The effect of asbestos-induced pleural fibrosis on pulmonary function: quantitative evaluation.
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Asbestos↗
Biomedical subjects
J Godbold
Publications and source records attributed to J Godbold.
Radiographic abnormalities in asbestos insulators: effects of duration from onset of exposure and smoking. Relationships of dyspnea with parenchymal and pleural fibrosis.
Chest radiographs and spirometry were evaluated in 2,907 active and retired asbestos insulators; most (86.8%) had greater than or equal to 30 years from onset of asbestos exposure. Testing was performed in 19 cities in the United States during 1981-1983. Complete demographic, smoking, clinical, and radiologic data were obtained for 2,790 workers. This is the largest single group of insulators that has been studied. Five hundred forty-eight (19.7%) had never smoked cigarettes, 942 (33.9%) were current cigarette smokers, and 1,300 (46.6%) were ex-smokers. Only 439 (15.7%) workers had no radiographic evidence of asbestos-related disease (normal chest X-ray); 668 (23.9%) had pleural fibrosis only, 325 (11.6%) had parenchymal fibrosis alone, and 1,358 (48.7%) had both parenchymal and pleural fibrosis. The prevalence of radiographic parenchymal changes increased significantly (p less than .001) from 38.6% (DURONSET less than 30 years) to 70% (greater than or equal to 40 years). For pleural changes the comparative prevalences were 55% and 82%. Those with no history of cigarette smoking were more likely to have normal films than those with a history of smoking (19.2% versus 14.4% for current smokers and 15.2% among ex-smokers), and were less likely to have parenchymal fibrosis (44.5% versus 69.7% for current smokers and 60.2% of ex-smokers). Dyspnea, MRC grade 3 and higher, was more prevalent when pleural fibrosis was associated with interstitial pulmonary fibrosis (at all profusion levels of small opacities) than when pleural fibrosis was absent. Logistic regression analysis of factors contributing to such dyspnea showed that the presence of combined parenchymal and pleural abnormalities was a significant explanatory variable, in addition to age, smoking, and body mass (Quetelet index); the presence of parenchymal changes only or of pleural changes only, as factors contributing to dyspnea, did not reach the level of statistical significance in the regression analysis. The results of these examinations show that pleural fibrosis is a frequent finding in asbestos-exposed groups with long-term follow-up and that its functional significance is not negligible. The contribution of cigarette smoking to prevalence and severity of interstitial fibrosis is an additional reason for smoking cessation among asbestos-exposed individuals.
Adult↗
Pulmonary function and pleural fibrosis: quantitative relationships with an integrative index of pleural abnormalities.
Pleural fibrosis due to asbestos exposure was fully appreciated considerably later than pulmonary interstitial fibrosis due to similar exposure. This is well exemplified by the fact that pleura face on was included in the International Labour Office's International Classification of Radiographs of Pneumoconioses only in the last revision of the Classification. The functional relevance of pleural fibrosis, in particular circumscribed pleural fibrosis, has remained controversial. Since pleural fibrosis can occur at various sites (diaphragmatic plaques, chest wall in profile and face on, mediastinal) and can be of different thickness and extent, a comprehensive integrative assessment of pleural fibrosis was undertaken in order to permit a quantitative study of relationships between pleural fibrosis and pulmonary function. This approach was used for chest X-ray films of 1,584 asbestos insulation workers examined (1981-1983); 1,185 (75%) had pleural fibrosis. The distribution pattern of the integrative pleural index was found to be different in the subgroup with circumscribed (n = 975) from that with diffuse (n = 197) pleural fibrosis, with a higher profusion of high INDEX values in the latter. Stepwise regression analysis indicated that there was a significant inverse relationship between forced vital capacity (FVC) and the integrative index of pleural fibrosis in the subgroup with circumscribed pleural fibrosis. In the subgroup with diffuse pleural fibrosis, the obliteration of costophrenic angle(s), even with pleural fibrosis of limited extent, resulted in marked decrement in FVC% predicted; higher values of INDEX did not result in additional significant reductions of FVC. In those with both parenchymal and pleural abnormalities (n = 862) the pleural index was found to make a significant contribution, independent of that of parenchymal abnormalities, to decrements of FVC. Since pleural fibrosis has gradually become the predominant radiologically detectable abnormality in asbestos exposed workers, establishing its quantifiable functional relevance is useful.
Adult↗
Two decades of increasing mortality from Parkinson's disease among the US elderly.
