[The missions of the Occupational Diseases Fund. Under-claim and recognition of occupational lung cancer, in particular those related to asbestos]. / Les missions du Fonds des Maladies Professionnelles. La sous-déclaration des cancers respiratoires professionnels, en particulier dus a l'amiante.

The missions of the Occupational Diseases Fund are defined in application of the law regarding the insurance against occupational diseases. The workers covered by this law are granted several rights, such as a financial compensation in case of temporary or permanent disability, a further compensation if they have to be taken away from the risk in the workplace, the reimbursement of health care costs related to the occupational disease, or the payment of an annuity to the widow(er) if death is its ultimate consequence. Among the compensable diseases, we shall focus on lung cancer, and especially the one related to asbestos exposure. This type of cancer is clearly under-registrated in Belgium as in most countries of the European Union, leading to an insufficient number of cases entitled to compensation by our institution. In this instance, the insurance against occupational diseases and all related social advantages are hugely under-exploited in our country. It is our duty to increase doctors' awareness of the problem and spread accurate information to reverse this trend and provide occupational cancer cases with a legitimate compensation, in particular those related to asbestos. A wider knowledge of the occupational history of cancer patients, thanks to occupational physicians, and a better use of mineralogical analyses on lung samples, would improve this situation inacceptable on any level : medical, social or even human.

ITER-like antenna capacitors voltage probes: Circuit/electromagnetic calculations and calibrations.

The analyses illustrated in this manuscript have been performed in order to provide the required data for the amplitude-and-phase calibration of the D-dot voltage probes used in the ITER-like antenna at the Joint European Torus tokamak. Their equivalent electrical circuit has been extracted and analyzed, and it has been compared to the one of voltage probes installed in simple transmission lines. A radio-frequency calibration technique has been formulated and exact mathematical relations have been derived. This technique mixes in an elegant fashion data extracted from measurements and numerical calculations to retrieve the calibration factors. The latter have been compared to previous calibration data with excellent agreement proving the robustness of the proposed radio-frequency calibration technique. In particular, it has been stressed that it is crucial to take into account environmental parasitic effects. A low-frequency calibration technique has been in addition formulated and analyzed in depth. The equivalence between the radio-frequency and low-frequency techniques has been rigorously demonstrated. The radio-frequency calibration technique is preferable in the case of the ITER-like antenna due to uncertainties on the characteristics of the cables connected at the inputs of the voltage probes. A method to extract the effect of a mismatched data acquisition system has been derived for both calibration techniques. Finally it has been outlined that in the case of the ITER-like antenna voltage probes can be in addition used to monitor the currents at the inputs of the antenna.

Pneumoconiosis after sericite inhalation.

BACKGROUND: Between 1997 and 1999 three sericite plant workers in Parana, Brazil, were diagnosed with pneumoconiosis. AIMS: To investigate and describe the radiological, clinical, and pathological changes in miners and millers exposed to sericite dust with mineralogical characteristics of inhaled dust. METHODS: The working premises were visited to examine the sericite processing and to classify the jobs according to make qualitative evaluation. Respirable dust was collected and the amount of crystalline silica and particle size distribution were measured. Forty four workers were examined by a standard questionnaire for respiratory symptoms, spirometry, and chest x ray. Material from an open lung biopsy was reviewed for histopathological and mineralogical analysis, together with sericite samples from the work site to compare the mineral characteristics in lung lesions and work area. RESULTS: Respirable dust contained 4.5-10.0% crystalline silica. Particle size distribution showed a heavy burden of very fine particles (23-55%) with a mean diameter of <0.5 microm. Mean age of sericite miners was 41.0 (11.9) and mean number of years of exposure was 13.5 (10.1). In 52.3% of workers (23/44), chest radiographs presented a median category of 1/0 or above, and 18.2% (8/44) had a reduced FEV1. There was a significant association between exposure indices and x ray category. Histological studies of the lung biopsy showed lesions compatible with mixed dust fibrosis with no silicotic nodules. x Ray diffraction analysis of the lung dust residue and the bulk samples collected from work area showed similar mineralogical characteristics. Muscovite and kaolinite were the major mineral particle inclusions in the lung. CONCLUSION: Exposure to fine sericite particles is associated with the development of functional and radiological changes in workers inducing mixed dust lesions, which are distinct histologically from silicosis.

Comparative analysis of inhaled particles contained in human bronchoalveolar lavage fluids, lung parenchyma and lymph nodes.

