Cases reported "Pneumoconiosis"

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1/14. Giant cell interstitial pneumonia in two hard metal workers: the role of bronchoalveolar lavage in diagnosis.

    Two cases of hard metal lung disease and pathological findings of giant cell interstitial pneumonia are reported. The cases worked in different factories manufacturing hard metal parts from tungsten carbide and cobalt. Pathological specimens were obtained by percutaneous thoracoscopy and transbronchial lung biopsy. X-ray microanalysis detected only tungsten carbide in the lung specimen of one case. bronchoalveolar lavage showed diagnostic bizarre macrophages in the lavage fluid.
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2/14. Rapidly fatal progression of cobalt lung in a diamond polisher.

    Interstitial lung disease was diagnosed in a 52-yr-old male diamond polisher, who worked with polishing disks containing cobalt. After a further 7 months of probably high occupational exposure without any specific treatment, he had to quit work because of dyspnea. Despite treatment with systemic corticosteroids and continuous oxygen administration, he died 3 months later in respiratory distress. Postmortem examination of the lung tissue showed a typical giant-cell interstitial fibrosis, with active inflammatory cell infiltration superimposed on an established centrilobular fibrosis. The lung tissue contained 2.1 micrograms cobalt/g wet weight (more than 100-fold the normal concentration); cobalt particles, mainly localized in macrophages, were identified by transmission electron microscopy and energy-dispersive X-ray analysis. We speculate that the rapid deterioration and fatal outcome resulted from the continued exposure to cobalt, leading to a high pulmonary concentration of cobalt, and from the oxygen treatment because cobalt promotes the formation of hydroxyl free radicals.
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3/14. Rare earth deposits in a deceased movie projectionist. A new case of rare earth pneumoconiosis?

    The subject described in this case report, a movie projectionist, had approximately 25 years of occupational exposure to carbon arc lamp fumes. The carbon arc deposits were visible in histological sections as small granules within macrophages of the tracheobronchial lymph nodes and hepatic Kupffer's cells. Electron microprobe analysis by energy dispersive analysis of x-rays showed the granules to be composed of the rare earth elements cerium, lanthanum and neodymium, which are the major constituents of carbon arc rods. Tissue concentrations, as determined by inductively coupled plasma spectroscopy, were approximately 250-2000 times those of unexposed controls, and there was evidence of their redistribution throughout the reticuloendothelial system. There were no respiratory symptoms, or radiographic or histological pulmonary changes attributable to the progressive accumulation of the rare earth elements, and as such the patient cannot be considered to have suffered from pneumoconiosis. Twenty-one published cases of rare earth pneumoconiosis, mainly in photoengravers exposed to carbon arc fumes, are reviewed and suggest that rare earth oxides are not innocuous dusts. With the increasingly widespread use of rare earth elements there is a likelhood that further occupational groups may have significant but unrecognised exposure.
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4/14. Acrylic resin pneumoconiosis: report of a case in a dental student.

    pneumoconiosis in dental laboratory workers has been associated with exposure to metal alloys and silica used in the manufacturing of dental prosthetics. In this report, we describe a 27-yr-old dental student who was found to have bilateral basal pulmonary interstitial infiltrates and nodules on a chest roentgenogram after a brief episode of upper respiratory infection. An open lung biopsy revealed interstitial pneumonitis with an abundance of vacuolated macrophages in the alveolar spaces. Ultrastructural analysis showed in the alveolar and interstitial spaces the accumulation of macrophages laden with electron-lucent bodies resembling plastic beads. An inhalation exposure history, taken subsequent to these findings, revealed exposure to high levels of acrylic plastic in a dental school laboratory. Removal from the site of exposure has resulted in the gradual resolution of the roentgenographic abnormalities.
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5/14. Giant-cell interstitial pneumonia and hard-metal pneumoconiosis. A clinicopathologic study of four cases and review of the literature.

    We report four cases of giant-cell interstitial pneumonia that occurred in association with exposure to hard metals. All patients presented with chronic interstitial lung disease and had open-lung biopsies that revealed marked interstitial fibrosis, cellular interstitial infiltrates, and prominent intraalveolar macrophages as well as giant cells displaying cellular cannibalism. We also review the literature to determine the sensitivity and specificity of giant-cell interstitial pneumonia for hard-metal pneumoconiosis. Although hard-metal pneumoconiosis may take the form of usual interstitial pneumonia, desquamative interstitial pneumonia, and giant-cell interstitial pneumonia, the finding of giant-cell interstitial pneumonia is almost pathognomonic of hard-metal disease and should provoke an investigation of occupational exposure.
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6/14. pathology of silicon carbide pneumoconiosis.

