and suppressed by cyclosporine. Although asbestosis is characterized by a predominant alveolar macrophage alveolitis, there is a subgroup with lymphocytic alveolitis and activated lymphocytes participating in the inflammatory response, especially in those without respiratory impairment early in the course of the disease process.
Malignant pleural mesothelioma due to environmental mineral fiber exposure in Turkey. Analysis of 135 cases. Z.T. Selçuk, L. Cöplü, S. Emri, et al. 1992;102(3):790-6. PubMed · Publisher

Abstract

We reviewed data from 135 patients with environment-associated malignant pleural mesothelioma (MPM) from the Central Anatolian region of Turkey. The most significant factors suggesting the diagnosis of MPM were the village where the patient resided and the typical presenting symptoms and signs of unilateral exudative pleural effusion associated with nonpleuritic chest pain. Computed tomography and ultrasonography were very useful for evaluating the extension of the tumor in the thoracic and abdominal cavities and chest wall. The tissue diagnosis was established by either thoracoscopy (39 percent) or pleural biopsy (39 percent) in the majority of the cases. The median survival after diagnosis was 13.52 months for erionite-associated MPM and 21.56 months for asbestos-associated MPM. The actuarial survival curves for the fibrous minerals were significantly different for survival computed both from onset of the symptoms and after diagnosis. Medical or surgical treatment or both did not change the outcome of the disease.
Pleural determinants of restrictive lung function and respiratory symptoms in an asbestos-exposed population. A. Broderick, L.J. Fuortes, J.A. Merchant, et al. 1992;101(3):684-91. PubMed · Publisher

Abstract

To further define the relationship between asbestos-induced pleural fibrosis and restrictive lung function, we investigated the pleural determinants of respiratory symptoms and restrictive physiology in 1,211 sheet metal workers. We evaluated the relationship between specific components of pleural fibrosis (costophrenic angle involvement, diaphragmatic plaques, width and length of pleural fibrosis, pleural calcification, and the type of fibrosis-circumscribed plaque or diffuse pleural thickening) and both forced vital capacity and respiratory symptoms. We found that costophrenic angle involvement, the width and length of pleural fibrosis, and the presence of either circumscribed plaque or diffuse pleural thickening were each significantly associated with a lower FVC. No consistent relationship was observed between FVC and either diaphragmatic plaques or pleural calcification. However, since the pleural abnormalities were highly collinear, none of these abnormalities alone or in combination predicted the reduction in FVC significantly better than a model that included circumscribed plaques and diffuse pleural thickening. We also investigated the relationship of each component of pleural fibrosis with cough, dyspnea, and chest pain. After controlling for appropriate confounders, a trend toward significance was observed between increased width and length of fibrosis and dyspnea with exertion. Otherwise, these pleural abnormalities were not consistently related to any of the three respiratory symptoms. Our results indicate that although pleural plaques and diffuse pleural thickening and their components are independently associated with a lower FVC, these components of pleural fibrosis do not substantially improve the previously defined relationship between FVC and both circumscribed plaques and diffuse pleural thickening. In addition, a trend toward significance was observed between the width and length of the pleural abnormality and dyspnea while hurrying.
Solitary pulmonary nodule in a patient without asbestos exposure. J.F. Turner, C. Gronbeck, C. Stacy. 1992;102(4):1267-8. Case report PubMed · Publisher
The role of closed pleural needle biopsy in the diagnosis of malignant mesothelioma of the pleura. H.D. Beauchamp, N.K. Kundra, R. Aranson, et al. 1992;102(4):1110-2. PubMed · Publisher

Abstract

Malignant mesothelioma of the pleura is a disease that requires a biopsy procedure for a definitive diagnosis. In the past, closed pleural needle biopsy (CPNB) has given poor yields due to the small amount of tissue obtained, and the patient has subsequently been subjected to a diagnostic thoracotomy. In recent years, the availability of more accurate histopathologic tests have enabled the pathologist to make a diagnosis more easily on samples obtained at CPNB. In this retrospective study of 20 consecutive cases of malignant mesothelioma of the pleura diagnosed between 1980 and 1990, we found that a blind CPNB was diagnostic in five of seven procedures and CT-guided CPNB was diagnostic in five of six procedures. An open pleural biopsy (OPB) was diagnostic in ten of ten procedures performed. There were no complications associated with any of the CPNB procedures. We conclude that CPNB is a safe and effective manner of diagnosing malignant mesothelioma of the pleura, and should be attempted prior to OPB.
Asbestos and other fiber-related diseases of the lungs and pleura. Distribution and determinants in exposed populations. M.R. Becklake. 1991;100(1):248-54. PubMed · Publisher

Summary

This review, published in the proceedings of the Fourth Annual Chicago Lung Conference, examined the epidemiologic literature on the distribution and determinants of lung (parenchymal) and pleural fibrosis in populations exposed to asbestos and other fibers. Workforce studies from the 1970s in mining and milling, textile manufacture and asbestos cement manufacture had calculated cumulative exposure for each worker. Most 1980s studies concerned occupations with intermittent, often high, exposure, such as insulators, railroad workers, marine engineers and sheet metal workers. In these, pleural changes were proportionally more common than parenchymal changes, by up to almost 13-fold. The author reviewed prospective studies of radiologic progression and its determinants. In an earlier review of about 375 published asbestosis cases, 39% had a restrictive lung function profile, about 18% an obstructive profile and 18% a mixed profile. Restrictive profiles were not related to exposure in the only 2 studies that examined this. Obstructive profiles were related to smoking. All pleural lesions could cause impairment: isolated plaques the least, diffuse pleural thickening the most. Commercial silicates appeared less toxic, with disease mostly attributed to contamination by tremolite, chrysotile or quartz; kaolin was the exception. The author concluded that pleural disease was becoming more frequent and was often the only sign of exposure. Lung dust burden might explain differences between workforces better than exposure measurements, although exposure-response relationships remained the basis of regulation.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.
Asbestos-induced alveolar injury. Evidence for macrophage-derived PDGF as a mediator of the fibrogenic response. J.C. Bonner, A.R. Brody. 1991;99(3 Suppl):54S-55S. PubMed · Publisher

Summary

The authors used asbestos exposure in rats and mice as a model of rapidly progressing interstitial lung fibrosis. They tested the idea that lung macrophages are the central mediators of the fibrogenic process, and focused on platelet-derived growth factor (PDGF), a growth factor for mesenchymal cells. In rats, alveolar macrophages were collected by lavage 1 week after a 3-hour inhalation exposure to chrysotile asbestos (10 mg/m3), carbonyl iron (50 mg/m3), a particle described as nonfibrogenic, or room air. Macrophages pooled from 3 to 4 rats were cultured in serum-free medium for 24 hours, and PDGF in the conditioned medium was measured by enzyme immunoassay. For comparison, macrophages from unexposed animals were exposed in culture to iron or asbestos for 24 hours. Results were the mean of 3 separate experiments. PDGF secretion by macrophages exposed by inhalation was 2.2- to 5.5-fold higher than after room air. In culture, iron and asbestos increased PDGF secretion 2.4- to 3.7-fold. Acid treatment of the medium was needed to detect most of the PDGF. The authors stated this was consistent with their earlier finding that much of this PDGF is bound to a macrophage-derived alpha-macroglobulin. They concluded that inhaled asbestos and iron increase PDGF secretion by lung macrophages. They proposed that asbestos may cause fibrosis by persisting in the lung and keeping macrophages activated over the long term.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.
Auscultated forced expiratory time as a clinical and epidemiologic test of airway obstruction. D.G. Kern, S.R. Patel. 1991;100(3):636-9. PubMed · Publisher

Abstract

Objective: Seeking an inexpensive, readily available, clinical, screening, and field surveillance test of airway obstruction, we determined the validity of current dogma that forced expiratory time (FET) is a good clinical test of airway obstruction yet is of no epidemiologic use given excessive intrasubject variability.

Subjects And Methods: Two hundred twenty-nine white male plumbers and pipefitters were evaluated by spirometry, chest roentgenography, and a standardized respiratory questionnaire during a union-sponsored asbestos screening program. Subjects were classified as having large airway obstruction (LAO), small airway obstruction (SAO) alone, or no obstruction, on the basis of standard spirometric prediction equations. Two physicians, blinded to clinical and spirometric data, independently measured FET while auscultating the trachea with a stethoscope. The FET was defined as the time taken for an individual to forcefully exhale through an open mouth from total lung capacity until airflow became inaudible. Five such times were recorded for each subject. The mean of the three times having the narrowest range was deemed the FET for calculating test sensitivity and specificity. Based on previous literature, an FET greater than or equal to 6 s was considered abnormally prolonged.

Results: Two hundred five subjects completed both spirometry and FET testing; 67 had LAO, 5 SAO, and 133 no obstruction. A total of 83 percent had three FETs reproducible within a range of less than or equal to 1 s. The sensitivity and specificity of FET for LAO were 92 and 43 percent, respectively, while for SAO alone, 60 and 44 percent, respectively. Overall, FET misclassified 56 percent of nonobstructed subjects. Adjusting the normal-abnormal cutoff points for both FET and SAO minimally improved the performance of FET.

Conclusion: Although FET is a simple, inexpensive, sensitive, and fairly reproducible clinical test of LAO, it cannot be recommended as a clinical or an epidemiologic tool because of its extremely low specificity.
Establishment and characterization of 20 human non-small cell lung cancer cell lines in a serum-free defined medium (ACL-4). N. Masuda, M. Fukuoka, M. Takada, et al. 1991;100(2):429-38. PubMed · Publisher

Abstract

To facilitate the studies in cell biology and drug sensitivity of non-small cell lung cancer, cell samples from 55 patients have been used to establish cell lines in culture using a chemically defined medium (ACL-4). A total of 20 cell lines (36 percent) were directly established and characterized: 14 (44 percent) from pleural effusions, five (29 percent) from resected primary tumors, and one (25 percent) from ascitic fluids. They comprised 16 adenocarcinoma, two large cell carcinoma, one squamous cell carcinoma, and one malignant mesothelioma. Each cell line had distinct gross morphologic features and population doubling times from 21 to 75 h. The plating efficiency was 0.01 to 9.51 percent. The modal chromosome number varied from 45 to 108. Secretion of tumor markers (carcinoembryonic antigen, sialyl Lewis Xi, CA 50, CA 125, and CA 19-9) into the medium was also different in each cell line. Most of the cell lines have been xenografted into nude mice and found to be tumorigenic. Survival of 20 patients whose tumor cell specimens continually grew in culture at any time during their clinical course was significantly shorter than that of 35 patients with no in vitro tumour growth (median survival time of 28 weeks vs 53 weeks, p = 0.0093). Our study indicates that in vitro tumor cell growth appears to be an adverse prognostic factor in patients with non-small cell lung cancer.
Insulin-like growth factor-1 (IGF-1) mRNA expression in bone marrow derived macrophages is stimulated by chrysotile asbestos and bleomycin. A potential marker for a reparative macrophage phenotype. P.W. Noble, P.M. Henson, D.W. Riches. 1991;99(3 Suppl):79S-80S. PubMed · Publisher
Metsovo lung outside Metsovo. Endemic pleural calcifications in the ophiolite belts of Greece. S.H. Constantopoulos, P. Theodoracopoulos, G. Dascalopoulos, et al. 1991;99(5):1158-61. PubMed · Publisher

Abstract

Endemic PCs and high incidence of malignant mesothelioma from household use of asbestos have been reported in Metsovo in northwestern Greece ("Metsovo lung"). In the present study, we present similar findings in six more areas of Greece. Like Metsovo, all these areas are located within ophiolite belts. Like Metsovo, material similar to "Metsovo whitewash" has been used for various domestic uses. Asbestos fibers (chrysotile, antigorite and tremolite) were found in three of the six areas. Also, in two, MPM has been diagnosed. These findings suggest that "Metsovo lung" occurs in several areas of Greece and has similar etiology and epidemiology.
New developments in asbestos-induced pleural disease. D.A. Schwartz. 1991;99(1):191-8. Review PubMed · Publisher
The relationship between large airway inflammation and airway metaplasia. W.W. Merrill, D. Carter, M.R. Cullen. 1991;100(1):131-5. PubMed · Publisher

Abstract

To assess the role of acute inflammatory cells in large airways in the pathogenesis of metaplasia, we performed BAL (divided into aliquots) and mucosal biopsies on asbestos workers. They had evidence of asbestos-related lung injury. We found that acute inflammatory cells were significantly increased in the first aliquot. Ex-smokers had a greater percentage of PMN compared with nonsmokers and current smokers. The subjects were subgrouped with respect to biopsy-detected metaplasia. There was no difference between these groups for percentage or total number of PMN in the first aliquot. However, subjects with metaplasia had significant reduction in FEV1/FVC compared with those without. We conclude that there are significant differences in cells between the first and subsequent aliquots. Although inflammatory stimuli may be important in the pathogenesis of metaplasia, PMN present in the first aliquot could not be related to the severity of the metaplastic changes in these workers.
Tranexamic acid treatment of hemothorax in two patients with malignant mesothelioma. W.A. De Boer, M.G. Koolen, C.M. Roos, et al. 1991;100(3):847-8. Case report PubMed · Publisher

