[Compensation for occupational diseases after tomodensitometry screening for benign pleuro-pulmonary disease in a multiregional post-occupational medical surveillance program of asbestos-exposed retired workers]. / Déclaration et reconnaissance en maladie professionnelle après dépistage tomodensitométrique de maladies pleuropulmonaires bénignes dans le programme multirégional de surveillance postprofessionnelle de personnes exposées à l'amiante.

BACKGROUND: Underreporting of occupational diseases related to asbestos exposure remains a matter of concern in France. The aim of this study was to evaluate the number of claims for compensation for asbestos-related non-malignant pulmonary or pleural occupational disease in subjects having undergone a chest CT-scan in a multiregional screening programme. METHODS: Among the 5444 voluntary retired asbestos-exposed subjects recruited in four regions between 2003 and 2005 who had undergone a chest CT-scan, the number of claims for compensation for an asbestos-related pulmonary or pleural benign disease was analysed in 2006 and 2010. RESULTS: Following CT-scan screening, 17.2% of participants were acknowledged as presenting with an asbestos-related non-malignant occupational disease, essentially pleural plaques, by the French National Health Insurance fund. Underreporting decreased as duration of follow-up after CT-scan increased. Nevertheless, 4 years after CT-scan, underreporting was still as high as 36% for subjects identified as presenting with pleural plaques. Mean duration between the date of CT-scan and the date of recognition as occupational disease was 7.4 months, shorter in cases where screening was coordinated by specialized centres. CONCLUSION: A plan of action for an easier claiming process for compensation of asbestos-related diseases is desired. This could probably be obtained through improved sensitization of physicians engaged in the follow-up of asbestos-exposed subjects, and by standardization of the interpretation and reporting of asbestos-related abnormalities observed on chest CT-scans.

Pleural plaques and asbestosis: dose- and time-response relationships based on HRCT data.

Most studies on asbestos-related diseases are based on chest radiographs, and dose-response relationships are still controversial. The aim of this study was to describe the most relevant parameters of asbestos exposure linked to pleural plaques and asbestosis diagnosed by high-resolution computed tomography (HRCT). A large screening programme including systematic HRCT examinations was organised from 2003 to 2005 in France for formerly asbestos-exposed workers. The time since first exposure (TSFE), level, duration and cumulative exposure to asbestos were used in adjusted unconditional logistic regression to model the relationships of the two diseases. Analysis of a population of 5,545 subjects demonstrated that TSFE (p<0.0001) and cumulative exposure (p = 0.02) (or level, depending on the models used), were independently associated with the frequency of pleural plaques. Only cumulative exposure (p<0.0001) or level of exposure (p = 0.02) were significantly associated with asbestosis. All trend tests were significant for these parameters. To date and to our knowledge, this study is the largest programme based on HRCT for the screening of asbestos-exposed subjects. Both time-response and dose-response relationships were demonstrated for pleural plaques, while only dose-response relationships were demonstrated for asbestosis. These parameters must be included in the definition of high-risk populations for HRCT-based screening programmes.

[Asbestos-related cancer risk in the presence of asbestosis or pleural plaques]. / Risque de cancer lié à l'amiante en présence d'asbestose ou de plaques pleurales.

INTRODUCTION: The relationships between benign asbestos-related diseases (asbestosis and pleural plaques) and thoracic cancers are still debated. The aim of this paper is to analyse epidemiological data which investigate this topic. STATE OF THE ART: Published studies show that there is a significant relationship between occupational exposure to asbestos and lung cancer risk, even in the absence of abnormalities consistent with asbestos exposure on postero-anterior chest x-ray. In subjects with occupational exposure to asbestos, an increased risk of lung cancer and pleural mesothelioma is observed in subjects with pleural plaques on chest x-ray, in comparison with the general population. In exposed subjects with similar cumulative exposure to asbestos, it is not demonstrated that pleural plaques are associated with an increased risk of lung cancer or pleural mesothelioma. PERSPECTIVES: All the analysed studies are only based on radiographic data. Their results must be confirmed by additional studies including a rigorous evaluation of the cumulative exposure to asbestos and chest CT-scans. CONCLUSION: In the present state of knowledge, isolated pleural plaques do not justify specific medical surveillance, as compared to that required by the mere estimated cumulative exposure to asbestos.

[Occupational respiratory cancers]. / Cancers respiratoires professionnels.

