44例恶性胸膜间皮瘤临床分析

目的　探讨恶性胸膜间皮瘤的临床特点。方法　回顾分析我院 1 990年 1月 - 2 0 0 3年 6月病理确诊的 4 4例恶性胸膜间皮瘤患者的临床资料。结果　本组病例男 2 6例、女 1 8例 ,男∶女为 1 44∶1 ;年龄以4 0～ 6 0岁多见 (占 4 3 % ) ;农民 1 5例 ,工人 7例 ,退休人员 5例 ,无业 5例 ,其他职业 6例。所有病例均无明显石棉接触史。首发症状胸痛 34例 ,活动后呼吸困难 31例 ,咳嗽 2 7例。 4 3例胸部X线表现为中 -大量积液 ,其中 1 0例伴胸膜广泛增厚 ;5例胸部CT检查显示胸膜增厚呈多发结节波浪状阴影。 38例胸腔穿刺抽液检查 ,其中 2 3例黄色胸液 ,1 5例为血性胸积液 ,31例积液的细胞分类计数淋巴细胞大于 5 0 %。 2 5例经胸膜针刺活检确诊 (5例胸液脱落细胞学检查同时找到恶性胸膜间皮瘤细胞 ) ;1 5例外科手术活检确诊。结论　恶性胸膜间皮瘤以胸痛、呼吸困难、咳嗽为主要表现 ,胸膜针刺活检为主要确诊方法。     

Malignant Mesothelioma in Japan: Analysis of Registered Autopsy Cases

In the Annual of the Pathological Autopsy Cases in Japan, issued by the Japanese Society of Pathology from 1958 to 1996, a total of 1,846 (0.17%) malignant mesothelioma cases (1,287 male, 558 female, 1 unknown) were registered among 1,056,259 autopsy cases. The frequency of mesothelioma (number of cases/total autopsy cases) was 0.10% (461/440,334) for the term 1958-1979, 0.18% (716/390,124) for 1980-1989, and 0.30% (669/225,801) for 1990-1996; the frequency of cases increased significantly over the time periods (p < .0001). Among 1,785 cases for which tumor sites were ascertained, there were 1,213 pleural mesothelioma (68.0%), 431 peritoneal (24.1%), 108 pericardial (6.1%), 6 tunica vaginalis testis (0.3%), and 28 “others” (1.6%). Histological cell type was noted in 598 cases; 245 (41.0%) were epithelial, 168 (28.1%) were biphasic, and 185 (30.9%) were sarcomatous. Seventy-three (0.007%) cases of malignant mesothelioma with asbestosis were found during the entire 39-y period. The frequency of those with asbestosis (number of cases/total autopsy cases) was 0.001% (5/440,334) for the term 1958-1979, 0.006% (27/390,124) for 1980-1989, and 0.018% (41/225,801) for 1990-1996; this increase over time was statistically significant (p < .0001). Researchers expect that cases of asbestos-related mesothelioma will increase in Japan in the future. Tumor sites and histological cell types of mesothelioma with asbestosis did not differ from those in individuals without asbestosis.     

Determination of Environmental Exposure to Asbestos (Tremolite) and Mesothelioma Risks in the Southeastern Region of Turkey

In this study, the authors examined the concentrations and mineralogical analyses of asbestos, and investigated mesothelioma risk in southeastern Anatolia, Turkey. They used a gravimetric dust sampler to collect samples from 2 villages and 2 asbestos mines (1 active). Samples were then evaluated by an X-ray diffractometer and an electron microscope. The authors found high concentrations of asbestos in an active mine (4.9 fibers[f]/cm³) and at a house that was plastered with asbestos (1.24 f/cm³) and had a very active population. They found a low concentration (0.0042 f/cm³) in indoor measurements taken in Armutova village, and an even lower concentration (0.000081 f/cm³) in the inactive mine environment. Outdoor measurements included a low concentration of 0.007 f/cm³ in the village environment, and a high concentration of 1.17 f/cm³ on the mine road during the passing of a sheep herd. The people in the region are continuously exposed to asbestos during normal activities. This cumulative exposure to asbestos carries sufficient risks for mesothelioma development.     