Abstract

Patients with malignant mesothelioma may present with hemothorax. We used a combination of oral and intrapleural tranexamic acid to treat two patients with this severe complication. Initiation of treatment with this potent anti-fibrinolytic drug resulted in rapid reduction of bleeding and of transfusion requirements.
Asbestos exposure results in increased lung procoagulant activity in vivo and in vitro. K.S. Callahan, D.E. Griffith, J.G. Garcia. 1990;98(1):112-9. PubMed · Publisher

Abstract

Enhanced fibrin deposition is a common histologic finding in fibrotic lung disorders including asbestosis and may be an important mechanism by which fibroblast proliferation is modulated. Asbestos-induced activation of lung interstitial cells may result in enhanced expression of procoagulant activity which contributes to the inflammatory response resulting in subsequent fibrin deposition. The current study examines procoagulant activity in bronchoalveolar lavage fluid from patients with clinically diagnosed asbestosis, patients with asbestos exposure without asbestosis, and normal, control subjects. Results indicated that asbestos exposure resulted in increased lung procoagulant expression in vivo, and furthermore, suggested that both endothelial cells and alveolar macrophages represented lung parenchymal cells which may contribute to this activity. This imbalance in coagulation homeostasis may be important in the regulation of fibrotic responses observed in asbestosis.
Asbestos in lung tissue. V.L. Roggli. 1990;97(6):1501-2. Comment · Letter PubMed · Publisher
Pleural effusion in an asymptomatic patient. Spectrum and frequency of causes and management considerations. N.A. Smyrnios, P.J. Jederlinic, R.S. Irwin. 1990;97(1):192-6. Review PubMed · Publisher

Abstract

We conducted retrospective chart and literature reviews to analyze the frequency and spectrum of causes of asymptomatic pleural effusion (APE). In our series, 16 percent of patients undergoing thoracentesis for PE were asymptomatic and the spectrum of causes was similar to that for symptomatic patients. Asymptomatic PEs were evenly distributed among transudates, exudates and indeterminate effusions. More symptomatic (S) PE were exudates, although the difference was not statistically significant (p greater than 0.1). In comparison to SPE, APE were more often free flowing and small. In both groups, the four most common diagnoses were malignancy, CHF, parapneumonic and postoperative effusions accounting for greater than 70 percent of each group. Review of the literature demonstrated the following associations with APE: recent childbirth or abdominal surgery, benign asbestos effusion, uremia, malignancy, and tuberculosis. In the uncomplicated postpartum or postoperative setting or in patients with typical findings of left ventricular failure, observation without diagnostic studies is appropriate. In all other situations, APE should be evaluated in traditional fashion. If thoracentesis is non-diagnostic and the effusion is an exudate, closed pleural biopsy and less often, fiberoptic bronchoscopy, should follow. Once malignant or granulomatous pleuritis has been excluded, it may be appropriate to observe for a period of time before proceeding to more invasive procedures.
Pleural fluid acidosis in the malignant variant of benign pleural mesothelioma. R.D. Brandstetter, F.M. Tamarin, O.J. O'Neill, et al. 1990;98(2):514-5. Case report · Letter PubMed · Publisher
Pulmonary functional impairment associated with pleural asbestos disease. Circumscribed and diffuse thickening. K.H. Kilburn, R. Warshaw. 1990;98(4):965-72. PubMed · Publisher

Abstract

To define the pulmonary functional impairment associated with pleural asbestos signs (PAS), we compared 738 men with only circumscribed (plaques) or diffuse pleural thickening on chest roentgenograms but no irregular opacities by ILO pneumoconiosis criteria (1980) with 738 age-matched asbestos-exposed men without any roentgenographic signs and with 228 men unexposed to asbestos. All men were white. Spirometry and total thoracic gas volumes (TGV) were measured and expressed as percentage of predicted of white Michigan men who have been modeled for spirometric values thereby adjusting for height, age, and in current and ex-smokers for duration of smoking. Asbestos-exposed men who never smoked had reduced FEF75-85 (p less than 0.01) and increased TGV (p less than .0001) as compared with unexposed men. The 155 men with PAS who had never smoked had reduced flows (p less than .0001), FVC (p less than 0.0056), and TGV (p less than .0001) when compared with 155 age-matched asbestos-exposed men. The 325 asbestos-exposed current smokers with normal chest roentgenograms compared with unexposed smokers had reduced expiratory airflows (p less than 0.0001), reduced FEV1 (p less than 0.004), and increased TGV (p less than 0.0001). The 325 current smokers with PAS had additional air trapping that further reduced vital capacity. Thus, PAS were associated with significant pulmonary dysfunction in men who never smoked, and current and ex-smokers had additional dysfunction even after adjustment for duration of smoking.
Reduced diffusing capacity as an isolated finding in asbestos- and silica-exposed workers. J.G. Garcia, D.E. Griffith, J.S. Williams, et al. 1990;98(1):105-11. PubMed · Publisher

Abstract

From a cohort of 286 patients referred to an Occupational Medicine Clinic because of exposure to asbestos and/or silica, we identified 53 patients with a reduced diffusing capacity (Dco) (less than 75 percent predicted) as their only abnormality. Specifically, their clinical evaluation, chest roentgenograms, and remaining pulmonary function test results were all normal. These patients were divided into non-smokers (n = 13) and smokers (n = 40). The significance of the isolated reduction in diffusing capacity in these patients (n = 53) was explored with graded exercise testing (n = 19) and bronchoalveolar lavage (BAL) (n = 50). The results obtained from the patients with reduced diffusion were compared with those obtained from comparable smoking (n = 35) and nonsmoking patients (n = 37) in the original cohort who had normal chest roentgenograms and normal results of pulmonary function studies, including normal Dco values (greater than or equal to 75 percent of predicted value). Patients with low diffusion demonstrated a tendency for elevated alveolar to arterial O2 differences both at rest and during exercise, and a significant reduction in exercise capacity (VO2 max) was observed in the smoking patients with reduced diffusion when compared with their smoking counterparts with normal diffusion. All other exercise testing indexes were normal in the study groups and there was no correlation between the percent predicted Dco value and any of the exercise variables. In contrast, BAL revealed significant differences between patient groups. Both the smoking and nonsmoking patient groups with low Dco values had greater numbers of total BAL cells, alveolar macrophages, neutrophils, lymphocytes, and eosinophils in their BAL fluid than did their comparable controls with normal diffusion values. These differences were statistically significant (p less than .05) for total BAL cells and total macrophages in the nonsmoking patients and for total BAL cells, total macrophages, and total lymphocytes in the smoking patients expressed as either the total cell number per BAL or total cells per milliliter of BAL. In contrast to the observed exercise testing results, there was significant and inverse correlation between Dco values and each BAL cell type for all four groups combined as well as nonsmokers alone. The Dco values from smokers were significantly and inversely correlated with total BAL cells and total macrophages. These results suggest that the finding of a reduced Dco may be related to an active inflammatory process in the lung caused by occupational dust exposure.(ABSTRACT TRUNCATED AT 400 WORDS)
Rounded atelectasis complicated by obstructive pneumonia and pulmonary arterial thrombosis. C.H. Chen, L. Newman. 1990;98(5):1283-5. Case report PubMed · Publisher

Abstract

A patient with a history of asbestos exposure developed rounded atelectasis. The mass was associated with local bronchial obstruction, obstructive pneumonia and arterial thrombosis. Autopsy demonstrated marked pleural thickening and radiographically inapparent asbestosis. This is the first reported case in which seemingly benign rounded atelectasis not only increased morbidity, but also contributed to mortality through airway obstruction and local arterial thrombosis.
Smoking and roentgenographic opacities in US Navy asbestos workers. A.M. Ducatman, B.F. Withers, W.N. Yang. 1990;97(4):810-3. PubMed · Publisher

Abstract

The US Navy's Asbestos Medical Surveillance Program monitors civilian and military employees with current or historical exposure to asbestos. The prevalence of definite radiologic parenchymal abnormalities (ILO category greater than or equal to 1/0) was 3.10 percent for 32,233 smokers vs 1.09 percent for 13,414 nonsmokers. The age-adjusted prevalence ratio was 2.23. The difference in prevalence between smokers and nonsmokers persisted in all age groups studied and was greatest among the oldest employees. These findings in a large population suggest that parenchymal opacifications alone will not reliably differentiate between the impacts of asbestos exposure and smoking in patients who face both risks.
The cigarette factor in asbestosis. W. Weiss. 1990;97(4):769-70. Editorial · Comment PubMed · Publisher

1980s

Asbestos and the lung. M.M. Dunn. 1989;95(6):1304-8. Case report · Review PubMed · Publisher

Summary

This article was a clinical conference presented at Internal Medicine Grand Rounds at Northwestern University Medical School, Chicago. It opened with a patient presentation and then reviewed asbestos-related lung disease. The patient was a white man whose age is illegible in the text. He had worked for 18 years in the "shingle and flex board" division of a major asbestos manufacturing corporation. He had dyspnea on effort, fine crackles, clubbing, a restrictive pattern on pulmonary function tests, a diffusing capacity of 50 percent of predicted, and pleural calcifications and interstitial infiltrates on chest radiograph. He was diagnosed with asbestosis, retired, and died of respiratory failure about five years later. The discussion covered asbestosis, bronchogenic carcinoma, benign pleural effusions and plaques, and mesothelioma, including their clinical features, diagnosis and proposed mechanisms of disease, such as oxygen radicals and iron in the fibre. The author stated that smokers had a tenfold excess risk of lung cancer and that asbestos exposure combined with smoking increased the risk 60-fold. He reported that malignant cells were found in pleural fluid in less than 20 percent of mesothelioma patients and that survival beyond three years was unusual. He concluded that asbestosis had no specific treatment, that steroids were not recommended, and that prevention and stopping smoking were the best measures. He added that lessons from asbestos should be kept in mind when developing replacement fibres.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.
Asbestos in lung cancer. J.L. Abraham. 1989;96(3):701-2. Comment · Letter PubMed · Publisher
Calcified plaque in the superior portion of the major fissure. An unusual manifestation of asbestos exposure. S.B. Rupp, H. Jolles. 1989;96(6):1436-7. Case report PubMed · Publisher

Abstract

Parietal pleural plaque is a well-recognized sign of exposure to asbestos. Visceral pleural involvement is an uncommon manifestation, and calcified visceral pleural plaques are rare. Those reported have been in the minor fissure and inferior major fissure. We describe a unique calcified plaque in the superior major fissure.
Carborundum pneumoconiosis. Fibers in the mineral activate macrophages to produce fibroblast growth factors and sustain the chronic inflammatory disease. R. Bégin, A. Dufresne, A. Cantin, et al. 1989;95(4):842-9. PubMed · Publisher

Abstract

Carborundum is a synthetic abrasive manufactured through fusion of high grade silica sand and finely ground carbon in an electric furnace at 2,400 degrees C. It had been considered an inert dust until recently. Two recent epidemiologic studies in Quebec have documented an excess of interstitial lung disease in plant workers and some 30 workers have received workman compensation. Histopathologic lesions have been described in four of the workers. To further investigate the carborundum pneumoconiosis, nine groups of eight sheep were exposed once in the tracheal lobe to either 100 ml saline, 100 mg latex beads in 100 ml saline, 100 mg graphite in 100 ml saline, 100 mg carborundum particles in 100 ml saline, 100 mg ashed carborundum particles in 100 ml saline, 100 mg of quartz (Minusil-5) in 100 ml saline, 100 mg crocidolite fibers in 100 ml saline, 100 mg carborundum fibers in 100 ml saline, and 100 mg ashed carborundum fibers in 100 ml saline solutions. The animals had BAL at two-month intervals and autopsy at month 8. The BAL analyses of cellularity, cytotoxicity and fibrogenicity, in association to necropsy histopathology, documented that all particles except for quartz were inert. The two-carborundum fiber samples produced a similar sustained nodular fibrosing alveolitis and crocidolite asbestos fibers produced a peribronchiolar fibrosing alveolitis of comparable severity. Thus, the major bioactive dusts in the carborundum manufacturing process are quartz particles and the carborundum fibers generated in the process. The latter have fibrogenic activities comparable to asbestos fibers of similar size and are likely to contribute to the pathogenesis of the interstitial lung disease of carborundum workers.
Gallium lung scanning and bronchoalveolar lavage in crocidolite-exposed workers. A.A. Hayes, B. Mullan, F.T. Lovegrove, et al. 1989;96(1):22-6. PubMed · Publisher

