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[Pleural cancer mortality and compensated cases of asbestosis in Sardinia Region municipalities (1980-2000)].

OBJECTIVE: To his study describes the geographical distribution of pleural cancer deaths and asbestosis cases from 1980 to 2000 in Sardinia Region (Italy). For both conditions regionwide registration systems have been available for a relatively long time and allow the identification of statistically significant clusters. DESIGN: For each town we have estimated Standardized Mortality Ratios (SMRs) for pleural cancer and Standardized Incidence Ratios (SIRs) for asbestosis. Expected cases were estimated from age- and gender specific rates in Sardinia. SatScan software was used to identify clusters and to verify their statistical significance. SETTING: Sardinia Region (Italy). MAIN OUTCOME MEASURES: Standardized mortality and incidence rates respectively for pleural cancers and asbestosis cases and territorial clusters. RESULTS: The most important cluster of pleural cancer was identified in the area defined by Carloforte, Calasetta, Portoscuso and Sant'Antioco municipalities (Southwestern Sardinia) with 15 observed cases (p value= 0.003). Other clusters were detected in the municipality of La Maddalena (11 observed cases against 1.91, expected p value= 0.008) and in Southern Sardinia between Cagliari and Sarroch (p value= 0.018). The town of Marrubiu is clearly the most important cluster (p value= 0. 001) with 6 asbestosis cases in the period. CONCLUSIONS: These results indicate the urgency of the epidemiological surveillance of asbestos related diseases in Sardinia. The active search for incident cases of malignant mesothelioma in the whole Region and the analysis of modalities of asbestos exposure (according to national guidelines) is an indispensable tool for the primary prevention of occupational, environmental and domestic exposures from unknown asbestos sources of contamination.

Asbestosis↗

PubMed1991

[Asbestosis in the thoracic roentgen image].

Asbestos is a silicate fiber that may cause asbestosis 20-30 years after exposition. Asbestosis is characterized by pulmonary fibrosis, thickening of the pleura and calcified pleuraplaques. In addition, asbestosis may lead to bronchial carcinoma or mesothelioma. As patients are rarely referred to rule out asbestosis, and chest films are obtained for other clinical questions, it is important for the radiologist to recognize the typical plain film findings. These typical signs are illustrated in the following manuscript.

Asbestosis↗

PubMed1991

Asbestosis: diagnostic dilution.

The term "asbestosis" usually has been applied to a disease characterized by diffuse pulmonary interstitial fibrosis. It was often associated with a significant adverse impact on the individual. A review of case definitions employed in published research studies show stability of the criteria for asbestosis case definitions over the past decade. Nevertheless, additional modalities have been suggested for the early diagnosis of asbestosis. It is probable that the significance of such abnormalities may be different from that of usual asbestosis, and there is therefore a need to carefully define the manner in which the terms are used. Additional anomalies may be seen in asbestos-exposed individuals including small airway physiologic abnormality, pathologic evidence of inflammation near the airways, positive gallium scan, abnormal lung compliance, exercise test abnormalities, CAT scan findings, and high-resolution CAT scan findings.

Asbestosis↗

PubMed1991

Pleural plaques do not predict asbestosis: high-resolution computed tomography and pathology study.

Pleural plaques can be caused by asbestos exposure, but their predictive value in diagnosing pulmonary asbestosis is uncertain. Similarly, although high-resolution computed tomography (HRCT) can accurately detect parenchymal lung lesions, its ability to detect asbestosis is unknown. In a test of the predictive value of pleural plaques and HRCT, lungs of 29 autopsied patients with bilateral parietal pleural plaques were compared with lungs from 29 age- and sex-matched controls without pleural plaques. Significantly more of the patients with pleural plaques had histories of asbestos exposure (P less than 0.01). One lung from each patient was inflation fixed and air dried. HRCT of the lungs did not show significantly more thickening, lines, or densities in patients with pleural plaques than did controls; and HRCT did not predict a significantly greater likelihood of asbestos-related parenchymal disease in the study group. Gross and histologic examinations showed no significant intergroup differences in the frequency or severity of several forms of emphysema and fibrosis. Average asbestos fiber counts were not significantly higher in the lungs with pleural plaques. We conclude that pleural plaques do not predict asbestosis, and that high-resolution computed tomography accurately detects interstitial and parenchymal lung disease but cannot reliably diagnose asbestosis.

Adult↗

PubMed1986

Correlation of bronchoalveolar lavage and clinical and functional findings in asbestosis.

