Worker's Pneumoconiosis Research Articles

Morphologic manifestation of interlobular septa and pathologic basis in different stage coal worker's pneumoconiosis on high-resolution CT

目的 研究煤工尘肺小叶间隔线在高分辨率CT(HRCT)上的基本形态和病理基础.方法28例有煤尘接触史的尸解全肺标本,固定、干燥,进行冠状面HRCT扫描.选取HRCT上线样影丰富的肺标本薄片进行冠状面大切片(50～150 μm)和组织学切片(5～8 μm)制作.分析比较小叶间隔线在HRCT上的形态.结果28例肺标本中HRCT扫描发现23例有不同类型的小叶间隔线.以规则型小叶间隔线为主10例,无尘肺9例、Ⅰ期1例;以不规则型小叶间隔线为主10例,无尘肺2例、Ⅰ期2例、Ⅱ期6例;破坏型小叶间隔3例,Ⅱ期2例、Ⅲ期1例.规则型与不规则型(q=4.3831,P=0.0024)、规则型与破坏型小叶间隔线(q=5.4715,P=0.0006)在不同期别煤工尘肺中的差异有统计学意义.组织病理学上规则型小叶间隔线主要表现为小叶间隔水肿(10/10)、小叶间隔内炎性渗出(8/10)和局限于小叶间隔内的纤维化(9/10);不规则型小叶间隔线主要表现为小叶间隔内及邻近小叶实质煤尘沉积(13/16)和纤维化突破小叶间隔(15/16);差异有统计学意义(Fisher精确概率法,P值均＜0.05).破坏型小叶间隔线是由于纤维融合块、肺气肿等造成小叶间隔线移位和破坏.结论规则型、不规则型和破坏型小叶间隔线并存于各期煤工尘肺和煤尘接触者中,其代表的是不同程度的纤维化和不同量的煤尘沉积。

Polymorphisms in chemokine and chemokine receptor genes and the development of coal workers' pneumoconiosis

Chemokines and their receptors are key regulators of inflammation and may participate in the lung fibrotic process. Associations of polymorphisms in CCL5 (G-403A) and its receptor CCR5 (Δ32), CCL2 (A-2578G) and CCR2 (V64I), and CX3CR1 V249I and T280M with coal worker's pneumoconiosis (CWP) were investigated in 209 miners examined in 1990, 1994 and 1999. Coal dust exposure was assessed by job history and ambient measures. The main health outcome was lung computed tomography (CT) score in 1990. Internal coherence was assessed by studying CT score in 1994, 4-year change in CT score, and CWP prevalence in 1999. CCR5 Δ32 carriers had significantly higher CT score in 1990 and 1994 (2.15 vs. 1.28, p = 0.01; 3.04 vs. 1.80, p = 0.04). The CX3CR1 I249 allele was significantly associated with lower 1990 CT score and lower progression in 4-year change in CT score in CCR5 Δ32 carriers only ( p for interaction = 0.03 and 0.02). CX3CR1 V249I was associated with lower 1999 CWP prevalence (16.7%, 13.2%, 0.0% for VV, VI and II); the effect was most evident in miners with high dust exposure (31.6%, 21.7%, 0.0%). Our findings indicate that chemokine receptors CCR5 and CX3CR1 may be involved in the development of pneumoconiosis.

Non-malignant occupational respiratory diseases in Germany in comparison with those of other countries

To present recent data on the occurrence of non-malignant occupational airway diseases in Germany and to compare mainly affected occupations of obstructive airway diseases caused by allergens and irritants with available surveillance data from other countries. Sources of German data were statistics for the year 2003 of the Ministry of Labour and Social Affairs and of the federation of statutory accident insurance institutions for the industrial sector. Confirmed cases of non-malignant occupational respiratory diseases in Germany are mainly benign asbestos-associated diseases (occupational disease no. 4103: 1,975 cases), silicosis/coal worker's pneumoconiosis (occupational disease no. 4101: 1,158 cases), obstructive airway diseases due to allergens (occupational disease no. 4301: 935 cases), chronic obstructive bronchitis and/or emphysema in hard coal miners (occupational disease no. 4111: 414 cases), obstructive airway diseases due to irritants and toxic agents (occupational disease no. 4302: 181 cases), diseases caused by ionising radiation (171 cases), diseases due to isocyanates (occupational disease no. 1315: 55 cases), and 22 cases of other rare occupational lung and airway diseases. Miners, bakers, chemical workers, hairdressers and health care workers are mostly affected. Bakers were also frequently affected by occupational asthma in Finland, France, Sweden, the United Kingdom, the Piedmont region in Italy, South Africa, and New Zealand. Further, high frequencies of occupational asthma were reported for health care workers in France, Italy, New Jersey, Michigan, and South Africa. Despite completely different legal definitions and regulations, comparably high numbers of occupational obstructive diseases in western countries require better primary and secondary prevention in industries with high incidence, especially in bakeries, the health care sector, farming, and mining. Furthermore, there is a urgent need for harmonization of recognition and compensation systems for occupational diseases as well as of respective preventive strategies within the European Union.

