Metsovo lung outside Metsovo. Endemic pleural calcifications in the ophiolite belts of Greece

Our plain-English summary of Metsovo lung outside Metsovo. Endemic pleural calcifications in the ophiolite belts of Greece, by S.H. Constantopoulos, P. Theodoracopoulos, G. Dascalopoulos, et al (Chest, 1991).

The study

• Authors: S.H. Constantopoulos, P. Theodoracopoulos, G. Dascalopoulos, N. Saratzis, K. Sideris
• Journal: Chest
• Published: 1991;99(5):1158-61
• Cited by: 30 articles, as counted by NIH iCite
• Read it: PubMed · Publisher
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 004925).

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.

In plain English

This study looked for "Metsovo lung" in other parts of Greece. The term refers to pleural calcifications that earlier reports had attributed to a tremolite-containing household whitewash in Metsovo, northwestern Greece. The authors searched chest X-ray archives of the Hellenic Thoracic Research Institute and examined inhabitants of the village of Distrato. They asked residents about household uses of local soil and analyzed those materials for minerals. Including Metsovo, they identified seven areas with endemic pleural calcifications, all within or near ophiolite belts. Asbestos fibers were found in local materials from three of the new areas: chrysotile and tremolite in Distrato's whitewash, antigorite and tremolite in Tsakaioi on Evoia, and chrysotile in Pella. No asbestos was found in soil from Trikala and Karditsa or from Serres. In Distrato, 24 of 101 examined inhabitants had calcifications, all older than 50. Two malignant pleural mesothelioma cases from Distrato had been diagnosed at Ioannina University Hospital since 1984. The authors concluded that Metsovo lung occurs in various areas of Greece, with similar etiology and epidemiology in most of them.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Epidemiologic survey of endemic pleural calcifications, combining review of chest X-ray archives, a field study in one village, interviews about household use of local soil, and mineral analysis (x-ray diffractometry) of those materials
• Who was studied: Inhabitants of seven areas of Greece, including Metsovo. Other areas: Distrato (101 of a population of 400 examined), Megarchi/Trikala and Mousaki/Karditsa (148,280 screened in 1975), Evoia (roughly 6,000 screened in the 1970s and 1988), Pella (roughly 20,000 screened in 1973) and Serres (screened in 1986)
• Exposure: Household (non-occupational) use of local soil or whitewash-like material, for example for whitewashing and, in Pella, insulation of boilers of family distilleries. Minerals found varied by area: tremolite, chrysotile and antigorite in some areas; talc, chlorite, quartz and nonfibrous minerals in others. The authors note there was no asbestos mining or other official exploitation in any of these areas.
• Main results:
  • Metsovo: from almost 1,000 chest X-rays (population 4,500), the incidence of pleural calcifications remained at 46 percent; tremolite in the whitewash was confirmed
  • Distrato: pleural calcifications in 24 of 101 examined inhabitants, all older than 50
  • Distrato compared with Metsovo: in those over 70, incidence was 65 vs 71 percent; in those aged 50 to 59 it was 18.5 vs 48 percent. The authors linked the difference to Distrato abandoning the whitewash when the village was burned in World War II, while Metsovo still used it in the 1960s and 1970s.
  • The Distrato whitewash contained chrysotile and tremolite fibers
  • Trikala and Karditsa: 198 individuals with Metsovo-like pleural calcifications were identified among 148,280 inhabitants examined, scattered in 50 villages
  • Trikala and Karditsa: analysis of local soil found quartz and other nonfibrous minerals, but no asbestos
  • Evoia: 118 individuals in 40 villages had unilateral calcified pleurisy. Separately, 35 individuals with bilateral Metsovo-like calcifications were clustered in nine villages around Tsakaioi, where 13 of 37 examined had calcifications.
  • Tsakaioi, Evoia: soil and stones from inside the village contained large amounts of antigorite and tremolite
  • Pella: 75 inhabitants of 16 villages had Metsovo-like calcifications, and 62 individuals in 44 villages had unilateral calcified pleurisy. Local soil, used among other things to insulate boilers of family distilleries, contained chrysotile.
  • Serres: Metsovo lung was identified in 72 inhabitants of six villages. Local whitewashing soil showed only talc and chlorite, with no asbestos fibers.
  • Malignant pleural mesothelioma: two cases from Distrato had been diagnosed at Ioannina University Hospital since 1984. Three cases from Pella were reported by a different group (Sichletides et al), not by this study.
  • Pleural calcifications were found in both Vlachi and non-Vlachi inhabitants in most of the new areas
• The authors' conclusion: The authors concluded that Metsovo lung occurs outside Metsovo in various areas of Greece, with similar etiology and epidemiology in most of them. In their view, the prerequisites are a village located inside a serpentine zone and household use of local soil containing asbestos.
• Limitations the authors state:
  • In the areas where no fiber was detected (Trikala/Karditsa and Serres), the cause of the calcifications remains open. The authors think the most likely explanation is that they had not identified the correct material.
  • For the unilateral calcifications in Evoia and Pella, previous hemothorax or tuberculous pleurisy was not ruled out, although the authors consider it unlikely
  • The map of endemic pleural calcifications in Greece may not be complete

Topics

The National Library of Medicine indexes this study under subjects our site covers: Asbestosis, Pleural plaques and thickening, Tremolite.

Medical terms in this study, explained in our Lexicon: Metsovo Lung, Endemic, Pleural Calcification, Ophiolite, Malignant Mesothelioma, Whitewash, Chrysotile, Antigorite.

Related studies

• Metsovo lung: pleural calcification and restrictive lung function in northwestern Greece. Environmental exposure to mineral fiber as etiology — S.H. Constantopoulos, J.A. Goudevenos, et al. (1985)
• Tremolite whitewashing and pleural calcifications — S.H. Constantopoulos, N.A. Saratzis, et al. (1987)
• Pleural effects of tremolite in north-west Greece — T. Bazas (1987)
• Association of Metsovo lung and pleural mesothelioma with exposure to tremolite-containing whitewash — A.M. Langer, R.P. Nolan, et al. (1987)
• Evidence Suggesting the End of Universal Domestic Asbestos Exposure in Metsovo, NW Greece — A. Gogali, E.E. Ntzani, et al. (2017)
• Pleural calcification in northwest Greece — T. Bazas, D. Oakes, et al. (1985)

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