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The article represents results of radionuclide study of hormonal levels and pulmonary microcirculation in anthracosilicosis. The authors discuss mechanisms underlying influence of vasoactive hormones on pulmonary microcirculation. The authors revealed relationships between hormonal and vascular disorders in anthracosilicosis.
Studies covered incidence of coronary heart disease, its risk factors and features of constitutional types among Kouzbass coal miners suffering from anthracosilicosis and chronic dust bronchitis. Findings are reliably higher incidence of coronary heart disease among coal miners having lung diseases caused by dust. Coronary heart disease among the miners with anthracosilicosis is favored by arterial hypertension, overweight and hypersthenic constitutional type, that among those with dust bronchitis is favored only by overweight.
In 50 lung cancers (25 small cell lung cancers, 17 squamous cell carcinomas, 8 adenocarcinomas) pulmonary, mediastinal and cervical lymph node-metastases were analyzed. Lymph-node "skipping" was demonstrated in 46% of the investigated tumors. In seven of these cases the lymph nodes were skipped, which showed complete hyalinization as a consequence of preexisting anthracosilicosis. In 5 other tumors additional lymph nodes with preserved structure were skipped by the metastatic process. Fibrosis of lymphatic tissue after tuberculosis or exposure to ionizing radiation were further reasons for lymph-node skipping. The skipping of intact lymph nodes can be explained by anatomically demonstrable intra- and perinodal short circuit connections. Apart from that, preexisting lymph node changes (silicosis, fibrosis) play an important part.
We report five cases of reactive mediastinal spindle cell proliferations associated with anthracosis and anthracosilicosis that simulated a malignant process both on clinical and morphological grounds. Clinically, the lesions formed radiographically evident masses or were infiltrative. Microscopically, a prominent storiform pattern of intertwining spindle cells was found in four cases. This proliferation extended outside of the lymph node capsule in three cases and surrounded nerves in two. Because of this combination of features, the submitted diagnoses included a malignant neoplasm in four cases. The spindle cells were immunoreactive for histiocytic markers and focally contained fine anthracotic pigment. All cases featured nodular hyaline scars and contained polarizable material suggestive of silica, although a history of industrial exposure was obtained in only two cases. No lesion has enlarged or otherwise progressed during follow-up ranging from 6 to 48 months. The differential diagnosis includes a variety of spindle cell neoplasms, including malignant fibrous histiocytoma, follicular dendritic cell tumor, spindle cell melanoma, and Kaposi's sarcoma.
The studies covered metabolism of serum phospholipids during lipids peroxidation and hydrolysis by phospholipase A2. Metabolism of serum phospholipids appeared to depend on duration of exposure to mine dust and on coal pneumoconiosis stage. Lipids peroxidation becomes activated after 20 and more years of service, intensifies with anthracosilicosis development on background of higher catalase activity that is low on early stages of the disease. Activity of phospholi pase A2 increases with pulmonary fibrosis progression.
In normal human lungs, neuroendocrine (NE) cells can be found as solitary NE cells and in corpuscular aggregates, the neuroepithelial bodies. By means of a quantitative morphometric method, we compared the number and distribution of chromogranin-reactive NE cells in anthracosilicotic and control lungs. After death, 14 pairs of control and 12 pairs of anthracosilicotic lungs were sampled. The extents of anthracosilicosis and emphysema were described for the right lung. The left upper lobe was used for quantitative determination of the number and distribution of NE cells, visualized by immunohistochemical staining for chromogranin. In contrast to expectations, we found no statistical difference in the numbers of chromogranin-reactive NE cells per 10 cm of epithelium between control (11.0) and anthracosilicotic (2.4) lungs. In both groups, there was a much greater number of chromogranin-reactive cells in the more peripheral compared to the central airways. Most peripheral NE cells were arranged in neuroepithelial bodies, which were not found in the central airways.
The article presents medical examination and clinical data on 117 cases of silicosis, anthracosilicosis, electric welder's pneumoconiosis and dust bronchitis. Diagnostic and therapeutic procedures were performed with due account of generally accepted resort treatment recommendations. The data obtained served as a basis for determining the role of different symptoms and results of complimentary medical, including immunologic, techniques, as well as for objective assessment of the effectiveness of resort treatment of occupational diseases.