Translocation of inhaled particles from the alveolar spaces to lung parenchyma and lymph nodes is one of the mechanisms that determine the biopersistence of particles. This study compares the nonfibrous particulate burden in bronchoalveolar lavage (BAL) fluids, lung parenchyma, and thoracic lymph nodes and attempts to detect the degree of differentiation, if any, based on particle size or type. This comparison can only be done on BAL, lung parenchyma, and lymph node samples collected from the same subject over a short time. Patients undergoing surgical lung resection are suitable for this purpose. Particles recovered by digestion-filtration were counted, sized, and analyzed by analytical transmission electron microscopy. Total particle load ranges grossly between 10(5) to 10(7) p/ml in BAL, 10(9) to 10(10) p/g dry tissue in parenchyma and 10(10) to 10(11) p/g dry tissue in lymph nodes. Diameters are log-normally distributed and mean diameters range between 0.5 to 0.9 micron. Nonlamellar silicate particles have a significantly larger diameter in lymph nodes. Differences in particle type between the three sampling sites are small and nonsystematic.

Environmental asbestotic pleural plaques in northeast Corsica: correlations with airborne and pleural mineralogic analysis.

We report a prevalence study of environmental pleural plaques in subjects over 50 years old from the northeastern Corsican village of Murato, built on asbestos surface deposits. The percentage of plaques was 41%, versus 7.5% in the control village of Vezzani. Although surface deposits contain both chrysotile and tremolite, airborne pollution and asbestos lung burden of exposed inhabitants consist essentially of tremolite as assessed by transmission electron microscopy (TEM). However, TEM analysis of the parietal pleura of three animals bred in exposed areas showed a predominance of short fibers of chrysotile. The respective roles of tremolite and chrysotile in inducing pleural plaques in Corsica should thus be considered.

Environmental asbestosis complicated by lung cancer.

Diagnosis of asbestosis and bronchiolo-alveolar carcinoma was made in a 55-year-old Turkish woman who was a nonsmoker. She originated from and was living in an area with a high prevalence of environmental diseases attributed to tremolite asbestos. Mineralogic analysis of lung tissue revealed very high concentrations of asbestos bodies (1.64 x 10(6)/g of dry tissue) and tremolite fibers (173.7 x 10(6) of dry tissue). This case illustrates the following points: (1) In some areas, environmental exposure can lead to cumulated fiber retention comparable to occupational exposure and thus can represent a risk for lung fibrosis (asbestosis). (2) Lung cancer as a complication of environmental asbestosis also should be considered as a potential environmental disease.

Quasistationary high confinement discharges with trans-greenwald density on TEXTOR-94

Confinement quality as good as ELM-free H-mode at densities substantially above the Greenwald density limit ( &nmacr;(e,0)/n(GW) = 1.4) has been obtained in discharges with a radiative boundary under quasistationary conditions for 20 times the energy confinement time. This is achieved by optimizing the gas-fueling rate of RI-mode discharges which tailors their favorable energy confinement and leads to discharges with beta values just below the operational limit beta(n) = 2 of TEXTOR-94, thereby effectively avoiding confinement back transitions or disruptions. In addition, this high-density regime is favorable for helium removal and results in figures of merit tau(*)(p,He)/tau(E) approximately 10-15, relevant for a future fusion power reactor.

Macroscopic assessment of pulmonary emphysema by image analysis.

AIMS: To propose a computerised image analysis based method for measuring, on paper mounted lung sections, the area macroscopically occupied by emphysema. METHODS: The study was based on the assessment of 69 lung sections prepared following a modified Gough-Wentworth technique. The results obtained from image analysis, point counting, and panel grading methods were compared, as was the repeatability of image analysis and panel grading. RESULTS: The results from image analysis and from point counting were not significantly different (p = 0.609) and significant quadratic regressions (r = 0.96, p < 0.001) were found between measurements from image analysis and from panel grading, the computerised technique being shown to be the most reproducible. CONCLUSIONS: Image analysis is a valuable and reproducible method to measure the area of lung macroscopically involved by emphysema.

An epidemiological study in an Anatolian village in Turkey environmentally exposed to tremolite asbestos.

After several cases of malignant pleural mesothelioma (MPM) were detected in the village of Kureysler in the Kütahya district of western Turkey, an epidemiological study was conducted. A questionnaire was completed by 124 villagers who were older than 20 years and standard posteroanterior chest X-rays were taken. The films were evaluated by three chest physicians. Samples of the white stucco that had been used by almost all villagers for indoor painting for many years were mineralogically examined. Chest X-rays showed that 23 (18%) had pleural plaques and calcifications compatible with asbestos exposure. Male sex and old age were associated with occurrence of pleural plaques. An analysis of white stucco samples revealed tremolite asbestos. In conclusion, tremolite fibers might be the cause of the high incidence of pleural plaques and MPM cases in the village of Kureysler.

[Role of biometric analysis in the retrospective assessment of exposure to asbestos]. / Place des analyses biométrologiques dans l'évaluation rétrospective des expositions à l'amiante.