Recent Mortality from Pleural Mesothelioma,Historical Patterns of Asbestos Use,and Adoption of Bans: A Global Assessment

Background

In response to the health risks posed by asbestos exposure, some countries have imposed strict regulations and adopted bans, whereas other countries have intervened less and continue to use varying quantities of asbestos.

Objectives

This study was designed to assess, on a global scale, national experiences of recent mortality from pleural mesothelioma, historical trends in asbestos use, adoption of bans, and their possible interrelationships.

Methods

For 31 countries with available data, we analyzed recent pleural mesothelioma (International Classification of Diseases, 10th Revision) mortality rates (MRs) using age-adjusted period MRs (deaths/million/year) from 1996 to 2005. We calculated annual percent changes (APCs) in age-adjusted MRs to characterize trends during the period. We characterized historical patterns of asbestos use by per capita asbestos use (kilograms per capita/year) and the status of national bans.

Results

Period MRs increased with statistical significance in five countries, with marginal significance in two countries, and were equivocal in 24 countries (five countries in Northern and Western Europe recorded negative APC values). Countries adopting asbestos bans reduced use rates about twice as fast as those not adopting bans. Turning points in use preceded bans. Change in asbestos use during 1970–1985 was a significant predictor of APC in mortality for pleural mesothelioma, with an adjusted R² value of 0.47 (p < 0.0001).

Conclusions

The observed disparities in global mesothelioma trends likely relate to country-to-country disparities in asbestos use trends.     

Death Certificate Categorization of Malignant Pleural and Peritoneal Mesothelioma in a Cohort of Asbestos Insulation Workers

Accuracy of diagnosis of malignant mesothelioma (pleural andperitoneal) was studied in a cohort of asbestos insulation workersin the United States and Canada. Initial clinical diagnosis,clinical diagnosis at death and death certificate diagnosiswere compared with the diagnosis of malignant mesothelioma ascertainedby full data review at the Division of Environmental and OccupationalMedicine, Mount Sinai Medical Center, New York (‘bestevidence’). In both groups the death certificate diagnosiswas somewhat less frequently accurate than clinical diagnosisat death. Knowledge of the patients' occupational history bythe attending physician and its relation to accuracy of diagnosisof malignant mesothelioma is considered. Requests for reprints should be addressed to: Dr Joseph Ribak, Department of Preventive and Social Medicine, Tel Aviv University, Sackler School of Medicine, Ramat Aviv, Tel Aviv 69978, Israel     

Workshop summary: Potential usefulness and feasibility of a US National Mesothelioma Registry

The burden and prognosis of malignant mesothelioma in the United States have remained largely unchanged for decades, with approximately 3200 new cases and 2400 deaths reported annually. To address care and research gaps contributing to poor outcomes, in March of 2019 the Mesothelioma Applied Research Foundation convened a workshop on the potential usefulness and feasibility of a national mesothelioma registry. The workshop included formal presentations by subject matter experts and a moderated group discussion. Workshop participants identified top priorities for a registry to be (a) connecting patients with high-quality care and clinical trials soon after diagnosis, and (b) making useful data and biospecimens available to researchers in a timely manner. Existing databases that capture mesothelioma cases are limited by factors such as delays in reporting, deidentification, and lack of exposure information critical to understanding as yet unrecognized causes of disease. National disease registries for amyotrophic lateral sclerosis (ALS) in the United States and for mesothelioma in other countries, provide examples of how a registry could be structured to meet the needs of patients and the scientific community. Small-scale pilot initiatives should be undertaken to validate methods for rapid case identification, develop procedures to facilitate patient access to guidelines-based standard care and investigational therapies, and explore approaches to data sharing with researchers. Ultimately, federal coordination and funding will be critical to the success of a National Mesothelioma Registry in improving mesothelioma outcomes and preventing future cases of this devastating disease.     

