急性间质性肺炎的影像特征

目的探讨急性间质性肺炎的影像特征。方法回顾分析经开胸肺活检或临床综合诊断证实的10例AIP系列影像资料。结果 AIP的影像学表现为:早期主要表现为两肺对称性分布磨玻璃影;中期主要表现为两肺弥漫分布磨玻璃影及实变影,但实变影不如磨玻璃影常见,可见小叶间隔增厚;晚期主要表现为牵拉性支气管扩张、蜂窝状影、肺气肿。结论急性间质性肺炎相对特征性的影像学表现为进行性间质纤维化和急进性肺结构的破坏。     

Pathologic spectrum and lung dust burden in giant cell interstitial pneumonia (hard metal disease/cobalt pneumonitis): review of 100 cases

Hard metal disease (HMD), the interstitial lung disease caused by dusts in the cemented tungsten carbide (WC) industry, has been attributed to cobalt. The rare histologic pattern of giant cell interstitial pneumonia (GIP) is characteristic in HMD. The authors reviewed the history of HMD and 100 cases of HMD that they have seen over 5 decades. GIP was proven in 59; analysis of the lung inorganic particle burden by scanning electron microscopy and energy-dispersive x-ray spectroscopy confirmed HMD in the other 41. Cases have been diagnosed by bronchoalveolar lavage, lung biopsy, and autopsy. Histopathology findings range from focal peribronchiolar inflammation to diffuse interstitial fibrosis and honeycombing. GIP cases in the WC industry reveal elevated concentrations of tungsten in all, but cobalt was detected in only 6 ( approximately 10%). Of the 746 diverse cases in the authors' analytical database, almost all cases with the highest tungsten concentration showed GIP. This study confirms that GIP is effectively pathognomonic for HMD.     

The Literature of Environmental and Occupational Health (EOH) I. Appreciating Diversity in the Literature of EOH

Hard metal disease (HMD), the interstitial lung disease caused by dusts in the cemented tungsten carbide (WC) industry, has been attributed to cobalt. The rare histologic pattern of giant cell interstitial pneumonia (GIP) is characteristic in HMD. The authors reviewed the history of HMD and 100 cases of HMD that they have seen over 5 decades. GIP was proven in 59; analysis of the lung inorganic particle burden by scanning electron microscopy and energy-dispersive x-ray spectroscopy confirmed HMD in the other 41. Cases have been diagnosed by bronchoalveolar lavage, lung biopsy, and autopsy. Histopathology findings range from focal peribronchiolar inflammation to diffuse interstitial fibrosis and honeycombing. GIP cases in the WC industry reveal elevated concentrations of tungsten in all, but cobalt was detected in only 6 (～10%). Of the 746 diverse cases in the authors' analytical database, almost all cases with the highest tungsten concentration showed GIP. This study confirms that GIP is effectively pathognomonic for HMD.     

皮肌炎合并急性/亚急性间质性肺炎临床研究

目的 了解合并急性/亚急性间质性肺炎(A/SW)的皮肌炎患者临床特点及转归.方法 工收集10例皮肌炎合并A/SIP患者(A/SIP组)临床资料,与同期收治的非A/SIP皮肌炎肺间质病变患者9例(非A/SIP组)进行对照,对患者生存率进行统计分析.结果 与非A/SIP组相比,A/SIP组患者病程较短,发热、眶周红斑发生率较高,而血清肌酸激酶不高,胸部CT多数可见毛玻璃样改变(P＜0.01或＜0.05);A/SIP组患者生存率显著降低,至6个月时仅有1例存活(P=0.0001).Logistic回归分析显示,激素、环磷酰胺、环孢素联合治疗病死率较低,但差异无统计学意义(P=0.107).结论 皮肌炎合并A/SIP病情进展快、病死率高,需要早期进行诊治.对于发病初期即出现胸闷气急,尤其伴有反复发热、眶周红斑而血清肌酸激酶不高的患者须警惕其发展为A/SIP.激素联合环磷酰胺、环孢素可能是较为有效的治疗方案.     

