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Biomedical subjects

G Hillerdal

Publications and source records attributed to G Hillerdal.

At least 37 records · Page 2Linked to original sources
PubMed1997

Progression of pleural and parenchymal disease on chest radiographs of workers exposed to amosite asbestos.

OBJECTIVES: To determine predictors of progression of pleural and parenchymal disease on the chest radiographs of workers exposed to a short term, intense exposure of amosite asbestos. METHODS: The first and last of a series of chest radiographs of 887 workers exposed to amosite was interpreted and coded according to International Labour Organisation (ILO) standards by two physicians. Significant predictors of disease progression were found by a linear stepwise regression analysis from among such variables as smoking history, latency (time since first exposure), duration and intensity of exposure, and cytology. RESULTS: Although most radiographs remained normal, some showed progression of disease with about twice as many patients with abnormalities on the last film. Various combinations of age, intensity of exposure, and time between films were significant predictors of pleural and parenchymal disease and progression of such disease. No predominance of one sided disease was noted. Cytology and smoking were unreliable predictors of disease. Most disease progression was minor, usually of less than two scoring categories. CONCLUSION: An intense, yet short, exposure to amosite asbestos can produce pleural and parenchymal changes on chest radiographs. The number of those affected roughly doubled over a period spanning 10 to 20 years after exposure. Age and intensity of exposure are the most important predictors of disease.

Adult↗
PubMed1997

Chylothorax and pseudochylothorax.

Chylothorax is the occurrence of chylus (lymph) in the pleura due to damage to the thoracic duct. There is a high content of triglycerides, and chylomicrons can be seen. It is usually right-sided, since most of the duct is within the right hemithorax. With damage at the level of the aorta, the chyle will appear on the left. Traumatic rupture occurs after accidents or surgery. Of nontraumatic causes, the most common is a malignant lymphoma. Computed tomography (CT) scan of the thorax and upper abdomen should be performed. Lymphography can show where the leakage or blockage is situated. With repeated drains, large amounts of fat, proteins, and lymphocytes are lost. Treatment is with low-fat diet or parenteral nutrition to decrease the amount of chyle, but chemical pleurodesis or ligation of the thoracic duct, usually via thoracoscopy, is often necessary. Pseudochylothorax (cholesterol pleurisy) occurs with long-standing fluid in a fibrotic pleura. The fluid has a high content of cholesterol but no triglycerides or chylomicrons. In both conditions, the pleural fluid is thick, opalescent, whitish or the colour of cafe-au-lait.

Cholesterol↗
PubMed1997

Pleural disease during treatment with bromocriptine in patients previously exposed to asbestos.

Bromocriptine, which is used in the treatment of Parkinson's disease, can cause adverse pleuropulmonary reactions. Exposure to asbestos can result in similar lesions. Fifteen patients with former exposure to asbestos, who developed pleural fibrosis after treatment with bromocriptine, were observed independently in Sweden (11 patients) and Australia (four patients). The patients complained of malaise, often associated with weight loss, dyspnoea, and a disturbing cough. Laboratory values included increased erythrocyte sedimentation rate and a low haemoglobin level. Lung function tests showed a restrictive lung function defect. Chest radiographs showed bilateral pleural fibrosis, with small amounts of fluid in some cases. Soon after bromocriptine was withdrawn, the patients improved clinically, and the laboratory values returned to normal. However, in most cases, pleural fibrosis and a restrictive lung function defect persisted to some extent. In conclusion, in patients who develop pleuropulmonary fibrosis whilst being treated with bromocriptine, former exposure to asbestos should be investigated. Conversely, when pleural changes develop in a patient on bromocriptine and with prior exposure to asbestos, the possible causative role of the drug should be discussed. Special follow-up may be indicated when bromocriptine is planned in a patient with previous asbestos exposure, and if symptoms or signs of pleural fibrosis develop, bromocriptine withdrawal should be considered.

Adolescent↗
PubMed1997

Asbestos, asbestosis, pleural plaques and lung cancer.