Silicosis Caused by Sandblasting of Jeans in Turkey: A Report of Two Concomitant Cases

Journal of Occupational HealthVolume 47, Issue 4 p. 346-349 Case StudyFree Access Silicosis Caused by Sandblasting of Jeans in Turkey: A Report of Two Concomitant Cases Metin Akgun, Corresponding Author Metin Akgun [email protected] [email protected] Chest DiseaseCorrespondence to: M. Akgun, Chest Disease, School of Medicine, Atatürk University, Aziziye Arastirma Hastanesi, Gogus Hastaliklari, 25240, Erzurum, Turkey (e-mail: [email protected], [email protected])Search for more papers by this authorMetin Gorguner, Metin Gorguner Chest DiseaseSearch for more papers by this authorMehmet Meral, Mehmet Meral Chest DiseaseSearch for more papers by this authorAtila Turkyilmaz, Atila Turkyilmaz Chest SurgerySearch for more papers by this authorFazli Erdogan, Fazli Erdogan Pathology Departments, School of Medicine, Atatürk University, TurkeySearch for more papers by this authorLeyla Saglam, Leyla Saglam Chest DiseaseSearch for more papers by this authorArzu Mirici, Arzu Mirici Chest DiseaseSearch for more papers by this author Metin Akgun, Corresponding Author Metin Akgun [email protected] [email protected] Chest DiseaseCorrespondence to: M. Akgun, Chest Disease, School of Medicine, Atatürk University, Aziziye Arastirma Hastanesi, Gogus Hastaliklari, 25240, Erzurum, Turkey (e-mail: [email protected], [email protected])Search for more papers by this authorMetin Gorguner, Metin Gorguner Chest DiseaseSearch for more papers by this authorMehmet Meral, Mehmet Meral Chest DiseaseSearch for more papers by this authorAtila Turkyilmaz, Atila Turkyilmaz Chest SurgerySearch for more papers by this authorFazli Erdogan, Fazli Erdogan Pathology Departments, School of Medicine, Atatürk University, TurkeySearch for more papers by this authorLeyla Saglam, Leyla Saglam Chest DiseaseSearch for more papers by this authorArzu Mirici, Arzu Mirici Chest DiseaseSearch for more papers by this author First published: 12 August 2005 https://doi.org/10.1539/joh.47.346Citations: 24AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL References 1Parker JE and Petsonk EL. Coal workers' lung diseases and silicosis. In: AP Fishman, JA Elias, JA Fishman, MA Grippi, LR Kaiser and RM Senior, eds. Fishman's Pulmonary diseases and disorders, 3rd ed. USA: McGraw-Hill, 1998: 901– 914. 2M Ding, F Chen, X Shi, B Yucesoy, B Mossman and V Vallyathan: Disease caused by silica: mechanisms of injury and disease development [review]. Int Immunopharmacol 2, 173– 182 (2002) 3C Sevinc, AH Cimrin, M Manisali, E Yalcin and Y Alkan: Sandblasting under uncontrolled and primitive conditions in Turkey. J Occup Health 45, 66– 69 (2002) 4Weisman DN and Banks DE. Silicosis and Coal Worker's Pneumoconiosis. In: MI Schwarz and TE King, eds. Interstitial lung disease, 3rd ed. Hamilton, BC: Decker Inc., 1998: 393– 422. 5 American Thoracic Society. Adverse effects of crystalline silica exposure. Am J Respir Crit Care Med 155, 761– 765 (1997) 6Glindmeyer HW, Hammad YY. Contributing factors to sandblasters' silicosis: inadequate respiratory protection equipment and standards. J Occup Med 30, 917– 921 (1988) 7G Wagner. The inexcusable persistence of silicosis [editorial]. Am J Public Health 85, 1346– 1347 (1995) 8Arda H, Karagoz T, Hatabay N. Tuberculosis and textile workers [In Turkish]. Göztepe Dergisi 14, 145– 148 (1999) Citing Literature Volume47, Issue4July 2005Pages 346-349 ReferencesRelatedInformation

