Respiration; International Review of Thoracic Diseases

About the journal

Publisher: Karger
Published: 1968 to the present, Switzerland
Language: English
ISSN: 0025-7931 (print), 1423-0356 (electronic)
Continues: Medicina Thoracalis
Its record in the NLM Catalog

2020s

Diagnostic Value of Computed Tomography Imaging Features in Malignant Pleural Mesothelioma. M. Fortin, E. Cabon, J. Berbis, et al. 2020;99(1):28-34. PubMed · Publisher

Abstract

Background: Medical history, thoracentesis, and imaging features are usually the first steps in the investigation of a possible malignant pleural effusion (MPE). Unfortunately, the diagnostic yield of thoracentesis in this situation is suboptimal even if the procedure is repeated, especially in the context of malignant pleural mesothelioma (MPM). The next step for confirming the diagnosis, if clinically appropriate, is thoracoscopy, but not all patients are fit to undergo this procedure, so the diagnosis is then based on the medical history and imaging features only.

Objectives: Our objective was to evaluate the diagnostic value of the medical history and imaging features in MPM.

Methods: We reviewed the imaging and medical charts of 92 patients with a final diagnosis of MPE included in our prospective medical thoracoscopy database. The clinical characteristics and imaging features of patients with primary MPE were compared with those of patients with secondary MPE.

Results: Male sex (82 vs. 59%, p = 0.02), asbestos exposure (58 vs. 10%, p < 0.001), and mediastinal (68 vs. 33%, p = 0.04), diaphragmatic (75 vs. 31%, p = 0.001) and circumferential pleural thickening (55 vs. 19% p = 0.001) were significantly more frequent in MPM patients. In a multivariate linear regression model, only asbestos exposure (OR 11.2; 95% CI 3.4-36.9) and circumferential pleural thickening (OR 4.7; 95% CI 1.6-13.9) were significantly associated with a diagnosis of MPM.

Conclusion: In situations where it is impossible to obtain adequate pleural samples to differentiate MPM from a secondary pleural malignancy, the combination of circumferential pleural thickening and a history of asbestos exposure may be sufficient to make a clinical diagnosis.

© 2019 S. Karger AG, Basel.

2010s

Catheter Tract Metastasis in Mesothelioma Patients with Indwelling Pleural Catheters: A Retrospective Cohort Study. M.A. Mitchell, P. Li, C. Pease, et al. 2019;97(5):428-435. PubMed · Publisher

Abstract

Background: Use of indwelling pleural catheters (IPCs) for the management of symptomatic pleural effusions in patients with mesothelioma has increased in popularity. An important concern with this approach is the potential for the development of catheter tract metastasis (CTM).

Objectives: To determine the incidence of IPC-related CTM in patients with malignant pleural mesothelioma (MPM).

Methods: In this single-center retrospective cohort study, patients with biopsy-confirmed MPM who had an IPC inserted between May 2006 and July 2017 were identified from a prospectively collected database. Thoracic CT scans following IPC insertion were reviewed to assess for evidence of CTM. Patients were followed until death or last documented patient encounter with a minimum of 6-month follow-up.

Results: A total of 90 patients were included in the cohort. CTM was identified in 23 of 90 patients (26%). Median time from IPC insertion to CTM was 408 days (interquartile range 196-721 days). Medical thoracoscopy at the time of IPC insertion did not lead to a significantly increased odds of CTM (OR 2.30; 95% CI 0.66-7.94; p = 0.19). Incidence of CTM was not different between mesothelioma subtypes (p = 0.09). Patient-reported dyspnea scores were improved following IPC insertion in 80% of patients.

Conclusions: CTM was identified in over a quarter of MPM patients when follow-up imaging was reviewed. Treating physicians should be cognizant of the possibility of CTM at the site of prior IPC.

© 2018 S. Karger AG, Basel.
Endoscopic Ultrasound with Bronchoscope-Guided Fine Needle Aspiration for the Diagnosis of Paraesophageally Located Lung Lesions. I. Skovgaard Christiansen, J.C. Kuijvenhoven, U. Bodtger, et al. 2019;97(4):277-283. Case report PubMed · Publisher · Free full text

Abstract

Background: Diagnosing centrally located lung tumors without endobronchial abnormalities and not located near the major airways is a diagnostic challenge. Tumors near or adjacent to the esophagus can be aspirated and detected with esophageal ultrasound (EUS) using gastrointestinal endoscopes.

Objective: To assess the feasibility and diagnostic yield of endoscopic ultrasound with bronchoscope-guided fine needle aspiration (EUS-B-FNA) in paraesophageally located lung tumors and its added value to bronchoscopy and endobronchial ultrasound (EBUS).

Methods: Retrospective, multicenter international study (from January 1, 2015 until January 1, 2018) of patients with suspected lung cancer, undergoing bronchoscopy, EBUS, and endoscopic ultrasound bronchoscopy (EUS-B) in one session by a single operator (pulmonologist), in whom the primary lung tumor was detected and aspirated by EUS-B. In the absence of malignancy following endoscopy, transthoracic ultrasound needle aspiration, clinical and radiological follow-up of at least 6 months was performed. The yield and sensitivity of EUS-B-FNA and its added value to bronchoscopy and EBUS was assessed.

Results: 58 patients were identified with the following diagnosis: non-small-cell lung cancer (n = 43), small-cell lung cancer (n = 6), mesothelioma (n = 2), metastasis (n = 1), nonmalignant (n = 6). The yield and sensitivity of EUS-B-FNA for detecting lung cancer was 90%. In 26 patients (45%), the intrapulmonary tumor was exclusively detected by EUS-B. Adding EUS-B to conventional bronchoscopy and EBUS increased the diagnostic yield for diagnosing lung cancer in para-esophageally located lung tumors from 51 to 91%. No EUS-B-related complications were observed.

Conclusion: EUS-B-FNA is a feasible and safe technique for diagnosing centrally located intrapulmonary tumors that are located near or adjacent to the esophagus. EUS-B should be considered in the same endoscopy session following nondiagnostic bronchoscopy and EBUS.

© 2018 The Author(s) Published by S. Karger AG, Basel.
Management and Survival of Pleural Mesothelioma: A Record Linkage Study. G. Carioli, M. Bonifazi, M. Rossi, et al. 2018;95(6):405-413. PubMed · Publisher

Abstract

Background: Pleural mesothelioma (PM) is a rare, highly lethal tumor. A definite consensus on its management has yet to be established.

Objectives: To assess management, overall survival (OS), and their predictors in a cohort of patients from Lombardy, the largest Italian region (about 10 million inhabitants).

Methods: Through a record linkage between Lombardy health care administrative databases, we identified patients diagnosed with PM in 2006-2011 without history of cancer, evaluating their management. OS from PM diagnosis was estimated using the Kaplan-Meier method. Predictors of OS and of treatment were assessed using Cox regression models with time-dependent covariates when appropriate.

Results: Out of 1,326 patients, 754 (56.9%) received treatment for PM: 205 (15.5%) underwent surgery, and 696 (52.5%) used chemotherapy. Surgery was spread across several hospitals, and most patients diagnosed in nonspecialized centers (70%) underwent surgery in the same centers. Age at diagnosis was a strong inverse determinant of surgery. Determinants of receiving chemotherapy were younger age, a more recent first diagnosis, and first diagnosis in a specialized center. OS was 45.4% at 1 year, 24.8% at 2 years, and 9.6% at 5 years (median 11 months). OS decreased with age, and was higher for those who underwent surgery, but not for those treated with chemotherapy.

Conclusions: Management of PM varied widely in clinical practice, and significant predictors of treatment were younger age and recent diagnosis, though a high proportion of patients were not treated. Patients were treated in various hospitals, indicating the importance of concentrating serious rare neoplasms in Comprehensive Cancer Centers (as recognized by the Italian Health Ministry).

© 2018 S. Karger AG, Basel.
Evidence Suggesting the End of Universal Domestic Asbestos Exposure in Metsovo, NW Greece. A. Gogali, E.E. Ntzani, C. Manda-Stachouli, et al. 2017;94(6):510-517. PubMed · Publisher

Abstract

Background: Inhabitants of Metsovo, NW Greece, had been domestically exposed to asbestos from a gradually abandoned whitewash ("luto") that resulted in a declining epidemic of malignant mesothelioma.

Objectives: We aimed to evaluate whether other sources of asbestos exposure exist following "luto" abandonment.