Lung cancer and pleural mesothelioma are the most common occupational cancers. Recent epidemiological studies have estimated that the fraction attributable to occupational factors varies from 13 to 29% for lung cancer in men and is about 85% for pleural mesothelioma in men. Previous occupational exposure to asbestos is the most common occupational exposure in these cancers. Mesothelioma immediately leads the clinician to look for past asbestos exposure. In contrast, the search for an occupational exposure that should be routine in all cases of lung cancer, is generally more difficult because of the number of occupational aetiological factors and the absence of criteria that allow distinction of an occupational cancer from a tobacco related one. Therefore attention should be paid to the identification of occupational exposure in order to set up primary prevention programmes to prevent exposure still present in the working environment and, on the other hand, to identify the subjects entitled to the acknowledgement of occupational disease and/or to obtain the compensation available to asbestos victims.

[Etiology, epidemiology, biology. Occupational respiratory cancers]. / Cancers respiratoires professionnels.

Lung cancer and pleural mesothelioma are the most common occupational cancers. Recent epidemiological studies have estimated that the fraction attributable to occupational factors varies from 13 to 29% for lung cancer in men and is about 85% for pleural mesothelioma in men. Previous occupational exposure to asbestos is the most common occupational exposure in these cancers. Mesothelioma immediately leads the clinician to look for past asbestos exposure. In contrast, the search for an occupational exposure that should be routine in all cases of lung cancer, is generally more difficult because of the number of occupational aetiological factors and the absence of criteria that allow distinction of an occupational cancer from a tobacco related one. Therefore attention should be paid to the identification of occupational exposure in order to set up primary prevention programmes to prevent exposure still present in the working environment and, on the other hand, to identify the subjects entitled to the acknowledgement of occupational disease and/or to obtain the compensation available to asbestos victims.

Computed tomography findings in urban transportation workers with low cumulative asbestos exposure.

OBJECTIVE: To assess the frequency of computed tomography (CT) scan pleural and interstitial changes in a population of urban transportation workers with low cumulative exposure to asbestos, and to measure inter-reader agreement. DESIGN: A total of 269 male volunteers (mean age 54.0 +/- 2.3 years, mean estimated cumulative exposure index 1.7 +/- 2.3 fibres/ml-years), underwent a CT scan which was read independently by three experienced readers, with further consensus reading in case of pleural or parenchymal abnormalities. Inter-reader agreement was assessed by means of Kappa statistic. RESULTS: On consensus reading, four subjects had interstitial opacities, three had diffuse pleural thickening and 26 (9.7%) had pleural plaques that were unilateral in 65% of cases and < or =2 mm thick in 54% of cases. No correlation was observed between pleural plaques and latency, duration of exposure or cumulative exposure. The inter-reader agreement for the detection of pleural abnormalities was fair. CONCLUSION: In this relatively young population with low cumulative exposure to asbestos, the prevalence of pleural abnormalities was low. These abnormalities were very limited in thickness and extent, leading to marked inter-reader variability and making it difficult to assess their relationship to asbestos exposure.

[Computed tomographic atlas of benign asbestos related pathology]. / Atlas iconographique tomodensitométrique des pathologies bénignes de l'amiante.

The demonstration by computed tomography of abnormalities related to asbestos is essential for the recognition of industrial disease, the compensation of which has considerable economic consequences. The use of compute tomography, the most reliable technique for the detection of pleuro-parenchymatous abnormalities related to asbestos exposure, has increased considerably in France since the publication of the results of a consensus conference in Paris in 1999. Since that time, developments in technology have noticeably modified the protocols of investigation and increased the sensitivity of the detection of pleural and interstitial parenchymatous abnormalities and of nodules. The technical recommendations and those for the interpretation of pleural and parenchymatous abnormalities need to be well known. They are presented in the form of an atlas that gives detailed criteria for asbestosis, pleural plaques and pleural fibrosis. The diagnosis of pleural plaques depends on the combination of clear limits at the pleural and pulmonary interface, typical topography and multiple, bilateral localization. In the context of asbestos exposure the plaques are characteristic of this exposure, unlike diffuse pleural thickening, crow's feet images, parenchymatous bands and entrapped atalectasis. The writing of the radiological report would be most appropriate on this basis.

[Computed tomographic atlas of benign asbestos related pathology]. / Atlas iconographique tomodensitométrique des pathologies bénignes de l'amiante.