Abstract

Gallium lung scanning is widely used to evaluate pulmonary inflammation in patients with interstitial lung disease but has not previously been reported in crocidolite-exposed workers. In order to characterize the pulmonary inflammation caused by crocidolite inhalation, GLS and BAL findings were related to chest x-ray film changes graded according to the ILO classification of roentgenograms of pneumoconioses. In individuals with roentgenographic evidence of asbestosis (CXR greater than or equal to 1/0, n = 15), 13 had a positive GLS and 13 had an abnormal BAL. In asbestos-exposed individuals with equivocal chest x-ray film changes (CXR 0/1, n = 12), six had a positive GLS and six had BAL changes (both GLS and BAL abnormal in three). In individuals with a normal chest x-ray film (CXR 0/0 n = 8), two had a positive GLS and two BAL changes (both abnormal in 1). These data demonstrate that most subjects with crocidolite-induced asbestosis have an abnormal GLS and BAL. In addition, many individuals with asbestos exposure and equivocal or no chest x-ray film changes have an abnormal GLS and/or BAL, suggesting the presence of active subclinical pulmonary inflammation in these individuals.
Immunocytology in malignant pleural mesothelioma. Expression of tumor markers and distribution of lymphocyte subsets. J. Guzman, K.J. Bross, G. Würtemberger, et al. 1989;95(3):590-5. PubMed · Publisher

Abstract

We studied the reactivity of malignant mesothelioma cells with tumor markers and the phenotypes of lymphocyte subsets in pleural effusions from 14 patients with malignant mesothelioma. For identification of cell surface antigens with monoclonal antibodies, the adhesive slide assay was used. The reaction pattern of mesothelioma cells was found to be CEA negative, Leu M1 negative, EMA positive, BMA-120 positive, My 4 positive, and BA-2 positive. The surface morphology of mesothelioma cells may be of additional help for diagnosis. By these markers, the distinction between mesotheliomas and carcinomas is facilitated. The differentiation of reactive benign mesothelial hyperplasia from malignant mesothelioma by surface marker staining is not yet possible, however. In many effusions in this study, a concomitant T-lymphocytosis was observed with a non-specific increase in the CD4/CD8 ratio, as known for other pleural diseases.
Natural history and staging of malignant mesothelioma. K.H. Antman. 1989;96(1 Suppl):93S-95S. PubMed · Publisher

Summary

This conference paper reviewed the clinical course and staging of malignant mesothelioma, drawing on published series including a registry of 180 patients. Patients with pleural mesothelioma were typically aged 50 to 80 years (median 60) and first sought care for shortness of breath, chest wall pain, or both. Men outnumbered women 2-5 to 1, which the author presumed reflected workplace exposure. Most patients had a large one-sided pleural effusion. About 60% had right-sided tumours and fewer than 5% had disease on both sides. Pleural plaques or lung fibrosis appeared on chest x-rays in only about 20% of patients, despite a history of asbestos contact in 50-70%. Calcifications were seen on CT in almost half and at autopsy in up to 87%. Painful masses at earlier procedure sites developed in about 10%. Clotting abnormalities were seen in up to 20% of patients with peritoneal mesothelioma. Median survival was 6-18 months across series, ranging from weeks to 16 years, and death was usually from respiratory failure. Longer survival was associated with younger age, good performance status, epithelial histology, no chest pain at diagnosis, and treatment with pleuropneumonectomy and chemotherapy. Four published staging systems were compared. The author concluded that none reproducibly predicted survival, that CT was indicated if treatment was contemplated, and that extensive baseline testing for metastases was usually nonproductive.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.
Pulmonary disease associated with pleural "asbestos" plaques. R.F. Sison, R.H. Hruban, G.W. Moore, et al. 1989;95(4):831-5. PubMed · Publisher

Abstract

The diagnosis of asbestos-related pulmonary disease is frequently based in part on the identification of pleural plaques; however, postmortem observations have suggested that pleural plaques may occur without associated pulmonary disease. To examine this issue, we compared the pulmonary parenchymal pathology in 93 patients with pleural plaques to 93 control patients matched for age, race, and sex, all autopsied at The Johns Hopkins Hospital between Jan 1, 1981 and March 31, 1986. Pulmonary sections were graded without knowledge of the patient's group for peribronchiolar fibrosis, other types of fibrosis, emphysema, and pleural changes. Correlations were found between the presence of pleural plaques and peribronchiolar fibrosis (p less than 0.001), alveolar fibrosis (p less than 0.05), large scars (p less than 0.02), scar-related emphysema (p less than 0.02), and pleural thickening (p less than 0.005). A history of smoking was also associated with pleural plaques (p less than 0.05). Interstitial fibrosis was not significantly different between the two groups. Peribronchiolar fibrosis was neither universally nor exclusively present in patients with pleural plaques, being found in 49 (53 percent) of 93 subjects with and 36 (39 percent) of 93 subjects without plaques. The results suggest that caution must be exercised in extrapolating from the identification of pleural plaques to a diagnosis of asbestos-related pulmonary disease.
Relationship between number of asbestos bodies in autopsy lung and pleural plaques on chest X-ray film. T. Kishimoto, T. Ono, K. Okada, et al. 1989;95(3):549-52. PubMed · Publisher

Abstract

We investigated the relationship between number of asbestos bodies and pleural plaques. Using sodium hypochrolite, we examined 400 autopsy lungs and could detect 71 cases whose asbestos bodies were significantly high. We checked pleural plaques on chest x-ray films of these 71 cases and compared the exact plaque at autopsy. By the criteria of Askergren and Szamosi, we classified these into three groups (probable, definite, definite with calcification). This classification is consistent with the pleural plaques found at autopsy. Cases whose pleural plaques were definite (thick) had many more asbestos bodies than indefinite cases. As for occupational histories, there were 23 cases who worked in Japanese Naval shipyards before and during World War II, 14 others in various shipyards, and 14 others who also had a history of asbestos exposure. These 51 patients died more than 30 years after the first asbestos exposure. Twenty had no definite asbestos exposure.
Roentgenographic evidence for predominant left-sided location of unilateral pleural plaques. B.F. Withers, A.M. Ducatman, W.N. Yang. 1989;95(6):1262-4. PubMed · Publisher

Abstract

The roentgenographic prevalence and anatomic distribution of pleural plaques were studied in the US Navy Asbestos Medical Surveillance Program population (105,064 individuals as of July 17, 1985). "Definite" or "probable" pleural plaques were noted in 4.4 percent of films. These were unilateral in 19.3 percent of roentgenograms with "definite" pleural plaque and 33.9 percent of films with "probable" pleural plaque. Unilateral findings were more often left-sided than right-sided; a ratio of 287:82 in the "definite" group and 625:287 in the "probable" group. Left-sided predominance of unilateral plaque is a consistent and unexplained epidemiologic finding that may provide clues to pleural pathogenesis following asbestos exposure.
Rounded atelectasis. Clinical experience with 74 patients. G. Hillerdal. 1989;95(4):836-41. PubMed · Publisher

Abstract

Rounded atelectasis is an atelectasis of a peripheral part of the lung due to pleural adhesions and fibrosis causing deformation of the lung and bending of some small bronchi. From 1970 to 1986, some 74 patients with rounded atelectasis have been seen at the Lung Department. Sixty-four of these patients had been exposed to asbestos. The lesion was secondary to a benign asbestos pleurisy in nine patients and resulted from a slowly increasing pleural fibrosis in 13 patients; in the remaining 39 patients with exposure to asbestos, rounded atelectasis was a sudden finding, with earlier roentgenograms showing only plaques or being normal. Three patients had bilateral lesions, and one had no fewer than three small rounded atelectases. All of the asbestos-exposed patients were men. Ten patients (four women and six men) had not been exposed to asbestos. Two of these cases occurred after trauma and four after a pleural exudate. One of the latter was the only one which disappeared spontaneously. The lingula was affected in 33 cases, the middle lobe in 16, the right lower lobe in 12, the left lower lobe in 11, the right upper lobe in six, and the left upper lobe (except the lingula) in one. Nine patients underwent surgery. Operation should be avoided; the typical roentgenologic and CT findings combined with negative results of bronchoscopy (and, in some cases, fine-needle biopsy) will suffice to exclude malignancy.
Sudden death as the initial manifestation of diffuse pleural mesothelioma. J.T. Lie. 1989;95(3):682-4. Case report PubMed · Publisher

Abstract

Malignant mesotheliomas are generally considered pathognomonic of asbestos exposure. The prognosis of mesothelioma varies with clinical staging of the disease. The overall survival of patients from the time of diagnosis is six to 16 months. Although patients with malignant mesotheliomas often have nonspecific symptoms and signs, occult diffuse pleural mesothelioma is uncommon, and one that occurs in a patient with no evidence of asbestos exposure must be exceedingly rare. Sudden death as the initial manifestation of pleural mesothelioma, to our knowledge, has not been previously reported in the literature. One such unusual case is documented here.
The discriminatory value of the P(A-a)O2 during exercise in the detection of asbestosis in asbestos exposed workers. D.D. Smith, P.G. Agostoni. 1989;95(1):52-5. PubMed · Publisher

Abstract

Asbestosis is commonly associated with abnormalities of gas transport but since most asbestos workers are smokers and smokers also commonly have abnormalities in P(A-a)O2, the actual specificity and sensitivity of the P(A-a)O2 has been unknown. The P(A-a)O2 was measured at rest and exercise in 92 asbestos-exposed patients. These patients were divided into five groups based on their x-ray and pulmonary function status; normal, CAO, CAO and pleural disease, pleural disease alone and asbestosis with or without CAO. The P(A-a)O2/VO2(mm Hg)/L of O2 was the most discriminatory measurement of gas transport between groups, with mean values of 14.45 +/- 9.24 for normal, 19.04 +/- 10.52 for CAO, 16.85 +/- 8.94 for CAO and pleural disease and 34.07 +/- 21.54 for asbestosis with or without CAO. The P(A-a)O2/VO2 was of high specificity if greater than 35 mm Hg/L of O2 with only two out of 65 patients without asbestosis being considered abnormal. It was of low sensitivity in that only nine out of 27 patients with asbestosis would be detected if this were the sole criterion for diagnosis.
The epidemiology and pathogenesis of malignant mesothelioma. J.E. Craighead. 1989;96(1 Suppl):92S-93S. Review PubMed · Publisher

Summary

In this brief review, the author set out to describe the general epidemiologic features of malignant mesothelioma of the pleura and peritoneum and to summarize understanding of how these tumors develop. He stated that, apart from therapeutic irradiation, amphibole asbestos (crocidolite and amosite) was the only established cause. He traced the history of the association: early German reports during the Second World War, the South African study by Wagner and colleagues of cases among miners and nearby residents, and later cases in shipbuilding communities such as Liverpool, heavy industry and the insulation trade. He predicted that excess cases would continue into the next century. On chrysotile, he noted the rare cases (fewer than 100 reported) among Canadian chrysotile miners and millers. He attributed these possibly to tremolite contaminants or to residual amphiboles, and stated that workers exposed only to processed chrysotile did not appear to have excess mesothelioma. He considered this to have major public health implications for the removal of chrysotile-containing materials from US buildings. He proposed a multistage mechanism. In this model, retained amphibole fibers are taken up by macrophages, which produce oxygen radicals and growth substances, and DNA damage combined with stimulated cell proliferation leads to neoplastic transformation. He contrasted this with chrysotile, which breaks down and is cleared from the lung. He concluded that research should aim at preventive approaches, such as altering macrophage activity.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.
Therapeutic approach to malignant mesothelioma. J. Aisner. 1989;96(1 Suppl):95S-97S. Review PubMed · Publisher

Summary

This review, presented at the 5th World Conference on Lung Cancer, described treatment approaches for malignant mesothelioma, a rare tumour associated with asbestos exposure at work and in the environment. The author noted a sharply rising incidence, due in part to increased asbestos use from World War II, and said data on optimal management were only beginning to develop. Before 1980, favourable prognostic factors were female sex, early stage and long duration of symptoms, and treatment could not be shown to matter. A more recent analysis found performance status, absence of chest pain, and chemotherapy or pleuropneumonectomy to be favourable. Aggressive surgery had earlier given 2-year survival of 10-37% and 5-year survival of 10% or less, but refined techniques and earlier presentation had made pleurectomy and pleuropneumonectomy more common. Radiotherapy alone could not be shown to improve survival (median about 10 months), though doses up to 60 Gy could now be given safely. Chemotherapy reports were mostly anecdotal. Intraperitoneal cisplatin and doxorubicin produced dramatic responses in peritoneal disease, with less striking responses in pleural disease. Combined-modality regimens of surgery, chemotherapy and irradiation were described, with some peritoneal patients alive and disease-free for 4+ years. The author concluded that people exposed to asbestos should be observed carefully so that early disease is found, and that patients should be referred to specialist centres for clinical trials.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.
Transbronchial needle aspiration for histology specimens. A.C. Mehta, M.S. Kavuru, D.P. Meeker, et al. 1989;96(6):1228-32. Case report PubMed · Publisher

Abstract

Fine-gauge (22-G) transbronchial needle aspiration (TBNA) has significantly added to the diagnostic yield of FOB, and in some institutions has become routine in staging bronchogenic carcinoma. Cytologic examination of the specimen obtained by n228G TBNA, however, has several limitations. The mediastinal aspirate can be contaminated by tumor cells from respiratory secretions, giving false positive diagnoses of unresectability. The diagnosis of benign conditions can seldom be made. Using 18-G TBNA, we can obtain specimens for histologic examination from paratracheal, peribronchial, and carinal areas by FOB. Both 18-G and 22-G TBNA were performed in 34 patients with radiographic abnormalities involving mediastinal or hilar areas. Tissue for histologic examination was obtained in 17 patients (50 percent) using 18-G TBNA and was diagnostic in 11 (32 percent), including three patients with benign conditions. The overall diagnostic yeild of 18-G TBNA was 41 percent (14/34 patients), increasing the yield of FOB from 50 percent to 58 percent. There were no false positive results and few minor complications. 18-G TBNA is effective in obtaining tissue for histologic examination and diagnosing benign conditions. In selected cases this technique increases the diagnostic yield of FOB.
Chronic constrictive pericarditis associated with asbestosis. L. Fischbein, M. Namade, R.N. Sachs, et al. 1988;94(3):646-7. Case report PubMed · Publisher