Coal worker's pneumoconiosis with esophagitis of Candida albicans

随着煤工尘肺患者院内感染中真菌感染逐渐增多,加之电子胃镜的广泛应用,念珠菌性食管炎的检出率逐渐提高.我院1997年10月至2003年10月在接受胃镜检查的煤工尘肺患者检出各类食管疾患282例,其中念珠菌性食管炎37例,占检出食管疾患的13.1%,现就其临床特点报告如下。

Clinical observation of HRV in patients with coal worker's pneumoconiosis

目的 了解煤工尘肺(CWP)患者心率变异(HRV)的临床变化.方法观察100例Ⅰ、Ⅱ、Ⅲ期CWP患者和30例健康煤矿工人在临床、动态心电图(DCG)和HRV的改变.结果(1)Ⅰ、Ⅱ、Ⅲ期CWP患者的心率变异指数(HRVI)分别为26.06±10.89、22.27±8.12、16.88±4.15,平均R-R间期标准差(S)分别为(38.86±18.43、31.96±16.45、25.44±18.21)s,平均R-R间期变异系数(CV)分别为4.55±1.82、3.84±1.50、2.99±1.23,较对照组(30.06±10.88、50.08±25.25、6.46±2.65)明显降低,差异有统计学意义(P＜0.05),Ⅲ期CWP各指标比工期降低明显,差异有统计学意义(P＜0.01).(2)严重室性心律失常组的HRVI、S、CV分别为15.88±4.14、(20.32±9.52)s、2.52±0.88,较轻级室性心律失常组[24.16±8.12、(30.87±17.44)s、3.26±1.64]及对照组[30.06±10.88、(50.08±25.25)s、6.46±2.65]降低,差异有统计学意义(P＜0.05),提示CWP患者的交感神经张力亢进,迷走神经张力减弱,易发生严重室性心律失常.结论CWP患者的HRV指标明显降低,可预测CWP患者严重室性心律失常或心性猝死的发生。

Antithetical effect of tumor necrosis factor-αgene polymorphism on coal workers' pneumoconiosis (CWP)

Inter-individual variation in the severity of pneumoconiosis has been described, even with the same environmental exposure. We hypothesized that TNF-alpha promoter polymorphisms associate with lung responses to environmental exposure in coal worker's pneumoconiosis (CWP) patients. We examined polymorphisms at -238, -308, and -376 in 124 patients with CWP who had similar dust exposure history and in 122 non-exposed controls. CWP patients were divided into two groups: (1) nodular CWP (n = 84); (2) progressive massive fibrosis (PMF) (n = 44). The -308 A allele frequency was higher in patients with CWP compared to controls (6.35% and 2.05%, P < 0.01). It was also higher in patients with nodular CWP compared to PMF (P < 0.05). Logistic regression analysis revealed that patients with the -308 A allele were 3.8 times (P = 0.036) and those with smoking habit were 2.3 times (P < 0.002) more likely to have nodular CWP than PMF. TNF-alpha-308 A allele might interact with smoking to enhance susceptibility to nodular CWP.

Detection of tuberculosis antibody in patients with coal worker's pneumoconiosis complicated by pulmonary tuberculosis

目的 探讨结核抗体(TB-Ab)在煤工尘肺并发肺结核诊断中的应用价值和临床意义.方法应用3种TB-Ab检测卡对2002年11月～2003年12月住院的240例煤工尘肺并发肺结核患者和20例单纯煤工尘肺患者进行血清TB-Ab检测,若有一种结果阳性者,则该患者TB-Ab判定为阳性.结果240例煤工尘肺并发肺结核患者中,TB-Ab阳性73例,敏感率为30.4%.其中,67例菌阳者中TB-Ab阳性31例,173例菌阴患者中TB-Ab阳性42例,其敏感率分别为46.3%、24.3%.20例单纯煤工尘肺患者有1例TB-Ab阳性,经标准化处理,特异性为94.7%,Ⅰ、Ⅱ、Ⅲ期尘肺并发肺结核患者TB-Ab测定的敏感率分别为27.1%、40.5%、14.8%.结论TB-Ab检测对煤工尘肺并发肺结核的诊断、筛查有较好的临床价值,但有其局限性。