The demonstration by computed tomography of abnormalities related to asbestos is essential for the recognition of industrial disease, the compensation of which has considerable economic consequences. The use of computed tomography, the most reliable technique for the detection of pleuro-parenchymatous abnormalities related to asbestos exposure, has increased considerably in France since the publication of the results of a consensus conference in Paris in 1999. Since that time, developments in CT technology have noticeably modified the protocols of investigation and increased the sensitivity of the detection of pleural and interstitial parenchymatous abnormalities and of nodules. The technical recommendations and those for the interpretation of pleural and parenchymatous abnormalities need to be well known. They are presented in the form of an atlas that gives detailed criteria for asbestosis, pleural plaques and pleural fibrosis. The diagnosis of pleural plaques depends on the combination of clear limits at the pleural and pulmonary interface, typical topography and multiple, bilateral localization. In the context of asbestos exposure the plaques are characteristic of this exposure, unlike diffuse pleural thickening, crow's feet images, parenchymatous bands and entrapped atalectasis. The writing of the radiological report would be most appropriate on this basis.

[Disabled workers with motor impairments: data from an occupational health service]. / Les travailleurs handicapés par une déficience neuromotrice en milieu ordinaire de travail. Données d'un service interentreprises de santé au travail.

INTRODUCTION: Mediclen is an occupational health service in charge of following-up 36,736 workers (divided among 1770 companies) in 3 cities of an area near Paris. The employment rate of disabled people among the French population is not well known (rough estimate 4.4%), and few studies have reported on the situation of workers with a motor impairment. SUBJECTS AND METHOD: The recent computerization of medical records allowed us to identify 195 workers considered disabled by the French administration (i.e. 0.55% of the 36,736 workers followed up in 2002). Among these, 26 had a motor impairment. RESULTS: Twenty-one neurological disabilities were central and 5 were peripheral or neuromuscular. The workers were 44-years-old. Only two workers had a severe handicap. Companies had to adapt workstations for half of the workers, with the advice of neurologists (7 of 10 advice given) and once a physical medicine doctor. DISCUSSION-CONCLUSION: The integration of people with motor impairments into the world of work is rare and difficult. This practical experience showed the difficulties people with motor impairment face. Close collaboration of physical medicine services with occupational health services is necessary to improve the integration of this population into the world of work.

[Epidemiology and etiologic agents of occupational asthma]. / Epidémiologie et étiologies de l'asthme professionnel.

INTRODUCTION: Occupational asthma is, by definition, a disease that can be prevented through appropriate protective strategies. Epidemiological information is required to guide these interventions, and we here examine epidemiological data on the burden, causes, and risk factors for this condition. STATE OF THE ART: Population-based surveys indicate that approximately 15% of adult asthma is attributable to the workplace environment. The most common occupational agents implicated include flour, isocyanates, latex, and persulphate salts. The occupations in which occupational asthma has been most commonly reported are bakers, spray painters, health-care workers, hairdressers, and cleaners. The level of exposure to sensitizing agents seems to be the most relevant risk factor. Atopy is a significant risk factor only for the development of sensitization to high molecular weight agents. The role of other individual determinants, such as genetic factors, has been less consistently established. Occupational asthma is associated with a substantial adverse impact on the employment and financial status of affected workers. PERSPECTIVES: Methodological improvements are required in order to distinguish more accurately between occupational and work-exacerbated asthma. Further investigations of the effectiveness of primary and secondary preventive interventions are also needed.

[Occupational chronic obstructive pulmonary disease: a poorly understood disease]. / La bronchopneumopathie chronique obstructive professionnelle: une maladie méconnue.

INTRODUCTION: According to several recent population-based studies 15-20% of chronic obstructive pulmonary disease (COPD) is work related. BACKGROUND: The occupational fields in which a causal relationship is established are the mining industry, construction and public works, iron and steel, textiles, grain (silo workers), dairy and pig farming. The main causative substances are silica, coal dust, cotton dust, grain dust and endotoxins. VIEWPOINT: Knowledge of the occupational causes of COPD is important for both prevention and compensation. CONCLUSIONS: The undertaking of a complete and rigorous occupational questionnaire is essential for all patients with COPD.

[Is the severity of occupational asthma related to the molecular weight of the allergen?]. / La sévérité de l'asthme professionnel est-elle liée au poids moléculaire de l'allergène?