Inhalation of asbestos fibers increases the risk of bronchial carcinoma. It has been claimed that asbestosis is a necessary prerequisite for the malignancy, but epidemiologic studies usually do not have enough statistical strength to prove that asbestos-exposed patients without asbestosis are without risk. Several recent studies do actually indicate that there is a risk for such patients. In addition, case-referent studies of patients with lung cancer show an attributable risk for asbestos of 6% to 23%, which is much higher than the actual occurrence of asbestosis among these patients. Thus there is an increasing body of evidence that, at low exposure levels, asbestos produces a slight increase in the relative risk of lung cancer even in the absence of asbestosis. Consequently, all exposure to asbestos must be minimized.

Adult↗
PubMed1996

Long-term survival of patients with lung cancer from a defined geographical area before and after radiological screening.

In the County of Uppsala, Sweden, a general health survey including a chest roentgenogram was operational from the late 1960s until the end of June, 1985. The screening was offered every 2 years and participation was about 70%. From the local cancer registry all cases of lung cancer during the period 1980-1990 aged 75 or less were obtained and their survival and mode of discovery investigated. Only WHO I-IV and undifferentiated cancers verified histologically were included. Twenty-eight cancers (11.5%) were discovered in the survey and these patients had a very good prognosis compared to those who presented with symptoms. During the health survey there were 35 of 244 (14.3%) who survived more than 4 years, and after the survey this figure was 34 out of 265 (12.8%), a nonsignificant difference. Survival for patients with squamous cell carcinoma or adenocarcinoma discovered in the health survey was much improved, and for these two groups combined the 4-year survival was 41.7% compared to 10.3% for those discovered by symptoms (P < 0.001). Thus, survival of patients with lung cancer of squamous cell or adenocarcinoma types can be improved by screening, but unfortunately, only few of the cancers will be discovered in this way, so the total impact of screening will be small.

Adult↗
PubMed1996

Diagnosis of pulmonary infections in immunocompromised patients by fiber-optic bronchoscopy with bronchoalveolar lavage and serology.

Fiber-optic bronchoscopy (FOB) and bronchoalveolar lavage (BAL) were performed on 67 occasions in 57 immunocompromised patients with symptoms consistent with pulmonary infection. Diagnosis was achieved more often in renal transplant patients than in patients with hematological malignancies (85% versus 28%). Culture (bacteria, virus, fungi), staining and microscopy (bacteria, fungi, Pneumocystis carinii (PC)) and antigen detection by indirect immunofluorescence (cytomegalovirus (CMV), respiratory viruses, PC, Legionella) were used for diagnosis. On 20 occasions transbronchial biopsies with histopathologic examination were performed. In addition, serology comprising the herpes group (HHV-6) and respiratory viruses was done. A microbial diagnosis was obtained on 45% of occasions. The most common pathogens found were CMV (31%) and PC (25%). On 22 (33%) occasions a rapid diagnosis of 1 or more microbial agents was obtained within 24 h by conventional staining or indirect immunofluorescence. The clinical relevance of findings of CMV, HHV-6, and Epstein-Barr virus in BAL by polymerase chain detection on 18, 6 and 3 occasions is discussed. On 4 occasions pathogenic bacteria were found. It was not possible to relate findings of coagulase-negative staphylococci, alpha-streptococci and Candida albicans to the pulmonary infection.

Adolescent↗
PubMed1995

Occurrence of pleural plaques in workers with exposure to mineral wool.

The objective of this study was to investigate whether occurrence of pleural plaques is associated with exposure to mineral wool. The occurrence of pleural plaques on routine chest radiographs of 933 persons employed in the mineral wool manufacturing industry and 865 referents was compared. Twelve men from the mineral wool industry had pleural plaques, as against three of the referents (P > 0.05). The occurrence of pleural plaques among men in the mineral wool industry was not associated with an increased exposure to mineral wool or with length of time between start of employment and time of chest radiograph. The results do not support the notion that inhalation of man-made mineral fibers causes pleural plaques. It must, however, be conceded--keeping in mind the limits imposed by the study size--that nor do they provide grounds for refutation of such a hypothesis.