Clinical analysis of Staphylococcus aureus resistance to methicillin in patients with coal worker's pneumoconiosis complicated by lung cancer

目的 探讨煤工尘肺并发肺癌患者耐甲氧西林葡萄球菌(MRS)感染状况及耐药性.方法体外药敏试验采用K-B扩散法,MRS菌株的检测采用K-B法苯唑西林耐药葡萄球菌试验.根据药敏试验结果给予患者去甲万古霉素,混合性感染者同时选用其他敏感抗生素.结果85例煤工尘肺并发肺癌患者中,62例分离出葡萄球菌,占73.6%.其中,22例(35.5%)为血浆凝固酶阴性葡萄球菌;40株(64.5%)为金黄色葡萄球菌,其中,耐甲氧西林金黄色葡萄球菌27株、耐甲氧西林血浆凝固酶阴性葡萄球菌13株.58例单纯煤工尘肺患者中,34例分离出葡萄球菌,占58.6%.煤工尘肺并发肺癌组以去甲万古霉素为主的抗菌治疗45例,临床有效率66.7%,痊愈率28.9%(13/45),不良反应发生率20.0%(停药后均可恢复).除万古霉素100%敏感外,患者对其余各类抗生素皆存在不同程度的耐药.结论MRS感染已成为肺癌院内感染的主要病因;煤工尘肺并发肺癌患者葡萄球菌的感染状况及耐药性较为严重,应引起重视。

Evaluation of paranasal sinus mucosa in coal worker's pneumoconiosis: a computed tomographic study.

To evaluate by computed tomographic scanning the paranasal mucosal changes of coal workers with and without pneumoconiosis. Examination of images and scores from paranasal computed tomographic scans. The study participants were 26 coal workers with pneumoconiosis, 29 coal workers without pneumoconiosis, and 20 controls. All were men. The extent and patterns of inflammatory paranasal sinus disease were evaluated on computed tomographic scans by 2 radiologists using the terminology and definitions of Newman and associates. Interobserver agreement for the presence of abnormalities was from good to excellent (kappa, 0.63-0.89). The mucosal scores of individuals and groups were higher for coal workers than for control subjects. Both scores were significantly higher in the pneumoconiosis group than in the 2 other groups. This study shows that paranasal sinuses were affected more severely in coal workers than in control subjects. In coal workers with pneumoconiosis, the affection was most severe. The relationship between coal dust exposure and paranasal mucosal changes needs further study.

Outcome of Coal Worker's Pneumoconiosis With Acute Respiratory Failure

To investigate the clinical features and prognosis of patients with coal worker's pneumoconiosis (CWP) requiring invasive mechanical ventilation (MV) in the ICU for their first episode of acute respiratory failure (ARF), with special attention to the prognostic implication of radiographic progressive massive fibrosis (PMF). Retrospective study. A 16-bed medical ICU at a community hospital. We reviewed 53 patients with CWP and ARF requiring invasive MV in the ICU for the first time between August 1998 and March 2002. Of the 53 patients with CWP, 28 patients (53%) with PMF had their first ARF at a younger age than those without PMF (69.1 +/- 7.9 years vs 74.8 +/- 7.2 years, p = 0.008 [mean +/- SD]). Pneumonia (49%) was the most common cause of ARF. The mean APACHE (acute physiology and chronic health evaluation) II score was 26.0 +/- 9.9, and the mean ICU stay was 14.7 +/- 16.1 days. Twenty-one patients (40%) were weaned successfully in the ICU, with mean ventilator time of 17.0 +/- 25.1 days. The ICU and in-hospital mortality rates were 40% and 43%, respectively. The median survivals for all patients and the ICU survivors were 2.6 months and 14.3 months, respectively. Multivariate analysis showed the following risk (or protective) factors for the ICU mortality: PaCO(2) > 45 mm Hg at the time of intubation (adjusted odds ratio [OR], 0.04; 95% confidence interval [CI], 0.003 to 0.44), PaO(2)/fraction of inspired oxygen ratio < 200 mm Hg at the time of intubation (OR, 8.78; 95% CI, 1.36 to 56.48), and APACHE II score >or= 25 (OR, 11.99; 95% CI, 1.49 to 96.78). PMF was not associated with the ICU mortality (OR, 1.18; 95% CI, 0.20 to 7.10). Radiographic PMF was not associated with the ICU mortality in patients with CWP and ARF receiving invasive MV in the ICU. Although a substantial proportion of them could be weaned from the ventilator and discharged from the hospital, their long-term prognosis was poor.