Abstract

Observation of chronic constrictive pericarditis associated with pulmonary asbestosis is reported here. Heart catheterization revealed typical patterns of cardiac constriction. The diagnosis of asbestosis was based on pathologic features associated with a long history of asbestos dust exposure without evidence for tuberculosis. The etiology of this constrictive pericarditis was related to an asbestosis pericarditis involvement.
Chrysotile, tremolite, and malignant mesothelioma in man. A. Churg. 1988;93(3):621-8. Review PubMed · Publisher

Abstract

The question of whether chrysotile asbestos ever causes mesothelioma in man has become a major public and occupational health issue. Review of the literature suggests that only 53 acceptable cases of chrysotile-induced mesothelioma have ever been reported; of these, 41 cases have occurred in individuals exposed to chrysotile mine dust, all of it naturally contaminated with tremolite. Ten cases have occurred in secondary industry workers, but here the suspicion of amosite or crocidolite contamination is high. Analysis of lung asbestos content indicates that induction of mesothelioma by chrysotile requires, on average, as great a lung fiber burden as induction of asbestosis by chrysotile, whereas amphibole (amosite or crocidolite)-induced mesotheliomas appear at a several hundred-fold smaller lung burden. Tremolite alone has definitely produced mesothelioma in man, particularly when exposure has been to long, high aspect ratio, fibers. Analysis of tremolite:chrysotile fiber ratios in human lung suggests that some, but not all tremolite is removed in milling chrysotile ores. The low incidence of mesothelioma in secondary chrysotile users may reflect the small amount of tremolite left in the product. These observations indicate that although chrysotile asbestos can produce mesothelioma in man, the total number of such cases is small and the required doses extremely large. The data are consistent with the idea that mesotheliomas seen in chrysotile miners and some secondary industry workers are produced by the tremolite contained in the chrysotile ore, but that the short length and low aspect ratio of the tremolite make its carcinogenicity quite low. However, these data are very indirect, and a role for the chrysotile fiber itself is still possible.
Comparison of light and electron microscopy for defining occupational asbestos exposure in transbronchial lung biopsies. R.F. Dodson, G.A. Hurst, M.G. Williams, et al. 1988;94(2):366-70. PubMed · Publisher

Abstract

Since asbestos burden in the lung can very among areas, the usefulness of small tissue samples for identifying past occupational exposure is examined. Simulated transbronchial biopsy samples and open lung biopsy samples were collected from autopsy material from 12 former amosite asbestos workers and ten persons from the general population. Tissue evaluation included (1) paraffin embedment and light microscopy screening for fibrosis and ferruginous bodies, and (2) tissue digestion, which was analyzed by the combination of (A) light microscopy screening for ferruginous bodies and (B) electron microscopy (EM) screening for uncoated fibers. Using standard pathology techniques to classify the small samples was generally unsuccessful, the samples being too small or their size compounding other random sampling problems. The most reliable method of establishing which transbronchial biopsy tissue samples were from the occupationally exposed group occurred when light and EM analyses were used to evaluate digested tissue. The combined data from the EM analysis of two samples per subject indicated controls had two or fewer observed asbestos fibers, while the amosite asbestos workers had six or more fibers. This distinction was valid even in those who, 21 years before sampling, had worked for only a few weeks in the asbestos plant.
Environmental pleural plaques in residents of a Quebec chrysotile mining town. A. Churg, L. DePaoli. 1988;94(1):58-60. PubMed · Publisher

Abstract

We report four cases of pleural plaques found at autopsy in individuals who resided in or near the chrysotile mining town of Thetford Mines, Quebec, and who had never been employed in the chrysotile mining and milling industry. Three of these patients were farmers, and one was a road construction worker. Lung asbestos content of these cases was compared with that of a group of nine persons living in the same vicinity who did not have pleural plaques. The plaque group was found to have an equal chrysotile content but about a fourfold elevation in median tremolite content, a statistically significant increase. Fiber sizes were the same in both groups. Also, one plaque case had an elevated level of relatively long titanium oxide fibers. These observations suggest that environmental pleural plaques in this region of Quebec are probably caused by exposure to tremolite derived from local soil and rock and that other types of mineral fibers such as titanium oxide may occasionally also be the cause of such lesions.
Extrathoracic lymph node metastases in malignant pleural mesothelioma. M. Huncharek, K. Smith. 1988;93(2):443-4. Letter PubMed · Publisher

Summary

This letter to the editor responded to a report by Kim et al of a 52-year-old man whose malignant pleural mesothelioma was diagnosed by axillary lymph node biopsy. That report included a review of 183 autopsied cases from the medical literature, in which 44 percent had tumor involvement of the hilar and mediastinal lymph nodes and only two cases (1 percent) had axillary lymph node involvement. Prompted by this, the authors reviewed 77 autopsy-confirmed cases of malignant pleural mesothelioma (44 men, 33 women) available at the Canadian Tumor Reference Center. Ages ranged from 23 to 89 years, with a mean of 61 years. Thirty-eight cases (49 percent) had documented asbestos exposure. At autopsy, 34 (44 percent) had lymph node involvement, and 31 (41 percent) of these had involvement of the hilar and mediastinal nodes. One case (1 percent) had axillary lymph node metastases, one had supraclavicular node involvement, and six had metastases to abdominal lymph nodes, so eight (10.4 percent) had extrathoracic lymph node metastases. The authors considered the 77 cases highly selected. They found that the pattern of lymph node spread closely paralleled the review by Kim et al, particularly the rarity of axillary metastases. They supported Kim and colleagues' suggestion of a prospective study to determine the true frequency of peripheral lymph node involvement in this disease.

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Malignant pleural mesothelioma and thoracic needle biopsy. W. Kwee, I. Utama. 1988;93(5):1115-6. Letter PubMed · Publisher
Natural killer cell activity in asbestos workers. Interactive effects of smoking and asbestos exposure. R.D. deShazo, J. Morgan, B. Bozelka, et al. 1988;94(3):482-5. PubMed · Publisher

Abstract

Both the numbers and function of natural killer (NK) cells in 60 were evaluated in asbestos cement workers grouped by smoking history and chest roentgenogram findings (ILO profusion scores less than 1/0 or greater than or equal to 1/0, or isolated pleural plaques). Worker and control subjects who smoked had smoking histories of less than 27 pack-years, a level of smoking lower than that previously determined to adversely affect NK function. Asbestos workers who did not smoke had percentages and total numbers of NK cells and NK function not different from that of nonsmoker control subjects. Workers who smoked and had evidence of asbestosis (ILO profusion category greater than or equal to 1/0) had significantly lower total numbers of NK cells and mononuclear cell NK activity than did smoker control subjects or smokers with pleural plaques only (p less than or equal to 0.05). Numbers of NK cells and NK cell function were not decreased in either of the asbestos-exposed smoking groups without asbestosis when compared to nonsmoker controls. We conclude that smoking and asbestos exposure interact to decrease mononuclear cell NK function in workers with levels of asbestos exposure sufficient to induce asbestosis. This finding may explain in part the previously reported synergistic effect of smoking and asbestos exposure on the risk of lung cancer. Furthermore, the data presented here clarify previous conflicting reports on NK function where asbestos exposed groups have not been stratified for analysis of data.
Neutrophil chemotactic factor release and neutrophil alveolitis in asbestos-exposed individuals. A.A. Hayes, A.H. Rose, A.W. Musk, et al. 1988;94(3):521-5. PubMed · Publisher

Abstract

Alveolar neutrophil accumulation occurs in asbestosis. To evaluate a possible role for release of neutrophil chemotactic factor (NCF) in the pathogenesis of asbestosis, spontaneous NCF release from alveolar macrophages obtained by bronchoalveolar lavage (BAL) in eight individuals with asbestosis, 13 asbestos-exposed individuals without asbestosis, and five control subjects has been studied. Alveolar macrophages were incubated in medium (four hours; 37 degrees C), and neutrophil responses to the supernatants were assayed in a microchemotaxis chamber. Alveolar macrophages from subjects with asbestosis released more NCF (97 +/- 19 neutrophils per high-power field [N/HPF]) than controls (3 +/- 1 N/HPF; p less than 0.01). Alveolar macrophages from individuals with asbestos exposure and increased BAL neutrophil proportions (n = 7) released more NCF (93 +/- 24 N/HPF) than individuals with asbestos exposure and normal BAL neutrophil proportions (n = 6; 11 +/- 6 N/HPF; p less than 0.02). The results show that spontaneous NCF release occurs in asbestosis and that NCF release is associated with neutrophil alveolitis in asbestos-exposed individuals without asbestosis, suggesting a pathogenic role for NCF in mediating this neutrophil alveolitis. The results of the study also suggest that the presence of crackles is a better predictor of the presence of neutrophil alveolitis than is an abnormal chest x-ray film.
Prognostic factors in diffuse malignant pleural mesothelioma. A study of 167 patients. E. Chailleux, G. Dabouis, D. Pioche, et al. 1988;93(1):159-62. PubMed · Publisher

Abstract

The existence of large shipyards accounts for the particular frequency of pleural mesothelioma in the Nantes-St. Nazaire region of France. From 1955 to 1985, 167 cases were diagnosed. Occupational exposure to asbestos was involved in 131 cases (88 percent). There was a great predominance of epithelial types (135) over mixed (25) and fibrosarcomatous (7) types. Survival, estimated by the actuarial method, was 54 percent at one year from first symptoms and 39 percent from histologic diagnosis. No subject was alive four years after diagnosis. Histologic type and asbestos exposure had no predictive value in our series. Survival was longer in patients under 60 years of age and when mesothelioma originated on the left side. Overall, treated patients had significantly longer survival than untreated patients. However, there was no significant difference in survival with respect to the type of treatment given: surgery, chemotherapy, talc poudrage or their combination.
Roentgenographic underestimation of early asbestosis by International Labor Organization classification. Analysis of data and probabilities. S.D. Rockoff, A. Schwartz. 1988;93(5):1088-91. PubMed · Publisher

Abstract

We analyzed the limitations of the International Labor Organization (ILO) classification of chest roentgenograms in predicting the presence of histologically determined early asbestosis. The ILO system is arbitrary, without histologic correlates, and does not consider the asbestos exposure history or clinical and laboratory information. We present data from the literature and our own work which demonstrate that the application of the ILO classification to an asbestos-exposed individual can result in a 10 to 20 percent probability of a "normal" roentgenographic interpretation in the presence of significant asbestosis at the histologic level, leading to an inappropriate conclusion regarding the presence of asbestosis. In view of the data and statistical analysis presented, we suggest that sole reliance upon the ILO classified chest roentgenogram for determination of the presence of early pulmonary asbestosis in individual cases is inappropriate.
The relationship between lung cancer and asbestos exposure. T. Kishimoto, K. Okada. 1988;94(3):486-90. PubMed · Publisher

Abstract

This study supports the theory that asbestos exposure may be implicated in a recent upsurge of terminal lung cancer cases in Kure, Japan. The number of asbestos bodies found in the lung during autopsy of 158 subjects from 1984 to 1986 suggests that 70.4 percent of the 51 diagnosed lung cancer cases could be attributed to asbestos exposure. Of the 107 subjects in whom death was not caused by cancer, 38.4 percent had significant asbestos exposure. Types of asbestos bodies found in diagnosed lung cancer cases were analyzed using scanning electron microscopy and x-ray analyzer. Chrysotile was the most widely found component, but amphiboles such as crocidolite and amosite also were detected. Residents of Kure had high exposure to the inhalation of asbestos bodies, possibly related to the upsurge in lung cancer deaths. In our earlier report, asbestos exposure was implicated in the increased incidence of malignant mesothelioma in Kure, an active Japanese ship-building port since the 1920s. Our current findings indicate that asbestos exposure may be a pathogenic factor in lung cancer in world seaports where asbestos exposure has been prevalent.
Total lung capacity. An insensitive measure of impairment in patients with asbestosis and chronic obstructive pulmonary disease?. S. Barnhart, L.D. Hudson, S.E. Mason, et al. 1988;93(2):299-302. PubMed · Publisher