Flow-volume values and their changes in response to salbutamol and methacin inhalations were studied with the help of a pneumotachograph in 69 patients with anthracosilicosis stage I, and in 70 patients with chronic dust bronchitis stages I and II. Pneumotachography was shown to extend diagnostic potentialities in the detection of ventilation insufficiency in patients with dust pulmonary pathology, making it possible to determine not only a degree but also a site of obstructive disorders. Disorders of the sympathetic and parasympathetic bronchial innervation and associated biochemical mechanisms were important in the mechanism of bronchospasm development. Pneumotachography was recommended in combination with bronchospasmolytic drugs of sympathomimetic and cholinolytic action for elucidation of the mechanism of disorders of the bronchial tone, a choice of adequate therapy and assessment of its efficacy.
Health conditions in the Huainan Coal Mine have improved greatly since 1950. In particular, the work and living environments, the underground dust concentration, the water supply and waste disposal systems, and the nutritional value of miners' food have become much better. Thus the rates of occupational, infectious, and parasitic diseases and nutritional deficiency diseases have decreased considerably among miners. The decreases in the prevalence of anthracosilicosis and hookworm have been especially striking.
Six endotracheal applications of 15 milligrams of cadmium sulfide (CdS) given to rats at weekly intervals induce pneumoconiosis with massive adhesions. The same quantities of lead sulfide (PbS) given under the same conditions have much less effect, causing only the formation of fairly small fibrous nodules. The tissue reactions to CdS and PbS were studied morphologically (light and electron microscope) and enzyme-histochemically. The results were compared with those observed in experimental anthracosilicosis in rats and with those seen in allergic-hyperergic reactions of the lung in guinea pigs (induced by several applications of the complete Freund adjuvans). A considerable increase in macrophages in the alveoli and interstices of the lungs with increased activity of acid phosphatase and oxydoreductases had occurred in every animal. None showed primary damage to type 2 pneumocytes. The results indicate that the two toxic agents differ in their capacity to induce fibrosis not because they interfere to a different degree with the clearing function of the lung or surfactant production, but because they differ in their capacity to stimulate fibroblast formation.
Angiotensin-converting enzyme (ACE) levels were measured in the serum of patients with various pulmonary affections (sarcoidosis, tuberculosis, anthracosilicosis, cancer, etc.), with diabetes or renal insufficiency, and in 247 healthy subjects. Mean ACE levels (41.5 U/ml +/- 16) were significantly higher in sarcoidosis than in normal controls (22 U/ml +/- 6), high values (greater than or equal to 34 U/ml) being observed in 62 p. cent of cases. In these patients, the ACE tended to become normal in parallel with clinical and radiological improvement in the disease, and to increase again during relapses. In 75 p. cent of sarcoidosis patients there was concordance between the increase in alveolar lymphocytes and that of serum ACE. Elevated ACE levels were noted in only 3 p. cent of non-sarcoidosis pneumopathies, and in 24 and 18 p. cent of diabetes and renal insufficiency cases respectively. In the absence of these two latter affections, measuring ACE levels is of obvious value for the diagnosis and follow-up surveillance of sarcoidosis.
Some types of pneumoconiosis, such as asbestosis, are characterized by marked restrictive functional patterns. Treatment is begun when definite arterial hypoxemia appears, since the inhalation of oxygen clearly lowers pulmonary artery pressure. It is also important that the onset of concomitant airway obstruction is recognized promptly. From the sociomedical standpoint the most significant pneumoconiosis continues to be the miner's anthracosilicosis. The functional pattern of this pneumoconiosis is clearly airway obstruction, and such anthracosilicotic airway obstruction responds like all other forms of airway obstruction to antiobstructive therapy. The fundamentals of this therapy, which is based on the use of bronchodilators, adrenal cortical hormones and antibiotics, are described.
263 patients with coniotuberculosis of the intrathoracic lymph nodes were compared clinically according to whether they were or not at 0ccupational risk of silicosis. Patients exposed to quartz dust had some special morphological picture of affected lymph nodes: periadenitis, dust caseosis and tubercula in the presence anthracosilicosis sclerosis. Silicotuberculous broncho-adenitis in silicosis patients is characterized by solitary lesions of the lymph nodes, bronchi, rare dissemination to the lungs. Coniotuberculous broncho-adenitis in elderly subjects arises in the result of occupation-unrelated accumulation in the lymph nodes of coal and quartz dust and runs chronically. Unless the disease is controlled early and actively, it may generalize and aggravate with perforation in the bronchi, vessels and esophagus. Profuse hemorrhage, caverns, atelectasis are also possible.