To examine the possible role of environmental factors in the cause of Parkinson's disease (PD), we reviewed mortality trends for PD in the United States from 1962 through 1984. We found that age-specific mortality for PD in all demographic groups had changed notably during this 23-year interval. Among whites of both sexes, substantial declines were observed among the middle-aged, while notable increases were seen in the geriatric age groups. Similar changes were found in nonwhites; among nonwhites in the geriatric age range, increases of 22% to 553% were observed among women. Men generally had a 100% higher risk of death due to PD than did women. Whites were at three times the risk of nonwhites. The observed temporal changes appear to reflect improved treatment, better case ascertainment, and a true rise in the incidence of PD, particularly among the elderly. This rise may be due to preventable environmental causes and will require further investigation.
Aged↗
Rising mortality from motoneuron disease in the USA, 1962-84.
From 1962 to 1984, age-specific mortality for motoneuron disease (MND) in the United States rose in all demographic groups over the age of 40. The increase was seen in both men and women, and both whites and non-whites, and was most pronounced in the elderly (eg, 378% in white women aged 80-84 years). Men were at 50% higher risk than women, and whites had twice the risk of non-whites. These increases may reflect an improvement in case ascertainment, but they also seem to show a true rise in the incidence of MND, particularly among the elderly. Such an increase suggests an environmental aetiology.
Adult↗
Effect of tobacco smoking on the presence of asbestosis at postmortem and on the reading of irregular opacities on roentgenograms in asbestos-exposed workers.
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Asbestosis↗
Low-grade soft tissue sarcomas of the extremities. Analysis of risk factors for metastasis.
Of 130 patients with low-grade localized soft tissue sarcomas of the extremities treated at Memorial Hospital between 1968 and 1978, 18 (14%) developed metastases. The risk of metastasis could not be predicted by the clinical or pathologic size, tumor depth, proximal location, recurrence before presentation or subsequent to treatment at our institution, the type of surgical and adjuvant therapies, and the adequacy of surgical margins. The median age of patients with metastases was 10 years older than the other patients (57.5 years and 47.5 years, respectively). Of the more common sarcomas in this study, malignant peripheral nerve tumors and malignant fibrous histiocytomas had the highest prevalence of metastasis (27% (three of 11) and 17% (three of 18), respectively). Although patients with low-grade extremity sarcomas treated during the first 5 years of this review had an increased rate of metastasis, no other patient, tumor, or treatment variable examined significantly differed between the two time periods. Although grade alone is a good predictor of the risk of metastasis from soft tissue sarcomas of the extremity, 14% of patients in this series with low-grade histology developed metastases. Further review of larger numbers of these tumors should be undertaken in an effort to more definitively identify risk factors predictive of metastatic potential in low-grade sarcomas.
Age Factors↗
Rectal epithelial cell proliferation in a group of young adults. Influence of age and genetic risk for colon cancer.
Twenty-one medical students with an average age of 23.3 +/- 1.5 years and no family history of large bowel cancer had a rectal biopsy taken for in vitro incorporation of tritiated thymidine (3HTdR). The number and position of labeled epithelial cells in this group was compared with an older control group of 12 and two groups of individuals at high risk for colon cancer. The latter were (1) 18 young asymptomatic individuals from familial colon cancer families without polyposis with a 50% risk for colon cancer, average age 24.1 +/- 3.7; and (2) 17 older individuals with the same genetic background and risk factor, average age 53.8 +/- 10.2 years. A group of 20 young individuals from cancer-free branches of familial colon cancer kindreds with a 25% risk for colon cancer, average age 23.1 +/- 3.6, also was studied. No overall differences in labeling index (LI) were found among the young groups, i.e., the control versus the low risk or high risk. The range of LI values was narrow regardless of risk. However age was associated with a significant increase in LI as observed among older controls and the 50% risk group as compared to younger persons; the range of LI values was wider among the older groups regardless of risk. Concerning the distribution of DNA-synthesizing cells, young controls had significantly more S-phase cells in the lower third of the crypts than either young high-risk or low-risk groups (P less than 0.05). Similarly, young controls had significantly fewer labeled cells in the middle third than the young high-risk group and young controls had significantly fewer S-phase cells in the upper third than did young low-risk or high-risk groups. When young and old members of the same group were pooled, the control group had the highest percentage of labeled cells in the lower third of the crypt (62.5%) which was significantly higher than both the low-risk (53.7%) and the pooled high-risk groups (51.6%). For the upper third of the glands, the low-risk (7.6%) and the pooled high-risk groups (6.8%) were significantly different from the controls (3.3%). Thus initial risk for colon cancer is more related to the distribution of S-phase cells than to their number, i.e., LI. Risk appears to be related to more DNA-synthesizing cells in the upper crypt, an indication that relatively early on in life the DNA switch-off mechanism shows signs of being defective.