INTRODUCTION: The aim of the study was to compare the characteristics of occupational asthma (OA) resulting from sensitisation to allergens of high (HMW) or low (LMW) molecular weight. METHODS: All new cases of allergic OA seen in an occupational health department between January 2001 and March 2004 were included. The patients underwent a standardised assessment including a questionnaire, skin tests, spirometry and measurement of non-specific bronchial reactivity. They were divided into 2 groups depending on the molecular weight of the causal agent (groups HMW and LMW). RESULTS: 77 patients were included, 30 in the HMW group and 47 in the LMW group. No significant difference in severity at the time of diagnosis was found between the two groups (symptoms, spirometry, PD20 methacholine) but the time between the first symptoms and diagnosis was longer in the HMW group (7.1 +/- 7.8 years against 3.2 +/- 4.1 years, p = 0.01). Atopy was more common in the HMW group (57% vs. 27%, p = 0.01). CONCLUSION: The severity of OA at the time of diagnosis does not appear to be influenced by the molecular weight of the causal agent.

[Screening for benign pleural disease in adults: why and how?]. / Les pathologies pleurales bénignes de l'amiante: pourquoi et comment les dépister.

Benign diseases of the pleura are clearly dominated by asbestos-related conditions. It is important to distinguish diseases affecting the parietal pleura (pleural plaques) and those affecting the visceral pleura (pleurisy and diffuse thickening). The social benefits which could be obtained by identifying affected persons warrants screening in France, even more so than non-demonstrated medical benefits. Thoracic computed tomography without contrast is the examination of choice. A rigorous protocol is required for proper execution and interpretation.

Asbestos-related rounded atelectasis. Radiologic and mineralogic data in 23 cases.

A retrospective study was conducted in 23 subjects with previous occupational exposure to asbestos and exhibiting rounded atelectasis (RA) on high-resolution computed tomography scan (HRCT scan) to evaluate the retention of asbestos bodies (ABs) using light microscopy in the bronchoalveolar lavage (BAL) fluid or lung parenchyma in such patients. A total of 31 RAs were identified, usually located in the lower (25 RAs) and posterior (23 RAs) parts of the lung. Pleural thickening in contact with the RA was observed in 27 RAs and parenchymal bands were detected in 15 cases. Twelve of the 20 patients who underwent BAL or surgery exhibited significant retention of ABs in BAL fluid or lung tissue. Moreover, a significant retention of ABs was observed in five of nine patients with a history of asbestos exposure but no diffuse pleural thickening on chest radiograph or interstitial opacities on HRCT scan. Patients with RAs and coexisting diffuse pleural thickening and/or interstitial fibrosis should be considered at a higher risk for lung cancer in comparison to patients with isolated circumscribed pleural plaques based on increased AB counts. By contrast, the excess risk of lung cancer is more questionable in patients with only RAs and circumscribed pleural plaques as they may have AB counts either above or below that associated with pleural plaques alone. This emphasizes the need for further follow-up studies to define criteria indicating the need for thoracotomy in these subjects.

Occupational hypersensitivity pneumonitis in a smelter exposed to zinc fumes.

A smelter exposed to zinc fumes reported severe recurrent episodes of cough, dyspnea and fever. Bronchoalveolar lavage showed a marked increase in lymphocytes count with predominance of CD8 T-lymphocytes. Presence of zinc in alveolar macrophages was assessed by analytic transmission electron microscopy. This is the first case of recurrent bronchoalveolitis related to zinc exposure in which the clinical picture and BAL results indicate a probable hypersensitivity pneumonitis.

Healthy worker effect and changes in respiratory symptoms and lung function in hairdressing apprentices.

AIMS: To compare the prevalence and incidence of respiratory symptoms and lung function values between hairdressing apprentices and office apprentices. METHODS: A total of 322 hairdressing apprentices and 277 office apprentices (controls) were studied. Two cross sectional surveys were conducted in 1994 and 1996/97 with longitudinal follow up for a subgroup of apprentices (191 hairdressing apprentices and 189 office apprentices). RESULTS: In the initial phase, the prevalence of respiratory symptoms was significantly lower among hairdressing apprentices than among office apprentices. Lung function test results showed significantly higher values for hairdressing apprentices. Non-specific bronchial reactivity was similar in the two groups. In the final phase, results for respiratory symptoms were similar. The incidence of respiratory symptoms was not significantly different between hairdressing apprentices and office apprentices. Subjects who dropped out had lower values for FVC and FEV1 in the initial phase than those who completed the final phase. There was a significant deterioration of FEV1 and FEF25-75% in hairdressing apprentices compared to office apprentices. There was a link between atopy and the incidence of most of the respiratory symptoms (day/night cough, wheezing, dyspnoea, mucosal hyperresponsiveness) and between smoking and the incidence of bronchial hyperreactivity. There was no significant correlation between change in lung function tests and specific hairdressing activities reported at the end of the apprenticeship or with environmental working conditions in hairdressing salons. CONCLUSIONS: Although a healthy worker effect can be suspected, results showed a significant deterioration of baseline values of lung function tests in the hairdressing apprentice group. However, no clear link was shown between change in lung function tests and specific parameters of occupational activities.

