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Biomedical subjects

G Hillerdal

Publications and source records attributed to G Hillerdal.

At least 109 records · Page 6Linked to original sources
PubMed1982

Infectious mediastinitis with an aortic aneurysm. A surgically treated case.

A patient presented with fever and a mediastinal mass. Aortography revealed a small aneurysm within the mass. At thoracic surgery a mediastinal abscess with a ruptured aortic aneurysm was found. The resected part of the aorta was successfully replaced with a graft and the patient survived for ten days, finally succumbing from the grave infection but with a functioning graft. Multiple sections revealed a necrotic tumour with solid cancer cells from an undifferentiated carcinoma, explaining the pathogenesis of the mediastinitis as well as the lack of cure with antibiotic treatment.

Abscess↗
PubMed1982

Asbestos exposure and aspergillus infection.

Four cases of asbestos-related changes of the lung complicated by aspergillus infection are described. In such cases, the resulting clinical and radiological picture can give rise to some confusion. It is suggested that exposure to asbestos leads to changes in the bronchi and the lung parenchyma which can facilitate growth of the fungus. It is also possible that asbestos can affect the immune system in such a way that the body's anti-fungal defences are weakened. The aspergillus infection can mimic a tumor and/or lead to obstructive symptoms, and in one of the cases described an infected empyema was found.

Aged↗
PubMed1981

Reference values for respiratory function tests in males: prediction formulas with tobacco smoking parameters.

Prediction equations for respiratory function tests were obtained by multiple regression of data from 263 healthy males. The material was evenly distributed in the ages 20-70 years, about one third each of non-smokers, smokers and ex-smokers. Measurements were done of lung volumes (with body plethysmograph), airways resistance, ventilatory capacity including flow-volume registration, gas distribution and closing volume, transfer factor and static elastic recoil pressures of the lung with calculation of static compliance. The parameters age, height, weight, years of tobacco smoking and grams of tobacco smoked each day showed significant correlation with the outcome of the test in most of the respiratory function tests. Therefore a set of basic regression equations including these parameters were calculated. In addition an 'extended' set of equations was calculated for prediction of some tests with inclusion of nonlinear terms and the parameter 'years of abstinence from smoking.' The reduction in variance which followed inclusion of tested parameters was moderate (20-69%). There were significant differences between results of the present study and several previously published regression formulas.

Adolescent↗
PubMed1981

Pulmonary aspergillus infection invading the pleura.

During a 10-year-period, six patients with non-postoperative aspergillus infection of the pleura were seen. In all patients a pulmonary aspergillus infection had been present for some years. The fungus invaded the pleura, causing a bronchopleural fistula and a cavity in the pleural space. A prerequisite for the pleural aspergillosis was that the lung and pleura were previously damaged, usually by therapeutic pneumothorax for active tuberculosis some decades earlier. The fungus can cause destruction of the lung and death of the patient from the chronic infection unless treated. The best treatment is early excision of the pleura with resection of the upper lobe or if necessary the whole lung. To reduce the risk of postoperative aspergillus empyema, the patient should be treated with antifungal agents before and after operation. In inoperable patients, local antifungal treatment may clear the infection but is not always effective.

Aged↗
PubMed1981

Non-malignant asbestos pleural disease.

During a 10-year period (1970-79) all patients in Uppsala County found to have pleural changes related to asbestos exposure were followed. The lesions could be divided into four types: parietal pleural plaques, exudative pleurisy, thickening of the visceral pleura, and progressive pleural fibrosis. There were 891 cases. The most common type was parietal plaques, which was seen in 827 patients, some of whom later developed other changes. In 22 types exudation was proven radiologically, and in 84 more cases obliteration of the costo-phrenic angle was seen. The exudations almost all had a benign course, despite sometimes fairly large and bloody effusions. They were practically all symptom-free, being a surprise finding on chest radiography. Thickening of the visceral pleura can only be seen radiologically in the fissures and occurred in a few cases in addition to other changes. In a small group of more heavily exposed individuals, a progressive pleural fibrosis developed, sometimes after an initial effusion.

Adult↗
PubMed1981

Increased lung stiffness of persons with pleural plaques.

Forty-five men with asbestos-related pleural plaques detected at a health screening centre were investigated with measurement of lung volumes, airways resistance, ventilatory capacity, transfer factor, gas distribution, closing volume and static recoil pressures of the lung. The men were subjectively healthy, had confirmed exposure to asbestos and had normal chest radiograms apart from the presence of pleural plaques. Most of the men had been exposed to small or moderate amounts of asbestos with a mean duration of 39 years since first exposure. Sixty-seven per cent of the men were smokers or ex-smokers. The lung function was evaluated using regression formulas which included smoking variables. The results clearly demonstrate the presence of lung parenchymal involvement with increased stiffness of the lungs and decreased lung volumes. The change in elastic recoil pressure of the lungs, in total lung capacity and residual volume show significant correlation with measures of asbestos exposure and extent of pleural changes. No synergistic effects between tobacco smoking and asbestos exposure on lung function could be demonstrated. Measurements of the static elastic lung recoil (Pst(max) and Cst/TLC) and total lung capacity were the most sensitive tests for separating the pleural plaque carriers from the controls.