Respiratory clinical, radiographic, and functional findings were assessed and correlated with bronchoalveolar lavage (BAL) cellular changes in 52 asbestos workers (27 with and 25 without asbestosis) and in 15 control subjects without asbestos exposure. Subjects with asbestosis had a moderate neutrophilic alveolitis (7.8 +/- 5%) compared with the other groups (p less than 0.001) that was correlated with the presence of crackles (p = 0.03) and PaO2 (p less than 0.05) and AaPO2 at rest (p less than 0.05) values. Asbestos bodies (AB) in BAL were quantitated in 34 of the 52 asbestos workers (21 with and 13 without asbestosis) and in the control group. They were present in 83% of asbestos workers but they were absent in the latter. No significant differences were observed in the number of AB between those asbestos workers with and without lung disease. We conclude that crackles on auscultation and PaO2 and AaPO2 values may well be good indicators of the staging of neutrophilic alveolitis in asbestosis. In contrast, the amount of AB in BAL is not a reliable marker of asbestos lung fibrosis.

Adult↗

PubMed1978

Cellular immunity in asbestosis.

A highly statistically significant correlation was found between asbestosis and impaired responsiveness in skin reaction to intermediate and second strength tuberculin and SK-SD. Considering ANA incidence these antibodies were found with higher frequency in asbestos workers who lacked a cutaneous response to the recall antigens. In asbestosis cases peripheral blood lymphocyte profiles are also abnormal demonstrating low proportions of E-RFC. Moreover, MIF test results showed the impairment of this cytokine generation when lymphocytes were stimulated with SK-SD, PPD and PHA in asbestosis cases. The lymphocyte transformation study documents an impaired response mainly to a lower dose of PHA and ConA in asbestosis cases and in asbestos workers with ANA.

Antibodies, Antinuclear↗

PubMed1981

Diminished suppressor cell function in patients with asbestosis.

Epidemiological and immunological studies of asbestos workers documented abnormalities in humoral and cell-mediated immunity which could result from defective immunoregulation. This study tests this hypothesis with comparison of lymphocyte function in age-, sex- and smoking-matched subjects with asbestosis. In vivo measure of delayed hypersensitivity (i.e. skin test response) was significantly depressed to two recall antigens, SKSD and Candida, in asbestosis patients. Skin reaction to dinitrochlorobenzene (DNCB) was not depressed, although lymphocytes of patients giving positive skin test reactions demonstrated a significantly lower (P less than 0.001) proliferative response to dinitrobenzene sulphonic acid (DNBSO3) in vitro. T cell counts (E-rosettes) were normal in patients with asbestosis, although a subset of T cells, those forming sheep erythrocyte rosettes after prolonged incubation (Elate), were significantly depressed (P less than 0.003). This population has been equated with 'suppressor' cells (Grossi et al., 1978). Numbers of B cells were increased nearly two-fold over controls. Mitogen response of lymphocytes was normal except at suboptimal doses of mitogens where the response is known to be influenced by suppressor cell activity, which was significantly elevated. Suppressor cell function, as determined by stimulation of peripheral blood lymphocytes preincubated with concanavalin A, was also significantly decreased in asbestosis patients (P less than 0.01).

Aged↗

PubMed1983

[Relation between the HLA system and the development of asbestosis fibrosis in a group of workers exposed to asbestos].

The various studies which have dealt up to the present with a possible relationship between asbestosis and HLA groups have led to differing conclusions. The present study evaluated this relationship by comparison of 57 workers with asbestosis confirmed radiologically (minimum S1 type opacities) and functionally (VC and/or DuaCO less than 88%) with 58 controls from the same population. In a second phase, statistical analysis involved the combination of these cases with those reported in the literature, estimating the mean relative risk and, for each gene, the heterogeneity of the results thus collected. No relation was found between class I (A and B) HLA antigens and asbestosis. The authors suggest extension of this study to class II (DR) and III (components of complement) antigens and to seek possible links between combinations of antigens and the development of asbestosis.

Adult↗

PubMed1995

Serum oncoproteins in asbestosis patients.

Using ELISAs, we determined the concentrations of transforming growth factor alpha (TGF-alpha), the extracellular domain of the erbB-2 receptor (erbB-2 ECD), and mutant p53 protein in stored serum samples of asbestosis patients with and without cancer and control subjects (without asbestosis or cancer). The percentage of individuals in these three groups with increased serum concentrations of TGF-alpha, erbB-2 ECD, and mutant p53, respectively, were: asbestosis patients with cancer, 36%, 16%, 19%; asbestosis patients without cancer, 38%, 19%, 6%; control subjects, 0%, 5%, 10%. Although differences in serum positivity for these oncoproteins were apparent among these groups, the differences did not achieve statistical significance (P > 0.05). In several of the cancer cases, increased concentrations of TGF-alpha, erbB-2 ECD, and mutant p53 were also detected in the stored serum samples collected years before the clinical diagnosis of disease.