Abstract

The total lung capacity (TLC) is frequently used as a measure of respiratory impairment in patients with asbestosis. Because asbestosis and chronic obstructive pulmonary disease (COPD) exert opposite effects on the TLC, it may be an insensitive measure of impairment in patients with both abnormalities. To assess this, we compared asbestos-exposed patients with functional evidence of COPD and radiographic evidence of interstitial fibrosis (group 1) to those with interstitial fibrosis alone (group 2). Despite the two groups being comparable in degree of radiographic "fibrosis," no case of restrictive impairment (reduced TLC) was identified among those with both interstitial fibrosis and COPD (group 1), compared to 33 percent of those with interstitial fibrosis alone (group 2). In addition, those patients with both interstitial fibrosis and COPD, compared to those with interstitial fibrosis alone, were found to have greater impairment as measured by alveolar-arterial oxygen difference and diffusing capacity. We conclude that the TLC is an insensitive measure of impairment due to asbestosis in patients with the common setting of coexistent asbestosis and COPD.
Veracity of disability claimants' self-reports of current smoking status. Comparison of carboxyhemoglobin levels from disability claimant and reference population. P. Harber, D. Tashkin, S. Shimozaki, et al. 1988;93(3):561-4. PubMed · Publisher

Abstract

Carboxyhemoglobin level (%COHB) obtained during pulmonary function testing was used as a measure of recent tobacco smoking among persons claiming to be nonsmokers and ex-smokers. Asbestos disability applicants and reference routine clinical patients had similar mean %COHB (2.09 +/- 1.34 and 1.99 +/- 0.88, respectively) and proportions with abnormally elevated %COHB (35 and 46 percent, respectively, had %COHB greater than 2 percent). However, comparisons of persons claiming to be ex-smokers and nonsmokers showed that the ex-smokers had higher mean %COHB (p less than 0.001 by analysis of variance) and proportions with elevated %COHB. This study suggests that disability applicants and routine clinical patients do not differ in veracity of self-stated smoking information, but many persons claiming to be ex-smokers are actually not.
Diagnosis of asbestos-related disease. H. Weill. 1987;91(6):802-3. Editorial PubMed · Publisher

Summary

In this editorial, the author argued that public policy on asbestos-related diseases should rest on sound scientific and medical knowledge, both for estimating risks and for compensating workers injured by past workplace exposure. He noted that a joint ACCP/ATS committee had recently published a consensus statement on diagnosing nonmalignant asbestos-related diseases. He highlighted several of its points, stating that the comments were his own. He wrote that asbestosis means diffuse lung fibrosis and not pleural abnormalities. Its diagnosis usually depends mainly on a compatible chest radiograph together with a history of nontrivial exposure, and a pathologic diagnosis requires both asbestos bodies and fibrosis. He described the ILO classification as descriptive and designed for epidemiologic research, with the greatest interobserver disagreement at the lower categories (0/1 to 1/1). He argued that no single category could serve as the diagnostic threshold for all readers, and that a 1/1 reading illustrates a film compatible with asbestosis, as might a 1/0 film. He stated that lung function changes and crackles are supportive but nonspecific, and that clinically significant chronic airways obstruction is not an expected consequence of asbestos exposure in the absence of far more important causes such as smoking. Plaques do not affect lung function. He concluded that both over- and underdiagnosis are harmful and that credible diagnostic standards are needed and achievable.

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Diagnosis of malignant pleural mesothelioma by axillary lymph node biopsy. S.B. Kim, B. Varkey, H. Choi. 1987;91(2):279-81. Case report PubMed · Publisher

Abstract

Diffuse malignant mesothelioma was diagnosed by axillary lymph node biopsy in a patient with brief asbestos exposure and extensive pleural masses. The clinical, radiographic and pathologic findings of this case are reported and lymph node involvement in DMM is briefly discussed.
Malignant primary cardiac tumors. The Cleveland Clinic experience, 1956 to 1986. P.A. Bear, D.S. Moodie. 1987;92(5):860-2. PubMed · Publisher

Abstract

Malignant primary cardiac tumors have uniformly been associated with poor long-term survival. We reviewed data on 11 patients with such tumors seen between 1956 and 1986. There were five men and six women, with a mean age at presentation of 44 years. Nine (82 percent) of 11 patients presented initially with respiratory symptoms, and 45 percent (five) presented with chest pain. No patient was asymptomatic on initial presentation. Forty-five percent (five) of the patients had elevated jugular venous pressure or a systolic murmur. Cardiomegaly was present in eight (73 percent) of 11 patients. Nine of ten patients had a hemoglobin level less than 12 g/100 ml, and 30 percent (3/10) presented with thrombocytosis. Seventy percent (eight) of the patients underwent surgical biopsy, and in 30 percent (three), surgical excision of the tumor was attempted. Angiosarcoma was the most frequent type of tumor (four patients), followed by malignant fibrous histiocytoma (three patients), mesothelioma (two patients), rhabdomyosarcoma (one patient), and primary lymphoma (one patient). Long-term follow-up data reveals that ten (91 percent) of 11 patients had died, with a mean duration from diagnosis until death of 9.7 months. Newer pathologic techniques for identification of sarcomas, aggressive surgical resection, and advanced chemotherapy for certain subgroups may contribute to better survival for patients with these tumors in the future. In addition, cardiac transplantation may play an important role in the future for those patients with localized disease.
Measurement of lung density by x-ray computed tomography. Relation to lung mechanics in workers exposed to asbestos cement. P. Wollmer, K. Jakobsson, M. Albin, et al. 1987;91(6):865-9. PubMed · Publisher

Abstract

We measured lung density by means of x-ray computed tomography and lung mechanics in 33 workers exposed to asbestos cement and in 39 normal subjects. The exposed group showed evidence of lung fibrosis with reduced static lung volumes and lung compliance, although only three subjects had signs of interstitial fibrosis at standard chest radiography. Lung density was significantly increased in the exposed workers compared to control subjects, with greater differences between nonsmokers than between smokers. Lung density correlated inversely with static lung volumes. There was no appreciable difference in the regional distribution of lung density between exposed workers and control subjects. We conclude that lung density is often increased in workers with mild asbestosis, even in the presence of a normal chest radiograph. Measurement of lung density may be of value in the evaluation of asbestos-exposed workers for assessment of the extent of parenchymal disease.
Physiologic categorization of asbestos-exposed workers. P. Harber, D.P. Tashkin, M. Lew, et al. 1987;92(3):494-9. PubMed · Publisher

Abstract

Categorization of the pattern of physiologic abnormalities in patients with asbestos-associated disease may be important for clinical, compensation, and epidemiologic reasons. A population of 658 asbestos-exposed workers was divided into six groups (restrictive, mixed restrictive-obstructive, obstructive, abnormal diffusing capacity, small airway disease, and normal) based upon pulmonary function test results. Use of two commonly employed prediction equations for diffusing capacity produced divergent results. Adjustment of the forced vital capacity for airtrapping based upon measurement of residual volume or of total lung capacity can improve the accuracy of categorization, particularly in smokers. Hence, the process of interpretation of pulmonary function testing should be chosen carefully.
Tremolite whitewashing and pleural calcifications. S.H. Constantopoulos, N.A. Saratzis, D. Kontogiannis, et al. 1987;92(4):709-12. PubMed · Publisher

Abstract

Radiologic screening of 688 inhabitants of the Metsovo area in Northwest Greece revealed that 323 (46.9 percent) had pleural calcifications. The percentage of positive examinations rose with age. Calcifications were observed in all four villages of the area where a material ("luto" soil) had been extensively used for whitewashing until 1940 to 1950. In four other villages in the immediate vicinity, where "luto" had never been used, pleural calcifications were not observed. Results suggest that Metsovo tremolite may have caused pleural calcifications to all individuals born in Metsovo before 1940. This is the first study indicating that environmental asbestos exposure can cause abnormalities in everyone exposed to it.
A young woman with apparent increase in the transverse cardiac diameter. W.K. Lam, S.Y. So, H. Ngan, et al. 1986;90(4):595-6. Case report PubMed · Publisher
Alveolitis of pulmonary asbestosis. Bronchoalveolar lavage studies in crocidolite- and chrysotile-exposed individuals. B.W. Robinson, A.H. Rose, A. James, et al. 1986;90(3):396-402. PubMed · Publisher

Abstract

Bronchoalveolar lavage (BAL) findings in 27 individuals with crocidolite- or chrysotile-induced asbestosis were compared to BAL findings in 29 unexposed control subjects. Alveolitis, defined as an increase in the proportions and/or absolute numbers of inflammatory cells present in BAL fluid compared to values in control subjects, was present in 26 (96 percent) subjects with asbestosis. Most exhibited a neutrophil-eosinophil alveolitis, with neutrophil proportions increased to 7.4 +/- 0.7 percent and eosinophil proportions increased to 2.2 +/- 0.4 percent, compared to 2 +/- 0.5 percent and 0.4 +/- 0.01 percent, respectively, in control subjects (p less than 0.01 for both neutrophils and eosinophils). An increase in the total number of neutrophils and eosinophils per ml of lavage fluid was also seen (neutrophils 23 +/- 5 and eosinophils 13 +/- 4 per ml; p less than 0.05 compared to control subjects). Severity of the alveolitis, defined by the neutrophil or eosinophil proportions, was independent of a history of exposure to cigarette smoke. The pattern and severity of alveolitis in crocidolite- and chrysotile-induced asbestosis were similar. There was a significant correlation between duration of exposure to asbestos and neutrophil proportions (p less than 0.01). No significant difference in the severity of the alveolitis was observed between individuals with radiologic and physiologic evidence of asbestosis compared to those with asbestos exposure and crackles alone, suggesting that, in asbestosis as in other chronic interstitial lung diseases, radiologic and physiologic parameters do not reflect the severity of the alveolitis. This study demonstrates that a neutrophil-eosinophil alveolitis is present in individuals with crocidolite- and chrysotile-induced asbestosis, that this alveolitis is independent of cigarette smoking, and that the severity of the BAL changes is not reflected in radiologic and physiologic changes.
Asbestos burden and the pathology of lung cancer. M.L. Warnock, W. Isenberg. 1986;89(1):20-6. PubMed · Publisher

Abstract

To determine whether we could distinguish asbestos-related lung cancers from unrelated ones, we typed and quantified by electron-optical methods the asbestos fibers in the lungs of 75 men with lung cancer. All but eight men had some history of asbestos exposure. On the basis of combined amosite and crocidolite (AC) concentrations, we divided the subjects into three groups (AC fibers per gram of dry lung): low (less than 10(5)); intermediate (10(5) to 10(6)); and high (greater than 10(6)). Age, smoking history, latent period, and type and location of tumors were similar in all three groups. Of 62 evaluated subjects, zero of 14 in the low group, seven of 29 in the intermediate group, and five of 19 in the high group had asbestosis. Epidemiologic studies suggest that persons exposed to concentrations of asbestos that can cause asbestosis are at increased risk for lung cancer. Thus, the subjects in our intermediate and high concentration groups may have been at increased risk for cancer, even when they did not have asbestosis. Because large burdens of asbestos do not always cause pulmonary fibrosis, asbestosis may be a poor marker of fiber-related lung cancer.
Asbestos related disease. 1986;89(4 Suppl):366S-368S. PubMed · Publisher
Cellular and molecular mechanisms of asbestosis. B.T. Mossman, R. Gilbert, J. Doherty, et al. 1986;89(3 Suppl):160S-161S. PubMed · Publisher

Summary

The authors asked whether asbestosis involves more replication of lung fibroblasts, a greater ability of individual fibroblasts to produce collagen, or both. They used in vitro and in vivo approaches. In vitro, a normal rat lung fibroblast cell line (RL-82, from Fischer 344 rats) was exposed to UICC crocidolite asbestos at 1, 2.5 and 5 µg/cm2. Collagen synthesis was measured with 3H-proline and bacterial collagenase, cell replication with 3H-thymidine autoradiography, and procollagen type I mRNA by quick-blot analysis. Asbestos increased total cell layer-associated collagen at 48 and 72 hours. For example, at 72 hours it was 37.69 cpm/ng DNA at 5.0 µg/cm2 versus 23.66 in controls. Fibroblast replication did not increase, and procollagen type I mRNA levels did not differ from controls. In vivo, male Fischer 344 rats (3-5 per group) inhaled crocidolite for 30 days (5 hr/day, 5 days/week). Their lungs showed fibrotic changes starting at the alveolar duct. Labeling indices rose in alveolar epithelial cells (4.13% vs 0.8%) and interstitial fibroblasts (3.07% vs 1.13%) but were comparable in bronchiolar epithelial cells. The authors concluded that at least two mechanisms result in asbestosis: increased procollagen synthesis by individual fibroblasts, which does not reflect higher steady-state procollagen type I mRNA levels, and enhanced replication of interstitial fibroblasts after inhalation.

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In plain English

This short conference report described laboratory experiments on mechanisms of asbestosis, a scarring of lung tissue. First, the researchers exposed a rat lung fibroblast cell line to crocidolite asbestos in culture dishes. Fibroblasts are the cells that make collagen, the main scar protein. At 48 hours, exposed cells had more collagen than unexposed cells at all three doses (25.59, 24.75 and 24.05 versus 18.38, measured per nanogram of DNA). At 72 hours, only the highest dose was higher (37.69 versus 23.66). The exposed cells did not multiply more, and the amount of type I procollagen genetic message did not differ. Second, rats breathed crocidolite for 30 days. Their lungs showed fibrotic changes. The researchers used a marker of DNA synthesis (tritiated thymidine). It labeled more alveolar epithelial cells (4.13% versus 0.8% in controls) and more interstitial cells identified as fibroblasts (3.07% versus 1.13%). The labeling of bronchiolar epithelial cells was comparable between the groups. The authors concluded that their work suggests at least two mechanisms. Individual fibroblasts make more collagen, and interstitial fibroblasts have an enhanced replicative potential in the lung after rats inhale asbestos.