Adolescent↗
PubMed1995

Asbestos-related radiographic changes by ILO classification of 10 x 10 cm chest X-rays in a screening of the general population.

A sample of 1388 10 x 10 cm chest X-rays from a previous population screening of males aged 40+ years were reevaluated by use of the ILO classification. There were 1036 films of subjects from an industrialized town, and 352 from a rural community. The observed rates of parenchymal changes (profusion > or = 1/0) at the reevaluation were 1.3% in the urban community and 3.4% in the rural community. The corresponding figures for pleural changes were 5.0% and 0.6%, respectively. Based on additional questionnaire information on asbestos exposure, it was found that the radiographic changes were probably related to past asbestos exposure for 2.3% of the subjects from the urban community and 0.6% from the rural community. In cases of asbestos-related illnesses the mean time since first exposure to asbestos was 35.9 years, whereas the mean duration of the exposures was 11.4 years. The results seem to indicate that the ILO reassessment of the radiographs was more sensitive in detecting pleural changes than the previous clinical screening of both small and large films.

Adult↗
PubMed1995

Large emphysematous bullae. Successful treatment with thoracoscopic technique using fibrin glue in poor-risk patients.

Five patients with poor lung function (FEV1, 0.8 to 1.0 L; MVV, 27 to 36 L/min) and large emphysematous bullae were operated on. Fibrin glue was introduced into the bullae through a thoracoscope. The results have been excellent and no serious perioperative or postoperative complications have occurred. The patients have all improved clinically and are very satisfied with the results. Postoperatively, FEV1 was between 1.0 and 1.2, and MVV was 30 to 52 L. The clinical improvement was, however, larger than these figures illustrate. Our preliminary experience using this technique suggests that it can be used in patients with very low lung function with a minimal risk. We propose that all patients with severe emphysema should be screened for bullous components because improvement might be possible by operation with this minimally traumatizing technique.

Aged↗
PubMed1995

Pleural malignancies including mesothelioma.

Malignant mesothelioma is caused almost exclusively by occupational exposure to asbestos. During the past few years, however, increasing evidence has mounted that background exposure to asbestos could be sufficient to cause mesothelioma. Treatment of malignant mesothelioma remains a big problem. Some new approaches are on their way, and the most exciting ones are local immunotherapy in very early cases. Some success has been reported with local interferon treatment. As for treatment of metastatic pleural disease, the main purpose is symptomatic relief of dyspnea caused by fluid accumulation. The best way to achieve a lasting palliation is pleurodesis, and the most common way to do this, is by chemical means. The drug of choice in the United States has for many years been tetracycline, but since injectable tetracycline is no longer available, some substitute must be found. The substance that will "win" is not yet clear, but the two leading contestants are talc and doxycycline. Bleomycin also has its supporters, and a dark horse is quinacrine, which although not easily available in the United States, has been used in many European centers for decades.

Asbestosis↗
PubMed1994

The human evidence: parenchymal and pleural changes.

Asbestos inhalation can cause fibrotic reactions both in the lung parenchyma and in the pleura. The incidence and relative proportions of these lesions in any cohort will be dependent on: (1) the time factor: both asbestosis and pleural plaques are progressive diseases and the longer the time from exposure, the more the changes; (2) the dose-response: the more intense the exposure, the earlier and the more advanced is the asbestosis. However, pleural plaques are only moderately dependent on the exposure level and will occur after approximately 30 years in most persons who develop them, even after fairly low exposure; (3) the early lesions are difficult to diagnose radiologically and are prone to overdiagnosis. Considerable caution is necessary when evaluating results if only such lesions are reported. It is generally accepted that the occurrence of radiological asbestosis is a risk factor, particularly for bronchial carcinoma. However, pleural plaques have been considered to be relatively harmless. Recent data have indicated, however, that they can be indicators of sufficient exposure to increase the risk of other asbestos-related diseases, including lung cancer and mesothelioma.

