Asbestos exposure biomarkers in the follow-up of asbestos-exposed workers.

Health surveillance of asbestos exposed workers should be stratified according to the exposure level. Unfortunately there is a lack of information regarding asbestos exposure in many working places and markers of asbestos exposure are often needed. The aim of the study was to assess the reliability of different dose and effect biomarkers in the follow up of asbestos-exposed workers. Mineralogical analysis of bronchoalveolar lavage fluid (BALF) as a biomarker of asbestos fibre burden was performed in a population of 307 male subjects occupationally exposed to asbestos. Using nonparametric statistical methods 8 variables were analyzed with respect to asbestos-related diseases and working sectors. The existence of a relationship between serum soluble mesothelin-related peptides (SMRP) and asbestos exposure levels was also investigated. Concentrations of amphiboles, chrysotile and asbestos bodies in BALF were higher in patients with asbestosis as well as in railway industry workers. A correlation between the onset of non malignant asbestos-related diseases and the levels of SMRP concentration was not found. This study confirms that fibre concentration in BALF may be considered as a reliable biomarker of previous asbestos exposure, whereas SMRP does not appear to be influenced by asbestos exposure levels.

Incidental and Underreported Pleural Plaques at Chest CT: Do Not Miss Them-Asbestos Exposure Still Exists.

Pleural plaques (PPs) may be a risk factor for mortality from lung cancer in asbestos-exposed workers and are considered to be a marker of exposure. Diagnosing PPs is also important because asbestos-exposed patients should be offered a health surveillance that is mandatory in many countries. On the other hand PPs are useful for compensation purposes. In this study we aimed to evaluate the prevalence, as incidental findings, and the underreporting rate of PPs in chest CT scans (CTs) performed in a cohort of patients (1512) who underwent chest CT with a slice thickness no more than 1.25 mm. PPs were found in 76 out of 1482 patients (5.1%); in 13 out of 76 (17,1%) CTs were performed because of clinical suspicion of asbestos exposure and 5 of them (38%) were underreported by radiologist. In the remaining 63 cases (82.9%) there was no clinical suspicion of asbestos exposure at the time of CTs (incidental findings) and in 38 of these 63 patients (60.3%) PPs were underreported. Reaching a correct diagnosis of PPs requires a good knowledge of normal locoregional anatomy and rigorous technical approach in chest CT execution. However the job history of the patient should always be kept in mind.

Silicosis en trabajadores expuestos a conglomerados artificiales de cuarzo: ¿es distinta a la silicosis crónica simple? / Silicosis in Workers Exposed to Artificial Quartz Conglomerates: Does It Differ From Chronic Simple Silicosis?

En la bibliografía, hay una serie de estudios recientes sobre silicosis en trabajadores expuestos a conglomerados artificiales de cuarzo con un alto porcentaje de partículas de sílice cristalina (70-90%) empleado para elaborar superficies de cocinas y baños. Se analizan tres casos de silicosis en trabajadores expuestos a conglomerados artificiales de cuarzo. El diagnóstico se realizó conforme a las clasificaciones de la Organización Internacional del Trabajo y la ICOERD (clasificación internacional de TAC de alta resolución para enfermedades respiratorias ocupacionales y ambientales) y mediante análisis citológico del líquido del lavado broncoalveolar. En dos casos, se midieron en el lugar de trabajo niveles de sílice respirable que superaban en gran medida los umbrales recomendados y el análisis citológico del líquido del lavado broncoalveolar mostró la prevalencia de linfocitos indicativos de diagnóstico de silicosis acelerada. Es preciso reestudiar esta neumoconiosis, sobre todo para evitar el uso de materiales innovadores como los conglomerados artificiales con alto contenido en sílice cristalina

Recently, a number of reports have been published on silicosis in workers exposed to artificial quartz conglomerates containing high levels of crystalline silica particles (70-90%) used in the construction of kitchen and bathroom surfaces. Three cases of silicosis in workers exposed to artificial quartz conglomerates are reported. The diagnosis was derived from both the International Labour Office and the International Classification of HRCT for Occupational and Environmental Respiratory Diseases (ICOERD) classifications and cytological analysis of bronchoalveolar lavage fluid. In 2 cases, levels of respirable silica greatly in excess of recommended standards were measured in the workplace, and cytological analysis of bronchoalveolar lavage fluid highlighted a prevalence of lymphocytes, meeting criteria for the diagnosis of accelerated silicosis. The prevention of pneumoconiosis caused by the use of innovative materials, such as artificial conglomerates with high crystalline silica content must be addressed

Silicosis in Workers Exposed to Artificial Quartz Conglomerates: Does It Differ From Chronic Simple Silicosis?