Antioxidant response at early stages and low grades of simple coal worker's pneumoconiosis diagnosed by high resolution computed tomography

In miners exposed to coal dusts, coal worker's pneumoconiosis (CWP) can occur. The purpose of the present study is to better understand the relations between coal dust exposure and activities of blood plasma antioxidant enzymes, namely, superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px), and lipid peroxidation end product malondialdehyde (MDA) concentration in coal workers with early and low grade simple CWP diagnosed by high resolution computed tomography (HRCT). Forty-three coal workers who had profusions of 0/1-2/2 according to ILO 1980 chest X-ray (CXR) classification, 43 coal workers without CWP (control group 1) and 44 healthy subjects (control group 2) who were randomly selected from the population register or recruited from the hospital staff were enrolled. Coal workers were reevaluated by HRCT (Hosoda-Shida classification) due to its higher sensitivity than standard CXR. Then, blood plasma SOD and GSH-Px activities and MDA plasma levels were measured. CWP was found positive in 46 of 89 coal workers by HRCT evaluation. Profusion 0 (P0, CWP not present), profusion 1 (P1, early CWP) and profusion 2 (P2, low grade CWP) were found in 43, 23 and 19 of patients found to have CWP by HRCT, respectively. We had no worker with profusion 3 (P3). Complicated CWP was shown in four of 46 patients and thesecases were excluded as the study was restricted to early and low-grade pneumoconiosis. In respect to the plasma levels of MDA and plasma activities of SOD and GSH-Px, statistically significant differences were found between CWP cases and control groups (p < 0.01, p < 0.01, p < 0.001 respectively). Statistical differences were also obtained for the plasma activities of SOD and GSH-Px and levels of MDA in relation to HRCT profusions (p < 0.05). In conclusion, these findings suggest an oxidative stress due to increased free radicals and reactive oxygen metabolite production in early stages and low grades of simple CWP diagnosed by HRCT.

Health impacts of coal and coal use: possible solutions

Coal will be a dominant energy source in both developed and developing countries for at least the first half of the 21st century. Environmental problems associated with coal, before mining, during mining, in storage, during combustion, and postcombustion waste products are well known and are being addressed by ongoing research. The connection between potential environmental problems with human health is a fairly new field and requires the cooperation of both the geoscience and medical disciplines. Three research programs that illustrate this collaboration are described and used to present a range of human health problems that are potentially caused by coal. Domestic combustion of coal in China has, in some cases, severely affected human health. Both on a local and regional scale, human health has been adversely affected by coals containing arsenic, fluorine, selenium, and possibly, mercury. Balkan endemic nephropathy (BEN), an irreversible kidney disease of unknown origin, has been related to the proximity of Pliocene lignite deposits. The working hypothesis is that groundwater is leaching toxic organic compounds as it passes through the lignites and that these organics are then ingested by the local population contributing to this health problem. Human disease associated with coal mining mainly results from inhalation of particulate matter during the mining process. The disease is Coal Worker's Pneumoconiosis characterized by coal dust-induced lesions in the gas exchange regions of the lung; the coal worker's “black lung disease”.

Melanoptysis: findings on CT and MRI

The purpose of this study was to demonstrate the CT and MRI features of liquefied progressive massive fibrosis (PMF) in coal worker's pneumoconiosis (CWP). A retrospective analysis was made of the CT and MRI features in five patients suffering from severe CWP with the initial clinical finding of melanoptysis ("black phtisis"). CT showed either an air-fluid level or a fluid-precipitate level with high density in the dependent layer. On pre-contrast T(1) weighted images, liquefied PMF showed a fluid level with isointensity relative to soft tissue in the upper layer and a signal loss in the dependent layer of the lesion. The wall of the PMF showed rim enhancement after administration of iv gadolinium. On T(2) weighted images there was a high signal intensity in the upper layer of the lesion. In conclusion, liquefied PMF results in characteristic features on CT and MRI owing to precipitation of silica in the mucous fluid.