Disabilities of patients with coal-workers' pneumoconiosis (CWP) are currently estimated by changes in lung function at rest and the degree of dust equivalents in chest x-ray (ILO-classification 1980). Functional disturbances during exercise are not taken into consideration on a regular basis. We assumed that standardised sub-maximal exercise tests might be useful even in disabled patients to give additional information on functional disabilities of patients with CWP. The impact of low-grade anthracosilicosis on ventilation and gas exchange during exercise was assessed in 20 patients (all male, age 64.55 +/- 3.78 years) and 24 healthy volunteers (all male, age 58.13 +/- 4.68 years, never dust exposed). Data were also analysed according to ILO classification subgroups (group 1: ILO-classification 1/0 to 1/2, n = 11; group 2: ILO-classification 2/1 to 2/2, n = 9). Heart rate (HR), minute ventilation (VE), ventilatory equivalent for O2 (VE/VO2), ventilatory equivalent for CO2 (VE/VCO2), O2 uptake (VO2)CO2 output (VCO2), end-tidal oxygen partial pressure (PetO2), end-tidal carbon dioxide partial pressure (petCO2) and estimated dead space to tidal volume ratio (VD/VT) were determined breath-by-breath during a 50 watts constant work load protocol on an exercise bicycle. The VE/VO2 (patients: 32.9 +/- 4.2; controls: 25.7 +/- 2.9; p < 0.001), the VE/CO2 (patients: 39.4 +/- 4.6; controls; 31.0 +/- 3.9), the VE (patients: 30.1 +/- 5.6, controls: 23.5 +/- 3.0; p < 0.001) and the PetO2 (patients 115.6 +/- 4.8; controls: 99.1 +/- 27.4; p < 0.05) at an exercise of 50 watts were significantly higher in the patients' group, the PetCO2 (patients: 38.4 +/- 4.5; controls: 44.0 +/- 4.1) were significantly lower in the patients' group. The comparison of patients subgroups did not reveal any significant differences between group 1 and group 2. A higher VE/VO2 during 50 watts of exercise is attributable to an increased ventilation/perfusion mismatch. There was no correlation between the radiological grade of the CWP (ILO classification) and the ventilation and gas exchange during exercise. We conclude that a sub-maximal spiroergometry with a 50 watts constant work load might serve as a sensitive and easy to apply procedure add information about the functional impairment in CWP. The exercise test should be included in the evaluation for disability benefits.
Thoracic computed tomography (CT) is an essential component in the preoperative staging of bronchial carcinomas as is mediastinoscopy (MSC) in cases of mediastinal lymphoma. It is known that endoscopic ultrasonography (EUS), as a new diagnostic procedure, can predict lymph-node involvement in cases of tumors in the upper gastrointestinal tract with an 80% probability. In a prospective study, we examined whether EUS could be used to ascertain the presence of mediastinal lymph nodes in cases of bronchial carcinoma. Since 1990, therefore, 32 patients with operable non-small-cell bronchial carcinoma have been examined with an Olympus-Aloka EU-M2 or EU-M3 (frequency 7.5 and 12 MHz) in addition to routine diagnostics. The graded cross-sections of lymph-node dissections obtained during subsequent surgery served as evidence as to the true or false prognosis of the lymph-node status. Endoscopic ultrasonography identifies the presence and estimates the size of subcarinal, tracheobronchial, paraortal and paraesophageal lymph nodes better than computed tomography. Lymph nodes lying behind organs containing air (pretracheal lymph nodes) cannot be identified by ultrasonography. Lymph-node involvement was correctly identified by EUS in 72% of the cases, and the specificity was 86%. The poor sensitivity, at 67%, is explained by the high proportion (37%) of patients with anthracosilicosis, as the latter produces the same echo pattern as malignant infiltration. In 47% of all the cases, CT showed enlarged mediastinal lymph nodes which were not actually infiltrated in 67%. Of these lymph nodes, 33% could be classified as definitely free of metastases on the strength of their echo pattern, the rest were inflamed or really infiltrated by metastases.(ABSTRACT TRUNCATED AT 250 WORDS)
