Smoking and colorectal cancer: a 20-year follow-up study of Swedish construction workers.

BACKGROUND: Although cigarette smoking has consistently been shown to be positively related to the risk of adenomatous polyp development (benign neoplastic growth of epithelial tissue in the colon), most studies of cigarette smoking and the risk of colorectal cancer have been negative. However, in two large prospective studies in women and men, a statistically significant association between cigarette smoking and an increased risk of colorectal cancer was found, but only after more than 35 years of smoking. PURPOSE: To shed further light on the alleged relationship between long-term smoking and colorectal cancer risk, we performed a retrospective cohort study among Swedish construction workers, with many long-term smokers, complete long-term follow-up, and a large number of observed cases. METHODS: We analyzed the association of smoking with colon cancer and with rectal cancer, using data on a cohort of approximately 135000 male construction workers. High-quality exposure information was collected with the use of a comprehensive questionnaire filled out at the time of enrollment in the cohort, from 1971 through 1975. Complete follow-up was achieved through 1991 and the subjects were observed for an average of 17.6 years, thereby contributing approximately 2375000 person-years of follow-up. We calculated age-adjusted rate ratios (RRs) with the use of Poisson-based multiplicative multivariate models followed by further multivariate modeling that adjusted for other variables. RESULTS: A total of 713 incident colon cancers and 505 rectal cancers were observed. There was no statistically significant association between current smoking status, number of cigarettes smoked or number of years smoking, and risk of colorectal cancer. The age-adjusted RRs were 0.98 (95% confidence interval [CI] = 0.82-1.17) and 1.16 (95% CI = 0.94-1.44) for colon and rectal cancers, respectively, among current smokers, and 1.07 (95% CI = 0.63-1.82) and 1.08 (95% CI = 0.58-2.03) among smokers of 25 or more cigarettes per day, relative to nonsmokers. Among smokers for more than 30 years at the start of follow-up, the age-adjusted RRs were 1.03 (95% CI = 0.85-1.25) and 1.21 (95% CI = 0.96-1.53) for colon and rectal cancers, respectively, relative to nonsmokers. Heavy smokers of cigars and pipes had a statistically nonsignificant tendency toward excess risk for colon cancer, but there was no clear dose-risk trend. CONCLUSION: Our large cohort study did not indicate any excess risk of colon cancer in males who were long-term heavy smokers and provided only weak support for an association with rectal cancer. Our data are thus consistent with the majority of previous reports. The reasons for the discrepancies in comparison with recent U.S. data have yet to be identified.

Tracheobronchopathia osteochondroplastica. A clinical bronchoscopic and spirometric study.

Tracheobronchopathia osteochondroplastica (TO) is a rare disease, although it probably occurs more frequently than expected. During an eight-year period, nine patients with TO were found among 2,180 performed bronchoscopies. There were four women and five men, with a mean age of 60 years. Cough, expectoration, dyspnea, hemoptysis, and recurrent airway infections were common, and most of the patients had had symptoms for more than ten years. Bronchoscopy revealed multiple yellow-white, hard, papilla-like formations reaching from the trachea to the segmental bronchi. Microscopy of biopsy specimens from the macroscopically altered mucosa showed osteocartilaginous tissue typical for TO in all patients. In eight of the patients spirometry showed an obstructive pattern.

Bronchostenosis due to sarcoidosis: a cause of atelectasis and airway obstruction simulating pulmonary neoplasm and chronic obstructive pulmonary disease.

Ninety-nine patients with clinically and histopathologically established sarcoidosis were studied during the period of January 1971 to October 1977 using the bronchoscope. In 32 patients, biopsy of the bronchial mucosa showed a microscopic picture typical of sarcoidosis. In eight (8 percent) of the 99 patients, severe stenosis of the bronchi was seen. We conclude that bronchial sarcoidosis with multiple segmental or lobar stenosis can closely imitate the clinical picture of chronic obstructive pulmonary disease. Bronchostenosis in sarcoidosis can cause atelectasis visible on the chest x-ray film and thus closely simulate a pulmonary neoplasm.

Childhood asthma in four regions in Scandinavia: risk factors and avoidance effects.