Pulmonary polymorphic centroblastic type malignant lymphoma in a patient with lymphomatoid granulomatosis, Sjögren syndrome and other manifestations of a dysimmune state.

A case of lymphomatoid granulomatosis arising in a patient with a long history of dysimmunity is reported. The autopsy reviewed the final evolution into a high grade malignant lymphoma with IgM K immunoglobulin production and discovered in deep lymph nodes modifications similar to angio-immunoblastic lymphadenopathy.

[Longitudinal study of radiologic anomalies in subjects working in asbestos-insulated buildings]. / Etude longitudinale des anomalies radiologiques chez des sujets travaillant dans des locaux floqués à l'amiante.

The respiratory effects of environmental pollution by asbestos was examined in a cohort of subjects working inside university buildings partly insulated with asbestos containing materials (University of Jussieu in Paris). The present study concerned 727 subjects having undergone two standard radiographic examinations (postero-anterior and oblique chest x-ray) in the period 1981-1992. The first examination was realized between 01/01/81 and 31/12/85 and the second examination took place between 01/01/86 and 31/12/92. The subjects were classified into three groups according to their exposure status: the group G1 consisted of 161 workers occupationally exposed to asbestos; the group G2 comprised 416 subjects working for at least 15 yr in asbestos-insulated buildings without known occupational exposure to asbestos; the group G3 consisted of 150 workers working for at least 15 yr in the university with no known exposure to asbestos. Whatever the radiological abnormalities considered, no significant difference was observed between G2 and G3 in cross-sectional analyses of the two phases. The group G1 exhibited a significantly higher prevalence of pleural thickening compared to the other exposure groups after adjustment for confounding variables. Detailed examination of oblique x-ray allowed to confirm that pleural thickening were largely due to extrapleural fat. Concerning the changes in pleural abnormalities between the two phases of the study, no difference was observed between G2 and G3. This study was unable to show any excess of radiographic chest abnormalities among subjects working in asbestos-insulated buildings compared to non-exposed subjects. However, the participation in the second phase of examination was 51.2%. The study is still on-going. Therefore, it would be necessary to continue to follow-up the subjects because respiratory disorders could occur after a long latent period.

Epidemiologic investigation of respiratory effects related to environmental exposure to asbestos inside insulated buildings.

The respiratory effects of environmental pollution by asbestos inside university buildings were studied by comparing radiographic, clinical, and functional parameters among three groups of workers with different levels of exposure. Eight hundred and twenty-eight (828) people who worked for at least 15 yr in asbestos-insulated buildings and who were without known occupational exposure to asbestos (environmentally exposed group [EE]) were compared to a group of 252 workers with occupational exposure (occupationally exposed group [OE]), used as positive control; and to a group of 350 people with no known exposure to asbestos (nonexposed group [NE]), within the same university. After adjustment for confounding variables, no differences could be seen between groups EE and NE. Group OE exhibited a higher prevalence of pleural changes and lower lung functions than groups EE and NE.

[Non-malignant asbestos-related diseases]. / Les pathologies asbestosiques non tumorales.

Non malignant asbestos diseases are dominated numerically by pleural plaques. This form of circumscribed fibrosis of the parietal pleural is generally asymptomatic and its potential for evolution is weak. More rarely diffuse pleural fibrosis results from disease of the visceral pleura with a secondary fusion of the two pleural layers. Usually it follows a pleural effusion which resolves spontaneously. Its functional effects are sometimes important. The generalised practice of computerized tomographic scanning as a work up for asbestos related disease has revealed the frequent association of this diffuse pleural fibrosis with a particular form of peripheral pulmonary collapse called round atelectasis. Asbestosis or pulmonary fibrosis induced by the inhalation of asbestos has become rarer due to the improvement in working conditions in the asbestos industry. It develops following heavy exposure. The frequency of bronchopulmonary cancer is increased when asbestosis exists although it is not currently possible to say if the two disorders are independent and each is only conditioned by exposure to asbestos or if the two diseases are inextricably linked by the same physiopathological process.