Asbestosis↗

PubMed1999

Cohort mortality study of women compensated for asbestosis in Italy.

BACKGROUND: The carcinogenic effect of asbestos is accepted for lung cancer and mesothelioma, while conflicting opinions exist for other cancer sites. The aim of the present investigation is to study cause-specific mortality of women compensated for asbestosis who had certainly been exposed to high levels of asbestos fibers. METHODS: The cause-specific mortality of all Italian women compensated for asbestosis and alive December 31, 1979, was investigated through October 30, 1997. In the total cohort, which included 631 subjects, 277 deaths occurred. Cause-specific SMRs (Standardized Mortality Ratio) were computed using the national rates for comparison. RESULTS: A significantly increased mortality for all diseases related to asbestos exposure was observed. Mortality for all causes, all neoplasms, lung cancer, uterine cancer, ovarian cancer, and non-neoplastic respiratory diseases was significantly increased. Separate analyses for textile (n = 276) and asbestos-cement (n = 278) workers were performed. Women employed in the textile industry, mainly exposed to chrysotile, who are compensated at a younger age, showed higher SMRs for lung cancer and asbestosis. Women in the asbestos-cement industry, mainly exposed to crocidolite containing asbestos mixtures, experienced higher mortality for pleural malignancies. CONCLUSIONS: The role of asbestos exposure in the development of gastrointestinal and genital neoplasms is discussed.

Adult↗

PubMed1984

Tumor markers and neurological signs in asbestosis patients.

Ninety asbestosis patients were examined clinically with special emphasis on the function of the peripheral and the central nervous system. Serum specimens were analyzed for carcinoembryonic antigen(s) (CEA), ferritin, and beta 2-microglobulin (beta 2m) content. The patients were classified into four subgroups: (1) those with peripheral neuropathy, (2) those with involvement of central nervous system, (3) those with both types of neurological signs, and (4) those with normal neurological status. The levels of serum CEA, ferritin, and beta 2m were elevated in all four subgroups. No statistically significant differences were found between the groups in the prevalence of elevated values of the three tumor markers (equal or above the following limits: CEA, 5 micrograms/liter; ferritin, 400 micrograms/liter, and beta 2m, 3 mg/liter). The patients currently smoking had a higher level of serum CEA than nonsmokers or exsmokers, but the differences were not statistically significant. In the subgroup that comprised those asbestosis patients in whom the disease could be considered progressive according to the ILO 1980 classification of the chest radiographs, the mean level of CEA in serum was higher than that of the patient group without such progression of the disease (p less than 0.05, Student's t test). Although the prevalence of abnormal neurological signs was high in these asbestosis patients, no obvious correlation was found between the neurological findings and the tumor markers studied.

Adult↗

PubMed1983

Lung function and nervous system involvement in asbestosis.

A group of 115 patients with asbestosis of the lungs was tested in detail for neurological functions and lung functions in order that any possible impaired pulmonary function and neurological signs (especially peripheral neuropathy) could be discovered. Attention was also paid to finding out whether peripheral neuropathy, which is frequently encountered among asbestosis patients, had any role in decreased pulmonary function. A slight trend towards lowered spirometrical values (vital capacity, forced expiratory volume in one second, maximal mid-expiratory flow and maximal expiratory flow at 25% of vital capacity) was found for the group of patients with peripheral neuropathy. No differences in diffusing capacity were found between the groups of patients either with or without peripheral neuropathy. We concluded that the spirometrical findings are more indicative of a parallel phenomenon than a causal factor. Nor was the involvement of the central nervous system associated with decreased pulmonary function. In short, the pulmonary dysfunction of our asbestosis patients did not appreciably contribute to the occurrence of nervous system involvement, whether central or peripheral.

Adult↗

PubMed1987

Immunogenetic factors as determinants of asbestosis.