Despite intrinsic limitations due to differences in the bio-persistence of the various asbestos types, in the definition of control populations and in analytical techniques used by the laboratories, mineralogical analysis of biological samples is useful in the assessment of past exposure to asbestos. It provides additional information to occupational and environmental questionnaires, particularly when exposure to asbestos is doubtful, unknown or forgotten by a subject. Results should be interpreted taking into account clinical information. A positive result does not mean existence of asbestos-related disease. A negative result does not exclude previous significant asbestos exposure, clearly identified by an occupational questionnaire (particularly for exposure to chrysotile). Threshold values indicative of a high probability of previous asbestos exposure have been established for bronchoalveolar lavage fluid (BALF) samples and lung tissue samples. Quantification of asbestos bodies by light microscopy is easy to perform. Sensitivity and specificity of this analysis towards the total pulmonary asbestos fiber burden is good. Therefore this analysis should be performed first. Mineralogical analysis in BALF or lung tissue should be considered only when sampling is supported by diagnostic or therapeutic implications.

[Environmental mesotheliomas in northeast Corsica]. / Les mésothéliomes environnementaux en Corse du nord-est.

Since 1980, we have collected fourteen cases of mesothelioma induced by environmental exposure to asbestos, going back to childhood in patients from north-east Corsica, in a region which was remote from the asbestos mine of Canari. There were eight men and six women with a mean age of 69.5 +/- 4 years. Six patients presented with bilateral calcified pleural plaques as evidence of environmental exposure. The mineral analysis carried out on five patients (four had thoracoscopies and one an alveolar lavage), showed a moderate deposit of chrysotile (0.3 to 3.4 x 10(6) fibres per gram of dry tissue), and elevated level of tremolite (1.4 to 62 x 10(6) fibres/g). The ambient dosage of asbestos has confirmed the existence of environmental pollution by chrysotile fibres and above all by tremolite. In addition, the same type of fibres have been identified in the parietal pleural of animals subjected to the same risk. In this region, the risk is estimated, on the basis of our results, as 10 cases of mesothelioma per 100,000 inhabitants per year.

[The diagnostic value of asbestos bodies in mesotheliomas]. / Intérêt diagnostique des corps asbestosiques dans le mésothéliome.

The exposure of asbestos was studied in 31 cases of mesothelioma from case histories and by microscopic mineralogical analysis of the broncho-alveolar lavage fluid (BAL) (31 cases) and of pulmonary tissue (5 cases). When definite exposure had occurred the lavage contained asbestos bodies in every case, except one patient with severe airflow obstruction. The most positive lavages, probably reflecting exposure to industrial amphiboles, were found in patients presenting with radiological evidence of asbestosis. Two patients had positive lavages 50 years after exposure had ceased. The lavage confirmed exposure in 6 out of 11 suspected cases and revealed contamination by asbestos in a further 4 cases, in a group of 6 not known to have been exposed. In 19.3% of cases there was a low concentration of asbestos bodies (less than 1AB/ml of BAL), comparable to what is found in 16.2% of controls from an urban population. An analysis of lung tissue confirmed massive exposure (greater than 20 000 AB/g) in two cases and in particular revealed a significant dust load (greater than 250 AB/g) in patients presenting with a weak positive BAL. Thus it seems that all the positive results should be taken into account. Of the 31 cases, 8 had a BAL without asbestos bodies. These were either mesotheliomas not linked to the inhalation of asbestos, or were the result of false negatives on account of artefacts related either to the BAL technique itself or linked to the technique of mineral analysis. Indeed the microscopic counts of asbestos bodies probably underestimate certain exposures, notably environmental exposure to chrysotile.

[The pneumology department]. / Le Service de Pneumologie.

The department of pneumology of the Erasme hospital exists since 25 years. The basic clinical activities include pulmonary function testing (7,500 patients per year), endoscopy, including interventional endoscopy (1,500 patients per year), thoracic oncology, allergology, rehabilitation and aid to smoking cessation. The following expertise fields have been largely developed: lung transplantation, treatment of cystic fibrosis in collaboration with the children's hospital Reine Fabiola, occupational.

Dioxin levels in fertilizers from Belgium: determination and evaluation of the potential impact on soil contamination.