BACKGROUND: The high and increasing prevalence of childhood asthma is a major public health issue. Various risk factors have been proposed in local studies with different designs. METHODS: We have made a questionnaire study of the prevalence of childhood asthma, potential risk factors and their relations in four regions in Scandinavia (Umeå and Malmö in Sweden, Kuopio in eastern Finland and Oslo, Norway). One urban and one less urbanized area were selected in each region, and a study group of 15962 children aged 6-12 years was recruited. RESULTS: The prevalence of symptoms suggestive of asthma varied considerably between different areas (dry cough 8-19%, asthma attacks 4-8%, physician-diagnosed asthma 4-9%), as did the potential risk factors. Urban residency was generally not a risk factor. However, dry cough was common in the most traffic polluted area. Exposure to some of the risk factors. such as smoking indoors and moisture stains or moulds at home during the first 2 years of life, resulted in an increased risk. However, current exposure was associated with odds ratios less than one. CONCLUSIONS: Our findings were probably due to a combination of early impact and later avoidance of these risk factors. The effects of some risk factors were found to differ significantly between regions. No overall pattern between air pollution and asthma was seen, but air pollution differed less than expected between the areas.

Endobronchial biopsy positive sarcoidosis: relation to bronchoalveolar lavage and course of disease.

Sixty-two patients with newly diagnosed sarcoidosis were examined with fibreoptic bronchoscopy, endobronchial biopsies and bronchoalveolar lavage (BAL) were analysed. Epithelioid granulomatosis in endobronchial biopsies were found in 28 (45%) of the patients (BPOS). The patients in this BPOS group showed higher inflammatory activity in BAL fluid compared to those with negative biopsies (BNEG), with significant increases in lymphocyte and mast cell counts, and concentrations of procollagen III peptide and albumin. The patients were followed over a period of 2 years. The BPOS group tended to have a worse clinical course with more patients having a progressive disease and more patients requiring treatment with systemic steroids. We conclude that the findings of epithelioid granulomatosis in endobronchial biopsies may reflect a more intense and widespread inflammation in the lung.

Biological markers of exposure to SO2: S-sulfonates in nasal lavage.

S-sulfonate levels were measured in the nasal lavage (NAL) fluid of humans exposed to sulfur dioxide as a potential biological marker of exposure. These levels were determined by treating NAL fluid protein with cyanide to cleave the S-S linkage and release the sulfite. The cyanolytically released sulfite was measured by ion chromatography. In two experiments, humans were exposed to air or 1 ppm SO2 for 10 minute, and to air or 7 ppm SO2 for 20 minutes and lavaged immediately after exposure. Releasable sulfite levels in NAL fluid were 1.06 +/- 0.24 and 2.61 +/- 0.55 micrograms SO=3/mg protein, respectively (mean +/- SE, n = 5), for the first experiment, and 1.16 +/- 0.37 and 4.91 +/- 0.76 micrograms SO=3/mg protein, respectively (mean +/- SE, n = 8), for the second. The subjects in the former study were persons with asthma. In both experiments, S-sulfonate levels were statistically elevated in the exposed group compared with the control groups (p < 0.05, paired t-test). The same individuals in the second experiment received five additional 20-minute exposures to 7 ppm SO2 every other day, for a total of six exposures. NAL fluid taken at the conclusion of the final exposure had releasable sulfite levels of 4.99 +/- 1.36 micrograms SO=3/mg protein; these levels were statistically elevated relative to controls but were not elevated relative to the 1-day exposure (mean +/- SE, n = 8). The lack of accumulation of S-sulfonates after 6 days of short-term exposure suggests clearance of these compounds from the nasal passages within 24 hours. The levels of S-sulfonates observed in NAL fluid in this study are almost three orders of magnitude higher than those measured in plasma following similar SO2 exposures. Measurement of S-sulfonates in the nasal passage may be an effective short-term biomarker of exposure to SO2.

Terpene exposure and respiratory effects among workers in Swedish joinery shops.