To evaluate the possible role of immunogenetic factors as predisposing determinants of the development of asbestosis in exposed workers, we obtained 53 phenotypes of the human leucocyte antigen (HLA)-A, B, C, and DR antigens in 72 long-term workers of the mines and mills of Quebec and in a reference population of 150 residents. Among the asbestos workers, 32 did not have any abnormality and 40 had asbestosis. The 2 groups did not differ in term of age, exposure, or cigarette smoking habits. In agreement with previous reports, we found no significant change in frequency of the HLA-A, B, or C phenotypes. Furthermore, we did not find any significant change in the frequency of 10 phenotypes of the HLA-DR loci. We conclude that immunogenetic factors are not major predisposing determinants of asbestosis.

Aged↗

PubMed1997

Immunohistochemical localization of transforming growth factor-beta and insulin-like growth factor-I in asbestosis in the sheep model.

Asbestosis is characterized by increased collagen deposition along the walls of terminal respiratory bronchioles that extends into the alveolar ducts and septae. Alveolar macrophages are activated and release growth factors that stimulate mesenchymal cell proliferation and enhanced formation of extracellular matrix. Both insulin-like growth factor-I (IGF-I), and transforming growth factor beta (TGF-beta) regulate cellular growth and promote matrix accumulation and are hypothesized to play important roles in asbestosis. We performed immunohistochemistry using polyclonal antibodies to specific synthetic peptides of the three mammalian isoforms of TGF-beta (TGF-beta 1, -beta 2, -beta 3) and to IGF-I on lungs of sheep treated intratracheally with chrysotile asbestos. All three TGF-beta isoforms were found in bronchial and bronchiolar epithelium, macrophages, and bronchial and vascular smooth muscle in control lungs. The distribution of TGF-beta was increased in these lung constituents as fibrotic lesions developed. Fibrotic lesions additionally demonstrated intense immunostaining of all three TGF-beta isoforms that localized to the extracellular matrix zones with little staining of interstitial cells. In the control sheep lungs, IGF-I staining was detected in bronchial and bronchiolar epithelium, bronchial glands, bronchial and vascular smooth muscle, endothelium, and macrophages. IGF-I immunostaining was detected in macrophages in peribronchial fibrosis and in fibroblasts along the periphery of and within lesions, but not in the extracellular matrix. Metaplastic proliferating epithelium and macrophages were strongly immunoreactive for IGF-I in advanced lesions. Our data demonstrate different immunostaining patterns for IGF-I and TGF-beta in asbestosis, with IGF-I in the cellular periphery and TGF-beta in the extracellular matrix consistent with a complementary role in stimulating interstitial fibroblast proliferation and new collagen deposition in areas of active fibrosis.

Animals↗

PubMed1993

Bronchoalveolar lavage and 99mTc-DTPA clearance as prognostic factors in asbestos workers with and without asbestosis.

The aims of this study are to investigate the change-over time of lung function and chest radiographic findings in patients with asbestosis (AS) and asbestos workers without asbestosis (AW). Secondly, to correlate these changes with broncho-alveolar lavage (BAL) profiles and with lung epithelial permeability, as detected by half-time lung-to-blood (t1/2 LB) clearance of an inhaled aerosol of diethylene triamine pentacetate labelled with technetium 99 (99mTc-DTPA) obtained a mean period of 4.2 yr (range 2.3-5.8) previously. Thirty-three patients with asbestosis and 24 asbestos workers with substantial asbestos exposure were followed-up. Nineteen healthy smokers (HS) with no asbestos exposure who were followed up for a mean period of 3.9 yr were taken as a control group for spirometric changes. Compared with AW, FEV1, FVC and TLCO were lower in AS (P < 0.0001 in each case). Smoker AS and AW had lower numbers (P < 0.03) and percentages (P < 0.004) of BAL lymphocytes and higher numbers (P < 0.04) and percentages (P < 0.02) of BAL neutrophils plus eosinophils than ex- and non-smokers. Annual declines of FEV1 (dFEV1 yr-1) and FVC (dFVC yr-1) in AS and AW were significantly greater than in HS and predicted annual declines (P < 0.002 in each case). Annual declines of TLCO (dTLCO yr-1) and KCO (dKCO yr-1) in AS and AW were significantly greater than predicted annual declines (P < 0.002 in each case). No significant differences were noted between AS and AW in annual declines in any lung function measurement. dTLCO yr-1, dKCO yr-1 were significantly greater in smokers than in ex- and non-smokers, (P < 0.05 and P < 0.04 respectively). Annual decline did not relate to base line values for any lung function measurement. Numbers and proportions of BAL lymphocyte were higher (P < 0.008 and P < 0.02, respectively) and numbers and proportions of BAL neutrophils and eosinophils were lower (P < 0.02 and P < 0.03, respectively) in patients in whom dTLCO yr-1 was less than 0.3 mmol min-1 kPa-1 than in patients in whom dTLCO yr-1 was more than 0.3 mmol min-1 kPa-1. dTLCO yr-1 inversely correlated with t1/2 LB; r = 0.51; (P < 0.008). Patients in whom the radiograph remained unchanged had higher numbers (P < 0.002) and percentages (P < 0.001) of BAL lymphocytes than patients in whom the radiograph deteriorated.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1993

Measuring lung volumes in advanced asbestosis: comparability of plethysmographic and radiographic versus helium rebreathing and single breath methods.