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Fibronectin and procollagen 3 levels in bronchoalveolar lavage of asbestos-exposed human subjects and sheep. R. Bégin, M. Martel, Y. Desmarais, et al. 1986;89(2):237-43. PubMed · Publisher

Abstract

To evaluate the potential interest of levels of fibronectin and procollagen 3 in bronchoalveolar lavage fluid as markers of fibrogenic activity, we characterized the time course of changes in fibronectin and procollagen 3 levels in the tracheal lobe of sheep exposed to nonfibrogenic and fibrogenic materials. We correlated these observations with those of bronchoalveolar lavage in long-term asbestos workers in various stages of disease activity. Following studies before exposure, the tracheal lobe of three groups of 24 sheep were exposed once to 100 ml of phosphate-buffered saline solution (PBS), to 100 mg of latex beads in 100 ml of PBS, or to 100 mg of chrysotile fibers in 100 ml of PBS. Bronchoalveolar lavages were obtained at 0, 1, 2, 4, 8, and 12 months after exposure, and four or five sheep per group were killed after each lavage for histopathologic analysis. Fibronectin in bronchoalveolar lavage fluid increased significantly only in the asbestos-exposed sheep to values two to three times above controls or latex-exposed sheep and remained elevated during the 12 months of the study. Levels of procollagen 3 in bronchoalveolar lavage fluid were increased significantly only during the first two months following exposure in the asbestos-exposed sheep only. In the asbestos workers without disease, levels of fibronectin and procollagen 3 in bronchoalveolar lavage fluid were comparable to controls, but these levels were significantly elevated in those with asbestos-associated alveolitis or asbestosis. This study documents that the measurement of levels of fibronectin and procollagen 3 in bronchoalveolar lavage fluid assesses fibrogenic activity of alveolitis and should be useful to predict its progression in a fibrotic process. In asbestos workers the potential use of these markers is primarily related to early detection of asbestos-induced pulmonary injury.
Immunologic investigations in asbestos-exposed workers. R.D. deShazo, C.B. Daul, J.E. Morgan, et al. 1986;89(3 Suppl):162S-165S. PubMed · Publisher

Summary

The authors examined whether immunologic abnormalities in the blood of asbestos-exposed workers were related to lung fibrosis (asbestosis). They studied asbestos cement workers from two plants in the New Orleans area who were taking part in longitudinal studies at Tulane. Chest x-ray films were classified using the ILO 1980 system by three readers. For humoral immunity, 144 workers were randomly selected from a cohort of 244 (mean age 60 years). Serum IgG was elevated in 61%, IgM in 14% and IgA in 33%, and these elevations were not related to radiographic category. Antinuclear antibodies were found in 22 of 144 workers (15%), rheumatoid factor in 4 (3%), and increased immune complexes in 17 of 140 (12%). For cell-mediated immunity, 29 workers were compared with 52 unexposed controls. Workers had significantly lower lymphocyte counts and lower numbers of total, helper and suppressor T cells, with no difference in helper-suppressor ratios. After adjustment for age, responses to the mitogen PHA did not differ significantly. In vitro, cells from 9 workers with fibrosis and hypergammaglobulinemia produced more spontaneous immunoglobulin than cells from 15 controls, and chrysotile asbestos augmented spontaneous production. No immunologic variable correlated with profusion scores or lung function. T-cell numbers were negatively correlated with time since exposure ceased. The authors concluded that the blood immunologic aberrations were epiphenomena unrelated to the pathogenesis of asbestosis.

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Observer agreement, chest auscultation, and crackles in asbestos-exposed workers. P. Workum, E.A. DelBono, S.K. Holford, et al. 1986;89(1):27-9. PubMed · Publisher

Abstract

Investigators cite observer variability as a problem in using crackles to diagnose asbestosis. We measured agreement on the presence or absence of crackles noted during auscultation of 64 asbestos-exposed workers in order to clarify this question. There was 89 percent agreement between two observers who simultaneously examined subjects breathing from functional residual capacity (FRC). Kappa (kappa), a statistic accounting for chance agreement, was 0.73. Unanimous agreement between four observers who listened to tape recordings of the breath sounds was 81 percent (kappa = 0.69). When the subjects breathed from residual volume (RV) there was 78 percent (kappa = 0.53) and 67 percent (kappa = 0.60) agreement, respectively. Comparing direct to tape-playback auscultation, there was 90 percent (kappa = 0.77) and 84 percent (kappa = 0.58) intraobserver agreement when the subjects breathed from FRC and 90 percent (kappa = 0.79) and 75 percent (kappa = 0.39) when they breathed from RV. We conclude that observer variability is sufficiently low to allow trained observers to monitor asbestos-exposed workers for crackles directly and during tape-playback auscultation.
Pulmonary cell interactions with asbestos fibers in vivo and in vitro. A.R. Brody. 1986;89(3 Suppl):155S-159S. PubMed · Publisher

Summary

This conference paper, presented at the 28th Annual Aspen Lung Conference, summarized studies from the author's laboratory at the National Institute of Environmental Health Sciences on how asbestos fibers interact with lung cells. It addressed four questions: where inhaled fibers land and how they move, which inflammatory cells respond, how the first lesion develops, and how fibers interact with cell membranes. In rats and mice that inhaled chrysotile or crocidolite for 1, 3 or 5 hours, scanning electron microscopy showed that most fibers were deposited at alveolar duct bifurcations. Shorter fibers were cleared earlier. One month after a 1-hour exposure, 20% of inhaled fibers remained, essentially all in the interstitium. Macrophages gathered at deposition sites within 48 hours. Complement-deficient mice and rats treated with cobra venom factor had significantly fewer macrophages there. Chemotactic activity was found in the 14-18,000-dalton range, which the author attributed most likely to C5a. Morphometry showed that macrophages and type I and II epithelial cells increased at bifurcations, with 10- to 25-fold increases in cells taking up tritiated thymidine. At one month, interstitial macrophages, fibroblasts and matrix were increased. In red blood cell and macrophage studies, positively charged chrysotile bound to sialic acid residues on cell membranes. The author concluded that the mechanisms remain largely undefined and that whether macrophage products cause disease in vivo remains to be determined.

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Asbestosis, pulmonary symptoms and functional impairment in shipyard workers. K.H. Kilburn, R. Warshaw, J.C. Thornton. 1985;88(2):254-9. PubMed · Publisher

Abstract

A group of 339 male shipyard workers responded to an invitation via shipyards, unions, and news media to be studied for the presence of asbestosis and its functional effects. Of these, 288 were white or black, had begun working in shipyards at least 20 years earlier, and had satisfactory chest x-ray film findings; 257 underwent spirometric testing, and 199 had single-breath diffusing capacities for carbon monoxide (Dsb) determined. There were radiographic signs of asbestosis in 64 percent. Of these, 28 percent had parenchymal disease only, 37 percent had pleural disease only, and 35 percent had both. There was pleural calcification in 9 percent. In only 14 (8 percent) was the profusion of opacities greater than 1/1 by the International Labour Organization's criteria. Age was closely related to the duration of exposure to asbestos. Thus, 87 percent of the workers who had asbestosis were born from before 1900 to 1910, 70 percent of those born in 1911 to 1920 had asbestosis, 62 percent of those born in 1921 to 1930 had the disease, and 31 percent of those born in 1931 to 1940 had signs of asbestosis. Function in nonsmokers was not significantly different from the reference population except for alveolar volume; ex-smokers had significantly reduced forced expiratory volume in one second, flow rates, Dsb, and alveolar volume. The forced vital capacity and thoracic gas volume were normal. Shipyard workers who smoked resembled reference smokers except for significantly reduced alveolar volume. These shipyard workers had minimal to moderate asbestosis with much pleural disease and little functional impairment when compared to a smoking-specific reference population.
Immune responses in asbestos-exposed individuals. D.L. Morris, S.D. Greenberg, E.C. Lawrence. 1985;87(3):278-80. Editorial PubMed · Publisher
Intrapulmonary lymph nodes. Clinical, radiologic, and pathologic features. R.L. Kradin, P.W. Spirn, E.J. Mark. 1985;87(5):662-7. PubMed · Publisher

Abstract

The clinical, radiographic, and pathologic material from ten patients with intrapulmonary lymph nodes was analyzed, along with information from all previously reported cases. In our series the median age was 56 years, and 80 percent (eight) of the patients were men. All patients are or were cigarette smokers. Sixty percent (six) had a history of exposure to either asbestos, nonfibrous silicates, or both. There were no characteristic symptoms attributable to the intrapulmonary lymph nodes. Forty percent (four) had an unexplained pulmonary nodule or nodules on the chest roentgenogram, which prompted further diagnostic studies, including thoracotomy, to rule out a malignant neoplasm. Radiographically, in our cases and in the literature, almost all cases of intrapulmonary lymph nodes are subpleural, inferior to the level of the carina, and less than 2.0 cm in diameter. Thirty-five percent are multiple. Pathologically, in our cases, all intrapulmonary lymph nodes were markedly anthracotic, and 60 percent were additionally silicotic. Although their histogenesis is uncertain, intrapulmonary lymph nodes are probably hyperplastic lymphoid nodules related to inhalation of irritant dusts and attendant distortion of local lymphatic vessels. Precise clinical and radiographic analysis correlated carefully with cytologic and histologic material obtained by percutaneous needle biopsy should obviate exploratory thoracotomy in most instances.
Treatment of malignant pleural effusion. K. Reshad, K. Inui, Y. Takeuchi, et al. 1985;88(3):393-7. PubMed · Publisher

Abstract

Two hundred consecutive patients with malignant pleural effusion were reviewed. The pathologic etiology of malignant pleurisy was: primary lung cancer in 123 cases; five, mesothelioma; and 72 cases secondary to metastatic tumors. Adenocarcinoma of the lung and mammary cancer were the most frequent tumors causing malignant pleural effusion. The modalities employed in local treatment consisted of thoracocentesis in 62 patients, tube thoracotomy in 111 cases with local instillation of adriamycin, MMC, CQ, 5FU, OK432 or talc. Surgical procedures including pleuropneumonectomy or reduction surgery of the tumor with decortication were performed in ten patients. Tube drainage with local instillation of drugs was more effective than thoracocentesis with or without local therapy. Excellent initial results were obtained in patients who received reduction surgery with decortication and pleurodesis. Results of cytologic investigation were positive in 157 cases (78.5 percent). The tumor cells disappeared in 79.4 percent of primary cancer pleurisy cases and 81.1 percent of patients with metastases while disappearance or significant decrease in pleural effusion following treatment was obtained in 75.2 and 77.8 percent respectively. The median survival was 11.3 months in primary cases, and 11.7 months in patients with metastases.
An unusual case of rounded atelectasis. G. Geremia, R.A. Mintzer. 1984;86(3):485-6. Case report PubMed · Publisher

Abstract

An unusual case of rounded atelectasis (RA) is described. This entity is likely to develop as a consequence of asbestos-induced pleural disease. The sine qua non of RA is a curvilinear tail extending from the inferior medial surface of a peripheral mass. Recognition of this "comet tail" prevents the necessity for surgery.
Exercise alveolar-arterial oxygen pressure difference in interstitial lung disease. C. Risk, G.R. Epler, E.A. Gaensler. 1984;85(1):69-74. PubMed · Publisher

Abstract

Abnormality of gas exchange is best evaluated by the exercise alveolar-arterial oxygen pressure difference, P(A-a)O2. We studied the P(A-a)O2 in 168 patients with sarcoidosis, desquamative interstitial pneumonia (DIP), usual interstitial pneumonia (UIP), berylliosis, and asbestosis who were seen for clinical and disability consultations. The increase of P(A-a)O2 with exercise was greatest in UIP (mean 16 mm Hg), least in sarcoidosis (mean 1 mm Hg), and intermediate in DIP, berylliosis, and asbestosis (means 9, 9, and 7 mm Hg, respectively). The increase was best predicted by the single breath diffusing capacity (Dsb), and it occurred in patients with sarcoidosis and DIP if the Dsb was less than 50 percent predicted and in patients with the other diseases if the Dsb was less than 70 percent predicted. However, the magnitude of the increase could not be predicted from resting tests, even when multilinear regression equations were used. We conclude that for clinical evaluation of patients with interstitial lung disease, the exercise test with arterial blood gas measurement adds important information if the Dsb is less than 70 percent predicted. For disability evaluation, the invasive exercise study may be helpful when there is a wide discrepancy between clinical findings and resting physiologic studies.
Parietal pleural plaques, asbestos bodies, and neoplasia. A clinical, pathologic, and roentgenographic correlation of 25 consecutive cases. S.L. Wain, V.L. Roggli, W.L. Foster. 1984;86(5):707-13. PubMed · Publisher