Asbestos, Serpentine↗
PubMed1994

Pleural plaques and risk for bronchial carcinoma and mesothelioma. A prospective study.

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.

Adolescent↗
PubMed1994

Excessive daytime sleepiness and fatigue in nonapnoeic snorers: improvement after UPPP.

Even in the absence of sleep apnoea, heavy snoring may be a cause of excessive daytime sleepiness (EDS) and fatigue. The aim of this investigation was to study whether uvulopalatopharyngoplasty (UPPP) is effective in relieving snoring and excessive daytime sleepiness in nonapnoeic snoring patients. UPPP was assessed in 155 nonapnoeic, snoring patients (136 men and 19 women, mean age 45 yrs). Postoperative evaluation was made after 3 months in 105 patients, and after 12 months in 50 patients. Fifty four patients were evaluated after both 3 and 12 months. In 49 patients, a further evaluation was made after 2 yrs. The results were compared with those of 76 conservatively-treated, nonapnoeic, snoring patients, who were reinvestigated 12 months after their initial examination. The proportion of patients with frequent loud snoring had decreased postoperatively from 96 to 18%. A highly significant improvement was reported in EDS and daytime fatigue. The proportion of patients who reported problems staying awake when driving had decreased from 29 to 7%, and the number who felt rested when awakening in the morning had increased from 23 to 78 after the operation. The patients in the UPPP group had somewhat more severe symptoms before treatment than those treated conservatively. One year after treatment the situation had been reversed, with significantly more snoring and excessive daytime sleepiness in the conservatively-treated group. In conclusion, these results indicate that UPPP is effective in relieving snoring and EDS in nonapnoeic snorers.

Adult↗
PubMed1993

Diagnosis of cytomegalovirus in bronchoalveolar lavage by polymerase chain reaction, in comparison with virus isolation and detection of viral antigen.

Bronchoalveolar lavage (BAL) products from 52 immunocompromised patients with symptoms of pulmonary infection was examined for cytomegalovirus (CMV) by virus isolation, polymerase chain reaction (PCR) and detection of CMV antigen by immunofluorescence or immunoperoxidase staining after short-term incubation in tissue culture and directly in BAL cells. We found that PCR detected all cases positive by virus isolation (15/52 samples) and the result was obtained within 5 h. PCR detected more cases of CMV than did virus isolation (22/52 samples). Positive PCR and negative virus isolation were consistent with probable CMV infection in 3/7 patients when other clinical and laboratory parameters of CMV infection were considered. The negative predictive value of PCR was high; none of 30 patients negative by PCR developed CMV pneumonia within the subsequent 2 months. Detection of CMV antigen after short-term incubation was rapid enough to be used in clinical practice, specific (100%) and with a sensitivity of 60%. Demonstration of CMV antigen in alveolar cells was highly specific (100%) but had too low a sensitivity (26.7%) to be used as the only rapid method. Our conclusion is that a combination of PCR and detection of CMV antigen after short-term incubation and directly in alveolar cells is optimal for rapid identification of CMV.

Adolescent↗
PubMed1992

High frequency of IgM antibodies to coxsackie B virus in sarcoidosis patients and patients with asbestos-related lesions.

By using radioimmunoassay (RIA) for detection of IgM antibodies to Coxsackie B viruses (CBV), the occurrence of these antibodies was investigated in patients with sarcoidosis and asbestos-related lesions. Sixty-one per cent of the patients with sarcoidosis, all patients with benign asbestos pleural effusion, and 67% of those with diffuse asbestos-related pleural thickening showed CBV-IgM. Patients with healed sarcoidosis or pleural plaques were all negative, and among the "healthy" controls seven per cent had CBV-IgM. Thus, there was a high frequency of CBV-IgM in patients with sarcoidosis and in those with asbestos-related diseases. Since the titres could be the effect of an unspecific polyclonal stimulation of the B cells, sera were tested for antibodies to rubella and cytomegalovirus, but without any remarkable results.

Adult↗