Negative effect of photocopier toner on alveolar macrophages determined by in vitro magnetometric evaluation

Photocopier toner has been implicated in the etiology of some pulmonary diseases. We examined here the in vitro toxicity of toner particles to alveolar macrophages. Cell magnetometry revealed that relaxation was not delayed in macrophages exposed to toner, which represents a rapid decrease in the remaining magnetism emitted by phagocytosed magnetite. However, relaxation was delayed in macrophages exposed to silica (positive controls). The release of intracellular LDH enzyme activity to the extracellular space was negligible in cells exposed to toner compared with negative and positive controls. Morphological examinations by light and electron microscopy revealed no abnormal findings in the exposed cells. A histochemical study using TUNEL staining and the electrophoretic profile of DNA obtained from cells exposed to toner and to silica were negative for apoptosis. The results of the present and other investigations into animal exposure indicate that photocopier toner is toxicologically inert. However, although the present study examined only effects in vitro, exposure to toner should be minimized because lung overloading in animals has been reported.     

Desquamative interstitial pneumonia associated with chrysotile asbestos fibres.

The drywall construction trade has in the past been associated with exposure to airborne asbestos fibres. This paper reports a drywall construction worker with 32 years of dust exposure who developed dyspnoea and diminished diffusing capacity, and showed diffuse irregular opacities on chest radiography. He did not respond to treatment with corticosteroids. Open lung biopsy examination showed desquamative interstitial pneumonia. Only a single ferruginous body was seen on frozen section, but tissue examination by electron microscopy showed an extraordinary pulmonary burden of mineral dust with especially high concentrations of chrysotile asbestos fibres. This report emphasises the need to consider asbestos fibre as an agent in the aetiology of desquamative interstitial pneumonia. The coexistent slight interstitial fibrosis present in this case is also considered to have resulted from exposure to mineral dust, particularly ultramicroscopic asbestos fibres.     

Desquamative interstitial pneumonia associated with chrysotile asbestos fibres.

The drywall construction trade has in the past been associated with exposure to airborne asbestos fibres. This paper reports a drywall construction worker with 32 years of dust exposure who developed dyspnoea and diminished diffusing capacity, and showed diffuse irregular opacities on chest radiography. He did not respond to treatment with corticosteroids. Open lung biopsy examination showed desquamative interstitial pneumonia. Only a single ferruginous body was seen on frozen section, but tissue examination by electron microscopy showed an extraordinary pulmonary burden of mineral dust with especially high concentrations of chrysotile asbestos fibres. This report emphasises the need to consider asbestos fibre as an agent in the aetiology of desquamative interstitial pneumonia. The coexistent slight interstitial fibrosis present in this case is also considered to have resulted from exposure to mineral dust, particularly ultramicroscopic asbestos fibres.     

Redefining idiopathic interstitial lung disease into occupational lung diseases by analysis of chemical composition of inhaled dust particles in induced sputum and/or lung biopsy specimens

There has been increased public awareness of the potential danger from exposure to hazardous dust in various occupations. This study aims to validate the qualitative analysis of scanning electron microscopy (SEM) of lung samples by 1) correlation of induced sputum (IS) findings to clinical findings, 2) comparing hazardous particles in IS to those in biopsied lung specimens, and 3) assessing whether the particles present in the lungs of transplanted patients correlate with occupational history of dust exposure. Forty patients with occupational history were included; of whom 35 filled in questionnaires. Twenty-four of them had SEM analysis of their IS, and 11 of these 24 also had SEM analysis of their lung tissue. Another 11 lung biopsies from patients with occupational history were scanned by SEM and compared with 10 lung biopsies from patients with no occupational history. SEM analysis of IS was as efficient for detecting hazardous particles as was SEM analysis of lung tissue; silica was detected better in sputum. Exposure to silica was the main chemical element associated with a high likelihood to show abnormalities in IS (Odds ratio 19.41 CI = 0.270-1398.33). The average number of detected hazardous chemical elements in patients with an occupational history of exposure was 4 +/- 1.61 in IS and 3.55 +/- 2.02 in lung tissue (P = 0.57); it was 1.5 +/- 0.85 from transplanted occupationally exposed patients compared with 0.36 +/- 0.67 in transplanted non-exposed patients (P = 0.003). SEM analysis of particles in IS and lung tissue can elucidate the causative agent(s) of otherwise idiopathic interstitial lung disease among occupationally exposed workers.     

A cross sectional study of the respiratory health of workers handling printing toner dust

Background

Although recent case reports have suggested possible respiratory effects of solid toner dust inhalation, this hypothesis has not been verified by epidemiological studies.