Adult↗
Soft-tissue sarcoma: initial characteristics and prognostic factors in patients with and without metastatic disease.
Five hundred and sixty-five patients with soft-tissue sarcoma were admitted to Memorial Sloan-Kettering Cancer Center from July 1, 1982 to July 1, 1985. Clinical and pathologic factors were analyzed to identify initial characteristics and to determine factors associated with prognosis and the development of metastasis. In decreasing order of frequency, the most common sites of primary tumor were the extremity (51.1%), retroperitoneum/viscera (28.8%), trunk (15.9%), head and neck (3.7%) and breast (0.4%). The most common histologic types were liposarcoma (21.4%), malignant fibrous histiocytoma (20.2%), leiomyosarcoma (20.0%), fibrosarcoma (11.0%), and tendosynovial sarcoma (9.6%). One hundred and twenty-eight patients (22.7%) had metastases in a median follow-up period of 19 months. Metastasis was more common in patients with retroperitoneal and visceral sarcomas than in patients with extremity sarcomas. Patients with leiomyosarcomas were more likely to develop metastases than those with other histologic types. Fibrosarcoma and liposarcomas were the least likely to develop metastases in this time frame. Tumors greater than 5 cm in diameter occurred more frequently in patients with metastases. Actuarial survival was related to the site of primary tumor and the histologic type and grade of malignancy. Multivariate analysis indicated that patients with low-grade sarcomas, extremity sarcomas, and fibrosarcomas and patients without metastatic disease demonstrated significantly improved survival. In patients with metastases, disease-free interval (less than 365 or greater than or equal to 365 days) was significantly related to overall survival.(ABSTRACT TRUNCATED AT 250 WORDS)
Actuarial Analysis↗
Prognostic factors for local recurrence and survival in patients with localized extremity soft-tissue sarcoma.
The charts of 423 patients with localized extremity soft-tissue sarcoma treated at our institution over a 10-year period (1968-1978) were reviewed. Data were subjected to both univariate and multivariate analysis, with independent variables in the multivariate analysis appearing in capital letters. Factors associated with an increased risk of local recurrence included the following: AGE greater than 53; PRESENTATION WITH RECURRENT DISEASE; HIGH TUMOR GRADE; positive regional nodes; TREATMENT BY LIMB-SPARING SURGERY (LSS); invasion of vital structures (LSS only); INADEQUATE MARGINS; and biopsy with delayed definitive resection. Survival was adversely affected by the following: AGE greater than 53; PAINFUL MASS; PROXIMAL SITE; SIZE greater than or equal to 10 cm; HIGH TUMOR GRADE; POSITIVE NODES; invasion of vital structures; TREATMENT BY AMPUTATION; INADEQUATE MARGINS; and local recurrence after treatment at our institution. Significant variations in both local recurrence and survival according to histopathology were also observed, with EMBRYONAL RHABDOMYOSARCOMA, ANGIOSARCOMA, and MALIGNANT PERIPHERAL NERVE TUMORS emerging as independent predictors of local recurrence. Using the Cox models for local recurrence and survival, patients were stratified into high-, intermediate-, and low-risk categories based on the presence or absence of each variable. Risk factor analysis should be part of the overall evaluation of each patient with extremity sarcoma.
Adolescent↗
Lactase dehydrogenase as a tumor marker for recurrent disease in Ewing's sarcoma.
The serum lactase dehydrogenase (LDH) of 56 patients with Ewing's sarcoma was examined to determine the use of LDH as a tumor marker. The initial LDH level was used to determine its ability to predict survival. The follow-up LDH level also was examined, as an indicator of recurrent disease. The initial LDH level was found to have no prognostic value. Both patients with elevated and normal LDH levels had the same survival rate. The LDH level at recurrence was significantly higher, however, than the follow-up LDH level of those without recurrence (P less than 0.001). The LDH level was most sensitive as a tumor marker for recurrent disease in those patients with multiple sites of tumor involvement at the time of recurrence.