Methods: Chest computed tomography (CT) and bronchoalveolar lavage (BAL) were used to evaluate residual asbestos exposure in younger Metsovites through the identification of pleural calcifications and asbestos bodies, respectively. In order to provide a historical universally exposed group for comparison, we used the accumulated chest CTs and chest roentgenograms of our previous studies, performed in Metsovites with confirmed exposure but negative chest roentgenogram. As an additional external comparison group, we also assessed CT scans and chest roentgenograms of Metsovites being older than our target group obtained from the records of the Radiology Department between 2009 and 2011. In order to be able to compare our BAL findings, we sought historical controls among BAL studies performed in Metsovites with known exposure to "luto," in the 1980s-1990s, mainly to evaluate alveolitis. Those belonging to individuals of the same age range were used for further comparison.

Results: Twenty-two Metsovites born between 1960 and 1980 consented to undergo a chest CT scan, while another 14 CTs were retrieved from the records of the Radiology Department (among 86 of all ages), thus increasing the number of individuals studied to 36. Five of the 36 Metsovites studied were former "luto" users for a short period of time. Minimal pleural calcifications were present in 2 of them, while all chest CTs of nonusers were negative. All 8 BAL studies were negative for asbestos bodies.

Conclusion: "Luto" use seems to have been the only source of considerable asbestos exposure in Metsovo.

© 2017 S. Karger AG, Basel.
Frozen Sections in Pleural Pathology: A Valuable Tool. G. Karpathiou, M. Froudarakis, F. Forest, et al. 2017;94(1):45-51. PubMed · Publisher

Abstract

Background: Knowledge of pleural malignancy can lead to immediate pleurodesis during thoracoscopy. However, the accuracy of pleural frozen sections is largely unknown.

Objectives: To investigate the accuracy of frozen sections in pleural tumor pathology.

Methods: A total of 156 frozen pleural sections performed with the question of malignancy were retrospectively reviewed. The original frozen sections were compared to the permanent section slides which were considered as the gold standard. The influence of the following parameters on the frozen section response was evaluated: specimen size, clinical information, as well as the processing by a specialized pulmonary pathologist or not. The reasons of discrepancies were categorized as sampling errors or interpretation errors.

Results: Frozen sections made up 16.4% of 951 pleural biopsies performed in the same time period. Accurate diagnosis was feasible in 92.3% of the cases. There were 7 (4.5%) deferred (inconclusive) cases and 5 (3.2%) discrepant cases. Sensitivity of the method was 96.26%, specificity 97.87%, the positive predictive value was 99.04%, and the negative predictive value was 92%. There was no association between the responses given during frozen section and specimen size, clinical information, or the evaluation by a specialized pulmonary pathologist. Four of the 12 cases were sampling errors, while 8 cases were interpretation errors mostly made in the absence of fat tissue invasion. Thus, paucicellular lesions without prominent invasion - fat invasion or haphazardly invading cellular proliferation - were those posing most of the difficulties during frozen section.

Conclusions: Frozen sections are a highly accurate tool in pleural pathology. Thus, they can be used when an immediate pleurodesis is requested.

© 2017 S. Karger AG, Basel.
CT Scan-Guided Abrams' Needle Pleural Biopsy versus Ultrasound-Assisted Cutting Needle Pleural Biopsy for Diagnosis in Patients with Pleural Effusion: A Randomized, Controlled Trial. M. Metintas, H. Yildirim, T. Kaya, et al. 2016;91(2):156-63. Randomized trial PubMed · Publisher

Abstract

Background: Image-guided pleural biopsies, both using ultrasound (US) or computed tomography (CT), are important in the diagnosis of pleural disease. However, no consensus exists regarding which biopsy needles are appropriate for specific procedures.

Objectives: In this randomized, prospective study, we aimed to compare CT scan-guided pleural biopsy using an Abrams' needle (CT-ANPB) with US-assisted pleural biopsy using a cutting needle (US-CNPB) with respect to both diagnostic yield and safety.

Methods: Between February 2009 and April 2013, 150 patients with exudative pleural effusion who could not be diagnosed by cytological analysis were included in the study. The patients were randomized into either the US-CNPB group or the CT-ANPB group. The two groups were compared in terms of diagnostic sensitivity and complications.

Results: Of the 150 patients enrolled in this study, 45 were diagnosed with malignant mesothelioma, 46 were diagnosed with metastatic pleural disease, 18 were diagnosed with pleural tuberculosis, 34 were diagnosed with benign pleural disease, and 7 were lost to follow-up. In the US-CNPB group, the diagnostic sensitivity was 66.7%, compared with 82.4% in the CT-ANPB group; the difference between the two groups was statistically significant (p = 0.029). The sensitivity of CT-ANPB increased to 93.7% for patients with a pleural thickness ≥1 cm. The complication rates were low and acceptable.

Conclusions: The first diagnostic intervention that should be preferred in patients with pleural effusion and associated pleural thickening on a CT scan is CT-ANPB. US-CNPB should be used primarily in cases for which only pleural thickening but no pleural effusion is noted.

© 2016 S. Karger AG, Basel.
Semi-Rigid Thoracoscopic Punch Biopsy Using a Hybrid Knife with a High-Pressure Water Jet for the Diagnosis of Pleural Effusions. Y. Yin, R. Eberhardt, X.B. Wang, et al. 2016;92(3):192-6. Case report PubMed · Publisher

Abstract

Semi-rigid thoracoscopy is an important technique in the definitive diagnosis of pleural diseases with high diagnostic sensitivity and specificity. Obtaining adequate samples from thickened pleura is the most important limitation of semi-rigid thoracoscopy with a standard flexible forceps (SFF) compared with rigid thoracoscopy, especially in patients with mesothelioma or benign fibrothorax. Developing a convenient, efficient and safe biopsy technique to obtain sufficient samples from such patients is a key topic in semi-rigid thoracoscopy. The hybrid knife (HK) is an innovative design fusing high-pressure water injection and a conventional diathermic knife that can allow for the safe resection of a larger lesion during gastrointestinal endoscopic dissection. Here, we describe 3 patients with unexplained pleural effusion who underwent pleural biopsy using an HK to investigate the potential use of the HK as a new pleural biopsy device in semi-rigid thoracoscopy when pleural lesions are difficult to biopsy using an SFF. The biopsies were obtained successfully by HK, and the diagnosis followed. The sizes of the biopsies collected by HK are larger than those collected by SFF. No complications were observed. Electrocautery biopsy using an HK during semi-rigid thoracoscopy has great potential for diagnosing consistent abnormal pleuras, which are difficult to biopsy with an SFF.

© 2016 S. Karger AG, Basel.
Positron Emission Tomography/Computed Tomography for the Pleural Staging of Malignant Pleural Mesothelioma: How Accurate Is It?. V. Pinelli, E. Roca, S. Lucchini, et al. 2015;89(6):558-64. PubMed · Publisher

Abstract

Background: Careful clinical staging in patients with malignant pleural mesothelioma (MPM) is fundamental in management planning. Positron emission tomography/computed tomography (PET/CT) is increasingly recognized as an important staging modality.

Objectives: The purpose of this study was to assess whether the metabolic activity of the pleural tumor detected with PET/CT correlates with specific endoscopic features and pleural distribution of the lesions as assessed by medical thoracoscopy.

Methods: Consecutive patients with MPM and available PET/CT performed before thoracoscopy were separated into 2 groups, according to their standardized uptake value (SUV). Kaplan-Meier-analysis for survival was performed on groups with low and high SUV. Agreement between PET/CT and thoracoscopy evaluation was analyzed using Cohen's kappa coefficient. The Wilcoxon test was used to compare the median SUV, and the χ(2) test was used to evaluate differences in endoscopic findings.

Results: A total of 32 patients were included. The median maximum SUV (SUV max) was 6.1 and patients were separated into 2 groups based on this cutoff. Patients with SUV max <6.1 had a better survival than those with SUV max ≥6.1 (p = 0.005). The comparison between PET/CT and thoracoscopy showed a fair agreement for visceral and diaphragmatic pleural involvement and moderate agreement for the presence of nodular lesions. There was a statistically significant association between median SUV max and visceral pleural involvement; nodular lesions and visceral pleural involvement were more common in the high-SUV group than in the low-SUV group (p = 0.0012 and p = 0.03, respectively).

Conclusions: PET/CT data may be predictive of thoracoscopic features of MPM associated with prognosis and staging, but the correlation is moderate at best. A degree of disagreement exists between these two modalities, which supports thoracoscopy as the gold standard for assessment of local invasion in MPM.

© 2015 S. Karger AG, Basel.
Asbestos-related diffuse pleural thickening. N. Fujimoto, K. Kato, I. Usami, et al. 2014;88(4):277-84. PubMed · Publisher

Abstract

Background: The clinical features of asbestos-related diffuse pleural thickening (DPT) remain unclear.