Total lung capacity was measured in 16 workers with pulmonary asbestosis using four standard methods: body plethysmography, radiographic lung area, helium dilution by multiple breath and by single breath (alveolar volume). All men had irregular opacities of ILO profusion category 2/1 or greater and four had pleural plaques in addition. The radiographic and plethysmographic methods produced virtually identical mean values for TLC of 7.52 l and 7.64 l and for RV of 4.06 l and 4.32 l and all values were larger than those by helium dilution. The closed circuit helium dilution method systematically underestimated TLC with a mean of 5.89 l as did single breath helium dilution with a mean of 6.39 l. These men had a larger mean RV/TLC, measuring 56.9% by body plethysmography and 54.6% by X-ray area than by the rebreathing dilutional method which was 43.8%. Air trapping within a normal TLC which characterizes asbestosis is revealed by radiographic and plethysmographic methods but concealed by gas dilution methods. Use of the latter is at least partly responsible for the impression that asbestosis is a 'restrictive disease'.

Aged↗

PubMed1987

Asbestos bodies or fibers and the diagnosis of asbestosis.

A committee of the College of American Pathologists has proposed that the diagnosis of asbestosis requires fibrosis in respiratory bronchiolar walls and the presence of asbestos bodies (ABs) in tissue sections. To determine whether histologic ABs reliably reflect asbestos fiber concentrations in asbestosis, we compared the concentration of ABs in histologic sections to concentrations of ABs and fibers in tissue extracts of 14 asbestos workers with nonspecific interstitial fibrosis. ABs in histologic sections and extracts correlated well, r = 0.95. Counted and classified by electron microscopy, electron diffraction, and X-ray spectroscopy, commercial amphibole fibers (r = 0.94) also correlated well with ABs, but noncommercial amphiboles (r = -0.02) or chrysotile (r = 0.29) did not. In five subjects with a high percentage of noncommerical amphibole fibers, fewer than 0.5 histologic ABs/cm2 were present despite a total amphibole concentration that was similar to that in subjects with more histologic ABs. We conclude that ABs will be scarce or absent in histologic sections from some subjects with asbestosis, and that for such subjects, extracts of asbestos fibers should yield over 500,000 total amphibole fibers/g dry lung to signify that interstitial fibrosis may be caused by asbestos.

Aged↗

PubMed1989

Lung asbestos burden in shipyard and construction workers with mesothelioma: comparison with burdens in subjects with asbestosis or lung cancer.

Although mesothelioma is generally considered to be caused by asbestos, epidemiologic studies indicate that some cases have another cause. In order to determine whether pulmonary asbestos burden can be used to define asbestos-related mesotheliomas, asbestos burden was quantified in 27 shipyard or construction workers with diffuse malignant mesothelioma of the pleura or peritoneum and a history of asbestos exposure. Their burden was significantly greater than the burden found in 19 unexposed men (P less than 0.001). The burdens were also compared to those of previously reported subjects with asbestosis or lung cancer. The median concentration for total amphibole fibers (2.7 million/g dry lung) in subjects with mesothelioma did not differ significantly from our previously reported median values for 14 subjects with asbestosis (1.3 million/g dry lung) or for 60 asbestos workers with lung cancer (1.3 million/g dry lung). Fiber size distribution for amosite, the most prevalent fiber type, was similar in all three subject groups. Fifteen of 25 (60%) subjects with mesothelioma had mild asbestosis. Asbestos body (AB) concentrations were greater than or equal to 1900/g dry lung, and total amphibole fiber concentrations were greater than or equal to 390,000/g dry lung. Counts of ABs greater than or equal to 0.5/cm2 in histologic sections always signified both of these concentrations in extracts. Thus, histologic sections showing greater than or equal to 0.5 ABs/cm2 or extracts containing asbestos body or amphibole fiber concentrations of at least 1900 or 390,000/g dry lung, respectively, will confirm an asbestos-related mesothelioma.

Aged↗