Bone Neoplasms↗
Localized operable soft tissue sarcoma of the upper extremity. Presentation, management, and factors affecting local recurrence in 108 patients.
Radical ablative surgery for upper extremity sarcoma often results in significant loss of function. With the recent emphasis on limb preservation, function-sparing excision has been combined with adjuvant radiation and chemotherapy in an increasing number of patients. To assess the effect of changing management on local recurrence rates and identify factors governing local failure, the records of 108 patients with operable, nonmetastatic soft tissue sarcoma of the upper extremity, treated at the Memorial Sloan-Kettering Cancer Center between 1968 and 1978, were reviewed. Median follow-up care was 8.2 years. One third of the patients presented with locally recurrent tumors after initial treatment elsewhere. Over half of the lesions were above the elbow and 62% were high grade. Seventy-three patients (68%) had limb-sparing surgery (LSS), but margins were considered adequate in less than half. Local recurrence was directly related to the adequacy of the surgical margins and was significantly higher in the LSS patients (p = 0.008). Other factors associated with an increased risk of local failure included: presentation with local recurrence, superficial location, and invasion of vital structures (LSS only). Local failure varied significantly with histologic type and was highest in patients with embryonal rhabdomyosarcoma and angiosarcoma. When the data were subjected to multivariate analysis, the following variables emerged as independent predictors of local failure: presentation with local recurrence, surgery by LSS, inadequate margins, angiosarcoma, and invasion of vital structures. These risk factors should be carefully weighed when selecting local treatment for patients with upper extremity soft tissue sarcomas.
Adolescent↗
Localized extremity soft tissue sarcoma: an analysis of factors affecting survival.
The management of extremity soft tissue sarcoma is undergoing rapid change as new techniques of adjuvant treatment are developed. Critical assessment of these advances requires a fundamental understanding of the natural course of this disease. In an effort to define important prognostic factors, this review of 423 adults with localized extremity soft tissue sarcomas, treated at one institution (1968 to 1978), was undertaken. The effect of the following variables on survival was examined: patient factors, ie, age, sex, symptoms, and status at presentation; tumor factors, ie, site, size, depth, bone or neurovascular invasion, histogenesis, grade, and nodal status; and treatment factors, ie, biopsy technique, type of operation, surgical margins, adjuvant treatment, and subsequent local treatment failure. Patient factors with an adverse impact on survival included age greater than 53 and the presence of local symptoms. High tumor grade, positive regional nodes, histology other than liposarcoma, fibrosarcoma or malignant fibrohistiocytoma, invasion of vital structures, proximal site, deep location, and size greater than 10 cm were also poor prognosticators. Treatment factors correlating with optimal survival included limb sparing surgery, adequate margins, biopsy with delayed definitive resection, and absence of subsequent local failure. Patients treated by amputation had a greater proportion of risk factors than patients treated with limb-sparing surgery (LSS). When the data were subjected to multivariate analysis, the following variables emerged as independent predictors of poor outcome: local symptoms, age greater than 53, high grade, proximal site, size greater than 10 cm, positive regional nodes, surgery by amputation, and inadequate margins. These factors are now to be evaluated in our prospective study based on 600 patients with soft tissue sarcoma of all sites admitted to our institution in the last 3 years. These factors should be considered as important stratifications in prospective trials.
Adolescent↗
Localized, operable soft tissue sarcoma of the lower extremity.
Recent developments in adjuvant treatment of soft tissue sarcomas of the extremities have altered the surgical approach to this disease. To assess the effects of changing management on local recurrence rates and to examine factors governing local failure, we reviewed the records of 315 adults with operable, nonmetastatic soft tissue sarcoma of the lower extremity who were treated at one institution over a ten-year period. The median follow-up was 8.2 years. One third of our patients presented with locally recurrent tumors after initial treatment elsewhere. Sixty-six percent of the lesions were above the knee, and 60% were high grade. Two thirds of the patients underwent limb-sparing surgery (LSS), which in the latter half of the study period outnumbered amputations by four to one. Local recurrence was directly related to the adequacy of the surgical margins. Adjuvant radiotherapy and chemotherapy did not significantly decrease local recurrence in patients who underwent LSS, although favorable trends were observed. A significantly increased risk of local failure was associated with age greater than 53 years, presentation with local recurrence, high tumor grade, deep location, positive nodes, and less than adequate surgical margins. Local failure also varied significantly with histologic type and was highest in patients with embryonal rhabdomyosarcoma and neurofibrosarcoma. Improved local control, particularly in patients with high-grade tumors, was observed in the latter half of the study period despite the increased use of LSS. When the data were subjected to multivariate analysis, the following variables emerged as independent predictors of local failure: age greater than 53 years, presentation with local recurrence, high grade, less than adequate margins, embryonal rhabdomyosarcoma, and neurofibrosarcoma. The key to local control of sarcomas of the extremities is resection of the tumor with adequate margins. The role of adjuvant treatment, particularly following LSS, is still being evaluated. The risk factor profile should be considered when selecting a treatment program for patients with lower extremity sarcomas.
