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Biomedical subjects

G Hillerdal

Publications and source records attributed to G Hillerdal.

At least 55 records · Page 3Linked to original sources
PubMed1991

Hyaluronan in pleural effusions and in serum.

It has been suggested that a high level of hyaluronan (hyaluronic acid, HYA) in pleural fluid is an indicator of malignant mesothelioma. In 78 consecutive patients with pleural effusion of various causes the HYA concentration was measured in pleural fluid samples and in serum. Nine patients had malignant pleural mesothelioma, and in three of them the HYA level in pleural fluid was 100 mg/l or more. In 42 patients with effusions due to metastatic malignancy, the mean HYA in the pleural fluid was 75 mg/l, and in five the HYA level was above 100 mg/l. Cardiac insufficiency caused the effusion in 11 patients, of whom two had a level above 100 mg/l in pleural fluid. Four patients had a serologically confirmed viral infection and had HYA levels in pleural fluid of 8, 157, 335, and 554 mg/l, respectively. One patient had postinfectious effusion with an HYA level in pleural exudate of 748 mg/l, the highest in this investigation. Two patients had benign asbestos pleural effusions, and both had high pleural HYA levels (256 and 490 mg/l, respectively). The serum HYA values were much lower than in the pleural fluid, namely from 15 to 480 micrograms/l; the levels were independent of the levels in the pleural fluid. Thus, a high level of HYA in pleural fluid is not specific for mesothelioma but can occur in other malignant or benign diseases, and a low level does not exclude mesothelioma.

Aged↗
PubMed1991

Pleural lesions and the ILO classification: the need for a revision.

The ILO system for radiographic classification of pneumoconioses is a very important epidemiological tool. Unfortunately, the classification is not precise for pleural lesions, which are especially important for evaluation of asbestos-related diseases. The classification cannot separate extrapleural fat from diffuse thickening of the pleura, nor large plaques from diffuse thickening. In this paper, a short review of the different lesions are given and a revised scheme is suggested. This scheme includes as separate lesions: pleural fat; lesions of the parietal pleura, i.e., pleural plaques; and lesions of the visceral pleura, i.e., diffuse thickening and rounded atelectasis. The extent and width, as in the present ILO scheme, could be abolished.

Evaluation Studies as Topic↗
PubMed1991

Symptoms in heavy snorers with and without obstructive sleep apnea.

Five hundred and eighty persons who were heavy snorers filled in a questionnaire regarding symptoms on a 5-grade scale. Of these, 178 had a complete polysomnography investigation while 402 patients underwent oxymetric screening during the night only. On the basis of these investigations. 217 were classified as suffering from the obstructive sleep apnea syndrome (OSAS) and 363 as snorers without OSAS. The symptom scores differed between the two groups, but the range was wide and some persons with OSAS claimed only minor daytime sleepiness, somnolence, etc., while a high proportion of persons without OSAS frequently suffered from such symptoms. Thus, it was not possible to discriminate between patients with and without OSAS on the basis of their symptoms only. Furthermore, there are many persons who are "only" heavy snorers but who have symptoms that affect their career and social life and who so far have only received scant interest from the medical profession. Excessive daytime sleepiness and somnolence thus do not seem to be secondary to hypoxemia at night but rather to poor quality of sleep, which may be the case in association with heavy snoring even without appreciable deterioration of oxygen saturation.

Adult↗
PubMed1990

Asbestos-related lesions of the pleura: parietal plaques compared to diffuse thickening studied with chest roentgenography, computed tomography, lung function, and gas exchange.