Objectives: To clarify the association between radiological findings of DPT and respiratory function.

Methods: Medical data from patients with asbestos-related DPT were collected, including their history of occupational or neighborhood asbestos exposure, initial symptoms, modified Medical Research Council dyspnea grade, smoking history, radiological findings, and respiratory function test results.

Results: There were 106 DPT patients between 2005 and 2010 [i.e. 103 men (97.2%) and 3 women (2.8%)]. The median age at diagnosis was 69 years (range 46-88). Patient occupations related to asbestos exposure included: asbestos product manufacturing (n = 17); the shipbuilding industry (n = 14); the construction industry (n = 13); heat insulation work (n = 12); plumbing, asbestos spraying, and electrical work (n = 7 each), and transportation and demolition work (n = 4 each). The median duration of asbestos exposure was 25 years (range 2-54), and the median latency period before the onset of DPT was 46 years (range 25-66). Involvement of the costophrenic angle (CPA) was also negatively correlated with the percent vital capacity (%VC; r = -0.448, p < 0.01). Pleural thickness and the craniocaudal and horizontal extension of pleural thickening, as determined by chest computed tomography (CT), were also negatively correlated with %VC (r = -0.226, p < 0.05; r = -0.409, p < 0.01, and r = -0.408, p < 0.01, respectively).

Conclusions: DPT develops after a long latency period following occupational asbestos exposure and causes marked respiratory dysfunction. The extension of DPT should be evaluated by chest CT, and chest X-ray would be important for the evaluation of the involvement of the CPA.
High performance of F-fluorodeoxyglucose positron emission tomography and contrast-enhanced CT in a rapid outpatient diagnostic program for patients with suspected lung cancer. P. Brocken, H.F. van der Heijden, P.N. Dekhuijzen, et al. 2014;87(1):32-7. PubMed · Publisher

Abstract

Background: The diagnostic evaluation of patients presenting with possible lung cancer is often complex and time consuming. A rapid outpatient diagnostic program (RODP) including (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET) and contrast-enhanced computed tomography (CT) as a routine diagnostic tool may improve timeliness, however the diagnostic performance of such a combined approach of RODP remains unclear.

Objectives: We evaluated timeliness of care and diagnostic performance of FDG-PET and contrast-enhanced CT (FDG-PET/CT) in an RODP for all patients referred with a chest X-ray suspicious of lung cancer.

Methods: Charts of patients referred to the 2-day RODP of our tertiary care university clinic after an abnormal chest X-ray between 1999 and 2009 were reviewed. Between 1999 and 2005 co-registered FDG-PET and CT imaging took place; from September 2005 onwards, a hybrid system was used. We analyzed timeliness of care and diagnostic performance of FDG-PET/CT to differentiate malignant from benign lesions.

Results: In 386 patients available for analysis, 260 were diagnosed with lung cancer and 23 had another type of malignancy; in 78 patients benign disease was confirmed, and in another 45 the diagnosis was not pathologically confirmed but a median 24.5-month follow-up confirmed a benign outcome. Sensitivity, specificity, negative and positive predictive values and accuracy of FDG-PET/CT to differentiate lung cancer from benign disease were 97.7, 60.2, 92.5, 84.0 and 85.8%, respectively. Lung cancer patients had a median referral, diagnostic and therapeutic delay of 7, 2 and 19 days, respectively.

Conclusions: FDG-PET/CT in an RODP setting for suspected lung cancer has high performance in detecting cancer and facilitates timely care.

Copyright © 2013 S. Karger AG, Basel.
Positive FDG-PET/CT of the pleura twenty years after talc pleurodesis: three cases of benign talcoma. T. Vandemoortele, S. Laroumagne, E. Roca, et al. 2014;87(3):243-8. Case report PubMed · Publisher

Abstract

The FDG-PET (fluorine-18 fluorodeoxyglucose positron emission tomography) scan is used with increasing frequency to investigate pleural abnormalities and to determine the possibility of neoplastic invasion. However, false-positive findings are not uncommon and talc pleurodesis has been reported to cause hypermetabolic pleural thickenings up to 5 years after the procedure. We report the cases of 3 patients (2 of whom had a history of asbestos exposure) requiring talc pleurodesis for recurrent pneumothoraces between 1988 and 1990, who were investigated in 2011 for pleural abnormalities. Avid pleural thickening on FDG-PET scan mimicking pleural cancer was found, but this was deemed secondary to the pleurodesis. Talc pleurodesis generates inflammation which promotes pleural adhesions. This inflammatory reaction could decrease with time, as in other inflammatory processes. Since talc is not metabolized by the body, the FDG-PET scan can remain positive, most likely because of a foreign-body granulomatous reaction, even 20 years later. It is important to be aware of this possibility and to question patients with pleural abnormalities about past procedures and mention such procedures to the colleagues who are responsible for interpreting metabolic imaging. Follow-up of hypermetabolic pleural lesions attributed to talc pleurodesis is important for the detection of new pleural lesions or neoplastic evolution.

© 2013 S. Karger AG, Basel.
Prognostic factors in patients presenting with pleural effusion revealing malignancy. S. Anevlavis, G. Kouliatsis, I. Sotiriou, et al. 2014;87(4):311-6. PubMed · Publisher

Abstract

Background: The survival of patients with malignant pleural effusion is considered generally poor. Most of the studies reporting results of prognostic factors are retrospective, using pleural thoracentesis for diagnosis. The objectives of our study were to reveal possible prognostic factors in patients initially presenting with undiagnosed pleural effusion proven to be malignant by diagnostic thoracoscopy.

Methods: Ninety consecutive patients, 48 of whom were male (53%), with a median age of 69 years (range 37-93) and a performance status (PS) of 0/1 (63%) and with initially undiagnosed pleural effusion that was proven to be malignant by thoracoscopy were evaluated. Survival time was defined as the time from thoracoscopic diagnosis to death or the last follow-up. A regression analysis was used to determine significant clinical and biological prognostic factors.

Results: Lung carcinoma (44.4%), breast carcinoma (24.4%), and mesothelioma (12.2%) were the most frequent tumors diagnosed. The median overall survival was 11 months (range 0.5-55). The survival of the patients was related to the following factors: histology of the primary tumor (p = 0.008), PS (p < 0.001), white blood cells (p = 0.018), and the blood neutrophil-to-lymphocyte (N/L) ratio (p = 0.002). Multiple regression showed PS, histology, and the N/L ratio.

Conclusion: The factors affecting survival in our patients were PS, primary tumor histology, and the N/L ratio. These factors may help physicians select patients for treatment and/or interventional procedures.

© 2014 S. Karger AG, Basel.
Malignant pleural mesothelioma in a patient with systemic sclerosis: the first report. N. Singh, K. Madan, A. Bhattacharya, et al. 2013;85(1):66-71. Case report PubMed · Publisher

Abstract

Malignant pleural mesothelioma (MPM) is a relatively rare but aggressive pleural tumor. Systemic sclerosis (SSc) is associated with the development of lung cancer and other malignancies. We describe a 58-year-old never-smoker female, previously diagnosed with limited cutaneous SSc, who presented with chest pain on the left side, dyspnea and circumferential nodular left pleural thickening. Fluorodeoxyglucose positron-emission tomography-computed tomography showed intense uptake in the thickened left pleura, mediastinal lymph nodes and left femur. Pleural fluid cytological examination along with nuclear and membranous positivity for Wilms tumor-1 antigen and epithelial membrane antigen on immunocytochemistry confirmed the diagnosis of MPM. To the best of our knowledge, this is the first report of MPM in a patient with SSc.

Copyright © 2012 S. Karger AG, Basel.
The use of indwelling pleural catheters for the management of malignant pleural effusion--direct costs in a Dutch hospital. R.C. Boshuizen, S. Onderwater, S.J. Burgers, et al. 2013;86(3):224-8. PubMed · Publisher

Abstract

Background: Indwelling pleural catheters (IPCs) are increasingly used in the treatment of malignant pleural effusion (MPE). In general, these catheters have been reported to manage MPE efficiently. Unfortunately, insurance companies in the Netherlands do not reimburse these catheters in either first-line treatment or following failed talc pleurodesis.

Objectives: Investigation of direct costs of IPC placement.

Methods: Retrospective analysis of a prospectively collected database. Direct costs for both catheters and vacuum bottles were calculated. Indicators for indirect costs such as adverse events and complications and the need for additional home care for drainage were registered.

