Pleural calcification associated with exposure to chrysotile asbestos in southeast Turkey

Our plain-English summary of Pleural calcification associated with exposure to chrysotile asbestos in southeast Turkey, by S. Yazicioglu (Chest, 1976).

The study

• Author: S. Yazicioglu
• Journal: Chest
• Published: 1976;70(1):43-7
• Cited by: 53 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. 002702).

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.

In plain English

This study examined pleural calcification among people living in Cermik and other towns and villages near Diyarbakir in southeast Turkey. Residents dug a local mineral and used it to paint the walls and floors of their houses. A state institute identified it as serpentine (chrysotile) asbestos in fiber form, including some talc. The author reviewed chest X-rays from Diyarbakir Chest Hospital (1966 to 1974) and from three tuberculosis dispensaries, plus 15,239 chest photofluorograms from a survey of people over age six. In total, 511 people had pleural calcification. In the survey, 389 of 15,239 people (2.6 percent) were affected. The figure was 3.8 percent in Cermik and 14 percent in the village of Yukari Seyhler. No one under 25 showed pleural calcification on X-ray, and calcification was on both sides of the chest in 90 percent of cases. Asbestos bodies were found in sputum from 28 of 64 hospital patients (44 percent). In rabbits given the raw material by inhalation or injection, slight calcification appeared on the pleura. The author concluded that the calcifications were caused by inhaling chrysotile asbestos.

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: Clinical and radiological survey drawing on hospital records, tuberculosis dispensary records and a population chest photofluorogram survey, with sputum examination in hospital patients, plus an experiment in rabbits
• Who was studied: Inhabitants of Cermik and other towns and villages around Diyarbakir, southeast Turkey. Sources were patients at Diyarbakir Chest Hospital from 1966 to 1974 (24 with pleural calcification), patients at tuberculosis dispensaries in Cermik, Cungus and Ergani (2,800 cases, 98 with pleural calcification), and 15,239 people screened by chest photofluorography after age six within the previous two years (389 with pleural calcification). The rabbit experiment used 18 albino New Zealand rabbits plus two given the material by gastric tube.
• Exposure: A locally dug mineral used to paint the walls and floors of houses, identified by the State Mining Investigation Institute in Ankara as serpentine asbestos (chrysotile asbestos) in fiber form, including some talc. There was no official mining and no factory. Rabbits received 20 mg of the chrysotile powder by inhalation or intrapleural injection, and two received it through a gastric tube.
• Main results:
  • Across all three sources, 511 patients had pleural calcification (24 hospital, 98 dispensary, 389 survey).
  • In the photofluorogram survey, pleural calcification of the asbestosis type was found in 389 of 15,239 people (2.6 percent).
  • In Cermik, 204 of 5,400 people surveyed (3.8 percent) were affected.
  • In Yukari Seyhler, 84 of 589 people (14 percent) were affected. The author described such villages as places where asbestos deposits are abundant and digging is most active.
  • By radiologic criteria, no one in the survey under age 25 had pleural calcification.
  • In the survey, 225 men (2.4 percent of 9,257 surveyed) and 164 women (2.7 percent of 5,982 surveyed) were affected. The author stated that the sex difference is not significant.
  • Among the cases, plaques were on both sides of the chest in 90 percent.
  • Among the cases, plaques were on the diaphragmatic domes in 70 percent.
  • Among the cases, pericardial involvement was seen in 1.7 percent.
  • Asbestos bodies were found in the sputum of 28 (44 percent) of 64 hospital patients. No sputum sample from these 64 patients was positive for acid-fast bacteria.
  • In rabbits given the material by inhalation or injection, hemosiderin pigment and slight calcification were found microscopically on the visceral and parietal pleurae.
  • In these rabbits, serum calcium and phosphorus rose to 1.5 to 2 times initial values. Weight loss, slight hair loss and loss of appetite also occurred. These changes were not seen in control animals or in rabbits fed asbestos by gastric tube.
• The authors' conclusion: The author concluded that the pleural calcifications among inhabitants of the area were caused by inhalation of chrysotile asbestos used to paint the walls and floors of houses.
• Limitations the authors state:
  • The author had no opportunity to describe autopsy findings.
  • Lesions with an area of involvement less than 1 sq cm were not counted. The author postulated that the true prevalence is much higher.
  • The time and duration of exposures could not be determined exactly.

Topics

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

Medical terms in this study, explained in our Lexicon: Pleural Calcification, Chrysotile, Pericardial, Asbestos Bodies.

Related studies

• Pleural calcification in northwest Greece — T. Bazas, D. Oakes, et al. (1985)
• Pleural calcification, pleural mesotheliomas, and bronchial cancers caused by tremolite dust — S. Yazicioglu, R. Ilçayto, et al. (1980)
• Environmental asbestos-related pleural plaque in southeast of Turkey — G. Ates, T. Yildiz, et al. (2010)
• The calcification of fibrous pleural lesions produced in guinea-pigs by the injection of chrysotile asbestos dust — J.M. Davis (1971)
• 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)
• Lymphocytic alveolitis and pleural calcifications in nonoccupational asbestos exposure. Protection against neoplasia? — S.H. Constantopoulos, Y.A. Dalavanga, et al. (1992)

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