Lung function tests, tests of working capacity with gas exchange, and computed tomography (CT) with density measurements with the patient supine and prone were performed in 23 males with asbestos-related bilateral pleural lesions. Two had pulmonary asbestosis grade 1/0 or more; all the others had normal lung parenchyma. On x-ray, the pleural lesions were divided into plaques involving only the parietal pleura There was a and diffuse pleural fibrosis of various degrees involving the visceral pleura. There was a good correlation between the findings at plain chest roentgenography and CT, but more lesions were seen on the CT scan. However, a few pleural plaques seen on conventional films were not observed at CT. Individuals with plaques had slightly lowered lung function compared to reference subjects. Bilateral diffuse pleural fibrosis was associated with a marked decrease in pulmonary function. The two patients with radiologically evident pulmonary asbestosis were found in this group. Decreased lung function was also observed in subjects with pleural fibrosis of only grade 1 (involving less than one fourth of the hemithorax) and a normal exercise capacity. The study shows the importance of differentiation between various asbestos-related pleural lesions.

Adult↗
PubMed1990

Pleural and parenchymal fibrosis mainly affecting the upper lung lobes in persons exposed to asbestos.

From the County of Uppsala, Sweden, more than 1600 persons with pleural plaques and/or asbestos-related pleural thickening have been seen at the Uppsala University Hospital during a period of about 15 years. During the observation time, 40 patients developed lesions mainly affecting the upper lobes of the lung. They were all men, 41 to 78-years-old, and all had been occupationally exposed to asbestos. The mean latency time from the first exposure was 34 years. The mean width of the apical pleural thickening was 21 mm. In 21 patients the lesions were on the right side, in 15 they were bilateral, and in only four patients was the left side alone affected. Biopsies from the pleura were available in twelve patients and from the lung parenchyma in eight. The biopsies of the lungs all showed varying degrees of asbestosis and of the pleura nonspecific pleuritis. The lesions tended to progress and in all cases except one they were part of a diffuse pleural and parenchymal fibrosis involving the rest of the lung. Consequently, the pulmonary function was impaired, with the vital capacity reduced to an average of 62% and total lung capacity to 68% of the predicted value. In many patients there was contraction of the upper lobe and deviation of the trachea towards the same side. Upper lobe changes are a relatively rare complication of exposure to asbestos but are important to recognise. Other possible causes of upper lobe changes such as tuberculosis must always be excluded before the diagnosis is made.

Adult↗
PubMed1990

Prospective clinical and radiologic study of zeolite-exposed Turkish immigrants in Sweden.

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.

Adolescent↗
PubMed1990

Preservation of the human cochlea with two different fixatives.

The cochlear morphology of eight inner ears from 4 patients was studied by electron microscopy. The perilymphatic perfusion was performed in 2 of them 2 and 2 1/2 h and in 2 others, 10 and 11 h post mortem. In each patient, Karnovsky's fixative was used in one ear and Britta's fixative in the other. No structural differences between the two ears were ascertained in the patients with a short post-mortem fixation time. The cochleas with 2 h post-mortem fixation time were better preserved than those with the 10 and 11 h delay. The cochleas with the longer delay from death to perilymphatic perfusion were still fairly well preserved. However, in these cochleas the stronger fixative (Britta's fixative) gave a better preservation.

Aged↗
PubMed1990

Hearing and cochlear morphology in patients treated with a combination of cytostatics.

Patients with small-cell carcinoma of the lung were treated at the Department of Lung Medicine. They all received the same combination treatment with repeated doses of doxorubicin, vincristine, cyclophosphamide and methotrexate. In 26 patients, hearing was tested with repeated audiograms during treatment. The follow-up time varied between one and 19 months (mean, 6 months). There was no significant impairment of hearing during the follow-up period. Postmortem fixation of the temporal bones was performed in 7 patients and the cochlear morphology studied. No specific alterations in cochlear morphology which could be attributed to the cytostatics were found.

Adult↗
PubMed1990

Association between exposure to asbestos and pleural effusion. Results from a questionnaire study of 31,000 persons.