Results: Mean costs for IPC amounted to EUR 2,173 and were different between tumor types - mesothelioma: EUR 4,028, breast: EUR 2,204, lung: EUR 1,146 and other: EUR 1,841; p = 0.017. Four patients were admitted to hospital for treatment of complications. Mean costs for IPC placement was similar when inserted as frontline treatment and after failed pleurodesis. Approximately 75% of patients did not need any help from specialized home care.

Conclusion: Direct costs for IPC placement turn out to be acceptable when compared with estimated hospitalization costs for pleurodesis treatment. Randomized controlled trials have to be performed to compare the cost-effectiveness of IPCs compared to pleurodesis.

Copyright © 2013 S. Karger AG, Basel.
Incidence of the pneumoconioses in the United Kingdom general population between 1997 and 2008. R.K. Amar, S.S. Jick, D. Rosenberg, et al. 2012;84(3):200-6. PubMed · Publisher

Abstract

Background: The incidence of the pneumoconioses in the UK is primarily estimated using occupational-based registries and disability pension schemes. These sources indicate a downward trend in the incidence of the pneumoconioses from 1995 onwards. There are no previously published general population-based observational studies quantifying the incidence of the pneumoconioses in the UK.

Objectives: The aim of this study was to investigate the incidence of the pneumoconioses in the UK general population between 1997 and 2008 using data from the General Practice Research Database (GPRD).

Methods: Data from the UK-based GPRD were used to estimate the incidence of pneumoconioses over a 12-year period (1997-2008). Crude incidence rates for asbestosis and non-asbestos-related pneumoconioses were stratified by gender, age group and calendar period, and rate ratios were adjusted using Poisson regression.

Results: The majority of cases was diagnosed with asbestosis, and the overall, crude incidence density for this pneumoconiosis during the 12-year study period was 2.7 (95% confidence interval 2.5-2.9) per 100,000 person-years. The incidence increased progressively during the period 1997-2005 and then decreased slightly during the period 2006-2008, even after controlling for the strong effect of an ageing UK population. The non-asbestos-related pneumoconioses, in contrast to asbestosis, showed a progressive reduction in incidence from 2003 onwards.

Conclusions: This study demonstrates that the pneumoconioses remain an important public health issue and, furthermore, documents an overall increase in asbestosis incidence in the UK between 1997 and 2008.

Copyright © 2012 S. Karger AG, Basel.
Malignant pleural mesothelioma: from the bench to the bedside. P. Astoul, E. Roca, F. Galateau-Salle, et al. 2012;83(6):481-93. Review PubMed · Publisher

Abstract

Optimal management of malignant pleural mesothelioma (MPM), which is mainly based on patient characteristics and clinical stage, is not clearly defined yet, although detailed, practical guidelines for these patients have been proposed by some scientific societies. Translational research, in the field of this disease, is currently in progress and different molecular oncogenic pathways leading to the growth and progression of MPM have been characterized with recent pharmaceutical developments. However, further in-depth analysis still needs to be done for a more advanced deciphering of the step-by-step process leading from early increased mesothelial cell proliferation to invasive mesothelioma, from which we are expecting the development of definitively effective therapy. Thus, this review is an overview of the recent advances in the biology of MPM and their potential therapeutic applications in the field of MPM diagnosis and treatment.

Copyright © 2012 S. Karger AG, Basel.
Mechanisms of pleurodesis. F. Rodriguez-Panadero, A. Montes-Worboys. 2012;83(2):91-8. Review PubMed · Publisher

Abstract

Pleurodesis aims to obliterate the pleural space by producing extensive adhesion of the visceral and parietal pleura, in order to control relapse of either pleural effusions (mostly malignant) or pneumothorax. A tight and complete apposition between the two pleural layers is a necessary condition to obtain a successful pleurodesis, but--besides this mechanical aspect--there are many biological mechanisms that appear to be common to most of the sclerosing agents currently used. Following intrapleural application of the sclerosing agent, diffuse inflammation, pleural coagulation-fibrinolysis imbalance (favoring the formation of fibrin adhesions), recruitment and subsequent proliferation of fibroblasts, and collagen production are findings in the pleural space. The pleural mesothelial lining is the primary target for the sclerosant and plays a pivotal role in the whole pleurodesis process, including the release of several mediators like interleukin-8, transforming growth factor-β and basic fibroblast growth factor. When the tumor burden is high, normal mesothelial cells are scarce, and consequently the response to the sclerosing agent is decreased, leading to failure of pleurodesis. Also, the type of tumor in the pleural cavity may also affect the outcome of pleurodesis (diffuse malignant mesothelioma and metastatic lung carcinomas have a poorer response). There is general agreement that talc obtains the best results, and there are also preliminary experimental studies suggesting that it can induce apoptosis in tumor cells and inhibit angiogenesis, thus contributing to a better control of the malignant pleural effusion. There is concern about complications (possibly associated with talc but other agents as well) related to systemic inflammation and possible activation of the coagulation cascade. In order to prevent extrapleural talc dissemination, large-particle talc is recommended. Although it could--to some degree--interfere with the mechanisms leading to pleurodesis and a carefully balanced clinical decision has therefore to be made, prophylactic treatment with subcutaneous heparin is recommended during hospitalization (immediately before and after the pleurodesis procedure).

Copyright © 2012 S. Karger AG, Basel.
Novel intrapleural therapies for malignant diseases. A.R. Haas, D.H. Sterman. 2012;83(4):277-92. Review PubMed · Publisher

Abstract

Pleural malignancies, either primary or metastatic, are common and problematic clinical issues in thoracic oncology and pulmonary medicine. Malignant pleural mesothelioma and metastatic pleural effusions often present late in the course of a disease and have a dramatic impact on the patient's quality of life and survival. Novel approaches to manage mesothelioma and malignant pleural effusions are desperately needed and the pleural space provides a unique platform as an easily accessible body cavity for developing and assessing these treatments and their responses. In this review, we discuss the unique intrapleural chemotherapeutic, immunotherapeutic and genetic treatments that have been investigated, as well as those under current clinical development. While responses have been demonstrated to variable degrees with all these approaches, an integrated multimodality approach incorporating these methods with other anti-neoplastic interventions ultimately will ensure the best responses and patient outcomes.

Copyright © 2012 S. Karger AG, Basel.
A clinical, radiographic and laboratory evaluation of prognostic factors in 363 patients with malignant pleural mesothelioma. A.C. Tanrikulu, A. Abakay, M.A. Kaplan, et al. 2010;80(6):480-7. PubMed · Publisher

Abstract

Background: Malignant pleural mesothelioma (MPM) has a poor prognosis.

Objectives: Only few studies in literature investigated the presence of pleural fluid and radiographic findings for the prognosis of MPM.

Methods: We retrospectively investigated the hospital charts of 363 MPM patients who were diagnosed from January 1989 to March 2010. Survival time was calculated by the Kaplan-Meier method. Pretreatment clinical, laboratory and radiographic features of each patient at the time of diagnosis were obtained from patients' charts.

Results: The mean age of 363 patients (217 men, 146 women) was 50.6 ± 11.2 years (range 19-85) and the mean survival time was 11.7 ± 8.6 months (range 1-53). Histological types of MPM were epithelial (71.2%), mixed (15.9%) and sarcomatous type (4.9%). The frequency of disease stages were 31.4% for stage 1, 24.2% for stage 2, 28.6% for stage 3 and 15.8% for stage 4. The most frequent symptoms were dyspnea (82.1%), chest pain (68.3%) and weight loss (58.9%). Results of univariate and multivariate analyses revealed that a Karnofsky performance score ≤60, a pleural fluid glucose level ≤40 mg/dl, a C-reactive protein level >50 mg/l, a serum lactate dehydrogenase level >500 U/l, the presence of pleural fluid, pleural thickening >1 cm and a platelet count of >420 × 10(3)/μl were found to be associated with poor prognosis in MPM.

Conclusions: Our data suggest that low pleural fluid glucose and high C-reactive protein, the presence of pleural fluid and pleural thickening were associated with poor MPM prognosis. Further prospective studies are needed to highlight prognostic factors more clearly.

Copyright © 2010 S. Karger AG, Basel.

2000s

Mortality from occupational exposure to relatively pure chrysotile: a 39-year study. L. Sichletidis, D. Chloros, D. Spyratos, et al. 2009;78(1):63-8. PubMed · Publisher

Abstract

Background: Asbestos exposure is related to serious adverse health effects. However, there is disagreement about the relationship between chrysotile exposure and mesothelioma or lung cancer.

Objectives: Our aim was to investigate the mortality rate among workers exposed to relatively pure chrysotile in an asbestos cement factory.