OBJECTIVES: Exposure to monoterpenes (alpha-pinene, beta-pinene and delta 3-carene) in joinery shops was studied in Sweden during the processing of Scot's pine, and the acute respiratory effects among the employees were evaluated. METHODS: A cross-sectional study of 38 workers was carried out in 4 joinery shops. The investigation included personal air sampling of monoterpenes, biological monitoring of metabolites of alpha-pinene in the workers' urine, interviews following a standardized questionnaire, and dynamic spirometry. RESULTS: The personal exposure to monoterpenes in the joinery shops was 10-214 mg/m3. The correlation (correlation coefficient = 0.69) between exposure to alpha-pinene and verbenols (metabolites from alpha-pinene) in urine was relatively good. No acute effects on forced vital capacity or forced expiratory volume during 1 s were detected. The workers had significantly reduced preshift lung function values when compared with the values of a local reference group, even when smokers and ex-smokers were excluded. CONCLUSIONS: Personal exposure to the monoterpenes alpha-pinene, and delta 3-carene in joinery shops may exceed the present Swedish occupational exposure limit of 150 mg/m3 during the winter season when workroom air is commonly recirculated. The determination of metabolites of alpha-pinene (verbenols) in urine can be used as an index of exposure to fumes released during wood-treating processes. The results from the lung function tests indicate chronic rather than acute reactions in the airways. The fact that there were no major changes in lung function over a workshift indicates chronic reaction in the airways.

Terpene exposure and respiratory effects among sawmill workers.

OBJECTIVES: This study was performed to evaluate exposure to terpenes in sawmills and to study the acute effects on lung function and the respiratory tract of exposed laborers. METHODS: The relationships between personal exposure to sawing fumes, assessed by air sampling, and terpene metabolites in urine were studied. The association between exposure to terpenes and acute effects on lung function was studied for 48 workers. The reactivity to methacholine within the study population was investigated. Variation in acute subjective respiratory symptoms during a workshift was evaluated by interviewing the employees before and after work, following a standardized questionnaire. RESULTS: Personal exposure to terpenes in the sawmills was 11-158 mg. m-3. The correlation (correlation coefficient = 0.84) between exposure to alpha-pinene and the concentration of verbenols (metabolites from alpha-pinene) in urine was good. No acute effects on forced vital capacity or forced expiratory volume during 1 s were detected. A decrease in carbon monoxide lung diffusing capacity after a workshift was detected. Workers with > or = 5 years of sawmill employment showed a higher reactivity to methacholine than those with < 5 years. Eye irritation increased during a workday. CONCLUSIONS: Personal exposure to monoterpenes during a workshift sometimes exceeds the present Swedish limit value. The results show that verbenols in urine can be used as a biological exposure index of sawing fumes. Exposure in sawmills can cause an acute decrease in diffusing capacity. Workers with < or = 5 years of employment showed increased bronchial reactivity.

Cell response in bronchoalveolar lavage fluid after sulfur dioxide exposure.

Environmental chamber exposure and bronchoalveolar lavage (BAL) were used to study the dose-response relationship between short-term exposure to sulfur dioxide (SO2) and inflammatory reactions in the human lung as reflected in BAL fluid. Healthy subjects were exposed to 10, 13, 20, or 30 mg/m3 for 20 min. BAL was performed several weeks preexposure and 24 h postexposure. Mast cells, lymphocytes, lysozyme positive macrophages, and the total number of macrophages were significantly increased after SO2 exposure. A dose-dependent increase in the cell response in BAL fluid was observed after exposure to 10-20 mg/m3, but no further increase was detected after 30 mg/m3. Inflammatory cell response was found in BAL fluid at SO2 levels that occur in industrial indoor environments worldwide, and cell response to SO2 was also seen below the short-term exposure limit of Sweden and many other countries (13 mg/m3).

Association between haptoglobin groups and hereditary predisposition for bronchial asthma.

Haptoglobin (Hp) groups were investigated in 148 patients with bronchial asthma. A significant (p less than 0.005) deviation from the expected Hardy-Weinberg equilibrium, with a decreased frequency of heterozygotes, was observed among patients with a family history of asthma. This deviation was more pronounced among patients with adult onset of asthma. The presence or absence of atopy had no significant influence on the phenotype distribution.

Postoperative pulmonary ventilation after cholecystectomy with and without peritoneal drain.