All visitors to a general health survey in 1979, 17,140 men and 14,371 women, completed a questionnaire on smoking habits, exposure to asbestos, silica and welding fumes, and diseases such as pleural effusion, pneumonia, cough, asthma and diabetes. Seven per cent of the men reported exposure to asbestos, 10% to welding fumes, and 6% to silica. Among those who reported work related dust exposure there was a higher proportion of smokers, and smokers exposed to dust smoked more tobacco per day than non exposed smokers. In the group of men 30-59 years of age, who did not indicate exposure to occupational pollutants 2.7% reported previous pleural effusions. However, among asbestos exposed men of the same ages, the prevalence was more than doubled (5.7%, p less than 0.01). This finding was highly significant in a logistic regression model where age and smoking habits were included. The data indicate that 10% or more of diagnosed cases of pleurisy could be associated with previous asbestos exposure.

Adult↗
PubMed1990

[Knowledge of carcinogenic and immunologic findings caused by the zeolite fiber erionite].

Prompted by the unusually high death rate from cancer of the lungs, in 1975 in the Middle-Anatolian village of Karain, later in two other villages, X-ray screening investigations were carried out. These revealed pleural mesotheliomas similar to those seen following exposure to asbestos, although no asbestos was found neither in the village itself or in its immediate surroundings. Minerological tests and examinations of the lungs of the deceased, together with animal experiments involving dust obtained from the village itself, performed in 1980, demonstrated that erionite, a fibrous zeolite is responsible for tumour lesions in the lungs and pleura. Early stages of this tumour located in the pleura were also found in a group of Karain inhabitants working in Sweden. On the basis of the examination results, an immune deficiency that did not correlate with age, sex or duration of exposure was found, and thus cannot readily be classified as an epiphenomenon. Since fibrous zeolites are frequently employed in industry, industrial hygiene and occupational medical consequences need to be drawn.

Aluminum Silicates↗
PubMed1989

Rounded atelectasis. Clinical experience with 74 patients.

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

Adult↗
PubMed1988

Infection with Rhodococcus equi in a patient with sarcoidosis treated with corticosteroids.

A 51-year-old female farmer was diagnosed as having sarcoidosis. During 4 years of observation, slow radiological progression was observed. Cough then developed, necessitating treatment with corticosteroids. After 28 months of continuous treatment with prednisolone in low doses (5-7.5 mg daily), she suffered fever episodes, recurrent haemoptyses, general malaise and loss of weight. A chest roentgenogram showed a left upper lobe infiltrate, which progressed and finally cavitated, and rib destruction. Despite efforts, including a thoracotomy, 22 months passed before a diagnosis could be made. Blood and sputum cultures and cultures from the destroyed rib showed growth of Rhodococcus equi, a common soil organism which can cause infections in foals and other animals. Treatment with rifampicin and erythromycin was successful. R. equi has been reported to cause infection in patients with neoplastic disease and/or immunosuppression, but the disease might be more common than is suggested by the sparse case reports in the literature, owing to lack of familiarity with the organism, which will tend to be overlooked as a contaminant.

Actinomycetales Infections↗
PubMed1988

Phenotypes of peripheral blood lymphoid cells in patients with asbestos-related pleural lesions.

Asbestos-related parietal pleural plaques develop slowly and are of little clinical significance. Other asbestos-related pleural reactions, for example acute exudative pleurisy and progressive pleural fibrosis, are of clinical importance. The pathogenesis of these reactions is unknown, but one hypothesis is that immunological disturbances are involved. To investigate this hypothesis a phenotypic characterization of lymphoid cells was performed in the peripheral blood of 45 patients with asbestos-related pleural lesions; 20 with pleural plaques (PP), 15 with diffuse pleural fibrosis (DPF), and 10 with benign asbestos pleural effusion (BAPE). Twenty-four healthy blood donors were used as controls. All asbestos groups together had a significantly higher percentage of B-cells than the controls. The percentage number of "helper/inducer" T-cells was significantly lower in the BAPE and DPF groups than in the control and PP groups. Thus, significant aberrations in peripheral blood lymphoid cells were found in patients with DPF and BAPE. This differed from patients with PP only who were similar to normals.

Aged↗