Cross sectional and longitudinal study on selenium, glutathione peroxidase, smoking, and occupational exposure in coal miners

OBJECTIVESTo understand the variations of selenium (Se) concentration relative to changes in occupational exposure to coal dust, taking into account age and changes in smoking habits in miners surveyed twice,...

National Occupational Health Service policies and programs for workers in small-scale industries in China.

Over the 14 years since economic reform began, and the restructuring of the economy to encourage international trade, a large number of township enterprises have been developed and put into operation in the Peoples Republic of China. From 1978 to 1991, the number of enterprises has increased 11.5 times; the number of employees has increased 2.4 times; the fixed assets have increased 13.7 times; and the value of the total output has increased 22.5 times. In this article, a report is given on a sample survey in 30 counties in 1990, which showed that 82.69% of rural industrial enterprises had at least one type of occupational hazard in their work environments. Workers engaged in at least one type of hazardous working environment accounted for 33.91% of the blue-collar workers. Physical examinations were performed for seven types of occupational diseases: silicosis, coal worker's pneumoconiosis, asbestosis, chronic lead poisoning, benzene analogs poisoning, chronic chromium poisoning, and noise-induced hearing loss. The total detectable rate of the seven types of occupational diseases was 4.4% among those workers. In addition, 11% had illnesses suspected of being (though not proven to be) caused by occupational exposures. Most township enterprises do not provide basic occupational health services. The coverage of five routine occupational health service activities provided for township enterprises were very limited, from 1.4 to 36%.

Recent trends of age-specific pneumoconiosis mortality rates in the United States, 1985-1996: coal workers' pneumoconiosis, asbestosis, and silicosis.

The authors examined the temporal trends of age-specific pneumoconiosis mortality from coal worker's pneumoconiosis (CWP), asbestosis, and silicosis in the United States in 1985-1996. Mortality data were derived from the National Center for Health Statistics multiple causes of death files for the period. Age-specific mortality rates were computed for three age groups (15-44, 45-64, and > or = 65 years) among decedents with mention of CWP, asbestosis, or silicosis. Linear regression analysis was performed to examine the annual changes in age-specific mortality rates, by age group, with each specific condition. The CWP mortality rates declined significantly (p = 0.0001) in the groups 45 years old and older, but not in the age group 15-44. Asbestosis mortality rates declined significantly (p = 0.005) for the age group 45-64, while increasing (p = 0.0001) for those aged 65 years and older. However, in the younger age group 15-44, the rates showed no significant trend. Silicosis mortality rates declined significantly (p = 0.0001) for all groups. The continued occurrence of deaths from CWP, asbestosis, and silicosis among young adults may be the result of high levels of exposure to occupational risks. These results suggest that pneumoconiosis surveillance may help to evaluate the temporal pneumoconiosis mortality patterns in the United States.

MCP-1 secretion in lung from nonsmoking patients with coal worker's pneumoconiosis

Exposure to coal dust leads to the development of coal worker's pneumoconiosis (CWP), a disease associated with an accumulation of macrophages in the lower respiratory tract. Mechanisms controlling monocyte recruitment are still poorly understood. Since monocyte chemoattractant protein-1 (MCP-1) is recognized as a potent chemotactic factor for blood monocytes, we analysed the presence of MCP-1 in the pulmonary compartment of patients with CWP. Bronchoalveolar lavage fluid (BALF) from 16 nonsmoking control subjects and 27 nonsmoking CWP patients (16 with simple pneumoconiosis (SP) and 11 with progressive massive fibrosis (PMF)) was analysed. Alveolar macrophages (AMs) were purified by adherence and BALF was concentrated tenfold by lyophilization. MCP-1 was measured in BALF and in 3 h AM supernatants using a sandwich enzyme-linked immunosorbent assay (ELISA). The localization of MCP-1 in lung tissue was determined by immunohistochemistry on tissue sections from three patients with CWP and two control subjects. MCP-1 levels were significantly higher in concentrated BALF from patients with SP or PMF (median 370 and 555 pg x mL-1, respectively) than in those from control subjects (median 11 pg x mL-1) (p<0.001). Released MCP-1 in AM supernatants was enhanced in patients with CWP (median 83 pg x mL-1) but compared to controls (median 41 pg x mL-1) this level did not reach significance. Although significantly increased, AM counts in BALF from patients with CWP did not correlate with MCP-1 levels. MCP-1 levels in BALF correlated with MCP-1 levels in AM supernatants (p=0.47; p<0.02). In control lung specimens, MCP-1 was expressed by a few AMs, type II pneumocytes and perivascular smooth muscle cells. CWP sections were characterized by an increased number of AMs and mainly by the presence of fibroblasts (in the myogenic area of fibrotic lesions) and hyperplastic type II pneumocytes, which were strongly immunostained for MCP-1. Our data demonstrate that: 1) patients with coal worker's pneumoconiosis have a marked pulmonary overproduction of monocyte chemoattractant protein-1; and 2) in addition to alveolar macrophages, fibroblasts (probably myofibroblasts) and hyperplastic type II pneumocytes may also be responsible for this increased level of monocyte chemoattractant protein-1 in coal worker's pneumoconiosis.