    silicon carbide is a widely used synthetic abrasive manufactured by heating silica and coke in electric furnaces at 2400 degrees C. Until recently it had been considered a relatively inert dust in humans and animals. However, several roentgenologic surveys had revealed lesions similar to low-grade silicosis. A recent epidemiological study has revealed a 35% incidence of pulmonary problems. tissues from three such workers were available for light microscopy. A mixed pneumoconiosis was found, and lesions can be summarized as follows: (a) abundance of intraalveolar macrophages associated with a mixture of inhaled particles including carbon, silicon, pleomorphic crystals, silicon carbide, and ferruginous bodies showing a thin black central core; (b) nodular fibrosis, generally profuse, containing silica and ferruginous bodies and associated with large amount of carbon pigment; (c) interstitial fibrosis, less prominent than the nodular form; (d) carcinoma in two cases. We believe this pneumoconiosis is sufficiently characteristic to be recognized as a distinct entity. The Stanton hypothesis on fiber properties and carcinogenesis could be applied to silicon carbide dust. At present, it appears that the occupational hazard is limited to the manufacturing process and powdered product used in some industries.
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7/14. titanium dioxide deposition and adenocarcinoma of the lung.

    A case of titanium dioxide pneumoconiosis accompanied by lung cancer is reported. The patient was a fifty-three-year-old male, who was engaged in packing titanium dioxide for about thirteen years. At autopsy, a papillary adenocarcinoma was located in the right lung. titanium was diffusely deposited in the lung and was engulfed by macrophages in the interstitium and alveolar spaces. Slight fibrosis of the interstitium around bronchioles and vessels was noticed as an effect of titanium deposition.
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8/14. polyvinyl chloride pneumoconiosis.

    A 53-year-old man, who had been exposed for 23 years to polyvinyl chloride (PVC) in the bagging area of a vinyl chloride polymerisation plant, presented with a diffuse micronodular infiltrate on his chest radiograph. light microscopy of lung obtained by drill biopsy showed a diffuse infiltration with histiocytes and multinucleated giant cells, with some collagen formation. Ultrastructural studies showed foreign particles in the macrophages, which were identical with PVC powder viewed under the electron microscope. Incubation of PVC powder with human lung macrophages in vitro showed that the macrophages englufed the powder to give a similar ultrastructural appearance.
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9/14. The role of electron microscopy and microanalytical techniques in the understanding of the pathophysiology of environmental dusts associated with lung disease.

    The purpose of this study has been to elucidate the usefulness of TEM/STEM/EDX system in the identification of environmental dust within the interstitial macrophages of the lung. The four cases chosen for this study gave variable history of exposure to occupational "dust". A review of literature with particular reference to clay associated pneumoconiosis has been made. Previous studies have given little prominence to the fate or behaviour of inhaled "dust" particles in the intracellular environment. It is here that it is believed that a TEM/STEM/EDX system has the potential of playing a significant role in promoting our understanding of "dust" associated pneumoconiotic disease of the lung. The results obtained from the three cases demonstrate the presence of clay particles in the form of granules, plates and needles or thin flakes within the phagosomes of the interstitial macrophages. On morphological grounds the thin needles or flakes appeared to undergo a process of stacking within the phagosomal matrix resulting in the formation of large closely stacked needle-like structures which lie free in the cytoplasm. The possibility of a physicochemical basis for such a morphological sequence is discussed. The fourth case, that of stainless steel associated pneumoconiosis, also showed evidence of breakdown of the original dust in the macrophages. From the evidence presented it is concluded that application of the TEM/STEM/EDX technique may advance our knowledge of the interaction of inhaled dust and the macrophages at the subcellular level.
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10/14. Cemented tungsten carbide pneumoconiosis.

    An autopsy case of cemented tungsten carbide pneumoconiosis, the first lethal case in our country, is presented. A 28-year-old woman, who had been engaged in grinding presintered metallic matrix for four years, developed respiratory symptoms. X-ray examinations were indicative of interstitial pulmonary fibrosis. Corticosteroid therapy revealed only little effect. She expired five years after the onset of the symptoms. Postmortem examination showed nonspecific interstitial pneumonitis resulting in marked lung fibrosis. Ultrastructurally, crystals were observed in cytoplasm of presumable macrophages in the fibrotic lung tissue. electron probe microanalysis of the lung tissue showed the presence of tungsten and other constituents of tungsten carbide except for cobalt. Metal analysis demonstrated a large amount of tungsten in the lung. cobalt was detected tenfold of the normal value in the bone. In pathogenesis of the pneumoconiosis in the cemented tungsten carbide workers, toxicity of cobalt is most suspectable, and in addition, individual susceptibility may be also important.
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