Postoperative lung function, chest X-ray and diaphragmatic movements were measured in 38 patients operated on with elective cholecystectomy with and without drain. 21 patients were drained and 17 were not drained. The results showed that there was a marked decrease of vital capacity (VC), peak expiratory flow (PEF) and diaphragmatic movements postoperatively in all patients. There was no statistically significant difference between patients with and without intraperitoneal drain. Postoperative chest X-ray changes were found in seven patients with drain and in two patients without drain. Patients with postoperative chest X-ray changes showed a much slower recovery of the measured variables. The difference in VC and PEF between patients with and without postoperative pulmonary complications was statistically significant from the third day postoperatively. It is postulated that pre- and postoperative monitoring of simple lung function tests can be helpful in early detection of postoperative pulmonary complications.

Spontaneous pneumothorax as first symptom in bronchial carcinoma.

Pneumothorax is a rare manifestation of lung cancer. It has been reported to date in a total of about 25 patients. We describe two patients with spontaneous pneumothorax as the first sign of a bronchial carcinoma.

Pulmonary function in patients with endobronchial sarcoidosis.

Sixty-four patients with clinically, radiologically and histopathologically established sarcoidosis were studied by bronchoscopy and static and dynamic spirometry. Sarcoid bronchostenosis was established by bronchoscopy in nine patients. Twenty-one had bronchial sarcoidosis without stenosis and 34 had no evidence of bronchial sarcoidosis. Patients with sarcoid bronchostenosis showed a marked impairment of lung function, mostly with an obstructive pattern. There was no improvement in lung function after bronchodilatation in these patients. Obstructive spirometry pattern was also found in three patients with bronchial sarcoidosis stage II without stenosis. None of the patients without bronchial sarcoidosis had an obstructive pattern. All six patients with restrictive spirometry pattern in the two groups without bronchostenosis had stage II sarcoidosis. At follow-up, lung function had improved in five patients, four with sarcoid bronchostenosis and one patient with stage II without bronchial sarcoidosis. Four of these patients were treated with oral corticosteroids. When clinical signs of airway obstruction are present in patients with sarcoidosis, bronchial sarcoidosis with or without bronchostenosis should be suspected. When bronchial sarcoidosis is present, oral corticosteroid treatment should be tried.

Chronic bronchitis in northern Sweden; a seven year follow-up.

In 1974 a prevalence survey of chronic bronchitis was performed in the Hörnefors community on individuals in the age group 20-65 years. Chronic bronchitis was diagnosed in 44 individuals giving a prevalence of 2.2% (3.4% in men and 0.9% in women). Of the individuals with chronic bronchitis 79% were men, 85% above 40 years of age, 80% smokers or ex-smokers and 75% were or had been employed at a nearby sulphite pulp factory. Alpha-1-antitrypsin deficiency phenotypes (MZ, MS, MF) were present in 11 (25% of the individuals). Spirometric obstruction was found in 12 (27%) of the individuals with chronic bronchitis. At a seven-year follow-up four of the 12 individuals with obstructive chronic bronchitis had died from chronic respiratory insufficiency, the remaining individuals still having obstructive chronic bronchitis (no information present in one individual). In individuals with simple chronic bronchitis two had developed obstruction and 12 (38%) had improved now having no respiratory symptoms. The improvement in most of them was due to termination of smoking or change of work.

Comparison of flexible fiberoptic bronchoscopy and scalene lymph node biopsy in the diagnosis of sarcoidosis.

The diagnostic accuracy achieved by taking bronchial mucosal and lung biopsies through flexible fiberoptic bronchoscopes was compared with scalene lymph node biopsy in 55 patients with sarcoidosis. The diagnostic yield with flexible fiberoptic bronchoscopy was 62 per cent in the whole material and increased to 76 per cent in patients with stage II sarcoidosis. Scalene lymph node biopsy was positive in 80 per cent. Flexible fiberoptic bronchoscopy is a useful method for obtaining biopsy material in sarcoidosis, especially in stage II sarcoidosis. We consider flexible fiberoptic bronchoscopy and scalene lymph node biopsy the methods of choice in the diagnosis of sarcoidosis.