Coal workers' pneumoconiosis: a study of prevalence in coal mines of eastern Madhya Pradesh and Orissa states of India.

With objective to find out prevalence of Coal Worker's Pneumoconiosis and variation among readers in reading x-ray plates for pneumoconiosis, a retrospective epidemiological survey of Coal Worker's Pneumoconiosis was undertaken in 72 collieries of Madhya Pradesh and Orissa by re-reading of x-ray plates taken during the Periodical Medical Examination at the Occupational Health Units over a period of 5 years. Six readers, trained abroad in reading pneumoconiosis x-ray plates, were involved for the study. Each reader reported approximately one sixth of the available x-ray plates of all the collieries and classified on the 12 point scale of I.L.O. (International Labour Organisation) 1980 in special format. Total 43,504 chest x-rays were reviewed. The overall prevalence was found to be 3.03%, ranging from 1.52% to 4.76% between 10 areas (group of mines). Major category of profusion was category-I (81.09%), followed by category-II (17.84%). Only 3 cases of Progressive Massive Fibrosis (PMF) were detected. Round shaped opacities are predominant (89.59%) in Coal Worker's Pneumoconiosis. Among the opacities, 'p' type is more prevalent (48.29%) followed by 'q' type (40.62%). There was variation amongst the different readers and ranged from 1.14% to 6.76% for reporting the prevalence of Coal Worker's Pneumoconiosis. However, when analysis of six readers for inter reader variation was conducted, that shows no abnormal deviation in the reading of any of the readers.

Goodpasture's syndrome

A 59-year-old white man with a history of recurrent pleural effusions, coal worker's pneumoconiosis, and a positive PPD presented with hemoptysis beginning on the morning of admission. The patient had coughed up small amounts of dark blood totaling approximately 4 ounces; although this was his first episode of hemoptysis, he had experienced epistaxis approximately once weekly in the previous year. The patient was married, had smoked one pack of cigarettes/day for 30 years, but had quit four years ago. He occasionally drank alcoholic beverages, and he was a retired coal miner who had worked directly in the mines. He denied fever, chills, night sweats, weight loss, decreased appetite, nausea, vomiting, shortness of breath, or cough. The patient complained of a transient nonspecific rash in the previous weeks that had resolved. The medical history was notable for a recurrent left-sided pleural effusion 5 years previously with a negative workup for collagen-vascular disease, malignancy, and infection. He had had nephrotic-range proteinuria four years prior to admission; renal biopsy then demonstrated focal segmental glomeruloselerosis. Treatment with an angiotensin-convertingenzyme inhibitor reduced the proteinuria to below 400 mg/24 hours. The family history was negative. Physical examination revealed a well-appearing white man in no apparent distress. His temperature was 37°C; respirations, 20/mm; pulse, 80 beats/mm; and blood pressure, 120/60 mm Hg. The head, eyes, ears, nose, and throat were normal, as was the neck. The lungs were clear to auscultation. Cardiac examination was unremarkable. His abdomen was soft, nontender, and his extremities showed no evidence of clubbing, cyanosis, or edema. Neurologic examination was normal. Laboratory evaluation revealed a white blood cell count of 9700/mm3; hematocrit, 41%; and platelets, 192,000/mm3. Blood urea nitrogen (BUN) was 40 mgJdl and serum creatinine concentration 2.3 mg/dl; two months ago, the BUN was 25 mg/dl and the serum ereatinine, 1.4 mg/dl. Total