Abstract

An investigation was made to correlate autopsy and roentgenographic findings of pleural plaques with occupational exposure to asbestos and occurrence of respiratory tract tumors. Of the 434 autopsies performed over a 2 1/2 year period, 25 (5.8 percent) had pleural plaques but no gross evidence of parenchymal fibrosis. Review of the posterior-anterior chest roentgenograms using the International Labor Office criteria for classification of pneumoconiosis (1980) revealed that only seven of the 25 cases had detectable pleural thickening or calcification, which demonstrates the poor sensitivity of standard x-ray films. There was no detectable difference in frequency of known or presumed exposure to asbestos between the pleural plaque cases and controls as determined by occupational information obtained from chart review. Asbestos bodies were identified in lung tissue digests from all 25 cases with pleural plaques, and exceeded the normal range for our laboratory in 14 cases (56 percent). Of the 25 cases with pleural plaques, four also had bronchogenic and three had laryngeal carcinoma. The prevalence of bronchogenic carcinoma in patients with plaques was not different from those without plaques (p greater than 0.50). However, the association between plaques and laryngeal carcinoma was highly significant (p = 0.004).
Rounded atelectasis due to acute exudative effusion. Spontaneous resolution. L.S. Smith, R.F. Schillaci. 1984;85(6):830-2. Case report PubMed · Publisher

Abstract

Rounded atelectasis is an interesting roentgenographic entity that must be distinguished from intrathoracic neoplasm. Chronic pleural disease, particularly that due to asbestos exposure, is a frequently cited cause, and is considered to be a sine qua non by some. We report a case of rounded atelectasis with an acute parapneumonic exudative effusion that resolved spontaneously with roentgenographically normal pleura.
Actin-containing microfilaments of pulmonary epithelial cells provide a mechanism for translocating asbestos to the interstitium. A.R. Brody, L.H. Hill, W.S. Stirewalt, et al. 1983;83(5 Suppl):11S-12S. PubMed · Publisher

Summary

The authors proposed that actin-containing microfilaments in alveolar epithelial cells provide a mechanism for moving inhaled asbestos fibers into the lung interstitium, the compartment chiefly affected in asbestosis. White rats were exposed to a chrysotile asbestos aerosol for 1 hour and were killed immediately afterward and at 24 hours, 48 hours and 1 month. Lungs were perfusion-fixed for electron microscopy. Some fresh tissue was treated with glycerol and heavy meromyosin to stabilize microfilaments. In vitro, asbestos fibers were added to tracheal organ cultures and to an established tracheal epithelial cell line. These were examined by electron microscopy, and polymerized and non-polymerized actin were measured by a DNase I inhibition assay. Inhaled fibers were found inside type I alveolar epithelial cells from immediately after exposure through 48 hours. They were generally not membrane-bound and were associated with filaments about 50-70 Å in diameter. Heavy meromyosin-treated tissue showed web-like microfilament complexes around fibers, and cultured cells also showed filaments associated with fibers. In hamster tracheal epithelial cells, filamentous actin was 12% in untreated cells compared with 25% and 21% in cells treated with two amounts of chrysotile. The experiment was repeated twice with nearly identical results. The authors concluded that contractile microfilaments may supply the force that moves asbestos fibers through the epithelium to the interstitium, where they interact with fibroblasts and macrophages.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.
Asbestos-associated diseases. Science, public policy, and litigation. H. Weill. 1983;84(5):601-8. PubMed · Publisher
Current issues in the pathologic and mineralogic diagnosis of asbestos-induced disease. A. Churg. 1983;84(3):275-80. PubMed · Publisher
Diffuse epithelial pleural mesothelioma presenting as a solitary lung mass. M.H. Gotfried, S.F. Quan, R.E. Sobonya. 1983;84(1):99-101. Case report PubMed · Publisher

Abstract

We report the occurrence of a malignant pleural epithelial mesothelioma which presented radiographically and at surgery as a localized solitary mass, but was found microscopically to involve grossly normal pleura. Clinically diffuse mesothelioma recurred 19 months later. Localized malignant mesothelioma has been associated with the same poor prognosis as the diffuse form and, as suggested by this case, may represent an early phase of diffuse disease.
Importance of oxygen free radicals in asbestos-induced injury to airway epithelial cells. B.T. Mossman, J.M. Landesman. 1983;83(5 Suppl):50S-51S. PubMed · Publisher
Single breath diffusing capacity in the industrial setting. B. Make, A. Miller, G. Epler, et al. 1982;82(3):351-6. Review PubMed · Publisher
The association of asbestos-induced pleural disease and rounded atelectasis. R.A. Mintzer, D.W. Cugell. 1982;81(4):457-60. PubMed · Publisher
The detection of thoracic abnormalities using posterior-anterior (PA) vs PA and oblique roentgenograms. R.B. Reger, R.G. Ames, J.A. Merchant, et al. 1982;81(3):290-5. PubMed · Publisher

Abstract

A reading trial was conducted as part of the 1978 Bay Area Asbestos Screening Project to evaluate the utility of adding oblique-view roentgenograms to standard posterior-anterior (PA) views. Chest films from a sample of 555 workers with histories of long-term asbestos exposure were read twice as PA and twice as PA + oblique sets, providing a basis for assessing reliability through intrareader, interreader, and intermethod agreement. The ancillary use of oblique view films resulted in higher rates of detection of asbestos-related abnormalities than with PA films alone, but the increased rates were gained at the expense of reliability in the interpretation process. Depending on the source of this unreliability, which requires further study, different remedial actions might be indicated. A reader's lack of experience could indicate the need for additional training, the use of several readers, an average over several reader judgements, or the development of standards for evaluating obliques. If, on the other hand, no way is found to reduce the unreliability, the use of oblique films in routine screening programs ought to be discouraged on the basis of measurement theory, since reliability is a prerequisite to validity.
Asbestos inhalation and the induction of splenic lymphocytic proliferation in the rat. E. Kagan, K. Miller. 1981;80(1 Suppl):11-2. PubMed · Publisher
Asbestos stimulates alveolar macrophages to release a factor causing human lung fibroblasts to replicate. P. Bitterman, S. Rennard, C. Schoenberger, et al. 1981;80(1 Suppl):38-9. PubMed · Publisher

Summary

This short report, published in a conference supplement, asked whether pulmonary alveolar macrophages (PAM) help form the clusters of lung fibroblasts seen around macrophages that have engulfed asbestos fibers in asbestosis. The authors tested whether PAM release soluble factors that make human lung fibroblasts replicate. PAM taken from minced guinea pig lung were incubated for four hours in culture medium with 0.5% fetal calf serum, with or without 100 µg/ml short chrysotile asbestos (fibers under 5 µm long). The supernatants, free of asbestos fibers, were placed on steady-state human lung fibroblasts. Cell counts were taken after one, two and four days. Medium with or without asbestos, incubated without macrophages, served as controls. Supernatants from unexposed PAM did not change the fibroblast replication rate. Supernatants from asbestos-exposed PAM significantly increased replication: doubling time fell about five-fold, from 310±21 hours in controls to 54±4 hours (P<.001). By 48 hours, treated plates had 68±2 cell-count units per plate against 43±3 in controls. The authors concluded that asbestos-treated PAM release a factor or factors that promote human lung fibroblast replication. They suggested PAM may have a role in forming the fibroblast clusters seen in early asbestosis. In the discussion, Dr. Bitterman said the effect was most likely not specific to asbestos. He reported that asbestos and medium without macrophages produced no growth factor, and that the factor was heat stable and was also obtained without serum.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.
Comparison of phagocytosis of uncoated versus coated asbestos fibers by cultured human pulmonary alveolar macrophages. T.L. McLemore, V. Roggli, M.V. Marshall, et al. 1981;80(1 Suppl):39-42. PubMed · Publisher
Deposition pattern and clearance pathways of inhaled chrysotile asbestos. A.R. Brody, L.H. Hill. 1981;80(1 Suppl):64-7. PubMed · Publisher

Summary

The authors noted that little was known about where inhaled asbestos is deposited in the most distal regions of the lung, or about the early events of particle translocation and cell injury. They studied how the initial deposition and subsequent movement of inhaled chrysotile asbestos related to the earliest lesions of asbestosis. White rats were exposed nose-only for one hour to aerosolized chrysotile at a respirable mass concentration of 4.0 mg per cubic metre of air. Animals were killed immediately afterwards and at five hours, 24 hours, four days and eight days after exposure. Lung tissue was examined by light, transmission and scanning electron microscopy. Asbestos deposition at alveolar duct bifurcations was scored from 0 to 3 according to the number of fibres seen. Most particles inhaled beyond the terminal bronchioles first landed on alveolar duct bifurcations. Immediately after exposure, mean scores were 2.44, 1.65 and 1.42 at the first, second and third bifurcations. After five hours in room air they were 1.80, 0.93 and 0.56. Small fibrils were taken into type I epithelial cells from the first hour onward. By 24 hours, asbestos was found in epithelial, interstitial and endothelial cells, basement membranes, connective tissue, capillaries and numerous alveolar macrophages. By four and eight days, few fibres remained on duct surfaces. The parenchyma approximately doubled in volume between one and eight days. The authors proposed that this was the initial lesion of asbestosis.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.
Exercise performance and functional impairment in asbestos-exposed workers. J. Pearle. 1981;80(6):701-5. PubMed · Publisher

Abstract

Eighty-eight shipyard workers with extensive asbestos exposure were evaluated in terms of dyspnea, smoking history, x-ray film abnormalities, static pulmonary function, and exercise performance. Pulmonary function abnormalities and roentgenographic pleuropulmonary disease were more frequent in smokers. Significant dyspnea was present in 41 percent of the workers and did not correlate with smoking history, pulmonary function, or exercise performance. Despite this high frequency of dyspnea, 70 percent of all workers had normal exercise tolerance by history of exercise testing. Of the 26 workers with exercise impairment, only nine had pulmonary mechanical or gas exchange limitation. Two of these workers had asbestosis, while the other had airways obstruction without asbestosis. The prevalence of both asbestosis and asbestos-related exercise impairment in this population was 2.3 percent.
Inflammation and asbestosis: characterization and maintenance of alveolitis following acute asbestos exposure. C. Schoenberger, G. Hunninghake, J. Gadek, et al. 1981;80(1 Suppl):70-1. PubMed · Publisher

Summary

This short conference report from the National Heart, Lung and Blood Institute, Bethesda, asked whether asbestos fibers trigger an acute inflammatory response in the lung. Guinea pigs received a single intratracheal injection of 25 mg of chrysotile asbestos fibers in 1 ml of saline, or 1 ml of saline alone. The number of animals was not stated. At four hours and ten days after injection, the authors examined lung tissue by light microscopy and analysed cells recovered by bronchoalveolar lavage (BAL). Lungs of control animals had no neutrophils and small numbers of alveolar macrophages. Lungs of asbestos-treated animals showed peribronchial and alveolar collections of neutrophils and alveolar macrophages. BAL confirmed more neutrophils after asbestos than after saline: mean values were 28 versus 4 at four hours and 38 versus 10 at ten days. In a separate experiment, alveolar macrophages exposed to chrysotile in vitro for three hours released a chemotactic factor for neutrophils (53 ± 8 neutrophils/hpf), while unstimulated macrophages did not (5 ± 1 neutrophils/hpf). Coating the fibers beforehand with fresh normal serum increased this release. The authors concluded that asbestos causes an acute neutrophil-rich inflammatory response in the lung, that asbestos may attract neutrophils partly by stimulating alveolar macrophages to release a chemotactic factor, and that serum coating of the fibers may increase this release.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.
Pleural mesothelioma with calcified liver metastases. G.D. Campbell, S.D. Greenberg. 1981;79(2):229-30. Case report PubMed · Publisher

Abstract

This is the second published report of a patient with a malignant pleural mesothelioma who presented with roentgenographic findings of massive liver calcifications. Necropsy examination revealed the hepatic calcifications to be dystrophic calcification within necrotic foci of metastatic malignant mesothelioma.
Asbestos and lung cancer. Attributability in the face of uncertainty. P.E. Enterline. 1980;78(2 Suppl):377-9. PubMed
Asbestos and lung cancer: has the case been proven?. J.C. McDonald. 1980;78(2 Suppl):374-6. PubMed
Asbestos and lung cancer: the clinicians' questions. M.R. Becklake. 1980;78(2 Suppl):372-3. PubMed
Asbestos bodies. M.L. Warnock, A.M. Churg. 1980;77(2):129-30. Editorial PubMed · Publisher
Basis for clinical decision making. H. Weill. 1980;78(2 Suppl):382-3. PubMed · Publisher
Development of radiographic abnormality in chrysotile miners and millers. G.M. Eyssen. 1980;78(2 Suppl):411-4. PubMed · Publisher
Differences between particulate and peptide stimuli on activation of oxidant production in alveolar macrophages. G.E. Hatch, A. Spock, D.E. Gardner, et al. 1980;77(2 Suppl):267-9. PubMed · Publisher

