Understanding Mentally Confused Elderly Persons

We bring to old age a built-in system of self-depreciation, having thoroughly absorbed the notion that the elderly are unattractive, useless and meddlesome. The oldster's struggle to adapt and adjust to this hostile environment can give rise to various symptoms. A common example is memory failure.     

螺旋CT诊断胸膜斑的临床价值

目的：研究胸膜斑的螺旋CT表现,提高诊断和鉴别诊断水平。材料和方法：回顾性分析与石棉粉尘密切接触的42例胸膜斑的螺旋CT表现。结果：42例中,螺旋CT发现胸膜斑407个,其中透明型/非钙化型胸膜斑250个、钙化型胸膜斑36个和混合型胸膜斑121个;单侧10例、双侧32例;单发胸膜斑5例,多发胸膜斑37例;最大胸膜斑长4.2cm,厚1.2cm;胸膜斑的形状多种多样;钙化型和混合型胸膜斑内可见不同形态的钙化;胸膜斑多位于中、下胸部前或后外侧胸壁,肋骨下方28例（66.7%）,侵犯双侧膈顶10例,心包4例,合并肺纤维化4例,6例增强扫描胸膜斑未见增强;肺尖和肋膈角不受累。正确诊断42例,正确诊断率100%。结论：螺旋CT能清晰地显示胸膜斑的部位、分布、范围、形态、大小、密度及其毗邻关系,结合石棉粉尘接触史,能与其他胸膜增厚病变鉴别,明确诊断。对胸膜斑/石棉肺,螺旋CT是最佳的影像学检查方法。     

A case of pulmonary asbestosis presenting with temporal arteritis involving multiple medium-sized vessels

A 76-year-old woman with pulmonary asbestosis was admitted with fever and polymyalgia. She subsequently developed a visual disorder, hemoptysis, and hemoperitoneum. A biopsy of the temporal artery revealed the presence of giant-cell arteritis. CT and angiography showed hemorrhaging from the bronchial and abdominal arteries. These observations suggested temporal arteritis in which medium-sized vessels were involved. This case implies the association between vasculitis and asbestosis, and suggests a problem in the classification of vasculitides.     

Changing attitudes and opinions regarding asbestos and cancer 1934-1965.

Literature published in the years 1934-1965 was reviewed to determine attitudes and opinions of scientists as to whether asbestos is a cause of cancer. In Germany, the issue was decided in 1943 when the government decreed that lung cancer, when associated with asbestosis (of any degree), was an occupational disease. In the United States, however, there was no consensus on the issue until 1964. Opinions of scientists over a 22 year period are shown and the contributions of various cultural, social, economic and political factors to these opinions are discussed. A lack of experimental and epidemiological evidence played a major role in delaying a consensus. Other important factors included a rejection of science conducted outside of the U.S. during this period, particularly a rejection of German scientific thought during and after WWII, and a rejection of clinical evidence in favor of epidemiological investigations. Individual writers rarely changed their minds on the subject of asbestos as a cause of cancer.     

石棉工人接尘量与石棉肺发病关系的研究

对北京市制动密封材料厂的1244名接尘职工(其中石棉肺患者115名),用寿命表法和Logistic回归模型进行接尘量与石棉肺发病关系的研究表明,石棉肺的发病概率与累积接尘量之间呈直线相关。若以工作30或40年发病概率小于1%计,则年平均粉尘浓度在1.10～3.13mg/m~3(寿命表法,40年)和0.63～0.78mg/m~3(Logistic回归模型,30年)之间。其对应的粉尘计数浓度为1.44～1.79f/ml和1.35～1.38f/ml。作者建议现行石棉粉尘最高容许浓度应该从2mg/m~3降低到1.5mg/m~3或1.5f/ml。     

Asbestos disease in sheet metal workers: II. Radiologic signs of asbestosis among active workers

A review of chest x-rays of 707 currently employed New York metropolitan area sheet metal workers found that 29.3% of the workers with 20 years or more of union membership (a surrogate for years of exposure) had radiologic abnormalities characteristic of parenchymal and/or pleural asbestosis, with 18.6% having abnormalities characteristic of parenchymal asbestosis (International Labor Organization [ILO] classification 1/0 or higher) and 17.4% of pleural asbestosis. The prevalence of abnormalities characteristic of either parenchymal and/or pleural asbestosis in the group as a whole was 16.4%, with 10.9% exhibiting signs of parenchymal asbestosis and 9.2% of pleural asbestosis. There was a strong, statistically significant relationship between years in the trade and the prevalence of radiologic abnormalities. These findings underscore the need for medical surveillance of all asbestos-exposed construction workers, including retirees and workers who have had past exposure but who are no longer exposed.     

Immunological aspects of asbestosis: Patients' neurological signs and asbestosis progression

This study is a component of a long-term, follow-up study aimed at evaluation of immunological and neurological findings with regard to the early detection of malignancies among patients at high risk of developing cancer. One hundred fifteen patients with diagnosed asbestosis were examined neurologically and immunologically (rheumatoid factor, antinuclear antibodies, C3 and C4 and circulating immune complexes). Patients with nervous system involvement (63 cases; 55%) revealed no significant immunological differences when compared with the other patients except for a more common presence of antinuclear antibodies among patients without nervous system involvement (21% vs 6%, p < 0.05). Significantly increased Wa-Ro titers (> 1/128) were found for 3–4% of the patients whose asbestosis was either progressive or not as to radiological fibrosis, whereas only 0.4% of the blood donors had a significantly increased Wa-Ro titer. The respective figures of latex agglutination (> 1/32) were found for 14–19% of the asbestosis patients whereas in 0.8% of the blood donors. The mean level of C3 was higher among progressive than nonprogressive asbestosis cases (1.48 vs 1.34, p < 0.05). Patients with radiographic progression of asbestosis had higher IgG-antinuclear antibody titers than the patients without progression.     

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.     

Previously undetected silicosis in New Jersey decedents

BACKGROUND: Despite a reported decline in mortality and hospitalizations associated with silicosis [U.S. Department of Health and Human Services, 1999], this decline may be artifactual, stemming in part from underdiagnosis by physicians. METHODS: This study estimates, through radiological confirmation, the prevalence of unrecognized silicosis in a group of silica-exposed New Jersey decedents whose cause of death was chronic obstructive pulmonary disease (COPD), tuberculosis, or cor pulmonale. Two expert readers re-evaluated the chest X-rays of this group to determine the presence or absence of silicosis. The study population was considered to be presumptively exposed to silica dust by virtue of their usual industry of employment as listed on the death certificate. RESULTS: Radiographic evidence of silicosis was found in 8.5% of this population, and evidence of asbestosis was found in another 10.7%, for a total of 19.2%. CONCLUSIONS: The existence of previously unrecognized silicosis and asbestosis in 19.2% of this study group suggests that occupational lung disease is under-recognized and, hence, undercounted.     

Asbestosis and lobar site of lung cancer

OBJECTIVE—To assess the evidence for the hypothesis that lung cancer has a predilection for the lower lobes in workers with asbestosis.
METHOD—A review of the available literature with relevant information.
RESULTS—Six published reports were analysed. In four studies limited to series of cases with diagnoses of asbestosis, three showed lower lobe predominance of lung cancer whereas the fourth study included cases in which the radiographic readings did not meet the usual criterion of profusion for asbestosis. One cohort study showed lower lobe predominance; the other reported only 33% lower lobe cancers compared with 20% in unexposed controls.
CONCLUSION—There is some support for the hypothesis but more studies are needed.


Keywords: asbestos; asbestosis; lung cancer