Lead Concentration in Soil from a Small 15th-century Industrial Site: Occupational and Environmental Health Implications

Abstract

Former industrial sites are often reclaimed for new homes and other occupational uses. Such sites may still contain toxic chemicals that could put the health of the community at risk. The persistence of these residual chemicals and their effects on human health must not be underestimated. Hence, there is a need to analyze such sites to ensure that the public health will not be put at risk. It is also essential that the levels of release of heavy metals into the environment be monitored and regulated. In this study the lead (Pb) concentration in soil from a small 15th-century industrial site was determined to assess and evaluate its occupational and environmental health implications. Concentrations of Pb measured by atomic absorption spectroscopy (AAS) and inductively coupled plasmaemission spectroscopy (ICP-AES) techniques were 4,298.755 mg/L (SD 0.316; RSD 0.5%) and 4,300 mg/L (SD 0.3809; RSD 0.8%), respectively, both above the safe limit. It is concluded that reclaiming a disused industrial site without adequate soil analysis and proper remediation would be likely to pose occupational and environmental health risks.     

两种术式治疗恶性胸膜间皮瘤的效果与安全性比较分析

目的比较胸膜切除术/胸膜剥脱术(P/D)与胸膜外全肺切除术(EPP)治疗恶性胸膜间皮瘤(MPM)的效果与安全性。方法选取我院2005年1月至2016年12月收治的21例MPM患者,根据不同的手术方式分为P/D组(11例)和EPP组(10例)。比较两组患者的疗效与围术期并发症。结果两组患者的总缓解率比较差异无统计学意义(P>0.05)。P/D组的并发症总发生率为36.4%,明显低于EPP组的80.0%,差异有统计学意义(P<0.05)。结论 P/D与EPP治疗MPM的效果相当,但P/D能显著降低患者的围术期并发症发生率,对于技术上可行的MPM患者,可优先考虑采用P/D治疗。     

Pleural mesothelioma: forecasts of the death toll in the area of Casale Monferrato,Italy

In the city of Casale Monferrato, the largest Italian factory that produced asbestos‐cement goods was active from 1907 to 1985. Consequently, asbestos fibers scattered in the surrounding area and caused an enormous number of cases of pleural mesothelioma. Owing to the very long latency of this disease, many subjects have not exhibited its symptoms yet. The aim of this paper is to model and predict the future evolution of the number of deaths due to this disease among residents in the area around that city. The model used here is based on a cellular automata that is assumed to pass through three steps: exposure, contamination, and diagnosis. In this way, forecasts of the future evolution take into account the environmental conditions that changed over the last century because of different levels of plant activity. The model is fitted to annual diagnosis data from 1954 to 2008. Results show that deaths will not end until 2031 and that in the next two decades, at least 505 more subjects will be diagnosed with this disease. Copyright © 2012 John Wiley & Sons, Ltd.     

Malignant mesothelioma in Lynch syndrome: A report of two cases and a review of the literature

Malignant mesothelioma is a rare and aggressive cancer most typically associated with prior asbestos exposure. The nature of the relationship between asbestos exposure and hereditary familial syndromes predisposing to malignancy has not been determined. We report two Lynch syndrome patients with paraoccupational asbestos exposure who developed diffuse malignant mesothelioma of the pleura or peritoneum. Interestingly, one showed a separate focus of pleural well-differentiated papillary mesothelioma. It is likely that Lynch syndrome patients are at increased risk for the development of mesothelioma in the setting of exposure to asbestos, even at what is generally considered to be low levels. In the presence of a documented history of low-level asbestos exposure, patients with genetic predisposition disorders (including Lynch syndrome) should be considered to have an independent risk factor modifying the effects of asbestos exposure.     