Patients And Methods: In an asbestos cement plant opened in 1968, we prospectively studied all 317 workers. A quantity of 2,000 tons of chrysotile, with minimal amphibole contamination, was used annually until 1 January 2005. Asbestos fiber concentration was measured regularly. Date and cause of death were recorded among active and retired workers.

Results: Asbestos fiber concentration was always below permissible levels. Fifty-two workers died during the study. The cause was cancer in 28 subjects; lung cancer was diagnosed in 16 of them. No case of mesothelioma was reported. Death was attributed to cardiovascular diseases in 23 subjects and to liver cirrhosis in 1. Overall mortality rate was significantly lower than that of the Greek general population, standardized mortality ratio (SMR) was 0.71 (95% CI 0.53-0.93). Mortality due to cancer was increased (SMR 1.15, 95% CI 0.77-1.67), mainly due to lung cancer mortality (SMR 1.71, 95% CI 0.98-2.78), but not significantly.

Conclusions: Occupational exposure to relatively pure chrysotile within permissible levels was not associated with a significant increase in lung cancer or with mesothelioma. Decreased overall mortality of workers indicates a healthy worker effect, which--together with the relatively small cohort size--could have prevented small risks to be detected.

Copyright 2008 S. Karger AG, Basel.
Mesothelioma and asbestos-related pleural diseases. L. Greillier, P. Astoul. 2008;76(1):1-15. Review PubMed · Publisher

Abstract

At present, the use of asbestos is not regulated at a worldwide scale. Moreover, there is a latency period between asbestos exposure and the manifestations of asbestos-related diseases. Consequently, pulmonologists are still dealing with consequences of asbestos exposure, which mainly occur at the pleural surface. The aim of this review is to provide an overview of asbestos-related pleural diseases. We summarized the most relevant data for the diagnosis and the management of benign asbestos pleural effusions, pleural plaques, diffuse pleural thickening and rounded atelectasis. Special attention is dedicated to malignant pleural mesothelioma, given the challenging issues of this disease, the recent advances in its management and the dynamism of research in this area.

2008 S. Karger AG, Basel.
Black spots of the parietal pleura: morphology and formal pathogenesis. K.M. Müller, I. Schmitz, K. Konstantinidis. 2002;69(3):261-7. PubMed · Publisher

Abstract

Background: Dark incorporations (black spots) have been described in various organs. 'Black spots' seen as flat-to-nodular lesions of the parietal pleura are common findings in former miners. They represent areas of coal dust accumulation. An increased incorporation of asbestos fibres has been described in these areas, causing them to be seen as potential starting points for malignant mesotheliomas.

Objectives: The aim of our examinations was to describe the morphology of black spots in order to understand their formal pathogenesis and discuss their role in the development of malignant mesotheliomas.

Materials: We report the results of the morphological and energy dispersive X-ray analysis of 12 black spots (4 surgical and 8 autopsy specimens) located in the parietal pleura.

Results: Black spots of the pleura develop in close correlation to lymphatic channels and blood vessels. Their formal pathogenesis is characterized by a mild fibrosis and an inflammatory reaction to the incorporated foreign particles. The proliferation of connective tissue may result in the formation of hyaline granulomas. Aluminum, silicone and sometimes fibres are also found in such areas. Mesothelial cells may be irritated.

Conclusion: Although there are hints for an increased proliferation of mesothelial cells in some areas with black spots, our findings do not support the classification of black spots as an obligate early lesion in the development of malignant mesotheliomas.

Copyright 2002 S. Karger AG, Basel
Ventilatory insufficiency due to asbestos-related diffuse pleural fibrosis successfully treated with noninvasive home mechanical ventilation. X. Muñoz, A. Roger, E. Pallisa, et al. 2001;68(5):533-6. Case report PubMed · Publisher

Abstract

A 54-year-old man with diffuse pleural fibrosis due to previous asbestos exposure developed hypercapnic respiratory failure. Noninvasive mechanical ventilation (NIMV) was started at the hospital and maintained at the patient's home, achieving reversal of the respiratory failure. During a 2-year follow-up, NIMV has been well tolerated by the patient and no relapse in ventilatory failure has occurred. Home NIMV can be considered as an alternative to pleural decortication in asbestos-related diffuse pleural fibrosis with ventilatory insufficiency.

Copyright 2001 S. Karger AG, Basel
Comparison of the effectiveness of some pleural sclerosing agents used for control of effusions in malignant pleural mesothelioma: a review of 117 cases. A. Senyiğit, H. Bayram, C. Babayiğit, et al. 2000;67(6):623-9. PubMed · Publisher

Abstract

Background And Objectives: Management of malignant pleural mesothelioma (MPM) has been an important clinical issue regardless of the treatment modality employed. We aimed to investigate the efficacy of oxytetracycline (OT), Corynebacterium parvum (CP), and nitrogen mustard (NM) in the management of pleural effusion associated with MPM.

Methods: One hundred and seventeen patients who had stage-2 MPM or over according to the Butchart staging system and unilateral or bilateral pleural effusion took part in the study. The patients received either OT (35 mg/kg), CP (7 mg), or NM (0.4 mg/kg) through a chest tube for pleurodesis. The association between several clinical parameters and patient survival was also investigated.

Results: OT was applied to 59, CP to 29 and NM to 29 cases. A statistical analysis of the results obtained by these agents have demonstrated that OT (30 days, 81%; 90 days, 76.2%) and CP (30 days, 86.2%; 90 days, 79.3%) led to a significantly higher rate of successful pleurodesis as compared to NM (30 days, 48.2%; 90 days, 41.3%; p <0.05). Although the procedure was generally well tolerated by the patients, the NM-treated group experienced significantly more nausea-vomiting (46.1%) and hypotension (35.8%) compared to patients who received OT (nausea-vomiting and hypotension 4.3%; p < 0.001) and CP (nausea-vomiting and hypotension 5.1%; p < 0.001). Furthermore, we found that thrombocytosis, chest pain and weight loss were significantly associated with poor prognosis, whereas epithelial type had a positive effect on survival.

Conclusion: These results suggest that OT and CP may be used as effective sclerosing agents for pleurodesis in the control of pleural effusions associated with MPM, without major side effects.

Copyright 2000 S. Karger AG, Basel
Deciduoid pleural mesothelioma affecting a young female without prior asbestos exposure. K. Gloeckner-Hofmann, X.Z. Zhu, H. Bartels, et al. 2000;67(4):456-8. Case report PubMed · Publisher

Abstract

Pleural mesothelioma is commonly associated to asbestos exposure. A 40-year-old woman is described who presented with shortness of breath. She had a smoking history but no history of asbestos exposure. Chest radiography and computed tomography showed a large tumour on the right lower lung. An open pleural biopsy was performed. A metastatic adenocarcinoma of the pleura was primarily diagnosed. The tumour progressed and after surgical excision an accurate histological and immunohistochemical examination was performed. It revealed a pleural mesothelioma with a deciduoid differentiation that has not been described before.

Copyright 2000 S. Karger AG, Basel
Environmental dangers: asbestos and tuberculosis. G. Hillerdal. 2000;67(2):134. Editorial PubMed · Publisher

Summary

In this editorial, the author commented on an article by Topçu and colleagues, in the same issue of Respiration, on high-resolution computed tomography in people with environmental asbestos exposure in Turkey. He noted that field studies in Turkey, pioneered by Professor Y. Izzettin Baris, had shown that environmental pollution from locally occurring mineral fibers, both asbestos and fibrous zeolite, could cause lung and chest diseases similar to those caused by workplace asbestos exposure. He listed other countries where environmental mineral fiber exposure had been reported, including Greece, Bulgaria, France, Russia, South Africa, Japan, China and New Caledonia. He stated that, because people move between countries, doctors elsewhere need to be aware of such problems in their patients' home countries. He discussed two aspects of the Topçu article. First, the patients had been selected because they had extensive pleural changes and chest symptoms. Because pleural plaques do not by themselves cause symptoms, he said the symptoms indicated another disease, and he considered it unsurprising that tuberculosis was one cause, given its fairly high incidence in Turkey. Second, he noted that apical pleural thickening, often attributed to tuberculosis, is increasingly recognized as a fairly rare but important lesion that can result from asbestos exposure. To his knowledge, the article was the first to describe it in people with environmental exposure only. He concluded that continued study of environmental health problems in Turkey was of national and wider scientific importance.

