胸膜病变对石棉肺观察对象肺功能的影响

<正>随着人们对石棉危害的深入了解,高浓度的职业接触已大大减少,相应的肺实质疾患的发病率也大大降低,而胸膜病变则将一跃成为与石棉相关的主要健康问题。     

石棉肺合并恶性腹膜间皮瘤 1 例

分析1例恶性腹膜间皮瘤患者的诊断及治疗过程,结合文献复习,总结恶性腹膜间皮瘤的诊断、鉴别诊断及治疗,提高对恶性腹膜间皮瘤的诊断意识及治疗水平。     

Differences in occupational mortality from pleural cancer, peritoneal cancer, and asbestosis.

OBJECTIVE--To assess whether the increased risk of disease related to asbestos in occupations from the construction and engineering industries applies equally to pleural cancer, peritoneal cancer, and asbestosis. METHODS--Analysis was based on deaths among men aged 20-74 in England and Wales during 1979-80 and 1982-90. (n = 1,656,096). Information about cause of death and the last full time occupation of decedents was derived from death certificates. Proportional mortality ratios (PMRs) by occupation were calculated for each of pleural cancer, peritoneal cancer, and asbestosis. RESULTS--Altogether, 2848 deaths were attributed to cancer of the pleura, 362 to cancer of the peritoneum, and 281 to asbestosis. When occupations were ranked according to PMRs from these diseases, striking differences were found. The category of construction workers which included laggers had the highest mortality from peritoneal cancer (PMR 990, 64 deaths), but a PMR of only 160 (77 deaths) for pleural cancer. In contrast, several occupations with much higher mortality from pleural tumours had no excess of peritoneal cancer. PMRs for asbestosis related more closely to those for peritoneal than pleural cancer. CONCLUSIONS--These findings suggest that the exposure-response relations for diseases related to asbestos are not all linear, and that risks of pleural mesothelioma may be underestimated by simple extrapolation from observations in cohorts with heavy exposure.     

Malignant pleural and peritoneal mesotheliomas in former miners and millers of crocidolite at Wittenoom, Western Australia

Methods: A group of 6493 men and 415 women who had worked at the former Wittenoom crocidolite mine and mill at some time between 1943 and 1966 have been followed up throughout Australia and Italy to the end of 2000.

Results: The cumulative number of mesotheliomas up to 2000 was 235 in men (202 pleural, 33 peritoneal) and seven (all pleural) in women. There had been 231 deaths with mesothelioma (9% of known deaths).

Conclusions: The number of deaths in men with mesothelioma between 1987 and 2000 was at the low end of the predictions made earlier based on the number of cases to 1986. If this trend continues, it is predicted that about another 110 deaths with mesothelioma will occur in men by 2020.

     

Diagnosis of malignant pleural mesothelioma and asbestosis

The incidence of malignant mesothelioma, the main consequence of exposure to asbestos, will increase considerably in the Netherlands in the coming decades. In the next 35 year, some 20,000 people will die from malignant mesothelioma. The diagnosis of malignant pleural mesothelioma in practice is based on histological examination in about 80%, on cytological examination in 15% and on other forms of examination, e.g., high resolution computer tomography (HRCT), in 6% of the cases. Using a combination of various noninvasive methods, such as anamnesis, physical and r?ntgenologic examination, HRCT and spirometry, the diagnosis of asbestosis is made erroneously in 5% of the patients examined. With regard to allowance of financial compensation to patients with pleural mesothelioma and asbestosis, a part is played by the fact that views differ internationally concerning the criteria on which the diagnosis should be based. For mesothelioma cytologic and histologic examination are the most important. For asbestosis, the Health Council considers HRCT as crucial, if necessary supplemented by histological examination, plus a history of exposure to asbestos and pulmonary dysfunction. In mesothelioma cytological and histological examination are the most important.     

石棉肺合并恶性胸膜间皮瘤1例

介绍1例石棉肺合并恶性胸膜间皮瘤患者的临床资料、胸膜活检病理结果,探讨恶性胸膜间皮瘤的病因。     

石棉肺合并肺曲菌球1例

介绍1例石棉肺合并肺曲菌球患者的临床资料,复习其影像学方面的表现。     

Fibre-years,pulmonary asbestos burden and asbestosis

The relations between cumulative asbestos fibre doses at the work-places and asbestos burden of the lung evaluated by lung dust analyses have been tested on 3 different groups of patients of the German Mesothelioma Register: 1. total collective (n = 366), 2. collective without elevated asbestos burden of the lungs (n = 193), 3. collective with asbestoses/minimal asbestoses (n = 64). The relations between the above mentioned parameters are in general only weak. The limit value of > 25 fibre-years is found in 19.6% of persons without increased pulmonary asbestos burden. In spite of reaching or exceeding the cumulative doses of 25 fibre-years, 24% of the whole collective also show no elevated asbestos-concentrations in their lung tissues. By contrast, 42% of patients with asbestos-associated lung fibroses do not attain 25 fibre-years at their work-places. Considering our data it is doubtful that the postulated limit value of 25 fibre-years can be an adequate parameter for the evaluation of asbestos-associated lung fibroses.     