大同市北村乡恶性肿瘤死亡与环境污染关系的调查研究

笔者对大同市北村乡进行了癌死因的调查研究。调查结果北村乡癌调整死亡率为１１７．０４／１０万，明显高于对照乡的６１．０６／１０万。北村乡居民饮水和常食用的几种蔬菜中硝酸盐、亚硝酸盐及血清中铜、铜／锌也明显高于对照乡，均Ｐ＜０．０５～ｐ＜０．００１。北村乡地区大气中３，４－苯并芘日均值为７．１６μｇ／１００ｍ￣３，颗粒物为９９．３１μｇ／ｇ，明显高于对照乡的１．６９μｇ／１００ｍ￣３和４６．３２μｇ／ｇ。调查结果表明，北村乡恶性肿瘤死亡率增高与该地区饮水、蔬菜和大气严重污染密切相关。     

在校青少年学生恶性肿瘤患病情况分析

通过对1978年5月至1997年6月在安徽省肿瘤医院收治的恶性肿瘤患者（白血病除外）4704人的患病情况分析，6～20岁恶性肿瘤患者245人，占住院总数4.2％，其中198人为在校学生，占该年龄恶性肿瘤患者的80.8％。结果表明所患恶性肿瘤依次为恶性淋巴瘤、成骨肉瘤、软组织肉瘤，分别为6～20岁恶性肿瘤患者的56．73％、19．18％及9．80％。这三种肿瘤均具有进展快、易发生血性转移、晚期预后差的特点，因此时在校青少年进行普及肿瘤知识的健康教育．以便做到对肿瘤的早期发现、早期诊断、早期治疗，以提高青少年恶性肿瘤患者的治愈率。     

影响城市居民对区域性环境问题认识因素的调查

目的了解影响城市居民对区域性环境问题认识的因素,评价城市居民的环境意识水平。方法采用直接入户调查的方式,取得500户居民对区域性环境问题认识的调查资料,用单因素和Logistic回归分析的方法进行分析。结果影响城市居民对区域性环境问题认识的因素包括:文化程度、经济收入。结论年龄、文化程度和经济收入越高对区域性环境问题的认识水平越高。     

Mesothelioma in household members of asbestos-exposed workers: 32 United States cases since 1990

BACKGROUND: Mesothelioma is significant as an indicator of asbestos exposure, as a continuing major cause of death in those exposed, and as a risk following lesser exposures. One such exposure is living in the household of an asbestos worker, and coming into contact with fibers brought home on his/her body, clothing, etc. METHODS: Law firms throughout the US known for their pursuit of asbestos claims were polled for mesothelioma claims brought on behalf of family members of identifiable asbestos-exposed workers. Cases with any occupational, environmental, or other possible exposure were not included. RESULTS: This study reports 32 household-exposure mesothelioma cases, diagnosed since 1990. Relationships were wife (15), daughter (11), son (3), sister-in law (1), niece (1), and boarder (1). Occupations of the workers included shipyard (13), insulator (7), and other (12). Of the 27 pleural cases, 13 were epithelial, 5 fibrous, 3 biphasic, and 6 not specified; of the 5 peritoneal cases, 4 were epithelial and 1 fibrous. Latency was greater than 40 years in 27 cases; 6 cases were 40-49 years of age and 17 were 60 or older. CONCLUSIONS: Records from law firms were a useful source of information. Mesothelioma resulting from household exposure is a continuing problem. It is more likely to present in the elderly, after latencies of >40 years.     