Worldwide almost no epidemiologic data are available on the prevalence or incidence of interstitial lung diseases (ILD) in the general population. Therefore, a registration programme of ILD-prevalence was organised by the VRGT (Vereniging voor Respiratoire Gezondheidszorg en Tuberculosebestrijding), among about 100 Flemish pneumologists since 1990. Most categories of the classification by Crystal et al. (1) were included and the diagnostic criteria (histology, laboratory tests, clinic, radiology) were registered. The present paper presents the results of 1992-1994: twenty pneumologists had forwarded the summary files of 237 patients to the central office in 1992 (n = 68), 1993 (n = 90) and 1994 (n = 79). The diagnoses that were most frequently made were: sarcoidosis in 27%, idiopathic pulmonary fibrosis in 20%, hypersensitivity pneumonitis in 14% (of which 68% by birds) and collagen-vascular disease in 10% (of which 54% in rheumatoid arthritis). Less frequent causes were eosinophilic pneumonia (4%), inhalation of inorganic material (4%, anthracosilicosis being excluded), histiocytosis X (3%), drugs (3%), angiitis and granulomatosis (2%), pulmonary hemosiderosis (1%), lymphocytic infiltrative lung disease (1%) and lymphangioleiomyomatosis (1%). The order of relative frequencies of the different categories of diseases was the same in the 3 registration years. In 9% of the patients the diagnosis was confined to "undefined fibrosis". The diagnosis was confirmed by histology in 63% of the cases. The overall male-female ratio was nearly one, with, however, a male preponderance in hypersensitivity pneumonitis (22/12), UIP(8/3) and "undefined fibrosis" (14/7).(ABSTRACT TRUNCATED AT 250 WORDS)
Cohort studies in three American asbestos factories were undertaken to investigate the effect of fibre type and manufacturing process on lung cancer, mesothelioma, and asbestosis. Reports have been published on a chrysotile textile plant in South Carolina and a mainly textile plant in Pennsylvania, which also used amphiboles. In the third plant in Connecticut friction products and packings were made from chrysotile only. In a cohort of 3641 men employed for one month or more, 1938-58, 3513 (96.5%) were traced, 1267 (36%) had died, and death certificates were obtained for 1228 (96.9%). Individual exposures were estimated (in mcpf . years) from impinger measurements. Life table analyses using Connecticut mortality rates gave an SMR for all causes of 108.5 (USA 107.9). The SMR (all causes) for men who had worked for less than a year was 129.9 and for those who had worked for a year or more, 101.2. The equivalent SMRs for respiratory cancer were 167.4 and 136.7 respectively. Excluding men who had worked for less than a year, there was possible evidence of some increase in risk of lung cancer with increasing exposure, supported also by a "log-rank" (case-control) analysis, of the same order as that observed in chrysotile mining and milling. These findings may be compared with chrysotile textile manufacture where the risk of lung cancer was some 50-fold greater. It is suggested that the differences in risk are perhaps related to the higher proportion of submicroscopic fibres in textile manufacture that may result from the traumatic carding , spinning, and weaving processes. No case of mesothelioma was found, consistent with a much lower risk of this tumour with chrysotile than with amphiboles. Twelve deaths (nine in men with very short and low asbestos exposure) were given ICD code 523 (pneumoconiosis); all but two were ascribed to anthracosilicosis or silicosis and none to asbestosis.
The authors examine the respiratory tests performed during a two years-period in 676 pneumoconiotic miners. Spirography was normal in 8% of the cases; a mixed ventilatory impairment, with an obstructive prevalence of variable extent, was present in 2/3 of the cases. Pharmacodynamic tests in 353 subjects showed a frequent non-specific bronchial sensitivity (34.2% of the whole group). Hypoxaemia (PaO2 below 75 mmHg) with normo- or hypocapnia was observed in 379 patients; hypercapnia was relatively uncommon (9.9%) and occurred mainly in bronchitic patients. The breath holding CO lung transfer test was very often disturbed, as the diffusing capacity (DLCO) was below the predicted value in about 80% of the population. Radiofunctional comparisons were carried out in an homogeneous group of 212 subjects. The data clearly demonstrate that functional abnormalities were not exclusively seen in extensive radiological forms. As far as it goes beyond a simple ventilatory study, the measurement of the breath holding lung transfer factor for CO has proved to be a valuable element in the functional statement of anthracosilicosis. The polymorphism of the pulmonary repercussions of dust exposure explains individual differences between the results of the main investigations, and this emphasizes the need for a series of diversified tests.