Wood smoke-associated lung disease: a clinical, functional, radiological and pathological description.

BACKGROUND: Approximately half of the world's population, and up to 90% of households in rural areas of developing countries, depend on biomass for cooking and heating. SETTING: The National Institute of Respiratory Diseases, México City. OBJECTIVE: To describe wood smoke-associated lung disease (WSLD). DESIGN: Description of the clinical, functional and radiological manifestations of patients with WSLD, and a comparison of pathological findings of patients who died of WSLD and smokers who died of chronic bronchitis. RESULTS: All patients with WSLD were non-smoking women with chronic bronchitis, in whom asthma, bronchiectasis, tuberculosis, congestive heart failure, extreme obesity and alfa-1 antitrypsin deficiency had been excluded. All patients used wood for cooking and had been exposed to wood smoke for a median of 45 years. Dyspnoea, airway obstruction, air trapping, increased airway resistance, pathological evidence of anthracosis, chronic bronchitis, centrilobular emphysema and pulmonary hypertension were present in most patients with WSLD. Bronchial squamous metaplasia was a common finding. There were no significant differences in the histopathological findings between patients with WSLD and smokers. Diffuse interstitial fibrosis was absent in all patients. CONCLUSIONS: Patients with WSLD have obstructive lung disease, chronic bronchitis, emphysema and pulmonary hypertension comparable to smokers.

[Changing pattern and frequency of lung cancer in Mexico]. / Frecuencia y patrón cambiante del cáncer pulmonar en México.

OBJECTIVE: To assess the frequency, histological type and the epidemiological pattern of lung cancer (LC), during a 40 year period, at the National Institute of Respiratory Diseases (INER). MATERIAL AND METHODS: This cross-sectional study was conducted in 1999. Data were abstracted from the INER's service reports for 1983-1996 and the surgical pathology archives for 1957-1996. Data from 1961 patients were analyzed, to obtain frequency measures on: the characteristics of INER LC patient admissions, age, sex, histological studies, specimens and diagnoses. RESULTS: Between 1983-1996, LC ranked eighth to second place in INER inpatient admissions. Results were grouped by decades. In the first two decades (1957-1976), 9% of patients were female; 32% in the third (1977-1986), and 38% in the last decade (1987-1996). Epidermoid cell carcinoma was more frequent in the two first decades (61%) and adenocarcinoma in the last two, (41% and 62%, respectively.) CONCLUSIONS: LC is currently more frequent in women, and adenocarcinoma is the most frequent neoplasia.

Ferruginous bodies as markers of environmental exposure to inorganic particles: experience with 270 autopsy cases in Mexico.

Ferruginous bodies (FB) were quantified in lung digests from 270 autopsy cases over 20 years of age. The cases were autopsied in three different hospitals of the Secretaria de Salud, Mexico, DF. Two hundred seventy samples of peripheral lung tissue were digested in commercial bleach, and all morphologic types of ferruginous bodies were quantified. The results showed that numbers of ferruginous bodies per gram of dry tissue increased over the years: 4.2 FB/g in cases from 1975 to 42.5 FB/g in cases from 1988 (r = 0.86). Higher counts of ferruginous bodies were seen in males, smokers, and Mexico City dwellers. However, more than 70% of them presented less than 100 FB/g. Our study demonstrates that most of our cases had a nonoccupational exposure to fibers.

Modification of the Smith and Naylor technique for the identification of ferruginous bodies.

Smith and Naylor's technique has been successfully used by many authors around the world to recover inorganic particles from the lungs. In this short report we compare the results of counting inorganic particles recovered from human lung tissue by two different methods: Smith and Naylor's technique and a modification to it. We used ferruginous bodies (FB) as markers for inorganic particles and we compared the results of the FB counts in both methods. In the traditional technique the interface formed in the 1:1 ethanol-chloroform mixture is discharged and FB are counted only in the formed pellet. Our modification also quantified FB in the interface fraction. Post-mortem samples from each of the lung lobes were taken from 22 individuals, totalling 198 samples. Each sample was digested in liquid commercial bleach and processed by both techniques. Our results showed that the modified technique was more sensitive in the detection of FB than the traditional method, with 16 out of 22 individuals showing positive identification against 14 out of 22, respectively. Furthermore, the modified technique proved not only to be more sensitive, but also almost twice as accurate: 49 FB/g vs. 26.7 FB/g of dry tissue.

[Presence of ferruginous bodies in cancerous pulmonary tissue]. / Presencia de cuerpos ferruginosos en tejido pulmonar canceroso.

The correlation between high counts of ferruginous bodies (FB) and pulmonary cancer was investigated. Autopsy cases between 1982 and 1988 were chosen, and studied at Instituto Nacional de Enfermedades Respiratorias. Two grams of lung tissue were digested with sodium hypochlorite. We found no differences in the histologic types of cancer: 18.0 FB per gram (FB/g) for the adenocarcinoma group and 16.0 FB/g for both the epidermoid and anaplastic groups. The asbestos core was predominant in all FB analysed (greater than 85%). Males, Mexico city residents and smokers showed to higher amounts of FB. We concluded that there is an environmental exposure to particles in the cases studied.

Ferruginous bodies in cases with occupational and non-occupational exposure to inorganic dusts. A study with 40 matched cases.

In this study we evaluated the usefulness of ferruginous bodies (FB) quantification in lung digest and histologic sections from 40 patients with a history of exposure to inorganic dusts. The patients were matched with 40 cases without occupational exposure. The samples of peripheral lung tissue were digested and all FB were quantified. Lung sections were also evaluated in order to confirm the presence of FB. The concentrations of FB in the patients were higher than the controls (Wilcoxon test, p < 0.001). The patients group showed a median concentration of 194.5 FB/g of dry lung tissue (FB/g) vs. 34.0 FB/g in the controls. Seventy percent of the patients had more than 100 FB/g vs. 27.5% in the controls cases. Pneumoconiosis was diagnosed in 19 patients, 17 had FB/g above 100 and only 4 were positive to FB in lung sections. We can conclude that lung digest and FB counts help to confirm exposures to inorganic dusts above the background values found in the general population. FB counts can help when the clinical file does not confirm the exposure.