Recently, a number of reports have been published on silicosis in workers exposed to artificial quartz conglomerates containing high levels of crystalline silica particles (70-90%) used in the construction of kitchen and bathroom surfaces. Three cases of silicosis in workers exposed to artificial quartz conglomerates are reported. The diagnosis was derived from both the International Labour Office and the International Classification of HRCT for Occupational and Environmental Respiratory Diseases (ICOERD) classifications and cytological analysis of bronchoalveolar lavage fluid. In 2 cases, levels of respirable silica greatly in excess of recommended standards were measured in the workplace, and cytological analysis of bronchoalveolar lavage fluid highlighted a prevalence of lymphocytes, meeting criteria for the diagnosis of accelerated silicosis. The prevention of pneumoconiosis caused by the use of innovative materials, such as artificial conglomerates with high crystalline silica content must be addressed.

Acute exacerbation of idiopathic pulmonary fibrosis after inhalation of a water repellent.

The natural course of idiopathic pulmonary fibrosis (IPF) is unpredictable at the time of diagnosis. Some patients may experience episodes of acute respiratory worsening that have been termed acute exacerbations. A 58-year-old male was admitted to our Emergency Department due to progressive and intense dyspnea and dry cough after accidental inhalation of waterproof's vapor containing siloxanes. Chest high resolution computed tomography (HRCT) scan showed diffuse and bilateral ground glass attenuation, basal predominant reticular abnormalities and subpleural honeycombing. The patient didn't know that he suffered from IPF and siloxanes' inhalation triggered an acute exacerbation of his disease. Clinical course after the inhalation was aggressive and, despite steroids and cyclophosphamide therapy, the patient died 3 months after due to a respiratory failure. Inhalation of water repellents has been associated with an acute onset of respiratory symptoms and acute lung injury; usually, however, the prognosis is commonly good with a complete recovery. Our case is an example of an extremely negative reaction probably because of pre-existing and misdiagnosed IPF. Currently, no literature concerning water repellent inhalation as a trigger of acute exacerbation of IPF is available.

Angora wool asthma in textile industry.

Up to now the exposures to hair and skin derivatives of animals have not yet been the subject of systematic studies. The observation of a clinical case has provided the opportunity for a review of the literature. The inpatient was a 49-year-old man, a carder in a textile factory, exposed to angora wool. He noticed the appearance of dyspnea during working hours. There was no eosinophilia in blood, and the results of pulmonary function tests were normal. The nonspecific bronchial provocation test with methacholine demonstrated an abnormal bronchial reactivity. The challenge test with angora wool was positive (decrease in FEV1 of more than 40%) as well as total IGE and specific IgE to rabbit epithelium (433 KU/l and 12.1 KUA/l, resp.). Several sources of allergens were found in the rabbit, and the main allergen was represented by proteins from epithelia, urine, and saliva. Most of these proteins belong to the family of lipocalin, they function as carriers for small hydrophobic molecules (vitamins and pheromones). If the diagnosis of occupational asthma caused by animal hair and skin derivatives may be relatively easy by means of the challenge test, defining etiology is complicated because of the lack of in vitro tests.

Erythropoiesis, erythropoietin and blood lead levels.

In a previous study EPO values were significantly lower in exposed subjects (PbB > or =30 mcg/dl) than in controls (PbB" 20 mcg/dl). The aim of the study was to verify if high PbB cause the reduction of EPO in connection with the serum concentration of this hormone expected considering the Hct and hemoglobin (Hb) levels. Both in Pb exposed workers and controls blood levels of EPO, PbB, Hb, Hct were measured. It was not observed any line relation between Hct e log EPO (p = 0.01) and any multiple regression relation between log EPO, Hct and PbB into the total studied population. In our subjects PbB does not change physiologic relation between EPO and Hct and between EPO and Hb. Maybe because normal levels of Hct and Hb reduce EPO production in the healthy population. In physiologic condition of erythropoiesis, EPO does not seem influenced by PbB.

Gardening in greenhouses as a risk factor for silicosis.

Silicosis is a typical occupational disease, although some cases caused by non-industrial exposure have also been reported. We saw a 53-year-old male gardener with recurrent non-productive cough. A routine radiograph of the chest showed bilateral pulmonary nodules and subsequent computed tomography suggested that the infiltrates could be metastases. Open lung biopsy revealed nodules consisting of fibrotic tissue while the presence of birefringent silica particles was observed by polarised light microscopy. Mineralogical analysis of the substrata from the patient's workplace revealed an SiO(2) concentration of 31%. This case indicates that the inhalation of siliceous particles in a closed environment such as a greenhouse is a risk factor for silicosis.