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.
High-resolution computed tomography in cases with environmental exposure to asbestos in Turkey. F. Topçu, H. Bayram, M. Simşek, et al. 2000;67(2):139-45. Comment PubMed · Publisher

Abstract

Background And Objectives: Although all parts of the lung can be affected as a consequence of asbestos exposure, most CT protocols tend to scan only the middle and lower parts of the thorax. The aim of this study was to investigate parenchymal and pleural lesions of persons exposed to environmental asbestos, using a high-resolution computed tomography (HRCT) protocol scanning the whole thorax.

Methods: We analyzed the chest radiographs and HRCT scans of 26 patients who presented bilaterally with multiple pleural plaques related to environmental asbestos exposure.

Results: Twenty-four cases (92%) had an abnormal HRCT suggestive of asbestosis. Apart from common HRCT changes related to asbestosis, we detected apical pleural thickening (APT) in 9 cases as well as a coarse honeycomb pattern adjacent to APT in 7 of these cases. Cavitary lesions due to pulmonary tuberculosis were observed on HRCT scans from 4 patients in total. Neither apical pulmonary fibrosis nor cavitary lesions were visible on chest radiographs.

Conclusions: We suggest that the HRCT protocol for examining asbestos-exposed individuals with pleural plaques on chest X-rays should include the whole thorax, since the asbestos-related pathologies may involve all parts of the lung.

Copyright 2000 S. Karger AG, Basel.
Incidence of malignant pleural mesothelioma due to environmental asbestos fiber exposure in the southeast of Turkey. A. Senyiğit, C. Babayiğit, M. Gökirmak, et al. 2000;67(6):610-4. PubMed · Publisher

Abstract

Background: Inhabitants of the southeast of Turkey (ST) have been exposed since childhood to inhalation of asbestos, from a material containing tremolite, used for whitewashing. This has resulted in an increased incidence of malignant pleural mesothelioma (MPM).

Objectives: To review the epidemiological features of MPM cases in ST; to calculate and compare the incidence with the previously reported ones.

Subjects And Methods: The study included 176 MPM cases from different places in ST. The incidence of MPM was calculated for those places according to the distribution of the cases.

Results: In the previously identified regions of asbestos (region 1) where the population had been informed of the danger with the soil some decades ago, the MPM incidence was decreased, as compared to the previous reports. The annual incidence of MPM in these places was found to be 42.9 per million in this study while it had been reported to be 105.5 per million in the previous studies. In contrast, the incidence that was reported previously to be 2.75 per million in the regions where asbestos exposure had not been identified before (region 2) was found to be 8.6 per million in this study. In region 2 the incidence of MPM increased even in the second half of the last decade (5.9 versus 11.9 per million).

Conclusions: Use of asbestos-containing soil continues in different places in ST. Even if the use of this soil is abandoned today, MPM will be an important health problem in this region till the third or fourth decades of this century. Informing the villagers of the danger and preventing the use of this soil may result in a considerable decrease in the incidence of MPM.

Copyright 2000 S. Karger AG, Basel
Malignant mesothelioma in subjects with Marfan's syndrome and Ehlers-Danlos syndrome: only an apparent association?. M. Bisconti, A. Bisetti, P. Bidoli. 2000;67(2):223-8. Case report · Review PubMed · Publisher

Abstract

Malignant mesothelioma is a rare neoplasm which could be favored by an hereditary predisposing factor. So far, malignant mesothelioma have never been described in patients with hereditary diseases of the connective tissue. Here, we report some cases of mesothelioma affecting subjects who were not exposed to inhalation of asbestos. One of these subjects was affected by Ehlers-Danlos syndrome, whereas in two brothers, mesothelioma was associated with Marfan's syndrome. The observation of the same histologic subtype of mesothelioma in two brothers and the coexistence of two pathologic conditions of mesodermal origin indicate the presence of hereditary factors predisposing to the cancerogenic action of even small amounts of asbestos. Structural alterations of collagen and primary immunodeficiency may represent the host factor inducing development of the neoplasm. We conclude that the association between these rare disorders of the connective tissue and mesothelioma may not be coincidental, but could be the result of the exposition to small amounts of asbestos in predisposed individuals.

Copyright 2000 S. Karger AG, Basel.
Malignant pleural mesothelioma caused by environmental exposure to asbestos in the Southeast of Turkey: CT findings in 117 patients. A. Senyiğit, H. Bayram, C. Babayiğit, et al. 2000;67(6):615-22. PubMed · Publisher

Abstract

Background And Objectives: Malignant pleural mesothelioma (MPM) is reported to be common in the southeast of Turkey, as a result of environmental asbestos exposure. The aim of this study was to evaluate the computed tomography (CT) features of MPM in patients with a history of asbestos exposure.

Methods: The CT scans of 117 patients who had a diagnosis of MPM were retrospectively evaluated. Additionally, CT findings of histologic subtypes were compared.

Results: The most common CT findings included pleural effusion (n = 104, 89%), pleural thickening (n = 96, 82%), mediastinal pleural involvement (n = 77, 66%) and interlobar fissural involvement (n = 62, 53%). Histologic subtype analysis was performed in 89 patients; of these, epithelial, sarcomatous and mixed types were identified in 46, 23 and 20 patients, respectively. An analysis of CT findings demonstrated that the involvement of mediastinal pleural (91%), interlobar fissure (87%) and lung parenchyma (48%) was significantly more frequent in sarcomatous type, as compared to epithelial (61% and p < 0.01; 35 and 4%, p < 0.0001, respectively) and mixed types (65% and p < 0.05; 10% and p < 0.0001; 10% and p < 0.01, respectively). Furthermore, there was a significant correlation between pericardial involvement and chest wall involvement (r = 0.42, p < 0.05) in sarcomatous type. Similarly, lymphadenopathy and parenchymal involvement (r = 0.23, p < 0.02), pericardial and chest wall involvement (r = 0.25, p < 0.01), chest wall and interlobar fissural involvement (r = 0.25, p < 0.01) were significantly correlated, when CT findings of all histologic subtypes were combined.

Conclusions: These results suggest that although CT findings of MPM vary, they may provide valuable clues to the diagnosis, at least in patients with a history of asbestos exposure. In addition, the presence of extensive lesions may suggest MPM of sarcomatous subtype.

Copyright 2000 S. Karger AG, Basel
Malignant pleural mesotheliomas: an environmental health risk in southeast Turkey. K.M. Müller, M. Fischer. 2000;67(6):608-9. Editorial · Comment PubMed · Publisher

1990s

Malignant localized fibrous tumor of the pleura occurring in a person environmentally exposed to tremolite asbestos. M. Metintas, A.R. Gibbs, E. Harmanci, et al. 1997;64(3):236-9. Case report PubMed · Publisher

Abstract

A case is presented of a malignant localized pleural fibroma occurring in a 60-year-old Turkish female who was environmentally exposed to tremolite. The tumor was excised but recurred 3 years later when it was again excised. It is possible that more radical surgery at initial presentation with chest wall resection would have been advantageous.
Simultaneous bilateral spontaneous pneumothorax in a patient with peritoneal and pleural papillary mesothelioma. P. Höllinger, D. Gaeng. 1997;64(3):233-5. Case report PubMed · Publisher

Abstract

Simultaneous bilateral spontaneous pneumothorax (SBSP) occurred in a patient with papillary mesothelioma of peritoneum and pleura. The patient initially suffered from ascites due to peritoneal tumor studding and later presented with simultaneous bilateral spontaneous pneumothorax. As the disease spread from the abdomen to the pleural cavity, a moderate loss of histologic differentiation was observed.
Tracheal carcinoma and mixed pneumoconiosis. A causal relationship?. D. Theegarten, S. Philippou, L. Freitag. 1995;62(1):49-52. Case report PubMed · Publisher

Abstract

We report on a 58-year-old man who had worked as a plumber and fitter for over 41 years and had been exposed to asbestos, man-made mineral fibers and welding fumes. Eighteen months before death, squamous cell carcinoma of the trachea occurred. Energy-dispersive X-ray analysis revealed intrapulmonal dust deposits in accordance with his exposure. A relationship between the tracheal carcinoma and the dust exposure causing a mixed pneumonoconiosis seems to be probable.
Diagnosis and prognostic factors in malignant pleural mesothelioma: a retrospective analysis of sixty-five patients. L. Tammilehto, P. Maasilta, S. Kostiainen, et al. 1992;59(3):129-35. PubMed · Publisher