Objectives

To conduct a cross sectional study to evaluate the association between the biological indices of lung fibrosis and toner dust exposure in an occupational cohort handling solid toner dust in their work life.

Methods

A total of 600 male toner workers and 212 control subjects were surveyed in terms of their subjective respiratory symptoms, pulmonary functions, and chest radiographic findings. In addition to the exposure history, the current working conditions and personal exposure levels to toner dust were also examined.

Results

Although subjects handling toner for more than 20 years tended to show a higher prevalence of respiratory symptoms and minimal chest x ray abnormalities, there was no consistent relation between the exposure to toner dust and the biological responses of the respiratory system.

Conclusion

Deterioration of respiratory health related to toner dust exposure is less likely to occur in current well controlled work environments, especially if the powdered toner is handled carefully. Nonetheless, it is important to collect further epidemiological evidence on the biological effects of toner dust inhalation, preferably using a longitudinal study design.     

Three cases of idiopathic interstitial pneumonia with bullae seen in schoolteachers

We encountered three patients with chronic interstitial pneumonia with many bullae in the lower lung fields whose lifetime occupation was teaching school. Pathological examination of autopsy lungs of these patients revealed interstitial pneumonia and multiple bullae throughout the lungs, including the lower lobe. Since blackboard chalk has been used as a popular writing material among teachers in Japan, the mineral contents in the lungs of two of the three cases and four control cases with idiopathic interstitial pneumonia (IIP) (whose occupations were not teaching) were analyzed. The amount of deposition of total dust, inorganic dust, non-SiO₂ inorganic dust, and calcium was significantly higher in the lungs of two schoolteachers compared with those of the control lungs. The amount of free silica in case 1 and alpha-quartz in case 3 were also significantly higher than in the controls. Two thirds of the chalk produced in Japan is still made from gypsum and involves small amounts of silica and other minerals, in addition to calcium. These findings indicated the deposition of chalk in the lungs of these patients with interstitial pneumonia and multiple bullae.     

Pneumoconiosis from Agricultural Dust Exposure among Young California Farmworkers

Background

Agricultural workers are exposed to airborne pollutants, including organic and inorganic (mineral) dusts.

Objectives

Lung autopsy specimens from consecutive coroner’s cases of Hispanic males in Fresno County, California, (n = 112) were obtained to determine whether mineral dust exposure in agricultural work leads to pneumoconiosis.

Methods

The left lung was fixed by inflation. We evaluated airway and parenchymal pathology using standardized diagnostic criteria and semiquantitative grading schemata, including the grading of small airways for fibrosis and birefringent mineral dust particles. We analyzed lung dust burden on a subset of 37 lungs following bleach digestion, using scanning electron microscopy (SEM), X-ray spectrometry (XRS) and image analysis, and by X-ray diffraction for crystalline silica (CSi). Farmworkers comprised 51.5% and nonfarmworkers 48.5% of the samples.

Results

Proximal airways demonstrated little mineral dust accumulation, but membranous and respiratory bronchioles had wall thickening, remodeling, and inflammation associated with carbonaceous and mineral dust deposition. These changes were independently associated with agricultural work, cigarette smoking, and increased age. Mineral dust small airways disease, pneumoconiosis (macules and nodules), and pathologic changes consistent with chronic bronchitis, emphysema, and interstitial fibrosis predominated in farmworkers compared with nonfarmworkers. CSi, determined gravimetrically, and aluminum silicate particles, determined by SEM/XRS, were increased in the lungs of farmworkers compared with nonfarmworkers and were significantly (p < 0.05) associated with small airway disease and pneumoconiosis.

Conclusion

Mineral dust exposure is associated with increased small airway disease and pneumoconiosis among California farmworkers; however, the clinical significance and natural history of these changes remains to be determined.     

Lung function in workers exposed to soft paper dust

In a cross-sectional study, 13 nonsmoking men with heavy exposure to paper dust were compared with 14 unexposed men, mainly office workers, employed at the same paper mill. They were studied using questionnaires, physical examinations, pulmonary function studies, and chest radiographs. Among those exposed there was an increased lung elastic recoil pressure (Pel) compared with controls which was significant (p less than 0.05) at the maximal level of total lung capacity (100% TLC). Furthermore, among the exposed workers there was also a significantly (p less than 0.05) decreased residual volume (RV). Two of the exposed men underwent lung biopsies, one of which showed fibrotic alveolar walls. Among the exposed there was also a significant (p less than 0.05) predominance of symptoms from the lower respiratory tract. We suggest that the observed pulmonary function impairment taken together with the histological examination of the lung biopsies are signs of a nonspecific reaction to high levels of paper dust.     