Trends and geographical patterns of pleural mesotheliomas in the Netherlands 1970-87

The sex and age related trends and geographical distribution of asbestos related mortality from pleural mesothelioma in the Netherlands between 1970 and 1987 were investigated. Deaths from pleural malignancies recorded by the Dutch Central Bureau of Statistics (CBS) were used and death rates were age adjusted per year by the indirect method. Standardised mortality ratios (SMRs) were computed for 43 regions over the period 1979-86. For men, total mortality increased from 10.8 per million in the period 1970-8 to 20.9 per million during 1979-87. The highest mortality occurred in the group aged between 65 and 74 with 147.7 per million in 1987. The death rate for the group aged between 55 and 64 was 96.5 per million in 1987. For women, total death rates for pleural mesothelioma showed a moderate increase from 2.5 per million in the period 1970-8 to 3.6 per million during 1979-87. The highest mortality occurred in the group aged over 65, fluctuating around 10-15 per million. For men and women under 45 mortality was very low and presented no upward trend. The geographical distribution over the country for the period 1979-86 showed a pattern with a clear concentration of deaths from mesothelioma in men, in conurbations with many harbours, shipyards, and heavy industry near the river mouths and along the North Sea Coast.     

Trends and geographical patterns of pleural mesotheliomas in the Netherlands 1970-87.

The sex and age related trends and geographical distribution of asbestos related mortality from pleural mesothelioma in the Netherlands between 1970 and 1987 were investigated. Deaths from pleural malignancies recorded by the Dutch Central Bureau of Statistics (CBS) were used and death rates were age adjusted per year by the indirect method. Standardised mortality ratios (SMRs) were computed for 43 regions over the period 1979-86. For men, total mortality increased from 10.8 per million in the period 1970-8 to 20.9 per million during 1979-87. The highest mortality occurred in the group aged between 65 and 74 with 147.7 per million in 1987. The death rate for the group aged between 55 and 64 was 96.5 per million in 1987. For women, total death rates for pleural mesothelioma showed a moderate increase from 2.5 per million in the period 1970-8 to 3.6 per million during 1979-87. The highest mortality occurred in the group aged over 65, fluctuating around 10-15 per million. For men and women under 45 mortality was very low and presented no upward trend. The geographical distribution over the country for the period 1979-86 showed a pattern with a clear concentration of deaths from mesothelioma in men, in conurbations with many harbours, shipyards, and heavy industry near the river mouths and along the North Sea Coast.     

Relation between pathological grading and lung fibre concentration in a patient with asbestosis

The fibre concentration and extent and severity of fibrosis have been analysed in 48 specimens from the left lung of a patient with asbestosis. Two different methods of fibre analysis were used. The results obtained by transmission electron microscopy were 2-2.5 times higher than those obtained by scanning electron microscopy. Low temperature ashed samples showed on average twice the number of fibres obtained after wet digestion of the samples. The transmission electron microscope detected considerably shorter fibres than the scanning electron microscope. Low temperature ashing produced also shorter fibres compared with the wet digestion procedure. A statistically significant correlation between fibre concentration and the grade of fibrosis was found only for low temperature ashed samples analysed in the transmission electron microscope. When dividing the lung into nine anatomical compartments and pooling the grade of fibrosis and the fibre concentration data within each compartment, an even better correlation was obtained.     

石棉肺合并淋巴瘤1例临床分析

报道1例石棉肺合并边缘区淋巴瘤病例的临床诊治体会。提示对出现肺部结节的石棉肺患者,需结合影像学、病理学等多种检查手段明确诊断,以防误诊。     

Relation between pathological grading and lung fibre concentration in a patient with asbestosis.

The fibre concentration and extent and severity of fibrosis have been analysed in 48 specimens from the left lung of a patient with asbestosis. Two different methods of fibre analysis were used. The results obtained by transmission electron microscopy were 2-2.5 times higher than those obtained by scanning electron microscopy. Low temperature ashed samples showed on average twice the number of fibres obtained after wet digestion of the samples. The transmission electron microscope detected considerably shorter fibres than the scanning electron microscope. Low temperature ashing produced also shorter fibres compared with the wet digestion procedure. A statistically significant correlation between fibre concentration and the grade of fibrosis was found only for low temperature ashed samples analysed in the transmission electron microscope. When dividing the lung into nine anatomical compartments and pooling the grade of fibrosis and the fibre concentration data within each compartment, an even better correlation was obtained.