Abstract

This report is an analysis of the medical records of 83 patients registered between 1960 and 1980 at Helsinki University Central Hospital as having malignant pleural mesothelioma. 65 of 83 patients had histologically confirmed malignant mesothelioma, and are the focus of this analysis. The remaining 18 (22%) patients were excluded because malignant mesothelioma was only confirmed cytologically, or because the primary tumor was not a mesothelioma. The ratio of men to women was 2:1.30 of 65 (46%) patients were not known or not likely to have been exposed to asbestos. The main symptoms at presentation were dyspnea, cough, chest pain, fatigue and weight loss. The median survival from diagnosis was 12 months, and from the onset of symptoms 18 months. Clinical stage and performance status were significant prognostic factors. Hematogenous metastases were present at autopsy in most cases. Disease and performance status therefore need to be well established and documented in clinical trials involving mesothelioma.
The relationship between large airway and alveolar space inflammation and airway metaplasia. W.W. Merrill, D. Carter, M.R. Cullen. 1992;59 Suppl 1:38-40. PubMed · Publisher

Abstract

Bronchoscopy and bronchoalveolar lavage (BAL) yield important information about the lower respiratory tract of subjects who have been exposed to asbestos. Evidence of metaplasia is easily detected with random biopsies in large airways and a relationship with smoking status can be found. A significant finding, however, is that inflammatory cells recovered by late BAL aliquots which presumably reflect alveolar space inflammation are also importantly associated with the presence of metaplasia. Asbestos provides an important stimulus for recruitment of inflammatory cells. These cells release oxidants which can be responsible for direct or indirect mutagenesis. Our data suggest that this inflammatory cell recruitment may be an important additional factor predictive of airway metaplasia and perhaps subsequent carcinogenesis.
Metastatic laryngeal carcinoma mimicking pleural mesothelioma. M. Huncharek, J. Muscat. 1991;58(3-4):204-6. Case report PubMed · Publisher

Abstract

We describe an unusual case of metastatic poorly differentiated laryngeal carcinoma to the pleura resembling pleural mesothelioma in a patient with a positive history of exposure to asbestos. This case not only describes an unusual presentation of metastatic laryngeal carcinoma, but also highlights the need for special pathological techniques to distinguish nonmesothelial tumors from primary pleural mesotheliomas.
Histopathology of the pleura. B. Corrin, B.J. Addis. 1990;57(3):160-75. Review PubMed · Publisher

Abstract

This review attempts to provide up to date information on structure/function relationships of the pleura and on the pathology of pleural effusions, pneumothorax, pleural repair, pleural infections, pleural involvement in systemic connective tissue disorders, non-malignant asbestos-induced pleural disease, mesothelioma and other pleural tumours.
Prospective clinical and radiologic study of zeolite-exposed Turkish immigrants in Sweden. M. Ozesmi, G. Hillerdal, B. Svane, et al. 1990;57(5):325-8. Case report PubMed · Publisher

Abstract

Ninety-four persons from the village of Karain, Turkey, now residing in Stockholm, were investigated clinically and radiologically. In this village, environmental exposure to erionite, a fibrous zeolite, occurs, and there is an extremely high risk of mesothelioma among the villagers. Since an earlier investigation of the cohort in 1980, another 4 young persons have fallen ill with malignant mesothelioma in this group, where the incidence thus approaches 1%/year and is the most common cause of death. Solitary pleural plaques were found in 6%, thickening of the interlobar pleura in 4% and other radiologic signs of affection of the pleura in 2%. Thickening of the interlobar fissures were observed in 1 patient as the first sign of mesothelioma which has remained asymptomatic until 1 year later. The comparatively low incidence of pleural lesions in the cohort is probably due to the low mean age (36 years). Further follow-up could give clues to the pathogenesis of malignant mesothelioma.

1980s

Humoral immunity alterations after environmental asbestos exposure. L.V. Zerva, S.H. Constantopoulos, H.M. Moutsopoulos. 1989;55(4):237-41. PubMed · Publisher

Abstract

The inhabitants of Metsovo in northwestern Greece have been environmentally exposed to asbestos from childhood because they had been using a tremolite-containing material for whitewash, without knowing its consistency. As a result, they have a very high incidence of calcified pleural plaques and malignant pleural mesothelioma but no pulmonary fibrosis. In the present study we examined certain aspects of the humoral immunity in the serum of 109 individuals: levels of immunoglobulins, C-reactive protein and complement components, as well as the presence of antinuclear antibodies, rheumatoid factor, antibodies to extractable nuclear antigens, to ds-DNA and to cardiolipin. Our results show that, compared to controls, those exposed to asbestos have increased IgG and C3 levels. Those with pleural plaques have, in addition, increased IgA levels and an increased incidence of antinuclear antibodies. The results of the study suggest that nonoccupational asbestos exposure affects humoral immunity. The presence of pleural plaques accentuates this effect.
Experimental lung tumors following specific intrabronchial application of chrysotile asbestos. Longitudinal light and electron microscopic investigations in rats. E. Fasske. 1988;53(2):111-27. PubMed · Publisher

Abstract

Longitudinal light and electron microscopy investigations were previously carried out on Wistar rats to study the pathogenesis of pulmonary fibrosis due to asbestos. In the present study, the genesis of pulmonary carcinomas and pleural mesotheliomas have been investigated by light and electron microscopy on the same model after intrabronchial instillation of chrysotile B and benz(a)pyrene, as well as a combination of the two carcinogens. A single instillation of 1 mg chrysotile B with a fiber length between 0.05 and 0.2 micron in 0.1 ml tricaprylin by means of a polyvinyl catheter into the right lower lobe of the lung of 70 anesthetized 6-week-old Wistar rats caused pulmonary carcinomas or malignant pleural mesotheliomas in 18 animals (24%). The tumors occur at intervals between 12 and 31 months after the asbestos application. By electron microscopy, small asbestos fragments can be detected under the pleural mesothelium at the earliest 1 year after the intrabronchial application of chrysotile. A single combined instillation of 1 mg chrysotile and 0.5 mg benz(a)pyrene does not increase the tumor incidence. With simultaneous administration of these two substances, however, lung tumors arise very much earlier than in instillation of only one of the carcinogens. Thus, an adenocarcinoma was found in the lungs after 4.5 months, and a pleural mesothelioma was already found after 7.7 months. The intrabronchial instillation of benz(a)pyrene alone causes fewer lung tumors (tumor incidence 10%, interval between 13 and 33 months).
Accuracy of diagnostic procedures in the initial evaluation and follow-up of mesothelioma patients. W.F. Strankinga, M. Sperber, M.C. Kaiser, et al. 1987;51(3):179-87. PubMed · Publisher

Abstract

The present study contains the review of 30 patients with malignant mesothelioma of the pleura, examined and treated at our institution. In an attempt to compare various methods of diagnosis in this entity, emphasis was laid on specific abilities and limitation of investigations such as pleural biopsy, pleural fluid cytology, diagnostic thoracoscopy and thoracotomy and radiological studies including computed tomography and magnetic resonance imaging. Clinical management problems encountered in this neoplasm are also discussed.
High incidence of malignant pleural mesothelioma in neighbouring villages of Northwestern Greece. S.H. Constantopoulos, V.D. Malamou-Mitsi, J.A. Goudevenos, et al. 1987;51(4):266-71. PubMed · Publisher

Abstract

Between 1981 and 1985 seven patients from three villages of the Metsovo area in Northwestern Greece (population 5000) developed malignant pleural mesothelioma (MPM). The diagnosis was made with pleural biopsy and pleural fluid cytology. Six of these patients have died 18-24 months after the first symptoms (usually dyspnea on exertion) and 1 is still alive after 24 months. Seven MPMs in 5,000 in five years is about 280 times the expected incidence of 1/1,000,000/year. In the same area, endemic pleural calcifications linked to nonoccupational asbestos exposure have recently been reported, but none of our patients with MPM had pleural calcifications. The combination of MPM and pleural plaques in such a high frequency in the same area strongly suggests asbestos fiber as a common etiologic agent. On the other hand, the fact that the combination of MPM and pleural plaques did not occur in the same individuals, suggests a different response to this common offending agent.
Multinuclear giant cells in bronchoalveolar lavage in interstitial lung diseases. C. Agustí, A. Xaubet, R. Arriols, et al. 1987;51(4):307-11. PubMed · Publisher