Identifying Environmental Health Priorities for a Whole Nation: The Use of Principal Environmental Exposure Pathways in the Philippines

Abstract

This paper presents a novel approach to establishing environmental health priorities for a large society, based upon the concept of principal environmental exposure pathways (PEEPs). Principal environmental exposure pathways extend the concept of a causal pathway backward from health outcome to exposure, then to the industrial, transportation, commercial, or living conditions that gave rise to the pollution of interest. In the Philippines, where the method was developed and used, five PEEPs were identified: an urban air-pollution pathway; a community water-supply pathway; an urban solid waste pathway; a rural “point-source” pathway; and a pathway whereby fertilizers and pesticides affect food, worker health, and rural water supplies. Characterizing the PEEPs involved pinpointing the populations at risk necessary to estimate the burden of morbidity and mortality related to each as well as identifying the health outcomes that were experienced by those exposed along each pathway or that they could be expected to experience; determining where adequate health out come information was available or absent; where exposure sources were or were not adequately identified; where there were significant gaps in agency responsibilities; where new data flows were needed; and where things could have been improved by improving inter-agency cooperation. The most important success of the PEEP method was to reduce the “problem of everything” in a complex country of 65 million people to a small and manageable number of priority environmental exposures.     

Unusually high incidence of malignant pleural mesothelioma in a town of eastern Sicily: an epidemiological and environmental study

In a recent epidemiological study, researchers investigated mortality from malignant pleural neoplasms in Italy, and they detected some geographic clusters of cases of this disease. We found a town located in a volcanic area of eastern Sicily to be of special interest. The residents, some of whom were diagnosed with pleural mesothelioma, had never had any relevant exposure to asbestos during their professional lives. The results of an environmental survey suggested that a possible cause of asbestos exposure was the stone quarries near the town. The products of the quarries contain fibrous amphiboles, which are used widely in the local building industry. These fibrous amphiboles were identified as intermediate phases between tremolite and actinolite. Samples were collected from buildings in the town, and concentrations of amphibole fibers were evaluated. Fibrous phases were detected in 71% of the samples, and fiber concentrations ranged from a few thousand to more than 4 x 10(4) fibers/mg of material. In addition, we conducted a study on the mineral fiber lung burden in a pleural mesothelioma case. Many mineral fibers that were classified as the same tremolite-actinolite fibrous amphibole found in the quarries and in the building materials were detected in the lung tissue. The results suggest that the inhabitants of the town we studied had been exposed for several decades to asbestos fibers that were present in the material extracted from the local stone quarries. The material was subsequently used in the building industry, and this has caused an increased risk of pleural mesothelioma in the area.     

Mesothelioma in blood related subjects: report of 11 clusters among 1954 Italy cases and review of the literature

BACKGROUND: Malignant mesothelioma is a sporadic tumor related to asbestos. Its occurrence in blood relatives raises the question of potential contribution of predisposing factors. METHODS: The study analyses the features of mesothelioma in blood relatives that might explain the disease clustering. Data sources of familial clusters were three population-based Mesothelioma Registries in Italy (Veneto and Apulia Regions, Brescia province; 1978-2005) and Medline, Toxline, and Oshline/Hseline databases for a review of the literature (1968-2006). RESULTS: Eleven clusters (22 cases) were identified among 1954 Italy mesothelioma cases, and 51 clusters (120 cases) were extracted from 33 studies. The proportion of Italy familial cases was 1.4 per 100 mesothelioma cases; the ratio between the number of familial clusters and the number of non-familial mesothelioma cases was 1:148. The mesothelioma profile in consanguineous is the same as in non-consanguineous subjects (male prevalence; pleural site; age at diagnosis >50 years; asbestos exposure). Most clusters occurred in asbestos workers (shipyard, asbestos-cement production/processing, and insulation) and household-exposed blood relatives. Others were related to asbestos-cement factory pollution, asbestos-in-place, and handling asbestos-contaminated textiles. Two clusters were without any known exposure. Cancer family history revealed lung cancer cases in eight clusters. CONCLUSIONS: Available data support asbestos exposure as the main risk factor in mesothelioma cases among blood relatives. Our finding of a low proportion of familial cases would not suggest the influence of a large genetic component for mesothelioma in blood relatives.