Lung cancer among silica-exposed workers: the quest for truth between chance and necessity

BACKGROUND: In 1997, IARC upgraded crystalline silica to a Group 1 human carcinogen. However, the IARC report itself acknowledged variations in risk depending on inherent characteristics of the crystalline silica or external factors affecting its biological activity or distribution of its polymorphs. METHODS: We reviewed silica physical and physico-chemical properties and how such properties may affect its interaction with the target cells. Studies of silica, silicosis and lung cancer published from 1997 onwards are then reviewed in the search of any new advances in knowledge about silica carcinogenicity. Finally, other possible confounding factors contributing to inconsistent findings on silica, silicosis, and lung cancer are reviewed. RESULTS: Host factors, physico-chemical characteristics of the surface of silica particles, exposure circumstances, and the mineral ore composition experimentally affect the ability of silica particles of inducing release of reactive oxygen species (ROS) and TNF-alpha by alveolar macrophages, possibly accounting for the great variation in lung cancer risk among dust exposed workers across the individual studies. Most recent epidemiological studies do not consider such complex pattern of modifying factors, and they keep replicating inconsistent findings. The hypothesis of a silicosis-mediated pathway, although more consistent from an epidemiological perspectives, and reassuring in terms of the effectiveness of current standards in preventing lung cancer risk among silica exposed workers, does not seem to explain elevated risks at low silica exposure levels. CONCLUSION: Future studies of lung cancer risk among workers exposed to silica-containing dust should consider measurement of ROS and TNF-alpha release by workplace dust samples as intermediate end-points predicting lung cancer risk better than silica concentration, allowing to more effectively address preventive action.     

Lung and pleural fibrosis in asbestos-exposed workers: a risk factor for pneumonia mortality

SUMMARY Lungs exposed to occupational dust may be especially vulnerable to fatal infections. We followed up asbestos-exposed workers (n=590) originally screened for lung cancer with computed tomography and scored for pleuropulmonary fibrosis. We checked these workers' influenza and pneumonia mortality data (ICD-10 codes J10-J18) in the national register. In total, 191 deaths, including 43 deaths from infectious pneumonia, occurred in 6158 person-years of follow-up (mean follow-up time 10·44 years). 'Some interstitial fibrosis' [hazard ratio (HR) 2·26, 95% confidence interval (CI) 0·98-5·19, P=0·06] and 'definite interstitial fibrosis' (HR 3·70, 95% CI 1·22-11·23, P=0·02) were associated with an increased risk of death from pneumonia compared to no fibrosis. Asbestosis patients, i.e. those with both asbestos exposure and lung fibrosis, therefore appear to be particularly at risk for death from pneumonia. These patients should be vaccinated against influenza and Pneumococcus.     

肺灌洗排尘病因治疗的资料分析和实验研究

目的针对支气管肺泡灌洗术（ＢＡＬ）治疗尘肺存在议点,探讨 ＢＡＬ治疗尘肺的可能性。方法对 ＢＡＬ治疗尘肺理论依据、肺间质排尘以及影响排尘的主要因素,进行了资料分析和实验研究。结果尘肺发生发展的剂量反应和剂量效应关系,为ＢＡＬ治疗尘肺奠定了理论基础;肺间质封闭技术建立及其应用,证实了肺间质内沉积尘和ＰＡＭ可随ＢＡＬＦ排出体外;尘肺病变程度和染尘后持续时间是影响排尘量的主要因素;模拟ＢＡＬ减尘实验的效果,加深了对尘肺 ＢＡＬ治疗的正确认识。结论ＢＡＬ拟用于早期和急性尘肺的治疗。     

Treatment and results of interstitial lung diseases in video assisted thoracoscopic lung biopsy

In order to establish treatment of interstitial lung diseases in video assisted thoracoscopic lung biopsy, we retrospectively reviewed our experiences. The present study included 7 patients with a mean age of 46.4, range from 24 to 61, who were treated at our department from 1996 through 1999. They were 5 men and 2 women. The pathologic diagnosis was nonspecific interstitial pneumonia in 3 patients who responded to steroid therapy. Three other patients had usual interstitial pneumonia. One patient had lymphocytic interstitial pneumonia. No complications occurred. The results indicate that video assisted thoracoscopic lung biopsy is an effective and safe way to diagnose interstitial lung diseases.     