Abstract

The presence of multinuclear giant cells (MGC) is a pathological feature of interstitial lung diseases produced either by some organic and inorganic dust or by granulomatous disorders. In order to assess the diagnostic significance of the presence of MGC in bronchoalveolar lavage (BAL), the percent of MGC in the BAL of 52 subjects exposed to asbestos (26 with asbestosis) as well as from 79 with several interstitial lung diseases (idiopathic pulmonary fibrosis, pulmonary fibrosis associated with collagen vascular disorders, hypersensitivity pneumonitis and sarcoidosis) was compared with that of a control group of 14 subjects with no evidence of diffuse pulmonary disease. The results of this study suggest that MGC are present in the BAL of subjects with no pulmonary disease, and the quantification of these cells does not aid in the diagnostic evaluation of interstitial lung diseases.
Small airway changes in workers exposed to asbestos. A. Miller. 1985;48(2):190-1. Letter PubMed · Publisher
Small airways changes in workers exposed to asbestos. B.M. Cohen, A. Adasczik, E.M. Cohen. 1984;45(3):296-302. PubMed · Publisher

Abstract

Although restriction is considered the classic pulmonary function profile of asbestosis, studies suggest that obstruction of the peripheral airways not revealed by standard spirometry is equally frequent and indicative of peribronchiolar fibrosis. We recorded flows and volumes from maximal expiratory flow volume (MEFV) curves, closing volume data and the phase III slope of the alveolar plateau for 610 litigants, 575 men and 35 women, exposed to asbestos for varying periods in a single workplace in northern New Jersey. Smokers (260) included current smokers and subjects who had stopped within the previous 10 years; nonsmokers (350) had either never smoked or had given up for more than 10 years. Analyses were made for both groups according to years worked. Compared to predicted, smokers and nonsmokers had significantly higher closing capacities (p less than 0.01) and delta N2% (p less than 0.001) means, and lower forced vital capacity (FVC), forced expiratory volume for the first second (FEV1.0, maximal expiratory flow rate (MEFR) and peak expiratory flow rate (PEFR) functions (p less than 0.05); the flow rate after 75% of the FVC had been exhaled (FEF75%) values were significantly reduced (p less than 0.01) only for workers exposed for more than 30 years. The change from predicted was significantly more rapid for smokers, compared with nonsmokers, for FVC, FEV1.0, PEFR, MEFR and FEF75% means, while the increase in closing capacity (CC) was twice as rapid for nonsmokers and the two groups did not differ in their mean rates of rise for delta N2%. CC and the slope of the alveolar plateau appeared to be the measures best able to discriminate between the data for both smoking and nonsmoking asbestos workers and their lung function prediction means.(ABSTRACT TRUNCATED AT 250 WORDS)
Abnormal wasted ventilation fraction and normal pulmonary hemodynamics during exercise in patients with exertional dyspnea. Z. Mohsenifar, H.V. Brown, S.K. Koerner. 1982;43(4):263-70. PubMed · Publisher

Abstract

We have previously reported a drop on wasted ventilation fraction (VD/VT) during exercise in patients with pulmonary vaso-occlusive diseases associated with collagen vascular disorders, despite an abnormally high mean pulmonary artery pressure and pulmonary vascular resistance at rest and during exercise. To further evaluate the diagnostic value of VD/VT measurements, we studied 8 subjects with normal spirometry, lung volumes and single-breath diffusing capacity who had previously demonstrated a high VD/VT at rest and during exercise. We found normal pulmonary hemodynamics in these subjects despite an abnormal rest and exercise VD/VT. Our findings effectively exclude hemodynamically significant pulmonary vascular obstruction, and do not support the use of VD/VT as a screening method for detecting diffuse pulmonary vaso-occlusive diseases.
Regional lung function in asbestos workers: observations and speculations. R.H. Secker-Walker, J.E. Ho. 1982;43(1):8-22. PubMed · Publisher

Abstract

The clinical findings, occupational exposure, smoking history, pulmonary function, chest radiograph and ventilation-perfusion studies have been examined in 12 men exposed to asbestos fibers in the course of their work. Minor abnormalities of regional ventilation, consistent with early small airway dysfunction, were found in the fibrotic zones of most of the nonsmokers or mild cigarette smokers. The whole-lung washout times, estimated by visual inspection of serial washout images, were strongly correlated with measurements of airflow obstruction, but not with pack-years of smoking. There was a close correspondence between radiographic extent of pulmonary fibrosis and the abnormalities in pulmonary blood flow in these regions. The severity of the abnormalities in regional pulmonary blood flow was significantly correlated with the years of asbestos exposure (r = + 0.73, p less than 0.01). It is suggested that the magnitude of the disturbance in pulmonary blood flow in the fibrotic zones could be used to estimate the proportion of pulmonary dysfunction due to asbestos exposure.
Asbestos-related disease from household exposure. G.R. Epler, M.X. Fitz Gerald, E.A. Gaensler, et al. 1980;39(4):229-40. Case report PubMed · Publisher

Abstract

The importance of nonoccupational asbestos exposure has been emphasized recently. To illustrate this problem, we report 4 persons with asbestos-related disease from household exposure. There were 2 wives of asbestos workers, who cleaned their husbands' work clothes. One developed a mesothelioma and the other plaques, calcification, benign asbestos pleural effusion and subpleural parenchymal fibrosis. 2 men were exposed as children while playing in a cellar room which was also used for their father's muffler repair business. At ages 27 and 33, they had pleural and diaphragmatic calcifications.
Maximal expiratory flow volume curves in workers exposed to asbestos. R. Rodriguez-Roisin, J.E. Merchant, G.M. Cochrane, et al. 1980;39(3):158-65. PubMed · Publisher

Abstract

We have studied 40 workers with varying industrial exposure to asbestos, using routine spirometry and maximal expiratory flow volume curves (MEFVC). Abnormalities of MEFVC were common and seen in those with normal spirometry and total lung capacity. The high incidence of abnormal MEFVC suggests that air flow dysfunction in small airways may follow prolonged asbestos exposure. Our findings support, therefore, the idea that asbestos exposure may cause an obstruction to airflow arising particularly in small airways, and that one of the common functional abnormalities attributable to asbestos exposure is airways obstruction.

1970s

Giant fibrous pleural mesothelioma associated with myocardial restriction and hypoglycemia. D.O. Kniznik, A.J. Roncoroni, M. Rosenberg, et al. 1979;37(6):346-51. Case report PubMed · Publisher

Abstract

A giant pleural fibrous mesothelioma was the cause of severe nonobstructive ventilatory incapacity, myocardial restriction with congestive failure and hypoglycemic episodes in a 58-year-old man. Surgical resection resulted in complete recovery of respiratory function and disappearance of hypoglycemic episodes.
Lung function in relation to radiographic changes in asbestos workers. S. Zedda, G. Aresini, I. Ghezzi, et al. 1973;30(2):132-40. PubMed · Publisher

Abstract

A functional study involving VC, FEV 1.0 sec, RV, steady-state DLCO and fractional CO uptake at rest and, where possible, at two exercise levels (50 and 100 W), has been carried out on 724 male subjects exposed to asbestos dust inhalation. Subjects were divided into 5 groups according to UICC radiological classification of Cincinnati (1970): group I 0/0-0/1, with asbestos exposure of less than 10 years; group II 0/0-0/1, with asbestos exposure of more than 10 years; group III 1/0—1/1, group IV 1/2-2/1-2/2 and group V 2/3—3/2—3/3. The following results were obtained: obstructive ventilatory insufficiency was observed in a percentage of cases variable between 11.2 and 24.2% in the different groups; restrictive ventilatory insufficiency was observed in 5.6% of subjects in group I, 10.1 % in group II, and 31.1-41.9-69.2%, respectively, in groups III, IV and V; impairment of gas exchange at rest and during exercise (reference to the lowest values obtained in 123 normal male subjects) was found in 4.6-6.4% of subjects in group I, 9.6-19.2% of subjects in group II and in a percentage of above 20% (till 100%) in groups III, IV and V. Low values of DLCO in some cases of asbestos-exposed workers without radiological changes and without obstructive pulmonary disease suggest that the pulmonary damage induced by asbestos fibers may determine functional alterations of gas exchanges even in the preradiological stages.

PubMed has no abstract for this study. This is the authors' abstract, copied from the article.
Asbestosis following brief exposure in cigarette filter manufacture. A.M. Goff, E.A. Gaensler. 1972;29(1):83-93. PubMed · Publisher

Abstract

Severe asbestosis was found on lung biopsy in a 47-year-old woolen mill worker, who, 16 years before, was exposed to asbestos dust for a period of only 9 months. He made cigarette filters which consisted of a mixture of Cape blue asbestos and acetate. The presenting symptom of dyspnea on exertion and classic radiographic changes first became evident 13 years later. Characteristic pathophysiologic findings of restrictive insufficiency and diffusing impairment were demonstrated. Pulmonary insufficiency progressed over a 2-year period to total disability. The myriad products containing asbestos are reviewed and the dangers of exposure in secondary industries using these products are emphasized.

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

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