Summary

The authors compared the oxidant production (respiratory burst) of alveolar macrophages stimulated by particles with that stimulated by a soluble peptide. Alveolar macrophages were obtained by lung lavage from guinea pigs, rabbits, rats, mice and hamsters. Human lavage cells came from therapeutic lung lavage at Duke Medical Center of patients with cystic fibrosis and alveolar proteinosis, and from small exploratory lavage samples of patients with pneumonia, lung cancer, asthma and bronchitis. The patients were aged 8 days to 58 years, and all were nonsmokers. Cells were exposed to the peptide N-formylmethionylphenylalanine (F-Met-Phe), zymosan, UICC crocidolite asbestos or latex beads. Oxidant production was measured by luminol-amplified chemiluminescence. Species differed. Peak responses of mouse and hamster macrophages were 1/50 of those of human cells and 1/7 of those of rat and guinea pig cells. Guinea pig cells responded to all agents. Rat cells responded only to zymosan and asbestos. Asbestos was the most effective stimulant for rabbit cells. Cells from cystic fibrosis patients had high basal levels and responded more to F-Met-Phe than to zymosan or asbestos. Peak light came 1-3 min after peptide and 8-140 min after particles. Cells made unresponsive by one stimulus still responded to the other. Omitting calcium and magnesium inhibited the asbestos and latex responses by 92% and 100%, but the F-Met-Phe response by only 52%. The authors concluded that more than one pathway can activate the oxidant-producing burst of alveolar macrophages.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.
Presence of asbestos bodies in organs other than the lung. O. Auerbach, A.S. Conston, L. Garfinkel, et al. 1980;77(2):133-7. PubMed · Publisher

Abstract

This study was designed to test the hypothesis that subjects with many asbestos bodies in their lungs at autopsy would also have asbestos bodies in various other organs. The subjects included 19 cases with diagnosis of asbestosis at death (two of these had mesothelioma, five had lung cancer) and 18 with pleural plaques but not asbestosis. Occupational histories were obtained from relatives. In subjects occupationally exposed to asbestos, large numbers of asbestos bodies were found in the lungs, and in most of these, asbestos bodies were found in many of the other organs examined. In the 18 cases with only pleural plaques found at autopsy, considerably fewer asbestos bodies were found in the lungs. The number of other organs with one or more asbestos bodies ranged from 32 percent to 62 percent of the sites examined. The findings seem to confirm the hypothesis of the study.
The relationship between asbestosis and bronchial cancer. G.K. Sluis-Cremer. 1980;78(2 Suppl):380-1. PubMed · Publisher

1970s

Asbestos fibers in laryngeal tissues. Findings in two patients with asbestosis associated with laryngeal tumors. A. Hirsch, J. Bignon, P. Sebastien, et al. 1979;76(6):697-9. Case report PubMed · Publisher

Abstract

Significant concentrations of asbestos fibers have been found in samples of laryngeal tissue from two patients with past exposure to asbestos and associated asbestosis. In one case, there was a polyp on a vocal cord and in the other one a laryngeal carcinoma. These findings could provide an indication of a local carcinogenic effect of asbestos fibers in laryngeal tissue.
Environmental exposure to asbestos: A factor in the rising rate of cancer in the industrialized world?. M.R. Becklake. 1979;76(3):245-7. Editorial PubMed · Publisher
Mixed pneumoconiosis: silicosis, asbestosis, talcosis, and berylliosis. G.J. Mark, C.B. Monroe, H. Kazemi. 1979;75(6):726-8. Case report PubMed · Publisher

Abstract

Mixed pneumoconiosis is pulmonary disease due to two or more inhaled mineral irritants. Chronic disease due to beryllium has not been a component of any described mixed pneumoconiosis. A man with occupational exposure to a combination of dusts developed severe pulmonary disease. Silicosis, talcosis, asbestosis, and berylliosis were all documented by an open biopsy of the lung. The varieties of mixed pneumoconiosis are summarized.
Numbers of asbestos bodies in urban patients with lung cancer and gastrointestinal cancer and in matched controls. A.M. Churg, M.L. Warnock. 1979;76(2):143-9. PubMed · Publisher

Abstract

We compared the numbers of asbestos bodies extracted from the lungs of 103 patients with lung cancer and 50 patients with gastrointestinal malignant neoplasms to the numbers of bodies extracted from lungs of control patients matched for age, sex, smoking habits, and, in some cases, occupation. All patients were urban dwellers over the age of 40 years, and none was a primary asbestos worker. No differences in the counts of asbestos bodies were observed between the tested and control populations. The numbers of asbestos bodies did correlate well with occupation; the highest counts were found in male manual laborers. We conclude that in the urban population studied herein, the numbers of asbestos bodies alone do not correlate with the presence of pulmonary or gastrointestinal carcinoma; however, uncoated asbestos fibers are also known to be present in the lung, and the possibility that such tumors may be related to the numbers of these fibers in lungs remains to be explored.
Crackles (rales) in the interstitial pulmonary diseases. G.R. Epler, C.B. Carrington, E.A. Gaensler. 1978;73(3):333-9. PubMed · Publisher

Abstract

There is renewed interest in the classification and methods of recording adventitious pulmonary sounds. This is a study of the importance of fine crackles (rales) in the diagnosis and estimation of the severity of diffuse infiltrative pulmonary disease. Among 272 cases documented by lung biopsy, bilateral fine crackles were heard in 60 percent of those with interstitial pneumonias and asbestosis but in only 20 percent of those with sarcoidosis and other granulomatoses. These incidences were identical in 335 patients diagnosed clinically. In 322 selected ambulatory patients with chronic obstructive pulmonary disease, fine crackles were recorded in only 10 to 12 percent, while coarse crackles were not uncommon in patients with chronic bronchitis. In workers exposed to asbestos, crackles correlated with exposure. In serial studies of such workers, the occurrence of crackles alone appeared to be a random event, while among those with crackles together with one other of five criteria, almost one-half developed asbestosis within four to six years. Fine crackles correlated with pathologic severity, with radiographic honeycombing, and with physiologic abnormalities.
Giant mass in the right diaphragmatic area. S. Katz, R. Gordon, H. Romanoff. 1978;74(1):83-4. Case report PubMed · Publisher
Malignant mesothelioma. Current status and future prospects. J. Aisner, P.H. Wiernik. 1978;74(4):438-44. Review PubMed · Publisher
Desquamative interstitial pneumonitis. Cellular phase of fibrosing alveolitis. R.R. Tubbs, S.P. Benjamin, N.E. Reich, et al. 1977;72(2):159-65. PubMed · Publisher

Abstract

Since the original description of desquamative interstitial pneumonitis in 1967, several investigators have questioned the specificity of the disease. The concept of desquamative interstitial pneumonitis and usual fibrosing interstitial pneumonitis as two manifestations of a nonspecific disease spectrum has been proposed. Twenty-six patients with desquamative interstitial pneumonitis were evaluated with respect to clinicopathologic correlates. Biopsies were reviewed without knowledge of the patients' clinical course. The absolute histopathologic criteria for the diagnosis were (1) intra-alveolar accumulations of free alveolar cells with PAS-positive diastaseresistant cytoplasmic granules; (2) mononuclear cell interstitial inflammation; and (3) absence of necrosis, hyaline membranes, intra-alveolar fibrosis, asbestos bodies, and birefringent crystalline dust material. Transmission electron microscopic studies revealed the dominant alveolar lining cell to be the granular pneumocyte, with a prominent population of free alveolar macrophages. Patients were segregated into group 1 (cellular phase) and 2 (cicatrized phase). Although favorable short-term responses to corticosteroid therapy were observed in both groups, long-term responses were variable. Apparent complete remissions were noted in both groups.
A diagnosable coin lesion. L. Goodman. 1976;70(03):405-6. Case report PubMed · Publisher
Lung function profiles in the chrysotile asbestos mines and mills of Quebec. M.R. Becklake, G. Fournier-Massey, R. Black. 1976;69(2 Suppl):303. PubMed · Publisher

Summary

This short conference report described lung function profiles in Quebec chrysotile asbestos mine and mill workers. The authors began from a clinical impression that profiles other than the classic restrictive pattern associated with asbestos exposure were not uncommon. They defined lung function profiles in a sample of over 1,000 men examined in 1967-68 as part of a comprehensive study of the effects of asbestos exposure in the chrysotile mines and mills of Quebec. Profiles were based on five standard tests, each expressed as a percent of predicted: total lung capacity, residual volume, forced expiratory volume in 0.75 second, FEV1/FVC, and maximal mid-expiratory flow rate. Results were related to dust exposure, measured as million particles per cubic foot years, and to smoking. Prevalences were age-standardized to the total working population as of October 31, 1966. Of the men, 44.3 percent had normal profiles and 26.5 percent had minor changes only. Restrictive and obstructive profiles occurred with comparable frequency (12.8 and 12.2 percent). Both were associated with radiologic features of asbestosis, and both occurred infrequently in non-smokers. The authors stated that these findings suggest an association between smoking and the development of asbestos-related fibrosis, insofar as this is reflected in a restrictive profile. A principal component analysis gave indirect evidence that, in workers who smoke, dust-associated impairment might be either obstructive or restrictive. The authors called for further studies on whether these findings apply to secondary industries that process chrysotile.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.
Pleural calcification associated with exposure to chrysotile asbestos in southeast Turkey. S. Yazicioglu. 1976;70(1):43-7. PubMed · Publisher

Abstract

In this study, pleural calcifications prevailing in the inhabitants of some villages and towns around Diyarbakir, a city in southeast Turkey, have been found to be caused by the inhalation of chrysotile asbestos, the mineral commonly used indiscriminately to paint the walls and floors of houses. There were no industrial establishments in the area, except some local mining, and asbestos deposits were even not included on the mining map of the country. Chest roentgenograms from the Chest Hospital and the tuberculosis dispensaries were screened: and, additionally, 15,239 photofluorograms were obtained during a survey. Of all these, 511 patients were found to have pleural calcifications, some with pericardial and diaphragmatic involvement. Forty-four percent (28) of the 64 patients who had examinations of samples of their sputa had asbestos bodies, and asbestosis was also induced in rabbits by administration of the raw material.
Massive bilateral upper lobe fibrosis secondary to asbestos exposure. R.A. Green, D.G. Dimcheff. 1974;65(1):52-5. PubMed · Publisher

Abstract

Three patients with massive bilateral upper lobe fibrosis due to asbestos exposure are presented. This pattern of involvement is unusual in asbestosis. Asbestosis should be considered as a possible cause of such roentgenographic changes, especially if the etiology of the upper lobe fibrosis is otherwise unclear.

PubMed has no abstract for this study. This is the authors' abstract, copied from the article.
Roentgenogram of the month. Migrating lung tumor. R.H. Hayward. 1974;66(1):77-8. PubMed · Publisher
Mesothelioma following exposure to asbestos: a review of 72 cases. M. Borow, A. Conston, L. Livornese, et al. 1973;64(5):641-6. PubMed · Publisher
Mesothelioma of the atrioventricular node. C. Ibarra-Perez, M.E. Korns, J.E. Edwards. 1973;63(5):824-7. PubMed · Publisher
Adenocarcinoma arising in a Ghon complex and presenting with massive pericardial effusion. R.R. McFadden, P.J. Dawson. 1972;62(4):520-3. Case report PubMed · Publisher

Abstract

A patient with carcinoma arising in the peripheral scar of a Ghon complex is reported. The tumor had an unusual presentation, suggestive of pericardial mesothelioma. The smallness of the primary lesion, its rapidly fatal course, superimposed consumption coagulopathy and histologic difficulties in diagnosis of the original biopsy add to the interest and complexity of the case.

PubMed has no abstract for this study. This is the authors' abstract, copied from the article.
Diffuse malignant mesothelioma of the pleura: a review of 37 cases. H.C. Oels, E.G. Harrison, D.T. Carr, et al. 1971;60(6):564-70. PubMed · Publisher
Mesothelioma (coelothelioma) of the atrioventricular node. R.T. Lafargue, A.M. Hand, M. Lev. 1971;59(5):571-4. Case report PubMed · Publisher
Pulmonary complications of asbestos exposure. 1971;59(1):77-81. PubMed · Publisher
Rapid growth of a pleural mesothelioma. G.C. Lulenski, R. Pifarré, W.E. Neville. 1971;59(2):230-2. PubMed · Publisher

Abstract

A patient with diffuse pleural mesothelioma presenting as a large mass in the left hemithorax is described. Despite a normal chest roentgenogram three months earlier and symptoms of only three days' duration, the patient expired within three weeks of admission. This confirms the potential rapid growth of this malignancy.

PubMed has no abstract for this study. This is the authors' abstract, copied from the article.
Solitary (localized) pleural mesothelioma. Report of two cases and review of the literature. F.H. Shabanah, S.F. Sayegh. 1971;60(6):558-63. PubMed · Publisher

Abstract

A few of the primary pleural mesotheliomas are benign. These tumors are localized. They can vary greatly in size. The majority are biologically benign lesions. The application of the techniques of tissue culture to the study of such tumors has considerably helped to clarify the origin of these tumors and their relation to the more common diffuse malignant variety. Review of the English literature since 1942 reveals the reporting of approximately 152 cases of localized pleural mesotheliomas in addition to the authors' two cases. The tumor is usually adequately treated by conservative resection or excision except when there is invasion of contiguous structures. The latter requires more radical treatment.

PubMed has no abstract for this study. This is the authors' abstract, copied from the article.

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