Adolescent↗
Unexplained persistent lymphadenopathy in homosexual men and the acquired immune deficiency syndrome.
Ninety-three homosexual men with persistent lymphadenopathy were followed at the Memorial Sloan-Kettering Cancer Center for a mean period of 20.8 months. Histories and serologic evidence of a number of previous infections were common, but the lymphadenopathy was not due to recognizable infections or neoplastic disease. Leukopenia, lymphopenia, granulocytopenia, monocytopenia, decreased ratios of T-helper to T-suppressor cells, decreased natural killer cell activity and increased serum immunoglobulin concentrations were common. Lymph node biopsies showed reactive hyperplasia without any unique histopathologic features. Antibody to the human T-lymphotropic virus-III (HTLV-III or LAV), a newly described retrovirus believed to be the etiologic agent of the acquired immune deficiency syndrome (AIDS), was detected in 91.4%. Over a 3-year period, 11 cases of AIDS were recognized in these patients: Kaposi's sarcoma developed in 7 and opportunistic infections in 4. The lymphadenopathy resolved in six patients and the others remained unchanged. Although most of these patients are asymptomatic and remain well, the risk of AIDS in this group of men was higher than in other groups of homosexual men in New York.
Acquired Immunodeficiency Syndrome↗
Spectrum of Kaposi's sarcoma in the epidemic of AIDS.
Kaposi's sarcoma (KS) is seen with increased frequency in the course of the epidemic of acquired immune deficiency syndrome. In this population, KS has manifested in an aggressive and more disseminated fashion as compared to the classical type. As the epidemic of acquired immune deficiency syndrome continues to spread and more cases of KS are evaluated, a distinct diversity in the clinical presentation and in the course of the disease as well as in variation in the prognosis and response to therapy is being observed. A preliminary description of the spectrum of KS in the epidemic of acquired immune deficiency syndrome is presented here.
Acquired Immunodeficiency Syndrome↗
Second primary cancers following treatment of Hodgkin's disease.
A cohort study designed to evaluate the carcinogenicity of treatment for Hodgkin's disease (HD) was conducted. This report describes 2,591 patients with HD diagnosed in 1940-75 and presents an analysis of follow-up findings through 1978. Seventy-four second primary cancers (excluding basal cell and squamous cell cancers of the skin and in situ carcinomas of the cervix uteri) were observed 1 year or more after diagnosis of HD, including 21 leukemias. Twenty leukemias occurred after chemotherapy. The relative risk (RR) of leukemia after intensive chemotherapy with or without radiotherapy was 136 relative to general population incidence rates. In the subgroup with both intensive chemotherapy and intensive radiotherapy, the RR of leukemia was 125. Both RR estimates differed significantly from unity. The RR of cancers other than leukemia 10 years or more after intensive radiotherapy relative to no intensive therapy was 19.5 (95% confidence limits: 4.8-80).
Adolescent↗
Pesticides and polychlorinated biphenyl residues in human breast lipids and their relation to breast cancer.
The etiology of human breast cancer is unknown; accepted risk factors, e.g., menstrual, reproductive, and family histories, are implicated in less than half of all cases. Various halogenated hydrocarbons--acting as either co-carcinogens or promoting agents--which are derived from the environment and are concentrated in human fatty stores, may also play a role in breast cancer risk. A pilot study was undertaken to measure and compare levels of chemical residues in mammary adipose tissue from women with malignant and nonmalignant breast disease. Elevated levels of polychlorinated biphenyls, bis (4-chlorophenyl)-1,1 dichloroethene, and bis(4-chlorophenyl)-1,1,1 trichloroethane were found in fat samples from women with cancer, compared with those who had benign breast disease. These results, although preliminary, suggest a role for environmentally derived suspect carcinogens in the genesis of mammary carcinoma.
Adipose Tissue↗