Aged↗
PubMed1981

Lung cancer: is the etiology changing?

A 16-year study of lung carcinomas seen at the Department of Pulmonary Medicine in Uppsala, Sweden, was studied retrospectively. The material was divided into four 4-year periods, which were compared with respect to the occurrence of pleural plaques, occupational and smoking history, and histological type of tumor. There were 205 women and 897 men with acceptable x-rays of the chest. Of the women, 27% of those up to age 70 were smokers in the first period and 70 in the last. Among men, the smoking habits remained the same with 95-97% smokers or exsmokers. Asbestos exposure, as judged from the pleural plaques and the occupational history, showed a highly significant increase among the men during the period. Only one of 77 patients with pleural plaques had never smoked. Tobacco thus remains the main carcinogen for lung cancer, but seems to be increasingly dependent on cocarcinogens. Among men with pleural plaques, there were relatively more adenocarcinomas than expected.

Adenocarcinoma↗
PubMed1980

Hard metal lung disease: importance of cobalt in coolants.

Four patients were found to react to occupational exposure to grinding of hard metal (tungsten carbide). Three of the patients had symptoms and signs compatible with an allergic alveolitis, the symptoms disappearing and the chest radiograph clearing when they were absent from work for a few months. Re-exposure to the offending agent led to new signs and symptoms. The first patient was re-exposed twice and each time reacted a little more seriously. After the last episode her chest radiograph has not cleared completely, in contrast to the first two times. The fourth patient had more typical occupational asthma. All the cases occurred in the part of the factory where air concentrations of cobalt were the lowest. The cobalt there is dissolved in the coolant necessary for grinding the hard metal. It occurs mainly in the ionised form, which is known to react with proteins and therefore presumably acts as a hapten. Protective measures, including choosing a coolant with minimal ability to dissolve cobalt and an effective exhaust system, should minimise the risk of this occupational disease in the future.

Aged↗
PubMed1980

Laryngeal cancer and asbestos.

A 10-year material of laryngeal carcinomas was studied retrospectively. The chest X-rays were examined for pleural plaques (PP), which are a reliable sign of earlier asbestos exposure. In 14 of 156 available chest X-rays typical PP were found; a significantly higher incidence that expected in the region (p less than 0.001), but in agreement with earlier studies, which are reviewed. It is suggested that all patients with laryngeal carcinoma should be questioned about exposure to asbestos, and that in patients occupationally exposed to asbestos, the occurrence of laryngeal carcinoma should be considered an occupational disease.

Adult↗
PubMed1980

Pulmonary pseudotumours and asbestos.

Ten patients are described in whom a localized reaction in the visceral pleura developed comparatively rapidly, involving parts of the underlying lung parenchyma, forming an atelectatic pseudotumour. The lesions were mistaken for pulmonary malignancy, leading to thoracotomy in 5 patients. It is suggested that these lesions can occur many years after exposure to asbestos and that they are sequelae of benign pleurisy. Computer tomography is of great value in these cases and may obviate thoracotomy.

Adult↗
PubMed1980

The pathogenesis of pleural plaques and pulmonary asbestosis: possibilities and impossibilities.

None of the various existing theories on the pathogenesis of pleura plaques (PP) is able to explain their peculiarities. Knowledge of physiology of the lung and pleura and in particular its lymphatic system as well as cellular activities when the cells are exposed to asbestos is necessary when discussing these problems. Short asbestos fibres when phagocytosed by macrophages will activate these cells to produce various substances, among them a factor that will stimulate fibroblasts to produce more collagen. Some of the small fibres will spread towards the visceral pleura of the lung, just like all inhaled dusts. Once in the visceral pleura, some of them will penetrate to the pleural space. There, they will follow the normal lymph flow from the pleural space, which is exclusively through the parietal pleura. Finally, in passing through the parietal pleura, a portion will remain in macrophages there, causing a low-grade stimulation of the submesothelial fibroblasts. After some decades, this will result in visible PP.

Animals↗
PubMed1980

Pleural plaques: correlation of autopsy findings to radiographic findings and occupational history.

An investigation was made to correlate autopsy findings of pleural plaques (PP) with the occupational history and findings of such plaques at X-ray before death. A good correlation was found between occupation and occurrence of PP at autopsy. Using strict criteria, 12.5% of all PP observed at autopsy, including small ones, were visible at X-ray. Almost half (3 of 8) of the widespread changes found at autopsy were seen on the X-rays. With more liberal roentgenological criteria 11 of the 24 cases were noted, but there were also 15 false positives.

Adult↗