Pulmonary function and intradermal tests in workers exposed to soft-paper dust

A survey was carried out in the processing department of a paper mill, consisting of environmental and personal monitoring, a short questionnaire concerning chronic non-specific lung disease (CNSLD), spirometry, and intradermal tests. Spirometry was performed on Monday, Wednesday, and Friday. Exposures to paper dust regularly exceeded the Dutch Maximal Allowable Concentrations (MACs) for total and respirable dust. There were indications of a qualitatively different exposure to molds inside the mill in comparison with the outdoor air. A comparison between a group of workers exposed to paper dust and a control group showed significantly more persons with positive late and delayed intradermal test reactions in the exposed population. The analysis of the spirometric measurements after correction for differences between the groups in age, height, and smoking habits gave evidence of the existence of lower FEV1, MMEF, MEF50, and MEF25 among exposed workers with a positive immediate intradermal reaction on Friday. The same workers showed a decline in pulmonary function over the week compared with the controls. These changes suggest an obstructive airway reaction with an immunologic mechanism to dust exposure in a paper mill.     

Chronic Ammonia Inhalation and Interstitial Pulmonary Fibrosis: A Case Report and Review of the Literature

Ammonia is an irritant gas with a characteristic pungent odor, which is widely used in industry. Inasmuch as ammonia is highly soluble in water and, upon inhalation, is deposited in the upper airways, occupational exposures to ammonia have commonly been associated with sinusitis, upper airway irritation, and eye irritation. Acute exposures to high levels of ammonia have also been associated with diseases of the lower airways and interstitial lung. In this study, the authors report on a patient with long-term, repetitive occupational exposure to ammonia at levels at or above odor recognition who developed interstitial lung disease. The scientific literature on inhaled ammonia exposure is reviewed and discussed. The authors conclude that the taking of a careful occupational exposure history for patients presenting with shortness of breath associated with ammonia exposure may assist with an early diagnosis, thus allowing for treatment early in the disease process and prevention of further exposure.     

Inorganic particulates in pneumoconiotic lungs of hard metal grinders

Data from the analysis of lung dust in 16 metal grinders who had been exposed to hard metals between five and 44 years is reported. The mean latent time between the first exposure and analysis in biopsy or necropsy specimens was 33.6 years. Mineralogical and elementary analysis by a variety of techniques showed small or trace amounts of hard metal in all lungs. Many specimens, however, did not contain all hard metal components, cobalt, for example, being detected in four cases only. All the lungs contained quartz and silicates and in most of the necropsy cases carborundum and corundum could also be shown. Histologically no specific pattern was found. The appearances included mixed dust nodular pneumoconiosis, diffuse interstitial lung fibrosis, and foreign body and sarcoid like granulomatous changes. In view of the mixed dust exposure of the hard metal grinders and the variable histological appearance we think that the term "mixed dust pneumoconiosis in hard metal grinders" is more appropriate than "hard metal lung" to describe this condition.     

Inorganic particulates in pneumoconiotic lungs of hard metal grinders.

Data from the analysis of lung dust in 16 metal grinders who had been exposed to hard metals between five and 44 years is reported. The mean latent time between the first exposure and analysis in biopsy or necropsy specimens was 33.6 years. Mineralogical and elementary analysis by a variety of techniques showed small or trace amounts of hard metal in all lungs. Many specimens, however, did not contain all hard metal components, cobalt, for example, being detected in four cases only. All the lungs contained quartz and silicates and in most of the necropsy cases carborundum and corundum could also be shown. Histologically no specific pattern was found. The appearances included mixed dust nodular pneumoconiosis, diffuse interstitial lung fibrosis, and foreign body and sarcoid like granulomatous changes. In view of the mixed dust exposure of the hard metal grinders and the variable histological appearance we think that the term "mixed dust pneumoconiosis in hard metal grinders" is more appropriate than "hard metal lung" to describe this condition.