Dioxins are harmful persistent organic pollutants (POPs) to which humans are exposed mostly via the consumption of animal products. They can enter the food chain at any stage, including crop fertilization. Fertilizers belong to several categories: synthetic chemicals providing the essential elements (mostly N, P and K) that are required by the crops but also organic fertilizers or amendments, liming materials, etc. Ninety-seven samples of fertilizers were taken in Belgium during the year 2011 and analyzed after a soft extraction procedure for polychlorinated dibenzo-p-dioxins (PCDDs), polychlorinated dibenzofurans (PCDFs) and dioxin-like polychlorinated biphenyls (DL-PCBs) using GC-IDHRMS. Only small qualitative differences could be observed between the main fertilizer categories since the PCDD:PCDF:DL-PCB average ratio obtained with the results expressed in TEQ was often close to 30:30:40 (typically for sewage sludge) or 40:30:30 (typically for compost). The median dioxin levels determined were generally lower than recorded previously and were the highest for sewage sludge and compost (5.6 and 5.5 ng TEQ/kg dry weight (dw), respectively). The levels in other fertilizers were lower including manure for which the median value was only 0.2 ng TEQ/kg dw. Several fertilization scenarios relying on the use of those fertilizers were assessed taking into consideration the application conditions prevailing in Belgium. From this assessment it could be concluded that the contribution of fertilizers to the overall soil contamination will be low by comparison of other sources of contamination such as atmospheric depositions. At the field scale, intensive use of compost and sewage sludge will increase dramatically the dioxin inputs compared with other fertilization practices but this kind of emission to the soil will still be relatively low compared to the dioxin atmospheric depositions.

Development of the gas-puff imaging diagnostic in the TEXTOR tokamak.

Gas puff imaging (GPI) [S. J. Zweben, D. P. Stotler et al., Phys. Plasmas 9, 1981 (2002); R. J. Maqueda, G. A. Wurden et al., Rev. Sci. Instrum. 74, 2020 (2003)] is a powerful diagnostic that permits a two-dimensional measurement of turbulence in the edge region of a fusion plasma and is based on the observation of the local emission of a neutral gas, actively puffed into the periphery of the plasma. The developed in-vessel GPI telescope observes the emission from the puffed gas along local (at the puff) magnetic field lines. The GPI telescope is specially designed to operate in severe TEXTOR conditions and can be treated as a prototype for the GPI systems on next generation machines. Also, the gas puff nozzle is designed to have a lower divergence of the gas flow than previous GPI diagnostics. The resulting images show poloidally and radially propagating structures, which are associated with plasma blobs. We demonstrate that the local gas puff does not disturb plasma properties. Our results indicate also that the neutral gas emission intensity is more sensitive to the electron density than the electron temperature. Here, we present implementation details of the GPI system on TEXTOR and discuss some design and diagnostic issues related to the development of GPI systems in general.

[Asbestosis still exists ]. / L'asbestose existe encore

A diagnosis of asbestosis, lung fibrosis due to asbestos exposure, was proposed in 2003 in a 64-year-old woman on the basis of the history, computed tomography appearances, lung function studies, and biometric data. This diagnosis was confirmed by the pathological examination of a lung lobe resected surgically for bronchial carcinoma in 2010. The diagnosis of asbestosis is now rarely made as a result of a substantial decrease in dust exposure over the past decades and mainly because of the interdiction of asbestos use in western countries. Currently, the most frequent thoracic manifestations of asbestos exposure are benign pleural lesions and mesothelioma. It has also become exceptional to have pathological confirmation of the diagnosis, obtained in this woman thanks to the surgical treatment of another complication of her occupational exposure.

Potential impact of fertilization practices on human dietary intake of dioxins in Belgium.

Dioxins can enter the food chain at any stage, including crop fertilization. Therefore, we developed a simple method for estimating the introduction of dioxins in the food chain according to various fertilization practices. Using dioxin's contamination data taken from the literature, we estimated that fertilization accounts for approximately 20% of the dioxin inputs on agricultural soils at country scale. For the estimations at the field scale, 6 fertilization scenarios were considered: sludge, compost, digestate, manure, mineral fertilizers, and a common fertilization scenario that corresponds to an average situation in Belgium and combines mineral and organic fertilizers. According to our first estimations, mineral fertilizers, common fertilization practices or manure bring less than 1 ng TEQ/m² while atmospheric deposition or digestate bring between 1 and 3 ng TEQ/m² and sludge or compost bring more than 3 ng TEQ/m². The use of solid fertilizers could potentially increase the dioxin levels in the 30 cm agricultural soil layer by 0 to ~1.5% per year (up to ~9% for the 5 cm thick surface layer). For animals, the increase in dioxin ingestion linked to the fertilization practices is lower than 1% for most scenarios with the exception of the compost scenario. Increases in human dietary intake of dioxin are estimated to be lower than 1% for conventional rearing methods (i.e. grazing animals are reared outdoor while pigs and poultry are reared indoor). Spraying liquid fertilizers on meadows and fodder crops, even if very limited in practice, deserves much more attention because this application method could theoretically lead to higher dioxin's intake by livestock (from 6 to ~300%). Considering an average half-life of dioxins in soils of 13 years, it appears that the risks of accumulation in soils and in the food chain are negligible for the various fertilization scenarios.